Accuracy of optical spectroscopy for the detection of cervical intraepithelial neoplasia without colposcopic tissue information; a step toward automation for low resource settings

Optical spectroscopy has been proposed as an accurate and low-cost alternative for detection of cervical intraepithelial neoplasia. We previously published an algorithm using optical spectroscopy as an adjunct to colposcopy and found good accuracy (sensitivity ¼ 1.00 [95% confidence interval ðCIÞ ¼ 0.92 to 1.00], specificity ¼ 0.71 [95% CI ¼ 0.62 to 0.79]). Those results used measurements taken by expert colposcopists as well as the colposcopy diagnosis. In this study, we trained and tested an algorithm for the detection of cervical intraepithelial neoplasia (i.e., identifying those patients who had histology reading CIN 2 or worse) that did not include the colposcopic diagnosis. Furthermore, we explored the interaction between spectroscopy and colposcopy, examining the importance of probe placement expertise. The colposcopic diagnosis-independent spectroscopy algorithm had a sensitivity of 0.98 (95% CI ¼ 0.89 to 1.00) and a specificity of 0.62 (95% CI ¼ 0.52 to 0.71). The difference in the partial area under the ROC curves between spectroscopy with and without the colposcopic diagnosis was statistically significant at the patient level (p ¼ 0.05) but not the site level (p ¼ 0.13). The results suggest that the device has high accuracy over a wide range of provider accuracy and hence could plausibly be implemented by providers with limited training

Preprotein mature domains contain translocase targeting signals that are essential for secretion

Secretory proteins are only temporary cytoplasmic residents. They are typically synthesized as preproteins, carrying signal peptides N-terminally fused to their mature domains. In bacteria secretion largely occurs posttranslationally through the membrane-embedded SecA-SecYEG translocase. Upon crossing the plasma membrane, signal peptides are cleaved off and mature domains reach their destinations and fold. Targeting to the translocase is mediated by signal peptides. The role of mature domains in targeting and secretion is unclear. We now reveal that mature domains harbor their own independent targeting signals (mature domain targeting signals [MTSs]). These are multiple, degenerate, interchangeable, linear or 3D hydrophobic stretches that become available because of the unstructured states of targeting-competent preproteins. Their receptor site on the cytoplasmic face of the SecYEG-bound SecA is also of hydrophobic nature and is located adjacent to the signal peptide cleft. Both the preprotein MTSs and their receptor site on SecA are essential for protein secretion. Evidently, mature domains have their own previously unsuspected distinct roles in preprotein targeting and secretion

Strategic performance measurement in a healthcare organisation: A multiple criteria approach based on balanced scorecard”,Omega-International

a b s t r a c t The Balanced Scorecard (BSC) methodology focuses on major critical issues of modern business organisations: the effective measurement of corporate performance and the evaluation of the successful implementation of corporate strategy. Despite the increased adoption of the BSC methodology by numerous business organisations during the last decade, limited case studies concern non-profit organisations (e.g. public sector, educational institutions, healthcare organisations, etc.). The main aim of this study is to present the development of a performance measurement system for public health care organisations, in the context of BSC methodology. The proposed approach considers the distinguished characteristics of the aforementioned sector (e.g. lack of competition, social character of organisations, etc.). The proposed measurement system contains the most important financial performance indicators, as well as non-financial performance indicators that are able to examine the quality of the provided services, the satisfaction of internal and external customers, the selfimprovement system of the organisation and the ability of the organisation to adapt and change. These indicators play the role of Key Performance Indicators (KPIs), in the context of BSC methodology. The presented analysis is based on a MCDA approach, where the UTASTAR method is used in order to aggregate the marginal performance of KPIs. This approach is able to take into account the preferences of the management of the organisation regarding the achievement of the defined strategic objectives. The main results of the proposed approach refer to the evaluation of the overall scores for each one of the main dimensions of the BSC methodology (i.e. financial, customer, internal business process, and innovation-learning). These results are able to help the organisation to evaluate and revise its strategy, and generally to adopt modern management approaches in every day practise

Strategic performance measurement in a healthcare organisation: A multiple criteria approach based on balanced scorecard”,Omega-International

a b s t r a c t The Balanced Scorecard (BSC) methodology focuses on major critical issues of modern business organisations: the effective measurement of corporate performance and the evaluation of the successful implementation of corporate strategy. Despite the increased adoption of the BSC methodology by numerous business organisations during the last decade, limited case studies concern non-profit organisations (e.g. public sector, educational institutions, healthcare organisations, etc.). The main aim of this study is to present the development of a performance measurement system for public health care organisations, in the context of BSC methodology. The proposed approach considers the distinguished characteristics of the aforementioned sector (e.g. lack of competition, social character of organisations, etc.). The proposed measurement system contains the most important financial performance indicators, as well as non-financial performance indicators that are able to examine the quality of the provided services, the satisfaction of internal and external customers, the selfimprovement system of the organisation and the ability of the organisation to adapt and change. These indicators play the role of Key Performance Indicators (KPIs), in the context of BSC methodology. The presented analysis is based on a MCDA approach, where the UTASTAR method is used in order to aggregate the marginal performance of KPIs. This approach is able to take into account the preferences of the management of the organisation regarding the achievement of the defined strategic objectives. The main results of the proposed approach refer to the evaluation of the overall scores for each one of the main dimensions of the BSC methodology (i.e. financial, customer, internal business process, and innovation-learning). These results are able to help the organisation to evaluate and revise its strategy, and generally to adopt modern management approaches in every day practise

Optimal survival trees

Tree-based models are increasingly popular due to their ability to identify complex relationships that are beyond the scope of parametric models. Survival tree methods adapt these models to allow for the analysis of censored outcomes, which often appear in medical data. We present a new Optimal Survival Trees algorithm that leverages mixed-integer optimization (MIO) and local search techniques to generate globally optimized survival tree models. We demonstrate that the OST algorithm improves on the accuracy of existing survival tree methods, particularly in large datasets

Recent Advances in the Optimization of Anti-TNF Treatment in Patients with Inflammatory Bowel Disease

Despite the evolution in inflammatory bowel disease (IBD) management during the last 20 years owing to the advent of new advanced therapies, anti-TNF agents still remain the cornerstone of therapy for both Crohn’s disease and ulcerative colitis. However, this does not only secure favorable outcomes for patients considering the progressive disease character and the high likelihood of primary or secondary loss of response. Therefore, trying to reach a better treatment approach and maximize the benefits anti-TNF agents offer, optimization strategies should be examined. It has been indicated that optimizing treatment with anti-TNF enhances drug efficacy and has been associated with improved disease outcomes and a complication-free disease course. From this perspective, we aim to provide an overview of currently available data and recent advances in the practices of anti-TNF treatment optimization. Special focus has been given to the role of therapeutic drug monitoring (TDM), as well as the utility of combining anti-TNF with an immunomodulator and the treat-to-target approach

Is there a correlation between infliximab trough levels and the development of adverse events in patients with inflammatory bowel disease?

Background/Aims: The measurement of infliximab trough levels (IFX-TLs) in patients with inflammatory bowel disease (IBD) is performed to optimize treatment. However, the association between the development of adverse events (AEs) and IFX-TLs has not been sufficiently studied thus far. To investigate the possible association of IFX-TLs with AEs in Greek patients with IBD receiving maintenance treatment with IFX Methods: A retrospective analysis of the registry data of the Gastroenterology Department of the University Hospital of Heraklion, from IBD patients with at least one available IFX-TL measurement during the years 2016 to 2017 was conducted. AEs reported 4 months before and 4 months after the measured IFX-TLs were recorded. The IFX-TLs of patients with or without AEs were compared. Results: Of a total of 83 IBD patients (61 Crohn’s disease [73%]; 52 men [63%]; mean age ± standard deviation, 43.3 ± 16.0 years), 147 measurements of IFX-TLs were available (median 4.69 µg/ mL [1.32–9.16]), and 99 AEs (67.3%, 14 severe) were registered. The median IFX-TL of patients with AEs was 5.79 µg/mL (1.36–10.25), higher than the median IFX-TL of patients without AEs (3.40 µg/mL [1.30–5.92]), but the difference was not significant (P = 0.97). The presence of infections or dermatologic reactions was not correlated with IFX-TLs. There was no difference in the prevalence of the total AEs (66.7% vs. 73.3%, P =0.77) or in the analysis of AEs by group between patients with IFX-TLs ≥ 15 µg/ mL and patients with IFX-TLs < 15 µg/mL. Conclusions: IFX-TLs are not significantly associated with the development of AEs in IBD patients receiving maintenance treatment with IFX. (Intest Res 2021;19:461–467) © 2021. Korean Association for the Study of Intestinal Diseases