The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026

Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95$7·3 trillion (95% UI 7·2–7·4) in 2019; 293·7 times the $24·8 billion (95$43·1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1·8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and$37·8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12·2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health-related COVID-19 response is 252·2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11–21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained

Automated Extraction of Phenotypic Leaf Traits of Individual Intact Herbarium Leaves from Herbarium Specimen Images Using Deep Learning Based Semantic Segmentation

With the increase in the digitization efforts of herbarium collections worldwide, dataset repositories such as iDigBio and GBIF now have hundreds of thousands of herbarium sheet images ready for exploration. Although this serves as a new source of plant leaves data, herbarium datasets have an inherent challenge to deal with the sheets containing other non-plant objects such as color charts, barcodes, and labels. Even for the plant part itself, a combination of different overlapping, damaged, and intact individual leaves exist together with other plant organs such as stems and fruits, which increases the complexity of leaf trait extraction and analysis. Focusing on segmentation and trait extraction on individual intact herbarium leaves, this study proposes a pipeline consisting of deep learning semantic segmentation model (DeepLabv3+), connected component analysis, and a single-leaf classifier trained on binary images to automate the extraction of an intact individual leaf with phenotypic traits. The proposed method achieved a higher F1-score for both the in-house dataset (96%) and on a publicly available herbarium dataset (93%) compared to object detection-based approaches including Faster R-CNN and YOLOv5. Furthermore, using the proposed approach, the phenotypic measurements extracted from the segmented individual leaves were closer to the ground truth measurements, which suggests the importance of the segmentation process in handling background noise. Compared to the object detection-based approaches, the proposed method showed a promising direction toward an autonomous tool for the extraction of individual leaves together with their trait data directly from herbarium specimen images

A study on loss functions and decision thresholds for the segmentation of multiple sclerosis lesions on spinal cord MRI

Multiple sclerosis (MS) patients often present hyper-intense T2-w lesions in the spinal cord. The severe imbalance between background and lesion classes poses a major challenge to Deep Learning segmentation approaches, requiring for ad hoc strategies. Careful selection of the loss function and adjustment of the conventional 0.5-thresholding may help mitigating this issue. Our results show the performance advantages of loss functions based on the Tversky Index and the benefits of threshold tuning over more standard settings and the state-of-the-art model for MS lesion segmentation on spinal cord MRI

Service Selection Using an Ensemble Meta-Learning Classifier for Students with Disabilities

International audienceStudents with special needs should be empowered to use assistive technologies and services that suit their individual circumstances and environments to maximize their learning attainment. Fortunately, modern distributed computing paradigms, such as the Internet of Things (IoT), cloud computing, and mobile computing, provide ample opportunities to create and offer a multitude of digital assistive services and devices for people with disabilities. However, choosing the appropriate services from a pool of competing services while satisfying the unique requirements of disabled learners remains a challenging research endeavor. In this article, we propose an ensemble meta-learning model that ranks and selects the best IoT services while considering the diverse needs of disabled students within the educational context. We train and test our deep ensemble meta-learning model using two synthetically generated assistive services datasets. The first dataset incorporates 50,000 records representing the possible use of 12 learning activities, fulfilled by 60 distinct assistive services. The second dataset includes a range of 120,000 service ratings of seven quality features, including response, availability, successibility, latency, cost, quality of service, and accessibility. Our deep learning model uses an ensemble of multiple input learners fused using a meta-classification network shared by all the outputs representing individual assistive services. The model achieves significantly better results than traditional machine learning models (i.e., support vector machine and random forest) and a simple feed-forward neural network model without the ensemble technique. Furthermore, we extended our model to utilize the accessibility rating of services to suggest appropriate educational services for disabled learners. The empirical results show the acceptability of our assistive service recommender for learners with disabilities

Expert Variability and Deep Learning Performance in Spinal Cord Lesion Segmentation for Multiple Sclerosis Patients

Accepted at 2023 IEEE 36th International Symposium on Computer-Based Medical Systems (CBMS).© 2023 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other work.International audienceMultiple sclerosis (MS) patients often present with lesions in spinal cord magnetic resonance (MR) volumes. However, accurately detecting these lesions is challenging and prone to inter-and intra-rater variability. Deep learning-based methods have the potential to aid clinicians in detecting and segmenting MS lesions, but can also be affected by rater variability. This study assesses the inter-and intra-rater variability in manual segmentation of spinal cord lesions, and evaluates raters and a state-of-the-art nnU-Net model against a ground truth (GT) segmentation of a senior expert. Four experts segmented twelve spinal cord MR volumes from six patients twice, at a time distance of two weeks. Considerable inter-and intra-rater variability were observed, with the total number of detected lesions ranging from 28 to 60, depending on the rater. Moreover, the segmented volumes of individual lesions varied substantially between raters. All raters and the model achieved high precision when evaluated against the senior expert GT, but sensitivity was notably lower. These results motivate the need for more sensitive automated methods to aid clinicians in lesion detection, and suggest that consideration should be given to inter-rater variability when training and evaluating automated methods

Expert Variability and Deep Learning Performance in Spinal Cord Lesion Segmentation for Multiple Sclerosis Patients

Accepted at 2023 IEEE 36th International Symposium on Computer-Based Medical Systems (CBMS).© 2023 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other work.International audienceMultiple sclerosis (MS) patients often present with lesions in spinal cord magnetic resonance (MR) volumes. However, accurately detecting these lesions is challenging and prone to inter-and intra-rater variability. Deep learning-based methods have the potential to aid clinicians in detecting and segmenting MS lesions, but can also be affected by rater variability. This study assesses the inter-and intra-rater variability in manual segmentation of spinal cord lesions, and evaluates raters and a state-of-the-art nnU-Net model against a ground truth (GT) segmentation of a senior expert. Four experts segmented twelve spinal cord MR volumes from six patients twice, at a time distance of two weeks. Considerable inter-and intra-rater variability were observed, with the total number of detected lesions ranging from 28 to 60, depending on the rater. Moreover, the segmented volumes of individual lesions varied substantially between raters. All raters and the model achieved high precision when evaluated against the senior expert GT, but sensitivity was notably lower. These results motivate the need for more sensitive automated methods to aid clinicians in lesion detection, and suggest that consideration should be given to inter-rater variability when training and evaluating automated methods