PlethAugment: GAN-based PPG augmentation for medical diagnosis in low-resource settings

The paucity of physiological time-series data collected from low-resource clinical settings limits the capabilities of modern machine learning algorithms in achieving high performance. Such performance is further hindered by class imbalance; datasets where a diagnosis is much more common than others. To overcome these two issues at low-cost while preserving privacy, data augmentation methods can be employed. In the time domain, the traditional method of time-warping could alter the underlying data distribution with detrimental consequences. This is prominent when dealing with physiological conditions that influence the frequency components of data. In this paper, we propose PlethAugment; three different conditional generative adversarial networks (CGANs) with an adapted diversity term for the generation of pathological photoplethysmogram (PPG) signals in order to boost medical classification performance. To evaluate and compare the GANs, we introduce a novel metric-agnostic method; the synthetic generalization curve. We validate this approach on two proprietary and two public datasets representing a diverse set of medical conditions. Compared to training on non-augmented class-balanced datasets, training on augmented datasets leads to an improvement of the AUROC by up to 29% when using cross validation. This illustrates the potential of the proposed CGANs to significantly improve classification performance

Trust, respect, and reciprocity: Informing culturally appropriate data-sharing practice in Vietnam

International science funders and publishers are driving a growing trend in data sharing. There is mounting pressure on researchers in low- and middle-income settings to conform to new sharing policies, despite minimal empirically grounded accounts of the ethical challenges of implementing the policies in these settings. This study used in-depth interviews and focus group discussions with 48 stakeholders in Vietnam to explore the experiences, attitudes, and expectations that inform ethical and effective approaches to sharing clinical research data. Distinct views on the role of trust, respect, and reciprocity were among those that emerged to inform culturally appropriate best practices. We conclude by discussing the challenges that authors of data-sharing policies should consider in this unique context

Trust, respect, and reciprocity: Informing culturally appropriate data-sharing practice in Vietnam

International science funders and publishers are driving a growing trend in data sharing. There is mounting pressure on researchers in low- and middle-income settings to conform to new sharing policies, despite minimal empirically grounded accounts of the ethical challenges of implementing the policies in these settings. This study used in-depth interviews and focus group discussions with 48 stakeholders in Vietnam to explore the experiences, attitudes, and expectations that inform ethical and effective approaches to sharing clinical research data. Distinct views on the role of trust, respect, and reciprocity were among those that emerged to inform culturally appropriate best practices. We conclude by discussing the challenges that authors of data-sharing policies should consider in this unique context

The first genome sequences of human bocaviruses from Vietnam

As part of an ongoing effort to generate complete genome sequences of hand, foot and mouth disease-causing enteroviruses directly from clinical specimens, two complete coding sequences and two partial genomic sequences of human bocavirus 1 (n=3) and 2 (n=1) were co-amplified and sequenced, representing the first genome sequences of human bocaviruses from Vietnam. The sequences may aid future study aiming at understanding the evolution of the virus

Severe enterovirus A71 associated hand, foot and mouth disease, Vietnam, 2018: preliminary report of an impending outbreak

Since the beginning of January 2018, there has been a significant increase in the number of hospitalisations (including cases with neurological symptoms) due to hand, foot and mouth disease (HFMD) across Vietnam. By the end of September more than 53,000 clinical cases were reported, of whom six died [1]. Our aim was to characterise the epidemiology, virology and clinical characteristics of patients, especially those with severe HFMD, through an ongoing clinical study conducted at a large tertiary referral hospital for children in Ho Chi Minh City, Vietnam from January to September 2018

Study protocol: The clinical features, epidemiology, and causes of paediatric encephalitis in southern Vietnam [version 2; peer review: 1 approved, 1 approved with reservations]

Encephalitis is a major cause of morbidity and mortality worldwide. The clinical syndrome of encephalitis consists of altered mental status, seizures, neurologic signs, and is often accompanied by fever, headache, nausea, and vomiting. The encephalitis in children has been known that more common than in adult, with the incidence rate of infants was 3.9 times higher than that of people 20-44 years of age. The reported incidence of hospitalization attributed to paediatric encephalitis ranged from 3 to 13 admissions per 100,000 children per year with the overall mortality ranging from 0 to 7%. There are however more than 100 pathogens that can cause encephalitis and accurate diagnosis is challenging. Over 50% of patients with encephalitis are left undiagnosed despite extensive laboratory investigations. Furthermore, recent studies in high-income settings have suggested autoimmune encephalitis has now surpassed infectious aetiologies, mainly due to increased awareness and diagnostic capacity, which further challenges routine diagnosis and clinical management, especially in developing countries. There are limited contemporary data on the causes of encephalitis in children in Vietnam. Improving our knowledge of the causative agents of encephalitis in this resource-constrained setting remains critical to informing case management, resource distribution and vaccination strategy. Therefore, we conduct a prospective observational study to characterise the clinical, microbiological, and epidemiological features of encephalitis in a major children’s hospital in southern Vietnam. Admission clinical samples will be collected alongside meta clinical data and from each study participants. A combination of classical assays (serology and PCR) and metagenomic next-generation sequencing will used to identify the causative agents. Undiagnosed patients with clinical presentations compatible with autoimmune encephalitis will then be tested for common forms of the disease. Finally, using direct- and indirect costs, we will estimate the economic burden of hospitalization and seven days post hospital discharge of paediatric encephalitis in our setting

Economic burden attributed to children presenting to hospitals with hand, foot, and mouth disease in Vietnam

BACKGROUND: Hand, foot, and mouth disease (HFMD) has become a major public health concern in the Asia-Pacific region. Knowledge of its economic burden is essential for policy makers in prioritizing the development and implementation of interventions. METHODS: A multi-hospital-based study was prospectively conducted at 3 major hospitals in Ho Chi Minh City, Vietnam, during 2016-2017. Data on direct and productivity costs were collected alongside clinical information and samples and demographic information from study participants. RESULTS: A total of 466 patients were enrolled. Two hundred three of 466 (43.6%) patients lived in Ho Chi Minh City, and 72/466 (15.5%) had severe HFMD. An enterovirus was identified in 74% of 466 patients, with EV-A71, CV-A6, CV-A10, and CV-A16 being the most common viruses identified (236/466, 50.6%). The mean economic burden per case was estimated at US$400.80 (95$353.80-$448.90), of which the total direct (medical) costs accounted for 69.7$90 761 749 (95% CI, $79 033 973-$103 009 756). CONCLUSIONS: Our findings are of public health significance because for the first time we demonstrate that HFMD causes a substantial economic burden in Vietnam, and although multivalent vaccines are required to control HFMD, effective EV-A71 vaccine could substantially reduce the burden posed by severe HFMD. The results will be helpful for health policy makers in prioritizing resources for the development and implementation of intervention strategies to reduce the burden of HFMD

Severe enterovirus A71 associated hand, foot and mouth disease, Vietnam, 2018: preliminary report of an impending outbreak

Since the beginning of January 2018, there has been a significant increase in the number of hospitalisations (including cases with neurological symptoms) due to hand, foot and mouth disease (HFMD) across Vietnam. By the end of September more than 53,000 clinical cases were reported, of whom six died [1]. Our aim was to characterise the epidemiology, virology and clinical characteristics of patients, especially those with severe HFMD, through an ongoing clinical study conducted at a large tertiary referral hospital for children in Ho Chi Minh City, Vietnam from January to September 2018