Repeating platinum/bevacizumab in recurrent or progressive cervical cancer yields marginal survival benefits

Our objective was to assess overall survival of cervical cancer patients following prior platinum/bevacizumab chemotherapy, comparing retreatment with platinum/bevacizumab with alternative therapies. A retrospective analysis was performed of women who received platinum/bevacizumab (PB) chemotherapy for cervical cancer at Washington University between July 1, 2005 and December 31, 2015. Wilcoxon rank-sum exact test and Fisher's exact test were used to compare the treatment groups, and Kaplan Meier curves were generated. Cox regression analyses were performed, with treatment free interval and prior therapy response included as covariates. Of 84 patients who received PB chemotherapy, 59 (70%) received no second line chemotherapy, as they did not recur, progressed without further chemotherapy, were lost to follow up, or expired. Of the remaining 25 patients, 9 were retreated with the combination of platinum/bevacizumab (PB), 6 were retreated with a platinum regimen without bevacizumab (P), and 10 were retreated with neither (not-P). The only long-term survivor was in the not-P group and was treated with an immunotherapy agent. Median overall survival of all patients was 7.1 months. There was a marginal difference in survival between women in the PB and not-PB groups (11.8 versus 5.7 months; HR 3.02, 95% CI, 0.98–9.28). There was no difference in survival based on platinum interval (HR 0.81; 95% CI, 0.27–2.45). Outcomes are grim for women retreated after platinum/bevacizumab therapy and are only marginally improved by retreatment with a platinum/bevacizumab regimen. Rather than additional PB therapy, women with cervical cancer who recur after platinum/bevacizumab should consider supportive care or clinical trials

Seroepidemiology of group A rotavirus in suburban São Paulo, Brazil

Age-specifc patterns of rotavirus infection were investigated using a randomly selected and representative sample of sera from a suburban community of São Paulo, Brazil screened for class-specifc antibodies to group A rotavirus. Age-serology of anti-rotavirus IgG showed primary infection predominant in young infants with a median age of around 18 months consistent with IgM serology suggesting highest rates of recent infection between ages 4 and 48 months. Anti-rotavirus serum IgA prevalence increased gradually with age. Paired samples from infants, collected 1 month apart, indicated high exposure rates with seroconversion occurring in several infants during the reported low transmission season. Between 5 and 10% of adults had elevated IgM levels indicative of recent infection and, potentially, of an important contribution adults may play to rotavirus transmission. Further understanding of the dynamics of rotavirus transmission within populations, at group and serotype level, would benefit the design and monitoring of future immunization programmes

MODELING the INTERACTION BETWEEN AIDS and TUBERCULOSIS

A deterministic model is proposed for the study of the dynamics of acquired immunodeficiency syndrome (AIDS) and tuberculosis (TB) co-infection. the model is comprised by a set of sixteen ordinary differential equations representing different states of both diseases, and it is intended to provide a theoretical framework for the study of the interaction between both infections. Numerical simulations of the model resulted in three striking outcomes: first, the pathogenicity of Human Immunodeficiency Virus (HIV) is enhanced by the presence of TB, and vice-versa; second, the prevalence of AIDS is higher in the presence of TB; and third, relative risk analysis demonstrated a much stronger influence of AIDS on TB than the other way around.ESCOLA PAULISTA MED,BR-04023 São Paulo,BRAZILUNIV São Paulo,INST PHYS,São Paulo,BRAZILHCFMUSP,BR-01246 São Paulo,BRAZILESCOLA PAULISTA MED,BR-04023 São Paulo,BRAZILWeb of Scienc

IMPLEMENTING SIFT AND BI-TRIANGULAR PLANE TRANSFORMATION FOR INTEGRATING DIGITAL TERRAIN MODELS

Since their inception in the middle of the twentieth century, Digital Terrain Models (DTMs) have played an important role in many fields and applications that are used by geospatial professionals, ranging from commercial companies to government agencies. Thus, both the scientific community and the industry have introduced many methods and technologies for DTM generation and data handling. These resulted in a high volume and variety of DTM databases, each having different coverage and data-characteristics, such as accuracy, resolution, level-of-detail – amongst others. These various factors can cause a dilemma for scientists, mappers, and engineers that now have to choose a DTM to work with, let alone if several of these representations exist for a specified area. Traditionally, researchers tackled this problem by using only one DTM (e.g., the most accurate or detailed one), and only rarely tried to implement data fusion approaches, combining several DTMs into one cohesive unit. Although to some extent this was successful in reducing errors and improving the overall integrated DTM accuracy, two prominent problems are still scarcely addressed. The first is that the horizontal datum distortions and discrepancies between the DTMs are mostly ignored, with only the height dimension taken into account, even though in most cases these are evident. The second is that most approaches operate on a global scale, and thus do not address the more localized variations and discrepancies that are presented in the different DTMs. Both problems affect the resulting integrated DTM quality, which retains these unresolved distortions and discrepancies, resulting in a representation that is to some extent inferior and ambiguous. In order to tackle this, we propose an image based fusion approach: using the SIFT algorithm for matching and registration of the different representations, alongside localized morphing. Implementing the proposed approach and algorithms on various DTMs, the results are promising, with the capacity correctly geospatially align the DTMs, thus reducing the mean height difference variance between the databases to close to zero, as well as reducing the standard deviation between them by more than 30 %

Approaches and concepts of modelling denitrification: increased process understanding using observational data can reduce uncertainties

Denitrification is a key but poorly quantified component of the Ncycle. Because it is difficult to measure the gaseous (NO$_{x}$, N$_{2}$O, N$_{2}$)and soluble (NO$_{3}$) components of denitrification with sufficientintensity, models of varying scope and complexity have beendeveloped and applied to estimate how vegetation cover, landmanagement and environmental factors such as soil type andweather interact to control these variables. In this paper we assessthe strengths and limitations of different modeling approaches,highlight major uncertainties, and suggest how differentobservational methods and process-based understanding can becombined to better quantify N cycling. Representation of howbiogeochemical (e.g. org. C., pH) and physical (e.g. soil structure)factors influence denitrification rates and product ratios combinedwith ensemble approaches may increase accuracy withoutrequiring additional site level model inputs

Improving newborn health in countries exposed to political violence: an assessment of the availability, accessibility, and distribution of neonatal health services at Palestinian hospitals

Introduction: Geopolitical segregation of Palestine has left a fragile healthcare system with an unequal distribution of services. Data from the Gaza Strip reflect an increase in infant mortality that coincided with a significant increase in neonatal mortality (12.0 to 20.3 per 1,000 live births). Objective: A baseline study was carried out to evaluate available resources in neonatal units throughout Palestine. Study Design: A cross-sectional, hospital-based study was conducted in 2017 using the World Health Organization's "Hospital care for mothers and newborn babies: quality assessment and improvement tool." Data on the main indicators were updated in 2018. Results: There were 38 neonatal units in Palestine: 27 in the West Bank, 3 in East Jerusalem, and 8 in the Gaza Strip. There was an uneven geographic distribution of incubators in relation to population and births that was more marked in the Gaza Strip; 79% of neonatal units and 75% of incubators were in the West Bank. While almost all hospitals with neonatal units accepted very and extremely low birth weight and admitted out-born neonatal cases, there was a shortage in the availability of incubators with humidifiers, high-frequency oscillatory ventilation, mechanical ventilators with humidifiers and isolation wards. There was also a considerable shortage in neonatologists, neonatal nurses, and pediatric subspecialties. Conclusion: Almost all the neonatal units accepted extremely low birth weight neonatal cases despite not being ready to receive these newborns due to considerable shortages in human resources, equipment, drugs, and essential blood tests, as well as frequent disruptions in the availability of based amenities. Together, these factors contribute to the burden of providing quality care to newborns, which is further exacerbated by the lack of referral guidelines and challenges to timely referrals resulting from Israeli measures. Ultimately, this contributes to suboptimal care for neonates and negatively impacts future health outcomes