Automated and unsupervised detection of malarial parasites in microscopic images

<p>Abstract</p> <p>Background</p> <p>Malaria is a serious infectious disease. According to the World Health Organization, it is responsible for nearly one million deaths each year. There are various techniques to diagnose malaria of which manual microscopy is considered to be the gold standard. However due to the number of steps required in manual assessment, this diagnostic method is time consuming (leading to late diagnosis) and prone to human error (leading to erroneous diagnosis), even in experienced hands. The focus of this study is to develop a robust, unsupervised and sensitive malaria screening technique with low material cost and one that has an advantage over other techniques in that it minimizes human reliance and is, therefore, more consistent in applying diagnostic criteria.</p> <p>Method</p> <p>A method based on digital image processing of Giemsa-stained thin smear image is developed to facilitate the diagnostic process. The diagnosis procedure is divided into two parts; enumeration and identification. The image-based method presented here is designed to automate the process of enumeration and identification; with the main advantage being its ability to carry out the diagnosis in an unsupervised manner and yet have high sensitivity and thus reducing cases of false negatives.</p> <p>Results</p> <p>The image based method is tested over more than 500 images from two independent laboratories. The aim is to distinguish between positive and negative cases of malaria using thin smear blood slide images. Due to the unsupervised nature of method it requires minimal human intervention thus speeding up the whole process of diagnosis. Overall sensitivity to capture cases of malaria is 100% and specificity ranges from 50-88% for all species of malaria parasites.</p> <p>Conclusion</p> <p>Image based screening method will speed up the whole process of diagnosis and is more advantageous over laboratory procedures that are prone to errors and where pathological expertise is minimal. Further this method provides a consistent and robust way of generating the parasite clearance curves.</p

Systematic review of tools to measure outcomes for young children with autism spectrum disorder

Background: The needs of children with autism spectrum disorder (ASD) are complex and this is reflected in the number and diversity of outcomes assessed and measurement tools used to collect evidence about children's progress. Relevant outcomes include improvement in core ASD impairments, such as communication, social awareness, sensory sensitivities and repetitiveness, skills such as social functioning and play, participation outcomes such as social inclusion, and parent and family impact. Objectives: To examine the measurement properties of tools used to measure progress and outcomes in children with ASD up to the age of 6 years. To identify outcome areas regarded as important by people with ASD and parents. Methods: The MeASURe (Measurement in Autism Spectrum disorder Under Review) research collaboration included ASD experts and review methodologists. We undertook systematic review of tools used in ASD early intervention and observational studies from 1992 to 2013, systematic review, using the COSMIN checklist (Consensus-based Standards for the selection of health Measurement Instruments) of papers addressing the measurement properties of identified tools in children with ASD, and synthesis of evidence and gaps. The review design and process was informed throughout by consultation with stakeholders including parents, young people with ASD, clinicians and researchers. Results: The conceptual framework developed for the review was drawn from the International Classification of Functioning, Disability and Health, including the domains 'Impairments', 'Activity Level Indicators', 'Participation', and 'Family Measures'. In review 1, 10,154 papers were sifted - 3091 by full text - and data extracted from 184, in total, 131 tools were identified, excluding observational coding, study-specific measures and those not in English. In review 2, 2665 papers were sifted and data concerning measurement properties of 57 (43%) tools were extracted from 128 papers. Evidence for the measurement properties of the reviewed tools was combined with information about their accessibility and presentation. Twelve tools were identified as having the strongest supporting evidence, the majority measuring autism characteristics and problem behaviour. The patchy evidence and limited scope of outcomes measured mean these tools do not constitute a 'recommended battery' for use. In particular,there is little evidence that the identified tools would be good at detecting change in intervention studies. The obvious gaps in available outcome measurement include well-being and participation outcomes for children, and family quality-of-life outcomes, domains particularly valued by our informants (young people with ASD and parents). Conclusions: This is the first systematic review of the quality and appropriateness of tools designed to monitor progress and outcomes of young children with ASD. Although it was not possible to recommend fully robust tools at this stage, the review consolidates what is known about the field and will act as a benchmark for future developments. With input from parents and other stakeholders, recommendations are made about priority targets for research. Future work: Priorities include development of a tool to measure child quality of life in ASD, and validation of a potential primary outcome tool for trials of early social communication intervention. Study registration: This study is registered as PROSPERO CRD42012002223. Funding: The National Institute for Health Research Health Technology Assessment programme

Rethinking the evolution of extant sub-Saharan African suids (Suidae, Artiodactyla)

Although African suids have been of scientific interest for over two centuries, their origin, evolution, phylogeography and phylogenetic relationships remain contentious. There has been a long-running debate concerning the evolution of pigs and hogs (Suidae), particularly regarding the phylogenetic relationships among extant Eurasian and African species of the subfamily Suinae. To investigate these issues, we analysed the mitochondrial and nuclear DNA sequences of extant genera of Suidae from Eurasia and Africa. Molecular phylogenetic analyses revealed that all extant sub-Saharan African genera form a monophyletic clade separate from Eurasian suid genera, contradicting previous attempts to resolve the Suidae phylogeny. Two major sub-Saharan African clades were identified, with Hylochoerus and Phacochoerus grouping together as a sister clade to Potamochoerus. In addition, we find that the ancestors of extant African suids may have evolved separately from the ancestors of modern day Sus and Porcula in Eurasia before they colonised Africa. Our results provide a revision of the intergeneric relationships within the family Suidae

Memory-guided saccades in youth-onset psychosis and attention deficit hyperactivity disorder (ADHD)

Aim : Working memory deficits have been shown to be present in children and adolescents with schizophrenia and attention deficit hyperactivity disorder. Considering the differences in clinical characteristics between these disorders, it was the goal of this study to assess differences in the specific components of working memory in children and adolescents with psychosis and attention deficit hyperactivity disorder. Methods : Children and adolescents with either a non-affective psychotic disorder, attention deficit hyperactivity disorder and controls were administered an oculomotor delayed-response task using both a recall and a control condition. Memory-guided saccades were measured during delay periods of 2, 8 and 20 s. Results : Although both clinical groups were less accurate than controls, there was no evidence of a disproportionate impairment in recall. In addition, there was no evidence of a delay-dependent impairment in psychosis; however, there was a delay-dependent impairment in attention deficit hyperactivity disorder when corrective saccades were included. Speed of information processing was correlated with distance errors in psychosis, suggesting that speed of encoding the stimulus location may have constrained the accuracy of the saccades. Conclusions : Our findings support impairments during encoding in the psychosis group and a delay-dependent deficit in the attention deficit hyperactivity disorder group

Care and support by Sexual Assault Referral Centres (SARCs) in England for survivors of sexual violence and abuse: a mixed-methods study (MESARCH)

Background: One million people in England and Wales experience sexual violence and abuse each year with around half experiencing serious sexual offences; 55,000 survivors access Sexual Assault Referral Centres (SARCs). Objectives: Our research was commissioned by NIHR to evaluate access, interventions and care pathways for survivors, specifically those provided through SARCs.Design, setting, participants: The SARC care pathway was investigated through six sub-studies. We conducted two Cochrane Reviews (4,274 participants). A process evaluation of SARCs interviewed 72 providers and 5 survivors at 8 sites; our children and young people (CYP) study involved 12 CYP from 2 SARCs. A cohort study with three waves of data collection over one-year (21 SARCs, 2,602 service users screened, 337 recruited) used a multilevel-modelling framework to explore risk factors for burden of post-traumatic stress disorder (PTSD) symptoms at baseline and change at one-year. We analysed costs and outcomes, and conducted an embedded narrative analysis (42 survivors). We prioritised the safety/welfare of participants and researchers and embedded lived expertise across the project lifecycle.Results: The Cochrane Reviews identified large effects from psychosocial interventions for PTSD and depression. SARCs delivered a high-quality frontline service for adult and young survivors, functioning as a gateway to onward services. Groups underrepresented at SARCs include those experiencing domestic abuse and some ethnic and cultural minorities. The research emphasised inter-agency/sector collaboration for survivor benefit. Supported by our qualitative research with minoritised groups, the cohort study showed a risk ‘triad’ with adverse childhood experiences, chronic mental health problems and economic deprivation. The research evidenced important improvements in trauma symptoms. These were unrelated to different SARC models and persisted for half of people a year later. Health-related quality of life was below population norms at baseline and high levels of service use were reported. Over the 12 month period, costs and outcomes were similar across SARC models and no significant differences were identified. Harmful encounters occurred in relation to police and justice practices/procedures for 25% of participants and our qualitative studies emphasised the vital interactions between experiences of justice and wellbeing. Good practice largely concerned enhanced communication (e.g. trauma-competent interviewing techniques; regular/timely updates; conveying case decisions with care). Limitations: The cohort study lacked a comparison group, reducing confidence in the finding that access to SARC and other health/therapeutic care explained the reduction observed in PTSD.Conclusions and future work: The risk ‘triad’ underscores the value of screening at SARCs and timely access to therapies/advocacy as part of multi-sectoral approach to supporting recovery. Poor mental health was the main barrier to service access beyond SARCs, suggesting the value of Independent Sexual Violence Advisors with mental health specialisation. The persistence of trauma symptoms supports calls for tackling wait-lists, expanding therapy options and commitment to lifelong care. Cohesive commissioning strategies can promote a whole pathway approach by supporting greater collaboration across providers. Access gaps at the population-level and for specific groups call for concerted efforts to support people to reach care early, for example, through outreach, campaigns and implementing trauma-informed universal health services. MESARCH provides a foundation for advancing trauma-informed practices when supporting people exposed to the effects of sexual violence and abuse<br/

Health and wellbeing of sexual abuse survivors attending sexual assault referral centres in England:the MESARCH mixed-methods evaluation

Background: One million people in England and Wales experience sexual violence and abuse each year with around half experiencing serious sexual offences; 55,000 survivors access Sexual Assault Referral Centres (SARCs).Objectives: Our research was commissioned by NIHR to evaluate access, interventions and care pathways for survivors, specifically those provided through SARCs. Design, setting, participants: The SARC care pathway was investigated through six sub-studies. We conducted two Cochrane Reviews (4,274 participants). A process evaluation of SARCs interviewed 72 providers and 5 survivors at 8 sites; our children and young people (CYP) study involved 12 CYP from 2 SARCs. A cohort study with three waves of data collection over one-year (21 SARCs, 2,602 service users screened, 337 recruited) used a multilevel-modelling framework to explore risk factors for burden of post-traumatic stress disorder (PTSD) symptoms at baseline and change at one-year. We analysed costs and outcomes, and conducted an embedded narrative analysis (42 survivors). We prioritised the safety/welfare of participants and researchers and embedded lived expertise across the project lifecycle.Results: The Cochrane Reviews identified large effects from psychosocial interventions for PTSD and depression. SARCs delivered a high-quality frontline service for adult and young survivors, functioning as a gateway to onward services. Groups underrepresented at SARCs include those experiencing domestic abuse and some ethnic and cultural minorities. The research emphasised inter-agency/sector collaboration for survivor benefit. Supported by our qualitative research with minoritised groups, the cohort study showed a risk ‘triad’ with adverse childhood experiences, chronic mental health problems and economic deprivation. The research evidenced important improvements in trauma symptoms. These were unrelated to different SARC models and persisted for half of people a year later. Health-related quality of life was below population norms at baseline and high levels of service use were reported. Over the 12 month period, costs and outcomes were similar across SARC models and no significant differences were identified. Harmful encounters occurred in relation to police and justice practices/procedures for 25% of participants and our qualitative studies emphasised the vital interactions between experiences of justice and wellbeing. Good practice largely concerned enhanced communication (e.g. trauma-competent interviewing techniques; regular/timely updates; conveying case decisions with care). Limitations: The cohort study lacked a comparison group, reducing confidence in the finding that access to SARC and other health/therapeutic care explained the reduction observed in PTSD. Conclusions and future work: The risk ‘triad’ underscores the value of screening at SARCs and timely access to therapies/advocacy as part of multi-sectoral approach to supporting recovery. Poor mental health was the main barrier to service access beyond SARCs, suggesting the value of Independent Sexual Violence Advisors with mental health specialisation. The persistence of trauma symptoms supports calls for tackling wait-lists, expanding therapy options and commitment to lifelong care. Cohesive commissioning strategies can promote a whole pathway approach by supporting greater collaboration across providers. Access gaps at the population-level and for specific groups call for concerted efforts to support people to reach care early, for example, through outreach, campaigns and implementing trauma-informed universal health services. MESARCH provides a foundation for advancing trauma-informed practices when supporting people exposed to the effects of sexual violence and abuse.Study registration: MESARCH is registered with ISRCTN registry ISRCTN30846825 https://doi.org/10.1186/ISRCTN30846825 Funding: Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research