Alternative Screening Method Research Articles

Evaluation of an Alternative Screening Method for Gestational Diabetes Diagnosis During the COVID-19 Pandemic (DIABECOVID STUDY): An Observational Cohort Study

Background: To evaluate the impact of applying alternative diagnostic criteria for gestational diabetes mellitus (GDM) during the COVID-19 pandemic on GDM prevalence, obstetrical and perinatal outcomes, and costs, as compared to the standard diagnostic method. Methods: A cohort of pregnant individuals undergoing GMD screening with the alternative GDM method, which uses plasma glucose (fasting or non-fasting) and HbA1c, was compared with a cohort of pregnant individuals undergoing the standard GDM screening method. Both cohorts were obtained from six hospitals across Catalonia, Spain, from April 2020 to April 2022. The primary outcome was large for gestational age rate at birth. The secondary outcomes were composite adverse outcomes, including pregnancy complications, delivery complications, and neonatal complications. The cost differences between screening methods were also evaluated. A similar analysis was performed in the subgroup diagnosed with GDM. Results: Data were collected from 1543 pregnant individuals in the standard screening group and 2197 in the alternative screening group. The standard screening group had a higher GDM diagnostic rate than the alternative screening group (10.8% vs. 6.9%, respectively; p < 0.0001). The primary outcome (large for gestational age rate) was similar between groups: 200/1543 (13.0%) vs. 303/2197 (13.8%). The adjusted OR for this outcome was 1.74 (95% CI: 0.74–4.10). An adjusted analysis showed no differences between groups in the composite adverse outcomes for pregnancy complications (OR: 1.11; 95% CI: 0.91–1.36), delivery complications (OR: 0.95; 95% CI: 0.75–1.19), and neonatal complications (OR: 1.28; 95% CI: 0.94–1.75). Among individuals diagnosed with GDM, the large for gestational age rate was similar between groups: 13/166 (7.8%) vs. 15/151 (9.9%). The OR adjusted for this outcome was 1.24 (95% CI: 0.51–3.09). An adjusted analysis showed no differences in the composite adverse outcomes for pregnancy complications (OR: 1.57; 95% CI: 0.84–2.98), delivery complications (OR: 1.21; 95% CI: 0.63–2.35), and neonatal complications (OR: 1.35; 95% CI: 0.61–3.04). The mean cost (which included expenses for consumables, equipment, and personnel) of the alternative screening method was 46.0 euros (22.3 SD), as compared to 85.6 euros (67.5 SD) for the standard screening method. Conclusions: In this Spanish population during the COVID-19 pandemic, GDM prevalence was lower in the alternative screening group than in the standard screening group. After adjusting for GDM risk factors, outcomes related to obstetrics, delivery, and neonatal complications were comparable between both groups. Finally, the alternative screening method was cheaper than the standard screening method.

Exploring the barriers to cervical screening and perspectives on new self-sampling methods amongst under-served groups

BackgroundCervical screening rates have fallen in recent years in the UK, representing a health inequity for some under-served groups. Self-sampling alternatives to cervical screening may be useful where certain barriers prohibit access to routine cervical screening. However, there is limited evidence on whether self-sampling methods address known barriers to cervical screening and subsequently increase uptake amongst under-screened groups. Addressing this research gap, the study aims to understand experiences during and barriers to attending cervical screening for under-screened groups and; explore the views of individuals eligible for screening towards self-sampling (vaginal swabbing and urine sampling) as alternative screening methods and how this may address existing barriers to screening.MethodsWe draw on three integrated theoretical frameworks (access to primary care services, intersectional and feminist perspectives) to examine participants’ barriers to screening and views toward self-sampling methods. We undertook primary qualitative data collection (interviews and focus groups) with 46 participants, facilitated by collaborations with the VCSE sector which successfully enhanced reach to under-served communities.ResultsKnown barriers to cervical screening persist for under-screened participant groups, but we also find numerous examples of good practice where some participants’ needs were met throughout the screening process. Both positive and negative experiences tend to centre around experiences with healthcare professionals, with negative experiences also centring around the use of the speculum. Self-sampling methods (vaginal swab and urine collection) were positively received by participants, and may address some existing barriers through the proponents of enhanced choice – between method and location (which also dovetailed with convenience) leading to greater empowerment. The removal of the speculum and lack of invasive examination by a healthcare professional was also positively received.ConclusionsWhilst barriers to cervical screening remain for under-served groups, examples of good practice are prevalent. Such examples should be implemented more widely to ensure consistency in patient experience and to ensure needs are better met for under-served groups. The introduction of self-sampling alongside traditional methods may reduce barriers to screening, and may boost screening rates for under-screened groups but only if they are implemented with appropriate information and sufficient communication. Failure to implement self-sampling without these considerations may threaten to undermine the identified and important benefits of self-sampling methods.

XGBoost Enhances the Performance of SAFE: A Novel Microwave Imaging System for Early Detection of Malignant Breast Cancer

Background/Objectives: Breast cancer is a significant global health concern, and early detection is crucial for improving patient outcomes. Mammography is widely used but has limitations, particularly for younger women with denser breasts. These include reduced sensitivity, false positives, and radiation risks. This highlights the need for alternative screening methods. In this study, we assess the performance of SAFE (Scan and Find Early), a novel microwave imaging device, in detecting breast cancer in a larger patient cohort. Unlike previous studies that predominantly relied on cross-validation, this study employs a more reliable, independent evaluation methodology to enhance generalizability. Methods: We developed an XGBoost model to classify breast cancer cases into positive (malignant) and negative (benign or healthy) groups. The model was analyzed with respect to key factors such as breast size, density, age, tumor size, and histopathological findings. This approach provides a better understanding of how these factors influence the model’s performance, using an independent evaluation methodology for increased reliability. Results: Our results demonstrate that SAFE exhibits high sensitivity, particularly in dense breasts (91%) and younger patients (83%), suggesting its potential as a supplemental screening tool. Additionally, the system shows high detection accuracy for both small (<2 cm) and larger lesions, proving effective in early cancer detection. Conclusions: This study reinforces the potential of SAFE to complement existing screening methods, particularly for patients with dense breasts, where mammography’s sensitivity is reduced. The promising results warrant further research to solidify SAFE’s clinical application as an alternative screening tool for breast cancer detection.

Breaking Barriers: Empowering Cervical Cancer Screening with HPV Self-Sampling for Sex Workers and Formerly Incarcerated Women in Toronto.

Although cervical cancer (CC) is highly preventable through appropriate screening methods like the Papanicolaou (Pap) test, which enables early detection of malignant and precancerous lesions, access to such screening has not been equitable across social groups. Sex workers and people with records of incarceration are among the most under-screened populations in Ontario. Little is known about the acceptability and feasibility of HPV self-sampling (HPV-SS) as an alternative cervical cancer screening method for these groups. This online, community-based mixed-methods pilot study aimed to address this knowledge gap. Eighty-four under- and never-screened sex workers and ex-prisoners aged 25-69 years and residing in the Greater Toronto Area, were recruited by community peer associates. Participants completed an online survey and viewed short videos about CC and screening with Pap and HPV-SS. Those who opted for HPV-SS conducted the test at one of two collaborating organizations. The median age of participants was 36.5 years. Most had limited knowledge about CC and screening. Approximately 13% identified as non-binary, and 5% as two-spirit or trans men, with the majority having completed secondary education. Of the participants, 88% chose HPV-SS, and one-third tested positive for high-risk HPV types. The ability to self-sample without judgment from healthcare providers was noted as a key advantage. However, there was a need for training on proper HPV-SS techniques. To improve cervical cancer screening among sex workers, increasing awareness through participatory community co-creation of sexual health education is essential. Additionally, offering HPV-SS as a screening option is crucial, given its demonstrated acceptability and feasibility within this population, many of whom lack a primary care provider and face discriminatory attitudes in healthcare settings.

Cervical Cancer Screening: Comparing PAPs Smear with VIA/VILI in Semiurban Women of Delhi

Abstract Introduction Screening with PAPs smear for screening of cervical cancer has been the gold standard for many years in high-income countries but has still not been successful in low- and middle-income country like India due to unavailability at public ground level. Thus, a simple, effective, and low-cost alternative to cervical cytology for cervical cancer prevention is urgently needed for high-risk, low-resource settings. Objectives The aim was to compare the efficacy of visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI) with the PAP smear for screening precursor intraepithelial lesions and early signs of cervical cancer, and to evaluate their potential as alternative screening methods to the PAP smear in a semiurban population in Delhi. Material and Method A total of 127 married, nonpregnant patients between 18 and 65 years were randomly selected from gynecology outpatient department. Then, PAP smear samples were taken from all patients followed by VIA and VILI. Biopsies were then taken from those who showed positive findings in either of the screening methods. Out of these, 50 PAP and VIA-negative women were included as a control group. The diagnostic accuracy of VIA and VILI was compared with PAP smear, for diagnosis of precancerous lesions. Results VIA and VILI results were positive in 22 patients out of 127 (17.3%). PAP cytology report showed epithelial cell abnormality in 13 cases (10.2%) with atypical squamous cells of undetermined significance in 1 case, atypical glandular cells of undetermined significance in 4 cases, low-grade squamous intraepithelial lesion in 3 cases, and high-grade squamous intraepithelial lesions in 5 cases. PAP smear had showed better specificity (90.79%) and less sensitivity (85.71%) as compared with VIA and VILI method. Sensitivity of VIA was 100% and specificity was 80.26%. Similar parameters were seen with the VILI method also. The overall p-value for all the parameters of either screening method was > 0.05; hence, both methods are comparable for screening. Conclusion VIA and VILI can be employed as initial screening tools in place of PAP smear, particularly in countries with limited resources or developing regions.

A self-reported questionnaire for screening of hearing impairment in older

IntroductionHearing loss is a prevalent concern for older adults aged 60 years and above, making early intervention essential. Accurate diagnosis relies on calibrated instruments, soundproof environments, and qualified audiologists. While these resources are often available, certain situations may limit access. This study investigates the potential of self-assessment tools as an alternative screening method for older adults to identify those who may require further audiological evaluation.AimTo study the efficacy of self-reported questionnaire in identifying hearing loss among older adults and its potential application in clinical practice.MethodThis cross-sectional study included a total of 160 older adults. Participants were divided into two groups: Group I with normal hearing sensitivity and Group II with mild to moderately severe sensorineural hearing loss. Pure-tone audiometry was used to measure hearing thresholds, followed by administering a questionnaire.ResultIt was observed that there was significant difference between scores of the self-awareness and communication difficulties for different degrees of hearing loss among older adults (p-value < 0.05). The cut-off score was observed to be increasing with the increase of the hearing loss, and also, it was observed that there is a positive strong correlation between scores of self-awareness domain and communication difficulties domain across different degrees of hearing loss.ConclusionThus, this questionnaire could be an effective tool for screening of hearing loss and assessing its severity, from mild to moderately severe in older adults. This will facilitate early detection and intervention, potentially enhancing their quality of life.

Acoustic and Clinical Data Analysis of Vocal Recordings: Pandemic Insights and Lessons.

Background/Objectives: The interest in processing human speech and other human-generated audio signals as a diagnostic tool has increased due to the COVID-19 pandemic. The project OSCAR (vOice Screening of CoronA viRus) aimed to develop an algorithm to screen for COVID-19 using a dataset of Portuguese participants with voice recordings and clinical data. Methods: This cross-sectional study aimed to characterise the pattern of sounds produced by the vocal apparatus in patients with SARS-CoV-2 infection documented by a positive RT-PCR test, and to develop and validate a screening algorithm. In Phase II, the algorithm developed in Phase I was tested in a real-world setting. Results: In Phase I, after filtering, the training group consisted of 166 subjects who were effectively available to train the classification model (34.3% SARS-CoV-2 positive/65.7% SARS-CoV-2 negative). Phase II enrolled 58 participants (69.0% SARS-CoV-2 positive/31.0% SARS-CoV-2 negative). The final model achieved a sensitivity of 85%, a specificity of 88.9%, and an F1-score of 84.7%, suggesting voice screening algorithms as an attractive strategy for COVID-19 diagnosis. Conclusions: Our findings highlight the potential of a voice-based detection strategy as an alternative method for respiratory tract screening.

Drip-Dry Strategy Assisted Blu-Ray Disc Biosensor for Fast Point of Care Testing.

Discs and numerous other consumer products have been developed for point of care testing (POCT) to replace traditional large and expensive biochemical devices in certain scenarios. Herein, we propose a drip-dry strategy (2D strategy) assisted Blu-ray disc (BD) biosensor, termed BDB, for rapid and portable POCT within 30 min with the cost of a single test < $1. The platform utilizes the covered area formed by the deposition of the substance to be measured on the activated BD surface after the evaporation of water and realizes the quantitative detection of the target through the error readout of free disc quality diagnosis software. As a proof of concept, we first demonstrated the feasibility of direct quantitative detection of substances in solution in a single system through the detection of pure proteins avoiding colorimetric reagent used in traditional optical detection. For the complex mixed systems, we then innovatively utilize the principle that soluble targets promote/inhibit the dissolution of insoluble precipitates to achieve specific detection of targets and successfully apply BDB to the indirect quantitative detection of glutathione (GSH) with LOD of 0.447 mM in the range of 2-16 mM and organophosphorus pesticides (OPs) with LOD of 2.122 × 10-7 M in the range of 1.289 × 10-7-1.289 × 10-4 M. The BDB is widely applicable, easy to operate, and less time-consuming, which is anticipated to provide an alternative method for early, on-site detection or screening.

CINtec PLUS: A Novel Alternative Screening Method for Detecting High-Risk Cervical Lesions in Romania.

Introduction CINtec PLUS is a relatively recent method introduced in Romania for detecting cervical precancerous lesions. This technique utilizes simultaneous double immunostaining with p16 and Ki67 to identify potentially transformative human papillomaviruses (HPVs). CINtec PLUS has demonstrated superior sensitivity and specificity compared to conventional Papanicolaou (PAP) cytology and PAP liquid-based cytology, allowing for more accurate identification of HPV infections that may progress to malignancy among women with abnormal screening results. The objectives of this study are to evaluate CINtec PLUS test results in comparison with PAP cytology and HPV genotype detection among Romanian women and to assess its potential as a complementary screening method within existing national cervical cancer screening programs. Materials and methods Cases were collected between December 22, 2022, and June 15, 2024. All 96 women enrolled in the study, regardless of the presence of pathological cervical lesions, underwent the CINtec PLUS test. The samples were stained using the Roche CINtec PLUS kit. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, NY, USA). To assess correlations and compare variables, we utilized crosstabulation tables, frequency tables, the chi-square test, and the Pearson correlation coefficient. Results The age range of participants in our study was from 19 to 64 years, with a mean age of 35.77 years and a standard deviation of 9.608. Among the women who underwent the CINtec PLUS test, over two-thirds were aged between 20 and 39 years. In 7.3% of cases with no history of HPV infection or cervical cytologic lesions, the CINtec PLUS test yielded a positive result. The study also revealed that CINtec PLUS showed a positive result in 23.3% of cases diagnosed with atypical squamous cells of undetermined significance on PAP cytology. Additionally, 36.5% of women who underwent CINtec PLUS testing as a screening method had a positive result, with more than one-fifth of these cases being positive. Conclusions The CINtec PLUS test is a valuable tool for identifying high-risk cervical lesions. Despite the limitations of our study, it provides a foundation for further research into the long-term benefits and cost-effectiveness of this test. Future studies could explore its potential for integration into national screening programs.

Health Professionals' Perceptions about Prostate Cancer-A Focus Group Study.

Prostate cancer (PCa) accounts for 20% of new cancer cases and 10.5% of cancer-associated mortality in Portugal. Associated risk factors include advanced age, family history, genetic alterations, and race/ethnicity. However, the role of lifestyle factors is often underestimated. To explore health professionals' perceptions of PCa risk factors, a qualitative study with three focus groups (FG), with a total of twenty-one general practitioners and urologists, was conducted via videoconference between February and April 2023. Seven themes emerged, including general perceptions of PCa; PCa risk factors; nutritional impact; the role of physical activity; alcohol consumption and smoking; sexual activity and sexually transmitted diseases roles in PCa; and screening, diagnosis, and treatment methods. Despite agreeing that healthy lifestyles could promote better PCa outcomes and quality of life, participants did not specify any lifestyle factors that could promote or prevent this disease, posing challenges to lifestyle changes, particularly among older adults. Non-invasive screening methods, such as biomarkers and alternative treatments, are crucial for future research. This study underscores the need for further investigation into the correlation of lifestyle factors with PCa and highlights the necessity of health professionals in encouraging their patients to adopt healthier lifestyles, while offering important insights into awareness, prevention, and alternative screening, diagnosis, and treatment methods, which could help reduce false positives and treatment side effects.

A hierarchical constrained density regression model for predicting cluster‐level dose‐response

AbstractWith the advent of new alternative methods for rapid toxicity screening of chemicals comes the need for new statistical methodologies which appropriately synthesize the large amount of data collected. For example, transcriptomic assays can be used to assess the impact of a chemical on thousands of genes, but current approaches to analyzing the data treat each gene separately and do not allow sharing of information among genes within pathways. Furthermore, the methods employed are fully parametric and do not account for changes in distribution shape that may occur at high exposure levels. To address the limitations of these methods, we propose Constrained Logistic Density Regression (COLDER) to model expression data from different genes simultaneously. Under COLDER, the dose‐response function for each gene is assigned a prior via a discrete logistic stick‐breaking process (LSBP) whose weights depend on gene‐level characteristics (e.g., pathway membership) and atoms consist of different dose‐response functions subject to a shape constraint that ensures biological plausibility. The posterior distribution for the benchmark dose among genes within the same pathways can be estimated directly from the model, which is another advantage over current methods. The ability of COLDER to predict gene‐level dose‐response is evaluated in a simulation study and the method is illustrated with data from a National Toxicology Program study of Aflatoxin B1.

Analytical methods for the determination of xylazine in pharmaceutical, clinical and forensic matrices - A review.

Xylazine, a non-opioid veterinary anaesthetic tranquillizer that is not licensed for human use, has been linked to an increase in overdose fatalities worldwide. The study delves into the forensic aspects of xylazine usage, emphasizing on chemical, clinical and toxicological analyses of drug seizures, bodily fluids and tissues. It advocates for validated analytical methods for determining xylazine. This study provides supporting material to pave the path for the usage and development of relevant and verified alternative screening and confirmation methods for laboratories. Google Scholar, Scopus, Science Direct and PubMed were searched for relevant articles and case reports in relation to xylazine misuse and established analytical methods for forensic investigation until April 2023. A total of 79 articles were evaluated, and 40 publications met the inclusion criteria. The most prevalent xylazine exposures recorded were incidental and intentional misuse/abuse. Common symptoms upon presentation were hypotension, bradycardia, drowsiness and lethargy, although mortality was less prevalent. Solid-phase extraction and liquid-liquid extraction are two extensively used sample preparation techniques. These techniques are used to extract desired analytes from complex matrices. Several analytical techniques have been stated, including GC-MS, LC-MS/MS, HPLC-DAD and others. The analytical procedures used are determined by the matrices involved, the amount of xylazine present, interfering compounds, the degree of precision required and the laboratory infrastructure. In the present context, the LC-MS/MS methods are preferred as the gold standard. In the near future, many analytical techniques such as capillary electrophoresis, PSI-MS, immuno-analytical techniques and SERRS may show significant potential.

Assessment of combined α-GAL enzyme activity and lyso-GL3 for Fabry disease screening in women with chronic kidney disease

IntroductionThe spectrum of clinical presentation of Fabry disease (FD) in women is broad and challenging. The aim is to evaluate the effectiveness of an alternative screening method for FD in women. MethodsA collaborative multicenter cross-sectional study to evaluate the sensitivity and specificity of the combination of two tests (α-GAL enzyme activity assay and lyso-GL3 assay) for the diagnosis of FD in women. We included women with chronic kidney disease (CKD) stages 3 to 5, receiving conservative treatment or on dialysis programs, from different nephrology services in Brazil. ResultsWe evaluated 1874 patients that underwent blood collection for α-GAL and lyso-GL3 assays. Isolated decreased α-GAL enzyme activity was found in 64 patients (3.5%), while isolated increased lyso-GL3 levels were found in 67 patients (3.6%), with one patient presenting alterations in both tests. All cases with low α-GAL enzyme activity and/or increased lyso-GL3 levels underwent genetic analysis for FD variants (132 performed GLA genetic test). Low α-GAL enzyme activity had higher sensitivity and specificity to detect FD compared to the other measures (elevated lyso-GL3 alone or both altered). The negative predictive value (NPV) of α-GAL activity was 99%, and the positive predictive value (PPV) was 9.2%. For lyso-GL3 assay, the specificity was 99.7% and the PPV was 2.9%, therefore considered inferior to α-GAL assay. Both assays altered, had higher PPV (100%) and higher NPV (99.7%) considered the best method. We found 7 cases of GLA gene variants found, resulting in an initial prevalence of 0.37% for FD in this sample female population. ConclusionThis study contributes to the diagnostic value of the biomarkers α-GAL and lyso-GL3 in the context of FD in women with CKD. The combination of these biomarkers was an effective approach for the diagnosis of the disease, with high PPV and NPV.

A health decision analytical model to evaluate the cost-effectiveness of female genital schistosomiasis screening strategies: The female genital schistosomiasis SCREEN framework.

Female genital schistosomiasis is a chronic gynaecological disease caused by the waterborne parasite Schistosoma (S.) haematobium. It affects an estimated 30-56 million girls and women globally, mostly in sub-Saharan Africa where it is endemic, and negatively impacts their sexual and reproductive life. Recent studies found evidence of an association between female genital schistosomiasis and increased prevalence of HIV and cervical precancer lesions. Despite the large population at risk, the burden and impact of female genital schistosomiasis are scarcely documented, resulting in neglect and insufficient resource allocation. There is currently no standardised method for individual or population-based female genital schistosomiasis screening and diagnosis which hinders accurate assessment of disease burden in endemic countries. To optimise financial allocations for female genital schistosomiasis screening, it is necessary to explore the cost-effectiveness of different strategies by combining cost and impact estimates. Yet, no economic evaluation has explored the value for money of alternative screening methods. This paper describes a novel application of health decision analytical modelling to evaluate the cost-effectiveness of different female genital schistosomiasis screening strategies across endemic settings. The model combines a decision tree for female genital schistosomiasis screening strategies, and a Markov model for the natural history of cervical cancer to estimate the cost per disability-adjusted life-years averted for different screening strategies, stratified by HIV status. It is a starting point for discussion and for supporting priority setting in a data-sparse environment.

P-554 Artificial intelligence (AI) for embryo genetic risk assessment: a novel form of preimplantation genetic screening

Abstract Study question Can an AI-based embryo ploidy screening tool effectively provide a genetic risk assessment on Day 5 embryos? Summary answer AI screening results showed strong predictive value for early detection of at-risk embryos warranting confirmatory diagnostic testing, based only on time lapse video assessment. What is known already Euploid embryo transfer is the dogma of IVF success. Embryo evaluation relies extensively on diagnostic preimplantation genetic testing for aneuploidy (PGT-A) by means of trophectoderm biopsy. Though pivotal, this presents substantial practical and financial limitations. There is demand for an alternative genetic screening method that provides a quantitative embryo genetic risk assessment for patients who opt out of invasive diagnostic testing, or who intend to undergo fresh transfer. These results can provide information for understanding your aneuploidy risk for more precise prognosis counseling and testing. This is important since diagnostic tests may incur excess financial burden, inconclusive outcomes, and time-to-results. Study design, size, duration Time lapse videos (N = 5,000) were used for AI training. The AI core architecture was a video transformer model for spatio-temporal video sampling. Known ploidy and live-birth results were used as ground truth, with maternal age and embryo quality scores incorporated as input parameters during calibrated logistic regression. A blind test dataset (N = 708 embryos; euploid=352; aneuploid=356; mean ± SD patient age: 35.9 ± 5.4 years) was used to evaluate predictive accuracy. Participants/materials, setting, methods The AI outputs a scalar (1-99) that associates with euploidy likelihood. The AI’s screening value was determined by its specificity (correct prediction of aneuploid), sensitivity (correct prediction of euploid), false positive, and false negative rate. We determined optimal AI score thresholds that identified high aneuploidy and euploidy risk categories (AI score &amp;lt;33; AI score &amp;gt;66, respectively). Main results and the role of chance Specificity of the AI screening test was 83.0%, with a sensitivity of 56.0%. The false positive rate was 26.7% and the false negative rate was 29.3%. The AI’s high specificity relative to its sensitivity shows its clinical value to deselect embryos with the strongest risk of genetic abnormality, and for the prioritization of embryos for confirmatory PGT. Boxplot visualization of the full AI score distribution showed successful discrimination between aneuploid and euploid embryos (mean AI score for aneuploid and euploid were 51.3 and 43.5, respectively) with appropriately minimized overlapping of the interquartile range. The optimal AI score thresholds for detecting embryos with the highest and lowest likelihoods of euploidy were &amp;gt;66 /&amp;lt;33, respectively, representing 71% likelihood of euploidy for the &amp;gt;66 group and 72% aneuploidy for the &amp;lt;33 group. Limitations, reasons for caution The screening does not provide diagnostic genetic testing on the chromosome level. The influence of mosaicism on the false positive/negative rates was not assessed. Wider implications of the findings Results support the use of an AI ploidy screening test for effective decision-making and triage of at-risk embryos for transfer or confirmatory diagnostic testing via PGT-A. Trial registration number Not applicable

Improving Consistency and Accuracy: A Novel C. auris Colonization Screening Strategy Using a Nares + Hands Composite Swab

Background: Candida auris is often identified in healthcare settings through bilateral composite of axilla/groin skin swabs screening. Re-screening the same patient has demonstrated inconsistent results over time, complicating the understanding of longitudinal colonization and limiting confidence in negative Results: Previous studies have described identification of colonized patients using other anatomical sites. Here, we compare bilateral composite of nares/hands with bilateral composite of axilla/groin screenings in a cohort of hospitalized patients in Miami, Florida, to assess the use of screening other body sites for C. auris surveillance. Methods: This study took place in a 560-bed academic acute-care facility and included patients previously colonized with C. auris who were cohorted on a 30-bed unit. Bilateral composite samples from both the axilla/groin and nares/hands were obtained simultaneously. Swabs were collected at six different time points at biweekly intervals between March and May 2023 (Figure 1) and sent to the Centers for Disease Control and Prevention for testing with culture and Real-time PCR-based methods. Results: A total of 102 swabs (51 from each swab type) were collected from 19 patients who were each sampled a median of twice (IQR: 1-5). Among the 102 swabs, 35 of 51 (69%) axilla/groin swabs were positive compared with 45 of 51 (88%) nares/hands swabs using culture (Figure 2). Furthermore, 48 of 51 (94%) swabs were positive by culture for both methods, with 15 positive from the nares/hands and one positive from the axilla/groin (Figure 3). Among 11 patients who were tested ≥2 times with nares/hands swabs, 9/11 (81%) tested positive on all sequential swabs via culture and 10/11 (90%) tested positive via PCR (Ct threshold &lt; 3 6.9). Among the same 11 patients but using the axilla/groin swabs, 3/11 (27%) patients tested positive on all sequential swabs using culture, and 5/11 (45%) tested positive using PCR (Figures 2-4). On average, samples collected from nares/hands swabs had lower Ct values (mean=27) compared to axilla/groin swabs (mean=31) (p-value=&lt; 0.001) (Figure 5). Discussion: Identifying the swab site with most consistent C. auris detection is important for surveillance purposes. In our study, there were more positives and consistent positivity for nares/hands by both culture and PCR-based methods, as well as lower Ct values, suggesting that these swabs provide more reliable detection of C. auris colonization. Alternative screening methods deserve consideration as CDC continues to explore whether swabbing of other body sites (e.g., nares, hands) would improve accuracy and consistency when identifying colonized patients.

A Systematic Review of Cost-Effectiveness Studies on Gastric Cancer Screening.

Gastric cancer (GC) poses notable economic and health burdens in settings where the incidence of disease is prevalent. Some countries have established early screening and treatment programs to address these challenges. The objectives of this systematic review were to summarize the cost-effectiveness of gastric cancer screening presented in the literature and to identify the critical factors that influence the cost-effectiveness of screening. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Economic evaluation studies of gastric cancer screening were reviewed from SCOPUS and PubMed. The Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) was used to assess the quality of reporting presented in the selected articles. Only primary economic evaluation studies addressing the cost-effectiveness, cost-utility, and cost-benefit of gastric cancer screening were selected. Two reviewers scrutinized the selected articles (title, abstract, and full text) to determine suitability for the systematic review based on inclusion and exclusion criteria. Authors' consensus was relied on where disagreements arose. The main outcome measures of concern in the systematic review were cost, effectiveness (as measured by either quality-adjusted life years (QALY) or life-years saved (LYS)), and incremental cost-effectiveness ratio (ICER) of screening versus either no screening or an alternative screening method. Thirty-one studies were selected for the final review. These studies investigated the cost-effectiveness of GC screening based on either primary, secondary, or a combination of primary and secondary interventions. The main primary intervention was Helicobacter pylori (Hp) screening with eradication, while the main secondary intervention was endoscopic screening. Cost-effectiveness was evaluated against no screening or screening using an alternative method in both observational and model-based studies. Screening was mainly cost-effective in Asian countries or their diasporas where the prevalence of GC was high. GC screening was generally not cost-effective among Western countries. GC screening can be cost-effective, but cost-effectiveness is dependent on context-specific factors, including geographical location, the prevalence of GC in the local population, and the screening tool adopted. However, there is benefit in targeting high-risk population groups in Asian countries and their diaspora for GC screening.

Volatile organic compounds: A promising new frontier for cancer screening

The late onset of cancer symptoms can cause a significant delay in diagnosis, impacting patients&amp;rsquo; prognosis and quality of life, thus prompting a need for alternative screening and detection methods. Neoplastic processes cause distinct and immediate changes to the body&amp;rsquo;s metabolism, creating unique patterns in the volatile organic compounds (VOCs) produced and released through exhaled breath. For this reason, VOC profiles have emerged as diagnostic indicators for several types of malignancies, facilitating early cancer detection. Both non-invasive and accessible, the analysis of breath VOCs for cancer screening and detection has gained recognition as a new frontier in cancer diagnostics. Using exhaled breath instead of gold-standard cancer detection and screening tools that are traditionally invasive and uncomfortable for the patient could be revolutionary in improving patient compliance. Further, compared to the gold-standard tools, breath testing is relatively inexpensive, and the method of analysis, storage, and transporting the samples is simplified. Several studies have demonstrated the accuracy of VOC analysis in detecting various types of cancer, including breast cancer, colon cancer, prostate cancer, gastric cancer, and melanoma. This article summarizes the evidence supporting VOC analysis for cancer screening and detection. It reviews the clinical utility, current limitations, and necessity for standardization across all VOC screening tools to ensure the standardization and reliability of measurements. The evidence supporting breath tests to detect cancer accurately is strong, demonstrating that VOC sampling improves patient outcomes and decreases the global burden of malignant conditions by detecting cancer earlier.

Screening Tools for Obstructive Sleep Apnea in Pregnant Women: An Extended and Updated Systematic Review and Meta-analysis.

The prevalence of obstructive sleep apnea syndrome (OSA) increases in women during pregnancy and negatively affects maternal and fetal outcomes. The updated systematic review and meta-analysis aimed to evaluate the validity of the Berlin, STOP-Bang, and Epworth sleepiness scale (ESS) questionnaires in detecting OSA in pregnant women. PubMed, Embase, and Web of Science were searched systematically up to March 2022. After eligible studies inclusion, two independent reviewers extracted demographic and clinical data. Bivariate random effects models were used to estimate the pooled accuracy measures including sensitivity and specificity, positive (PPV) and negative predictive values (NPVs), diagnostic odds ratio (DOR), and receiver operating characteristic curve (ROC) curve. We included 8 studies including 710 pregnant women with suspected OSA. The performance values of Berlin, STOP-Bang, and ESS questionnaires were as follows: the pooled sensitivity were 61% (95% confidence interval (CI): 40%-80%), 59% (95% CI: 49%-69%), and 29%, (95% CI: 10%-60%); pooled specificity were 61% (95% CI: 42%-78%), 80% (95% CI: 55%-93%), and 80% (95% CI: 50%-94%); pooled PPVs were 60% (95% CI: 0.49-0.72), 73% (95% CI: 61%-85%), and 59% (95% CI: 31%-87%); pooled NPVs were 60% (95% CI: 0.49-0.71), 65% (95% CI: 54%-76%), and 53% (95% CI: 41%-64%); and pooled DORs were 3 (95% CI: 1-5), 6 (95% CI: 2-19), and 2 (95% CI: 1-3), respectively. It seems that the Berlin, STOP-Bang, and ESS questionnaires had poor to moderate sensitivity and specificity in pregnancy, with the ESS showing the worst characteristics. Further studies are required to evaluate the performance of alternative screening methods for OSA in pregnancy.

Patient Perspectives on Portal-Based Anxiety and Depression Screening in HIV Care: A Qualitative Study Using the Consolidated Framework for Implementation Research.

Electronic patient portals represent a promising means of integrating mental health assessments into HIV care where anxiety and depression are highly prevalent. Patient attitudes toward portal-based mental health screening within HIV clinics have not been well described. The aim of this formative qualitative study is to characterize the patient-perceived facilitators and barriers to portal-based anxiety and depression screening within HIV care in order to inform implementation strategies for mental health screening. Twelve adult HIV clinic patients participated in semi-structured interviews that were audio recorded and transcribed. The transcripts were coded using constructs from the Consolidated Framework for Implementation Research and analyzed thematically to identify the barriers to and facilitators of portal-based anxiety and depression screening. Facilitators included an absence of alternative screening methods, an approachable design, perceived adaptability, high compatibility with HIV care, the potential for linkage to treatment, an increased self-awareness of mental health conditions, the ability to bundle screening with clinic visits, and communicating an action plan for results. The barriers included difficulty navigating the patient portal system, a lack of technical support, stigmatization from the healthcare system, care team response times, and the novelty of using patient portals for communication. The patients in the HIV clinic viewed the use of a portal-based anxiety and depression screening tool as highly compatible with routine HIV care. Technical difficulties, follow-up concerns, and a fear of stigmatization were commonly perceived as barriers to portal use. The results of this study can be used to inform implementation strategies when designing or incorporating portal-based mental health screening into other HIV care settings.