Case Detection Rate Research Articles

Empirical Modeling of COVID-19 Evolution with High/Direct Impact on Public Health and Risk Assessment.

This report develops a conceivable mathematical model for the transmission and spread of COVID-19 in Romania. Understanding the early spread dynamics of the infection and evaluating the effectiveness of control measures in the first wave of infection is crucial for assessing and evaluating the potential for sustained transmission occurring in the second wave. The main aim of the study was to emphasize the impact of control measures and the rate of case detection in slowing the spread of the disease. Non pharmaceutical control interventions include government actions, public reactions, and other measures. The methodology consists of an empirical model, taking into consideration the generic framework of the Stockholm Environment Institute (SEI) Epidemic–Macroeconomic Model, and incorporates the effect of interventions through a multivalued parameter, a stepwise constant varying during different phases of the interventions designed to capture their impact on the model. The model is mathematically consistent and presents various simulation results using best-estimated parameter values. The model can be easily updated later in response to real-world alterations, for example, the easing of restrictions. We hope that our simulation results may guide local authorities to make timely, correct decisions for public health and risk assessment.

Risk-adjusted active tuberculosis case finding strategy in central Ethiopia

BackgroundThe World Health Organization recommends active case finding for tuberculosis (TB). Our study evaluated the targeted screening of household contacts (HHCs) of patients with contagious pulmonary tuberculosis (PTB) in Central Ethiopia. MethodsThe HHCs of patients with microbiologically confirmed PTB were screened for TB symptoms and risk factors for TB transmission. Symptomatic HHCs were subjected to secondary investigation. Antimicrobial resistance was investigated among study participants. ResultsOverall, 112 index patients with TB were included, and 289 HHCs from 89 households were screened. Multidrug-resistant-TB was detected in 2.7% (n=3) of index patients. The routine public health system process did not identify any TB suspects among HHCs. In total, 23.9% (n=69) of HHCs reported ≥1 TB symptom and PTB was confirmed in 2.1% (n=6). Reporting >1 TB symptom (relative risk [RR] 29.4, 95% CI 3.5−245.5, P<0.001) and night sweats (RR 27.1, 95% CI 3.2−226.6, P<0.001) were associated with the greatest relative risk. Regular alcohol consumption was identified as an individual risk factor for TB among HHCs (P=0.022). ConclusionThe MDR-TB rate among our patients was higher than recently reported for Ethiopia. Enhanced contact tracing using a risk-adjusted approach seems feasible and increases the case detection rate among HHCs of confirmed TB cases.

Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 After the Second Wave in South Africa in Human Immunodeficiency Virus-Infected and Uninfected Persons: A Cross-Sectional Household Survey.

BackgroundSeroprevalence studies are important for quantifying the burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in resource-constrained countries.MethodsWe conducted a cross-sectional household survey spanning the second pandemic wave (November 2020 to April 2021) in 3 communities. Blood was collected for SARS-CoV-2 antibody (2 enzyme-linked immunosorbent assays targeting spike and nucleocapsid) and human immunodeficiency virus (HIV) testing. An individual was considered seropositive if testing positive on ≥1 assay. Factors associated with infection, and the age-standardized infection case detection rate, infection hospitalization rate, and infection fatality rate were calculated.ResultsOverall, 7959 participants were enrolled, with a median age of 34 years and an HIV prevalence of 22.7%. SARS-CoV-2 seroprevalence was 45.2% (95% confidence interval 43.7%–46.7%) and increased from 26.9% among individuals enrolled in December 2020 to 47.1% among those enrolled in April 2021. On multivariable analysis, seropositivity was associated with age, sex, race, being overweight/obese, having respiratory symptoms, and low socioeconomic status. Persons living with HIV with high viral load were less likely to be seropositive than HIV-uninfected individuals. The site-specific infection case detection rate, infection hospitalization rate, and infection fatality rate ranged across sites from 4.4% to 8.2%, 1.2% to 2.5%, and 0.3% to 0.6%, respectively.ConclusionsSouth Africa has experienced a large burden of SARS-CoV-2 infections, with <10% of infections diagnosed. Lower seroprevalence among persons living with HIV who are not virally suppressed, likely as a result of inadequate antibody production, highlights the need to prioritize this group for intervention.

Effects of Motivation, Knowledge, and Skills of Lung Tuberculosis Officers on Case Detection Rate of Health Centers

Background: One of the main indicators of tuberculosis prevention is the Case Detection Rate (CDR). The CDR of health centers in East Lampung Regency in 2017 was 24.8% which is still below the national standard. Case finding was still being done passively and suspect screening in several health centers was found lacking attention to the patient's medical history. Accordingly, increasing CDR needs improvement efforts to be strongly influenced by tuberculosis officers.Objectives: This study aimed to determine the effects of motivation, knowledge and skills of tuberculosis Officers on CDRs of community health centers in East Lampung Regency.Methods: This study is a cross-sectional quantitative study with total sampling. Data were obtained from questionnaires, checklists and secondary data from community health centers and East Lampung District Health Office. Respondents are 34 community health centers in Lampung Timur represented by 89 officers. Dependent variable was CDR while motivation, knowledge, and skills were the independent variables. The data were analyzed by Rank Spearman tests and multiple linear regression methods.Results: Respondents showed they were lacking in motivation, good knowledge and skills. Rank Spearman correlation coefficient ranged between 0.665 to 0.696 with sig.=0,000. Regression sig values were 0.000 for motivation, 0.0962 for knowledge and 0.001 for skills. Adjusted R square was 0.703, while regression coefficient was 2.872 for motivation and 1.196 for skills.Conclusion: There were significant correlations between motivation, knowledge and skills with CSRs of community health centers in East Lampung Regency. Knowledge had no effect on CSR but motivation and skills have a significant effect partially and simultaneously. Motivation contributed the biggest effect.

Sustained Actions in Combating Neglected Tropical Diseases during the COVID-19 Pandemic: Lessons Learned From the Leprosy Program in the Hyper-Endemic Area in Papua Province, Indonesia

In 2020 we witnessed the global pandemic of COVID-19. Papua, Indonesia announced the first case of COVID-19 on 7 March 2020, and reached 41,137 positive cases with a total of 1,183 fatality cases in August 2021. In the midst of the effort to handle COVID-19, this area of hyper-endemic tropical diseases, including leprosy, has also had to cope with these established problems. Some leprosy indicators have shown decreased performance. The new case detection rate (NCDR) per 100,000 population in Papua Province decreased from 45.36 in 2019 to 29.75 in December 2020. Grade 2 disability (G2D) proportion amongst the new cases increased from 9.0% in 2019 to 11.4% in 2020. There was a 27% decrease of the proportion of child leprosy, following the decrease of elementary school surveys from 6.1% in 2019 to only 1.0% in 2020. Although precautions should be taken, it should be done to minimalize impacts not only for the current pandemic, but also the existing neglected tropical diseases (NTDs). The central government should optimize their functions as a control system to maintain standard services and to monitor the local health authority. The current guidelines regarding implementation of NTD programs during the COVID-19 pandemic should be evaluated and revised, and followed by adequate explanation and proper training to accommodate better services. Emphasis on prevention and early detection should be considered as the main way forward to strengthen the health system.

ROLE OF ASPIRATION CYTOLOGY AND BIOPSY IN THE RAPID DIAGNOSIS OF NASOPHARYNGEAL CARCINOMA – A COMPARATIVE STUDY FROM A TERTIARY CARE CENTRE .

BACKGROUND: Nasopharyngeal carcinoma accounts for a fair number of malignancies in the head and neck region. Cancerous growth in this location maybe very small and inconspicuous. Frequent clinical examination and repeated biopsy needs to be taken to come to an early diagnosis. FNAC can be utilized as a reliable and quick tool to aid in the early diagnosis of nasopharyngeal carcinoma before the patient is subjected to biopsy. FNAC if followed by biopsy rules out any false negative cases by FNAC and further reduces the chances of missing out on a diagnosis of nasopharyngeal carcinoma. OBJECTIVES :To compare the role of FNAC and biopsy in the rapid diagnosis of nasopharyngeal carcinoma. MATERIALS AND METHODS: All suspected case of nasopharyngeal carcinoma underwent FNAC followed by biopsy . FNAC smears were stained with Giemsa stain and biopsy sections were stained in hematoxyline and eosin (H&amp;E) .Special stains were used whenever indicated. RESULTS: Nasopharyngeal carcinoma affected males more than the females and most of the cases were in their 4th - 5th decade . There was a clear preponderance of nasopharyngeal carcinoma amongst the tribal community accounting for 69% of the cases. Metastatic lymph nodes in varied locations were found to be present in 60% of the cases studied. Success rate of FNAC in the rst half of the cases was 26.6% which increased to 60% in the second half of the cases. Biopsy revealed a success rate of 80 % and 66.6 % in the rst and second half of the cases respectively. Out of the 22 histopathologically conrmed cases of nasopharyngeal carcinoma, FNAC could correctly diagnose 63.3 % of the cases and there were no false positive cases. The overall diagnostic accuracy of FNAC was 68 % with a sensitivity of 46.7%, specicity of 100 % while predictive positive value was 100 % and predictive negative value was 55.5 % . CONCLUSION: FNAC is a safe, reliable , cost effective technique for the early diagnosis of nasopharyngeal carcinoma . Other diagnostic modalitieslike endoscopic FNAC or CT guided FNAC may also be incorporated to improve the detection rate in early and deep-seated cases of nasopharyngeal carcinoma.

Leprosy Update in China, 2019

Abstract Objective: To study the epidemiology of leprosy in China in 2019 and give suggestions to improve future leprosy control activities. Methods: We collected leprosy data from the Leprosy Management Information System in China, which includes data from 31 Chinese provinces, autonomous regions, and municipalities, except for Hong Kong, Macao, and Taiwan. We then performed a descriptive analysis of these data. Results: A total of 464 new leprosy cases were reported nationwide in 2019, with a case detection rate of 0.033/100,000. The proportions of children younger than 15years, multibacillary cases, and cases with World Health Organization grade 2 disability were 1.3%, 90.3%, and 21.6%, respectively. A total of 2,219 leprosy cases were registered in China by the end of 2019, giving a prevalence rate of 0.158/100,000. Fifty-six counties had a prevalence rate of more than 1/100,000, and most of them were located in Southwest China. There were 31 reported relapse cases. Conclusion: The prevalence of leprosy has improved continuously throughout China, but the southwest region is still an area of concern.

Spatio-temporal analysis of leprosy risks in a municipality in the state of Mato Grosso-Brazilian Amazon: results from the leprosy post-exposure prophylaxis program in Brazil

BackgroundLeprosy post-exposure prophylaxis (LPEP) with single dose rifampicin (SDR) can be integrated into different leprosy control program set-ups once contact tracing has been established. We analyzed the spatio-temporal changes in the distribution of index cases (IC) and co-prevalent cases among contacts of leprosy patients (CP) over the course of the LPEP program in one of the four study areas in Brazil, namely the municipality of Alta Floresta, state of Mato Grosso, in the Brazilian Amazon basin.MethodsLeprosy cases were mapped, and socioeconomic indicators were evaluated to explain the leprosy distribution of all leprosy cases diagnosed in the period 2016–2018. Data were obtained on new leprosy cases [Notifiable diseases information system (Sinan)], contacts traced by the LPEP program, and socioeconomic variables [Brazilian Institute of Geography and Statistics (IBGE)]. Kernel, SCAN, factor analysis and spatial regression were applied to analyze changes.ResultsOverall, the new case detection rate (NCDR) was 20/10 000 inhabitants or 304 new cases, of which 55 were CP cases among the 2076 examined contacts. Changes over time were observed in the geographic distribution of cases. The highest concentration of cases was observed in the northeast of the study area, including one significant cluster (Relative risk = 2.24; population 27 427, P-value < 0.001) in an area characterized by different indicators associated with poverty as identified through spatial regression (Coefficient 3.34, P-value = 0.01).ConclusionsThe disease distribution was partly explained by poverty indicators. LPEP influences the spatial dynamic of the disease and results highlighted the relevance of systematic contact surveillance for leprosy elimination.Graphical

Effectiveness of contact tracing in the control of infectious diseases: a systematic review

BackgroundContact tracing is used for multiple infectious diseases, most recently for COVID-19, but data regarding its effectiveness in disease control are scarce. To address this knowledge gap and inform public health decision making for COVID-19, we systematically reviewed the existing literature to determine the effectiveness of contact tracing in the control of communicable illness.MethodsWe searched PubMed, Embase, and the Cochrane Library from database inception up to Nov 22, 2021, for published studies evaluating associations between provider-initiated contact tracing for transmissible infectious diseases and one of three outcomes of interest: case detection rates among contacts or at the community level, overall forward transmission, or overall disease incidence. Clinical trials and observational studies were eligible, with no language or date restrictions. Reference lists of reviews were searched for additional studies. We excluded studies without a control group, using only mathematical modelling, not reporting a primary outcome of interest, or solely examining patient-initiated contact tracing. One reviewer applied eligibility criteria to each screened abstract and full-text article, and two reviewers independently extracted summary effect estimates and additional data from eligible studies. Only data reported in published manuscripts or supplemental material was extracted. Risk of bias for each included study was assessed with the Cochrane Risk of Bias 2 tool (randomised studies) or the Newcastle–Ottawa Scale (non-randomised studies).FindingsWe identified 9050 unique citations, of which 47 studies met the inclusion criteria: six were focused on COVID-19, 20 on tuberculosis, eight on HIV, 12 on curable sexually transmitted infections (STIs), and one on measles. More than 2 million index patients were included across a variety of settings (both urban and rural areas and low-resource and high-resource settings). Of the 47 studies, 29 (61·7%) used observational designs, including all studies on COVID-19, and 18 (38·3%) were randomised controlled trials. 40 studies compared provider-initiated contact tracing with other interventions or evaluated expansions of provider-initiated contact tracing, and seven compared programmatic adaptations within provider-initiated contact tracing. 29 (72·5%) of the 40 studies evaluating the effect of provider-initiated contact tracing, including four (66·7%) of six COVID-19 studies, found contact tracing interventions were associated with improvements in at least one outcome of interest. 23 (48·9%) studies had low risk of bias, 22 (46·8%) studies had some risk of bias, and two (4·3%) studies (both randomised controlled trials on curable STIs) had high risk of bias.InterpretationProvider-initiated contact tracing can be an effective public health tool. However, the ability of authorities to make informed choices about its deployment might be limited by heterogenous approaches to contact tracing in studies, a scarcity of quantitative evidence on its effectiveness, and absence of specificity of tracing parameters most important for disease control.FundingThe Sullivan Family Foundation, Massachusetts General Hospital Executive Committee on Research, and US National Institutes of Health.

Pitfalls and solutions in case fatality risk estimation – A multi-country analysis on the effects of demographics, surveillance, time lags between case reports and deaths and healthcare system capacity on COVID-19 CFR estimates

Across European countries, there have been large differences in COVID-19 case fatality risk (CFR) estimates, and considerable variation in these estimates over time. CFR estimates vary depending on both the method used for estimation and countryspecific characteristics. While crude methods simply use cumulative total numbers of cases and deaths, the CFR can be influenced by the demographic characteristics of the cases, the case detection rates, the time lags between the reporting of infections and deaths and infrastructure characteristics, such as healthcare capacities. We use publicly available weekly data for 11 European countries on the COVID- 19 case and death numbers by age group for the year 2020. Moreover, we use data on national weekly test rates to adjust the case numbers, and to investigate the effects of different time lags between the reporting of cases and deaths on the estimation of CFRs. Finally, we describe the association between case fatality rates and the demand for hospital and intensive care unit beds for COVID-19 cases, while taking into account national bed capacities. The crude CFR estimates differ considerably across the investigated countries. In the crude international CFR time series, the differences are smaller when adjusting for the demographics of the cases. Differences in testing policies significantly affect the CFR estimates as well. However, the question of precisely how these testing procedures should be adjusted requires further investigation. Lag adjustments of CFRs do not lead to improvements in estimates of COVID-19 CFRs, and no connection between hospital capacities and CFRs can be found for the countries included in our study.

Real-time pandemic surveillance using hospital admissions and mobility data

Forecasting the burden of COVID-19 has been impeded by limitations in data, with case reporting biased by testing practices, death counts lagging far behind infections, and hospital census reflecting time-varying patient access, admission criteria, and demographics. Here, we show that hospital admissions coupled with mobility data can reliably predict severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission rates and healthcare demand. Using a forecasting model that has guided mitigation policies in Austin, TX, we estimate that the local reproduction number had an initial 7-d average of 5.8 (95% credible interval [CrI]: 3.6 to 7.9) and reached a low of 0.65 (95% CrI: 0.52 to 0.77) after the summer 2020 surge. Estimated case detection rates ranged from 17.2% (95% CrI: 11.8 to 22.1%) at the outset to a high of 70% (95% CrI: 64 to 80%) in January 2021, and infection prevalence remained above 0.1% between April 2020 and March 1, 2021, peaking at 0.8% (0.7-0.9%) in early January 2021. As precautionary behaviors increased safety in public spaces, the relationship between mobility and transmission weakened. We estimate that mobility-associated transmission was 62% (95% CrI: 52 to 68%) lower in February 2021 compared to March 2020. In a retrospective comparison, the 95% CrIs of our 1, 2, and 3 wk ahead forecasts contained 93.6%, 89.9%, and 87.7% of reported data, respectively. Developed by a task force including scientists, public health officials, policy makers, and hospital executives, this model can reliably project COVID-19 healthcare needs in US cities.

The role of saliva PCR assay in the diagnosis of COVID-19.

The introduction of a self-collection sampling method with less discomfort would be of great benefit in reducing the risk of medical provider's contamination and patient's acceptance. The aim of the present study was to investigate saliva samples' diagnostic performance for the COVID-19 RT-PCR test compared to pharyngeal swabs. From individuals referred to a medical center with presentations compatible with COVID-19 who were eligible for molecular diagnostic tests, 80 cases were selected. Nasopharyngeal and oropharyngeal swabs (placed into the same transport tube) along with self-collected saliva sample were taken from each participant for COVID-19 RT-PCR assay. The results of pharyngeal swabs and saliva sample were compared. Sixty-two (78%) infected cases were detected, of whom 31 (39%) cases tested positive for both pharyngeal swab and saliva samples. 24 (30%) and 7 (9%) cases tested positive only for pharyngeal or saliva samples, respectively. The overall percentage of agreement between pharyngeal swab and saliva sample was 61%, with a kappa value of 0.24 (p-value = 0.019, 95% CI: 0.04-0.44), showing a fair level of agreement. The diagnostic sensitivity of pharyngeal swabs was 88.71% (95% CI: 78.11-95.34), and the diagnostic sensitivity of saliva samples was 61.29% (95% CI: 48.07-73.40). Compared to pharyngeal swabs (oropharyngeal and nasopharyngeal swabs in the same collection tube), an important observation was that seven more positive cases were detected among saliva samples. The findings of the present study indicated that self-collected saliva samples cannot replace pharyngeal swabs. Still, saliva samples significantly increased the case detection rate and can be used along with pharyngeal swabs.

Initiating a district-based public\u2013private mix to overcome tuberculosis missing cases in Indonesia: readiness to engage

BackgroundDistrict-based public–private mix (DPPM) is a variant of a relatively new PPM strategy of addressing missing cases in the tuberculosis (TB) care cascade in Indonesia. We aimed to determine the readiness of various stakeholders to engage in implementing the DPPM strategy.MethodsThe research design was sequential exploratory mixed methods. A qualitative study in the first stage was carried out through in-depth interviews, FGD and study documents. Data were analyzed through coding, categorizing, pattern matching and theorizing. The second stage was a survey conducted using instruments built in the first stage. Data were analyzed using Rasch modeling and logistic regression.ResultsDistrict TB case detection rate (CDR) has improved from 35% (2018) to 104% (2019). The contribution of private hospitals has increased considerably. However, there were almost none from the private primary healthcare facilities. The substantive theory generated indicates that awareness and concern of the TB problem, TB program comprehension and involvement, and institutional support are behind the readiness of facilities to engage the TB program (the readiness to engage). The measurement results indicate the significant correlation of all dimensions on readiness to engage. Concern of the TB problem and institutional support are variables that influence readiness to engage (p < 0.05).ConclusionsEngaging private and public facility stakeholders is a challenge for local government. Intervention is through a personalized approach, encourages institutional support of health facilities for the TB program and system approach.

Therapeutic effect of cycloserine combined with anti-tuberculosis drugs in the treatment of multidrug-resistant tuberculosis

&#x0D; &#x0D; &#x0D; &#x0D; Purpose: The present study analyzes the comprehensive therapeutic effect of cycloserine, in combination with anti-tuberculosis drugs using chest X-ray and chest CT (computed tomography) scan techniques.&#x0D; Methods: A total of 90 patients, diagnosed with multidrug resistant tuberculosis (MDR TB) were subjected to chest x-ray and CT scan before and after treatment in the two groups. Different views such as sagittal, coronal, lung window and multiplanar imaging of mediastinal window were taken. Some parameters such as case detection rate (CDR) in chest X-ray and CT scan and comprehensive curative effect were observed in two groups. Further, the changes in chest CT signs in addition to absorption of focus, cavity closure and changes in CT extra pulmonary signs were also observed.&#x0D; Results: The clinical profile of the patients and the course of disease were statistically insignificant (p &gt; 0.05). Total effectiveness rate and case detection rate (CDR) values exhibited a significant difference between the groups (p &lt; 0.05). Lung consolidation, nodules and cavities significantly improved in both groups before and after the treatment (p &lt; 0.05). Both groups showed significant improvements in extrapulmonary signs in CT scan (p &lt; 0.05) after the treatment.&#x0D; Conclusion: Based on the study outcomes, the CT scan method has good potentials for diagnosing and treating MDR TB at the early stages. Further, it can clarify the signs and outcomes of the disease at early stages, thus providing the medical fraternity a great opportunity to cure the disease.&#x0D; &#x0D; &#x0D; &#x0D;

Tuberculosis care quality in urban Nigeria: A cross-sectional study of adherence to screening and treatment initiation guidelines in multi-cadre networks of private health service providers.

Nigeria has a high burden of tuberculosis (TB) and low case detection rates. Nigeria's large private health sector footprint represents an untapped resource for combating the disease. To examine the quality of private sector contributions to TB, the USAID-funded Sustaining Health Outcomes through the Private Sector (SHOPS) Plus program evaluated adherence to national standards for management of presumptive and confirmed TB among the clinical facilities, laboratories, pharmacies, and drug shops it trained to deliver TB services. The study used a standardized patient (SP) survey methodology to measure case management protocol adherence among 837 private and 206 public providers in urban Lagos and Kano. It examined two different scenarios: a "textbook" case of presumptive TB and a treatment initiation case where SPs presented as referred patients with confirmed TB diagnoses. Private sector results were benchmarked against public sector results. A bottleneck analysis examined protocol adherence departures at key points along the case management sequence that providers were trained to follow. Except for laboratories, few providers met the criteria for fully correct management of presumptive TB, though more than 70% of providers correctly engaged in TB screening. In the treatment initiation case 18% of clinical providers demonstrated fully correct case management. Private and public providers' adherence was not significantly different. Bottleneck analysis revealed that the most common deviations from correct management were failure to initiate sputum collection for presumptive patients and failure to conduct sufficiently thorough treatment initiation counseling for confirmed patients. This study found the quality of private providers' TB case management to be comparable to public providers in Nigeria, as well as to providers in other high burden countries. Findings support continued efforts to include private providers in Nigeria's national TB program. Though most providers fell short of desired quality, the bottleneck analysis points to specific issues that TB stakeholders can feasibly address with system- and provider-level interventions.

γ-Net: Superresolving SAR Tomographic Inversion via Deep Learning

Synthetic aperture radar tomography (TomoSAR) has been extensively employed in 3-D reconstruction in dense urban areas using high-resolution SAR acquisitions. Compressive sensing (CS)-based algorithms are generally considered as the state-of-the art in super-resolving TomoSAR, in particular in the single look case. This superior performance comes at the cost of extra computational burdens, because of the sparse reconstruction, which cannot be solved analytically, and we need to employ computationally expensive iterative solvers. In this article, we propose a novel deep learning-based super-resolving TomoSAR inversion approach, <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\boldsymbol {\gamma }$ </tex-math></inline-formula> -Net, to tackle this challenge. <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\boldsymbol {\gamma }$ </tex-math></inline-formula> -Net adopts advanced complex-valued learned iterative shrinkage thresholding algorithm (CV-LISTA) to mimic the iterative optimization step in sparse reconstruction. Simulations show the height estimate from a well-trained <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\boldsymbol {\gamma }$ </tex-math></inline-formula> -Net approaches the Cramér-Rao lower bound (CRLB) while improving the computational efficiency by one to two orders of magnitude comparing to the first-order CS-based methods. It also shows no degradation in the super-resolution power comparing to the state-of-the-art second-order TomoSAR solvers, which are much more computationally expensive than the first-order methods. Specifically, <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\boldsymbol {\gamma }$ </tex-math></inline-formula> -Net reaches more than 90% detection rate in moderate super-resolving cases at 25 measurements at 6 dB SNR. Moreover, simulation at limited baselines demonstrates that the proposed algorithm outperforms the second-order CS-based method by a fair margin. Test on real TanDEM-X data with just six interferograms also shows high-quality 3-D reconstruction with high-density detected double scatterers.

Tendência temporal, distribuição e autocorrelação espacial da hanseníase no Brasil: estudo ecológico, 2011 a 2021

To characterize the temporal trend and spatial behavior of leprosy in Brazil, from 2011 to 2021. This is an ecological study, with data from the Notifiable Diseases Information System, obtained in June 2022. The annual detection rate of new leprosy cases per 100 thousand inhabitants was calculated. To estimate the trend of the 2011-2019 and 2011-2021 series, the polynomial regression model was used, testing first-, second-, and third-order polynomials. For spatiality, natural breaks were used and, later, the univariate global and local Moran's indexes. A significance level of 5% was adopted and the analyses were performed using SPSS®, GeoDa®, and QGIS® software. The findings indicated an upward trend in the incidence of leprosy in Brazilian regions and in 20 federative units between 2011 and 2019. However, there was a decrease in most of the country when considering the COVID-19 pandemic years. Spatiality showed that the highest detection rates throughout the period were observed in the North, Midwest, and Northeast regions, with high-risk clusters, and the lowest detection rates in the South and Southeast regions, with low-risk clusters. The leprosy detection rate showed an upward trend in Brazil between 2011 and 2019, with greater spatial concentration in the North, Northeast, and Midwest regions. Nevertheless, the study raises an alert for the programmatic sustainability of leprosy control in Brazil, considering the drop in the COVID-19 pandemic, presumably due to the influence of the reorganization of the development of initiatives and provision of services in face of COVID-19.

Innovations in the Implementation of Polio Surveillance Enhancement Plan in Oyo State, Nigeria: Key Benefits, Lessons Learned, Challenges and Opportunities

Background: Nigeria attained the milestone of being certified wild poliovirus free in the year 2020. However, a drop in the key performance indicators of polio surveillance system was across various Local Government Areas (LGAs) in Oyo State. This drop highlighted the need for an innovative way of enhancing polio surveillance in Oyo State. Methods: This study was conducted in four phases and each phase utilized a cross-sectional study design and purposive sampling technique to select eligible LGAs and participants. LGAs that met at least two of the set-out criteria (had not reported at least a case of Acute Flaccid Paralysis (AFP) 12 months preceding the survey, with decline in AFP case detection rate, had not met AFP key indicators, are densely populated, and has an international border) were selected. A concurrent mixed method of data collection was utilized, and quantitative data were collected with a semi-structured questionnaire administered using Computer Assisted Personal Interviews (CAPI) during community active case search, health facility retroactive case search (HFRACS). Qualitative data collection was done through Focus Group Discussion (FGD). Surveillance intensification activities were conducted over eight weeks period. Data were analyzed using Microsoft Excel Software; summarization was done using frequencies and percentages while presentation was done using charts and spot maps. Results: A total of 1277, 49, 259 and 632 settlements, households and health facilities respectively were visited across 24 (73%) LGAs in Oyo State. Of the 150 suspected AFP cases identified, 45 (30%) were rejected cases, 33 (22%) were missed cases and 72 (48%) were true AFP cases. Non-Polio AFP Rate (NP-AFP rate) increased from 2.7 to 6.9 (P < 0.0001) after the surveillance intensification, also, the Non-Polio Enterovirus (NPENT) isolation was increased by 40% (16% to 23%). At the end of the intensification activities, all LGAs in Oyo State had met the WHO recommended Non-Polio Acute Flaccid Paralysis (NP-AFP) rate of ≥3/100,000 population. Conclusions: Innovative strategies implemented in AFP surveillance across Oyo State have resulted in improvement in AFP surveillance performance indicators in the State. There is therefore the need for dynamic and innovative ways of conducting AFP surveillance to prevent poliomyelitis epidemics and to ensure maintenance of Nigeria polio free certification status.

Diagnostic Accuracy amongst Two Week Wait Referrals for Skin Malignancy

The two week wait pathway initiative was proposed in 1997 to expedite referrals from general practice to dermatology and to facilitate access to timely treatment for patients with suspected skin malignancy. However, since its implementation it has come under fire for its poor specificity and case detection rate with dermatologists raising concerns about their increased workload and consequently lack of time for other urgent cases.

Correlation of the detection rate of upper GI cancer with artificial intelligence score: results from a multicenter trial (with video)

The quality of EGD is a prerequisite for a high detection rate of upper GI lesions, especially early gastric cancer. Our previous study showed that an artificial intelligence system, named intelligent detection endoscopic assistant (IDEA), could help to monitor blind spots and provide an operation score during EGD. Here, we verified the effectiveness of IDEA to help evaluate the quality of EGD in a large-scale multicenter trial. Patients undergoing EGD in 12 hospitals were consecutively enrolled. All hospitals were equipped with IDEA developed using deep convolutional neural networks and long short-term memory. Patients were examined by EGD, and the results were recorded by IDEA. The primary outcome was the detection rate of upper GI cancer. Secondary outcomes were part scores, total scores, and endoscopic procedure time, which were analyzed by IDEA. A total of 17,787 patients were recruited. The total detection rate of cancer-positive cases was 1.50%, rangingfrom .60% to 3.94% in each hospital. The total detection rate of early cancer-positive cases was .36%, ranging from .00% to 1.58% in each hospital. The average total score analyzed by IDEA ranged from 64.87 ± 16.87 to 83.50 ±9.57 in each hospital. The cancer detection rate in each hospital was positively correlated with total score (r= .775, P= .003). Similarly, the early cancer detection rate was positively correlated with total score (r= .756, P= .004). This multicenter trial confirmed that the quality of the EGD result is positively correlated with the detection rate of cancer, which can be monitored by IDEA. (Clinical trial registration number: ChiCTR2000029001.).