Pro-equity immunization and health systems strengthening strategies in select Gavi-supported countries

BackgroundAchieving universal immunization coverage and reaching every child with life-saving vaccines will require the implementation of pro-equity immunization strategies, especially in poorer countries. Gavi-supported countries continue to implement and report strategies that aim to address implementation challenges and improve equity. This paper summarizes the first mapping of these strategies from country reports.MethodsThirteen Gavi-supported countries were purposively selected with emphasis on Gavi’s priority countries. Following a scoping of different documents submitted to Gavi by countries, 47 Gavi Joint Appraisals (JAs) for the period 2016–2019 from the 13 selected countries were included in the mapping. We used a consolidated framework synthesized from 16 different equity and health systems frameworks, which incorporated UNICEF’s coverage and equity assessment approach – an adaptation of the Tanahashi model. Using search terms, the mapping was conducted using a combination of manual search and the MAXQDA qualitative analysis tool. Pro-equity strategies meeting the inclusion criteria were identified and compiled in an Excel database, and then populated on a tableau visualization dashboard.ResultsIn total, 258 pro-equity strategies were implemented by the 13 sampled Gavi-supported countries between 2016 and 2019. The framework determinants of social norms, utilization, and management and coordination accounted for more than three-quarters of all pro-equity strategies implemented in these countries. The median number of strategies reported per country was 17. Afghanistan, Nigeria, and Uganda reported the highest number of strategies that we considered as pro-equity.ConclusionFindings from this mapping can be useful in addressing equity gaps, reaching partially immunized, and ‘zero-dose’ vaccinated children, and valuable resource for countries planning to implement pro-equity strategies, especially as immunization stakeholders reimagine immunization delivery in light of COVID-19, and as Gavi finalizes its fifth organizational strategy. Future efforts should seek to identify pro-equity strategies being implemented across additional countries, and to assess the extent to which these strategies have improved immunization coverage and equity.     

Predictive value of the coronary artery calcium score and advanced plaque characteristics: Post hoc analysis of the PREDICT registry

BackgroundWhether coronary plaque characteristics assessed in coronary computed tomography angiography (CCTA) in association with the coronary artery calcium score (CACS) have predictive value for coronary events is unclear. We aimed to examine the predictive value of the CACS and plaque characteristics for the occurrence of coronary events.MethodsAmong 2802 patients who were analyzed in the PREDICT registry, 2083 with suspected coronary artery disease (CAD) were studied using post hoc analysis. High-risk plaques were defined as having ≥2 adverse characteristics, such as low computed tomographic attenuation, positive remodeling, spotty calcification, and napkin-ring sign. An adjudicative composite of coronary events (cardiac death, nonfatal acute coronary syndrome, and coronary revascularization ≥3 months after indexed CCTA) were analyzed.ResultsSeventy-three (3.5%) patients had coronary events and 313 (15.0%) had high-risk plaques. Multivariate Cox proportional hazard analysis showed that high-risk plaques remained an independent predictor of coronary events (adjusted hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.13–3.34, P ?= ?0.0154), as well as the log-transformed CACS (adjusted HR 1.24, 95% CI 1.11–1.39, P ?= ?0.0002) and the presence of obstructive stenosis (adjusted HR 5.63, 95% CI 3.22–10.12, P 0.0001). In subgroup analyses, high-risk plaques were independently predictive only in the low CACS class (<100).ConclusionThis study shows that assessment of adverse features by coronary plaque imaging independently predicts coronary events in patients with suspected CAD and a low CACS. Our findings suggest that the clinical value of high-risk plaques to CACS and stenosis assessment appears marginal.     

Coronary plaque characteristics in computed tomography and 2-year outcomes: The PREDICT study

BackgroundCoronary computed tomography angiography (CCTA) not only provides information regarding luminal stenoses but also allows for visualization of mural atheromatous changes (coronary plaques).ObjectiveWe sought to elucidate whether plaques seen on CCTA enable prediction of 2-year outcomes in patients with suspected and known coronary artery disease (CAD).MethodsOf 3015 patients who underwent CCTA, the images and 2-year clinical courses of 2802 patients were independently analyzed. The primary endpoint was the composite of all-cause death and acute coronary syndrome.ResultsDuring the 2-year observation period, 49 (1.7%) patients developed the primary outcome. The 2-year rates of the primary outcome in the normal (n = 515, no mural lesions), calcium (n = 654, calcified lesion alone), and plaque groups (n = 1633, presence of noncalcified or partially calcified plaques) were 0.2%, 2.0%, and 2.1%, respectively (P = 0.0028). Adverse plaque features such as low attenuation, positive remodeling, spotty calcification, and the napkin-ring sign (low-attenuation core with a higher-attenuation rim) were assessed by an independent core laboratory. Stepwise multivariate Cox proportional hazard analysis showed that a plaque with two or more characteristics (adjusted hazard ratio, 1.98; 95% confidence interval, 1.09–3.60; P = 0.0254), age of ≥67 years (mean), statin treatment after CCTA, and obstructive stenosis remained independent predictors of the primary outcome.ConclusionsPlaque imaging in CCTA has predictive value for the 2-year outcome and is a useful identifier for high-risk patients among those with known and suspected CAD.     

肝血窦连续切片的计算机三维重建

本文应用计算机图形学和图像处理技术，采用一种新的连续切片的计算机三维重建的定位方法，成功地重建了肝血窦的三维图像，形像地揭示肝血窦的立体态。理论分析和实验研究均证实了该方法的可行性和实用性。     

基于图像特征的CT-MR图像配准

本文采用了基于图像特征的相关性算法对3－D CT－MR图像进行配准。首先使用基于局部坐标系的二阶导数算子对CT和MR图像进行处理,获取由图像的“脊”或“谷”,组成的特征图像然,然后在进行刚体变换条件下对特征图像进行相关计算,使其相关系数达到最大,从而获取配准后的图像。该方法不需在成像过程中人为增加标记物,后续处理中不需人为干预,是一种自动的图像配准方法,最后本文给出了这一方法用于实际数据的结果。     

A Projection-Based Image Registration Algorithm and Its Application

Summary: Proposed is a projection-based image registration technique where, by rearranging the projections of characteristic images, the image registration is implemented with two independent steps - rotation and translation, to perform the two-dimensional or three-dimensional rigid-body image registration addressing the head motion problem in functional magnetic resonance imaging (fMRI). For a 2D problem, the approach is based on a one-dimensional projection of a segmented two-dimensional characteristic image, in which the translation and rotation parameters are obtained with a one-dimensional cross-correlation-based estimator. This is then used to compute the cross-correlation between the projection of an image and a registration table that is created by rearranged projections of a selected two-dimensional image with various rotation angles. In this approach, the translation registration table may be created by rearranged projections of sub-voxel level two-dimensional images with various sub-voxel level parameters, and so it may be applied into a sub-voxel registration. Such an approach replaced the general multi-dimensional optimization procedure with a linear projection calculation and a finite cross-correlation with a registration table, thus the amount of computation is considerably reduced. The performance of this method was confirmed by simulation study different SNRs and applications to 2D and 3D actual functional MRI images. Supported by the 973 Project number 2003CB716106, NSFC 90208003, #30130180 and #30200059, TRAPOYT, Doctor training Fund of MOE, PRC, Fok Ying Tong Education Foundation (91041). The authors wish to thank the Wellcome Department of Imaging Neuroscience for the permission of using the fMRI experimental data.     

Spinal intraoperative three-dimensional navigation: correlation between clinical and absolute engineering accuracy

Background Context

Spinal intraoperative computer-assisted navigation (CAN) may guide pedicle screw placement. Computer-assisted navigation techniques have been reported to reduce pedicle screw breach rates across all spinal levels. However, definitions of screw breach vary widely across studies, if reported at all. The absolute quantitative error of spinal navigation systems is theoretically a more precise and generalizable metric of navigation accuracy. It has also been computed variably and reported in less than a quarter of clinical studies of CAN-guided pedicle screw accuracy.

PBL教学法在留学生妇产科见习中的实践

目的：探讨PBL教学法在留学生妇产科见习中的实践和教学效果。方法将2011级115名留学生分为两组,观察组采用PBL教学法,对照组采用传统的LBL教学法,通过期末考试成绩和问卷调查综合评价PBL教学法的教学效果。结果观察组留学生期末考试主观题得分[(44.62±8.47)分]、客观题得分[(36.94±10.75）分]和总成绩[(81.56±11.64)分]均显著高于对照组[(38.45±7.84)分、(27.33±9.38)分、(65.78±12.37)分],差异均有显著统计学意义(P<0.01);观察组留学生对问卷调查各项指标的评价均高于对照组(54人vs 35人,48人vs 36人,51人vs 33人,46人vs 31人,54人vs 36人),差异均有显著统计学意义(P<0.01)。结论 PBL教学法应用于留学生妇产科见习教学中,有利于提高教学质量,并获得学生认可。