Effective and efficient active learning for deep learning-based tissue image analysis.

MOTIVATION: Deep learning attained excellent results in digital pathology recently. A challenge with its use is that high quality, representative training datasets are required to build robust models. Data annotation in the domain is labor intensive and demands substantial time commitment from expert pathologists. Active learning (AL) is a strategy to minimize annotation. The goal is to select samples from the pool of unlabeled data for annotation that improves model accuracy. However, AL is a very compute demanding approach. The benefits for model learning may vary according to the strategy used, and it may be hard for a domain specialist to fine tune the solution without an integrated interface. RESULTS: We developed a framework that includes a friendly user interface along with run-time optimizations to reduce annotation and execution time in AL in digital pathology. Our solution implements several AL strategies along with our diversity-aware data acquisition (DADA) acquisition function, which enforces data diversity to improve the prediction performance of a model. In this work, we employed a model simplification strategy [Network Auto-Reduction (NAR)] that significantly improves AL execution time when coupled with DADA. NAR produces less compute demanding models, which replace the target models during the AL process to reduce processing demands. An evaluation with a tumor-infiltrating lymphocytes classification application shows that: (i) DADA attains superior performance compared to state-of-the-art AL strategies for different convolutional neural networks (CNNs), (ii) NAR improves the AL execution time by up to 4.3×, and (iii) target models trained with patches/data selected by the NAR reduced versions achieve similar or superior classification quality to using target CNNs for data selection. AVAILABILITY AND IMPLEMENTATION: Source code: https://github.com/alsmeirelles/DADA.

Global research publications on cardiovascular and pulmonary rehabilitation and their alignment with population rehabilitation needs: An ecological study.

PURPOSE: Towards informing health research policy and planning, this article evaluates the relationship of the research publications in cardiac rehabilitation (CR) and pulmonary rehabilitation (PR) with the rehabilitation needs arising from cardiovascular diseases (except stroke) and chronic respiratory diseases, over time (1990-2017). METHODS: Ecological study using a secondary analysis and linear regressions of public domain data to associate two datasets of population-level data: (1) research publications for CR and PR (data from the PubMed database); and (2) global need for CR and PR (data from the Global Burden of Disease study). RESULTS: The percentage of both CR and PR publications (among total rehabilitation research) significantly decreased from 1990 to 2017 (both: p < 0.01). PR needs and research publications were aligned: around 5% of total rehabilitation needs and rehabilitation research. For CR needs (around 2%, but significantly increasing since 1990), we found a greater portion of CR research publications (6.5% or over). Finally, we found an inverse association among the percentage of CR research publications and CR needs (b = -6.08; r2  = 0.37, p = 0.001). CONCLUSION: The portion of CR and PR research (among total rehabilitation research) is declining over time. Yearly percentage of CR publications were greater than those of PR but for lower level of rehabilitation need, but the disparate trend was significantly decreasing over time. Population rehabilitation needs and their alignment with research volume must be one factor in the design of population-centred, equitable health research priorities.

A Software Defined Radio Based Anti-UAV Mobile System with Jamming and Spoofing Capabilities.

The number of incidents between unmanned aerial vehicles (UAVs) and aircrafts at airports and airfields has been increasing over the last years. To address the problem, in this paper we describe a portable system capable of protecting areas against unauthorized UAVs, which is based on the use of low-cost SDR (software defined radio) platforms. The proposed anti-UAV system supports target localization and integrates effective jamming techniques with the generation of global positioning system (GPS) spoofing signals aimed at the drone. Real-life tests of the implemented prototype have shown that the proposed approach is capable of stopping the reliable reception of radionavigation signals and can also divert or even take control of unauthorized UAVs, whose flight path depends on the information obtained by the GPS system.

Adherence to antihypertensive medication after referral to secondary healthcare: A prospective cohort study.

BACKGROUND: Nonadherence (NAd) to antihypertensive medication is associated with lack of blood pressure control and worsened long-term outcomes. Increased access to a programme for high-risk cardiovascular patients has the potential to reduce NAd and improve clinical outcomes. We evaluated implementation NAd prevalence and risk factors among severely hypertensive patients after 12-month-long access to secondary healthcare centres. METHODS: The Morisky Green Levine Scale (MGLS) was used to analyse antihypertensive medication NAd in a prospective cohort of 485 patients. Logistic regression models evaluated the influence of ecological model factors on NAd. RESULTS: The majority of patients were female, had low health literacy, a low family income and a mean age of 61.8 ± 12.5 years. Prevalence of NAd fell from 57.1% at programme entry to 28.3% (P < .001) at the end of the study. After access to a secondary healthcare centre, we observed better blood pressure control, an increase in the number of pills/day and a higher number of antihypertensive medications. Predictive variables of NAd were age (OR 1.027; CI 1.003-1.051; P = .023), low health literacy (OR 1.987; CI 1.009-3.913; P = .047), systolic blood pressure (OR 1.010; CI 1.003-1.021; P = .049), dosages ≥ 2 times/day (OR 1.941; CI 1.091-3.451; P = .024) and patient satisfaction with the healthcare team (OR 0.711; IC 0.516-0.980; P = .037). CONCLUSIONS: Greater access to health services is associated with a reduction in NAd to antihypertensive medication and better blood pressure control. NAd was correlated with modifiable variables such as treatment complexity and, for the first time, team satisfaction, suggesting that implementation of similar programmes may limit NAd in similar patient groups.

Low Complexity Hybrid Precoding Designs for Multiuser mmWave/THz Ultra Massive MIMO Systems.

Millimeter-wave and terahertz technologies have been attracting attention from the wireless research community since they can offer large underutilized bandwidths which can enable the support of ultra-high-speed connections in future wireless communication systems. While the high signal attenuation occurring at these frequencies requires the adoption of very large (or the so-called ultra-massive) antenna arrays, in order to accomplish low complexity and low power consumption, hybrid analog/digital designs must be adopted. In this paper we present a hybrid design algorithm suitable for both mmWave and THz multiuser multiple-input multiple-output (MIMO) systems, which comprises separate computation steps for the digital precoder, analog precoder and multiuser interference mitigation. The design can also incorporate different analog architectures such as phase shifters, switches and inverters, antenna selection and so on. Furthermore, it is also applicable for different structures, namely fully-connected structures, arrays of subarrays (AoSA) and dynamic arrays of subarrays (DAoSA), making it suitable for the support of ultra-massive MIMO (UM-MIMO) in severely hardware constrained THz systems. We will show that, by using the proposed approach, it is possible to achieve good trade-offs between spectral efficiency and simplified implementation, even as the number of users and data streams increases.

Application Performance Analysis and Efficient Execution on Systems with multi-core CPUs, GPUs and MICs: A Case Study with Microscopy Image Analysis.

We carry out a comparative performance study of multi-core CPUs, GPUs and Intel Xeon Phi (Many Integrated Core-MIC) with a microscopy image analysis application. We experimentally evaluate the performance of computing devices on core operations of the application. We correlate the observed performance with the characteristics of computing devices and data access patterns, computation complexities, and parallelization forms of the operations. The results show a significant variability in the performance of operations with respect to the device used. The performances of operations with regular data access are comparable or sometimes better on a MIC than that on a GPU. GPUs are more efficient than MICs for operations that access data irregularly, because of the lower bandwidth of the MIC for random data accesses. We propose new performance-aware scheduling strategies that consider variabilities in operation speedups. Our scheduling strategies significantly improve application performance compared to classic strategies in hybrid configurations.

Tear ferning test in horses and its correlation with ocular surface evaluation.

OBJECTIVE: To describe the tear ferning test (TFT) in healthy horses and its correlation with other parameters for evaluating the ocular surface. ANIMALS STUDIED: Thirty male and female adult healthy horses (60 eyes), of no defined breed. PROCEDURES: Tear sample was collected with a microcapillary tube, placed on the surface of a glass slide, and allowed to dry at room temperature. The crystallization pattern was classified according to Rolando (Chibret International Journal Ophthamology, 1984; 2, 32). The program STEPanizer(©) stereology tool, version 1.0, was utilized for counting points on the digitally captured crystallization image. A conjunctival biopsy was performed. RESULTS: Tear ferning test was classified as Type I in 18 eyes (30%), Type II in 31 eyes (51.7%), and Type III in 11 eyes (18.3%), at a mean temperature of 27.3 ± 1.5 °C and relative humidity of 61.5 ± 5.7%. In the Type I crystallization, the count varied between 27 and 36 points (mean: 33.27 ± 2.40), in Type II between 22 and 31 points (25.42 ± 1.95), and in Type III between 13 and 25 points (16.82 ± 3.76). There was no statistical difference or correlation between the right and left eyes, nor was there a statistically significant influence (P < 0.05) on TFT by the factors evaluated. The mean goblet cells values were 50 ± 11.4 cells/field. All samples showed the presence of lymphocytes, plasmocytes, and eosinophils. CONCLUSION: Tear ferning test is easy to perform, without risks to the patient. Once standardized for horses, associated or not with the program STEPanizer(©) stereology tool, it is an additional method for evaluating the ocular surface.

Removal of Mefenamic acid from aqueous solutions by oxidative process: Optimization through experimental design and HPLC/UV analysis.

Mefenamic acid (MEF) is a non-steroidal anti-inflammatory drug indicated for relief of mild to moderate pain, and for the treatment of primary dysmenorrhea. The presence of MEF in raw and sewage waters has been detected worldwide at concentrations exceeding the predicted no-effect concentration. In this study, using experimental designs, different oxidative processes (H2O2, H2O2/UV, fenton and Photo-fenton) were simultaneously evaluated for MEF degradation efficiency. The influence and interaction effects of the most important variables in the oxidative process (concentration and addition mode of hydrogen peroxide, concentration and type of catalyst, pH, reaction period and presence/absence of light) were investigated. The parameters were determined based on the maximum efficiency to save time and minimize the consumption of reagents. According to the results, the photo-Fenton process is the best procedure to remove the drug from water. A reaction mixture containing 1.005 mmol L(-1) of ferrioxalate and 17.5 mmol L(-1) of hydrogen peroxide, added at the initial reaction period, pH of 6.1 and 60 min of degradation indicated the most efficient degradation, promoting 95% of MEF removal. The development and validation of a rapid and efficient qualitative and quantitative HPLC/UV methodology for detecting this pollutant in aqueous solution is also reported. The method can be applied in water quality control that is generated and/or treated in municipal or industrial wastewater treatment plants.

A proposal to analyze the progression of non-dialytic chronic kidney disease by surrogate endpoints: introducing parametric survival models.

Introduction: Chronic kidney disease (CDK) progression studies increasingly use surrogate endpoints based on the estimated glomerular filtration rate. The clinical characteristics of these endpoints bring new challenges in comparing groups of patients, as traditional Cox models may lead to biased estimates mainly because they do not assume a hazard function. Objective: This study proposes the use of parametric survival analysis models with the three most commonly used endpoints in nephrology based on a case study. Estimated glomerular filtration rate (eGFR) decay > 5 mL/year, eGFR decline > 30%, and change in CKD stage were evaluated. Method: The case study is a 5-year retrospective cohort study that enrolled 778 patients in the predialysis stage. Exponential, Weibull, Gompertz, lognormal, and logistic models were compared, and proportional hazard and accelerated failure time (AFT) models were evaluated. Results: The endpoints had quite different hazard functions, demonstrating the importance of choosing appropriate models for each. AFT models were more suitable for the clinical interpretation of the effects of covariates on these endpoints. Conclusion: Surrogate endpoints have different hazard distributions over time, which is already recognized by nephrologists. More flexible analysis techniques that capture these relevant clinical characteristics in decision-making should be encouraged and disseminated in nephrology research.

Biosensors Based on Stanniocalcin-1 Protein Antibodies Thin Films for Prostate Cancer Diagnosis.

Prostate cancer is one of the most prevalent tumors in men, accounting for about 7.3% of cancer deaths. Although there are several strategies for diagnosing prostate cancer, these are only accurate when the tumor is already at a very advanced stage, so early diagnosis is essential. Stanniocalcin 1 (STC1) is a secreted glycoprotein, which has been suggested as a tumor marker as its increased expression is associated with the development and/or progression of different types of malignant tumors. In this work, an electronic tongue (ET) prototype, based on a set of four sensors prepared from thin films that included STC1 antibodies for detecting prostate cancer, was developed. In the preparation of the thin films, polyelectrolytes of polyallylamine hydrochloride, polystyrene sulfonate of sodium and polyethyleneimine, and the biomolecules chitosan, protein A, and STC1 antibody were used. These films were deposited on quartz lamellae and on solid supports using layer-on-layer and self-assembly techniques. The deposition of the films was analyzed by ultraviolet-visible spectroscopy, and the detection of STC1 in aqueous solutions of PBS was analyzed by impedance spectroscopy. The impedance data were statistically analyzed using principal component analysis. The ETs formed by the four sensors and the three best sensors could detect the antigen at concentrations in the range from 5 × 10-11 to 5 × 10-4 M. They showed a linear dependence with the logarithm of the antigen concentration and a sensitivity of 5371 ± 820 and 4863 ± 634 per decade of concentration, respectively. Finally, the results allow us to conclude that this prototype can advance to the calibration phase with patient samples.

Use of ergogenic aids among Brazilian athletes: a cross-sectional study exploring competitive level, sex and sports.

Was investigated ergogenic aids (EAs) used by Brazilian athletes and their association with performance, sex, sports classification, and modality. It identified the main purposes of EAs and their prescription. Methods: 239 athletes of 15 modalities, ranging from regional to international level, answered a survey online. Results: Highly competitive athletes consumed nutritional and mechanical aids more (OR = 1.96 CI 95% [1.28-2.9]; OR = 1.79 CI 95% [1.29-2.47]), while the use of psychological EAs decreased [OR = 1.66 95% CI (1.18-2.94); p = 0.001]. Male athletes [OR = 1.44 CI 95% (1.11-2.88)] and individual sports practitioners [OR = 1.78 CI 95% (1.02-3.11)] used nutritional aids more. Triathlon athletes had higher nutritional EA use, while soccer athletes had lower. Combat sports athletes had higher pharmacological EA use. Conclusion: Athletes use nutritional and pharmacological aids more to improve performance and gain lean body mass. Mechanical aids were used for recovery and psychological aids for motivation. Self-prescription is common, especially for pharmacological aids.

Development of microsatellite primers for Jatropha curcas (Euphorbiaceae) and transferability to congeners.

PREMISE OF THE STUDY: Microsatellite primers were developed for Jatropha curcas (Euphorbiaceae), a tree species with large potential for biofuel production, to investigate its natural genetic diversity and mating system to facilitate the establishment of tree improvement and conservation programs. METHODS AND RESULTS: Using a protocol for genomic library enrichment, 104 clones containing 195 repeat motifs were identified. Primer pairs were developed for 40 microsatellite loci and validated in 41 accessions of J. curcas from six provenances. Nine loci were polymorphic revealing from two to eight alleles per locus, and six primers were able to amplify alleles in the congeners J. podagrica, J. pohliana, and J. gossypifolia, but not in other Euphorbiaceae species, such as Hevea brasiliensis, Manihot esculenta, or Ricinus communis. CONCLUSIONS: The primers developed here revealed polymorphic loci that are suitable for genetic diversity and structure, mating system, and gene flow studies in J. curcas, and some congeners.

Relative age effect in Olympic Taekwondo athletes.

Relative age effects refer to the effects of age differences among individuals who have been grouped together for a performance activity. This study aimed to investigate the relative age effect on Olympic Taekwondo athletes, in several Olympic Games, and in both sexes. The study sample consisted of 291 athletes who had competed in Atlanta, Sydney, and Beijing Olympic Games. The relative age effect was examined for the general distribution of athletes by quartile, for each of the individuals, and for male and female athletes. There were no discernable effects of relative age on Olympic Taekwondo athletes.

Building Efficient CNN Architectures for Histopathology Images Analysis: A Case-Study in Tumor-Infiltrating Lymphocytes Classification.

Background: Deep learning methods have demonstrated remarkable performance in pathology image analysis, but they are computationally very demanding. The aim of our study is to reduce their computational cost to enable their use with large tissue image datasets. Methods: We propose a method called Network Auto-Reduction (NAR) that simplifies a Convolutional Neural Network (CNN) by reducing the network to minimize the computational cost of doing a prediction. NAR performs a compound scaling in which the width, depth, and resolution dimensions of the network are reduced together to maintain a balance among them in the resulting simplified network. We compare our method with a state-of-the-art solution called ResRep. The evaluation is carried out with popular CNN architectures and a real-world application that identifies distributions of tumor-infiltrating lymphocytes in tissue images. Results: The experimental results show that both ResRep and NAR are able to generate simplified, more efficient versions of ResNet50 V2. The simplified versions by ResRep and NAR require 1.32× and 3.26× fewer floating-point operations (FLOPs), respectively, than the original network without a loss in classification power as measured by the Area under the Curve (AUC) metric. When applied to a deeper and more computationally expensive network, Inception V4, NAR is able to generate a version that requires 4× lower than the original version with the same AUC performance. Conclusions: NAR is able to achieve substantial reductions in the execution cost of two popular CNN architectures, while resulting in small or no loss in model accuracy. Such cost savings can significantly improve the use of deep learning methods in digital pathology. They can enable studies with larger tissue image datasets and facilitate the use of less expensive and more accessible graphics processing units (GPUs), thus reducing the computing costs of a study.

Reconstruction of Scalp Anterior Hairline with Tissue Expansion and Skin Flap.

Introduction: Cutaneous defects involving the frontal region and anterior hairline of the scalp can result from congenital or acquired conditions. The negative esthetic impact can cause disturbances in the psychic and social sphere of the patient, causing problems in interpersonal relationships and in the body image itself. The use of skin expanders is usually effective in this region due to the bone base providing support and stability for its use. Case Report: We describe the case of a 64-year-old woman submitted to reconstruction of the anterior hairline of the scalp due to scar sequelae after coronal rhytidoplasty followed by pustular erosive dermatosis. We used tissue expansion (50 mL of saline per week until it reached 300 mL) and advancement flap. Discussion/Conclusion: Scalp reconstruction also includes vascularized soft tissue coverage, acceptable cosmetic appearance, and minimal morbidity for the donor area. The correction of scalp scars must obey 2 basic principles: tissue similarity and natural capillary pattern (direction, angle, capillary growth, and proper capillary line design). Tissue expansion and skin flap techniques can successfully correct defects in extensive scarring alopecia such as in the presented case.

Physicians' quality of life, illness and presenteeism: a cross-sectional epidemiological study.

Introduction: The World Health Organization defines quality of life as " an individuals' perception of their position in life, in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns." physicians, when dealing with illness and exposing themselves to the risks of their profession, must act without compromising their own health status in view of the function performed. Objectives: To evaluate and correlate physicians' quality of life, professional illness, and presenteeism. Methods: This is an epidemiological, cross-sectional, descriptive study with an exploratory quantitative approach. Overall, 309 physicians working in Juiz de Fora, state of Minas Gerais, Brazil were interviewed and answered a questionnaire with sociodemographic and health information and the World Health Organization Quality of Life instrument-Abbreviated version (WHOQOL-BREF). Results: Of physicians in the sample, 57.6% fell ill during their professional activities, 35% took sickness absence, and 82.8% practiced presenteeism. The most prevalent diseases were those involving the respiratory system (29.5%), infectious or parasitic diseases (14.38%), and those involving the circulatory system (9.59%). WHOQOL-BREF scores were boas, and were influenced by sociodemographic characteristics such as sex, age, and time of professional experience. Male sex, professional experience greater than 10 years, and age above 39 years were associated with beter quality of life. Previous illness and presenteeism were negative factors. Conclusions: The participating physicians had a good quality of life in all domains. Sex, age, and time of professional experience were relevant factors. The highest score was observed in the physical health domain, followed by psychological domain, social relationships, and environment, in a descending order.

Introdução: A Organização Mundial da Saúde define qualidade de vida como "a percepção do indivíduo de sua inserção na vida, no contexto da cultura e nos sistemas de valores nos quais ele vive e em relação a seus objetivos, expectativas, padrões e preocupações". Os médicos, ao lidarem com pacientes e se exporem aos riscos da profissão, devem atuar sem comprometer seu estado de saúde frente à função desempenhada. Objetivos: Avaliar e correlacionar a qualidade de vida, o adoecimento profissional e o presenteísmo do médico. Métodos: Estudo epidemiológico de corte transversal, descritivo e exploratório, com características quantitativas. Foram entrevistados 309 médicos atuantes em Juiz de Fora, no estado de Minas Gerais, submetidos a questionário com informações sociodemográficas e de condições de saúde e ao World Health Organization Quality of Life instrument-Abbreviated version (WHOQOL-BREF). Resultados: Na amostra, 57,6% adoeceram durante a atuação profissional, 35% se afastaram do trabalho e 82,8% praticaram presenteísmo. As doenças mais prevalentes foram do sistema respiratório (29,5%), infectoparasitárias (14,38%) e do sistema circulatório (9,59%). As pontuações no WHOQOL-BREF foram boas, afetadas por características sociodemográficas como sexo, idade e tempo de atuação profissional. Sexo masculino, atuação superior a 10 anos e idade maior que 39 anos foram associados a melhor qualidade de vida. Adoecimento prévio e presenteísmo foram fatores negativos. Conclusões: Os médicos participantes do estudo apresentaram boa qualidade de vida em todos os domínios. Sexo, idade e tempo de atuação profissional mostraram-se fatores relevantes. A melhor nota foi observada no domínio físico, com pontuações decrescentes nos domínios psicológico, social e ambiental.

Efficacy and Safety of BCG Revaccination With M. bovis BCG Moscow to Prevent COVID-19 Infection in Health Care Workers: A Randomized Phase II Clinical Trial.

The Bacillus Calmette-Guérin (BCG) vaccine, which is widely used to protect children against tuberculosis, can also improve immune response against viral infections. This unicentric, randomized-controlled clinical trial assessed the efficacy and safety of revaccination with BCG Moscow in reducing the positivity and symptoms of COVID-19 in health care workers (HCWs) during the COVID-19 pandemic. HCWs who had negative COVID-19 IgM and IgG and who dedicated at least eight hours per week in facilities that attended to individuals suspected of having COVID-19 were included in the study and were followed for 7, 15, 30, 60, and 180 days by telemedicine. The HCWs were randomly allocated to a revaccinated with BCG group, which received the BCG vaccine, or an unvaccinated group. Revaccination with BCG Moscow was found to be safe, and its efficacy ranged from 30.0% (95.0%CI -78.0 to 72.0%) to 31.0% (95.0%CI -74.0 to 74.0%). Mycobacterium bovis BCG Moscow did not induce NK cell activation at 15-20 days post-revaccination. As hypothesized, revaccination with BCG Moscow was associated with a lower incidence of COVID-19 positivity, though the results did not reach statistical significance. Further studies should be carried out to assess whether revaccination with BCG is able to protect HCWs against COVID-19. The protocol of this clinical trial was registered on August 5th, 2020, at REBEC (Registro Brasileiro de Ensaios Clínicos, RBR-4kjqtg - ensaiosclinicos.gov.br/rg/RBR-4kjqtg/1) and the WHO (# U1111-1256-3892). The clinical trial protocol was approved by the Comissão Nacional de ética de pesquisa- CONEP (CAAE 31783720.0.0000.5078).

Dentists' knowledge about osteoporosis and their ability to identify the disease.

BACKGROUND: Osteoporosis is an underdiagnosed condition, and its seriousness is not considered until severe complications arise. This study aimed to evaluate general dentists' knowledge about osteoporosis and their ability to identify patients with this disease by assessing mandibular cortical width (MCW) and mandibular cortical index (MCI) on panoramic dental radiographs using a visual method. METHODS: In this cross-sectional study, an email questionnaire regarding the diagnosis and prevention of osteoporosis was sent to 20,773 dentists in 2016. Those who completed the questionnaire were invited to participate in radiomorphometric training and then to analyze the MCI and MCW of 114 panoramic radiographs of postmenopausal women who underwent both panoramic radiography and bone densitometry. Based on the radiomorphometric indices and while blinded to the densitometry results, the dentists determined whether they would indicate densitometry for these patients. RESULTS: The response rate was 2.3%: 485 dentists completed the questionnaire, and 50 evaluated panoramic radiographs using the MCW and MCI. All of them reported some knowledge about osteoporosis, but 41.6% demonstrated a misleading conceptualization of the disease. Approximately 90% reported minimal access to this information during graduation, and only 27.0% were exposed to the topic during their postgraduate studies. Interest in osteoporosis prevention was expressed by 70.7% of the respondents, and interest in learning the radiomorphometric indices was expressed by 99.0%. The sensitivity in the detection of low bone mineral density through the MCW and MCI was 52.9%, and the specificity was 64%. CONCLUSIONS: Brazilian dentists demonstrated insufficient knowledge about osteoporosis and a low ability to detect osteopenia or osteoporosis by applying radiomorphometric indices.

Building robust pathology image analyses with uncertainty quantification.

BACKGROUND AND OBJECTIVE: Computerized pathology image analysis is an important tool in research and clinical settings, which enables quantitative tissue characterization and can assist a pathologist's evaluation. The aim of our study is to systematically quantify and minimize uncertainty in output of computer based pathology image analysis. METHODS: Uncertainty quantification (UQ) and sensitivity analysis (SA) methods, such as Variance-Based Decomposition (VBD) and Morris One-At-a-Time (MOAT), are employed to track and quantify uncertainty in a real-world application with large Whole Slide Imaging datasets - 943 Breast Invasive Carcinoma (BRCA) and 381 Lung Squamous Cell Carcinoma (LUSC) patients. Because these studies are compute intensive, high-performance computing systems and efficient UQ/SA methods were combined to provide efficient execution. UQ/SA has been able to highlight parameters of the application that impact the results, as well as nuclear features that carry most of the uncertainty. Using this information, we built a method for selecting stable features that minimize application output uncertainty. RESULTS: The results show that input parameter variations significantly impact all stages (segmentation, feature computation, and survival analysis) of the use case application. We then identified and classified features according to their robustness to parameter variation, and using the proposed features selection strategy, for instance, patient grouping stability in survival analysis has been improved from in 17% and 34% for BRCA and LUSC, respectively. CONCLUSIONS: This strategy created more robust analyses, demonstrating that SA and UQ are important methods that may increase confidence digital pathology.

The prevalence and associated factors of nonadherence to antihypertensive medication in secondary healthcare.

PURPOSE: Non-adherence (NA) to medication is a major contributor to treatment failure in hypertensive patients. Factors of the ecological model, at family/healthcare professional, service, and system levels, are rarely evaluated as correlates of NA in hypertensive patients. METHODS: This crossectional study assessed the prevalence of and associated factors of NA to antihypertensive medication among 485 hypertensive patients upon receiving secondary healthcare. The Morisky Green Levine Scale (MGLS) measured the implementation phase of adherence, and the Short Assessment of Health Literacy for Portuguese-speaking Adults (SAHLPA) instrument, health literacy. Multivariate analysis to NA included variables according to the levels of the ecological model. RESULTS: Most patients were female (56.3%), white (53.2%), mean age of 62.0 ± 12.6 years, illiterate (61.6%), with low health literacy (70.9%), and low income (65.4%). Uncontrolled BP was frequent (75.2%); 57.1% of patients were nonadherent. In multivariate analysis based on the ecological model, adjusted for micro, meso- and macro-level correlates, NA was associated only with variables of patient-level: low health literacy (OR 1.62, CI 1.07-2.44, p = 0.020), income ≥ two reference wages (OR 0.46, CI 0.22-0.93, p = 0.031), lack of homeownership (OR 1.99, CI 1.13-3.51, p = 0.017), sedentarism (OR 1.78, CI 1.12-2.83, p = 0.014), and complexity of treatment (number of medications taken ≥ two times/day) (OR 1.56, CI 1.01-2.41, p = 0.042). CONCLUSION: In this group of severely hypertensive patients with high cardiovascular risk, only patient-related characteristics were associated with NA. Our findings highlight the need for effective actions to optimize clinical outcomes in similar healthcare programs.