Evaluation of a Booster Dose of Pentavalent Rotavirus Vaccine Coadministered With Measles, Yellow Fever, and Meningitis A Vaccines in 9-Month-Old Malian Infants.

Background: Rotavirus vaccines given to infants are safe and efficacious. A booster dose of rotavirus vaccine could extend protection into the second year of life in low-resource countries. Methods: We conducted an open-label, individual-randomized trial in Bamako, Mali. We assigned 600 infants aged 9-11 months to receive measles vaccine (MV), yellow fever vaccine (YFV), and meningococcal A conjugate vaccine (MenAV) with or without pentavalent rotavirus vaccine (PRV). We assessed the noninferiority (defined as a difference of ≤10%) of seroconversion and seroresponse rates to MV, YFV, and MenAV. We compared the seroresponse to PRV. Results: Seroconversion to MV occurred in 255 of 261 PRV recipients (97.7%) and 246 of 252 control infants (97.6%; difference, 0.1% [95% confidence interval {CI}, -4.0%-4.2%]). Seroresponse to YFV occurred in 48.1% of PRV recipients (141 of 293), compared with 52.2% of controls (153 of 293; difference, -4.1% [95% CI, -12.2%-4.0%]). A 4-fold rise in meningococcus A bactericidal titer was observed in 273 of 292 PRV recipients (93.5%) and 276 of 293 controls (94.2%; difference, -0.7% [95% CI, -5.2%-3.8%]). Rises in geometric mean concentrations of immunoglobulin A and immunoglobulin G antibodies to rotavirus were higher among PRV recipients (118 [95% CI, 91-154] and 364 [95% CI, 294-450], respectively), compared with controls (68 [95% CI, 50-92] and 153 [95% CI, 114-207], respectively). Conclusions: PRV did not interfere with MV and MenAV; this study could not rule out interference with YFV. PRV increased serum rotavirus antibody levels. Clinical Trials Registration: NCT02286895.

Denoising of pre-beamformed photoacoustic data using generative adversarial networks.

We have trained generative adversarial networks (GANs) to mimic both the effect of temporal averaging and of singular value decomposition (SVD) denoising. This effectively removes noise and acquisition artifacts and improves signal-to-noise ratio (SNR) in both the radio-frequency (RF) data and in the corresponding photoacoustic reconstructions. The method allows a single frame acquisition instead of averaging multiple frames, reducing scan time and total laser dose significantly. We have tested this method on experimental data, and quantified the improvement over using either SVD denoising or frame averaging individually for both the RF data and the reconstructed images. We achieve a mean squared error (MSE) of 0.05%, structural similarity index measure (SSIM) of 0.78, and a feature similarity index measure (FSIM) of 0.85 compared to our ground-truth RF results. In the subsequent reconstructions using the denoised data we achieve a MSE of 0.05%, SSIM of 0.80, and a FSIM of 0.80 compared to our ground-truth reconstructions.

Integrating photoacoustic tomography into a multimodal automated breast ultrasound scanner.

SIGNIFICANCE: Photoacoustic tomography (PAT) is a promising emergent modality for the screening and staging of breast cancer. To minimize barriers to clinical translation, it is common to develop PAT systems based upon existing ultrasound hardware, which can entail significant design challenges in terms of light delivery. This often results in inherently non-uniform fluence within the tissue and should be accounted for during image reconstruction. AIM: We aim to integrate PAT into an automated breast ultrasound scanner with minimal change to the existing system. APPROACH: We designed and implemented an illuminator that directs spatially non-uniform light to the tissue near the acquisition plane of the imaging array. We developed a graphics processing unit-accelerated reconstruction method, which accounts for this illumination geometry by modeling the structure of the light in the sample. We quantified the performance of this system using a custom, modular photoacoustic phantom and graphite rods embedded in chicken breast tissue. RESULTS: Our illuminator provides a fluence of 2.5 mJ cm - 2 at the tissue surface, which was sufficient to attain a signal-to-noise ratio (SNR) of 8 dB at 2 cm in chicken breast tissue and image 0.25-mm features at depths of up to 3 cm in a medium with moderate optical scattering. Our reconstruction scheme is 200 × faster than a CPU implementation; it provides a 25% increase in SNR at 2 cm in chicken breast tissue and lowers image error by an average of 31% at imaging depths >1.5 cm compared with a method that does not account for the inhomogeneity of the illumination or the transducer directivity. CONCLUSIONS: A fan-shaped illumination geometry is feasible for PAT; however, it is important to account for non-uniform fluence in illumination scenarios such as this. Future work will focus on increasing fluence and further optimizing the ultrasound hardware to improve SNR and overall image quality.

Development of a battery of functional tests for low vision.

PURPOSE: We describe the development and evaluation of a battery of tests of functional visual performance of everyday tasks intended to be suitable for assessment of low vision patients. METHODS: The functional test battery comprises-Reading rate: reading aloud 20 unrelated words for each of four print sizes (8, 4, 2, & 1 M); Telephone book: finding a name and reading the telephone number; Medicine bottle label: reading the name and dosing; Utility bill: reading the due date and amount due; Cooking instructions: reading cooking time on a food package; Coin sorting: making a specified amount from coins placed on a table; Playing card recognition: identifying denomination and suit; and Face recognition: identifying expressions of printed, life-size faces at 1 and 3 m. All tests were timed except face and playing card recognition. Fourteen normally sighted and 24 low vision subjects were assessed with the functional test battery. Visual acuity, contrast sensitivity, and quality of life (National Eye Institute Visual Function Questionnaire 25 [NEI-VFQ 25]) were measured and the functional tests repeated. Subsequently, 23 low vision patients participated in a pilot randomized clinical trial with half receiving low vision rehabilitation and half a delayed intervention. The functional tests were administered at enrollment and 3 months later. RESULTS: Normally sighted subjects could perform all tasks but the proportion of trials performed correctly by the low vision subjects ranged from 35% for face recognition at 3 m, to 95% for the playing card identification. On average, low vision subjects performed three times slower than the normally sighted subjects. Timed tasks with a visual search component showed poorer repeatability. In the pilot clinical trial, low vision rehabilitation produced the greatest improvement for the medicine bottle and cooking instruction tasks. CONCLUSIONS: Performance of patients on these functional tests has been assessed. Some appear responsive to low vision rehabilitation.

Long-term immunity against yellow fever in children vaccinated during infancy: a longitudinal cohort study.

BACKGROUND: A single dose of vaccine against yellow fever is routinely administered to infants aged 9-12 months under the Expanded Programme on Immunization, but the long-term outcome of vaccination in this age group is unknown. We aimed to evaluate the long-term persistence of neutralising antibodies to yellow fever virus following routine vaccination in infancy. METHODS: We did a longitudinal cohort study, using a microneutralisation assay to measure protective antibodies against yellow fever in Malian and Ghanaian children vaccinated around age 9 months and followed up for 4·5 years (Mali), or 2·3 and 6·0 years (Ghana). Healthy children with available day-0 sera, a complete follow-up history, and no record of yellow fever revaccination were included; children seropositive for yellow fever at baseline were excluded. We standardised antibody concentrations with reference to the yellow fever WHO International Standard. FINDINGS: We included 587 Malian and 436 Ghanaian children vaccinated between June 5, 2009, and Dec 26, 2012. In the Malian group, 296 (50·4%, 95% CI 46·4-54·5) were seropositive (antibody concentration ≥0·5 IU/mL) 4·5 years after vaccination. Among the Ghanaian children, 121 (27·8%, 23·5-32·0) were seropositive after 2·3 years. These results show a large decrease from the proportions of seropositive infants 28 days after vaccination, 96·7% in Mali and 72·7% in Ghana, reported by a previous study of both study populations. The number of seropositive children increased to 188 (43·1%, 95% CI 38·5-47·8) in the Ghanaian group 6·0 years after vaccination, but this result might be confounded by unrecorded revaccination or natural infection with wild yellow fever virus during a 2011-12 outbreak in northern Ghana. INTERPRETATION: Rapid waning of immunity during the early years after vaccination of 9-month-old infants argues for a revision of the single-dose recommendation for this target population in endemic countries. The short duration of immunity in many vaccinees suggests that booster vaccination is necessary to meet the 80% population immunity threshold for prevention of yellow fever outbreaks. FUNDING: Wellcome Trust.

Sexual Networks and HIV Risk among Black Men Who Have Sex with Men in 6 U.S. Cities.

BACKGROUND: Sexual networks may place U.S. Black men who have sex with men (MSM) at increased HIV risk. METHODS: Self-reported egocentric sexual network data from the prior six months were collected from 1,349 community-recruited Black MSM in HPTN 061, a multi-component HIV prevention intervention feasibility study. Sexual network composition, size, and density (extent to which members are having sex with one another) were compared by self-reported HIV serostatus and age of the men. GEE models assessed network and other factors associated with having a Black sex partner, having a partner with at least two age category difference (age difference between participant and partner of at least two age group categories), and having serodiscordant/serostatus unknown unprotected anal/vaginal intercourse (SDUI) in the last six months. RESULTS: Over half had exclusively Black partners in the last six months, 46% had a partner of at least two age category difference, 87% had ≤5 partners. Nearly 90% had sex partners who were also part of their social networks. Among HIV-negative men, not having anonymous/exchange/ trade partners and lower density were associated with having a Black partner; larger sexual network size and having non-primary partners were associated with having a partner with at least two age category difference; and having anonymous/exchange/ trade partners was associated with SDUI. Among HIV-positive men, not having non-primary partners was associated with having a Black partner; no sexual network characteristics were associated with having a partner with at least two age category difference and SDUI. CONCLUSIONS: Black MSM sexual networks were relatively small and often overlapped with the social networks. Sexual risk was associated with having non-primary partners and larger network size. Network interventions that engage the social networks of Black MSM, such as interventions utilizing peer influence, should be developed to address stable partnerships, number of partners, and serostatus disclosure.