Audrey Durand

Rapid testing versus karyotyping in Down's syndrome screening: cost-effectiveness and detection of clinically significant chromosome abnormalities

In all, 80% of antenatal karyotypes are generated by Downs syndrome screening programmes (DSSP). After a positive screening, women are offered prenatal foetus karyotyping, the gold standard. Reliable molecular methods for rapid aneuploidy diagnosis (RAD: fluorescence in situ hybridization (FISH) and quantitative fluorescence PCR (QF-PCR)) can detect common aneuploidies, and are faster and less expensive than karyotyping.In the UK, RAD is recommended as a standalone approach in DSSP, whereas the US guidelines recommend that RAD be followed up by karyotyping. A cost-effectiveness (CE) analysis of RAD in various DSSP is lacking. There is a debate over the significance of chromosome abnormalities (CA) detected with karyotyping but not using RAD. Our objectives were to compare the CE of RAD versus karyotyping, to evaluate the clinically significant missed CA and to determine the impact of detecting the missed CA. We performed computer simulations to compare six screening options followed by FISH, PCR or karyotyping using a population of 110 948 pregnancies. Among the safer screening strategies, the most cost-effective strategy was contingent screening with QF-PCR (CE ratio of

Cost-effectiveness and accuracy of prenatal Down syndrome screening strategies: should the combined test continue to be widely used?

24 084 per Downs syndrome (DS) detected). Using karyotyping, the CE ratio increased to

An economic evaluation: Simulation of the cost-effectiveness and cost-utility of universal prevention strategies against osteoporosis-related fractures

27 898. QF-PCR missed only six clinically significant CA of which only one was expected to confer a high risk of an abnormal outcome. The incremental CE ratio (ICER) to find the CA missed by RAD was

Multi-objective evolutionary optimization for generating ensembles of classifiers in the ROC space

66 608 per CA. These costs are much higher than those involved for detecting DS cases. As the DSSP are mainly designed for DS detection, it may be relevant to question the additional costs of karyotyping.

Population-Based Simulation for Public Health: Generic Software Infrastructure and Its Application to Osteoporosis

OBJECTIVE We analyzed the cost-effectiveness (CE) and performances of commonly used prenatal Down syndrome (DS) screening strategies. STUDY DESIGN We performed computer simulations to compare 8 screening options by applying empirical data from Serum, Urine, and Ultrasound Screening Study trials on the population of 110,948 pregnancies. Screening strategies outcomes, CE ratios, and incremental CE ratios were measured. RESULTS The most CE DS screening strategy was the contingent screening method (CE ratio of Can

Bayesian optimization for conditional hyperparameter spaces

26,833 per DS case). Its incremental CE ratio compared to the second-most CE strategy (serum integrated screening) was Can

Bayesian classification and unsupervised learning for isolating weeds in row crops

3815 per DS birth detected. Among the procedures respecting guidelines, our results identified the combined test as the screening strategy with the highest CE ratio (Can

SCHNAPS: a generic population-based simulator for public health purposes

47,358) and the highest number of procedure-related euploid miscarriages (n = 71). CONCLUSION In regard to CE, contingent screening is the best choice. The combined test, which is the most popular screening strategy, shows many limitations.

Rating Super-Resolution Microscopy Images With Deep Learning.

A patient‐level Markov decision model was used to simulate a virtual cohort of 500,000 women 40 years old and over, in relation to osteoporosis‐related hip, clinical vertebral, and wrist bone fractures events. Sixteen different screening options of three main scenario groups were compared: (1) the status quo (no specific national prevention program); (2) a universal primary prevention program; and (3) a universal screening and treatment program based on the 10‐year absolute risk of fracture. The outcomes measured were total directs costs from the perspective of the public health care system, number of fractures, and quality‐adjusted life‐years (QALYs). Results show that an option consisting of a program promoting physical activity and treatment if a fracture occurs is the most cost‐effective (CE) (cost/fracture averted) alternative and also the only cost saving one, especially for women 40 to 64 years old. In women who are 65 years and over, bone mineral density (BMD)‐based screening and treatment based on the 10‐year absolute fracture risk calculated using a Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tool is the best next alternative. In terms of cost‐utility (CU), results were similar. For women less than 65 years old, a program promoting physical activity emerged as cost‐saving but BMD‐based screening with pharmacological treatment also emerged as an interesting alternative. In conclusion, a program promoting physical activity is the most CE and CU option for women 40 to 64 years old. BMD screening and pharmacological treatment might be considered a reasonable alternative for women 65 years old and over because at a healthcare capacity of

Learning to Become an Expert: Deep Networks Applied to Super-Resolution Microscopy.

50,000 Canadian dollars (