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Background Implementation of new technologies into national health care systems requires careful capacity planning. This is sometimes informed by data from pilot studies that implement the technology on a small scale in selected areas. A critical consideration when using implementation pilot studies for capacity planning in the wider system is generalisability. We studied the feasibility of using publicly available national statistics to determine the degree to which results from a pilot might generalise for non-pilot areas, using the English human papillomavirus (HPV) cervical screening pilot as an exemplar. Methods From a publicly available source on population indicators in England (“Public Health Profiles”), we selected seven area-level indicators associated with cervical cancer incidence, to produce a framework for post-hoc pilot generalisability analysis. We supplemented these data by those from publicly available English Office for National Statistics modules. We compared pilot to non-pilot areas, and pilot regimens (pilot areas using the previous standard of care (cytology) vs. the new screening test (HPV)). For typical process indicators that inform real-world capacity planning in cancer screening, we used standardisation to re-weight the values directly observed in the pilot, to better reflect the wider population. A non-parametric quantile bootstrap was used to calculate 95% confidence intervals (CI) for differences in area-weighted means for indicators. Results The range of area-level statistics in pilot areas covered most of the spectrum observed in the wider population. Pilot areas were on average more deprived than non-pilot areas (average index of multiple deprivation 24.8 vs. 21.3; difference: 3.4, 95% CI: 0.2–6.6). Participants in HPV pilot areas were less deprived than those in cytology pilot areas, matching area-level statistics. Differences in average values of the other six indicators were less pronounced. The observed screening process indicators showed minimal change after standardisation for deprivation. Conclusions National statistical sources can be helpful in establishing the degree to which the types of areas outside pilot studies are represented, and the extent to which they match selected characteristics of the rest of the health care system ex-post. Our analysis lends support to extrapolation of process indicators from the HPV screening pilot across England.

AbstractObjectivesTo provide updated evidence about the risk of cervical intraepithelial neoplasia grade 3 or higher (CIN3+) and cervical cancer after a negative human papillomavirus (HPV) test in primary cervical screening, by age group and test assay.DesignObservational study.SettingReal world data from the English HPV screening pilot’s first and second rounds (2013-16, follow-up to end of 2019).Participants1 341 584 women.InterventionsCervical screening with HPV testing or liquid based cytological testing (cytology or smear tests). Women screened with cytology were referred to colposcopy after high grade cytological abnormalities or after borderline or low grade abnormalities combined with a positive HPV triage test. Women screened with HPV testing who were positive were referred at baseline if their cytology triage test showed at least borderline abnormalities or after a retest (early recall) at 12 and 24 months if they had persistent abnormalities.Main outcome measuresDetection of CIN3+ and cervical cancer after a negative HPV test.ResultsFor women younger than 50 years, second round detection of CIN3+ in this study was significantly lower after a negative HPV screen in the first round than after cytology testing (1.21/1000 v 4.52/1000 women screened, adjusted odds ratio 0.26, 95% confidence interval 0.23 to 0.30), as was the risk of interval cervical cancer (1.31/100 000 v 2.90/100 000 woman years, adjusted hazard ratio 0.44, 0.23 to 0.84). Risk of an incident CIN3+ detected at the second screening round in the pilot five years after a negative HPV test was even lower in women older than 50 years, than in three years in women younger than 50 years (0.57/1000 v 1.21/1000 women screened, adjusted odds ratio 0.46, 0.27 to 0.79). Women with negative HPV tests at early recall after a positive HPV screening test without cytological abnormalities had a higher detection rate of CIN3+ at the second routine recall than women who initially tested HPV negative (5.39/1000 v 1.21/1000 women screened, adjusted odds ratio 3.27, 95% confidence interval 2.21 to 4.84). Detection after a negative result on a clinically validated APTIMA mRNA HPV test was similar to that after clinically validated cobas and RealTime DNA tests (for CIN3+ at the second round 1.32/1000 v 1.14/1000 women screened, adjusted odds ratio 1.05, 0.73 to 1.50).ConclusionsThese data support an extension of the screening intervals, regardless of the test assay used: to five years after a negative HPV test in women aged 25-49 years, and even longer for women aged 50 years and older. The screening interval for HPV positive women who have negative HPV tests at early recall should be kept at three years.

Key Points Eukaryotic cells contain two distinct but interrelated pools of DNA precursors for the replication of nuclear and mitochondrial DNA. Deoxyribonucleoside triphosphate (dNTP) biosynthesis begins either with the reduction of ribonucleotides or with the salvage of preformed nucleosides or nucleobases. dNTP pool sizes are regulated mostly at the level of biosynthesis, particularly involving ribonucleotide reductase. However, controlled dNTP degradation brought about by the sterile α-motif and histidine-aspartate domain-containing protein (SAMHD1) protein has recently emerged as a major regulatory mechanism. An increase in the spontaneous mutation rate is almost certainly an essential feature of carcinogenesis. Abnormal regulation of dNTP pool sizes contributes to determination of the mutation rate. Several oncogenes and tumour suppressors control dNTP pool sizes and have as-yet-unexplained effects on oncogene-induced senescence. Much evidence indicates that 'sanitation', the enzymatic hydrolysis of abnormal or damaged nucleotides, is important to the maintenance of genomic stability. However, recent evidence indicates that one sanitizing enzyme, MTH1, is an important target for inhibition in cancer treatment. Many anticancer drugs achieve their effectiveness because they are analogues to DNA precursors. Effective use of these analogues requires a thorough understanding of nucleotide biosynthesis, transport processes, cell cycle regulation and interactions with target enzymes. This Review discusses nucleotide metabolism and how fluctuations in deoxyribonucleoside triphosphate (dNTP) pools affect genomic instability. Drugs that target this system have been in use for many years and some of these are discussed, as well as newer approaches to manipulating deoxyribonucleotide metabolism for cancer treatment. Cancer was recognized as a genetic disease at least four decades ago, with the realization that the spontaneous mutation rate must increase early in tumorigenesis to account for the many mutations in tumour cells compared with their progenitor pre-malignant cells. Abnormalities in the deoxyribonucleotide pool have long been recognized as determinants of DNA replication fidelity, and hence may contribute to mutagenic processes that are involved in carcinogenesis. In addition, many anticancer agents antagonize deoxyribonucleotide metabolism. Here, we consider the extent to which aspects of deoxyribonucleotide metabolism contribute to our understanding of both carcinogenesis and to the effective use of anticancer agents.

The clinical development of drug combinations is typically achieved through trial-and-error or via insight gained through a detailed molecular understanding of dysregulated signaling pathways in a specific cancer type. Unbiased small-molecule combination (matrix) screening represents a high-throughput means to explore hundreds and even thousands of drug–drug pairs for potential investigation and translation. Here, we describe a high-throughput screening platform capable of testing compounds in pairwise matrix blocks for the rapid and systematic identification of synergistic, additive, and antagonistic drug combinations. We use this platform to define potential therapeutic combinations for the activated B-cell–like subtype (ABC) of diffuse large B-cell lymphoma (DLBCL). We identify drugs with synergy, additivity, and antagonism with the Bruton’s tyrosine kinase inhibitor ibrutinib, which targets the chronic active B-cell receptor signaling that characterizes ABC DLBCL. Ibrutinib interacted favorably with a wide range of compounds, including inhibitors of the PI3K-AKT-mammalian target of rapamycin signaling cascade, other B-cell receptor pathway inhibitors, Bcl-2 family inhibitors, and several components of chemotherapy that is the standard of care for DLBCL.

The chemogenetic technology DREADD (designer receptors exclusively activated by designer drugs) is widely used for remote manipulation of neuronal activity in freely moving animals. DREADD technology posits the use of “designer receptors,” which are exclusively activated by the “designer drug” clozapine N-oxide (CNO). Nevertheless, the in vivo mechanism of action of CNO at DREADDs has never been confirmed. CNO does not enter the brain after systemic drug injections and shows low affinity for DREADDs. Clozapine, to which CNO rapidly converts in vivo, shows high DREADD affinity and potency. Upon systemic CNO injections, converted clozapine readily enters the brain and occupies central nervous system–expressed DREADDs, whereas systemic subthreshold clozapine injections induce preferential DREADD-mediated behaviors.

This manuscript presents the development of a two-color laser-absorption-spectroscopy (LAS) sensor capable of providing calibration-free measurements of temperature and H 2 O at 1 MHz in particle-laden combustion environments. This sensor employs scanned-wavelength-modulation spectroscopy with first-harmonic-normalized second-harmonic detection (scanned-WMS-2 f /1 f ) with two distributed-feedback (DFB) tunable diode lasers (TDLs) emitting near 1392 nm and 1469 nm. The wavelength of each laser was modulated at 35 or 45.5 MHz to frequency multiplex the lasers and, more importantly, enable simultaneous wavelength scanning across the peak of each H 2 O absorption transition at 1 MHz. This method provides an absolute, in situ wavelength reference which improves measurement accuracy and robustness. Methods to characterize the lasers’ wavelength and intensity modulation at frequencies above 10 MHz are presented. Measurements of temperature and H 2 O mole fraction within 0.3–2.5% and 2–10%, respectively, of known values were acquired in a static-gas cell at temperatures of 700–1200 K. The sensor was applied to measure the path-integrated temperature and H 2 O column density in fireballs produced by igniting 0.75 g of grade 3, class B HMX with and without H-5 micro-aluminum powder (20% by mass). Temperature measurements were acquired in the fireballs with a 1– σ precision of 50 K, 30 K, and 15 K for measurement rates of 1 MHz, 250 kHz, and 25 kHz, respectively. The results are the first to demonstrate that calibration-free measurements of gas properties can be acquired at 1 MHz using WMS-2 f /1 f .

The HIV care continuum (diagnosis, linkage to care, retention in care, receipt of antiretroviral therapy (ART), viral suppression) has been used to identify opportunities for improving the delivery of HIV care. Continuum steps are typically calculated in a conditional manner, with the number of persons completing the prior step serving as the base population for the next step. This approach may underestimate the prevalence of viral suppression by excluding patients who are suppressed but do not meet standard definitions of retention in care. Understanding how retention in care and viral suppression interact and change over time may improve our ability to intervene on these steps in the continuum. We followed 17,140 patients at 11 U.S. HIV clinics between 2010-2012. For each calendar year, patients were classified into one of five categories: (1) retained/suppressed, (2) retained/not-suppressed, (3) not-retained/suppressed, (4) not-retained/not-suppressed, and (5) lost to follow-up (for calendar years 2011 and 2012 only). Retained individuals were those completing ≥ 2 HIV medical visits separated by ≥ 90 days in the year. Persons not retained completed ≥ 1 HIV medical visit during the year, but did not meet the retention definition. Persons lost to follow-up had no HIV medical visits in the year. HIV viral suppression was defined as HIV-1 RNA ≤ 200 copies/mL at the last measure in the year. Multinomial logistic regression was used to determine the probability of patients' transitioning between retention/suppression categories from 2010 to 2011 and 2010 to 2012, adjusting for age, sex, race/ethnicity, HIV risk factor, insurance status, CD4 count, and use of ART. Overall, 65.8% of patients were retained/suppressed, 17.4% retained/not-suppressed, 10.0% not-retained/suppressed, and 6.8% not-retained/not-suppressed in 2010. 59.5% of patients maintained the same status in 2011 (kappa=0.458) and 53.3% maintained the same status in 2012 (kappa=0.437). Not counting patients not-retained/suppressed as virally suppressed, as is commonly done in the HIV care continuum, underestimated the proportion suppressed by 13%. Applying the care continuum in a longitudinal manner will enhance its utility.