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The 12th Conference of the European Society for Reproductive Immunology will be held at Magdalen College, Oxford from Monday 21st – Thursday 24th September 2015
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Oxford University
Refined selection of individuals for preventive cardiovascular disease treatment with a transformer-based risk model.
BACKGROUND: Although statistical models have been commonly used to identify patients at risk of cardiovascular disease for preventive therapy, these models tend to over-recommend therapy. Moreover, in populations with pre-existing diseases, the current approach is to indiscriminately treat all, as modelling in this context is currently inadequate. This study aimed to develop and validate the Transformer-based Risk assessment survival (TRisk) model, a novel deep learning model, for predicting 10-year risk of cardiovascular disease in both the primary prevention population and individuals with diabetes. METHODS: An open cohort of 3 million adults aged 25-84 years was identified using linked electronic health records from 291 general practices, for model development, and 98 general practices, for validation, across England from 1998 to 2015. Comparison against the QRISK3 score and a deep learning derivation of it was done. Additional analyses compared discriminatory performance in other age groups, by sex, and across categories of socioeconomic status. FINDINGS: TRisk showed superior discrimination (C index in the primary prevention population 0·910; 95% CI 0·906-0·913). TRisk's performance was found to be less sensitive to population age range than the benchmark models and outperformed other models also in analyses stratified by age, sex, or socioeconomic status. All models were overall well calibrated. In decision curve analyses, TRisk showed a greater net benefit than benchmark models across the range of relevant thresholds. At the widely recommended 10% risk threshold and the higher 15% threshold, TRisk reduced both the total number of patients classified at high risk (by 20·6% and 34·6%, respectively) and the number of false negatives as compared with recommended strategies. TRisk similarly outperformed other models in patients with diabetes. Compared with the widely recommended treat-all policy approach for patients with diabetes, TRisk at a 10% risk threshold would lead to deselection of 24·3% of individuals, with a small fraction of false negatives (0·2% of the cohort). INTERPRETATION: TRisk enabled a more targeted selection of individuals at risk of cardiovascular disease in both the primary prevention population and cohorts with diabetes, compared with benchmark approaches. Incorporation of TRisk into routine care could potentially reduce the number of treatment-eligible patients by approximately one-third while preventing at least as many events as with currently adopted approaches. FUNDING: None.
Clinical and cost-effectiveness of detailed anomaly ultrasound screening in the first trimester: a mixed-methods study.
BACKGROUND: In the United Kingdom, pregnant women are offered two scans: at 11-14 and 18-20 weeks' gestation. Current guidance supports fetal anatomical screening at the second scan, but evidence suggests earlier detection is possible. OBJECTIVES: To determine clinical and cost-effectiveness of a detailed two-dimensional ultrasound scan in the first trimester for detection of fetal anomalies, in addition to usual practice. DESIGN: Systematic review and meta-analysis. Nationwide survey. Analysis of National Congenital Anomaly Disease Registry data. Consensus procedure. Prospective survey of parental opinions. Probabilistic decision-analytic model for cost-effectiveness. Value-of-information analysis. SETTING: United Kingdom National Health Service. PARTICIPANTS: Pregnant women and partners. INTERVENTIONS: Detailed anomaly ultrasound at 11-14 weeks' gestation, in addition to usual practice. MAIN OUTCOME MEASURES: Diagnostic accuracy, protocol development, health economic modelling and value-of-information analysis. DATA SOURCES: MEDLINE (OvidSP), EMBASE (OvidSP), Science Citation Index and Conference Proceedings Citation Index-Science (Web of Science Core Collection); National Congenital Anomaly Disease Registry; European Congenital Anomalies Registry; Surveys of National Health Service Trusts; screening sonographers, midwives and doctors; and parents; National Schedule of National Health Service Costs (2019-20). REVIEW METHODS: Systematic review and meta-analysis for diagnostic accuracy. RESULTS: First-trimester ultrasound detects 93.3% (95% confidence interval 90.4% to 95.7%) of a pre-selected group of eight major anomalies with specificity of 99.99% (95% confidence interval 99.98% to 99.99%) and positive predictive value of 96.5% (95% confidence interval 93.3 to 98.8, 416,877 fetuses, 40 studies). For major cardiac anomalies, the respective data are 55.8% (95% confidence interval 45.9% to 65.5%), 99.98% (95% confidence interval 99.97% to 99.99%) and 94.85% (95% confidence interval 91.63% to 97.32%, 306,872 fetuses, 45 studies). Of NHS trusts surveyed, 77% currently perform first-trimester anatomy assessment, with evidence of inequity of care; earlier screening resulted in more diagnoses before 16 weeks' gestation. A consensus procedure (n = 172) developed an anatomical protocol and minimum targets for diagnosis. Parental survey (n = 1374) indicated that over 90% would opt for such screening. Modelling of singleton pregnancies undergoing earlier anomaly screening using two-dimensional ultrasound was associated with increased mean healthcare costs per woman (£11, 95% confidence interval £1 to £29) and maternal quality-adjusted life-years (0.002065, 95% confidence interval 0.000565 to 0.00358), an incremental cost per quality-adjusted life-year of £5270, with likelihood of being cost-effective at £20,000 per quality-adjusted life-year of over 95%. Additional modelling predicted reductions in infant healthcare costs and quality-adjusted life-years. Decision uncertainty was low. Value-of-information analysis of cost-effectiveness results showed no groups of parameters for which further research to reduce uncertainty would likely prove cost-effective. LIMITATIONS: Study heterogeneity; the lack of a universal reference standard; simplifying assumptions relating to economic model structure; and estimation of some parameters are documented and justified. The rarity of the conditions made estimation of longer-term maternal and infant costs and quality-adjusted life-years challenging, resulting in likely under-estimation of healthcare costs. CONCLUSIONS: With standardisation and training, first-trimester ultrasound screening for fetal anomalies is clinically effective with over 90% detection for eight major conditions and low false-positive rates. Decision uncertainty around implementation is low and a prospective study would not be an efficient investment. Adding first-trimester anomaly screening to the current screening likely represents a cost-effective use of resources and is acceptable to parents. FUTURE WORK: Focus on developing an implementation framework to modify the current United Kingdom Fetal Anomaly Screening Programme. STUDY REGISTRATION: This study is registered as PROSPERO CRD42018111781 and CRD42018112434. FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/19/10) and is published in full in Health Technology Assessment; Vol. 29, No. 22. See the NIHR Funding and Awards website for further award information.
Small for Gestational Age sub-groups have differential morbidity, growth and neurodevelopment at age 2: the INTERBIO-21st Newborn Study.
BACKGROUND: Small for Gestational Age (SGA) is a complex perinatal syndrome associated with increased neonatal morbidity, mortality, and impaired childhood growth and neurodevelopment. Current classifications rely primarily on birth weight, which does not capture the heterogeneity of the condition nor predict long-term health outcomes. Here we aim to identify and characterise distinct SGA sub-groups and assess their neonatal and early childhood health trajectories. OBJECTIVES: To refine the classification of SGA by identifying sub-groups based on maternal, fetal, and environmental factors and evaluating their associations with neonatal morbidity, growth, and neurodevelopment at age 2. STUDY DESIGN: Prospective Cohort Study. In six countries worldwide, between 2012 and 2018, the INTERBIO-21st Study enrolled SGA and non-SGA newborns defined by the <10th centile of international standards with moderate (≥3rd to <10th centile) and severe (<3rd centile) SGA sub-groups; we assessed their growth, health, nutrition, motor development, and neurodevelopment up to age 2. We used 2-step cluster analysis to identify SGA sub-groups, and a probabilistic approach to choose the optimal sub-group model based on a statistical measure of fit. We performed logistic regression analysis (OR; 95% CI) to assess health and development outcomes among sub-groups using the non-SGA as reference group, adjusting for key confounders. RESULTS: We enrolled 5153 non-SGA and 1549 SGA newborns: moderate (≥3rd to <10th centile) SGA=947 and severe (<3rd centile) SGA=602). We identified nine SGA sub-groups: 'no main condition detected' (29.0%); 'previous low birth weight (LBW)/preterm birth (PTB)' (14.6%); 'severe maternal disease' (12.0%); 'maternal short stature (11.6%); 'hypertensive disorders' (9.6%); 'extrauterine infection' (6.8%); 'previous miscarriage(s)' (6.5%); 'smoking' (5.2%), and 'maternal under-nutrition' (4.7%). Severe SGA newborns in the 'severe maternal disease' (OR: 3.2; 95% CI, 1.8-6.0), 'previous LBW/PTB' (OR: 2.8; 95% CI, 1.6-4.8), and 'smoking' (OR: 5.4; 95% CI, 1.3-21.8) sub-groups had increased risk of neonatal and long-term morbidity, and low anthropometric measures at age 2 as compared to the non-SGA group. Moderate SGA newborns in the "hypertensive disorders" sub-group had increased risk of neonatal morbidity (OR: 2.6; 95% CI, 1.5-4.6), and higher odds of scoring <10th centile of normative values in language (OR: 3.5; 95%CI, 1.0-12.0) and positive behavior (OR: 2.2; 95%CI, 1.1-4.5). The 'severe maternal disease' sub-group had also higher risk of deficit (<10th centile of normative values) in language (OR: 5.7; 95%CI, 1.3-24.8), positive behavior (OR: 3.4; 95%CI, 1.5-7.6). CONCLUSIONS: SGA comprises heterogeneous sub-groups with distinct patterns of neonatal morbidity, postnatal growth, and neurodevelopmental outcomes up to age 2.
Lessons for low‐resource settings: externally validated prediction models for pre‐eclampsia
Linked article: This Correspondence comments on Tiruneh et al. Click here to view the article.
Association between gestational age specific weight gain in pregnancy and risk of adverse perinatal outcomes: A secondary analysis of the INTERBIO-21st Fetal Study.
BACKGROUND: Gestational Weight gain (GWG) is a potentially modifiable factor that can influence perinatal health outcomes. OBJECTIVES: To investigate the association between gestational age (GA)-specific weight gain and adverse perinatal outcomes. METHODS: This study is a secondary analysis of the INTERBIO-21st Fetal Study, a prospective, longitudinal cohort conducted from February 8, 2012, to November 30, 2019, across six sites in Brazil, Kenya, Pakistan, South Africa, Thailand, and the United Kingdom. A total of 3,354 pregnant women, aged ≥18 years with a Body Mass Index (BMI) <35 kg/m2, initiated antenatal care before 14 weeks' gestation. Weight was measured at 5 ± 1-week intervals from 14 to 40 weeks. GWG was assessed using the GA specific INTERGROWTH-21st and BMI-specific Institute of Medicine (IOM) guidelines. Adverse outcomes included gestational diabetes mellitus (GDM), pregnancy induced hypertension (PIH), emergency caesarean delivery, low birthweight (LBW), preterm birth (PTB), small or large for gestational age (SGA, LGA), macrosomia, and birth length or head circumference (HC) <10th or >90th centile. RESULTS: Inadequate GWG was prevalent, with 53% (n=1,767) below the 25th centile of INTERGROWTH-21st standards and 62% (n=2,079) below IOM guidelines. Compared to GWG between 25th and 75th centile (n=370), females with GWG <25th centile (n=1767) had a higher odds of SGA (Odds ratio, OR=2.7, 95% confidence interval, CI: 2.2, 3.4), birth HC<10th centile (OR= 2.4, 95% CI: 1.8, 3.2), GDM (OR=1.9, 95% CI: 1.3, 2.7), LBW (OR=1.9, 95% CI: 1.5, 2.4), and birth length<10th centile (OR=1.7, 95% CI: 1.4, 2.1). Similarly, females with GWG >75th centile (n=458) had higher odds for emergency caesarean section (OR=1.7, 95% CI: 1.1, 2.7) and PIH (OR= 1.5, 95% CI: 1.1, 1.9). CONCLUSIONS: Appropriate-for-age (AGA) specific GWG between the 25th and 75th centiles standards is associated with reduced adverse outcomes, highlighting the importance of tailored guidelines for optimal maternal and neonatal health.
Endometriosis: A Review.
IMPORTANCE: Endometriosis is a chronic, estrogen-dependent, inflammatory disease defined by endometrial-like tissue (lesions) outside the uterine lining. It affects up to 10% of women worldwide, and 9 million women in the US, during reproductive years. OBSERVATIONS: Endometriosis has varying clinical presentations; however, 90% of people with endometriosis report pelvic pain, including dysmenorrhea, nonmenstrual pelvic pain, and dyspareunia, and 26% report infertility. Risk factors for endometriosis include younger age at menarche, shorter menstrual cycle length, lower body mass index, nulliparity, and congenital obstructive müllerian anomalies such as obstructed hemivagina. Although definitive diagnosis requires surgical visualization of lesions, a suspected clinical diagnosis can be made based on symptoms, supported by physical examination findings and imaging with transvaginal ultrasound and/or pelvic magnetic resonance imaging; normal physical examination and imaging do not exclude the diagnosis. The diagnosis is often delayed, averaging 5 to 12 years after onset of symptoms, with most women consulting 3 or more clinicians prior to diagnosis. Hormonal medications, such as combined oral contraceptives and progestin-only options, are first-line treatment and should be offered to symptomatic premenopausal women who do not currently desire pregnancy. In a network meta-analysis (n = 1680, 15 clinical trials), hormonal treatments including combined oral contraceptives, progestins, and gonadotropin-releasing hormone (GnRH) agonists led to clinically significant pain reduction compared with placebo, with mean differences ranging between 13.15 and 17.6 points (0-100 visual analog scale) with little difference in effectiveness among options. However, 11% to 19% of individuals with endometriosis have no pain reduction with hormonal medications and 25% to 34% experience recurrent pelvic pain within 12 months of discontinuing hormonal treatment. Surgical removal of lesions, usually with laparoscopy, should be considered if first-line hormonal therapies are ineffective or contraindicated. Second-line hormone therapies include GnRH agonists and antagonists, and third-line treatments include aromatase inhibitors. Hysterectomy with surgical removal of lesions may be considered when initial treatments are ineffective. However, approximately 25% of patients who undergo hysterectomy for endometriosis experience recurrent pelvic pain and 10% undergo additional surgery, such as lysis of adhesions, to treat pain. CONCLUSIONS AND RELEVANCE: Endometriosis is a common cause of pelvic pain affecting approximately 10% of reproductive-age women. Hormonal suppression with combined estrogen-progestin contraceptives or progestins is first-line treatment for women who are not seeking immediate pregnancy. Surgical removal of endometriosis lesions may be performed if hormonal therapies are ineffective or contraindicated, and hysterectomy may be considered if medical treatments and surgical removal of lesions do not relieve symptoms.
Blood Pressure Lowering and Risk of Cancer: Individual Participant-Level Data Meta-Analysis and Mendelian Randomization Studies.
BACKGROUND: Pharmacologic blood pressure (BP) lowering is typically a lifelong treatment, and both clinicians and patients may have concerns about the long-term use of antihypertensive agents and the risk for cancer. However, evidence from randomized controlled trials (RCTs) regarding the effect of long-term pharmacologic BP lowering on the risk for new-onset cancer is limited, with most knowledge derived from observational studies. OBJECTIVES: The aim of this study was to assess whether long-term BP lowering affects the risk for new-onset cancer, cause-specific cancer death, and selected site-specific cancers. METHODS: Individual-level data from 42 RCTs were pooled using a one-stage individual participant data meta-analysis. The primary outcome was incident cancer of all types, and secondary outcomes were cause-specific cancer death and selected site-specific cancers. Prespecified subgroup analyses were conducted to assess the heterogeneity of the BP-lowering effect by baseline variables and over follow-up time. Cox proportional hazards regression, stratified by trial, was used for the statistical analysis. For site-specific cancers, analyses were complemented with Mendelian randomization, using naturally randomized genetic variants associated with BP lowering to mimic the design of a long-term RCT. RESULTS: Data from 314,016 randomly allocated participants without known cancer at baseline were analyzed. Over a median follow-up of 4 years (Q1-Q3: 3-5 years), 17,954 participants (5.7%) developed cancer, and 4,878 (1.5%) died of cancer. In the individual participant data meta-analysis, no associations were found between reductions in systolic or diastolic BP and cancer risk (HR per 5 mm Hg reduction in systolic BP: 1.03 [95% CI: 0.99-1.06]; HR per 3 mm Hg reduction in diastolic BP: 1.03 [95% CI: 0.98-1.07]). No changes in relative risk for incident cancer were observed over follow-up time, nor was there evidence of heterogeneity in treatment effects across baseline subgroups. No effect on cause-specific cancer death was found. For site-specific cancers, no evidence of an effect was observed, except a possible link with lung cancer risk (HR for systolic BP reduction: 1.17; 99.5% CI: 1.02-1.32). Mendelian randomization studies showed no association between systolic or diastolic BP reduction and site-specific cancers, including overall lung cancer and its subtypes. CONCLUSIONS: Randomized data analysis provided no evidence to indicate that pharmacologic BP lowering has a substantial impact, either increasing or decreasing, on the risk for incident cancer, cause-specific cancer death, or selected site-specific cancers.
Using Single-Cell Raman Microspectroscopy to Profile Human Peripheral Blood Mononuclear Cells.
A reliable, validated test would enhance our ability to treat and research chronic conditions. Early and accurate diagnosis would provide an entry point into clinical care, give access to benefits, remove the stigma associated with these conditions, and importantly, provide researchers with a fundamental tool they require to study these heterogeneous disorders. In this chapter, we describe how Raman microspectroscopy can be utilised to study the biology of peripheral blood mononuclear cells (PBMCs) isolated from human blood samples. Using machine learning approaches, the data generated can be used to attempt to separate different patient and control groups, subgroups within a patient cohort, and identify differences in intracellular metabolites which may provide clues about disease mechanisms.
Melanin Nanoparticles as a Safe and Effective Iron Chelation Therapy: An ex vivo Assessment of Placental Transfer in Pregnant Beta-Thalassemia
Background: Iron toxicity is a major contributor to adverse pregnancy outcomes in women with transfusion-dependent thalassemia. Currently used iron chelators are not recommended during pregnancy, as they can cross the placenta causing potential risk to the fetus. However, ceasing medication may adversely affect the mother’s health in both the short-and long-term. Objective: We previously demonstrated that melanin nanoparticles can effectively chelate iron, and this has been confirmed by others in iron-overloaded mice. This study aims to assess whether these nanoparticles cross the placenta and evaluate their biocompatibility and haemocompatibility. Study Design: A library of 50 nm, 200 nm, and 500 nm melanin nanoparticles were synthesized and coated with Polyethylene Glycol (PEG) to improve their stability. The particles were tested for chelating iron efficacy in and biocompatibility. An in vitro BeWo (choriocarcinoma) cell model and ex vivo human placental perfusion system were used to assess nanoparticle transplacental passage. Results: Melanin nanoparticles of all sizes were able to chelate iron with a maximum adsorption of 14 mm iron/g of material; significantly higher than Desferrioxamine (DFO) of the same concentration. It was also determined that PEGylated melanin nanoparticles with appropriate size (cut off 200 nm) could be restricted from passing across the placental barrier in an in vitro model using a human choriocarcinoma cell line and in an ex vivo human placental perfusion model. The particles did not cause red cell haemolysis or blood clotting at concentrations up to 1 mM. Conclusion: It was demonstrated herein that transport of MNPs across the placental barrier is highly dependent on particle size (cut off size of 200 nm PEGylated MNPs). Findings suggest the possibility of providing a safe method of iron chelation during pregnancy. Future work in in vivo models will be applied to study systemic particle interaction. Plain Language Summary: At present, clinicians are faced with the choice of whether to continue maternal chelation therapy with possible risk to the fetus, or to cease medication with risk to the mother. The latter may adversely affect the mother’s health long after delivery of the baby. Although there are very few clinical trials on using DFO during pregnancy, the use of the small MW DFO on pregnant women is contraindicated. Thus, DFO is classified by the Food and Drug Association as category C during pregnancy due to severe skeletal anomalies and teratogenic effects reported in animal studies. PEGylated melanin nanoparticles (MNPs) of 200 nm or larger are unable to cross the placenta, as shown in both an in vitro BeWo cell model and an ex vivo human placental perfusion model. These findings suggest that MNPs may be a safer option for iron chelation during pregnancy. However, pre-clinical animal testing and clinical trials are needed to determine overall interaction of MNPs in vivo before routine use in a clinical setting. The exclusion of pregnant women from clinical trials has limited research on medications specifically designed for pregnancy with only a couple of drugs developed in the past four decades.1 There is a critical need to fill the knowledge gap regarding safer and effective therapeutics in this population. The use of clinically approved nanoparticles in pregnancy has increased rapidly; with the Covid 19 vaccines developed by Pfizer and Moderna being prominent examples. These vaccines have been used in a large population of pregnant women without reports of unfavorable complications,2 paving the way for more nanoparticle medications to be used in the future.
A deep learning sex-specific body composition ageing biomarker using dual-energy X-ray absorptiometry scan.
BACKGROUND: Chronic diseases are closely linked to alterations in body composition, yet there is a need for reliable biomarkers to assess disease risk and progression. This study aimed to develop and validate a biological age indicator based on body composition derived from dual-energy X-ray absorptiometry (DXA) scans, offering a novel approach to evaluating health status and predicting disease outcomes. METHODS: A deep learning model was trained on a reference population from the UK Biobank to estimate body composition biological age (BCBA). The model's performance was assessed across various groups, including individuals with typical and atypical body composition, those with pre-existing diseases, and those who developed diseases after DXA imaging. Key metrics such as c-index were employed to examine BCBA's diagnostic and prognostic potential for type 2 diabetes, major adverse cardiovascular events (MACE), atherosclerotic cardiovascular disease (ASCVD), and hypertension. RESULTS: Here we show that BCBA strongly correlates with chronic disease diagnoses and risk prediction. BCBA demonstrated significant associations with type 2 diabetes (odds ratio 1.08 for females and 1.04 for males, p
Effects of preconception nutrition interventions on pregnancy and birth outcomes in South Asia: a systematic review
Undernutrition amongst reproductive age women, low birth weight, small for gestational age and preterm birth present significant health burdens in South Asia which interventions in pregnancy alone have not resolved. Effectiveness of preconception nutrition interventions is not well-documented. This systematic review summarises evidence on the effect of preconception nutrition interventions on pregnancy and birth outcomes in South Asia. We found highly heterogeneous evidence across four micronutrient supplementation, two food supplementation, and three complex interventions trials. Preconception micronutrient supplementation alone did not affect birth size, but food supplementation was effective with and without multiple micronutrients, especially when initiated at least 90 days before conception. Combined health, nutrition, psychosocial care, and WaSH interventions addressing determinants at multiple levels were most effective. However intensive delivery by project employees poses problems for scale-up. More robust South Asian preconception intervention trials to identify scalable interventions that are effective in real-world delivery settings are needed. Funding: UNICEF Regional Office for South Asia contract number 43384734.
Bridging the gaps: advancing preconception nutrition in South Asia through evidence, policy, and action
This paper summarises the research, policy, and program gaps impeding the advancement of preconception nutrition in South Asia. In line with our evidence reviews, qualitative semi-structured interviews with researchers and programme implementers identified gaps in our understanding of the prevalence and burden of preconception malnutrition due to limited survey and programme data, poor coverage of recommended interventions, and gaps in programme knowledge on effective intervention mechanism. Key barriers identified were the lack of evidence linking preconception care with long-term maternal and child health and nutrition outcomes and how to integrate preconception nutrition interventions into national health systems. We highlight the need for evidence-based, context-specific interventions which utilise effective delivery platforms and engage appropriate actors to reach diverse groups of women and men during the preconception period. We, as part of the South Asia Preconception Nutrition Collective, present actionable recommendations to address these gaps. Funding: UNICEF Regional Office for South Asia contract number 43384734.
Policies and programmes to improve preconception nutrition in South Asia
The health and health behaviours of women before conception significantly influence maternal and child health outcomes. Despite growing evidence supporting preconception nutrition care, data on the implementation of related policies and programmes remains limited. This paper reviews public policies and programmes delivering preconception nutrition interventions in eight South Asian countries, targeting married pre-pregnant women aged 15–49 years and identifies the systems bottlenecks in programme implementation. Most countries, except Sri Lanka, lack universal programmes for health and nutrition screening, provision of essential micronutrients, counselling on healthy eating and treatment for at-risk women. Even in countries, where supportive policies exist, implementation of comprehensive nutrition services for pre-pregnant women faces significant bottlenecks across six health system building blocks. Addressing these barriers is critical to improving intervention effectiveness, programme implementation, and informed decision-making. Further testing of a proposed comprehensive algorithm for preconception nutrition in diverse country contexts across South Asia is necessary.
AnchorInv: Few-Shot Class-Incremental Learning of Physiological Signals via Feature Space-Guided Inversion
Deep learning models have demonstrated exceptional performance in a variety of real-world applications. These successes are often attributed to strong base models that can generalize to novel tasks with limited supporting data while keeping prior knowledge intact. However, these impressive results are based on the availability of a large amount of high-quality data, which is often lacking in specialized biomedical applications. In such fields, models are usually developed with limited data that arrive incrementally with novel categories. This requires the model to adapt to new information while preserving existing knowledge. Few-Shot Class-Incremental Learning (FSCIL) methods offer a promising approach to addressing these challenges, but they also depend on strong base models that face the same aforementioned limitations. To overcome these constraints, we propose AnchorInv following the straightforward and efficient buffer-replay strategy. Instead of selecting and storing raw data, AnchorInv generates synthetic samples guided by anchor points in the feature space. This approach protects privacy and regularizes the model for adaptation. When evaluated on three public physiological time series datasets, AnchorInv exhibits efficient knowledge forgetting prevention and improved adaptation to novel classes, surpassing state-of-the-art baselines.