Background: A school-based program with quadrivalent human papillomavirus (HPV) vaccination was implemented in Alberta in 2008. We assessed the impact of this program on Pap test cytology results using databases of provincewide vaccination and cervical cancer screening. Methods:We conducted a nested case-control study involving a cohort of women in Alberta born between 1994 and 1997 who had at least 1 Pap test between 2012 and 2015. Women with negative cytology results were controls. Women with low-grade (atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion) and highgrade (atypical squamous cells, cannot rule out a high-grade lesion; or high-grade squamous intraepithelial lesion) cervical abnormalities were cases. Exposure status was assigned according to records of HPV vaccination. Odds ratios (ORs) for abnormal cytology results by vaccination status were adjusted for neighbourhood income, laboratory service, rural versus urban residency, and age. Results:The total study population was 10 204. Adjusting for age, vaccinated women had a higher screening rate than unvaccinated women (13.0% v. 11.4%, p < 0.001). Among women who received full vaccination (≥ 3 doses), the adjusted OR for cervical abnormalities was 0.72 (95% confidence interval [CI] 0.63-0.82). For high-grade lesions, the adjusted OR was 0.50 (95% CI 0.30-0.85). With 2-dose HPV vaccination, the adjusted OR for cervical abnormalities was 1.08 (95% CI 0.84-1.38).Interpretation: Quadrivalent HPV vaccination significantly reduced high-grade cervical abnormalities but required 3 doses. Vaccination against HPV was associated with screening uptake. Population-based vaccination and screening programs should work together to optimize cervical cancer prevention. AbstractResearch
A two-terminal graph is an undirected graph G with vertex set V (G), edge set E(G), and two specified target vertices in V (G). If each edge of such a graph operates independently with the same fixed probability p, the two-terminal reliability is the probability that there exists a path between the target vertices. A two-terminal graph is uniformly most reliable if its reliability polynomial is greater than or equal to that of all other two-terminal graphs with the same fixed number of vertices, n, and edges, m. In this article, we present specific values of n and m for which no uniformly most reliable two-terminal simple graph exists, as well as values of n and m for which there does exist a uniformly most reliable two-terminal simple graph. K E Y W O R D Sgraph polynomial, optimal network, reliability polynomial, two-terminal reliability, two-terminal graph, uniformly most reliable Networks. 2018;00:1-17.wileyonlinelibrary.com/journal/net
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