High Awareness but Low Coverage of a Locally Produced Fortified Complementary Food in Abidjan, Côte d'Ivoire: Findings from a Cross-Sectional Survey.

PubMed

Leyvraz, Magali; Rohner, Fabian; Konan, Amoin G; Esso, Lasme J C E; Woodruff, Bradley A; Norte, Augusto; Adiko, Adiko F; Bonfoh, Bassirou; Aaron, Grant J

2016-01-01

Poor complementary feeding practices among infants and young children in Côte d'Ivoire are major contributing factors to the country's high burden of malnutrition. As part of a broad effort to address this issue, an affordable, nutritious, and locally produced fortified complementary food product was launched in the Côte d'Ivoire in 2011. The objective of the current research was to assess various levels of coverage of the program and to identify coverage barriers. A cross-sectional household survey was conducted among caregivers of children less than 2-years of age living in Abidjan, Côte d'Ivoire. Four measures of coverage were assessed: "message coverage" (i.e., has the caregiver ever heard of the product?), "contact coverage" (i.e., has the caregiver ever fed the child the product?), "partial coverage" (i.e., has the caregiver fed the child the product in the previous month?), and "effective coverage" (i.e., has the caregiver fed the child the product in the previous 7 days?). A total of 1,113 caregivers with children between 0 and 23 months of age were interviewed. Results showed high message coverage (85.0%), moderate contact coverage (37.8%), and poor partial and effective coverages (8.8% and 4.6%, respectively). Product awareness was lower among caregivers from poorer households, but partial and effective coverages were comparable in both poor and non-poor groups. Infant and young child feeding (IYCF) practices were generally poor and did not appear to have improved since previous assessments. In conclusion, the results from the present study indicate that availability on the market and high awareness among the target population is not sufficient to achieve high and effective coverage. With market-based delivery models, significant efforts are needed to improve demand. Moreover, given the high prevalence of malnutrition and poor IYCF practices, additional modes of delivering IYCF interventions and improving IYCF practices should be considered.

How effective is integrated vector management against malaria and lymphatic filariasis where the diseases are transmitted by the same vector?

PubMed

Stone, Christopher M; Lindsay, Steve W; Chitnis, Nakul

2014-12-01

The opportunity to integrate vector management across multiple vector-borne diseases is particularly plausible for malaria and lymphatic filariasis (LF) control where both diseases are transmitted by the same vector. To date most examples of integrated control targeting these diseases have been unanticipated consequences of malaria vector control, rather than planned strategies that aim to maximize the efficacy and take the complex ecological and biological interactions between the two diseases into account. We developed a general model of malaria and LF transmission and derived expressions for the basic reproductive number (R0) for each disease. Transmission of both diseases was most sensitive to vector mortality and biting rate. Simulating different levels of coverage of long lasting-insecticidal nets (LLINs) and larval control confirms the effectiveness of these interventions for the control of both diseases. When LF was maintained near the critical density of mosquitoes, minor levels of vector control (8% coverage of LLINs or treatment of 20% of larval sites) were sufficient to eliminate the disease. Malaria had a far greater R0 and required a 90% population coverage of LLINs in order to eliminate it. When the mosquito density was doubled, 36% and 58% coverage of LLINs and larval control, respectively, were required for LF elimination; and malaria elimination was possible with a combined coverage of 78% of LLINs and larval control. Despite the low level of vector control required to eliminate LF, simulations suggest that prevalence of LF will decrease at a slower rate than malaria, even at high levels of coverage. If representative of field situations, integrated management should take into account not only how malaria control can facilitate filariasis elimination, but strike a balance between the high levels of coverage of (multiple) interventions required for malaria with the long duration predicted to be required for filariasis elimination.

Influenza vaccination coverage among US children from 2004/2005 to 2015/2016.

PubMed

Tian, Changwei; Wang, Hua; Wang, Wenming; Luo, Xiaoming

2018-05-15

Quantify the influenza vaccine coverage is essential to identify emerging concerns and to immunization programs for targeting interventions. Data from National Health Interview Survey were used to estimate receipt of at least one dose of influenza vaccination among children 6 months to 17 years of age. Influenza vaccination coverage increased from 16.70% during 2004/2005 to 49.43% during 2015/2016 (3.18% per year, P < 0.001); however, the coverage increased slightly after 2010/2011. Children at high risk of influenza complications had higher influenza vaccination coverage than non at-risk children. Boys and girls had similar coverage each year. While the coverage increased from 2004/2005 to 2015/2016 for all age groups, the coverage decreased with age each year (-0.64 to -1.58% per age group). There was a higher and rapid increase of coverage in Northeast than Midwest, South and West. American Indian or Alaskan Native and Asian showed higher coverage than other race groups (White, Black/African American, Multiple race). Multivariable analysis showed that high-risk status and region had the greatest associations with levels of vaccine coverage. Although the influenza vaccination coverage among children had increased remarkably since 2004/2005, establishing more effective immunization programs are warranted to achieve the Healthy People 2020 target.

Structural and electronic properties of AlN(0001) surface under partial N coverage as determined by ab initio approach

DOE Office of Scientific and Technical Information (OSTI.GOV)

Strak, Pawel; Sakowski, Konrad; Kempisty, Pawel

2015-09-07

Properties of bare and nitrogen-covered Al-terminated AlN(0001) surface were determined using density functional theory (DFT) calculations. At a low nitrogen coverage, the Fermi level is pinned by Al broken bond states located below conduction band minimum. Adsorption of nitrogen is dissociative with an energy gain of 6.05 eV/molecule at a H3 site creating an overlap with states of three neighboring Al surface atoms. During this adsorption, electrons are transferred from Al broken bond to topmost N adatom states. Accompanying charge transfer depends on the Fermi level. In accordance with electron counting rule (ECR), the DFT results confirm the Fermi levelmore » is not pinned at the critical value of nitrogen coverage θ{sub N}(1) = 1/4 monolayer (ML), but it is shifted from an Al-broken bond state to Np{sub z} state. The equilibrium thermodynamic potential of nitrogen in vapor depends drastically on the Fermi level pinning being shifted by about 4 eV for an ECR state at 1/4 ML coverage. For coverage above 1/4 ML, adsorption is molecular with an energy gain of 1.5 eV at a skewed on-top position above an Al surface atom. Electronic states of the admolecule are occupied as in the free molecule, no electron transfer occurs and adsorption of a N{sub 2} molecule does not depend on the Fermi level. The equilibrium pressure of molecular nitrogen above an AlN(0001) surface depends critically on the Fermi level position, being very low and very high for low and high coverage, respectively. From this fact, one can conclude that at typical growth conditions, the Fermi level is not pinned, and the adsorption and incorporation of impurities depend on the position of Fermi level in the bulk.« less

From the parents' perspective: a user-satisfaction survey of immunization services in Guatemala.

PubMed

Barrera, Lissette; Trumbo, Silas Pierson; Bravo-Alcántara, Pamela; Velandia-González, Martha; Danovaro-Holliday, M Carolina

2014-03-06

Immunization coverage levels in Guatemala have increased over the last two decades, but national targets of ≥95% have yet to be reached. To determine factors related to undervaccination, Guatemala's National Immunization Program conducted a user-satisfaction survey of parents and guardians of children aged 0-5 years. Variables evaluated included parental immunization attitudes, preferences, and practices; the impact of immunization campaigns and marketing strategies; and factors inhibiting immunization. Based on administrative coverage levels and socio-demographic indicators in Guatemala's 22 geographical departments, five were designated as low-coverage and five as high-coverage areas. Overall, 1194 parents and guardians of children aged 0-5 years were interviewed in these 10 departments. We compared indicators between low- and high-coverage areas and identified risk factors associated with undervaccination. Of the 1593 children studied, 29 (1.8%) were determined to be unvaccinated, 458 (28.8%) undervaccinated, and 1106 (69.4%) fully vaccinated. In low-coverage areas, children of less educated (no education: RR=1.49, p=0.01; primary or less: 1.39, p=0.009), older (aged>39 years: RR=1.31, p=0.05), and single (RR=1.32, p=0.03) parents were more likely to have incomplete vaccination schedules. Similarly, factors associated with undervaccination in high-coverage areas included the caregiver's lack of education (none: RR=1.72, p=0.0007; primary or less: RR=1.30, p=0.05) and single marital status (RR=1.36, p=0.03), as well as the child's birth order (second: RR=1.68, p=0.003). Although users generally approved of immunization services, problems in service quality were identified. According to participants, topics such as the risk of adverse events (47.4%) and next vaccination appointments (32.3%) were inconsistently communicated to parents. Additionally, 179 (15.0%) participants reported the inability to vaccinate their child on at least one occasion. Compared to high-coverage areas, participants in low-coverage areas reported poorer service, longer wait times, and greater distances to health centers. In high-coverage areas, participants reported less knowledge about the availability of services. Generally, immunization barriers in Guatemala are related to problems in accessing and attaining high-quality immunization services rather than to a population that does not adequately value vaccination. We provide recommendations to aid the country in maintaining its achievements and addressing new challenges.

Adult vaccination coverage levels among users of complementary/alternative medicine - results from the 2002 National Health Interview Survey (NHIS).

PubMed

Stokley, Shannon; Cullen, Karen A; Kennedy, Allison; Bardenheier, Barbara H

2008-02-22

While many Complementary/Alternative Medicine (CAM) practitioners do not object to immunization, some discourage or even actively oppose vaccination among their patients. However, previous studies in this area have focused on childhood immunizations, and it is unknown whether and to what extent CAM practitioners may influence the vaccination behavior of their adult patients. The purpose of this study was to describe vaccination coverage levels of adults aged > or = 18 years according to their CAM use status and determine if there is an association between CAM use and adult vaccination coverage. Data from the 2002 National Health Interview Survey, limited to 30,617 adults that provided at least one valid answer to the CAM supplement, were analyzed. Receipt of influenza vaccine during the past 12 months, pneumococcal vaccine (ever), and > or = 1 dose of hepatitis B vaccine was self-reported. Coverage levels for each vaccine by CAM use status were determined for adults who were considered high priority for vaccination because of the presence of a high risk condition and for non-priority adults. Multivariable analyses were conducted to evaluate the association between CAM users and vaccination status, adjusting for demographic and healthcare utilization characteristics. Overall, 36% were recent CAM users. Among priority adults, adjusted vaccination coverage levels were significantly different between recent and non-CAM users for influenza (44% vs 38%; p-value < 0.001) and pneumococcal (40% vs 33%; p-value < 0.001) vaccines but were not significantly different for hepatitis B (60% vs 56%; p-value = 0.36). Among non-priority adults, recent CAM users had significantly higher unadjusted and adjusted vaccination coverage levels compared to non-CAM users for all three vaccines (p-values < 0.001). Vaccination coverage levels among recent CAM users were found to be higher than non-CAM users. Because CAM use has been increasing over time in the U.S., it is important to continue monitoring CAM use and its possible influence on receipt of immunizations among adults. Since adult vaccination coverage levels remain below Healthy People 2010 goals, it may be beneficial to work with CAM practitioners to promote adult vaccines as preventive services in keeping with their commitment to maintaining good health.

Accuracy and impact of spatial aids based upon satellite enumeration to improve indoor residual spraying spatial coverage.

PubMed

Bridges, Daniel J; Pollard, Derek; Winters, Anna M; Winters, Benjamin; Sikaala, Chadwick; Renn, Silvia; Larsen, David A

2018-02-23

Indoor residual spraying (IRS) is a key tool in the fight to control, eliminate and ultimately eradicate malaria. IRS protection is based on a communal effect such that an individual's protection primarily relies on the community-level coverage of IRS with limited protection being provided by household-level coverage. To ensure a communal effect is achieved through IRS, achieving high and uniform community-level coverage should be the ultimate priority of an IRS campaign. Ensuring high community-level coverage of IRS in malaria-endemic areas is challenging given the lack of information available about both the location and number of households needing IRS in any given area. A process termed 'mSpray' has been developed and implemented and involves use of satellite imagery for enumeration for planning IRS and a mobile application to guide IRS implementation. This study assessed (1) the accuracy of the satellite enumeration and (2) how various degrees of spatial aid provided through the mSpray process affected community-level IRS coverage during the 2015 spray campaign in Zambia. A 2-stage sampling process was applied to assess accuracy of satellite enumeration to determine number and location of sprayable structures. Results indicated an overall sensitivity of 94% for satellite enumeration compared to finding structures on the ground. After adjusting for structure size, roof, and wall type, households in Nchelenge District where all types of satellite-based spatial aids (paper-based maps plus use of the mobile mSpray application) were used were more likely to have received IRS than Kasama district where maps used were not based on satellite enumeration. The probability of a household being sprayed in Nchelenge district where tablet-based maps were used, did not differ statistically from that of a household in Samfya District, where detailed paper-based spatial aids based on satellite enumeration were provided. IRS coverage from the 2015 spray season benefited from the use of spatial aids based upon satellite enumeration. These spatial aids can guide costly IRS planning and implementation leading to attainment of higher spatial coverage, and likely improve disease impact.

Women In The United States Experience High Rates Of Coverage 'Churn' In Months Before And After Childbirth.

PubMed

Daw, Jamie R; Hatfield, Laura A; Swartz, Katherine; Sommers, Benjamin D

2017-04-01

Insurance transitions-sometimes referred to as "churn"-before and after childbirth can adversely affect the continuity and quality of care. Yet little is known about coverage patterns and changes for women giving birth in the United States. Using nationally representative survey data for the period 2005-13, we found high rates of insurance transitions before and after delivery. Half of women who were uninsured nine months before delivery had acquired Medicaid or CHIP coverage by the month of delivery, but 55 percent of women with that coverage at delivery experienced a coverage gap in the ensuing six months. Risk factors associated with insurance loss after delivery include not speaking English at home, being unmarried, having Medicaid or CHIP coverage at delivery, living in the South, and having a family income of 100-185 percent of the poverty level. To minimize the adverse effects of coverage disruptions, states should consider policies that promote the continuity of coverage for childbearing women, particularly those with pregnancy-related Medicaid eligibility. Project HOPE—The People-to-People Health Foundation, Inc.

Evaluation of immunization coverage by lot quality assurance sampling compared with 30-cluster sampling in a primary health centre in India.

PubMed

Singh, J; Jain, D C; Sharma, R S; Verghese, T

1996-01-01

The immunization coverage of infants, children and women residing in a primary health centre (PHC) area in Rajasthan was evaluated both by lot quality assurance sampling (LQAS) and by the 30-cluster sampling method recommended by WHO's Expanded Programme on Immunization (EPI). The LQAS survey was used to classify 27 mutually exclusive subunits of the population, defined as residents in health subcentre areas, on the basis of acceptable or unacceptable levels of immunization coverage among infants and their mothers. The LQAS results from the 27 subcentres were also combined to obtain an overall estimate of coverage for the entire population of the primary health centre, and these results were compared with the EPI cluster survey results. The LQAS survey did not identify any subcentre with a level of immunization among infants high enough to be classified as acceptable; only three subcentres were classified as having acceptable levels of tetanus toxoid (TT) coverage among women. The estimated overall coverage in the PHC population from the combined LQAS results showed that a quarter of the infants were immunized appropriately for their ages and that 46% of their mothers had been adequately immunized with TT. Although the age groups and the periods of time during which the children were immunized differed for the LQAS and EPI survey populations, the characteristics of the mothers were largely similar. About 57% (95% CI, 46-67) of them were found to be fully immunized with TT by 30-cluster sampling, compared with 46% (95% CI, 41-51) by stratified random sampling. The difference was not statistically significant. The field work to collect LQAS data took about three times longer, and cost 60% more than the EPI survey. The apparently homogeneous and low level of immunization coverage in the 27 subcentres makes this an impractical situation in which to apply LQAS, and the results obtained were therefore not particularly useful. However, if LQAS had been applied by local staff in an area with overall high coverage and population subunits with heterogeneous coverage, the method would have been less costly and should have produced useful results.

RNA-seq: technical variability and sampling

PubMed Central

2011-01-01

Background RNA-seq is revolutionizing the way we study transcriptomes. mRNA can be surveyed without prior knowledge of gene transcripts. Alternative splicing of transcript isoforms and the identification of previously unknown exons are being reported. Initial reports of differences in exon usage, and splicing between samples as well as quantitative differences among samples are beginning to surface. Biological variation has been reported to be larger than technical variation. In addition, technical variation has been reported to be in line with expectations due to random sampling. However, strategies for dealing with technical variation will differ depending on the magnitude. The size of technical variance, and the role of sampling are examined in this manuscript. Results In this study three independent Solexa/Illumina experiments containing technical replicates are analyzed. When coverage is low, large disagreements between technical replicates are apparent. Exon detection between technical replicates is highly variable when the coverage is less than 5 reads per nucleotide and estimates of gene expression are more likely to disagree when coverage is low. Although large disagreements in the estimates of expression are observed at all levels of coverage. Conclusions Technical variability is too high to ignore. Technical variability results in inconsistent detection of exons at low levels of coverage. Further, the estimate of the relative abundance of a transcript can substantially disagree, even when coverage levels are high. This may be due to the low sampling fraction and if so, it will persist as an issue needing to be addressed in experimental design even as the next wave of technology produces larger numbers of reads. We provide practical recommendations for dealing with the technical variability, without dramatic cost increases. PMID:21645359

High Throughput Transcriptomics @ USEPA (Toxicology ...

EPA Pesticide Factsheets

The ideal chemical testing approach will provide complete coverage of all relevant toxicological responses. It should be sensitive and specific It should identify the mechanism/mode-of-action (with dose-dependence). It should identify responses relevant to the species of interest. Responses should ideally be translated into tissue-, organ-, and organism-level effects. It must be economical and scalable. Using a High Throughput Transcriptomics platform within US EPA provides broader coverage of biological activity space and toxicological MOAs and helps fill the toxicological data gap. Slide presentation at the 2016 ToxForum on using High Throughput Transcriptomics at US EPA for broader coverage biological activity space and toxicological MOAs.

Coverage of Community-Based Management of Severe Acute Malnutrition Programmes in Twenty-One Countries, 2012-2013

PubMed Central

Rogers, Eleanor; Myatt, Mark; Woodhead, Sophie; Guerrero, Saul; Alvarez, Jose Luis

2015-01-01

Objective This paper reviews coverage data from programmes treating severe acute malnutrition (SAM) collected between July 2012 and June 2013. Design This is a descriptive study of coverage levels and barriers to coverage collected by coverage assessments of community-based SAM treatment programmes in 21 countries that were supported by the Coverage Monitoring Network. Data from 44 coverage assessments are reviewed. Setting These assessments analyse malnourished populations from 6 to 59 months old to understand the accessibility and coverage of services for treatment of acute malnutrition. The majority of assessments are from sub-Saharan Africa. Results Most of the programmes (33 of 44) failed to meet context-specific internationally agreed minimum standards for coverage. The mean level of estimated coverage achieved by the programmes in this analysis was 38.3%. The most frequently reported barriers to access were lack of awareness of malnutrition, lack of awareness of the programme, high opportunity costs, inter-programme interface problems, and previous rejection. Conclusions This study shows that coverage of CMAM is lower than previous analyses of early CTC programmes; therefore reducing programme impact. Barriers to access need to be addressed in order to start improving coverage by paying greater attention to certain activities such as community sensitisation. As barriers are interconnected focusing on specific activities, such as decentralising services to satellite sites, is likely to increase significantly utilisation of nutrition services. Programmes need to ensure that barriers are continuously monitored to ensure timely removal and increased coverage. PMID:26042827

Premium growth and its effect on employer-sponsored insurance.

PubMed

Vistnes, Jessica; Selden, Thomas

2011-03-01

We use variation in premium inflation and general inflation across geographic areas to identify the effects of downward nominal wage rigidity on employers' health insurance decisions. Using employer level data from the 2000 to 2005 Medical Expenditure Panel Survey-Insurance Component, we examine the effect of premium growth on the likelihood that an employer offers insurance, eligibility rates among employees, continuous measures of employee premium contributions for both single and family coverage, and deductibles. We find that small, low-wage employers are less likely to offer health insurance in response to increased premium inflation, and if they do offer coverage they increase employee contributions and deductible levels. In contrast, larger, low-wage employers maintain their offers of coverage, but reduce eligibility for such coverage. They also increase employee contributions for single and family coverage, but not deductibles. Among high-wage employers, all but the largest increase deductibles in response to cost pressures.

Systematic review of the incremental costs of interventions that increase immunization coverage.

PubMed

Ozawa, Sachiko; Yemeke, Tatenda T; Thompson, Kimberly M

2018-05-10

Achieving and maintaining high vaccination coverage requires investments, but the costs and effectiveness of interventions to increase coverage remain poorly characterized. We conducted a systematic review of the literature to identify peer-reviewed studies published in English that reported interventions aimed at increasing immunization coverage and the associated costs and effectiveness of the interventions. We found limited information in the literature, with many studies reporting effectiveness estimates, but not providing cost information. Using the available data, we developed a cost function to support future programmatic decisions about investments in interventions to increase immunization coverage for relatively low and high-income countries. The cost function estimates the non-vaccine cost per dose of interventions to increase absolute immunization coverage by one percent, through either campaigns or routine immunization. The cost per dose per percent increase in absolute coverage increased with higher baseline coverage, demonstrating increasing incremental costs required to reach higher coverage levels. Future studies should evaluate the performance of the cost function and add to the database of available evidence to better characterize heterogeneity in costs and generalizability of the cost function. Copyright © 2018. Published by Elsevier Ltd.

A qualitative analysis of immunization programs with sustained high coverage, 2000-2005.

PubMed

Kennedy, Allison; Groom, Holly; Evans, Victoria; Fasano, Nancy

2010-01-01

Despite record-high immunization coverage nationally, there is considerable variation across state and local immunization programs, which are responsible for the implementation of vaccine recommendations in their jurisdictions. The objectives of this study were to describe activities of state and local immunization programs that sustained high coverage levels across several years and to identify common themes and practical examples for sustaining childhood vaccination coverage rates that could be applied elsewhere. We conducted 95 semi-structured key informant interviews with internal staff members and external partners at the 10 immunization programs with the highest sustained childhood immunization coverage from 2000 to 2005, as measured by the National Immunization Survey. Interview transcripts were analyzed qualitatively using a general inductive approach. Common themes across the 10 programs included maintaining a strong program infrastructure, using available data to drive planning and decision making, a commitment to building and sustaining relationships, and a focus on education and communication. Given the challenges of an increasingly complex immunization system, the lessons learned from these programs may help inform others who are working to improve childhood immunization delivery and coverage in their own programs.

An adjusted bed net coverage indicator with estimations for 23 African countries

PubMed Central

2013-01-01

Background Many studies have assessed the level of bed net coverage in populations at risk of malaria infection. These revealed large variations in bed net use across countries, regions and social strata. Such studies are often aimed at identifying populations with low access to bed nets that should be prioritized in future interventions. However, often spatial differences in malaria endemicity are not taken into account. By ignoring variability in malaria endemicity, these studies prioritize populations with little access to bed nets, even if these happen to live in low endemicity areas. Conversely, populations living in regions with high malaria endemicity will receive a lower priority once a seizable proportion is protected by bed nets. Adequately assigning priorities requires accounting for both the current level of bed net coverage and the local malaria endemicity. Indeed, as shown here for 23 African countries, there is no correlation between the level of bed net coverage and the level of malaria endemicity in a region. Therefore, the need for future interventions can not be assessed based on current bed net coverage alone. This paper proposes the Adjusted Bed net Coverage (ABC) statistic as a measure taking into account both local malaria endemicity and the level of bed net coverage. The measure allows setting priorities for future interventions taking into account both local malaria endemicity and bed net coverage. Methods A mathematical formulation of the ABC as a weighted difference of bed net coverage and malaria endemicity is presented. The formulation is parameterized based on a model of malaria epidemiology (Smith et al. Trends Parasitol 25:511-516, 2009). By parameterizing the ABC based on this model, the ABC as used in this paper is proxy for the steady-state malaria burden given the current level of bed net coverage. Data on the bed net coverage in under five year olds and malaria endemicity in 23 Sub-Saharan countries is used to show that the ABC prioritizes different populations than the level of bed net coverage by itself. Data from the following countries was used: Angola, Burkina Faso, Burundi, Cameroon, Congo Democratic Republic, Ethiopia, Ghana, Guinea, Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique, Namibia, Nigeria, Rwanda, Senegal, Sierra Leone, Tanzania, Uganda, Zambia and Zimbabwe. The priority order given by the ABC and the bed net coverage are compared at the countries’ level, the first level administrative divisions and for five different wealth quintiles. Results Both at national level and at the level of the administrative divisions the ABC suggests a different priority order for selecting countries and divisions for future interventions. When taking into account malaria endemicity, measures assessing equality in access to bed nets across wealth quintiles, such as slopes of inequality, are prone to change. This suggests that when assessing inequality in access to bed nets one should take into account the local malaria endemicity for populations from different wealth quintiles. Conclusion Accounting for malaria endemicity highlights different countries, regions and socio-economic strata for future intervention than the bed net coverage by itself. Therefore, care should be taken to factor out any effects of local malaria endemicity in assessing bed net coverage and in prioritizing populations for further scale-up of bed net coverage. The ABC is proposed as a simple means to do this that is derived from an existing model of malaria epidemiology. PMID:24359227

Comparing errors in Medicaid reporting across surveys: evidence to date.

PubMed

Call, Kathleen T; Davern, Michael E; Klerman, Jacob A; Lynch, Victoria

2013-04-01

To synthesize evidence on the accuracy of Medicaid reporting across state and federal surveys. All available validation studies. Compare results from existing research to understand variation in reporting across surveys. Synthesize all available studies validating survey reports of Medicaid coverage. Across all surveys, reporting some type of insurance coverage is better than reporting Medicaid specifically. Therefore, estimates of uninsurance are less biased than estimates of specific sources of coverage. The CPS stands out as being particularly inaccurate. Measuring health insurance coverage is prone to some level of error, yet survey overstatements of uninsurance are modest in most surveys. Accounting for all forms of bias is complex. Researchers should consider adjusting estimates of Medicaid and uninsurance in surveys prone to high levels of misreporting. © Health Research and Educational Trust.

Enhanced surface modification engineering (H, F, Cl, Br, and NO{sub 2}) of CdS nanowires with and without surface dangling bonds

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zeng, Yijie; Xing, Huaizhong, E-mail: xinghz@dhu.edu.cn; Lu, Aijiang

2015-08-07

Semiconductor nanowires (NWs) can be applied in gas sensing and cell detection, but the sensing mechanism is not clearly understood. In this study, surface modification effect on the electronic properties of CdS NWs for different diameters with several species (H, F, Cl, Br, and NO{sub 2}) is investigated by first principles calculations. The surface dangling bonds and halogen elements are chosen to represent the environment of the surface. Halogen passivation drastically changes the band gaps due to the strong electronegativity and the energy level of halogen atoms. Density of states analysis indicates that valence band maximum (VBM) of halogen-passivated NWsmore » is formed by the p states of halogen atoms, while VBM of H-passivated NWs is originated from Cd 4d and S 3p orbitals. To illustrate that surface modification can be applied in gas sensing, NO{sub 2}-absorbed NWs with different coverage are calculated. Low coverage of NO{sub 2} introduces a deep p-type dopant-like level, while high coverage introduces a shallow n-type dopant-like level into the band structure. The transformation is due to that at low coverage the adsorption is chemical while at high coverage is physical. These findings might promote the understanding of surface modification effect and the sensing mechanism of NWs as gas sensors.« less

Cluster-sample surveys and lot quality assurance sampling to evaluate yellow fever immunisation coverage following a national campaign, Bolivia, 2007.

PubMed

Pezzoli, Lorenzo; Pineda, Silvia; Halkyer, Percy; Crespo, Gladys; Andrews, Nick; Ronveaux, Olivier

2009-03-01

To estimate the yellow fever (YF) vaccine coverage for the endemic and non-endemic areas of Bolivia and to determine whether selected districts had acceptable levels of coverage (>70%). We conducted two surveys of 600 individuals (25 x 12 clusters) to estimate coverage in the endemic and non-endemic areas. We assessed 11 districts using lot quality assurance sampling (LQAS). The lot (district) sample was 35 individuals with six as decision value (alpha error 6% if true coverage 70%; beta error 6% if true coverage 90%). To increase feasibility, we divided the lots into five clusters of seven individuals; to investigate the effect of clustering, we calculated alpha and beta by conducting simulations where each cluster's true coverage was sampled from a normal distribution with a mean of 70% or 90% and standard deviations of 5% or 10%. Estimated coverage was 84.3% (95% CI: 78.9-89.7) in endemic areas, 86.8% (82.5-91.0) in non-endemic and 86.0% (82.8-89.1) nationally. LQAS showed that four lots had unacceptable coverage levels. In six lots, results were inconsistent with the estimated administrative coverage. The simulations suggested that the effect of clustering the lots is unlikely to have significantly increased the risk of making incorrect accept/reject decisions. Estimated YF coverage was high. Discrepancies between administrative coverage and LQAS results may be due to incorrect population data. Even allowing for clustering in LQAS, the statistical errors would remain low. Catch-up campaigns are recommended in districts with unacceptable coverage.

Marital disruption and health insurance.

PubMed

Peters, H Elizabeth; Simon, Kosali; Taber, Jamie Rubenstein

2014-08-01

Despite the high levels of marital disruption in the United States and the fact that a significant portion of health insurance coverage for those less than age 65 is based on family membership, surprisingly little research is available on the consequences of marital disruption for the health insurance coverage of men, women, and children. We address this shortfall by examining patterns of coverage surrounding marital disruption for men, women, and children, further subset by educational level. Using the 1996, 2001, and 2004 panels of the Survey of Income and Program Participation (SIPP), we find large differences in health insurance coverage across marital status groups in the cross-section. In longitudinal analyses that focus on within-person change, we find small overall coverage changes but large changes in type of coverage following marital disruption. Both men and women show increases in private coverage in their own names, but offsetting decreases in dependent coverage tend to be larger. One surprising result is that dependent coverage for children also declines after marital dissolution, even though children are still likely to be eligible for that coverage. Children and (to a lesser extent) women show increases in public coverage around the time of divorce or separation. We also find that these patterns differ by education. The most vulnerable group appears to be lower-educated women with children because the increases in private, own-name, and public insurance are not large enough to offset the large decrease in dependent coverage. As the United States implements federal health reform, it is critical that we understand the ways in which life course events-specifically, marital disruption-shape the dynamic patterns of coverage.

Full-mouth treatment of gingival recessions and noncarious cervical lesions with coronally advanced flap and xenogeneic collagen matrix: 
a 2-year case report.

PubMed

Martiniello, Nello; Stefanini, Martina; Zucchelli, Giovanni

In clinical practice it is common to observe adjacent multiple gingival recessions (MGRs) associated with noncarious cervical lesions (NCCLs). The aim of this 2-year case report was to describe the full-mouth treatment of a patient affected by MGRs and NCCLs, with a combined restorative-surgical approach using a coronally advanced flap (CAF) and a xenogeneic collagen matrix (CM). Before surgery, a composite restoration filled the deepest portion of the NCCL defects and was finished at the level of the maximum root coverage (MRC). The surgical technique adopted for the root coverage procedures was CAF for MGRs without vertical releasing incisions in the maxilla, and with one vertical releasing incision in the mandible. The CM was positioned at the level of the cementoenamel junction (CEJ), and sutured at the base of the anatomic de-epithelialized papillae. The flap was shifted coronally, providing complete coverage of the CM, and sutured coronal to the CEJ with a variable number of sling sutures. At 2 years, complete root coverage was achieved in all treated sites, and the patient reported complete resolution of dental hypersensitivity. In the questionnaire, the patient-reported outcome showed a high level of esthetic satisfaction (mean score: 9.6; range: 9 to 10), and the objective esthetic evaluation with the root coverage esthetic score (RES) system showed a very high result (mean: 9.4). The suggested combined restorative-surgical approach provided successful root coverage and a favorable esthetic outcome in the treatment of MGR associated with NCCLs.

Evaluation of human papilloma virus (HPV) vaccination strategies and vaccination coverage in adolescent girls worldwide.

PubMed

Owsianka, Barbara; Gańczak, Maria

2015-01-01

An analysis of HPV vaccination strategies and vaccination coverage in adolescent girls worldwide for the last eight years with regard to potential improvement of vaccination coverage rates in Poland. Literature search, covering the period 2006-2014, was performed using Medline. Comparative analysis of HPV vaccination strategies and coverage between Poland and other countries worldwide was conducted. In the last eight years, a number of countries introduced HPV vaccination for adolescent girls to their national immunization programmes. Vaccination strategies differ, consequently affecting vaccination coverage, ranging from several percent to more than 90%. Usually, there are also disparities at national level. The highest HPV vaccination coverage rates are observed in countries where vaccines are administered in school settings and funded from the national budget. Poland is one of the eight EU countries where HPV vaccination has not been introduced to mandatory immunization programme and where paid vaccination is only provided in primary health care settings. HPV vaccination coverage in adolescent girls is estimated at 7.5-10%. Disparities in HPV vaccination coverage rates in adolescent girls worldwide may be due to different strategies of vaccination implementation between countries. Having compared to other countries, the low HPV vaccination coverage in Polish adolescent girls may result from the lack of funding at national level and the fact that vaccines are administered in a primary health care setting. A multidimensional approach, involving the engagement of primary health care and school personnel as well as financial assistance of government at national and local level and the implementation of media campaigns, particularly in regions with high incidence of cervical cancer, could result in an increase of HPV vaccination coverage rates in Poland.

Balancing Evidence and Uncertainty when Considering Rubella Vaccine Introduction

PubMed Central

Lessler, Justin; Metcalf, C. Jessica E.

2013-01-01

Background Despite a safe and effective vaccine, rubella vaccination programs with inadequate coverage can raise the average age of rubella infection; thereby increasing rubella cases among pregnant women and the resulting congenital rubella syndrome (CRS) in their newborns. The vaccination coverage necessary to reduce CRS depends on the birthrate in a country and the reproductive number, R0, a measure of how efficiently a disease transmits. While the birthrate within a country can be known with some accuracy, R0 varies between settings and can be difficult to measure. Here we aim to provide guidance on the safe introduction of rubella vaccine into countries in the face of substantial uncertainty in R0. Methods We estimated the distribution of R0 in African countries based on the age distribution of rubella infection using Bayesian hierarchical models. We developed an age specific model of rubella transmission to predict the level of R0 that would result in an increase in CRS burden for specific birth rates and coverage levels. Combining these results, we summarize the safety of introducing rubella vaccine across demographic and coverage contexts. Findings The median R0 of rubella in the African region is 5.2, with 90% of countries expected to have an R0 between 4.0 and 6.7. Overall, we predict that countries maintaining routine vaccination coverage of 80% or higher are can be confident in seeing a reduction in CRS over a 30 year time horizon. Conclusions Under realistic assumptions about human contact, our results suggest that even in low birth rate settings high vaccine coverage must be maintained to avoid an increase in CRS. These results lend further support to the WHO recommendation that countries reach 80% coverage for measles vaccine before introducing rubella vaccination, and highlight the importance of maintaining high levels of vaccination coverage once the vaccine is introduced. PMID:23861777

Balancing evidence and uncertainty when considering rubella vaccine introduction.

PubMed

Lessler, Justin; Metcalf, C Jessica E

2013-01-01

Despite a safe and effective vaccine, rubella vaccination programs with inadequate coverage can raise the average age of rubella infection; thereby increasing rubella cases among pregnant women and the resulting congenital rubella syndrome (CRS) in their newborns. The vaccination coverage necessary to reduce CRS depends on the birthrate in a country and the reproductive number, R0, a measure of how efficiently a disease transmits. While the birthrate within a country can be known with some accuracy, R0 varies between settings and can be difficult to measure. Here we aim to provide guidance on the safe introduction of rubella vaccine into countries in the face of substantial uncertainty in R0. We estimated the distribution of R0 in African countries based on the age distribution of rubella infection using Bayesian hierarchical models. We developed an age specific model of rubella transmission to predict the level of R0 that would result in an increase in CRS burden for specific birth rates and coverage levels. Combining these results, we summarize the safety of introducing rubella vaccine across demographic and coverage contexts. The median R0 of rubella in the African region is 5.2, with 90% of countries expected to have an R0 between 4.0 and 6.7. Overall, we predict that countries maintaining routine vaccination coverage of 80% or higher are can be confident in seeing a reduction in CRS over a 30 year time horizon. Under realistic assumptions about human contact, our results suggest that even in low birth rate settings high vaccine coverage must be maintained to avoid an increase in CRS. These results lend further support to the WHO recommendation that countries reach 80% coverage for measles vaccine before introducing rubella vaccination, and highlight the importance of maintaining high levels of vaccination coverage once the vaccine is introduced.

Exposure-response relationship of neighbourhood sanitation and children's diarrhoea.

PubMed

Jung, Youngmee Tiffany; Lou, Wendy; Cheng, Yu-Ling

2017-07-01

To assess the association of neighbourhood sanitation coverage with under-five children's diarrhoeal morbidity and to evaluate its exposure-response relationship. We used the Demographic and Health Surveys (DHS) of 29 developing countries in sub-Saharan Africa and South Asia, conducted between 2010 and 2014. The primary outcome was two-week incidence of diarrhoea in children under 5 years of age (N = 269014). We conducted three-level logistic regression analyses and applied cubic splines to assess the trend between neighbourhood-level coverage of improved household sanitation and diarrhoeal morbidity. A significant association between neighbourhood-level coverage of improved household sanitation and diarrhoeal morbidity (OR [95% CI] = 0.68 [0.62-0.76]) was found. Exposure-relationship analyses results showed improved sanitation coverage threshold at 0.6. We found marginal degree of association (OR [95% CI] = 0.82 [0.77-0.87]) below the threshold, which, beyond the threshold, sharply increased to OR of 0.44 (95% CI: 0.29-0.67) at sanitation coverage of 1 (i.e. neighbourhood-wide use of improved household sanitation). Similar exposure-response trends were identified for urban and rural subgroups. Our findings suggest that neighbourhood sanitation plays a key role in reducing diarrhoeal diseases and that increase in sanitation coverage may only have minimal impact on diarrhoeal illness, unless sufficiently high coverage is achieved. © 2017 John Wiley & Sons Ltd.

Improving estimates of insecticide-treated mosquito net coverage from household surveys: using geographic coordinates to account for endemicity

PubMed Central

2014-01-01

Background Coverage estimates of insecticide-treated nets (ITNs) are often calculated at the national level, but are intended to be a proxy for coverage among the population at risk of malaria. The analysis uses data for surveyed households, linking survey enumeration areas (clusters) with levels of malaria endemicity and adjusting coverage estimates based on the population at risk. This analysis proposes an approach that is not dependent on being able to identify malaria risk in a location during the survey design (since survey samples are typically selected on the basis of census sampling frames that do not include information on malaria zones), but rather being able to assign risk zones after a survey has already been completed. Methods The analysis uses data from 20 recent nationally representative Demographic and Health Survey (DHS), Malaria Indicator Surveys (MIS), an AIDS Indicator Survey (AIS), and an Anemia and Malaria Prevalence Survey (AMP). The malaria endemicity classification was assigned from the Malaria Atlas Project (MAP) 2010 interpolated data layers, using the Geographic Positioning System (GPS) location of the survey clusters. National ITN coverage estimates were compared with coverage estimates in intermediate/high endemicity zones (i.e., the population at risk of malaria) to determine whether the difference between estimates was statistically different from zero (p-value <0.5). Results Endemicity varies substantially in eight of the 20 studied countries. In these countries with heterogeneous transmission of malaria, stratification of households by endemicity zones shows that ITN coverage in intermediate/high endemicity zones is significantly higher than ITN coverage at the national level (Burundi, Kenya, Namibia, Rwanda, Tanzania, Senegal, Zambia, and Zimbabwe.). For example in Zimbabwe, the national ownership of ITNs is 28%, but ownership in the intermediate/high endemicity zone is 46%. Conclusion Incorporating this study’s basic and easily reproducible approach into estimates of ITN coverage is applicable and even preferable in countries with areas at no/low risk of malaria and will help ensure that the highest-quality data are available to inform programmatic decisions in countries affected by malaria. The extension of this type of analysis to other malaria interventions can provide further valuable information to support evidence-based decision-making. PMID:24993082

A review of measles supplementary immunization activities and the implications for Pacific Island countries and territories.

PubMed

Clements, C John; Soakai, Taniela Sunia; Sadr-Azodi, Nahad

2017-02-01

Standard measles control strategies include achieving high levels of measles vaccine coverage using routine delivery systems, supplemented by mass immunization campaigns as needed to close population immunity gaps. Areas covered: This review looks at how supplementary immunization activities (SIAs) have contributed to measles control globally, and asks whether such a strategy has a place in Pacific Islands today. Expert commentary: Very high coverage with two doses of measles vaccine seems to be the optimal strategy for controlling measles. By 2015, all but two Pacific Islands had introduced a second dose in the routine schedule; however, a number of countries have not yet reached high coverage with their second dose. The literature and the country reviews reported here suggest that a high coverage SIA combined with one dose of measles vaccine given in the routine system will also do the job. The arguments for and against the use of SIAs are complex, but it is clear that to be effective, SIAs need to be well designed to meet specific needs, must be carried out effectively and safely with very high coverage, and should, when possible, carry with them other public health interventions to make them even more cost-effective.

Can ivermectin mass treatments eliminate onchocerciasis in Africa?

PubMed Central

Winnen, M.; Plaisier, A. P.; Alley, E. S.; Nagelkerke, N. J. D.; van Oortmarssen, G.; Boatin, B. A.; Habbema, J. D. F.

2002-01-01

OBJECTIVE: To elucidate the conditions in which mass treatment with ivermectin reduces the transmission of Onchocerca volvulus sufficiently to eliminate infection from an African community. METHODS: ONCHOSIM, a microsimulation model for onchocerciasis transmission, was used to explore the implications of different treatment intervals, coverage levels and precontrol endemicities for the likelihood of elimination. FINDINGS: Simulations suggested that control strategies based exclusively on ivermectin mass treatments could eliminate onchocerciasis. The duration of treatment required to eliminate infection depended heavily on the treatment programme and precontrol endemicity. In areas with medium to high levels of infection, annual mass treatments with 65% coverage for at least 25 years were necessary. Model predictions suggested that durations exceeding 35 years would be required if there were much heterogeneity in exposure to vector bites and, consequently, wide individual variation in microfilaria counts. If the treatment interval were reduced from 12 to 6 months the time for completion of the programme could be more than halved and elimination could be accomplished in areas of hyperendemicity, provided that the effects of each treatment would be the same as with annual treatments. However, it was doubtful whether high coverage levels could be sustained long enough to achieve worldwide eradication. CONCLUSION: Elimination of onchocerciasis from most endemic foci in Africa appears to be possible. However, the requirements in terms of duration, coverage, and frequency of treatment may be prohibitive in highly endemic areas. PMID:12077614

Comparing Errors in Medicaid Reporting across Surveys: Evidence to Date

PubMed Central

Call, Kathleen T; Davern, Michael E; Klerman, Jacob A; Lynch, Victoria

2013-01-01

Objective To synthesize evidence on the accuracy of Medicaid reporting across state and federal surveys. Data Sources All available validation studies. Study Design Compare results from existing research to understand variation in reporting across surveys. Data Collection Methods Synthesize all available studies validating survey reports of Medicaid coverage. Principal Findings Across all surveys, reporting some type of insurance coverage is better than reporting Medicaid specifically. Therefore, estimates of uninsurance are less biased than estimates of specific sources of coverage. The CPS stands out as being particularly inaccurate. Conclusions Measuring health insurance coverage is prone to some level of error, yet survey overstatements of uninsurance are modest in most surveys. Accounting for all forms of bias is complex. Researchers should consider adjusting estimates of Medicaid and uninsurance in surveys prone to high levels of misreporting. PMID:22816493

Why CO bonds side-on at low coverage and both side-on and upright at high coverage on the Cr(110) surface

NASA Technical Reports Server (NTRS)

Mehandru, S. P.; Anderson, A. B.

1985-01-01

An atom superposition and electron delocalization molecular orbital study of CO adsorption on the Cr(110) surface shows a high coordinate lying down orientation is favored. This is a result of the large number of empty d-band energy levels in chromium, which allows the antibonding counterparts to sigma and pi donation bonds to the surface to be empty. When lying down, backbonding to CO pi sup * orbitals is enhanced. Repulsive interactions cause additional CO to stand upright at 1/4 monolyer coverage. The results confirm the recent experimental study of Shinn and Madey.

The Impact of State Legislation and Model Policies on Bullying in Schools.

PubMed

Terry, Amanda

2018-04-01

The purpose of this study was to determine the impact of the coverage of state legislation and the expansiveness ratings of state model policies on the state-level prevalence of bullying in schools. The state-level prevalence of bullying in schools was based on cross-sectional data from the 2013 High School Youth Risk Behavior Survey. Multiple regression was conducted to determine whether the coverage of state legislation and the expansiveness rating of a state model policy affected the state-level prevalence of bullying in schools. The purpose and definition category of components in state legislation and the expansiveness rating of a state model policy were statistically significant predictors of the state-level prevalence of bullying in schools. The other 3 categories of components in state legislation-District Policy Development and Review, District Policy Components, and Additional Components-were not statistically significant predictors in the model. Extensive coverage in the purpose and definition category of components in state legislation and a high expansiveness rating of a state model policy may be important in efforts to reduce bullying in schools. Improving these areas may reduce the state-level prevalence of bullying in schools. © 2018, American School Health Association.

45 CFR 800.107 - Levels of coverage.

Code of Federal Regulations, 2014 CFR

2014-10-01

... to offer an MSP pursuant to a contract with OPM. (b) Bronze or platinum metal levels of coverage... coverage or the platinum level of coverage, or both, on any Exchange or SHOP in any State. (c) Child-only...

45 CFR 800.107 - Levels of coverage.

Code of Federal Regulations, 2013 CFR

2013-10-01

... to offer an MSP pursuant to a contract with OPM. (b) Bronze or platinum metal levels of coverage... coverage or the platinum level of coverage, or both, on any Exchange or SHOP in any State. (c) Child-only...

Influenza Vaccination Coverage among Adults in Korea: 2008–2009 to 2011–2012 Seasons

PubMed Central

Yang, Hye Jung; Cho, Sung-il

2014-01-01

The aim of this study was to examine seasonal and pandemic influenza vaccination coverage in adults from the 2008–2009 season to the 2011–2012 season, including pandemic and post-pandemic seasons in Korea. We collected data of self-reported vaccine use from the Korean Community Health Survey. We also collected information on socioeconomic status and health behaviors in subpopulations. We tested for linear trends among the data to investigate vaccine coverage before and after the pandemic; and multiple logistic regression analyses were performed to identify predictors of obtaining the influenza vaccination. The results revealed a steady increase in vaccination coverage in every subgroup during four consecutive seasons. The highest rate of vaccine coverage (43.6%) occurred two years after the pandemic. Factors associated with vaccine receipt were: older age; lower education level; lower income; and health behaviors such as regular walking and receiving a health check-up. Smoking and drinking alcohol were inversely associated with vaccination. Having a chronic health condition was also a strong predictor of vaccine receipt. Though vaccination coverage rates were high in high-risk groups; disparities in coverage rates were substantial; particularly in young adults. Interventions are needed to minimize the coverage gaps among subgroups and to improve overall vaccination rates. PMID:25429683

Influenza vaccination coverage among adults in Korea: 2008-2009 to 2011-2012 seasons.

PubMed

Yang, Hye Jung; Cho, Sung-Il

2014-11-25

The aim of this study was to examine seasonal and pandemic influenza vaccination coverage in adults from the 2008-2009 season to the 2011-2012 season, including pandemic and post-pandemic seasons in Korea. We collected data of self-reported vaccine use from the Korean Community Health Survey. We also collected information on socioeconomic status and health behaviors in subpopulations. We tested for linear trends among the data to investigate vaccine coverage before and after the pandemic; and multiple logistic regression analyses were performed to identify predictors of obtaining the influenza vaccination. The results revealed a steady increase in vaccination coverage in every subgroup during four consecutive seasons. The highest rate of vaccine coverage (43.6%) occurred two years after the pandemic. Factors associated with vaccine receipt were: older age; lower education level; lower income; and health behaviors such as regular walking and receiving a health check-up. Smoking and drinking alcohol were inversely associated with vaccination. Having a chronic health condition was also a strong predictor of vaccine receipt. Though vaccination coverage rates were high in high-risk groups; disparities in coverage rates were substantial; particularly in young adults. Interventions are needed to minimize the coverage gaps among subgroups and to improve overall vaccination rates.

Overview of Global, Regional, and National Routine Vaccination Coverage Trends and Growth Patterns From 1980 to 2009: Implications for Vaccine-Preventable Disease Eradication and Elimination Initiatives

PubMed Central

Wallace, Aaron S.; Ryman, Tove K.; Dietz, Vance

2015-01-01

Background Review of the historical growth in annual vaccination coverage across countries and regions can better inform decision makers’ development of future goals and strategies to improve routine vaccination services. Methods Using the World Health Organization (WHO) and the United Nations Children's Fund estimates of annual national third dose of diphtheria-tetanus-pertussis–containing vaccine (DTP3) and third dose of polio vaccine (POL3) coverage for 1980–2009, we calculated the mean absolute annual rate of change in national DTP3 coverage among all countries (globally) and among countries within each WHO region, as well as the number of years taken by each region to reach specific regional coverage levels. Last, we assessed differences in mean absolute annual rate of change in DTP3 coverage, stratified by baseline level of DTP3 coverage. Results During the 1980s, global DTP3 coverage increased a mean of 5.3 percentage points/year. Annual rate of change decreased to 0.5 percentage points/year in the 1990s and then increased to 0.9 percentage points/year during the 2000s. Mean annual rate of change in coverage across all countries was highest (9.2 percentage points) when national coverage levels were 26%–30% and lowest (−0.9 percentage points) when national coverage levels were 96%–100%. Regional differences existed as both WHO South-East Asia Region and WHO African Region countries experienced mean negative DTP3 coverage growth at lower coverage levels (81%–85%) than other regions. The regions that have achieved 95% DTP3 coverage (Americas, Western Pacific, and European) took 25–29 years to reach that level from a level of 50% DTP3 coverage. POL3 coverage change trends were similar to described DTP3 coverage change trends. Conclusions Mean national coverage growth patterns across all regions are nonlinear as coverage levels increase. Saturation points of mean 0 percentage-point growth in annual coverage varies by region and require further investigation. The achievement of >90% routine coverage is observed to take decades, which has implications for disease eradication and elimination initiatives. PMID:25316875

Is endemic political corruption hampering provision of ART and PMTCT in developing countries?

PubMed

Young Nicola Man, Wing; Worth, Heather; Kelly, Angela; Wilson, David P; Siba, Peter

2014-01-01

Leadership is a key factor in the success of HIV prevention and treatment. Positive HIV-related outcomes are also affected by funding levels for HIV, health sector resources, disease burden and the socio-economic environment. Leadership on HIV as well as these other factors are affected by the quality of political governance of the country, which may be an overarching factor that influences the making of effective responses to the HIV epidemic. The aim of the study was to investigate the association between quality of political governance, on one hand, and coverage of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT), on the other, in low- to middle-income countries. This investigation was carried out through a global review, online data sourcing and statistical analyses. We collected data on health burden and resources, the socio-economic environment, HIV prevalence, ART and PMTCT coverage and indicators of political governance. Outcome variables were coverage of ART (from 2004) and PMTCT (from 2007) to 2009 as a percentage of persons needing it. Potential predictors of treatment coverage were fitted with a baseline multilevel model for univariable and multivariable analyses. Countries with higher levels of political voice and accountability, more political stability and better control of corruption have higher levels of ART coverage but not PMTCT coverage. Control of corruption (in standard deviation units) had a strong association with ART (AOR=1.82, p=0.002) and PMTCT (AOR=1.97, p=0.01) coverage. Indicators of economic development were not significant when control of corruption was included in the multivariable regression model. Many countries in all income groups had high ART but not PMTCT coverage (e.g. Mexico, Brazil and Romania in the upper-middle-income group; Papua New Guinea and Philippines in the lower-middle-income group; and Cambodia, Laos and Comoros in the low-income group). Very few low-income countries (notably, Haiti and Kenya) had high PMTCT coverage. Our research found a significant relationship between quality of political governance and treatment coverage. Measures and policies for improving the quality of political governance should be considered as a part of HIV programme implementation to more effectively improve the welfare of people living with HIV, particularly mothers living with HIV and their babies.

Is endemic political corruption hampering provision of ART and PMTCT in developing countries?

PubMed Central

Man, Wing Young Nicola; Worth, Heather; Kelly, Angela; Wilson, David P; Siba, Peter

2014-01-01

Introduction Leadership is a key factor in the success of HIV prevention and treatment. Positive HIV-related outcomes are also affected by funding levels for HIV, health sector resources, disease burden and the socio-economic environment. Leadership on HIV as well as these other factors are affected by the quality of political governance of the country, which may be an overarching factor that influences the making of effective responses to the HIV epidemic. Aim The aim of the study was to investigate the association between quality of political governance, on one hand, and coverage of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT), on the other, in low- to middle-income countries. Methods This investigation was carried out through a global review, online data sourcing and statistical analyses. We collected data on health burden and resources, the socio-economic environment, HIV prevalence, ART and PMTCT coverage and indicators of political governance. Outcome variables were coverage of ART (from 2004) and PMTCT (from 2007) to 2009 as a percentage of persons needing it. Potential predictors of treatment coverage were fitted with a baseline multilevel model for univariable and multivariable analyses. Results Countries with higher levels of political voice and accountability, more political stability and better control of corruption have higher levels of ART coverage but not PMTCT coverage. Control of corruption (in standard deviation units) had a strong association with ART (AOR=1.82, p=0.002) and PMTCT (AOR=1.97, p=0.01) coverage. Indicators of economic development were not significant when control of corruption was included in the multivariable regression model. Many countries in all income groups had high ART but not PMTCT coverage (e.g. Mexico, Brazil and Romania in the upper-middle-income group; Papua New Guinea and Philippines in the lower-middle-income group; and Cambodia, Laos and Comoros in the low-income group). Very few low-income countries (notably, Haiti and Kenya) had high PMTCT coverage. Conclusions Our research found a significant relationship between quality of political governance and treatment coverage. Measures and policies for improving the quality of political governance should be considered as a part of HIV programme implementation to more effectively improve the welfare of people living with HIV, particularly mothers living with HIV and their babies. PMID:24802716

Assessing Requirements Quality through Requirements Coverage

NASA Technical Reports Server (NTRS)

Rajan, Ajitha; Heimdahl, Mats; Woodham, Kurt

2008-01-01

In model-based development, the development effort is centered around a formal description of the proposed software system the model. This model is derived from some high-level requirements describing the expected behavior of the software. For validation and verification purposes, this model can then be subjected to various types of analysis, for example, completeness and consistency analysis [6], model checking [3], theorem proving [1], and test-case generation [4, 7]. This development paradigm is making rapid inroads in certain industries, e.g., automotive, avionics, space applications, and medical technology. This shift towards model-based development naturally leads to changes in the verification and validation (V&V) process. The model validation problem determining that the model accurately captures the customer's high-level requirements has received little attention and the sufficiency of the validation activities has been largely determined through ad-hoc methods. Since the model serves as the central artifact, its correctness with respect to the users needs is absolutely crucial. In our investigation, we attempt to answer the following two questions with respect to validation (1) Are the requirements sufficiently defined for the system? and (2) How well does the model implement the behaviors specified by the requirements? The second question can be addressed using formal verification. Nevertheless, the size and complexity of many industrial systems make formal verification infeasible even if we have a formal model and formalized requirements. Thus, presently, there is no objective way of answering these two questions. To this end, we propose an approach based on testing that, when given a set of formal requirements, explores the relationship between requirements-based structural test-adequacy coverage and model-based structural test-adequacy coverage. The proposed technique uses requirements coverage metrics defined in [9] on formal high-level software requirements and existing model coverage metrics such as the Modified Condition and Decision Coverage (MC/DC) used when testing highly critical software in the avionics industry [8]. Our work is related to Chockler et al. [2], but we base our work on traditional testing techniques as opposed to verification techniques.

High Tempo Knowledge Collaboration in Wikipedia's Coverage of Breaking News Events

ERIC Educational Resources Information Center

Keegan, Brian C.

2012-01-01

When major news breaks in our hyper-connected society, we increasingly turn to an encyclopedia for the latest information. Wikipedia's coverage of breaking news events attracts unique levels of attention; the articles with the most page views, edits, and contributors in any given month since 2003 are related to current events. Extant…

Improving the cost-effectiveness of IRS with climate informed health surveillance systems

PubMed Central

Worrall, Eve; Connor, Stephen J; Thomson, Madeleine C

2008-01-01

Background This paper examines how the cost-effectiveness of IRS varies depending on the severity of transmission and level of programme coverage and how efficiency could be improved by incorporating climate information into decision making for malaria control programmes as part of an integrated Malaria Early Warning and Response System (MEWS). Methods A climate driven model of malaria transmission was used to simulate cost-effectiveness of alternative IRS coverage levels over six epidemic and non-epidemic years. Decision rules for a potential MEWS system that triggers different IRS coverage are described. The average and marginal cost per case averted with baseline IRS coverage (24%) and under varying IRS coverage levels (50%, 75% and 100%) were calculated. Results Average cost-effectiveness of 24% coverage varies dramatically between years, from US$108 per case prevented in low transmission to US$0.42 in epidemic years. Similarly for higher coverage (24–100%) cost per case prevented is far higher in low than high transmission years ($108–$267 to $0.88–$2.26). Discussion Efficiency and health benefit gains could be achieved by implementing MEWS that provides timely, accurate information. Evidence from southern Africa, (especially Botswana) supports this. Conclusion Advance knowledge of transmission severity can help managers make coverage decisions which optimise resource use and exploit efficiency gains if a fully integrated MEWS is in place alongside a health system with sufficient flexibility to modify control plans in response to information. More countries and programmes should be supported to use the best available evidence and science to integrate climate informed MEWS into decision making within malaria control programmes. PMID:19108723

Vaccination coverage among children in kindergarten--United States, 2009-10 school year.

PubMed

2011-06-03

Healthy People 2020 objectives include maintaining vaccination coverage among children in kindergarten (IID-10) (1). The target is ≥95% vaccination coverage for the following vaccines: poliovirus; diphtheria and tetanus toxoids and acellular pertussis (DTP/DTaP/DT); measles, mumps, and rubella (MMR); hepatitis B (HepB); and varicella (1). Data from school assessment surveys are used to monitor vaccination coverage and vaccination exemption levels among children enrolled in kindergarten. This report summarizes data from school assessment surveys submitted to CDC by 48 federal immunization program grantees (including 47 states and the District of Columbia) for the 2009-10 school year to describe vaccination coverage and exemption rates (2). For that period, 17 grantees reported coverage of ?95% for four vaccines (poliovirus, DTP/DTaP/DT, MMR, and HepB) and four grantees reported coverage of ≥95% for 2 doses of varicella vaccine. Total exemption rates, including medical, religious, and philosophical exemptions, ranged from <1% to 6.2% across grantees, and 15 grantees reported exemption rates<1%. Survey methods for vaccination coverage and exemption rates varied among grantees, making comparisons difficult and limiting the use of school assessment surveys to report aggregate national rates. Further standardization of school assessment survey methods will generate comparable data between grantees to monitor and track progress in reaching national objectives, and allow development of best practice guidelines for grantees to more effectively use and report school coverage and exemption data. CDC will continue to monitor vaccination coverage and exemption levels and assist grantees in identification of local areas with low vaccination coverage or high exemption rates for further evaluation or intervention.

Health care access, concentrated poverty, and pediatric asthma hospital care use in California's San Joaquin Valley: A multilevel approach.

PubMed

Alcala, Emanuel; Cisneros, Ricardo; Capitman, John A

2017-12-20

California's San Joaquin Valley is a region with a history of poverty, low health care access, and high rates of pediatric asthma. It is important to understand the potential barriers to care that challenge vulnerable populations. The objective was to describe pediatric asthma-related utilization patterns in the emergency department (ED) and hospital by insurance coverage as well as to identify contributing individual-level indicators (age, sex, race/ethnicity, and insurance coverage) and neighborhood-level indicators of health care access. This was a retrospective study based on secondary data from California hospital and ED records 2007-2012. Children who used services for asthma-related conditions, were aged 0-14 years, Hispanic or non-Hispanic white, and resided in the San Joaquin Valley were included in the analysis. Poisson multilevel modeling was used to control for individual- and neighborhood-level factors. The effect of insurance coverage on asthma ED visits and hospitalizations was modified by the neighborhood-level percentage of concentrated poverty (RR = 1.01, 95% CI = 1.01-1.02; RR = 1.03, 95% CI = 1.02-1.04, respectively). The effect of insurance coverage on asthma hospitalizations was completely explained by the neighborhood-level percentage of concentrated poverty. Observed effects of insurance coverage on hospital care use were significantly modified by neighborhood-level measures of health care access and concentrated poverty. This suggests not only an overall greater risk for poor children on Medi-Cal, but also a greater vulnerability or response to neighborhood social factors such as socioeconomic status, community cohesiveness, crime, and racial/ethnic segregation.

A method for deriving a 4D-interpolated balanced planning target for mobile tumor radiotherapy.

PubMed

Roland, Teboh; Hales, Russell; McNutt, Todd; Wong, John; Simari, Patricio; Tryggestad, Erik

2012-01-01

Tumor control and normal tissue toxicity are strongly correlated to the tumor and normal tissue volumes receiving high prescribed dose levels in the course of radiotherapy. Planning target definition is, therefore, crucial to ensure favorable clinical outcomes. This is especially important for stereotactic body radiation therapy of lung cancers, characterized by high fractional doses and steep dose gradients. The shift in recent years from population-based to patient-specific treatment margins, as facilitated by the emergence of 4D medical imaging capabilities, is a major improvement. The commonly used motion-encompassing, or internal-target volume (ITV), target definition approach provides a high likelihood of coverage for the mobile tumor but inevitably exposes healthy tissue to high prescribed dose levels. The goal of this work was to generate an interpolated balanced planning target that takes into account both tumor coverage and normal tissue sparing from high prescribed dose levels, thereby improving on the ITV approach. For each 4DCT dataset, 4D deformable image registration was used to derive two bounding targets, namely, a 4D-intersection and a 4D-composite target which minimized normal tissue exposure to high prescribed dose levels and maximized tumor coverage, respectively. Through definition of an "effective overlap volume histogram" the authors derived an "interpolated balanced planning target" intended to balance normal tissue sparing from prescribed doses with tumor coverage. To demonstrate the dosimetric efficacy of the interpolated balanced planning target, the authors performed 4D treatment planning based on deformable image registration of 4D-CT data for five previously treated lung cancer patients. Two 4D plans were generated per patient, one based on the interpolated balanced planning target and the other based on the conventional ITV target. Plans were compared for tumor coverage and the degree of normal tissue sparing resulting from the new approach was quantified. Analysis of the 4D dose distributions from all five patients showed that while achieving tumor coverage comparable to the ITV approach, the new planning target definition resulted in reductions of lung V(10), V(20), and V(30) of 6.3% ± 1.7%, 10.6% ± 3.9%, and 12.9% ± 5.5%, respectively, as well as reductions in mean lung dose, mean dose to the GTV-ring and mean heart dose of 8.8% ± 2.5%, 7.2% ± 2.5%, and 10.6% ± 3.6%, respectively. The authors have developed a simple and systematic approach to generate a 4D-interpolated balanced planning target volume that implicitly incorporates the dynamics of respiratory-organ motion without requiring 4D-dose computation or optimization. Preliminary results based on 4D-CT data of five previously treated lung patients showed that this new planning target approach may improve normal tissue sparing without sacrificing tumor coverage.

To close the childhood immunization gap, we need a richer understanding of parents' decision-making.

PubMed

Corben, Paul; Leask, Julie

2016-12-01

Vaccination is widely acknowledged as one of the most successful public health interventions globally and in most high-income countries childhood vaccination coverage rates are moderately high. Yet in many instances, immunisation rates remain below aspirational targets and have shown only modest progress toward those targets in recent years, despite concerted efforts to improve uptake. In part, coverage rates reflect individual parents' vaccination attitudes and decisions and, because vaccination decision-making is complex and context-specific, it remains challenging at individual and community levels to assist parents to make positive decisions. Consequently, in the search for opportunities to improve immunisation coverage, there has been a renewed research focus on parents' decision-making. This review provides an overview of the literature surrounding parents' vaccination decision-making, offering suggestions for where efforts to increase vaccination coverage should be targeted and identifying areas for further research.

Income Eligibility Thresholds, Premium Contributions, and Children's Coverage Outcomes: A Study of CHIP Expansions

PubMed Central

Gresenz, Carole Roan; Edgington, Sarah E; Laugesen, Miriam J; Escarce, José J

2013-01-01

Objective To understand the effects of Children's Health Insurance Program (CHIP) income eligibility thresholds and premium contribution requirements on health insurance coverage outcomes among children. Data Sources 2002–2009 Annual Social and Economic Supplements of the Current Population Survey linked to data from multiple secondary data sources. Study Design We use a selection correction model to simultaneously estimate program eligibility and coverage outcomes conditional upon eligibility. We simulate the effects of three premium schedules representing a range of generosity levels and the effects of income eligibility thresholds ranging from 200 to 400 percent of the federal poverty line. Principal Findings Premium contribution requirements decrease enrollment in public coverage and increase enrollment in private coverage, with larger effects for greater contribution levels. Our simulation results suggest minimal changes in coverage outcomes from eligibility expansions to higher income families under premium schedules that require more than a modest contribution (medium or high schedules). Conclusions Our simulation results are useful counterpoints to previous research that has estimated the average effect of program expansions as they were implemented without disentangling the effects of premiums or other program features. The sensitivity to premiums observed suggests that although contribution requirements may be effective in reducing crowd-out, they also have the potential, depending on the level of contribution required, to nullify the effects of CHIP expansions entirely. The persistence of uninsurance among children under the range of simulated scenarios points to the importance of Affordable Care Act provisions designed to make the process of obtaining coverage transparent and navigable. PMID:23398477

Income eligibility thresholds, premium contributions, and children's coverage outcomes: a study of CHIP expansions.

PubMed

Gresenz, Carole Roan; Edgington, Sarah E; Laugesen, Miriam J; Escarce, José J

2013-04-01

To understand the effects of Children's Health Insurance Program (CHIP) income eligibility thresholds and premium contribution requirements on health insurance coverage outcomes among children. 2002-2009 Annual Social and Economic Supplements of the Current Population Survey linked to data from multiple secondary data sources. We use a selection correction model to simultaneously estimate program eligibility and coverage outcomes conditional upon eligibility. We simulate the effects of three premium schedules representing a range of generosity levels and the effects of income eligibility thresholds ranging from 200 to 400 percent of the federal poverty line. Premium contribution requirements decrease enrollment in public coverage and increase enrollment in private coverage, with larger effects for greater contribution levels. Our simulation results suggest minimal changes in coverage outcomes from eligibility expansions to higher income families under premium schedules that require more than a modest contribution (medium or high schedules). Our simulation results are useful counterpoints to previous research that has estimated the average effect of program expansions as they were implemented without disentangling the effects of premiums or other program features. The sensitivity to premiums observed suggests that although contribution requirements may be effective in reducing crowd-out, they also have the potential, depending on the level of contribution required, to nullify the effects of CHIP expansions entirely. The persistence of uninsurance among children under the range of simulated scenarios points to the importance of Affordable Care Act provisions designed to make the process of obtaining coverage transparent and navigable. © Health Research and Educational Trust.

Pew Memorial Trust policy synthesis: 5. State coverage for organ transplantation: a framework for decision making.

PubMed

Lindsey, P A; McGlynn, E A

1988-02-01

Transplantation of hearts and livers for both adults and children is increasingly viewed as therapeutic and lifesaving, but access to these procedures is impeded by their high cost as well as by a limited supply of organs. In the absence of comprehensive federal coverage, pressure is being brought to bear on states to provide broader access to these procedures. This synthesis provides a framework for the consideration of coverage decisions at the state level. While there are no "right" answers about whether a state should support such coverage, the analytic tools of cost analysis, demand estimation, and assessment of capacity described in this synthesis can better inform the decision-making process.

Shifted Transversal Design smart-pooling for high coverage interactome mapping

PubMed Central

Xin, Xiaofeng; Rual, Jean-François; Hirozane-Kishikawa, Tomoko; Hill, David E.; Vidal, Marc; Boone, Charles; Thierry-Mieg, Nicolas

2009-01-01

“Smart-pooling,” in which test reagents are multiplexed in a highly redundant manner, is a promising strategy for achieving high efficiency, sensitivity, and specificity in systems-level projects. However, previous applications relied on low redundancy designs that do not leverage the full potential of smart-pooling, and more powerful theoretical constructions, such as the Shifted Transversal Design (STD), lack experimental validation. Here we evaluate STD smart-pooling in yeast two-hybrid (Y2H) interactome mapping. We employed two STD designs and two established methods to perform ORFeome-wide Y2H screens with 12 baits. We found that STD pooling achieves similar levels of sensitivity and specificity as one-on-one array-based Y2H, while the costs and workloads are divided by three. The screening-sequencing approach is the most cost- and labor-efficient, yet STD identifies about twofold more interactions. Screening-sequencing remains an appropriate method for quickly producing low-coverage interactomes, while STD pooling appears as the method of choice for obtaining maps with higher coverage. PMID:19447967

Assessment of the quality and content of website health information about herbal remedies for menopausal symptoms.

PubMed

Sowter, Julie; Astin, Felicity; Dye, Louise; Marshall, Paul; Knapp, Peter

2016-06-01

To assess the quality, readability and coverage of website information about herbal remedies for menopausal symptoms. A purposive sample of commercial and non-commercial websites was assessed for quality (DISCERN), readability (SMOG) and information coverage. Non-parametric and parametric tests were used to explain the variability of these factors across types of websites and to assess associations between website quality and information coverage. 39 sites were assessed. Median quality and information coverage scores were 44/80 and 11/30 respectively. The median readability score was 18.7, similar to UK broadsheets. Commercial websites scored significantly lower on quality (p=0.014), but there were no statistical differences for information coverage or readability. There was a significant positive correlation between information quality and coverage scores irrespective of website provider (r=0.69, p<0.001, n=39). Overall website quality and information coverage are poor and the required reading level high. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Effective coverage of primary care services in eight high-mortality countries

PubMed Central

Malata, Address; Ndiaye, Youssoupha; Kruk, Margaret E

2017-01-01

Introduction Measurement of effective coverage (quality-corrected coverage) of essential health services is critical to monitoring progress towards the Sustainable Development Goal for health. We combine facility and household surveys from eight low-income and middle-income countries to examine effective coverage of maternal and child health services. Methods We developed indices of essential clinical actions for antenatal care, family planning and care for sick children from existing guidelines and used data from direct observations of clinical visits conducted in Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania and Uganda between 2007 and 2015 to measure quality of care delivered. We calculated healthcare coverage for each service from nationally representative household surveys and combined quality with utilisation estimates at the subnational level to quantify effective coverage. Results Health facility and household surveys yielded over 40 000 direct clinical observations and over 100 000 individual reports of healthcare utilisation. Coverage varied between services, with much greater use of any antenatal care than family planning or sick-child care, as well as within countries. Quality of care was poor, with few regions demonstrating more than 60% average performance of basic clinical practices in any service. Effective coverage across all eight countries averaged 28% for antenatal care, 26% for family planning and 21% for sick-child care. Coverage and quality were not strongly correlated at the subnational level; effective coverage varied by as much as 20% between regions within a country. Conclusion Effective coverage of three primary care services for women and children in eight countries was substantially lower than crude service coverage due to major deficiencies in care quality. Better performing regions can serve as examples for improvement. Systematic increases in the quality of care delivered—not just utilisation gains—will be necessary to progress towards truly beneficial universal health coverage. PMID:29632704

Trends in influenza vaccination coverage rates in South Korea from 2005 to 2014: Effect of public health policies on vaccination behavior.

PubMed

Seo, Jeongmin; Lim, Juwon

2018-05-05

Influenza is a major cause of morbidity and mortality worldwide. Annual vaccination is effective in its prevention and is recommended especially in susceptible populations such as the elderly over 65 years, children younger than 5, pregnant women, and people with chronic diseases. Overall, South Korea has a high vaccination rate owing to its National Immunization Program, although the method and extent of its coverage varies among the target subgroups. The aim of this study is to assess the trend of influenza vaccination coverage between 2005 and 2014 in South Korea to address the influence of sociodemographic and disease factors on vaccination behavior. Also, we aim to compare the vaccination coverage of target subgroups and evaluate the effect of relevant policies to provide suggestions for their improvement. A total of 61,036 respondents from the Korea National Health and Nutrition Examination Surveys III to VI were included. The total influenza vaccination coverage increased from 38.0% in 2005 to 44.1% in 2014. Vaccination coverage was higher among the elderly aged ≥65 years (range, 70.0-79.8%; p-for-trend <0.001) and children under 5 (range, 64.6-78.9%; p-for-trend < 0.001) than among pregnant women (range, 9.4-37.8%; p-for-trend = 0.122) and people with chronic diseases (range, 29.6-42.6%; p-for-trend = 0.068) from 2005 to 2014. High vaccination coverage was associated with female gender, rural residence, low education level, high income, and increasing number of chronic diseases. But the effect of high income on high vaccination coverage was absent in the elderly aged ≥65 years and children under 5. Influenza vaccination rates have steadily increased from 2005 to 2014 in South Korea. Disparities between target groups correspond to their financial coverage under the National Immunization Program, and financial aids remove the influence of high income on higher vaccination rates. Future vaccination policies should focus on pregnant women and people with chronic diseases. Copyright © 2018 Elsevier Ltd. All rights reserved.

Vaccination Coverage Cluster Surveys in Middle Dreib – Akkar, Lebanon: Comparison of Vaccination Coverage in Children Aged 12-59 Months Pre- and Post-Vaccination Campaign

PubMed Central

Assaad, Ramia; Rebeschini, Arianna; Hamadeh, Randa

2016-01-01

Introduction With the high proportion of refugee population throughout Lebanon and continuous population movement, it is sensible to believe that, in particular vulnerable areas, vaccination coverage may not be at an optimal level. Therefore, we assessed the vaccination coverage in children under 5 in a district of the Akkar governorate before and after a vaccination campaign. During the vaccination campaign, conducted in August 2015, 2,509 children were vaccinated. Materials and Methods We conducted a pre- and post-vaccination campaign coverage surveys adapting the WHO EPI cluster survey to the Lebanese MoPH vaccination calendar. Percentages of coverage for each dose of each vaccine were calculated for both surveys. Factors associated with complete vaccination were explored. Results Comparing the pre- with the post-campaign surveys, coverage for polio vaccine increased from 51.9% to 84.3%, for Pentavalent from 49.0% to 71.9%, for MMR from 36.2% to 61.0%, while the percentage of children with fully updated vaccination calendar increased from 32.9% to 53.8%. While Lebanese children were found to be better covered for some antigens compared to Syrians at the first survey, this difference disappeared at the post-campaign survey. Awareness and logistic obstacles were the primary reported causes of not complete vaccination in both surveys. Discussion Vaccination campaigns remain a quick and effective approach to increase vaccination coverage in crisis-affected areas. However, campaigns cannot be considered as a replacement of routine vaccination services to maintain a good level of coverage. PMID:27992470

High-coverage quantitative proteomics using amine-specific isotopic labeling.

PubMed

Melanson, Jeremy E; Avery, Steven L; Pinto, Devanand M

2006-08-01

Peptide dimethylation with isotopically coded formaldehydes was evaluated as a potential alternative to techniques such as the iTRAQ method for comparative proteomics. The isotopic labeling strategy and custom-designed protein quantitation software were tested using protein standards and then applied to measure proteins levels associated with Alzheimer's disease (AD). The method provided high accuracy (10% error), precision (14% RSD) and coverage (70%) when applied to the analysis of a standard solution of BSA by LC-MS/MS. The technique was then applied to measure protein abundance levels in brain tissue afflicted with AD relative to normal brain tissue. 2-D LC-MS analysis identified 548 unique proteins (p<0.05). Of these, 349 were quantified with two or more peptides that met the statistical criteria used in this study. Several classes of proteins exhibited significant changes in abundance. For example, elevated levels of antioxidant proteins and decreased levels of mitochondrial electron transport proteins were observed. The results demonstrate the utility of the labeling method for high-throughput quantitative analysis.

Timeliness Vaccination of Measles Containing Vaccine and Barriers to Vaccination among Migrant Children in East China

PubMed Central

Hu, Yu; Li, Qian; Luo, Shuying; Lou, Linqiao; Qi, Xiaohua; Xie, Shuyun

2013-01-01

Background The reported coverage rates of first and second doses of measles containing vaccine (MCV) are almost 95% in China, while measles cases are constantly being reported. This study evaluated the vaccine coverage, timeliness, and barriers to immunization of MCV1 and MCV2 in children aged from 8–48 months. Methods We assessed 718 children aged 8–48 months, of which 499 children aged 18–48 months in September 2011. Face to face interviews were administered with children’s mothers to estimate MCV1 and MCV2 coverage rate, its timeliness and barriers to vaccine uptake. Results The coverage rates were 76.9% for MCV1 and 44.7% for MCV2 in average. Only 47.5% of surveyed children received the MCV1 timely, which postpone vaccination by up to one month beyond the stipulated age of 8 months. Even if coverage thus improves with time, postponed vaccination adds to the pool of unprotected children in the population. Being unaware of the necessity for vaccination and its schedule, misunderstanding of side-effect of vaccine, and child being sick during the recommended vaccination period were significant preventive factors for both MCV1 and MCV2 vaccination. Having multiple children, mother’s education level, household income and children with working mothers were significantly associated with delayed or missing MCV1 immunization. Conclusions To avoid future outbreaks, it is crucial to attain high coverage levels by timely vaccination, thus, accurate information should be delivered and a systematic approach should be targeted to high-risk groups. PMID:24013709

Timeliness vaccination of measles containing vaccine and barriers to vaccination among migrant children in East China.

PubMed

Hu, Yu; Li, Qian; Luo, Shuying; Lou, Linqiao; Qi, Xiaohua; Xie, Shuyun

2013-01-01

The reported coverage rates of first and second doses of measles containing vaccine (MCV) are almost 95% in China, while measles cases are constantly being reported. This study evaluated the vaccine coverage, timeliness, and barriers to immunization of MCV1 and MCV2 in children aged from 8-48 months. We assessed 718 children aged 8-48 months, of which 499 children aged 18-48 months in September 2011. Face to face interviews were administered with children's mothers to estimate MCV1 and MCV2 coverage rate, its timeliness and barriers to vaccine uptake. The coverage rates were 76.9% for MCV1 and 44.7% for MCV2 in average. Only 47.5% of surveyed children received the MCV1 timely, which postpone vaccination by up to one month beyond the stipulated age of 8 months. Even if coverage thus improves with time, postponed vaccination adds to the pool of unprotected children in the population. Being unaware of the necessity for vaccination and its schedule, misunderstanding of side-effect of vaccine, and child being sick during the recommended vaccination period were significant preventive factors for both MCV1 and MCV2 vaccination. Having multiple children, mother's education level, household income and children with working mothers were significantly associated with delayed or missing MCV1 immunization. To avoid future outbreaks, it is crucial to attain high coverage levels by timely vaccination, thus, accurate information should be delivered and a systematic approach should be targeted to high-risk groups.

Staff Acceptance of Tele-ICU Coverage

PubMed Central

Chan, Paul S.; Cram, Peter

2011-01-01

Background: Remote coverage of ICUs is increasing, but staff acceptance of this new technology is incompletely characterized. We conducted a systematic review to summarize existing research on acceptance of tele-ICU coverage among ICU staff. Methods: We searched for published articles pertaining to critical care telemedicine systems (aka, tele-ICU) between January 1950 and March 2010 using PubMed, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Library and abstracts and presentations delivered at national conferences. Studies were included if they provided original qualitative or quantitative data on staff perceptions of tele-ICU coverage. Studies were imported into content analysis software and coded by tele-ICU configuration, methodology, participants, and findings (eg, positive and negative staff evaluations). Results: Review of 3,086 citations yielded 23 eligible studies. Findings were grouped into four categories of staff evaluation: overall acceptance level of tele-ICU coverage (measured in 70% of studies), impact on patient care (measured in 96%), impact on staff (measured in 100%), and organizational impact (measured in 48%). Overall acceptance was high, despite initial ambivalence. Favorable impact on patient care was perceived by > 82% of participants. Staff impact referenced enhanced collaboration, autonomy, and training, although scrutiny, malfunctions, and contradictory advice were cited as potential barriers. Staff perceived the organizational impact to vary. An important limitation of available studies was a lack of rigorous methodology and validated survey instruments in many studies. Conclusions: Initial reports suggest high levels of staff acceptance of tele-ICU coverage, but more rigorous methodologic study is required. PMID:21051386

Decision making with regard to antiviral intervention during an influenza pandemic.

PubMed

Shim, Eunha; Chapman, Gretchen B; Galvani, Alison P

2010-01-01

Antiviral coverage is defined by the proportion of the population that takes antiviral prophylaxis or treatment. High coverage of an antiviral drug has epidemiological and evolutionary repercussions. Antivirals select for drug resistance within the population, and individuals may experience adverse effects. To determine optimal antiviral coverage in the context of an influenza outbreak, we compared 2 perspectives: 1) the individual level (the Nash perspective), and 2) the population level (utilitarian perspective). We developed an epidemiological game-theoretic model of an influenza pandemic. The data sources were published literature and a national survey. The target population was the US population. The time horizon was 6 months. The perspective was individuals and the population overall. The interventions were antiviral prophylaxis and treatment. The outcome measures were the optimal coverage of antivirals in an influenza pandemic. At current antiviral pricing, the optimal Nash strategy is 0% coverage for prophylaxis and 30% coverage for treatment, whereas the optimal utilitarian strategy is 19% coverage for prophylaxis and 100% coverage for treatment. Subsidizing prophylaxis by $440 and treatment by $85 would bring the Nash and utilitarian strategies into alignment. For both prophylaxis and treatment, the optimal antiviral coverage decreases as pricing of antivirals increases. Our study does not incorporate the possibility of an effective vaccine and lacks probabilistic sensitivity analysis. Our survey also does not completely represent the US population. Because our model assumes a homogeneous population and homogeneous antiviral pricing, it does not incorporate heterogeneity of preference. The optimal antiviral coverage from the population perspective and individual perspectives differs widely for both prophylaxis and treatment strategies. Optimal population and individual strategies for prophylaxis and treatment might be aligned through subsidization.

Decision Making with Regard to Antiviral Intervention during an Influenza Pandemic

PubMed Central

Shim, Eunha; Chapman, Gretchen B.; Galvani, Alison P.

2012-01-01

Background Antiviral coverage is defined by the proportion of the population that takes antiviral prophylaxis or treatment. High coverage of an antiviral drug has epidemiological and evolutionary repercussions. Antivirals select for drug resistance within the population, and individuals may experience adverse effects. To determine optimal antiviral coverage in the context of an influenza outbreak, we compared 2 perspectives: 1) the individual level (the Nash perspective), and 2) the population level (utilitarian perspective). Methods We developed an epidemiological game-theoretic model of an influenza pandemic. The data sources were published literature and a national survey. The target population was the US population. The time horizon was 6 months. The perspective was individuals and the population overall. The interventions were antiviral prophylaxis and treatment. The outcome measures were the optimal coverage of antivirals in an influenza pandemic. Results At current antiviral pricing, the optimal Nash strategy is 0% coverage for prophylaxis and 30% coverage for treatment, whereas the optimal utilitarian strategy is 19% coverage for prophylaxis and 100% coverage for treatment. Subsidizing prophylaxis by $440 and treatment by $85 would bring the Nash and utilitarian strategies into alignment. For both prophylaxis and treatment, the optimal antiviral coverage decreases as pricing of antivirals increases. Our study does not incorporate the possibility of an effective vaccine and lacks probabilistic sensitivity analysis. Our survey also does not completely represent the US population. Because our model assumes a homogeneous population and homogeneous antiviral pricing, it does not incorporate heterogeneity of preference. Conclusions The optimal antiviral coverage from the population perspective and individual perspectives differs widely for both prophylaxis and treatment strategies. Optimal population and individual strategies for prophylaxis and treatment might be aligned through subsidization. PMID:20634545

Impact of current and scaled-up levels of hepatitis C prevention and treatment interventions for people who inject drugs in three UK settings-what is required to achieve the WHO's HCV elimination targets?

PubMed

Ward, Zoe; Platt, Lucy; Sweeney, Sedona; Hope, Vivian D; Maher, Lisa; Hutchinson, Sharon; Palmateer, Norah; Smith, Josie; Craine, Noel; Taylor, Avril; Martin, Natasha; Ayres, Rachel; Dillon, John; Hickman, Matthew; Vickerman, Peter

2018-05-17

To estimate the impact of existing high-coverage needle and syringe provision (HCNSP, defined as obtaining more than one sterile needle and syringe per injection reported) and opioid substitution therapy (OST) on hepatitis C virus (HCV) transmission among people who inject drugs (PWID) in three UK settings and to determine required scale-up of interventions, including HCV treatment, needed to reach the World Health Organization (WHO) target of reducing HCV incidence by 90% by 2030. HCV transmission modelling using UK empirical estimates for effect of OST and/or HCNSP on individual risk of HCV acquisition. Three UK cities with varying chronic HCV prevalence (Bristol 45%, Dundee 26%, Walsall 19%), OST (72-81%) and HCNSP coverage (28-56%). Relative change in new HCV infections throughout 2016-30 if current interventions were stopped. Scale-up of HCNSP, OST and HCV treatment required to achieve the WHO elimination target. Removing HCNSP or OST would increase the number of new HCV infections throughout 2016 to 2030 by 23-64 and 92-483%, respectively. Conversely, scaling-up these interventions to 80% coverage could achieve a 29 or 49% reduction in Bristol and Walsall, respectively, whereas Dundee may achieve a 90% decrease in incidence with current levels of intervention because of existing high levels of HCV treatment (47-58 treatments per 1000 PWID). If OST and HCNSP are scaled-up, Walsall and Bristol can achieve the same impact by treating 14 or 40 per 1000 PWID annually, respectively (currently two and nine treatments per 1000 PWID), while 18 and 43 treatments per 1000 PWID would be required if OST and HCNSP are not scaled-up. Current opioid substitution therapy and high-coverage needle and syringe provision coverage is averting substantial hepatitis C transmission in the United Kingdom. Maintaining this coverage while getting current drug injectors onto treatment can reduce incidence by 90% by 2030. © 2018 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

The challenges of achieving high training coverage for IMCI: case studies from Kenya and Tanzania

PubMed Central

Mushi, Hildegalda P; Mullei, Kethi; Macha, Janet; Wafula, Frank; Borghi, Josephine; Goodman, Catherine; Gilson, Lucy

2011-01-01

Health worker training is a key component of the integrated management of childhood illness (IMCI). However, training coverage remains low in many countries. We conducted in-depth case studies in two East African countries to examine the factors underlying low training coverage 10 years after IMCI had been adopted as policy. A document review and in-depth semi-structured interviews with stakeholders at facility, district, regional/provincial and national levels in two districts in Kenya (Homa Bay and Malindi) and Tanzania (Bunda and Tarime) were carried out in 2007–08. Bunda and Malindi achieved higher levels of training coverage (44% and 25%) compared with Tarime and Homa Bay (5% and 13%). Key factors allowing the first two districts to perform better were: strong district leadership and personal commitment to IMCI, which facilitated access to external funding and encouraged local-level policy adaptation; sensitization and training of district health managers; and lower staff turnover. However, IMCI training coverage remained well below target levels across all sites. The main barrier to expanding coverage was the cost of training due to its duration, the number of facilitators and its residential nature. Mechanisms for financing IMCI also restricted district capacity to raise funds. In Tanzania, districts could not spend more than 10% of their budgets on training. In Kenya, limited financial decentralization meant that district managers had to rely on donors for financial support. Critically, the low priority given to IMCI at national and international levels also limited the expansion of training. Levels of domestic and donor support for IMCI have diminished over time in favour of vertical programmes, partly due to the difficulty in monitoring and measuring the impact of an integrated intervention like IMCI. Alternative, lower cost methods of IMCI training need to be promoted, and greater advocacy for IMCI is needed both nationally and internationally. PMID:21047808

Is It Really Possible to Test All Educationally Significant Achievements with High Levels of Reliability?

ERIC Educational Resources Information Center

Davis, Andrew

2015-01-01

PISA claims that it can extend its reach from its current core subjects of Reading, Science, Maths and problem-solving. Yet given the requirement for high levels of reliability for PISA, especially in the light of its current high stakes character, proposed widening of its subject coverage cannot embrace some important aspects of the social and…

High-Resolution Spatial Distribution and Estimation of Access to Improved Sanitation in Kenya.

PubMed

Jia, Peng; Anderson, John D; Leitner, Michael; Rheingans, Richard

2016-01-01

Access to sanitation facilities is imperative in reducing the risk of multiple adverse health outcomes. A distinct disparity in sanitation exists among different wealth levels in many low-income countries, which may hinder the progress across each of the Millennium Development Goals. The surveyed households in 397 clusters from 2008-2009 Kenya Demographic and Health Surveys were divided into five wealth quintiles based on their national asset scores. A series of spatial analysis methods including excess risk, local spatial autocorrelation, and spatial interpolation were applied to observe disparities in coverage of improved sanitation among different wealth categories. The total number of the population with improved sanitation was estimated by interpolating, time-adjusting, and multiplying the surveyed coverage rates by high-resolution population grids. A comparison was then made with the annual estimates from United Nations Population Division and World Health Organization /United Nations Children's Fund Joint Monitoring Program for Water Supply and Sanitation. The Empirical Bayesian Kriging interpolation produced minimal root mean squared error for all clusters and five quintiles while predicting the raw and spatial coverage rates of improved sanitation. The coverage in southern regions was generally higher than in the north and east, and the coverage in the south decreased from Nairobi in all directions, while Nyanza and North Eastern Province had relatively poor coverage. The general clustering trend of high and low sanitation improvement among surveyed clusters was confirmed after spatial smoothing. There exists an apparent disparity in sanitation among different wealth categories across Kenya and spatially smoothed coverage rates resulted in a closer estimation of the available statistics than raw coverage rates. Future intervention activities need to be tailored for both different wealth categories and nationally where there are areas of greater needs when resources are limited.

A Performance Analysis of Public Expenditure on Maternal Health in Mexico.

PubMed

Servan-Mori, Edson; Avila-Burgos, Leticia; Nigenda, Gustavo; Lozano, Rafael

2016-01-01

We explore the relationship between public expenditure, coverage of adequate ANC (including timing, frequent and content), and the maternal mortality ratio--adjusted by coverage of adequate ANC--observed in Mexico in 2012 at the State level. Additionally, we examine the inequalities and concentration of public expenditure between populations with and without Social Security. Results suggest that in the 2003-2011 period, the public expenditure gap between women with and without Social Security decreased 74%, however, the distribution is less equitable among women without Social Security, across the States. Despite high levels of coverage on each dimension of ANC explored, coverage of adequate ANC was lower among Social Security than non-Social Security women. This variability results in differences up to 1.5 times in State-adjusted maternal mortality rate at the same level of expense and maternal mortality rate, respectively. The increase in the economic resources is only a necessary condition for achieving improved health outcomes. Providing adequate health services and achieving efficient, effective and transparent use of resources in health, are critical elements for health systems performance. The attainment of universal effective coverage of maternal health and reducing maternal mortality in Mexico, requires the adjustment of policy innovations including the rules of allocation and execution of health resources. Health policies should be designed on a more holistic view promoting a balance between accessibility, effective implementation and rigorous stewardship.

A Performance Analysis of Public Expenditure on Maternal Health in Mexico

PubMed Central

Servan-Mori, Edson; Avila-Burgos, Leticia; Nigenda, Gustavo; Lozano, Rafael

2016-01-01

We explore the relationship between public expenditure, coverage of adequate ANC (including timing, frequent and content), and the maternal mortality ratio -adjusted by coverage of adequate ANC- observed in Mexico in 2012 at the State level. Additionally, we examine the inequalities and concentration of public expenditure between populations with and without Social Security. Results suggest that in the 2003–2011 period, the public expenditure gap between women with and without Social Security decreased 74%, however, the distribution is less equitable among women without Social Security, across the States. Despite high levels of coverage on each dimension of ANC explored, coverage of adequate ANC was lower among Social Security than non-Social Security women. This variability results in differences up to 1.5 times in State-adjusted maternal mortality rate at the same level of expense and maternal mortality rate, respectively. The increase in the economic resources is only a necessary condition for achieving improved health outcomes. Providing adequate health services and achieving efficient, effective and transparent use of resources in health, are critical elements for health systems performance. The attainment of universal effective coverage of maternal health and reducing maternal mortality in Mexico, requires the adjustment of policy innovations including the rules of allocation and execution of health resources. Health policies should be designed on a more holistic view promoting a balance between accessibility, effective implementation and rigorous stewardship. PMID:27043819

Factors associated with routine immunization coverage of children under one year old in Lao People's Democratic Republic.

PubMed

Phoummalaysith, Bounfeng; Yamamoto, Eiko; Xeuatvongsa, Anonh; Louangpradith, Viengsakhone; Keohavong, Bounxou; Saw, Yu Mon; Hamajima, Nobuyuki

2018-05-03

Routine vaccination is administered free of charge to all children under one year old in Lao People's Democratic Republic (Lao PDR) and the national goal is to achieve at least 95% coverage with all vaccines included in the national immunization program by 2025. In this study, factors related to the immunization system and characteristics of provinces and districts in Lao PDR were examined to evaluate the association with routine immunization coverage. Coverage rates for Bacillus Calmette-Guerin (BCG), Diphtheria-Tetanus-Pertussis-Hepatitis B (DTP-HepB), DTP-HepB-Hib (Haemophilus influenzae type B), polio (OPV), and measles (MCV1) vaccines from 2002 to 2014 collected through regular reporting system, were used to identify the immunization coverage trends in Lao PDR. Correlation analysis was performed using immunization coverage, characteristics of provinces or districts (population, population density, and proportion of poor villages and high-risk villages), and factors related to immunization service (including the proportions of the following: villages served by health facility levels, vaccine session types, and presence of well-functioning cold chain equipment). To determine factors associated with low coverage, provinces were categorized based on 80% of DTP-HepB-Hib3 coverage (<80% = low group; ≥80% = high group). Coverages of BCG, DTP-HepB3, OPV3 and MCV1 increased gradually from 2007 to 2014 (82.2-88.3% in 2014). However, BCG coverage showed the least improvement from 2002 to 2014. The coverage of each vaccine correlated with the coverage of the other vaccines and DTP-HepB-Hib dropout rate in provinces as well as districts. The provinces with low immunization coverage were correlated with higher proportions of poor villages. Routine immunization coverage has been improving in the last 13 years, but the national goal is not yet reached in Lao PDR. The results of this study suggest that BCG coverage and poor villages should be targeted to improve nationwide coverage. Copyright © 2018 Elsevier Ltd. All rights reserved.

Moving toward universal coverage of health insurance in Vietnam: barriers, facilitating factors, and lessons from Korea.

PubMed

Do, Ngan; Oh, Juhwan; Lee, Jin-Seok

2014-07-01

Vietnam has pursued universal health insurance coverage for two decades but has yet to fully achieve this goal. This paper investigates the barriers to achieve universal coverage and examines the validity of facilitating factors to shorten the transitional period in Vietnam. A comparative study of facilitating factors toward universal coverage of Vietnam and Korea reveals significant internal forces for Vietnam to further develop the National Health Insurance Program. Korea in 1977 and Vietnam in 2009 have common characteristics to be favorable of achieving universal coverage with similarities of level of income, highly qualified administrative ability, tradition of solidarity, and strong political leadership although there are differences in distribution of population and structure of the economy. From a comparative perspective, Vietnam can consider the experience of Korea in implementing the mandatory enrollment approach, household unit of eligibility, design of contribution and benefit scheme, and resource allocation to health insurance for sustainable government subsidy to achieve and sustain the universal coverage of health insurance.

The effect of Health Savings Accounts on group health insurance coverage.

PubMed

Ye, Jinqi

2015-12-01

This paper presents new empirical evidence on the impact of tax subsidies for Health Savings Accounts (HSAs) on group insurance coverage. HSAs are tax-free health care expenditure savings accounts. Coupled with high deductible health insurance plans (HDHPs), they together represent new health insurance options. The tax advantage of HSAs expands the group health insurance market by making health care more affordable. Using individual level data from the Current Population Survey and exploiting policy variation by state and year from 2004 to 2012, I find that HSA tax subsidies increase small-group coverage by a statistically significant 2.5 percentage points, although not coverage in larger firms. Moreover, if the tax price of HSA contribution decreases by 10 cents, small-group insurance coverage increases by almost 2 percentage points. I also find that for older workers or less-educated workers, HSA subsidies are associated with 2-3 percentage point increase in their group insurance coverage. Copyright © 2015 Elsevier B.V. All rights reserved.

[Inequality in primary care interventions in maternal and child health care in Mexico].

PubMed

Ramírez-Tirado, Laura Alejandra; Tirado-Gómez, Laura Leticia; López-Cervantes, Malaquías

2014-04-01

To analyze the principal indicators associated with maternal mortality and mortality in children under 1 year of age and evaluate coverage levels and variability among the federative entities of Mexico. Eight interventions in maternal and child primary health care (variables) were studied: complete vaccination series, measles vaccine, and pentavalent vaccine in children under 1 year of age; early breast-feeding; prenatal care with at least one check-up by trained staff; prevalence of contraceptive use among married women of reproductive age; obstetric care in delivery by trained staff; and the administration of tetanus toxoid (TT) to pregnant women. The average and standard deviation of national coverage for each variable was calculated. Within each federative entity the proportion of municipalities with high, medium, and low marginalization was determined. States were ranked by the proportion of municipalities with high marginalization (highest to lowest) and divided into quintiles. Absolute inequality was measured using the observed difference and relative inequality, using the ratio of each variable studied. The average national coverage for the eight variables studied ranged from 86.5% to 97.5%, with administration of TT to pregnant women the lowest and administration of measles vaccine to children under 1 year of age the highest. Obstetric care in delivery, prevalence of contraceptive use, and prenatal checkup were the variables with less equitable coverage. In states with higher levels of marginalization, activities dependent on a structured health system-e.g., obstetric care in delivery-showed lower levels of coverage compared to preventive activities not requiring costly inputs or infrastructure-e.g., early breast-feeding. Interventions exhibiting greater inequity are associated with the lack of medical infrastructure and are more accentuated in federative entities with higher levels of marginalization. Greater public health expenditure is urgently needed to implement feasible, effective alternatives in terms of access and health care. Intersectoral policies and activities should be implemented to create synergies that will equitably improve the health of Mexican mothers and children.

Correlation between measles vaccine doses: implications for the maintenance of elimination.

PubMed

McKee, A; Ferrari, M J; Shea, K

2018-03-01

Measles eradication efforts have been successful at achieving elimination in many countries worldwide. Such countries actively work to maintain this elimination by continuing to improve coverage of two routine doses of measles vaccine following measles elimination. While improving measles vaccine coverage is always beneficial, we show, using a steady-state analysis of a dynamical model, that the correlation between populations receiving the first and second routine dose also has a significant impact on the population immunity achieved by a specified combination of first and second dose coverage. If the second dose is administered to people independently of whether they had the first dose, high second-dose coverage improves the proportion of the population receiving at least one dose, and will have a large effect on population immunity. If the second dose is administered only to people who have had the first dose, high second-dose coverage reduces the rate of primary vaccine failure, but does not reach people who missed the first dose; this will therefore have a relatively small effect on population immunity. When doses are administered dependently, and assuming the first dose has higher coverage, increasing the coverage of the first dose has a larger impact on population immunity than does increasing the coverage of the second. Correlation between vaccine doses has a significant impact on the level of population immunity maintained by current vaccination coverage, potentially outweighing the effects of age structure and, in some cases, recent improvements in vaccine coverage. It is therefore important to understand the correlation between vaccine doses as such correlation may have a large impact on the effectiveness of measles vaccination strategies.

Vaccination Week in the Americas, 2011: an opportunity to assess the routine vaccination program in the Bolivarian Republic of Venezuela.

PubMed

Sánchez, Daniel; Sodha, Samir V; Kurtis, Hannah J; Ghisays, Gladys; Wannemuehler, Kathleen A; Danovaro-Holliday, M Carolina; Ropero-Álvarez, Alba María

2015-04-17

Vaccination Week in the Americas (VWA) is an annual initiative in countries and territories of the Americas every April to highlight the work of national expanded programs on immunization (EPI) and increase access to vaccination services for high-risk population groups. In 2011, as part of VWA, Venezuela targeted children aged less than 6 years in 25 priority border municipalities using social mobilization to increase institution-based vaccination. Implementation of social communication activities was decentralized to the local level. We conducted a survey in one border municipality of Venezuela to evaluate the outcome of VWA 2011 and provide a snapshot of the overall performance of the routine EPI at that level. We conducted a coverage survey, using stratified cluster sampling, in the Venezuelan municipality of Bolivar (bordering Colombia) in August 2011. We collected information for children aged <6 years through caregiver interviews and transcription of vaccination card data. We estimated each child's eligibility to receive a specific vaccine dose during VWA 2011 and whether or not they were actually vaccinated during VWA activities. We also estimated baseline vaccination coverage, timeliness and 95% confidence intervals (CI), and used chi-square tests to compare coverage across age cohorts, taking into account the sampling design. We surveyed 839 children from 698 households; 93% of children had a vaccination card. Among households surveyed, 216 (31%) caregivers reported having heard about a vaccination activity during April or May 2011. Of the 528 children eligible to receive a vaccine during VWA, 24% received at least one dose, while 13% received all doses due. Overall, baseline coverage with routine vaccines, as measured by the survey, was >85%, with a few exceptions. Low levels of VWA awareness among caregivers probably contributed to the limited vaccination of eligible children during the VWA activities in Bolivar in 2011. However, vaccine coverage for most EPI vaccines was high. Additionally, high vaccination card availability and high participation in VWA among those caregivers aware of it in 2011 suggest public trust in the EPI program in the municipality. Health authorities have used survey findings to inform changes to the routine EPI and better VWA implementation in subsequent years.

Community based rehabilitation: Does it really improve the level of productivity among persons with physical disabilities?

PubMed

Moniruzzaman; Saha, Palash Chandra; Habib, Md Monjurul

2015-01-01

The Community Based Rehabilitation (CBR) is a common approach to work with disable people to improve their quality of life by improving the level of productivity and integrating them into society. But the effectiveness of CBR varies by country to country. The aim of the study was to find out whether CBR programs really improved the level of productivity among persons with physical disabilities. A cross-sectional study was conducted among equal number of respondents (n=51) from each CBR coverage and non-coverage areas from two different upazilla (sub-districts) located 40 km away from the capital city of Bangladesh. Respondents were selected purposively and data were collected by face to face interviews. Willer's (1994) version of the Community Integration Questionnaire (CIQ) was used to measure the level of productivity among adult with physical disabilities. The mean score of total productivity integration in CBR coverage and non-coverage areas were 4.3 ± 2.4 and 4.5 ± 2.2 respectively. This difference was statistically non-significant (p=0.602).The levels of productivity integration between CBR coverage and non-coverage areas varied only 2-4% (p=0.793). The mean score of productivity integration and levels of productivity were not different significantly in CBR coverage and non-coverage areas.

Prevention, screening and treatment of colorectal cancer: a global and regional generalized cost effectiveness analysis

PubMed Central

2010-01-01

Background Regional generalized cost-effectiveness estimates of prevention, screening and treatment interventions for colorectal cancer are presented. Methods Standardised WHO-CHOICE methodology was used. A colorectal cancer model was employed to provide estimates of screening and treatment effectiveness. Intervention effectiveness was determined via a population state-transition model (PopMod) that simulates the evolution of a sub-regional population accounting for births, deaths and disease epidemiology. Economic costs of procedures and treatment were estimated, including programme overhead and training costs. Results In regions characterised by high income, low mortality and high existing treatment coverage, the addition of screening to the current high treatment levels is very cost-effective, although no particular intervention stands out in cost-effectiveness terms relative to the others. In regions characterised by low income, low mortality with existing treatment coverage around 50%, expanding treatment with or without screening is cost-effective or very cost-effective. Abandoning treatment in favour of screening (no treatment scenario) would not be cost effective. In regions characterised by low income, high mortality and low treatment levels, the most cost-effective intervention is expanding treatment. Conclusions From a cost-effectiveness standpoint, screening programmes should be expanded in developed regions and treatment programmes should be established for colorectal cancer in regions with low treatment coverage. PMID:20236531

45 CFR 156.140 - Levels of coverage.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.140 Levels of coverage. (a) General requirement for levels of coverage. AV...

45 CFR 156.140 - Levels of coverage.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.140 Levels of coverage. (a) General requirement for levels of coverage. AV...

Monitoring maternal, newborn, and child health interventions using lot quality assurance sampling in Sokoto State of northern Nigeria.

PubMed

Abegunde, Dele; Orobaton, Nosa; Shoretire, Kamil; Ibrahim, Mohammed; Mohammed, Zainab; Abdulazeez, Jumare; Gwamzhi, Ringpon; Ganiyu, Akeem

2015-01-01

Maternal mortality ratio and infant mortality rate are as high as 1,576 per 100,000 live births and 78 per 1,000 live births, respectively, in Nigeria's northwestern region, where Sokoto State is located. Using applicable monitoring indicators for tracking progress in the UN/WHO framework on continuum of maternal, newborn, and child health care, this study evaluated the progress of Sokoto toward achieving the Millennium Development Goals (MDGs) 4 and 5 by December 2015. The changes in outcomes in 2012-2013 associated with maternal and child health interventions were assessed. We used baseline and follow-up lot quality assurance sampling (LQAS) data obtained in 2012 and 2013, respectively. In each of the surveys, data were obtained from 437 households sampled from 19 LQAS locations in each of the 23 local government areas (LGAs). The composite state-level coverage estimates of the respective indicators were aggregated from estimated LGA coverage estimates. None of the nine indicators associated with the continuum of maternal, neonatal, and child care satisfied the recommended 90% coverage target for achieving MDGs 4 and 5. Similarly, the average state coverage estimates were lower than national coverage estimates. Marginal improvements in coverage were obtained in the demand for family planning satisfied, antenatal care visits, postnatal care for mothers, and exclusive breast-feeding. Antibiotic treatment for acute pneumonia increased significantly by 12.8 percentage points. The majority of the LGAs were classifiable as low-performing, high-priority areas for intensified program intervention. Despite the limited time left in the countdown to December 2015, Sokoto State, Nigeria, is not on track to achieving the MDG 90% coverage of indicators tied to the continuum of maternal and child care, to reduce maternal and childhood mortality by a third by 2015. Targeted health system investments at the primary care level remain a priority, for intensive program scale-up to accelerate impact.

Urbanization reduces and homogenizes trait diversity in stream macroinvertebrate communities.

PubMed

Barnum, Thomas R; Weller, Donald E; Williams, Meghan

2017-12-01

More than one-half of the world's population lives in urban areas, so quantifying the effects of urbanization on ecological communities is important for understanding whether anthropogenic stressors homogenize communities across environmental and climatic gradients. We examined the relationship of impervious surface coverage (a marker of urbanization) and the structure of stream macroinvertebrate communities across the state of Maryland and within each of Maryland's three ecoregions: Coastal Plain, Piedmont, and Appalachian, which differ in stream geomorphology and community composition. We considered three levels of trait organization: individual traits, unique combinations of traits, and community metrics (functional richness, functional evenness, and functional divergence) and three levels of impervious surface coverage (low [<2.5%], medium [2.5% to 10%], and high [>10%]). The prevalence of an individual trait differed very little between low impervious surface and high impervious surface sites. The arrangement of trait combinations in community trait space for each ecoregion differed when impervious surface coverage was low, but the arrangement became more similar among ecoregions as impervious surface coverage increased. Furthermore, trait combinations that occurred only at low or medium impervious surface coverage were clustered in a subset of the community trait space, indicating that impervious surface affected the presence of only a subset of trait combinations. Functional richness declined with increasing impervious surface, providing evidence for environmental filtering. Community metrics that include abundance were also sensitive to increasing impervious surface coverage: functional divergence decreased while functional evenness increased. These changes demonstrate that increasing impervious surface coverage homogenizes the trait diversity of macroinvertebrate communities in streams, despite differences in initial community composition and stream geomorphology among ecoregions. Community metrics were also more sensitive to changes in the abundance rather than the gain or loss of trait combinations, showing the potential for trait-based approaches to serve as early warning indicators of environmental stress for monitoring and biological assessment programs. © 2017 by the Ecological Society of America.

Monitoring maternal, newborn, and child health interventions using lot quality assurance sampling in Sokoto State of northern Nigeria

PubMed Central

Abegunde, Dele; Orobaton, Nosa; Shoretire, Kamil; Ibrahim, Mohammed; Mohammed, Zainab; Abdulazeez, Jumare; Gwamzhi, Ringpon; Ganiyu, Akeem

2015-01-01

Background Maternal mortality ratio and infant mortality rate are as high as 1,576 per 100,000 live births and 78 per 1,000 live births, respectively, in Nigeria's northwestern region, where Sokoto State is located. Using applicable monitoring indicators for tracking progress in the UN/WHO framework on continuum of maternal, newborn, and child health care, this study evaluated the progress of Sokoto toward achieving the Millennium Development Goals (MDGs) 4 and 5 by December 2015. The changes in outcomes in 2012–2013 associated with maternal and child health interventions were assessed. Design We used baseline and follow-up lot quality assurance sampling (LQAS) data obtained in 2012 and 2013, respectively. In each of the surveys, data were obtained from 437 households sampled from 19 LQAS locations in each of the 23 local government areas (LGAs). The composite state-level coverage estimates of the respective indicators were aggregated from estimated LGA coverage estimates. Results None of the nine indicators associated with the continuum of maternal, neonatal, and child care satisfied the recommended 90% coverage target for achieving MDGs 4 and 5. Similarly, the average state coverage estimates were lower than national coverage estimates. Marginal improvements in coverage were obtained in the demand for family planning satisfied, antenatal care visits, postnatal care for mothers, and exclusive breast-feeding. Antibiotic treatment for acute pneumonia increased significantly by 12.8 percentage points. The majority of the LGAs were classifiable as low-performing, high-priority areas for intensified program intervention. Conclusions Despite the limited time left in the countdown to December 2015, Sokoto State, Nigeria, is not on track to achieving the MDG 90% coverage of indicators tied to the continuum of maternal and child care, to reduce maternal and childhood mortality by a third by 2015. Targeted health system investments at the primary care level remain a priority, for intensive program scale-up to accelerate impact. PMID:26455491

Prevalence, Characteristics, and Perception of Nursery Antibiotic Stewardship Coverage in the United States.

PubMed

Cantey, Joseph B; Vora, Niraj; Sunkara, Mridula

2017-09-01

Prolonged or unnecessary antibiotic use is associated with adverse outcomes in infants. Antibiotic stewardship programs (ASPs) aim to prevent these adverse outcomes and optimize antibiotic prescribing. However, data evaluating ASP coverage of nurseries are limited. The objectives of this study were to describe the characteristics of nurseries with and without ASP coverage and to determine perceptions of and barriers to nursery ASP coverage. The 2014 American Hospital Association annual survey was used to randomly select a level III neonatal intensive care unit from all 50 states. A level I and level II nursery from the same city as the level III nursery were then randomly selected. Hospital, nursery, and ASP characteristics were collected. Nursery and ASP providers (pharmacists or infectious disease providers) were interviewed using a semistructured template. Transcribed interviews were analyzed for themes. One hundred forty-six centers responded; 104 (71%) provided nursery ASP coverage. In multivariate analysis, level of nursery, university affiliation, and number of full-time equivalent ASP staff were the main predictors of nursery ASP coverage. Several themes were identified from interviews: unwanted coverage, unnecessary coverage, jurisdiction issues, need for communication, and a focus on outcomes. Most providers had a favorable view of nursery ASP coverage. Larger, higher-acuity nurseries in university-affiliated hospitals are more likely to have ASP coverage. Low ASP staffing and a perceived lack of importance were frequently cited as barriers to nursery coverage. Most nursery ASP coverage is viewed favorably by providers, but nursery providers regard it as less important than ASP providers. © The Author 2016. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Country-level predictors of vaccination coverage and inequalities in Gavi-supported countries.

PubMed

Arsenault, Catherine; Johri, Mira; Nandi, Arijit; Mendoza Rodríguez, José M; Hansen, Peter M; Harper, Sam

2017-04-25

Important inequalities in childhood vaccination coverage persist between countries and population groups. Understanding why some countries achieve higher and more equitable levels of coverage is crucial to redress these inequalities. In this study, we explored the country-level determinants of (1) coverage of the third dose of diphtheria-tetanus-pertussis- (DTP3) containing vaccine and (2) within-country inequalities in DTP3 coverage in 45 countries supported by Gavi, the Vaccine Alliance. We used data from the most recent Demographic and Health Surveys (DHS) conducted between 2005 and 2014. We measured national DTP3 coverage and the slope index of inequality in DTP3 coverage with respect to household wealth, maternal education, and multidimensional poverty. We collated data on country health systems, health financing, governance and geographic and sociocultural contexts from published sources. We used meta-regressions to assess the relationship between these country-level factors and variations in DTP3 coverage and inequalities. To validate our findings, we repeated these analyses for coverage with measles-containing vaccine (MCV). We found considerable heterogeneity in DTP3 coverage and in the magnitude of inequalities across countries. Results for MCV were consistent with those from DTP3. Political stability, gender equality and smaller land surface were important predictors of higher and more equitable levels of DTP3 coverage. Inequalities in DTP3 coverage were also lower in countries receiving more external resources for health, with lower rates of out-of-pocket spending and with higher national coverage. Greater government spending on heath and lower linguistic fractionalization were also consistent with better vaccination outcomes. Improving vaccination coverage and reducing inequalities requires that policies and programs address critical social determinants of health including geographic and social exclusion, gender inequality and the availability of financial protection for health. Further research should investigate the mechanisms contributing to these associations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Tanzania's countdown to 2015: an analysis of two decades of progress and gaps for reproductive, maternal, newborn, and child health, to inform priorities for post-2015.

PubMed

Afnan-Holmes, Hoviyeh; Magoma, Moke; John, Theopista; Levira, Francis; Msemo, Georgina; Armstrong, Corinne E; Martínez-Álvarez, Melisa; Kerber, Kate; Kihinga, Clement; Makuwani, Ahmad; Rusibamayila, Neema; Hussein, Asia; Lawn, Joy E

2015-07-01

Tanzania is on track to meet Millennium Development Goal (MDG) 4 for child survival, but is making insufficient progress for newborn survival and maternal health (MDG 5) and family planning. To understand this mixed progress and to identify priorities for the post-2015 era, Tanzania was selected as a Countdown to 2015 case study. We analysed progress made in Tanzania between 1990 and 2014 in maternal, newborn, and child mortality, and unmet need for family planning, in which we used a health systems evaluation framework to assess coverage and equity of interventions along the continuum of care, health systems, policies and investments, while also considering contextual change (eg, economic and educational). We had five objectives, which assessed each level of the health systems evaluation framework. We used the Lives Saved Tool (LiST) and did multiple linear regression analyses to explain the reduction in child mortality in Tanzania. We analysed the reasons for the slower changes in maternal and newborn survival and family planning, to inform priorities to end preventable maternal, newborn, and child deaths by 2030. In the past two decades, Tanzania's population has doubled in size, necessitating a doubling of health and social services to maintain coverage. Total health-care financing also doubled, with donor funding for child health and HIV/AIDS more than tripling. Trends along the continuum of care varied, with preventive child health services reaching high coverage (≥85%) and equity (socioeconomic status difference 13-14%), but lower coverage and wider inequities for child curative services (71% coverage, socioeconomic status difference 36%), facility delivery (52% coverage, socioeconomic status difference 56%), and family planning (46% coverage, socioeconomic status difference 22%). The LiST analysis suggested that around 39% of child mortality reduction was linked to increases in coverage of interventions, especially of immunisation and insecticide-treated bednets. Economic growth was also associated with reductions in child mortality. Child health programmes focused on selected high-impact interventions at lower levels of the health system (eg, the community and dispensary levels). Despite its high priority, implementation of maternal health care has been intermittent. Newborn survival has gained attention only since 2005, but high-impact interventions are already being implemented. Family planning had consistent policies but only recent reinvestment in implementation. Mixed progress in reproductive, maternal, newborn, and child health in Tanzania indicates a complex interplay of political prioritisation, health financing, and consistent implementation. Post-2015 priorities for Tanzania should focus on the unmet need for family planning, especially in the Western and Lake regions; addressing gaps for coverage and quality of care at birth, especially in rural areas; and continuation of progress for child health. Government of Canada, Foreign Affairs, Trade, and Development; US Fund for UNICEF; and the Bill & Melinda Gates Foundation. Copyright © 2015 Afnan-Holmes et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

Clustered lot quality assurance sampling to assess immunisation coverage: increasing rapidity and maintaining precision.

PubMed

Pezzoli, Lorenzo; Andrews, Nick; Ronveaux, Olivier

2010-05-01

Vaccination programmes targeting disease elimination aim to achieve very high coverage levels (e.g. 95%). We calculated the precision of different clustered lot quality assurance sampling (LQAS) designs in computer-simulated surveys to provide local health officers in the field with preset LQAS plans to simply and rapidly assess programmes with high coverage targets. We calculated sample size (N), decision value (d) and misclassification errors (alpha and beta) of several LQAS plans by running 10 000 simulations. We kept the upper coverage threshold (UT) at 90% or 95% and decreased the lower threshold (LT) progressively by 5%. We measured the proportion of simulations with < or =d individuals unvaccinated or lower if the coverage was set at the UT (pUT) to calculate beta (1-pUT) and the proportion of simulations with >d unvaccinated individuals if the coverage was LT% (pLT) to calculate alpha (1-pLT). We divided N in clusters (between 5 and 10) and recalculated the errors hypothesising that the coverage would vary in the clusters according to a binomial distribution with preset standard deviations of 0.05 and 0.1 from the mean lot coverage. We selected the plans fulfilling these criteria: alpha < or = 5% beta < or = 20% in the unclustered design; alpha < or = 10% beta < or = 25% when the lots were divided in five clusters. When the interval between UT and LT was larger than 10% (e.g. 15%), we were able to select precise LQAS plans dividing the lot in five clusters with N = 50 (5 x 10) and d = 4 to evaluate programmes with 95% coverage target and d = 7 to evaluate programmes with 90% target. These plans will considerably increase the feasibility and the rapidity of conducting the LQAS in the field.

Further observations on comparison of immunization coverage by lot quality assurance sampling and 30 cluster sampling.

PubMed

Singh, J; Jain, D C; Sharma, R S; Verghese, T

1996-06-01

Lot Quality Assurance Sampling (LQAS) and standard EPI methodology (30 cluster sampling) were used to evaluate immunization coverage in a Primary Health Center (PHC) where coverage levels were reported to be more than 85%. Of 27 sub-centers (lots) evaluated by LQAS, only 2 were accepted for child coverage, whereas none was accepted for tetanus toxoid (TT) coverage in mothers. LQAS data were combined to obtain an estimate of coverage in the entire population; 41% (95% CI 36-46) infants were immunized appropriately for their ages, while 42% (95% CI 37-47) of their mothers had received a second/ booster dose of TT. TT coverage in 149 contemporary mothers sampled in EPI survey was also 42% (95% CI 31-52). Although results by the two sampling methods were consistent with each other, a big gap was evident between reported coverage (in children as well as mothers) and survey results. LQAS was found to be operationally feasible, but it cost 40% more and required 2.5 times more time than the EPI survey. LQAS therefore, is not a good substitute for current EPI methodology to evaluate immunization coverage in a large administrative area. However, LQAS has potential as method to monitor health programs on a routine basis in small population sub-units, especially in areas with high and heterogeneously distributed immunization coverage.

Benchmarking health system performance across regions in Uganda: a systematic analysis of levels and trends in key maternal and child health interventions, 1990-2011.

PubMed

Roberts, D Allen; Ng, Marie; Ikilezi, Gloria; Gasasira, Anne; Dwyer-Lindgren, Laura; Fullman, Nancy; Nalugwa, Talemwa; Kamya, Moses; Gakidou, Emmanuela

2015-12-03

Globally, countries are increasingly prioritizing the reduction of health inequalities and provision of universal health coverage. While national benchmarking has become more common, such work at subnational levels is rare. The timely and rigorous measurement of local levels and trends in key health interventions and outcomes is vital to identifying areas of progress and detecting early signs of stalled or declining health system performance. Previous studies have yet to provide a comprehensive assessment of Uganda's maternal and child health (MCH) landscape at the subnational level. By triangulating a number of different data sources - population censuses, household surveys, and administrative data - we generated regional estimates of 27 key MCH outcomes, interventions, and socioeconomic indicators from 1990 to 2011. After calculating source-specific estimates of intervention coverage, we used a two-step statistical model involving a mixed-effects linear model as an input to Gaussian process regression to produce regional-level trends. We also generated national-level estimates and constructed an indicator of overall intervention coverage based on the average of 11 high-priority interventions. National estimates often veiled large differences in coverage levels and trends across Uganda's regions. Under-5 mortality declined dramatically, from 163 deaths per 1,000 live births in 1990 to 85 deaths per 1,000 live births in 2011, but a large gap between Kampala and the rest of the country persisted. Uganda rapidly scaled up a subset of interventions across regions, including household ownership of insecticide-treated nets, receipt of artemisinin-based combination therapies among children under 5, and pentavalent immunization. Conversely, most regions saw minimal increases, if not actual declines, in the coverage of indicators that required multiple contacts with the health system, such as four or more antenatal care visits, three doses of oral polio vaccine, and two doses of intermittent preventive therapy during pregnancy. Some of the regions with the lowest levels of overall intervention coverage in 1990, such as North and West Nile, saw marked progress by 2011; nonetheless, sizeable disparities remained between Kampala and the rest of the country. Countrywide, overall coverage increased from 40% in 1990 to 64% in 2011, but coverage in 2011 ranged from 57% to 70% across regions. The MCH landscape in Uganda has, for the most part, improved between 1990 and 2011. Subnational benchmarking quantified the persistence of geographic health inequalities and identified regions in need of additional health systems strengthening. The tracking and analysis of subnational health trends should be conducted regularly to better guide policy decisions and strengthen responsiveness to local health needs.

Enhancing the spatial coverage of a regional high-quality hydraulic conductivity dataset with estimates made from domestic water-well specific-capacity tests

NASA Astrophysics Data System (ADS)

Priebe, Elizabeth H.; Neville, C. J.; Rudolph, D. L.

2018-03-01

The spatial coverage of hydraulic conductivity ( K) values for large-scale groundwater investigations is often poor because of the high costs associated with hydraulic testing and the large areas under investigation. Domestic water wells are ubiquitous and their well logs represent an untapped resource of information that includes mandatory specific-capacity tests, from which K can be estimated. These specific-capacity tests are routinely conducted at such low pumping rates that well losses are normally insignificant. In this study, a simple and practical approach to augmenting high-quality K values with reconnaissance-level K values from water-well specific-capacity tests is assessed. The integration of lesser quality K values from specific-capacity tests with a high-quality K data set is assessed through comparisons at two different scales: study-area-wide (a 600-km2 area in Ontario, Canada) and in a single geological formation within a portion of the broader study area (200 km2). Results of the comparisons demonstrate that reconnaissance-level K estimates from specific-capacity tests approximate the ranges and distributions of the high-quality K values. Sufficient detail about the physical basis and assumptions that are invoked in the development of the approach are presented here so that it can be applied with confidence by practitioners seeking to enhance their spatial coverage of K values with specific-capacity tests.

An Analysis of Misconceptions in Science Textbooks: Earth Science in England and Wales

ERIC Educational Resources Information Center

King, Chris John Henry

2010-01-01

Surveys of the earth science content of all secondary (high school) science textbooks and related publications used in England and Wales have revealed high levels of error/misconception. The 29 science textbooks or textbook series surveyed (51 texts in all) showed poor coverage of National Curriculum earth science and contained a mean level of one…

Preventing Childhood Malaria in Africa by Protecting Adults from Mosquitoes with Insecticide-Treated Nets

PubMed Central

Killeen, Gerry F; Smith, Tom A; Ferguson, Heather M; Mshinda, Hassan; Abdulla, Salim; Lengeler, Christian; Kachur, Steven P

2007-01-01

Background Malaria prevention in Africa merits particular attention as the world strives toward a better life for the poorest. Insecticide-treated nets (ITNs) represent a practical means to prevent malaria in Africa, so scaling up coverage to at least 80% of young children and pregnant women by 2010 is integral to the Millennium Development Goals (MDG). Targeting individual protection to vulnerable groups is an accepted priority, but community-level impacts of broader population coverage are largely ignored even though they may be just as important. We therefore estimated coverage thresholds for entire populations at which individual- and community-level protection are equivalent, representing rational targets for ITN coverage beyond vulnerable groups. Methods and Findings Using field-parameterized malaria transmission models, we show that high (80% use) but exclusively targeted coverage of young children and pregnant women (representing <20% of the population) will deliver limited protection and equity for these vulnerable groups. In contrast, relatively modest coverage (35%–65% use, with this threshold depending on ecological scenario and net quality) of all adults and children, rather than just vulnerable groups, can achieve equitable community-wide benefits equivalent to or greater than personal protection. Conclusions Coverage of entire populations will be required to accomplish large reductions of the malaria burden in Africa. While coverage of vulnerable groups should still be prioritized, the equitable and communal benefits of wide-scale ITN use by older children and adults should be explicitly promoted and evaluated by national malaria control programmes. ITN use by the majority of entire populations could protect all children in such communities, even those not actually covered by achieving existing personal protection targets of the MDG, Roll Back Malaria Partnership, or the US President's Malaria Initiative. PMID:17608562

Coverage of pilot parenteral vaccination campaign against canine rabies in N'Djaména, Chad.

PubMed Central

Kayali, U.; Mindekem, R.; Yémadji, N.; Vounatsou, P.; Kaninga, Y.; Ndoutamia, A. G.; Zinsstag, J.

2003-01-01

Canine rabies, and thus human exposure to rabies, can be controlled through mass vaccination of the animal reservoir if dog owners are willing to cooperate. Inaccessible, ownerless dogs, however, reduce the vaccination coverage achieved in parenteral campaigns. This study aimed to estimate the vaccination coverage in dogs in three study zones of N'Djaména, Chad, after a pilot free parenteral mass vaccination campaign against rabies. We used a capture-mark-recapture approach for population estimates, with a Bayesian, Markov chain, Monte Carlo method to estimate the total number of owned dogs, and the ratio of ownerless to owned dogs to calculate vaccination coverage. When we took into account ownerless dogs, the vaccination coverage in the dog populations was 87% (95% confidence interval (CI), 84-89%) in study zone I, 71% (95% CI, 64-76%) in zone II, and 64% (95% CI, 58-71%) in zone III. The proportions of ownerless dogs to owned dogs were 1.1% (95% CI, 0-3.1%), 7.6% (95% CI, 0.7-16.5%), and 10.6% (95% CI, 1.6-19.1%) in the three study zones, respectively. Vaccination coverage in the three populations of owned dogs was 88% (95% CI, 84-92%) in zone I, 76% (95% CI, 71-81%) in zone II, and 70% (95% CI, 66-76%) in zone III. Participation of dog owners in the free campaign was high, and the number of inaccessible ownerless dogs was low. High levels of vaccination coverage could be achieved with parenteral mass vaccination. Regular parenteral vaccination campaigns to cover all of N'Djaména should be considered as an ethical way of preventing human rabies when post-exposure treatment is of limited availability and high in cost. PMID:14758434

State Medicaid Coverage, ESRD Incidence, and Access to Care

PubMed Central

Goldstein, Benjamin A.; Hall, Yoshio N.; Mitani, Aya A.; Winkelmayer, Wolfgang C.

2014-01-01

The proportion of low-income nonelderly adults covered by Medicaid varies widely by state. We sought to determine whether broader state Medicaid coverage, defined as the proportion of each state’s low-income nonelderly adult population covered by Medicaid, associates with lower state-level incidence of ESRD and greater access to care. The main outcomes were incidence of ESRD and five indicators of access to care. We identified 408,535 adults aged 20–64 years, who developed ESRD between January 1, 2001, and December 31, 2008. Medicaid coverage among low-income nonelderly adults ranged from 12.2% to 66.0% (median 32.5%). For each additional 10% of the low-income nonelderly population covered by Medicaid, there was a 1.8% (95% confidence interval, 1.0% to 2.6%) decrease in ESRD incidence. Among nonelderly adults with ESRD, gaps in access to care between those with private insurance and those with Medicaid were narrower in states with broader coverage. For a 50-year-old white woman, the access gap to the kidney transplant waiting list between Medicaid and private insurance decreased by 7.7 percentage points in high (>45%) versus low (<25%) Medicaid coverage states. Similarly, the access gap to transplantation decreased by 4.0 percentage points and the access gap to peritoneal dialysis decreased by 3.8 percentage points in high Medicaid coverage states. In conclusion, states with broader Medicaid coverage had a lower incidence of ESRD and smaller insurance-related access gaps. PMID:24652791

Impact of the school lunch program on overweight and obesity among junior high school students: a nationwide study in Japan.

PubMed

Miyawaki, A; Lee, J S; Kobayashi, Y

2018-06-05

Japan has experienced a low prevalence of childhood obesity. The Japanese nationwide school lunch program is suggested to have helped this phenomenon, but it has not been proven. From official statistics, we combined annual data for 2006-15 about the prefecture-level school lunch coverage rate for public junior high school students and the prefecture-level nutritional indicators calculated by randomly selected age-sex groups of 13-15-year olds: the percentage of overweight, obese or underweight children, who are 20% heavier, 30% heavier or 20% lighter than the standard weight by sex, age and height; and mean body weight (kg) or height (cm). We estimated the impact of the school lunch coverage rate on the nutritional indicators in subsequent years, adjusting for the lagged dependent variable and dummies for prefecture, age and year. A 10 percentage point increase in the prefecture-level school lunch coverage rate significantly decreased the percentage of overweight (0.37%, 95% CI: 0.18-0.56) and obesity (0.23%, 0.10-0.37) in subsequent years among boys, but not among girls. No significant effect on the percentage of underweight or mean body weight/height was observed for either sex. Appropriate nutritional intake through school lunch may be effective to reduce childhood obesity.

High vaccination coverage is associated with low epidemic level of seasonal influenza in elementary schools: an observational study in Matsumoto City, Japan.

PubMed

Uchida, Mitsuo; Kaneko, Minoru; Hidaka, Yoshihiko; Yamamoto, Hiroshi; Honda, Takayuki; Takeuchi, Shouhei; Saito, Masaya; Kawa, Shigeyuki

2018-03-13

Influenza virus transmission may be prevented by infection control measures, including vaccination, wearing a mask, gargling with water, and hand washing. It is unclear, however, whether these measures affect influenza epidemics in school settings. A prospective epidemiological survey in all public elementary schools in Matsumoto City, Japan, during the 2014/2015 season evaluated the number of diagnosed patients in each school and calculated the reproduction number of schoolchildren. At the end of the prospective survey, a cross-sectional survey evaluated the implementation of infection control measures in these schools. Both results were combined and associations among infection control measures including vaccination, mask wearing, hand washing, water gargling, and epidemic level were evaluated. Of the 13,217 schoolchildren in 29 schools, 2548 were diagnosed with seasonal influenza. A significant negative association was observed between vaccination coverage and reproduction number at each school, but not between other infection control measures and the reproduction number. A regression curve with exponential function was most predictive. At 0% vaccination, the reproduction number was estimated to be 1.39. These findings provide evidence that high vaccination coverage was associated with reduced epidemic levels in schools and suggest the need for increased vaccination of schoolchildren.

Staff-related access deficit and antenatal care coverage across the NUTS level 1 regions of Turkey.

PubMed

Yardim, Mahmut S

2010-01-01

At the heart of each health system, the workforce is central to advancing health. The World Health Organization has identified a threshold in workforce density below which high coverage of essential interventions, including those necessary to meet the health-related Millennium Development Goals (MDGs), is very unlikely. The International Labor Organization (ILO) has launched a similar indicator -staff related access deficit- using Thailand's health care professional density as a benchmark. The aim of this study is to assess the staff-related access deficit of the population across the 12 NUTS 1 level regions of Turkey. The main hypothesis is that staff-related access deficit has a correlation with and predicts the gap in antenatal care coverage (percentage of women unable to access to antenatal care) across different regions. Staff-related access deficit, as a threshold indicator, seems to have a linear relationship with the antenatal care coverage gap. The known inequalities in the distribution of the health care workforce among different regions of Turkey were put forward once more in this study using the SRA indicator. The staff-related access deficit indicator can be easily used to monitor the status of distributional inequalities of the health care workforce at different sub-national levels in the future.

Socio-economic determinants and inequities in coverage and timeliness of early childhood immunisation in rural Ghana.

PubMed

Gram, Lu; Soremekun, Seyi; ten Asbroek, Augustinus; Manu, Alexander; O'Leary, Maureen; Hill, Zelee; Danso, Samuel; Amenga-Etego, Seeba; Owusu-Agyei, Seth; Kirkwood, Betty R

2014-07-01

To assess the extent of socio-economic inequity in coverage and timeliness of key childhood immunisations in Ghana. Secondary analysis of vaccination card data collected from babies born between January 2008 and January 2010 who were registered in the surveillance system supporting the ObaapaVita and Newhints Trials was carried out. 20 251 babies had 6 weeks' follow-up, 16 652 had 26 weeks' follow-up, and 5568 had 1 year's follow-up. We performed a descriptive analysis of coverage and timeliness of vaccinations by indicators for urban/rural status, wealth and educational attainment. The association of coverage with socio-economic indicators was tested using a chi-square-test and the association with timeliness using Cox regression. Overall coverage at 1 year of age was high (>95%) for Bacillus Calmette-Guérin (BCG), all three pentavalent diphtheria-pertussis-tetanus-haemophilus influenzae B-hepatitis B (DPTHH) doses and all polio doses except polio at birth (63%). Coverage against measles and yellow fever was 85%. Median delay for BCG was 1.7 weeks. For polio at birth, the median delay was 5 days; all other vaccine doses had median delays of 2-4 weeks. We found substantial health inequity across all socio-economic indicators for all vaccines in terms of timeliness, but not coverage at 1 year. For example, for the last DPTHH dose, the proportion of children delayed more than 8 weeks were 27% for urban children and 31% for rural children (P < 0.001), 21% in the wealthiest quintile and 41% in the poorest quintile (P < 0.001), and 9% in the most educated group and 39% in the least educated group (P < 0.001). However, 1-year coverage of the same dose remained above 90% for all levels of all socio-economic indicators. Ghana has substantial health inequity across urban/rural, socio-economic and educational divides. While overall coverage was high, most vaccines suffered from poor timeliness. We suggest that countries achieving high coverage should include timeliness indicators in their surveillance systems. © 2014 John Wiley & Sons Ltd.

NSW Annual Immunisation Coverage Report, 2009.

PubMed

Hull, Brynley; Dey, Aditi; Mahajan, Deepika; Campbell-Lloyd, Sue; Menzies, Robert I; McIntyre, Peter B

2010-01-01

This is the first in a series of annual immunisation coverage reports that document trends in NSW for a range of standard measures derived from Australian Childhood Immunisation Register data, including overall coverage at standard age milestones and for individual vaccines. This report includes data up to and including 2009. Data from the Australian Childhood Immunisation Register, the NSW Health Survey and the NSW School Immunisation Program were used to calculate various measures of population coverage relating to childhood vaccines, adult influenza and pneumococcal vaccines and adolescent vaccination, respectively. Immunise Australia Program targets have been reached for children at 12 and 24 months of age but not for children at 5 years of age. Delayed receipt of vaccines is an issue for vaccines recommended for Aboriginal children. Pneumococcal vaccination in the elderly has been steadily rising, although it has remained lower than the influenza coverage estimates. For adolescents, there is better coverage for the first and second doses of human papillomavirus vaccine and the dose of dTpa than for varicella. This comprehensive analysis provides important baseline data for NSW against which future reports can be compared to monitor progress in improving immunisation coverage. Immunisation at the earliest appropriate age should be a public health goal for countries such as Australia where high levels of vaccine coverage at milestone ages have been achieved.

Beyond health aid: would an international equalization scheme for universal health coverage serve the international collective interest?

PubMed Central

2014-01-01

It has been argued that the international community is moving ‘beyond aid’. International co-financing in the international collective interest is expected to replace altruistically motivated foreign aid. The World Health Organization promotes ‘universal health coverage’ as the overarching health goal for the next phase of the Millennium Development Goals. In order to provide a basic level of health care coverage, at least some countries will need foreign aid for decades to come. If international co-financing of global public goods is replacing foreign aid, is universal health coverage a hopeless endeavor? Or would universal health coverage somehow serve the international collective interest? Using the Sustainable Development Solutions Network proposal to finance universal health coverage as a test case, we examined the hypothesis that national social policies face the threat of a ‘race to the bottom’ due to global economic integration and that this threat could be mitigated through international social protection policies that include international cross-subsidies – a kind of ‘equalization’ at the international level. The evidence for the race to the bottom theory is inconclusive. We seem to be witnessing a ‘convergence to the middle’. However, the ‘middle’ where ‘convergence’ of national social policies is likely to occur may not be high enough to keep income inequality in check. The implementation of the international equalization scheme proposed by the Sustainable Development Solutions Network would allow to ensure universal health coverage at a cost of US$55 in low income countries-the minimum cost estimated by the World Health Organization. The domestic efforts expected from low and middle countries are far more substantial than the international co-financing efforts expected from high income countries. This would contribute to ‘convergence’ of national social policies at a higher level. We therefore submit that the proposed international equalization scheme should not be considered as foreign aid, but rather as an international collective effort to protect and promote national social policy in times of global economic integration: thus serving the international collective interest. PMID:24886583

Towards achieving Abuja targets: identifying and addressing barriers to access and use of insecticides treated nets among the poorest populations in Kenya.

PubMed

Chuma, Jane; Okungu, Vincent; Ntwiga, Janet; Molyneux, Catherine

2010-03-16

Ensuring that the poor and vulnerable population benefit from malaria control interventions remains a challenge for malaria endemic countries. Until recently, ownership and use of insecticides treated nets (ITNs) in most countries was low and inequitable, although coverage has increased in countries where free ITN distribution is integrated into mass vaccination campaigns. In Kenya, free ITNs were distributed to children aged below five years in 2006 through two mass campaigns. High and equitable coverage were reported after the campaigns in some districts, although national level coverage remained low, suggesting that understanding barriers to access remains important. This study was conducted to explore barriers to ownership and use of ITNs among the poorest populations before and after the mass campaigns, to identify strategies for improving coverage, and to make recommendations on how increased coverage levels can be sustained. The study was conducted in the poorest areas of four malaria endemic districts in Kenya. Multiple data collection methods were applied including: cross-sectional surveys (n = 708 households), 24 focus group discussions and semi-structured interviews with 70 ITN suppliers. Affordability was reported as a major barrier to access but non-financial barriers were also shown to be important determinants. On the demand side key barriers to access included: mismatch between the types of ITNs supplied through interventions and community preferences; perceptions and beliefs on illness causes; physical location of suppliers and; distrust in free delivery and in the distribution agencies. Key barriers on the supply side included: distance from manufacturers; limited acceptability of ITNs provided through interventions; crowding out of the commercial sector and the price. Infrastructure, information and communication played a central role in promoting or hindering access. Significant resources have been directed towards addressing affordability barriers through providing free ITNs to vulnerable groups, but the success of these interventions depends largely on the degree to which other barriers to access are addressed. Only if additional efforts are directed towards addressing non-financial barriers to access, will high coverage levels be achieved and sustained.

Modelling the cost-effectiveness of mass screening and treatment for reducing Plasmodium falciparum malaria burden.

PubMed

Crowell, Valerie; Briët, Olivier J T; Hardy, Diggory; Chitnis, Nakul; Maire, Nicolas; Di Pasquale, Aurelio; Smith, Thomas A

2013-01-03

Past experience and modelling suggest that, in most cases, mass treatment strategies are not likely to succeed in interrupting Plasmodium falciparum malaria transmission. However, this does not preclude their use to reduce disease burden. Mass screening and treatment (MSAT) is preferred to mass drug administration (MDA), as the latter involves massive over-use of drugs. This paper reports simulations of the incremental cost-effectiveness of well-conducted MSAT campaigns as a strategy for P. falciparum malaria disease-burden reduction in settings with varying receptivity (ability of the combined vector population in a setting to transmit disease) and access to case management. MSAT incremental cost-effectiveness ratios (ICERs) were estimated in different sub-Saharan African settings using simulation models of the dynamics of malaria and a literature-based MSAT cost estimate. Imported infections were simulated at a rate of two per 1,000 population per annum. These estimates were compared to the ICERs of scaling up case management or insecticide-treated net (ITN) coverage in each baseline health system, in the absence of MSAT. MSAT averted most episodes, and resulted in the lowest ICERs, in settings with a moderate level of disease burden. At a low pre-intervention entomological inoculation rate (EIR) of two infectious bites per adult per annum (IBPAPA) MSAT was never more cost-effective than scaling up ITNs or case management coverage. However, at pre-intervention entomological inoculation rates (EIRs) of 20 and 50 IBPAPA and ITN coverage levels of 40 or 60%, respectively, the ICER of MSAT was similar to that of scaling up ITN coverage further. In all the transmission settings considered, achieving a minimal level of ITN coverage is a "best buy". At low transmission, MSAT probably is not worth considering. Instead, MSAT may be suitable at medium to high levels of transmission and at moderate ITN coverage. If undertaken as a burden-reducing intervention, MSAT should be continued indefinitely and should complement, not replace, case management and vector control interventions.

Hepatitis B vaccination coverage among adults aged ≥18 years traveling to a country of high or intermediate endemicity, United States, 2015.

PubMed

Lu, Peng-Jun; O'Halloran, Alissa C; Williams, Walter W; Nelson, Noele P

2018-04-28

Persons from the United States who travel to developing countries are at substantial risk for hepatitis B virus (HBV) infection. Hepatitis B vaccine has been recommended for adults at increased risk for infection, including travelers to high or intermediate hepatitis B endemic countries. To assess hepatitis B vaccination coverage among adults ≥18 years traveling to a country of high or intermediate endemicity from the United States. Data from the 2015 National Health Interview Survey (NHIS) were analyzed to determine hepatitis B vaccination coverage (≥1 dose) and series completion (≥3 doses) among persons aged ≥18 years who reported traveling to a country of high or intermediate hepatitis B endemicity. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with hepatitis B vaccination. In 2015, hepatitis B vaccination coverage (≥1 dose) among adults aged ≥18 years who reported traveling to high or intermediate hepatitis B endemic countries was 38.6%, significantly higher compared with 25.9% among non-travelers. Series completion (≥3 doses) was 31.7% and 21.2%, respectively (P < 0.05). On multivariable analysis among all respondents, travel status was significantly associated with hepatitis B vaccination coverage and series completion. Other characteristics independently associated with vaccination (≥1 dose, and ≥3 doses) among travelers included age, race/ethnicity, educational level, duration of US residence, number of physician contacts in the past year, status of ever being tested for HIV, and healthcare personnel status. Although travel to a country of high or intermediate hepatitis B endemicity was associated with higher likelihood of hepatitis B vaccination, hepatitis B vaccination coverage was low among adult travelers to these areas. Healthcare providers should ask their patients about travel plans and recommend and offer travel related vaccinations to their patients or refer them to alternate sites for vaccination. Published by Elsevier Ltd.

Hepatitis B vaccination coverage among adults aged ≥ 18 years traveling to a country of high or intermediate endemicity, United States, 2015.

PubMed

Lu, Peng-Jun; O'Halloran, Alissa C; Williams, Walter W; Nelson, Noele P

2018-04-25

Persons from the United States who travel to developing countries are at substantial risk for hepatitis B virus (HBV) infection. Hepatitis B vaccine has been recommended for adults at increased risk for infection, including travelers to high or intermediate hepatitis B endemic countries. To assess hepatitis B vaccination coverage among adults ≥ 18 years traveling to a country of high or intermediate endemicity from the United States. Data from the 2015 National Health Interview Survey (NHIS) were analyzed to determine hepatitis B vaccination coverage (≥1 dose) and series completion (≥3 doses) among persons aged ≥ 18 years who reported traveling to a country of high or intermediate hepatitis B endemicity. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with hepatitis B vaccination. In 2015, hepatitis B vaccination coverage (≥1 dose) among adults aged ≥ 18 years who reported traveling to high or intermediate hepatitis B endemic countries was 38.6%, significantly higher compared with 25.9% among non-travelers. Series completion (≥3 doses) was 31.7% and 21.2%, respectively (P < 0.05). On multivariable analysis among all respondents, travel status was significantly associated with hepatitis B vaccination coverage and series completion. Other characteristics independently associated with vaccination (≥1 dose, and ≥ 3 doses) among travelers included age, race/ethnicity, educational level, duration of U.S. residence, number of physician contacts in the past year, status of ever being tested for HIV, and healthcare personnel status. Although travel to a country of high or intermediate hepatitis B endemicity was associated with higher likelihood of hepatitis B vaccination, hepatitis B vaccination coverage was low among adult travelers to these areas. Healthcare providers should ask their patients about travel plans and recommend and offer travel related vaccinations to their patients or refer them to alternate sites for vaccination. Published by Elsevier Ltd.

Disparity in maternal, newborn and child health services in high focus states in India: a district-level cross-sectional analysis.

PubMed

Awasthi, Ashish; Pandey, C M; Chauhan, Rajesh K; Singh, Uttam

2016-08-05

To examine the level and trend in the coverage gap of a set of interventions of maternal and child health services using a summary index and to assess the disparity in usage of maternal and child health services in the districts of high focus states of India. Data for the present study are taken from the Annual Health Survey (AHS), 2010-2013 and Census of India, 2011. This study used secondary data from states having higher mortality and fertility rates, termed as high focus states in India. District-level information regarding children aged 12-23 months and ever married women aged 15-49 years has been extracted from the AHS (2010-2013), and household amenities, female literacy and main workforce information has been obtained from the Census of India 2011. 2 summary indexes were calculated first for maternal and child health services and another for socioeconomic and development status, using data from AHS and Census. Cronbach's α was used to assess the internal consistency of the items used in the index. The result shows that the coverage gap is highest in Uttar Pradesh (37%) and lowest in Madhya Pradesh (21%). Converge gap and socioeconomic development are negatively correlated (r=-0.49, p=0.01). The average coverage gap was highest in the lowest quintile of socioeconomic development. There was an absolute change of 1.5% per year in coverage gap during 2009-2013. In regression analysis, the coefficient of determination was 0.24, β=-30.05, p=0.01 for a negative relationship between socioeconomic development and coverage gap. There is a significant disparity in the usage of maternal and child healthcare services in the districts of India. Resource-rich people (urban residents and richest quintile) are way ahead of marginalised people (rural residents and poorest quintile) in the usage of healthcare services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Assessing levels and trends of child health inequality in 88 developing countries: from 2000 to 2014

PubMed Central

Li, Zhihui; Li, Mingqiang; Subramanian, S. V.; Lu, Chunling

2017-01-01

ABSTRACT Background: Reducing child mortality was one of the Millennium Development Goals. In the current Sustainable Development Goals era, achieving equity is prioritized as a major aim. Objective: This study aims to provide a comprehensive and updated picture of inequalities in child health intervention coverage and child health outcomes by wealth status, as well as their trends between 2000 and 2014. Methods: Using data from Demographic Health Surveys and Multiple Indicator Cluster Surveys, we adopted three measures of inequality, including one absolute inequality indicator and two relative inequality indicators, to estimate the level and trends of inequalities in three child health outcome variables and 17 intervention coverages in 88 developing countries. Results: While improvements in child health outcomes and coverage of interventions have been observed between 2000 and 2014, large inequalities remain. There was a high level of variation between countries’ progress toward reducing child health inequalities, with some countries significantly improving, some deteriorating, and some remaining statistically unchanged. Among child health interventions, the least equitable one was access to improved sanitation (The absolute difference in coverages between the richest quintile and the poorest quintile reached 49.5% [42.7, 56.2]), followed by access to improved water (34.1% [29.5, 38.6]), and skilled birth attendant (SBA) (34.1% [28.8, 39.4]). The most equitable intervention coverage was insecticide-treated bed net for children (1.0% [−3.9, 5.9]), followed by oral rehydration therapy for diarrhea ((8.0% [5.2, 10.8]), and vitamin A supplement (8.4% [5.1, 11.7]). These findings were robust to various inequality measurements. Conclusions: Although child health outcomes and coverage of interventions have improved largely over the study period for almost all wealth quintiles, insufficient progress was made in reducing child health inequalities between the poorest and richest wealth quintiles. Future efforts should focus on reaching the poorest children by increasing investments toward expanding the coverage of interventions in resource-limited settings. PMID:29228888

Determinants of vaccination coverage in rural Nigeria.

PubMed

Odusanya, Olumuyiwa O; Alufohai, Ewan F; Meurice, Francois P; Ahonkhai, Vincent I

2008-11-05

Childhood immunization is a cost effective public health strategy. Expanded Programme on Immunisation (EPI) services have been provided in a rural Nigerian community (Sabongidda-Ora, Edo State) at no cost to the community since 1998 through a privately financed vaccination project (private public partnership). The objective of this survey was to assess vaccination coverage and its determinants in this rural community in Nigeria A cross-sectional survey was conducted in September 2006, which included the use of interviewer-administered questionnaire to assess knowledge of mothers of children aged 12-23 months and vaccination coverage. Survey participants were selected following the World Health Organization's (WHO) immunization coverage cluster survey design. Vaccination coverage was assessed by vaccination card and maternal history. A child was said to be fully immunized if he or she had received all of the following vaccines: a dose of Bacille Calmette Guerin (BCG), three doses of oral polio (OPV), three doses of diphtheria, pertussis and tetanus (DPT), three doses of hepatitis B (HB) and one dose of measles by the time he or she was enrolled in the survey, i.e. between the ages of 12-23 months. Knowledge of the mothers was graded as satisfactory if mothers had at least a score of 3 out of a maximum of 5 points. Logistic regression was performed to identify determinants of full immunization status. Three hundred and thirty-nine mothers and 339 children (each mother had one eligible child) were included in the survey. Most of the mothers (99.1%) had very positive attitudes to immunization and > 55% were generally knowledgeable about symptoms of vaccine preventable diseases except for difficulty in breathing (as symptom of diphtheria). Two hundred and ninety-five mothers (87.0%) had a satisfactory level of knowledge. Vaccination coverage against all the seven childhood vaccine preventable diseases was 61.9% although it was significantly higher (p = 0.002) amongst those who had a vaccination card (131/188, 69.7%) than in those assessed by maternal history (79/151, 52.3%). Multiple logistic regression showed that mothers' knowledge of immunization (p = 0.006) and vaccination at a privately funded health facility (p < 0.001) were significantly correlated with the rate of full immunization. Eight years after initiation of this privately financed vaccination project (private-public partnership), vaccination coverage in this rural community is at a level that provides high protection (81%) against DPT/OPV. Completeness of vaccination was significantly correlated with knowledge of mothers on immunization and adequate attention should be given to this if high coverage levels are to be sustained.

Measuring and Specifying Combinatorial Coverage of Test Input Configurations

PubMed Central

Kuhn, D. Richard; Kacker, Raghu N.; Lei, Yu

2015-01-01

A key issue in testing is how many tests are needed for a required level of coverage or fault detection. Estimates are often based on error rates in initial testing, or on code coverage. For example, tests may be run until a desired level of statement or branch coverage is achieved. Combinatorial methods present an opportunity for a different approach to estimating required test set size, using characteristics of the test set. This paper describes methods for estimating the coverage of, and ability to detect, t-way interaction faults of a test set based on a covering array. We also develop a connection between (static) combinatorial coverage and (dynamic) code coverage, such that if a specific condition is satisfied, 100% branch coverage is assured. Using these results, we propose practical recommendations for using combinatorial coverage in specifying test requirements. PMID:28133442

The potential impact and cost of focusing HIV prevention on young women and men: A modeling analysis in western Kenya.

PubMed

Alsallaq, Ramzi A; Buttolph, Jasmine; Cleland, Charles M; Hallett, Timothy; Inwani, Irene; Agot, Kawango; Kurth, Ann E

2017-01-01

We compared the impact and costs of HIV prevention strategies focusing on youth (15-24 year-old persons) versus on adults (15+ year-old persons), in a high-HIV burden context of a large generalized epidemic. Compartmental age-structured mathematical model of HIV transmission in Nyanza, Kenya. The interventions focused on youth were high coverage HIV testing (80% of youth), treatment at diagnosis (TasP, i.e., immediate start of antiretroviral therapy [ART]) and 10% increased condom usage for HIV-positive diagnosed youth, male circumcision for HIV-negative young men, pre-exposure prophylaxis (PrEP) for high-risk HIV-negative females (ages 20-24 years), and cash transfer for in-school HIV-negative girls (ages 15-19 years). Permutations of these were compared to adult-focused HIV testing coverage with condoms and TasP. The youth-focused strategy with ART treatment at diagnosis and condom use without adding interventions for HIV-negative youth performed better than the adult-focused strategy with adult testing reaching 50-60% coverage and TasP/condoms. Over the long term, the youth-focused strategy approached the performance of 70% adult testing and TasP/condoms. When high coverage male circumcision also is added to the youth-focused strategy, the combined intervention outperformed the adult-focused strategy with 70% testing, for at least 35 years by averting 94,000 more infections, averting 5.0 million more disability-adjusted life years (DALYs), and saving US$46.0 million over this period. The addition of prevention interventions beyond circumcision to the youth-focused strategy would be more beneficial if HIV care costs are high, or when program delivery costs are relatively high for programs encompassing HIV testing coverage exceeding 70%, TasP and condoms to HIV-infected adults compared to combination prevention programs among youth. For at least the next three decades, focusing in high burden settings on high coverage HIV testing, ART treatment upon diagnosis, condoms and male circumcision among youth may outperform adult-focused ART treatment upon diagnosis programs, unless the adult testing coverage in these programs reaches very high levels (>70% of all adults reached) at similar program costs. Our results indicate the potential importance of age-targeting for HIV prevention in the current era of 'test and start, ending AIDS' goals to ameliorate the HIV epidemic globally.

Invitation coverage and participation in Italian cervical, breast and colorectal cancer screening programmes.

PubMed

Giorgi Rossi, Paolo; Carrozzi, Giuliano; Federici, Antonio; Mancuso, Pamela; Sampaolo, Letizia; Zappa, Marco

2018-03-01

Objectives In Italy, regional governments organize cervical, breast and colorectal cancer screening programmes, but there are difficulties in regularly inviting all the target populations and participation remains low. We analysed the determinants associated with invitation coverage of and participation in these programmes. Methods We used data on screening programmes from annual Ministry of Health surveys, 1999-2012 for cervical, 1999-2011 for breast and 2005-2011 for colorectal cancer. For recent years, we linked these data to the results of the national routine survey on preventive behaviours to evaluate the effect of spontaneous screening at Province level. Invitation and participation relative risk were calculated using Generalized Linear Models. Results There is a strong decreasing trend in invitation coverage and participation in screening programmes from North to South Italy. In metropolitan areas, both invitation coverage (rate ratio 0.35-0.96) and participation (rate ratio 0.63-0.88) are lower. An inverse association exists between spontaneous screening and both screening invitation coverage (1-3% decrease in invitation coverage per 1% spontaneous coverage increase) and participation (2% decrease in participation per 1% spontaneous coverage increase) for the three programmes. High recall rate has a negative effect on invitation coverage in the next round for breast cancer (1% decrease in invitation per 1% recall increase). Conclusions Organizational and cultural changes are needed to better implement cancer screening in southern Italy.

Broader health coverage is good for the nation's health: evidence from country level panel data.

PubMed

Moreno-Serra, Rodrigo; Smith, Peter C

2015-01-01

Progress towards universal health coverage involves providing people with access to needed health services without entailing financial hardship and is often advocated on the grounds that it improves population health. The paper offers econometric evidence on the effects of health coverage on mortality outcomes at the national level. We use a large panel data set of countries, examined by using instrumental variable specifications that explicitly allow for potential reverse causality and unobserved country-specific characteristics. We employ various proxies for the coverage level in a health system. Our results indicate that expanded health coverage, particularly through higher levels of publicly funded health spending, results in lower child and adult mortality, with the beneficial effect on child mortality being larger in poorer countries.

Broader health coverage is good for the nation's health: evidence from country level panel data

PubMed Central

Moreno-Serra, Rodrigo; Smith, Peter C

2015-01-01

Progress towards universal health coverage involves providing people with access to needed health services without entailing financial hardship and is often advocated on the grounds that it improves population health. The paper offers econometric evidence on the effects of health coverage on mortality outcomes at the national level. We use a large panel data set of countries, examined by using instrumental variable specifications that explicitly allow for potential reverse causality and unobserved country-specific characteristics. We employ various proxies for the coverage level in a health system. Our results indicate that expanded health coverage, particularly through higher levels of publicly funded health spending, results in lower child and adult mortality, with the beneficial effect on child mortality being larger in poorer countries. PMID:25598588

Clinical Paresthesia Atlas Illustrates Likelihood of Coverage Based on Spinal Cord Stimulator Electrode Location.

PubMed

Taghva, Alexander; Karst, Edward; Underwood, Paul

2017-08-01

Concordant paresthesia coverage is an independent predictor of pain relief following spinal cord stimulation (SCS). Using aggregate data, our objective is to produce a map of paresthesia coverage as a function of electrode location in SCS. This retrospective analysis used x-rays, SCS programming data, and paresthesia coverage maps from the EMPOWER registry of SCS implants for chronic neuropathic pain. Spinal level of dorsal column stimulation was determined by x-ray adjudication and active cathodes in patient programs. Likelihood of paresthesia coverage was determined as a function of stimulating electrode location. Segments of paresthesia coverage were grouped anatomically. Fisher's exact test was used to identify significant differences in likelihood of paresthesia coverage as a function of spinal stimulation level. In the 178 patients analyzed, the most prevalent areas of paresthesia coverage were buttocks, anterior and posterior thigh (each 98%), and low back (94%). Unwanted paresthesia at the ribs occurred in 8% of patients. There were significant differences in the likelihood of achieving paresthesia, with higher thoracic levels (T5, T6, and T7) more likely to achieve low back coverage but also more likely to introduce paresthesia felt at the ribs. Higher levels in the thoracic spine were associated with greater coverage of the buttocks, back, and thigh, and with lesser coverage of the leg and foot. This paresthesia atlas uses real-world, aggregate data to determine likelihood of paresthesia coverage as a function of stimulating electrode location. It represents an application of "big data" techniques, and a step toward achieving personalized SCS therapy tailored to the individual's chronic pain. © 2017 International Neuromodulation Society.

Measuring individual-level needle and syringe coverage among people who inject drugs in Myanmar.

PubMed

O'Keefe, Daniel; Aung, Soe Moe; Pasricha, Naanki; Wun, Thu; Linn, Soe Khaing; Lin, Nay; Aitken, Campbell; Hughes, Chad; Dietze, Paul

2018-05-10

Myanmar has prioritised people who inject drugs (PWID) as a key population for HIV mitigation efforts, with targets for needle and syringe distribution set at a population level. However, individual-level coverage, defined as the percentage of an individual's injecting episodes covered by a sterile syringe, is a more sensitive measure of intervention coverage. We sought to examine individual-level coverage in a sample of PWID in Myanmar. We recruited 512 PWID through urban drop-in-centres in Yangon, Mandalay and Pyin Oo Lwin. Participants were administered a quantitative questionnaire covering five domains: demographics, drug use, treatment and coverage, and injecting risk behaviour. We calculated past fortnight individual-level syringe coverage, estimating levels of sufficient (≥100% of injecting episodes covered by a sterile syringe) and insufficient (<100%) coverage, and examined associations between key variables and insufficient coverage via logistic regression. Our sample was predominately male (97%), employed (76%), and living in stable accommodation (96%), with a median age of 27. All participants reported heroin as the drug most frequently injected, and injected a median of 27 times in the past two weeks. Nineteen per cent of participants had insufficient coverage in the two weeks before interview. Insufficient coverage was positively associated with syringe re-use (AOR: 5.19, 95% CIs: 2.57, 10.48) and acquiring sterile syringes from a location other than a formal drop-in-centre (AOR: 2.04, 95% CIs: 1.08, 3.82). Participants recruited in Mandalay (AOR: 0.30, 95% CIs: 0.11, 0.80) and Pyin Oo Lwin (AOR: 0.39, 95% CIs: 0.18, 0.87) had lower odds of insufficient coverage than those recruited in Yangon. Our study shows coverage in selected areas of Myanmar was comparable with studies in other countries. Our results inform the delivery of harm reduction services for PWID, specifically by encouraging the use of formal drop-in-centres, over other sources of syringe distribution, such as pharmacies. Copyright © 2018 Elsevier B.V. All rights reserved.

Longitudinal analysis of change in individual-level needle and syringe coverage amongst a cohort of people who inject drugs in Melbourne, Australia.

PubMed

O'Keefe, Daniel; Scott, Nick; Aitken, Campbell; Dietze, Paul

2017-07-01

Needle and syringe program (NSP) coverage is often calculated at the individual level. This method relates sterile needle and syringe acquisition to injecting frequency, resulting in a percentage of injecting episodes that utilise a sterile syringe. Most previous research using this method was restricted by their cross-sectional design, calling for longitudinal exploration of coverage. We used the data of 518 participants from an ongoing cohort of people who inject drugs in Melbourne, Australia. We calculated individual-level syringe coverage for the two weeks prior to each interview, then dichotomised the outcome as either "sufficient" (≥100% of injecting episodes covered by at least one reported sterile syringe) or "insufficient" (<100%). Time-variant predictors of change in recent coverage (from sufficient to insufficient coverage) were estimated longitudinally using logistic regression with fixed effects for each participant. Transitioning to methamphetamine injection (AOR:2.16, p=0.004) and a newly positive HCV RNA test result (AOR:4.93, p=0.001) were both associated with increased odds of change to insufficient coverage, whilst change to utilising NSPs as the primary source of syringe acquisition (AOR: 0.41, p=0.003) and opioid substitution therapy (OST) enrolment (AOR:0.51, p=0.013) were protective against a change to insufficient coverage. We statistically tested the transitions between time-variant exposure sub-groups and transitions in individual-level syringe coverage. Our results give important insights into means of improving coverage at the individual level, suggesting that methamphetamine injectors should be targeted, whilst both OST prescription and NSP should be expanded. Copyright © 2017 Elsevier B.V. All rights reserved.

Heterogeneity in the spread and control of infectious disease: consequences for the elimination of canine rabies

NASA Astrophysics Data System (ADS)

Ferguson, Elaine A.; Hampson, Katie; Cleaveland, Sarah; Consunji, Ramona; Deray, Raffy; Friar, John; Haydon, Daniel T.; Jimenez, Joji; Pancipane, Marlon; Townsend, Sunny E.

2015-12-01

Understanding the factors influencing vaccination campaign effectiveness is vital in designing efficient disease elimination programmes. We investigated the importance of spatial heterogeneity in vaccination coverage and human-mediated dog movements for the elimination of endemic canine rabies by mass dog vaccination in Region VI of the Philippines (Western Visayas). Household survey data was used to parameterise a spatially-explicit rabies transmission model with realistic dog movement and vaccination coverage scenarios, assuming a basic reproduction number for rabies drawn from the literature. This showed that heterogeneous vaccination reduces elimination prospects relative to homogeneous vaccination at the same overall level. Had the three vaccination campaigns completed in Region VI in 2010-2012 been homogeneous, they would have eliminated rabies with high probability. However, given the observed heterogeneity, three further campaigns may be required to achieve elimination with probability 0.95. We recommend that heterogeneity be reduced in future campaigns through targeted efforts in low coverage areas, even at the expense of reduced coverage in previously high coverage areas. Reported human-mediated dog movements did not reduce elimination probability, so expending limited resources on restricting dog movements is unnecessary in this endemic setting. Enhanced surveillance will be necessary post-elimination, however, given the reintroduction risk from long-distance dog movements.

Determinants of Vaccination Coverage and Consequences for Rabies Control in Bali, Indonesia.

PubMed

Arief, Riana A; Hampson, Katie; Jatikusumah, Andri; Widyastuti, Maria D W; Sunandar; Basri, Chaerul; Putra, Anak A G; Willyanto, Iwan; Estoepangestie, Agnes T S; Mardiana, I W; Kesuma, I K G N; Sumantra, I P; Doherty, Paul F; Salman, M D; Gilbert, Jeff; Unger, Fred

2016-01-01

Maintaining high vaccination coverage is key to successful rabies control, but mass dog vaccination can be challenging and population turnover erodes coverage. Declines in rabies incidence following successive island-wide vaccination campaigns in Bali suggest that prospects for controlling and ultimately eliminating rabies are good. Rabies, however, has continued to circulate at low levels. In the push to eliminate rabies from Bali, high coverage needs to be maintained across all areas of the island. We carried out door-to-door (DTD) questionnaire surveys ( n  = 10,352 dog-owning households) and photographic mark-recapture surveys (536 line transects, 2,597 observations of free-roaming dogs) in 2011-2012 to estimate dog population sizes and assess rabies vaccination coverage and dog demographic characteristics in Bali, Indonesia. The median number of dogs per subvillage unit ( banjar ) was 43 (range 0-307) for owned dogs estimated from the DTD survey and 17 (range 0-83) for unconfined dogs (including both owned and unowned) from transects. Vaccination coverage of owned dogs was significantly higher in adults (91.4%) compared to juveniles (<1 year, 43.9%), likely due to insufficient targeting of pups and from puppies born subsequent to vaccination campaigns. Juveniles had a 10-70 times greater risk of not being vaccinated in urban, suburban, and rural areas [combined odds ratios (ORs): 9.9-71.1, 95% CI: 8.6-96.0]. Free-roaming owned dogs were also 2-3 times more likely to be not vaccinated compared to those confined (combined Ors: 1.9-3.6, 95% CI: 1.4-5.4), with more dogs being confined in urban (71.2%) than in suburban (16.1%) and rural areas (8.0%). Vaccination coverage estimates from transects were also much lower (30.9%) than household surveys (83.6%), possibly due to loss of collars used to identify the vaccination status of free-roaming dogs, but these unconfined dogs may also include dogs that were unowned or more difficult to vaccinate. Overall, coverage levels were high in the owned dog population, but for future campaigns in Bali to have the highest chance of eliminating rabies, concerted effort should be made to vaccinate free-roaming dogs particularly in suburban and rural areas, with advertising to ensure that owners vaccinate pups. Long-lasting, cheap, and quick methods are needed to mark vaccinated animals and reassure communities of the reach of vaccination campaigns.

Determinants of Vaccination Coverage and Consequences for Rabies Control in Bali, Indonesia

PubMed Central

Arief, Riana A.; Hampson, Katie; Jatikusumah, Andri; Widyastuti, Maria D. W.; Sunandar; Basri, Chaerul; Putra, Anak A. G.; Willyanto, Iwan; Estoepangestie, Agnes T. S.; Mardiana, I. W.; Kesuma, I. K. G. N.; Sumantra, I. P.; Doherty, Paul F.; Salman, M. D.; Gilbert, Jeff; Unger, Fred

2017-01-01

Maintaining high vaccination coverage is key to successful rabies control, but mass dog vaccination can be challenging and population turnover erodes coverage. Declines in rabies incidence following successive island-wide vaccination campaigns in Bali suggest that prospects for controlling and ultimately eliminating rabies are good. Rabies, however, has continued to circulate at low levels. In the push to eliminate rabies from Bali, high coverage needs to be maintained across all areas of the island. We carried out door-to-door (DTD) questionnaire surveys (n = 10,352 dog-owning households) and photographic mark–recapture surveys (536 line transects, 2,597 observations of free-roaming dogs) in 2011–2012 to estimate dog population sizes and assess rabies vaccination coverage and dog demographic characteristics in Bali, Indonesia. The median number of dogs per subvillage unit (banjar) was 43 (range 0–307) for owned dogs estimated from the DTD survey and 17 (range 0–83) for unconfined dogs (including both owned and unowned) from transects. Vaccination coverage of owned dogs was significantly higher in adults (91.4%) compared to juveniles (<1 year, 43.9%), likely due to insufficient targeting of pups and from puppies born subsequent to vaccination campaigns. Juveniles had a 10–70 times greater risk of not being vaccinated in urban, suburban, and rural areas [combined odds ratios (ORs): 9.9–71.1, 95% CI: 8.6–96.0]. Free-roaming owned dogs were also 2–3 times more likely to be not vaccinated compared to those confined (combined Ors: 1.9–3.6, 95% CI: 1.4–5.4), with more dogs being confined in urban (71.2%) than in suburban (16.1%) and rural areas (8.0%). Vaccination coverage estimates from transects were also much lower (30.9%) than household surveys (83.6%), possibly due to loss of collars used to identify the vaccination status of free-roaming dogs, but these unconfined dogs may also include dogs that were unowned or more difficult to vaccinate. Overall, coverage levels were high in the owned dog population, but for future campaigns in Bali to have the highest chance of eliminating rabies, concerted effort should be made to vaccinate free-roaming dogs particularly in suburban and rural areas, with advertising to ensure that owners vaccinate pups. Long-lasting, cheap, and quick methods are needed to mark vaccinated animals and reassure communities of the reach of vaccination campaigns. PMID:28119919

5 CFR 319.101 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Coverage. 319.101 Section 319.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT IN SENIOR-LEVEL AND SCIENTIFIC AND PROFESSIONAL POSITIONS General § 319.101 Coverage. (a) This part covers senior-level (SL) and...

5 CFR 319.101 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Coverage. 319.101 Section 319.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT IN SENIOR-LEVEL AND SCIENTIFIC AND PROFESSIONAL POSITIONS General § 319.101 Coverage. (a) This part covers senior-level (SL) and...

5 CFR 319.101 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Coverage. 319.101 Section 319.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT IN SENIOR-LEVEL AND SCIENTIFIC AND PROFESSIONAL POSITIONS General § 319.101 Coverage. (a) This part covers senior-level (SL) and...

5 CFR 319.101 - Coverage.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Coverage. 319.101 Section 319.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT IN SENIOR-LEVEL AND SCIENTIFIC AND PROFESSIONAL POSITIONS General § 319.101 Coverage. (a) This part covers senior-level (SL) and...

5 CFR 319.101 - Coverage.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Coverage. 319.101 Section 319.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT IN SENIOR-LEVEL AND SCIENTIFIC AND PROFESSIONAL POSITIONS General § 319.101 Coverage. (a) This part covers senior-level (SL) and...

Coverage of Nutrition Interventions Intended for Infants and Young Children Varies Greatly across Programs: Results from Coverage Surveys in 5 Countries.

PubMed

Leyvraz, Magali; Aaron, Grant J; Poonawala, Alia; van Liere, Marti J; Schofield, Dominic; Myatt, Mark; Neufeld, Lynnette M

2017-05-01

Background: The efficacy of a number of interventions that include fortified complementary foods (FCFs) or other products to improve infant and young child feeding (IYCF) is well established. Programs that provide such products free or at a subsidized price are implemented in many countries around the world. Demonstrating the impact at scale of these programs has been challenging, and rigorous information on coverage and utilization is lacking. Objective: The objective of this article is to review key findings from 11 coverage surveys of IYCF programs distributing or selling FCFs or micronutrient powders in 5 countries. Methods: Programs were implemented in Ghana, Cote d'Ivoire, India, Bangladesh, and Vietnam. Surveys were implemented at different stages of program implementation between 2013 and 2015. The Fortification Assessment Coverage Toolkit (FACT) was developed to assess 3 levels of coverage (message: awareness of the product; contact: use of the product ≥1 time; and effective: regular use aligned with program-specific goals), as well as barriers and factors that facilitate coverage. Analyses included the coverage estimates, as well as an assessment of equity of coverage between the poor and nonpoor, and between those with poor and adequate child feeding practices. Results: Coverage varied greatly between countries and program models. Message coverage ranged from 29.0% to 99.7%, contact coverage from 22.6% to 94.4%, and effective coverage from 0.8% to 88.3%. Beyond creating awareness, programs that achieved high coverage were those with effective mechanisms in place to overcome barriers for both supply and demand. Conclusions: Variability in coverage was likely due to the program design, delivery model, quality of implementation, and product type. Measuring program coverage and understanding its determinants is essential for program improvement and to estimate the potential for impact of programs at scale. Use of the FACT can help overcome this evidence gap.

Coverage of Nutrition Interventions Intended for Infants and Young Children Varies Greatly across Programs: Results from Coverage Surveys in 5 Countries123

PubMed Central

Aaron, Grant J; Poonawala, Alia; van Liere, Marti J; Schofield, Dominic; Myatt, Mark

2017-01-01

Background: The efficacy of a number of interventions that include fortified complementary foods (FCFs) or other products to improve infant and young child feeding (IYCF) is well established. Programs that provide such products free or at a subsidized price are implemented in many countries around the world. Demonstrating the impact at scale of these programs has been challenging, and rigorous information on coverage and utilization is lacking. Objective: The objective of this article is to review key findings from 11 coverage surveys of IYCF programs distributing or selling FCFs or micronutrient powders in 5 countries. Methods: Programs were implemented in Ghana, Cote d’Ivoire, India, Bangladesh, and Vietnam. Surveys were implemented at different stages of program implementation between 2013 and 2015. The Fortification Assessment Coverage Toolkit (FACT) was developed to assess 3 levels of coverage (message: awareness of the product; contact: use of the product ≥1 time; and effective: regular use aligned with program-specific goals), as well as barriers and factors that facilitate coverage. Analyses included the coverage estimates, as well as an assessment of equity of coverage between the poor and nonpoor, and between those with poor and adequate child feeding practices. Results: Coverage varied greatly between countries and program models. Message coverage ranged from 29.0% to 99.7%, contact coverage from 22.6% to 94.4%, and effective coverage from 0.8% to 88.3%. Beyond creating awareness, programs that achieved high coverage were those with effective mechanisms in place to overcome barriers for both supply and demand. Conclusions: Variability in coverage was likely due to the program design, delivery model, quality of implementation, and product type. Measuring program coverage and understanding its determinants is essential for program improvement and to estimate the potential for impact of programs at scale. Use of the FACT can help overcome this evidence gap. PMID:28404839

Estimation of the cost-effectiveness of HIV prevention portfolios for people who inject drugs in the United States: A model-based analysis

PubMed Central

Owens, Douglas K.; Goldhaber-Fiebert, Jeremy D.; Brandeau, Margaret L.

2017-01-01

Background The risks of HIV transmission associated with the opioid epidemic make cost-effective programs for people who inject drugs (PWID) a public health priority. Some of these programs have benefits beyond prevention of HIV—a critical consideration given that injection drug use is increasing across most United States demographic groups. To identify high-value HIV prevention program portfolios for US PWID, we consider combinations of four interventions with demonstrated efficacy: opioid agonist therapy (OAT), needle and syringe programs (NSPs), HIV testing and treatment (Test & Treat), and oral HIV pre-exposure prophylaxis (PrEP). Methods and findings We adapted an empirically calibrated dynamic compartmental model and used it to assess the discounted costs (in 2015 US dollars), health outcomes (HIV infections averted, change in HIV prevalence, and discounted quality-adjusted life years [QALYs]), and incremental cost-effectiveness ratios (ICERs) of the four prevention programs, considered singly and in combination over a 20-y time horizon. We obtained epidemiologic, economic, and health utility parameter estimates from the literature, previously published models, and expert opinion. We estimate that expansions of OAT, NSPs, and Test & Treat implemented singly up to 50% coverage levels can be cost-effective relative to the next highest coverage level (low, medium, and high at 40%, 45%, and 50%, respectively) and that OAT, which we assume to have immediate and direct health benefits for the individual, has the potential to be the highest value investment, even under scenarios where it prevents fewer infections than other programs. Although a model-based analysis can provide only estimates of health outcomes, we project that, over 20 y, 50% coverage with OAT could avert up to 22,000 (95% CI: 5,200, 46,000) infections and cost US$18,000 (95% CI: US$14,000, US$24,000) per QALY gained, 50% NSP coverage could avert up to 35,000 (95% CI: 8,900, 43,000) infections and cost US$25,000 (95% CI: US$7,000, US$76,000) per QALY gained, 50% Test & Treat coverage could avert up to 6,700 (95% CI: 1,200, 16,000) infections and cost US$27,000 (95% CI: US$15,000, US$48,000) per QALY gained, and 50% PrEP coverage could avert up to 37,000 (22,000, 58,000) infections and cost US$300,000 (95% CI: US$162,000, US$667,000) per QALY gained. When coverage expansions are allowed to include combined investment with other programs and are compared to the next best intervention, the model projects that scaling OAT coverage up to 50%, then scaling NSP coverage to 50%, then scaling Test & Treat coverage to 50% can be cost-effective, with each coverage expansion having the potential to cost less than US$50,000 per QALY gained relative to the next best portfolio. In probabilistic sensitivity analyses, 59% of portfolios prioritized the addition of OAT and 41% prioritized the addition of NSPs, while PrEP was not likely to be a priority nor a cost-effective addition. Our findings are intended to be illustrative, as data on achievable coverage are limited and, in practice, the expansion scenarios considered may exceed feasible levels. We assumed independence of interventions and constant returns to scale. Extensive sensitivity analyses allowed us to assess parameter sensitivity, but the use of a dynamic compartmental model limited the exploration of structural sensitivities. Conclusions We estimate that OAT, NSPs, and Test & Treat, implemented singly or in combination, have the potential to effectively and cost-effectively prevent HIV in US PWID. PrEP is not likely to be cost-effective in this population, based on the scenarios we evaluated. While local budgets or policy may constrain feasible coverage levels for the various interventions, our findings suggest that investments in combined prevention programs can substantially reduce HIV transmission and improve health outcomes among PWID. PMID:28542184

Estimation of the cost-effectiveness of HIV prevention portfolios for people who inject drugs in the United States: A model-based analysis.

PubMed

Bernard, Cora L; Owens, Douglas K; Goldhaber-Fiebert, Jeremy D; Brandeau, Margaret L

2017-05-01

The risks of HIV transmission associated with the opioid epidemic make cost-effective programs for people who inject drugs (PWID) a public health priority. Some of these programs have benefits beyond prevention of HIV-a critical consideration given that injection drug use is increasing across most United States demographic groups. To identify high-value HIV prevention program portfolios for US PWID, we consider combinations of four interventions with demonstrated efficacy: opioid agonist therapy (OAT), needle and syringe programs (NSPs), HIV testing and treatment (Test & Treat), and oral HIV pre-exposure prophylaxis (PrEP). We adapted an empirically calibrated dynamic compartmental model and used it to assess the discounted costs (in 2015 US dollars), health outcomes (HIV infections averted, change in HIV prevalence, and discounted quality-adjusted life years [QALYs]), and incremental cost-effectiveness ratios (ICERs) of the four prevention programs, considered singly and in combination over a 20-y time horizon. We obtained epidemiologic, economic, and health utility parameter estimates from the literature, previously published models, and expert opinion. We estimate that expansions of OAT, NSPs, and Test & Treat implemented singly up to 50% coverage levels can be cost-effective relative to the next highest coverage level (low, medium, and high at 40%, 45%, and 50%, respectively) and that OAT, which we assume to have immediate and direct health benefits for the individual, has the potential to be the highest value investment, even under scenarios where it prevents fewer infections than other programs. Although a model-based analysis can provide only estimates of health outcomes, we project that, over 20 y, 50% coverage with OAT could avert up to 22,000 (95% CI: 5,200, 46,000) infections and cost US$18,000 (95% CI: US$14,000, US$24,000) per QALY gained, 50% NSP coverage could avert up to 35,000 (95% CI: 8,900, 43,000) infections and cost US$25,000 (95% CI: US$7,000, US$76,000) per QALY gained, 50% Test & Treat coverage could avert up to 6,700 (95% CI: 1,200, 16,000) infections and cost US$27,000 (95% CI: US$15,000, US$48,000) per QALY gained, and 50% PrEP coverage could avert up to 37,000 (22,000, 58,000) infections and cost US$300,000 (95% CI: US$162,000, US$667,000) per QALY gained. When coverage expansions are allowed to include combined investment with other programs and are compared to the next best intervention, the model projects that scaling OAT coverage up to 50%, then scaling NSP coverage to 50%, then scaling Test & Treat coverage to 50% can be cost-effective, with each coverage expansion having the potential to cost less than US$50,000 per QALY gained relative to the next best portfolio. In probabilistic sensitivity analyses, 59% of portfolios prioritized the addition of OAT and 41% prioritized the addition of NSPs, while PrEP was not likely to be a priority nor a cost-effective addition. Our findings are intended to be illustrative, as data on achievable coverage are limited and, in practice, the expansion scenarios considered may exceed feasible levels. We assumed independence of interventions and constant returns to scale. Extensive sensitivity analyses allowed us to assess parameter sensitivity, but the use of a dynamic compartmental model limited the exploration of structural sensitivities. We estimate that OAT, NSPs, and Test & Treat, implemented singly or in combination, have the potential to effectively and cost-effectively prevent HIV in US PWID. PrEP is not likely to be cost-effective in this population, based on the scenarios we evaluated. While local budgets or policy may constrain feasible coverage levels for the various interventions, our findings suggest that investments in combined prevention programs can substantially reduce HIV transmission and improve health outcomes among PWID.

Go big or go home: impact of screening coverage on syphilis infection dynamics.

PubMed

Tuite, Ashleigh; Fisman, David

2016-02-01

Syphilis outbreaks in urban men who have sex with men (MSM) are an ongoing public health challenge in many high-income countries, despite intensification of efforts to screen and treat at-risk individuals. We sought to understand how population-level coverage of asymptomatic screening impacts the ability to control syphilis transmission. We developed a risk-structured deterministic compartmental mathematical model of syphilis transmission in a population of sexually active MSM. We assumed a baseline level of treatment of syphilis cases due to seeking medical care in all scenarios. We evaluated the impact of sustained annual population-wide screening coverage ranging from 0% to 90% on syphilis incidence over the short term (20 years) and at endemic equilibrium. The relationship between screening coverage and equilibrium syphilis incidence displayed an inverted U-shape relationship, with peak equilibrium incidence occurring with 20-30% annual screening coverage. Annual screening of 62% of the population was required for local elimination (incidence <1 case per 100 000 population). Results were qualitatively similar in the face of differing programmatic, behavioural and natural history assumptions, although the screening thresholds for local elimination differed. With 6-monthly or 3-monthly screening, the population coverage required to achieve local elimination was reduced to 39% or 23%, respectively. Although screening has the potential to control syphilis outbreaks, suboptimal coverage may paradoxically lead to a higher equilibrium infection incidence than that observed in the absence of intervention. Suboptimal screening programme design should be considered as a possible contributor to unsuccessful syphilis control programmes in the context of the current epidemic. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Effective coverage of essential inpatient care for small and sick newborns in a high mortality urban setting: a cross-sectional study in Nairobi City County, Kenya.

PubMed

Murphy, Georgina A V; Gathara, David; Mwachiro, Jacintah; Abuya, Nancy; Aluvaala, Jalemba; English, Mike

2018-05-22

Effective coverage requires that those in need can access skilled care supported by adequate resources. There are, however, few studies of effective coverage of facility-based neonatal care in low-income settings, despite the recognition that improving newborn survival is a global priority. We used a detailed retrospective review of medical records for neonatal admissions to public, private not-for-profit (mission) and private-for-profit (private) sector facilities providing 24×7 inpatient neonatal care in Nairobi City County to estimate the proportion of small and sick newborns receiving nationally recommended care across six process domains. We used our findings to explore the relationship between facility measures of structure and process and estimate effective coverage. Of 33 eligible facilities, 28 (four public, six mission and 18 private), providing an estimated 98.7% of inpatient neonatal care in the county, agreed to partake. Data from 1184 admission episodes were collected. Overall performance was lowest (weighted mean score 0.35 [95% confidence interval or CI: 0.22-0.48] out of 1) for correct prescription of fluid and feed volumes and best (0.86 [95% CI: 0.80-0.93]) for documentation of demographic characteristics. Doses of gentamicin, when prescribed, were at least 20% higher than recommended in 11.7% cases. Larger (often public) facilities tended to have higher process and structural quality scores compared with smaller, predominantly private, facilities. We estimate effective coverage to be 25% (estimate range: 21-31%). These newborns received high-quality inpatient care, while almost half (44.5%) of newborns needed care but did not receive it and a further 30.4% of newborns received an inadequate service. Failure to receive services and gaps in quality of care both contribute to a shortfall in effective coverage in Nairobi City County. Three-quarters of small and sick newborns do not have access to high-quality facility-based care. Substantial improvements in effective coverage will be required to tackle high neonatal mortality in this urban setting with high levels of poverty.

Modelling strategies to break transmission of lymphatic filariasis--aggregation, adherence and vector competence greatly alter elimination.

PubMed

Irvine, M A; Reimer, L J; Njenga, S M; Gunawardena, S; Kelly-Hope, L; Bockarie, M; Hollingsworth, T D

2015-10-22

With ambitious targets to eliminate lymphatic filariasis over the coming years, there is a need to identify optimal strategies to achieve them in areas with different baseline prevalence and stages of control. Modelling can assist in identifying what data should be collected and what strategies are best for which scenarios. We develop a new individual-based, stochastic mathematical model of the transmission of lymphatic filariasis. We validate the model by fitting to a first time point and predicting future timepoints from surveillance data in Kenya and Sri Lanka, which have different vectors and different stages of the control programme. We then simulate different treatment scenarios in low, medium and high transmission settings, comparing once yearly mass drug administration (MDA) with more frequent MDA and higher coverage. We investigate the potential impact that vector control, systematic non-compliance and different levels of aggregation have on the dynamics of transmission and control. In all settings, increasing coverage from 65 to 80 % has a similar impact on control to treating twice a year at 65 % coverage, for fewer drug treatments being distributed. Vector control has a large impact, even at moderate levels. The extent of aggregation of parasite loads amongst a small portion of the population, which has been estimated to be highly variable in different settings, can undermine the success of a programme, particularly if high risk sub-communities are not accessing interventions. Even moderate levels of vector control have a large impact both on the reduction in prevalence and the maintenance of gains made during MDA, even when parasite loads are highly aggregated, and use of vector control is at moderate levels. For the same prevalence, differences in aggregation and adherence can result in very different dynamics. The novel analysis of a small amount of surveillance data and resulting simulations highlight the need for more individual level data to be analysed to effectively tailor programmes in the drive for elimination.

Estimation of child vaccination coverage at state and national levels in India

PubMed Central

Gupta, Satish; Kumar, Rakesh; Haldar, Pradeep; Sethi, Raman; Bahl, Sunil

2016-01-01

Abstract Objective To review the data, for 1999–2013, on state-level child vaccination coverage in India and provide estimates of coverage at state and national levels. Methods We collated data from administrative reports, population-based surveys and other sources and used them to produce annual estimates of vaccination coverage. We investigated bacille Calmette–Guérin vaccine, the first and third doses of vaccine against diphtheria, tetanus and pertussis, the third dose of oral polio vaccine and the first dose of vaccine against measles. We obtained relevant data covering the period 1999–2013 for each of 16 states and territories and the period 2001–2013 for the state of Jharkhand – which was only created in 2000. We aggregated the resultant state-level estimates, using a population-weighted approach, to give national values. Findings For each of the vaccinations we investigated, about half of the 253 estimates of annual coverage at state level that we produced were based on survey results. The rest were based on interpolation between – or extrapolation from – so-called anchor points or, more rarely, on administrative data. Our national estimates indicated that, for each of the vaccines we investigated, coverage gradually increased between 1999 and 2010 but then levelled off. Conclusion The delivery of routine vaccination services to Indian children appears to have improved between 1999 and 2013. There remains considerable scope to improve the recording and reporting of childhood vaccination coverage in India and regular systematic reviews of the coverage data are recommended. PMID:27843162

Seroprevalence and Determinants of Immunity to Diphtheria for Children Living in Two Districts of Contrasting Incidence During an Outbreak in East Java, Indonesia.

PubMed

Hughes, Gareth J; Mikhail, Amy F W; Husada, Dominicus; Irawan, Eveline; Kafatos, George; Bracebridge, Samantha; Pebody, Richard; Efstratiou, Androulla

2015-11-01

In 2012, an ongoing outbreak of diphtheria in Indonesia was focused in the province of East Java. There was a need to assess vaccine coverage and immunity gaps in children. We conducted a cross-sectional seroprevalence and vaccine coverage survey of children 1-15 years of age in 2 districts of East Java: one of high incidence (on the island of Madura) and one of low incidence (on the mainland). From each district, we sampled 150 children (10 children per year of age). Sera and throat swabs were taken to determine immunity and carriage status. Immunity was defined as ≥0.1 international unit/mL of antibody to diphtheria toxin. A total of 297 children were selected to participate in the study. Coverage of three doses of combined vaccine for diphtheria, tetanus and pertussis was significantly lower (P < 0.001) in the high incidence district compared with the low [57%, 95% confidence interval (CI): 36-78 vs. 97%, 95% CI: 93-100]. Despite this higher vaccine coverage, seroprevalence of immunity was lower in the low incidence district compared with the high (71%, 95% CI: 63-80 vs. 83%, 95% CI: 76-90). Immunity in the high incidence district was associated with increased age, increased prevalence of toxigenic Corynebacterium diphtheriae carriers and with receipt of multiple (and likely more recent) boosters. Significant variation exists in vaccine coverage and seroprevalence of immunity to diphtheria in East Java. Immunity in high incidence districts is likely because of natural immunity acquired through exposure to toxigenic C. diphtheriae. Booster vaccines are essential for achieving protective levels of immunity.

Quantifying the impact of cross coverage on physician's workload and performance in radiation oncology.

PubMed

Mosaly, Prithima R; Mazur, Lukasz M; Jones, Ellen L; Hoyle, Lesley; Zagar, Timothy; Chera, Bhishamjit S; Marks, Lawrence B

2013-01-01

To quantitatively assess the difference in workload and performance of radiation oncology physicians during radiation therapy treatment planning tasks under the conditions of "cross coverage" versus planning a patient with whom they were familiar. Eight physicians (3 experienced faculty physicians and 5 physician residents) performed 2 cases. The first case represented a "cross-coverage" scenario where the physicians had no prior information about the case to be planned. The second exposure represented a "regular-coverage" scenario where the physicians were familiar with the patient case to be planned. Each case involved 3 tasks to be completed systematically. Workload was assessed both subjectively (perceived) using National Aeronautics and Space Administration-Task Load Index (NASA-TLX), and objectively (physiological) throughout the task using eye data (via monitoring pupil size and blink rate). Performance of each task and the case was measured using completion time. Subjective willingness to approve or disapprove the generated plan was obtained after completion of the case only. Forty-eight perceived and 48 physiological workload assessments were obtained. Overall, results revealed a significant increase in perceived workload (high NASA-TLX score) and decrease in performance (longer completion time and reduced approval rate) during cross coverage. There were nonsignificant increases in pupil diameter and decreases in the blink rate during cross-coverage versus regular-coverage scenario. In both cross-coverage and regular-coverage scenarios the level of experience did not affect workload and performance. The cross-coverage scenario significantly increases perceived workload and degrades performance versus regular coverage. Hence, to improve patient safety, efforts must be made to develop policies, standard operating procedures, and usability improvements to electronic medical record and treatment planning systems for "easier" information processing to deal with cross coverage, while recognizing strengths and limitations of human performance. Published by Elsevier Inc.

Health and Economic Implications of National Treatment Coverage for Cardiovascular Disease in India: Cost-Effectiveness Analysis.

PubMed

Basu, Sanjay; Bendavid, Eran; Sood, Neeraj

2015-11-01

Whether to cover cardiovascular disease costs is an increasingly pressing question for low- and middle-income countries. We sought to identify the impact of expanding national insurance to cover primary prevention, secondary prevention, and tertiary treatment for cardiovascular disease in India. We incorporated data from coverage experiments into a validated microsimulation model of myocardial infarction and stroke in India to evaluate the cost-effectiveness of alternate coverage strategies. Coverage of primary prevention alone saved 3.6 million disability-adjusted life-years (DALY) per annum at an incremental cost-effectiveness ratio of $469 per DALY averted when compared with the status quo of no coverage. Coverage of primary and secondary preventions was dominated by a strategy of covering primary prevention and tertiary treatment, which prevented 6.6 million DALYs at an incremental cost-effectiveness ratio of $2241 per DALY averted, when compared with that of primary prevention alone. The combination of all 3 categories yielded the greatest impact at an incremental cost per DALY averted of $5588 when compared with coverage of primary prevention plus tertiary treatment. When compared with the status quo of no coverage, coverage of all 3 categories of prevention/treatment yielded an incremental cost-effectiveness ratio of $1331 per DALY averted. In sensitivity analyses, coverage of primary preventive treatments remained cost-effective even if adherence and access to therapy were low, but tertiary coverage would require avoiding unnecessary procedures to remain cost-effective. Coverage of all 3 major types of cardiovascular treatment would be expected to have high impact and reasonable cost-effectiveness in India across a broad spectrum of access and adherence levels. © 2015 American Heart Association, Inc.

Sources of health insurance and characteristics of the uninsured: analysis of the March 2007 Current Population Survey.

PubMed

Fronstin, Paul

2007-10-01

This Issue Brief provides historic data through 2006 on the number and percentage of nonelderly individuals with and without health insurance. Based on EBRI estimates from the U.S. Census Bureau's March 2007 Current Population Survey (CPS), it reflects 2006 data. It also discusses trends in coverage for the 1994-2006 period and highlights characteristics that typically indicate whether an individual is insured. HEALTH COVERAGE CONTINUES DECLINE: The percentage of the nonelderly population (under age 65) with health insurance coverage continued to decline, reaching to a post-1994 low of 82.1 percent in 2006. Declines in health insurance coverage have been recorded in all but four years since 1994, when 36.5 million nonelderly individuals were uninsured; in 2006, the uninsured population was 46.5 million. EMPLOYMENT-BASED COVERAGE REMAINS DOMINANT SOURCE OF HEALTH COVERAGE: Employment-based health benefits remain by far the most common form of health coverage in the United States, consistently covering 60-70 percent of nonelderly individuals. In 2006, 62.2 percent of the nonelderly population had employment-based health benefits, as compared with 64.4 percent in 1994. Between 1994 and 2000, the percentage of the nonelderly population with employment-based coverage expanded. Since 2000, the percentage has declined. PUBLIC PROGRAM COVERAGE IS STABLE: Public-sector health coverage was slightly lower as a percentage of the population in 2006, accounting for 17.5 percent of the nonelderly population. The decline was due to a drop in the percentage of the population covered by the Tricare/CHAMPVA program. Enrollment in Medicaid and the State Children's Health Insurance Program increased, reaching 34.9 million in 2006, and covering 13.4 percent of the nonelderly population, which is significantly above the 10.5 percent level of 1999, but not far above the 12.7 percent level of 1994. INDIVIDUAL COVERAGE STABLE: Individually purchased health coverage was unchanged in 2006 and has basically hovered in the high 6 and low 7 percent range since 1994. PRIVATE- VS. PUBLIC-COVERAGE TRENDS REVERSING: Health insurance coverage generally has not sustained unbroken trends since 1994. There were crosscurrents: Employment-based coverage expanded significantly in the 1994-2000 period to exceed the growth in public programs. Subsequently, the dynamic reversed, as public programs expanded while employment-based coverage declined. It appears that 2005 might be the beginning of a new trend, where the erosion in employment-based coverage is not being offset by expansions in public programs. This may be due to the fact that, while unemployment is relatively low, the cost of providing health benefits continues to increase faster than inflation.

The relationship between HIV and fertility in the era of antiretroviral therapy in sub-Saharan Africa: evidence from 49 Demographic and Health Surveys.

PubMed

Marston, M; Zaba, B; Eaton, J W

2017-12-01

To describe regional differences in the relative fertility of HIV-positive vs. HIV-negative women and changes as antiretroviral treatment (ART) is scaled up, to improve estimates of predicted need for and coverage of prevention of mother-to-child transmission services at national and subnational levels. We analysed 49 nationally representative household surveys in sub-Saharan Africa between 2003 and 2016 to estimate fertility rate ratios of HIV-positive and HIV-negative women by age using exponential regression and test for regional and urban/rural differences. We estimated the association between national ART coverage and the relationship between HIV and fertility. Significant regional differences exist in HIV and fertility relationships, with less HIV-associated subfertility in Southern Africa. Age patterns of relative fertility are similar. HIV impact on fertility is weaker in urban than rural areas. For women below age 30, regional and urban/rural differences are largely explained by differences in age at sexual debut. Higher levels of national ART coverage were associated with slight attenuation of the relationship between HIV and fertility. Regional differences in HIV-associated subfertility and urban-rural differences in age patterns of relative fertility should be accounted for when predicting need for and coverage of PMTCT services at national and subnational level. Although HIV impacts on fertility are somewhat reduced at higher levels of national ART coverage, differences in fertility between HIV positive and negative remain, and fertility of women on ART should not be assumed to be the same as HIV-negative women. There were few data in recent years, when ART has reached high levels, and this relationship should continue to be assessed as further evidence becomes available. © 2017 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Successful polio eradication in Uttar Pradesh, India: the pivotal contribution of the Social Mobilization Network, an NGO/UNICEF collaboration

PubMed Central

Coates, Ellen A; Waisbord, Silvio; Awale, Jitendra; Solomon, Roma; Dey, Rina

2013-01-01

ABSTRACT In Uttar Pradesh, India, in response to low routine immunization coverage and ongoing poliovirus circulation, a network of U.S.-based CORE Group member and local nongovernmental organizations partnered with UNICEF, creating the Social Mobilization Network (SMNet). The SMNet's goal was to improve access and reduce family and community resistance to vaccination. The partners trained thousands of mobilizers from high-risk communities to visit households, promote government-run child immunization services, track children's immunization history and encourage vaccination of children missing scheduled vaccinations, and mobilize local opinion leaders. Creative behavior change activities and materials promoted vaccination awareness and safety, household hygiene, sanitation, home diarrheal-disease control, and breastfeeding. Program decision-makers at all levels used household-level data that were aggregated at community and district levels, and senior staff provided rapid feedback and regular capacity-building supervision to field staff. Use of routine project data and targeted research findings offered insights into and informed innovative approaches to overcoming community concerns impacting immunization coverage. While the SMNet worked in the highest-risk, poorly served communities, data suggest that the immunization coverage in SMNet communities was often higher than overall coverage in the district. The partners' organizational and resource differences and complementary technical strengths posed both opportunities and challenges; overcoming them enhanced the partnership's success and contributions. PMID:25276518

Implications of private sector Hib vaccine coverage for the introduction of public sector Hib-containing pentavalent vaccine in India: evidence from retrospective time series data.

PubMed

Sharma, Abhishek; Kaplan, Warren A; Chokshi, Maulik; Hasan Farooqui, Habib; Zodpey, Sanjay P

2015-02-23

Haemophilus influenzae type b (Hib) vaccine has been available in India's private sector market since 1997. It was not until 14 December 2011 that the Government of India initiated the phased public sector introduction of a Hib (and DPT, diphtheria, pertussis, tetanus)-containing pentavalent vaccine. Our objective was to investigate the state-specific coverage and behaviour of Hib vaccine in India when it was available only in the private sector market but not in the public sector. This baseline information can act as a guide to determine how much coverage the public sector rollout of pentavalent vaccine (scheduled April 2015) will need to bear in order to achieve complete coverage. 16 of 29 states in India, 2009-2012. Retrospective descriptive secondary data analysis. (1) Annual sales of Hib vaccines, by volume, from private sector hospitals and retail pharmacies collected by IMS Health and (2) national household surveys. State-specific Hib vaccine coverage (%) and its associations with state-specific socioeconomic status. The overall private sector Hib vaccine coverage among the 2009-2012 birth cohort was low (4%) and varied widely among the studied Indian states (minimum 0.3%; maximum 4.6%). We found that private sector Hib vaccine coverage depends on urban areas with good access to the private sector, parent's purchasing capacity and private paediatricians' prescribing practices. Per capita gross domestic product is a key explanatory variable. The annual Hib vaccine uptake and the 2009-2012 coverage levels were several times higher in the capital/metropolitan cities than the rest of the state, suggesting inequity in access to Hib vaccine delivered by the private sector. If India has to achieve high and equitable Hib vaccine coverage levels, nationwide public sector introduction of the pentavalent vaccine is needed. However, the role of private sector in universal Hib vaccine coverage is undefined as yet but it should not be neglected as a useful complement to public sector services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Implications of private sector Hib vaccine coverage for the introduction of public sector Hib-containing pentavalent vaccine in India: evidence from retrospective time series data

PubMed Central

Sharma, Abhishek; Kaplan, Warren A; Chokshi, Maulik; Hasan Farooqui, Habib; Zodpey, Sanjay P

2015-01-01

Objective Haemophilus influenzae type b (Hib) vaccine has been available in India's private sector market since 1997. It was not until 14 December 2011 that the Government of India initiated the phased public sector introduction of a Hib (and DPT, diphtheria, pertussis, tetanus)-containing pentavalent vaccine. Our objective was to investigate the state-specific coverage and behaviour of Hib vaccine in India when it was available only in the private sector market but not in the public sector. This baseline information can act as a guide to determine how much coverage the public sector rollout of pentavalent vaccine (scheduled April 2015) will need to bear in order to achieve complete coverage. Setting 16 of 29 states in India, 2009–2012. Design Retrospective descriptive secondary data analysis. Data (1) Annual sales of Hib vaccines, by volume, from private sector hospitals and retail pharmacies collected by IMS Health and (2) national household surveys. Outcome measures State-specific Hib vaccine coverage (%) and its associations with state-specific socioeconomic status. Results The overall private sector Hib vaccine coverage among the 2009–2012 birth cohort was low (4%) and varied widely among the studied Indian states (minimum 0.3%; maximum 4.6%). We found that private sector Hib vaccine coverage depends on urban areas with good access to the private sector, parent's purchasing capacity and private paediatricians’ prescribing practices. Per capita gross domestic product is a key explanatory variable. The annual Hib vaccine uptake and the 2009–2012 coverage levels were several times higher in the capital/metropolitan cities than the rest of the state, suggesting inequity in access to Hib vaccine delivered by the private sector. Conclusions If India has to achieve high and equitable Hib vaccine coverage levels, nationwide public sector introduction of the pentavalent vaccine is needed. However, the role of private sector in universal Hib vaccine coverage is undefined as yet but it should not be neglected as a useful complement to public sector services. PMID:25712822

Hitting the Optimal Vaccination Percentage and the Risks of Error: Why to Miss Right.

PubMed

Harvey, Michael J; Prosser, Lisa A; Messonnier, Mark L; Hutton, David W

2016-01-01

To determine the optimal level of vaccination coverage defined as the level that minimizes total costs and explore how economic results change with marginal changes to this level of coverage. A susceptible-infected-recovered-vaccinated model designed to represent theoretical infectious diseases was created to simulate disease spread. Parameter inputs were defined to include ranges that could represent a variety of possible vaccine-preventable conditions. Costs included vaccine costs and disease costs. Health benefits were quantified as monetized quality adjusted life years lost from disease. Primary outcomes were the number of infected people and the total costs of vaccination. Optimization methods were used to determine population vaccination coverage that achieved a minimum cost given disease and vaccine characteristics. Sensitivity analyses explored the effects of changes in reproductive rates, costs and vaccine efficacies on primary outcomes. Further analysis examined the additional cost incurred if the optimal coverage levels were not achieved. Results indicate that the relationship between vaccine and disease cost is the main driver of the optimal vaccination level. Under a wide range of assumptions, vaccination beyond the optimal level is less expensive compared to vaccination below the optimal level. This observation did not hold when the cost of the vaccine cost becomes approximately equal to the cost of disease. These results suggest that vaccination below the optimal level of coverage is more costly than vaccinating beyond the optimal level. This work helps provide information for assessing the impact of changes in vaccination coverage at a societal level.

Private Long-Term Care Insurance: Cost, Coverage, and Restrictions.

ERIC Educational Resources Information Center

Wiener, Joshua M.; And Others

1987-01-01

Conducted descriptive analysis of 31 private long-term care insurance policies. Examined policies for premium rates, extent and levels of coverage, restrictions of eligibility to purchase a policy, and indemnity payment levels. Findings suggest that policies are expensive, impose numerous restrictions, offer limited coverage for certain services,…

Tuning the tunneling magnetoresistance by using fluorinated graphene in graphene based magnetic junctions

NASA Astrophysics Data System (ADS)

Meena, Shweta; Choudhary, Sudhanshu

2017-12-01

Spin polarized properties of fluorinated graphene as tunnel barrier with CrO2 as two HMF electrodes are studied using first principle methods based on density functional theory. Fluorinated graphene with different fluorine coverages is explored as tunnel barriers in magnetic tunnel junctions. Density functional computation for different fluorine coverages imply that with increase in fluorine coverages, there is increase in band gap (Eg) of graphene, Eg ˜ 3.466 e V was observed when graphene sheet is fluorine adsorbed on both-side with 100% coverage (CF). The results of CF graphene are compared with C4F (fluorination on one-side of graphene sheet with 25% coverage) and out-of-plane graphene based magnetic tunnel junctions. On comparison of the results it is observed that CF graphene based structure offers high TMR ˜100%, and the transport of carrier is through tunneling as there are no transmission states near Fermi level. This suggests that graphene sheet with both-side fluorination with 100% coverages acts as a perfect insulator and hence a better barrier to the carriers which is due to negligible spin down current (I ↓ ) in both Parallel Configuration (PC) and Antiparallel Configuration (APC).

Testing Strategies for Model-Based Development

NASA Technical Reports Server (NTRS)

Heimdahl, Mats P. E.; Whalen, Mike; Rajan, Ajitha; Miller, Steven P.

2006-01-01

This report presents an approach for testing artifacts generated in a model-based development process. This approach divides the traditional testing process into two parts: requirements-based testing (validation testing) which determines whether the model implements the high-level requirements and model-based testing (conformance testing) which determines whether the code generated from a model is behaviorally equivalent to the model. The goals of the two processes differ significantly and this report explores suitable testing metrics and automation strategies for each. To support requirements-based testing, we define novel objective requirements coverage metrics similar to existing specification and code coverage metrics. For model-based testing, we briefly describe automation strategies and examine the fault-finding capability of different structural coverage metrics using tests automatically generated from the model.

Inferring rubella outbreak risk from seroprevalence data in Belgium.

PubMed

Abrams, Steven; Kourkouni, Eleni; Sabbe, Martine; Beutels, Philippe; Hens, Niel

2016-12-07

Rubella is usually a mild disease for which infections often pass by unnoticed. In approximately 50% of the cases, there are no or only few clinical symptoms. However, rubella contracted during early pregnancy could lead to spontaneous abortion, to central nervous system defects, or to one of a range of other serious and debilitating conditions in a newborn such as the congenital rubella syndrome. Before the introduction of mass vaccination, rubella was a common childhood infection occurring all over the world. However, since the introduction of rubella antigen-containing vaccines, the incidence of rubella has declined dramatically in high-income countries. Recent large-scale mumps outbreaks, one of the components in the combined measles-mumps-rubella vaccine, occurring in countries throughout Europe with high vaccination coverage, provide evidence of pathogen-specific waning of vaccine-induced immunity and primary vaccine failure. In addition, recent measles outbreaks affecting populations with suboptimal vaccination coverages stress the importance of maintaining high vaccination coverages. In this paper, we focus on the assessment of rubella outbreak risk using a previously developed method to identify geographic regions of high outbreak potential. The methodology relies on 2006 rubella seroprevalence data and vaccination coverage data from Belgium and information on primary and secondary vaccine failure obtained from extensive literature reviews. We estimated the rubella outbreak risk in Belgium to be low, however maintaining high levels of immunisation and surveillance are of utmost importance to avoid future outbreaks. Copyright © 2016 Elsevier Ltd. All rights reserved.

Variation in cervical and breast cancer screening coverage in England: a cross-sectional analysis to characterise districts with atypical behaviour

PubMed Central

Massat, Nathalie J; Douglas, Elaine; Waller, Jo; Wardle, Jane; Duffy, Stephen W

2015-01-01

Objectives Reducing cancer screening inequalities in England is a major focus of the 2011 Department of Health cancer outcome strategy. Screening coverage requires regular monitoring in order to implement targeted interventions where coverage is low. This study aimed to characterise districts with atypical coverage levels for cervical or breast screening. Design Observational study of district-level coverage in the English Cervical and Breast screening programmes in 2012. Setting England, UK. Participants All English women invited to participate in the cervical (age group 25–49 and 50–64) and breast (age group 50–64) screening programmes. Outcomes Risk adjustment models for coverage were developed based on district-level characteristics. Funnel plots of adjusted coverage were constructed, and atypical districts examined by correlation analysis. Results Variability in coverage was primarily explained by population factors, whereas general practice characteristics had little independent effect. Deprivation and ethnicity other than white, Asian, black or mixed were independently associated with poorer coverage in both screening programmes, with ethnicity having the strongest effect; by comparison, the influence of Asian, black or mixed ethnic minority was limited. Deprivation, ethnicity and urbanisation largely accounted for the lower cervical screening coverage in London. However, for breast screening, being located in London remained a strong negative predictor. A subset of districts was identified as having atypical coverage across programmes. Correlates of deprivation in districts with relatively low adjusted coverage were substantially different from overall correlates of deprivation. Discussion These results inform the continuing drive to reduce avoidable cancer deaths in England, and encourage implementation of targeted interventions in communities residing in districts identified as having atypically low coverage. Sequential implementation to monitor the impact of local interventions would help accrue evidence on ‘what works’. PMID:26209119

Determinants of vaccination coverage in rural Nigeria

PubMed Central

Odusanya, Olumuyiwa O; Alufohai, Ewan F; Meurice, Francois P; Ahonkhai, Vincent I

2008-01-01

Background Childhood immunization is a cost effective public health strategy. Expanded Programme on Immunisation (EPI) services have been provided in a rural Nigerian community (Sabongidda-Ora, Edo State) at no cost to the community since 1998 through a privately financed vaccination project (private public partnership). The objective of this survey was to assess vaccination coverage and its determinants in this rural community in Nigeria Methods A cross-sectional survey was conducted in September 2006, which included the use of interviewer-administered questionnaire to assess knowledge of mothers of children aged 12–23 months and vaccination coverage. Survey participants were selected following the World Health Organization's (WHO) immunization coverage cluster survey design. Vaccination coverage was assessed by vaccination card and maternal history. A child was said to be fully immunized if he or she had received all of the following vaccines: a dose of Bacille Calmette Guerin (BCG), three doses of oral polio (OPV), three doses of diphtheria, pertussis and tetanus (DPT), three doses of hepatitis B (HB) and one dose of measles by the time he or she was enrolled in the survey, i.e. between the ages of 12–23 months. Knowledge of the mothers was graded as satisfactory if mothers had at least a score of 3 out of a maximum of 5 points. Logistic regression was performed to identify determinants of full immunization status. Results Three hundred and thirty-nine mothers and 339 children (each mother had one eligible child) were included in the survey. Most of the mothers (99.1%) had very positive attitudes to immunization and > 55% were generally knowledgeable about symptoms of vaccine preventable diseases except for difficulty in breathing (as symptom of diphtheria). Two hundred and ninety-five mothers (87.0%) had a satisfactory level of knowledge. Vaccination coverage against all the seven childhood vaccine preventable diseases was 61.9% although it was significantly higher (p = 0.002) amongst those who had a vaccination card (131/188, 69.7%) than in those assessed by maternal history (79/151, 52.3%). Multiple logistic regression showed that mothers' knowledge of immunization (p = 0.006) and vaccination at a privately funded health facility (p < 0.001) were significantly correlated with the rate of full immunization. Conclusion Eight years after initiation of this privately financed vaccination project (private-public partnership), vaccination coverage in this rural community is at a level that provides high protection (81%) against DPT/OPV. Completeness of vaccination was significantly correlated with knowledge of mothers on immunization and adequate attention should be given to this if high coverage levels are to be sustained. PMID:18986544

Modelling the impact of vaccination on curtailing Haemophilus influenzae serotype 'a'.

PubMed

Konini, Angjelina; Moghadas, Seyed M

2015-12-21

Haemophilus influenzae serotype a (Hia) is a human-restricted bacterial pathogen transmitted via direct contacts with an infectious individual. Currently, there is no vaccine available for prevention of Hia, and the disease is treated with antibiotics upon diagnosis. With ongoing efforts for the development of an anti-Hia protein-polysaccharide conjugated vaccine, we sought to investigate the effect of vaccination on curtailing Hia infection. We present the first stochastic model of Hia transmission and control dynamics, and parameterize it using available estimates in the literature. Since both naturally acquired and vaccine-induced immunity wane with time, model simulations show three important results. First, vaccination of only newborns cannot eliminate the pathogen from the population, even when a booster program is implemented with a high coverage. Second, achieving and maintaining a sufficiently high level of herd immunity for pathogen elimination requires vaccination of susceptible individuals in addition to a high vaccination coverage of newborns. Third, for a low vaccination rate of susceptible individuals, a high coverage of booster dose may be needed to raise the level of herd immunity for Hia eradication. Our findings highlight the importance of vaccination and timely boosting of the individual׳s immunity within the expected duration of vaccine-induced protection against Hia. When an anti-Hia vaccine becomes available, enhanced surveillance of Hia incidence and herd immunity could help determine vaccination rates and timelines for booster doses necessary to eliminate Hia from affected populations. Copyright © 2015 Elsevier Ltd. All rights reserved.

The varicella vaccination pattern among children under 5 years old in selected areas in China.

PubMed

Yue, Chenyan; Li, Yan; Wang, Yamin; Liu, Yan; Cao, Linsheng; Zhu, Xu; Martin, Kathryn; Wang, Huaqing; An, Zhijie

2017-07-11

Vaccine is the most effective way to protect susceptible children from varicella. Few published literature or reports on varicella vaccination of Chinese children exist. Thus, in order to obtain specific information on varicella vaccination of this population, we conducted this survey. We first used purposive sampling methods to select 6 provinces 10 counties from eastern, middle and western parts of China with high quality of Immunization Information Management System (IIMS), and then randomly select children from population in the IIMS, then we checked vaccination certificate on-site. Based on the varicella vaccination information collected from 481 children's vaccination certificates from all ten selected counties in China, overall coverage of the first dose of varicella vaccine was 73.6%. There is a positive linear correlation between per capita GDP and vaccine coverage at county level (r=0.929, P < 0.01). The cumulative vaccine coverage among children at 1 year, 2 years and ≥3 years old were 67.6%, 71.9% and 73.6% respectively (X2=4.53, P =0.10). The age of vaccination was mainly concentrated in 12-17 months. The coverage rate of the first dose of varicella vaccine in selected areas was lower than that recommended by WHO position paper. The coverage rate was relatively low in areas of low social-economic status. The cumulative coverage had no significant statistical difference among different age group. Most children received varicella vaccine before 3 years old. We suggest introducing the varicella vaccine into routine immunization program, to ensure universal high coverage among children in China. We also suggest that varicella vaccination information should be checked before entering school, in order to control and prevent varicella outbreaks in schools.

How does the use of multiple needles/syringes per injecting episode impact on the measurement of individual level needle and syringe program coverage?

PubMed

O'Keefe, Daniel; McCormack, Angus; Cogger, Shelley; Aitken, Campbell; Burns, Lucinda; Bruno, Raimondo; Stafford, Jenny; Butler, Kerryn; Breen, Courtney; Dietze, Paul

2017-08-01

Recent work by McCormack et al. (2016) showed that the inclusion of syringe stockpiling improves the measurement of individual-level syringe coverage. We explored whether including the use of a new parameter, multiple sterile syringes per injecting episode, further improves coverage measures. Data comes from 838 people who inject drugs, interviewed as part of the 2015 Illicit Drug Reporting System. Along with syringe coverage questions, the survey recorded the number of sterile syringes used on average per injecting episode. We constructed three measures of coverage: one adapted from Bluthenthal et al. (2007), the McCormack et al. measure, and a new coverage measure that included use of multiple syringes. Predictors of multiple syringe use and insufficient coverage (<100% of injecting episodes using a sterile syringe) using the new measure, were tested in logistic regression and the ability of the measures to discriminate key risk behaviours was compared using ROC curve analysis. 134 (16%) participants reported needing multiple syringes per injecting episode. Women showed significantly increased odds of multiple syringe use, as did those reporting injection related injuries/diseases and injecting of opioid substitution drugs or pharmaceutical opioids. Levels of insufficient coverage across the three measures were substantial (20%-28%). ROC curve analysis suggested that our new measure was no better at discriminating injecting risk behaviours than the existing measures. Based on our findings, there appears to be little need for adding a multiple syringe use parameter to existing coverage formulae. Hence, we recommend that multiple syringe use is not included in the measurement of individual-level syringe coverage. Copyright © 2017 Elsevier B.V. All rights reserved.

Measurement of fault latency in a digital avionic mini processor, part 2

NASA Technical Reports Server (NTRS)

Mcgough, J.; Swern, F.

1983-01-01

The results of fault injection experiments utilizing a gate-level emulation of the central processor unit of the Bendix BDX-930 digital computer are described. Several earlier programs were reprogrammed, expanding the instruction set to capitalize on the full power of the BDX-930 computer. As a final demonstration of fault coverage an extensive, 3-axis, high performance flght control computation was added. The stages in the development of a CPU self-test program emphasizing the relationship between fault coverage, speed, and quantity of instructions were demonstrated.

78 FR 53646 - Shared Responsibility Payment for Not Maintaining Minimum Essential Coverage

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-30

... disabled child who requires an institutional level of care (such as that provided in a nursing facility... because their income is too high. Children eligible for Medicaid under this option are entitled to the... eligibility to individuals with high medical expenses who would otherwise be eligible for Medicaid but for...

[Comprehensive sexual education in Mexico: an analysis of coverage, comprehensiveness and continuity of contents in Mexican public and private schools].

PubMed

Rojas, Rosalba; Castro, Filipa de; Villalobos, Aremis; Allen-Leigh, Betania; Romero, Martin; Braverman-Bronstein, Ariela; Uribe, Patricia

2017-01-01

To analyze coverage of comprehensive sex education (CSE) in high schools in Mexico and describe whether it is comprehensive, homogeneous and has continuity based on student reports of exposure to topics in three dimensions: reproductive and sexual health, self-efficacy and rights and relations. Within a probabilistic, cross-sectional survey with stratified, cluster sampling, a nationally representative sample of 3 824 adolescents attending 45 public and private high-schools in urban and rural areas completed questionnaires on CSE. The proportion of adolescents reporting having received sex education from school personnel varies depending on topics and grade level. Topics most frequently covered are those related to sexual and reproductive health while rights and relations are least frequently dealt with. Most sex education topics are covered during junior high school and much less frequently in elementary or high school. CSE needs to be comprehensive and homogenous in terms of content, ensure inclusion of priority topics, meet national and international recommendations, ensure continuity and adapt contents to student age through all education levels.

Relationship between vegetation coverage and abundance, size, and diet of juvenile largemouth bass during winter

USGS Publications Warehouse

Miranda, L.E.; Pugh, L.L.

1997-01-01

Juvenile largemouth bass Micropterus salmoides were collected by electrofishing during October through March 1992-1994 from coves (???25 ha) covered with aquatic macrophytes over 1-65% of their area. Mean total length of juvenile largemouth bass was highest in coves with the least vegetated cover, but increase in mean length between October and March was highest in coves having near 20% vegetation coverage. Catch per unit effort decreased between October and March; decreases were least at vegetation coverages near 10-20%, highest at coverages of 5% or less, and intermediate at coverages of 30-65%. By March, these disparate decreases contributed to the formation of a dome-like relationship between vegetation coverage and catch per unit effort. Consumption of fish foods was highest when vegetation coverage was low, but decreased asymptotically as coverage increased; consumption of invertebrate foods increased at low coverage, peaked near 20-30% coverage, and decreased at higher coverage. We suggest that greater length increases and greater abundance at 10-25% vegetation coverage were stimulated by a favorable blend of food availability and cover. Our results support reports that maximum recruitment of largemouth bass occurs at intermediate levels of vegetation coverage, and we further suggests that such increased production is reinforced during winter, when survival, invertebrate consumption, and length increases are highest at intermediate levels of vegetation coverage.

Cloud radiative effect, cloud fraction and cloud type at two stations in Switzerland using hemispherical sky cameras

NASA Astrophysics Data System (ADS)

Aebi, Christine; Gröbner, Julian; Kämpfer, Niklaus; Vuilleumier, Laurent

2017-11-01

The current study analyses the cloud radiative effect during the daytime depending on cloud fraction and cloud type at two stations in Switzerland over a time period of 3 to 5 years. Information on fractional cloud coverage and cloud type is retrieved from images taken by visible all-sky cameras. Cloud-base height (CBH) data are retrieved from a ceilometer and integrated water vapour (IWV) data from GPS measurements. The longwave cloud radiative effect (LCE) for low-level clouds and a cloud coverage of 8 oktas has a median value between 59 and 72 Wm-2. For mid- and high-level clouds the LCE is significantly lower. It is shown that the fractional cloud coverage, the CBH and IWV all have an influence on the magnitude of the LCE. These observed dependences have also been modelled with the radiative transfer model MODTRAN5. The relative values of the shortwave cloud radiative effect (SCErel) for low-level clouds and a cloud coverage of 8 oktas are between -90 and -62 %. Also here the higher the cloud is, the less negative the SCErel values are. In cases in which the measured direct radiation value is below the threshold of 120 Wm-2 (occulted sun) the SCErel decreases substantially, while cases in which the measured direct radiation value is larger than 120 Wm-2 (visible sun) lead to a SCErel of around 0 %. In 14 and 10 % of the cases in Davos and Payerne respectively a cloud enhancement has been observed with a maximum in the cloud class cirrocumulus-altocumulus at both stations. The calculated median total cloud radiative effect (TCE) values are negative for almost all cloud classes and cloud coverages.

Geographical Inequalities in Use of Improved Drinking Water Supply and Sanitation across Sub-Saharan Africa: Mapping and Spatial Analysis of Cross-sectional Survey Data

PubMed Central

Pullan, Rachel L.; Freeman, Matthew C.; Gething, Peter W.; Brooker, Simon J.

2014-01-01

Background Understanding geographic inequalities in coverage of drinking-water supply and sanitation (WSS) will help track progress towards universal coverage of water and sanitation by identifying marginalized populations, thus helping to control a large number of infectious diseases. This paper uses household survey data to develop comprehensive maps of WSS coverage at high spatial resolution for sub-Saharan Africa (SSA). Analysis is extended to investigate geographic heterogeneity and relative geographic inequality within countries. Methods and Findings Cluster-level data on household reported use of improved drinking-water supply, sanitation, and open defecation were abstracted from 138 national surveys undertaken from 1991–2012 in 41 countries. Spatially explicit logistic regression models were developed and fitted within a Bayesian framework, and used to predict coverage at the second administrative level (admin2, e.g., district) across SSA for 2012. Results reveal substantial geographical inequalities in predicted use of water and sanitation that exceed urban-rural disparities. The average range in coverage seen between admin2 within countries was 55% for improved drinking water, 54% for use of improved sanitation, and 59% for dependence upon open defecation. There was also some evidence that countries with higher levels of inequality relative to coverage in use of an improved drinking-water source also experienced higher levels of inequality in use of improved sanitation (rural populations r = 0.47, p = 0.002; urban populations r = 0.39, p = 0.01). Results are limited by the quantity of WSS data available, which varies considerably by country, and by the reliability and utility of available indicators. Conclusions This study identifies important geographic inequalities in use of WSS previously hidden within national statistics, confirming the necessity for targeted policies and metrics that reach the most marginalized populations. The presented maps and analysis approach can provide a mechanism for monitoring future reductions in inequality within countries, reflecting priorities of the post-2015 development agenda. Please see later in the article for the Editors' Summary PMID:24714528

Geographical inequalities in use of improved drinking water supply and sanitation across Sub-Saharan Africa: mapping and spatial analysis of cross-sectional survey data.

PubMed

Pullan, Rachel L; Freeman, Matthew C; Gething, Peter W; Brooker, Simon J

2014-04-01

Understanding geographic inequalities in coverage of drinking-water supply and sanitation (WSS) will help track progress towards universal coverage of water and sanitation by identifying marginalized populations, thus helping to control a large number of infectious diseases. This paper uses household survey data to develop comprehensive maps of WSS coverage at high spatial resolution for sub-Saharan Africa (SSA). Analysis is extended to investigate geographic heterogeneity and relative geographic inequality within countries. Cluster-level data on household reported use of improved drinking-water supply, sanitation, and open defecation were abstracted from 138 national surveys undertaken from 1991-2012 in 41 countries. Spatially explicit logistic regression models were developed and fitted within a Bayesian framework, and used to predict coverage at the second administrative level (admin2, e.g., district) across SSA for 2012. Results reveal substantial geographical inequalities in predicted use of water and sanitation that exceed urban-rural disparities. The average range in coverage seen between admin2 within countries was 55% for improved drinking water, 54% for use of improved sanitation, and 59% for dependence upon open defecation. There was also some evidence that countries with higher levels of inequality relative to coverage in use of an improved drinking-water source also experienced higher levels of inequality in use of improved sanitation (rural populations r = 0.47, p = 0.002; urban populations r = 0.39, p = 0.01). Results are limited by the quantity of WSS data available, which varies considerably by country, and by the reliability and utility of available indicators. This study identifies important geographic inequalities in use of WSS previously hidden within national statistics, confirming the necessity for targeted policies and metrics that reach the most marginalized populations. The presented maps and analysis approach can provide a mechanism for monitoring future reductions in inequality within countries, reflecting priorities of the post-2015 development agenda. Please see later in the article for the Editors' Summary.

Evaluation of impact of measles rubella campaign on vaccination coverage and routine immunization services in Bangladesh.

PubMed

Uddin, Md Jasim; Adhikary, Gourab; Ali, Md Wazed; Ahmed, Shahabuddin; Shamsuzzaman, Md; Odell, Chris; Hashiguchi, Lauren; Lim, Stephen S; Alam, Nurul

2016-08-12

Like other countries in Asia, measles-rubella (MR) vaccine coverage in Bangladesh is suboptimal whereas 90-95 % coverage is needed for elimination of these diseases. The Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh implemented MR campaign in January-February 2014 to increase MR vaccination coverage. Strategically, the MOHFW used both routine immunization centres and educational institutions for providing vaccine to the children aged 9 months to <15 years. The evaluation was carried out to assess the impact of the campaign on MR vaccination and routine immunization services. Both quantitative and qualitative evaluations were done before and after implementation of the campaign. Quantitative data were presented with mean (standard deviation, SD) for continuous variables and with proportion for categorical variables. The overall and age- and sex-specific coverage rates were calculated for each region and then combined. Categorical variables were compared by chi-square statistics. Multiple logistic regression analysis were performed to estimate odds ratios (OR) and 95 % confidence intervals (CI) of coverage associated with covariates, with adjustment for other covariates. Qualitative data were analyzed using content analysis. The evaluations found MR coverage was very low (<13 %) before the campaign and it rose to 90 % after the campaign. The pre-post campaign difference in MR coverage in each stratum was highly significant (p < 0.001). The campaign achieved high coverage despite relatively low level (23 %) of interpersonal communication with caregivers through registration process. Child registration was associated with higher MR coverage (OR 2.91, 95 % CI 1.91-4.44). Children who attended school were more likely to be vaccinated (OR 8.97, 95 % CI 6.17-13.04) compared to those who did not attend school. Children of caregivers with primary or secondary or higher education had higher coverage compared to children of caregivers with no formal education. Most caregivers mentioned contribution of the campaign in vaccination for the children not previously vaccinated. The results of the evaluation indicated that the campaign was successful in terms of improving MR coverage and routine immunization services. The evaluation provided an important guideline for future evaluation of similar efforts in Bangladesh and elsewhere.

Comparing Methods of Assessing Dog Rabies Vaccination Coverage in Rural and Urban Communities in Tanzania

PubMed Central

Sambo, Maganga; Johnson, Paul C. D.; Hotopp, Karen; Changalucha, Joel; Cleaveland, Sarah; Kazwala, Rudovick; Lembo, Tiziana; Lugelo, Ahmed; Lushasi, Kennedy; Maziku, Mathew; Mbunda, Eberhard; Mtema, Zacharia; Sikana, Lwitiko; Townsend, Sunny E.; Hampson, Katie

2017-01-01

Rabies can be eliminated by achieving comprehensive coverage of 70% of domestic dogs during annual mass vaccination campaigns. Estimates of vaccination coverage are, therefore, required to evaluate and manage mass dog vaccination programs; however, there is no specific guidance for the most accurate and efficient methods for estimating coverage in different settings. Here, we compare post-vaccination transects, school-based surveys, and household surveys across 28 districts in southeast Tanzania and Pemba island covering rural, urban, coastal and inland settings, and a range of different livelihoods and religious backgrounds. These approaches were explored in detail in a single district in northwest Tanzania (Serengeti), where their performance was compared with a complete dog population census that also recorded dog vaccination status. Post-vaccination transects involved counting marked (vaccinated) and unmarked (unvaccinated) dogs immediately after campaigns in 2,155 villages (24,721 dogs counted). School-based surveys were administered to 8,587 primary school pupils each representing a unique household, in 119 randomly selected schools approximately 2 months after campaigns. Household surveys were conducted in 160 randomly selected villages (4,488 households) in July/August 2011. Costs to implement these coverage assessments were $12.01, $66.12, and $155.70 per village for post-vaccination transects, school-based, and household surveys, respectively. Simulations were performed to assess the effect of sampling on the precision of coverage estimation. The sampling effort required to obtain reasonably precise estimates of coverage from household surveys is generally very high and probably prohibitively expensive for routine monitoring across large areas, particularly in communities with high human to dog ratios. School-based surveys partially overcame sampling constraints, however, were also costly to obtain reasonably precise estimates of coverage. Post-vaccination transects provided precise and timely estimates of community-level coverage that could be used to troubleshoot the performance of campaigns across large areas. However, transects typically overestimated coverage by around 10%, which therefore needs consideration when evaluating the impacts of campaigns. We discuss the advantages and disadvantages of these different methods and make recommendations for how vaccination campaigns can be better monitored and managed at different stages of rabies control and elimination programs. PMID:28352630

Inefficiency, heterogeneity and spillover effects in maternal care in India: a spatial stochastic frontier analysis.

PubMed

Kinfu, Yohannes; Sawhney, Monika

2015-03-25

Institutional delivery is one of the key and proven strategies to reduce maternal deaths. Since the 1990s, the government of India has made substantial investment on maternal care to reduce the huge burden of maternal deaths in the country. However, despite the effort access to institutional delivery in India remains below the global average. In addition, even in places where health investments have been comparable, inter- and intra-state difference in access to maternal care services remain wide and substantial. This raises a fundamental question on whether the sub-national units themselves differ in terms of the efficiency with which they use available resources, and if so, why? Data obtained from round 3 of the country's District Level Health and Facility Survey was analyzed to measure the level and determinants of inefficiency of institutional delivery in the country. Analysis was conducted using spatial stochastic frontier models that correct for heterogeneity and spatial interactions between sub-national units. Inefficiency differences in maternal care services between and within states are substantial. The top one third of districts in the country has a mean efficiency score of 90 per cent or more, while the bottom 10 per cent of districts exhibit mean inefficiency score of as high as over 75 per cent or more. Overall mean inefficiency is about 30 per cent. The result also reveals the existence of both heterogeneity and spatial correlation in institutional delivery in the country. Given the high level of inefficiency in the system, further progress in improving coverage of institutional delivery in the country should focus both on improving the efficiency of resource utilization--especially where inefficiency levels are extremely high--and on bringing new resources in to the system. The additional investment should specifically focus on those parts of the country where coverage rates are still low but efficiency levels are already at a high level. In addition, given that inefficiency was also associated inversely with literacy and urbanization and positively related with proportion of households belonging to poor households, investment in these areas can also improve coverage of institutional delivery in the country.

How changes in coverage affect equity in maternal and child health interventions in 35 Countdown to 2015 countries: an analysis of national surveys.

PubMed

Victora, Cesar G; Barros, Aluisio J D; Axelson, Henrik; Bhutta, Zulfiqar A; Chopra, Mickey; França, Giovanny V A; Kerber, Kate; Kirkwood, Betty R; Newby, Holly; Ronsmans, Carine; Boerma, J Ties

2012-09-29

Achievement of global health goals will require assessment of progress not only nationally but also for population subgroups. We aimed to assess how the magnitude of socioeconomic inequalities in health changes in relation to different rates of national progress in coverage of interventions for the health of mothers and children. We assessed coverage in low-income and middle-income countries for which two Demographic Health Surveys or Multiple Indicator Cluster Surveys were available. We calculated changes in overall coverage of skilled birth attendants, measles vaccination, and a composite coverage index, and examined coverage of a newly introduced intervention, use of insecticide-treated bednets by children. We stratified coverage data according to asset-based wealth quintiles, and calculated relative and absolute indices of inequality. We adjusted correlation analyses for time between surveys and baseline coverage levels. We included 35 countries with surveys done an average of 9·1 years apart. Pro-rich inequalities were very prevalent. We noted increased coverage of skilled birth attendants, measles vaccination, and the composite index in most countries from the first to the second survey, while inequalities were reduced. Rapid changes in overall coverage were associated with improved equity. These findings were not due to a capping effect associated with limited scope for improvement in rich households. For use of insecticide-treated bednets, coverage was high for the richest households, but countries making rapid progress did almost as well in reaching the poorest groups. National increases in coverage were primarily driven by how rapidly coverage increased in the poorest quintiles. Equity should be accounted for when planning the scaling up of interventions and assessing national progress. Bill & Melinda Gates Foundation; World Bank; Governments of Australia, Brazil, Canada, Norway, Sweden, and UK. Copyright © 2012 Elsevier Ltd. All rights reserved.

Workers' decisions to take-up offered health insurance coverage: assessing the importance of out-of-pocket premium costs.

PubMed

Cooper, Philip F; Vistnes, Jessica

2003-07-01

Many proposed policy initiatives involve subsidies directed toward encouraging employers to offer coverage and toward workers to encourage enrollment in offered plans. Given that insurance coverage reflects employers' decisions to offer coverage, eligibility requirements for such coverage, and employees' take-up decisions, all three elements are important when considering mechanisms to decrease the number of uninsured individuals. In this study, we examine the relationship between workers' decisions to take-up offers of health insurance and annual out-of-pocket contributions, total premiums, and employer and workforce characteristics. We model the take-up decision using cross-sectional data from approximately 18,000 establishments per year from the 1997 to 1999 Medical Expenditure Panel Survey - Insurance Component. We find that workers are less likely to enroll in coverage as single employee contributions increase. Our results for family contributions are much smaller than for single contributions and are not statistically significant in all years. Our simulation results suggest that reducing employee contribution levels for single coverage from existing levels in 1999 to zero would yield an increase in take-up rates of roughly 6% points in establishments that had required a positive level of contributions. Our results also indicate that of the 13.8 million private sector workers who decline coverage from their employers, 2.5 million would potentially enroll in employer-sponsored coverage if the cost of single coverage were to fall to zero. Reducing employee contributions will increase take-up rates; however, even when employees pay nothing for their coverage, some employees elect not to enroll.

Drivers of routine immunization coverage improvement in Africa: findings from district-level case studies

PubMed Central

LaFond, Anne; Kanagat, Natasha; Steinglass, Robert; Fields, Rebecca; Sequeira, Jenny; Mookherji, Sangeeta

2015-01-01

There is limited understanding of why routine immunization (RI) coverage improves in some settings in Africa and not in others. Using a grounded theory approach, we conducted in-depth case studies to understand pathways to coverage improvement by comparing immunization programme experience in 12 districts in three countries (Ethiopia, Cameroon and Ghana). Drawing on positive deviance or assets model techniques we compared the experience of districts where diphtheria–tetanus–pertussis (DTP3)/pentavalent3 (Penta3) coverage improved with districts where DTP3/Penta3 coverage remained unchanged (or steady) over the same period, focusing on basic readiness to deliver immunization services and drivers of coverage improvement. The results informed a model for immunization coverage improvement that emphasizes the dynamics of immunization systems at district level. In all districts, whether improving or steady, we found that a set of basic RI system resources were in place from 2006 to 2010 and did not observe major differences in infrastructure. We found that the differences in coverage trends were due to factors other than basic RI system capacity or service readiness. We identified six common drivers of RI coverage performance improvement—four direct drivers and two enabling drivers—that were present in well-performing districts and weaker or absent in steady coverage districts, and map the pathways from driver to improved supply, demand and coverage. Findings emphasize the critical role of implementation strategies and the need for locally skilled managers that are capable of tailoring strategies to specific settings and community needs. The case studies are unique in their focus on the positive drivers of change and the identification of pathways to coverage improvement, an approach that should be considered in future studies and routine assessments of district-level immunization system performance. PMID:24615431

Sources of health insurance and characteristics of the uninsured: analysis of the March 2011 current population survey.

PubMed

Fronstin, Paul

2011-09-01

LATEST CENSUS DATA: This Issue Brief provides historical data through 2010 on the number and percentage of nonelderly individuals with and without health insurance. Based on EBRI estimates from the U.S. Census Bureau's March 2011 Current Population Survey (CPS), it reflects 2010 data. It also discusses trends in coverage for the 1994-2010 period and highlights characteristics that typically indicate whether an individual is insured. HEALTH COVERAGE RATE CONTINUES TO DECREASE, UNINSURED INCREASE: The percentage of the nonelderly population (under age 65) with health insurance coverage decreased to 81.5 percent in 2010. Increases in health insurance coverage have been recorded in only three years since 1994, when 36.5 million nonelderly individuals were uninsured. The percentage of nonelderly individuals without health insurance coverage was 18.5 percent in 2010, up from 18.3 percent in 2009, and its highest level during the 1994-2010 period. EMPLOYMENT-BASED COVERAGE REMAINS DOMINANT SOURCE OF HEALTH COVERAGE, BUT CONTINUES TO ERODE: Employment-based health benefits remain the most common form of health coverage in the United States. In 2010, 58.7 percent of the nonelderly population had employment-based health benefits, down from 69.3 percent in 2000. SHIFTING COMPOSITION OF EMPLOYMENT-BASED COVERAGE: Between 2007 and 2010, the percentage of individuals under age 65 with employment-based coverage in their own name has dropped. In 2007, 54.2 percent had coverage in their own name. By 2010, it was down to 51.5 percent. Dependent coverage during this time period fell slightly from 17.5 percent to 17.1 percent, and increased slightly from 16.8 percent to 17.1 percent between 2009 and 2010. PUBLIC PROGRAM COVERAGE IS GROWING: Public program health coverage expanded as a percentage of the population in 2010, accounting for 21.6 percent of the nonelderly population. Enrollment in Medicaid and the State Children's Health Insurance Program increased, reaching a combined 45 million in 2010, and covering 16.9 percent of the nonelderly population, significantly above the 10.2 percent level of 1999. INDIVIDUAL COVERAGE STABLE: Individually purchased health coverage was unchanged in 2010 and has basically hovered in the 6-7 percent range since 1994. WHAT TO EXPECT IN 2011: 2010 is the most recent year for data on sources of health coverage. Unemployment in 2011 has been about 9 percent since the beginning of the year. While down from the 2010 average of 9.6 percent, it remains high and there is a continued threat of a double-dip recession increasing it even further. As a result, the nation is likely to see continued erosion of employment-based health benefits when the data for 2011 are released in 2012. Fewer working individuals translates into fewer individuals with access to health benefits in the work place, especially after COBRA subsidies have been exhausted.

Analysing and recommending options for maintaining universal coverage with long-lasting insecticidal nets: the case of Tanzania in 2011

PubMed Central

2013-01-01

Background Tanzania achieved universal coverage with long-lasting insecticidal nets (LLINs) in October 2011, after three years of free mass net distribution campaigns and is now faced with the challenge of maintaining high coverage as nets wear out and the population grows. A process of exploring options for a continuous or “Keep-Up” distribution system was initiated in early 2011. This paper presents for the first time a comprehensive national process to review the major considerations, findings and recommendations for the implementation of a new strategy. Methods Stakeholder meetings and site visits were conducted in five locations in Tanzania to garner stakeholder input on the proposed distribution systems. Coverage levels for LLINs and their decline over time were modelled using NetCALC software, taking realistic net decay rates, current demographic profiles and other relevant parameters into consideration. Costs of the different distribution systems were estimated using local data. Results LLIN delivery was considered via mass campaigns, Antenatal Care-Expanded Programme on Immunization (ANC/EPI), community-based distribution, schools, the commercial sector and different combinations of the above. Most approaches appeared unlikely to maintain universal coverage when used alone. Mass campaigns, even when combined with a continuation of the Tanzania National Voucher Scheme (TNVS), would produce large temporal fluctuations in coverage levels; over 10 years this strategy would require 63.3 million LLINs and a total cost of $444 million USD. Community mechanisms, while able to deliver the required numbers of LLINs, would require a massive scale-up in monitoring, evaluation and supervision systems to ensure accurate application of identification criteria at the community level. School-based approaches combined with the existing TNVS would reach most Tanzanian households and deliver 65.4 million LLINs over 10 years at a total cost of $449 million USD and ensure continuous coverage. The cost of each strategy was largely driven by the number of LLINs delivered. Conclusions The most cost-efficient strategy to maintain universal coverage is one that best optimizes the numbers of LLINs needed over time. A school-based approach using vouchers targeting all students in Standards 1, 3, 5, 7 and Forms 1 and 2 in combination with the TNVS appears to meet best the criteria of effectiveness, equity and efficiency. PMID:23641705

Use of Antibiotic-Impregnated Absorbable Beads and Tissue Coverage of Complex Wounds.

PubMed

White, Terris L; Culliford, Alfred T; Zomaya, Martin; Freed, Gary; Demas, Christopher P

2016-11-01

The treatment of complex wounds is commonplace for plastic surgeons. Standard management is debridement of infected and devitalized tissue and systemic antibiotic therapy. In cases where vital structures are exposed within the wound, coverage is obtained with the use of vascularized tissue using both muscle and fasciocutaneous flaps. The use of nondissolving polymethylmethacrylate and absorbable antibiotic-impregnated beads has been shown to deliver high concentrations of antibiotics with low systemic levels of the same antibiotic. We present a multicenter retrospective review of all cases that used absorbable antibiotic-impregnated beads for complex wound management from 2003 to 2013. A total of 104 cases were investigated, flap coverage was used in 97 cases (93.3%). Overall, 15 patients (14.4%) required reoperation with the highest groups involving orthopedic wounds and sternal wounds. The advantages of using absorbable antibiotic-impregnated beads in complex infected wounds have been demonstrated with minimal disadvantages. The utilization of these beads is expanding to a variety of complex infectious wounds requiring high concentrations of local antibiotics.

Lot quality assurance sampling to monitor supplemental immunization activity quality: an essential tool for improving performance in polio endemic countries.

PubMed

Brown, Alexandra E; Okayasu, Hiromasa; Nzioki, Michael M; Wadood, Mufti Z; Chabot-Couture, Guillaume; Quddus, Arshad; Walker, George; Sutter, Roland W

2014-11-01

Monitoring the quality of supplementary immunization activities (SIAs) is a key tool for polio eradication. Regular monitoring data, however, are often unreliable, showing high coverage levels in virtually all areas, including those with ongoing virus circulation. To address this challenge, lot quality assurance sampling (LQAS) was introduced in 2009 as an additional tool to monitor SIA quality. Now used in 8 countries, LQAS provides a number of programmatic benefits: identifying areas of weak coverage quality with statistical reliability, differentiating areas of varying coverage with greater precision, and allowing for trend analysis of campaign quality. LQAS also accommodates changes to survey format, interpretation thresholds, evaluations of sample size, and data collection through mobile phones to improve timeliness of reporting and allow for visualization of campaign quality. LQAS becomes increasingly important to address remaining gaps in SIA quality and help focus resources on high-risk areas to prevent the continued transmission of wild poliovirus. © Crown copyright 2014.

Controlling measles using supplemental immunization activities: A mathematical model to inform optimal policy

PubMed Central

Verguet, Stéphane; Johri, Mira; Morris, Shaun K.; Gauvreau, Cindy L.; Jha, Prabhat; Jit, Mark

2015-01-01

Background The Measles & Rubella Initiative, a broad consortium of global health agencies, has provided support to measles-burdened countries, focusing on sustaining high coverage of routine immunization of children and supplementing it with a second dose opportunity for measles vaccine through supplemental immunization activities (SIAs). We estimate optimal scheduling of SIAs in countries with the highest measles burden. Methods We develop an age-stratified dynamic compartmental model of measles transmission. We explore the frequency of SIAs in order to achieve measles control in selected countries and two Indian states with high measles burden. Specifically, we compute the maximum allowable time period between two consecutive SIAs to achieve measles control. Results Our analysis indicates that a single SIA will not control measles transmission in any of the countries with high measles burden. However, regular SIAs at high coverage levels are a viable strategy to prevent measles outbreaks. The periodicity of SIAs differs between countries and even within a single country, and is determined by population demographics and existing routine immunization coverage. Conclusions Our analysis can guide country policymakers deciding on the optimal scheduling of SIA campaigns and the best combination of routine and SIA vaccination to control measles. PMID:25541214

5 CFR 430.202 - Coverage.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Coverage. 430.202 Section 430.202... Performance Appraisal for General Schedule, Prevailing Rate, and Certain Other Employees § 430.202 Coverage..., coverage includes, but is not limited to, senior-level and scientific and professional employees paid under...

5 CFR 430.202 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Coverage. 430.202 Section 430.202... Performance Appraisal for General Schedule, Prevailing Rate, and Certain Other Employees § 430.202 Coverage..., coverage includes, but is not limited to, senior-level and scientific and professional employees paid under...

5 CFR 430.202 - Coverage.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Coverage. 430.202 Section 430.202... Performance Appraisal for General Schedule, Prevailing Rate, and Certain Other Employees § 430.202 Coverage..., coverage includes, but is not limited to, senior-level and scientific and professional employees paid under...

5 CFR 430.202 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Coverage. 430.202 Section 430.202... Performance Appraisal for General Schedule, Prevailing Rate, and Certain Other Employees § 430.202 Coverage..., coverage includes, but is not limited to, senior-level and scientific and professional employees paid under...

5 CFR 430.202 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Coverage. 430.202 Section 430.202... Performance Appraisal for General Schedule, Prevailing Rate, and Certain Other Employees § 430.202 Coverage..., coverage includes, but is not limited to, senior-level and scientific and professional employees paid under...

Determinants of antiretroviral therapy coverage in Sub-Saharan Africa

PubMed Central

Hoque, Mohammad Zahirul

2015-01-01

Among 35 million people living with the human immunodeficiency virus (HIV) in 2013, only 37% had access to antiretroviral therapy (ART). Despite global concerted efforts to provide the universal access to the ART treatment, the ART coverage varies among countries and regions. At present, there is a lack of systematic empirical analyses on factors that determine the ART coverage. Therefore, the current study aimed to identify the determinants of the ART coverage in 41 countries in Sub-Saharan Africa. It employed statistical analyses for this purpose. Four elements, namely, the HIV prevalence, the level of national income, the level of medical expenditure and the number of nurses, were hypothesised to determine the ART coverage. The findings revealed that among the four proposed determinants only the HIV prevalence had a statistically significant impact on the ART coverage. In other words, the HIV prevalence was the sole determinant of the ART coverage in Sub-Saharan Africa. PMID:26664812

Long-term financing needs for HIV control in sub-Saharan Africa in 2015–2050: a modelling study

PubMed Central

Atun, Rifat; Chang, Angela Y; Ogbuoji, Osondu; Silva, Sachin; Resch, Stephen; Hontelez, Jan; Bärnighausen, Till

2016-01-01

Objectives To estimate the present value of current and future funding needed for HIV treatment and prevention in 9 sub-Saharan African (SSA) countries that account for 70% of HIV burden in Africa under different scenarios of intervention scale-up. To analyse the gaps between current expenditures and funding obligation, and discuss the policy implications of future financing needs. Design We used the Goals module from Spectrum, and applied the most up-to-date cost and coverage data to provide a range of estimates for future financing obligations. The four different scale-up scenarios vary by treatment initiation threshold and service coverage level. We compared the model projections to current domestic and international financial sources available in selected SSA countries. Results In the 9 SSA countries, the estimated resources required for HIV prevention and treatment in 2015–2050 range from US$98 billion to maintain current coverage levels for treatment and prevention with eligibility for treatment initiation at CD4 count of <500/mm3 to US$261 billion if treatment were to be extended to all HIV-positive individuals and prevention scaled up. With the addition of new funding obligations for HIV—which arise implicitly through commitment to achieve higher than current treatment coverage levels—overall financial obligations (sum of debt levels and the present value of the stock of future HIV funding obligations) would rise substantially. Conclusions Investing upfront in scale-up of HIV services to achieve high coverage levels will reduce HIV incidence, prevention and future treatment expenditures by realising long-term preventive effects of ART to reduce HIV transmission. Future obligations are too substantial for most SSA countries to be met from domestic sources alone. New sources of funding, in addition to domestic sources, include innovative financing. Debt sustainability for sustained HIV response is an urgent imperative for affected countries and donors. PMID:26948960

High-throughput amplicon sequencing and stream benthic bacteria: identifying the best taxonomic level for multiple-stressor research

PubMed Central

Salis, R. K.; Bruder, A.; Piggott, J. J.; Summerfield, T. C.; Matthaei, C. D.

2017-01-01

Disentangling the individual and interactive effects of multiple stressors on microbial communities is a key challenge to our understanding and management of ecosystems. Advances in molecular techniques allow studying microbial communities in situ and with high taxonomic resolution. However, the taxonomic level which provides the best trade-off between our ability to detect multiple-stressor effects versus the goal of studying entire communities remains unknown. We used outdoor mesocosms simulating small streams to investigate the effects of four agricultural stressors (nutrient enrichment, the nitrification inhibitor dicyandiamide (DCD), fine sediment and flow velocity reduction) on stream bacteria (phyla, orders, genera, and species represented by Operational Taxonomic Units with 97% sequence similarity). Community composition was assessed using amplicon sequencing (16S rRNA gene, V3-V4 region). DCD was the most pervasive stressor, affecting evenness and most abundant taxa, followed by sediment and flow velocity. Stressor pervasiveness was similar across taxonomic levels and lower levels did not perform better in detecting stressor effects. Community coverage decreased from 96% of all sequences for abundant phyla to 28% for species. Order-level responses were generally representative of responses of corresponding genera and species, suggesting that this level may represent the best compromise between stressor sensitivity and coverage of bacterial communities. PMID:28327636

Modelling the impact of a combined varicella and zoster vaccination programme on the epidemiology of varicella zoster virus in England.

PubMed

van Hoek, Albert Jan; Melegaro, Alessia; Zagheni, Emelio; Edmunds, W John; Gay, Nigel

2011-03-16

This study updates previous work on modelling the incidence of varicella and Herpes Zoster (HZ) following the introduction of childhood vaccination. The updated model includes new data on age-specific contact patterns, as well as data on the efficacy of zoster vaccination in the elderly and allows for HZ among vaccinees. The current study also looks at two-dose varicella childhood programmes, and assesses the combined impact of varicella vaccination in childhood and zoster vaccination of the elderly. The results suggest that a two-dose schedule is likely to reduce the incidence of varicella to very low levels, provided first dose coverage is around 90% and second dose coverage is in excess of 70%. Single dose varicella vaccination programmes are expected to result in large numbers of breakthrough cases. Childhood vaccination is expected to increase the incidence of zoster for more than 40 years after introduction of the programme, the magnitude of this increase being influenced primarily by the duration of boosting following exposure to the varicella zoster virus. Though this increase in zoster incidence can be partly offset by vaccination of the elderly, the effectiveness of this combined strategy is limited, as much of the increase occurs in those adults too young to be vaccinated. Childhood vaccination at intermediate levels of coverage (70% and 60% for first and second dose coverage respectively) is expected to lead to an increase in adult varicella. At high coverage (90% and 80% coverage) this is unlikely to be the case. These results will be used to inform a cost-effectiveness analysis of combined varicella and zoster vaccination programmes. Copyright © 2011 Elsevier Ltd. All rights reserved.

The Role of Smoking and Gingival Crevicular Fluid Markers on Coronally Advanced Flap Outcomes

PubMed Central

Kaval, Başak; Renaud, Diane E.; Scott, David A.; Buduneli, Nurcan

2015-01-01

Background This study evaluates possible effects of smoking on the following: 1) biochemical content in gingival crevicular fluid (GCF) samples from sites of gingival recession and saliva; and 2) clinical outcomes of coronally advanced flap (CAF) for root coverage. Methods Eighteen defects in 15 patients were included in each of the smoker and non-smoker groups. Baseline cotinine, basic fibroblast growth factor, vascular endothelial growth factor, platelet-derived growth factor, interleukin (IL)-8, IL-10, IL-12, tumor necrosis factor-α, matrix metalloproteinase (MMP)-8, MMP-9, and plasminogen activator inhibitor-1 levels were determined in GCF and saliva samples. CAF with microsurgery technique was applied. Plaque index, papilla bleeding index, recession depth (RD), recession width (RW), and root surface area were evaluated at baseline and postoperative months 1, 3, and 6. Probing depth, clinical attachment level (CAL), and keratinized gingival width (KGW) was recorded at baseline and month 6. Percentage of root coverage and complete root coverage were calculated at postoperative months 1, 3, and 6. Results All biochemical parameters were similar in the two groups apart from the definite difference in salivary cotinine concentrations (P = 0.000). Compared with the baseline values, RD, RW, CAL, and root surface area decreased, and KGW increased, with no significant difference between the study groups. CAL gain, percentage of root coverage, and complete root-coverage rates were similar in the study groups. Conclusion Similar baseline biochemical data and comparably high success rates of root coverage with CAF in systemically and periodontally healthy smokers versus non-smokers suggest lack of adverse effects of smoking on clinical outcomes. PMID:23725027

Two low coverage bird genomes and a comparison of reference-guided versus de novo genome assemblies.

PubMed

Card, Daren C; Schield, Drew R; Reyes-Velasco, Jacobo; Fujita, Matthew K; Andrew, Audra L; Oyler-McCance, Sara J; Fike, Jennifer A; Tomback, Diana F; Ruggiero, Robert P; Castoe, Todd A

2014-01-01

As a greater number and diversity of high-quality vertebrate reference genomes become available, it is increasingly feasible to use these references to guide new draft assemblies for related species. Reference-guided assembly approaches may substantially increase the contiguity and completeness of a new genome using only low levels of genome coverage that might otherwise be insufficient for de novo genome assembly. We used low-coverage (∼3.5-5.5x) Illumina paired-end sequencing to assemble draft genomes of two bird species (the Gunnison Sage-Grouse, Centrocercus minimus, and the Clark's Nutcracker, Nucifraga columbiana). We used these data to estimate de novo genome assemblies and reference-guided assemblies, and compared the information content and completeness of these assemblies by comparing CEGMA gene set representation, repeat element content, simple sequence repeat content, and GC isochore structure among assemblies. Our results demonstrate that even lower-coverage genome sequencing projects are capable of producing informative and useful genomic resources, particularly through the use of reference-guided assemblies.

Two low coverage bird genomes and a comparison of reference-guided versus de novo genome assemblies

USGS Publications Warehouse

Card, Daren C.; Schield, Drew R.; Reyes-Velasco, Jacobo; Fujita, Matthre K.; Andrew, Audra L.; Oyler-McCance, Sara J.; Fike, Jennifer A.; Tomback, Diana F.; Ruggiero, Robert P.; Castoe, Todd A.

2014-01-01

As a greater number and diversity of high-quality vertebrate reference genomes become available, it is increasingly feasible to use these references to guide new draft assemblies for related species. Reference-guided assembly approaches may substantially increase the contiguity and completeness of a new genome using only low levels of genome coverage that might otherwise be insufficient for de novo genome assembly. We used low-coverage (~3.5–5.5x) Illumina paired-end sequencing to assemble draft genomes of two bird species (the Gunnison Sage-Grouse, Centrocercus minimus, and the Clark's Nutcracker, Nucifraga columbiana). We used these data to estimate de novo genome assemblies and reference-guided assemblies, and compared the information content and completeness of these assemblies by comparing CEGMA gene set representation, repeat element content, simple sequence repeat content, and GC isochore structure among assemblies. Our results demonstrate that even lower-coverage genome sequencing projects are capable of producing informative and useful genomic resources, particularly through the use of reference-guided assemblies.

Vectorial capacity and vector control: reconsidering sensitivity to parameters for malaria elimination

PubMed Central

Brady, Oliver J.; Godfray, H. Charles J.; Tatem, Andrew J.; Gething, Peter W.; Cohen, Justin M.; McKenzie, F. Ellis; Perkins, T. Alex; Reiner, Robert C.; Tusting, Lucy S.; Sinka, Marianne E.; Moyes, Catherine L.; Eckhoff, Philip A.; Scott, Thomas W.; Lindsay, Steven W.; Hay, Simon I.; Smith, David L.

2016-01-01

Background Major gains have been made in reducing malaria transmission in many parts of the world, principally by scaling-up coverage with long-lasting insecticidal nets and indoor residual spraying. Historically, choice of vector control intervention has been largely guided by a parameter sensitivity analysis of George Macdonald's theory of vectorial capacity that suggested prioritizing methods that kill adult mosquitoes. While this advice has been highly successful for transmission suppression, there is a need to revisit these arguments as policymakers in certain areas consider which combinations of interventions are required to eliminate malaria. Methods and Results Using analytical solutions to updated equations for vectorial capacity we build on previous work to show that, while adult killing methods can be highly effective under many circumstances, other vector control methods are frequently required to fill effective coverage gaps. These can arise due to pre-existing or developing mosquito physiological and behavioral refractoriness but also due to additive changes in the relative importance of different vector species for transmission. Furthermore, the optimal combination of interventions will depend on the operational constraints and costs associated with reaching high coverage levels with each intervention. Conclusions Reaching specific policy goals, such as elimination, in defined contexts requires increasingly non-generic advice from modelling. Our results emphasize the importance of measuring baseline epidemiology, intervention coverage, vector ecology and program operational constraints in predicting expected outcomes with different combinations of interventions. PMID:26822603

National, State, and Selected Local Area Vaccination Coverage Among Children Aged 19-35 Months - United States, 2014.

PubMed

Hill, Holly A; Elam-Evans, Laurie D; Yankey, David; Singleton, James A; Kolasa, Maureen

2015-08-28

The reduction in morbidity and mortality associated with vaccine-preventable diseases in the United States has been described as one of the 10 greatest public health achievements of the first decade of the 21st century. A recent analysis concluded that routine childhood vaccination will prevent 322 million cases of disease and about 732,000 early deaths among children born during 1994-2013, for a net societal cost savings of $1.38 trillion. The National Immunization Survey (NIS) has monitored vaccination coverage among U.S. children aged 19-35 months since 1994. This report presents national, regional, state, and selected local area vaccination coverage estimates for children born from January 2011 through May 2013, based on data from the 2014 NIS. For most vaccinations, there was no significant change in coverage between 2013 and 2014. The exception was hepatitis A vaccine (HepA), for which increases were observed in coverage with both ≥1 and ≥2 doses. As in previous years, <1% of children received no vaccinations. National coverage estimates indicate that the Healthy People 2020 target* of 90% was met for ≥3 doses of poliovirus vaccine (93.3%), ≥1 dose of measles, mumps, and rubella vaccine (MMR) (91.5%), ≥3 doses of hepatitis B vaccine (HepB) (91.6%), and ≥1 dose of varicella vaccine (91.0%). Coverage was below target for ≥4 doses of diphtheria, tetanus, and acellular pertussis vaccine (DTaP), the full series of Haemophilus influenzae type b (Hib) vaccine, hepatitis B (HepB) birth dose,† ≥4 doses pneumococcal conjugate vaccine (PCV), ≥2 doses of HepA, the full series of rotavirus vaccine, and the combined vaccine series.§ Examination of coverage by child's race/ethnicity revealed lower estimated coverage among non-Hispanic black children compared with non-Hispanic white children for several vaccinations, including DTaP, the full series of Hib, PCV, rotavirus vaccine, and the combined series. Children from households classified as below the federal poverty level had lower estimated coverage for almost all of the vaccinations assessed, compared with children living at or above the poverty level. Significant variation in coverage by state¶ was observed for several vaccinations, including HepB birth dose, HepA, and rotavirus. High vaccination coverage must be maintained across geographic and sociodemographic groups if progress in reducing the impact of vaccine-preventable diseases is to be sustained.

Employer-sponsored health insurance coverage continues to decline in a new decade.

PubMed

Gould, Elise

2013-01-01

Most Americans, particularly those under age 65, rely on health insurance offered through the workplace. Given continuing high unemployment, it comes as no surprise that the share of Americans under age 65 covered by employer-sponsored health insurance (ESI) eroded for the 11th year in a row in 2011, falling from 58.6 percent in 2010 to 58.3 percent. The situation started deteriorating long before the Great Recession: the share of Americans under age 65 covered by ESI eroded every year from 2000 to 2011, decreasing by a total of 10.9 percentage points. As many as 29 million more people under age 65 would have had ESI in 2011 if the coverage rate had remained at the 2000 level. The decline in ESI coverage has been accompanied by an overall decline in health insurance coverage. The number of uninsured non-elderly Americans was 47.9 million in 2011--11.7 million higher than in 2000. Increasing public insurance coverage, particularly among children, is the only reason the uninsured rate did not rise one-for-one with losses in ESI. In addition, key components in the Patient Protection and Affordable Care Act took effect in 2010, shielding young adults from further coverage losses.

An Agent-Based Model of School Closing in Under-Vacccinated Communities During Measles Outbreaks.

PubMed

Getz, Wayne M; Carlson, Colin; Dougherty, Eric; Porco Francis, Travis C; Salter, Richard

2016-04-01

The winter 2014-15 measles outbreak in the US represents a significant crisis in the emergence of a functionally extirpated pathogen. Conclusively linking this outbreak to decreases in the measles/mumps/rubella (MMR) vaccination rate (driven by anti-vaccine sentiment) is critical to motivating MMR vaccination. We used the NOVA modeling platform to build a stochastic, spatially-structured, individual-based SEIR model of outbreaks, under the assumption that R 0 ≈ 7 for measles. We show this implies that herd immunity requires vaccination coverage of greater than approximately 85%. We used a network structured version of our NOVA model that involved two communities, one at the relatively low coverage of 85% coverage and one at the higher coverage of 95%, both of which had 400-student schools embedded, as well as students occasionally visiting superspreading sites (e.g. high-density theme parks, cinemas, etc.). These two vaccination coverage levels are within the range of values occurring across California counties. Transmission rates at schools and superspreading sites were arbitrarily set to respectively 5 and 15 times background community rates. Simulations of our model demonstrate that a 'send unvaccinated students home' policy in low coverage counties is extremely effective at shutting down outbreaks of measles.

An Agent-Based Model of School Closing in Under-Vacccinated Communities During Measles Outbreaks

PubMed Central

Getz, Wayne M.; Carlson, Colin; Dougherty, Eric; Porco, Travis C.; Salter, Richard

2016-01-01

The winter 2014–15 measles outbreak in the US represents a significant crisis in the emergence of a functionally extirpated pathogen. Conclusively linking this outbreak to decreases in the measles/mumps/rubella (MMR) vaccination rate (driven by anti-vaccine sentiment) is critical to motivating MMR vaccination. We used the NOVA modeling platform to build a stochastic, spatially-structured, individual-based SEIR model of outbreaks, under the assumption that R0 ≈ 7 for measles. We show this implies that herd immunity requires vaccination coverage of greater than approximately 85%. We used a network structured version of our NOVA model that involved two communities, one at the relatively low coverage of 85% coverage and one at the higher coverage of 95%, both of which had 400-student schools embedded, as well as students occasionally visiting superspreading sites (e.g. high-density theme parks, cinemas, etc.). These two vaccination coverage levels are within the range of values occurring across California counties. Transmission rates at schools and superspreading sites were arbitrarily set to respectively 5 and 15 times background community rates. Simulations of our model demonstrate that a ‘send unvaccinated students home’ policy in low coverage counties is extremely effective at shutting down outbreaks of measles. PMID:27668297

Towards Direct Manipulation and Remixing of Massive Data: The EarthServer Approach

NASA Astrophysics Data System (ADS)

Baumann, P.

2012-04-01

Complex analytics on "big data" is one of the core challenges of current Earth science, generating strong requirements for on-demand processing and fil tering of massive data sets. Issues under discussion include flexibility, performance, scalability, and the heterogeneity of the information types invo lved. In other domains, high-level query languages (such as those offered by database systems) have proven successful in the quest for flexible, scalable data access interfaces to massive amounts of data. However, due to the lack of support for many of the Earth science data structures, database systems are only used for registries and catalogs, but not for the bulk of spatio-temporal data. One core information category in this field is given by coverage data. ISO 19123 defines coverages, simplifying, as a representation of a "space-time varying phenomenon". This model can express a large class of Earth science data structures, including rectified and non-rectified rasters, curvilinear grids, point clouds, TINs, general meshes, trajectories, surfaces, and solids. This abstract definition, which is too high-level to establish interoperability, is concretized by the OGC GML 3.2.1 Application Schema for Coverages Standard into an interoperable representation. The OGC Web Coverage Processing Service (WCPS) Standard defines a declarative query language on multi-dimensional raster-type coverages, such as 1D in-situ sensor timeseries, 2D EO imagery, 3D x/y/t image time series and x/y/z geophysical data, 4D x/y/z/t climate and ocean data. Hence, important ingredients for versatile coverage retrieval are given - however, this potential has not been fully unleashed by service architectures up to now. The EU FP7-INFRA project EarthServer, launched in September 2011, aims at enabling standards-based on-demand analytics over the Web for Earth science data based on an integration of W3C XQuery for alphanumeric data and OGC-WCPS for raster data. Ultimately, EarthServer will support all OGC coverage types. The platform used by EarthServer is the rasdaman raster database system. To exploit heterogeneous multi-parallel platforms, automatic request distribution and orchestration is being established. Client toolkits are under development which will allow to quickly compose bespoke interactive clients, ranging from mobile devices over Web clients to high-end immersive virtual reality. The EarthServer platform has been deployed in six large-scale data centres with the aim of setting up Lighthouse Applications addressing all Earth Sciences, including satellite and airborne earth observation as well as use cases from atmosphere, ocean, snow, and ice monitoring, and geology on Earth and Mars. These services, each of which will ultimately host at least 100 TB, will form a peer cloud with distributed query processing for arbitrarily mixing database and in-situ access. With its ability to directly manipulate, analyze and remix massive data, the goal of EarthServer is to lift the data providers' semantic level from data stewardship to service stewardship.

Open Tibia Shaft Fractures and Soft-Tissue Coverage: The Effects of Management by an Orthopaedic Microsurgical Team.

PubMed

VandenBerg, James; Osei, Daniel; Boyer, Martin I; Gardner, Michael J; Ricci, William M; Spraggs-Hughes, Amanda; McAndrew, Christopher M

2017-06-01

To compare the timing of soft-tissue (flap) coverage and occurrence of complications before and after the establishment of an integrated orthopaedic trauma/microsurgical team. Retrospective cohort study. A single level 1 trauma center. Twenty-eight subjects (13 pre- and 15 post-integration) with open tibia shaft fractures (OTA/AO 42A, 42B, and 42C) treated with flap coverage between January 2009 and March 2015. Flap coverage for open tibia shaft fractures treated before ("preintegration") and after ("postintegration") implementation of an integrated orthopaedic trauma/microsurgical team. Time from index injury to flap coverage. The unadjusted median time to coverage was 7 days (95% confidence interval, 5.9-8.1) preintegration, and 6 days (95% confidence interval, 4.6-7.4) postintegration (P = 0.48). For preintegration, 9 (69%) of the patients experienced complications, compared with 7 (47%) postintegration (P = 0.23). After formation of an integrated orthopaedic trauma/microsurgery team, we observed a 1-day decrease in median days to coverage from index injury. Complications overall were lowered in the postintegration group, although statistically insignificant. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

An Investigation into Physics Teaching in Senior High Schools

ERIC Educational Resources Information Center

Buabeng, Isaac; Ossei-Anto, Theophilus Aquinas; Ampiah, Joseph Ghartey

2014-01-01

This study sought to examine the activities that go on in physics classrooms in Senior High Schools in Ghana. Specifically, the study sought to investigate the pattern of interaction and instructional methods used for teaching physics and level of coverage of physics syllabus. The survey design was employed for the study in which questionnaire was…

Exploring the relationship between population density and maternal health coverage.

PubMed

Hanlon, Michael; Burstein, Roy; Masters, Samuel H; Zhang, Raymond

2012-11-21

Delivering health services to dense populations is more practical than to dispersed populations, other factors constant. This engenders the hypothesis that population density positively affects coverage rates of health services. This hypothesis has been tested indirectly for some services at a local level, but not at a national level. We use cross-sectional data to conduct cross-country, OLS regressions at the national level to estimate the relationship between population density and maternal health coverage. We separately estimate the effect of two measures of density on three population-level coverage rates (6 tests in total). Our coverage indicators are the fraction of the maternal population completing four antenatal care visits and the utilization rates of both skilled birth attendants and in-facility delivery. The first density metric we use is the percentage of a population living in an urban area. The second metric, which we denote as a density score, is a relative ranking of countries by population density. The score's calculation discounts a nation's uninhabited territory under the assumption those areas are irrelevant to service delivery. We find significantly positive relationships between our maternal health indicators and density measures. On average, a one-unit increase in our density score is equivalent to a 0.2% increase in coverage rates. Countries with dispersed populations face higher burdens to achieve multinational coverage targets such as the United Nations' Millennial Development Goals.

The Impact of State Legislation and Model Policies on Bullying in Schools

ERIC Educational Resources Information Center

Terry, Amanda

2018-01-01

Background: The purpose of this study was to determine the impact of the coverage of state legislation and the expansiveness ratings of state model policies on the state-level prevalence of bullying in schools. Methods: The state-level prevalence of bullying in schools was based on cross-sectional data from the 2013 High School Youth Risk Behavior…

National Rules for Drug–Drug Interactions: Are They Appropriate for Tertiary Hospitals?

PubMed Central

2016-01-01

The application of appropriate rules for drug–drug interactions (DDIs) could substantially reduce the number of adverse drug events. However, current implementations of such rules in tertiary hospitals are problematic as physicians are receiving too many alerts, causing high override rates and alert fatigue. We investigated the potential impact of Korean national DDI rules in a drug utilization review program in terms of their severity coverage and the clinical efficiency of how physicians respond to them. Using lists of high-priority DDIs developed with the support of the U.S. government, we evaluated 706 contraindicated DDI pairs released in May 2015. We evaluated clinical log data from one tertiary hospital and prescription data from two other tertiary hospitals. The measured parameters were national DDI rule coverage for high-priority DDIs, alert override rate, and number of prescription pairs. The coverage rates of national DDI rules were 80% and 3.0% at the class and drug levels, respectively. The analysis of the system log data showed an overall override rate of 79.6%. Only 0.3% of all of the alerts (n = 66) were high-priority DDI rules. These showed a lower override rate of 51.5%, which was much lower than for the overall DDI rules. We also found 342 and 80 unmatched high-priority DDI pairs which were absent in national rules in inpatient orders from the other two hospitals. The national DDI rules are not complete in terms of their coverage of severe DDIs. They also lack clinical efficiency in tertiary settings, suggesting improved systematic approaches are needed. PMID:27822925

Variation in cervical and breast cancer screening coverage in England: a cross-sectional analysis to characterise districts with atypical behaviour.

PubMed

Massat, Nathalie J; Douglas, Elaine; Waller, Jo; Wardle, Jane; Duffy, Stephen W

2015-07-24

Reducing cancer screening inequalities in England is a major focus of the 2011 Department of Health cancer outcome strategy. Screening coverage requires regular monitoring in order to implement targeted interventions where coverage is low. This study aimed to characterise districts with atypical coverage levels for cervical or breast screening. Observational study of district-level coverage in the English Cervical and Breast screening programmes in 2012. England, UK. All English women invited to participate in the cervical (age group 25-49 and 50-64) and breast (age group 50-64) screening programmes. Risk adjustment models for coverage were developed based on district-level characteristics. Funnel plots of adjusted coverage were constructed, and atypical districts examined by correlation analysis. Variability in coverage was primarily explained by population factors, whereas general practice characteristics had little independent effect. Deprivation and ethnicity other than white, Asian, black or mixed were independently associated with poorer coverage in both screening programmes, with ethnicity having the strongest effect; by comparison, the influence of Asian, black or mixed ethnic minority was limited. Deprivation, ethnicity and urbanisation largely accounted for the lower cervical screening coverage in London. However, for breast screening, being located in London remained a strong negative predictor. A subset of districts was identified as having atypical coverage across programmes. Correlates of deprivation in districts with relatively low adjusted coverage were substantially different from overall correlates of deprivation. These results inform the continuing drive to reduce avoidable cancer deaths in England, and encourage implementation of targeted interventions in communities residing in districts identified as having atypically low coverage. Sequential implementation to monitor the impact of local interventions would help accrue evidence on 'what works'. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Errors and correlates in parental recall of child immunizations: effects on vaccination coverage estimates.

PubMed

Suarez, L; Simpson, D M; Smith, D R

1997-05-01

We evaluated the accuracy of parental recall of children's immunization histories as compared with provider records and examined how errors in parental recall correlate with sociodemographic characteristics. The validation study was part of a population-based household survey designed to assess immunization levels among Texas children under age 2 years. For 72% (n = 3278), interviewers used vaccination records from the parent to copy dates for the diphtheria and tetanus toxoids and pertussis vaccine (DTP), oral polio vaccine (OPV), and measles, mumps, and rubella (MMR) shots. For parents without shot records (n = 1216), interviewers asked about each vaccine, whether the child had received the shot, how many, and at what age. Of these, 85% (n = 1029) were validated with health provider records. Measured against provider records, only 34% of parents accurately recalled the number of DTP shots a child had. More often (42%) parents underestimated the number of DTP shots than overestimated (24%). Agreement between parental recall and provider records was high (83%) for the single dose of MMR. Accuracy of parents' recall did not differ by race/ethnicity, education level, or type of health insurance coverage, but decreased as child's age increased. Having a vaccination record at home was associated with a higher immunization status. Hispanic, lower educated, and uninsured parents were more likely to have a vaccination record than non-Hispanic, higher educated, and privately insured parents. Validity of parental recall of children's immunization histories depends on the vaccine and the age of the child, which is highly correlated with the number of shots parents must recollect. Results suggest that inclusion of parent recall information from vaccination surveys underestimates DTP:OPV:MMR coverage. This underestimation is consistent across economic and race/ethnic groups. Thus, community surveys based on cards and recall should provide reliable conclusions about which groups need intensive program efforts. For the routine monitoring of vaccination coverage, reasonable estimates can be obtained by combining parent-held record and parent recall data. Caution is required when comparing coverage estimates from different surveys since the source of information and method of derivation will produce widely varying coverage rates.

A Spatial Heterodyne Spectrometer for Laboratory Astrophysics; First Interferogram

NASA Technical Reports Server (NTRS)

Lawler, J. E.; Labby, Z. E.; Roesler, F. L.; Harlander, J.

2006-01-01

A Spatial Heterodyne Spectrometer with broad spectral coverage across the VUV - UV region and with a high (> 500,000 ) spectral resolving power is being built for laboratory measurements of spectroscopic data including emission branching fractions, improved level energies, and hyperfine/isotopic parameters.

General practitioner services in primary care groups in England: is there inequity between service availability and population need?

PubMed

Baker, D; Hann, M

2001-06-01

This study examined the coverage of minor surgery, child health surveillance and chronic disease management for asthma and diabetes in relation to population need and key organisational features of general practice in the 481 primary care groups (PCGs) in England. PCG-level summary scores were developed to estimate the relative availability of all four services and their relative importance in discriminating between high and low levels of service provision. The coverage of services was widespread and, in such circumstances, there was no systematic evidence of poorer service availability for PCGs with higher population need (the 'inverse care' law). Rather this relation was localised, being most predominant for PCGs covering London and its suburbs. In these PCGs, there was no association between indicators of lack of capacity, such as single-handed practice, and levels of service provision.

Factors associated with dental health care coverage in Mexico: Findings from the National Performance Evaluation Survey 2002-2003.

PubMed

Pérez-Núñez, Ricardo; Medina-Solis, Carlo Eduardo; Maupomé, Gerardo; Vargas-Palacios, Armando

2006-10-01

To determine the level of dental health care coverage in people aged > or =18 years across the country, and to identify the factors associated with coverage. Using the instruments and sampling strategies developed by the World Health Organization for the World Health Survey, a cross-sectional national survey was carried out at the household and individual (adult) levels. Dental data were collected in 20 of Mexico's 32 states. The relationship between coverage and environmental and individual characteristics was examined through logistic regression models. Only 6098 of 24 159 individual respondents reported having oral problems during the preceding 12 months (accounting for 14 284 621 inhabitants of the country if weighted). Only 48% of respondents reporting problems were covered, although details of the appropriateness, timeliness and effectiveness of the intervention(s) were not assessed. The multivariate regression model showed that higher level of education, better socioeconomic status, having at least one chronic disease and having medical insurance were positively associated with better dental care coverage. Age and sex were also associated. Overall dental health care coverage could be improved, assuming that ideal coverage is 100%. Some equality of access issues are apparent because there are differences in coverage across populations in terms of wealth and social status. Identifying the factors associated with sparse coverage is a step in the right direction allowing policymakers to establish strategies aimed at increasing this coverage, focusing on more vulnerable groups and on individuals in greater need of preventive and rehabilitative interventions.

mHealth Series: Measuring maternal newborn and child health coverage by text messaging – a county–level model for China

PubMed Central

Zhang, Yanfeng; Chen, Li; van Velthoven, Michelle H. M. M. T.; Wang, Wei; Liu, Li; Du, Xiaozhen; Wu, Qiong; Li, Ye; Car, Josip

2013-01-01

Background Effective interventions in maternal, newborn and child health (MNCH), if achieving high level of population coverage, could prevent most of deaths in children under five years of age. High–quality measurements of MNCH coverage are essential for tracking progress and making evidence–based decisions. Methods MNCH coverage data are mainly collected through fieldworkers’ interview with preselected households in standard programs of Demographic and Health Surveys (DHS) or Multiple Indicator Cluster Surveys (MICS) in most low– and middle–income countries. Household surveys will continue to be the major data source for MNCH coverage in the foreseeable future. However, face–to–face data collection broadly used in household surveys is labor–intensive, time–consuming and expensive. Mobile phones are drawing more and more interest in medical research with the rapid increase in usage and text messaging could be an innovative way of data collection, that is, we could collect DHS data through mHealth method. We refer to it as “mDHS”. Finding We propose in this paper a conceptual model for measuring MNCH coverage by text messaging in China. In developing this model, we considered resource constraints, sample representativeness, sample size and survey bias. The components of the model are text messaging platform, routine health information system, health facilities, communities and households. Conclusions Measuring MNCH interventions coverage by text messaging could be advantageous in many ways and establish a much larger evidence–base for MNCH health policies in China. Before mDHS could indeed be launched, research priorities would include a systematic assessment of routine health information systems and exploring feasibility to collect name lists, mobile phone numbers and general demographic and socio–economic data; qualitative interviews with health workers and caregivers; assessment of data validity of all indicators to be collected by text messaging; and exploring approaches to increase participation rate. PMID:24363920

Modelling the affordability and distributional implications of future health care financing options in South Africa.

PubMed

McIntyre, Di; Ataguba, John E

2012-03-01

South Africa is considering introducing a universal health care system. A key concern for policy-makers and the general public is whether or not this reform is affordable. Modelling the resource and revenue generation requirements of alternative reform options is critical to inform decision-making. This paper considers three reform scenarios: universal coverage funded by increased allocations to health from general tax and additional dedicated taxes; an alternative reform option of extending private health insurance coverage to all formal sector workers and their dependents with the remainder using tax-funded services; and maintaining the status quo. Each scenario was modelled over a 15-year period using a spreadsheet model. Statistical analyses were also undertaken to evaluate the impact of options on the distribution of health care financing burden and benefits from using health services across socio-economic groups. Universal coverage would result in total health care spending levels equivalent to 8.6% of gross domestic product (GDP), which is comparable to current spending levels. It is lower than the status quo option (9.5% of GDP) and far lower than the option of expanding private insurance cover (over 13% of GDP). However, public funding of health services would have to increase substantially. Despite this, universal coverage would result in the most progressive financing system if the additional public funding requirements are generated through a surcharge on taxable income (but not if VAT is increased). The extended private insurance scheme option would be the least progressive and would impose a very high payment burden; total health care payments on average would be 10.7% of household consumption expenditure compared with the universal coverage (6.7%) and status quo (7.5%) options. The least pro-rich distribution of service benefits would be achieved under universal coverage. Universal coverage is affordable and would promote health system equity, but needs careful design to ensure its long-term sustainability.

Trends of improved water and sanitation coverage around the globe between 1990 and 2010: inequality among countries and performance of official development assistance

PubMed Central

Cha, Seungman; Mankadi, Paul Mansiangi; Elhag, Mousab Siddig; Lee, Yongjoo; Jin, Yan

2017-01-01

ABSTRACT Background: As the Millennium Development Goals ended, and were replaced by the Sustainable Development Goals, efforts have been made to evaluate the achievements and performance of official development assistance (ODA) in the health sector. In this study, we explore trends in the expansion of water and sanitation coverage in developing countries and the performance of ODA. Design: We explored inequality across developing countries by income level, and investigated how ODA for water and sanitation was committed by country, region, and income level. Changes in inequality were tested via slope changes by investigating the interaction of year and income level with a likelihood ratio test. A random effects model was applied according to the results of the Hausman test. Results: The slope of the linear trend between economic level and sanitation coverage has declined over time. However, a random effects model suggested that the change in slope across years was not significant (e.g. for the slope change between 2000 and 2010: likelihood ratio χ2 = 2.49, probability > χ2 = 0.1146). A similar pro-rich pattern across developing countries and a non-significant change in the slope associated with different economic levels were demonstrated for water coverage. Our analysis shows that the inequality of water and sanitation coverage among countries across the world has not been addressed effectively during the past decade. Our findings demonstrate that the countries with the least coverage persistently received far less ODA per capita than did countries with much more extensive water and sanitation coverage, suggesting that ODA for water and sanitation is poorly targeted. Conclusion: The most deprived countries should receive more attention for water and sanitation improvements from the world health community. A strong political commitment to ODA targeting the countries with the least coverage is needed at the global level. PMID:28604256

Long-term financing needs for HIV control in sub-Saharan Africa in 2015-2050: a modelling study.

PubMed

Atun, Rifat; Chang, Angela Y; Ogbuoji, Osondu; Silva, Sachin; Resch, Stephen; Hontelez, Jan; Bärnighausen, Till

2016-03-06

To estimate the present value of current and future funding needed for HIV treatment and prevention in 9 sub-Saharan African (SSA) countries that account for 70% of HIV burden in Africa under different scenarios of intervention scale-up. To analyse the gaps between current expenditures and funding obligation, and discuss the policy implications of future financing needs. We used the Goals module from Spectrum, and applied the most up-to-date cost and coverage data to provide a range of estimates for future financing obligations. The four different scale-up scenarios vary by treatment initiation threshold and service coverage level. We compared the model projections to current domestic and international financial sources available in selected SSA countries. In the 9 SSA countries, the estimated resources required for HIV prevention and treatment in 2015-2050 range from US$98 billion to maintain current coverage levels for treatment and prevention with eligibility for treatment initiation at CD4 count of <500/mm(3) to US$261 billion if treatment were to be extended to all HIV-positive individuals and prevention scaled up. With the addition of new funding obligations for HIV--which arise implicitly through commitment to achieve higher than current treatment coverage levels--overall financial obligations (sum of debt levels and the present value of the stock of future HIV funding obligations) would rise substantially. Investing upfront in scale-up of HIV services to achieve high coverage levels will reduce HIV incidence, prevention and future treatment expenditures by realising long-term preventive effects of ART to reduce HIV transmission. Future obligations are too substantial for most SSA countries to be met from domestic sources alone. New sources of funding, in addition to domestic sources, include innovative financing. Debt sustainability for sustained HIV response is an urgent imperative for affected countries and donors. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Chemical waves in the O2 + H2 reaction on a Rh(111) surface alloyed with nickel. I. Photoelectron emission microscopy

NASA Astrophysics Data System (ADS)

Smolinsky, Tim; von Boehn, Bernhard; Imbihl, Ronald

2018-04-01

Chemical waves that arise in the H2 + O2 reaction on a bimetallic Rh(111)/Ni surface have been studied in the 10-6 and 10-5 mbar range at T = 773 K with photoelectron emission microscopy (PEEM), low-energy electron diffraction (LEED), and Auger electron spectroscopy (AES). Nickel coverages of 0.3, 0.6, and 1.0 monolayers were investigated. Coadsorbed with some oxygen, Ni starts to penetrate the Rh bulk region substantially only beyond 900 K. In the 10-5 mbar range, chemical waves are characterized by three distinct gray levels in PEEM. This number reduces to only two levels in the 10-6 mbar range. In situ LEED showed the periodic appearance of a (n × 1) (n = 8, 10) pattern during chemical waves which was assigned to a 2D-Ni oxide. With in situ AES, one observes that the bright phase in PEEM correlates with a high Ni coverage and the dark phase with a low Ni coverage.

[HPV prophylactic vaccine coverage in France: Results of a survey among high school and university students in Marseilles' area].

PubMed

Sabiani, L; Bremond, A; Mortier, I; Lecuyer, M; Boubli, L; Carcopino, X

2012-04-01

To assess HPV prophylactic vaccine coverage among French high school and university students as well as their level of education about this vaccine. An anonymous survey was conducted among 2500 high school and university students from the area of Marseilles, France, from December 2009 to April 2010. A total of 2018 questionnaires were collected (80.7% participation rate). Mean age of participants was 20 years (range, 15-45 years). Only 671 (35.4%) participants reported having been vaccinated against HPV, of whom 510 (73.4%) had completed the three injections scheme. Practice of cytological cervical cancer screening was not significantly influenced by vaccination status. Thus, 578 (45.2%) participants who had not been vaccinated already had had a cervical cytology performed, versus 295 (43.3%) vaccinated ones (P=0.445). Among those not being vaccinated, 671 (49.8%) fulfilled criteria for a catch-up vaccination, of whom only 325 (48.4%) agreed for such a catch-up. Main reasons given for refusal for a catch-up vaccination were the lack of information about HPV vaccine and fear of side effects. In total, 1722 (90%) considered themselves as educated about the HPV vaccine. Source of education was attributed to doctors and media by 54.4% and 53.7% of participants, respectively. Educational role attributed to school and university was poor (3.4%). Despite apparent satisfactory level of education, HPV prophylactic vaccine coverage among high school and university students appears to be insufficient. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

The effect of lack of insurance, poverty and paediatrician supply on immunization rates among children 19-35 months of age in the United States.

PubMed

Becton, James L; Cheng, Lee; Nieman, Linda Z

2008-04-01

Previous studies found that the increasing number of paediatricians in the United States was associated with improved childhood immunization coverage, while the increasing poverty level and the lack of health insurance reduced access to health care. We evaluated whether changes in the number of paediatricians, poverty level and health insurance affected national childhood immunization coverage in the state levels of the United States. Data were collected primarily from the US National Immunization Surveys, series 4:3:1:3:3 from years 1995 and 2003. Ordinal logistic regression analysis was used to analyse the relationships among variables. Over 8 years studied, immunization coverage increased for children aged 19-35 months from 52.3% to 79.8% in the 50 states. The average number of paediatricians per 1000 births increased 28.7% while the percentage of children without health insurance declined 15.6%, and the percentage of children who lived in poverty level declined 17.3%. In 1995, the states with higher immunization coverage were associated with higher numbers of paediatricians [odds ratio (OR), 32.73; 95% confidence interval (CI), 5.96-179.77]. In 2003, the higher numbers of paediatricians still played a role in the increased immunization coverage (OR, 4.69; 95% CI, 1.01-21.78); however, the higher rate of uninsured children in 2003 had an even greater effect upon immunization coverage. Compared with states with lower rates of uninsured children, states with intermediate and higher rates of uninsured children had sixfold (OR, 0.16; 95% CI, 0.03-0.81) and 16-fold (OR, 0.06; 95% CI, 0.01-0.40) decreased childhood immunization coverage, respectively. Between 1995 and 2003 in the United States, the lack of health insurance became more prominent than the supply of paediatricians in affecting immunization coverage for children aged 19-35 months. Future improvements in insurance coverage for children will likely lead to greater immunization coverage.

45 CFR 156.20 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Affordable Care Act; and (3) A bronze, silver, gold, or platinum level of coverage as described in section....103 of this subtitle. Level of coverage means one of four standardized actuarial values as defined by...

Superstructures at Te/Au(111) interface evolving upon increasing Te coverage

NASA Astrophysics Data System (ADS)

Guan, Jiaqi; Huang, Xiaochun; Xu, Xiaofeng; Zhang, Shuyuan; Jia, Xun; Zhu, Xuetao; Wang, Weihua; Guo, Jiandong

2018-03-01

By in-situ low temperature scanning tunneling microscopy, we systematically investigated the superstructure evolution at Te/Au(111) interface upon increasing Te coverage. Te atoms form one-dimensional √{ 3} R30∘ chains at ∼0.10 monolayer (ML) coverage. Two two-dimensional chiral superstructures, (√{ 111} ×√{ 111}) R 4 .7∘ and (3√{ 21} × 3√{ 21}) R 10 .9∘ , are selectively formed with the Te coverage below and above 1/3 ML, respectively. The two chiral superstructures can be converted to each other reversibly by adding Te atoms or moderately annealing. A honeycomb-like superstructure, decorated with adatoms that are distributed in quasi-one-dimensional chains, is observed by further increasing the Te coverage to 4/9 ML. At the Te/Au(111) interface, an interfacial state at -0.65 eV to -0.55 eV below the Fermi level is also resolved by scanning tunneling spectroscopy. The formation of these Te-induced high-order superstructures is accompanied by relaxation of gold atoms in the surface layer, indicating a strong Te-Au interaction. Our work demonstrates a reliable method to fabricate Te nanostructures on noble metals in a controlled way.

Objective sea level pressure analysis for sparse data areas

NASA Technical Reports Server (NTRS)

Druyan, L. M.

1972-01-01

A computer procedure was used to analyze the pressure distribution over the North Pacific Ocean for eleven synoptic times in February, 1967. Independent knowledge of the central pressures of lows is shown to reduce the analysis errors for very sparse data coverage. The application of planned remote sensing of sea-level wind speeds is shown to make a significant contribution to the quality of the analysis especially in the high gradient mid-latitudes and for sparse coverage of conventional observations (such as over Southern Hemisphere oceans). Uniform distribution of the available observations of sea-level pressure and wind velocity yields results far superior to those derived from a random distribution. A generalization of the results indicates that the average lower limit for analysis errors is between 2 and 2.5 mb based on the perfect specification of the magnitude of the sea-level pressure gradient from a known verification analysis. A less than perfect specification will derive from wind-pressure relationships applied to satellite observed wind speeds.

Discontinuity of Medicaid Coverage: Impact on Cost and Utilization Among Adult Medicaid Beneficiaries With Major Depression.

PubMed

Ji, Xu; Wilk, Adam S; Druss, Benjamin G; Lally, Cathy; Cummings, Janet R

2017-08-01

Gaps in Medicaid coverage may disrupt access to and continuity of care. This can be detrimental for beneficiaries with chronic conditions, such as major depression, for whom disruptions in access to outpatient care may lead to increased use of acute care. However, little is known about how Medicaid coverage discontinuities impact acute care utilization among adults with depression. Examine the relationship between Medicaid discontinuities and service utilization among adults with major depression. A total of 139,164 adults (18-64) with major depression was identified using the 2003-2004 Medicaid Analytic eXtract Files. We used generalized linear and two-part models to examine the effect of Medicaid discontinuity on service utilization. To establish causality in this relationship, we used instrumental variables analysis, relying on exogenous variation in a state-level policy for identification. Emergency department (ED) visits, inpatient episodes, inpatient days, and Medicaid-reimbursed costs. Approximately 29.4% of beneficiaries experienced coverage disruptions. In instrumental variables models, those with coverage disruptions incurred an increase of $650 in acute care costs per-person per Medicaid-covered month compared with those with continuous coverage, evidenced by an increase in ED use (0.1 more ED visits per-person-month) and inpatient days (0.6 more days per-person-month). The increase in acute costs contributed to an overall increase in all-cause costs by $310 per-person-month (all P-values<0.001). Among depressed adults, those experiencing coverage disruptions have, on average, significantly greater use of costly ED/inpatient services than those with continuous coverage. Maintenance of continuous Medicaid coverage may help prevent acute episodes requiring high-cost interventions.

A landscape analysis of universal health coverage for mothers and children in South Asia.

PubMed

Scammell, Katy; Noble, Douglas J; Rasanathan, Kumanan; O'Connell, Thomas; Ahmed, Aishath Shahula; Begkoyian, Genevieve; Goldner, Tania; Jayatissa, Renuka; Kuppens, Lianne; Raaijmakers, Hendrikus; Simbeye, Isabel Vashti; Varkey, Sherin; Chopra, Mickey

2016-01-01

The United Nations made universal health coverage (UHC) a key health goal in 2012 and it is one of the Sustainable Development Goals' targets. This analysis focuses on UHC for mothers and children in the 8 countries of South Asia. A high level overview of coverage of selected maternal, newborn and child health services, equity, quality of care and financial risk protection is presented. Common barriers countries face in achieving UHC are discussed and solutions explored. In countries of South Asia, except Bhutan and Maldives, between 42% and 67% of spending on health comes from out-of-pocket expenditure (OOPE) and government expenditure does not align with political aspirations. Even where reported coverage of services is good, quality of care is often low and the poorest fare worst. There are strong examples of ongoing successes in countries such as Bhutan, the Maldives and Sri Lanka. Related to this success are factors such as lower OOPE and higher spending on health. To make progress in achieving UHC, financial and non-financial barriers to accessing and receiving high-quality healthcare need to be reduced, the amount of investment in essential health services needs to be increased and allocation of resources must disproportionately benefit the poorest.

A landscape analysis of universal health coverage for mothers and children in South Asia

PubMed Central

Scammell, Katy; Noble, Douglas J; Rasanathan, Kumanan; O'Connell, Thomas; Ahmed, Aishath Shahula; Begkoyian, Genevieve; Goldner, Tania; Jayatissa, Renuka; Kuppens, Lianne; Raaijmakers, Hendrikus; Simbeye, Isabel Vashti; Varkey, Sherin; Chopra, Mickey

2016-01-01

The United Nations made universal health coverage (UHC) a key health goal in 2012 and it is one of the Sustainable Development Goals' targets. This analysis focuses on UHC for mothers and children in the 8 countries of South Asia. A high level overview of coverage of selected maternal, newborn and child health services, equity, quality of care and financial risk protection is presented. Common barriers countries face in achieving UHC are discussed and solutions explored. In countries of South Asia, except Bhutan and Maldives, between 42% and 67% of spending on health comes from out-of-pocket expenditure (OOPE) and government expenditure does not align with political aspirations. Even where reported coverage of services is good, quality of care is often low and the poorest fare worst. There are strong examples of ongoing successes in countries such as Bhutan, the Maldives and Sri Lanka. Related to this success are factors such as lower OOPE and higher spending on health. To make progress in achieving UHC, financial and non-financial barriers to accessing and receiving high-quality healthcare need to be reduced, the amount of investment in essential health services needs to be increased and allocation of resources must disproportionately benefit the poorest. PMID:28588912

Medicaid Coverage for Methadone Maintenance and Use of Opioid Agonist Therapy in Specialty Addiction Treatment.

PubMed

Saloner, Brendan; Stoller, Kenneth B; Barry, Colleen L

2016-06-01

This study examined differences in opioid agonist therapy (OAT) utilization among Medicaid-enrolled adults receiving public-sector opioid use disorder treatment in states with Medicaid coverage of methadone maintenance, states with block grant funding only, and states without public coverage of methadone. Person-level treatment admission data, which included information on reason for treatment and use of OAT from 36 states were linked to state-level Medicaid policies collected in a 50-state survey. Probabilities of OAT use among Medicaid enrollees in opioid addiction treatment were calculated, with adjustment for demographic characteristics and patterns of substance use. In adjusted analysis, 45.0% of Medicaid-enrolled individuals in opioid addiction treatment in states with Medicaid coverage for methadone maintenance used OAT, compared with 30.1% in states with block grant coverage only and 17.0% in states with no coverage. Differences were widest in nonintensive outpatient settings. Medicaid methadone maintenance coverage is critical for encouraging OAT among individuals with opioid use disorders.

Attack Coverage in High-Level Men’s Volleyball: Organization on the Edge of Chaos?

PubMed Central

Laporta, Lorenzo; Nikolaidis, Pantelis; Thomas, Luke; Afonso, José

2015-01-01

Change is pervasive, but emerging patterns are occasionally detectable through analysis of systemic behaviors. Match analysis uses these patterns in order to reduce the degree of improvisation and to optimize the training process. However, it is possible that certain game phases elude systematic patterning. In this vein, our aim was to analyze the case of attack coverage in men’s volleyball, as we suspected it would elude systematic patterning and has received negligible attention in scientific research. We analyzed the occurrence of attack coverage in 4544 plays of the 2011 Volleyball World League. A Chi-square test with residual adjusted values was applied to explore significant associations between variables. A Monte Carlo correction was applied, as some cells had n<5. Effect sizes were determined using Cramer’s V. Overall, attack coverage occurred in 3.89% of ball possessions, and 23 distinct structures emerged. These structures lacked significant associations with the game complex, setting zone, and effect of attack coverage. Conversely, attack coverage structures showed significant associations with the attack zone and tempo, with very strong effect sizes (V=0.472 and V=0.521, respectively). As certain attack zones are deeply associated with attack tempo, it is apparent that quicker attack plays affect attack coverage structuring, promoting the formation of less complex structures. Ultimately, attack coverage structures seem to depend on momentary constraints, thereby rendering rigid systematization impracticable. Still, we contended that a principle-based approach might be suitable. This invites researchers to rethink how to interpret game regularities. PMID:26557208

Full Coverage Shaped Hole Film Cooling in an Accelerating Boundary Layer with High Free-Stream Turbulence

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ames, Forrest E.; Kingery, Joseph E.

2015-06-17

Full coverage shaped-hole film cooling and downstream heat transfer measurements have been acquired in the accelerating flows over a large cylindrical leading edge test surface. The shaped holes had an 8° lateral expansion angled at 30° to the surface with spanwise and streamwise spacings of 3 diameters. Measurements were conducted at four blowing ratios, two Reynolds numbers and six well documented turbulence conditions. Film cooling measurements were acquired over a four to one range in blowing ratio at the lower Reynolds number and at the two lower blowing ratios for the higher Reynolds number. The film cooling measurements were acquiredmore » at a coolant to free-stream density ratio of approximately 1.04. The flows were subjected to a low turbulence condition (Tu = 0.7%), two levels of turbulence for a smaller sized grid (Tu = 3.5%, and 7.9%), one turbulence level for a larger grid (8.1%), and two levels of turbulence generated using a mock aero-combustor (Tu = 9.3% and 13.7%). Turbulence level is shown to have a significant influence in mixing away film cooling coverage progressively as the flow develops in the streamwise direction. Effectiveness levels for the aero-combustor turbulence condition are reduced to as low as 20% of low turbulence values by the furthest downstream region. The film cooling discharge is located close to the leading edge with very thin and accelerating upstream boundary layers. Film cooling data at the lower Reynolds number, show that transitional flows have significantly improved effectiveness levels compared with turbulent flows. Downstream effectiveness levels are very similar to slot film cooling data taken at the same coolant flow rates over the same cylindrical test surface. However, slots perform significantly better in the near discharge region. These data are expected to be very useful in grounding computational predictions of full coverage shaped hole film cooling with elevated turbulence levels and acceleration. IR measurements were performed for the two lowest turbulence levels to document the spanwise variation in film cooling effectiveness and heat transfer.« less

Knowledge and awareness of HPV vaccine and acceptability to vaccinate in sub-Saharan Africa: a systematic review.

PubMed

Perlman, Stacey; Wamai, Richard G; Bain, Paul A; Welty, Thomas; Welty, Edith; Ogembo, Javier Gordon

2014-01-01

We assessed the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate in sub-Saharan African (SSA) countries. We further identified countries that fulfill the two GAVI Alliance eligibility criteria to support nationwide HPV vaccination. We conducted a systematic review of peer-reviewed studies on the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate. Trends in Diphtheria-tetanus-pertussis (DTP3) vaccine coverage in SSA countries from 1990-2011 were extracted from the World Health Organization database. The review revealed high levels of willingness and acceptability of HPV vaccine but low levels of knowledge and awareness of cervical cancer, HPV or HPV vaccine. We identified only six countries to have met the two GAVI Alliance requirements for supporting introduction of HPV vaccine: 1) the ability to deliver multi-dose vaccines for no less than 50% of the target vaccination cohort in an average size district, and 2) achieving over 70% coverage of DTP3 vaccine nationally. From 2008 through 2011 all SSA countries, with the exception of Mauritania and Nigeria, have reached or maintained DTP3 coverage at 70% or above. There is an urgent need for more education to inform the public about HPV, HPV vaccine, and cervical cancer, particularly to key demographics, (adolescents, parents and healthcare professionals), to leverage high levels of willingness and acceptability of HPV vaccine towards successful implementation of HPV vaccination programs. There is unpreparedness in most SSA countries to roll out national HPV vaccination as per the GAVI Alliance eligibility criteria for supporting introduction of the vaccine. In countries that have met 70% DTP3 coverage, pilot programs need to be rolled out to identify the best practice and strategies for delivering HPV vaccines to adolescents and also to qualify for GAVI Alliance support.

Knowledge and Awareness of HPV Vaccine and Acceptability to Vaccinate in Sub-Saharan Africa: A Systematic Review

PubMed Central

Perlman, Stacey; Wamai, Richard G.; Bain, Paul A.; Welty, Thomas; Welty, Edith; Ogembo, Javier Gordon

2014-01-01

Objectives We assessed the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate in sub-Saharan African (SSA) countries. We further identified countries that fulfill the two GAVI Alliance eligibility criteria to support nationwide HPV vaccination. Methods We conducted a systematic review of peer-reviewed studies on the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate. Trends in Diphtheria-tetanus-pertussis (DTP3) vaccine coverage in SSA countries from 1990–2011 were extracted from the World Health Organization database. Findings The review revealed high levels of willingness and acceptability of HPV vaccine but low levels of knowledge and awareness of cervical cancer, HPV or HPV vaccine. We identified only six countries to have met the two GAVI Alliance requirements for supporting introduction of HPV vaccine: 1) the ability to deliver multi-dose vaccines for no less than 50% of the target vaccination cohort in an average size district, and 2) achieving over 70% coverage of DTP3 vaccine nationally. From 2008 through 2011 all SSA countries, with the exception of Mauritania and Nigeria, have reached or maintained DTP3 coverage at 70% or above. Conclusion There is an urgent need for more education to inform the public about HPV, HPV vaccine, and cervical cancer, particularly to key demographics, (adolescents, parents and healthcare professionals), to leverage high levels of willingness and acceptability of HPV vaccine towards successful implementation of HPV vaccination programs. There is unpreparedness in most SSA countries to roll out national HPV vaccination as per the GAVI Alliance eligibility criteria for supporting introduction of the vaccine. In countries that have met 70% DTP3 coverage, pilot programs need to be rolled out to identify the best practice and strategies for delivering HPV vaccines to adolescents and also to qualify for GAVI Alliance support. PMID:24618636

Essential surgery: key messages from Disease Control Priorities, 3rd edition.

PubMed

Mock, Charles N; Donkor, Peter; Gawande, Atul; Jamison, Dean T; Kruk, Margaret E; Debas, Haile T

2015-05-30

The World Bank will publish the nine volumes of Disease Control Priorities, 3rd edition, in 2015-16. Volume 1--Essential Surgery--identifies 44 surgical procedures as essential on the basis that they address substantial needs, are cost effective, and are feasible to implement. This report summarises and critically assesses the volume's five key findings. First, provision of essential surgical procedures would avert about 1·5 million deaths a year, or 6-7% of all avertable deaths in low-income and middle-income countries. Second, essential surgical procedures rank among the most cost effective of all health interventions. The surgical platform of the first-level hospital delivers 28 of the 44 essential procedures, making investment in this platform also highly cost effective. Third, measures to expand access to surgery, such as task sharing, have been shown to be safe and effective while countries make long-term investments in building surgical and anaesthesia workforces. Because emergency procedures constitute 23 of the 28 procedures provided at first-level hospitals, expansion of access requires that such facilities be widely geographically diffused. Fourth, substantial disparities remain in the safety of surgical care, driven by high perioperative mortality rates including anaesthesia-related deaths in low-income and middle-income countries. Feasible measures, such as WHO's Surgical Safety Checklist, have led to improvements in safety and quality. Fifth, the large burden of surgical disorders, cost-effectiveness of essential surgery, and strong public demand for surgical services suggest that universal coverage of essential surgery should be financed early on the path to universal health coverage. We point to estimates that full coverage of the component of universal coverage of essential surgery applicable to first-level hospitals would require just over US$3 billion annually of additional spending and yield a benefit-cost ratio of more than 10:1. It would efficiently and equitably provide health benefits, financial protection, and contributions to stronger health systems. Copyright © 2015 Elsevier Ltd. All rights reserved.

The challenges and opportunities of translating best practice immunisation strategies among low performing general practices to reduce equity gaps in childhood immunisation coverage in New Zealand.

PubMed

Turner, Nikki M; Charania, Nadia A; Chong, Angela; Stewart, Joanna; Taylor, Lynn

2017-01-01

Immunisation coverage rates vary considerably at the local level across New Zealand and challenges remain with effectively translating best available research evidence into public health practice. This study aimed to translate best practices from high performing general practices into strategies to improve childhood immunisation coverage among low performing practices. An intervention study was undertaken of general practices with low immunisation coverage rates and a high percentage of the enrolled population being of Māori ethnicity. Intervention groups received customised action plans and support for a 12 month period while control groups received 'business as usual' support. Structured interviews were conducted with key informants from all participating practices to understand current aspects related to childhood immunisation delivery and surveys were conducted to understand how the intervention worked. Collected data were thematically analysed. Ten sites were randomised to either intervention ( n  = 6) or control group ( n  = 4). Positive aspects of childhood immunisation delivery included high prioritisation at the practice and staff being pro-immunisation and knowledgeable. Key challenges experienced included inaccurate family contact information and discrepancies with referral processes to other providers. Other challenges noted were building rapport with families and vaccine hesitancy. The action plans included various strategies aimed to improve processes at the practice, contact and engagement with parents, and partnership development with local service providers. Creating customised action plans and providing support to providers were considered as helpful approaches when attempting to improve childhood immunisation coverage rates. Our study supports the notion that one strategy will not solely by itself improve childhood immunisation rates and highlights the importance of having a toolkit of strategies from which to draw from.

Food nanotechnology in the news. Coverage patterns and thematic emphases during the last decade.

PubMed

Dudo, Anthony; Choi, Doo-Hun; Scheufele, Dietram A

2011-02-01

For novel issues like food nanotechnology, media can play an important role in shaping the awareness and mental associations that underlie public opinion. Seeking to complement recent research exploring public opinion formation about food nanotechnology, this study tracks the evolution of U.S. newspaper coverage of food nanotechnology, identifying the descriptive and thematic traits that have characterized this coverage over time. We use a rigorous methodology to examine the levels of coverage, authorship patterns, and thematic emphases exhibited in the American journalistic narrative about this burgeoning application of nanoscience. Our findings indicate that U.S. newspaper coverage of food nanotechnology is relatively modest in terms of how often it has been covered, its thematic diversity, and the level of journalistic expertise from which it was produced. To our knowledge, this is the first study to empirically assess journalistic coverage of food nanotechnology. Copyright © 2010 Elsevier Ltd. All rights reserved.

Exploring the relationship between population density and maternal health coverage

PubMed Central

2012-01-01

Background Delivering health services to dense populations is more practical than to dispersed populations, other factors constant. This engenders the hypothesis that population density positively affects coverage rates of health services. This hypothesis has been tested indirectly for some services at a local level, but not at a national level. Methods We use cross-sectional data to conduct cross-country, OLS regressions at the national level to estimate the relationship between population density and maternal health coverage. We separately estimate the effect of two measures of density on three population-level coverage rates (6 tests in total). Our coverage indicators are the fraction of the maternal population completing four antenatal care visits and the utilization rates of both skilled birth attendants and in-facility delivery. The first density metric we use is the percentage of a population living in an urban area. The second metric, which we denote as a density score, is a relative ranking of countries by population density. The score’s calculation discounts a nation’s uninhabited territory under the assumption those areas are irrelevant to service delivery. Results We find significantly positive relationships between our maternal health indicators and density measures. On average, a one-unit increase in our density score is equivalent to a 0.2% increase in coverage rates. Conclusions Countries with dispersed populations face higher burdens to achieve multinational coverage targets such as the United Nations’ Millennial Development Goals. PMID:23170895

Inequalities in full immunization coverage: trends in low- and middle-income countries

PubMed Central

Barros, Aluísio JD; Wong, Kerry LM; Johnson, Hope L; Pariyo, George; França, Giovanny VA; Wehrmeister, Fernando C; Victora, Cesar G

2016-01-01

Abstract Objective To investigate disparities in full immunization coverage across and within 86 low- and middle-income countries. Methods In May 2015, using data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys, we investigated inequalities in full immunization coverage – i.e. one dose of bacille Calmette-Guérin vaccine, one dose of measles vaccine, three doses of vaccine against diphtheria, pertussis and tetanus and three doses of polio vaccine – in 86 low- or middle-income countries. We then investigated temporal trends in the level and inequality of such coverage in eight of the countries. Findings In each of the World Health Organization’s regions, it appeared that about 56–69% of eligible children in the low- and middle-income countries had received full immunization. However, within each region, the mean recorded level of such coverage varied greatly. In the African Region, for example, it varied from 11.4% in Chad to 90.3% in Rwanda. We detected pro-rich inequality in such coverage in 45 of the 83 countries for which the relevant data were available and pro-urban inequality in 35 of the 86 study countries. Among the countries in which we investigated coverage trends, Madagascar and Mozambique appeared to have made the greatest progress in improving levels of full immunization coverage over the last two decades, particularly among the poorest quintiles of their populations. Conclusion Most low- and middle-income countries are affected by pro-rich and pro-urban inequalities in full immunization coverage that are not apparent when only national mean values of such coverage are reported. PMID:27821882

A systematic evaluation of different methods for calculating adolescent vaccination levels using immunization information system data.

PubMed

Gowda, Charitha; Dong, Shiming; Potter, Rachel C; Dombkowski, Kevin J; Stokley, Shannon; Dempsey, Amanda F

2013-01-01

Immunization information systems (IISs) are valuable surveillance tools; however, population relocation may introduce bias when determining immunization coverage. We explored alternative methods for estimating the vaccine-eligible population when calculating adolescent immunization levels using a statewide IIS. We performed a retrospective analysis of the Michigan State Care Improvement Registry (MCIR) for all adolescents aged 11-18 years registered in the MCIR as of October 2010. We explored four methods for determining denominators: (1) including all adolescents with MCIR records, (2) excluding adolescents with out-of-state residence, (3) further excluding those without MCIR activity ≥ 10 years prior to the evaluation date, and (4) using a denominator based on U.S. Census data. We estimated state- and county-specific coverage levels for four adolescent vaccines. We found a 20% difference in estimated vaccination coverage between the most inclusive and restrictive denominator populations. Although there was some variability among the four methods in vaccination at the state level (2%-11%), greater variation occurred at the county level (up to 21%). This variation was substantial enough to potentially impact public health assessments of immunization programs. Generally, vaccines with higher coverage levels had greater absolute variation, as did counties with smaller populations. At the county level, using the four denominator calculation methods resulted in substantial differences in estimated adolescent immunization rates that were less apparent when aggregated at the state level. Further research is needed to ascertain the most appropriate method for estimating vaccine coverage levels using IIS data.

A developing country perspective on vaccine-associated paralytic poliomyelitis.

PubMed

John, T Jacob

2004-01-01

When the Expanded Programme on Immunization was established and oral poliovirus vaccine (OPV) was introduced for developing countries to use exclusively, national leaders of public health had no opportunity to make an informed choice between OPV and the inactivated poliovirus vaccine (IPV). Today, as progress is made towards the goal of global eradication of poliomyelitis attributable to wild polioviruses, all developing countries where OPV is used face the risk of vaccine-associated paralytic poliomyelitis (VAPP). Until recently, awareness of VAPP has been poor and quantitative risk analysis scanty but it is now well known that the continued use of OPV perpetuates the risk of VAPP. Discontinuation or declining immunization coverage of OPV will increase the risk of emergence of circulating vaccine-derived polioviruses (cVDPV) that re-acquire wild virus-like properties and may cause outbreaks of polio. To eliminate the risk of cVDPV, either very high immunization coverage must be maintained as long as OPV is in use, or IPV should replace OPV. Stopping OPV without first achieving high immunization coverage with IPV is unwise on account of the possibility of emergence of cVDPV. Increasing numbers of developed nations prefer IPV, and manufacturing capacities have not been scaled up, so its price remains prohibitively high and unaffordable by developing countries, where, in addition, large-scale field experience with IPV is lacking. Under these circumstances, a policy shift to increase the use of IPV in national immunization programmes in developing countries is a necessary first step; once IPV coverage reaches high levels (over 85%), the withdrawal of OPV may begin.

The Structures of Life.

ERIC Educational Resources Information Center

National Inst. of General Medical Sciences (NIH), Bethesda, MD.

This booklet, geared toward an advanced high school or early college-level audience, explains how structural biology provides insight into health and disease and is useful in developing new medications. This publication contains a general introduction to proteins, coverage of the techniques used to determine protein structures, and a chapter on…

Correlates of human papillomavirus vaccine coverage: a state-level analysis.

PubMed

Moss, Jennifer L; Reiter, Paul L; Brewer, Noel T

2015-02-01

We tested the hypothesis that states with higher rates of cancers associated with human papillomavirus (HPV) would have lower HPV vaccine coverage. We gathered state-level data on HPV-related cancer rates and HPV vaccine initiation coverage for girls and boys, separately, and HPV vaccine follow-through (i.e., receipt of 3 doses among those initiating the series) for girls only. In addition, we gathered state-level data on demographic composition and contact with the health care system. We calculated Pearson correlations for these ecological relationships. Human papillomavirus vaccine initiation among girls was lower in states with higher levels of cervical cancer incidence and mortality (r = -0.29 and -0.46, respectively). In addition, vaccine follow-through among girls was lower in states with higher levels of cervical cancer mortality (r = -0.30). Other cancer rates were associated with HPV vaccine initiation and follow-through among girls, but not among boys. Human papillomavirus vaccine initiation among girls was lower in states with higher proportions of non-Hispanic black residents and lower proportions of higher-income residents. Human papillomavirus vaccine follow-through was higher in states with greater levels of adolescents' contact with the health care system. Human papillomavirus vaccine coverage for girls was lower in states with higher HPV-related cancer rates. Public health efforts should concentrate on geographic areas with higher cancer rates. Strengthening adolescent preventive health care use may be particularly important to increase vaccine follow-through. Cost-effectiveness analyses may overestimate the benefits of current vaccination coverage and underestimate the benefits of increasing coverage.

Associations between key intervention coverage and child mortality: an analysis of 241 sub-national regions of sub-Saharan Africa.

PubMed

Akachi, Yoko; Steenland, Maria; Fink, Günther

2017-12-21

Reducing child mortality remains a key objective in the Sustainable Development Goals. Although remarkable progress has been made with respect to under-5 mortality over the last 25 years, little is known regarding the relative contributions of public health interventions and general improvements in socioeconomic status during this time period. We combined all available data from the Demographic and Health Survey (DHS) to construct a longitudinal, multi-level dataset with information on subnational-level key intervention coverage, household socioeconomic status and child health outcomes in sub-Saharan Africa. The dataset covers 562 896 child records and 769 region-year observations across 24 countries. We used multi-level multivariable logistics regression models to assess the associations between child mortality and changes in the coverage of 17 key reproductive, maternal, newborn and child health interventions such as bednets, water and sanitation infrastructure, vaccination and breastfeeding practices, as well as concurrent improvements in social and economic development. Full vaccination coverage was associated with a 30% decrease in the odds of child mortality [odds ratio (OR) 0.698, 95% confidence interval (CI) 0.564, 0.864], and continued breastfeeding was associated with a 24% decrease in the odds of child mortality (OR 0.759, 95% CI 0.642, 0.898). Our results suggest that changes in vaccination coverage, as well as increases in female education and economic development, made the largest contributions to the positive mortality trends observed. Breastfeeding was associated with child survival but accounts for little of the observed declines in mortality due to declining coverage levels during our study period. Our findings suggest that a large amount of progress has been made with respect to coverage levels of key health interventions. Whereas all socioeconomic variables considered appear to strongly predict health outcomes, the same was true only for very few health coverage indicators. © The Author(s) 2017; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association

Front-End Electron Transfer Dissociation Coupled to a 21 Tesla FT-ICR Mass Spectrometer for Intact Protein Sequence Analysis

NASA Astrophysics Data System (ADS)

Weisbrod, Chad R.; Kaiser, Nathan K.; Syka, John E. P.; Early, Lee; Mullen, Christopher; Dunyach, Jean-Jacques; English, A. Michelle; Anderson, Lissa C.; Blakney, Greg T.; Shabanowitz, Jeffrey; Hendrickson, Christopher L.; Marshall, Alan G.; Hunt, Donald F.

2017-09-01

High resolution mass spectrometry is a key technology for in-depth protein characterization. High-field Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR MS) enables high-level interrogation of intact proteins in the most detail to date. However, an appropriate complement of fragmentation technologies must be paired with FTMS to provide comprehensive sequence coverage, as well as characterization of sequence variants, and post-translational modifications. Here we describe the integration of front-end electron transfer dissociation (FETD) with a custom-built 21 tesla FT-ICR mass spectrometer, which yields unprecedented sequence coverage for proteins ranging from 2.8 to 29 kDa, without the need for extensive spectral averaging (e.g., 60% sequence coverage for apo-myoglobin with four averaged acquisitions). The system is equipped with a multipole storage device separate from the ETD reaction device, which allows accumulation of multiple ETD fragment ion fills. Consequently, an optimally large product ion population is accumulated prior to transfer to the ICR cell for mass analysis, which improves mass spectral signal-to-noise ratio, dynamic range, and scan rate. We find a linear relationship between protein molecular weight and minimum number of ETD reaction fills to achieve optimum sequence coverage, thereby enabling more efficient use of instrument data acquisition time. Finally, real-time scaling of the number of ETD reactions fills during method-based acquisition is shown, and the implications for LC-MS/MS top-down analysis are discussed. [Figure not available: see fulltext.

Vectorial capacity and vector control: reconsidering sensitivity to parameters for malaria elimination.

PubMed

Brady, Oliver J; Godfray, H Charles J; Tatem, Andrew J; Gething, Peter W; Cohen, Justin M; McKenzie, F Ellis; Perkins, T Alex; Reiner, Robert C; Tusting, Lucy S; Sinka, Marianne E; Moyes, Catherine L; Eckhoff, Philip A; Scott, Thomas W; Lindsay, Steven W; Hay, Simon I; Smith, David L

2016-02-01

Major gains have been made in reducing malaria transmission in many parts of the world, principally by scaling-up coverage with long-lasting insecticidal nets and indoor residual spraying. Historically, choice of vector control intervention has been largely guided by a parameter sensitivity analysis of George Macdonald's theory of vectorial capacity that suggested prioritizing methods that kill adult mosquitoes. While this advice has been highly successful for transmission suppression, there is a need to revisit these arguments as policymakers in certain areas consider which combinations of interventions are required to eliminate malaria. Using analytical solutions to updated equations for vectorial capacity we build on previous work to show that, while adult killing methods can be highly effective under many circumstances, other vector control methods are frequently required to fill effective coverage gaps. These can arise due to pre-existing or developing mosquito physiological and behavioral refractoriness but also due to additive changes in the relative importance of different vector species for transmission. Furthermore, the optimal combination of interventions will depend on the operational constraints and costs associated with reaching high coverage levels with each intervention. Reaching specific policy goals, such as elimination, in defined contexts requires increasingly non-generic advice from modelling. Our results emphasize the importance of measuring baseline epidemiology, intervention coverage, vector ecology and program operational constraints in predicting expected outcomes with different combinations of interventions. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

Two Low Coverage Bird Genomes and a Comparison of Reference-Guided versus De Novo Genome Assemblies

PubMed Central

Card, Daren C.; Schield, Drew R.; Reyes-Velasco, Jacobo; Fujita, Matthew K.; Andrew, Audra L.; Oyler-McCance, Sara J.; Fike, Jennifer A.; Tomback, Diana F.; Ruggiero, Robert P.; Castoe, Todd A.

2014-01-01

As a greater number and diversity of high-quality vertebrate reference genomes become available, it is increasingly feasible to use these references to guide new draft assemblies for related species. Reference-guided assembly approaches may substantially increase the contiguity and completeness of a new genome using only low levels of genome coverage that might otherwise be insufficient for de novo genome assembly. We used low-coverage (∼3.5–5.5x) Illumina paired-end sequencing to assemble draft genomes of two bird species (the Gunnison Sage-Grouse, Centrocercus minimus, and the Clark's Nutcracker, Nucifraga columbiana). We used these data to estimate de novo genome assemblies and reference-guided assemblies, and compared the information content and completeness of these assemblies by comparing CEGMA gene set representation, repeat element content, simple sequence repeat content, and GC isochore structure among assemblies. Our results demonstrate that even lower-coverage genome sequencing projects are capable of producing informative and useful genomic resources, particularly through the use of reference-guided assemblies. PMID:25192061

Reproducibility and Consistency of In Vitro Nucleosome Reconstitutions Demonstrated by Invitrosome Isolation and Sequencing

PubMed Central

Kempton, Colton E.; Heninger, Justin R.; Johnson, Steven M.

2014-01-01

Nucleosomes and their positions in the eukaryotic genome play an important role in regulating gene expression by influencing accessibility to DNA. Many factors influence a nucleosome's final position in the chromatin landscape including the underlying genomic sequence. One of the primary reasons for performing in vitro nucleosome reconstitution experiments is to identify how the underlying DNA sequence will influence a nucleosome's position in the absence of other compounding cellular factors. However, concerns have been raised about the reproducibility of data generated from these kinds of experiments. Here we present data for in vitro nucleosome reconstitution experiments performed on linear plasmid DNA that demonstrate that, when coverage is deep enough, these reconstitution experiments are exquisitely reproducible and highly consistent. Our data also suggests that a coverage depth of 35X be maintained for maximal confidence when assaying nucleosome positions, but lower coverage levels may be generally sufficient. These coverage depth recommendations are sufficient in the experimental system and conditions used in this study, but may vary depending on the exact parameters used in other systems. PMID:25093869

A composite indicator to measure universal health care coverage in India: way forward for post-2015 health system performance monitoring framework.

PubMed

Prinja, Shankar; Gupta, Rakesh; Bahuguna, Pankaj; Sharma, Atul; Kumar Aggarwal, Arun; Phogat, Amit; Kumar, Rajesh

2017-02-01

There is limited work done on developing methods for measurement of universal health coverage. We undertook a study to develop a methodology and demonstrate the practical application of empirically measuring the extent of universal health coverage at district level. Additionally, we also develop a composite indicator to measure UHC. A cross-sectional survey was undertaken among 51 656 households across 21 districts of Haryana state in India. Using the WHO framework for UHC, we identified indicators of service coverage, financial risk protection, equity and quality based on the Government of India and the Haryana Government's proposed UHC benefit package. Geometric mean approach was used to compute a composite UHC index (CUHCI). Various statistical approaches to aggregate input indicators with or without weighting, along with various incremental combinations of input indicators were tested in a comprehensive sensitivity analysis. The population coverage for preventive and curative services is presented. Adjusting for inequality, the coverage for all the indicators were less than the unadjusted coverage by 0.1-6.7% in absolute term and 0.1-27% in relative term. There was low unmet need for curative care. However, about 11% outpatient consultations were from unqualified providers. About 30% households incurred catastrophic health expenditures, which rose to 38% among the poorest 20% population. Summary index (CUHCI) for UHC varied from 12% in Mewat district to 71% in Kurukshetra district. The inequality unadjusted coverage for UHC correlates highly with adjusted coverage. Our paper is an attempt to develop a methodology to measure UHC. However, careful inclusion of others indicators of service coverage is recommended for a comprehensive measurement which captures the spirit of universality. Further, more work needs to be done to incorporate quality in the measurement framework. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Nuclear War in High School History Textbooks.

ERIC Educational Resources Information Center

Fleming, Daniel B.

1983-01-01

A review of 19 recently published, secondary-level United States and world history textbooks found only brief coverage of the Hiroshima and Nagasaki (Japan) bombings, slight attention to the arms race and disarmament, and concentration on scientific and technical developments behind the atomic bomb rather than on its effects. (Author/RW)

Modernizing Medicare's Benefit Design and Low-Income Subsidies to Ensure Access and Affordability.

PubMed

Schoen, Cathy; Davis, Karen; Buttorff, Christine; Andersen, Martin

2015-07-01

Insurance coverage through the traditional Medicare program is complex, fragmented, and incomplete. Beneficiaries must purchase supplemental private insurance to fill in the gaps. While impoverished beneficiaries may receive supplemental coverage through Medicaid and subsidies for prescription drugs, help is limited for people with incomes above the poverty level. This patchwork quilt leads to confusion for beneficiaries and high administrative costs, while also undermining coverage and care coordination. Most important, Medicare's benefits fail to limit out-of-pocket costs or ensure adequate financial protection, especially for beneficiaries with low incomes and serious health problems. This brief, part of a series about Medicare's past, present, and future, presents options for an integrated benefit for enrollees in traditional Medicare. The new benefit would not only reduce cost burdens but also could potentially strengthen the Medicare program and enhance its role in stimulating and supporting innovations throughout the health care delivery system.

National Immunization Program: Computerized System as a tool for new challenges

PubMed Central

Sato, Ana Paula Sayuri

2015-01-01

The scope and coverage of the Brazilian Immunization Program can be compared with those in developed countries because it provides a large number of vaccines and has a considerable coverage. The increasing complexity of the program brings challenges regarding its development, high coverage levels, access equality, and safety. The Immunization Information System, with nominal data, is an innovative tool that can more accurately monitor these indicators and allows the evaluation of the impact of new vaccination strategies. The main difficulties for such a system are in its implementation process, training of professionals, mastering its use, its constant maintenance needs and ensuring the information contained remain confidential. Therefore, encouraging the development of this tool should be part of public health policies and should also be involved in the three spheres of government as well as the public and private vaccination services. PMID:26176746

Initial stability of a highly porous titanium cup in an acetabular bone defect model.

PubMed

Yoshimoto, Kensei; Nakashima, Yasuharu; Wakiyama, Miyo; Hara, Daisuke; Nakamura, Akihiro; Iwamoto, Mikio

2018-04-12

The purpose of this study was to quantify the initial stability of a highly porous titanium cup using an acetabular bone defect model. The maximum torque of a highly porous titanium cup, with a pore size of 640 μm and porosity of 60%, was measured using rotational and lever-out torque testing and compared to that of a titanium-sprayed cup. The bone models were prepared using a polyurethane foam block and had three levels of bone coverage: 100, 70, and 50%. The highly porous titanium cup demonstrated significantly higher maximum torque than the titanium-sprayed cups in the three levels of bone defects. On rotational torque testing, it was found to be 1.5, 1.3, and 1.3 times stronger than the titanium-sprayed cups with 100, 70 and 50% bone coverage, respectively. Furthermore, it was found to be 2.2, 2.3, and 1.5 times stronger on lever-out testing than the titanium-sprayed cup. No breakage in the porous layers was noted during the testing. This study provides additional evidence of the initial stability of highly porous titanium cup, even in the presence of acetabular bone defects. Copyright © 2018. Published by Elsevier B.V.

Defining epitope coverage requirements for T cell-based HIV vaccines: Theoretical considerations and practical applications

PubMed Central

2011-01-01

Background HIV vaccine development must address the genetic diversity and plasticity of the virus that permits the presentation of diverse genetic forms to the immune system and subsequent escape from immune pressure. Assessment of potential HIV strain coverage by candidate T cell-based vaccines (whether natural sequence or computationally optimized products) is now a critical component in interpreting candidate vaccine suitability. Methods We have utilized an N-mer identity algorithm to represent T cell epitopes and explore potential coverage of the global HIV pandemic using natural sequences derived from candidate HIV vaccines. Breadth (the number of T cell epitopes generated) and depth (the variant coverage within a T cell epitope) analyses have been incorporated into the model to explore vaccine coverage requirements in terms of the number of discrete T cell epitopes generated. Results We show that when multiple epitope generation by a vaccine product is considered a far more nuanced appraisal of the potential HIV strain coverage of the vaccine product emerges. By considering epitope breadth and depth several important observations were made: (1) epitope breadth requirements to reach particular levels of vaccine coverage, even for natural sequence-based vaccine products is not necessarily an intractable problem for the immune system; (2) increasing the valency (number of T cell epitope variants present) of vaccine products dramatically decreases the epitope requirements to reach particular coverage levels for any epidemic; (3) considering multiple-hit models (more than one exact epitope match with an incoming HIV strain) places a significantly higher requirement upon epitope breadth in order to reach a given level of coverage, to the point where low valency natural sequence based products would not practically be able to generate sufficient epitopes. Conclusions When HIV vaccine sequences are compared against datasets of potential incoming viruses important metrics such as the minimum epitope count required to reach a desired level of coverage can be easily calculated. We propose that such analyses can be applied early in the planning stages and during the execution phase of a vaccine trial to explore theoretical and empirical suitability of a vaccine product to a particular epidemic setting. PMID:22152192

Linking high parity and maternal and child mortality: what is the impact of lower health services coverage among higher order births?

PubMed

Sonneveldt, Emily; DeCormier Plosky, Willyanne; Stover, John

2013-01-01

A number of data sets show that high parity births are associated with higher child mortality than low parity births. The reasons for this relationship are not clear. In this paper we investigate whether high parity is associated with lower coverage of key health interventions that might lead to increased mortality. We used DHS data from 10 high fertility countries to examine the relationship between parity and coverage for 8 child health intervention and 9 maternal health interventions. We also used the LiST model to estimate the effect on maternal and child mortality of the lower coverage associated with high parity births. Our results show a significant relationship between coverage of maternal and child health services and birth order, even when controlling for poverty. The association between coverage and parity for maternal health interventions was more consistently significant across countries all countries, while for child health interventions there were fewer overall significant relationships and more variation both between and within countries. The differences in coverage between children of parity 3 and those of parity 6 are large enough to account for a 12% difference in the under-five mortality rate and a 22% difference in maternal mortality ratio in the countries studied. This study shows that coverage of key health interventions is lower for high parity children and the pattern is consistent across countries. This could be a partial explanation for the higher mortality rates associated with high parity. Actions to address this gap could help reduce the higher mortality experienced by high parity birth.

A Systematic Evaluation of Different Methods for Calculating Adolescent Vaccination Levels Using Immunization Information System Data

PubMed Central

Gowda, Charitha; Dong, Shiming; Potter, Rachel C.; Dombkowski, Kevin J.; Stokley, Shannon

2013-01-01

Objective Immunization information systems (IISs) are valuable surveillance tools; however, population relocation may introduce bias when determining immunization coverage. We explored alternative methods for estimating the vaccine-eligible population when calculating adolescent immunization levels using a statewide IIS. Methods We performed a retrospective analysis of the Michigan State Care Improvement Registry (MCIR) for all adolescents aged 11–18 years registered in the MCIR as of October 2010. We explored four methods for determining denominators: (1) including all adolescents with MCIR records, (2) excluding adolescents with out-of-state residence, (3) further excluding those without MCIR activity ≥10 years prior to the evaluation date, and (4) using a denominator based on U.S. Census data. We estimated state- and county-specific coverage levels for four adolescent vaccines. Results We found a 20% difference in estimated vaccination coverage between the most inclusive and restrictive denominator populations. Although there was some variability among the four methods in vaccination at the state level (2%–11%), greater variation occurred at the county level (up to 21%). This variation was substantial enough to potentially impact public health assessments of immunization programs. Generally, vaccines with higher coverage levels had greater absolute variation, as did counties with smaller populations. Conclusion At the county level, using the four denominator calculation methods resulted in substantial differences in estimated adolescent immunization rates that were less apparent when aggregated at the state level. Further research is needed to ascertain the most appropriate method for estimating vaccine coverage levels using IIS data. PMID:24179260

5 CFR 319.201 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Coverage. 319.201 Section 319.201 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT IN SENIOR-LEVEL AND SCIENTIFIC AND PROFESSIONAL POSITIONS Position Allocations and Establishment § 319.201 Coverage. This section...

5 CFR 319.201 - Coverage.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Coverage. 319.201 Section 319.201 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT IN SENIOR-LEVEL AND SCIENTIFIC AND PROFESSIONAL POSITIONS Position Allocations and Establishment § 319.201 Coverage. This section...

5 CFR 319.201 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Coverage. 319.201 Section 319.201 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT IN SENIOR-LEVEL AND SCIENTIFIC AND PROFESSIONAL POSITIONS Position Allocations and Establishment § 319.201 Coverage. This section...

5 CFR 319.201 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Coverage. 319.201 Section 319.201 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT IN SENIOR-LEVEL AND SCIENTIFIC AND PROFESSIONAL POSITIONS Position Allocations and Establishment § 319.201 Coverage. This section...

5 CFR 319.201 - Coverage.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Coverage. 319.201 Section 319.201 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT IN SENIOR-LEVEL AND SCIENTIFIC AND PROFESSIONAL POSITIONS Position Allocations and Establishment § 319.201 Coverage. This section...

MISR Level 2 TOA/Cloud Classifier parameters (MIL2TCCL_V3)

NASA Technical Reports Server (NTRS)

Diner, David J. (Principal Investigator)

The TOA/Cloud Classifiers contain the Angular Signature Cloud Mask (ASCM), a scene classifier calculated using support vector machine technology (SVM) both of which are on a 1.1 km grid, and cloud fractions at 17.6 km resolution that are available in different height bins (low, middle, high) and are also calculated on an angle-by-angle basis. [Temporal_Coverage: Start_Date=2000-02-24; Stop_Date=] [Spatial_Coverage: Southernmost_Latitude=-90; Northernmost_Latitude=90; Westernmost_Longitude=-180; Easternmost_Longitude=180] [Data_Resolution: Latitude_Resolution=1.1 km; Longitude_Resolution=1.1 km; Temporal_Resolution=about 15 orbits/day].

Spatial-temporal Evolution of Vegetation Coverage and Analysis of it’s Future Trends in Wujiang River Basin

NASA Astrophysics Data System (ADS)

Xiao, Jianyong; Bai, Xiaoyong; Zhou, Dequan; Qian, Qinghuan; Zeng, Cheng; Chen, Fei

2018-01-01

Vegetation coverage dynamics is affected by climatic, topography and human activities, which is an important indicator reflecting the regional ecological environment. Revealing the spatial-temporal characteristics of vegetation coverage is of great significance to the protection and management of ecological environment. Based on MODIS NDVI data and the Maximum Value Composites (MVC), we excluded soil spectrum interference to calculate Fractional Vegetation Coverage (FVC). Then the long-term FVC was used to calculate the spatial pattern and temporal variation of vegetation in Wujiang River Basin from 2000 to 2016 by using Trend analysis and Hurst index. The relationship between topography and spatial distribution of FVC was analyzed. The main conclusions are as follows: (1) The multi-annual mean vegetation coverage reveals a spatial distribution variation characteristic of low value in midstream and high level in other parts of the basin, owing a mean value of 0.6567. (2) From 2000 to 2016, the FVC of the Wujiang River Basin fluctuated between 0.6110 and 0.7380, and the overall growth rate of FVC was 0.0074/a. (3) The area of vegetation coverage tending to improve is more than that going to degrade in the future. Grass land, Arable land and Others improved significantly; karst rocky desertification comprehensive management project lead to persistent vegetation coverage improvement of Grass land, Arable land and Others. Residential land is covered with obviously degraded vegetation, resulting of urban sprawl; (4) The spatial distribution of FVC is positively correlated with TNI. Researches of spatial-temporal evolution of vegetation coverage have significant meaning for the ecological environment protection and management of the Wujiang River Basin.

Community-Level Sanitation Coverage More Strongly Associated with Child Growth and Household Drinking Water Quality than Access to a Private Toilet in Rural Mali.

PubMed

Harris, Michael; Alzua, Maria Laura; Osbert, Nicolas; Pickering, Amy

2017-06-20

Sanitation access can provide positive externalities; for example, safe disposal of feces by one household prevents disease transmission to households nearby. However, little empirical evidence exists to characterize the potential health benefits from sanitation externalities. This study investigated the effect of community sanitation coverage versus individual household sanitation access on child health and drinking water quality. Using a census of 121 villages in rural Mali, we analyzed the association of community latrine coverage (defined by a 200 m radius surrounding a household) and individual household latrine ownership with child growth and household stored water quality. Child height-for-age had a significant and positive linear relationship with community latrine coverage, while child weight-for-age and household water quality had nonlinear relationships that leveled off above 60% coverage (p < 0.01; generalized additive models). Child growth and water quality were not associated with individual household latrine ownership. The relationship between community latrine coverage and child height was strongest among households without a latrine; for these households, each 10% increase in latrine coverage was associated with a 0.031 (p-value = 0.040) increase in height-for-age z-score. In this study, the level of sanitation access of surrounding households was more important than private latrine access for protecting water quality and child health.

Community-Level Sanitation Coverage More Strongly Associated with Child Growth and Household Drinking Water Quality than Access to a Private Toilet in Rural Mali

PubMed Central

2017-01-01

Sanitation access can provide positive externalities; for example, safe disposal of feces by one household prevents disease transmission to households nearby. However, little empirical evidence exists to characterize the potential health benefits from sanitation externalities. This study investigated the effect of community sanitation coverage versus individual household sanitation access on child health and drinking water quality. Using a census of 121 villages in rural Mali, we analyzed the association of community latrine coverage (defined by a 200 m radius surrounding a household) and individual household latrine ownership with child growth and household stored water quality. Child height-for-age had a significant and positive linear relationship with community latrine coverage, while child weight-for-age and household water quality had nonlinear relationships that leveled off above 60% coverage (p < 0.01; generalized additive models). Child growth and water quality were not associated with individual household latrine ownership. The relationship between community latrine coverage and child height was strongest among households without a latrine; for these households, each 10% increase in latrine coverage was associated with a 0.031 (p-value = 0.040) increase in height-for-age z-score. In this study, the level of sanitation access of surrounding households was more important than private latrine access for protecting water quality and child health. PMID:28514143

[Surveillance Plan on Recent Outbreak of Measles and Rubella in Catalonia, Spain].

PubMed

Jané, Mireia; Torner, Nuria; Vidal, Ma José

2015-01-01

Measles and rubella are two immuno-preventive illnesses. In Catalonia, since 1988 all children are given two doses of measles and rubella vaccine with high levels of vaccination coverage. The measles elimination programme has been carried out since 1990 in Catalonia. This programme includes achieving and keeping high immunization levels among population with high vaccination coverage, intense epidemiological surveillance and an immediate response to the appearance of a case or outbreak. In 2014, the measles incidence rate was 1.9 cases/ 100,000 inhabitants. There were 4 recent outbreaks in 2006, 2011, 2013 and 2014 that affected 381, 289, 31 and 124 people respectively. All outbreaks were triggered by an imported case. In 2011 and 2014 measles outbreaks, 6% and 5.5% of affected people were health care workers. All outbreaks presented a great variety of measles genotypes. Concerning rubella elimination programme, since 2002, 68 cases of postnatal rubella and 5 cases of congenital rubella were confirmed. Regarding measles and rubella surveillance and control, in addition to strengthen vaccination coverage, it is essential immediate notification, within the first 24 hours since suspicion and laboratory confirmation. In addition there is a need to enforce vaccination among health care workers as well as in other susceptible and unvaccinated people. It is recommended to vaccinate all people who were born after 1966 and who have not been vaccinated with two doses of trivalent measles-mumps-rubella vaccine. Furthermore, we have to emphasize that the progress concerning genotypes study allows identifying various imported cases from other European countries with active outbreaks, aspect that makes easier the surveillance of these illnesses.

LEVEL III ECOREGION:ECOREGIONS FOR THE MAIA STUDY REGION

EPA Science Inventory

This data set is a geographic information system (GIS) coverage of aquatic ecoregions for the US Environmental Protection Agency (EPA) Mid-Atlantic Integrated Assessment (MAIA) Project. This coverage was produced from the USEPA Omernik Level III Ecoregions of the Conterminous U...

Epidemiological game-theory dynamics of chickenpox vaccination in the USA and Israel

PubMed Central

Liu, Jingzhou; Kochin, Beth F.; Tekle, Yonas I.; Galvani, Alison P.

2012-01-01

The general consensus from epidemiological game-theory studies is that vaccination coverage driven by self-interest (Nash vaccination) is generally lower than group-optimal coverage (utilitarian vaccination). However, diseases that become more severe with age, such as chickenpox, pose an exception to this general consensus. An individual choice to be vaccinated against chickenpox has the potential to harm those not vaccinated by increasing the average age at infection and thus the severity of infection as well as those already vaccinated by increasing the probability of breakthrough infection. To investigate the effects of these externalities on the relationship between Nash and utilitarian vaccination coverages for chickenpox, we developed a game-theory epidemic model that we apply to the USA and Israel, which has different vaccination programmes, vaccination and treatment costs, as well as vaccination coverage levels. We find that the increase in chickenpox severity with age can reverse the typical relationship between utilitarian and Nash vaccination coverages in both the USA and Israel. Our model suggests that to obtain herd immunity of chickenpox vaccination, subsidies or external regulation should be used if vaccination costs are high. By contrast, for low vaccination costs, improving awareness of the vaccine and the potential cost of chickenpox infection is crucial. PMID:21632611

Epidemiological game-theory dynamics of chickenpox vaccination in the USA and Israel.

PubMed

Liu, Jingzhou; Kochin, Beth F; Tekle, Yonas I; Galvani, Alison P

2012-01-07

The general consensus from epidemiological game-theory studies is that vaccination coverage driven by self-interest (Nash vaccination) is generally lower than group-optimal coverage (utilitarian vaccination). However, diseases that become more severe with age, such as chickenpox, pose an exception to this general consensus. An individual choice to be vaccinated against chickenpox has the potential to harm those not vaccinated by increasing the average age at infection and thus the severity of infection as well as those already vaccinated by increasing the probability of breakthrough infection. To investigate the effects of these externalities on the relationship between Nash and utilitarian vaccination coverages for chickenpox, we developed a game-theory epidemic model that we apply to the USA and Israel, which has different vaccination programmes, vaccination and treatment costs, as well as vaccination coverage levels. We find that the increase in chickenpox severity with age can reverse the typical relationship between utilitarian and Nash vaccination coverages in both the USA and Israel. Our model suggests that to obtain herd immunity of chickenpox vaccination, subsidies or external regulation should be used if vaccination costs are high. By contrast, for low vaccination costs, improving awareness of the vaccine and the potential cost of chickenpox infection is crucial.

Surveillance of mother-to-child HIV transmission: socioeconomic and health care coverage indicators.

PubMed

Barcellos, Christovam; Acosta, Lisiane Morelia Weide; Lisboa, Eugenio; Bastos, Francisco Inácio

2009-12-01

To identify clustering areas of infants exposed to HIV during pregnancy and their association with indicators of primary care coverage and socioeconomic condition. Ecological study where the unit of analysis was primary care coverage areas in the city of Porto Alegre, Southern Brazil, in 2003. Geographical Information System and spatial analysis tools were used to describe indicators of primary care coverage areas and socioeconomic condition, and estimate the prevalence of liveborn infants exposed to HIV during pregnancy and delivery. Data was obtained from Brazilian national databases. The association between different indicators was assessed using Spearman's nonparametric test. There was found an association between HIV infection and high birth rates (r=0.22, p<0.01) and lack of prenatal care (r=0.15, p<0.05). The highest HIV infection rates were seen in areas with poor socioeconomic conditions and difficult access to health services (r=0.28, p<0.01). The association found between higher rate of prenatal care among HIV-infected women and adequate immunization coverage (r=0.35, p<0.01) indicates that early detection of HIV infection is effective in those areas with better primary care services. Urban poverty is a strong determinant of mother-to-child HIV transmission but this trend can be fought with health surveillance at the primary care level.

Effect of hydrogen coverage on hydrogenation of o-cresol on Pt(111)

NASA Astrophysics Data System (ADS)

Li, Yaping; Liu, Zhimin; Crossley, Steven P.; Jentoft, Friederike C.; Wang, Sanwu

2018-06-01

The conversion of phenolics over metal catalysts is an important process for upgrading biofuels. With density functional calculations, hydrogenation of o-cresol on the hydrogen-covered Pt(111) surface was investigated. The results show that the coverage of hydrogen plays a significant role in the reaction rate while it does not affect the reaction selectivity. The reaction barriers of the hydrogenation process leading to the formation of both 2-methyl-cyclohexanone (the intermediate product) and 2-methyl-cyclohexanol (the final product) at high H coverages (∼1 ML) are found to be smaller by 0.14-0.69 eV than those at lower H coverages (∼1/25 ML). After both hydrogen and cresol are adsorbed on Pt(111) from their initial gas phase state, the reaction energy of each hydrogenation step on the surface is also dependent on the hydrogen coverage. On the H-covered Pt(111) surface, most steps of hydrogenation involve exothermic reactions when the hydrogen coverage is high while they are endothermic reactions at low hydrogen coverages. The differences in reaction rate and reaction energy between high and low H coverages can be understood with the coverage-dependent bonding strength and configurations.

Cost of lifetime immunosuppression coverage for kidney transplant recipients.

PubMed

Page, Timothy F; Woodward, Robert S

2008-01-01

On January 1, 2000, Medicare extended the coverage of immunosuppression medications from 3 years to life for elderly and disabled kidney transplant recipients. This research estimates the impact of extending this lifetime coverage to all kidney transplant recipients on Medicare's cash flows. The study finds that extending coverage to all kidney transplant recipients would have increased Medicare's net cash outflows if the coverage were extended for patients of all income levels. There is evidence that extending coverage to only patients in the lowest income quartile could have resulted in a net cost savings to Medicare.

The Effect of Lexical Coverage and Dictionary Use on L2 Reading Comprehension

ERIC Educational Resources Information Center

Prichard, Caleb; Matsumoto, Yuko

2011-01-01

This study aims to further understand the role of lexical coverage on L2 reading comprehension. It examines test scores of learners at or near the 90-95% coverage level to determine if this coverage range allows for comprehension of authentic texts. The findings suggest that 92-93% may be a threshold mark at which understanding of a text…

Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis.

PubMed

Bruni, Laia; Diaz, Mireia; Barrionuevo-Rosas, Leslie; Herrero, Rolando; Bray, Freddie; Bosch, F Xavier; de Sanjosé, Silvia; Castellsagué, Xavier

2016-07-01

Since 2006, many countries have implemented publicly funded human papillomavirus (HPV) immunisation programmes. However, global estimates of the extent and impact of vaccine coverage are still unavailable. We aimed to quantify worldwide cumulative coverage of publicly funded HPV immunisation programmes up to 2014, and the potential impact on future cervical cancer cases and deaths. Between Nov 1 and Dec 22, 2014, we systematically reviewed PubMed, Scopus, and official websites to identify HPV immunisation programmes worldwide, and retrieved age-specific HPV vaccination coverage rates up to October, 2014. To estimate the coverage and number of vaccinated women, retrieved coverage rates were converted into birth-cohort-specific rates, with an imputation algorithm to impute missing data, and applied to global population estimates and cervical cancer projections by country and income level. From June, 2006, to October, 2014, 64 countries nationally, four countries subnationally, and 12 overseas territories had implemented HPV immunisation programmes. An estimated 118 million women had been targeted through these programmes, but only 1% were from low-income or lower-middle-income countries. 47 million women (95% CI 39-55 million) received the full course of vaccine, representing a total population coverage of 1·4% (95% CI 1·1-1·6), and 59 million women (48-71 million) had received at least one dose, representing a total population coverage of 1·7% (1·4-2·1). In more developed regions, 33·6% (95% CI 25·9-41·7) of females aged 10-20 years received the full course of vaccine, compared with only 2·7% (1·8-3·6) of females in less developed regions. The impact of the vaccine will be higher in upper-middle-income countries (178 192 averted cases by age 75 years) than in high-income countries (165 033 averted cases), despite the lower number of vaccinated women (13·3 million vs 32·2 million). Many women from high-income and upper-middle-income countries have been vaccinated against HPV. However, populations with the highest incidence and mortality of disease remain largely unprotected. Rapid roll-out of the vaccine in low-income and middle-income countries might be the only feasible way to narrow present inequalities in cervical cancer burden and prevention. PATH, Instituto de Salud Carlos III, and Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR). Copyright © 2016 Bruni et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

5 CFR 534.501 - Coverage.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Coverage. 534.501 Section 534.501 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.501 Coverage. (a) This subpart implements 5...

5 CFR 534.501 - Coverage.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Coverage. 534.501 Section 534.501 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.501 Coverage. (a) This subpart implements 5...

5 CFR 534.501 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Coverage. 534.501 Section 534.501 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.501 Coverage. (a) This subpart implements 5...

5 CFR 534.501 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Coverage. 534.501 Section 534.501 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.501 Coverage. (a) This subpart implements 5...

5 CFR 534.501 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Coverage. 534.501 Section 534.501 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.501 Coverage. (a) This subpart implements 5...

Vaccination coverage in the US Commonwealth of the Northern Mariana Islands, 2005.

PubMed

Luman, Elizabeth T; Sablan, Mariana; Anaya, Gabriel; Stokley, Shannon; McCauley, Mary Mason; Shaw, Kate M; Salazar, Angela; Balajadia, Ron; Chaine, Jean Paul; Duncan, Richard

2007-01-01

In July 2005, a house-to-house survey was conducted to determine vaccination coverage achieved through routine health services on the three inhabited islands (Saipan, Rota, and Tinian) of the US Commonwealth of the Northern Mariana Islands (CNMI). A population-based cluster survey was conducted on Saipan; clusters and households were selected by systematic random sampling. On the smaller islands of Rota and Tinian, all households were visited. Vaccination histories and demographic information were obtained during household interview for all children aged 19-35 months, children aged 6 years, and adults aged 65 years and older. Vaccination histories for children were supplemented by hospital/clinic records and an electronic vaccination registry. Among 295 children aged 19-35 months, estimated coverage with the primary vaccination series was 80 percent; coverage with individual vaccines was generally higher. Among 193 children aged 6 years, coverage for vaccines required at school-aged was 83 percent. Among 226 adults aged 65 years and older, 52 percent received influenza vaccine during the previous season while 21 percent had ever received pneumococcal vaccine. The CNMI has achieved the US Healthy People 2010 objective of 80 percent coverage for the standard vaccination series among children aged 19-35 months. High coverage levels among 6-year-old children may reflect the benefit of school entry requirements. Influenza and pneumococcal vaccination among older adults remains low. Efforts to ensure that children and older adults throughout the CNMI are equally well-protected should continue. Strategies to address parental awareness of vaccinations that are due should be explored and may be facilitated by upgrading the electronic vaccination registry.

Analysis of aeromedical retrieval coverage using elliptical isochrones: An evaluation of helicopter fleet size configurations in Scotland.

PubMed

Dodds, Naomi; Emerson, Philip; Phillips, Stephanie; Green, David R; Jansen, Jan O

2017-03-01

Trauma systems in remote and rural regions often rely on helicopter emergency medical services to facilitate access to definitive care. The siting of such resources is key, but often relies on simplistic modeling of coverage, using circular isochrones. Scotland is in the process of implementing a national trauma network, and there have been calls for an expansion of aeromedical retrieval capacity. The aim of this study was to analyze population and area coverage of the current retrieval service configuration, with three aircraft, and a configuration with an additional helicopter, in the North East of Scotland, using a novel methodology. Both overall coverage and coverage by physician-staffed aircraft, with enhanced clinical capability, were analyzed. This was a geographical analysis based on calculation of elliptical isochrones, which consider the "open-jaw" configuration of many retrieval flights. Helicopters are not always based at hospitals. We modeled coverage based on different outbound and inbound flights. Areally referenced population data were obtained from the Scottish Government. The current helicopter network configuration provides 94.2% population coverage and 59.0% area coverage. The addition of a fourth helicopter would marginally increase population coverage to 94.4% and area coverage to 59.1%. However, when considering only physician-manned aircraft, the current configuration provides only 71.7% population coverage and 29.4% area coverage, which would be increased to 91.1% and 51.2%, respectively, with a second aircraft. Scotland's current helicopter network configuration provides good population coverage for retrievals to major trauma centers, which would only be increased minimally by the addition of a fourth aircraft in the North East. The coverage provided by the single physician-staffed aircraft is more limited, however, and would be increased considerably by a second physician-staffed aircraft in the North East. Elliptical isochrones provide a useful means of modeling "open-jaw" retrieval missions and provide a more realistic estimate of coverage. Epidemiological study, level IV; therapeutic study, level IV.

Health Care Coverage Decision Making in Low- and Middle-Income Countries: Experiences from 25 Coverage Schemes.

PubMed

Gutierrez, Hialy; Shewade, Ashwini; Dai, Minghan; Mendoza-Arana, Pedro; Gómez-Dantés, Octavio; Jain, Nishant; Khonelidze, Irma; Nabyonga-Orem, Juliet; Saleh, Karima; Teerawattananon, Yot; Nishtar, Sania; Hornberger, John

2015-08-01

Lessons learned by countries that have successfully implemented coverage schemes for health services may be valuable for other countries, especially low- and middle-income countries (LMICs), which likewise are seeking to provide/expand coverage. The research team surveyed experts in population health management from LMICs for information on characteristics of health care coverage schemes and factors that influenced decision-making processes. The level of coverage provided by the different schemes varied. Nearly all the health care coverage schemes involved various representatives and stakeholders in their decision-making processes. Maternal and child health, cardiovascular diseases, cancer, and HIV were among the highest priorities guiding coverage development decisions. Evidence used to inform coverage decisions included medical literature, regional and global epidemiology, and coverage policies of other coverage schemes. Funding was the most commonly reported reason for restricting coverage. This exploratory study provides an overview of health care coverage schemes from participating LMICs and contributes to the scarce evidence base on coverage decision making. Sharing knowledge and experiences among LMICs can support efforts to establish systems for accessible, affordable, and equitable health care.

Safe motherhood voucher programme coverage of health facility deliveries among poor women in South-western Uganda.

PubMed

Kanya, Lucy; Obare, Francis; Warren, Charlotte; Abuya, Timothy; Askew, Ian; Bellows, Ben

2014-07-01

There has been increased interest in and experimentation with demand-side mechanisms such as the use of vouchers that place purchasing power in the hands of targeted consumers to improve the uptake of healthcare services in low-income settings. A key measure of the success of such interventions is the extent to which the programmes have succeeded in reaching the target populations. This article estimates the coverage of facility deliveries by a maternal health voucher programme in South-western Uganda and examines whether such coverage is correlated with district-level characteristics such as poverty density and the number of contracted facilities. Analysis entails estimating the voucher coverage of health facility deliveries among the general population and poor population (PP) using programme data for 2010, which was the most complete calendar year of implementation of the Uganda safe motherhood (SM) voucher programme. The results show that: (1) the programme paid for 38% of estimated deliveries among the PP in the targeted districts, (2) there was a significant negative correlation between the poverty density in a district and proportions of births to poor women that were covered by the programme and (3) improving coverage of health facility deliveries for poor women is dependent upon increasing the sales and redemption rates. The findings suggest that to the extent that the programme stimulated demand for SM services by new users, it has the potential of increasing facility-based births among poor women in the region. In addition, the significant negative correlation between the poverty density and the proportions of facility-based births to poor women that are covered by the voucher programme suggests that there is need to increase both voucher sales and the rate of redemption to improve coverage in districts with high levels of poverty. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Geo-spatial reporting for monitoring of household immunization coverage through mobile phones: Findings from a feasibility study.

PubMed

Kazi, A M; Ali, M; K, Ayub; Kalimuddin, H; Zubair, K; Kazi, A N; A, Artani; Ali, S A

2017-11-01

The addition of Global Positioning System (GPS) to a mobile phone makes it a very powerful tool for surveillance and monitoring coverage of health programs. This technology enables transfer of data directly into computer applications and cross-references to Geographic Information Systems (GIS) maps, which enhances assessment of coverage and trends. Utilization of these systems in low and middle income countries is currently limited, particularly for immunization coverage assessments and polio vaccination campaigns. We piloted the use of this system and discussed its potential to improve the efficiency of field-based health providers and health managers for monitoring of the immunization program. Using "30×7" WHO sampling technique, a survey of children less than five years of age was conducted in random clusters of Karachi, Pakistan in three high risk towns where a polio case was detected in 2011. Center point of the cluster was calculated by the application on the mobile. Data and location coordinates were collected through a mobile phone. This data was linked with an automated mHealth based monitoring system for monitoring of Supplementary Immunization Activities (SIAs) in Karachi. After each SIA, a visual report was generated according to the coordinates collected from the survey. A total of 3535 participants consented to answer to a baseline survey. We found that the mobile phones incorporated with GIS maps can improve efficiency of health providers through real-time reporting and replacing paper based questionnaire for collection of data at household level. Visual maps generated from the data and geospatial analysis can also give a better assessment of the immunization coverage and polio vaccination campaigns. The study supports a model system in resource constrained settings that allows routine capture of individual level data through GPS enabled mobile phone providing actionable information and geospatial maps to local public health managers, policy makers and study staff monitoring immunization coverage. Copyright © 2017 Elsevier B.V. All rights reserved.

How universal is coverage and access to diagnosis and treatment for Chagas disease in Colombia? A health systems analysis.

PubMed

Cucunubá, Zulma M; Manne-Goehler, Jennifer M; Díaz, Diana; Nouvellet, Pierre; Bernal, Oscar; Marchiol, Andrea; Basáñez, María-Gloria; Conteh, Lesong

2017-02-01

Limited access to Chagas disease diagnosis and treatment is a major obstacle to reaching the 2020 World Health Organization milestones of delivering care to all infected and ill patients. Colombia has been identified as a health system in transition, reporting one of the highest levels of health insurance coverage in Latin America. We explore if and how this high level of coverage extends to those with Chagas disease, a traditionally marginalised population. Using a mixed methods approach, we calculate coverage for screening, diagnosis and treatment of Chagas. We then identify supply-side constraints both quantitatively and qualitatively. A review of official registries of tests and treatments for Chagas disease delivered between 2008 and 2014 is compared to estimates of infected people. Using the Flagship Framework, we explore barriers limiting access to care. Screening coverage is estimated at 1.2% of the population at risk. Aetiological treatment with either benznidazol or nifurtimox covered 0.3-0.4% of the infected population. Barriers to accessing screening, diagnosis and treatment are identified for each of the Flagship Framework's five dimensions of interest: financing, payment, regulation, organization and persuasion. The main challenges identified were: a lack of clarity in terms of financial responsibilities in a segmented health system, claims of limited resources for undertaking activities particularly in primary care, non-inclusion of confirmatory test(s) in the basic package of diagnosis and care, poor logistics in the distribution and supply chain of medicines, and lack of awareness of medical personnel. Very low screening coverage emerges as a key obstacle hindering access to care for Chagas disease. Findings suggest serious shortcomings in this health system for Chagas disease, despite the success of universal health insurance scale-up in Colombia. Whether these shortcomings exist in relation to other neglected tropical diseases needs investigating. We identify opportunities for improvement that can inform additional planned health reforms. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Attendance at cervical cancer screening and use of diagnostic and therapeutic procedures on the uterine cervix assessed from individual health insurance data (Belgium, 2002-2006).

PubMed

Arbyn, Marc; Fabri, Valérie; Temmerman, Marleen; Simoens, Cindy

2014-01-01

To assess the coverage for cervical cancer screening as well as the use of cervical cytology, colposcopy and other diagnostic and therapeutic interventions on the uterine cervix in Belgium, using individual health insurance data. The Intermutualistic Agency compiled a database containing 14 million records from reimbursement claims for Pap smears, colposcopies, cervical biopsies and surgery, performed between 2002 and 2006. Cervical cancer screening coverage was defined as the proportion of women aged 25-64 that had a Pap smear within the last 3 years. Cervical cancer screening coverage was 61% at national level, for the target population of women between 25 and 64 years old, in the period 2004-2006. Differences between the 3 regions were small, but varied more substantially between provinces. Coverage was 70% for 25-34 year old women, 67% for those aged 35-39 years, and decreased to 44% in the age group of 60-64 years. The median screening interval was 13 months. The screening coverage varied substantially by social category: 40% and 64%, in women categorised as beneficiary or not-beneficiary of increased reimbursement from social insurance, respectively. In the 3-year period 2004-2006, 3.2 million screen tests were done in the target group consisting of 2.8 million women. However, only 1.7 million women got one or more smears and 1.1 million women had no smears, corresponding to an average of 1.88 smears per woman in three years of time. Colposcopy was excessively used (number of Pap smears over colposcopies = 3.2). The proportion of women with a history of conisation or hysterectomy, before the age of 65, was 7% and 19%, respectively. The screening coverage increased slightly from 59% in 2000 to 61% in 2006. The screening intensity remained at a high level, and the number of cytological examinations was theoretically sufficient to cover more than the whole target population.

Estimates of the timing of reductions in genital warts and high grade cervical intraepithelial neoplasia after onset of human papillomavirus (HPV) vaccination in the United States.

PubMed

Chesson, Harrell W; Ekwueme, Donatus U; Saraiya, Mona; Dunne, Eileen F; Markowitz, Lauri E

2013-08-20

The objective of this study was to estimate the number of years after onset of a quadrivalent HPV vaccination program before notable reductions in genital warts and cervical intraepithelial neoplasia (CIN) will occur in teenagers and young adults in the United States. We applied a previously published model of HPV vaccination in the United States and focused on the timing of reductions in genital warts among both sexes and reductions in CIN 2/3 among females. Using different coverage scenarios, the lowest being consistent with current 3-dose coverage in the United States, we estimated the number of years before reductions of 10%, 25%, and 50% would be observed after onset of an HPV vaccination program for ages 12-26 years. The model suggested female-only HPV vaccination in the intermediate coverage scenario will result in a 10% reduction in genital warts within 2-4 years for females aged 15-19 years and a 10% reduction in CIN 2/3 among females aged 20-29 years within 7-11 years. Coverage had a major impact on when reductions would be observed. For example, in the higher coverage scenario a 25% reduction in CIN2/3 would be observed with 8 years compared with 15 years in the lower coverage scenario. Our model provides estimates of the potential timing and magnitude of the impact of HPV vaccination on genital warts and CIN 2/3 at the population level in the United States. Notable, population-level impacts of HPV vaccination on genital warts and CIN 2/3 can occur within a few years after onset of vaccination, particularly among younger age groups. Our results are generally consistent with early reports of declines in genital warts among youth. Published by Elsevier Ltd.

Ecological restoration and its effects on a regional climate: the source region of the Yellow River, China.

PubMed

Li, Zhouyuan; Liu, Xuehua; Niu, Tianlin; Kejia, De; Zhou, Qingping; Ma, Tianxiao; Gao, Yunyang

2015-05-19

The source region of the Yellow River, China, experienced degradation during the 1980s and 1990s, but effective ecological restoration projects have restored the alpine grassland ecosystem. The local government has taken action to restore the grassland area since 1996. Remote sensing monitoring results show an initial restoration of this alpine grassland ecosystem with the structural transformation of land cover from 2000 to 2009 as low- and high-coverage grassland recovered. From 2000 to 2009, the low-coverage grassland area expanded by over 25% and the bare soil area decreased by approximately 15%. To examine the relationship between ecological structure and function, surface temperature (Ts) and evapotranspiration (ET) levels were estimated to study the dynamics of the hydro-heat pattern. The results show a turning point in approximately the year 2000 from a declining ET to a rising ET, eventually reaching the 1990 level of approximately 1.5 cm/day. We conclude that grassland coverage expansion has improved the regional hydrologic cycle as a consequence of ecological restoration. Thus, we suggest that long-term restoration and monitoring efforts would help maintain the climatic adjustment functions of this alpine grassland ecosystem.

Improving Health Care Coverage, Equity, And Financial Protection Through A Hybrid System: Malaysia's Experience.

PubMed

Rannan-Eliya, Ravindra P; Anuranga, Chamara; Manual, Adilius; Sararaks, Sondi; Jailani, Anis S; Hamid, Abdul J; Razif, Izzanie M; Tan, Ee H; Darzi, Ara

2016-05-01

Malaysia has made substantial progress in providing access to health care for its citizens and has been more successful than many other countries that are better known as models of universal health coverage. Malaysia's health care coverage and outcomes are now approaching levels achieved by member nations of the Organization for Economic Cooperation and Development. Malaysia's results are achieved through a mix of public services (funded by general revenues) and parallel private services (predominantly financed by out-of-pocket spending). We examined the distributional aspects of health financing and delivery and assessed financial protection in Malaysia's hybrid system. We found that this system has been effective for many decades in equalizing health care use and providing protection from financial risk, despite modest government spending. Our results also indicate that a high out-of-pocket share of total financing is not a consistent proxy for financial protection; greater attention is needed to the absolute level of out-of-pocket spending. Malaysia's hybrid health system presents continuing unresolved policy challenges, but the country's experience nonetheless provides lessons for other emerging economies that want to expand access to health care despite limited fiscal resources. Project HOPE—The People-to-People Health Foundation, Inc.

Timing and delay in children vaccination; evaluation of expanded program of immunization in outskirt of Iranian cities.

PubMed

Rejali, Mehri; Mohammadbeigi, Abolfazl; Mokhtari, Mohsen; Zahraei, Seyed Mohsen; Eshrati, Babak

2015-01-01

Most studies evaluated the vaccine coverage, but the time of vaccination is important as coverage. This study was conducted to evaluate the Expanded Program of Immunization (EPI) in outskirt of Iranian cities regarding to incidence of delay vaccination among children less than 4 years. This cross sectional descriptive study was conducted among children 24-47 months old, living in the suburbs of five metropolises of Iran. Totally, 3610 eligible children selected with proportioned cluster sampling method and data of vaccination card extracted after interview with child parents. Delayed incidence rate reported and predictive factors assessed by Chi square test and Multivariate logistic regression. Overall, 56.6% to 93.2% vaccines were administered out of time. Delayed vaccination incidence with more than one-week delay varies from 5.5% to 74.9% for polio at birth and MMR2 at 18 month, respectively. Mother's educational level and birth order were the most important predictors of delayed vaccination. Incidence of delayed vaccination was enlarged by increasing birth order and decreased in lower educated mothers. Incidence rate of delayed vaccination is more than expectation. Regarding to high coverage vaccines in Iran, heath officers and health policy makers should attempt for on-time vaccination beside of high immunization coverage especially in slum areas with more concentrated immigrants due to low literature and crowded families.

EVATS: a proactive solution to improve surgical education and maintain flexibility in the new training era.

PubMed

Horvath, Karen D; Mann, Gary N; Pellegrini, Carlos

2006-01-01

To describe the development of the EVATS rotation. Descriptive document. University teaching hospital. Faculty and residents of the University of Washington. In July 2003 we identified the need for a new, independent, educational module within our residency training. Requirements for this rotation included dedicated time for technical skills training on simulators, independent competency learning modules, academic research project time, vacation time and coverage, and flexibility for unplanned leave (eg, interview travel, m/paternity leave). An EVATS rotation was created in July 2003 that is provided at each training level and lasts from 4 to 8 weeks depending on R-level. EVATS meets the following challenges: Emergency coverage (EVATS residents available for last-minute service coverage), vacation time/vacation coverage (2 weeks vacation + 1 week vacation coverage; this maintains vacations for all residents every 6 months), academic time (residents now must complete 1 academic project for graduation) and ACGME competency learning and assessment, and technical skills training (includes simulator work for open/lap skills). Initial implementation indices are high and include resident satisfaction, 80-hour work week compliance, academic productivity, and patient continuity of care. The 21st century brought new challenges for surgical training. Increased societal demands for skills training in a laboratory setting using simulators and the 6 ACGME competencies all require classroom-type training periods. Paradoxically, the 80-hour work week restricted the time available for these educational activities and made it more difficult for programs to accommodate resident vacations and emergencies. These challenges provided an opportunity to enhance the educational experience for our residency program. The product was the EVATS rotation. Early data after implementation are favorable.

Assessing alternative industrial fortification portfolios: a Bangladesh case study.

PubMed

Fiedler, John L; Lividini, Keith; Guyondet, Christophe; Bermudez, Odilia I

2015-03-01

Approximately 1.2 million disability-adjusted life years (DALYs) are lost annually in Bangladesh due to deficiencies of vitamin A, iron, and zinc. To provide evidence on the coverage, costs, and cost-effectiveness of alternative fortification interventions to inform nutrition policy-making in Bangladesh. Combining the 2005 Bangladesh Household Income and Expenditure Survey with a Bangladesh food composition table, apparent intakes of energy, vitamin A, iron, and zinc, and the coverage and apparent consumption levels of fortifiable vegetable oil and wheat flour are estimated. Assuming that fortification levels are those established in official regulations, the costs and cost-effectiveness of the two vehicles are assessed independently and as a two-vehicle portfolio. Vegetable oil has a coverage rate of 76% and is estimated to reduce the prevalence of inadequate vitamin A intake from 83% to 64%. The coverage of wheat flour is high (65%), but the small quantities consumed result in small reductions in the prevalence of inadequate intakes: 1.5 percentage points for iron, less than 1 for zinc, and 2 for vitamin A, while reducing average Estimated Average Requirement (EAR) gaps by 8%, 9%, and 15%, respectively. The most cost-effective 10-micronutrient wheat flour formulation costs US $1.91 million annually, saving 129,212 DALYs at a unit cost of US $14.75. Fortifying vegetable oil would cost US $1.27 million annually, saving 406,877 DALYs at an average cost of US $3.25. Sensitivity analyses explore various permutations of the wheat flour formulation. Divisional variations in coverage, cost, and impact are examined. Vegetable oil fortification is the most cost-effective of the three portfolios analyzed, but all three are very cost-effective options for Bangladesh.

Seroprevalence of Mumps in The Netherlands: Dynamics over a Decade with High Vaccination Coverage and Recent Outbreaks

PubMed Central

Smits, Gaby; Mollema, Liesbeth; Hahné, Susan; de Melker, Hester; Tcherniaeva, Irina; Waaijenborg, Sandra; van Binnendijk, Rob; van der Klis, Fiona; Berbers, Guy

2013-01-01

Here we present mumps virus specific antibody levels in a large cross-sectional population-based serosurveillance study performed in the Netherlands in 2006/2007 (n = 7900). Results were compared with a similar study (1995/1996) and discussed in the light of recent outbreaks. Mumps antibodies were tested using a fluorescent bead-based multiplex immunoassay. Overall seroprevalence was 90.9% with higher levels in the naturally infected cohorts compared with vaccinated cohorts. Mumps virus vaccinations at 14 months and 9 years resulted in an increased seroprevalence and antibody concentration. The second vaccination seemed to be important in acquiring stable mumps antibody levels in the long term. In conclusion, the Dutch population is well protected against mumps virus infection. However, we identified specific age- and population groups at increased risk of mumps infection. Indeed, in 2007/2008 an outbreak has occurred in the low vaccination coverage groups emphasizing the predictive value of serosurveillance studies. PMID:23520497

7 CFR 760.633 - 2008 SURE guarantee calculation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... percent of the NAP established price for the crop; (2) Coverage level in § 760.631(a)(1)(iv) is 70 percent... the NAP established price for the crop; and (ii) Coverage level in §§ 760.631(a)(1)(iv) and 760.634(a...

Endorsement of universal health coverage financial principles in Burkina Faso.

PubMed

Agier, Isabelle; Ly, Antarou; Kadio, Kadidiatou; Kouanda, Seni; Ridde, Valéry

2016-02-01

In West Africa, health system funding rarely involves cross-subsidization among population segments. In some countries, a few community-based or professional health insurance programs are present, but coverage is very low. The financial principles underlying universal health coverage (UHC) sustainability and solidarity are threefold: 1) anticipation of potential health risks; 2) risk sharing and; 3) socio-economic status solidarity. In Burkina Faso, where decision-makers are favorable to national health insurance, we measured endorsement of these principles and discerned which management configurations would achieve the greatest adherence. We used a sequential exploratory design. In a qualitative step (9 interviews, 12 focus groups), we adapted an instrument proposed by Goudge et al. (2012) to the local context and addressed desirability bias. Then, in a quantitative step (1255 respondents from the general population), we measured endorsement. Thematic analysis (qualitative) and logistic regressions (quantitative) were used. High levels of endorsement were found for each principle. Actual practices showed that anticipation and risk sharing were not only intentions. Preferences were given to solidarity between socio-economic status (SES) levels and progressivity. Although respondents seemed to prefer the national level for implementation, their current solidarity practices were mainly focused on close family. Thus, contribution levels should be set so that the entire family benefits from healthcare. Some critical conditions must be met to make UHC financial principles a reality through health insurance in Burkina Faso: trust, fair and mandatory contributions, and education. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Structural Effects of Network Sampling Coverage I: Nodes Missing at Random1.

PubMed

Smith, Jeffrey A; Moody, James

2013-10-01

Network measures assume a census of a well-bounded population. This level of coverage is rarely achieved in practice, however, and we have only limited information on the robustness of network measures to incomplete coverage. This paper examines the effect of node-level missingness on 4 classes of network measures: centrality, centralization, topology and homophily across a diverse sample of 12 empirical networks. We use a Monte Carlo simulation process to generate data with known levels of missingness and compare the resulting network scores to their known starting values. As with past studies (Borgatti et al 2006; Kossinets 2006), we find that measurement bias generally increases with more missing data. The exact rate and nature of this increase, however, varies systematically across network measures. For example, betweenness and Bonacich centralization are quite sensitive to missing data while closeness and in-degree are robust. Similarly, while the tau statistic and distance are difficult to capture with missing data, transitivity shows little bias even with very high levels of missingness. The results are also clearly dependent on the features of the network. Larger, more centralized networks are generally more robust to missing data, but this is especially true for centrality and centralization measures. More cohesive networks are robust to missing data when measuring topological features but not when measuring centralization. Overall, the results suggest that missing data may have quite large or quite small effects on network measurement, depending on the type of network and the question being posed.

Comparative assessment of immunization coverage of migrant children between national immunization program vaccines and non-national immunization program vaccines in East China

PubMed Central

Hu, Yu; Luo, Shuying; Tang, Xuewen; Lou, Linqiao; Chen, Yaping; Guo, Jing

2015-01-01

This study aimed to describe the disparities in immunization coverage between National Immunization Program (NIP) vaccines and non-NIP vaccines in Yiwu and to identify potential determinants. A face-to-face interview-based questionnaire survey among 423 migrant children born from 1 June 2010 to 31 May 2013 was conducted. Immunization coverage was estimated according to the vaccines scheduled at different age, the birth cohorts, and socio- demographic characteristics. Single-level logistic regression analysis was applied to identify the determinants of coverage of non-NIP vaccines. We found that NIP vaccines recorded higher immunization coverage compared with non-NIP vaccines (87.9100%– vs 0%-74.8%). Among the non-NIP vaccines, varicella vaccine (VarV) recorded the highest coverage of 85.4%, which was introduced in 1998; while 7-valent pneumococcal conjugate vaccine(PCV7) recorded the lowest coverage of 0% for primary series, which was introduced recently. Lower coverage rate of non-NIP vaccines was significantly associated with more siblings in household, shorter duration of living in the surveyed areas, lower family income, mother with a job, mother with poor awareness of vaccination, and mother with lower education level. We found the immunization coverage rate of non-NIP vaccines was significant lower than that of NIP vaccines. Expansion of NIP to include non-NIP vaccines can provide better protection against the vaccine preventable diseases through increased immunization coverage. PMID:25760670

Comparative assessment of immunization coverage of migrant children between national immunization program vaccines and non-national immunization program vaccines in East China.

PubMed

Hu, Yu; Luo, Shuying; Tang, Xuewen; Lou, Linqiao; Chen, Yaping; Guo, Jing

2015-01-01

This study aimed to describe the disparities in immunization coverage between National Immunization Program (NIP) vaccines and non-NIP vaccines in Yiwu and to identify potential determinants. A face-to-face interview-based questionnaire survey among 423 migrant children born from 1 June 2010 to 31 May 2013 was conducted. Immunization coverage was estimated according to the vaccines scheduled at different age, the birth cohorts, and socio- demographic characteristics. Single-level logistic regression analysis was applied to identify the determinants of coverage of non-NIP vaccines. We found that NIP vaccines recorded higher immunization coverage compared with non-NIP vaccines (87.9100%- vs 0%-74.8%). Among the non-NIP vaccines, varicella vaccine (VarV) recorded the highest coverage of 85.4%, which was introduced in 1998; while 7-valent pneumococcal conjugate vaccine(PCV7) recorded the lowest coverage of 0% for primary series, which was introduced recently. Lower coverage rate of non-NIP vaccines was significantly associated with more siblings in household, shorter duration of living in the surveyed areas, lower family income, mother with a job, mother with poor awareness of vaccination, and mother with lower education level. We found the immunization coverage rate of non-NIP vaccines was significant lower than that of NIP vaccines. Expansion of NIP to include non-NIP vaccines can provide better protection against the vaccine preventable diseases through increased immunization coverage.

Can coverage of schistosomiasis and soil transmitted helminthiasis control programmes targeting school-aged children be improved? New approaches.

PubMed

Massa, K; Olsen, A; Sheshe, A; Ntakamulenga, R; Ndawi, B; Magnussen, P

2009-11-01

Control programmes generally use a school-based strategy of mass drug administration to reduce morbidity of schistosomiasis and soil-transmitted helminthiasis (STH) in school-aged populations. The success of school-based programmes depends on treatment coverage. The community-directed treatment (ComDT) approach has been implemented in the control of onchocerciasis and lymphatic filariasis in Africa and improves treatment coverage. This study compared the treatment coverage between the ComDT approach and the school-based treatment approach, where non-enrolled school-aged children were invited for treatment, in the control of schistosomiasis and STH among enrolled and non-enrolled school-aged children. Coverage during the first treatment round among enrolled children was similar for the two approaches (ComDT: 80.3% versus school: 82.1%, P=0.072). However, for the non-enrolled children the ComDT approach achieved a significantly higher coverage than the school-based approach (80.0 versus 59.2%, P<0.001). Similar treatment coverage levels were attained at the second treatment round. Again, equal levels of treatment coverage were found between the two approaches for the enrolled school-aged children, while the ComDT approach achieved a significantly higher coverage in the non-enrolled children. The results of this study showed that the ComDT approach can obtain significantly higher treatment coverage among the non-enrolled school-aged children compared to the school-based treatment approach for the control of schistosomiasis and STH.

Invasive bacterial diseases: national surveillance in Italy and vaccination coverage in the Local Health Agency 4 "Chiavarese", Liguria region (Italy).

PubMed

Trucchi, C; Zoppi, G

2012-06-01

In 2007 in Italy, the National Institute of Health published a new protocol for the National Surveillance of Invasive Bacterial Diseases, in order to enhance the notification system of these diseases and to improve immunization strategies. Available vaccines to prevent these diseases were introduced for the first time into the 1999-2000 National Immunization Plan (NIP) (vaccination against Haemophilus influenzae type b) and the 2005-2007 NIP (vaccination against Streptococcus pneumoniae and Neisseria meningitidis serogroup C). We evaluated the frequency of invasive diseases, on the basis of the number of notifications, the different immunization strategies in the Italian Regions and the vaccination coverage in Local Health Agency 4 "Chiavarese" (LHA) in the Liguria Region (Italy). We evaluated the number of notifications of invasive diseases collected by the national databank coordinated by the ISS (Informative System of Infectious Diseases, SIMI) from 1994 to 2011. We also examined regional regulations concerning immunization policies. Immunization coverage was calculated by means of the "OASIS" software (version 9.0.0) used in our LHA. Available data indicate that the large-scale vaccination policy begun in 1999 in Italy has led to a great reduction in Haemophilus influenzae-related diseases in the pediatric age. Meningococcal diseases have declined to a lesser degree; this is due to the more recent introduction of vaccination against serogroup C (in 2005), the variability of the immunization strategies adopted in the different Italian Regions and the availability of the vaccination against serogroup C only in the pediatric age. The diseases caused by Streptococcus pneumoniae seem to have increased since 2007 because of the implementation of the Surveillance of Invasive Diseases Program and the subsequent notification of all invasive diseases (not only meningitis). Furthermore, the various Italian Regions have adopted different immunization strategies against this disease, too. We evaluated vaccination coverage in LHA 4 from 2003 to 2008. VC levels against Haemophilus influenzae are excellent; the objective indicated in the 2005-2007 NIP (> or = 95%) has therefore been reached. Vaccination coverage levels against Streptococcus pneumoniae and Neisseria meningitidis serogroup C at the 24th month of age are also good. However, we need to implement specific immunization strategies for adolescents, since the vaccination coverage levels are not completely satisfactory. The improvement of the national invasive disease surveillance system has provided better knowledge of the size of the problem and the impact of immunization strategies on the incidence of invasive bacterial diseases. Furthermore, immunization policies in Italy display territorial heterogeneity. Vaccination coverage levels against Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis at the 24th month in LHA 4 are very high. In adolescents (15 year-olds) the immunization coverage are good but needs to be improved through specific strategies, such as raising the awareness of healthcare workers, involving general practitioners and educating the target population.

Women's health insurance coverage 1980-2005.

PubMed

Glied, Sherry; Jack, Kathrine; Rachlin, Jason

2008-01-01

In the fragmented US health insurance system, women's health insurance coverage is an outcome both of changes in the availability of private and public health insurance and of changing patterns of labor force participation and household formation. Over the past 2 decades, women's socioeconomic circumstances have changed and public policy around health insurance coverage for low-income women has also undergone substantial modification. This study examines the roles of these changes in circumstances and policy on the level and composition of women's health insurance. Using the Census Bureau's March Current Population Survey 1980-2005, the government's principal source of nationally representative labor market and health insurance data, we examine how changes in marriage, full-time and part-time labor force participation, and public policy around coverage affected the level and source of women's health insurance coverage over 3 periods: 1980-1987, 1988-1994, and 1995-2005. Health insurance coverage rates have fallen for both women and men since 1980. What makes women different is that, in addition to the decline in coverage, the composition of health insurance coverage for women has also changed markedly. More women now obtain health insurance on their own, rather than as dependents, than did in 1980. A larger fraction of insured women are now enrolled in Medicaid than were in 1980. Women's routes to coverage have changed as their social and economic circumstances have changed and as policy, especially Medicaid policy, has evolved. Women's channels for obtaining health insurance coverage are more fragmented than those of men. The availability of multiple sources of coverage, and the possibility of moving amongst them, have not, however, insulated women from the overall declines in health insurance coverage caused by the rising cost of private health insurance.

Social costs of illicit financial flows in low- and middle-income countries: the case of infant vaccination coverage.

PubMed

Ortega, Bienvenido; Sanjuán, Jesús; Casquero, Antonio

2018-03-01

The liberalization of capital flows is generally associated with prospects of higher growth. However, in developing countries, opening the capital account may also facilitate the flow of capital out of the country through illicit financial flows (IFFs). Given that IFFs drain the scarce public resources available to finance the provision of public goods and services, the extent of illicit capital flows from developing countries is serious cause for concern. In this context, as a first step in analysing the social costs of IFFs in developing countries, this article studied the relationship between IFFs and infant immunization coverage rates. Data for 56 low- and middle-income countries for the period 2002-13 were used in the empirical analysis. The main result was that the relative level of IFFs to total trade negatively impacted vaccination coverage but only in the case of countries with very high levels of perceived corruption. In this case, the total effect of an annual 1 p.p. increase in the ratio of IFFs to total trade was to reduce the level of vaccination coverage rates over the coming years by 0.19 p.p. Given that there was an annual average of 18 million infants in this cluster of 25 countries, this result suggests that at least 34 000 children may not receive this basic health care intervention in the future as a consequence of this increase in IFFs in any particular year. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Community health worker interventions are key to optimal infant immunization coverage, evidence from a pretest-posttest experiment in Mwingi, Kenya.

PubMed

Nzioki, Japheth Mativo; Ouma, James; Ombaka, James Hebert; Onyango, Rosebella Ongutu

2017-01-01

Immunization is a powerful and cost-effective health intervention which averts an estimated 2 to 3 million deaths every year. Kenya has a high infant and under five mortality and morbidity rates. Increasing routine child immunization coverage is one way of reducing child morbidity and mortality rates in Kenya. Community Health Workers (CHWs) have emerged as critical human resources for health in developing countries. The Community Strategy (CS) is one of the CHW led interventions promoting Maternal and Child Health (MCH) in Kenya. This study sought to establish the effect of CS on infant vaccination Coverage (IVC) in Mwingi west sub-county; Kenya. This was a pretest - posttest experimental study design with 1 pretest and 2 post-test surveys conducted in intervention and control sites. Mwingi west and Mwingi north sub-counties where intervention and control sites respectively. Sample size in each survey was 422 households. Women with a child aged 9-12 months were main respondents. Intervention site end-term evaluation indicated that; the CS increased IVC by 10.1% (Z =6.0241, P <0.0001), from a suboptimal level of 88.7% at baseline survey to optimal level of 98.8% at end term survey. Infants in intervention site were 2.5 times more likely to receive all recommended immunizations within their first year of life [(crude OR= 2.475, P<0.0001; 95%CI: 1.794-3.414) (adj. OR=2.516, P<0.0001; 95%CI: 1.796-3.5240)]. CS increased IVC in intervention site to optimal level (98.8%). To improve child health outcomes through immunization coverage, Kenya needs to fast-track nationwide implementation of the CS intervention.

Community health worker interventions are key to optimal infant immunization coverage, evidence from a pretest-posttest experiment in Mwingi, Kenya

PubMed Central

Nzioki, Japheth Mativo; Ouma, James; Ombaka, James Hebert; Onyango, Rosebella Ongutu

2017-01-01

Introduction Immunization is a powerful and cost-effective health intervention which averts an estimated 2 to 3 million deaths every year. Kenya has a high infant and under five mortality and morbidity rates. Increasing routine child immunization coverage is one way of reducing child morbidity and mortality rates in Kenya. Community Health Workers (CHWs) have emerged as critical human resources for health in developing countries. The Community Strategy (CS) is one of the CHW led interventions promoting Maternal and Child Health (MCH) in Kenya. This study sought to establish the effect of CS on infant vaccination Coverage (IVC) in Mwingi west sub-county; Kenya. Methods This was a pretest - posttest experimental study design with 1 pretest and 2 post-test surveys conducted in intervention and control sites. Mwingi west and Mwingi north sub-counties where intervention and control sites respectively. Sample size in each survey was 422 households. Women with a child aged 9-12 months were main respondents. Results Intervention site end-term evaluation indicated that; the CS increased IVC by 10.1% (Z =6.0241, P <0.0001), from a suboptimal level of 88.7% at baseline survey to optimal level of 98.8% at end term survey. Infants in intervention site were 2.5 times more likely to receive all recommended immunizations within their first year of life [(crude OR= 2.475, P<0.0001; 95%CI: 1.794-3.414) (adj. OR=2.516, P<0.0001; 95%CI: 1.796-3.5240)]. Conclusion CS increased IVC in intervention site to optimal level (98.8%). To improve child health outcomes through immunization coverage, Kenya needs to fast-track nationwide implementation of the CS intervention. PMID:29138657

Phase Variation of NadA in Invasive Neisseria meningitidis Isolates Impacts on Coverage Estimates for 4C-MenB, a MenB vaccine.

PubMed

Green, Luke R; Lucidarme, Jay; Dave, Neelam; Chan, Hannah; Clark, Stephen; Borrow, Ray; Bayliss, Christopher D

2018-06-27

A recombinant NadA protein is one of the four major protective antigens of 4C-MenB (Bexsero®), a vaccine developed for serogroup B Neisseria meningitidis (MenB). The Meningococcal Antigen Typing System (MATS) is utilised as a high throughput assay for assessing the invasive MenB strain coverage of 4C-MenB. Where present, the nadA gene is subject to phase variable changes in transcription due to a 5'TAAA repeat tract located in a regulatory region. The promoter-containing intergenic region sequences (IGR) and 5'TAAA repeat numbers were determined for 906 invasive meningococcal disease isolates possessing the nadA gene. Exclusion of the 5'TAAA repeats reduced the number of IGR alleles from 82 to 23. Repeat numbers were associated with low and high levels of NadA expression by Western blotting and ELISA. Low expression repeat numbers were present in 83% of 179 MenB isolates with NadA-2/3 or Nad-1 peptide variants and 68% of 480 MenW ST-11 complex isolates with Nad-2/3 peptide variants. For isolates with vaccine-compatible NadA variants, 93% of MATS negative isolates were associated with low expression repeat numbers whereas 63% of isolates with MATS RP scores above the 95% confidence interval for the positive bactericidal threshold had high expression repeat numbers. Analysis of the 5'TAAA repeat number has potential as a rapid, high throughput method for assessing strain coverage for the NadA-component of 4C-MenB. A key application will be assessing coverage in meningococcal disease cases where confirmation is by PCR only and MATS cannot be applied. Copyright © 2018 Green et al.

Variation in Empiric Coverage Versus Detection of Methicillin-Resistant Staphylococcus aureus and Pseudomonas aeruginosa in Hospitalizations for Community-Onset Pneumonia Across 128 US Veterans Affairs Medical Centers.

PubMed

Jones, Barbara E; Brown, Kevin Antoine; Jones, Makoto M; Huttner, Benedikt D; Greene, Tom; Sauer, Brian C; Madaras-Kelly, Karl; Rubin, Michael A; Bidwell Goetz, Matthew; Samore, Matthew H

2017-08-01

OBJECTIVE To examine variation in antibiotic coverage and detection of resistant pathogens in community-onset pneumonia. DESIGN Cross-sectional study. SETTING A total of 128 hospitals in the Veterans Affairs health system. PARTICIPANTS Hospitalizations with a principal diagnosis of pneumonia from 2009 through 2010. METHODS We examined proportions of hospitalizations with empiric antibiotic coverage for methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PAER) and with initial detection in blood or respiratory cultures. We compared lowest- versus highest-decile hospitals, and we estimated adjusted probabilities (AP) for patient- and hospital-level factors predicting coverage and detection using hierarchical regression modeling. RESULTS Among 38,473 hospitalizations, empiric coverage varied widely across hospitals (MRSA lowest vs highest, 8.2% vs 42.0%; PAER lowest vs highest, 13.9% vs 44.4%). Detection rates also varied (MRSA lowest vs highest, 0.5% vs 3.6%; PAER lowest vs highest, 0.6% vs 3.7%). Whereas coverage was greatest among patients with recent hospitalizations (AP for anti-MRSA, 54%; AP for anti-PAER, 59%) and long-term care (AP for anti-MRSA, 60%; AP for anti-PAER, 66%), detection was greatest in patients with a previous history of a positive culture (AP for MRSA, 7.9%; AP for PAER, 11.9%) and in hospitals with a high prevalence of the organism in pneumonia (AP for MRSA, 3.9%; AP for PAER, 3.2%). Low hospital complexity and rural setting were strong negative predictors of coverage but not of detection. CONCLUSIONS Hospitals demonstrated widespread variation in both coverage and detection of MRSA and PAER, but probability of coverage correlated poorly with probability of detection. Factors associated with empiric coverage (eg, healthcare exposure) were different from those associated with detection (eg, microbiology history). Providing microbiology data during empiric antibiotic decision making could better align coverage to risk for resistant pathogens and could promote more judicious use of broad-spectrum antibiotics. Infect Control Hosp Epidemiol 2017;38:937-944.

Bundled automobile insurance coverage and accidents.

PubMed

Li, Chu-Shiu; Liu, Chwen-Chi; Peng, Sheng-Chang

2013-01-01

This paper investigates the characteristics of automobile accidents by taking into account two types of automobile insurance coverage: comprehensive vehicle physical damage insurance and voluntary third-party liability insurance. By using a unique data set in the Taiwanese automobile insurance market, we explore the bundled automobile insurance coverage and the occurrence of claims. It is shown that vehicle physical damage insurance is the major automobile coverage and affects the decision to purchase voluntary liability insurance coverage as a complement. Moreover, policyholders with high vehicle physical damage insurance coverage have a significantly higher probability of filing vehicle damage claims, and if they additionally purchase low voluntary liability insurance coverage, their accident claims probability is higher than those who purchase high voluntary liability insurance coverage. Our empirical results reveal that additional automobile insurance coverage information can capture more driver characteristics and driving behaviors to provide useful information for insurers' underwriting policies and to help analyze the occurrence of automobile accidents. Copyright © 2012 Elsevier Ltd. All rights reserved.

Medicine, Media, and Celebrities: News Coverage of Breast Cancer, 1960-1995.

ERIC Educational Resources Information Center

Corbett, Julia B.; Mori, Motomi

1999-01-01

Contributes to scholarship on the role of mass media in breast cancer coverage. Finds extremely high, significant correlations between numbers of medical-journal articles and newspaper, magazine, and TV coverage; a two-way concurrent relationship between breast cancer funding and media coverage, and between breast cancer incidence and TV coverage;…

26 CFR 1.36B-0 - Table of contents.

Code of Federal Regulations, 2013 CFR

2013-04-01

... health plan. (d) Family and family size. (e) Household income. (1) In general. (2) Modified adjusted... credit payment. (k) Exchange. (l) Self-only coverage. (m) Family coverage. (n) Rating area. (o) Effective...) Applicable benchmark plan. (1) In general. (2) Family coverage. (3) Silver level plan not covering a taxpayer...

26 CFR 1.36B-0 - Table of contents.

Code of Federal Regulations, 2014 CFR

2014-04-01

... health plan. (d) Family and family size. (e) Household income. (1) In general. (2) Modified adjusted... credit payment. (k) Exchange. (l) Self-only coverage. (m) Family coverage. (n) Rating area. (o) Effective...) Applicable benchmark plan. (1) In general. (2) Family coverage. (3) Silver level plan not covering a taxpayer...

Demographic history and rare allele sharing among human populations.

PubMed

Gravel, Simon; Henn, Brenna M; Gutenkunst, Ryan N; Indap, Amit R; Marth, Gabor T; Clark, Andrew G; Yu, Fuli; Gibbs, Richard A; Bustamante, Carlos D

2011-07-19

High-throughput sequencing technology enables population-level surveys of human genomic variation. Here, we examine the joint allele frequency distributions across continental human populations and present an approach for combining complementary aspects of whole-genome, low-coverage data and targeted high-coverage data. We apply this approach to data generated by the pilot phase of the Thousand Genomes Project, including whole-genome 2-4× coverage data for 179 samples from HapMap European, Asian, and African panels as well as high-coverage target sequencing of the exons of 800 genes from 697 individuals in seven populations. We use the site frequency spectra obtained from these data to infer demographic parameters for an Out-of-Africa model for populations of African, European, and Asian descent and to predict, by a jackknife-based approach, the amount of genetic diversity that will be discovered as sample sizes are increased. We predict that the number of discovered nonsynonymous coding variants will reach 100,000 in each population after ∼1,000 sequenced chromosomes per population, whereas ∼2,500 chromosomes will be needed for the same number of synonymous variants. Beyond this point, the number of segregating sites in the European and Asian panel populations is expected to overcome that of the African panel because of faster recent population growth. Overall, we find that the majority of human genomic variable sites are rare and exhibit little sharing among diverged populations. Our results emphasize that replication of disease association for specific rare genetic variants across diverged populations must overcome both reduced statistical power because of rarity and higher population divergence.

Demographic history and rare allele sharing among human populations

PubMed Central

Gravel, Simon; Henn, Brenna M.; Gutenkunst, Ryan N.; Indap, Amit R.; Marth, Gabor T.; Clark, Andrew G.; Yu, Fuli; Gibbs, Richard A.; Bustamante, Carlos D.; Altshuler, David L.; Durbin, Richard M.; Abecasis, Gonçalo R.; Bentley, David R.; Chakravarti, Aravinda; Clark, Andrew G.; Collins, Francis S.; De La Vega, Francisco M.; Donnelly, Peter; Egholm, Michael; Flicek, Paul; Gabriel, Stacey B.; Gibbs, Richard A.; Knoppers, Bartha M.; Lander, Eric S.; Lehrach, Hans; Mardis, Elaine R.; McVean, Gil A.; Nickerson, Debbie A.; Peltonen, Leena; Schafer, Alan J.; Sherry, Stephen T.; Wang, Jun; Wilson, Richard K.; Gibbs, Richard A.; Deiros, David; Metzker, Mike; Muzny, Donna; Reid, Jeff; Wheeler, David; Wang, Jun; Li, Jingxiang; Jian, Min; Li, Guoqing; Li, Ruiqiang; Liang, Huiqing; Tian, Geng; Wang, Bo; Wang, Jian; Wang, Wei; Yang, Huanming; Zhang, Xiuqing; Zheng, Huisong; Lander, Eric S.; Altshuler, David L.; Ambrogio, Lauren; Bloom, Toby; Cibulskis, Kristian; Fennell, Tim J.; Gabriel, Stacey B.; Jaffe, David B.; Shefler, Erica; Sougnez, Carrie L.; Bentley, David R.; Gormley, Niall; Humphray, Sean; Kingsbury, Zoya; Koko-Gonzales, Paula; Stone, Jennifer; McKernan, Kevin J.; Costa, Gina L.; Ichikawa, Jeffry K.; Lee, Clarence C.; Sudbrak, Ralf; Lehrach, Hans; Borodina, Tatiana A.; Dahl, Andreas; Davydov, Alexey N.; Marquardt, Peter; Mertes, Florian; Nietfeld, Wilfiried; Rosenstiel, Philip; Schreiber, Stefan; Soldatov, Aleksey V.; Timmermann, Bernd; Tolzmann, Marius; Egholm, Michael; Affourtit, Jason; Ashworth, Dana; Attiya, Said; Bachorski, Melissa; Buglione, Eli; Burke, Adam; Caprio, Amanda; Celone, Christopher; Clark, Shauna; Conners, David; Desany, Brian; Gu, Lisa; Guccione, Lorri; Kao, Kalvin; Kebbel, Andrew; Knowlton, Jennifer; Labrecque, Matthew; McDade, Louise; Mealmaker, Craig; Minderman, Melissa; Nawrocki, Anne; Niazi, Faheem; Pareja, Kristen; Ramenani, Ravi; Riches, David; Song, Wanmin; Turcotte, Cynthia; Wang, Shally; Mardis, Elaine R.; Wilson, Richard K.; Dooling, David; Fulton, Lucinda; Fulton, Robert; Weinstock, George; Durbin, Richard M.; Burton, John; Carter, David M.; Churcher, Carol; Coffey, Alison; Cox, Anthony; Palotie, Aarno; Quail, Michael; Skelly, Tom; Stalker, James; Swerdlow, Harold P.; Turner, Daniel; De Witte, Anniek; Giles, Shane; Gibbs, Richard A.; Wheeler, David; Bainbridge, Matthew; Challis, Danny; Sabo, Aniko; Yu, Fuli; Yu, Jin; Wang, Jun; Fang, Xiaodong; Guo, Xiaosen; Li, Ruiqiang; Li, Yingrui; Luo, Ruibang; Tai, Shuaishuai; Wu, Honglong; Zheng, Hancheng; Zheng, Xiaole; Zhou, Yan; Li, Guoqing; Wang, Jian; Yang, Huanming; Marth, Gabor T.; Garrison, Erik P.; Huang, Weichun; Indap, Amit; Kural, Deniz; Lee, Wan-Ping; Leong, Wen Fung; Quinlan, Aaron R.; Stewart, Chip; Stromberg, Michael P.; Ward, Alistair N.; Wu, Jiantao; Lee, Charles; Mills, Ryan E.; Shi, Xinghua; Daly, Mark J.; DePristo, Mark A.; Altshuler, David L.; Ball, Aaron D.; Banks, Eric; Bloom, Toby; Browning, Brian L.; Cibulskis, Kristian; Fennell, Tim J.; Garimella, Kiran V.; Grossman, Sharon R.; Handsaker, Robert E.; Hanna, Matt; Hartl, Chris; Jaffe, David B.; Kernytsky, Andrew M.; Korn, Joshua M.; Li, Heng; Maguire, Jared R.; McCarroll, Steven A.; McKenna, Aaron; Nemesh, James C.; Philippakis, Anthony A.; Poplin, Ryan E.; Price, Alkes; Rivas, Manuel A.; Sabeti, Pardis C.; Schaffner, Stephen F.; Shefler, Erica; Shlyakhter, Ilya A.; Cooper, David N.; Ball, Edward V.; Mort, Matthew; Phillips, Andrew D.; Stenson, Peter D.; Sebat, Jonathan; Makarov, Vladimir; Ye, Kenny; Yoon, Seungtai C.; Bustamante, Carlos D.; Clark, Andrew G.; Boyko, Adam; Degenhardt, Jeremiah; Gravel, Simon; Gutenkunst, Ryan N.; Kaganovich, Mark; Keinan, Alon; Lacroute, Phil; Ma, Xin; Reynolds, Andy; Clarke, Laura; Flicek, Paul; Cunningham, Fiona; Herrero, Javier; Keenen, Stephen; Kulesha, Eugene; Leinonen, Rasko; McLaren, William M.; Radhakrishnan, Rajesh; Smith, Richard E.; Zalunin, Vadim; Zheng-Bradley, Xiangqun; Korbel, Jan O.; Stütz, Adrian M.; Humphray, Sean; Bauer, Markus; Cheetham, R. Keira; Cox, Tony; Eberle, Michael; James, Terena; Kahn, Scott; Murray, Lisa; Chakravarti, Aravinda; Ye, Kai; De La Vega, Francisco M.; Fu, Yutao; Hyland, Fiona C. L.; Manning, Jonathan M.; McLaughlin, Stephen F.; Peckham, Heather E.; Sakarya, Onur; Sun, Yongming A.; Tsung, Eric F.; Batzer, Mark A.; Konkel, Miriam K.; Walker, Jerilyn A.; Sudbrak, Ralf; Albrecht, Marcus W.; Amstislavskiy, Vyacheslav S.; Herwig, Ralf; Parkhomchuk, Dimitri V.; Sherry, Stephen T.; Agarwala, Richa; Khouri, Hoda M.; Morgulis, Aleksandr O.; Paschall, Justin E.; Phan, Lon D.; Rotmistrovsky, Kirill E.; Sanders, Robert D.; Shumway, Martin F.; Xiao, Chunlin; McVean, Gil A.; Auton, Adam; Iqbal, Zamin; Lunter, Gerton; Marchini, Jonathan L.; Moutsianas, Loukas; Myers, Simon; Tumian, Afidalina; Desany, Brian; Knight, James; Winer, Roger; Craig, David W.; Beckstrom-Sternberg, Steve M.; Christoforides, Alexis; Kurdoglu, Ahmet A.; Pearson, John V.; Sinari, Shripad A.; Tembe, Waibhav D.; Haussler, David; Hinrichs, Angie S.; Katzman, Sol J.; Kern, Andrew; Kuhn, Robert M.; Przeworski, Molly; Hernandez, Ryan D.; Howie, Bryan; Kelley, Joanna L.; Melton, S. Cord; Abecasis, Gonçalo R.; Li, Yun; Anderson, Paul; Blackwell, Tom; Chen, Wei; Cookson, William O.; Ding, Jun; Kang, Hyun Min; Lathrop, Mark; Liang, Liming; Moffatt, Miriam F.; Scheet, Paul; Sidore, Carlo; Snyder, Matthew; Zhan, Xiaowei; Zöllner, Sebastian; Awadalla, Philip; Casals, Ferran; Idaghdour, Youssef; Keebler, John; Stone, Eric A.; Zilversmit, Martine; Jorde, Lynn; Xing, Jinchuan; Eichler, Evan E.; Aksay, Gozde; Alkan, Can; Hajirasouliha, Iman; Hormozdiari, Fereydoun; Kidd, Jeffrey M.; Sahinalp, S. Cenk; Sudmant, Peter H.; Mardis, Elaine R.; Chen, Ken; Chinwalla, Asif; Ding, Li; Koboldt, Daniel C.; McLellan, Mike D.; Dooling, David; Weinstock, George; Wallis, John W.; Wendl, Michael C.; Zhang, Qunyuan; Durbin, Richard M.; Albers, Cornelis A.; Ayub, Qasim; Balasubramaniam, Senduran; Barrett, Jeffrey C.; Carter, David M.; Chen, Yuan; Conrad, Donald F.; Danecek, Petr; Dermitzakis, Emmanouil T.; Hu, Min; Huang, Ni; Hurles, Matt E.; Jin, Hanjun; Jostins, Luke; Keane, Thomas M.; Le, Si Quang; Lindsay, Sarah; Long, Quan; MacArthur, Daniel G.; Montgomery, Stephen B.; Parts, Leopold; Stalker, James; Tyler-Smith, Chris; Walter, Klaudia; Zhang, Yujun; Gerstein, Mark B.; Snyder, Michael; Abyzov, Alexej; Balasubramanian, Suganthi; Bjornson, Robert; Du, Jiang; Grubert, Fabian; Habegger, Lukas; Haraksingh, Rajini; Jee, Justin; Khurana, Ekta; Lam, Hugo Y. K.; Leng, Jing; Mu, Xinmeng Jasmine; Urban, Alexander E.; Zhang, Zhengdong; Li, Yingrui; Luo, Ruibang; Marth, Gabor T.; Garrison, Erik P.; Kural, Deniz; Quinlan, Aaron R.; Stewart, Chip; Stromberg, Michael P.; Ward, Alistair N.; Wu, Jiantao; Lee, Charles; Mills, Ryan E.; Shi, Xinghua; McCarroll, Steven A.; Banks, Eric; DePristo, Mark A.; Handsaker, Robert E.; Hartl, Chris; Korn, Joshua M.; Li, Heng; Nemesh, James C.; Sebat, Jonathan; Makarov, Vladimir; Ye, Kenny; Yoon, Seungtai C.; Degenhardt, Jeremiah; Kaganovich, Mark; Clarke, Laura; Smith, Richard E.; Zheng-Bradley, Xiangqun; Korbel, Jan O.; Humphray, Sean; Cheetham, R. Keira; Eberle, Michael; Kahn, Scott; Murray, Lisa; Ye, Kai; De La Vega, Francisco M.; Fu, Yutao; Peckham, Heather E.; Sun, Yongming A.; Batzer, Mark A.; Konkel, Miriam K.; Walker, Jerilyn A.; Xiao, Chunlin; Iqbal, Zamin; Desany, Brian; Blackwell, Tom; Snyder, Matthew; Xing, Jinchuan; Eichler, Evan E.; Aksay, Gozde; Alkan, Can; Hajirasouliha, Iman; Hormozdiari, Fereydoun; Kidd, Jeffrey M.; Chen, Ken; Chinwalla, Asif; Ding, Li; McLellan, Mike D.; Wallis, John W.; Hurles, Matt E.; Conrad, Donald F.; Walter, Klaudia; Zhang, Yujun; Gerstein, Mark B.; Snyder, Michael; Abyzov, Alexej; Du, Jiang; Grubert, Fabian; Haraksingh, Rajini; Jee, Justin; Khurana, Ekta; Lam, Hugo Y. K.; Leng, Jing; Mu, Xinmeng Jasmine; Urban, Alexander E.; Zhang, Zhengdong; Gibbs, Richard A.; Bainbridge, Matthew; Challis, Danny; Coafra, Cristian; Dinh, Huyen; Kovar, Christie; Lee, Sandy; Muzny, Donna; Nazareth, Lynne; Reid, Jeff; Sabo, Aniko; Yu, Fuli; Yu, Jin; Marth, Gabor T.; Garrison, Erik P.; Indap, Amit; Leong, Wen Fung; Quinlan, Aaron R.; Stewart, Chip; Ward, Alistair N.; Wu, Jiantao; Cibulskis, Kristian; Fennell, Tim J.; Gabriel, Stacey B.; Garimella, Kiran V.; Hartl, Chris; Shefler, Erica; Sougnez, Carrie L.; Wilkinson, Jane; Clark, Andrew G.; Gravel, Simon; Grubert, Fabian; Clarke, Laura; Flicek, Paul; Smith, Richard E.; Zheng-Bradley, Xiangqun; Sherry, Stephen T.; Khouri, Hoda M.; Paschall, Justin E.; Shumway, Martin F.; Xiao, Chunlin; McVean, Gil A.; Katzman, Sol J.; Abecasis, Gonçalo R.; Blackwell, Tom; Mardis, Elaine R.; Dooling, David; Fulton, Lucinda; Fulton, Robert; Koboldt, Daniel C.; Durbin, Richard M.; Balasubramaniam, Senduran; Coffey, Allison; Keane, Thomas M.; MacArthur, Daniel G.; Palotie, Aarno; Scott, Carol; Stalker, James; Tyler-Smith, Chris; Gerstein, Mark B.; Balasubramanian, Suganthi; Chakravarti, Aravinda; Knoppers, Bartha M.; Abecasis, Gonçalo R.; Bustamante, Carlos D.; Gharani, Neda; Gibbs, Richard A.; Jorde, Lynn; Kaye, Jane S.; Kent, Alastair; Li, Taosha; McGuire, Amy L.; McVean, Gil A.; Ossorio, Pilar N.; Rotimi, Charles N.; Su, Yeyang; Toji, Lorraine H.; TylerSmith, Chris; Brooks, Lisa D.; Felsenfeld, Adam L.; McEwen, Jean E.; Abdallah, Assya; Juenger, Christopher R.; Clemm, Nicholas C.; Collins, Francis S.; Duncanson, Audrey; Green, Eric D.; Guyer, Mark S.; Peterson, Jane L.; Schafer, Alan J.; Abecasis, Gonçalo R.; Altshuler, David L.; Auton, Adam; Brooks, Lisa D.; Durbin, Richard M.; Gibbs, Richard A.; Hurles, Matt E.; McVean, Gil A.

2011-01-01

High-throughput sequencing technology enables population-level surveys of human genomic variation. Here, we examine the joint allele frequency distributions across continental human populations and present an approach for combining complementary aspects of whole-genome, low-coverage data and targeted high-coverage data. We apply this approach to data generated by the pilot phase of the Thousand Genomes Project, including whole-genome 2–4× coverage data for 179 samples from HapMap European, Asian, and African panels as well as high-coverage target sequencing of the exons of 800 genes from 697 individuals in seven populations. We use the site frequency spectra obtained from these data to infer demographic parameters for an Out-of-Africa model for populations of African, European, and Asian descent and to predict, by a jackknife-based approach, the amount of genetic diversity that will be discovered as sample sizes are increased. We predict that the number of discovered nonsynonymous coding variants will reach 100,000 in each population after ∼1,000 sequenced chromosomes per population, whereas ∼2,500 chromosomes will be needed for the same number of synonymous variants. Beyond this point, the number of segregating sites in the European and Asian panel populations is expected to overcome that of the African panel because of faster recent population growth. Overall, we find that the majority of human genomic variable sites are rare and exhibit little sharing among diverged populations. Our results emphasize that replication of disease association for specific rare genetic variants across diverged populations must overcome both reduced statistical power because of rarity and higher population divergence. PMID:21730125

[Caregivers and residents, raising awareness of the influenza vaccine].

PubMed

Plantet, Claire; Sanchez, Stéphane; Cohen, Nadia; Denormandie, Philippe; Dinh, Aurélien

Influenza epidemics in nursing homes can lead to serious complications with a high level of lethality. It has been shown that an active policy of awareness campaigns with obligatory information materials and easy access to influenza immunisation increases the rate of vaccination coverage. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Incremental benefits of male HPV vaccination: accounting for inequality in population uptake.

PubMed

Smith, Megan A; Canfell, Karen

2014-01-01

Vaccines against HPV16/18 are approved for use in females and males but most countries currently have female-only programs. Cultural and geographic factors associated with HPV vaccine uptake might also influence sexual partner choice; this might impact post-vaccination outcomes. Our aims were to examine the population-level impact of adding males to HPV vaccination programs if factors influencing vaccine uptake also influence partner choice, and additionally to quantify how this changes the post-vaccination distribution of disease between subgroups, using incident infections as the outcome measure. A dynamic model simulated vaccination of pre-adolescents in two scenarios: 1) vaccine uptake was correlated with factors which also affect sexual partner choice ("correlated"); 2) vaccine uptake was unrelated to these factors ("unrelated"). Coverage and degree of heterogeneity in uptake were informed by observed data from Australia and the USA. Population impact was examined via the effect on incident HPV16 infections. The rate ratio for post-vaccination incident HPV16 in the lowest compared to the highest coverage subgroup (RR(L)) was calculated to quantify between-group differences in outcomes. The population-level incremental impact of adding males was lower if vaccine uptake was "correlated", however the difference in population-level impact was extremely small (<1%) in the Australia and USA scenarios, even under the conservative and extreme assumption that subgroups according to coverage did not mix at all sexually. At the subgroup level, "correlated" female-only vaccination resulted in RR(L)= 1.9 (Australia) and 1.5 (USA) in females, and RR(L)= 1.5 and 1.3 in males. "Correlated" both-sex vaccination increased RR(L) to 4.2 and 2.1 in females and 3.9 and 2.0 in males in the Australia and USA scenarios respectively. The population-level incremental impact of male vaccination is unlikely to be substantially impacted by feasible levels of heterogeneity in uptake. However, these findings emphasize the continuing importance of prioritizing high coverage across all groups in HPV vaccination programs in terms of achieving equality of outcomes.

Operational strategies of anti-malarial drug campaigns for malaria elimination in Zambia's southern province: a simulation study.

PubMed

Stuckey, Erin M; Miller, John M; Littrell, Megan; Chitnis, Nakul; Steketee, Rick

2016-03-09

Malaria elimination requires reducing both the potential of mosquitoes to transmit parasites to humans and humans to transmit parasites to mosquitoes. To achieve this goal in Southern province, Zambia a mass test and treat (MTAT) campaign was conducted from 2011-2013 to complement high coverage of long-lasting insecticide-treated nets (LLIN). To identify factors likely to increase campaign effectiveness, a modelling approach was applied to investigate the simulated effect of alternative operational strategies for parasite clearance in southern province. OpenMalaria, a discrete-time, individual-based stochastic model of malaria, was parameterized for the study area to simulate anti-malarial drug administration for interruption of transmission. Simulations were run for scenarios with a range of artemisinin-combination therapies, proportion of the population reached by the campaign, targeted age groups, time between campaign rounds, Plasmodium falciparum test protocols, and the addition of drugs aimed at preventing onward transmission. A sensitivity analysis was conducted to assess uncertainty of simulation results. Scenarios were evaluated based on the reduction in all-age parasite prevalence during the peak transmission month one year following the campaign, compared to the currently-implemented strategy of MTAT 19 % population coverage at pilot and 40 % coverage during the first year of implementation in the presence of 56 % LLIN use and 18 % indoor residual spray coverage. Simulation results suggest the most important determinant of success in reducing prevalence is the population coverage achieved in the campaign, which would require more than 1 year of campaign implementation for elimination. The inclusion of single low-dose primaquine, which acts as a gametocytocide, or ivermectin, which acts as an endectocide, to the drug regimen did not further reduce parasite prevalence one year following the campaign compared to the currently-implemented strategy. Simulation results indicate a high proportion of low-density infections were missed by rapid diagnostic tests that would be treated and cleared with mass drug administration (MDA). The optimal implementation strategy for MTAT or MDA will vary by background level of prevalence, by rate of infections imported to the area, and by ability to operationally achieve high population coverage. Overall success with new parasite clearance strategies depends on continued coverage of vector control interventions to ensure sustained gains in reduction of disease burden.

An Analysis of Aircraft Requirements to Meet United States Department of Agriculture Remote Sensing Goals

NASA Technical Reports Server (NTRS)

Arno, R. D.

1977-01-01

The survey needs of the U.S. De pa rtment of Agriculture are immense, ranging from individual crop coverage at specific intervals to general land use classification. The aggregate of all desirable resolutions and sensor types applicable to airborne platforms yields an annual survey coverage rate eqivalent to about 6 times the U.S. land area. An intermediate annual survey level equal to the U. S. area can meet all currently perceived crop survey needs and provide sample imagery over many other resource areas. This decreased survey level can be accomplished with one or two high altitude aircraft (e.g., U-2 or WB-57) or medium altitude aircraft ( such as the Learjet or Jetstar). Survey costs range from about 25 cents to several dollars per square nautical mile depending primarily on resolution requirements and the aircraft used.

ReaxFF Grand Canonical Monte Carlo simulation of adsorption and dissociation of oxygen on platinum (111)

NASA Astrophysics Data System (ADS)

Valentini, Paolo; Schwartzentruber, Thomas E.; Cozmuta, Ioana

2011-12-01

Atomic-level Grand Canonical Monte Carlo (GCMC) simulations equipped with a reactive force field (ReaxFF) are used to study atomic oxygen adsorption on a Pt(111) surface. The off-lattice GCMC calculations presented here rely solely on the interatomic potential and do not necessitate the pre-computation of surface adlayer structures and their interpolation. As such, they provide a predictive description of adsorbate phases. In this study, validation is obtained with experimental evidence (steric heats of adsorption and isotherms) as well as DFT-based state diagrams available in the literature. The ReaxFF computed steric heats of adsorption agree well with experimental data, and this study clearly shows that indirect dissociative adsorption of O2 on Pt(111) is an activated process at non-zero coverages, with an activation energy that monotonically increases with coverage. At a coverage of 0.25 ML, a highly ordered p(2 × 2) adlayer is found, in agreement with several low-energy electron diffraction observations. Isotherms obtained from the GCMC simulations compare qualitatively and quantitatively well with previous DFT-based state diagrams, but are in disagreement with the experimental data sets available. ReaxFF GCMC simulations at very high coverages show that O atoms prefer to bind in fcc hollow sites, at least up to 0.8 ML considered in the present work. At moderate coverages, little to no disorder appears in the Pt lattice. At high coverages, some Pt atoms markedly protrude out of the surface plane. This observation is in qualitative agreement with recent STM images of an oxygen covered Pt surface. The use of the GCMC technique based on a transferable potential is particularly valuable to produce more realistic systems (adsorbent and adsorbate) to be used in subsequent dynamical simulations (Molecular Dynamics) to address recombination reactions (via either Eley-Rideal or Langmuir-Hinshelwood mechanisms) on variously covered surfaces. By using GCMC and Molecular Dynamics simulations, the ReaxFF force field can be a valuable tool for understanding heterogeneous catalysis on a solid surface. Finally, the use of a reactive potential is a necessary requirement to investigate problems where dissociative adsorption occurs, as typical of many important catalytic processes.

Coverage, efficacy or dosing interval: which factor predominantly influences the impact of routine childhood vaccination for the prevention of varicella? A model-based study for Italy.

PubMed

Holl, Katsiaryna; Sauboin, Christophe; Amodio, Emanuele; Bonanni, Paolo; Gabutti, Giovanni

2016-10-21

Varicella is a highly infectious disease with a significant public health and economic burden, which can be prevented with childhood routine varicella vaccination. Vaccination strategies differ by country. Some factors are known to play an important role (number of doses, coverage, dosing interval, efficacy and catch-up programmes), however, their relative impact on the reduction of varicella in the population remains unclear. This paper aims to help policy makers prioritise the critical factors to achieve the most successful vaccination programme with the available budget. Scenarios assessed the impact of different vaccination strategies on reduction of varicella disease in the population. A dynamic transmission model was used and adapted to fit Italian demographics and population mixing patterns. Inputs included coverage, number of doses, dosing intervals, first-dose efficacy and availability of catch-up programmes, based on strategies currently used or likely to be used in different countries. The time horizon was 30 years. Both one- and two-dose routine varicella vaccination strategies prevented a comparable number of varicella cases with complications, but two-doses provided broader protection due to prevention of a higher number of milder varicella cases. A catch-up programme in susceptible adolescents aged 10-14 years old reduced varicella cases by 27-43 % in older children, which are often more severe than in younger children. Coverage, for all strategies, sustained at high levels achieved the largest reduction in varicella. In general, a 20 % increase in coverage resulted in a further 27-31 % reduction in varicella cases. When high coverage is reached, the impact of dosing interval and first-dose vaccine efficacy had a relatively lower impact on disease prevention in the population. Compared to the long (11 years) dosing interval, the short (5 months) and medium (5 years) interval schedules reduced varicella cases by a further 5-13 % and 2-5 %, respectively. Similarly, a 10 % increase in first-dose efficacy (from 65 to 75 % efficacy) prevented 2-5 % more varicella cases, suggesting it is the least influential factor when considering routine varicella vaccination. Vaccination strategies can be implemented differently in each country depending on their needs, infrastructure and healthcare budget. However, ensuring high coverage remains the critical success factor for significant prevention of varicella when introducing varicella vaccination in the national immunisation programme.

The potential impact of pre-exposure prophylaxis for HIV prevention among men who have sex with men and transwomen in Lima, Peru: a mathematical modelling study.

PubMed

Gomez, Gabriela B; Borquez, Annick; Caceres, Carlos F; Segura, Eddy R; Grant, Robert M; Garnett, Geoff P; Hallett, Timothy B

2012-01-01

HIV pre-exposure prophylaxis (PrEP), the use of antiretroviral drugs by uninfected individuals to prevent HIV infection, has demonstrated effectiveness in preventing acquisition in a high-risk population of men who have sex with men (MSM). Consequently, there is a need to understand if and how PrEP can be used cost-effectively to prevent HIV infection in such populations. We developed a mathematical model representing the HIV epidemic among MSM and transwomen (male-to-female transgender individuals) in Lima, Peru, as a test case. PrEP effectiveness in the model is assumed to result from the combination of a "conditional efficacy" parameter and an adherence parameter. Annual operating costs from a health provider perspective were based on the US Centers for Disease Control and Prevention interim guidelines for PrEP use. The model was used to investigate the population-level impact, cost, and cost-effectiveness of PrEP under a range of implementation scenarios. The epidemiological impact of PrEP is largely driven by programme characteristics. For a modest PrEP coverage of 5%, over 8% of infections could be averted in a programme prioritising those at higher risk and attaining the adherence levels of the Pre-Exposure Prophylaxis Initiative study. Across all scenarios, the highest estimated cost per disability-adjusted life year averted (uniform strategy for a coverage level of 20%, US$1,036-US$4,254) is below the World Health Organization recommended threshold for cost-effective interventions, while only certain optimistic scenarios (low coverage of 5% and some or high prioritisation) are likely to be cost-effective using the World Bank threshold. The impact of PrEP is reduced if those on PrEP decrease condom use, but only extreme behaviour changes among non-adherers (over 80% reduction in condom use) and a low PrEP conditional efficacy (40%) would adversely impact the epidemic. However, PrEP will not arrest HIV transmission in isolation because of its incomplete effectiveness and dependence on adherence, and because the high cost of programmes limits the coverage levels that could potentially be attained. A strategic PrEP intervention could be a cost-effective addition to existing HIV prevention strategies for MSM populations. However, despite being cost-effective, a substantial expenditure would be required to generate significant reductions in incidence. Please see later in the article for the Editors' Summary.

The Potential Impact of Pre-Exposure Prophylaxis for HIV Prevention among Men Who Have Sex with Men and Transwomen in Lima, Peru: A Mathematical Modelling Study

PubMed Central

Caceres, Carlos F.; Segura, Eddy R.; Grant, Robert M.; Garnett, Geoff P.; Hallett, Timothy B.

2012-01-01

Background HIV pre-exposure prophylaxis (PrEP), the use of antiretroviral drugs by uninfected individuals to prevent HIV infection, has demonstrated effectiveness in preventing acquisition in a high-risk population of men who have sex with men (MSM). Consequently, there is a need to understand if and how PrEP can be used cost-effectively to prevent HIV infection in such populations. Methods and Findings We developed a mathematical model representing the HIV epidemic among MSM and transwomen (male-to-female transgender individuals) in Lima, Peru, as a test case. PrEP effectiveness in the model is assumed to result from the combination of a “conditional efficacy” parameter and an adherence parameter. Annual operating costs from a health provider perspective were based on the US Centers for Disease Control and Prevention interim guidelines for PrEP use. The model was used to investigate the population-level impact, cost, and cost-effectiveness of PrEP under a range of implementation scenarios. The epidemiological impact of PrEP is largely driven by programme characteristics. For a modest PrEP coverage of 5%, over 8% of infections could be averted in a programme prioritising those at higher risk and attaining the adherence levels of the Pre-Exposure Prophylaxis Initiative study. Across all scenarios, the highest estimated cost per disability-adjusted life year averted (uniform strategy for a coverage level of 20%, US$1,036–US$4,254) is below the World Health Organization recommended threshold for cost-effective interventions, while only certain optimistic scenarios (low coverage of 5% and some or high prioritisation) are likely to be cost-effective using the World Bank threshold. The impact of PrEP is reduced if those on PrEP decrease condom use, but only extreme behaviour changes among non-adherers (over 80% reduction in condom use) and a low PrEP conditional efficacy (40%) would adversely impact the epidemic. However, PrEP will not arrest HIV transmission in isolation because of its incomplete effectiveness and dependence on adherence, and because the high cost of programmes limits the coverage levels that could potentially be attained. Conclusions A strategic PrEP intervention could be a cost-effective addition to existing HIV prevention strategies for MSM populations. However, despite being cost-effective, a substantial expenditure would be required to generate significant reductions in incidence. Please see later in the article for the Editors' Summary PMID:23055836

Less is More: Membrane Protein Digestion Beyond Urea–Trypsin Solution for Next-level Proteomics*

PubMed Central

Zhang, Xi

2015-01-01

The goal of next-level bottom-up membrane proteomics is protein function investigation, via high-coverage high-throughput peptide-centric quantitation of expression, modifications and dynamic structures at systems scale. Yet efficient digestion of mammalian membrane proteins presents a daunting barrier, and prevalent day-long urea–trypsin in-solution digestion proved insufficient to reach this goal. Many efforts contributed incremental advances over past years, but involved protein denaturation that disconnected measurement from functional states. Beyond denaturation, the recent discovery of structure/proteomics omni-compatible detergent n-dodecyl-β-d-maltopyranoside, combined with pepsin and PNGase F columns, enabled breakthroughs in membrane protein digestion: a 2010 DDM-low-TCEP (DLT) method for H/D-exchange (HDX) using human G protein-coupled receptor, and a 2015 flow/detergent-facilitated protease and de-PTM digestions (FDD) for integrative deep sequencing and quantitation using full-length human ion channel complex. Distinguishing protein solubilization from denaturation, protease digestion reliability from theoretical specificity, and reduction from alkylation, these methods shifted day(s)-long paradigms into minutes, and afforded fully automatable (HDX)-protein-peptide-(tandem mass tag)-HPLC pipelines to instantly measure functional proteins at deep coverage, high peptide reproducibility, low artifacts and minimal leakage. Promoting—not destroying—structures and activities harnessed membrane proteins for the next-level streamlined functional proteomics. This review analyzes recent advances in membrane protein digestion methods and highlights critical discoveries for future proteomics. PMID:26081834

Angle-resolved and core-level photoemission study of interfacing the topological insulator Bi1.5Sb0.5Te1.7Se1.3 with Ag, Nb, and Fe

NASA Astrophysics Data System (ADS)

de Jong, N.; Frantzeskakis, E.; Zwartsenberg, B.; Huang, Y. K.; Wu, D.; Hlawenka, P.; Sańchez-Barriga, J.; Varykhalov, A.; van Heumen, E.; Golden, M. S.

2015-08-01

Interfaces between a bulk-insulating topological insulator (TI) and metallic adatoms have been studied using high-resolution, angle-resolved, and core-level photoemission. Fe, Nb, and Ag were evaporated onto Bi1 .5Sb0 .5Te1 .7Se1 .3 (BSTS) surfaces both at room temperature and 38 K. The coverage and temperature dependence of the adsorption and interfacial formation process have been investigated, highlighting the effects of the overlayer growth on the occupied electronic structure of the TI. For all coverages at room temperature and for those equivalent to less than 0.2 monolayer at low temperature all three metals lead to a downward shift of the TI bands with respect to the Fermi level. At room temperature Ag appears to intercalate efficiently into the van der Waals gap of BSTS, accompanied by low-level substitution for the Te/Se atoms of the termination layer of the crystal. This Te/Se substitution with silver increases significantly for low temperature adsorption, and can even dominate the electrostatic environment of the Bi/Sb atoms in the BSTS near-surface region. On the other hand, Fe and Nb evaporants remain close to the termination layer of the crystal. On room temperature deposition, they initially substitute isoelectronically for Bi as a function of coverage, before substituting for Te/Se atoms. For low temperature deposition, Fe and Nb are too immobile for substitution processes and show a behavior consistent with clustering on the surface. For both Ag and Fe/Nb, these differing adsorption pathways still lead to the qualitatively similar and remarkable behavior for low temperature deposition that the chemical potential first moves downward (p -type dopant behavior) and then upward (n -type behavior) on increasing coverage.

Health insurance coverage among women in Indonesia's major cities: A multilevel analysis.

PubMed

Christiani, Yodi; Byles, Julie E; Tavener, Meredith; Dugdale, Paul

2017-03-01

We examined women's access to health insurance in Indonesia. We analyzed IFLS-4 data of 1,400 adult women residing in four major cities. Among this population, the health insurance coverage was 24%. Women who were older, involved in paid work, and with higher education had greater access to health insurance (p < .05). We also found there were disparities in the probability of having health insurance across community levels (Median Odds Ratios = 3.40). Given the importance of health insurance for women's health, strategies should be developed to expand health insurance coverage among women in Indonesia, including the disparities across community levels. Such problems might also be encountered in other developing countries with low health insurance coverage.

Accelerated HIV testing for PMTCT in maternity and labour wards is vital to capture mothers at a critical point in the programme at district level in Malawi.

PubMed

Beltman, J J; Fitzgerald, M; Buhendwa, L; Moens, M; Massaquoi, M; Kazima, J; Alide, N; van Roosmalen, J

2010-11-01

Round the clock (24 hours×7 days) HIV testing is vital to maintain a high prevention of mother to child transmission (PMTCT) coverage for women delivering in district health facilities. PMTCT coverage increases when most of the pregnant women will have their HIV status tested. Therefore routine offering of HIV testing should be integrated and seen as a part of comprehensive antenatal care. For women who miss antenatal care and deliver in a health facility without having had their HIV status tested, the labour and maternity ward could still serve as other entry points.

Multiscale Drivers of Global Environmental Health

NASA Astrophysics Data System (ADS)

Desai, Manish Anil

In this dissertation, I motivate, develop, and demonstrate three such approaches for investigating multiscale drivers of global environmental health: (1) a metric for analyzing contributions and responses to climate change from global to sectoral scales, (2) a framework for unraveling the influence of environmental change on infectious diseases at regional to local scales, and (3) a model for informing the design and evaluation of clean cooking interventions at community to household scales. The full utility of climate debt as an analytical perspective will remain untapped without tools that can be manipulated by a wide range of analysts, including global environmental health researchers. Chapter 2 explains how international natural debt (IND) apportions global radiative forcing from fossil fuel carbon dioxide and methane, the two most significant climate altering pollutants, to individual entities -- primarily countries but also subnational states and economic sectors, with even finer scales possible -- as a function of unique trajectories of historical emissions, taking into account the quite different radiative efficiencies and atmospheric lifetimes of each pollutant. Owing to its straightforward and transparent derivation, IND can readily operationalize climate debt to consider issues of equity and efficiency and drive scenario exercises that explore the response to climate change at multiple scales. Collectively, the analyses presented in this chapter demonstrate how IND can inform a range of key question on climate change mitigation at multiple scales, compelling environmental health towards an appraisal of the causes and not just the consequences of climate change. The environmental change and infectious disease (EnvID) conceptual framework of Chapter 3 builds on a rich history of prior efforts in epidemiologic theory, environmental science, and mathematical modeling by: (1) articulating a flexible and logical system specification; (2) incorporating transmission groupings linked to public health intervention strategies; (3) emphasizing the intersection of proximal environmental characteristics and transmission cycles; (4) incorporating a matrix formulation to identify knowledge gaps and facilitate an integration of research; and (5) highlighting hypothesis generation amidst dynamic processes. A systems based approach leverages the reality that studies relevant to environmental change and infectious disease are embedded within a wider web of interactions. As scientific understanding advances, the EnvID framework can help integrate the various factors at play in determining environment-disease relationships and the connections between intrinsically multiscale causal networks. In Chapter 4, the coverage effect model functions primarily as a "proof of concept" analysis to address whether the efficacy of a clean cooking technology may be determined by the extent of not only household level use but also community level coverage. Such coverage dependent efficacy, or a "coverage effect," would transform how interventions are studied and deployed. Ensemble results are consistent with the concept that an appreciable coverage effect from clean cooking interventions can manifest within moderately dense communities. Benefits for users derive largely from direct effects; initially, at low coverage levels, almost exclusively so. Yet, as coverage expands within a user's community, a coverage effect becomes increasingly beneficial. In contrast, non users, despite also experiencing comparable exposure reductions from community-level intervention use, cannot proportionately benefit because their exposures remain overwhelmingly dominated by household-level use of traditional solid fuel cookstoves. The coverage effect model strengthens the rationale for public health programs and policies to encourage clean cooking technologies with an added incentive to realize high coverage within contiguous areas. The implications of the modeling exercise extend to priorities for data collection, underscoring the importance of outdoor pollution concentrations during, as well as before and/or after, community cooking windows and also routine measurement of ventilation, meteorology, time activity patterns, and cooking practices. The possibility of a coverage effect necessitates appropriate strategies to estimate not only direct effects but also coverage and total effects to avoid impaired conclusions. The specter of accelerating social and ecological change challenges efforts to respond to climate change, re/emerging infectious diseases, and household air pollution. Environmental health possesses a well-established and well-tested repertoire of methods but contending with multiscale drivers of risk requires complementary approaches, as well. Integrating metrics, frameworks, and models -- and their insights -- into its analytical arsenal can help global environmental health meet the challenges of today and tomorrow. (Abstract shortened by ProQuest.).

An Alternative Approach of Coastal Sea-Level Observation from Remote Sensing Imageries

NASA Astrophysics Data System (ADS)

Peng, H. Y.; Tseng, K. H.; Chung-Yen, K.; Lin, T. H.; Liao, W. H.; Chen, C. F.

2017-12-01

Coastal sea level can be observed as waterline changes along a coastal digital elevation model (DEM). However, most global DEMs, such as the Shuttle Radar Topography Mission (SRTM) DEM with 30 m resolution, provide limited coverage over coastal area due to the impermeability of radar signal over water and the lack of low-tide coincidence. Therefore, we aim to extend to coverage of SRTM DEM for the determination of intertidal zone and to monitor sea-level changes along the entire coastline of Taiwan (>1200km). We firstly collect historical cloud-free images since the 1980s, including Landsat series, SPOT series and Sentinel-2, and then calculate the Modified Normalized Difference Water Index (MNDWI) to identify water pixels. After computing water appearance probability of each pixel, it is converted into actual elevation by introducing the DTU10 tide model for high tide and low tide boundaries. A coastal DEM of intertidal zone is reconstructed and the accuracy is at 50 cm level as compared with in situ DEM built by an unmanned aerial vehicle (UAV). Finally, we use this product to define the up-to-date intertidal zone and estimate sea-level changes by using remote sensing snapshots.

Using Poisson mixed-effects model to quantify transcript-level gene expression in RNA-Seq.

PubMed

Hu, Ming; Zhu, Yu; Taylor, Jeremy M G; Liu, Jun S; Qin, Zhaohui S

2012-01-01

RNA sequencing (RNA-Seq) is a powerful new technology for mapping and quantifying transcriptomes using ultra high-throughput next-generation sequencing technologies. Using deep sequencing, gene expression levels of all transcripts including novel ones can be quantified digitally. Although extremely promising, the massive amounts of data generated by RNA-Seq, substantial biases and uncertainty in short read alignment pose challenges for data analysis. In particular, large base-specific variation and between-base dependence make simple approaches, such as those that use averaging to normalize RNA-Seq data and quantify gene expressions, ineffective. In this study, we propose a Poisson mixed-effects (POME) model to characterize base-level read coverage within each transcript. The underlying expression level is included as a key parameter in this model. Since the proposed model is capable of incorporating base-specific variation as well as between-base dependence that affect read coverage profile throughout the transcript, it can lead to improved quantification of the true underlying expression level. POME can be freely downloaded at http://www.stat.purdue.edu/~yuzhu/pome.html. yuzhu@purdue.edu; zhaohui.qin@emory.edu Supplementary data are available at Bioinformatics online.

[Immunization and equity in the Regional Initiative of the Mesoamerican Health Initiative].

PubMed

Franco-Paredes, Carlos; Hernández-Ramos, Isabel; Santos-Preciado, José Ignacio

2011-01-01

National immunization rates indicate high vaccine coverage in Mesoamerica, but there is growing evidence that the most vulnerable groups are not being reached by immunization programs. Therefore, there is likely low effective vaccine coverage in the region, leading to persistent and growing health inequity. The planning phase of this project was from June to December 2009. The project will be conducted in the target populations which includes children under five, pregnant women, and women of child-bearing age from the most vulnerable populations within countries of the Mesoamerican region, as indicated geographically by a low human development index (HDI) and/or high prevalence of poverty at the municipal level and through the use of participatory methods to define poverty and vulnerability in local contexts. We defined three lines of action for vaccine-preventable disease interventions: 1) pilot projects to fill gaps in knowledge; 2) strengthening immunization policy; and 3) implementation of evidence-based practices. Health system strengthening through health equity is the central regional objective of the immunization workgroup. We hope to have a transformational impact on health systems so as to improve effective coverage, including vaccine and other integrated primary healthcare services.

Comparative habitat ecology of Texas and masked bobwhites

USGS Publications Warehouse

Guthery, F.S.; King, N.M.; Nolte, K.R.; Kuvlesky, W.P.; DeStefano, S.; Gall, S.A.; Silvy, N.J.

2000-01-01

The habitat ecology of masked bobwhites (Colinus virginianus ridgwayi) is poorly understood, which hampers recovery efforts for this endangered bird. During 1994-96, we analyzed the habitat ecology of masked bobwhites in Sonora, Mexico, and Arizona, and compared these findings with the habitat ecology of Texas bobwhites (C. v. texanus) in southern Texas. Mean values for the quantity of low screening cover (<50 cm aboveground), operative temperature (??C), and exposure to aerial predators were relatively constant across regions (CV <14.2%), indicating these variables are important in adaptive habitat-use decisions by bobwhites. Bobwhites exhibited preference in all regions for higher canopy coverage of woody vegetation, lower exposure to aerial predators, and lower operative temperatures in comparison with randomly available conditions. The major habitat deficiencies for masked bobwhites were lack of woody and herbaceous cover, which led to high exposure to aerial predators in Sonora and Arizona. High operative temperatures at quail level were associated with the loss of ???24% of potential habitat space-time in Texas, Sonora, and Arizona. Management to improve habitat for masked bobwhites includes any practice that increases canopy coverage of woody vegetation, and height and coverage of herbaceous vegetation.

Successful Control of Winter Pyrexias Caused by Equine Herpesvirus Type 1 in Japanese Training Centers by Achieving High Vaccination Coverage

PubMed Central

Mae, Naomi; Ode, Hirotaka; Nemoto, Manabu; Tsujimura, Koji; Yamanaka, Takashi; Kondo, Takashi; Matsumura, Tomio

2014-01-01

Equine herpesvirus type 1 (EHV-1) is a major cause of winter pyrexia in racehorses in two training centers (Ritto and Miho) in Japan. Until the epizootic period of 2008-2009, a vaccination program using a killed EHV-1 vaccine targeted only susceptible 3-year-old horses with low antibody levels to EHV-1 antigens. However, because the protective effect was not satisfactory, in 2009-2010 the vaccination program was altered to target all 3-year-old horses. To evaluate the vaccine's efficacy, we investigated the number of horses with pyrexia due to EHV-1 or equine herpesvirus type 4 (EHV-4) infection or both and examined the vaccination coverage in the 3-year-old population and in the whole population before and after changes in the program. The mean (± standard deviation [SD]) estimated numbers of horses infected with EHV-1 or EHV-4 or both, among pyretic horses from 1999-2000 to 2008-2009 were 105 ± 47 at Ritto and 66 ± 44 at Miho. Although the estimated number of infected horses did not change greatly in the first period of the current program, it decreased from the second period, with means (±SD) of 21 ± 12 at Ritto and 14 ± 15 at Miho from 2010-2011 to 2012-2013. Vaccination coverage in the 3-year-old population was 99.4% at Ritto and 99.8% at Miho in the first period, and similar values were maintained thereafter. Coverage in the whole population increased more gradually than that in the 3-year-old population. The results suggest that EHV-1 epizootics can be suppressed by maintaining high vaccination coverage, not only in the 3-year-old population but also in the whole population. PMID:24872513

Comparison of inflation of third dose diphtheria tetanus pertussis (DTP3) administrative coverage to other vaccine antigens.

PubMed

Dolan, Samantha B; MacNeil, Adam

2017-06-14

Third dose diphtheria tetanus pertussis (DTP3) administrative coverage is a commonly used indicator for immunization program performance, although studies have demonstrated data quality issues with administrative DTP3 coverage. It is possible that administrative coverage for DTP3 may be inflated more than for other antigens. To examine this, theory, we compiled immunization coverage estimates from recent country surveys (n=71) and paired these with corresponding administrative coverage estimates, by country and cohort year, for DTP3 and 4 other antigens. Median administrative coverage was higher than survey estimates of coverage for all antigens (median differences from 26 to 30%), however this difference was similar for DTP3 as for all other antigens. These findings were consistent when countries were stratified by income level and eligibility for Gavi funding. Our findings demonstrate that while country administrative coverage estimates tend to be higher than survey estimates, DTP3 administrative coverage is not inflated more than other antigens. Published by Elsevier Ltd.

Health Insurance Stability and Health Status: Do Family-Level Coverage Patterns Matter?

ERIC Educational Resources Information Center

Nielsen, Robert B.; Garasky, Steven

2008-01-01

Being uninsured affects one's ability to access medical services and maintain health. Using longitudinal data from the Survey of Income and Program Participation, the authors investigated how individual and family insurance coverage affects adult health. They found that health insurance coverage often varies across family members and changes…

Newspaper Coverage of Biological Subissues in the Spotted Owl Debate, 1989-1993.

ERIC Educational Resources Information Center

Furlow, F. Bryant

1994-01-01

Computer archives for 27 U.S. daily newspapers were accessed to evaluate the levels of coverage for 5 biological subissues and 5 ecological concepts in articles on the spotted owl debate. The author identified a correlation between biologist/reporter contact and increased biological subissue and ecological concepts coverage. (LZ)

The health insurance status of US Latino women: A profile from the 1982-1984 HHANES.

PubMed

de la Torre, A; Friis, R; Hunter, H R; Garcia, L

1996-04-01

This research studied the correlates of health insurance status among three major subpopulations (Mexican, Puerto Rican, and Cuban) of adult (ages of 20 to 64) Latino women. Data from the Hispanic Health and Nutrition Examination Survey (HHANES), 1982-1984, were examined to determine the percentages of health insurance coverage among the sample populations and to assess the relationship between access to coverage and selected sociodemographic employment/income, ancestry, and acculturation variables. Variations in health insurance coverage existed by Latina subpopulation. While Puerto Rican women had the highest percentage of any health insurance coverage, Mexican-origin women (particularly those 50 to 64 years old) had the lowest. For all three Latina groups, health insurance coverage was greater among those who reported a family income above the poverty level than among those whose income fell below the poverty level; employment location, acculturation variables, and ancestry were also related to coverage. Eligibility requirements, particularly for Mexican-and Cuban-origin women, need to be streamlined, and innovative health insurance programs need to be developed to increase access of Latinas to health insurance.

Trends in Preventable Inpatient and Emergency Department Utilization in California Between 2012 and 2015: The Role of Health Insurance Coverage and Primary Care Supply.

PubMed

Cunningham, Peter; Sheng, Yaou

2018-06-01

Expansions of health insurance coverage tend to increase hospital emergency department (ED) utilization and inpatient admissions. However, provisions in the Affordable Care Act that expanded primary care supply were intended in part to offset the potential for increased hospital utilization. To examine the association between health insurance coverage, primary care supply, and ED and inpatient utilization, and to assess how both factors contributed to trends in utilization in California between 2012 and 2015. Population-based measures of ED and inpatient utilization, insurance coverage, and primary care supply were constructed for California counties for the years 2012 through 2015. Fixed effects regression analysis is used to examine the association between health insurance coverage, primary care supply, and rates of preventable ED and inpatient utilization. Higher levels of Medicaid coverage in a county are associated with higher levels of preventable ED and inpatient utilization, although greater numbers of primary care practitioners and Federally Qualified Health Centers reduce this type of utilization. Increases in coverage accelerated a long-term increase in ED visits and prevented an even larger decrease in inpatient admissions, but changes in coverage do not fully explain these underlying trends. Increases in primary care supply offset the effects of coverage changes only modestly. Policymakers should not overstate the impact of the Affordable Care Act on increasing ED visits, and should focus on better understanding the underlying factors that are driving the trends.

Tetanus toxoid coverage as an indicator of serological protection against neonatal tetanus.

PubMed Central

Deming, Michael S.; Roungou, Jean-Baptiste; Kristiansen, Max; Heron, Iver; Yango, Alphonse; Guenengafo, Alexis; Ndamobissi, Robert

2002-01-01

OBJECTIVE: A Multiple-Indicator Cluster Survey (MICS) was conducted at mid-decade in more than 60 developing countries to measure progress towards the year 2000 World Summit for Children goals. These goals included the protection of at least 90% of children against neonatal tetanus through the immunization of their mothers, as measured by tetanus toxoid (TT) coverage. In the Central African Republic (CAR), serological testing was added to the MICS to understand better the relationship between survey estimates of TT coverage and the prevalence of serological protection. METHODS: In the CAR MICS, mothers of children younger than one year of age gave verbal histories of the TT vaccinations they had received, using the MICS TT questionnaire. A subsample of mothers was tested for tetanus antitoxin, using a double-antigen enzyme-linked immunoadsorbent assay (ELISA). Seropositivity was defined as a titre of > or =0.01 IU/ml, and TT coverage was defined as the proportion of mothers protected at delivery, according to their history of TT vaccinations. FINDINGS: Among the 222 mothers in the subsample, weighted TT coverage was 74.4% (95% Confidence Interval (CI); 67.0% - 81.7%) and tetanus antitoxin seroprevalence was 88.7% (95% CI; 83.2% - 94.2%). The weighted median antitoxin titre was 0.35 IU/ml. CONCLUSIONS: Tetanus toxoid coverage in the CAR was lower than the prevalence of serological protection against neonatal tetanus. If this relationship holds for other countries, TT coverage estimates from the MICS may underestimate the extent to which the year 2000 goal for protecting children against neonatal tetanus was reached. We also showed that a high level of serological protection had been achieved in a country facing major public health challenges and resource constraints. PMID:12378286

Uniqueness of Nash equilibrium in vaccination games.

PubMed

Bai, Fan

2016-12-01

One crucial condition for the uniqueness of Nash equilibrium set in vaccination games is that the attack ratio monotonically decreases as the vaccine coverage level increasing. We consider several deterministic vaccination models in homogeneous mixing population and in heterogeneous mixing population. Based on the final size relations obtained from the deterministic epidemic models, we prove that the attack ratios can be expressed in terms of the vaccine coverage levels, and also prove that the attack ratios are decreasing functions of vaccine coverage levels. Some thresholds are presented, which depend on the vaccine efficacy. It is proved that for vaccination games in homogeneous mixing population, there is a unique Nash equilibrium for each game.

Economic reforms and health insurance in China.

PubMed

Du, Juan

2009-08-01

During the 1990s, Chinese state-owned enterprises (SOEs) and collective enterprises continually decreased coverage of public health insurance to their employees. This paper investigates this changing pattern of health insurance coverage in China using panel data from the China Nutrition and Health Survey (1991-2000). It is the first attempt in this literature that tries to identify precisely the effects of specific policies and reforms on health insurance coverage in the transitional period of China. The fixed effects linear model clustering at the province level is used for estimation, and results are compared to alternative models, including pooled OLS, random effects GLS model and fixed effects logit model. Strong empirical evidence is found that unemployment as a side effect of the Open Door Policy, and the deregulation of SOE and collective enterprises were the main causes for the decreasing trend. For example, urban areas that were highly affected by the Open Door Policy were associated with 17 percentage points decrease in the insurance coverage. Moreover, I found evidence that the gaps between SOE and non-SOE employees, collective and non-collective employees, urban and rural employees have considerably decreased during the ten years.

The Impact of Imitation on Vaccination Behavior in Social Contact Networks

PubMed Central

Ndeffo Mbah, Martial L.; Liu, Jingzhou; Bauch, Chris T.; Tekel, Yonas I.; Medlock, Jan; Meyers, Lauren Ancel; Galvani, Alison P.

2012-01-01

Previous game-theoretic studies of vaccination behavior typically have often assumed that populations are homogeneously mixed and that individuals are fully rational. In reality, there is heterogeneity in the number of contacts per individual, and individuals tend to imitate others who appear to have adopted successful strategies. Here, we use network-based mathematical models to study the effects of both imitation behavior and contact heterogeneity on vaccination coverage and disease dynamics. We integrate contact network epidemiological models with a framework for decision-making, within which individuals make their decisions either based purely on payoff maximization or by imitating the vaccination behavior of a social contact. Simulations suggest that when the cost of vaccination is high imitation behavior may decrease vaccination coverage. However, when the cost of vaccination is small relative to that of infection, imitation behavior increases vaccination coverage, but, surprisingly, also increases the magnitude of epidemics through the clustering of non-vaccinators within the network. Thus, imitation behavior may impede the eradication of infectious diseases. Calculations that ignore behavioral clustering caused by imitation may significantly underestimate the levels of vaccination coverage required to attain herd immunity. PMID:22511859

Modeling genome coverage in single-cell sequencing

PubMed Central

Daley, Timothy; Smith, Andrew D.

2014-01-01

Motivation: Single-cell DNA sequencing is necessary for examining genetic variation at the cellular level, which remains hidden in bulk sequencing experiments. But because they begin with such small amounts of starting material, the amount of information that is obtained from single-cell sequencing experiment is highly sensitive to the choice of protocol employed and variability in library preparation. In particular, the fraction of the genome represented in single-cell sequencing libraries exhibits extreme variability due to quantitative biases in amplification and loss of genetic material. Results: We propose a method to predict the genome coverage of a deep sequencing experiment using information from an initial shallow sequencing experiment mapped to a reference genome. The observed coverage statistics are used in a non-parametric empirical Bayes Poisson model to estimate the gain in coverage from deeper sequencing. This approach allows researchers to know statistical features of deep sequencing experiments without actually sequencing deeply, providing a basis for optimizing and comparing single-cell sequencing protocols or screening libraries. Availability and implementation: The method is available as part of the preseq software package. Source code is available at http://smithlabresearch.org/preseq. Contact: andrewds@usc.edu Supplementary information: Supplementary material is available at Bioinformatics online. PMID:25107873

Marginalization and health service coverage among indigenous, rural, and urban populations: a public health problem in Mexico.

PubMed

Roldán, José; Álvarez, Marsela; Carrasco, María; Guarneros, Noé; Ledesma, José; Cuchillo-Hilario, Mario; Chávez, Adolfo

2017-12-01

  Marginalization is a significant issue in Mexico, involving a lack of access to health services with differential impacts on Indigenous, rural and urban populations. The objective of this study was to understand Mexico’s public health problem across three population areas, Indigenous, rural and urban, in relation to degree of marginalization and health service coverage.   The sampling universe of the study consisted of 107 458 geographic locations in the country. The study was retrospective, comparative and confirmatory. The study applied analysis of variance, parametric and non-parametric, correlation and correspondence analyses.   Significant differences were identified between the Indigenous, rural and urban populations with respect to their level of marginalization and access to health services. The most affected area was Indigenous, followed by rural areas. The sector that was least affected was urban.   Although health coverage is highly concentrated in urban areas in Mexico, shortages are mostly concentrated in rural areas where Indigenous groups represent the extreme end of marginalization and access to medical coverage. Inadequate access to health services in the Indigenous and rural populations throws the gravity of the public health problem into relief.

Hyperspectral Cubesat Constellation for Rapid Natural Hazard Response

NASA Astrophysics Data System (ADS)

Mandl, D.; Huemmrich, K. F.; Ly, V. T.; Handy, M.; Ong, L.; Crum, G.

2015-12-01

With the advent of high performance space networks that provide total coverage for Cubesats, the paradigm for low cost, high temporal coverage with hyperspectral instruments becomes more feasible. The combination of ground cloud computing resources, high performance with low power consumption onboard processing, total coverage for the cubesats and social media provide an opprotunity for an architecture that provides cost-effective hyperspectral data products for natural hazard response and decision support. This paper provides a series of pathfinder efforts to create a scalable Intelligent Payload Module(IPM) that has flown on a variety of airborne vehicles including Cessna airplanes, Citation jets and a helicopter and will fly on an Unmanned Aerial System (UAS) hexacopter to monitor natural phenomena. The IPM's developed thus far were developed on platforms that emulate a satellite environment which use real satellite flight software, real ground software. In addition, science processing software has been developed that perform hyperspectral processing onboard using various parallel processing techniques to enable creation of onboard hyperspectral data products while consuming low power. A cubesat design was developed that is low cost and that is scalable to larger consteallations and thus can provide daily hyperspectral observations for any spot on earth. The design was based on the existing IPM prototypes and metrics that were developed over the past few years and a shrunken IPM that can perform up to 800 Mbps throughput. Thus this constellation of hyperspectral cubesats could be constantly monitoring spectra with spectral angle mappers after Level 0, Level 1 Radiometric Correction, Atmospheric Correction processing. This provides the opportunity daily monitoring of any spot on earth on a daily basis at 30 meter resolution which is not available today.

Intervene before leaving: clustered lot quality assurance sampling to monitor vaccination coverage at health district level before the end of a yellow fever and measles vaccination campaign in Sierra Leone in 2009.

PubMed

Pezzoli, Lorenzo; Conteh, Ishata; Kamara, Wogba; Gacic-Dobo, Marta; Ronveaux, Olivier; Perea, William A; Lewis, Rosamund F

2012-06-07

In November 2009, Sierra Leone conducted a preventive yellow fever (YF) vaccination campaign targeting individuals aged nine months and older in six health districts. The campaign was integrated with a measles follow-up campaign throughout the country targeting children aged 9-59 months. For both campaigns, the operational objective was to reach 95% of the target population. During the campaign, we used clustered lot quality assurance sampling (C-LQAS) to identify areas of low coverage to recommend timely mop-up actions. We divided the country in 20 non-overlapping lots. Twelve lots were targeted by both vaccinations, while eight only by measles. In each lot, five clusters of ten eligible individuals were selected for each vaccine. The upper threshold (UT) was set at 90% and the lower threshold (LT) at 75%. A lot was rejected for low vaccination coverage if more than 7 unvaccinated individuals (not presenting vaccination card) were found. After the campaign, we plotted the C-LQAS results against the post-campaign coverage estimations to assess if early interventions were successful enough to increase coverage in the lots that were at the level of rejection before the end of the campaign. During the last two days of campaign, based on card-confirmed vaccination status, five lots out of 20 (25.0%) failed for having low measles vaccination coverage and three lots out of 12 (25.0%) for low YF coverage. In one district, estimated post-campaign vaccination coverage for both vaccines was still not significantly above the minimum acceptable level (LT = 75%) even after vaccination mop-up activities. C-LQAS during the vaccination campaign was informative to identify areas requiring mop-up activities to reach the coverage target prior to leaving the region. The only district where mop-up activities seemed to be unsuccessful might have had logistical difficulties that should be further investigated and resolved.

[The relationship between MMR vaccination level and the number of new cases of autism in children].

PubMed

Mrozek-Budzyn, Dorota; Kiełtyka, Agnieszka

2008-01-01

The MMR vaccination coverage in Malopolskie voivodeship improved rapidly and finally reached a high level during last years. The number of new cases of autism spectrum disorders in children during that time revealed a slightly rising but not significant trend, while the number of childhood autism were stable. Ecological study showed no correlation between MMR vaccination and an increased risk of childhood autism and autism spectrum disorders in children.

High-performance perovskite CH3NH3PbI3 thin films for solar cells prepared by single-source physical vapour deposition

PubMed Central

Fan, Ping; Gu, Di; Liang, Guang-Xing; Luo, Jing-Ting; Chen, Ju-Long; Zheng, Zhuang-Hao; Zhang, Dong-Ping

2016-01-01

In this work, an alternative route to fabricating high-quality CH3NH3PbI3 thin films is proposed. Single-source physical vapour deposition (SSPVD) without a post-heat-treating process was used to prepare CH3NH3PbI3 thin films at room temperature. This new process enabled complete surface coverage and moisture stability in a non-vacuum solution. Moreover, the challenges of simultaneously controlling evaporation processes of the organic and inorganic sources via dual-source vapour evaporation and the heating process required to obtain high crystallization were avoided. Excellent composition with stoichiometry transferred from the powder material, a high level of tetragonal phase-purity, full surface coverage, well-defined grain structure, high crystallization and reproducibility were obtained. A PCE of approximately 10.90% was obtained with a device based on SSPVD CH3NH3PbI3. These initial results suggest that SSPVD is a promising method to significantly optimize perovskite CH3NH3PbI3 solar cell efficiency. PMID:27426686

Barrier Coverage for 3D Camera Sensor Networks

PubMed Central

Wu, Chengdong; Zhang, Yunzhou; Jia, Zixi; Ji, Peng; Chu, Hao

2017-01-01

Barrier coverage, an important research area with respect to camera sensor networks, consists of a number of camera sensors to detect intruders that pass through the barrier area. Existing works on barrier coverage such as local face-view barrier coverage and full-view barrier coverage typically assume that each intruder is considered as a point. However, the crucial feature (e.g., size) of the intruder should be taken into account in the real-world applications. In this paper, we propose a realistic resolution criterion based on a three-dimensional (3D) sensing model of a camera sensor for capturing the intruder’s face. Based on the new resolution criterion, we study the barrier coverage of a feasible deployment strategy in camera sensor networks. Performance results demonstrate that our barrier coverage with more practical considerations is capable of providing a desirable surveillance level. Moreover, compared with local face-view barrier coverage and full-view barrier coverage, our barrier coverage is more reasonable and closer to reality. To the best of our knowledge, our work is the first to propose barrier coverage for 3D camera sensor networks. PMID:28771167

Barrier Coverage for 3D Camera Sensor Networks.

PubMed

Si, Pengju; Wu, Chengdong; Zhang, Yunzhou; Jia, Zixi; Ji, Peng; Chu, Hao

2017-08-03

Barrier coverage, an important research area with respect to camera sensor networks, consists of a number of camera sensors to detect intruders that pass through the barrier area. Existing works on barrier coverage such as local face-view barrier coverage and full-view barrier coverage typically assume that each intruder is considered as a point. However, the crucial feature (e.g., size) of the intruder should be taken into account in the real-world applications. In this paper, we propose a realistic resolution criterion based on a three-dimensional (3D) sensing model of a camera sensor for capturing the intruder's face. Based on the new resolution criterion, we study the barrier coverage of a feasible deployment strategy in camera sensor networks. Performance results demonstrate that our barrier coverage with more practical considerations is capable of providing a desirable surveillance level. Moreover, compared with local face-view barrier coverage and full-view barrier coverage, our barrier coverage is more reasonable and closer to reality. To the best of our knowledge, our work is the first to propose barrier coverage for 3D camera sensor networks.

A Practical Tutorial on Modified Condition/Decision Coverage

NASA Technical Reports Server (NTRS)

Hayhurst, Kelly J.; Veerhusen, Dan S.; Chilenski, John J.; Rierson, Leanna K.

2001-01-01

This tutorial provides a practical approach to assessing modified condition/decision coverage (MC/DC) for aviation software products that must comply with regulatory guidance for DO-178B level A software. The tutorial's approach to MC/DC is a 5-step process that allows a certification authority or verification analyst to evaluate MC/DC claims without the aid of a coverage tool. In addition to the MC/DC approach, the tutorial addresses factors to consider in selecting and qualifying a structural coverage analysis tool, tips for reviewing life cycle data related to MC/DC, and pitfalls common to structural coverage analysis.

Amount of newspaper coverage of high school athletics for boys and girls on sports page and newspaper circulation.

PubMed

Pedersen, Paul M; Whisenant, Warren A

2002-02-01

This study analyzed the amount of coverage for high school athletics in 43 newspapers with small circulation by devoting 40% of their interscholastic athletics coverage to girls in athletics, printed significantly more articles about girls' athletics than did the newspapers with medium (33%) or large (32%) circulation. Therefore, the smaller the newspaper circulation, the more equitable the coverage of athletics for girls and boys. This finding was consistent with some prior work but not all.

Vaccination coverage survey in Dhaka District.

PubMed

Khan, M N A; Rahman, M L; Awal Miah, A; Islam, M S; Musa, S A J M; Tofail, F

2005-08-01

A survey was conducted in Dhaka District to measure the level of routine immunization coverage of children (12-23 months), to assess the tetanus toxoid (TT) immunization coverage among mothers of children (12-23 month), to evaluate EPI program continuity (dropout rates) and quality (percent of Invalid doses, vaccination card availability etc.) For this purpose, a thirty cluster cross-sectional survey was conducted in October 2002 to assess the immunization coverage in Dhaka. In this survey 30 clusters were randomly selected from a list of villages in 63 Unions of Dhaka following probability proportion to size (PPS) sampling procedure. A total of 210 children was studied using pre-tested structured questionnaire. Descriptive statistics was employed using software SPSS package for data analysis. The study showed that the routine immunization coverage in Dhaka among children by 12 months of age by card + history was 97% for BCG, 97% for Diphtheria, Pertussis Tetanus (DPT 1) and Oral Polio Vaccine (OPV 1), 75% for DPT3 and OPV3 and 67% for measles. Sixty six percent of all children surveyed had received valid doses of all vaccines by 12 months (fully immunized child). Programme access as measured by crude DPT1 coverage was better in Keranigonj (97%). Vaccination cards retention rate for children was 84%. Invalid DPT (1,2 or 3) doses were given to 25% of vaccinated children; 18% of measles doses were invalid. Surprisingly, major cause for invalid doses were not due to early immunizations or due to card lost but for giving tick in the card, instead of writing a valid date. DPT1 and DPT3 and DPT1- Measles drop out rates were 5% and 13% respectively. Major reason parents gave for never vaccinating their children (zero dose children) was (43%), major reasons for incomplete vaccination was lack of knowledge regarding subsequent doses (46%). TT surveys were also conducted for mothers of the children surveyed for vaccination coverage (mothers between 15-49 year old). Valid TT 1-5 coverage by card+ history was 97%, 55%, 44%, 24% and 11%, respectively. Card retention rate for TT was 67%. The findings of this study revealed that access to child and TT immunizations were good. But high dropouts and invalid doses reduced these percentages of fully immunized child to 66%. Programmatic strategy must be undertaken to reduce the existing high dropout rate in both child and TT immunizations.

Surface diffusion of Sb on Ge(111) monitored quantitatively with optical second harmonic microscopy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schultz, K.A.; Seebauer, E.G.

Surface diffusion of Sb on Ge(111) has been measured with the newly developed technique of optical second harmonic microscopy. In this method, concentration profiles at submonolayer coverage are imaged directly by surface second harmonic generation with 5 {mu} spatial resolution. A Boltzmann--Matano analysis yields the coverage dependence of the diffusivity {ital D} without parametrization. Experiments were performed at roughly 70% of the bulk melting temperature {ital T}{sub {ital m}}. In the coverage range 0{le}{theta}{le}0.6, the activation energy {ital E}{sub diff} remains constant at 47.5{plus minus}1.5 kcal/mol, but the pre-exponential factor {ital D}{sub 0} decreases from 8.7{times}10{sup 3{plus minus}0.4} to 1.6{times}10{supmore » 2{plus minus}0.4} cm{sup 2}/s. Both {ital E}{sub diff} and {ital D}{sub 0} are quite large, which is consistent with high-temperature measurements in other systems. The inadequacies of current theories for high-temperature surface diffusion are outlined, and a new vacancy model is proposed for low-coverage diffusion. The model accounts semiquantitatively for the large values of {ital E}{sub diff} and {ital D}{sub 0}, and suggests that these quantities may be manipulated using doping levels and photon illumination. An islanding mechanism is proposed to explain the decrease in {ital D}{sub 0} with {theta}.« less

Combination HIV prevention among MSM in South Africa: results from agent-based modeling.

PubMed

Brookmeyer, Ron; Boren, David; Baral, Stefan D; Bekker, Linda-Gail; Phaswana-Mafuya, Nancy; Beyrer, Chris; Sullivan, Patrick S

2014-01-01

HIV prevention trials have demonstrated the effectiveness of a number of behavioral and biomedical interventions. HIV prevention packages are combinations of interventions and offer potential to significantly increase the effectiveness of any single intervention. Estimates of the effectiveness of prevention packages are important for guiding the development of prevention strategies and for characterizing effect sizes before embarking on large scale trials. Unfortunately, most research to date has focused on testing single interventions rather than HIV prevention packages. Here we report the results from agent-based modeling of the effectiveness of HIV prevention packages for men who have sex with men (MSM) in South Africa. We consider packages consisting of four components: antiretroviral therapy for HIV infected persons with CD4 count <350; PrEP for high risk uninfected persons; behavioral interventions to reduce rates of unprotected anal intercourse (UAI); and campaigns to increase HIV testing. We considered 163 HIV prevention packages corresponding to different intensity levels of the four components. We performed 2252 simulation runs of our agent-based model to evaluate those packages. We found that a four component package consisting of a 15% reduction in the rate of UAI, 50% PrEP coverage of high risk uninfected persons, 50% reduction in persons who never test for HIV, and 50% ART coverage over and above persons already receiving ART at baseline, could prevent 33.9% of infections over 5 years (95% confidence interval, 31.5, 36.3). The package components with the largest incremental prevention effects were UAI reduction and PrEP coverage. The impact of increased HIV testing was magnified in the presence of PrEP. We find that HIV prevention packages that include both behavioral and biomedical components can in combination prevent significant numbers of infections with levels of coverage, acceptance and adherence that are potentially achievable among MSM in South Africa.

A Computational Approach to Characterizing the Impact of Social Influence on Individuals’ Vaccination Decision Making

PubMed Central

Xia, Shang; Liu, Jiming

2013-01-01

In modeling individuals vaccination decision making, existing studies have typically used the payoff-based (e.g., game-theoretical) approaches that evaluate the risks and benefits of vaccination. In reality, whether an individual takes vaccine or not is also influenced by the decisions of others, i.e., due to the impact of social influence. In this regard, we present a dual-perspective view on individuals decision making that incorporates both the cost analysis of vaccination and the impact of social influence. In doing so, we consider a group of individuals making their vaccination decisions by both minimizing the associated costs and evaluating the decisions of others. We apply social impact theory (SIT) to characterize the impact of social influence with respect to individuals interaction relationships. By doing so, we propose a novel modeling framework that integrates an extended SIT-based characterization of social influence with a game-theoretical analysis of cost minimization. We consider the scenario of voluntary vaccination against an influenza-like disease through a series of simulations. We investigate the steady state of individuals’ decision making, and thus, assess the impact of social influence by evaluating the coverage of vaccination for infectious diseases control. Our simulation results suggest that individuals high conformity to social influence will increase the vaccination coverage if the cost of vaccination is low, and conversely, will decrease it if the cost is high. Interestingly, if individuals are social followers, the resulting vaccination coverage would converge to a certain level, depending on individuals’ initial level of vaccination willingness rather than the associated costs. We conclude that social influence will have an impact on the control of an infectious disease as they can affect the vaccination coverage. In this respect, our work can provide a means for modeling the impact of social influence as well as for estimating the effectiveness of a voluntary vaccination program. PMID:23585835

A computational approach to characterizing the impact of social influence on individuals' vaccination decision making.

PubMed

Xia, Shang; Liu, Jiming

2013-01-01

In modeling individuals vaccination decision making, existing studies have typically used the payoff-based (e.g., game-theoretical) approaches that evaluate the risks and benefits of vaccination. In reality, whether an individual takes vaccine or not is also influenced by the decisions of others, i.e., due to the impact of social influence. In this regard, we present a dual-perspective view on individuals decision making that incorporates both the cost analysis of vaccination and the impact of social influence. In doing so, we consider a group of individuals making their vaccination decisions by both minimizing the associated costs and evaluating the decisions of others. We apply social impact theory (SIT) to characterize the impact of social influence with respect to individuals interaction relationships. By doing so, we propose a novel modeling framework that integrates an extended SIT-based characterization of social influence with a game-theoretical analysis of cost minimization. We consider the scenario of voluntary vaccination against an influenza-like disease through a series of simulations. We investigate the steady state of individuals' decision making, and thus, assess the impact of social influence by evaluating the coverage of vaccination for infectious diseases control. Our simulation results suggest that individuals high conformity to social influence will increase the vaccination coverage if the cost of vaccination is low, and conversely, will decrease it if the cost is high. Interestingly, if individuals are social followers, the resulting vaccination coverage would converge to a certain level, depending on individuals' initial level of vaccination willingness rather than the associated costs. We conclude that social influence will have an impact on the control of an infectious disease as they can affect the vaccination coverage. In this respect, our work can provide a means for modeling the impact of social influence as well as for estimating the effectiveness of a voluntary vaccination program.

A critical analysis of hazard resilience measures within sustainability assessment frameworks

DOE Office of Scientific and Technical Information (OSTI.GOV)

Matthews, Elizabeth C., E-mail: echiso1@lsu.edu; Sattler, Meredith, E-mail: msattler@lsu.edu; Friedland, Carol J., E-mail: friedland@lsu.edu

Today, numerous sustainability assessment frameworks (SAFs) exist to guide designers in achieving sustainable performance in the design of structures and communities. SAFs are beneficial in educating users and are useful tools for incorporating sustainability strategies into planning, design, and construction; however, there is currently a substantial gap in the ability of existing SAFs to incorporate hazard resistance and hazard mitigation in the broader context of sustainable design. This paper analyzes the incorporation of hazard resistant design and hazard mitigation strategies within SAFs via a multi-level analysis of eleven SAFs. The SAFs analyzed range in scale of application (i.e. building, site,more » community). Three levels of analysis are presented: (1) macro-level analysis comparing the number of measures strictly addressing resilience versus sustainability, (2) meso-level analysis of the coverage of types of hazards within SAFs (e.g. flood, fire), and (3) micro-level analysis of SAF measures connected to flood-related hazard resilience. The results demonstrate that hazard resistance and hazard mitigation do not figure prominently in the intent of SAFs and that weaknesses in resilience coverage exist that have the potential to lead to the design of structures and communities that are still highly vulnerable to the impacts of extreme events. - Highlights: • Sustainability assessment frameworks (SAFs) were analyzed for resilience coverage • Hazard resistance and mitigation do not figure prominently in the intent of SAFs • Approximately 75% of SAFs analyzed address three or fewer hazards • Lack of economic measures within SAFs could impact resilience and sustainability • Resilience measures for flood hazards are not consistently included in SAFs.« less

Modelling the implications of moving towards universal coverage in Tanzania.

PubMed

Borghi, Josephine; Mtei, Gemini; Ally, Mariam

2012-03-01

A model was developed to assess the impact of possible moves towards universal coverage in Tanzania over a 15-year time frame. Three scenarios were considered: maintaining the current situation ('the status quo'); expanded health insurance coverage (the estimated maximum achievable coverage in the absence of premium subsidies, coverage restricted to those who can pay); universal coverage to all (government revenues used to pay the premiums for the poor). The model estimated the costs of delivering public health services and all health services to the population as a proportion of Gross Domestic Product (GDP), and forecast revenue from user fees and insurance premiums. Under the status quo, financial protection is provided to 10% of the population through health insurance schemes, with the remaining population benefiting from subsidized user charges in public facilities. Seventy-six per cent of the population would benefit from financial protection through health insurance under the expanded coverage scenario, and 100% of the population would receive such protection through a mix of insurance cover and government funding under the universal coverage scenario. The expanded and universal coverage scenarios have a significant effect on utilization levels, especially for public outpatient care. Universal coverage would require an initial doubling in the proportion of GDP going to the public health system. Government health expenditure would increase to 18% of total government expenditure. The results are sensitive to the cost of health system strengthening, the level of real GDP growth, provider reimbursement rates and administrative costs. Promoting greater cross-subsidization between insurance schemes would provide sufficient resources to finance universal coverage. Alternately, greater tax funding for health could be generated through an increase in the rate of Value-Added Tax (VAT) or expanding the income tax base. The feasibility and sustainability of efforts to promote universal coverage will depend on the ability of the system to contain costs.

Modeling Impact and Cost-Effectiveness of Increased Efforts to Attract Voluntary Medical Male Circumcision Clients Ages 20-29 in Zimbabwe.

PubMed

Kripke, Katharine; Hatzold, Karin; Mugurungi, Owen; Ncube, Gertrude; Xaba, Sinokuthemba; Gold, Elizabeth; Ahanda, Kim Seifert; Kruse-Levy, Natalie; Njeuhmeli, Emmanuel

2016-01-01

Zimbabwe aims to increase circumcision coverage to 80% among 13- to 29-year-olds. However, implementation data suggest that high coverage among men ages 20 and older may not be achievable without efforts specifically targeted to these men, incurring additional costs per circumcision. Scale-up scenarios were created based on trends in implementation data in Zimbabwe, and the cost-effectiveness of increasing efforts to recruit clients ages 20-29 was examined. Zimbabwe voluntary medical male circumcision (VMMC) program data were used to project trends in male circumcision coverage by age into the future. The projection informed a base scenario in which, by 2018, the country achieves 80% circumcision coverage among males ages 10-19 and lower levels of coverage among men above age 20. The Zimbabwe DMPPT 2.0 model was used to project costs and impacts, assuming a US$109 VMMC unit cost in the base scenario and a 3% discount rate. Two other scenarios assumed that the program could increase coverage among clients ages 20-29 with a corresponding increase in unit cost for these age groups. When circumcision coverage among men ages 20-29 is increased compared with a base scenario reflecting current implementation trends, fewer VMMCs are required to avert one infection. If more than 50% additional effort (reflected as multiplying the unit cost by >1.5) is required to double the increase in coverage among this age group compared with the base scenario, the cost per HIV infection averted is higher than in the base scenario. Although increased investment in recruiting VMMC clients ages 20-29 may lead to greater overall impact if recruitment efforts are successful, it may also lead to lower cost-effectiveness, depending on the cost of increasing recruitment. Programs should measure the relationship between increased effort and increased ability to attract this age group.

Potential for reduction of burden and local elimination of malaria by reducing Plasmodium falciparum malaria transmission: a mathematical modelling study

PubMed Central

Griffin, Jamie T; Bhatt, Samir; Sinka, Marianne E; Gething, Peter W; Lynch, Michael; Patouillard, Edith; Shutes, Erin; Newman, Robert D; Alonso, Pedro; Cibulskis, Richard E; Ghani, Azra C

2016-01-01

Summary Background Rapid declines in malaria prevalence, cases, and deaths have been achieved globally during the past 15 years because of improved access to first-line treatment and vector control. We aimed to assess the intervention coverage needed to achieve further gains over the next 15 years. Methods We used a mathematical model of the transmission of Plasmodium falciparum malaria to explore the potential effect on case incidence and malaria mortality rates from 2015 to 2030 of five different intervention scenarios: remaining at the intervention coverage levels of 2011–13 (Sustain), for which coverage comprises vector control and access to treatment; two scenarios of increased coverage to 80% (Accelerate 1) and 90% (Accelerate 2), with a switch from quinine to injectable artesunate for management of severe disease and seasonal malaria chemoprevention where recommended for both Accelerate scenarios, and rectal artesunate for pre-referral treatment at the community level added to Accelerate 2; a near-term innovation scenario (Innovate), which included longer-lasting insecticidal nets and expansion of seasonal malaria chemoprevention; and a reduction in coverage to 2006–08 levels (Reverse). We did the model simulations at the first administrative level (ie, state or province) for the 80 countries with sustained stable malaria transmission in 2010, accounting for variations in baseline endemicity, seasonality in transmission, vector species, and existing intervention coverage. To calculate the cases and deaths averted, we compared the total number of each under the five scenarios between 2015 and 2030 with the predicted number in 2015, accounting for population growth. Findings With an increase to 80% coverage, we predicted a reduction in case incidence of 21% (95% credible intervals [CrI] 19–29) and a reduction in mortality rates of 40% (27–61) by 2030 compared with 2015 levels. Acceleration to 90% coverage and expansion of treatment at the community level was predicted to reduce case incidence by 59% (Crl 56–64) and mortality rates by 74% (67–82); with additional near-term innovation, incidence was predicted to decline by 74% (70–77) and mortality rates by 81% (76–87). These scenarios were predicted to lead to local elimination in 13 countries under the Accelerate 1 scenario, 20 under Accelerate 2, and 22 under Innovate by 2030, reducing the proportion of the population living in at-risk areas by 36% if elimination is defined at the first administrative unit. However, failing to maintain coverage levels of 2011–13 is predicted to raise case incidence by 76% (Crl 71–80) and mortality rates by 46% (39–51) by 2020. Interpretation Our findings show that decreases in malaria transmission and burden can be accelerated over the next 15 years if the coverage of key interventions is increased. Funding UK Medical Research Council, UK Department for International Development, the Bill & Melinda Gates Foundation, the Swiss Development Agency, and the US Agency for International Development. PMID:26809816

'Disease, disaster and despair'? The presentation of health in low- and middle-income countries on Australian television.

PubMed

Imison, Michelle; Chapman, Simon

2010-11-24

In high-income nations mainstream television news remains an important source of information about both general health issues and low- and middle-income countries (LMICs). However, research on news coverage of health in LMICs is scarce. The present paper examines the general features of Australian television coverage of LMIC health issues, testing the hypotheses that this coverage conforms to the general patterns of foreign news reporting in high-income countries and, in particular, that LMIC health coverage will largely reflect Australian interests. We analysed relevant items from May 2005 - December 2009 from the largest health-related television dataset of its kind, classifying each story on the basis of the region(s) it covered, principal content relating to health in LMICs and the presence of an Australian reference point. LMICs that are culturally proximate and politically significant to Australia had higher levels of reportage than more distant and unengaged nations. Items concerning communicable diseases, injury and aspects of child health generally consonant with 'disease, disaster and despair' news frames predominated, with relatively little emphasis given to chronic diseases which are increasingly prevalent in many LMICs. Forty-two percent of LMIC stories had explicit Australian content, such as imported medical expertise or health risk to Australians in LMICs. Media consumers' perceptions of disease burdens in LMICs and of these nations' capacity to identify and manage their own health priorities may be distorted by the major news emphasis on exotic disease, disaster and despair stories. Such perceptions may inhibit the development of appropriate policy emphases in high-income countries. In this context, non-government organisations concerned with international development may find it more difficult to strike a balance between crises and enduring issues in their health programming and fundraising efforts.

Health care expenditure burdens among adults with diabetes in 2001.

PubMed

Bernard, Didem M; Banthin, Jessica S; Encinosa, William E

2006-03-01

High out-of-pocket costs can pose a significant burden on patients with chronic conditions such as diabetes and contribute to decreased treatment adherence. We examined financial burdens among adults with diabetes using nationally representative data. estimated how frequently adults with diabetes live in families in which spending on health insurance premiums and health care services exceed a specified percentage of family-level after-tax disposable income. We found that adults with diabetes face greater risks of high burdens compared with adults with any other highly prevalent medical condition. Adults with diabetes have lower incomes and pay a higher share of total expenditures out-of-pocket compared with adults with heart disease, hypertension, and cancer. Among adults with diabetes, women, those who live in poverty, and those with coexisting conditions are more likely to bear high burdens. Among nonelderly adults, those with public coverage and the uninsured have greater risk of high burdens compared with those with private insurance. More than 23% of the uninsured and more than 20% of those with public coverage spend more than half of their disposable income on health care. Among the elderly, those with private nonemployment related insurance have the greatest risk of high burdens followed by those with Medicare only, those with private employment-related coverage, and those enrolled in Medicaid. Prescription medications and diabetic supplies account for 63% to 70% of out-of-pocket expenditures among the nonelderly and 62% to 69% among the elderly. Our study identifies the subpopulations among adults with diabetes who are more likely to have high burdens, so that intervention measures can be targeted to help reduce treatment noncompliance. Our analysis also emphasizes the role of medications and diabetic supplies in contributing to high out-of-pocket burdens.

Dynamics of Phenanthrenequinone on Carbon Nano-Onion Surfaces Probed by Quasielastic Neutron Scattering

DOE Office of Scientific and Technical Information (OSTI.GOV)

Anjos, Daniela M; Mamontov, Eugene; Brown, Gilbert M

We used quasielastic neutron scattering (QENS) to study the dynamics of phenanthrenequinone (PQ) on the surface of onion-like carbon (OLC), or so called carbon onions, as a function of surface coverage and temperature. For both the high- and low-coverage samples, we observed two diffusion processes; a faster process and nearly an order of magnitude slower process. On the high-coverage surface, the slow diffusion process is of long-range translational character, whereas the fast diffusion process is spatially localized on the length scale of ~ 4.7 . On the low-coverage surface, both diffusion processes are spatially localized; on the same length scalemore » of ~ 4.7 for the fast diffusion and a somewhat larger length scale for the slow diffusion. Arrhenius temperature dependence is observed except for the long-range diffusion on the high-coverage surface. We attribute the fast diffusion process to the generic localized in-cage dynamics of PQ molecules, and the slow diffusion process to the long-range translational dynamics of PQ molecules, which, depending on the coverage, may be either spatially restricted, or long-range. On the low-coverage surface, uniform surface coverage is not attained, and the PQ molecules experience the effect of spatial constraints on their long-range translational dynamics. Unexpectedly, the dynamics of PQ molecules on OLC as a function of temperature and surface coverage bears qualitative resemblance to the dynamics of water molecules on oxide surfaces, including practically temperature-independent residence times for the low-coverage surface. The dynamics features that we observed may be universal across different classes of surface adsorbates.« less

High and equitable mass vitamin A supplementation coverage in Sierra Leone: a post-event coverage survey.

PubMed

Hodges, Mary H; Sesay, Fatmata F; Kamara, Habib I; Turay, Mohamed; Koroma, Aminata S; Blankenship, Jessica L; Katcher, Heather I

2013-08-01

In Sierra Leone, children ages 6-59 months receive twice-yearly vitamin A supplementation (VAS) through Maternal and Child Health Week (MCHW) events. VAS coverage in 2011 was calculated using government tally sheets of vitamin A capsule distribution and outdated population projections from the 2004 census. We conducted a national post-event coverage (PEC) survey to validate coverage and inform strategies to reach universal coverage of VAS in Sierra Leone. Immediately following the November 2011 MCHW event, we conducted a national PEC survey by interviewing caregivers with children ages 6-59 months using a randomized 30X30 cluster design (N = 900). We also interviewed one health worker and one community health worker in each cluster to determine their knowledge about VAS (N = 60). VAS coverage was 91.8% among children ages 6-59 months, which was lower than the 105.1% reported through tally sheets. Coverage was high and equitable among all districts and between age groups (98.5% for infants ages 6-11 months and 90.5% for children ages 12-59 months). Major reasons for not receiving VAS were that the child was out of the area (42.4%), the household was not visited by community health workers (28.0%), and the caretaker was not aware of the event (11.9%). Twice-yearly delivery of VAS through MCHW events achieved consistently high and equitable coverage in Sierra Leone. Universal coverage may be achieved through continued focus on communication and targeted outreach to hard-to-reach areas during the MCHWs.

Breast Cancer Screening Programmes across the WHO European Region: Differences among Countries Based on National Income Level.

PubMed

Altobelli, Emma; Rapacchietta, Leonardo; Angeletti, Paolo Matteo; Barbante, Luca; Profeta, Filippo Valerio; Fagnano, Roberto

2017-04-23

Breast cancer (BC) is the most frequent tumour affecting women all over the world. In low- and middle-income countries, where its incidence is expected to rise further, BC seems set to become a public health emergency. The aim of the present study is to provide a systematic review of current BC screening programmes in WHO European Region to identify possible patterns. Multiple correspondence analysis was performed to evaluate the association among: measures of occurrence; GNI level; type of BC screening programme; organization of public information and awareness campaigns regarding primary prevention of modifiable risk factors; type of BC screening services; year of screening institution; screening coverage and data quality. A key difference between High Income (HI) and Low and Middle Income (LMI) States, emerging from the present data, is that in the former screening programmes are well organized, with approved screening centres, the presence of mobile units to increase coverage, the offer of screening tests free of charge; the fairly high quality of occurrence data based on high-quality sources, and the adoption of accurate methods to estimate incidence and mortality. In conclusion, the governments of LMI countries should allocate sufficient resources to increase screening participation and they should improve the accuracy of incidence and mortality rates.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Edwards, Timothy S.

Normal tolerance limits are frequently used in dynamic environments specifications of aerospace systems as a method to account for aleatory variability in the environments. Upper tolerance limits, when used in this way, are computed from records of the environment and used to enforce conservatism in the specification by describing upper extreme values the environment may take in the future. Components and systems are designed to withstand these extreme loads to ensure they do not fail under normal use conditions. The degree of conservatism in the upper tolerance limits is controlled by specifying the coverage and confidence level (usually written inmore » “coverage/confidence” form). Moreover, in high-consequence systems it is common to specify tolerance limits at 95% or 99% coverage and confidence at the 50% or 90% level. Despite the ubiquity of upper tolerance limits in the aerospace community, analysts and decision-makers frequently misinterpret their meaning. The misinterpretation extends into the standards that govern much of the acceptance and qualification of commercial and government aerospace systems. As a result, the risk of a future observation of the environment exceeding the upper tolerance limit is sometimes significantly underestimated by decision makers. This note explains the meaning of upper tolerance limits and a related measure, the upper prediction limit. So, the objective of this work is to clarify the probability of exceeding these limits in flight so that decision-makers can better understand the risk associated with exceeding design and test levels during flight and balance the cost of design and development with that of mission failure.« less

Out-of-Pocket Financial Burden for Low-Income Families with Children: Socioeconomic Disparities and Effects of Insurance

PubMed Central

Galbraith, Alison A; Wong, Sabrina T; Kim, Sue E; Newacheck, Paul W

2005-01-01

Objective To determine whether socioeconomic disparities exist in the financial burden of out-of-pocket (OOP) health care expenditures for families with children, and whether health insurance coverage decreases financial burden for low-income families. Data Source The Household Component of the 2001 Medical Expenditure Panel Survey. Study Design Cross-sectional family-level analysis. We used bivariate statistics to examine whether financial burden varied by poverty level. Multivariate regression models were used to assess whether family insurance coverage was associated with level of financial burden for low-income families. The main outcome was financial burden, defined as the proportion of family income spent on OOP health care expenditures, including premiums, for all family members. Data Collection/Extraction We aggregated annual OOP expenditures for all members of 4,531 families with a child <18 years old. Family insurance coverage was categorized as follows: (1) all members publicly insured all year, (2) all members privately insured all year, (3) all members uninsured all year, (4) partial coverage, or (5) mix of public and private with no uninsured periods. Principal Findings A regressive gradient was noted for financial burden across income groups, with families with incomes <100 percent of the Federal Poverty Level (FPL) spending a mean of $119.66 OOP per $1,000 of family income and families with incomes 100–199 percent FPL spending $66.30 OOP per $1,000, compared with $37.75 for families with incomes >400 percent FPL. For low-income families (<200 percent FPL), there was a 785 percent decrease in financial burden for those with full-year public coverage compared with those with full-year private insurance (p<.001). Conclusions Socioeconomic disparities exist in the financial burden of OOP health care expenditures for families with children. For low-income families, full-year public coverage provides significantly greater protection from financial burden than full-year private coverage. PMID:16336545

Out-of-pocket financial burden for low-income families with children: socioeconomic disparities and effects of insurance.

PubMed

Galbraith, Alison A; Wong, Sabrina T; Kim, Sue E; Newacheck, Paul W

2005-12-01

To determine whether socioeconomic disparities exist in the financial burden of out-of-pocket (OOP) health care expenditures for families with children, and whether health insurance coverage decreases financial burden for low-income families. The Household Component of the 2001 Medical Expenditure Panel Survey. Cross-sectional family-level analysis. We used bivariate statistics to examine whether financial burden varied by poverty level. Multivariate regression models were used to assess whether family insurance coverage was associated with level of financial burden for low-income families. The main outcome was financial burden, defined as the proportion of family income spent on OOP health care expenditures, including premiums, for all family members. We aggregated annual OOP expenditures for all members of 4,531 families with a child <18 years old. Family insurance coverage was categorized as follows: (1) all members publicly insured all year, (2) all members privately insured all year, (3) all members uninsured all year, (4) partial coverage, or (5) mix of public and private with no uninsured periods. A regressive gradient was noted for financial burden across income groups, with families with incomes <100 percent of the Federal Poverty Level (FPL) spending a mean of 119.66 US dollars OOP per 1,000 US dollars of family income and families with incomes 100-199 percent FPL spending 66.30 US dollars OOP per 1,000 US dollars, compared with 37.75 US dollars for families with incomes >400 percent FPL. For low-income families (<200 percent FPL), there was a 785 percent decrease in financial burden for those with full-year public coverage compared with those with full-year private insurance (p < .001). Socioeconomic disparities exist in the financial burden of OOP health care expenditures for families with children. For low-income families, full-year public coverage provides significantly greater protection from financial burden than full-year private coverage.

Two Birds With One Stone: Estimating Population Vaccination Coverage From a Test-negative Vaccine Effectiveness Case-control Study.

PubMed

Doll, Margaret K; Morrison, Kathryn T; Buckeridge, David L; Quach, Caroline

2016-10-15

Vaccination program evaluation includes assessment of vaccine uptake and direct vaccine effectiveness (VE). Often examined separately, we propose a design to estimate rotavirus vaccination coverage using controls from a rotavirus VE test-negative case-control study and to examine coverage following implementation of the Quebec, Canada, rotavirus vaccination program. We present our assumptions for using these data as a proxy for coverage in the general population, explore effects of diagnostic accuracy on coverage estimates via simulations, and validate estimates with an external source. We found 79.0% (95% confidence interval, 74.3%, 83.0%) ≥2-dose rotavirus coverage among participants eligible for publicly funded vaccination. No differences were detected between study and external coverage estimates. Simulations revealed minimal bias in estimates with high diagnostic sensitivity and specificity. We conclude that controls from a VE case-control study may be a valuable resource of coverage information when reasonable assumptions can be made for estimate generalizability; high rotavirus coverage demonstrates success of the Quebec program. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Temporal trends in coverage of historical cardiac arrests using a volunteer-based network of automated external defibrillators accessible to laypersons and emergency dispatch centers.

PubMed

Hansen, Carolina Malta; Lippert, Freddy Knudsen; Wissenberg, Mads; Weeke, Peter; Zinckernagel, Line; Ruwald, Martin H; Karlsson, Lena; Gislason, Gunnar Hilmar; Nielsen, Søren Loumann; Køber, Lars; Torp-Pedersen, Christian; Folke, Fredrik

2014-11-18

Although increased dissemination of automated external defibrillators (AEDs) has been associated with more frequent AED use, the trade-off between the number of deployed AEDs and coverage of cardiac arrests remains unclear. We investigated how volunteer-based AED dissemination affected public cardiac arrest coverage in high- and low-risk areas. All public cardiac arrests (1994-2011) and all registered AEDs (2007-2011) in Copenhagen, Denmark, were identified and geocoded. AED coverage of cardiac arrests was defined as historical arrests ≤100 m from an AED. High-risk areas were defined as those with ≥1 arrest every 2 years and accounted for 1.0% of the total city area. Of 1864 cardiac arrests, 18.0% (n=335) occurred in high-risk areas throughout the study period. From 2007 to 2011, the number of AEDs and the corresponding coverage of cardiac arrests increased from 36 to 552 and from 2.7% to 32.6%, respectively. The corresponding increase for high-risk areas was from 1 to 30 AEDs and coverage from 5.7% to 51.3%, respectively. Since the establishment of the AED network (2007-2011), few arrests (n=55) have occurred ≤100 m from an AED with only 14.5% (n=8) being defibrillated before the arrival of emergency medical services. Despite the lack of a coordinated public access defibrillation program, the number of AEDs increased 15-fold with a corresponding increase in cardiac arrest coverage from 2.7% to 32.6% over a 5-year period. The highest increase in coverage was observed in high-risk areas (from 5.7% to 51.3%). AED networks can be used as useful tools to optimize AED placement in community settings. © 2014 American Heart Association, Inc.

SWATHtoMRM: Development of High-Coverage Targeted Metabolomics Method Using SWATH Technology for Biomarker Discovery.

PubMed

Zha, Haihong; Cai, Yuping; Yin, Yandong; Wang, Zhuozhong; Li, Kang; Zhu, Zheng-Jiang

2018-03-20

The complexity of metabolome presents a great analytical challenge for quantitative metabolite profiling, and restricts the application of metabolomics in biomarker discovery. Targeted metabolomics using multiple-reaction monitoring (MRM) technique has excellent capability for quantitative analysis, but suffers from the limited metabolite coverage. To address this challenge, we developed a new strategy, namely, SWATHtoMRM, which utilizes the broad coverage of SWATH-MS technology to develop high-coverage targeted metabolomics method. Specifically, SWATH-MS technique was first utilized to untargeted profile one pooled biological sample and to acquire the MS 2 spectra for all metabolites. Then, SWATHtoMRM was used to extract the large-scale MRM transitions for targeted analysis with coverage as high as 1000-2000 metabolites. Then, we demonstrated the advantages of SWATHtoMRM method in quantitative analysis such as coverage, reproducibility, sensitivity, and dynamic range. Finally, we applied our SWATHtoMRM approach to discover potential metabolite biomarkers for colorectal cancer (CRC) diagnosis. A high-coverage targeted metabolomics method with 1303 metabolites in one injection was developed to profile colorectal cancer tissues from CRC patients. A total of 20 potential metabolite biomarkers were discovered and validated for CRC diagnosis. In plasma samples from CRC patients, 17 out of 20 potential biomarkers were further validated to be associated with tumor resection, which may have a great potential in assessing the prognosis of CRC patients after tumor resection. Together, the SWATHtoMRM strategy provides a new way to develop high-coverage targeted metabolomics method, and facilitates the application of targeted metabolomics in disease biomarker discovery. The SWATHtoMRM program is freely available on the Internet ( http://www.zhulab.cn/software.php ).

Improved hybrid de novo genome assembly of domesticated apple (Malus x domestica).

PubMed

Li, Xuewei; Kui, Ling; Zhang, Jing; Xie, Yinpeng; Wang, Liping; Yan, Yan; Wang, Na; Xu, Jidi; Li, Cuiying; Wang, Wen; van Nocker, Steve; Dong, Yang; Ma, Fengwang; Guan, Qingmei

2016-08-08

Domesticated apple (Malus × domestica Borkh) is a popular temperate fruit with high nutrient levels and diverse flavors. In 2012, global apple production accounted for at least one tenth of all harvested fruits. A high-quality apple genome assembly is crucial for the selection and breeding of new cultivars. Currently, a single reference genome is available for apple, assembled from 16.9 × genome coverage short reads via Sanger and 454 sequencing technologies. Although a useful resource, this assembly covers only ~89 % of the non-repetitive portion of the genome, and has a relatively short (16.7 kb) contig N50 length. These downsides make it difficult to apply this reference in transcriptive or whole-genome re-sequencing analyses. Here we present an improved hybrid de novo genomic assembly of apple (Golden Delicious), which was obtained from 76 Gb (~102 × genome coverage) Illumina HiSeq data and 21.7 Gb (~29 × genome coverage) PacBio data. The final draft genome is approximately 632.4 Mb, representing ~ 90 % of the estimated genome. The contig N50 size is 111,619 bp, representing a 7 fold improvement. Further annotation analyses predicted 53,922 protein-coding genes and 2,765 non-coding RNA genes. The new apple genome assembly will serve as a valuable resource for investigating complex apple traits at the genomic level. It is not only suitable for genome editing and gene cloning, but also for RNA-seq and whole-genome re-sequencing studies.

Attendance at Cervical Cancer Screening and Use of Diagnostic and Therapeutic Procedures on the Uterine Cervix Assessed from Individual Health Insurance Data (Belgium, 2002-2006)

PubMed Central

Arbyn, Marc; Fabri, Valérie; Temmerman, Marleen; Simoens, Cindy

2014-01-01

Objective To assess the coverage for cervical cancer screening as well as the use of cervical cytology, colposcopy and other diagnostic and therapeutic interventions on the uterine cervix in Belgium, using individual health insurance data. Methods The Intermutualistic Agency compiled a database containing 14 million records from reimbursement claims for Pap smears, colposcopies, cervical biopsies and surgery, performed between 2002 and 2006. Cervical cancer screening coverage was defined as the proportion of women aged 25–64 that had a Pap smear within the last 3 years. Results Cervical cancer screening coverage was 61% at national level, for the target population of women between 25 and 64 years old, in the period 2004–2006. Differences between the 3 regions were small, but varied more substantially between provinces. Coverage was 70% for 25–34 year old women, 67% for those aged 35–39 years, and decreased to 44% in the age group of 60–64 years. The median screening interval was 13 months. The screening coverage varied substantially by social category: 40% and 64%, in women categorised as beneficiary or not-beneficiary of increased reimbursement from social insurance, respectively. In the 3-year period 2004–2006, 3.2 million screen tests were done in the target group consisting of 2.8 million women. However, only 1.7 million women got one or more smears and 1.1 million women had no smears, corresponding to an average of 1.88 smears per woman in three years of time. Colposcopy was excessively used (number of Pap smears over colposcopies = 3.2). The proportion of women with a history of conisation or hysterectomy, before the age of 65, was 7% and 19%, respectively. Conclusion The screening coverage increased slightly from 59% in 2000 to 61% in 2006. The screening intensity remained at a high level, and the number of cytological examinations was theoretically sufficient to cover more than the whole target population. PMID:24690620

Viewing the Kenyan health system through an equity lens: implications for universal coverage

PubMed Central

2011-01-01

Introduction Equity and universal coverage currently dominate policy debates worldwide. Health financing approaches are central to universal coverage. The way funds are collected, pooled, and used to purchase or provide services should be carefully considered to ensure that population needs are addressed under a universal health system. The aim of this paper is to assess the extent to which the Kenyan health financing system meets the key requirements for universal coverage, including income and risk cross-subsidisation. Recommendations on how to address existing equity challenges and progress towards universal coverage are made. Methods An extensive review of published and gray literature was conducted to identify the sources of health care funds in Kenya. Documents were mainly sourced from the Ministry of Medical Services and the Ministry of Public Health and Sanitation. Country level documents were the main sources of data. In cases where data were not available at the country level, they were sought from the World Health Organisation website. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. Results The Kenyan health sector relies heavily on out-of-pocket payments. Government funds are mainly allocated through historical incremental approach. The sector is largely underfunded and health care contributions are regressive (i.e. the poor contribute a larger proportion of their income to health care than the rich). Health financing in Kenya is fragmented and there is very limited risk and income cross-subsidisation. The country has made little progress towards achieving international benchmarks including the Abuja target of allocating 15% of government's budget to the health sector. Conclusions The Kenyan health system is highly inequitable and policies aimed at promoting equity and addressing the needs of the poor and vulnerable have not been successful. Some progress has been made towards addressing equity challenges, but universal coverage will not be achieved unless the country adopts a systemic approach to health financing reforms. Such an approach should be informed by the wider health system goals of equity and efficiency. PMID:21612669

Medicaid dental coverage alone may not lower rates of dental emergency department visits.

PubMed

Fingar, Kathryn R; Smith, Mark W; Davies, Sheryl; McDonald, Kathryn M; Stocks, Carol; Raven, Maria C

2015-08-01

Medicaid was expanded to millions of individuals under the Affordable Care Act, but many states do not provide dental coverage for adults under their Medicaid programs. In the absence of dental coverage, patients may resort to costly emergency department (ED) visits for dental conditions. Medicaid coverage of dental benefits could help ease the burden on the ED, but ED use for dental conditions might remain a problem in areas with a scarcity of dentists. We examined county-level rates of ED visits for nontraumatic dental conditions in twenty-nine states in 2010 in relation to dental provider density and Medicaid coverage of nonemergency dental services. Higher density of dental providers was associated with lower rates of dental ED visits by patients with Medicaid in rural counties but not in urban counties, where most dental ED visits occurred. County-level Medicaid-funded dental ED visit rates were lower in states where Medicaid covered nonemergency dental services than in other states, although this difference was not significant after other factors were adjusted for. Providing dental coverage alone might not reduce Medicaid-funded dental ED visits if patients do not have access to dental providers. Project HOPE—The People-to-People Health Foundation, Inc.

Critical assessment of high-circulation print newspaper coverage of the Institute of Medicine report Dietary Reference Intakes for Calcium and Vitamin D

USDA-ARS?s Scientific Manuscript database

The objective of this article is to evaluate high-circulation US and Canadian newspaper coverage of the Institute of Medicine (IOM) report Dietary Reference Intakes for Calcium and Vitamin D and assess pre-report and post-report reporter-specific vitamin D-related coverage. Two independent reviewers...

50 CFR 635.7 - At-sea observer coverage.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false At-sea observer coverage. 635.7 Section... ADMINISTRATION, DEPARTMENT OF COMMERCE ATLANTIC HIGHLY MIGRATORY SPECIES General § 635.7 At-sea observer coverage. (a) Applicability. NMFS may select for at-sea observer coverage any vessel that has an Atlantic HMS...

50 CFR 635.7 - At-sea observer coverage.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 10 2011-10-01 2011-10-01 false At-sea observer coverage. 635.7 Section... ADMINISTRATION, DEPARTMENT OF COMMERCE ATLANTIC HIGHLY MIGRATORY SPECIES General § 635.7 At-sea observer coverage. (a) Applicability. NMFS may select for at-sea observer coverage any vessel that has an Atlantic HMS...

50 CFR 635.7 - At-sea observer coverage.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 8 2010-10-01 2010-10-01 false At-sea observer coverage. 635.7 Section... ADMINISTRATION, DEPARTMENT OF COMMERCE ATLANTIC HIGHLY MIGRATORY SPECIES General § 635.7 At-sea observer coverage. (a) Applicability. NMFS may select for at-sea observer coverage any vessel that has an Atlantic HMS...

50 CFR 635.7 - At-sea observer coverage.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 12 2013-10-01 2013-10-01 false At-sea observer coverage. 635.7 Section... ADMINISTRATION, DEPARTMENT OF COMMERCE ATLANTIC HIGHLY MIGRATORY SPECIES General § 635.7 At-sea observer coverage. (a) Applicability. NMFS may select for at-sea observer coverage any vessel that has an Atlantic HMS...

50 CFR 635.7 - At-sea observer coverage.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 12 2012-10-01 2012-10-01 false At-sea observer coverage. 635.7 Section... ADMINISTRATION, DEPARTMENT OF COMMERCE ATLANTIC HIGHLY MIGRATORY SPECIES General § 635.7 At-sea observer coverage. (a) Applicability. NMFS may select for at-sea observer coverage any vessel that has an Atlantic HMS...

Validity of vaccination cards and parental recall to estimate vaccination coverage: a systematic review of the literature.

PubMed

Miles, Melody; Ryman, Tove K; Dietz, Vance; Zell, Elizabeth; Luman, Elizabeth T

2013-03-15

Immunization programs frequently rely on household vaccination cards, parental recall, or both to calculate vaccination coverage. This information is used at both the global and national level for planning and allocating performance-based funds. However, the validity of household-derived coverage sources has not yet been widely assessed or discussed. To advance knowledge on the validity of different sources of immunization coverage, we undertook a global review of literature. We assessed concordance, sensitivity, specificity, positive and negative predictive value, and coverage percentage point difference when subtracting household vaccination source from a medical provider source. Median coverage difference per paper ranged from -61 to +1 percentage points between card versus provider sources and -58 to +45 percentage points between recall versus provider source. When card and recall sources were combined, median coverage difference ranged from -40 to +56 percentage points. Overall, concordance, sensitivity, specificity, positive and negative predictive value showed poor agreement, providing evidence that household vaccination information may not be reliable, and should be interpreted with care. While only 5 papers (11%) included in this review were from low-middle income countries, low-middle income countries often rely more heavily on household vaccination information for decision making. Recommended actions include strengthening quality of child-level data and increasing investments to improve vaccination card availability and card marking. There is also an urgent need for additional validation studies of vaccine coverage in low and middle income countries. Copyright © 2013. Published by Elsevier Ltd.

Toward Revealing the Critical Role of Perovskite Coverage in Highly Efficient Electron-Transport Layer-Free Perovskite Solar Cells: An Energy Band and Equivalent Circuit Model Perspective.

PubMed

Huang, Like; Xu, Jie; Sun, Xiaoxiang; Du, Yangyang; Cai, Hongkun; Ni, Jian; Li, Juan; Hu, Ziyang; Zhang, Jianjun

2016-04-20

Currently, most efficient perovskite solar cells (PVKSCs) with a p-i-n structure require simultaneously electron transport layers (ETLs) and hole transport layers (HTLs) to help collecting photogenerated electrons and holes for obtaining high performance. ETL free planar PVKSC is a relatively new and simple structured solar cell that gets rid of the complex and high temperature required ETL (such as compact and mesoporous TiO2). Here, we demonstrate the critical role of high coverage of perovskite in efficient ETL free PVKSCs from an energy band and equivalent circuit model perspective. From an electrical point of view, we confirmed that the low coverage of perovskite does cause localized short circuit of the device. With coverage optimization, a planar p-i-n(++) device with a power conversion efficiency of over 11% was achieved, implying that the ETL layer may not be necessary for an efficient device as long as the perovskite coverage is approaching 100%.

MISR Level 2 TOA/Cloud Classifier parameters (MIL2TCCL_V2)

NASA Technical Reports Server (NTRS)

Diner, David J. (Principal Investigator)

The TOA/Cloud Classifiers contain the Angular Signature Cloud Mask (ASCM), a scene classifier calculated using support vector machine technology (SVM) both of which are on a 1.1 km grid, and cloud fractions at 17.6 km resolution that are available in different height bins (low, middle, high) and are also calculated on an angle-by-angle basis. [Location=GLOBAL] [Temporal_Coverage: Start_Date=2000-02-24; Stop_Date=] [Spatial_Coverage: Southernmost_Latitude=-90; Northernmost_Latitude=90; Westernmost_Longitude=-180; Easternmost_Longitude=180] [Data_Resolution: Latitude_Resolution=17.6 km; Longitude_Resolution=17.6 km; Horizontal_Resolution_Range=10 km - < 50 km or approximately .09 degree - < .5 degree; Temporal_Resolution=about 15 orbits/day; Temporal_Resolution_Range=Daily - < Weekly, Daily - < Weekly].

High Rate of Discontinuation May Diminish PrEP Coverage Among Young Men Who Have Sex with Men.

PubMed

Morgan, Ethan; Ryan, Daniel T; Newcomb, Michael E; Mustanski, Brian

2018-05-04

Understanding pre-exposure prophylaxis (PrEP) discontinuation is key to maximizing its effectiveness at the individual and population levels. Data came from the RADAR cohort study of MSM aged 16-29 years, 2015-2017. Participants included those who reported past 6-month PrEP use and discontinued its use by the interview date. Of the 197 participants who had used PrEP in the past 6 months, 65 discontinued use. Primary reasons for PrEP discontinuation included trouble getting to doctor's appointments (14, 21.5%) and issues related to insurance coverage or loss (13, 20.0%). Few (21%) who discontinued spoke to their doctor first, which has important implications for future long acting formulations.

Expansion of Coverage under the Patient Protection and Affordable Care Act and Primary Care Utilization

PubMed Central

Hofer, Adam N; Abraham, Jean Marie; Moscovice, Ira

2011-01-01

Context: Provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA) expand Medicaid to all individuals in families earning less than 133 percent of the federal poverty level (FPL) and make available subsidies to uninsured lower-income Americans (133 to 400 percent of FPL) without access to employer-based coverage to purchase insurance in new exchanges. Since primary care physicians typically serve as the point of entry into the health care delivery system, an adequate supply of them is critical to meeting the anticipated increase in demand for medical care resulting from the expansion of coverage. This article provides state-level estimates of the anticipated increases in primary care utilization given the PPACA's provisions for expanded coverage. Methods: Using the Medical Expenditure Panel Survey, this article estimates a multivariate regression model of annual primary care utilization. Using the model estimates and state-level information regarding the number of uninsured, it predicts, by state, the change in primary care visits expected from the expanded coverage. Finally, the article predicts the number of primary care physicians needed to accommodate this change in utilization. Findings: This expanded coverage is predicted to increase by 2019 the number of annual primary care visits between 15.07 million and 24.26 million. Assuming stable levels of physicians’ productivity, between 4,307 and 6,940 additional primary care physicians would be needed to accommodate this increase. Conclusions: The PPACA's health insurance expansion parameters are expected to significantly increase the use of primary care. Two strategies that policymakers may consider are creating stronger financial incentives to attract medical school students to primary care and changing the delivery of care in ways that lead to operational improvements, higher throughput, and better quality of care. PMID:21418313

Technical efficiency of rural primary health care system for diabetes treatment in Iran: a stochastic frontier analysis.

PubMed

Qorbani, Mostafa; Farzadfar, Farshad; Majdzadeh, Reza; Mohammad, Kazem; Motevalian, Abbas

2017-01-01

Our aim was to explore the technical efficiency (TE) of the Iranian rural primary healthcare (PHC) system for diabetes treatment coverage rate using the stochastic frontier analysis (SFA) as well as to examine the strength and significance of the effect of human resources density on diabetes treatment. In the SFA model diabetes treatment coverage rate, as a output, is a function of health system inputs (Behvarz worker density, physician density, and rural health center density) and non-health system inputs (urbanization rate, median age of population, and wealth index) as a set of covariates. Data about the rate of self-reported diabetes treatment coverage was obtained from the Non-Communicable Disease Surveillance Survey, data about health system inputs were collected from the health census database and data about non-health system inputs were collected from the census data and household survey. In 2008, rate of diabetes treatment coverage was 67% (95% CI: 63%-71%) nationally, and at the provincial level it varied from 44% to 81%. The TE score at the national level was 87.84%, with considerable variation across provinces (from 59.65% to 98.28%).Among health system and non-health system inputs, only the Behvarz density (per 1000 population)was significantly associated with diabetes treatment coverage (β (95%CI): 0.50 (0.29-0.70), p  < 0.001). Our findings show that although the rural PHC system can considered efficient in diabetes treatment at the national level, a wide variation exists in TE at the provincial level. Because the only variable that is predictor of TE is the Behvarz density, the PHC system may extend the diabetes treatment coverage by using this group of health care workers.

Whom and where are we not vaccinating? Coverage after the introduction of a new conjugate vaccine against group A meningococcus in Niger in 2010.

PubMed

Kim, Sung Hye; Pezzoli, Lorenzo; Yacouba, Harouna; Coulibaly, Tiekoura; Djingarey, Mamoudou H; Perea, William A; Wierzba, Thomas F

2012-01-01

MenAfriVac is a new conjugate vaccine against Neisseria meningitidis serogroup A developed for the African "meningitis belt". In Niger, the first two phases of the MenAfriVac introduction campaign were conducted targeting 3,135,942 individuals aged 1 to 29 years in the regions of Tillabéri, Niamey, and Dosso, in September and December 2010. We evaluated the campaign and determined which sub-populations or areas had low levels of vaccination coverage in the regions of Tillabéri and Niamey. After Phase I, conducted in the Filingué district, we estimated coverage using a 30×15 cluster-sampling survey and nested lot quality assurance (LQA) analysis in the clustered samples to identify which subpopulations (defined by age 1-14/15-29 and sex) had unacceptable vaccination coverage (<70%). After Phase II, we used Clustered Lot Quality Assurance Sampling (CLQAS) to assess if any of eight districts in Niamey and Tillabéri had unacceptable vaccination coverage (<75%) and estimated overall coverage. Estimated vaccination coverage was 77.4% (95%CI: 84.6-70.2) as documented by vaccination cards and 85.5% (95% CI: 79.7-91.2) considering verbal history of vaccination for Phase I; 81.5% (95%CI: 86.1-77.0) by card and 93.4% (95% CI: 91.0-95.9) by verbal history for Phase II. Based on vaccination cards, in Filingué, we identified both the male and female adult (age 15-29) subpopulations as not reaching 70% coverage; and we identified three (one in Tillabéri and two in Niamey) out of eight districts as not reaching 75% coverage confirmed by card. Combined use of LQA and cluster sampling was useful to estimate vaccination coverage and to identify pockets with unacceptable levels of coverage (adult population and three districts). Although overall vaccination coverage was satisfactory, we recommend continuing vaccination in the areas or sub-populations with low coverage and reinforcing the social mobilization of the adult population.

Screening, prevention and treatment of cervical cancer -- a global and regional generalized cost-effectiveness analysis.

PubMed

Ginsberg, Gary Michael; Edejer, Tessa Tan-Torres; Lauer, Jeremy A; Sepulveda, Cecilia

2009-10-09

The paper calculates regional generalized cost-effectiveness estimates of screening, prevention, treatment and combined interventions for cervical cancer. Using standardised WHO-CHOICE methodology, a cervical cancer model was employed to provide estimates of screening, vaccination and treatment effectiveness. Intervention effectiveness was determined via a population state-transition model (PopMod) that simulates the evolution of a sub-regional population accounting for births, deaths and disease epidemiology. Economic costs of procedures and treatment were estimated, including programme overhead and training costs. In regions characterized by high income, low mortality and high existing treatment coverage, the addition of any screening programme to the current high treatment levels is very cost-effective. However, based on projections of the future price per dose (representing the economic costs of the vaccination excluding monopolistic rents and vaccine development cost) vaccination is the most cost-effective intervention. In regions characterized by low income, low mortality and existing treatment coverage around 50%, expanding treatment with or without combining it with screening appears to be cost-effective or very cost-effective. Abandoning treatment in favour of screening in a no-treatment scenario would not be cost-effective. Vaccination is usually the most cost-effective intervention. Penta or tri-annual PAP smears appear to be cost-effective, though when combined with HPV-DNA testing they are not cost-effective. In regions characterized by low income, high mortality and low treatment levels, expanding treatment with or without adding screening would be very cost-effective. A one off vaccination plus expanding treatment was usually very cost-effective. One-off PAP or VIA screening at age 40 are more cost-effective than other interventions though less effective overall. From a cost-effectiveness perspective, consideration should be given to implementing vaccination (depending on cost per dose and longevity of efficacy) and screening programmes on a worldwide basis to reduce the burden of disease from cervical cancer. Treatment should also be increased where coverage is low.

Coverage-dependent adsorption and desorption of oxygen on Pd(100)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dunnen, Angela den; Jacobse, Leon; Wiegman, Sandra

2016-06-28

We have studied the adsorption and desorption of O{sub 2} on Pd(100) by supersonic molecular beam techniques and thermal desorption spectroscopy. Adsorption measurements on the bare surface confirm that O{sub 2} initially dissociates for all kinetic energies between 56 and 380 meV and surface temperatures between 100 and 600 K via a direct mechanism. At and below 150 K, continued adsorption leads to a combined O/O{sub 2} overlayer. Dissociation of molecularly bound O{sub 2} during a subsequent temperature ramp leads to unexpected high atomic oxygen coverages, which are also obtained at high incident energy and high surface temperature. At intermediatemore » temperatures and energies, these high final coverages are not obtained. Our results show that kinetic energy of the gas phase reactant and reaction energy dissipated during O{sub 2} dissociation on the cold surface both enable activated nucleation of high-coverage surface structures. We suggest that excitation of local substrate phonons may play a crucial role in oxygen dissociation at any coverage.« less

24/7/365 in-house radiologist coverage: effect on resident education.

PubMed

Collins, Jannette; Gruppen, Larry D; Bailey, Janet E; Bokhari, Syed Ahmad Jamal; Paladin, Angelisa M; Robbins, Jessica; White, Richard D

2014-07-01

To compare programs with and without 24-hour/7 days a week/365 days a year (24/7/365) in-house radiologist coverage regarding resident perceptions of their on-call experience, volume of resident dictations on call, and report turnaround time. Residents from six academic radiology departments were invited to participate in an 11-item online survey. Survey items were related to workload, level of autonomy, faculty feedback, comfort level, faculty supervision, and overall educational experience while on call from 8 pm to 8 am. Each site provided data on imaging volume, radiologist coverage, volume of examinations dictated by residents, number of residents on call, and report turnaround time from 8 pm to 8 am. F-ratios and eta-squares were calculated to determine the relationships between dependent and independent variables. A P value < .05 was considered statistically significant. A total of 146 (67%) of 217 residents responded. Residents in programs with 24/7/365 in-house radiologist coverage dictated a lower percentage of examinations (46%) compared with other residents (81%) and rated faculty feedback more positively (mean 3.8 vs. 3.3) but rated their level of autonomy (mean 3.6 vs. 4.5) and educational experience (mean 3.6 vs. 4.2) more negatively (all P < .05). Report turnaround time was lower in programs with 24/7/365 coverage than those without (mean 1.7 hours vs. 9.1 hours). The majority of resident comments were negative and related to loss of autonomy with 24/7/365 coverage. More rapid report turnaround time related to 24/7/365 coverage may come at the expense of resident education. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

Less is More: Membrane Protein Digestion Beyond Urea-Trypsin Solution for Next-level Proteomics.

PubMed

Zhang, Xi

2015-09-01

The goal of next-level bottom-up membrane proteomics is protein function investigation, via high-coverage high-throughput peptide-centric quantitation of expression, modifications and dynamic structures at systems scale. Yet efficient digestion of mammalian membrane proteins presents a daunting barrier, and prevalent day-long urea-trypsin in-solution digestion proved insufficient to reach this goal. Many efforts contributed incremental advances over past years, but involved protein denaturation that disconnected measurement from functional states. Beyond denaturation, the recent discovery of structure/proteomics omni-compatible detergent n-dodecyl-β-d-maltopyranoside, combined with pepsin and PNGase F columns, enabled breakthroughs in membrane protein digestion: a 2010 DDM-low-TCEP (DLT) method for H/D-exchange (HDX) using human G protein-coupled receptor, and a 2015 flow/detergent-facilitated protease and de-PTM digestions (FDD) for integrative deep sequencing and quantitation using full-length human ion channel complex. Distinguishing protein solubilization from denaturation, protease digestion reliability from theoretical specificity, and reduction from alkylation, these methods shifted day(s)-long paradigms into minutes, and afforded fully automatable (HDX)-protein-peptide-(tandem mass tag)-HPLC pipelines to instantly measure functional proteins at deep coverage, high peptide reproducibility, low artifacts and minimal leakage. Promoting-not destroying-structures and activities harnessed membrane proteins for the next-level streamlined functional proteomics. This review analyzes recent advances in membrane protein digestion methods and highlights critical discoveries for future proteomics. © 2015 by The American Society for Biochemistry and Molecular Biology, Inc.

Vitamin A supplementation in Tanzania: the impact of a change in programmatic delivery strategy on coverage.

PubMed

Masanja, Honorati; Schellenberg, Joanna Armstrong; Mshinda, Hassan M; Shekar, Meera; Mugyabuso, Joseph K L; Ndossi, Godwin D; de Savigny, Don

2006-11-01

Efficient delivery strategies for health interventions are essential for high and sustainable coverage. We report impact of a change in programmatic delivery strategy from routine delivery through the Expanded Programme on Immunization (EPI+) approach to twice-yearly mass distribution campaigns on coverage of vitamin A supplementation in Tanzania We investigated disparities in age, sex, socio-economic status, nutritional status and maternal education within vitamin A coverage in children between 1 and 2 years of age from two independent household level child health surveys conducted (1) during a continuous universal targeting scheme based on routine EPI contacts for children aged 9, 15 and 21 months (1999); and (2) three years later after the introduction of twice-yearly vitamin A supplementation campaigns for children aged 6 months to 5 years, a 6-monthly universal targeting scheme (2002). A representative cluster sample of approximately 2,400 rural households was obtained from Rufiji, Morogoro Rural, Kilombero and Ulanga districts. A modular questionnaire about the health of all children under the age of five was administered to consenting heads of households and caretakers of children. Information on the use of child health interventions including vitamin A was asked. Coverage of vitamin A supplementation among 1-2 year old children increased from 13% [95% CI 10-18%] in 1999 to 76% [95%CI 72-81%] in 2002. In 2002 knowledge of two or more child health danger signs was negatively associated with vitamin A supplementation coverage (80% versus 70%) (p = 0.04). Nevertheless, we did not find any disparities in coverage of vitamin A by district, gender, socio-economic status and DPT vaccinations. Change in programmatic delivery of vitamin A supplementation was associated with a major improvement in coverage in Tanzania that was been sustained by repeated campaigns for at least three years. There is a need to monitor the effect of such campaigns on the routine health system and on equity of coverage. Documentation of vitamin A supplementation campaign contacts on routine maternal and child health cards would be a simple step to facilitate this monitoring.

Global yellow fever vaccination coverage from 1970 to 2016: an adjusted retrospective analysis.

PubMed

Shearer, Freya M; Moyes, Catherine L; Pigott, David M; Brady, Oliver J; Marinho, Fatima; Deshpande, Aniruddha; Longbottom, Joshua; Browne, Annie J; Kraemer, Moritz U G; O'Reilly, Kathleen M; Hombach, Joachim; Yactayo, Sergio; de Araújo, Valdelaine E M; da Nóbrega, Aglaêr A; Mosser, Jonathan F; Stanaway, Jeffrey D; Lim, Stephen S; Hay, Simon I; Golding, Nick; Reiner, Robert C

2017-11-01

Substantial outbreaks of yellow fever in Angola and Brazil in the past 2 years, combined with global shortages in vaccine stockpiles, highlight a pressing need to assess present control strategies. The aims of this study were to estimate global yellow fever vaccination coverage from 1970 through to 2016 at high spatial resolution and to calculate the number of individuals still requiring vaccination to reach population coverage thresholds for outbreak prevention. For this adjusted retrospective analysis, we compiled data from a range of sources (eg, WHO reports and health-service-provider registeries) reporting on yellow fever vaccination activities between May 1, 1939, and Oct 29, 2016. To account for uncertainty in how vaccine campaigns were targeted, we calculated three population coverage values to encompass alternative scenarios. We combined these data with demographic information and tracked vaccination coverage through time to estimate the proportion of the population who had ever received a yellow fever vaccine for each second level administrative division across countries at risk of yellow fever virus transmission from 1970 to 2016. Overall, substantial increases in vaccine coverage have occurred since 1970, but notable gaps still exist in contemporary coverage within yellow fever risk zones. We estimate that between 393·7 million and 472·9 million people still require vaccination in areas at risk of yellow fever virus transmission to achieve the 80% population coverage threshold recommended by WHO; this represents between 43% and 52% of the population within yellow fever risk zones, compared with between 66% and 76% of the population who would have required vaccination in 1970. Our results highlight important gaps in yellow fever vaccination coverage, can contribute to improved quantification of outbreak risk, and help to guide planning of future vaccination efforts and emergency stockpiling. The Rhodes Trust, Bill & Melinda Gates Foundation, the Wellcome Trust, the National Library of Medicine of the National Institutes of Health, the European Union's Horizon 2020 research and innovation programme. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Variation in Content Coverage by Classroom Composition: An Analysis of Advanced Math Course Content

ERIC Educational Resources Information Center

Covay, Elizabeth

2011-01-01

Everyone knows that there is racial inequality in achievement returns from advanced math; however, they do not know why black students and white students taking the same level of math courses are not leaving with the same or comparable skill levels. To find out, the author examines variation in course coverage by the racial composition of the…

78 FR 15553 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-11

... at a single level of coverage but would have the option of doing so. For plan years beginning on or... exercise this option, but would instead assist employers in choosing a single QHP to offer their qualified... a SHOP (Sec. 155.705) Facilitating employee choice at a single level of coverage selected by the...

Fully immunized child: coverage, timing and sequencing of routine immunization in an urban poor settlement in Nairobi, Kenya.

PubMed

Mutua, Martin Kavao; Kimani-Murage, Elizabeth; Ngomi, Nicholas; Ravn, Henrik; Mwaniki, Peter; Echoka, Elizabeth

2016-01-01

More efforts have been put in place to increase full immunization coverage rates in the last decade. Little is known about the levels and consequences of delaying or vaccinating children in different schedules. Vaccine effectiveness depends on the timing of its administration, and it is not optimal if given early, delayed or not given as recommended. Evidence of non-specific effects of vaccines is well documented and could be linked to timing and sequencing of immunization. This paper documents the levels of coverage, timing and sequencing of routine childhood vaccines. The study was conducted between 2007 and 2014 in two informal urban settlements in Nairobi. A total of 3856 children, aged 12-23 months and having a vaccination card seen were included in analysis. Vaccination dates recorded from the cards seen were used to define full immunization coverage, timeliness and sequencing. Proportions, medians and Kaplan-Meier curves were used to assess and describe the levels of full immunization coverage, vaccination delays and sequencing. The findings indicate that 67 % of the children were fully immunized by 12 months of age. Missing measles and third doses of polio and pentavalent vaccine were the main reason for not being fully immunized. Delays were highest for third doses of polio and pentavalent and measles. About 22 % of fully immunized children had vaccines in an out-of-sequence manner with 18 % not receiving pentavalent together with polio vaccine as recommended. Results show higher levels of missed opportunities and low coverage of routine childhood vaccinations given at later ages. New strategies are needed to enable health care providers and parents/guardians to work together to increase the levels of completion of all required vaccinations. In particular, more focus is needed on vaccines given in multiple doses (polio, pentavalent and pneumococcal conjugate vaccines).

BayMeth: improved DNA methylation quantification for affinity capture sequencing data using a flexible Bayesian approach

PubMed Central

2014-01-01

Affinity capture of DNA methylation combined with high-throughput sequencing strikes a good balance between the high cost of whole genome bisulfite sequencing and the low coverage of methylation arrays. We present BayMeth, an empirical Bayes approach that uses a fully methylated control sample to transform observed read counts into regional methylation levels. In our model, inefficient capture can readily be distinguished from low methylation levels. BayMeth improves on existing methods, allows explicit modeling of copy number variation, and offers computationally efficient analytical mean and variance estimators. BayMeth is available in the Repitools Bioconductor package. PMID:24517713

Winners and losers in health insurance: access and type of coverage for women in same-sex and opposite-sex partnerships.

PubMed

Pals, Heili; Waren, Warren

2014-01-01

Using data from the American Community Survey, 2009 (N=580,754), we compared rates of health insurance coverage and types of coverage used between women in same-sex and opposite-sex partnerships. This large, national dataset also allowed us to investigate regional variation in insurance coverage for women in same-sex partnerships by comparing "gay-tolerant" states versus other states. Multivariate analyses revealed that women in same-sex partnerships consistently had lower rates of health insurance coverage than married women in opposite-sex partnerships, but always more than unmarried women in opposite-sex partnerships. We also found that state-level variation in gay tolerance did not contribute to the access or type of coverage used by women in same-sex partnerships.

Patterns in coverage of maternal, newborn, and child health interventions: projections of neonatal and under-5 mortality to 2035.

PubMed

Walker, Neff; Yenokyan, Gayane; Friberg, Ingrid K; Bryce, Jennifer

2013-09-21

Urgent calls have been made for improved understanding of changes in coverage of maternal, newborn, and child health interventions, and their country-level determinants. We examined historical trends in coverage of interventions with proven effectiveness, and used them to project rates of child and neonatal mortality in 2035 in 74 Countdown to 2015 priority countries. We investigated coverage of all interventions for which evidence was available to suggest effective reductions in maternal and child mortality, for which indicators have been defined, and data have been obtained through household surveys. We reanalysed coverage data from 312 nationally-representative household surveys done between 1990 and 2011 in 69 countries, including 58 Countdown countries. We developed logistic Loess regression models for patterns of coverage change for each intervention, and used k-means cluster analysis to divide interventions into three groups with different historical patterns of coverage change. Within each intervention group, we examined performance of each country in achieving coverage gains. We constructed models that included baseline coverage, region, gross domestic product, conflict, and governance to examine country-specific annual percentage coverage change for each group of indicators. We used the Lives Saved Tool (LiST) to predict mortality rates of children younger than 5 years (henceforth, under 5) and in the neonatal period in 2035 for Countdown countries if trends in coverage continue unchanged (historical trends scenario) and if each country accelerates intervention coverage to the highest level achieved by a Countdown country with similar baseline coverage level (best performer scenario). Odds of coverage of three interventions (antimalarial treatment, skilled attendant at birth, and use of improved sanitation facilities) have decreased since 1990, with a mean annual decrease of 5·5% (SD 2·7%). Odds of coverage of four interventions--all related to the prevention of malaria--have increased rapidly, with a mean annual increase of 27·9% (7·3%). Odds of coverage of other interventions have slowly increased, with a mean annual increase of 5·3% (3·5%). Rates of coverage change varied widely across countries; we could not explain the differences by measures of gross domestic product, conflict, or governance. On the basis of LiST projections, we predicted that the number of Countdown countries with an under-5 mortality rate of fewer than 20 deaths per 1000 livebirths per year would increase from four (5%) of the 74 in 2010, to nine (12%) by 2035 under the historical trends scenario, and to 15 (20%) under the best performer scenario. The number of countries with neonatal mortality rates of fewer than 11 per 1000 livebirths per year would increase from three (4%) in 2010, to ten (14%) by 2035 under the historical trends scenario, and 67 (91%) under the best performer scenario. The number of under-5 deaths per year would decrease from an estimated 7·6 million in 2010, to 5·4 million (28% decrease) if historical trends continue, and to 2·3 million (71% decrease) under the best performer scenario. Substantial reductions in child deaths are possible, but only if intensified efforts to achieve intervention coverage are implemented successfully within each of the Countdown countries. The Bill & Melinda Gates Foundation. Copyright © 2013 Elsevier Ltd. All rights reserved.

Sources of health insurance and characteristics of the uninsured: analysis of the March 2009 Current Population Survey.

PubMed

Fronstin, Paul

2009-09-01

This Issue Brief provides historical data through 2008 on the number and percentage of nonelderly individuals with and without health insurance. Based on EBRI estimates from the U.S. Census Bureau's March 2009 Current Population Survey (CPS), it reflects 2008 data. It also discusses trends in coverage for the 1994-2008 period and highlights characteristics that typically indicate whether an individual is insured. HEALTH COVERAGE RATE CONTINUES TO DECREASE: The percentage of the nonelderly population (under age 65) with health insurance coverage decreased to 82.6 percent in 2008. Increases in health insurance coverage have been recorded in only four years since 1994, when 36.5 million nonelderly individuals were uninsured; in 2008, the uninsured population was 45.7 million. EMPLOYMENT-BASED COVERAGE REMAINS DOMINANT SOURCE OF HEALTH COVERAGE, BUT CONTINUES TO SLOWLY ERODE: Employment-based health benefits remain the most common form of health coverage in the United States. In 2008, 61.1 percent of the nonelderly population had employment-based health benefits, down from 68.4 percent in 2000. Between 1994 and 2000, the percentage of the nonelderly population with employment-based coverage expanded. PUBLIC PROGRAM COVERAGE IS GROWING: Public program health coverage expanded as a percentage of the population in 2008, accounting for 19.4 percent of the nonelderly population. Enrollment in Medicaid and the State Children's Health Insurance Program increased, reaching a combined 39.2 million in 2008, and covering 14.9 percent of the nonelderly population, significantly above the 10.5 percent level of 1999. INDIVIDUAL COVERAGE STABLE: Individually purchased health coverage was unchanged in 2008 and has basically hovered in the 6-7 percent range since 1994. MOST/LEAST LIKELY TO HAVE HEALTH INSURANCE: Full-time, full-year workers, public-sector workers, workers employed in manufacturing, managerial and professional workers, and individuals living in high-income families are most likely to have employment-based health benefits. Poor families are most likely to be covered by public coverage programs such as Medicaid or S-CHIP. RETHINKING THE VALUE OF OFFERING HEALTH INSURANCE: Research illustrates the advantages to consumers of having health insurance and the benefits to employers of offering it. In general, the availability of health insurance allows consumers to avoid unnecessary pain and suffering and improves the quality of life, and employers report that offering benefits has a positive impact on worker recruitment, retention, health status, and productivity. Employers may believe in the business case for providing health benefits today, but in the future they may rethink the value that offering coverage provides, especially if health costs continue to escalate sharply or if health reform changes the value proposition.

Do female primary care physicians practise preventive care differently from their male colleagues?

PubMed Central

Woodward, C. A.; Hutchison, B. G.; Abelson, J.; Norman, G.

1996-01-01

OBJECTIVE: To assess whether female primary care physicians' reported coverage of patients eligible for certain preventive care strategies differs from male physicians' reported coverage. DESIGN: A mailed survey. SETTING: Primary care practices in southern Ontario. PARTICIPANTS: All primary care physicians who graduated between 1972 and 1988 and practised in a defined geographic area of Ontario were selected from the Canadian Medical Association's physician resource database. Response rate was 50%. MAIN OUTCOME MEASURES: Answers to questions on sociodemographic and practice characteristics, attitudes toward preventive care, and perceptions about preventive care behaviour and practices. RESULTS: In general, reported coverage for Canadian Task Force on the Periodic Health Examination's (CTFPHE) A and B class recommendations was low. However, more female than male physicians reported high coverage of women patients for female-specific preventive care measures (i.e., Pap smears, breast examinations, and mammography) and for blood pressure measurement. Female physicians appeared to question more patients about a greater number of health risks. Often, sex of physician was the most salient factor affecting whether preventive care services thought effective by the CTFPHE were offered. However, when evidence for effectiveness of preventive services was equivocal or lacking, male and female physicians reported similar levels of coverage. CONCLUSION: Female primary care physicians are more likely than their male colleagues to report that their patients eligible for preventive health measures as recommended by the CTFPHE take advantage of these measures. PMID:8969856

[Anti-pneumococcal vaccine coverage for hospitalized risk patients: Assessment and suggestions for improvements].

PubMed

Richard, C; Le Garlantezec, P; Lamand, V; Rasamijao, V; Rapp, C

2016-05-01

Streptococcus pneumoniae can cause invasive infections. Incidence and severity are linked to patients' risk factors. Due to the resistance to leading antibiotics, the anti-pneumococcal vaccination has become a major public health issue. The purpose of this survey was to evaluate the anti-pneumococcal vaccine coverage in a population of adults with risk factors. This was a prospective study that included patients with at least one recommendation for pneumococcal vaccination as indicated by the Weekly Epidemiological Bulletin (BEH), to which three further US recommendations were added (diabetes, obesity and age>65years). One hundred and thirty-four patients with an average age of 70 years were included. The physician could only confirm 68 % of the patients' vaccination status. Vaccination coverage as recommended by the BEH board was 30 % (n=54). All HIV patients were vaccinated (n=2) and the vaccination coverage was 75 % (n=8) for patients treated for autoimmune diseases and only 10 % (n=20) for patients treated with chemotherapy. Patients with no vaccination didn't know the existence of the vaccine or didn't know that vaccination was recommended to them. This study has highlighted a deficit in pneumococcal vaccination coverage and a high level of ignorance of the existence of recommended vaccination. In addition to awareness campaign for patients and caregiver training, the expansion of the vaccine e-book utilization could improve the vaccination status. Copyright © 2015 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

Maintaining and Enhancing Diversity of Sampled Protein Conformations in Robotics-Inspired Methods.

PubMed

Abella, Jayvee R; Moll, Mark; Kavraki, Lydia E

2018-01-01

The ability to efficiently sample structurally diverse protein conformations allows one to gain a high-level view of a protein's energy landscape. Algorithms from robot motion planning have been used for conformational sampling, and several of these algorithms promote diversity by keeping track of "coverage" in conformational space based on the local sampling density. However, large proteins present special challenges. In particular, larger systems require running many concurrent instances of these algorithms, but these algorithms can quickly become memory intensive because they typically keep previously sampled conformations in memory to maintain coverage estimates. In addition, robotics-inspired algorithms depend on defining useful perturbation strategies for exploring the conformational space, which is a difficult task for large proteins because such systems are typically more constrained and exhibit complex motions. In this article, we introduce two methodologies for maintaining and enhancing diversity in robotics-inspired conformational sampling. The first method addresses algorithms based on coverage estimates and leverages the use of a low-dimensional projection to define a global coverage grid that maintains coverage across concurrent runs of sampling. The second method is an automatic definition of a perturbation strategy through readily available flexibility information derived from B-factors, secondary structure, and rigidity analysis. Our results show a significant increase in the diversity of the conformations sampled for proteins consisting of up to 500 residues when applied to a specific robotics-inspired algorithm for conformational sampling. The methodologies presented in this article may be vital components for the scalability of robotics-inspired approaches.

Intervene before leaving: clustered lot quality assurance sampling to monitor vaccination coverage at health district level before the end of a yellow fever and measles vaccination campaign in Sierra Leone in 2009

PubMed Central

2012-01-01

Background In November 2009, Sierra Leone conducted a preventive yellow fever (YF) vaccination campaign targeting individuals aged nine months and older in six health districts. The campaign was integrated with a measles follow-up campaign throughout the country targeting children aged 9–59 months. For both campaigns, the operational objective was to reach 95% of the target population. During the campaign, we used clustered lot quality assurance sampling (C-LQAS) to identify areas of low coverage to recommend timely mop-up actions. Methods We divided the country in 20 non-overlapping lots. Twelve lots were targeted by both vaccinations, while eight only by measles. In each lot, five clusters of ten eligible individuals were selected for each vaccine. The upper threshold (UT) was set at 90% and the lower threshold (LT) at 75%. A lot was rejected for low vaccination coverage if more than 7 unvaccinated individuals (not presenting vaccination card) were found. After the campaign, we plotted the C-LQAS results against the post-campaign coverage estimations to assess if early interventions were successful enough to increase coverage in the lots that were at the level of rejection before the end of the campaign. Results During the last two days of campaign, based on card-confirmed vaccination status, five lots out of 20 (25.0%) failed for having low measles vaccination coverage and three lots out of 12 (25.0%) for low YF coverage. In one district, estimated post-campaign vaccination coverage for both vaccines was still not significantly above the minimum acceptable level (LT = 75%) even after vaccination mop-up activities. Conclusion C-LQAS during the vaccination campaign was informative to identify areas requiring mop-up activities to reach the coverage target prior to leaving the region. The only district where mop-up activities seemed to be unsuccessful might have had logistical difficulties that should be further investigated and resolved. PMID:22676225

The impact of 2-dose routine measles, mumps, rubella, and varicella vaccination in France on the epidemiology of varicella and zoster using a dynamic model with an empirical contact matrix.

PubMed

Ouwens, Mario J N M; Littlewood, Kavi J; Sauboin, Christophe; Téhard, Bertrand; Denis, François; Boëlle, Pierre-Yves; Alain, Sophie

2015-04-01

Varicella has a high incidence affecting the vast majority of the population in France and can lead to severe complications. Almost every individual infected by varicella becomes susceptible to herpes zoster later in life due to reactivation of the latent virus. Zoster is characterized by pain that can be long-lasting in some cases and has no satisfactory treatment. Routine varicella vaccination can prevent varicella. The vaccination strategy of replacing both doses of measles, mumps, and rubella (MMR) with a combined MMR and varicella (MMRV) vaccine is a means of reaching high vaccination coverage for varicella immunization. The objective of this analysis was to assess the impact of routine varicella vaccination, with MMRV in place of MMR, on the incidence of varicella and zoster diseases in France and to assess the impact of exogenous boosting of zoster incidence, age shift in varicella cases, and other possible indirect effects. A dynamic transmission population-based model was developed using epidemiological data for France to determine the force of infection, as well as an empirically derived contact matrix to reduce assumptions underlying these key drivers of dynamic models. Scenario analyses tested assumptions regarding exogenous boosting, vaccine waning, vaccination coverage, risk of complications, and contact matrices. The model provides a good estimate of the incidence before varicella vaccination implementation in France. When routine varicella vaccination is introduced with French current coverage levels, varicella incidence is predicted to decrease by 57%, and related complications are expected to decrease by 76% over time. After vaccination, it is observed that exogenous boosting is the main driver of change in zoster incidence. When exogenous boosting is assumed, there is a temporary increase in zoster incidence before it gradually decreases, whereas without exogenous boosting, varicella vaccination leads to a gradual decrease in zoster incidence. Changing vaccine efficacy waning levels and coverage assumptions are still predicted to result in overall benefits with varicella vaccination. In conclusion, the model predicted that MMRV vaccination can significantly reduce varicella incidence. With suboptimal coverage, a limited age shift of varicella cases is predicted to occur post-vaccination with MMRV. However, it does not result in an increase in the number of complications. GSK study identifier: HO-12-6924. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Progress in Childhood Vaccination Data in Immunization Information Systems - United States, 2013-2016.

PubMed

Murthy, Neil; Rodgers, Loren; Pabst, Laura; Fiebelkorn, Amy Parker; Ng, Terence

2017-11-03

In 2016, 55 jurisdictions in 49 states and six cities in the United States* used immunization information systems (IISs) to collect and manage immunization data and support vaccination providers and immunization programs. To monitor progress toward achieving IIS program goals, CDC surveys jurisdictions through an annual self-administered IIS Annual Report (IISAR). Data from the 2013-2016 IISARs were analyzed to assess progress made in four priority areas: 1) data completeness, 2) bidirectional exchange of data with electronic health record systems, 3) clinical decision support for immunizations, and 4) ability to generate childhood vaccination coverage estimates. IIS participation among children aged 4 months through 5 years increased from 90% in 2013 to 94% in 2016, and 33 jurisdictions reported ≥95% of children aged 4 months through 5 years participating in their IIS in 2016. Bidirectional messaging capacity in IISs increased from 25 jurisdictions in 2013 to 37 in 2016. In 2016, nearly all jurisdictions (52 of 55) could provide automated provider-level coverage reports, and 32 jurisdictions reported that their IISs could send vaccine forecasts to providers via Health Level 7 (HL7) messaging, up from 17 in 2013. Incremental progress was made in each area since 2013, but continued effort is needed to implement these critical functionalities among all IISs. Success in these priority areas, as defined by the IIS Functional Standards (1), bolsters clinicians' and public health practitioners' ability to attain high vaccination coverage in pediatric populations, and prepares IISs to develop more advanced functionalities to support state/local immunization services. Success in these priority areas also supports the achievement of federal immunization objectives, including the use of IISs as supplemental sampling frames for vaccination coverage surveys like the National Immunization Survey (NIS)-Child, reducing data collection costs, and supporting increased precision of state-level estimates.

The effect of immunization on measles incidence in the Democratic Republic of Congo: Results from a model of surveillance data.

PubMed

Doshi, Reena H; Shidi, Calixte; Mulumba, Audry; Eckhoff, Philip; Nguyen, Catherine; Hoff, Nicole A; Gerber, Sue; Okitolonda, Emile; Ilunga, Benoit Kebela; Rimoin, Anne W

2015-11-27

Measles continues to be a leading cause of vaccine-preventable disease mortality among children under five despite a safe and efficacious vaccine being readily available. While global vaccination coverage has improved tremendously, measles outbreaks persist throughout sub-Saharan Africa. Since 2010, the Democratic Republic of Congo (DRC) has seen a resurgence of measles outbreaks affecting all 11 provinces. These outbreaks are mainly attributed to gaps in routine immunization (RI) coverage compounded with missed supplementary immunization activities (SIAs). We utilized national passive surveillance data from DRC's Integrated Disease Surveillance and Response (IDSR) system to estimate the effect of immunization on measles incidence in DRC. We investigated the decline in measles incidence post-immunization with one dose of measles containing vaccine (MCV1) with and without the addition of supplementary immunization activities (SIAs) and outbreak response immunization (ORI) campaigns. Measles case counts by health zone were obtained from the IDSR system between January 1, 2010 and December 31, 2013. The impact of measles immunization was modeled using a random effects multi-level model for count data with RI coverage levels and mass campaign activities from one year prior. The presence of an SIA (aIRR [95% CI] 0.86 [0.60-1.25]) and ORI (0.28 [0.20-0.39]) in the year prior were both associated with a decrease in measles incidence. When interaction terms were included, our results suggested that the high levels of MCV1 reported in the year prior and the presence of either mass campaign was associated with a decrease in measles incidence. Our results highlight the importance of a two-dose measles vaccine schedule and the need for a strong routine immunization program coupled with frequent SIAs. Repeated occurrences of large-scale outbreaks in DRC suggest that vaccination coverage rates are grossly overestimated and signify the importance of the evaluation and modification of measles prevention and control strategies. Copyright © 2015 Elsevier Ltd. All rights reserved.

Potential for reduction of burden and local elimination of malaria by reducing Plasmodium falciparum malaria transmission: a mathematical modelling study.

PubMed

Griffin, Jamie T; Bhatt, Samir; Sinka, Marianne E; Gething, Peter W; Lynch, Michael; Patouillard, Edith; Shutes, Erin; Newman, Robert D; Alonso, Pedro; Cibulskis, Richard E; Ghani, Azra C

2016-04-01

Rapid declines in malaria prevalence, cases, and deaths have been achieved globally during the past 15 years because of improved access to first-line treatment and vector control. We aimed to assess the intervention coverage needed to achieve further gains over the next 15 years. We used a mathematical model of the transmission of Plasmodium falciparum malaria to explore the potential effect on case incidence and malaria mortality rates from 2015 to 2030 of five different intervention scenarios: remaining at the intervention coverage levels of 2011-13 (Sustain), for which coverage comprises vector control and access to treatment; two scenarios of increased coverage to 80% (Accelerate 1) and 90% (Accelerate 2), with a switch from quinine to injectable artesunate for management of severe disease and seasonal malaria chemoprevention where recommended for both Accelerate scenarios, and rectal artesunate for pre-referral treatment at the community level added to Accelerate 2; a near-term innovation scenario (Innovate), which included longer-lasting insecticidal nets and expansion of seasonal malaria chemoprevention; and a reduction in coverage to 2006-08 levels (Reverse). We did the model simulations at the first administrative level (ie, state or province) for the 80 countries with sustained stable malaria transmission in 2010, accounting for variations in baseline endemicity, seasonality in transmission, vector species, and existing intervention coverage. To calculate the cases and deaths averted, we compared the total number of each under the five scenarios between 2015 and 2030 with the predicted number in 2015, accounting for population growth. With an increase to 80% coverage, we predicted a reduction in case incidence of 21% (95% credible intervals [CrI] 19-29) and a reduction in mortality rates of 40% (27-61) by 2030 compared with 2015 levels. Acceleration to 90% coverage and expansion of treatment at the community level was predicted to reduce case incidence by 59% (Crl 56-64) and mortality rates by 74% (67-82); with additional near-term innovation, incidence was predicted to decline by 74% (70-77) and mortality rates by 81% (76-87). These scenarios were predicted to lead to local elimination in 13 countries under the Accelerate 1 scenario, 20 under Accelerate 2, and 22 under Innovate by 2030, reducing the proportion of the population living in at-risk areas by 36% if elimination is defined at the first administrative unit. However, failing to maintain coverage levels of 2011-13 is predicted to raise case incidence by 76% (Crl 71-80) and mortality rates by 46% (39-51) by 2020. Our findings show that decreases in malaria transmission and burden can be accelerated over the next 15 years if the coverage of key interventions is increased. UK Medical Research Council, UK Department for International Development, the Bill & Melinda Gates Foundation, the Swiss Development Agency, and the US Agency for International Development. Copyright © Griffin et al. Open Access article distributed under the terms of CC BY. 2015. World Health Organization; licensee Elsevier. This is an Open Access article published without any waiver of WHO's privileges and immunities under international law, convention, or agreement. This article should not be reproduced for use in association with the promotion of commercial products, services, or any legal entity. There should be no suggestion that WHO endorses any specific organisation or products. The use of the WHO logo is not permitted. This notice should be preserved along with the Article's original URL.

Using lot quality assurance sampling to improve immunization coverage in Bangladesh.

PubMed Central

Tawfik, Y.; Hoque, S.; Siddiqi, M.

2001-01-01

OBJECTIVE: To determine areas of low vaccination coverage in five cities in Bangladesh (Chittagong, Dhaka, Khulna, Rajshahi, and Syedpur). METHODS: Six studies using lot quality assurance sampling were conducted between 1995 and 1997 by Basic Support for Institutionalizing Child Survival and the Bangladesh National Expanded Programme on Immunization. FINDINGS: BCG vaccination coverage was acceptable in all lots studied; however, the proportion of lots rejected because coverage of measles vaccination was low ranged from 0% of lots in Syedpur to 12% in Chittagong and 20% in Dhaka's zones 7 and 8. The proportion of lots rejected because an inadequate number of children in the sample had been fully vaccinated varied from 11% in Syedpur to 30% in Dhaka. Additionally, analysis of aggregated, weighted immunization coverage showed that there was a high BCG vaccination coverage (the first administered vaccine) and a low measles vaccination coverage (the last administered vaccine) indicating a high drop-out rate, ranging from 14% in Syedpur to 36% in Dhaka's zone 8. CONCLUSION: In Bangladesh, where resources are limited, results from surveys using lot quality assurance sampling enabled managers of the National Expanded Programme on Immunization to identify areas with poor vaccination coverage. Those areas were targeted to receive focused interventions to improve coverage. Since this sampling method requires only a small sample size and was easy for staff to use, it is feasible for routine monitoring of vaccination coverage. PMID:11436470

Sensitivity of Medication Use to Formulary Controls in Medicare Beneficiaries: A Review of the Literature

PubMed Central

Shenolikar, Rahul; Bruno, Amanda Schofield; Eaddy, Michael; Cantrell, Christopher

2011-01-01

Background Several studies have examined the impact of formulary management strategies on medication use in the elderly, but little has been done to synthesize the findings to determine whether the results show consistent trends. Objective To summarize the effects of formulary controls (ie, tiered copays, step edits, prior authorization, and generic substitution) on medication use in the Medicare population to inform future Medicare Part D and other coverage decisions. Methods This systematic review included research articles (found via PubMed, Google Scholar, and specific scientific journals) that evaluated the impact of drug coverage or cost-sharing on medication use in elderly (aged ≥65 years) Medicare beneficiaries. The impact of drug coverage was assessed by comparing patients with some drug coverage to those with no drug coverage or by comparing varying levels of drug coverage (eg, full coverage vs $1000 coverage or capped benefits vs noncapped benefits). Articles that were published before 1995, were not original empirical research, were published in languages other than English, or focused on populations other than Medicare beneficiaries were excluded. All studies selected were classified as positive, negative, or neutral based on the significance of the relationship (P <.05 or as otherwise specified) between the formulary control mechanism and the medication use, and on the direction of that relationship. Results Included were a total of 47 research articles (published between 1995 and 2009) that evaluated the impact of drug coverage or cost-sharing on medication use in Medicare beneficiaries. Overall, 24 studies examined the impact of the level of drug coverage on medication use; of these, 96% (N = 23) supported the association between better drug coverage (ie, branded and generic vs generic-only coverage, capped benefit vs noncapped benefit, supplemental drug insurance vs no supplemental drug insurance) or having some drug coverage and enhanced medication use. Furthermore, 84% (N = 16) of the 19 studies that examined the effect of cost-sharing on medication use demonstrated that decreased cost-sharing was significantly associated with improved medication use. Conclusion Current evidence from the literature suggests that restricting drug coverage or increasing out-of-pocket expenses for Medicare beneficiaries may lead to decreased medication use in the elderly, with all its potential implications. PMID:25126370

Genome-wide ancestry and divergence patterns from low-coverage sequencing data reveal a complex history of admixture in wild baboons

PubMed Central

Wall, Jeffrey D; Schlebusch, Stephen A; Alberts, Susan C; Cox, Laura A; Snyder-Mackler, Noah; Nevonen, Kimberly; Carbone, Lucia; Tung, Jenny

2017-01-01

Naturally occurring admixture has now been documented in every major primate lineage, suggesting its key role in primate evolutionary history. Active primate hybrid zones can provide valuable insight into this process. Here, we investigate the history of admixture in one of the best-studied natural primate hybrid zones, between yellow baboons (Papio cynocephalus) and anubis baboons (Papio anubis) in the Amboseli ecosystem of Kenya. We generated a new genome assembly for yellow baboon and low coverage genome-wide resequencing data from yellow baboons, anubis baboons, and known hybrids (n=44). Using a novel composite likelihood method for estimating local ancestry from low coverage data, we found high levels of genetic diversity and genetic differentiation between the parent taxa, and excellent agreement between genome-scale ancestry estimates and a priori pedigree, life history, and morphology-based estimates (r2=0.899). However, even putatively unadmixed Amboseli yellow individuals carried a substantial proportion of anubis ancestry, presumably due to historical admixture. Further, the distribution of shared versus fixed differences between a putatively unadmixed Amboseli yellow baboon and an unadmixed anubis baboon, both sequenced at high coverage, are inconsistent with simple isolation-migration or equilibrium migration models. Our findings suggest a complex process of intermittent contact that has occurred multiple times in baboon evolutionary history, despite no obvious fitness costs to hybrids or major geographic or behavioral barriers. In combination with the extensive phenotypic data available for baboon hybrids, our results provide valuable context for understanding the history of admixture in primates, including in our own lineage. PMID:27145036

[Spatio-temporal analysis of the biophysical and ecological conditions of Triatoma dimidiata (Hemiptera: Reduviidae: Triatominae) in the northeast region of Colombia].

PubMed

Badel-Mogollón, Jaime; Rodríguez-Figueroa, Laura; Parra-Henao, Gabriel

2017-03-29

Due to the lack of information regarding biophysical and spatio-temporal conditions (hydrometheorologic and vegetal coverage density) in areas with Triatoma dimidiata in the Colombian departments of Santander and Boyacá, there is a need to elucidate the association patterns of these variables to determine the distribution and control of this species. To make a spatio-temporal analysis of biophysical variables related to the distribution of T. dimidiate observed in the northeast region of Colombia. We used the Intergovernmental Panel on Climate Change Special Report on Emissions Scenarios (IPCC SRES) data bases registering vector presence and hydrometheorologic data. We studied the variables of environmental temperature, relative humidity, rainfall and vegetal coverage density at regional and local levels, and we conducted spatial geostatistic, descriptive statistical and Fourier temporal series analyses. Temperatures two meters above the ground and on covered surface ranged from 14,5°C to 18,8°C in the areas with the higher density of T. dimidiata. The environmental temperature fluctuated between 30 and 32°C. Vegetal coverage density and rainfall showed patterns of annual and biannual peaks. Relative humidity values fluctuated from 66,8 to 85,1%. Surface temperature and soil coverage were the variables that better explained the life cycle of T. dimidiata in the area. High relative humidity promoted the seek of shelters and an increase of the geographic distribution in the annual and biannual peaks of regional rainfall. The ecologic and anthropic conditions suggest that T. dimidiata is a highly resilient species.

Cost-Effectiveness of Opt-Out Chlamydia Testing for High-Risk Young Women in the U.S.

PubMed

Owusu-Edusei, Kwame; Hoover, Karen W; Gift, Thomas L

2016-08-01

In spite of chlamydia screening recommendations, U.S. testing coverage continues to be low. This study explored the cost-effectiveness of a patient-directed, universal, opportunistic Opt-Out Testing strategy (based on insurance coverage, healthcare utilization, and test acceptance probabilities) for all women aged 15-24 years compared with current Risk-Based Screening (30% coverage) from a societal perspective. Based on insurance coverage (80%); healthcare utilization (83%); and test acceptance (75%), the proposed Opt-Out Testing strategy would have an expected annual testing coverage of approximately 50% for sexually active women aged 15-24 years. A basic compartmental heterosexual transmission model was developed to account for population-level transmission dynamics. Two groups were assumed based on self-reported sexual activity. All model parameters were obtained from the literature. Costs and benefits were tracked over a 50-year period. The relative sensitivity of the estimated incremental cost-effectiveness ratios to the variables/parameters was determined. This study was conducted in 2014-2015. Based on the model, the Opt-Out Testing strategy decreased the overall chlamydia prevalence by >55% (2.7% to 1.2%). The Opt-Out Testing strategy was cost saving compared with the current Risk-Based Screening strategy. The estimated incremental cost-effectiveness ratio was most sensitive to the female pre-opt out prevalence, followed by the probability of female sequelae and discount rate. The proposed Opt-Out Testing strategy was cost saving, improving health outcomes at a lower net cost than current testing. However, testing gaps would remain because many women might not have health insurance coverage, or not utilize health care. Published by Elsevier Inc.

Scaling up prevention of mother-to-child HIV transmission programs in sub-Saharan African countries: a multilevel assessment of site-, program- and country-level determinants of performance.

PubMed

Audureau, Etienne; Kahn, James G; Besson, Marie-Hélène; Saba, Joseph; Ladner, Joël

2013-04-01

Uptake of prevention of mother-to-child HIV transmission (PMTCT) programs remains challenging in sub-Saharan Africa because of multiple barriers operating at the individual or health facility levels. Less is known regarding the influence of program-level and contextual determinants. In this study, we explored the multilevel factors associated with coverage in single-dose nevirapine PMTCT programs. We analyzed aggregate routine data collected within the framework of the Viramune(®) Donation Programme (VDP) from 269 sites in 20 PMTCT programs and 15 sub-Saharan countries from 2002 to 2005. Site performance was measured using a nevirapine coverage ratio (NCR), defined as the reported number of women receiving nevirapine divided by the number of women who should have received nevirapine (observed HIV prevalence x number of women in antenatal care [ANC]). Data on program-level determinants were drawn from the initial application forms, and country-level determinants from the Demographic and Health Surveys (DHS) and the World Bank (World Development Indicators). Multilevel linear mixed models were used to identify independent factors associated with NCR at the site-, program- and country-level. Of 283,410 pregnant women attending ANC in the included sites, 174,312 women (61.5%) underwent HIV testing after receiving pre-test counselling, of whom 26,700 tested HIV positive (15.3%), and 22,591 were dispensed NVP (84.6%). Site performance was highly heterogeneous between and within programs. Mean NCR by site was 43.8% (interquartile range: 19.1-63.9). Multilevel analysis identified higher HIV prevalence (Beta coefficient: 25.1, 95% confidence interval [CI] 18.7 to 31.6), higher proportion of persons with knowledge of PMTCT (8.3; CI 0.5 to 16.0), higher health expenditure as a proportion of Gross Domestic Product (3.9 per %; CI 2.0 to 5.8) and lower percentage of rural population (-0.7 per %; CI -1.0 to -0.5) as significant country-level predictors of higher NCR at the p<0.05 level. A medium ANC monthly activity (30-100/month) was the only site-level predictor found (-7.6; CI -15.1 to -0.1). Heterogeneity of nevirapine coverage between sites and programs was high. Multilevel analysis identified several significant contextual determinants, which may warrant additional research to further define important multi-level and potentially modifiable determinants of performance of PMTCT programs.

Clinic accessibility and clinic-level predictors of the geographic variation in 2009 pandemic influenza vaccine coverage in Montreal, Canada

PubMed Central

Charland, Katia M; de Montigny, Luc; Brownstein, John S; Buckeridge, David L

2014-01-01

Background Nineteen mass vaccination clinics were established in Montreal, Canada, as part of the 2009 influenza A/H1N1p vaccination campaign. Although approximately 50% of the population was vaccinated, there was a considerable variation in clinic performance and community vaccine coverage. Objective To identify community- and clinic-level predictors of vaccine uptake, while accounting for the accessibility of clinics from the community of residence. Methods All records of influenza A/H1N1p vaccinations administered in Montreal were obtained from a vaccine registry. Multivariable regression models, specifically Bayesian gravity models, were used to assess the relationship between vaccination rates and clinic accessibility, clinic-level factors, and community-level factors. Results Relative risks compare the vaccination rates at the variable's upper quartile to the lower quartile. All else being equal, clinics in areas with high violent crime rates, high residential density, and high levels of material deprivation tended to perform poorly (adjusted relative risk [ARR]: 0·917, 95% CI [credible interval]: 0·915, 0·918; ARR: 0·663, 95% CI: 0·660, 0·666, ARR: 0·649, 95% CI: 0·645, 0·654, respectively). Even after controlling for accessibility and clinic-level predictors, communities with a greater proportion of new immigrants and families living below the poverty level tended to have lower rates (ARR: 0·936, 95% CI: 0·913, 0·959; ARR: 0·918, 95% CI: 0·893, 0·946, respectively), while communities with a higher proportion speaking English or French tended to have higher rates (ARR: 1·034, 95% CI: 1·012, 1·059). Conclusion In planning future mass vaccination campaigns, the gravity model could be used to compare expected vaccine uptake for different clinic location strategies. PMID:24382000

Clinic accessibility and clinic-level predictors of the geographic variation in 2009 pandemic influenza vaccine coverage in Montreal, Canada.

PubMed

Charland, Katia M; de Montigny, Luc; Brownstein, John S; Buckeridge, David L

2014-05-01

Nineteen mass vaccination clinics were established in Montreal, Canada, as part of the 2009 influenza A/H1N1p vaccination campaign. Although approximately 50% of the population was vaccinated, there was a considerable variation in clinic performance and community vaccine coverage. To identify community- and clinic-level predictors of vaccine uptake, while accounting for the accessibility of clinics from the community of residence. All records of influenza A/H1N1p vaccinations administered in Montreal were obtained from a vaccine registry. Multivariable regression models, specifically Bayesian gravity models, were used to assess the relationship between vaccination rates and clinic accessibility, clinic-level factors, and community-level factors. Relative risks compare the vaccination rates at the variable's upper quartile to the lower quartile. All else being equal, clinics in areas with high violent crime rates, high residential density, and high levels of material deprivation tended to perform poorly (adjusted relative risk [ARR]: 0·917, 95% CI [credible interval]: 0·915, 0·918; ARR: 0·663, 95% CI: 0·660, 0·666, ARR: 0·649, 95% CI: 0·645, 0·654, respectively). Even after controlling for accessibility and clinic-level predictors, communities with a greater proportion of new immigrants and families living below the poverty level tended to have lower rates (ARR: 0·936, 95% CI: 0·913, 0·959; ARR: 0·918, 95% CI: 0·893, 0·946, respectively), while communities with a higher proportion speaking English or French tended to have higher rates (ARR: 1·034, 95% CI: 1·012, 1·059). In planning future mass vaccination campaigns, the gravity model could be used to compare expected vaccine uptake for different clinic location strategies. © 2014 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

Coverage of childhood vaccination among children aged 12-23 months, Tamil Nadu, 2015, India

PubMed Central

Murhekar, Manoj V.; Kamaraj, P.; Kanagasabai, K.; Elavarasu, G.; Rajasekar, T. Daniel; Boopathi, K.; Mehendale, Sanjay

2017-01-01

Background & objectives: District-Level Household Survey-4 (DLHS-4) indicated that during 2012-2013, only 56 per cent of children aged 12-23 months in Tamil Nadu were fully vaccinated, which were lesser than those reported in earlier national surveys. We, therefore, conducted cluster surveys to estimate coverage of childhood vaccination in the State, and also to identify the factors associated with low coverage. Methods: Cross-sectional surveys were conducted in 15 strata [municipal corporation non-slum (n=1), municipal corporation slum (n=1), hilly (n=1), rural (n=6) and urban (n=6)]. From each stratum, 30 clusters were selected using probability proportional to the population size linear systematic sampling; seven children aged 12-23 months were selected from each cluster and their mothers/care-takers were interviewed to collect information about vaccination status of the child. A child was considered fully vaccinated if he/she received bacillus Calmette-Guérin (BCG), three doses of pentavalent, three doses of oral polio vaccine and one dose of measles vaccine, and appropriately vaccinated if all vaccine doses were given at right age and with right interval. Further, coverage of fully vaccinated children (FVC) as per vaccination cards or mothers’ recall, validated coverage of FVC (V-FVC) among those having cards, and coverage of appropriately vaccinated children (AVC) were estimated using survey data analysis module with appropriate sampling weights. Results: A total of 3150 children were surveyed, of them 2528 (80.3%) had vaccination card. The weighted coverage of FVC, V-FVC and AVC in the State was 79.9 per cent [95% confidence interval (CI): 78.2-81.5], 78.8 per cent (95% CI: 76.9-80.5) and 69.7 per cent (95% CI: 67.7-71.7), respectively. The coverage of individual vaccine ranged between 84 per cent (measles) and 99.8 per cent (BCG). About 12 per cent V-FVC were not vaccinated as per the vaccination schedule. Interpretation & conclusions: The coverage of FVC in Tamil Nadu was high, with about 80 per cent children completing primary vaccination. Efforts to increase vaccination coverage in the State need to focus on educating vaccinators about the need to adhere to the national vaccination schedule and strengthening supervision to ensure that children are vaccinated appropriately. PMID:28749402

Coverage of childhood vaccination among children aged 12-23 months, Tamil Nadu, 2015, India.

PubMed

Murhekar, Manoj V; Kamaraj, P; Kanagasabai, K; Elavarasu, G; Rajasekar, T Daniel; Boopathi, K; Mehendale, Sanjay

2017-03-01

District-Level Household Survey-4 (DLHS-4) indicated that during 2012-2013, only 56 per cent of children aged 12-23 months in Tamil Nadu were fully vaccinated, which were lesser than those reported in earlier national surveys. We, therefore, conducted cluster surveys to estimate coverage of childhood vaccination in the State, and also to identify the factors associated with low coverage. Cross-sectional surveys were conducted in 15 strata [municipal corporation non-slum (n=1), municipal corporation slum (n=1), hilly (n=1), rural (n=6) and urban (n=6)]. From each stratum, 30 clusters were selected using probability proportional to the population size linear systematic sampling; seven children aged 12-23 months were selected from each cluster and their mothers/care-takers were interviewed to collect information about vaccination status of the child. A child was considered fully vaccinated if he/she received bacillus Calmette-Guérin (BCG), three doses of pentavalent, three doses of oral polio vaccine and one dose of measles vaccine, and appropriately vaccinated if all vaccine doses were given at right age and with right interval. Further, coverage of fully vaccinated children (FVC) as per vaccination cards or mothers' recall, validated coverage of FVC (V-FVC) among those having cards, and coverage of appropriately vaccinated children (AVC) were estimated using survey data analysis module with appropriate sampling weights. A total of 3150 children were surveyed, of them 2528 (80.3%) had vaccination card. The weighted coverage of FVC, V-FVC and AVC in the State was 79.9 per cent [95% confidence interval (CI): 78.2-81.5], 78.8 per cent (95% CI: 76.9-80.5) and 69.7 per cent (95% CI: 67.7-71.7), respectively. The coverage of individual vaccine ranged between 84 per cent (measles) and 99.8 per cent (BCG). About 12 per cent V-FVC were not vaccinated as per the vaccination schedule. The coverage of FVC in Tamil Nadu was high, with about 80 per cent children completing primary vaccination. Efforts to increase vaccination coverage in the State need to focus on educating vaccinators about the need to adhere to the national vaccination schedule and strengthening supervision to ensure that children are vaccinated appropriately.

The effect of EDTA in attachment gain and root coverage.

PubMed

Kassab, Moawia M; Cohen, Robert E; Andreana, Sebastiano; Dentino, Andrew R

2006-06-01

Root surface biomodification using low pH agents such as citric acid and tetracycline has been proposed to enhance root coverage following connective tissue grafting. The authors hypothesized that root conditioning with neutral pH edetic acid would improve vertical recession depth, root surface coverage, pocket depth, and clinical attachment levels. Twenty teeth in 10 patients with Miller class I and II recession were treated with connective tissue grafting. The experimental sites received 24% edetic acid in sterile distilled water applied to the root surface for 2 minutes before grafting. Controls were pretreated with only sterile distilled water. Measurements were evaluated before surgery and 6 months after surgery. Analysis of variance was used to determine differences between experimental and control groups. We found significant postoperative improvements in vertical recession depth, root surface coverage, and clinical attachment levels in test and control groups, compared to postoperative data. Pocket depth differences were not significant (P<.01).

Measuring coverage in MNCH: total survey error and the interpretation of intervention coverage estimates from household surveys.

PubMed

Eisele, Thomas P; Rhoda, Dale A; Cutts, Felicity T; Keating, Joseph; Ren, Ruilin; Barros, Aluisio J D; Arnold, Fred

2013-01-01

Nationally representative household surveys are increasingly relied upon to measure maternal, newborn, and child health (MNCH) intervention coverage at the population level in low- and middle-income countries. Surveys are the best tool we have for this purpose and are central to national and global decision making. However, all survey point estimates have a certain level of error (total survey error) comprising sampling and non-sampling error, both of which must be considered when interpreting survey results for decision making. In this review, we discuss the importance of considering these errors when interpreting MNCH intervention coverage estimates derived from household surveys, using relevant examples from national surveys to provide context. Sampling error is usually thought of as the precision of a point estimate and is represented by 95% confidence intervals, which are measurable. Confidence intervals can inform judgments about whether estimated parameters are likely to be different from the real value of a parameter. We recommend, therefore, that confidence intervals for key coverage indicators should always be provided in survey reports. By contrast, the direction and magnitude of non-sampling error is almost always unmeasurable, and therefore unknown. Information error and bias are the most common sources of non-sampling error in household survey estimates and we recommend that they should always be carefully considered when interpreting MNCH intervention coverage based on survey data. Overall, we recommend that future research on measuring MNCH intervention coverage should focus on refining and improving survey-based coverage estimates to develop a better understanding of how results should be interpreted and used.

Measuring Coverage in MNCH: Total Survey Error and the Interpretation of Intervention Coverage Estimates from Household Surveys

PubMed Central

Eisele, Thomas P.; Rhoda, Dale A.; Cutts, Felicity T.; Keating, Joseph; Ren, Ruilin; Barros, Aluisio J. D.; Arnold, Fred

2013-01-01

Nationally representative household surveys are increasingly relied upon to measure maternal, newborn, and child health (MNCH) intervention coverage at the population level in low- and middle-income countries. Surveys are the best tool we have for this purpose and are central to national and global decision making. However, all survey point estimates have a certain level of error (total survey error) comprising sampling and non-sampling error, both of which must be considered when interpreting survey results for decision making. In this review, we discuss the importance of considering these errors when interpreting MNCH intervention coverage estimates derived from household surveys, using relevant examples from national surveys to provide context. Sampling error is usually thought of as the precision of a point estimate and is represented by 95% confidence intervals, which are measurable. Confidence intervals can inform judgments about whether estimated parameters are likely to be different from the real value of a parameter. We recommend, therefore, that confidence intervals for key coverage indicators should always be provided in survey reports. By contrast, the direction and magnitude of non-sampling error is almost always unmeasurable, and therefore unknown. Information error and bias are the most common sources of non-sampling error in household survey estimates and we recommend that they should always be carefully considered when interpreting MNCH intervention coverage based on survey data. Overall, we recommend that future research on measuring MNCH intervention coverage should focus on refining and improving survey-based coverage estimates to develop a better understanding of how results should be interpreted and used. PMID:23667331

The Coverage of Human Evolution in High School Biology Textbooks in the 20th Century and in Current State Science Standards

ERIC Educational Resources Information Center

Skoog, Gerald

2005-01-01

Efforts to eliminate or neutralize the coverage of evolution in high school biology textbooks in the United States have persisted with varying degrees of intensity and success since the 1920s. In particular, the coverage of human evolution has been impacted by these efforts. Evidence of the success of these efforts can be chronicled by the…

Early Coverage, Access, Utilization, and Health Effects of the Affordable Care Act Medicaid Expansions: A Quasi-Experimental Study

PubMed Central

Wherry, Laura R.; Miller, Sarah

2016-01-01

Background In 2014, only 26 states and D.C. chose to implement the Affordable Care Act (ACA) Medicaid expansions for low-income adults. Objective To estimate whether the state Medicaid expansions were associated with changes in insurance coverage, access to and utilization of health care, and self-reported health. Design Comparison of outcomes before and after the expansions in states that did and did not expand Medicaid. Setting U.S. Participants Citizens aged 19–64 with family incomes below 138% of the Federal Poverty Level in the 2010–2014 National Health Interview Surveys. Measurements Health insurance coverage (private, Medicaid, uninsured); health insurance better than last year; visits with doctors in general practice and with specialists; hospitalizations and ED visits; skipped or delayed medical care; usual source of care; diagnoses of diabetes, high cholesterol, and hypertension; self-reported health; and depression. Results In the second half of 2014, low-income adults in expansion states experienced increased health insurance (7.4 percentage points; 95% CI, −11.3 to −3.4) and Medicaid (10.5 percentage points; 95% CI, 6.5 to 14.5) coverage, and increased quality of insurance coverage compared to a year ago (7.1 percentage points; 95% CI, 2.7 to 11.5) when compared to adults in states that did not expand Medicaid. Medicaid expansions were associated with increased visits with doctors in general practice (6.6 percentage points; 95% CI, 1.3 to 12.0), overnight hospital stays (2.4 percentage points; 95% CI, 0.7 to 4.2), and rates of diagnosis of diabetes (5.2 percentage points; 95% CI, 2.4 to 8.1) and high cholesterol (5.7 percentage points; 95% CI, 2.0 to 9.4); changes in other outcomes were not statistically significant. Limitations Observational study may be susceptible to unmeasured confounders; relies on self-reported data; limited post-ACA timeframe provides information on short-term changes only. Conclusions The ACA Medicaid expansions were associated with higher rates of insurance coverage, improved quality of coverage, increased utilization of some types of health care, and higher rates of diagnosis of chronic health conditions for low-income adults. PMID:27088438

High Coverages of Hydrogen on a (10,0) Carbon Nanotube

NASA Technical Reports Server (NTRS)

Bauschlicher, Charles W., Jr.; Arnold, James (Technical Monitor)

2001-01-01

The binding energy of H to a (10,0) carbon nanotube is calculated at 24, 50, and 100% coverage. Several different bonding configurations are considered for the 50% coverage case. Using the ONIOM (our own n-layered integrated molecular orbital and molecular mechanics) approach, the average C-H bond energy for the most stable 50% coverage and for the 100% coverage are 57.3 and 38.6 kcal/mol, respectively. Considering the size of the bond energy of H2, these values suggest that it will be difficult to achieve 100% atomic H coverage on a (10,0) nanotube.

Effective Universal Coverage of Diabetes Mellitus Type 2 in Chile

PubMed Central

Guerrero-Núñez, Sara; Valenzuela-Suazo, Sandra; Cid-Henríquez, Patricia

2017-01-01

ABSTRACT Objective: determine the prevalence of Effective Universal Coverage of Diabetes Mellitus Type 2 in Chile and its relation with the variables: Health Care Coverage of Diabetes Mellitus Type 2; Average of diabetics with metabolic control in 2011-2013; Mortality Rate for Diabetes Mellitus; and Percentage of nurses participating in the Cardiovascular Health Program. Method: cross-sectional descriptive study with ecological components that uses documentary sources of the Ministry of Health. It was established that there is correlation between the Universal Effective Coverage of Diabetes Mellitus Type 2 and the independent variables; it was applied the Pearson Coefficient, being significant at the 0.05 level. Results: in Chile Universal Health Care Coverage of Diabetes Mellitus Type 2 (HbA1c<7% estimated population) is less than 20%; this is related with Mortality Rate for Diabetes Mellitus and Percentage of nurses participating in the Cardiovascular Health Program, being significant at the 0.01 level. Conclusion: effective prevalence of Universal Health Coverage of Diabetes Mellitus Type 2 is low, even though some regions stand out in this research and in the metabolic control of patients who participate in health control program; its relation with percentage of nurses participating in the Cardiovascular Health Program represents a challenge and an opportunity for the health system. PMID:28403339

AIDS in Black and White: The Influence of Newspaper Coverage of HIV/AIDS on HIV/AIDS Testing Among African Americans and White Americans, 1993–2007

PubMed Central

STEVENS, ROBIN; HORNIK, ROBERT C.

2014-01-01

This study examined the impact of newspaper coverage of HIV/AIDS on HIV testing behavior in the US population. HIV testing data were taken from the CDC’s National Behavioral Risk Factor Surveillance System (BRFSS) from 1993 to 2007 (n=265,557). News stories from 24 daily newspapers and one wire service during the same time period were content analyzed. Distributed lagged regression models were employed to estimate how well HIV/AIDS newspaper coverage predicted later HIV testing behavior. Increases in HIV/AIDS newspaper coverage were associated with declines in population level HIV testing. Each additional 100 HIV/AIDS related newspaper stories published each month was associated with a 1.7% decline in HIV testing levels in the subsequent month. This effect differed by race, with African Americans exhibiting greater declines in HIV testing subsequent to increased news coverage than did Whites. These results suggest that mainstream newspaper coverage of HIV/AIDS may have a particularly deleterious effect on African Americans, one of the groups most impacted by the disease. The mechanisms driving the negative effect deserve further investigation to improve reporting on HIV/AIDS in the media. PMID:24597895

Improving immunization in Afghanistan: results from a cross-sectional community-based survey to assess routine immunization coverage.

PubMed

Mugali, Raveesha R; Mansoor, Farooq; Parwiz, Sardar; Ahmad, Fazil; Safi, Najibullah; Higgins-Steele, Ariel; Varkey, Sherin

2017-04-04

Despite progress in recent years, Afghanistan is lagging behind in realizing the full potential of immunization. The country is still endemic for polio transmission and measles outbreaks continue to occur. In spite of significant reductions over the past decade, the mortality rate of children under 5 years of age continues to remain high at 91 per 1000 live births. The study was a descriptive community-based cross sectional household survey. The survey aimed to estimate the levels of immunization coverage at national and province levels. Specific objectives are to: establish valid baseline information to monitor progress of the immunization program; identify reasons why children are not immunized; and make recommendations to enhance access and quality of immunization services in Afghanistan. The survey was carried out in all 34 provinces of the country, with a sample of 6125 mothers of children aged 12-23 months. Nationally, 51% of children participating in the survey received all doses of each antigen irrespective of the recommended date of immunization or recommended interval between doses. About 31% of children were found to be partially vaccinated. Reasons for partial vaccination included: place to vaccinate child too far (23%), not aware of the need of vaccination (17%), no faith in vaccination (16%), mother was too busy (15%), and fear of side effects (11%). The innovative mechanism of contracting out delivery of primary health care services in Afghanistan, including immunization, to non-governmental organizations is showing some positive results in quickly increasing coverage of essential interventions, including routine immunization. Much ground still needs to be covered with proper planning and management of resources in order to improve the immunization coverage in Afghanistan and increase survival and health status of its children.

The Influence of Household- and Community-Level Sanitation and Fecal Sludge Management on Urban Fecal Contamination in Households and Drains and Enteric Infection in Children

PubMed Central

Berendes, David; Kirby, Amy; Clennon, Julie A.; Raj, Suraja; Yakubu, Habib; Leon, Juan; Robb, Katharine; Kartikeyan, Arun; Hemavathy, Priya; Gunasekaran, Annai; Ghale, Ben; Kumar, J. Senthil; Mohan, Venkata Raghava; Kang, Gagandeep; Moe, Christine

2017-01-01

Urban sanitation necessitates management of fecal sludge inside and outside the household. This study examined associations between household sanitation, fecal contamination, and enteric infection in two low-income neighborhoods in Vellore, India. Surveys and spatial analysis assessed the presence and clustering of toilets and fecal sludge management (FSM) practices in 200 households. Fecal contamination was measured in environmental samples from 50 households and household drains. Enteric infection was assessed from stool specimens from children under 5 years of age in these households. The two neighborhoods differed significantly in toilet coverage (78% versus 33%) and spatial clustering. Overall, 49% of toilets discharged directly into open drains (“poor FSM”). Children in households with poor FSM had 3.78 times higher prevalence of enteric infection when compared with children in other households, even those without toilets. In the neighborhood with high coverage of household toilets, children in households with poor FSM had 10 times higher prevalence of enteric infection than other children in the neighborhood and drains in poor FSM clusters who had significantly higher concentrations of genogroup II norovirus. Conversely, children in households with a toilet that contained excreta in a tank onsite had 55% lower prevalence of enteric infection compared with the rest of the study area. Notably, households with a toilet in the neighborhood with low toilet coverage had more fecal contamination on floors where children played compared with those without a toilet. Overall, both toilet coverage levels and FSM were associated with environmental fecal contamination and, subsequently, enteric infection prevalence in this urban setting. PMID:28719269

Finding the gap: revealing local disparities in coverage of maternal, newborn and child health services in South Sudan using lot quality assurance sampling.

PubMed

Valadez, Joseph J; Berendes, Sima; Lako, Richard; Gould, Simon; Vargas, William; Milner, Susan

2015-12-01

We adapted a rapid monitoring method to South Sudan, a new nation with one of the world's highest maternal and child mortality rates, aiming to assess coverage of maternal, neonatal and child health (MNCH) services at the time of independence, and introducing a monitoring and evaluation system (M&E) for equity-sensitive tracking of progress related to Millennium Development Goals (MDG) 4 and 5 at national, state and county levels to detect local variability. We conducted a national cross-sectional household survey among women from six client populations in all, but six of South Sudan's 79 counties. We used lot quality assurance sampling (LQAS) to measure coverage with diverse MNCH indicators to obtain information for national-, state- and county-level health system management decision-making. National coverage of MNCH services was low for all maternal and neonatal care, child immunisation, and child care indicators. However, results varied across states and counties. Central Equatoria State (CES), where the capital is located, showed the highest coverage for most indicators (e.g. ≥4 antenatal care visits range: 4.5% in Jonglei to 40.1% in CES). Urban counties often outperformed rural ones. This adaptation of LQAS to South Sudan demonstrates how it can be used in the future as an M&E system to track progress of MDGs at national, state and county levels to detect local disparities. Overall, our data reveal a desperate need for improving MNCH service coverage in all states. © 2015 The Authors.Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Health financing for universal coverage and health system performance: concepts and implications for policy.

PubMed

Kutzin, Joseph

2013-08-01

Unless the concept is clearly understood, "universal coverage" (or universal health coverage, UHC) can be used to justify practically any health financing reform or scheme. This paper unpacks the definition of health financing for universal coverage as used in the World Health Organization's World health report 2010 to show how UHC embodies specific health system goals and intermediate objectives and, broadly, how health financing reforms can influence these. All countries seek to improve equity in the use of health services, service quality and financial protection for their populations. Hence, the pursuit of UHC is relevant to every country. Health financing policy is an integral part of efforts to move towards UHC, but for health financing policy to be aligned with the pursuit of UHC, health system reforms need to be aimed explicitly at improving coverage and the intermediate objectives linked to it, namely, efficiency, equity in health resource distribution and transparency and accountability. The unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Concern only with specific schemes is incompatible with a universal coverage approach and may even undermine UHC, particularly in terms of equity. Conversely, if a scheme is fully oriented towards system-level goals and objectives, it can further progress towards UHC. Policy and policy analysis need to shift from the scheme to the system level.

Vegetation Coverage Mapping and Soil Effect Correction in Estimating Vegetation Water Content and Dry Biomass from Satellites

NASA Astrophysics Data System (ADS)

Huang, J.; Chen, D.

2005-12-01

Vegetation water content (VWC) attracts great research interests in hydrology research in recent years. As an important parameter describing the horizontal expansion of vegetation, vegetation coverage is essential to implement soil effect correction for partially vegetated fields to estimate VWC accurately. Ground measurements of corn and soybeans in SMEX02 resulted in an identical expolinear relationship between vegetation coverage and leaf area index (LAI), which is used for vegetation coverage mapping. Results illustrated two parts of LAI growth quantitatively: the horizontal expansion of leaf coverage and the vertical accumulation of leaf layers. It is believed that the former part contributes significantly to LAI growth at initial vegetation growth stage and the latter is more dominant after vegetation coverage reaches a certain level. The Normalized Difference Water Index (NDWI) using short-wave infrared bands is convinced for its late saturation at high LAI values, in contrast to the Normalized Difference Vegetation Index (NDVI). NDWI is then utilized to estimate LAI, via another expolinear relationship, which is evidenced having vegetation species independency in study of corn and soybeans in SMEX02 sites. It is believed that the surface reflectance measured at satellites spectral bands are the mixed results of signals reflected from vegetation and bare soil, especially at partially vegetated fields. A simple linear mixture model utilizing vegetation coverage information is proposed to correct soil effect in such cases. Surface reflectance fractions for -rpure- vegetation are derived from the model. Comparing with ground measurements, empirical models using soil effect corrected vegetation indices to estimate VWC and dry biomass (DB) are generated. The study enhanced the in-depth understanding of the mechanisms how vegetation growth takes effect on satellites spectral reflectance with and without soil effect, which are particularly useful for modeling in hydrology, agriculture, forestry and meteorology etc.

Interventions to increase HPV vaccination coverage: A systematic review

PubMed Central

Smulian, Elizabeth A.; Mitchell, Krista R.; Stokley, Shannon

2016-01-01

ABSTRACT We reviewed intervention studies designed to increase human papillomavirus (HPV) vaccination coverage to further understand the impact interventions can have on HPV vaccination coverage. We searched 5 databases for intervention studies published from June 2006 to May 2015. Studies were included if they quantitatively measured HPV vaccination coverage as an outcome and were conducted in the United States. We abstracted outcomes, methods, and results from each study and classified by type of intervention conducted. Findings from 34 studies suggest many types of intervention strategies can increase HPV vaccination coverage in different settings, and with modest cost. Interventions were effective especially when implemented in combination at both provider and community levels. However, not all interventions showed significant effects on coverage. More research is needed to identify the best methods for widespread implementation of effective strategies. PMID:26838959

Racial gaps in child health insurance coverage in four South American countries: the role of wealth, human capital, and other household characteristics.

PubMed

Wehby, George L; Murray, Jeffrey C; McCarthy, Ann Marie; Castilla, Eduardo E

2011-12-01

OBJECTIVE. To evaluate the extent of racial gaps in child health insurance coverage in South America and study the contribution of wealth, human capital, and other household characteristics to accounting for racial disparities in insurance coverage. DATA SOURCES/STUDY SETTING. Primary data collected between 2005 and 2006 in 30 pediatric practices in Argentina, Brazil, Ecuador, and Chile. DESIGN. Country-specific regression models are used to assess differences in insurance coverage by race. A decomposition model is used to quantify the extent to which wealth, human capital, and other household characteristics account for racial disparities in insurance coverage. DATA COLLECTION/EXTRACTION METHODS. In-person interviews were conducted with the mothers of 2,365 children. PRINCIPAL FINDINGS. The majority of children have no insurance coverage except in Chile. Large racial disparities in insurance coverage are observed. Household wealth is the single most important household-level factor accounting for racial disparities in coverage and is significantly and positively associated with coverage, followed by maternal education and employment/occupational status. Geographic differences account for the largest part of racial disparities in insurance coverage in Argentina and Ecuador. CONCLUSIONS. Increasing the coverage of children in less affluent families is important for reducing racial gaps in health insurance coverage in the study countries. © Health Research and Educational Trust.

Planning long lasting insecticide treated net campaigns: should households’ existing nets be taken into account?

PubMed Central

2013-01-01

Background Mass distribution of long-lasting insecticide treated bed nets (LLINs) has led to large increases in LLIN coverage in many African countries. As LLIN ownership levels increase, planners of future mass distributions face the challenge of deciding whether to ignore the nets already owned by households or to take these into account and attempt to target individuals or households without nets. Taking existing nets into account would reduce commodity costs but require more sophisticated, and potentially more costly, distribution procedures. The decision may also have implications for the average age of nets in use and therefore on the maintenance of universal LLIN coverage over time. Methods A stochastic simulation model based on the NetCALC algorithm was used to determine the scenarios under which it would be cost saving to take existing nets into account, and the potential effects of doing so on the age profile of LLINs owned. The model accounted for variability in timing of distributions, concomitant use of continuous distribution systems, population growth, sampling error in pre-campaign coverage surveys, variable net ‘decay’ parameters and other factors including the feasibility and accuracy of identifying existing nets in the field. Results Results indicate that (i) where pre-campaign coverage is around 40% (of households owning at least 1 LLIN), accounting for existing nets in the campaign will have little effect on the mean age of the net population and (ii) even at pre-campaign coverage levels above 40%, an approach that reduces LLIN distribution requirements by taking existing nets into account may have only a small chance of being cost-saving overall, depending largely on the feasibility of identifying nets in the field. Based on existing literature the epidemiological implications of such a strategy is likely to vary by transmission setting, and the risks of leaving older nets in the field when accounting for existing nets must be considered. Conclusions Where pre-campaign coverage levels established by a household survey are below 40% we recommend that planners do not take such LLINs into account and instead plan a blanket mass distribution. At pre-campaign coverage levels above 40%, campaign planners should make explicit consideration of the cost and feasibility of accounting for existing LLINs before planning blanket mass distributions. Planners should also consider restricting the coverage estimates used for this decision to only include nets under two years of age in order to ensure that old and damaged nets do not compose too large a fraction of existing net coverage. PMID:23763773

Planning long lasting insecticide treated net campaigns: should households' existing nets be taken into account?

PubMed

Yukich, Joshua; Bennett, Adam; Keating, Joseph; Yukich, Rudy K; Lynch, Matt; Eisele, Thomas P; Kolaczinski, Kate

2013-06-14

Mass distribution of long-lasting insecticide treated bed nets (LLINs) has led to large increases in LLIN coverage in many African countries. As LLIN ownership levels increase, planners of future mass distributions face the challenge of deciding whether to ignore the nets already owned by households or to take these into account and attempt to target individuals or households without nets. Taking existing nets into account would reduce commodity costs but require more sophisticated, and potentially more costly, distribution procedures. The decision may also have implications for the average age of nets in use and therefore on the maintenance of universal LLIN coverage over time. A stochastic simulation model based on the NetCALC algorithm was used to determine the scenarios under which it would be cost saving to take existing nets into account, and the potential effects of doing so on the age profile of LLINs owned. The model accounted for variability in timing of distributions, concomitant use of continuous distribution systems, population growth, sampling error in pre-campaign coverage surveys, variable net 'decay' parameters and other factors including the feasibility and accuracy of identifying existing nets in the field. Results indicate that (i) where pre-campaign coverage is around 40% (of households owning at least 1 LLIN), accounting for existing nets in the campaign will have little effect on the mean age of the net population and (ii) even at pre-campaign coverage levels above 40%, an approach that reduces LLIN distribution requirements by taking existing nets into account may have only a small chance of being cost-saving overall, depending largely on the feasibility of identifying nets in the field. Based on existing literature the epidemiological implications of such a strategy is likely to vary by transmission setting, and the risks of leaving older nets in the field when accounting for existing nets must be considered. Where pre-campaign coverage levels established by a household survey are below 40% we recommend that planners do not take such LLINs into account and instead plan a blanket mass distribution. At pre-campaign coverage levels above 40%, campaign planners should make explicit consideration of the cost and feasibility of accounting for existing LLINs before planning blanket mass distributions. Planners should also consider restricting the coverage estimates used for this decision to only include nets under two years of age in order to ensure that old and damaged nets do not compose too large a fraction of existing net coverage.

Golden trout habitat selection and movement patterns in degraded and recovering sites within the Golden Trout Wilderness, California

Treesearch

K.R. Matthews

1996-01-01

Abstract.—I used radio transmitters to determine habitat selection and movement patterns of California golden trout Oncorhynchus mykiss aguabonita in two areas defined by their different levels of habitat recovery in the Golden Trout Wilderness, California. Study areas were differentiated by the amount of streamside vegetation (low or high coverage of beaked sedge...

Children's Access to Health Insurance and Health Status in Washington State: Influential Factors. Research Brief. Publication #2009-21

ERIC Educational Resources Information Center

Matthews, Gregory; Moore, Kristin Anderson; Terzian, Mary

2009-01-01

Health insurance, and especially coverage for children, has been a subject of recent political debate in Washington State, as well as on the national stage. Policy makers and health care providers can use high-quality state-level data to assess which children lack health insurance and devise possible solutions to address this need. Illustrating…

Infinium HumanMethylation450 BeadChip

Cancer.gov

The HumanMethylation450 BeadChip offers a unique combination of comprehensive, expert-selected coverage and high throughput at a low price, making it ideal for screening large sample populations such as those used in genome-wide association study cohorts. By providing quantitative methylation measurement at the single-CpG–site level for normal and FFPE samples, this assay offers powerful resolution for understanding epigenetic changes.

Towards a Multilingual Medical Lexicon

PubMed Central

Markó, Kornél; Baud, Robert; Zweigenbaum, Pierre; Borin, Lars; Merkel, Magnus; Schulz, Stefan

2006-01-01

We present results of the collaboration of a multinational team of researchers from (computational) linguistics, medicine, and medical informatics with the goal of building a multilingual medical lexicon with high coverage and complete morpho-syntactic information. Monolingual lexical resources were collected and subsequently mapped between languages using a morpho-semantic term normalization engine, which captures intra- as well as interlingual synonymy relationships on the level of subwords. PMID:17238398

Potential for Controlling Cholera Using a Ring Vaccination Strategy: Re-analysis of Data from a Cluster-Randomized Clinical Trial.

PubMed

Ali, Mohammad; Debes, Amanda K; Luquero, Francisco J; Kim, Deok Ryun; Park, Je Yeon; Digilio, Laura; Manna, Byomkesh; Kanungo, Suman; Dutta, Shanta; Sur, Dipika; Bhattacharya, Sujit K; Sack, David A

2016-09-01

Vaccinating a buffer of individuals around a case (ring vaccination) has the potential to target those who are at highest risk of infection, reducing the number of doses needed to control a disease. We explored the potential vaccine effectiveness (VE) of oral cholera vaccines (OCVs) for such a strategy. This analysis uses existing data from a cluster-randomized clinical trial in which OCV or placebo was given to 71,900 participants in Kolkata, India, from 27 July to 10 September 2006. Cholera surveillance was then conducted on 144,106 individuals living in the study area, including trial participants, for 5 y following vaccination. First, we explored the risk of cholera among contacts of cholera patients, and, second, we measured VE among individuals living within 25 m of cholera cases between 8 and 28 d after onset of the index case. For the first analysis, individuals living around each index case identified during the 5-y period were assembled using a ring to define cohorts of individuals exposed to cholera index cases. An index control without cholera was randomly selected for each index case from the same population, matched by age group, and individuals living around each index control were assembled using a ring to define cohorts not exposed to cholera cases. Cholera attack rates among the exposed and non-exposed cohorts were compared using different distances from the index case/control to define the rings and different time frames to define the period at risk. For the VE analysis, the exposed cohorts were further stratified according to the level of vaccine coverage into high and low coverage strata. Overall VE was assessed by comparing the attack rates between high and low vaccine coverage strata irrespective of individuals' vaccination status, and indirect VE was assessed by comparing the attack rates among unvaccinated members between high and low vaccine coverage strata. Cholera risk among the cohort exposed to cholera cases was 5-11 times higher than that among the cohort not exposed to cholera cases. The risk gradually diminished with an increase in distance and time. The overall and indirect VE measured between 8 and 28 d after exposure to a cholera index case during the first 2 y was 91% (95% CI 62%-98%) and 93% (95% CI 44%-99%), respectively. VE persisted for 5 y after vaccination and was similar whether the index case was a young child (<5 y) or was older. Of note, this study was a reanalysis of a cholera vaccine trial that used two doses; thus, a limitation of the study relates to the assumption that a single dose, if administered quickly, will induce a similar level of total and indirect protection over the short term as did two doses. These findings suggest that high-level protection can be achieved if individuals living close to cholera cases are living in a high coverage ring. Since this was an observational study including participants who had received two doses of vaccine (or placebo) in the clinical trial, further studies are needed to determine whether a ring vaccination strategy, in which vaccine is given quickly to those living close to a case, is feasible and effective. ClinicalTrials.gov NCT00289224.

Potential for Controlling Cholera Using a Ring Vaccination Strategy: Re-analysis of Data from a Cluster-Randomized Clinical Trial

PubMed Central

Ali, Mohammad; Luquero, Francisco J.; Kim, Deok Ryun; Park, Je Yeon; Digilio, Laura; Manna, Byomkesh; Kanungo, Suman; Dutta, Shanta; Sur, Dipika; Bhattacharya, Sujit K.

2016-01-01

Introduction Vaccinating a buffer of individuals around a case (ring vaccination) has the potential to target those who are at highest risk of infection, reducing the number of doses needed to control a disease. We explored the potential vaccine effectiveness (VE) of oral cholera vaccines (OCVs) for such a strategy. Methods and Findings This analysis uses existing data from a cluster-randomized clinical trial in which OCV or placebo was given to 71,900 participants in Kolkata, India, from 27 July to 10 September 2006. Cholera surveillance was then conducted on 144,106 individuals living in the study area, including trial participants, for 5 y following vaccination. First, we explored the risk of cholera among contacts of cholera patients, and, second, we measured VE among individuals living within 25 m of cholera cases between 8 and 28 d after onset of the index case. For the first analysis, individuals living around each index case identified during the 5-y period were assembled using a ring to define cohorts of individuals exposed to cholera index cases. An index control without cholera was randomly selected for each index case from the same population, matched by age group, and individuals living around each index control were assembled using a ring to define cohorts not exposed to cholera cases. Cholera attack rates among the exposed and non-exposed cohorts were compared using different distances from the index case/control to define the rings and different time frames to define the period at risk. For the VE analysis, the exposed cohorts were further stratified according to the level of vaccine coverage into high and low coverage strata. Overall VE was assessed by comparing the attack rates between high and low vaccine coverage strata irrespective of individuals’ vaccination status, and indirect VE was assessed by comparing the attack rates among unvaccinated members between high and low vaccine coverage strata. Cholera risk among the cohort exposed to cholera cases was 5–11 times higher than that among the cohort not exposed to cholera cases. The risk gradually diminished with an increase in distance and time. The overall and indirect VE measured between 8 and 28 d after exposure to a cholera index case during the first 2 y was 91% (95% CI 62%–98%) and 93% (95% CI 44%–99%), respectively. VE persisted for 5 y after vaccination and was similar whether the index case was a young child (<5 y) or was older. Of note, this study was a reanalysis of a cholera vaccine trial that used two doses; thus, a limitation of the study relates to the assumption that a single dose, if administered quickly, will induce a similar level of total and indirect protection over the short term as did two doses. Conclusions These findings suggest that high-level protection can be achieved if individuals living close to cholera cases are living in a high coverage ring. Since this was an observational study including participants who had received two doses of vaccine (or placebo) in the clinical trial, further studies are needed to determine whether a ring vaccination strategy, in which vaccine is given quickly to those living close to a case, is feasible and effective. Trial registration ClinicalTrials.gov NCT00289224 PMID:27622507

The role of ERTS in the establishment and of a nationwide land cover information system

NASA Technical Reports Server (NTRS)

Abram, P.; Tullos, J.

1974-01-01

The economic potential of utilizing an ERTS type satellite in the development, updating, and maintenance of a nation-wide land cover information system in the post-1977 time frame was examined. Several alternative acquisition systems were evaluated for land cover data acquisition, processing, and interpretation costs in order to determine, on a total life cycle cost basis, under which conditions of user demand (i.e., area of coverage, frequency of coverage, timeliness of information, and level of information detail) an ERTS type satellite would be cost effective, and what the annual cost savings benefits would be. It was concluded that a three satellite system with high and low altitude aircraft and ground survey team utilizing automatic interpretation and classification techniques is an economically sound proposal.

The perfect haze: Scientists link 1999 U.S. pollution episode to midwest aerosol plumes and Kennedy plane crash

NASA Astrophysics Data System (ADS)

Showstack, Randy

The crash of John F Kennedy Jrs single-engine Piper Saratoga airplane in the waters off of Marthas Vineyard, Massachusetts, on July 16, 1999, prompted round-the-clock, global media coverage. Cameras panned the waters as the search began the following day, Saturday Pundits at first commented on the likelihood of survival of the late U.S. president's son, who piloted the plane, and the passengers—his wife and sister-in-law. Television screens displayed the projected, hour-and-one-half, nighttime flight path east from New Jersey As the tragedy unfolded, coverage focused on speculation about the cause of the crash. News analysts repeatedly mentioned that haze attributed to summertime heat and high humidity levels may have sharply reduced visibility during the flight.

Impact of hepatitis B vaccination on acute hepatitis B epidemiology in European Union/European Economic Area countries, 2006 to 2014

PubMed Central

Miglietta, Alessandro; Quinten, Chantal; Lopalco, Pier Luigi; Duffell, Erika

2018-01-01

Hepatitis B prevention in European Union/European Economic Area (EU/EEA) countries relies on vaccination programmes. We describe the epidemiology of acute hepatitis B virus (HBV) at country and EU/EEA level during 2006–2014. Using a multi-level mixed-effects Poisson regression model we assessed differences in the acute HBV infection notification rates between groups of countries that started universal HBV vaccination before/in vs after 1995; implemented or not a catch-up strategy; reached a vaccine coverage ≥ 95% vs < 95% and had a hepatitis B surface antigen prevalence ≥ 1% vs < 1%. Joinpoint regression analysis was used to assess trends by groups of countries, and additional Poisson regression models to evaluate the association between three-dose HBV vaccine coverage and acute HBV infection notification rates at country and EU/EEA level. The EU/EEA acute HBV infection notification rate decreased from 1.6 per 100,000 population in 2006 to 0.7 in 2014. No differences (p > 0.05) were found in the acute HBV infection notification rates between groups of countries, while as vaccine coverage increased, such rates decreased (p < 0.01). Countries with universal HBV vaccination before 1995, a catch-up strategy, and a vaccine coverage ≥ 95% had significant decreasing trends (p < 0.01). Ending HBV transmission in Europe by 2030 will require high vaccine coverage delivered through universal programmes, supported, where appropriate, by catch-up vaccination campaigns. PMID:29439751

Access to dental care among 15–64 year old people

PubMed Central

Eslamipour, Faezeh; Heydari, Kamal; Ghaiour, Marzieh; Salehi, Hoda

2018-01-01

INTRODUCTION: The current study aims to study people's access to oral and dental health-care services and their satisfaction with the services provided to them. MATERIALS AND METHODS: A descriptive study with multi-stage sampling was conducted on 1360 people aged 16–64 years residing in Isfahan city, Iran. The required data were collected by a questionnaire which comprised of three main parts: demographic characteristics, patients’ access to oral and dental health-care services and its barriers and participants’ satisfaction with access to services. Data were analyzed by SPSS statistical software. RESULTS: The results showed 40% of participants reported an average level for oral health, and 82% of them did not have any problems regarding access to dental care facilities. The main causes of their dissatisfaction were high cost of services (60%) and insufficient health insurance coverage (40%). About 73% reported that they had to spend 30 min or less to access to a dental health-care facility. In addition, 50% of participants were satisfied with the provided services. The main reported reasons for referring to dentists were oral and dental problems (69%) and regular check-ups (15%). There was no significant relationship between participants’ gender, education level, insurance coverage, and access to dental health-care centers (P > 0.05). CONCLUSION: Most participants were satisfied with access to dental healthcare, but they were dissatisfied with the costs and inadequate insurance coverage. About half of the participants were satisfied with the services provided to them, and the highest level of satisfaction was reported for easy access to health-care centers. PMID:29693027

Linkage of the Third National Health and Nutrition Examination Survey to air quality data.

PubMed

Kravets, Nataliya; Parker, Jennifer D

2008-11-01

This report describes the linked data file obtained as a result of combining air pollution data and National Health and Nutrition Examination Survey (NHANES) III data. Average annual air pollution exposures to particulate matter consisting of particles smaller than 10 micrometers in diameter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO) were created for NHANES III examined persons by averaging values from monitors within a 5-, 10-, 15-, and 20-mile radius from the block-group centroid of their residence and in the county of their residence. Percentage records geocoded to block-group level, percentage records linked to air pollution, and distributions of exposure values were estimated for the total sample and various demographic groups. The percentages of respondents who were assigned countywide air pollution values ranges from a low of 43 percent in the case of NO2 data to a high of 68 percent in the case of PM10 data. Among the pollutants considered, PM10 data provides the best coverage. Of all the metrics created, the highest coverage is achieved by averaging readings of monitors located within a 20-mile distance from the centroid of respondents' block groups. Among the demographic variables analyzed, differences in air pollution coverage and exposure levels occur most often among groups defined by race and Hispanic origin, region, and county level of urbanization. However, differences among groups depend on the pollutant and geographic linkage method. The linked dataset provides researchers with opportunities to investigate the relationship between air pollution and various health outcomes.

Probability of Future Observations Exceeding One-Sided, Normal, Upper Tolerance Limits

DOE PAGES

Edwards, Timothy S.

2014-10-29

Normal tolerance limits are frequently used in dynamic environments specifications of aerospace systems as a method to account for aleatory variability in the environments. Upper tolerance limits, when used in this way, are computed from records of the environment and used to enforce conservatism in the specification by describing upper extreme values the environment may take in the future. Components and systems are designed to withstand these extreme loads to ensure they do not fail under normal use conditions. The degree of conservatism in the upper tolerance limits is controlled by specifying the coverage and confidence level (usually written inmore » “coverage/confidence” form). Moreover, in high-consequence systems it is common to specify tolerance limits at 95% or 99% coverage and confidence at the 50% or 90% level. Despite the ubiquity of upper tolerance limits in the aerospace community, analysts and decision-makers frequently misinterpret their meaning. The misinterpretation extends into the standards that govern much of the acceptance and qualification of commercial and government aerospace systems. As a result, the risk of a future observation of the environment exceeding the upper tolerance limit is sometimes significantly underestimated by decision makers. This note explains the meaning of upper tolerance limits and a related measure, the upper prediction limit. So, the objective of this work is to clarify the probability of exceeding these limits in flight so that decision-makers can better understand the risk associated with exceeding design and test levels during flight and balance the cost of design and development with that of mission failure.« less

An assessment of Lot Quality Assurance Sampling to evaluate malaria outcome indicators: extending malaria indicator surveys.

PubMed

Biedron, Caitlin; Pagano, Marcello; Hedt, Bethany L; Kilian, Albert; Ratcliffe, Amy; Mabunda, Samuel; Valadez, Joseph J

2010-02-01

Large investments and increased global prioritization of malaria prevention and treatment have resulted in greater emphasis on programme monitoring and evaluation (M&E) in many countries. Many countries currently use large multistage cluster sample surveys to monitor malaria outcome indicators on a regional and national level. However, these surveys often mask local-level variability important to programme management. Lot Quality Assurance Sampling (LQAS) has played a valuable role for local-level programme M&E. If incorporated into these larger surveys, it would provide a comprehensive M&E plan at little, if any, extra cost. The Mozambique Ministry of Health conducted a Malaria Indicator Survey (MIS) in June and July 2007. We applied LQAS classification rules to the 345 sampled enumeration areas to demonstrate identifying high- and low-performing areas with respect to two malaria program indicators-'household possession of any bednet' and 'household possession of any insecticide-treated bednet (ITN)'. As shown by the MIS, no province in Mozambique achieved the 70% coverage target for household possession of bednets or ITNs. By applying LQAS classification rules to the data, we identify 266 of the 345 enumeration areas as having bednet coverage severely below the 70% target. An additional 73 were identified with low ITN coverage. This article demonstrates the feasibility of integrating LQAS into multistage cluster sampling surveys and using these results to support a comprehensive national, regional and local programme M&E system. Furthermore, in the recommendations we outlined how to integrate the Large Country-LQAS design into macro-surveys while still obtaining results available through current sampling practices.

An operando Raman study of molecular structure and reactivity of molybdenum(VI) oxide supported on anatase for the oxidative dehydrogenation of ethane.

PubMed

Tsilomelekis, George; Boghosian, Soghomon

2012-02-21

Supported molybdenum oxide catalysts on TiO(2) (anatase) with surface densities in the range of 1.8-17.0 Mo per nm(2) were studied at temperatures of 410-480 °C for unraveling the configuration and molecular structure of the deposited (MoO(x))(n) species and examining their behavior for the ethane oxidative dehydrogenation (ODH). In situ Raman and in situ FTIR spectra under oxidizing conditions combined with (18)O/(16)O isotope exchange studies provide the first sound evidence for mono-oxo configuration for the deposited (MoO(x))(n) species on anatase. Isolated O=Mo(-O-)(3) tetra-coordinated species in C(3v)-like symmetry prevail at all surface coverages with a low presence of associated (polymeric) species (probably penta-coordinated) evidenced at high coverages, below the approximate monolayer of 6 Mo per nm(2). A mechanistic scenario for (18)O/(16)O isotope exchange and next-nearest-neighbor vibrational isotope effect is proposed at the molecular level to account for the pertinent spectral observations. Catalytic measurements for ethane ODH with simultaneous monitoring of operando Raman spectra were performed. The selectivity to ethylene increases with increasing surface density up to the monolayer coverage, where primary steps of ethane activation follow selective reaction pathways leading to ∼100% C(2)H(4) selectivity. The operando Raman spectra and a quantitative exploitation of the relative normalized Mo=O band intensities for surface densities of 1.8-5.9 Mo per nm(2) and various residence times show that the terminal Mo=O sites are involved in non-selective reaction turnovers. Reaction routes follow primarily non-selective pathways at low coverage and selective pathways at high coverage. Trends in the initial rates of ethane consumption (apparent reactivity per Mo) as a function of Mo surface density are discussed on the basis of several factors.

The Patient Protection and Affordable Care Act dependent coverage expansion: Disparities in impact among young adult oncology patients.

PubMed

Alvarez, Elysia M; Keegan, Theresa H; Johnston, Emily E; Haile, Robert; Sanders, Lee; Wise, Paul H; Saynina, Olga; Chamberlain, Lisa J

2018-01-01

Private health insurance is associated with improved outcomes in patients with cancer. However, to the authors' knowledge, little is known regarding the impact of the Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE), which extended private insurance to young adults (to age 26 years) beginning in 2010, on the insurance status of young adults with cancer. The current study was a retrospective, population-based analysis of hospitalized young adult oncology patients (aged 22-30 years) in California during 2006 through 2014 (11,062 patients). Multivariable regression analyses examined factors associated with having private insurance. Results were presented as adjusted odds ratios and 95% confidence intervals. A difference-in-difference analysis examined the influence of the ACA-DCE on insurance coverage by race/ethnicity and federal poverty level. Multivariable regression demonstrated that patients of black and Hispanic race/ethnicity were less likely to have private insurance before and after the ACA-DCE, compared with white patients. Younger age (22-25 years) was associated with having private insurance after implementation of the ACA-DCE (odds ratio, 1.20; 95% confidence interval, 1.06-1.35). In the difference-in-difference analysis, private insurance increased among white patients aged 22 to 25 years who were living in medium-income (2006-2009: 64.6% vs 2011-2014: 69.1%; P = .003) and high-income (80.4% vs 82%; P = .043) zip codes and among Asians aged 22 to 25 years living in high-income zip codes (73.2 vs 85.7%; P = .022). Private insurance decreased for all Hispanic patients aged 22 to 25 years between the 2 time periods. The ACA-DCE provision increased insurance coverage, but not among all patients. Private insurance increased for white and Asian patients in higher income neighborhoods, potentially widening social disparities in private insurance coverage among young adults with cancer. Cancer 2018;124:110-7. © 2017 American Cancer Society. © 2017 American Cancer Society.

Contrasting Trends in Arctic and Antarctic Sea Ice Coverage Since the Late 1970s

NASA Astrophysics Data System (ADS)

Parkinson, C. L.

2016-12-01

Satellite observations have allowed a near-continuous record of Arctic and Antarctic sea ice coverage since late 1978. This record has revealed considerable interannual variability in both polar regions but also significant long-term trends, with the Arctic losing, the Antarctic gaining, and the Earth as a whole losing sea ice coverage. Over the period 1979-2015, the trend in yearly average sea ice extents in the Arctic is -53,100 km2/yr (-4.3 %/decade) and in the Antarctic is 23,800 km2/yr (2.1 %/decade). For all 12 months, trends are negative in the Arctic and positive in the Antarctic, with the highest magnitude monthly trend being for September in the Arctic, at -85,300 km2/yr (-10.9 %/decade). The decreases in Arctic sea ice extents have been so dominant that not a single month since 1986 registered a new monthly record high, whereas 75 months registered new monthly record lows between 1987 and 2015 and several additional record lows were registered in 2016. The Antarctic sea ice record highs and lows are also out of balance, in the opposite direction, although not in such dramatic fashion. Geographic details on the changing ice covers, down to the level of individual pixels, can be seen by examining changes in the length of the sea ice season. Results reveal (and quantify) shortening ice seasons throughout the bulk of the Arctic marginal ice zone, the main exception being within the Bering Sea, and lengthening sea ice seasons through much of the Southern Ocean but shortening seasons in the Bellingshausen Sea, southern Amundsen Sea, and northwestern Weddell Sea. The decreasing Arctic sea ice coverage was widely anticipated and fits well with a large array of environmental changes in the Arctic, whereas the increasing Antarctic sea ice coverage was not widely anticipated and explaining it remains an area of active research by many scientists exploring a variety of potential explanations.

Surface diffusion of Sb on Ge(111) investigated by second harmonic microscopy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schultz, K.A.

Surface diffusion of Sb on Ge(111) has been measured with the newly-developed technique of second harmonic microscopy. In this method, concentration profiles at submonolayer coverage are imaged directly by second harmonic generation with 5 [mu]m spatial resolution. A Boltzmann-Matano analysis of the concentration profiles yields the coverage dependence of the diffusivity D without parameterization. Experiments were performed at roughly 70% of the bulk melting temperature T[sub m]. In the coverage range of 0 < [theta] < 0.6, the activation energy E[sub diff] remains constant at 47.5 [+-] 1.5 kcal/mol. The corresponding pre-exponential factor decreases from 8.7 [times] 10[sup 3[+-]0.4] tomore » 1.6 [times] 10[sup 2[+-]0.4] cm[sup 2]/sec. The results are explained in terms of a new vacancy model for surface diffusion at high-temperatures. The model accounts semiquantitatively for the large values of E[sub diff] and D[sub o], and suggest that these quantities may be manipulated by bulk doping levels and photon illumination of the surface.« less

Engineering design skills coverage in K-12 engineering program curriculum materials in the USA

NASA Astrophysics Data System (ADS)

Chabalengula, Vivien M.; Mumba, Frackson

2017-11-01

The current K-12 Science Education framework and Next Generation Science Standards (NGSS) in the United States emphasise the integration of engineering design in science instruction to promote scientific literacy and engineering design skills among students. As such, many engineering education programmes have developed curriculum materials that are being used in K-12 settings. However, little is known about the nature and extent to which engineering design skills outlined in NGSS are addressed in these K-12 engineering education programme curriculum materials. We analysed nine K-12 engineering education programmes for the nature and extent of engineering design skills coverage. Results show that developing possible solutions and actual designing of prototypes were the highly covered engineering design skills; specification of clear goals, criteria, and constraints received medium coverage; defining and identifying an engineering problem; optimising the design solution; and demonstrating how a prototype works, and making iterations to improve designs were lowly covered. These trends were similar across grade levels and across discipline-specific curriculum materials. These results have implications on engineering design-integrated science teaching and learning in K-12 settings.

Inclusive state immigrant policies and health insurance among Latino, Asian/Pacific Islander, Black, and White noncitizens in the United States.

PubMed

Young, Maria-Elena De Trinidad; Leon-Perez, Gabriela; Wells, Christine R; Wallace, Steven P

2017-10-20

Policy-making related to immigrant populations is increasingly conducted at the state-level. State policy contexts may influence health insurance coverage by determining noncitizens' access to social and economic resources and shaping social environments. Using nationally representative data, we investigate the relationship between level of inclusion of state immigrant policies and health insurance coverage and its variation by citizenship and race/ethnicity. Data included a measure of level of inclusion of the state policy context from a scan of 10 policies enacted prior to 2014 and data for adults ages 18-64 from the 2014 American Community Survey. A fixed-effects logistic regression model tested the association between having health insurance and the interaction of level of inclusiveness, citizenship, and race/ethnicity, controlling for state- and individual-level characteristics. Latino noncitizens experienced higher rates of being insured in states with higher levels of inclusion, while Asian/Pacific Islander noncitizens experienced lower levels. The level of inclusion was not associated with differences in insurance coverage among noncitizen Whites and Blacks. Contexts with more inclusive immigrant policies may have the most benefit for Latino noncitizens.

Universal Health Coverage - The Critical Importance of Global Solidarity and Good Governance Comment on "Ethical Perspective: Five Unacceptable Trade-offs on the Path to Universal Health Coverage".

PubMed

Reis, Andreas A

2016-06-07

This article provides a commentary to Ole Norheim' s editorial entitled "Ethical perspective: Five unacceptable trade-offs on the path to universal health coverage." It reinforces its message that an inclusive, participatory process is essential for ethical decision-making and underlines the crucial importance of good governance in setting fair priorities in healthcare. Solidarity on both national and international levels is needed to make progress towards the goal of universal health coverage (UHC). © 2016 by Kerman University of Medical Sciences.

Studies of high coverage oxidation of the Cu(100) surface using low energy positrons

NASA Astrophysics Data System (ADS)

Fazleev, N. G.; Maddox, W. B.; Weiss, A. H.

2012-02-01

The study of oxidation of single crystal metal surfaces is important in understanding the corrosive and catalytic processes associated with thin film metal oxides. The structures formed on oxidized transition metal surfaces vary from simple adlayers of chemisorbed oxygen to more complex structures which result from the diffusion of oxygen into subsurface regions. In this work we present the results of theoretical studies of positron surface and bulk states and annihilation probabilities of surface-trapped positrons with relevant core electrons at the oxidized Cu(100) surface under conditions of high oxygen coverage. Calculations are performed for various high coverage missing row structures ranging between 0.50 and 1.50 ML oxygen coverage. The results of calculations of positron binding energy, positron work function, and annihilation characteristics of surface trapped positrons with relevant core electrons as function of oxygen coverage are compared with experimental data obtained from studies of oxidation of the Cu(100) surface using positron annihilation induced Auger electron spectroscopy (PAES).

Pre-Scheduled and Self Organized Sleep-Scheduling Algorithms for Efficient K-Coverage in Wireless Sensor Networks

PubMed Central

Hwang, I-Shyan

2017-01-01

The K-coverage configuration that guarantees coverage of each location by at least K sensors is highly popular and is extensively used to monitor diversified applications in wireless sensor networks. Long network lifetime and high detection quality are the essentials of such K-covered sleep-scheduling algorithms. However, the existing sleep-scheduling algorithms either cause high cost or cannot preserve the detection quality effectively. In this paper, the Pre-Scheduling-based K-coverage Group Scheduling (PSKGS) and Self-Organized K-coverage Scheduling (SKS) algorithms are proposed to settle the problems in the existing sleep-scheduling algorithms. Simulation results show that our pre-scheduled-based KGS approach enhances the detection quality and network lifetime, whereas the self-organized-based SKS algorithm minimizes the computation and communication cost of the nodes and thereby is energy efficient. Besides, SKS outperforms PSKGS in terms of network lifetime and detection quality as it is self-organized. PMID:29257078

Assessing the performance of LOINC® and RadLex for coverage of CT scans across three sites in a health information exchange.

PubMed

Beitia, Anton Oscar; Kuperman, Gilad; Delman, Bradley N; Shapiro, Jason S

2013-01-01

We evaluated the performance of LOINC® and RadLex standard terminologies for covering CT test names from three sites in a health information exchange (HIE) with the eventual goal of building an HIE-based clinical decision support system to alert providers of prior duplicate CTs. Given the goal, the most important parameter to assess was coverage for high frequency exams that were most likely to be repeated. We showed that both LOINC® and RadLex provided sufficient coverage for our use case through calculations of (a) high coverage of 90% and 94%, respectively for the subset of CTs accounting for 99% of exams performed and (b) high concept token coverage (total percentage of exams performed that map to terminologies) of 92% and 95%, respectively. With trends toward greater interoperability, this work may provide a framework for those wishing to map radiology site codes to a standard nomenclature for purposes of tracking resource utilization.

Understanding consumer preferences in the context of managed competition: evidence from a choice experiment in Colombia.

PubMed

Trujillo, Antonio J; Ruiz, Fernando; Bridges, John F P; Amaya, Jeannette L; Buttorff, Christine; Quiroga, Angélica M

2012-03-01

In many countries, health insurance coverage is the primary way for individuals to access care. Governments can support access through social insurance programmes; however, after a certain period, governments struggle to achieve universal coverage. Evidence suggests that complex individual behaviour may play a role. Using a choice experiment, this research explored consumer preferences for health insurance in Colombia. We also evaluated whether preferences differed across consumers with differing demographic and health status factors. A household field experiment was conducted in Bogotá in 2010. The sample consisted of 109 uninsured and 133 low-income insured individuals. Each individual evaluated 12 pair-wise comparisons of hypothetical health plans. We focused on six characteristics of health insurance: premium, out-of-pocket expenditure, chronic condition coverage, quality of care, family coverage and sick leave. A main effects orthogonal design was used to derive the 72 scenarios used in the choice experiment. Parameters were estimated using conditional logit models. Since price data were included, we estimated respondents' willingness to pay for characteristics. Consumers valued health benefits and family coverage more than other attributes. Additionally, differences in preferences can be exploited to increase coverage. The willingness to pay for benefits may partially cover the average cost of providing them. Policy makers might be able to encourage those insured via the subsidized system to enrol in the next level of the social health insurance scheme through expanding benefits to family members and expanding the level of chronic condition coverage.

Whole genome sequence analysis of BT-474 using complete Genomics' standard and long fragment read technologies.

PubMed

Ciotlos, Serban; Mao, Qing; Zhang, Rebecca Yu; Li, Zhenyu; Chin, Robert; Gulbahce, Natali; Liu, Sophie Jia; Drmanac, Radoje; Peters, Brock A

2016-01-01

The cell line BT-474 is a popular cell line for studying the biology of cancer and developing novel drugs. However, there is no complete, published genome sequence for this highly utilized scientific resource. In this study we sought to provide a comprehensive and useful data set for the scientific community by generating a whole genome sequence for BT-474. Five μg of genomic DNA, isolated from an early passage of the BT-474 cell line, was used to generate a whole genome sequence (114X coverage) using Complete Genomics' standard sequencing process. To provide additional variant phasing and structural variation data we also processed and analyzed two separate libraries of 5 and 6 individual cells to depths of 99X and 87X, respectively, using Complete Genomics' Long Fragment Read (LFR) technology. BT-474 is a highly aneuploid cell line with an extremely complex genome sequence. This ~300X total coverage genome sequence provides a more complete understanding of this highly utilized cell line at the genomic level.

Coverage of a national cardiovascular risk assessment and management programme (NHS Health Check): Retrospective database study.

PubMed

Chang, Kiara Chu-Mei; Soljak, Michael; Lee, John Tayu; Woringer, Maria; Johnston, Desmond; Khunti, Kamlesh; Majeed, Azeem; Millett, Christopher

2015-09-01

To determine coverage of NHS Health Check, a national cardiovascular risk assessment programme in England, in the first four years after implementation, and to examine prevalence of high cardiovascular disease (CVD) risk and uptake of statins in high risk patients. Study sample was 95,571 patients in England aged 40-74years continuously registered with 509 practices in the Clinical Practice Research Datalink between April 2009 and March 2013. Multilevel logistic regression models were used to assess predictors of Health Check attendance; elevated CVD risk factors and statin prescribing among attendees. Programme coverage was 21.4% over four years, with large variations between practices (0%-72.7%) and regions (9.4%-30.7%). Coverage was higher in older patients (adjusted odds ratio 2.88, 95% confidence interval 2.49-3.31 for patients 70-74years) and in patients with a family history of premature coronary heart disease (2.37, 2.22-2.53), but lower in Black Africans (0.75, 0.61-0.92) and Chinese (0.68, 0.47-0.96) compared with White British. Coverage was similar in patients living in deprived and affluent areas. Prevalence of high CVD risk (QRISK2≥20%) among attendees was 4.6%. One third (33.6%) of attendees at high risk were prescribed a statin after Health Checks. Coverage of the programme and statin prescribing in high risk individuals was low. Coverage was similar in deprived and affluent groups but lower in some ethnic minority groups, possibly widening inequalities. These findings raise a question about whether recommendations by WHO to develop CVD risk assessment programmes internationally will deliver anticipated health benefits. Copyright © 2015. Published by Elsevier Inc.

Seasonal influenza vaccine coverage among high-risk populations in Thailand, 2010-2012.

PubMed

Owusu, Jocelynn T; Prapasiri, Prabda; Ditsungnoen, Darunee; Leetongin, Grit; Yoocharoen, Pornsak; Rattanayot, Jarowee; Olsen, Sonja J; Muangchana, Charung

2015-01-29

The Advisory Committee on Immunization Practice of Thailand prioritizes seasonal influenza vaccinations for populations who are at highest risk for serious complications (pregnant women, children 6 months-2 years, persons ≥65 years, persons with chronic diseases, obese persons), and healthcare personnel and poultry cullers. The Thailand government purchases seasonal influenza vaccine for these groups. We assessed vaccination coverage among high-risk groups in Thailand from 2010 to 2012. National records on persons who received publicly purchased vaccines from 2010 to 2012 were analyzed by high-risk category. Denominator data from multiple sources were compared to calculate coverage. Vaccine coverage was defined as the proportion of individuals in each category who received the vaccine. Vaccine wastage was defined as the proportion of publicly purchased vaccines that were not used. From 2010 to 2012, 8.18 million influenza vaccines were publicly purchased (range, 2.37-3.29 million doses/year), and vaccine purchases increased 39% over these years. Vaccine wastage was 9.5%. Approximately 5.7 million (77%) vaccine doses were administered to persons ≥65 years and persons with chronic diseases, 1.4 million (19%) to healthcare personnel/poultry cullers, 82,570 (1.1%) to children 6 months-2 years, 78,885 (1.1%) to obese persons, 26,481 (0.4%) to mentally disabled persons, and 17,787 (0.2%) to pregnant women. Between 2010 and 2012, coverage increased among persons with chronic diseases (8.6% versus 14%; p<0.01) and persons ≥65 years (12%, versus 20%; p<0.01); however, coverage decreased for mentally disabled persons (6.1% versus 4.9%; p<0.01), children 6 months-2 years (2.3% versus 0.9%; p<0.01), pregnant women (1.1% versus 0.9%; p<0.01), and obese persons (0.2% versus 0.1%; p<0.01). From 2010 to 2012, the availability of publicly purchased vaccines increased. While coverage remained low for all target groups, coverage was highest among persons ≥65 years and persons with chronic diseases. Annual coverage assessments are necessary to promote higher coverage among high-risk groups in Thailand. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Seasonal influenza vaccine coverage among high-risk populations in Thailand, 2010–2012

PubMed Central

Owusu, Jocelynn T.; Prapasiri, Prabda; Ditsungnoen, Darunee; Leetongin, Grit; Yoocharoen, Pornsak; Rattanayot, Jarowee; Olsen, Sonja J.; Muangchana, Charung

2015-01-01

Background The Advisory Committee on Immunization Practice of Thailand prioritizes seasonal influenza vaccinations for populations who are at highest risk for serious complications (pregnant women, children 6 months–2 years, persons ≥65 years, persons with chronic diseases, obese persons), and health-care personnel and poultry cullers. The Thailand government purchases seasonal influenza vaccine for these groups. We assessed vaccination coverage among high-risk groups in Thailand from 2010 to 2012. Methods National records on persons who received publicly purchased vaccines from 2010 to 2012 were analyzed by high-risk category. Denominator data from multiple sources were compared to calculate coverage. Vaccine coverage was defined as the proportion of individuals in each category who received the vaccine. Vaccine wastage was defined as the proportion of publicly purchased vaccines that were not used. Results From 2010 to 2012, 8.18 million influenza vaccines were publicly purchased (range, 2.37–3.29 million doses/year), and vaccine purchases increased 39% over these years. Vaccine wastage was 9.5%. Approximately 5.7 million (77%) vaccine doses were administered to persons ≥65 years and persons with chronic diseases, 1.4 million (19%) to healthcare personnel/poultry cullers, 82,570 (1.1%) to children 6 months–2 years, 78,885 (1.1%) to obese persons, 26,481 (0.4%) to mentally disabled persons, and 17,787 (0.2%) to pregnant women. Between 2010 and 2012, coverage increased among persons with chronic diseases (8.6% versus 14%; p < 0.01) and persons ≥65 years (12%, versus 20%; p < 0.01); however, coverage decreased for mentally disabled persons (6.1% versus 4.9%; p < 0.01), children 6 months–2 years (2.3% versus 0.9%; p < 0.01), pregnant women (1.1% versus 0.9%; p < 0.01), and obese persons (0.2% versus 0.1%; p < 0.01). Conclusions From 2010 to 2012, the availability of publicly purchased vaccines increased. While coverage remained low for all target groups, coverage was highest among persons ≥65 years and persons with chronic diseases. Annual coverage assessments are necessary to promote higher coverage among high-risk groups in Thailand. PMID:25454853

Functional architecture and global properties of the Corynebacterium glutamicum regulatory network: Novel insights from a dataset with a high genomic coverage.

PubMed

Freyre-González, Julio A; Tauch, Andreas

2017-09-10

Corynebacterium glutamicum is a Gram-positive, anaerobic, rod-shaped soil bacterium able to grow on a diversity of carbon sources like sugars and organic acids. It is a biotechnological relevant organism because of its highly efficient ability to biosynthesize amino acids, such as l-glutamic acid and l-lysine. Here, we reconstructed the most complete C. glutamicum regulatory network to date and comprehensively analyzed its global organizational properties, systems-level features and functional architecture. Our analyses show the tremendous power of Abasy Atlas to study the functional organization of regulatory networks. We created two models of the C. glutamicum regulatory network: all-evidences (containing both weak and strong supported interactions, genomic coverage=73%) and strongly-supported (only accounting for strongly supported evidences, genomic coverage=71%). Using state-of-the-art methodologies, we prove that power-law behaviors truly govern the connectivity and clustering coefficient distributions. We found a non-previously reported circuit motif that we named complex feed-forward motif. We highlighted the importance of feedback loops for the functional architecture, beyond whether they are statistically over-represented or not in the network. We show that the previously reported top-down approach is inadequate to infer the hierarchy governing a regulatory network because feedback bridges different hierarchical layers, and the top-down approach disregards the presence of intermodular genes shaping the integration layer. Our findings all together further support a diamond-shaped, three-layered hierarchy exhibiting some feedback between processing and coordination layers, which is shaped by four classes of systems-level elements: global regulators, locally autonomous modules, basal machinery and intermodular genes. Copyright © 2016 Elsevier B.V. All rights reserved.

Insurance cancellations in context: stability of coverage in the nongroup market prior to health reform.

PubMed

Sommers, Benjamin D

2014-05-01

Recent cancellations of nongroup health insurance plans generated much policy debate and raised concerns that the Affordable Care Act (ACA) may increase the number of uninsured Americans in the short term. This article provides evidence on the stability of nongroup coverage using US census data for the period 2008-11, before ACA provisions took effect. The principal findings are threefold. First, this market was characterized by high turnover: Only 42 percent of people with nongroup coverage at the outset of the study period retained that coverage after twelve months. Second, 80 percent of people experiencing coverage changes acquired other insurance within a year, most commonly from an employer. Third, turnover varied across groups, with stable coverage more common for whites and self-employed people than for other groups. Turnover was particularly high among adults ages 19-35, with only 21 percent of young adults retaining continuous nongroup coverage for two years. Given estimates from 2012 that 10.8 million people were covered in this market, these results suggest that 6.2 million people leave nongroup coverage annually. This suggests that the nongroup market was characterized by frequent disruptions in coverage before the ACA and that the effects of the recent cancellations are not necessarily out of the norm. These results can serve as a useful pre-ACA baseline with which to evaluate the law's long-term impact on the stability of nongroup coverage.

[Complete immunization coverage and reasons for non-vaccination in a periurban area of Abidjan].

PubMed

Sackou, K J; Oga, A S S; Desquith, A A; Houenou, Y; Kouadio, K L

2012-10-01

An immunization coverage survey was conducted among children aged 12-59 months in a suburban neighbourhood in Abidjan. The objective was to determine the complete immunization coverage, the reasons for non-vaccination and factors influencing the immunization status of children. The method of exhaustive sampling enabled us to interview the mothers of 669 children using a questionnaire. Overall vaccination coverage was 68.6% with 1.2%, with 1.2% of children never having received vaccine. The logistic regression analysis showed that the level of education, knowledge of the immunization schedule and the marital status of mothers, as well as the type of habitat, were associated with full immunization of children. These determinants must be taken into account to improve vaccination coverage.

Unemployment insurance and deteriorating self-rated health in 23 European countries.

PubMed

Ferrarini, Tommy; Nelson, Kenneth; Sjöberg, Ola

2014-07-01

The global financial crisis of 2008 is likely to have repercussions on public health in Europe, not least through escalating mass unemployment, fiscal austerity measures and inadequate social protection systems. The purpose of this study is to analyse the role of unemployment insurance for deteriorating self-rated health in the working age population at the onset of the fiscal crisis in Europe. Multilevel logistic conditional change models linking institutional-level data on coverage and income replacement in unemployment insurance to individual-level panel data on self-rated health in 23 European countries at two repeated occasions, 2006 and 2009. Unemployment insurance significantly reduces transitions into self-rated ill-health and, particularly, programme coverage is important in this respect. Unemployment insurance is also of relevance for the socioeconomic gradients of health at individual level, where programme coverage significantly reduces health risks attached to educational attainment. Unemployment insurance mitigated adverse health effects both at individual and country-level during the financial crisis. Due to the centrality of programme coverage, reforms to unemployment insurance should focus on extending the number of insured people in the labour force. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Paper-like electronic displays: Large-area rubber-stamped plastic sheets of electronics and microencapsulated electrophoretic inks

PubMed Central

Rogers, John A.; Bao, Zhenan; Baldwin, Kirk; Dodabalapur, Ananth; Crone, Brian; Raju, V. R.; Kuck, Valerie; Katz, Howard; Amundson, Karl; Ewing, Jay; Drzaic, Paul

2001-01-01

Electronic systems that use rugged lightweight plastics potentially offer attractive characteristics (low-cost processing, mechanical flexibility, large area coverage, etc.) that are not easily achieved with established silicon technologies. This paper summarizes work that demonstrates many of these characteristics in a realistic system: organic active matrix backplane circuits (256 transistors) for large (≈5 × 5-inch) mechanically flexible sheets of electronic paper, an emerging type of display. The success of this effort relies on new or improved processing techniques and materials for plastic electronics, including methods for (i) rubber stamping (microcontact printing) high-resolution (≈1 μm) circuits with low levels of defects and good registration over large areas, (ii) achieving low leakage with thin dielectrics deposited onto surfaces with relief, (iii) constructing high-performance organic transistors with bottom contact geometries, (iv) encapsulating these transistors, (v) depositing, in a repeatable way, organic semiconductors with uniform electrical characteristics over large areas, and (vi) low-temperature (≈100°C) annealing to increase the on/off ratios of the transistors and to improve the uniformity of their characteristics. The sophistication and flexibility of the patterning procedures, high level of integration on plastic substrates, large area coverage, and good performance of the transistors are all important features of this work. We successfully integrate these circuits with microencapsulated electrophoretic “inks” to form sheets of electronic paper. PMID:11320233

Predicting the impact of insecticide-treated bed nets on malaria transmission: the devil is in the detail.

PubMed

Gu, Weidong; Novak, Robert J

2009-11-16

Insecticide-treated bed nets (ITNs), including long-lasting insecticidal nets (LLINs), play a primary role in global campaigns to roll back malaria in tropical Africa. Effectiveness of treated nets depends on direct impacts on individual mosquitoes including killing and excite-repellency, which vary considerably among vector species due to variations in host-seeking behaviours. While monitoring and evaluation programmes of ITNs have focuses on morbidity and all-cause mortality in humans, local entomological context receives little attention. Without knowing the dynamics of local vector species and their responses to treated nets, it is difficult to predict clinical outcomes when ITN applications are scaled up across African continent. Sound model frameworks incorporating intricate interactions between mosquitoes and treated nets are needed to develop the predictive capacity for scale-up applications of ITNs. An established agent-based model was extended to incorporate the direct outcomes, e.g. killing and avoidance, of individual mosquitoes exposing to ITNs in a hypothetical village setting with 50 houses and 90 aquatic habitats. Individual mosquitoes were tracked throughout the life cycle across the landscape. Four levels of coverage, i.e. 40, 60, 80 and 100%, were applied at the household level with treated houses having only one bed net. By using Latin hypercube sampling scheme, parameters governing killing, diverting and personal protection of net users were evaluated for their relative roles in containing mosquito populations, entomological inoculation rates (EIRs) and malaria incidence. There were substantial gaps in coverage between households and individual persons, and 100% household coverage resulted in circa 50% coverage of the population. The results show that applications of ITNs could give rise to varying impacts on population-level metrics depending on values of parameters governing interactions of mosquitoes and treated nets at the individual level. The most significant factor in determining effectiveness was killing capability of treated nets. Strong excito-repellent effect of impregnated nets might lead to higher risk exposure to non-bed net users. With variabilities of vector mosquitoes in host-seeking behaviours and the responses to treated nets, it is anticipated that scale-up applications of INTs might produce varying degrees of success dependent on local entomological and epidemiological contexts. This study highlights that increased ITN coverage led to significant reduction in risk exposure and malaria incidence only when treated nets yielded high killing effects. It is necessary to test efficacy of treated nets on local dominant vector mosquitoes, at least in laboratory, for monitoring and evaluation of ITN programmes.

Automated Generation and Assessment of Autonomous Systems Test Cases

NASA Technical Reports Server (NTRS)

Barltrop, Kevin J.; Friberg, Kenneth H.; Horvath, Gregory A.

2008-01-01

This slide presentation reviews some of the issues concerning verification and validation testing of autonomous spacecraft routinely culminates in the exploration of anomalous or faulted mission-like scenarios using the work involved during the Dawn mission's tests as examples. Prioritizing which scenarios to develop usually comes down to focusing on the most vulnerable areas and ensuring the best return on investment of test time. Rules-of-thumb strategies often come into play, such as injecting applicable anomalies prior to, during, and after system state changes; or, creating cases that ensure good safety-net algorithm coverage. Although experience and judgment in test selection can lead to high levels of confidence about the majority of a system's autonomy, it's likely that important test cases are overlooked. One method to fill in potential test coverage gaps is to automatically generate and execute test cases using algorithms that ensure desirable properties about the coverage. For example, generate cases for all possible fault monitors, and across all state change boundaries. Of course, the scope of coverage is determined by the test environment capabilities, where a faster-than-real-time, high-fidelity, software-only simulation would allow the broadest coverage. Even real-time systems that can be replicated and run in parallel, and that have reliable set-up and operations features provide an excellent resource for automated testing. Making detailed predictions for the outcome of such tests can be difficult, and when algorithmic means are employed to produce hundreds or even thousands of cases, generating predicts individually is impractical, and generating predicts with tools requires executable models of the design and environment that themselves require a complete test program. Therefore, evaluating the results of large number of mission scenario tests poses special challenges. A good approach to address this problem is to automatically score the results based on a range of metrics. Although the specific means of scoring depends highly on the application, the use of formal scoring - metrics has high value in identifying and prioritizing anomalies, and in presenting an overall picture of the state of the test program. In this paper we present a case study based on automatic generation and assessment of faulted test runs for the Dawn mission, and discuss its role in optimizing the allocation of resources for completing the test program.

Use of Lot Quality Assurance Sampling (LQAS) to estimate vaccination coverage helps guide future vaccination efforts.

PubMed

Alberti, K P; Guthmann, J P; Fermon, F; Nargaye, K D; Grais, R F

2008-03-01

Inadequate evaluation of vaccine coverage after mass vaccination campaigns, such as used in national measles control programmes, can lead to inappropriate public health responses. Overestimation of vaccination coverage may leave populations at risk, whilst underestimation can lead to unnecessary catch-up campaigns. The problem is more complex in large urban areas where vaccination coverage may be heterogeneous and the programme may have to be fine-tuned at the level of geographic subunits. Lack of accurate population figures in many contexts further complicates accurate vaccination coverage estimates. During the evaluation of a mass vaccination campaign carried out in N'Djamena, the capital of Chad, Lot Quality Assurance Sampling was used to estimate vaccination coverage. Using this method, vaccination coverage could be evaluated within smaller geographic areas of the city as well as for the entire city. Despite the lack of accurate population data by neighbourhood, the results of the survey showed heterogeneity of vaccination coverage within the city. These differences would not have been identified using a more traditional method. The results can be used to target areas of low vaccination coverage during follow-up vaccination activities.

A Comparative Study of the RAPINA and the Virus-Neutralizing Test (RFFIT) for the Estimation of Antirabies-Neutralizing Antibody Levels in Dog Samples.

PubMed

Manalo, D L; Yamada, K; Watanabe, I; Miranda, M E G; Lapiz, S M D; Tapdasan, E; Petspophonsakul, W; Inoue, S; Khawplod, P; Nishizono, A

2017-08-01

The mass vaccination of dogs against rabies is a highly rational strategy for interrupting the natural transmission of urban rabies. According to the World Organization for Animal Health (OIE) and the World Health Organization (WHO), the immunization of at least 70% of the total dog population minimizes the risk of endemic rabies. Knowledge of the virus-neutralizing antibody (VNA) level against the rabies virus (RABV) is required to evaluate protective immunity and vaccine coverage of dogs in the field. The rapid focus fluorescent inhibition test (RFFIT) and the fluorescent antibody virus neutralization (FAVN) test are recommended by OIE and WHO to determine the VNA levels in serum. However, these tests are cell culture based and require the use of live viruses and specialized equipment. The rapid neutralizing antibody test (RAPINA) is a novel, immunochromatographic test that uses inactivated virus to estimate the VNA level qualitatively. It is a simple, rapid and inexpensive, although indirect, assay for the detection of VNA levels. The RAPINA has shown good positive and negative predictive values and a high concordance with the RFFIT results. In this study, we compared the performance of the two tests for evaluating the vaccination status of dogs in the Philippines, Thailand and Japan. A total of 1135 dog sera were analysed by the RAPINA and compared to the VNA levels determined by the RFFIT. The overall positive and negative predictive values of the RAPINA were 96.2-99.3% and 84.5-94.8%, respectively, with a concordance (kappa) of 0.946-0.97 among the three countries. The RAPINA results were highly homologous and reproducible among different laboratories. These results suggest that this test is appropriate to survey vaccination coverage in countries with limited resources. © 2016 The Authors. Zoonoses and Public Health published by Blackwell Verlag GmbH.

Observations of Penetration Electric Fields and Sub-Auroral Ion Drifts With Mid-Latitude SuperDARN Radars

NASA Astrophysics Data System (ADS)

Baker, J. B.; Greenwald, R. A.; Yin, Y.; Ruohoniemi, J. M.; Clausen, L.; Frissell, N. A.; Ribeiro, A. J.

2009-12-01

The Super Dual Auroral Radar Network (SuperDARN) provides continuous Doppler measurements of ionospheric plasma convection over extended spatial scales with high temporal resolution. First generation SuperDARN radars were constructed at magnetic latitudes near 60 degrees to optimize coverage during periods of moderate geomagnetic activity. In recent years there has been an expansion of the network to middle latitudes to increase coverage during enhanced geomagnetic activity, such as during magnetic storms. In this paper we present measurements of prompt penetration electric fields and sub-auroral ion drift (SAID) events observed by the Wallops and Blackstone radars at middle latitudes. Together, these two radars provide a capability to continuously examine the temporal evolution of these features over an extended local time sector. We present case studies and statistical results showing that transient sub-auroral flow enhancements occur over a wide range of magnetospheric disturbance levels and are often highly correlated with activity at higher latitudes.

Buckling in serpentine microstructures and applications in elastomer-supported ultra-stretchable electronics with high areal coverage

PubMed Central

Zhang, Yihui; Xu, Sheng; Fu, Haoran; Lee, Juhwan; Su, Jessica; Hwang, Keh-Chih; Rogers, John A.; Huang, Yonggang

2014-01-01

Lithographically defined electrical interconnects with thin, filamentary serpentine layouts have been widely explored for use in stretchable electronics supported by elastomeric substrates. We present a systematic and thorough study of buckling physics in such stretchable serpentine microstructures, and a strategic design of serpentine layout for ultra-stretchable electrode, via analytical models, finite element method (FEM) computations, and quantitative experiments. Both the onset of buckling and the postbuckling behaviors are examined, to determine scaling laws for the critical buckling strain and the limits of elastic behavior. Two buckling modes, namely the symmetric and anti-symmetric modes, are identified and analyzed, with experimental images and numerical results that show remarkable levels of agreement for the associated postbuckling processes. Based on these studies and an optimization in design layout, we demonstrate routes for application of serpentine interconnects in an ultra-stretchable electrode that offer, simultaneously, an areal coverage as high as 81%, and a biaxial stretchability as large as ~170%. PMID:25309616

Buckling in serpentine microstructures and applications in elastomer-supported ultra-stretchable electronics with high areal coverage.

PubMed

Zhang, Yihui; Xu, Sheng; Fu, Haoran; Lee, Juhwan; Su, Jessica; Hwang, Keh-Chih; Rogers, John A; Huang, Yonggang

2013-01-01

Lithographically defined electrical interconnects with thin, filamentary serpentine layouts have been widely explored for use in stretchable electronics supported by elastomeric substrates. We present a systematic and thorough study of buckling physics in such stretchable serpentine microstructures, and a strategic design of serpentine layout for ultra-stretchable electrode, via analytical models, finite element method (FEM) computations, and quantitative experiments. Both the onset of buckling and the postbuckling behaviors are examined, to determine scaling laws for the critical buckling strain and the limits of elastic behavior. Two buckling modes, namely the symmetric and anti-symmetric modes, are identified and analyzed, with experimental images and numerical results that show remarkable levels of agreement for the associated postbuckling processes. Based on these studies and an optimization in design layout, we demonstrate routes for application of serpentine interconnects in an ultra-stretchable electrode that offer, simultaneously, an areal coverage as high as 81%, and a biaxial stretchability as large as ~170%.

Rethinking Medicaid Coverage and Payment Policy to Promote High Value Care: The Case of Long-Acting Reversible Contraception.

PubMed

Vela, Veronica X; Patton, Elizabeth W; Sanghavi, Darshak; Wood, Susan F; Shin, Peter; Rosenbaum, Sara

Long-acting reversible contraception (LARC) is the most effective reversible method to prevent unplanned pregnancies. Variability in state-level policies and the high cost of LARC could create substantial inconsistencies in Medicaid coverage, despite federal guidance aimed at enhancing broad access. This study surveyed state Medicaid payment policies and outreach activities related to LARC to explore the scope of services covered. Using publicly available information, we performed a content analysis of state Medicaid family planning and LARC payment policies. Purposeful sampling led to a selection of nine states with diverse geographic locations, political climates, Medicaid expansion status, and the number of women covered by Medicaid. All nine states' Medicaid programs covered some aspects of LARC. However, only a single state's payment structure incorporated all core aspects of high-quality LARC service delivery, including counseling, device, insertion, removal, and follow-up care. Most states did not explicitly address counseling, device removal, or follow-up care. Some states had strategies to enhance access, including policies to increase device reimbursement, stocking and delivery programs to remove cost barriers, and covering devices and insertion after an abortion. Although Medicaid policy encourages LARC methods, state payment policies frequently fail to address key aspects of care, including counseling, follow-up care, and removal, resulting in highly variable state-level practices. Although some states include payment policy innovations to support LARC access, significant opportunities remain. Published by Elsevier Inc.

Extensive gene tree discordance and hemiplasy shaped the genomes of North American columnar cacti.

PubMed

Copetti, Dario; Búrquez, Alberto; Bustamante, Enriquena; Charboneau, Joseph L M; Childs, Kevin L; Eguiarte, Luis E; Lee, Seunghee; Liu, Tiffany L; McMahon, Michelle M; Whiteman, Noah K; Wing, Rod A; Wojciechowski, Martin F; Sanderson, Michael J

2017-11-07

Few clades of plants have proven as difficult to classify as cacti. One explanation may be an unusually high level of convergent and parallel evolution (homoplasy). To evaluate support for this phylogenetic hypothesis at the molecular level, we sequenced the genomes of four cacti in the especially problematic tribe Pachycereeae, which contains most of the large columnar cacti of Mexico and adjacent areas, including the iconic saguaro cactus ( Carnegiea gigantea ) of the Sonoran Desert. We assembled a high-coverage draft genome for saguaro and lower coverage genomes for three other genera of tribe Pachycereeae ( Pachycereus , Lophocereus , and Stenocereus ) and a more distant outgroup cactus, Pereskia We used these to construct 4,436 orthologous gene alignments. Species tree inference consistently returned the same phylogeny, but gene tree discordance was high: 37% of gene trees having at least 90% bootstrap support conflicted with the species tree. Evidently, discordance is a product of long generation times and moderately large effective population sizes, leading to extensive incomplete lineage sorting (ILS). In the best supported gene trees, 58% of apparent homoplasy at amino sites in the species tree is due to gene tree-species tree discordance rather than parallel substitutions in the gene trees themselves, a phenomenon termed "hemiplasy." The high rate of genomic hemiplasy may contribute to apparent parallelisms in phenotypic traits, which could confound understanding of species relationships and character evolution in cacti. Published under the PNAS license.

Extensive gene tree discordance and hemiplasy shaped the genomes of North American columnar cacti

PubMed Central

Búrquez, Alberto; Bustamante, Enriquena; Charboneau, Joseph L. M.; Childs, Kevin L.; Eguiarte, Luis E.; Lee, Seunghee; Liu, Tiffany L.; McMahon, Michelle M.; Whiteman, Noah K.; Wing, Rod A.; Wojciechowski, Martin F.; Sanderson, Michael J.

2017-01-01

Few clades of plants have proven as difficult to classify as cacti. One explanation may be an unusually high level of convergent and parallel evolution (homoplasy). To evaluate support for this phylogenetic hypothesis at the molecular level, we sequenced the genomes of four cacti in the especially problematic tribe Pachycereeae, which contains most of the large columnar cacti of Mexico and adjacent areas, including the iconic saguaro cactus (Carnegiea gigantea) of the Sonoran Desert. We assembled a high-coverage draft genome for saguaro and lower coverage genomes for three other genera of tribe Pachycereeae (Pachycereus, Lophocereus, and Stenocereus) and a more distant outgroup cactus, Pereskia. We used these to construct 4,436 orthologous gene alignments. Species tree inference consistently returned the same phylogeny, but gene tree discordance was high: 37% of gene trees having at least 90% bootstrap support conflicted with the species tree. Evidently, discordance is a product of long generation times and moderately large effective population sizes, leading to extensive incomplete lineage sorting (ILS). In the best supported gene trees, 58% of apparent homoplasy at amino sites in the species tree is due to gene tree-species tree discordance rather than parallel substitutions in the gene trees themselves, a phenomenon termed “hemiplasy.” The high rate of genomic hemiplasy may contribute to apparent parallelisms in phenotypic traits, which could confound understanding of species relationships and character evolution in cacti. PMID:29078296

Quality of antenatal care service provision in health facilities across sub–Saharan Africa: Evidence from nationally representative health facility assessments

PubMed Central

Kanyangarara, Mufaro; Munos, Melinda K; Walker, Neff

2017-01-01

Background Utilization of antenatal care (ANC) services has increased over the past two decades. Continued gains in maternal and newborn health will require an understanding of both access and quality of ANC services. We linked health facility and household survey data to examine the quality of service provision for five ANC interventions across health facilities in sub–Saharan Africa. Methods Using data from 20 nationally representative health facility assessments – the Service Provision Assessment (SPA) and the Service Availability and Readiness Assessment (SARA), we estimated facility level readiness to deliver five ANC interventions: tetanus toxoid vaccine for pregnant women, intermittent preventive treatment for malaria in pregnancy (IPTp), syphilis detection and treatment in pregnancy, iron supplementation and hypertensive disease case management. Facility level indicators were stratified by health facility type, managing authority and location, then linked to estimates of ANC utilization in that stratum from the corresponding Demographic and Health Surveys (DHS) to generate population level estimates of the ‘likelihood of appropriate care’. Finally, the association between estimates of the ‘likelihood of appropriate care’ from the linking approach and estimates of coverage levels from the DHS were assessed. Findings A total of 10 534 health facilities were surveyed in the 20 health facility assessments, of which 8742 reported offering ANC services and were included in the analysis. Health facility readiness to deliver IPTp, iron supplementation, and tetanus toxoid vaccination was higher (median: 84.1%, 84.9% and 82.8% respectively) than readiness to deliver hypertensive disease case management and syphilis detection and treatment (median: 23.0% and 19.9% respectively). Coverage of at least 4 ANC visits ranged from 24.8% to 75.8%. Estimates of the likelihood of appropriate care derived from linking health facility and household survey data showed marked gaps for all interventions, particularly hypertensive disease case management and syphilis detection and treatment. There was fairly good concordance between our estimates of high likelihood of appropriate care and DHS estimates of coverage for iron supplementation, IPTp, and tetanus toxoid vaccination. Conclusion Linking household surveys to health facility assessments revealed marked gaps in population–level coverage of quality ANC interventions and underscored the need for a double–pronged approach to increase ANC utilization and improve the quality of ANC services. PMID:29163936

Quality of antenatal care service provision in health facilities across sub-Saharan Africa: Evidence from nationally representative health facility assessments.

PubMed

Kanyangarara, Mufaro; Munos, Melinda K; Walker, Neff

2017-12-01

Utilization of antenatal care (ANC) services has increased over the past two decades. Continued gains in maternal and newborn health will require an understanding of both access and quality of ANC services. We linked health facility and household survey data to examine the quality of service provision for five ANC interventions across health facilities in sub-Saharan Africa. Using data from 20 nationally representative health facility assessments - the Service Provision Assessment (SPA) and the Service Availability and Readiness Assessment (SARA), we estimated facility level readiness to deliver five ANC interventions: tetanus toxoid vaccine for pregnant women, intermittent preventive treatment for malaria in pregnancy (IPTp), syphilis detection and treatment in pregnancy, iron supplementation and hypertensive disease case management. Facility level indicators were stratified by health facility type, managing authority and location, then linked to estimates of ANC utilization in that stratum from the corresponding Demographic and Health Surveys (DHS) to generate population level estimates of the 'likelihood of appropriate care'. Finally, the association between estimates of the 'likelihood of appropriate care' from the linking approach and estimates of coverage levels from the DHS were assessed. A total of 10 534 health facilities were surveyed in the 20 health facility assessments, of which 8742 reported offering ANC services and were included in the analysis. Health facility readiness to deliver IPTp, iron supplementation, and tetanus toxoid vaccination was higher (median: 84.1%, 84.9% and 82.8% respectively) than readiness to deliver hypertensive disease case management and syphilis detection and treatment (median: 23.0% and 19.9% respectively). Coverage of at least 4 ANC visits ranged from 24.8% to 75.8%. Estimates of the likelihood of appropriate care derived from linking health facility and household survey data showed marked gaps for all interventions, particularly hypertensive disease case management and syphilis detection and treatment. There was fairly good concordance between our estimates of high likelihood of appropriate care and DHS estimates of coverage for iron supplementation, IPTp, and tetanus toxoid vaccination. Linking household surveys to health facility assessments revealed marked gaps in population-level coverage of quality ANC interventions and underscored the need for a double-pronged approach to increase ANC utilization and improve the quality of ANC services.

Impact of an Individual Mandate and Other Health Reforms on Dependent Coverage for Adolescents and Young Adults.

PubMed

Wisk, Lauren E; Finkelstein, Jonathan A; Toomey, Sara L; Sawicki, Gregory S; Schuster, Mark A; Galbraith, Alison A

2018-06-01

To determine the effect of state-level dependent coverage expansion (DCE) with and without other state health reforms on exit from dependent coverage for adolescents and young adults (AYA). Administrative longitudinal data for 131,542 privately insured AYA in Massachusetts (DCE with other reforms) versus Maine and New Hampshire (DCE without other reforms) across three periods: prereform (1/00-12/06), poststate reform (1/07-9/10), and postfederal reform (10/10-12/12). A difference-in-differences estimator was used to determine the rate of exit from dependent coverage, age at exit from dependent coverage, and re-uptake of dependent coverage among AYA in states with comprehensive reforms versus DCE only. Implementation of DCE with other reforms was significantly associated with a 23 percent reduction in exit from dependent coverage among AYA compared to the reduction observed for DCE alone. Additionally, comprehensive reforms were associated with over two additional years of dependent coverage for the average AYA and a 33 percent increase in the odds of regaining dependent coverage after a prior loss. Findings suggest that an individual mandate and other reforms may enhance the effect of DCE in preventing loss of coverage among AYA. © Health Research and Educational Trust.

A Two-Phase Coverage-Enhancing Algorithm for Hybrid Wireless Sensor Networks.

PubMed

Zhang, Qingguo; Fok, Mable P

2017-01-09

Providing field coverage is a key task in many sensor network applications. In certain scenarios, the sensor field may have coverage holes due to random initial deployment of sensors; thus, the desired level of coverage cannot be achieved. A hybrid wireless sensor network is a cost-effective solution to this problem, which is achieved by repositioning a portion of the mobile sensors in the network to meet the network coverage requirement. This paper investigates how to redeploy mobile sensor nodes to improve network coverage in hybrid wireless sensor networks. We propose a two-phase coverage-enhancing algorithm for hybrid wireless sensor networks. In phase one, we use a differential evolution algorithm to compute the candidate's target positions in the mobile sensor nodes that could potentially improve coverage. In the second phase, we use an optimization scheme on the candidate's target positions calculated from phase one to reduce the accumulated potential moving distance of mobile sensors, such that the exact mobile sensor nodes that need to be moved as well as their final target positions can be determined. Experimental results show that the proposed algorithm provided significant improvement in terms of area coverage rate, average moving distance, area coverage-distance rate and the number of moved mobile sensors, when compare with other approaches.

[The evaluation of quality of implementation of preventive medical examinations of underage persons in the Russian Federation].

PubMed

Baranov, A A; Namazova-Baranova, L S; Terletskaia, R N; Baibarina, E N; Chumakova, O V; Ustinova, N V; Antonova, E V

2017-01-01

The analysis was implemented concerning informational statistic data characterizing health of children population of different age groups in the Russian Federation on the basis of results of dispensarization in its federal okrugs and subjects in 2014. The purpose of the study was to discover ways and modes of developing and increasing efficiency of preventive examinations of underage population. The following indices were analyzed: coverage of children population by preventive medical examinations, distribution according health groups and medical groups for physical culture involvement, level and stricture of established total and primary morbidity, rate of dispensary registration, requirements in additional consultations, examinations and treatment in out-patient condition, day hospital, day-and-night hospital and also coverage with all these medical services. In the most of the subjects of the Russian Federation a high level of coverage of underage population with preventive medical examinations is registered. The percentage of healthy children population in the Russian Federation comprises more than one third of all covered by dispensarization. The significant variations in indices of rate of healthy children and children with functional disorders and chronic diseases in subjects of the Russian Federation is determined by quality and accessibility of medical care at the regional level. The established total and primary morbidity of children population in significant percentage (more than one third) of the subjects has a level higher than a national one. The leading causes of morbidity in children are diseases of respiratory system, musculoskeletal system, nervous system. In adolescents, these causes are diseases of musculoskeletal system, eye diseases and diseases of respiratory system. Despite high prevalence of chronic pathology in children population of the Russian Federation, the guidelines concerning treatment and rehabilitation on the basis of results of preventive medical examinations were developed in inadequate scope. The regional characteristics of the results of dispensarization are established. These results made it possible to sort out the most unfavorable territories and to determine defects in its organization and absence of continuity between medeical institutions providing the given type of medical services.

Global report on preterm birth and stillbirth (4 of 7): delivery of interventions

PubMed Central

2010-01-01

Background The efficacious interventions identified in the previous article of this report will fail unless they are delivered at high and equitable coverage. This article discusses critical delivery constraints and strategies. Barriers to scaling up interventions Achieving universal coverage entails addressing major barriers at many levels. An overarching constraint is the lack of political will, resulting from the dearth of preterm birth and stillbirth data and the lack of visibility. Other barriers exist at the household and community levels, such as insufficient demand for interventions or sociocultural barriers; at the health services level, such as a lack of resources and trained healthcare providers; and at the health sector policy and management level, such as poorly functioning, centralized systems. Additional constraints involve weak governance and accountability, political instability, and challenges in the physical environment. Strategies and examples Scaling up maternal, newborn and child health interventions requires strengthening health systems, but there is also a role for focused, targeted interventions. Choosing a strategy involves identifying appropriate channels for reaching high coverage, which depends on many factors such as access to and attendance at healthcare facilities. Delivery channels vary, and may include facility- and community-based healthcare providers, mass media campaigns, and community-based approaches and marketing strategies. Issues related to scaling up are discussed in the context of four interventions that may be given to mothers at different stages throughout pregnancy or to newborns: (1) detection and treatment of syphilis; (2) emergency Cesarean section; (3) newborn resuscitation; and (4) kangaroo mother care. Systematic reviews of the literature and large-scale implementation studies are analyzed for each intervention. Conclusion Equitable and successful scale-up of preterm birth and stillbirth interventions will require addressing multiple barriers, and utilizing multiple delivery approaches and channels. Another important need is developing strategies to discontinue ineffective or harmful interventions. Preterm birth and stillbirth interventions must also be placed in the broader maternal, newborn and child health context to identify and prioritize those that will help improve several outcomes at the same time. The next article discusses advocacy challenges and opportunities. PMID:20233385

Global report on preterm birth and stillbirth (4 of 7): delivery of interventions.

PubMed

Victora, Cesar G; Rubens, Craig E

2010-02-23

The efficacious interventions identified in the previous article of this report will fail unless they are delivered at high and equitable coverage. This article discusses critical delivery constraints and strategies. Achieving universal coverage entails addressing major barriers at many levels. An overarching constraint is the lack of political will, resulting from the dearth of preterm birth and stillbirth data and the lack of visibility. Other barriers exist at the household and community levels, such as insufficient demand for interventions or sociocultural barriers; at the health services level, such as a lack of resources and trained healthcare providers; and at the health sector policy and management level, such as poorly functioning, centralized systems. Additional constraints involve weak governance and accountability, political instability, and challenges in the physical environment. Scaling up maternal, newborn and child health interventions requires strengthening health systems, but there is also a role for focused, targeted interventions. Choosing a strategy involves identifying appropriate channels for reaching high coverage, which depends on many factors such as access to and attendance at healthcare facilities. Delivery channels vary, and may include facility- and community-based healthcare providers, mass media campaigns, and community-based approaches and marketing strategies. Issues related to scaling up are discussed in the context of four interventions that may be given to mothers at different stages throughout pregnancy or to newborns: (1) detection and treatment of syphilis; (2) emergency Cesarean section; (3) newborn resuscitation; and (4) kangaroo mother care. Systematic reviews of the literature and large-scale implementation studies are analyzed for each intervention. Equitable and successful scale-up of preterm birth and stillbirth interventions will require addressing multiple barriers, and utilizing multiple delivery approaches and channels. Another important need is developing strategies to discontinue ineffective or harmful interventions. Preterm birth and stillbirth interventions must also be placed in the broader maternal, newborn and child health context to identify and prioritize those that will help improve several outcomes at the same time. The next article discusses advocacy challenges and opportunities.

Effect of the 80-hour work week on resident case coverage.

PubMed

Shin, Susanna; Britt, Rebecca; Britt, L D

2008-05-01

On July 1, 2003, residency training programs were required to institute restricted duty hours as mandated by the Accreditation Council for Graduate Medical Education. A major concern, voiced by both surgical residents and faculty, was an expectation that this would result in a decrease in operative experience. We hypothesized that implementing restricted duty hours would decrease case coverage by resident trainees. A retrospective study was performed of operative and endoscopic cases scheduled for a single general surgery practice for a year before and after July 1, 2003. Data collected included operation performed, number of attending surgeons present, whether a resident was present, and level of resident. From July 2002 to June 2003, there were 1,278 cases scheduled; 890 records were available. From July 2004 to June 2005, there were 1,182 cases scheduled; 960 records were available. Before institution of the restricted duty hours, 24.6% of junior-level (PGY1 and 2) cases, 21.7% of intermediate-level (PGY3) cases, and 6.2% of senior-level (PGY4 and 5) cases were not covered by residents. After restricted duty hours were implemented, 27.3% of junior-level cases, 15.9% of intermediate-level cases, and 8.1% of senior-level cases were not covered by residents. Overall 20.8% (185 of 890) and 20.4% (196 of 960) of cases were not covered by residents before and after instituting restricted duty hours, respectively. No difference in case coverage was statistically significant in each category or overall. Restricted duty hours have not affected resident case coverage.

Effect of the 80-hour work week on resident case coverage: corrected article.

PubMed

Shin, Susanna; Britt, Rebecca; Britt, L D

2008-07-01

On July 1, 2003, residency training programs were required to institute restricted duty hours as mandated by the Accreditation Council for Graduate Medical Education. A major concern,voiced by both surgical residents and faculty, was an expectation that this would result in a decrease in operative experience. We hypothesized that implementing restricted duty hours would decrease case coverage by resident trainees. A retrospective study was per formed of operative and endoscopic cases scheduled for a single general surgery practice for a year before and after July 1, 2003. Data collected included operation per formed, number of attending surgeons present, whether a resident was present,and level of resident. From July 2002 to June 2003, there were 1,278 cases scheduled; 890 records were available. From July 2004 to June 2005, there were 1,182 cases scheduled; 960 records were available. Before institution of the restricted duty hours, 24.6% of junior-level (PGY1 and 2) cases, 21.7%of intermediate-level (PGY3) cases, and 6.2% of senior-level (PGY4 and 5) cases were not covered by residents. After restricted duty hours were implemented, 27.3% of junior-level cases,15.9% of intermediate-level cases, and 8.1% of senior-level cases were not covered by residents. Overall 20.8% (185 of 890) and 20.4% (196 of 960) of cases were not covered by residents before and after instituting restricted duty hours, respectively. No difference in case coverage was statistically significant in each category or overall. Restricted duty hours have not affected resident case coverage.

Understanding the Potential Impact of a Combination HIV Prevention Intervention in a Hyper-Endemic Community

PubMed Central

Alsallaq, Ramzi A.; Baeten, Jared M.; Celum, Connie L.; Hughes, James P.; Abu-Raddad, Laith J.; Barnabas, Ruanne V.; Hallett, Timothy B.

2013-01-01

Objectives Despite demonstrating only partial efficacy in preventing new infections, available HIV prevention interventions could offer a powerful strategy when combined. In anticipation of combination HIV prevention programs and research studies we estimated the population-level impact of combining effective scalable interventions at high population coverage, determined the factors that influence this impact, and estimated the synergy between the components. Methods We used a mathematical model to investigate the effect on HIV incidence of a combination HIV prevention intervention comprised of high coverage of HIV testing and counselling, risk reduction following HIV diagnosis, male circumcision for HIV-uninfected men, and antiretroviral therapy (ART) for HIV-infected persons. The model was calibrated to data for KwaZulu-Natal, South Africa, where adult HIV prevalence is approximately 23%. Results Compared to current levels of HIV testing, circumcision, and ART, the combined intervention with ART initiation according to current guidelines could reduce HIV incidence by 47%, from 2.3 new infections per 100 person-years (pyar) to 1.2 per 100 pyar within 4 years and by almost 60%, to 1 per 100 pyar, after 25 years. Short-term impact is driven primarily by uptake of testing and reductions in risk behaviour following testing while long-term effects are driven by periodic HIV testing and retention in ART programs. If the combination prevention program incorporated HIV treatment upon diagnosis, incidence could be reduced by 63% after 4 years and by 76% (to about 0.5 per 100 pyar) after 15 years. The full impact of the combination interventions accrues over 10–15 years. Synergy is demonstrated between the intervention components. Conclusion High coverage combination of evidence-based strategies could generate substantial reductions in population HIV incidence in an African generalized HIV epidemic setting. The full impact could be underestimated by the short assessment duration of typical evaluations. PMID:23372738

Newborn Survival Case Study in Rwanda - Bottleneck Analysis and Projections in Key Maternal and Child Mortality Rates Using Lives Saved Tool (LiST).

PubMed

Khurmi, Manpreet Singh; Sayinzoga, Felix; Berhe, Atakilt; Bucyana, Tatien; Mwali, Assumpta Kayinamura; Manzi, Emmanuel; Muthu, Maharajan

2017-01-01

The Newborn Survival Case study in Rwanda provides an analysis of the newborn health and survival situation in the country. It reviews evidence-based interventions and coverage levels already implemented in the country; identifies key issues and bottlenecks in service delivery and uptake of services by community/beneficiaries, and provides key recommendations aimed at faster reduction in newborn mortality rate. This study utilized mixed method research including qualitative and quantitative analyses of various maternal and newborn health programs implemented in the country. This included interviewing key stakeholders at each level, field visits and also interviewing beneficiaries for assessment of uptake of services. Monitoring systems such as Health Management Information Systems (HMIS), maternal and newborn death audits were reviewed and data analyzed to aid these analyses. Policies, protocols, various guidelines and tools for monitoring are already in place however, implementation of these remains a challenge e.g. infection control practices to reduce deaths due to sepsis. Although existing staff are quite knowledgeable and are highly motivated, however, shortage of health personnel especially doctors in an issue. New facilities are being operationalized e.g. at Gisenyi, however, the existing facilities needs expansion. It is essential to implement high impact evidence based interventions but coverage levels need to be significantly high in order to achieve higher reduction in newborn mortality rate. Equity approach should be considered in planning so that the services are better implemented and the poor and needy can get the benefits of public health programs.

Recovery considerations for possible high inclination long duration earth orbital missions

NASA Technical Reports Server (NTRS)

Obriant, T. E.; Ferguson, J. E.

1969-01-01

Problem areas are discussed and various solutions proposed. One of the major recovery problems encountered with missions having higher orbital inclinations than previous missions is the greater likelihood of severe weather conditions in the landing zones, especially if landing zones are optimized for orbital coverage considerations. Restricting the reentry window and increasing in-orbit wait times can partially eliminate the weather problem, but the possibility of emergency landings at higher latitudes still exists. It can be expected that the increased confidence level in spacecraft reliability that will exist by the time the high-inclination missions are flown will reduce the probabilities of an emergency landing in an unfavorable recovery location to a very low level.

Do Medicaid benefit expansions have teeth? The effect of Medicaid adult dental coverage on the use of dental services and oral health.

PubMed

Decker, Sandra L; Lipton, Brandy J

2015-12-01

This article examines the effect of Medicaid adult dental coverage on use of dental care and dental health outcomes using state-level variation in dental coverage during 2000-2012. Our findings imply that dental coverage is associated with an increase in the likelihood of a recent dental visit, with the size of the effect increasing with Medicaid payment rates to dentists, and a reduction in the likelihood of untreated dental caries. We are among the first to detect an effect of Medicaid coverage on a clinical health outcome other than mortality. These findings may have implications for states expanding Medicaid coverage to adults with incomes of up to 138% of the federal poverty threshold under the Affordable Care Act as most of these states offer an adult dental benefit. Copyright © 2015 Elsevier B.V. All rights reserved.

Student Publications Localize Conflict in Iraq.

ERIC Educational Resources Information Center

Inouye, Emily

2003-01-01

Notes that high school students have an incredible number of issues they must face daily. Contends that it is vital for a high school newspaper to find a balance between coverage of world events and local occurrences so that everything is relevant to high-school readers. Provides examples of eight high school newspapers' coverage of the 2003 war…

On the level of coverage and citation of publications by mechanicians of the national academy of sciences of Ukraine in the Scopus database

NASA Astrophysics Data System (ADS)

Guz, A. N.; Rushchitsky, J. J.

2009-11-01

The paper analyzes the level of coverage and citation of publications by mechanicians of the National Academy of Sciences of Ukraine (NASU) in the Scopus database. Two groups of mechanicians are considered. One group includes 66 doctors of sciences of the S. P. Timoshenko Institute of Mechanics as representatives of the oldest institute of the NASU. The other group includes 34 members (academicians and corresponding members) of the Division of Mechanics of the NASU as representatives of the authoritative community of mechanicians in Ukraine. The results are presented for each scientist in the form of two indices—the total number of publications accessible in the database as the level of coverage of the scientist's publications in this database and the h-index as the citation level of these publications. This paper may be considered to continue the papers [6-12] published in Prikladnaya Mekhanika (International Applied Mechanics) in 2005-2009

Aeolian processes over gravel beds: Field wind tunnel simulation and its application atop the Mogao Grottoes, China

NASA Astrophysics Data System (ADS)

Zhang, Weimin; Tan, Lihai; Zhang, Guobin; Qiu, Fei; Zhan, Hongtao

2014-12-01

The aeolian processes of erosion, transport and deposition are threatening the Mogao Grottoes, a world culture heritage site. A field wind tunnel experiment was conducted atop the Mogao Grottoes using weighing sensors to quantify aeolian processes over protective gravel beds. Results reveal that aeolian erosion and deposition over gravel beds are basically influenced by gravel coverage and wind speed. Erosion is a main aeolian process over gravel beds and its strength level is mainly determined by gravel coverage: strong (<30%), medium (30-50%) and slight (>50%). Aeolian deposition only occurs when gravel coverage is equal to or greater than 30% and wind speeds are between 8 and 12 m s-1, and this process continues until the occurrence of the equilibrium coverage. In addition, the change in conditions of external sand supply affects the transition between aeolian deposition and erosion over gravel beds, and the quantity of sand transport at the height of 0-24 mm is an important indicator of aeolian deposition and erosion over gravel beds. Our results also demonstrate that making the best use of wind regime atop the Mogao Grottoes and constructing an artificial gobi surface in staggered arrays, with 30% coverage and 30-mm-high gravels and in 40 mm spacing can trap westerly invading sand flow and enable the stronger easterly wind to return the deposited sand on the gravel surface back to the Mingsha Mountain so as to minimize the damage of the blown sand flux to the Mogao Grottoes.

Effect of Coadsorbed Water on the Photodecomposition of Acetone on TiO2(110)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Henderson, Michael A.

2008-06-10

The influence of coadsorbed water on the photodecomposition of acetone on TiO2 was examined using temperature programmed desorption (TPD) and the rutile TiO2(110) surface as a model photocatalyst. Of the two major influences ascribed to water in the heterogeneous photocatalysis literature (promotion via OH radical supply and inhibition due to site blocking), only the negative influence of water was observed. As long as the total water and acetone coverage was maintained well below the first layer saturation coverage (‘1 ML’), little inhibition of acetone photodecomposition was observed. However, as the total water+acetone coverage exceeded 1 ML, acetone was preferentially displacedmore » from the first layer to physisorbed states by water and the extent of acetone photodecomposition attenuated. The displacement originated from water compressing acetone into high coverage regions where increased acetone-acetone repulsions caused displacement from the first layer. The immediate product of acetone photodecomposition was adsorbed acetate, which occupies twice as many surface sites per molecule as compared to acetone. Since the acetate intermediate was more stable on the TiO2(110) surface than either water or acetone (as gauged by TPD) and since its photodecomposition rate was less than that of acetone, additional surface sites were not opened up during acetone photodecomposition for previously displaced acetone molecules to re-enter the first layer. Results in this study suggest that increased molecular-level repulsions between organic molecules brought about by increased water coverage are as influential in the inhibiting effect of water on photooxidation rates as are water-organic repulsions.« less

Media Coverage, Journal Press Releases and Editorials Associated with Randomized and Observational Studies in High-Impact Medical Journals: A Cohort Study.

PubMed

Wang, Michael T M; Bolland, Mark J; Gamble, Greg; Grey, Andrew

2015-01-01

Publication of clinical research findings in prominent journals influences health beliefs and medical practice, in part by engendering news coverage. Randomized controlled trials (RCTs) should be most influential in guiding clinical practice. We determined whether study design of clinical research published in high-impact journals influences media coverage. We compared the incidence and amount of media coverage of RCTs with that of observational studies published in the top 7 medical journals between 1 January 2013 and 31 March 2013. We specifically assessed media coverage of the most rigorous RCTs, those with >1000 participants that reported 'hard' outcomes. There was no difference between RCTs and observational studies in coverage by major newspapers or news agencies, or in total number of news stories generated (all P>0.63). Large RCTs reporting 'hard' outcomes did not generate more news coverage than small RCTs that reported surrogate outcomes and observational studies (all P>0.32). RCTs were more likely than observational studies to attract a journal editorial (70% vs 46%, P = 0.003), but less likely to be the subject of a journal press release (17% vs 50%, P<0.001). Large RCTs that reported 'hard' outcomes did not attract an editorial more frequently than other studies (61% vs 58%, P>0.99), nor were they more likely to be the subject of a journal press release (14% vs 38%, P = 0.14). The design of clinical studies whose results are published in high-impact medical journals is not associated with the likelihood or amount of ensuing news coverage.

Benchmarking health system performance across districts in Zambia: a systematic analysis of levels and trends in key maternal and child health interventions from 1990 to 2010.

PubMed

Colson, Katherine Ellicott; Dwyer-Lindgren, Laura; Achoki, Tom; Fullman, Nancy; Schneider, Matthew; Mulenga, Peter; Hangoma, Peter; Ng, Marie; Masiye, Felix; Gakidou, Emmanuela

2015-04-02

Achieving universal health coverage and reducing health inequalities are primary goals for an increasing number of health systems worldwide. Timely and accurate measurements of levels and trends in key health indicators at local levels are crucial to assess progress and identify drivers of success and areas that may be lagging behind. We generated estimates of 17 key maternal and child health indicators for Zambia's 72 districts from 1990 to 2010 using surveys, censuses, and administrative data. We used a three-step statistical model involving spatial-temporal smoothing and Gaussian process regression. We generated estimates at the national level for each indicator by calculating the population-weighted mean of the district values and calculated composite coverage as the average of 10 priority interventions. National estimates masked substantial variation across districts in the levels and trends of all indicators. Overall, composite coverage increased from 46% in 1990 to 73% in 2010, and most of this gain was attributable to the scale-up of malaria control interventions, pentavalent immunization, and exclusive breastfeeding. The scale-up of these interventions was relatively equitable across districts. In contrast, progress in routine services, including polio immunization, antenatal care, and skilled birth attendance, stagnated or declined and exhibited large disparities across districts. The absolute difference in composite coverage between the highest-performing and lowest-performing districts declined from 37 to 26 percentage points between 1990 and 2010, although considerable variation in composite coverage across districts persisted. Zambia has made marked progress in delivering maternal and child health interventions between 1990 and 2010; nevertheless, substantial variations across districts and interventions remained. Subnational benchmarking is important to identify these disparities, allowing policymakers to prioritize areas of greatest need. Analyses such as this one should be conducted regularly and feed directly into policy decisions in order to increase accountability at the local, regional, and national levels.

Utilization of smoking cessation medication benefits among medicaid fee-for-service enrollees 1999-2008.

PubMed

Kahende, Jennifer; Malarcher, Ann; England, Lucinda; Zhang, Lei; Mowery, Paul; Xu, Xin; Sevilimedu, Varadan; Rolle, Italia

2017-01-01

To assess state coverage and utilization of Medicaid smoking cessation medication benefits among fee-for-service enrollees who smoked cigarettes. We used the linked National Health Interview Survey (survey years 1995, 1997-2005) and the Medicaid Analytic eXtract files (1999-2008) to assess utilization of smoking cessation medication benefits among 5,982 cigarette smokers aged 18-64 years enrolled in Medicaid fee-for-service whose state Medicaid insurance covered at least one cessation medication. We excluded visits during pregnancy, and those covered by managed care or under dual enrollment (Medicaid and Medicare). Multivariate logistic regression was used to determine correlates of cessation medication benefit utilization among Medicaid fee-for-service enrollees, including measures of drug coverage (comprehensive cessation medication coverage, number of medications in state benefit, varenicline coverage), individual-level demographics at NHIS interview, age at Medicaid enrollment, and state-level cigarette excise taxes, statewide smoke-free laws, and per-capita tobacco control funding. In 1999, the percent of smokers with ≥1 medication claims was 5.7% in the 30 states that covered at least one Food and Drug Administration (FDA)-approved cessation medication; this increased to 9.9% in 2008 in the 44 states that covered at least one FDA-approved medication (p<0.01). Cessation medication utilization was greater among older individuals (≥ 25 years), females, non-Hispanic whites, and those with higher educational attainment. Comprehensive coverage, the number of smoking cessation medications covered and varenicline coverage were all positively associated with utilization; cigarette excise tax and per-capita tobacco control funding were also positively associated with utilization. Utilization of medication benefits among fee-for-service Medicaid enrollees increased from 1999-2008 and varied by individual and state-level characteristics. Given that the Affordable Care Act bars state Medicaid programs from excluding any FDA-approved cessation medications from coverage as of January 2014, monitoring Medicaid cessation medication claims may be beneficial for informing efforts to increase utilization and maximize smoking cessation.

Towards universal health coverage: an evaluation of Rwanda Mutuelles in its first eight years.

PubMed

Lu, Chunling; Chin, Brian; Lewandowski, Jiwon Lee; Basinga, Paulin; Hirschhorn, Lisa R; Hill, Kenneth; Murray, Megan; Binagwaho, Agnes

2012-01-01

Mutuelles is a community-based health insurance program, established since 1999 by the Government of Rwanda as a key component of the national health strategy on providing universal health care. The objective of the study was to evaluate the impact of Mutuelles on achieving universal coverage of medical services and financial risk protection in its first eight years of implementation. We conducted a quantitative impact evaluation of Mutuelles between 2000 and 2008 using nationally-representative surveys. At the national and provincial levels, we traced the evolution of Mutuelles coverage and its impact on child and maternal care coverage from 2000 to 2008, as well as household catastrophic health payments from 2000 to 2006. At the individual level, we investigated the impact of Mutuelles' coverage on enrollees' medical care utilization using logistic regression. We focused on three target populations: the general population, under-five children, and women with delivery. At the household level, we used logistic regression to study the relationship between Mutuelles coverage and the probability of incurring catastrophic health spending. The main limitation was that due to insufficient data, we are not able to study the impact of Mutuelles on health outcomes, such as child and maternal mortalities, directly. The findings show that Mutuelles improved medical care utilization and protected households from catastrophic health spending. Among Mutuelles enrollees, those in the poorest expenditure quintile had a significantly lower rate of utilization and higher rate of catastrophic health spending. The findings are robust to various estimation methods and datasets. Rwanda's experience suggests that community-based health insurance schemes can be effective tools for achieving universal health coverage even in the poorest settings. We suggest a future study on how eliminating Mutuelles copayments for the poorest will improve their healthcare utilization, lower their catastrophic health spending, and affect the finances of health care providers.

Towards Universal Health Coverage: An Evaluation of Rwanda Mutuelles in Its First Eight Years

PubMed Central

Lu, Chunling; Chin, Brian; Lewandowski, Jiwon Lee; Basinga, Paulin; Hirschhorn, Lisa R.; Hill, Kenneth; Murray, Megan; Binagwaho, Agnes

2012-01-01

Background Mutuelles is a community-based health insurance program, established since 1999 by the Government of Rwanda as a key component of the national health strategy on providing universal health care. The objective of the study was to evaluate the impact of Mutuelles on achieving universal coverage of medical services and financial risk protection in its first eight years of implementation. Methods and Findings We conducted a quantitative impact evaluation of Mutuelles between 2000 and 2008 using nationally-representative surveys. At the national and provincial levels, we traced the evolution of Mutuelles coverage and its impact on child and maternal care coverage from 2000 to 2008, as well as household catastrophic health payments from 2000 to 2006. At the individual level, we investigated the impact of Mutuelles' coverage on enrollees' medical care utilization using logistic regression. We focused on three target populations: the general population, under-five children, and women with delivery. At the household level, we used logistic regression to study the relationship between Mutuelles coverage and the probability of incurring catastrophic health spending. The main limitation was that due to insufficient data, we are not able to study the impact of Mutuelles on health outcomes, such as child and maternal mortalities, directly. The findings show that Mutuelles improved medical care utilization and protected households from catastrophic health spending. Among Mutuelles enrollees, those in the poorest expenditure quintile had a significantly lower rate of utilization and higher rate of catastrophic health spending. The findings are robust to various estimation methods and datasets. Conclusions Rwanda's experience suggests that community-based health insurance schemes can be effective tools for achieving universal health coverage even in the poorest settings. We suggest a future study on how eliminating Mutuelles copayments for the poorest will improve their healthcare utilization, lower their catastrophic health spending, and affect the finances of health care providers. PMID:22723985

The availability and marginal costs of dependent employer-sponsored health insurance.

PubMed

Miller, G Edward; Vistnes, Jessica; Buettgens, Matthew; Dubay, Lisa

2017-01-21

In this study, we examine differences by firm size in the availability of dependent coverage and the incremental cost of such coverage. We use data from the Medical Expenditure Panel Survey - Insurance Component (MEPS-IC) to show that among employees eligible for single coverage, dependent coverage was almost always available for employees in large firms (100 or more employees) but not in smaller firms, particularly those with fewer than 10 employees. In addition, when dependent coverage was available, eligible employees in smaller firms were more likely than employees in large firms to face two situations that represented the extremes of the incremental cost distribution: (1) they paid nothing for single or family coverage or (2) they paid nothing for single coverage but faced a high contribution for family coverage. These results suggest that firm size may be an important factor in policy assessments, such as analyses of the financial implications for families excluded from subsidized Marketplace coverage due to affordable offers of single coverage or of potential rollbacks to public coverage for children.

The impact of HIV prevalence, conflict, corruption, and GDP/capita on treatment cascades: data from 137 countries.

PubMed

Levi, Jacob; Pozniak, Anton; Heath, Katherine; Hill, Andrew

2018-04-01

In 2014, UNAIDS and partners set the 90-90-90 targets for the HIV treatment cascade. Multiple social, political and structural factors might influence progress towards these targets. We assessed how close countries and regions are to reaching these targets, and compared cascade outcomes with HIV prevalence, gross domestic product (GDP)/capita, conflict and corruption. Country-level HIV cascade data on diagnosis, ART coverage and viral suppression, from 2010 to 2016 were extracted from national reports, published papers and the www.AIDSinfoOnline database, and analysed. Weighted least-squares regression was used to assess predictors of cascade achievement: region, HIV prevalence, GDP/capita, the 2016 Corruption Perceptions Index (CPI), which is an international ranking system, and the 2016 Global Peace Index (GPI), which ranks all countries based on three main categories: societal safety, militarisation and conflict. Data were available for diagnosis for 84 countries, ART coverage for 137 countries, and viral suppression for 94 countries. Regions with the lowest ART coverage were South-east Asia and Pacific (36%), Eastern Europe and Central Asia (17%), and Middle East and North Africa (13%). Lower HIV prevalence was associated with poorer cascade results. Countries with higher GDP/capita achieved higher ART coverage ( P <0.001). Furthermore, countries with lower levels of peace and higher corruption had lower ART coverage ( P <0.001). Countries with a GPI >2.5 all had ART coverage of <40%. Only one country has reached the UNAIDS 90-90-90 targets. International comparison remains difficult due to heterogeneous data reporting. Difficulty meeting UNAIDS targets is associated with lower GDP/capita, lower HIV prevalence, higher corruption and conflict levels.

Ongoing Coverage for Ongoing Care: Access, Utilization, and Out-of-Pocket Spending Among Uninsured Working-Aged Adults with Chronic Health Care Needs

PubMed Central

Rasch, Elizabeth K.; Chan, Leighton

2011-01-01

Objectives. We sought to determine how part-year and full-year gaps in health insurance coverage affected working-aged persons with chronic health care needs. Methods. We conducted multivariate analyses of the 2002–2004 Medical Expenditure Panel Survey to compare access, utilization, and out-of-pocket spending burden among key groups of persons with chronic conditions and disabilities. The results are generalizable to the US community-dwelling population aged 18 to 64 years. Results. Among 92 million adults with chronic conditions, 21% experienced at least 1 month uninsured during the average year (2002–2004). Among the 25 million persons reporting both chronic conditions and disabilities, 23% were uninsured during the average year. These gaps in coverage were associated with significantly higher levels of access problems, lower rates of ambulatory visits and prescription drug use, and higher levels of out-of-pocket spending. Conclusions. Implementation of health care reform must focus not only on the prevention of chronic conditions and the expansion of insurance coverage but also on the long-term stability of the coverage to be offered. PMID:21164090

Access to and use of health services among undocumented Mexican immigrants in a US urban area.

PubMed

Nandi, Arijit; Galea, Sandro; Lopez, Gerald; Nandi, Vijay; Strongarone, Stacey; Ompad, Danielle C

2008-11-01

We assessed access to and use of health services among Mexican-born undocumented immigrants living in New York City in 2004. We used venue-based sampling to recruit participants from locations where undocumented immigrants were likely to congregate. Participants were 18 years or older, born in Mexico, and current residents of New York City. The main outcome measures were health insurance coverage, access to a regular health care provider, and emergency department care. In multivariable models, living in a residence with fewer other adults, linguistic acculturation, higher levels of formal income, higher levels of social support, and poor health were associated with health insurance coverage. Female gender, fewer children, arrival before 1997, higher levels of formal income, health insurance coverage, greater social support, and not reporting discrimination were associated with access to a regular health care provider. Higher levels of education, higher levels of formal income, and poor health were associated with emergency department care. Absent large-scale political solutions to the challenges of undocumented immigrants, policies that address factors shown to limit access to care may improve health among this growing population.

The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda.

PubMed

Wang, Wenjuan; Temsah, Gheda; Mallick, Lindsay

2017-04-01

While research has assessed the impact of health insurance on health care utilization, few studies have focused on the effects of health insurance on use of maternal health care. Analyzing nationally representative data from the Demographic and Health Surveys (DHS), this study estimates the impact of health insurance status on the use of maternal health services in three countries with relatively high levels of health insurance coverage-Ghana, Indonesia and Rwanda. The analysis uses propensity score matching to adjust for selection bias in health insurance uptake and to assess the effect of health insurance on four measurements of maternal health care utilization: making at least one antenatal care visit; making four or more antenatal care visits; initiating antenatal care within the first trimester and giving birth in a health facility. Although health insurance schemes in these three countries are mostly designed to focus on the poor, coverage has been highly skewed toward the rich, especially in Ghana and Rwanda. Indonesia shows less variation in coverage by wealth status. The analysis found significant positive effects of health insurance coverage on at least two of the four measures of maternal health care utilization in each of the three countries. Indonesia stands out for the most systematic effect of health insurance across all four measures. The positive impact of health insurance appears more consistent on use of facility-based delivery than use of antenatal care. The analysis suggests that broadening health insurance to include income-sensitive premiums or exemptions for the poor and low or no copayments can increase use of maternal health care. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

The influence of performance-based payment on childhood immunisation coverage.

PubMed

Merilind, Eero; Salupere, Rauno; Västra, Katrin; Kalda, Ruth

2015-06-01

Pay-for-performance, also called the quality system (QS) in Estonia, was implemented in 2006 and one indicator for achievement is the childhood immunisation coverage rate. The WHO vaccination coverage in Europe for diphtheria, tetanus and pertussis, and measles in children aged around one year old should meet or exceed 90 per cent. The study was conducted using a database from the Estonian Health Insurance Fund. The study compared childhood immunisation coverage rates of all Estonian family physicians in two groups, joined and not joined to the quality system during the observation period 2006-2012. Immunisation coverage was calculated as the percentage of persons in the target age group who received a vaccine dose by a given age. The target level of immunisations in Estonia is set at 90 per cent and higher. Immunisation coverage rates of family doctors (FD) in Estonia showed significant differences between two groups of doctors: joined to the quality system and not joined. Doctors joined to the quality system met the 90 per cent vaccination criterion more frequently compared to doctors not joined to the quality system. Doctors not joined to the quality system were below the 90 per cent vaccination criterion in all vaccinations listed in the Estonian State Immunisation Schedule. Pay-for-performance as a financial incentive encourages higher levels of childhood immunisations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Impact of insecticide-treated bed nets on malaria transmission indices on the south coast of Kenya

PubMed Central

2011-01-01

Background Besides significantly reducing malaria vector densities, prolonged usage of bed nets has been linked to decline of Anopheles gambiae s.s. relative to Anopheles arabiensis, changes in host feeding preference of malaria vectors, and behavioural shifts to exophagy (outdoor biting) for the two important malaria vectors in Africa, An. gambiae s.l. and Anopheles funestus. In southern coastal Kenya, bed net use was negligible in 1997-1998 when Anopheles funestus and An. gambiae s.s. were the primary malaria vectors, with An. arabiensis and Anopheles merus playing a secondary role. Since 2001, bed net use has increased progressively and reached high levels by 2009-2010 with corresponding decline in malaria transmission. Methods To evaluate the impact of the substantial increase in household bed net use within this area on vector density, vector composition, and human-vector contact, indoor and outdoor resting mosquitoes were collected in the same region during 2009-2010 using pyrethrum spray catches and clay pots for indoor and outdoor collections respectively. Information on bed net use per sleeping spaces and factors influencing mosquito density were determined in the same houses using Poisson regression analysis. Species distribution was determined, and number of mosquitoes per house, human-biting rates (HBR), and entomological inoculation rate (EIR) were compared to those reported for the same area during 1997-1998, when bed net coverage had been minimal. Results Compared to 1997-1998, a significant decline in the relative proportion of An. gambiae s.s. among collected mosquitoes was noted, coupled with a proportionate increase of An. arabiensis. Following > 5 years of 60-86% coverage with bed nets, the density, human biting rate and EIR of indoor resting mosquitoes were reduced by more than 92% for An. funestus and by 75% for An. gambiae s.l. In addition, the host feeding choice of both vectors shifted more toward non-human vertebrates. Besides bed net use, malaria vector abundance was also influenced by type of house construction and according to whether one sleeps on a bed or a mat (both of these are associated with household wealth). Mosquito density was positively associated with presence of domestic animals. Conclusions These entomological indices indicate a much reduced human biting rate and a diminishing role of An. gambiae s.s. in malaria transmission following high bed net coverage. While increasing bed net coverage beyond the current levels may not significantly reduce the transmission potential of An. arabiensis, it is anticipated that increasing or at least sustaining high bed net coverage will result in a diminished role for An. funestus in malaria transmission. PMID:22165904