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.

TU-CD-304-06: Using FFF Beams Improves Tumor Control in Radiotherapy of Lung Cancers

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

Vassiliev, O; Wang, H

Purpose: Electron disequilibrium at the lung-tumor interface results in an under-dosage of tumor regions close to its surface. This under-dosage is known to be significant and can compromise tumor control. Previous studies have shown that in FFF beams, disequilibrium effects are less pronounced, which is manifested in an increased skin dose. In this study we investigate the improvement in tumor dose coverage that can be achieved with FFF beams. The significance of this improvement is evaluated by comparing tumor control probabilities of FFF beams and conventional flattened beams. Methods: The dosimetric coverage was investigated in a virtual phantom representing themore » chest wall, lung tissue and the tumor. A range of tumor sizes was investigated, and two tumor locations – central and adjacent to the chest wall. Calculations were performed with BEAMnrc Monte Carlo code. Parallel-opposed and multiple coplanar 6-MV beams were simulated. The tumor control probabilities were calculated using the logistic model with parameters derived from clinical data for non-small lung cancer patients. Results: FFF beams were not entirely immune to disequilibrium effects. They nevertheless consistently delivered more uniform dose distribution throughout the volume of the tumor, and eliminated up to ∼15% of under-dosage in the most affected by disequilibrium 1-mm thick surface region of the tumor. A voxel-by-voxel comparison of tumor control probabilities between FFF and conventional flattened beams showed an advantage of FFF beams that, depending on the set up, was from a few to ∼9 percent. Conclusion: A modest improvement in tumor control probability on the order of a few percent can be achieved by replacing conventional flattened beams with FFF beams. However, given the large number of lung cancer patients undergoing radiotherapy, these few percent can potentially prevent local tumor recurrence for a significant number of patients.« less

Target Coverage in Wireless Sensor Networks with Probabilistic Sensors

PubMed Central

Shan, Anxing; Xu, Xianghua; Cheng, Zongmao

2016-01-01

Sensing coverage is a fundamental problem in wireless sensor networks (WSNs), which has attracted considerable attention. Conventional research on this topic focuses on the 0/1 coverage model, which is only a coarse approximation to the practical sensing model. In this paper, we study the target coverage problem, where the objective is to find the least number of sensor nodes in randomly-deployed WSNs based on the probabilistic sensing model. We analyze the joint detection probability of target with multiple sensors. Based on the theoretical analysis of the detection probability, we formulate the minimum ϵ-detection coverage problem. We prove that the minimum ϵ-detection coverage problem is NP-hard and present an approximation algorithm called the Probabilistic Sensor Coverage Algorithm (PSCA) with provable approximation ratios. To evaluate our design, we analyze the performance of PSCA theoretically and also perform extensive simulations to demonstrate the effectiveness of our proposed algorithm. PMID:27618902

Coverage-based constraints for IMRT optimization

NASA Astrophysics Data System (ADS)

Mescher, H.; Ulrich, S.; Bangert, M.

2017-09-01

Radiation therapy treatment planning requires an incorporation of uncertainties in order to guarantee an adequate irradiation of the tumor volumes. In current clinical practice, uncertainties are accounted for implicitly with an expansion of the target volume according to generic margin recipes. Alternatively, it is possible to account for uncertainties by explicit minimization of objectives that describe worst-case treatment scenarios, the expectation value of the treatment or the coverage probability of the target volumes during treatment planning. In this note we show that approaches relying on objectives to induce a specific coverage of the clinical target volumes are inevitably sensitive to variation of the relative weighting of the objectives. To address this issue, we introduce coverage-based constraints for intensity-modulated radiation therapy (IMRT) treatment planning. Our implementation follows the concept of coverage-optimized planning that considers explicit error scenarios to calculate and optimize patient-specific probabilities q(\\hat{d}, \\hat{v}) of covering a specific target volume fraction \\hat{v} with a certain dose \\hat{d} . Using a constraint-based reformulation of coverage-based objectives we eliminate the trade-off between coverage and competing objectives during treatment planning. In-depth convergence tests including 324 treatment plan optimizations demonstrate the reliability of coverage-based constraints for varying levels of probability, dose and volume. General clinical applicability of coverage-based constraints is demonstrated for two cases. A sensitivity analysis regarding penalty variations within this planing study based on IMRT treatment planning using (1) coverage-based constraints, (2) coverage-based objectives, (3) probabilistic optimization, (4) robust optimization and (5) conventional margins illustrates the potential benefit of coverage-based constraints that do not require tedious adjustment of target volume objectives.

Immigrants and Employer-Sponsored Health Insurance

PubMed Central

Buchmueller, Thomas C; Lo Sasso, Anthony T; Lurie, Ithai; Dolfin, Sarah

2007-01-01

Objective To investigate the factors underlying the lower rate of employer-sponsored health insurance coverage for foreign-born workers. Data Sources 2001 Survey of Income and Program Participation. Study Design We estimate probit regressions to determine the effect of immigrant status on employer-sponsored health insurance coverage, including the probabilities of working for a firm that offers coverage, being eligible for coverage, and taking up coverage. Data Extraction Methods We identified native born citizens, naturalized citizens, and noncitizen residents between the ages of 18 and 65, in the year 2002. Principal Findings First, we find that the large difference in coverage rates for immigrants and native-born Americans is driven by the very low rates of coverage for noncitizen immigrants. Differences between native-born and naturalized citizens are quite small and for some outcomes are statistically insignificant when we control for observable characteristics. Second, our results indicate that the gap between natives and noncitizens is explained mainly by differences in the probability of working for a firm that offers insurance. Conditional on working for such a firm, noncitizens are only slightly less likely to be eligible for coverage and, when eligible, are only slightly less likely to take up coverage. Third, roughly two-thirds of the native/noncitizen gap in coverage overall and in the probability of working for an insurance-providing employer is explained by characteristics of the individual and differences in the types of jobs they hold. Conclusions The substantially higher rate of uninsurance among immigrants is driven by the lower rate of health insurance offers by the employers of immigrants. PMID:17355593

Coverage and Preventive Screening

PubMed Central

Meeker, Daniella; Joyce, Geoffrey F; Malkin, Jesse; Teutsch, Steven M; Haddix, Anne C; Goldman, Dana P

2011-01-01

Context Preventive care has been shown as a high-value health care service. Many employers now offer expanded coverage of preventive care to encourage utilization. Objective To determine whether expanding coverage is an effective means to encourage utilization. Design Comparison of screening rates before and after introduction of deductible-free coverage. Setting People insured through large corporations between 2002 and 2006. Patients or Other Participants Preferred Provider Organization (PPO) enrollees from an employer introducing deductible-free coverage, and a control group enrolled in a PPO from a second employer with no policy change. Main Outcome Measures Adjusted probability of endoscopy, fecal occult blood test (FOBT), lipid screens, mammography, and Papanicolaou (pap) smears. Intervention Introduction of first-dollar coverage (FDC) of preventive services in 2003. Results After adjusting for demographics and secular trends, there were between 23 and 78 additional uses per 1,000 eligible patients of covered preventive screens (lipid screens, pap smears, mammograms, and FOBT), with no significant changes in the control group or in a service without FDC (endoscopy). Conclusions FDC improves utilization modestly among healthy individuals, particularly those in lower deductible plans. Compliance with guidelines can be encouraged by lowering out-of-pocket costs, but patients' predisposing characteristics merit attention. PMID:21029084

Cost-effectiveness of 64-slice CT angiography compared to conventional coronary angiography based on a coverage with evidence development study in Ontario.

PubMed

Goeree, Ron; Blackhouse, Gord; Bowen, James M; O'Reilly, Daria; Sutherland, Simone; Hopkins, Robert; Chow, Benjamin; Freeman, Michael; Provost, Yves; Dennie, Carole; Cohen, Eric; Marcuzzi, Dan; Iwanochko, Robert; Moody, Alan; Paul, Narinder; Parker, John D

2013-10-01

Conventional coronary angiography (CCA) is the standard diagnostic for coronary artery disease (CAD), but multi-detector computed tomography coronary angiography (CTCA) is a non-invasive alternative. A multi-center coverage with evidence development study was undertaken and combined with an economic model to estimate the cost-effectiveness of CTCA followed by CCA vs CCA alone. Alternative assumptions were tested in patient scenario and sensitivity analyses. CCA was found to dominate CTCA, however, CTCA was relatively more cost-effective in females, in advancing age, in patients with lower pre-test probabilities of CAD, the higher the sensitivity of CTCA and the lower the probability of undergoing a confirmatory CCA following a positive CTCA. RESULTS were very sensitive to alternative patient populations and modeling assumptions. Careful consideration of patient characteristics, procedures to improve the diagnostic yield of CTCA and selective use of CCA following CTCA will impact whether CTCA is cost-effective or dominates CCA.

Annual immunisation coverage report, 2010.

PubMed

Hull, Brynley; Dey, Aditi; Menzies, Rob; McIntyre, Peter

2013-03-31

This, the fourth annual immunisation coverage report, documents trends during 2010 for a range of standard measures derived from Australian Childhood Immunisation Register (ACIR) data. These include coverage at standard age milestones and for individual vaccines included on the National Immunisation Program (NIP). For the first time, coverage from other sources for adolescents and the elderly are included. The proportion of children 'fully vaccinated' at 12, 24 and 60 months of age was 91.6%, 92.1% and 89.1% respectively. For vaccines available on the NIP but not currently assessed for 'fully immunised' status or for eligibility for incentive payments (rotavirus and pneumococcal at 12 months and meningococcal C and varicella at 24 months) coverage varied. Although pneumococcal vaccine had similar coverage at 12 months to other vaccines, coverage was lower for rotavirus at 12 months (84.7%) and varicella at 24 months (83.0%). Overall coverage at 24 months of age exceeded that at 12 months of age nationally and for most jurisdictions, but as receipt of varicella vaccine at 18 months is excluded from calculations, this represents delayed immunisation, with some contribution from immunisation incentives. The 'fully immunised' coverage estimates for immunisations due by 60 months increased substantially in 2009, reaching almost 90% in 2010, probably related to completed immunisation by 60 months of age being introduced in 2009 as a requirement for GP incentive payments. As previously documented, vaccines recommended for Indigenous children only (hepatitis A and pneumococcal polysaccharide vaccine) had suboptimal coverage at around 57%. Delayed receipt of vaccines by Indigenous children at the 60-month milestone age improved from 56% to 62% but the disparity in on-time vaccination between Indigenous and non-Indigenous children at earlier age milestones did not improve. Coverage data for human papillomavirus (HPV)from the national HPV register are consistent with high coverage in the school-based program (73%) but were lower for the catch-up program for women outside school (30-38%). Coverage estimates for vaccines on the NIP from 65 years of age were comparable with other developed countries.

Patient Protection and Affordable Care Act Medicaid expansion and gains in health insurance coverage and access among cancer survivors.

PubMed

Nikpay, Sayeh S; Tebbs, Margaret G; Castellanos, Emily H

2018-04-17

The Patient Protection and Affordable Care Act extends Medicaid coverage to millions of low-income adults, including many survivors of cancer who were unable to purchase affordable health insurance coverage in the individual health insurance market. Using data from the 2011 to 2015 Behavioral Risk Factor Surveillance System, the authors compared changes in coverage and health care access measures for low-income cancer survivors in states that did and did not expand Medicaid. The study population of 17,381 individuals included adults aged 18 to 64 years, and was predominantly female, white, and unmarried. The authors found a relative reduction in the uninsured rate of 11.7 percentage points and a relative increase in the probability of having a personal physician of 5.8 percentage points. Stratifying by whether states expanded Medicaid by 2015, the authors found that relative gains in coverage and access were larger among those individuals residing in states with expanded Medicaid compared with those residing in nonexpansion states. The results of the current study suggest that the Patient Protection and Affordable Care Act Medicaid expansion has improved coverage and access for cancer survivors. Cancer 2018. © 2018 American Cancer Society. © 2018 American Cancer Society.

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

Quantifying the impact of expanded age group campaigns for polio eradication.

PubMed

Wagner, Bradley G; Behrend, Matthew R; Klein, Daniel J; Upfill-Brown, Alexander M; Eckhoff, Philip A; Hu, Hao

2014-01-01

A priority of the Global Polio Eradication Initiative (GPEI) 2013-2018 strategic plan is to evaluate the potential impact on polio eradication resulting from expanding one or more Supplementary Immunization Activities (SIAs) to children beyond age five-years in polio endemic countries. It has been hypothesized that such expanded age group (EAG) campaigns could accelerate polio eradication by eliminating immunity gaps in older children that may have resulted from past periods of low vaccination coverage. Using an individual-based mathematical model, we quantified the impact of EAG campaigns in terms of probability of elimination, reduction in polio transmission and age stratified immunity levels. The model was specifically calibrated to seroprevalence data from a polio-endemic region: Zaria, Nigeria. We compared the impact of EAG campaigns, which depend only on age, to more targeted interventions which focus on reaching missed populations. We found that EAG campaigns would not significantly improve prospects for polio eradication; the probability of elimination increased by 8% (from 24% at baseline to 32%) when expanding three annual SIAs to 5-14 year old children and by 18% when expanding all six annual SIAs. In contrast, expanding only two of the annual SIAs to target hard-to-reach populations at modest vaccination coverage-representing less than one tenth of additional vaccinations required for the six SIA EAG scenario-increased the probability of elimination by 55%. Implementation of EAG campaigns in polio endemic regions would not improve prospects for eradication. In endemic areas, vaccination campaigns which do not target missed populations will not benefit polio eradication efforts.

Effect of Medicaid Expansions on Health Insurance Coverage and Access to Care among Low-Income Adults with Behavioral Health Conditions.

PubMed

Wen, Hefei; Druss, Benjamin G; Cummings, Janet R

2015-12-01

To examine the effect of Medicaid expansions on health insurance coverage and access to care among low-income adults with behavioral health conditions. Nine years (2004-2012) of individual-level cross-sectional data from a restricted-access version of National Survey on Drug Use and Health. A quasi-experimental difference-in-differences design comparing outcomes among residents in 14 states that implemented Medicaid expansions for low-income adults under the Section §1115 waiver with those residing in the rest of the country. The analytic sample includes low-income adult respondents with household incomes below 200 percent of the federal poverty level who have a behavioral health condition: approximately 28,400 low-income adults have past-year serious psychological distress and 24,900 low-income adults have a past-year substance use disorder (SUD). Among low-income adults with behavioral health conditions, Medicaid expansions were associated with a reduction in the rate of uninsurance (p < .05), a reduction in the probability of perceiving an unmet need for mental health (MH) treatment (p < .05) and for SUD treatment (p < .05), as well as an increase in the probability of receiving MH treatment (p < .01). The ongoing implementation of Medicaid expansions has the potential to improve health insurance coverage and access to care for low-income adults with behavioral health conditions. © Health Research and Educational Trust.

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.

Prediction of Low Community Sanitation Coverage Using Environmental and Sociodemographic Factors in Amhara Region, Ethiopia

PubMed Central

Oswald, William E.; Stewart, Aisha E. P.; Flanders, W. Dana; Kramer, Michael R.; Endeshaw, Tekola; Zerihun, Mulat; Melaku, Birhanu; Sata, Eshetu; Gessesse, Demelash; Teferi, Tesfaye; Tadesse, Zerihun; Guadie, Birhan; King, Jonathan D.; Emerson, Paul M.; Callahan, Elizabeth K.; Moe, Christine L.; Clasen, Thomas F.

2016-01-01

This study developed and validated a model for predicting the probability that communities in Amhara Region, Ethiopia, have low sanitation coverage, based on environmental and sociodemographic conditions. Community sanitation coverage was measured between 2011 and 2014 through trachoma control program evaluation surveys. Information on environmental and sociodemographic conditions was obtained from available data sources and linked with community data using a geographic information system. Logistic regression was used to identify predictors of low community sanitation coverage (< 20% versus ≥ 20%). The selected model was geographically and temporally validated. Model-predicted probabilities of low community sanitation coverage were mapped. Among 1,502 communities, 344 (22.90%) had coverage below 20%. The selected model included measures for high topsoil gravel content, an indicator for low-lying land, population density, altitude, and rainfall and had reasonable predictive discrimination (area under the curve = 0.75, 95% confidence interval = 0.72, 0.78). Measures of soil stability were strongly associated with low community sanitation coverage, controlling for community wealth, and other factors. A model using available environmental and sociodemographic data predicted low community sanitation coverage for areas across Amhara Region with fair discrimination. This approach could assist sanitation programs and trachoma control programs, scaling up or in hyperendemic areas, to target vulnerable areas with additional activities or alternate technologies. PMID:27430547

The effect of health-facility admission and skilled birth attendant coverage on maternal survival in India: a case-control analysis.

PubMed

Montgomery, Ann L; Fadel, Shaza; Kumar, Rajesh; Bondy, Sue; Moineddin, Rahim; Jha, Prabhat

2014-01-01

Research in areas of low skilled attendant coverage found that maternal mortality is paradoxically higher in women who seek obstetric care. We estimated the effect of health-facility admission on maternal survival, and how this effect varies with skilled attendant coverage across India. Using unmatched population-based case-control analysis of national datasets, we compared the effect of health-facility admission at any time (antenatal, intrapartum, postpartum) on maternal deaths (cases) to women reporting pregnancies (controls). Probability of maternal death decreased with increasing skilled attendant coverage, among both women who were and were not admitted to a health-facility, however, the risk of death among women who were admitted was higher (at 50% coverage, OR = 2.32, 95% confidence interval 1.85-2.92) than among those women who were not; while at higher levels of coverage, the effect of health-facility admission was attenuated. In a secondary analysis, the probability of maternal death decreased with increasing coverage among both women admitted for delivery or delivered at home but there was no effect of admission for delivery on mortality risk (50% coverage, OR = 1.0, 0.80-1.25), suggesting that poor quality of obstetric care may have attenuated the benefits of facility-based care. Subpopulation analysis of obstetric hemorrhage cases and report of 'excessive bleeding' in controls showed that the probability of maternal death decreased with increasing skilled attendant coverage; but the effect of health-facility admission was attenuated (at 50% coverage, OR = 1.47, 0.95-1.79), suggesting that some of the effect in the main model can be explained by women arriving at facility with complications underway. Finally, highest risk associated with health-facility admission was clustered in women with education ≤ 8 years. The effect of health-facility admission did vary by skilled attendant coverage, and this effect appears to be driven partially by reverse causality; however, inequitable access to and possibly poor quality of healthcare for primary and emergency services appears to play a role in maternal survival as well.

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.

Low photon-count tip-tilt sensor

NASA Astrophysics Data System (ADS)

Saathof, Rudolf; Schitter, Georg

2016-07-01

Due to the low photon-count of dark areas of the universe, signal strength of tip-tilt sensor is low, limiting sky-coverage of reliable tip-tilt measurements. This paper presents the low photon-count tip-tilt (LPC-TT) sensor, which potentially achieves improved signal strength. Its optical design spatially samples and integrates the scene. This increases the probability that several individual sources coincide on a detector segment. Laboratory experiments show feasibility of spatial sampling and integration and the ability to measure tilt angles. By simulation an improvement of the SNR of 10 dB compared to conventional tip-tilt sensors is shown.

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.

TU-AB-BRB-01: Coverage Evaluation and Probabilistic Treatment Planning as a Margin Alternative

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

Siebers, J.

The accepted clinical method to accommodate targeting uncertainties inherent in fractionated external beam radiation therapy is to utilize GTV-to-CTV and CTV-to-PTV margins during the planning process to design a PTV-conformal static dose distribution on the planning image set. Ideally, margins are selected to ensure a high (e.g. >95%) target coverage probability (CP) in spite of inherent inter- and intra-fractional positional variations, tissue motions, and initial contouring uncertainties. Robust optimization techniques, also known as probabilistic treatment planning techniques, explicitly incorporate the dosimetric consequences of targeting uncertainties by including CP evaluation into the planning optimization process along with coverage-based planning objectives. Themore » treatment planner no longer needs to use PTV and/or PRV margins; instead robust optimization utilizes probability distributions of the underlying uncertainties in conjunction with CP-evaluation for the underlying CTVs and OARs to design an optimal treated volume. This symposium will describe CP-evaluation methods as well as various robust planning techniques including use of probability-weighted dose distributions, probability-weighted objective functions, and coverage optimized planning. Methods to compute and display the effect of uncertainties on dose distributions will be presented. The use of robust planning to accommodate inter-fractional setup uncertainties, organ deformation, and contouring uncertainties will be examined as will its use to accommodate intra-fractional organ motion. Clinical examples will be used to inter-compare robust and margin-based planning, highlighting advantages of robust-plans in terms of target and normal tissue coverage. Robust-planning limitations as uncertainties approach zero and as the number of treatment fractions becomes small will be presented, as well as the factors limiting clinical implementation of robust planning. Learning Objectives: To understand robust-planning as a clinical alternative to using margin-based planning. To understand conceptual differences between uncertainty and predictable motion. To understand fundamental limitations of the PTV concept that probabilistic planning can overcome. To understand the major contributing factors to target and normal tissue coverage probability. To understand the similarities and differences of various robust planning techniques To understand the benefits and limitations of robust planning techniques.« less

TU-AB-BRB-03: Coverage-Based Treatment Planning to Accommodate Organ Deformable Motions and Contouring Uncertainties for Prostate Treatment

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

Xu, H.

The accepted clinical method to accommodate targeting uncertainties inherent in fractionated external beam radiation therapy is to utilize GTV-to-CTV and CTV-to-PTV margins during the planning process to design a PTV-conformal static dose distribution on the planning image set. Ideally, margins are selected to ensure a high (e.g. >95%) target coverage probability (CP) in spite of inherent inter- and intra-fractional positional variations, tissue motions, and initial contouring uncertainties. Robust optimization techniques, also known as probabilistic treatment planning techniques, explicitly incorporate the dosimetric consequences of targeting uncertainties by including CP evaluation into the planning optimization process along with coverage-based planning objectives. Themore » treatment planner no longer needs to use PTV and/or PRV margins; instead robust optimization utilizes probability distributions of the underlying uncertainties in conjunction with CP-evaluation for the underlying CTVs and OARs to design an optimal treated volume. This symposium will describe CP-evaluation methods as well as various robust planning techniques including use of probability-weighted dose distributions, probability-weighted objective functions, and coverage optimized planning. Methods to compute and display the effect of uncertainties on dose distributions will be presented. The use of robust planning to accommodate inter-fractional setup uncertainties, organ deformation, and contouring uncertainties will be examined as will its use to accommodate intra-fractional organ motion. Clinical examples will be used to inter-compare robust and margin-based planning, highlighting advantages of robust-plans in terms of target and normal tissue coverage. Robust-planning limitations as uncertainties approach zero and as the number of treatment fractions becomes small will be presented, as well as the factors limiting clinical implementation of robust planning. Learning Objectives: To understand robust-planning as a clinical alternative to using margin-based planning. To understand conceptual differences between uncertainty and predictable motion. To understand fundamental limitations of the PTV concept that probabilistic planning can overcome. To understand the major contributing factors to target and normal tissue coverage probability. To understand the similarities and differences of various robust planning techniques To understand the benefits and limitations of robust planning techniques.« less

TU-AB-BRB-00: New Methods to Ensure Target Coverage

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

NONE

2015-06-15

The accepted clinical method to accommodate targeting uncertainties inherent in fractionated external beam radiation therapy is to utilize GTV-to-CTV and CTV-to-PTV margins during the planning process to design a PTV-conformal static dose distribution on the planning image set. Ideally, margins are selected to ensure a high (e.g. >95%) target coverage probability (CP) in spite of inherent inter- and intra-fractional positional variations, tissue motions, and initial contouring uncertainties. Robust optimization techniques, also known as probabilistic treatment planning techniques, explicitly incorporate the dosimetric consequences of targeting uncertainties by including CP evaluation into the planning optimization process along with coverage-based planning objectives. Themore » treatment planner no longer needs to use PTV and/or PRV margins; instead robust optimization utilizes probability distributions of the underlying uncertainties in conjunction with CP-evaluation for the underlying CTVs and OARs to design an optimal treated volume. This symposium will describe CP-evaluation methods as well as various robust planning techniques including use of probability-weighted dose distributions, probability-weighted objective functions, and coverage optimized planning. Methods to compute and display the effect of uncertainties on dose distributions will be presented. The use of robust planning to accommodate inter-fractional setup uncertainties, organ deformation, and contouring uncertainties will be examined as will its use to accommodate intra-fractional organ motion. Clinical examples will be used to inter-compare robust and margin-based planning, highlighting advantages of robust-plans in terms of target and normal tissue coverage. Robust-planning limitations as uncertainties approach zero and as the number of treatment fractions becomes small will be presented, as well as the factors limiting clinical implementation of robust planning. Learning Objectives: To understand robust-planning as a clinical alternative to using margin-based planning. To understand conceptual differences between uncertainty and predictable motion. To understand fundamental limitations of the PTV concept that probabilistic planning can overcome. To understand the major contributing factors to target and normal tissue coverage probability. To understand the similarities and differences of various robust planning techniques To understand the benefits and limitations of robust planning techniques.« less

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

Medicaid Coverage Expansions and Cigarette Smoking Cessation Among Low-income Adults.

PubMed

Koma, Jonathan W; Donohue, Julie M; Barry, Colleen L; Huskamp, Haiden A; Jarlenski, Marian

2017-12-01

Expanding Medicaid coverage to low-income adults may have increased smoking cessation through improved access to evidence-based treatments. Our study sought to determine if states' decisions to expand Medicaid increased recent smoking cessation. Using pooled cross-sectional data from the Behavioral Risk Factor Surveillance Survey for the years 2011-2015, we examined the association between state Medicaid coverage and the probability of recent smoking cessation among low-income adults without dependent children who were current or former smokers (n=36,083). We used difference-in-differences estimation to examine the effects of Medicaid coverage on smoking cessation, comparing low-income adult smokers in states with Medicaid coverage to comparable adults in states without Medicaid coverage, with ages 18-64 years to those ages 65 years and above. Analyses were conducted for the full sample and stratified by sex. Residence in a state with Medicaid coverage among low-income adult smokers ages 18-64 years was associated with an increase in recent smoking cessation of 2.1 percentage points (95% confidence interval, 0.25-3.9). In the comparison group of individuals ages 65 years and above, residence in a state with Medicaid coverage expansion was not associated with a change in recent smoking cessation (-0.1 percentage point, 95% confidence interval, -2.1 to 1.8). Similar increases in smoking cessation among those ages 18-64 years were estimated for females and males (1.9 and 2.2 percentage point, respectively). Findings are consistent with the hypothesis that Medicaid coverage expansions may have increased smoking cessation among low-income adults without dependent children via greater access to preventive health care services, including evidence-based smoking cessation services.

Global Estimates of Syphilis in Pregnancy and Associated Adverse Outcomes: Analysis of Multinational Antenatal Surveillance Data

PubMed Central

Newman, Lori; Kamb, Mary; Hawkes, Sarah; Gomez, Gabriela; Say, Lale; Seuc, Armando; Broutet, Nathalie

2013-01-01

Background The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥90% of pregnant women to be tested for syphilis and ≥90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC) coverage for women with syphilis. Methods and Findings Estimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million) pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963) adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938; 249,716) stillbirths (>28 wk) or early fetal deaths (22 to 28 wk), 91,764 (76,141; 107,397) neonatal deaths, 65,267 (56,929; 73,605) preterm or low birth weight infants, and 151,547 (117,848; 185,245) infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was “probable active,” and for testing and treatment coverage. Conclusions Syphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that could be prevented by early testing and treatment. In this analysis, most adverse outcomes occurred among women who attended ANC but were not tested or treated for syphilis, highlighting the need to improve the quality of ANC as well as ANC coverage. In addition, improved ANC data on syphilis testing coverage, positivity, and treatment are needed. Please see later in the article for the Editors' Summary PMID:23468598

Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data.

PubMed

Newman, Lori; Kamb, Mary; Hawkes, Sarah; Gomez, Gabriela; Say, Lale; Seuc, Armando; Broutet, Nathalie

2013-01-01

The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥ 90% of pregnant women to be tested for syphilis and ≥ 90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC) coverage for women with syphilis. Estimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million) pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963) adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938; 249,716) stillbirths (>28 wk) or early fetal deaths (22 to 28 wk), 91,764 (76,141; 107,397) neonatal deaths, 65,267 (56,929; 73,605) preterm or low birth weight infants, and 151,547 (117,848; 185,245) infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was "probable active," and for testing and treatment coverage. Syphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that could be prevented by early testing and treatment. In this analysis, most adverse outcomes occurred among women who attended ANC but were not tested or treated for syphilis, highlighting the need to improve the quality of ANC as well as ANC coverage. In addition, improved ANC data on syphilis testing coverage, positivity, and treatment are needed. Please see later in the article for the Editors' Summary.

Does Retiree Health Insurance Encourage Early Retirement?*

PubMed Central

Nyce, Steven; Schieber, Sylvester J.; Shoven, John B.; Slavov, Sita Nataraj; Wise, David A.

2013-01-01

The strong link between health insurance and employment in the United States may cause workers to delay retirement until they become eligible for Medicare at age 65. However, some employers extend health insurance benefits to their retirees, and individuals who are eligible for such retiree health benefits need not wait until age 65 to retire with group health coverage. We investigate the impact of retiree health insurance on early retirement using employee-level data from 54 diverse firms that are clients of Towers Watson, a leading benefits consulting firm. We find that retiree health coverage has its strongest effects at ages 62 through 64. Coverage that includes an employer contribution is associated with a 6.3 percentage point (36.2 percent) increase in the probability of turnover at age 62, a 7.7 percentage point (48.8 percent) increase in the probability of turnover at age 63, and a 5.5 percentage point (38.0 percent) increase in the probability of turnover at age 64. Conditional on working at age 57, such coverage reduces the expected retirement age by almost three months and reduces the total number of person-years worked between ages 58 and 64 by 5.6 percent. PMID:24039312

The role of retiree health insurance in the early retirement of public sector employees.

PubMed

Shoven, John B; Slavov, Sita Nataraj

2014-12-01

Most government employees have access to retiree health coverage, which provides them with group health coverage even if they retire before Medicare eligibility. We study the impact of retiree health coverage on the labor supply of public sector workers between the ages of 55 and 64. We find that retiree health coverage raises the probability of stopping full time work by 4.3 percentage points (around 38 percent) over two years among public sector workers aged 55-59, and by 6.7 percentage points (around 26 percent) over two years among public sector workers aged 60-64. In the younger age group, retiree health insurance mostly seems to facilitate transitions to part-time work rather than full retirement. However, in the older age group, it increases the probability of stopping work entirely by 4.3 percentage points (around 22 percent). Copyright © 2014 Elsevier B.V. All rights reserved.

Trends in, and projections of, indicators of universal health coverage in Bangladesh, 1995-2030: a Bayesian analysis of population-based household data.

PubMed

Rahman, Md Shafiur; Rahman, Md Mizanur; Gilmour, Stuart; Swe, Khin Thet; Krull Abe, Sarah; Shibuya, Kenji

2018-01-01

Many countries are implementing health system reforms to achieve universal health coverage (UHC) by 2030. To understand the progress towards UHC in Bangladesh, we estimated trends in indicators of the health service and of financial risk protection. We also estimated the probability of Bangladesh's achieving of UHC targets of 80% essential health-service coverage and 100% financial risk protection by 2030. We estimated the coverage of UHC indicators-13 prevention indicators and four treatment indicators-from 19 nationally representative population-based household surveys done in Bangladesh from Jan 1, 1991, to Dec 31, 2014. We used a Bayesian regression model to estimate the trend and to predict the coverage of UHC indicators along with the probabilities of achieving UHC targets of 80% coverage of health services and 100% coverage of financial risk protection from catastrophic and impoverishing health payments by 2030. We used the concentration index and relative index of inequality to assess wealth-based inequality in UHC indicators. If the current trends remain unchanged, we estimated that coverage of childhood vaccinations, improved water, oral rehydration treatment, satisfaction with family planning, and non-use of tobacco will achieve the 80% target by 2030. However, coverage of four antenatal care visits, facility-based delivery, skilled birth attendance, postnatal checkups, care seeking for pneumonia, exclusive breastfeeding, non-overweight, and adequate sanitation were not projected to achieve the target. Quintile-specific projections showed wide wealth-based inequality in access to antenatal care, postnatal care, delivery care, adequate sanitation, and care seeking for pneumonia, and this inequality was projected to continue for all indicators. The incidence of catastrophic health expenditure and impoverishment were projected to increase from 17% and 4%, respectively, in 2015, to 20% and 9%, respectively, by 2030. Inequality analysis suggested that wealthiest households would disproportionately face more financial catastrophe than the most disadvantaged households. Despite progress, Bangladesh will not achieve the 2030 UHC targets unless the country scales up interventions related to maternal and child health services, and reforms health financing systems to avoid high dependency on out-of-pocket payments. The introduction of a national health insurance system, increased public funding for health care, and expansion of community-based clinics in rural areas could help to move the country towards UHC. Japan Ministry of Health, Labour, and Welfare. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

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.

Uncertainties in Parameters Estimated with Neural Networks: Application to Strong Gravitational Lensing

DOE PAGES

Perreault Levasseur, Laurence; Hezaveh, Yashar D.; Wechsler, Risa H.

2017-11-15

In Hezaveh et al. (2017) we showed that deep learning can be used for model parameter estimation and trained convolutional neural networks to determine the parameters of strong gravitational lensing systems. Here we demonstrate a method for obtaining the uncertainties of these parameters. We review the framework of variational inference to obtain approximate posteriors of Bayesian neural networks and apply it to a network trained to estimate the parameters of the Singular Isothermal Ellipsoid plus external shear and total flux magnification. We show that the method can capture the uncertainties due to different levels of noise in the input data,more » as well as training and architecture-related errors made by the network. To evaluate the accuracy of the resulting uncertainties, we calculate the coverage probabilities of marginalized distributions for each lensing parameter. By tuning a single hyperparameter, the dropout rate, we obtain coverage probabilities approximately equal to the confidence levels for which they were calculated, resulting in accurate and precise uncertainty estimates. Our results suggest that neural networks can be a fast alternative to Monte Carlo Markov Chains for parameter uncertainty estimation in many practical applications, allowing more than seven orders of magnitude improvement in speed.« less

Uncertainties in Parameters Estimated with Neural Networks: Application to Strong Gravitational Lensing

NASA Astrophysics Data System (ADS)

Perreault Levasseur, Laurence; Hezaveh, Yashar D.; Wechsler, Risa H.

2017-11-01

In Hezaveh et al. we showed that deep learning can be used for model parameter estimation and trained convolutional neural networks to determine the parameters of strong gravitational-lensing systems. Here we demonstrate a method for obtaining the uncertainties of these parameters. We review the framework of variational inference to obtain approximate posteriors of Bayesian neural networks and apply it to a network trained to estimate the parameters of the Singular Isothermal Ellipsoid plus external shear and total flux magnification. We show that the method can capture the uncertainties due to different levels of noise in the input data, as well as training and architecture-related errors made by the network. To evaluate the accuracy of the resulting uncertainties, we calculate the coverage probabilities of marginalized distributions for each lensing parameter. By tuning a single variational parameter, the dropout rate, we obtain coverage probabilities approximately equal to the confidence levels for which they were calculated, resulting in accurate and precise uncertainty estimates. Our results suggest that the application of approximate Bayesian neural networks to astrophysical modeling problems can be a fast alternative to Monte Carlo Markov Chains, allowing orders of magnitude improvement in speed.

Uncertainties in Parameters Estimated with Neural Networks: Application to Strong Gravitational Lensing

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

Perreault Levasseur, Laurence; Hezaveh, Yashar D.; Wechsler, Risa H.

In Hezaveh et al. (2017) we showed that deep learning can be used for model parameter estimation and trained convolutional neural networks to determine the parameters of strong gravitational lensing systems. Here we demonstrate a method for obtaining the uncertainties of these parameters. We review the framework of variational inference to obtain approximate posteriors of Bayesian neural networks and apply it to a network trained to estimate the parameters of the Singular Isothermal Ellipsoid plus external shear and total flux magnification. We show that the method can capture the uncertainties due to different levels of noise in the input data,more » as well as training and architecture-related errors made by the network. To evaluate the accuracy of the resulting uncertainties, we calculate the coverage probabilities of marginalized distributions for each lensing parameter. By tuning a single hyperparameter, the dropout rate, we obtain coverage probabilities approximately equal to the confidence levels for which they were calculated, resulting in accurate and precise uncertainty estimates. Our results suggest that neural networks can be a fast alternative to Monte Carlo Markov Chains for parameter uncertainty estimation in many practical applications, allowing more than seven orders of magnitude improvement in speed.« less

Resolution Enhanced Magnetic Sensing System for Wide Coverage Real Time UXO Detection

NASA Astrophysics Data System (ADS)

Zalevsky, Zeev; Bregman, Yuri; Salomonski, Nizan; Zafrir, Hovav

2012-09-01

In this paper we present a new high resolution automatic detection algorithm based upon a Wavelet transform and then validate it in marine related experiments. The proposed approach allows obtaining an automatic detection in a very low signal to noise ratios. The amount of calculations is reduced, the magnetic trend is depressed and the probability of detection/ false alarm rate can easily be controlled. Moreover, the algorithm enables to distinguish between close targets. In the algorithm we use the physical dependence of the magnetic field of a magnetic dipole in order to define a Wavelet mother function that later on can detect magnetic targets modeled as dipoles and embedded in noisy surrounding, at improved resolution. The proposed algorithm was realized on synthesized targets and then validated in field experiments involving a marine surface-floating system for wide coverage real time unexploded ordinance (UXO) detection and mapping. The detection probability achieved in the marine experiment was above 90%. The horizontal radial error of most of the detected targets was only 16 m and two baseline targets that were immersed about 20 m one to another could easily be distinguished.

Estimating Premium Sensitivity for Children's Public Health Insurance Coverage: Selection but No Death Spiral

PubMed Central

Marton, James; Ketsche, Patricia G; Snyder, Angela; Adams, E Kathleen; Zhou, Mei

2015-01-01

Objective To estimate the effect of premium increases on the probability that near-poor and moderate-income children disenroll from public coverage. Data Sources Enrollment, eligibility, and claims data for Georgia's PeachCare for Kids™ (CHIP) program for multiple years. Study Design We exploited policy-induced variation in premiums generated by cross-sectional differences and changes over time in enrollee age, family size, and income to estimate the duration of enrollment as a function of the effective (per child) premium. We classify children as being of low, medium, or high illness severity. Principal Findings A dollar increase in the per-child premium is associated with a slight increase in a typical child's monthly probability of exiting coverage from 7.70 to 7.83 percent. Children with low illness severity have a significantly higher monthly baseline probability of exiting than children with medium or high illness severity, but the enrollment response to premium increases is similar across all three groups. Conclusions Success in achieving coverage gains through public programs is tempered by persistent problems in maintaining enrollment, which is modestly affected by premium increases. Retention is subject to adverse selection problems, but premium increases do not appear to significantly magnify the selection problem in this case. PMID:25130764

Theoretical studies of positron states and annihilation characteristics at the oxidized Cu(100) surface

NASA Astrophysics Data System (ADS)

Fazleev, N. G.; Weiss, A. H.

2013-04-01

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. An ab-initio study of the electronic properties of the Cu(100) missing row reconstructed surface at various on surface and sub-surface oxygen coverages has been performed on the basis of the density functional theory (DFT) using the Dmol3 code and the generalized gradient approximation (GGA). Surface structures in calculations have been constructed by adding oxygen atoms to various surface hollow and sub-surface octahedral sites of the 0.5 monolayer (ML) missing row reconstructed phase of the Cu(100) surface with oxygen coverages ranging from 0.5 to 1.5 ML. The charge redistribution at the surface and variations in atomic structure and chemical composition of the topmost layers associated with oxidation and surface reconstruction have been found to affect the spatial extent and localization of the positron surface state wave function and annihilation probabilities of surface trapped positrons with relevant core electrons. Theoretical results are compared with experimental data obtained from studies of oxidation of the Cu(100) surface using positron annihilation induced Auger electron spectroscopy (PAES). It has been shown that positron annihilation probabilities with Cu 3s and 3p core electrons decrease when total (on-surface and sub-surface) oxygen coverage of the Cu(100) surface increases up to 1 ML. The calculations show that for high oxygen coverage when total oxygen coverage is 1. 5 ML the positron is not bound to the surface.

Theoretical studies of positron states and annihilation characteristics at the oxidized Cu(100) surface

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

Fazleev, N. G.; Weiss, A. H.

2013-04-19

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. An ab-initio study of the electronic properties of the Cu(100) missing row reconstructed surface at various on surface and sub-surface oxygen coverages has been performed on the basis of the density functional theory (DFT) using the Dmol3 code and the generalized gradient approximation (GGA). Surface structures in calculations have been constructed by adding oxygen atoms to various surface hollow and sub-surface octahedral sitesmore » of the 0.5 monolayer (ML) missing row reconstructed phase of the Cu(100) surface with oxygen coverages ranging from 0.5 to 1.5 ML. The charge redistribution at the surface and variations in atomic structure and chemical composition of the topmost layers associated with oxidation and surface reconstruction have been found to affect the spatial extent and localization of the positron surface state wave function and annihilation probabilities of surface trapped positrons with relevant core electrons. Theoretical results are compared with experimental data obtained from studies of oxidation of the Cu(100) surface using positron annihilation induced Auger electron spectroscopy (PAES). It has been shown that positron annihilation probabilities with Cu 3s and 3p core electrons decrease when total (on-surface and sub-surface) oxygen coverage of the Cu(100) surface increases up to 1 ML. The calculations show that for high oxygen coverage when total oxygen coverage is 1. 5 ML the positron is not bound to the surface.« less

Intervals for posttest probabilities: a comparison of 5 methods.

PubMed

Mossman, D; Berger, J O

2001-01-01

Several medical articles discuss methods of constructing confidence intervals for single proportions and the likelihood ratio, but scant attention has been given to the systematic study of intervals for the posterior odds, or the positive predictive value, of a test. The authors describe 5 methods of constructing confidence intervals for posttest probabilities when estimates of sensitivity, specificity, and the pretest probability of a disorder are derived from empirical data. They then evaluate each method to determine how well the intervals' coverage properties correspond to their nominal value. When the estimates of pretest probabilities, sensitivity, and specificity are derived from more than 80 subjects and are not close to 0 or 1, all methods generate intervals with appropriate coverage properties. When these conditions are not met, however, the best-performing method is an objective Bayesian approach implemented by a simple simulation using a spreadsheet. Physicians and investigators can generate accurate confidence intervals for posttest probabilities in small-sample situations using the objective Bayesian approach.

TU-AB-BRB-02: Stochastic Programming Methods for Handling Uncertainty and Motion in IMRT Planning

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

Unkelbach, J.

The accepted clinical method to accommodate targeting uncertainties inherent in fractionated external beam radiation therapy is to utilize GTV-to-CTV and CTV-to-PTV margins during the planning process to design a PTV-conformal static dose distribution on the planning image set. Ideally, margins are selected to ensure a high (e.g. >95%) target coverage probability (CP) in spite of inherent inter- and intra-fractional positional variations, tissue motions, and initial contouring uncertainties. Robust optimization techniques, also known as probabilistic treatment planning techniques, explicitly incorporate the dosimetric consequences of targeting uncertainties by including CP evaluation into the planning optimization process along with coverage-based planning objectives. Themore » treatment planner no longer needs to use PTV and/or PRV margins; instead robust optimization utilizes probability distributions of the underlying uncertainties in conjunction with CP-evaluation for the underlying CTVs and OARs to design an optimal treated volume. This symposium will describe CP-evaluation methods as well as various robust planning techniques including use of probability-weighted dose distributions, probability-weighted objective functions, and coverage optimized planning. Methods to compute and display the effect of uncertainties on dose distributions will be presented. The use of robust planning to accommodate inter-fractional setup uncertainties, organ deformation, and contouring uncertainties will be examined as will its use to accommodate intra-fractional organ motion. Clinical examples will be used to inter-compare robust and margin-based planning, highlighting advantages of robust-plans in terms of target and normal tissue coverage. Robust-planning limitations as uncertainties approach zero and as the number of treatment fractions becomes small will be presented, as well as the factors limiting clinical implementation of robust planning. Learning Objectives: To understand robust-planning as a clinical alternative to using margin-based planning. To understand conceptual differences between uncertainty and predictable motion. To understand fundamental limitations of the PTV concept that probabilistic planning can overcome. To understand the major contributing factors to target and normal tissue coverage probability. To understand the similarities and differences of various robust planning techniques To understand the benefits and limitations of robust planning techniques.« less

Effects of healthcare reforms on coverage, access, and disparities: quasi-experimental analysis of evidence from Massachusetts.

PubMed

Pande, Aakanksha H; Ross-Degnan, Dennis; Zaslavsky, Alan M; Salomon, Joshua A

2011-07-01

The 2010 Patient Protection and Affordable Care Act (PPACA) has been controversial. The potential impact of national healthcare reform may be considered using a similar set of state-level reforms including exchanges and a mandate, enacted in 2006 in Massachusetts. To evaluate the effects of reforms on healthcare access, affordability, and disparities. Interrupted time series with comparison series. Longitudinal survey data from 2002 to 2009 from the Behavioral Risk Factor Surveillance System including 178,040 nonelderly adults residing in Massachusetts, Vermont, New Hampshire, Rhode Island, and Connecticut. Analysis was conducted from January to August 2010. Massachusetts 2006 healthcare reform, which included an individual health insurance mandate. Being uninsured, having no personal doctor, and forgoing care because of cost, evaluated in Massachusetts and four comparison states before (2002-2005) and after (2007-2009) the healthcare reform. Effects on disparities defined by race, education, income, and employment also were assessed. Living in Massachusetts in 2009 was associated with a 7.6 percentage point (95% CI=3.9, 11.3) higher probability of being insured; 4.8 percentage point (-0.9, 10.6) lower probability of forgoing care because of cost; and a 6.6 percentage point (1.9, 11.3) higher probability of having a personal doctor, compared to expected levels in the absence of reform, defined by trends in control states and adjusting for socioeconomic factors. The effects of the reform on insurance coverage attenuated from 2008 to 2009. In a socioeconomically disadvantaged group, the reforms had a greater effect in improving outcomes on the absolute but not relative scale. Healthcare reforms in Massachusetts, which included a health insurance mandate, were associated with significant increases in insurance coverage and access. The absolute effects of the reform were greater for disadvantaged populations. This is important evidence to consider as debate over national healthcare reform continues. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Implementing a Continuous Quality Improvement Program in a High-Volume Clinical Echocardiography Laboratory: Improving Care for Patients With Aortic Stenosis.

PubMed

Samad, Zainab; Minter, Stephanie; Armour, Alicia; Tinnemore, Amanda; Sivak, Joseph A; Sedberry, Brenda; Strub, Karen; Horan, Seanna M; Harrison, J Kevin; Kisslo, Joseph; Douglas, Pamela S; Velazquez, Eric J

2016-03-01

The management of aortic stenosis rests on accurate echocardiographic diagnosis. Hence, it was chosen as a test case to examine the utility of continuous quality improvement (CQI) approaches to increase echocardiographic data accuracy and reliability. A novel, multistep CQI program was designed and prospectively used to investigate whether it could minimize the difference in aortic valve mean gradients reported by echocardiography when compared with cardiac catheterization. The Duke Echo Laboratory compiled a multidisciplinary CQI team including 4 senior sonographers and MD faculty to develop a mapped CQI process that incorporated Intersocietal Accreditation Commission standards. Quarterly, the CQI team reviewed all moderate- or greater-severity aortic stenosis echocardiography studies with concomitant catheterization data, and deidentified individual and group results were shared at meetings attended by cardiologists and sonographers. After review of 2011 data, the CQI team proposed specific amendments implemented over 2012: the use of nontraditional imaging and Doppler windows as well as evaluation of aortic gradients by a second sonographer. The primary outcome measure was agreement between catheterization- and echocardiography-derived mean gradients calculated by using the coverage probability index with a prespecified acceptable echocardiography-catheterization difference of <10 mm Hg in mean gradient. Between January 2011 and January 2014, 2093 echocardiograms reported moderate or greater aortic stenosis. Among cases with available catheterization data pre- and post-CQI, the coverage probability index increased from 54% to 70% (P=0.03; 98 cases, year 2011; 70 cases, year 2013). The proportion of patients referred for invasive valve hemodynamics decreased from 47% pre-CQI to 19% post-CQI (P<0.001). A laboratory practice pattern that was amenable to reform was identified, and a multistep modification was designed and implemented that produced clinically valuable performance improvements. The new protocol improved aortic stenosis mean gradient agreement between echocardiography and catheterization and was associated with a measurable decrease in referrals of patients for invasive studies. © 2016 American Heart Association, Inc.

Optimize the Coverage Probability of Prediction Interval for Anomaly Detection of Sensor-Based Monitoring Series

PubMed Central

Liu, Datong; Peng, Yu; Peng, Xiyuan

2018-01-01

Effective anomaly detection of sensing data is essential for identifying potential system failures. Because they require no prior knowledge or accumulated labels, and provide uncertainty presentation, the probability prediction methods (e.g., Gaussian process regression (GPR) and relevance vector machine (RVM)) are especially adaptable to perform anomaly detection for sensing series. Generally, one key parameter of prediction models is coverage probability (CP), which controls the judging threshold of the testing sample and is generally set to a default value (e.g., 90% or 95%). There are few criteria to determine the optimal CP for anomaly detection. Therefore, this paper designs a graphic indicator of the receiver operating characteristic curve of prediction interval (ROC-PI) based on the definition of the ROC curve which can depict the trade-off between the PI width and PI coverage probability across a series of cut-off points. Furthermore, the Youden index is modified to assess the performance of different CPs, by the minimization of which the optimal CP is derived by the simulated annealing (SA) algorithm. Experiments conducted on two simulation datasets demonstrate the validity of the proposed method. Especially, an actual case study on sensing series from an on-orbit satellite illustrates its significant performance in practical application. PMID:29587372

Joint coverage probability in a simulation study on Continuous-Time Markov Chain parameter estimation.

PubMed

Benoit, Julia S; Chan, Wenyaw; Doody, Rachelle S

2015-01-01

Parameter dependency within data sets in simulation studies is common, especially in models such as Continuous-Time Markov Chains (CTMC). Additionally, the literature lacks a comprehensive examination of estimation performance for the likelihood-based general multi-state CTMC. Among studies attempting to assess the estimation, none have accounted for dependency among parameter estimates. The purpose of this research is twofold: 1) to develop a multivariate approach for assessing accuracy and precision for simulation studies 2) to add to the literature a comprehensive examination of the estimation of a general 3-state CTMC model. Simulation studies are conducted to analyze longitudinal data with a trinomial outcome using a CTMC with and without covariates. Measures of performance including bias, component-wise coverage probabilities, and joint coverage probabilities are calculated. An application is presented using Alzheimer's disease caregiver stress levels. Comparisons of joint and component-wise parameter estimates yield conflicting inferential results in simulations from models with and without covariates. In conclusion, caution should be taken when conducting simulation studies aiming to assess performance and choice of inference should properly reflect the purpose of the simulation.

Analytical Study on Multi-Tier 5G Heterogeneous Small Cell Networks: Coverage Performance and Energy Efficiency.

PubMed

Xiao, Zhu; Liu, Hongjing; Havyarimana, Vincent; Li, Tong; Wang, Dong

2016-11-04

In this paper, we investigate the coverage performance and energy efficiency of multi-tier heterogeneous cellular networks (HetNets) which are composed of macrocells and different types of small cells, i.e., picocells and femtocells. By virtue of stochastic geometry tools, we model the multi-tier HetNets based on a Poisson point process (PPP) and analyze the Signal to Interference Ratio (SIR) via studying the cumulative interference from pico-tier and femto-tier. We then derive the analytical expressions of coverage probabilities in order to evaluate coverage performance in different tiers and investigate how it varies with the small cells' deployment density. By taking the fairness and user experience into consideration, we propose a disjoint channel allocation scheme and derive the system channel throughput for various tiers. Further, we formulate the energy efficiency optimization problem for multi-tier HetNets in terms of throughput performance and resource allocation fairness. To solve this problem, we devise a linear programming based approach to obtain the available area of the feasible solutions. System-level simulations demonstrate that the small cells' deployment density has a significant effect on the coverage performance and energy efficiency. Simulation results also reveal that there exits an optimal small cell base station (SBS) density ratio between pico-tier and femto-tier which can be applied to maximize the energy efficiency and at the same time enhance the system performance. Our findings provide guidance for the design of multi-tier HetNets for improving the coverage performance as well as the energy efficiency.

Analytical Study on Multi-Tier 5G Heterogeneous Small Cell Networks: Coverage Performance and Energy Efficiency

PubMed Central

Xiao, Zhu; Liu, Hongjing; Havyarimana, Vincent; Li, Tong; Wang, Dong

2016-01-01

In this paper, we investigate the coverage performance and energy efficiency of multi-tier heterogeneous cellular networks (HetNets) which are composed of macrocells and different types of small cells, i.e., picocells and femtocells. By virtue of stochastic geometry tools, we model the multi-tier HetNets based on a Poisson point process (PPP) and analyze the Signal to Interference Ratio (SIR) via studying the cumulative interference from pico-tier and femto-tier. We then derive the analytical expressions of coverage probabilities in order to evaluate coverage performance in different tiers and investigate how it varies with the small cells’ deployment density. By taking the fairness and user experience into consideration, we propose a disjoint channel allocation scheme and derive the system channel throughput for various tiers. Further, we formulate the energy efficiency optimization problem for multi-tier HetNets in terms of throughput performance and resource allocation fairness. To solve this problem, we devise a linear programming based approach to obtain the available area of the feasible solutions. System-level simulations demonstrate that the small cells’ deployment density has a significant effect on the coverage performance and energy efficiency. Simulation results also reveal that there exits an optimal small cell base station (SBS) density ratio between pico-tier and femto-tier which can be applied to maximize the energy efficiency and at the same time enhance the system performance. Our findings provide guidance for the design of multi-tier HetNets for improving the coverage performance as well as the energy efficiency. PMID:27827917

An empirical Bayes approach to analyzing recurring animal surveys

USGS Publications Warehouse

Johnson, D.H.

1989-01-01

Recurring estimates of the size of animal populations are often required by biologists or wildlife managers. Because of cost or other constraints, estimates frequently lack the accuracy desired but cannot readily be improved by additional sampling. This report proposes a statistical method employing empirical Bayes (EB) estimators as alternatives to those customarily used to estimate population size, and evaluates them by a subsampling experiment on waterfowl surveys. EB estimates, especially a simple limited-translation version, were more accurate and provided shorter confidence intervals with greater coverage probabilities than customary estimates.

Effects of sampling conditions on DNA-based estimates of American black bear abundance

USGS Publications Warehouse

Laufenberg, Jared S.; Van Manen, Frank T.; Clark, Joseph D.

2013-01-01

DNA-based capture-mark-recapture techniques are commonly used to estimate American black bear (Ursus americanus) population abundance (N). Although the technique is well established, many questions remain regarding study design. In particular, relationships among N, capture probability of heterogeneity mixtures A and B (pA and pB, respectively, or p, collectively), the proportion of each mixture (π), number of capture occasions (k), and probability of obtaining reliable estimates of N are not fully understood. We investigated these relationships using 1) an empirical dataset of DNA samples for which true N was unknown and 2) simulated datasets with known properties that represented a broader array of sampling conditions. For the empirical data analysis, we used the full closed population with heterogeneity data type in Program MARK to estimate N for a black bear population in Great Smoky Mountains National Park, Tennessee. We systematically reduced the number of those samples used in the analysis to evaluate the effect that changes in capture probabilities may have on parameter estimates. Model-averaged N for females and males were 161 (95% CI = 114–272) and 100 (95% CI = 74–167), respectively (pooled N = 261, 95% CI = 192–419), and the average weekly p was 0.09 for females and 0.12 for males. When we reduced the number of samples of the empirical data, support for heterogeneity models decreased. For the simulation analysis, we generated capture data with individual heterogeneity covering a range of sampling conditions commonly encountered in DNA-based capture-mark-recapture studies and examined the relationships between those conditions and accuracy (i.e., probability of obtaining an estimated N that is within 20% of true N), coverage (i.e., probability that 95% confidence interval includes true N), and precision (i.e., probability of obtaining a coefficient of variation ≤20%) of estimates using logistic regression. The capture probability for the larger of 2 mixture proportions of the population (i.e., pA or pB, depending on the value of π) was most important for predicting accuracy and precision, whereas capture probabilities of both mixture proportions (pA and pB) were important to explain variation in coverage. Based on sampling conditions similar to parameter estimates from the empirical dataset (pA = 0.30, pB = 0.05, N = 250, π = 0.15, and k = 10), predicted accuracy and precision were low (60% and 53%, respectively), whereas coverage was high (94%). Increasing pB, the capture probability for the predominate but most difficult to capture proportion of the population, was most effective to improve accuracy under those conditions. However, manipulation of other parameters may be more effective under different conditions. In general, the probabilities of obtaining accurate and precise estimates were best when p≥ 0.2. Our regression models can be used by managers to evaluate specific sampling scenarios and guide development of sampling frameworks or to assess reliability of DNA-based capture-mark-recapture studies.

SU-F-T-419: Evaluation of PlanIQ Feasibility DVH as Planning Objectives for Skull Base SBRT Patients

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

Jiang, W; Wang, H; Chi, P

2016-06-15

Purpose: PlanIQ(Sun Nuclear Corporation) can provide feasibility measures on organs-at-risk(OARs) around the target based on depth, local anatomy density and energy of radiation beam used. This study is to test and evaluate PlanIQ feasibility DVHs as optimization objectives in the treatment planning process, and to investigate the potential to use them in routine clinical cases to improve planning efficiency. Methods: Two to three arcs VMAT Treatment plans were generated in Pinnacle based on PlanIQ feasibility DVH for six skull base patients who previously treated with SBRT. The PlanIQ feasibility DVH for each OAR consists of four zones – impossible (atmore » 100% target coverage), difficult, challenging and probable. Constrains to achieve DVH in difficult zone were used to start plan optimization. Further adjustment was made to improve coverage. The plan DVHs were compared to PlanIQ feasibility DVH to assess the dose received by 0%(D0), 5%(D5), 10%(D10) and 50%(D50) of the OAR volumes. Results: A total of 90 OARs were evaluated for 6 patients (mean 15 OARs, range 11–18 OARs). We used >98% PTV coverage as planning goal since it’s difficult to achieve 100% target coverage. For the generated plans, 96.7% of the OARs achieved D0 or D5 within difficult zone or impossible zone (ipsilateral OARs 93.5%, contralateral OARs 100%), while 90% and 65.6% of the OARs achieved D10 and D50 within difficult zone, respectively. Seventeen of the contralateral and out of field OARs achieved DVHs in impossible zone. For OARs adjacent or overlapped with target volume, the D0 and D5 are challenging to be optimized into difficult zone. All plans were completed within 2–4 adjustments to improve target coverage and uniformity. Conclusion: PlanIQ feasibility tool has the potential to provide difficult but achievable initial optimization objectives and therefore reduce the planning time to obtain a well optimized plan.« less

Evaluation of a community-based intervention to improve maternal and neonatal health service coverage in the most rural and remote districts of Zambia

PubMed Central

Michelo, Charles; Chola, Mumbi; Oliphant, Nicholas; Halwiindi, Hikabasa; Maswenyeho, Sitali; Baboo, Kumar Sridutt; Moshabela, Mosa

2018-01-01

Background A community-based intervention comprising both men and women, known as Safe Motherhood Action Groups (SMAGs), was implemented in four of Zambia’s poorest and most remote districts to improve coverage of selected maternal and neonatal health interventions. This paper reports on outcomes in the coverage of maternal and neonatal care interventions, including antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC) in the study areas. Methodology Three serial cross-sectional surveys were conducted between 2012 and 2015 among 1,652 mothers of children 0–5 months of age using a ‘before-and-after’ evaluation design with multi-stage sampling, combining probability proportional to size and simple random sampling. Logistic regression and chi-square test for trend were used to assess effect size and changes in measures of coverage for ANC, SBA and PNC during the intervention. Results Mothers’ mean age and educational status were non-differentially comparable at all the three-time points. The odds of attending ANC at least four times (aOR 1.63; 95% CI 1.38–1.99) and SBA (aOR 1.72; 95% CI 1.38–1.99) were at least 60% higher at endline than baseline surveillance. A two-fold and four-fold increase in the odds of mothers receiving PNC from an appropriate skilled provider (aOR 2.13; 95% CI 1.62–2.79) and a SMAG (aOR 4.87; 95% CI 3.14–7.54), respectively, were observed at endline. Receiving birth preparedness messages from a SMAG during pregnancy (aOR 1.76; 95% CI, 1.20–2.19) and receiving ANC from a skilled provider (aOR 4.01; 95% CI, 2.88–5.75) were significant predictors for SBA at delivery and PNC. Conclusions Strengthening community-based action groups in poor and remote districts through the support of mothers by SMAGs was associated with increased coverage of maternal and newborn health interventions, measured through ANC, SBA and PNC. In remote and marginalised settings, where the need is greatest, context-specific and innovative task-sharing strategies using community health volunteers can be effective in improving coverage of maternal and neonatal services and hold promise for better maternal and child survival in poorly-resourced parts of sub-Saharan Africa. PMID:29337995

Examples of measurement uncertainty evaluations in accordance with the revised GUM

NASA Astrophysics Data System (ADS)

Runje, B.; Horvatic, A.; Alar, V.; Medic, S.; Bosnjakovic, A.

2016-11-01

The paper presents examples of the evaluation of uncertainty components in accordance with the current and revised Guide to the expression of uncertainty in measurement (GUM). In accordance with the proposed revision of the GUM a Bayesian approach was conducted for both type A and type B evaluations.The law of propagation of uncertainty (LPU) and the law of propagation of distribution applied through the Monte Carlo method, (MCM) were used to evaluate associated standard uncertainties, expanded uncertainties and coverage intervals. Furthermore, the influence of the non-Gaussian dominant input quantity and asymmetric distribution of the output quantity y on the evaluation of measurement uncertainty was analyzed. In the case when the probabilistically coverage interval is not symmetric, the coverage interval for the probability P is estimated from the experimental probability density function using the Monte Carlo method. Key highlights of the proposed revision of the GUM were analyzed through a set of examples.

Determinants of apparent rural-urban differentials in measles vaccination uptake in Indonesia.

PubMed

Fernandez, Renae C; Awofeso, Niyi; Rammohan, Anu

2011-01-01

Regional differences in vaccination uptake are common in both developed and developing countries, and are often linked to the availability of healthcare services and socioeconomic factors. In 2007, 0.9 million eligible Indonesian children missed measles vaccination, and 19 456 cases of measles were documented among Indonesian children. The authors investigated rural-urban differentials in measles vaccination coverage among young Indonesian children, and sought to identify key factors influencing the probability of a child receiving the first dose of measles vaccination in Indonesia. Data used in the analyses were sourced from the nationally representative Indonesia Demographic and Health Survey 2007. The influence of location of residence, household wealth, maternal and paternal education, total children ever born and use of skilled birth attendants on measles vaccination coverage was investigated using bivariate analysis and chi-square tests. The independent effects of these variables were established using binomial logistic regression analysis. Indonesia's 2007 first-dose measles national vaccination coverage was, at 72.8%, lower than the 2008 global first-dose measles vaccination average coverage of 82%. Bivariate analysis revealed that the first-dose measles vaccination coverage in rural areas of Indonesia was 68.5%, compared with 80.1% in urban regions (p < 0.001). The apparent significance of rural residence in impairing vaccination coverage was marginal after controlling for the sex of the child, maternal age, maternal and paternal education, wealth, and access to skilled health workers. Apart from sustainable initiatives to increase measles vaccination coverage globally, it is important to close the rural-urban gap in Indonesia's measles vaccination uptake. Addressing critical determinants of inferior measles vaccination coverage in Indonesia's rural regions will facilitate major improvements in Indonesia's child health trends. This article suggests initiatives for addressing three of such determinants in Indonesia's rural areas: poverty, parental education and access to skilled health workers.

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

Antenatal Care Among Poor Women in Mexico in the Context of Universal Health Coverage.

PubMed

Servan-Mori, Edson; Wirtz, Veronika; Avila-Burgos, Leticia; Heredia-Pi, Ileana

2015-10-01

To study the influence of enrollment in the subsidized insurance program, Seguro Popular (SP), on timely (within three gestational months) and complete (at least four visits) antenatal care, in the context of expanding health coverage in Mexico. A cross-sectional study using data from the National Health and Nutrition Survey 2012 was conducted. Using quasi-experimental matching methods, we analyzed the influence of SP on timely antenatal care and a minimum of four visits for 6175 women (aged 14-49), and explored heterogeneous influences by socioeconomic status (SES) and educational level. Approximately 80 % of women reported timely antenatal care, with no significant difference between SP and non-SP-except among SP women from low SES households, who had an increased probability of timely antenatal care by 1.88 (p < 0.05). Enrollment in SP increased the probability of receiving at least four visits (1.65, p < 0.01) but this was not independently associated with SP enrollment when modeled together with timely antenatal care. Overall, higher SES increased the probability of antenatal care, while higher educational level increased the probability of four visits. To increase the impact of SP on antenatal care requires focusing on efforts to promote timely attendance as an important factor towards achieving the goal of universal health coverage of maternal and child health services in Mexico.

Medicaid Expansion Under the Affordable Care Act and Insurance Coverage in Rural and Urban Areas.

PubMed

Soni, Aparna; Hendryx, Michael; Simon, Kosali

2017-04-01

To analyze the differential rural-urban impacts of the Affordable Care Act Medicaid expansion on low-income childless adults' health insurance coverage. Using data from the American Community Survey years 2011-2015, we conducted a difference-in-differences regression analysis to test for changes in the probability of low-income childless adults having insurance in states that expanded Medicaid versus states that did not expand, in rural versus urban areas. Analyses employed survey weights, adjusted for covariates, and included a set of falsification tests as well as sensitivity analyses. Medicaid expansion under the Affordable Care Act increased the probability of Medicaid coverage for targeted populations in rural and urban areas, with a significantly greater increase in rural areas (P < .05), but some of these gains were offset by reductions in individual purchased insurance among rural populations (P < .01). Falsification tests showed that the insurance increases were specific to low-income childless adults, as expected, and were largely insignificant for other populations. The Medicaid expansion increased the probability of having "any insurance" for the pooled urban and rural low-income populations, and it specifically increased Medicaid coverage more in rural versus urban populations. There was some evidence that the expansion was accompanied by some shifting from individual purchased insurance to Medicaid in rural areas, and there is a need for future work to understand the implications of this shift on expenditures, access to care and utilization. © 2017 National Rural Health Association.

Sky coverage modeling for the whole sky for laser guide star multiconjugate adaptive optics.

PubMed

Wang, Lianqi; Andersen, David; Ellerbroek, Brent

2012-06-01

The scientific productivity of laser guide star adaptive optics systems strongly depends on the sky coverage, which describes the probability of finding natural guide stars for the tip/tilt wavefront sensor(s) to achieve a certain performance. Knowledge of the sky coverage is also important for astronomers planning their observations. In this paper, we present an efficient method to compute the sky coverage for the laser guide star multiconjugate adaptive optics system, the Narrow Field Infrared Adaptive Optics System (NFIRAOS), being designed for the Thirty Meter Telescope project. We show that NFIRAOS can achieve more than 70% sky coverage over most of the accessible sky with the requirement of 191 nm total rms wavefront.

Biological Modeling Based Outcome Analysis (BMOA) in 3D Conformal Radiation Therapy (3DCRT) Treatments for Lung and Breast Cancers

NASA Astrophysics Data System (ADS)

Pyakuryal, Anil; Chen, Chiu-Hao; Dhungana, Sudarshan

2010-03-01

3DCRT treatments are the most commonly used techniques in the treatment of lung and breast cancers. The purpose of this study was to perform the BMOA of the 3DCRT plans designed for the treatment of breast and lung cancers utilizing HART program (Med. Phys. 36, p.2547(2009)). The BMOA parameters include normal tissue complication probability (NTCP), tumor control probability (TCP), and the complication-free tumor control probability (P+). The 3DCRT plans were designed for (i) the palliative treatment of 8 left lung cancer patients (CPs) at early stage (m=8), (ii) the curative treatment of 8 left lung CPs at stages II and III (k=8), and (iii) the curative treatment of 8 left breast CPs (n=8). The NTCPs were noticeably small (<2%) for heart, lungs and cord in both types of treatments except for the esophagus in lung CPs (k=8). Assessments of the TCPs and P+s also indicated good improvements in local tumor control in all plans. Homogeneous target coverage and improved dose conformality were the major advantages of such techniques in the treatment of breast cancer. These achievements support the efficacy of the 3DCRT techniques for the efficient treatment of various types of cancer.

APPLICATION OF A MULTIPURPOSE UNEQUAL-PROBABILITY STREAM SURVEY IN THE MID-ATLANTIC COASTAL PLAIN

EPA Science Inventory

A stratified random sample with unequal-probability selection was used to design a multipurpose survey of headwater streams in the Mid-Atlantic Coastal Plain. Objectives for data from the survey include unbiased estimates of regional stream conditions, and adequate coverage of un...

Expanding Lipidome Coverage Using LC-MS/MS Data-Dependent Acquisition with Automated Exclusion List Generation

NASA Astrophysics Data System (ADS)

Koelmel, Jeremy P.; Kroeger, Nicholas M.; Gill, Emily L.; Ulmer, Candice Z.; Bowden, John A.; Patterson, Rainey E.; Yost, Richard A.; Garrett, Timothy J.

2017-05-01

Untargeted omics analyses aim to comprehensively characterize biomolecules within a biological system. Changes in the presence or quantity of these biomolecules can indicate important biological perturbations, such as those caused by disease. With current technological advancements, the entire genome can now be sequenced; however, in the burgeoning fields of lipidomics, only a subset of lipids can be identified. The recent emergence of high resolution tandem mass spectrometry (HR-MS/MS), in combination with ultra-high performance liquid chromatography, has resulted in an increased coverage of the lipidome. Nevertheless, identifications from MS/MS are generally limited by the number of precursors that can be selected for fragmentation during chromatographic elution. Therefore, we developed the software IE-Omics to automate iterative exclusion (IE), where selected precursors using data-dependent topN analyses are excluded in sequential injections. In each sequential injection, unique precursors are fragmented until HR-MS/MS spectra of all ions above a user-defined intensity threshold are acquired. IE-Omics was applied to lipidomic analyses in Red Cross plasma and substantia nigra tissue. Coverage of the lipidome was drastically improved using IE. When applying IE-Omics to Red Cross plasma and substantia nigra lipid extracts in positive ion mode, 69% and 40% more molecular identifications were obtained, respectively. In addition, applying IE-Omics to a lipidomics workflow increased the coverage of trace species, including odd-chained and short-chained diacylglycerides and oxidized lipid species. By increasing the coverage of the lipidome, applying IE to a lipidomics workflow increases the probability of finding biomarkers and provides additional information for determining etiology of disease.

Surveillance of Vaccination Coverage Among Adult Populations - United States, 2014.

PubMed

Williams, Walter W; Lu, Peng-Jun; O'Halloran, Alissa; Kim, David K; Grohskopf, Lisa A; Pilishvili, Tamara; Skoff, Tami H; Nelson, Noele P; Harpaz, Rafael; Markowitz, Lauri E; Rodriguez-Lainz, Alfonso; Bridges, Carolyn B

2016-02-05

Overall, the prevalence of illness attributable to vaccine-preventable diseases is greater among adults than among children. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults is low. August 2013-June 2014 (for influenza vaccination) and January-December 2014 (for pneumococcal, tetanus and diphtheria [Td] and tetanus and diphtheria with acellular pertussis [Tdap], hepatitis A, hepatitis B, herpes zoster, and human papillomavirus [HPV] vaccination). The National Health Interview Survey (NHIS) is a continuous, cross-sectional national household survey of the noninstitutionalized U.S. civilian population. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. The survey objective is to monitor the health of the U.S. population and provide estimates of health indicators, health care use and access, and health-related behaviors. Compared with data from the 2013 NHIS, increases in vaccination coverage occurred for Tdap vaccine among adults aged ≥19 years (a 2.9 percentage point increase to 20.1%) and herpes zoster vaccine among adults aged ≥60 years (a 3.6 percentage point increase to 27.9%). Aside from these modest improvements, vaccination coverage among adults in 2014 was similar to estimates from 2013 (for influenza coverage, similar to the 2012-13 season). Influenza vaccination coverage among adults aged ≥19 years was 43.2%. Pneumococcal vaccination coverage among high-risk persons aged 19-64 years was 20.3% and among adults aged ≥65 years was 61.3%. Td vaccination coverage among adults aged ≥19 years was 62.2%. Hepatitis A vaccination coverage among adults aged ≥19 years was 9.0%. Hepatitis B vaccination coverage among adults aged ≥19 years was 24.5%. HPV vaccination coverage among adults aged 19-26 years was 40.2% for females and 8.2% for males. Racial/ethnic differences in coverage persisted for all seven vaccines, with higher coverage generally for whites compared with most other groups. Adults without health insurance were significantly less likely than those with health insurance to report receipt of influenza vaccine (aged ≥19 years), pneumococcal vaccine (aged 19-64 years with high-risk conditions and aged ≥65 years), Td vaccine (aged ≥19 years), Tdap vaccine (aged ≥19 years and 19-64 years), hepatitis A vaccine (aged ≥19 years overall and among travelers), hepatitis B vaccine (aged ≥19 years, 19-49 years, and 19-59 years with diabetes), herpes zoster vaccine (aged ≥60 years and 60-64 years), and HPV vaccine (females aged 19-26 years and males aged 19-26 years). Adults who reported having a usual place for health care generally were more likely to receive recommended vaccinations than those who did not have a usual place for health care, regardless of whether they had health insurance. Vaccination coverage was significantly higher among those reporting one or more physician contacts in the past year compared with those who had not visited a physician in the past year, regardless of whether they had health insurance. Even among adults who had health insurance and ≥10 physician contacts within the past year, 23.8%-88.8% reported not having received vaccinations that were recommended either for all persons or for those with some specific indication. Overall, vaccination coverage among U.S.-born respondents was significantly higher than that of foreign-born respondents with few exceptions (influenza vaccination [adults aged 19-49 years], hepatitis A vaccination [adults aged ≥19 years], hepatitis B vaccination [adults with diabetes aged ≥60 years], and HPV vaccination [males aged 19-26 years]). Overall, increases in adult vaccination coverage are needed. Although modest gains occurred in Tdap vaccination coverage among adults aged ≥19 years and herpes zoster vaccination coverage among adults aged ≥60 years, coverage for other vaccines and risk groups did not improve, and racial/ethnic disparities persisted for routinely recommended adult vaccines. Coverage for all vaccines for adults remained low, and missed opportunities to vaccinate adults continued. Although having health insurance coverage and a usual place for health care are associated with higher vaccination coverage, these factors alone do not assure optimal adult vaccination coverage. Assessing associations with vaccination is important for understanding factors that contribute to low coverage rates and to disparities in vaccination, and for implementing strategies to improve vaccination coverage. Practices that have been demonstrated to improve vaccination coverage should be used. These practices include assessment of patients' vaccination indications by health care providers and routine recommendation and offer of needed vaccines to adults, implementation of reminder-recall systems, use of standing-order programs for vaccination, and assessment of practice-level vaccination rates with feedback to staff members. For vaccination to be improved among those least likely to be up-to-date on recommended adult vaccines, efforts also are needed to identify adults who do not have a regular provider or insurance and who report fewer health care visits.

Comparison of semilunar coronally repositioned flap with gingival massaging using an Ayurvedic product (irimedadi taila) in the treatment of class-I gingival recession: A clinical study

PubMed Central

Mishra, Amit Kumar; Kumathalli, Kanteshwari; Sridhar, Raja; Maru, Rahul; Mangal, Brijesh; Kedia, Sameer; Shrihatti, Ravi

2014-01-01

AIM: To study the comparison in terms of root coverage the effect of gingival massaging using an ayurvedic product and semilunar coronally repositioned flap (SCRF) to assess the treatment outcomes in the management of Miller’s class I gingival recessions over a-6 mo period. METHODS: The present study comprised of total of 90 sites of Miller’s class-I gingival recessions in the maxillary anteriors, the sites were divided into three groups each comprising 30 sites, Group I-were treated by massaging using a Placebo (Ghee) Group II-were treated by massaging using an ayurvedic product (irimedadi taila). Group III-were treated by SCRF. Clinical parameters assessed included recession height, recession width, probing pocket depth, width of attached gingiva, clinical attachment level and thickness of keratinized tissue. Clinical recordings were performed at baseline and 6 mo later. The results were analyzed to determine improvements in the clinical parameters. The comparison was done using Wilcoxon signed rank test. The overall differences in the clinical improvements between the three groups was done using Kruskal-Wallis test. The probability value (P-value) of less than 0.01 was considered as statistically significant. RESULTS: Non-surgical periodontal therapy and gingival massaging improves facial gingival recessions and prevents further progression of mucogingival defects. Root coverage was achieved in both the experimental groups. The SCRF group proved to be superior in terms of all the clinical parameters. CONCLUSION: Root coverage is significantly better with semilunar coronally repositioned flap compared with the gingival massaging technique in the treatment of shallow maxillary Miller class I gingival recession defects. PMID:25325064

Is Welfare Reform Responsible for Low Skilled Women's Declining Health Insurance Coverage in the 1990s?

ERIC Educational Resources Information Center

DeLeire, Thomas; Levine, Judith A.; Levy, Helen

2006-01-01

We use data from the 1989-2001 March Supplements to the Current Population Survey to determine whether welfare reform contributed to declines in health insurance coverage experienced by low-skilled women. Between 1988 and 2000, women with less than a high school education experienced an 8.0 percentage point decline in the probability of having…

The demand for preventive and restorative dental services.

PubMed

Meyerhoefer, Chad D; Zuvekas, Samuel H; Manski, Richard

2014-01-01

Chronic tooth decay is the most common chronic condition in the United States among children ages 5-17 and also affects a large percentage of adults. Oral health conditions are preventable, but less than half of the US population uses dental services annually. We seek to examine the extent to which limited dental coverage and high out-of-pocket costs reduce dental service use by the nonelderly privately insured and uninsured. Using data from the 2001-2006 Medical Expenditure Panel Survey and an American Dental Association survey of dental procedure prices, we jointly estimate the probability of using preventive and both basic and major restorative services through a correlated random effects specification that controls for endogeneity. We found that dental coverage increased the probability of preventive care use by 19% and the use of restorative services 11% to 16%. Both conditional and unconditional on dental coverage, the use of dental services was not sensitive to out-of-pocket costs. We conclude that dental coverage is an important determinant of preventive dental service use, but other nonprice factors related to consumer preferences, especially education, are equal if not stronger determinants. Copyright © 2013 John Wiley & Sons, Ltd.

Health insurance coverage among disabled Medicare enrollees

PubMed Central

Rubin, Jeffrey I.; Wilcox-Gök, Virginia

1991-01-01

In this article, we use the Survey of Income and Program Participation to identify patterns of non-Medicare insurance coverage among disabled Medicare enrollees. Compared with the aged, the disabled are less likely to have private insurance coverage and more likely to have Medicaid. Probit analysis of the determinants of private insurance for disabled Medicare enrollees shows that income, education, marital status, sex, and having an employed family member are positively related to the likelihood of having private health insurance, whereas age and the probability of Medicaid enrollment are negatively related to this likelihood. PMID:10170806

Inequalities in child immunization coverage in Ghana: evidence from a decomposition analysis.

PubMed

Asuman, Derek; Ackah, Charles Godfred; Enemark, Ulrika

2018-04-11

Childhood vaccination has been promoted as a global intervention aimed at improving child survival and health, through the reduction of vaccine preventable deaths. However, there exist significant inequalities in achieving universal coverage of child vaccination among and within countries. In this paper, we examine rural-urban inequalities in child immunizations in Ghana. Using data from the recent two waves of the Ghana Demographic and Health Survey, we examine the probability that a child between 12 and 59 months receives the required vaccinations and proceed to decompose the sources of inequalities in the probability of full immunization between rural and urban areas. We find significant child-specific, maternal and household characteristics on a child's immunization status. The results show that children in rural areas are more likely to complete the required vaccinations. The direction and sources of inequalities in child immunizations have changed between the two survey waves. We find a pro-urban advantage in 2008 arising from differences in observed characteristics whilst a pro-rural advantage emerges in 2014 dominated by the differences in coefficients. Health system development and campaign efforts have focused on rural areas. There is a need to also specifically target vulnerable children in urban areas, to maintain focus on women empowerment and pay attention to children from high socio-economic households in less favourable economic times.

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.

Dosimetric advantages of generalised equivalent uniform dose-based optimisation on dose–volume objectives in intensity-modulated radiotherapy planning for bilateral breast cancer

PubMed Central

Lee, T-F; Ting, H-M; Chao, P-J; Wang, H-Y; Shieh, C-S; Horng, M-F; Wu, J-M; Yeh, S-A; Cho, M-Y; Huang, E-Y; Huang, Y-J; Chen, H-C; Fang, F-M

2012-01-01

Objective We compared and evaluated the differences between two models for treating bilateral breast cancer (BBC): (i) dose–volume-based intensity-modulated radiation treatment (DV plan), and (ii) dose–volume-based intensity-modulated radiotherapy with generalised equivalent uniform dose-based optimisation (DV-gEUD plan). Methods The quality and performance of the DV plan and DV-gEUD plan using the Pinnacle3® system (Philips, Fitchburg, WI) were evaluated and compared in 10 patients with stage T2–T4 BBC. The plans were delivered on a Varian 21EX linear accelerator (Varian Medical Systems, Milpitas, CA) equipped with a Millennium 120 leaf multileaf collimator (Varian Medical Systems). The parameters analysed included the conformity index, homogeneity index, tumour control probability of the planning target volume (PTV), the volumes V20 Gy and V30 Gy of the organs at risk (OAR, including the heart and lungs), mean dose and the normal tissue complication probability. Results Both plans met the requirements for the coverage of PTV with similar conformity and homogeneity indices. However, the DV-gEUD plan had the advantage of dose sparing for OAR: the mean doses of the heart and lungs, lung V20 Gy, and heart V30 Gy in the DV-gEUD plan were lower than those in the DV plan (p<0.05). Conclusions A better result can be obtained by starting with a DV-generated plan and then improving it by adding gEUD-based improvements to reduce the number of iterations and to improve the optimum dose distribution. Advances to knowledge The DV-gEUD plan provided superior dosimetric results for treating BBC in terms of PTV coverage and OAR sparing than the DV plan, without sacrificing the homogeneity of dose distribution in the PTV. PMID:23091290

Interventions for improving coverage of childhood immunisation in low- and middle-income countries.

PubMed

Oyo-Ita, Angela; Wiysonge, Charles S; Oringanje, Chioma; Nwachukwu, Chukwuemeka E; Oduwole, Olabisi; Meremikwu, Martin M

2016-07-10

Immunisation is a powerful public health strategy for improving child survival, not only by directly combating key diseases that kill children but also by providing a platform for other health services. However, each year millions of children worldwide, mostly from low- and middle-income countries (LMICs), do not receive the full series of vaccines on their national routine immunisation schedule. This is an update of the Cochrane review published in 2011 and focuses on interventions for improving childhood immunisation coverage in LMICs. To evaluate the effectiveness of intervention strategies to boost and sustain high childhood immunisation coverage in LMICs. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2016, Issue 4, part of The Cochrane Library. www.cochranelibrary.com, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (searched 12 May 2016); MEDLINE In-Process and Other Non-Indexed Citations, MEDLINE Daily and MEDLINE 1946 to Present, OvidSP (searched 12 May 2016); CINAHL 1981 to present, EbscoHost (searched 12 May 2016); Embase 1980 to 2014 Week 34, OvidSP (searched 2 September 2014); LILACS, VHL (searched 2 September 2014); Sociological Abstracts 1952 - current, ProQuest (searched 2 September 2014). We did a citation search for all included studies in Science Citation Index and Social Sciences Citation Index, 1975 to present; Emerging Sources Citation Index 2015 to present, ISI Web of Science (searched 2 July 2016). We also searched the two Trials Registries: ICTRP and ClinicalTrials.gov (searched 5 July 2016) SELECTION CRITERIA: Eligible studies were randomised controlled trials (RCT), non-RCTs, controlled before-after studies, and interrupted time series conducted in LMICs involving children aged from birth to four years, caregivers, and healthcare providers. We independently screened the search output, reviewed full texts of potentially eligible articles, assessed risk of bias, and extracted data in duplicate; resolving discrepancies by consensus. We then conducted random-effects meta-analyses and used GRADE to assess the certainty of evidence. Fourteen studies (10 cluster RCTs and four individual RCTs) met our inclusion criteria. These were conducted in Georgia (one study), Ghana (one study), Honduras (one study), India (two studies), Mali (one study), Mexico (one study), Nicaragua (one study), Nepal (one study), Pakistan (four studies), and Zimbabwe (one study). One study had an unclear risk of bias, and 13 had high risk of bias. The interventions evaluated in the studies included community-based health education (three studies), facility-based health education (three studies), household incentives (three studies), regular immunisation outreach sessions (one study), home visits (one study), supportive supervision (one study), information campaigns (one study), and integration of immunisation services with intermittent preventive treatment of malaria (one study).We found moderate-certainty evidence that health education at village meetings or at home probably improves coverage with three doses of diphtheria-tetanus-pertussis vaccines (DTP3: risk ratio (RR) 1.68, 95% confidence interval (CI) 1.09 to 2.59). We also found low-certainty evidence that facility-based health education plus redesigned vaccination reminder cards may improve DTP3 coverage (RR 1.50, 95% CI 1.21 to 1.87). Household monetary incentives may have little or no effect on full immunisation coverage (RR 1.05, 95% CI 0.90 to 1.23, low-certainty evidence). Regular immunisation outreach may improve full immunisation coverage (RR 3.09, 95% CI 1.69 to 5.67, low-certainty evidence) which may substantially improve if combined with household incentives (RR 6.66, 95% CI 3.93 to 11.28, low-certainty evidence). Home visits to identify non-vaccinated children and refer them to health clinics may improve uptake of three doses of oral polio vaccine (RR 1.22, 95% CI 1.07 to 1.39, low-certainty evidence). There was low-certainty evidence that integration of immunisation with other services may improve DTP3 coverage (RR 1.92, 95% CI 1.42 to 2.59). Providing parents and other community members with information on immunisation, health education at facilities in combination with redesigned immunisation reminder cards, regular immunisation outreach with and without household incentives, home visits, and integration of immunisation with other services may improve childhood immunisation coverage in LMIC. Most of the evidence was of low certainty, which implies a high likelihood that the true effect of the interventions will be substantially different. There is thus a need for further well-conducted RCTs to assess the effects of interventions for improving childhood immunisation coverage in LMICs.

Epidemiology of pertussis in two Ibero-American countries with different vaccination policies: lessons derived from different surveillance systems.

PubMed

Solano, Rubén; Masa-Calles, Josefa; Garib, Zacarías; Grullón, Patricia; Santiago, Sandy L; Brache, Altagracia; Domínguez, Ángela; Caylà, Joan A

2016-11-22

Pertussis is a re-emerging disease worldwide despite its high vaccination coverage. European and Latin-American countries have used different surveillance and vaccination policies against pertussis. We compared the epidemiology of this disease in two Ibero-American countries with different vaccination and surveillance policies. We compared the epidemiology of pertussis in Spain and the Dominican Republic (DR). We present a 10-year observational study of reported pertussis based on suspected and/or probable cases of pertussis identified by the national mandatory reporting system in both countries between 2005 and 2014. Both countries have a similar case definition for pertussis surveillance, although Spain applies laboratory testing, and uses real time PCR and/or culture for case confirmation while in DR only probable and/or suspected cases are reported. We analyzed incidence, hospitalization, case-fatality rates, mortality and vaccination coverage. The average annual incidence in children aged <1 year was 3.40/100,000 population in Spain and 12.15/100,000 in DR (p = 0.01). While the incidence in DR was generally higher than in Spain, in 2011 it was six times higher in Spain than in DR. The highest infant mortality in Spain was 0.017/100,000 in 2011, and the highest in DR was 0.08/100,000 in 2014 (p = 0.01). The proportion of hospitalized cases per year among children <1 year varied between 22.0% and 93.7% in Spain, and between 1.1% and 29.4% in DR (p = 0.0002), while mortality varied from 0 to 0.017 and 0 to 0.08 per 100,000 population in Spain and DR, respectively (p = 0.001). Vaccination coverage was 96.5% in Spain and 82.2% in DR (p = 0.001). Pertussis is a public health problem in both countries. Surveillance, prevention and control measures should be improved, especially in DR. Current vaccination programs are not sufficient for preventing continued pertussis transmission, even in Spain which has high vaccination coverage.

A Cooperative Search and Coverage Algorithm with Controllable Revisit and Connectivity Maintenance for Multiple Unmanned Aerial Vehicles.

PubMed

Liu, Zhong; Gao, Xiaoguang; Fu, Xiaowei

2018-05-08

In this paper, we mainly study a cooperative search and coverage algorithm for a given bounded rectangle region, which contains several unknown stationary targets, by a team of unmanned aerial vehicles (UAVs) with non-ideal sensors and limited communication ranges. Our goal is to minimize the search time, while gathering more information about the environment and finding more targets. For this purpose, a novel cooperative search and coverage algorithm with controllable revisit mechanism is presented. Firstly, as the representation of the environment, the cognitive maps that included the target probability map (TPM), the uncertain map (UM), and the digital pheromone map (DPM) are constituted. We also design a distributed update and fusion scheme for the cognitive map. This update and fusion scheme can guarantee that each one of the cognitive maps converges to the same one, which reflects the targets’ true existence or absence in each cell of the search region. Secondly, we develop a controllable revisit mechanism based on the DPM. This mechanism can concentrate the UAVs to revisit sub-areas that have a large target probability or high uncertainty. Thirdly, in the frame of distributed receding horizon optimizing, a path planning algorithm for the multi-UAVs cooperative search and coverage is designed. In the path planning algorithm, the movement of the UAVs is restricted by the potential fields to meet the requirements of avoiding collision and maintaining connectivity constraints. Moreover, using the minimum spanning tree (MST) topology optimization strategy, we can obtain a tradeoff between the search coverage enhancement and the connectivity maintenance. The feasibility of the proposed algorithm is demonstrated by comparison simulations by way of analyzing the effects of the controllable revisit mechanism and the connectivity maintenance scheme. The Monte Carlo method is employed to validate the influence of the number of UAVs, the sensing radius, the detection and false alarm probabilities, and the communication range on the proposed algorithm.

Cost-Utility Analysis of Extending Public Health Insurance Coverage to Include Diabetic Retinopathy Screening by Optometrists.

PubMed

van Katwyk, Sasha; Jin, Ya-Ping; Trope, Graham E; Buys, Yvonne; Masucci, Lisa; Wedge, Richard; Flanagan, John; Brent, Michael H; El-Defrawy, Sherif; Tu, Hong Anh; Thavorn, Kednapa

2017-09-01

Diabetic retinopathy (DR) is one of the leading causes of vision loss and blindness in Canada. Eye examinations play an important role in early detection. However, DR screening by optometrists is not always universally covered by public or private health insurance plans. This study assessed whether expanding public health coverage to include diabetic eye examinations for retinopathy by optometrists is cost-effective from the perspective of the health care system. We conducted a cost-utility analysis of extended coverage for diabetic eye examinations in Prince Edward Island to include examinations by optometrists, not currently publicly covered. We used a Markov chain to simulate disease burden based on eye examination rates and DR progression over a 30-year time horizon. Results were presented as an incremental cost per quality-adjusted life year (QALY) gained. A series of one-way and probabilistic sensitivity analyses were performed. Extending public health coverage to eye examinations by optometrists was associated with higher costs ($9,908,543.32) and improved QALYs (156,862.44), over 30 years, resulting in an incremental cost-effectiveness ratio of $1668.43/QALY gained. Sensitivity analysis showed that the most influential determinants of the results were the cost of optometric screening and selected utility scores. At the commonly used threshold of $50,000/QALY, the probability that the new policy was cost-effective was 99.99%. Extending public health coverage to eye examinations by optometrists is cost-effective based on a commonly used threshold of $50,000/QALY. Findings from this study can inform the decision to expand public-insured optometric services for patients with diabetes. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Using known populations of pronghorn to evaluate sampling plans and estimators

USGS Publications Warehouse

Kraft, K.M.; Johnson, D.H.; Samuelson, J.M.; Allen, S.H.

1995-01-01

Although sampling plans and estimators of abundance have good theoretical properties, their performance in real situations is rarely assessed because true population sizes are unknown. We evaluated widely used sampling plans and estimators of population size on 3 known clustered distributions of pronghorn (Antilocapra americana). Our criteria were accuracy of the estimate, coverage of 95% confidence intervals, and cost. Sampling plans were combinations of sampling intensities (16, 33, and 50%), sample selection (simple random sampling without replacement, systematic sampling, and probability proportional to size sampling with replacement), and stratification. We paired sampling plans with suitable estimators (simple, ratio, and probability proportional to size). We used area of the sampling unit as the auxiliary variable for the ratio and probability proportional to size estimators. All estimators were nearly unbiased, but precision was generally low (overall mean coefficient of variation [CV] = 29). Coverage of 95% confidence intervals was only 89% because of the highly skewed distribution of the pronghorn counts and small sample sizes, especially with stratification. Stratification combined with accurate estimates of optimal stratum sample sizes increased precision, reducing the mean CV from 33 without stratification to 25 with stratification; costs increased 23%. Precise results (mean CV = 13) but poor confidence interval coverage (83%) were obtained with simple and ratio estimators when the allocation scheme included all sampling units in the stratum containing most pronghorn. Although areas of the sampling units varied, ratio estimators and probability proportional to size sampling did not increase precision, possibly because of the clumped distribution of pronghorn. Managers should be cautious in using sampling plans and estimators to estimate abundance of aggregated populations.

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.

Can a More User-Friendly Medicare Plan Finder Improve Consumers' Selection of Medicare Plans?

PubMed

Martino, Steven C; Kanouse, David E; Miranda, David J; Elliott, Marc N

2017-10-01

To evaluate the efficacy for consumers of two potential enhancements to the Medicare Plan Finder (MPF)-a simplified data display and a "quick links" home page designed to match the specific tasks that users seek to accomplish on the MPF. Participants (N = 641) were seniors and adult caregivers of seniors who were recruited from a national online panel. Participants browsed a simulated version of the MPF, made a hypothetical plan choice, and reported on their experience. Participants were randomly assigned to one of eight conditions in a fully factorial design: 2 home pages (quick links, current MPF home page) × 2 data displays (simplified, current MPF display) × 2 plan types (stand-alone prescription drug plan [PDP], Medicare Advantage plan with prescription drug coverage [MA-PD]). The quick links page resulted in more favorable perceptions of the MPF, improved users' understanding of the information, and increased the probability of choosing the objectively best plan. The simplified data display resulted in a more favorable evaluation of the website, better comprehension of the displayed information, and, among those choosing a PDP only, an increased probability of choosing the best plan. Design enhancements could markedly improve average website users' understanding, ability to use, and experience of using the MPF. © Health Research and Educational Trust.

COSPAS-SARSAT Satellite Orbit Predictor. Volume 3

NASA Technical Reports Server (NTRS)

Friedman, Morton L.; Garrett, James

1984-01-01

The satellite orbit predictor is a graphical aid for determining the relationship between the satellite (SARSAT or COSPAS) orbit, antenna coverage of the spacecraft and coverage of the LUTs. The predictor allows the user to quickly visualize if a selected position will probably be detected and is composed of a base map and a satellite track overlay for each satellite. Additionally, a table of equator crossings for each satellite is included.

Multi-Agent Cooperative Target Search

PubMed Central

Hu, Jinwen; Xie, Lihua; Xu, Jun; Xu, Zhao

2014-01-01

This paper addresses a vision-based cooperative search for multiple mobile ground targets by a group of unmanned aerial vehicles (UAVs) with limited sensing and communication capabilities. The airborne camera on each UAV has a limited field of view and its target discriminability varies as a function of altitude. First, by dividing the whole surveillance region into cells, a probability map can be formed for each UAV indicating the probability of target existence within each cell. Then, we propose a distributed probability map updating model which includes the fusion of measurement information, information sharing among neighboring agents, information decay and transmission due to environmental changes such as the target movement. Furthermore, we formulate the target search problem as a multi-agent cooperative coverage control problem by optimizing the collective coverage area and the detection performance. The proposed map updating model and the cooperative control scheme are distributed, i.e., assuming that each agent only communicates with its neighbors within its communication range. Finally, the effectiveness of the proposed algorithms is illustrated by simulation. PMID:24865884

Adjusting for Confounding in Early Postlaunch Settings: Going Beyond Logistic Regression Models.

PubMed

Schmidt, Amand F; Klungel, Olaf H; Groenwold, Rolf H H

2016-01-01

Postlaunch data on medical treatments can be analyzed to explore adverse events or relative effectiveness in real-life settings. These analyses are often complicated by the number of potential confounders and the possibility of model misspecification. We conducted a simulation study to compare the performance of logistic regression, propensity score, disease risk score, and stabilized inverse probability weighting methods to adjust for confounding. Model misspecification was induced in the independent derivation dataset. We evaluated performance using relative bias confidence interval coverage of the true effect, among other metrics. At low events per coefficient (1.0 and 0.5), the logistic regression estimates had a large relative bias (greater than -100%). Bias of the disease risk score estimates was at most 13.48% and 18.83%. For the propensity score model, this was 8.74% and >100%, respectively. At events per coefficient of 1.0 and 0.5, inverse probability weighting frequently failed or reduced to a crude regression, resulting in biases of -8.49% and 24.55%. Coverage of logistic regression estimates became less than the nominal level at events per coefficient ≤5. For the disease risk score, inverse probability weighting, and propensity score, coverage became less than nominal at events per coefficient ≤2.5, ≤1.0, and ≤1.0, respectively. Bias of misspecified disease risk score models was 16.55%. In settings with low events/exposed subjects per coefficient, disease risk score methods can be useful alternatives to logistic regression models, especially when propensity score models cannot be used. Despite better performance of disease risk score methods than logistic regression and propensity score models in small events per coefficient settings, bias, and coverage still deviated from nominal.

[Fair health financing and catastrophic health expenditures: potential impact of the coverage extension of the popular health insurance in Mexico].

PubMed

Knaul, Felicia; Arreola-Ornelas, Héctor; Méndez, Oscar; Martínez, Alejandra

2005-01-01

To assess the impact on fair health financing and household catastrophic health expenditures of the implementation of the Popular Health Insurance (Seguro Popular de Salud). Data analyzed in this study come from the National Income and Expenditure Household Survey (Encuesta Nacional de Ingresos y Gastos de los Hogares, ENIGH), 2000, and the National Health Insurance and Expenditure Survey, (Encuesta Nacional de Aseguramiento y Gasto en Salud, ENAGS), 2001. Estimations are based on projections of extension of the Popular Health Insurance under different conditions of coverage and out-of-pocket expenditure reductions in the uninsured population. The mathematic simulation model assumes applying the new Popular Health Insurance financial structure to the 2000 expenditure values reported by ENIGH, given the probability of affiliation by households. The model of determinants of affiliation to the Popular Health Insurance yielded three significant variables: being in income quintiles I and II, being a female head of household, and that a household member had a medical visit in the past year. Simulation results show that important impacts on the performance of the Mexican Health System will occur in terms of fair financing and catastrophic expenditures, even before achieving the universal coverage goal in 2010. A reduction of 40% in out-of-pocket expenditures and a Popular Health Insurance coverage of 100% will decrease catastrophic health expenditures from 3.4% to 1.6%. Our results show that the reduction of out-of-pocket expenditures generated by the new financing and health provision Popular Health Insurance model, will improve the financial fairness index and the financial contribution to the health system, and will decrease the percentage of households with catastrophic expenditures, even before reaching universal coverage. A greater impact may be expected due to coverage extension initiating in the poorest communities that have a very restricted and progressive financial contribution.

Rural water supply and sanitation (RWSS) coverage in Swaziland: Toward achieving millennium development goals

NASA Astrophysics Data System (ADS)

Mwendera, E. J.

An assessment of rural water supply and sanitation (RWSS) coverage in Swaziland was conducted in 2004/2005 as part of the Rural Water Supply and Sanitation Initiative (RWSSI). The initiative was developed by the African Development Bank with the aim of implementing it in the Regional Member Countries (RMCs), including Swaziland. Information on the RWSS sector programmes, costs, financial requirements and other related activities was obtained from a wide range of national documents, including sector papers and project files and progress reports. Interviews were held with staff from the central offices and field stations of Government of Swaziland (GOS) ministries and departments, non-governmental organizations (NGOs), bilateral and multilateral external support agencies, and private sector individuals and firms with some connection to the sector and/or its programmes. The assessment also involved field visits to various regions in order to obtain first hand information about the various technologies and institutional structures used in the provision of water supplies and sanitation services in the rural areas of the country. The results showed that the RWSS sector has made significant progress towards meeting the national targets of providing water and sanitation to the entire rural population by the year 2022. The assessment indicated that rural water supply coverage was 56% in 2004 while sanitation coverage was 63% in the same year. The results showed that there is some decline in the incidence of water-related diseases, such as diarrhoeal diseases, probably due to improved water supply and sanitation coverage. The study also showed that, with adequate financial resources, Swaziland is likely to achieve 100% coverage of both water supply and sanitation by the year 2022. It was concluded that in achieving its own national goals Swaziland will exceed the Millennium Development Goals (MDGs). However, such achievement is subject to adequate financial resources being made available for the RWSS sector.

The effects of unequal access to health insurance for same-sex couples in California.

PubMed

Ponce, Ninez A; Cochran, Susan D; Pizer, Jennifer C; Mays, Vickie M

2010-08-01

Inequities in marriage laws and domestic partnership benefits may have implications for who bears the burden of health care costs. We examined a recent period in California to illuminate disparities in health insurance coverage faced by same-sex couples. Partnered gay men are less than half as likely (42 percent) as married heterosexual men to get employer-sponsored dependent coverage, and partnered lesbians have an even slimmer chance (28 percent) of getting dependent coverage compared to married heterosexual women. As a result of these much lower rates of employer-provided coverage, partnered lesbians and gay men are more than twice as likely to be uninsured as married heterosexuals. The exclusion of gay men and women from civil marriage and the failure of domestic partnership benefits to provide insurance parity contribute to unequal access to health coverage, with the probable result that more health spending is pushed onto these individuals and onto the public.

in silico Surveillance: evaluating outbreak detection with simulation models

PubMed Central

2013-01-01

Background Detecting outbreaks is a crucial task for public health officials, yet gaps remain in the systematic evaluation of outbreak detection protocols. The authors’ objectives were to design, implement, and test a flexible methodology for generating detailed synthetic surveillance data that provides realistic geographical and temporal clustering of cases and use to evaluate outbreak detection protocols. Methods A detailed representation of the Boston area was constructed, based on data about individuals, locations, and activity patterns. Influenza-like illness (ILI) transmission was simulated, producing 100 years of in silico ILI data. Six different surveillance systems were designed and developed using gathered cases from the simulated disease data. Performance was measured by inserting test outbreaks into the surveillance streams and analyzing the likelihood and timeliness of detection. Results Detection of outbreaks varied from 21% to 95%. Increased coverage did not linearly improve detection probability for all surveillance systems. Relaxing the decision threshold for signaling outbreaks greatly increased false-positives, improved outbreak detection slightly, and led to earlier outbreak detection. Conclusions Geographical distribution can be more important than coverage level. Detailed simulations of infectious disease transmission can be configured to represent nearly any conceivable scenario. They are a powerful tool for evaluating the performance of surveillance systems and methods used for outbreak detection. PMID:23343523

Photon-enhanced thermionic emission from p-GaAs with nonequilibrium Cs overlayers

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

Zhuravlev, A. G.; Romanov, A. S.; Alperovich, V. L., E-mail: alper@isp.nsc.ru

2014-12-22

Photon-enhanced thermionic emission (PETE), which is promising for increasing the efficiency of solar energy conversion, is studied during cesium deposition on the As- and Ga-rich p-GaAs(001) surfaces and subsequent relaxation in the nonequilibrium Cs overlayer by means of photoemission quantum yield spectroscopy adapted for systems with time-variable parameters. Along with direct photoemission of “hot” electrons excited by light above the vacuum level, the spectra contain PETE contribution of “thermalized” electrons, which are excited below the vacuum level and emit in vacuum due to thermalization up in energy by phonon absorption. Comparing the measured and calculated spectra, the effective electron affinitymore » and escape probabilities of hot and thermalized electrons are obtained as functions of submonolayer Cs coverage. The minima in the affinity and pronounced peaks in the escape probabilities are observed for Cs deposition on both the As- and Ga-rich surfaces. Possible reasons for the low mean values of the electron escape probabilities and for the observed enhancement of the probabilities at certain Cs coverages are discussed, along with the implications for the PETE device realization.« less

Predicting the evolution of spreading on complex networks

PubMed Central

Chen, Duan-Bing; Xiao, Rui; Zeng, An

2014-01-01

Due to the wide applications, spreading processes on complex networks have been intensively studied. However, one of the most fundamental problems has not yet been well addressed: predicting the evolution of spreading based on a given snapshot of the propagation on networks. With this problem solved, one can accelerate or slow down the spreading in advance if the predicted propagation result is narrower or wider than expected. In this paper, we propose an iterative algorithm to estimate the infection probability of the spreading process and then apply it to a mean-field approach to predict the spreading coverage. The validation of the method is performed in both artificial and real networks. The results show that our method is accurate in both infection probability estimation and spreading coverage prediction. PMID:25130862

Taking up or turning down: new estimates of household demand for employer-sponsored health insurance.

PubMed

Abraham, Jean Marie; Feldman, Roger

2010-01-01

This study provides new estimates of demand for employer-sponsored health insurance, using the 1997-2001 linked Household Component-Insurance Component of the Medical Expenditure Panel Survey (MEPS). Our focus is on households' decisions to take up coverage through a worker's employer. We found a significant inverse relationship between the out-of-pocket premium and the probability of taking up coverage, with the price effect considerably larger when we used instrumental variables methods to account for endogenous out-of-pocket premiums. Additionally, workers in families with more children eligible for Medicaid were less likely to take up coverage.

Kinetic aspects of chain growth in Fischer-Tropsch synthesis.

PubMed

Filot, Ivo A W; Zijlstra, Bart; Broos, Robin J P; Chen, Wei; Pestman, Robert; Hensen, Emiel J M

2017-04-28

Microkinetics simulations are used to investigate the elementary reaction steps that control chain growth in the Fischer-Tropsch reaction. Chain growth in the FT reaction on stepped Ru surfaces proceeds via coupling of CH and CR surface intermediates. Essential to the growth mechanism are C-H dehydrogenation and C hydrogenation steps, whose kinetic consequences have been examined by formulating two novel kinetic concepts, the degree of chain-growth probability control and the thermodynamic degree of chain-growth probability control. For Ru the CO conversion rate is controlled by the removal of O atoms from the catalytic surface. The temperature of maximum CO conversion rate is higher than the temperature to obtain maximum chain-growth probability. Both maxima are determined by Sabatier behavior, but the steps that control chain-growth probability are different from those that control the overall rate. Below the optimum for obtaining long hydrocarbon chains, the reaction is limited by the high total surface coverage: in the absence of sufficient vacancies the CHCHR → CCHR + H reaction is slowed down. Beyond the optimum in chain-growth probability, CHCR + H → CHCHR and OH + H → H 2 O limit the chain-growth process. The thermodynamic degree of chain-growth probability control emphasizes the critical role of the H and free-site coverage and shows that at high temperature, chain depolymerization contributes to the decreased chain-growth probability. That is to say, during the FT reaction chain growth is much faster than chain depolymerization, which ensures high chain-growth probability. The chain-growth rate is also fast compared to chain-growth termination and the steps that control the overall CO conversion rate, which are O removal steps for Ru.

Taking error into account when fitting models using Approximate Bayesian Computation.

PubMed

van der Vaart, Elske; Prangle, Dennis; Sibly, Richard M

2018-03-01

Stochastic computer simulations are often the only practical way of answering questions relating to ecological management. However, due to their complexity, such models are difficult to calibrate and evaluate. Approximate Bayesian Computation (ABC) offers an increasingly popular approach to this problem, widely applied across a variety of fields. However, ensuring the accuracy of ABC's estimates has been difficult. Here, we obtain more accurate estimates by incorporating estimation of error into the ABC protocol. We show how this can be done where the data consist of repeated measures of the same quantity and errors may be assumed to be normally distributed and independent. We then derive the correct acceptance probabilities for a probabilistic ABC algorithm, and update the coverage test with which accuracy is assessed. We apply this method, which we call error-calibrated ABC, to a toy example and a realistic 14-parameter simulation model of earthworms that is used in environmental risk assessment. A comparison with exact methods and the diagnostic coverage test show that our approach improves estimation of parameter values and their credible intervals for both models. © 2017 by the Ecological Society of America.

Distribution, characterization, and exposure of MC252 oil in the supratidal beach environment.

PubMed

Lemelle, Kendall R; Elango, Vijaikrishnah; Pardue, John H

2014-07-01

The distribution and characteristics of MC252 oil:sand aggregates, termed surface residue balls (SRBs), were measured on the supratidal beach environment of oil-impacted Fourchon Beach in Louisiana (USA). Probability distributions of 4 variables, surface coverage (%), size of SRBs (mm(2) of projected area), mass of SRBs per m(2) (g/m(2)), and concentrations of polycyclic aromatic hydrocarbons (PAHs) and n-alkanes in the SRBs (mg of crude oil component per kg of SRB) were determined using parametric and nonparametric statistical techniques. Surface coverage of SRBs, an operational remedial standard for the beach surface, was a gamma-distributed variable ranging from 0.01% to 8.1%. The SRB sizes had a mean of 90.7 mm(2) but fit no probability distribution, and a nonparametric ranking was used to describe the size distributions. Concentrations of total PAHs ranged from 2.5 mg/kg to 126 mg/kg of SRB. Individual PAH concentration distributions, consisting primarily of alkylated phenanthrenes, dibenzothiophenes, and chrysenes, did not consistently fit a parametric distribution. Surface coverage was correlated with an oil mass per unit area but with a substantial error at lower coverage (i.e., <2%). These data provide probabilistic risk assessors with the ability to specify uncertainty in PAH concentration, exposure frequency, and ingestion rate, based on SRB characteristics for the dominant oil form on beaches along the US Gulf Coast. © 2014 SETAC.

Yellow Fever in Africa: estimating the burden of disease and impact of mass vaccination from outbreak and serological data.

PubMed

Garske, Tini; Van Kerkhove, Maria D; Yactayo, Sergio; Ronveaux, Olivier; Lewis, Rosamund F; Staples, J Erin; Perea, William; Ferguson, Neil M

2014-05-01

Yellow fever is a vector-borne disease affecting humans and non-human primates in tropical areas of Africa and South America. While eradication is not feasible due to the wildlife reservoir, large scale vaccination activities in Africa during the 1940s to 1960s reduced yellow fever incidence for several decades. However, after a period of low vaccination coverage, yellow fever has resurged in the continent. Since 2006 there has been substantial funding for large preventive mass vaccination campaigns in the most affected countries in Africa to curb the rising burden of disease and control future outbreaks. Contemporary estimates of the yellow fever disease burden are lacking, and the present study aimed to update the previous estimates on the basis of more recent yellow fever occurrence data and improved estimation methods. Generalised linear regression models were fitted to a dataset of the locations of yellow fever outbreaks within the last 25 years to estimate the probability of outbreak reports across the endemic zone. Environmental variables and indicators for the surveillance quality in the affected countries were used as covariates. By comparing probabilities of outbreak reports estimated in the regression with the force of infection estimated for a limited set of locations for which serological surveys were available, the detection probability per case and the force of infection were estimated across the endemic zone. The yellow fever burden in Africa was estimated for the year 2013 as 130,000 (95% CI 51,000-380,000) cases with fever and jaundice or haemorrhage including 78,000 (95% CI 19,000-180,000) deaths, taking into account the current level of vaccination coverage. The impact of the recent mass vaccination campaigns was assessed by evaluating the difference between the estimates obtained for the current vaccination coverage and for a hypothetical scenario excluding these vaccination campaigns. Vaccination campaigns were estimated to have reduced the number of cases and deaths by 27% (95% CI 22%-31%) across the region, achieving up to an 82% reduction in countries targeted by these campaigns. A limitation of our study is the high level of uncertainty in our estimates arising from the sparseness of data available from both surveillance and serological surveys. With the estimation method presented here, spatial estimates of transmission intensity can be combined with vaccination coverage levels to evaluate the impact of past or proposed vaccination campaigns, thereby helping to allocate resources efficiently for yellow fever control. This method has been used by the Global Alliance for Vaccines and Immunization (GAVI Alliance) to estimate the potential impact of future vaccination campaigns.

Yellow Fever in Africa: Estimating the Burden of Disease and Impact of Mass Vaccination from Outbreak and Serological Data

PubMed Central

Garske, Tini; Van Kerkhove, Maria D.; Yactayo, Sergio; Ronveaux, Olivier; Lewis, Rosamund F.; Staples, J. Erin; Perea, William; Ferguson, Neil M.

2014-01-01

Background Yellow fever is a vector-borne disease affecting humans and non-human primates in tropical areas of Africa and South America. While eradication is not feasible due to the wildlife reservoir, large scale vaccination activities in Africa during the 1940s to 1960s reduced yellow fever incidence for several decades. However, after a period of low vaccination coverage, yellow fever has resurged in the continent. Since 2006 there has been substantial funding for large preventive mass vaccination campaigns in the most affected countries in Africa to curb the rising burden of disease and control future outbreaks. Contemporary estimates of the yellow fever disease burden are lacking, and the present study aimed to update the previous estimates on the basis of more recent yellow fever occurrence data and improved estimation methods. Methods and Findings Generalised linear regression models were fitted to a dataset of the locations of yellow fever outbreaks within the last 25 years to estimate the probability of outbreak reports across the endemic zone. Environmental variables and indicators for the surveillance quality in the affected countries were used as covariates. By comparing probabilities of outbreak reports estimated in the regression with the force of infection estimated for a limited set of locations for which serological surveys were available, the detection probability per case and the force of infection were estimated across the endemic zone. The yellow fever burden in Africa was estimated for the year 2013 as 130,000 (95% CI 51,000–380,000) cases with fever and jaundice or haemorrhage including 78,000 (95% CI 19,000–180,000) deaths, taking into account the current level of vaccination coverage. The impact of the recent mass vaccination campaigns was assessed by evaluating the difference between the estimates obtained for the current vaccination coverage and for a hypothetical scenario excluding these vaccination campaigns. Vaccination campaigns were estimated to have reduced the number of cases and deaths by 27% (95% CI 22%–31%) across the region, achieving up to an 82% reduction in countries targeted by these campaigns. A limitation of our study is the high level of uncertainty in our estimates arising from the sparseness of data available from both surveillance and serological surveys. Conclusions With the estimation method presented here, spatial estimates of transmission intensity can be combined with vaccination coverage levels to evaluate the impact of past or proposed vaccination campaigns, thereby helping to allocate resources efficiently for yellow fever control. This method has been used by the Global Alliance for Vaccines and Immunization (GAVI Alliance) to estimate the potential impact of future vaccination campaigns. Please see later in the article for the Editors' Summary PMID:24800812

Fluorine atom abstraction by Si(100). I. Experimental

NASA Astrophysics Data System (ADS)

Tate, M. R.; Gosalvez-Blanco, D.; Pullman, D. P.; Tsekouras, A. A.; Li, Y. L.; Yang, J. J.; Laughlin, K. B.; Eckman, S. C.; Bertino, M. F.; Ceyer, S. T.

1999-08-01

In the interaction of low energy F2 with Si(100) at 250 K, a dissociative chemisorption mechanism called atom abstraction is identified in which only one of the F atoms is adsorbed while the other F atom is scattered into the gas phase. The dynamics of atom abstraction are characterized via time-of-flight measurements of the scattered F atoms. The F atoms are translationally hyperthermal but only carry a small fraction (˜3%) of the tremendous exothermicity of the reaction. The angular distribution of F atoms is unusually broad for the product of an exothermic reaction. These results suggest an "attractive" interaction potential between F2 and the Si dangling bond with a transition state that is not constrained geometrically. These results are in disagreement with the results of theoretical investigations implying that the available potential energy surfaces are inadequate to describe the dynamics of this gas-surface interaction. In addition to single atom abstraction, two atom adsorption, a mechanism analogous to classic dissociative chemisorption in which both F atoms are adsorbed onto the surface, is also observed. The absolute probability of the three scattering channels (single atom abstraction, two atom adsorption, and unreactive scattering) for an incident F2 are determined as a function of F2 exposure. The fluorine coverage is determined by integrating the reaction probabilities over F2 exposure, and the reaction probabilities are recast as a function of fluorine coverage. Two atom adsorption is the dominant channel [P2=0.83±0.03(95%, N=9)] in the limit of zero coverage and decays monotonically to zero. Single atom abstraction is the minor channel (P1=0.13±0.03) at low coverage but increases to a maximum (P1=0.35±0.08) at about 0.5 monolayer (ML) coverage before decaying to zero. The reaction ceases at 0.94±0.11(95%, N=9) ML. Thermal desorption and helium diffraction confirm that the dangling bonds are the abstraction and adsorption sites. No Si lattice bonds are broken, in contrast to speculation by other investigators that the reaction exothermicity causes lattice disorder.

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.

Surface states and annihilation characteristics of positrons trapped at the oxidized Cu(100) surface

NASA Astrophysics Data System (ADS)

Fazleev, N. G.; Weiss, A. H.

2013-06-01

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. Oxidation of the Cu(100) surface has been studied by performing an ab-initio investigation of the stability and electronic structure of the Cu(100) missing row reconstructed surface at various on-surface and subsurface oxygen coverages ranging from 0.5 to 1.5 monolayers using density functional theory (DFT). All studied structures have been found to be energetically more favorable as compared to structures formed by purely on-surface oxygen adsorption. The observed decrease in the positron work function when oxygen atoms occupy on-surface and subsurface sites has been attributed to a significant charge redistribution within the first two layers, buckling effects within each layer and an interlayer expansion. The computed positron binding energy, positron surface state wave function, and annihilation probabilities of the surface trapped positrons with relevant core electrons demonstrate their sensitivity to oxygen coverage, atomic structure of the topmost layers of surfaces, and charge transfer effects. Theoretical results are compared with experimental data obtained from studies of oxidation of the Cu(100) surface using positron annihilation induced Auger electron spectroscopy (PAES). The results presented provide an explanation for the changes observed in the probability of annihilation of surface trapped positrons with Cu 3p core-level electrons as a function of annealing temperature.

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.

Workers on the margin: who drops health coverage when prices rise?

PubMed

Okeke, Edward N; Hirth, Richard A; Grazier, Kyle

2010-01-01

We revisit the question of price elasticity of employer-sponsored insurance (ESI) take-up by directly examining changes in the take-up of ESI at a large firm in response to exogenous changes in employee premium contributions. We find that, on average, a 10% increase in the employee's out-of-pocket premium increases the probability of dropping coverage by approximately 1%. More importantly, we find heterogeneous impacts: married workers are much more price-sensitive than single employees, and lower-paid workers are disproportionately more likely to drop coverage than higher-paid workers. Elasticity estimates for employees below the 25th percentile of salary distribution in our sample are nearly twice the average.

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).

The Effects Of Unequal Access To Health Insurance For Same-Sex Couples In California

PubMed Central

Ponce, Ninez A.; Cochran, Susan D.; Pizer, Jennifer C.; Mays, Vickie M.

2013-01-01

Inequities in marriage laws and domestic partnership benefits may have implications for who bears the burden of health care costs. We examined a recent period in California to illuminate disparities in health insurance coverage faced by same-sex couples. Partnered gay men are less than half as likely (42 percent) as married heterosexual men to get employer-sponsored dependent coverage, and partnered lesbians have an even slimmer chance (28 percent) of getting dependent coverage compared to married heterosexual women. As a result of these much lower rates of employer-provided coverage, partnered lesbians and gay men are more than twice as likely to be uninsured as married heterosexuals. The exclusion of gay men and women from civil marriage and the failure of domestic partnership benefits to provide insurance parity contribute to unequal access to health coverage, with the probable result that more health spending is pushed onto these individuals and onto the public. PMID:20576694

Examples of S1 coverage intervals with very good and very bad long-run success rate

NASA Astrophysics Data System (ADS)

Giaquinto, Nicola; Fabbiano, Laura

2016-04-01

The paper illustrates, by means of selected examples, the merits and the limits of the method for computing coverage intervals described in the Supplement 1 to the GUM. The assessment of coverage intervals is done by evaluating their long-run success rate. Three pairs of examples are presented, relative to three different ways of generating incomplete knowledge about quantities: toss of dice, presence of additive noise, quantization. In all the pairs of examples, the first one results in a coverage interval with a long-run success rate equal to the coverage probability (set to 95%); the second one, instead, yields an interval with a success rate near to zero. The paper shows that the propagation mechanism of the Supplement 1, while working well in certain special cases, yields unacceptable results in others, and that the problematic issues cannot be neglected. The conclusion is that, if a Bayesian approach to uncertainty evaluation is adopted, the propagation is a particularly delicate issue.

Surveillance of Vaccination Coverage among Adult Populations - United States, 2015.

PubMed

Williams, Walter W; Lu, Peng-Jun; O'Halloran, Alissa; Kim, David K; Grohskopf, Lisa A; Pilishvili, Tamara; Skoff, Tami H; Nelson, Noele P; Harpaz, Rafael; Markowitz, Lauri E; Rodriguez-Lainz, Alfonso; Fiebelkorn, Amy Parker

2017-05-05

Overall, the prevalence of illness attributable to vaccine-preventable diseases is greater among adults than among children. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults is low. August 2014-June 2015 (for influenza vaccination) and January-December 2015 (for pneumococcal, tetanus and diphtheria [Td] and tetanus and diphtheria with acellular pertussis [Tdap], hepatitis A, hepatitis B, herpes zoster, and human papillomavirus [HPV] vaccination). The National Health Interview Survey (NHIS) is a continuous, cross-sectional national household survey of the noninstitutionalized U.S. civilian population. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. The survey objective is to monitor the health of the U.S. population and provide estimates of health indicators, health care use and access, and health-related behaviors. Compared with data from the 2014 NHIS, increases in vaccination coverage occurred for influenza vaccine among adults aged ≥19 years (a 1.6 percentage point increase compared with the 2013-14 season to 44.8%), pneumococcal vaccine among adults aged 19-64 years at increased risk for pneumococcal disease (a 2.8 percentage point increase to 23.0%), Tdap vaccine among adults aged ≥19 years and adults aged 19-64 years (a 3.1 percentage point and 3.3 percentage point increase to 23.1% and to 24.7%, respectively), herpes zoster vaccine among adults aged ≥60 years and adults aged ≥65 years (a 2.7 percentage point and 3.2 percentage point increase to 30.6% and to 34.2%, respectively), and hepatitis B vaccine among health care personnel (HCP) aged ≥19 years (a 4.1 percentage point increase to 64.7%). Herpes zoster vaccination coverage in 2015 met the Healthy People 2020 target of 30%. Aside from these modest improvements, vaccination coverage among adults in 2015 was similar to estimates from 2014. Racial/ethnic differences in coverage persisted for all seven vaccines, with higher coverage generally for whites compared with most other groups. Adults without health insurance reported receipt of influenza vaccine (all age groups), pneumococcal vaccine (adults aged 19-64 years at increased risk), Td vaccine (adults aged ≥19 years, 19-64 years, and 50-64 years), Tdap vaccine (adults aged ≥19 years and 19-64 years), hepatitis A vaccine (adults aged ≥19 years overall and among travelers), hepatitis B vaccine (adults aged ≥19 years, 19-49 years, and among travelers), herpes zoster vaccine (adults aged ≥60 years), and HPV vaccine (males and females aged 19-26 years) less often than those with health insurance. Adults who reported having a usual place for health care generally reported receipt of recommended vaccinations more often than those who did not have such a place, regardless of whether they had health insurance. Vaccination coverage was higher among adults reporting one or more physician contacts in the past year compared with those who had not visited a physician in the past year, regardless of whether they had health insurance. Even among adults who had health insurance and ≥10 physician contacts within the past year, depending on the vaccine, 18.2%-85.6% reported not having received vaccinations that were recommended either for all persons or for those with specific indications. Overall, vaccination coverage among U.S.-born adults was higher than that among foreign-born adults, with few exceptions (influenza vaccination [adults aged 19-49 years and 50-64 years], hepatitis A vaccination [adults aged ≥19 years], and hepatitis B vaccination [adults aged ≥19 years with diabetes or chronic liver conditions]). Coverage for all vaccines for adults remained low but modest gains occurred in vaccination coverage for influenza (adults aged ≥19 years), pneumococcal (adults aged 19-64 years with increased risk), Tdap (adults aged ≥19 years and adults aged 19-64 years), herpes zoster (adults aged ≥60 years and ≥65 years), and hepatitis B (HCP aged ≥19 years); coverage for other vaccines and groups with vaccination indications did not improve. The 30% Healthy People 2020 target for herpes zoster vaccination was met. Racial/ethnic disparities persisted for routinely recommended adult vaccines. Missed opportunities to vaccinate remained. Although having health insurance coverage and a usual place for health care were associated with higher vaccination coverage, these factors alone were not associated with optimal adult vaccination coverage. HPV vaccination coverage for males and females has increased since CDC recommended vaccination to prevent cancers caused by HPV, but many adolescents and young adults remained unvaccinated. Assessing factors associated with low coverage rates and disparities in vaccination is important for implementing strategies to improve vaccination coverage. Evidence-based practices that have been demonstrated to improve vaccination coverage should be used. These practices include assessment of patients' vaccination indications by health care providers and routine recommendation and offer of needed vaccines to adults, implementation of reminder-recall systems, use of standing-order programs for vaccination, and assessment of practice-level vaccination rates with feedback to staff members. For vaccination coverage to be improved among those who reported lower coverage rates of recommended adult vaccines, efforts also are needed to identify adults who do not have a regular provider or insurance and who report fewer health care visits.

Surveillance of Vaccination Coverage among Adult Populations — United States, 2015

PubMed Central

Lu, Peng-Jun; O’Halloran, Alissa; Kim, David K.; Grohskopf, Lisa A.; Pilishvili, Tamara; Skoff, Tami H.; Nelson, Noele P.; Harpaz, Rafael; Markowitz, Lauri E.; Rodriguez-Lainz, Alfonso; Fiebelkorn, Amy Parker

2017-01-01

Problem/Condition Overall, the prevalence of illness attributable to vaccine-preventable diseases is greater among adults than among children. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults is low. Period Covered August 2014–June 2015 (for influenza vaccination) and January–December 2015 (for pneumococcal, tetanus and diphtheria [Td] and tetanus and diphtheria with acellular pertussis [Tdap], hepatitis A, hepatitis B, herpes zoster, and human papillomavirus [HPV] vaccination). Description of System The National Health Interview Survey (NHIS) is a continuous, cross-sectional national household survey of the noninstitutionalized U.S. civilian population. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. The survey objective is to monitor the health of the U.S. population and provide estimates of health indicators, health care use and access, and health-related behaviors. Results Compared with data from the 2014 NHIS, increases in vaccination coverage occurred for influenza vaccine among adults aged ≥19 years (a 1.6 percentage point increase compared with the 2013–14 season to 44.8%), pneumococcal vaccine among adults aged 19–64 years at increased risk for pneumococcal disease (a 2.8 percentage point increase to 23.0%), Tdap vaccine among adults aged ≥19 years and adults aged 19–64 years (a 3.1 percentage point and 3.3 percentage point increase to 23.1% and to 24.7%, respectively), herpes zoster vaccine among adults aged ≥60 years and adults aged ≥65 years (a 2.7 percentage point and 3.2 percentage point increase to 30.6% and to 34.2%, respectively), and hepatitis B vaccine among health care personnel (HCP) aged ≥19 years (a 4.1 percentage point increase to 64.7%). Herpes zoster vaccination coverage in 2015 met the Healthy People 2020 target of 30%. Aside from these modest improvements, vaccination coverage among adults in 2015 was similar to estimates from 2014. Racial/ethnic differences in coverage persisted for all seven vaccines, with higher coverage generally for whites compared with most other groups. Adults without health insurance reported receipt of influenza vaccine (all age groups), pneumococcal vaccine (adults aged 19–64 years at increased risk), Td vaccine (adults aged ≥19 years, 19–64 years, and 50–64 years), Tdap vaccine (adults aged ≥19 years and 19–64 years), hepatitis A vaccine (adults aged ≥19 years overall and among travelers), hepatitis B vaccine (adults aged ≥19 years, 19–49 years, and among travelers), herpes zoster vaccine (adults aged ≥60 years), and HPV vaccine (males and females aged 19–26 years) less often than those with health insurance. Adults who reported having a usual place for health care generally reported receipt of recommended vaccinations more often than those who did not have such a place, regardless of whether they had health insurance. Vaccination coverage was higher among adults reporting one or more physician contacts in the past year compared with those who had not visited a physician in the past year, regardless of whether they had health insurance. Even among adults who had health insurance and ≥10 physician contacts within the past year, depending on the vaccine, 18.2%–85.6% reported not having received vaccinations that were recommended either for all persons or for those with specific indications. Overall, vaccination coverage among U.S.-born adults was higher than that among foreign-born adults, with few exceptions (influenza vaccination [adults aged 19–49 years and 50–64 years], hepatitis A vaccination [adults aged ≥19 years], and hepatitis B vaccination [adults aged ≥19 years with diabetes or chronic liver conditions]). Interpretation Coverage for all vaccines for adults remained low but modest gains occurred in vaccination coverage for influenza (adults aged ≥19 years), pneumococcal (adults aged 19–64 years with increased risk), Tdap (adults aged ≥19 years and adults aged 19–64 years), herpes zoster (adults aged ≥60 years and ≥65 years), and hepatitis B (HCP aged ≥19 years); coverage for other vaccines and groups with vaccination indications did not improve. The 30% Healthy People 2020 target for herpes zoster vaccination was met. Racial/ethnic disparities persisted for routinely recommended adult vaccines. Missed opportunities to vaccinate remained. Although having health insurance coverage and a usual place for health care were associated with higher vaccination coverage, these factors alone were not associated with optimal adult vaccination coverage. HPV vaccination coverage for males and females has increased since CDC recommended vaccination to prevent cancers caused by HPV, but many adolescents and young adults remained unvaccinated. Public Health Actions Assessing factors associated with low coverage rates and disparities in vaccination is important for implementing strategies to improve vaccination coverage. Evidence-based practices that have been demonstrated to improve vaccination coverage should be used. These practices include assessment of patients’ vaccination indications by health care providers and routine recommendation and offer of needed vaccines to adults, implementation of reminder-recall systems, use of standing-order programs for vaccination, and assessment of practice-level vaccination rates with feedback to staff members. For vaccination coverage to be improved among those who reported lower coverage rates of recommended adult vaccines, efforts also are needed to identify adults who do not have a regular provider or insurance and who report fewer health care visits. PMID:28472027

Confidence intervals for the between-study variance in random-effects meta-analysis using generalised heterogeneity statistics: should we use unequal tails?

PubMed

Jackson, Dan; Bowden, Jack

2016-09-07

Confidence intervals for the between study variance are useful in random-effects meta-analyses because they quantify the uncertainty in the corresponding point estimates. Methods for calculating these confidence intervals have been developed that are based on inverting hypothesis tests using generalised heterogeneity statistics. Whilst, under the random effects model, these new methods furnish confidence intervals with the correct coverage, the resulting intervals are usually very wide, making them uninformative. We discuss a simple strategy for obtaining 95 % confidence intervals for the between-study variance with a markedly reduced width, whilst retaining the nominal coverage probability. Specifically, we consider the possibility of using methods based on generalised heterogeneity statistics with unequal tail probabilities, where the tail probability used to compute the upper bound is greater than 2.5 %. This idea is assessed using four real examples and a variety of simulation studies. Supporting analytical results are also obtained. Our results provide evidence that using unequal tail probabilities can result in shorter 95 % confidence intervals for the between-study variance. We also show some further results for a real example that illustrates how shorter confidence intervals for the between-study variance can be useful when performing sensitivity analyses for the average effect, which is usually the parameter of primary interest. We conclude that using unequal tail probabilities when computing 95 % confidence intervals for the between-study variance, when using methods based on generalised heterogeneity statistics, can result in shorter confidence intervals. We suggest that those who find the case for using unequal tail probabilities convincing should use the '1-4 % split', where greater tail probability is allocated to the upper confidence bound. The 'width-optimal' interval that we present deserves further investigation.

Link Connectivity and Coverage of Underwater Cognitive Acoustic Networks under Spectrum Constraint

PubMed Central

Wang, Qiu; Cheang, Chak Fong

2017-01-01

Extensive attention has been given to the use of cognitive radio technology in underwater acoustic networks since the acoustic spectrum became scarce due to the proliferation of human aquatic activities. Most of the recent studies on underwater cognitive acoustic networks (UCANs) mainly focus on spectrum management or protocol design. Few efforts have addressed the quality-of-service (QoS) of UCANs. In UCANs, secondary users (SUs) have lower priority to use acoustic spectrum than primary users (PUs) with higher priority to access spectrum. As a result, the QoS of SUs is difficult to ensure in UCANs. This paper proposes an analytical model to investigate the link connectivity and the probability of coverage of SUs in UCANs. In particular, this model takes both topological connectivity and spectrum availability into account, though spectrum availability has been ignored in most recent studies. We conduct extensive simulations to evaluate the effectiveness and the accuracy of our proposed model. Simulation results show that our proposed model is quite accurate. Besides, our results also imply that the link connectivity and the probability of coverage of SUs heavily depend on both the underwater acoustic channel conditions and the activities of PUs. PMID:29215561

Reproducibility of preclinical animal research improves with heterogeneity of study samples

PubMed Central

Vogt, Lucile; Sena, Emily S.; Würbel, Hanno

2018-01-01

Single-laboratory studies conducted under highly standardized conditions are the gold standard in preclinical animal research. Using simulations based on 440 preclinical studies across 13 different interventions in animal models of stroke, myocardial infarction, and breast cancer, we compared the accuracy of effect size estimates between single-laboratory and multi-laboratory study designs. Single-laboratory studies generally failed to predict effect size accurately, and larger sample sizes rendered effect size estimates even less accurate. By contrast, multi-laboratory designs including as few as 2 to 4 laboratories increased coverage probability by up to 42 percentage points without a need for larger sample sizes. These findings demonstrate that within-study standardization is a major cause of poor reproducibility. More representative study samples are required to improve the external validity and reproducibility of preclinical animal research and to prevent wasting animals and resources for inconclusive research. PMID:29470495

Marginal analysis in assessing factors contributing time to physician in the Emergency Department using operations data.

PubMed

Pathan, Sameer A; Bhutta, Zain A; Moinudheen, Jibin; Jenkins, Dominic; Silva, Ashwin D; Sharma, Yogdutt; Saleh, Warda A; Khudabakhsh, Zeenat; Irfan, Furqan B; Thomas, Stephen H

2016-01-01

Background: Standard Emergency Department (ED) operations goals include minimization of the time interval (tMD) between patients' initial ED presentation and initial physician evaluation. This study assessed factors known (or suspected) to influence tMD with a two-step goal. The first step was generation of a multivariate model identifying parameters associated with prolongation of tMD at a single study center. The second step was the use of a study center-specific multivariate tMD model as a basis for predictive marginal probability analysis; the marginal model allowed for prediction of the degree of ED operations benefit that would be affected with specific ED operations improvements. Methods: The study was conducted using one month (May 2015) of data obtained from an ED administrative database (EDAD) in an urban academic tertiary ED with an annual census of approximately 500,000; during the study month, the ED saw 39,593 cases. The EDAD data were used to generate a multivariate linear regression model assessing the various demographic and operational covariates' effects on the dependent variable tMD. Predictive marginal probability analysis was used to calculate the relative contributions of key covariates as well as demonstrate the likely tMD impact on modifying those covariates with operational improvements. Analyses were conducted with Stata 14MP, with significance defined at p  < 0.05 and confidence intervals (CIs) reported at the 95% level. Results: In an acceptable linear regression model that accounted for just over half of the overall variance in tMD (adjusted r 2 0.51), important contributors to tMD included shift census ( p  = 0.008), shift time of day ( p  = 0.002), and physician coverage n ( p  = 0.004). These strong associations remained even after adjusting for each other and other covariates. Marginal predictive probability analysis was used to predict the overall tMD impact (improvement from 50 to 43 minutes, p  < 0.001) of consistent staffing with 22 physicians. Conclusions: The analysis identified expected variables contributing to tMD with regression demonstrating significance and effect magnitude of alterations in covariates including patient census, shift time of day, and number of physicians. Marginal analysis provided operationally useful demonstration of the need to adjust physician coverage numbers, prompting changes at the study ED. The methods used in this analysis may prove useful in other EDs wishing to analyze operations information with the goal of predicting which interventions may have the most benefit.

NSW annual immunisation coverage report, 2011.

PubMed

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

2012-12-01

This annual report, the third in the series, documents trends in immunisation coverage in NSW for children, adolescents and the elderly, to the end of 2011. Data from the Australian Childhood Immunisation Register, the NSW School Immunisation Program and the NSW Population Health Survey were used to calculate various measures of population coverage. During 2011, greater than 90% coverage was maintained for children at 12 and 24 months of age. For children at 5 years of age the improvement seen in 2010 was sustained, with coverage at or near 90%. For adolescents, there was improved coverage for all doses of human papillomavirus vaccine, both doses of hepatitis B vaccine, varicella vaccine and the dose of diphtheria, tetanus and acellular pertussis given to school attendees in Years 7 and 10. Pneumococcal vaccination coverage in the elderly has been steadily rising, although it has remained lower than the influenza coverage estimates. This report provides trends in immunisation coverage in NSW across the age spectrum. The inclusion of coverage estimates for the pneumococcal conjugate, varicella and meningococcal C vaccines in the official coverage assessments for 'fully immunised' in 2013 is a welcome initiative.

Do mobile clinics provide high-quality antenatal care? A comparison of care delivery, knowledge outcomes and perception of quality of care between fixed and mobile clinics in central Haiti.

PubMed

Phillips, Erica; Stoltzfus, Rebecca J; Michaud, Lesly; Pierre, Gracia Lionel Fils; Vermeylen, Francoise; Pelletier, David

2017-10-16

Antenatal care (ANC) is an important health service for women in developing countries, with numerous proven benefits. Global coverage of ANC has steadily increased over the past 30 years, in part due to increased community-based outreach. However, commensurate improvements in health outcomes such as reductions in the prevalence of maternal anemia and infants born small-for-gestational age have not been achieved, even with increased coverage, indicating that quality of care may be inadequate. Mobile clinics are one community-based strategy used to further improve coverage of ANC, but their quality of care delivery has rarely been evaluated. To determine the quality of care of ANC in central Haiti, we compared adherence to national guidelines between fixed and mobile clinics by performing direct observations of antenatal care consultations and exit interviews with recipients of care using a multi-stage random sampling procedure. Outcome variables were eight components of care, and women's knowledge and perception of care quality. There were significant differences in the predicted proportion or probability of recommended services for four of eight care components, including intake, laboratory examinations, infection control, and supplies, iron folic acid supplements and Tetanus Toxoid vaccine provided to women. These care components were more likely performed in fixed clinics, except for distribution of supplies, iron-folic acid supplements, and Tetanus Toxoid vaccine, more likely provided in mobile clinics. There were no differences between clinic type for the proportion of total physical exam procedures performed, health and communication messages delivered, provider communication or documentation. Women's knowledge about educational topics was poor, but women perceived extremely high quality of care in both clinic models. Although adherence to guidelines differed by clinic type for half of the care components, both clinics had a low percentage of overall services delivered. Efforts to improve provider performance and quality are therefore needed in both models. Mobile clinics must deliver high-quality ANC to improve health and nutrition outcomes.

Can Plan Recommendations Improve the Coverage Decisions of Vulnerable Populations in Health Insurance Marketplaces?

PubMed

Barnes, Andrew J; Hanoch, Yaniv; Rice, Thomas

2016-01-01

The Affordable Care Act's marketplaces present an important opportunity for expanding coverage but consumers face enormous challenges in navigating through enrollment and re-enrollment. We tested the effectiveness of a behaviorally informed policy tool--plan recommendations--in improving marketplace decisions. Data were gathered from a community sample of 656 lower-income, minority, rural residents of Virginia. We conducted an incentive-compatible, computer-based experiment using a hypothetical marketplace like the one consumers face in the federally-facilitated marketplaces, and examined their decision quality. Participants were randomly assigned to a control condition or three types of plan recommendations: social normative, physician, and government. For participants randomized to a plan recommendation condition, the plan that maximized expected earnings, and minimized total expected annual health care costs, was recommended. Primary data were gathered using an online choice experiment and questionnaire. Plan recommendations resulted in a 21 percentage point increase in the probability of choosing the earnings maximizing plan, after controlling for participant characteristics. Two conditions, government or providers recommending the lowest cost plan, resulted in plan choices that lowered annual costs compared to marketplaces where no recommendations were made. As millions of adults grapple with choosing plans in marketplaces and whether to switch plans during open enrollment, it is time to consider marketplace redesigns and leverage insights from the behavioral sciences to facilitate consumers' decisions.

Estimating juvenile Chinook salmon (Oncorhynchus tshawytscha) abundance from beach seine data collected in the Sacramento–San Joaquin Delta and San Francisco Bay, California

USGS Publications Warehouse

Perry, Russell W.; Kirsch, Joseph E.; Hendrix, A. Noble

2016-06-17

Resource managers rely on abundance or density metrics derived from beach seine surveys to make vital decisions that affect fish population dynamics and assemblage structure. However, abundance and density metrics may be biased by imperfect capture and lack of geographic closure during sampling. Currently, there is considerable uncertainty about the capture efficiency of juvenile Chinook salmon (Oncorhynchus tshawytscha) by beach seines. Heterogeneity in capture can occur through unrealistic assumptions of closure and from variation in the probability of capture caused by environmental conditions. We evaluated the assumptions of closure and the influence of environmental conditions on capture efficiency and abundance estimates of Chinook salmon from beach seining within the Sacramento–San Joaquin Delta and the San Francisco Bay. Beach seine capture efficiency was measured using a stratified random sampling design combined with open and closed replicate depletion sampling. A total of 56 samples were collected during the spring of 2014. To assess variability in capture probability and the absolute abundance of juvenile Chinook salmon, beach seine capture efficiency data were fitted to the paired depletion design using modified N-mixture models. These models allowed us to explicitly test the closure assumption and estimate environmental effects on the probability of capture. We determined that our updated method allowing for lack of closure between depletion samples drastically outperformed traditional data analysis that assumes closure among replicate samples. The best-fit model (lowest-valued Akaike Information Criterion model) included the probability of fish being available for capture (relaxed closure assumption), capture probability modeled as a function of water velocity and percent coverage of fine sediment, and abundance modeled as a function of sample area, temperature, and water velocity. Given that beach seining is a ubiquitous sampling technique for many species, our improved sampling design and analysis could provide significant improvements in density and abundance estimation.

The effectiveness of vaccine day and educational interventions on influenza vaccine coverage among health care workers at long-term care facilities.

PubMed

Kimura, Akiko C; Nguyen, Christine N; Higa, Jeffrey I; Hurwitz, Eric L; Vugia, Duc J

2007-04-01

We examined barriers to influenza vaccination among long-term care facility (LTCF) health care workers in Southern California and developed simple, effective interventions to improve influenza vaccine coverage of these workers. In 2002, health care workers at LTCFs were surveyed regarding their knowledge and attitudes about influenza and the influenza vaccine. Results were used to develop 2 interventions, an educational campaign and Vaccine Day (a well-publicized day for free influenza vaccination of all employees at the worksite). Seventy facilities were recruited to participate in an intervention trial and randomly assigned to 4 study groups. The combination of Vaccine Day and an educational campaign was most effective in increasing vaccine coverage (53% coverage; prevalence ratio [PR]=1.45; 95% confidence interval [CI]=1.24, 1.71, compared with 27% coverage in the control group). Vaccine Day alone was also effective (46% coverage; PR= 1.41; 95% CI=1.17, 1.71). The educational campaign alone was not effective in improving coverage levels (34% coverage; PR=1.18; 95% CI=0.93, 1.50). Influenza vaccine coverage of LTCF health care workers can be improved by providing free vaccinations at the worksite with a well-publicized Vaccine Day.

A Two-Phase Coverage-Enhancing Algorithm for Hybrid Wireless Sensor Networks

PubMed Central

Zhang, Qingguo; Fok, Mable P.

2017-01-01

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. PMID:28075365

Covered today, sick tomorrow? Trends and correlates of children's health insurance instability.

PubMed

Hill, Heather D; Shaefer, H Luke

2011-10-01

Many children with health insurance will experience gaps in coverage over time, potentially reducing their access to and use of preventive health care services. This article uses the Survey of Income and Program Participation to examine how the stability of children's health insurance changed between 1990 and 2005 and to identify dynamic aspects of family life associated with transitions in coverage. Children's health insurance instability has increased since the early 1990s, due to greater movement between insured and uninsured states and between private and public insurance coverage. Changes in the employment and marital status of the family head are highly associated with an increased risk of a child losing and gaining public and private coverage, largely in hypothesized directions. The exception is that marital dissolution and job loss are associated with an increased probability of a child losing public insurance, despite there being no clear policy explanation for such a relationship.

TU-EF-304-11: Therapeutic Benefits of Collimation in Spot Scanning Proton Therapy in the Treatment of Brain Cancer

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

Moignier, A; Gelover, E; Wang, D

Purpose: A dynamic collimation system (DCS) based on two orthogonal pairs of mobile trimmer blades has recently been proposed to reduce the lateral penumbra in spot scanning proton therapy (SSPT). The purpose of this work is to quantify the therapeutic benefit of using the DCS for SSPT of brain cancer by comparing un-collimated and collimated treatment plans. Methods: Un-collimated and collimated brain treatment plans were created for five patients, previously treated with SSPT, using an in-house treatment planning system capable of modeling collimated and un-collimated beamlets. Un-collimated plans reproduced the clinically delivered plans in terms of target coverage and organ-at-riskmore » (OAR) sparing, whereas collimated plans were re-optimized to improve the organ-at-risk sparing while maintaining target coverage. Physical and biological comparison metrics such as dose distribution conformity, mean and maximum doses, normal tissue complication probability (NTCP) and risk of secondary brain cancer were used to evaluate the plans. Results: The DCS systematically improved the dose distribution conformity while preserving the target coverage. The average reduction of the mean dose to the 10-mm ring surrounding the target and the healthy brain were 7.1% (95% CI: 4.2%–9.9%; p<0.01) and 14.3% (95% CI: 7.8%–20.8%; p<0.01), respectively. This yielded an average reduction of 12.0% (95% CI: 8.2%–15.7%; p<0.01) for the brain necrosis NTCP using the Flickinger model, and 14.2% (95% CI: 7.7%–20.8%; p<0.01) for the risk of secondary brain cancer. The average maximum dose reductions for the brainstem, chiasm, optic nerves, cochleae and pituitary gland when comparing un-collimated and collimated plans were 14.3%, 10.4%, 11.2%, 13.0%, 12.9% and 3.4%, respectively. Evaluating individual plans using the Lyman-Kutcher-Burman NTCP model also yielded improvements. Conclusion: The lateral penumbra reduction performed by the DCS increases the normal tissue sparing capabilities of SSPT for brain tumor treatment while preserving the target coverage. This research was financially supported by Ion Beam Applications S.A. (IBA, Louvain-La-Neuve, Belgium)« less

Memetic Algorithm-Based Multi-Objective Coverage Optimization for Wireless Sensor Networks

PubMed Central

Chen, Zhi; Li, Shuai; Yue, Wenjing

2014-01-01

Maintaining effective coverage and extending the network lifetime as much as possible has become one of the most critical issues in the coverage of WSNs. In this paper, we propose a multi-objective coverage optimization algorithm for WSNs, namely MOCADMA, which models the coverage control of WSNs as the multi-objective optimization problem. MOCADMA uses a memetic algorithm with a dynamic local search strategy to optimize the coverage of WSNs and achieve the objectives such as high network coverage, effective node utilization and more residual energy. In MOCADMA, the alternative solutions are represented as the chromosomes in matrix form, and the optimal solutions are selected through numerous iterations of the evolution process, including selection, crossover, mutation, local enhancement, and fitness evaluation. The experiment and evaluation results show MOCADMA can have good capabilities in maintaining the sensing coverage, achieve higher network coverage while improving the energy efficiency and effectively prolonging the network lifetime, and have a significant improvement over some existing algorithms. PMID:25360579

Memetic algorithm-based multi-objective coverage optimization for wireless sensor networks.

PubMed

Chen, Zhi; Li, Shuai; Yue, Wenjing

2014-10-30

Maintaining effective coverage and extending the network lifetime as much as possible has become one of the most critical issues in the coverage of WSNs. In this paper, we propose a multi-objective coverage optimization algorithm for WSNs, namely MOCADMA, which models the coverage control of WSNs as the multi-objective optimization problem. MOCADMA uses a memetic algorithm with a dynamic local search strategy to optimize the coverage of WSNs and achieve the objectives such as high network coverage, effective node utilization and more residual energy. In MOCADMA, the alternative solutions are represented as the chromosomes in matrix form, and the optimal solutions are selected through numerous iterations of the evolution process, including selection, crossover, mutation, local enhancement, and fitness evaluation. The experiment and evaluation results show MOCADMA can have good capabilities in maintaining the sensing coverage, achieve higher network coverage while improving the energy efficiency and effectively prolonging the network lifetime, and have a significant improvement over some existing algorithms.

Assessing Coverage of Population-Based and Targeted Fortification Programs with the Use of the Fortification Assessment Coverage Toolkit (FACT): Background, Toolkit Development, and Supplement Overview.

PubMed

Friesen, Valerie M; Aaron, Grant J; Myatt, Mark; Neufeld, Lynnette M

2017-05-01

Food fortification is a widely used approach to increase micronutrient intake in the diet. High coverage is essential for achieving impact. Data on coverage is limited in many countries, and tools to assess coverage of fortification programs have not been standardized. In 2013, the Global Alliance for Improved Nutrition developed the Fortification Assessment Coverage Toolkit (FACT) to carry out coverage assessments in both population-based (i.e., staple foods and/or condiments) and targeted (e.g., infant and young child) fortification programs. The toolkit was designed to generate evidence on program coverage and the use of fortified foods to provide timely and programmatically relevant information for decision making. This supplement presents results from FACT surveys that assessed the coverage of population-based and targeted food fortification programs across 14 countries. It then discusses the policy and program implications of the findings for the potential for impact and program improvement.

Role of non-traditional locations for seasonal flu vaccination: Empirical evidence and evaluation.

PubMed

Kim, Namhoon; Mountain, Travis P

2017-05-19

This study investigated the role of non-traditional locations in the decision to vaccinate for seasonal flu. We measured individuals' preferred location for seasonal flu vaccination by examining the National H1N1 Flu Survey (NHFS) conducted from late 2009 to early 2010. Our econometric model estimated the probabilities of possible choices by varying individual characteristics, and predicted the way in which the probabilities are expected to change given the specific covariates of interest. From this estimation, we observed that non-traditional locations significantly influenced the vaccination of certain individuals, such as those who are high-income, educated, White, employed, and living in a metropolitan statistical area (MSA), by increasing the coverage. Thus, based on the empirical evidence, our study suggested that supporting non-traditional locations for vaccination could be effective in increasing vaccination coverage. Copyright © 2017 Elsevier Ltd. All rights reserved.

Standardized likelihood ratio test for comparing several log-normal means and confidence interval for the common mean.

PubMed

Krishnamoorthy, K; Oral, Evrim

2017-12-01

Standardized likelihood ratio test (SLRT) for testing the equality of means of several log-normal distributions is proposed. The properties of the SLRT and an available modified likelihood ratio test (MLRT) and a generalized variable (GV) test are evaluated by Monte Carlo simulation and compared. Evaluation studies indicate that the SLRT is accurate even for small samples, whereas the MLRT could be quite liberal for some parameter values, and the GV test is in general conservative and less powerful than the SLRT. Furthermore, a closed-form approximate confidence interval for the common mean of several log-normal distributions is developed using the method of variance estimate recovery, and compared with the generalized confidence interval with respect to coverage probabilities and precision. Simulation studies indicate that the proposed confidence interval is accurate and better than the generalized confidence interval in terms of coverage probabilities. The methods are illustrated using two examples.

Confidence intervals and sample size calculations for the standardized mean difference effect size between two normal populations under heteroscedasticity.

PubMed

Shieh, G

2013-12-01

The use of effect sizes and associated confidence intervals in all empirical research has been strongly emphasized by journal publication guidelines. To help advance theory and practice in the social sciences, this article describes an improved procedure for constructing confidence intervals of the standardized mean difference effect size between two independent normal populations with unknown and possibly unequal variances. The presented approach has advantages over the existing formula in both theoretical justification and computational simplicity. In addition, simulation results show that the suggested one- and two-sided confidence intervals are more accurate in achieving the nominal coverage probability. The proposed estimation method provides a feasible alternative to the most commonly used measure of Cohen's d and the corresponding interval procedure when the assumption of homogeneous variances is not tenable. To further improve the potential applicability of the suggested methodology, the sample size procedures for precise interval estimation of the standardized mean difference are also delineated. The desired precision of a confidence interval is assessed with respect to the control of expected width and to the assurance probability of interval width within a designated value. Supplementary computer programs are developed to aid in the usefulness and implementation of the introduced techniques.

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.

The Impact of Exceeding TANF Time Limits on the Access to Healthcare of Low-Income Mothers.

PubMed

Narain, Kimberly; Ettner, Susan

2017-01-01

The objective of this article is to estimate the relationship of exceeding Temporary Assistance for Needy Families (TANF) time limits, with health insurance, healthcare, and health outcomes. The authors use Heckman selection models that exploit variability in state time-limit duration and timing of policy implementation as identifying exclusion restrictions to adjust the effect estimates of exceeding time limits for possible correlations between the probability of exceeding time limits and unobservable factors influencing the outcomes. The authors find that exceeding time limits decreases the predicted probability of Medicaid coverage, increases the predicted probability of being uninsured, and decreases the predicted probability of annual medical provider contact.

Interventions for improving coverage of childhood immunisation in low- and middle-income countries

PubMed Central

Oyo-Ita, Angela; Wiysonge, Charles S; Oringanje, Chioma; Nwachukwu, Chukwuemeka E; Oduwole, Olabisi; Meremikwu, Martin M

2016-01-01

Background Immunisation is a powerful public health strategy for improving child survival, not only by directly combating key diseases that kill children but also by providing a platform for other health services. However, each year millions of children worldwide, mostly from low- and middle-income countries (LMICs), do not receive the full series of vaccines on their national routine immunisation schedule. This is an update of the Cochrane review published in 2011 and focuses on interventions for improving childhood immunisation coverage in LMICs. Objectives To evaluate the effectiveness of intervention strategies to boost and sustain high childhood immunisation coverage in LMICs. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2016, Issue 4, part of The Cochrane Library. www.cochranelibrary.com, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (searched 12 May 2016); MEDLINE In-Process and Other Non-Indexed Citations, MEDLINE Daily and MEDLINE 1946 to Present, OvidSP (searched 12 May 2016); CINAHL 1981 to present, EbscoHost (searched 12 May 2016); Embase 1980 to 2014 Week 34, OvidSP (searched 2 September 2014); LILACS, VHL (searched 2 September 2014); Sociological Abstracts 1952 - current, ProQuest (searched 2 September 2014). We did a citation search for all included studies in Science Citation Index and Social Sciences Citation Index, 1975 to present; Emerging Sources Citation Index 2015 to present, ISI Web of Science (searched 2 July 2016). We also searched the two Trials Registries: ICTRP and ClinicalTrials.gov (searched 5 July 2016) Selection criteria Eligible studies were randomised controlled trials (RCT), non-RCTs, controlled before-after studies, and interrupted time series conducted in LMICs involving children aged from birth to four years, caregivers, and healthcare providers. Data collection and analysis We independently screened the search output, reviewed full texts of potentially eligible articles, assessed risk of bias, and extracted data in duplicate; resolving discrepancies by consensus. We then conducted random-effects meta-analyses and used GRADE to assess the certainty of evidence. Main results Fourteen studies (10 cluster RCTs and four individual RCTs) met our inclusion criteria. These were conducted in Georgia (one study), Ghana (one study), Honduras (one study), India (two studies), Mali (one study), Mexico (one study), Nicaragua (one study), Nepal (one study), Pakistan (four studies), and Zimbabwe (one study). One study had an unclear risk of bias, and 13 had high risk of bias. The interventions evaluated in the studies included community-based health education (three studies), facility-based health education (three studies), household incentives (three studies), regular immunisation outreach sessions (one study), home visits (one study), supportive supervision (one study), information campaigns (one study), and integration of immunisation services with intermittent preventive treatment of malaria (one study). We found moderate-certainty evidence that health education at village meetings or at home probably improves coverage with three doses of diphtheria-tetanus-pertussis vaccines (DTP3: risk ratio (RR) 1.68, 95% confidence interval (CI) 1.09 to 2.59). We also found low-certainty evidence that facility-based health education plus redesigned vaccination reminder cards may improve DTP3 coverage (RR 1.50, 95% CI 1.21 to 1.87). Household monetary incentives may have little or no effect on full immunisation coverage (RR 1.05, 95% CI 0.90 to 1.23, low-certainty evidence). Regular immunisation outreach may improve full immunisation coverage (RR 3.09, 95% CI 1.69 to 5.67, low-certainty evidence) which may substantially improve if combined with household incentives (RR 6.66, 95% CI 3.93 to 11.28, low-certainty evidence). Home visits to identify non-vaccinated children and refer them to health clinics may improve uptake of three doses of oral polio vaccine (RR 1.22, 95% CI 1.07 to 1.39, low-certainty evidence). There was low-certainty evidence that integration of immunisation with other services may improve DTP3 coverage (RR 1.92, 95% CI 1.42 to 2.59). Authors' conclusions Providing parents and other community members with information on immunisation, health education at facilities in combination with redesigned immunisation reminder cards, regular immunisation outreach with and without household incentives, home visits, and integration of immunisation with other services may improve childhood immunisation coverage in LMIC. Most of the evidence was of low certainty, which implies a high likelihood that the true effect of the interventions will be substantially different. There is thus a need for further well-conducted RCTs to assess the effects of interventions for improving childhood immunisation coverage in LMICs. Interventions that will increase and sustain the uptake of vaccines in low- and middle-income countries What is the aim of this review? The aim of this Cochrane review was to evaluate the effect of different strategies to increase the number of children in low-and-middle-income countries who are vaccinated to prevent infection by a disease. Researchers in Cochrane collected and analysed all relevant studies to answer this question and found 14 relevant studies. Do strategies to improve childhood vaccination work? Giving information about vaccination to parents and community members, handing out specially designed vaccination reminder cards, offering vaccines through regular immunisation outreach with and without household incentives (rewards), identifying unvaccinated children through home visits and referring them to health clinics, and integrating vaccination services with other services may lead to more children getting vaccinated. However, offering parents money to vaccinate their children may not improve vaccination uptake. Most of these findings were of low-certainty, and we need more well-conducted research in this area. What was studied in the review? Millions of children in low-and-middle-income countries still die from diseases that could have been prevented with vaccines. There are a number of reasons for this. Governments and others have tried different strategies to increase the number of children vaccinated. What are the main results of the review? The review authors found 14 relevant studies from Georgia, Ghana, Honduras, India, Mali, Mexico, Nicaragua, Nepal, Pakistan, and Zimbabwe. The studies compared people receiving these strategies to people who only received the usual healthcare services. The studies showed the following: Giving information and discussing vaccination with parents and other community members at village meetings or at home probably leads to more children receiving three doses of diphtheria-tetanus-pertussis vaccine (moderate-certainty evidence). Giving information to parents about the importance of vaccinations during visits to health clinics combined with a specially designed participant reminder card and integration of vaccination services with other health services may improve the uptake of three doses of diphtheria-tetanus-pertussis vaccine (low-certainty evidence). Offering money to parents on the condition that they vaccinate their children may make little or no difference to the number of children that are fully vaccinated (low-certainty evidence). Using vaccination outreach teams to offer vaccination to villages on fixed times monthly may improve coverage for full vaccination (low-certainty evidence). How up-to-date is this review? The review authors searched for studies that were published up to May 2016. PMID:27394698

Strategies for expanding health insurance coverage in vulnerable populations.

PubMed

Jia, Liying; Yuan, Beibei; Huang, Fei; Lu, Ying; Garner, Paul; Meng, Qingyue

2014-11-26

Health insurance has the potential to improve access to health care and protect people from the financial risks of diseases. However, health insurance coverage is often low, particularly for people most in need of protection, including children and other vulnerable populations. To assess the effectiveness of strategies for expanding health insurance coverage in vulnerable populations. We searched Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library. www.thecochranelibrary.com (searched 2 November 2012), PubMed (searched 1 November 2012), EMBASE (searched 6 July 2012), Global Health (searched 6 July 2012), IBSS (searched 6 July 2012), WHO Library Database (WHOLIS) (searched 1 November 2012), IDEAS (searched 1 November 2012), ISI-Proceedings (searched 1 November 2012),OpenGrey (changed from OpenSIGLE) (searched 1 November 2012), African Index Medicus (searched 1 November 2012), BLDS (searched 1 November 2012), Econlit (searched 1 November 2012), ELDIS (searched 1 November 2012), ERIC (searched 1 November 2012), HERDIN NeON Database (searched 1 November 2012), IndMED (searched 1 November 2012), JSTOR (searched 1 November 2012), LILACS(searched 1 November 2012), NTIS (searched 1 November 2012), PAIS (searched 6 July 2012), Popline (searched 1 November 2012), ProQuest Dissertation &Theses Database (searched 1 November 2012), PsycINFO (searched 6 July 2012), SSRN (searched 1 November 2012), Thai Index Medicus (searched 1 November 2012), World Bank (searched 2 November 2012), WanFang (searched 3 November 2012), China National Knowledge Infrastructure (CHKD-CNKI) (searched 2 November 2012).In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via Web of Science to find other potentially relevant studies. Randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) studies and Interrupted time series (ITS) studies that evaluated the effects of strategies on increasing health insurance coverage for vulnerable populations. We defined strategies as measures to improve the enrolment of vulnerable populations into health insurance schemes. Two categories and six specified strategies were identified as the interventions. At least two review authors independently extracted data and assessed the risk of bias. We undertook a structured synthesis. We included two studies, both from the United States. People offered health insurance information and application support by community-based case managers were probably more likely to enrol their children into health insurance programmes (risk ratio (RR) 1.68, 95% confidence interval (CI) 1.44 to 1.96, moderate quality evidence) and were probably more likely to continue insuring their children (RR 2.59, 95% CI 1.95 to 3.44, moderate quality evidence). Of all the children that were insured, those in the intervention group may have been insured quicker (47.3 fewer days, 95% CI 20.6 to 74.0 fewer days, low quality evidence) and parents may have been more satisfied on average (satisfaction score average difference 1.07, 95% CI 0.72 to 1.42, low quality evidence).In the second study applications were handed out in emergency departments at hospitals, compared to not handing out applications, and may have had an effect on enrolment (RR 1.5, 95% CI 1.03 to 2.18, low quality evidence). Community-based case managers who provide health insurance information, application support, and negotiate with the insurer probably increase enrolment of children in health insurance schemes. However, the transferability of this intervention to other populations or other settings is uncertain. Handing out insurance application materials in hospital emergency departments may help increase the enrolment of children in health insurance schemes. Further studies evaluating the effectiveness of different strategies for expanding health insurance coverage in vulnerable population are needed in different settings, with careful attention given to study design.

Media advocacy, tobacco control policy change and teen smoking in Florida

PubMed Central

Niederdeppe, Jeff; Farrelly, Matthew C; Wenter, Dana

2007-01-01

Objective To assess whether media advocacy activities implemented by the Florida Tobacco Control Program contributed to increased news coverage, policy changes and reductions in youth smoking. Methods A content analysis of news coverage appearing in Florida newspapers between 22 April 1998 and 31 December 2001 was conducted, and patterns of coverage before and after the implementation of media advocacy efforts to promote tobacco product placement ordinances were compared. Event history analysis was used to assess whether news coverage increased the probability of enacting these ordinances in 23 of 67 Florida counties and ordinary least square (OLS) regression was used to gauge the effect of these policies on changes in youth smoking prevalence. Results The volume of programme‐related news coverage decreased after the onset of media advocacy efforts, but the ratio of coverage about Students Working Against Tobacco (the Florida Tobacco Control Program's youth advocacy organisation) relative to other topics increased. News coverage contributed to the passage of tobacco product placement ordinances in Florida counties, but these ordinances did not lead to reduced youth smoking. Conclusion This study adds to the growing literature supporting the use of media advocacy as a tool to change health‐related policies. However, results suggest caution in choosing policy goals that may or may not influence health behaviour. PMID:17297073

Early impact of the Affordable Care Act on health insurance coverage of young adults.

PubMed

Cantor, Joel C; Monheit, Alan C; DeLia, Derek; Lloyd, Kristen

2012-10-01

To evaluate one of the first implemented provisions of the Patient Protection and Affordable Care Act (ACA), which permits young adults up to age 26 to enroll as dependents on a parent's private health plan. Nearly one-in-three young adults lacked coverage before the ACA. STUDY DESIGN, METHODS, AND DATA: Data from the Current Population Survey 2005-2011 are used to estimate linear probability models within a difference-in-differences framework to estimate how the ACA affected coverage of eligible young adults compared to slightly older adults. Multivariate models control for individual characteristics, economic trends, and prior state-dependent coverage laws. This ACA provision led to a rapid and substantial increase in the share of young adults with dependent coverage and a reduction in their uninsured rate in the early months of implementation. Models accounting for prior state dependent expansions suggest greater policy impact in 2010 among young adults who were also eligible under a state law. ACA-dependent coverage expansion represents a rare public policy success in the effort to cover the uninsured. Still, this policy may have later unintended consequences for premiums for alternative forms of coverage and employer-offered rates for young adult workers. © Health Research and Educational Trust.

Early Impact of the Affordable Care Act on Health Insurance Coverage of Young Adults

PubMed Central

Cantor, Joel C; Monheit, Alan C; DeLia, Derek; Lloyd, Kristen

2012-01-01

Research Objective To evaluate one of the first implemented provisions of the Patient Protection and Affordable Care Act (ACA), which permits young adults up to age 26 to enroll as dependents on a parent's private health plan. Nearly one-in-three young adults lacked coverage before the ACA. Study Design, Methods, and Data Data from the Current Population Survey 2005–2011 are used to estimate linear probability models within a difference-in-differences framework to estimate how the ACA affected coverage of eligible young adults compared to slightly older adults. Multivariate models control for individual characteristics, economic trends, and prior state-dependent coverage laws. Principal Findings This ACA provision led to a rapid and substantial increase in the share of young adults with dependent coverage and a reduction in their uninsured rate in the early months of implementation. Models accounting for prior state dependent expansions suggest greater policy impact in 2010 among young adults who were also eligible under a state law. Conclusions and Implications ACA-dependent coverage expansion represents a rare public policy success in the effort to cover the uninsured. Still, this policy may have later unintended consequences for premiums for alternative forms of coverage and employer-offered rates for young adult workers. PMID:22924684

Improving care for patients on antiretroviral therapy through a gap analysis framework.

PubMed

Massoud, M Rashad; Shakir, Fazila; Livesley, Nigel; Muhire, Martin; Nabwire, Juliana; Ottosson, Amanda; Jean-Baptiste, Rachel; Megere, Humphrey; Karamagi-Nkolo, Esther; Gaudreault, Suzanne; Marks, Pamela; Jennings, Larissa

2015-07-01

To improve quality of care through decreasing existing gaps in the areas of coverage, retention, and wellness of patients receiving HIV care and treatment. The antiretroviral therapy (ART) Framework utilizes improvement methods and the Chronic Care Model to address the coverage, retention, and wellness gaps in HIV care and treatment. This is a time-series study. The ART Framework was applied in five health centers in Buikwe District, Uganda. Quality improvement teams, consisting of healthcare workers and expert patients, were established in each of the five healthcare facilities. The intervention period was October 2010 to September 2012. It consisted of quality improvement teams analyzing their facility and systems of care from the perspective of the Chronic Care Model to identify areas of improvement. They implemented the ART Framework, collected data and assessed outcomes, focused on self-management support for patients, to improve coverage, retention, and wellness gaps in HIV care and treatment. Coverage was defined as every patient who needs ART in the catchment area, receives it. Retention was defined as every patient who receives ART stays on ART, and wellness defined as having a positive clinical, immunological, and/or virological response to treatment without intolerable or unmanageable side-effects. Results from Buikwe show the gaps in coverage, retention, and wellness greatly decreased a gap in coverage of 44-19%, gap in retention of 49-24%, and gap in wellness of 53-14% during a 2-year intervention period. The ART Framework is an innovative and practical tool for HIV program managers to improve HIV care and treatment.

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.

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition.

PubMed

Chopra, Mickey; Sharkey, Alyssa; Dalmiya, Nita; Anthony, David; Binkin, Nancy

2012-10-13

Implementation of innovative strategies to improve coverage of evidence-based interventions, especially in the most marginalised populations, is a key focus of policy makers and planners aiming to improve child survival, health, and nutrition. We present a three-step approach to improvement of the effective coverage of essential interventions. First, we identify four different intervention delivery channels--ie, clinical or curative, outreach, community-based preventive or promotional, and legislative or mass media. Second, we classify which interventions' deliveries can be improved or changed within their channel or by switching to another channel. Finally, we do a meta-review of both published and unpublished reviews to examine the evidence for a range of strategies designed to overcome supply and demand bottlenecks to effective coverage of interventions that improve child survival, health, and nutrition. Although knowledge gaps exist, several strategies show promise for improving coverage of effective interventions-and, in some cases, health outcomes in children-including expanded roles for lay health workers, task shifting, reduction of financial barriers, increases in human-resource availability and geographical access, and use of the private sector. Policy makers and planners should be informed of this evidence as they choose strategies in which to invest their scarce resources. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

Williamson, Casey W.; Green, Garrett; Noticewala, Sonal S.

Purpose: Validated models are needed to justify strategies to define planning target volumes (PTVs) for intact cervical cancer used in clinical practice. Our objective was to independently validate a previously published shape model, using data collected prospectively from clinical trials. Methods and Materials: We analyzed 42 patients with intact cervical cancer treated with daily fractionated pelvic intensity modulated radiation therapy and concurrent chemotherapy in one of 2 prospective clinical trials. We collected online cone beam computed tomography (CBCT) scans before each fraction. Clinical target volume (CTV) structures from the planning computed tomography scan were cast onto each CBCT scan aftermore » rigid registration and manually redrawn to account for organ motion and deformation. We applied the 95% isodose cloud from the planning computed tomography scan to each CBCT scan and computed any CTV outside the 95% isodose cloud. The primary aim was to determine the proportion of CTVs that were encompassed within the 95% isodose volume. A 1-sample t test was used to test the hypothesis that the probability of complete coverage was different from 95%. We used mixed-effects logistic regression to assess effects of time and patient variability. Results: The 95% isodose line completely encompassed 92.3% of all CTVs (95% confidence interval, 88.3%-96.4%), not significantly different from the 95% probability anticipated a priori (P=.19). The overall proportion of missed CTVs was small: the grand mean of covered CTVs was 99.9%, and 95.2% of misses were located in the anterior body of the uterus. Time did not affect coverage probability (P=.71). Conclusions: With the clinical implementation of a previously proposed PTV definition strategy based on a shape model for intact cervical cancer, the probability of CTV coverage was high and the volume of CTV missed was low. This PTV expansion strategy is acceptable for clinical trials and practice; however, we recommend daily image guidance to avoid systematic large misses in select patients.« less

Cost-Effectiveness Analysis of Screening for and Managing Identified Hypertension for Cardiovascular Disease Prevention in Vietnam

PubMed Central

Nguyen, Thi-Phuong-Lan; Wright, E. Pamela; Nguyen, Thanh-Trung; Schuiling-Veninga, C. C. M.; Bijlsma, M. J.; Nguyen, Thi-Bach-Yen; Postma, M. J.

2016-01-01

Objective To inform development of guidelines for hypertension management in Vietnam, we evaluated the cost-effectiveness of different strategies on screening for hypertension in preventing cardiovascular disease (CVD). Methods A decision tree was combined with a Markov model to measure incremental cost-effectiveness of different approaches to hypertension screening. Values used as input parameters for the model were taken from different sources. Various screening intervals (one-off, annually, biannually) and starting ages to screen (35, 45 or 55 years) and coverage of treatment were analysed. We ran both a ten-year and a lifetime horizon. Input parameters for the models were extracted from local and regional data. Probabilistic sensitivity analysis was used to evaluate parameter uncertainty. A threshold of three times GDP per capita was applied. Results Cost per quality adjusted life year (QALY) gained varied in different screening scenarios. In a ten-year horizon, the cost-effectiveness of screening for hypertension ranged from cost saving to Int$ 758,695 per QALY gained. For screening of men starting at 55 years, all screening scenarios gave a high probability of being cost-effective. For screening of females starting at 55 years, the probability of favourable cost-effectiveness was 90% with one-off screening. In a lifetime horizon, cost per QALY gained was lower than the threshold of Int$ 15,883 in all screening scenarios among males. Similar results were found in females when starting screening at 55 years. Starting screening in females at 45 years had a high probability of being cost-effective if screening biannually was combined with increasing coverage of treatment by 20% or even if sole biannual screening was considered. Conclusion From a health economic perspective, integrating screening for hypertension into routine medical examination and related coverage by health insurance could be recommended. Screening for hypertension has a high probability of being cost-effective in preventing CVD. An adequate screening strategy can best be selected based on age, sex and screening interval. PMID:27192051

Work disability and depressive disorders: impact on the European population.

PubMed

Veronese, Antonio; Ayuso-Mateos, José Luis; Cabello, Maria; Chatterji, Somnath; Nuevo, Roberto

2012-02-01

Our aim was to study the impact of depressive disorders on work disability to discover the determinants of depression for work disability in the European countries. The sample was composed of 31,126 individuals from 29 countries included in the 2002 World Health Survey of the World Health Organization. National representative samples of countries from all regions of Europe and with different levels of economic development and health coverage were selected. Estimates of people not working because of ill health did not differ among European countries in relation to levels of economic development or health coverage. Significant determinants of people with diagnosis of depression not working because of ill health (reference category) versus working were age (odds ratio = 0.97), female sex (odds ratio = 1.71), education (odds ratio = 1.11), marital status (being unmarried indicating less probability), lowest income level, and comorbidity with angina pectoris (odds ratio = 0.51). Moreover, according to previous studies, we found some determinants (comorbidity with other diseases, young age, and unemployment) impacting on health status. Depression is a substantial cause of work disability and it is a complex phenomenon that involves many variables. Investigation into this relationship should improve, focusing on the role of determinants.

Ungulate exclusion, conifer thinning and mule deer forage in northeastern New Mexico

USGS Publications Warehouse

Kramer, David W.; Sorensen, Grant E.; Taylor, Chase A.; Cox, Robert D.; Gipson, Philip S.; Cain, James W.

2015-01-01

The southwestern United States has experienced expansion of conifer species (Juniperus spp. and Pinus ponderosa) into areas of semi-arid grassland over the past century. The expansion of conifers can limit palatable forage and reduce grass and forb communities. Conifer species are sometimes thinned through hydraulic mulching or selective cutting. We assessed the effects of these treatments on mule deer (Odocoileus hemionus) habitat in northeastern New Mexico to determine if conifer thinning improved cover of preferred forage species for mule deer in areas with and without ungulates. We measured plant cover and occurrence of preferred forage species in the summers of 2011 and 2012. An ongoing regional drought probably reduced vegetation response, with preferred forage species and herbaceous cover responding to conifer thinning or ungulate exclusion immediately following treatment, but not the following year. In 2011, areas that received thinning treatments had a higher abundance of preferred forage when compared to sites with no treatment. Grass coverage exhibited an immediate response in 2011, with ungulate exclosures containing 8% more coverage than areas without exclosures. The results suggest that conifer thinning and ungulate exclusion may elicit a positive response, however in the presence of drought; the positive effects are only short-term.

Rapid assessment of avoidable blindness in Bhutan.

PubMed

Lepcha, Nor Tshering; Chettri, Chandra Kumar; Getshen, Kunzang; Rai, Bhim Bahadur; Ramaswamy, Shamanna Bindiganavale; Saibaba, Saravanan; Nirmalan, Praveen Kumar; Demarchis, Emilia Hansson; Tabin, Geoffrey; Morley, Michael; Morley, Katharine

2013-08-01

To conduct a rapid assessment of avoidable blindness survey in Bhutan to obtain estimates of blindness, visual impairment, and cataract surgical coverage, outcomes and barriers among persons ≥50 years old. A total of 82 clusters of 50 people ≥50 years were selected using probability proportionate to size sampling. Eligible participants were selected from households using compact segment sampling, and underwent ophthalmic examination for visual acuity, followed by penlight and direct ophthalmoscopy. Participants with cataract were interviewed regarding surgical outcomes and barriers to surgery. Overall, 4046 of 4100 persons enumerated (98.7%) underwent ophthalmic examination. Adjusting for age and sex, the prevalence of bilaterally blind persons with available correction was 1.5% (95% confidence interval 1.09-1.89). Most blindness (67.1%) and severe visual impairment (74.1%) resulted from cataract, but 22.1% resulted from posterior segment pathology. Cataract surgical coverage for bilaterally blind persons was 72.7%. Almost 90% of patients reported moderate or good satisfaction, despite poor surgical outcomes in 23.6%. The prevalence of blindness in people aged ≥50 years in Bhutan was relatively low when compared with neighboring countries and World Health Organization sub-region estimates. Areas for improvement include community outreach, surgical outcomes, and posterior segment diseases.

Access to an optimal treatment. Current situation.

PubMed

Ugarte-Gil, Manuel F; Silvestre, Adriana M R; Pons-Estel, Bernardo A

2015-03-01

Access to an optimal treatment is determined by several factors, like availability, pricing/funding, and acceptability. In Latin America (LA), one of the regions with more disparities particularly on healthcare in the world, access is affected by other factors, including socio-demographic factors like poverty, living in rural regions, and/or health coverage. Regarding rheumatoid arthritis (RA), an inadequate access to specialists leads to diagnosis and treatment delays diminishing the probability of remission or control. Unfortunately, in almost every LA country, there are cities with more than 100,000 inhabitants without rheumatologists; furthermore, a primary care reference system is present in only about half the countries. In the public health system, coverage of biologic disease-modifying antirheumatic drugs occurs for less than 10 % of the patients in about half of the countries. Also, as healthcare providers based their funding decisions mainly in direct costs instead of on patient-centered healthcare quality indicators, access to new drugs is more complicated in this region than in high-income countries. More accurate epidemiological data from LA need to be obtained in order to improve the management of patients with rheumatic diseases in general and RA in particular.

SU-F-BRB-13: Correlation of Improved Target and Organ-At-Risk Dosimetric Quantities and Clinical Outcomes for Helical Tomotherapy Treated Mesothelioma

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

Qi, S; Kishan, A; Alexander, S

2015-06-15

Purpose: We have observed improved local control probability (LCP) for adjuvant mesothelioma radiotherapy following pleurectomy/decortication using Tomotherapy compared to the conventional 3D technique (p<0.05). This work assesses the correlation between the improved clinical outcomes against dosimetry quantities. Methods: Thirty-eight mesothelioma cases consecutively treated at our clinic were retrospectively analyzed. Sixteen patients were treated using 3D technique planned on the Eclipse for c-arm accelerators prior to 7/2012; the other 22 cases were treated on Tomotherapy using helical IMRT after 7/2012. Typical 3D plans consisting of 15 MV AP/PA photon fields prescribed to 10 cm depth followed by matching electron fields withmore » energy ranging from 8–16 MeV. Tomotherapy plans were designed using 2.5cm jaw, 0.287 pitch with directional blocking of the contralateral lung. The same prescription of 45 Gy (1.8GyX25) was used for both techniques. The dosimetry metrics for the critical structures: ipsilateral-/contralateral-lung, heart, cord, esophagus, etc were compared between two techniques. Results: Superior LCP is closely associated with improved target coverage. Tomotherapy plans yielded dramatically better target coverage and less dose heterogeneity despite of more advanced/larger disease. The averaged PTV volumes were 2287.3±569.9 (Tomotherapy) vs. 1904.8±312.3cc (3D); V100s were: 91.1±4.0 (%) vs. 47.8±12.7 (%) with heterogeneity indices of 1.20±0.1 vs.1.37±0.38 and for the Tomotherapy and 3D plans, respectively. Compared to the 3D technique, we observed significant lower maximum cord doses (p<0.001), lower mean esophagus doses (p<0.002), and lower heart mean doses when tumor was left-sided (p=0.002). For ipsilateral-/contralateral-lungs, however, the mean doses and V20, V5 of Tomotherapy plans were significantly higher than the 3D plans (p<0.01) regardless which sides of lung were treated. However, rates of radiation pneumonitis were no different. Conclusion: Tomotherapy achieved great improvement of plan quality including target coverage, resulting in significantly better local control over the traditional 3D technique for adjuvant radiotherapy for mesothelioma.« less

Theoretical aspects of 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.

2010-10-01

The study of adsorption of oxygen on transition metal surface is important for the understanding of oxidation, heterogeneous catalysis, and metal corrosion. The structures formed on transition metal surfaces vary from simple adlayers of chemisorbed oxygen to oxygen diffusion into the sub-surface region and the formation of oxides. In this work we present the results of an ab-initio investigation 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. Calculations are also performed for the on-surface adsorption of oxygen on the unreconstructed Cu(001) surface for coverages up to one monolayer to use for comparison. The geometry of the surfaces with adsorbed oxygen is fully optimized. Theoretical results are compared with experimental data obtained from studies of oxidation of the Cu(100) surface using positron annihilation induced Auger electron spectroscopy.

Medicaid Expansions from 1997 to 2009 Increased Coverage and Improved Access and Mental Health Outcomes for Low-Income Parents.

PubMed

McMorrow, Stacey; Kenney, Genevieve M; Long, Sharon K; Goin, Dana E

2016-08-01

To assess the effects of past Medicaid eligibility expansions to parents on coverage, access to care, out-of-pocket (OOP) spending, and mental health outcomes, and consider implications for the Affordable Care Act (ACA) Medicaid expansion. Person-level data from the National Health Interview Survey (1998-2010) is used to measure insurance coverage and related outcomes for low-income parents. Using state identifiers available at the National Center for Health Statistics Research Data Center, we attach state Medicaid eligibility thresholds for parents collected from a variety of sources to NHIS observations. We use changes in the Medicaid eligibility threshold for parents within states over time to identify the effects of changes in eligibility on low-income parents. We find that expanding Medicaid eligibility increases insurance coverage, reduces unmet needs due to cost and OOP spending, and improves mental health status among low-income parents. Moreover, our findings suggest that uninsured populations in states not currently participating in the ACA Medicaid expansion would experience even larger improvements in coverage and related outcomes than those in participating states if they chose to expand eligibility. The ACA Medicaid expansion has the potential to improve a wide variety of coverage, access, financial, and health outcomes for uninsured parents in states that choose to expand coverage. © Health Research and Educational Trust.

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.

Measuring populations to improve vaccination coverage

NASA Astrophysics Data System (ADS)

Bharti, Nita; Djibo, Ali; Tatem, Andrew J.; Grenfell, Bryan T.; Ferrari, Matthew J.

2016-10-01

In low-income settings, vaccination campaigns supplement routine immunization but often fail to achieve coverage goals due to uncertainty about target population size and distribution. Accurate, updated estimates of target populations are rare but critical; short-term fluctuations can greatly impact population size and susceptibility. We use satellite imagery to quantify population fluctuations and the coverage achieved by a measles outbreak response vaccination campaign in urban Niger and compare campaign estimates to measurements from a post-campaign survey. Vaccine coverage was overestimated because the campaign underestimated resident numbers and seasonal migration further increased the target population. We combine satellite-derived measurements of fluctuations in population distribution with high-resolution measles case reports to develop a dynamic model that illustrates the potential improvement in vaccination campaign coverage if planners account for predictable population fluctuations. Satellite imagery can improve retrospective estimates of vaccination campaign impact and future campaign planning by synchronizing interventions with predictable population fluxes.

Measuring populations to improve vaccination coverage

PubMed Central

Bharti, Nita; Djibo, Ali; Tatem, Andrew J.; Grenfell, Bryan T.; Ferrari, Matthew J.

2016-01-01

In low-income settings, vaccination campaigns supplement routine immunization but often fail to achieve coverage goals due to uncertainty about target population size and distribution. Accurate, updated estimates of target populations are rare but critical; short-term fluctuations can greatly impact population size and susceptibility. We use satellite imagery to quantify population fluctuations and the coverage achieved by a measles outbreak response vaccination campaign in urban Niger and compare campaign estimates to measurements from a post-campaign survey. Vaccine coverage was overestimated because the campaign underestimated resident numbers and seasonal migration further increased the target population. We combine satellite-derived measurements of fluctuations in population distribution with high-resolution measles case reports to develop a dynamic model that illustrates the potential improvement in vaccination campaign coverage if planners account for predictable population fluctuations. Satellite imagery can improve retrospective estimates of vaccination campaign impact and future campaign planning by synchronizing interventions with predictable population fluxes. PMID:27703191

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.

Medication coverage for lawmakers may worsen access for everyone else.

PubMed

Taglione, Michael S; Boozary, Andrew; Persaud, Nav

2018-03-01

Despite numerous recommendations for universal public coverage of prescription drugs in Canada based on evidence that millions of Canadians cannot afford medications, no province or territory has adopted first dollar coverage for all residents. However, one group unaffected by the lack of public coverage are lawmakers. Lawmakers receive excellent drug coverage plans for themselves and their immediate families. Evidence suggests that lawmakers' decisions are influenced by their personal circumstances; in this case, they are insulated from the effects of poor access to medications by their drug coverage plans. In contrast, a patchwork system of 46 programs across Canada provides some drug coverage to vulnerable populations. Reducing the disparity in prescription drug access between Canadian lawmakers and the public may promote progress towards better medication access for everyone. This could be achieved either by reducing lawmaker coverage or improving upon the public patchwork system. Since the goal should be to improve the overall access of medications for all Canadians, lawmakers included, the latter method is preferred. A universal drug plan with first dollar coverage could replace the current patchwork system and expand coverage to all Canadians. Copyright © 2017 Elsevier Inc. All rights reserved.

Impact of Alternative Medical Device Approval Processes on Costs and Health

PubMed Central

George, Benjamin P.; Venkataraman, Vinayak; Dorsey, E. Ray

2014-01-01

Background Medical devices are often introduced prior to randomized‐trial evidence of efficacy and this slows completion of trials. Alternative regulatory approaches include restricting device use outside of trials prior to trial evidence of efficacy (like the drug approval process) or restricting out‐of‐trial use but permitting coverage within trials such as Medicare's Coverage with Study Participation (CSP). Methods We compared the financial impact to manufacturers and insurers of three regulatory alternatives: (1) limited regulation (current approach), (2) CSP, and (3) restrictive regulation (like the current drug approval process). Using data for patent foramen ovale closure devices, we modeled key parameters including recruitment time, probability of device efficacy, market adoption, and device cost/price to calculate profits to manufacturers, costs to insurers, and overall societal impact on health. Results For manufacturers, profits were greatest under CSP—driven by faster market adoption of effective devices—followed by restrictive regulation. Societal health benefit in total quality‐adjusted life years was greatest under CSP. Insurers’ expenditures for ineffective devices were greatest with limited regulation. Findings were robust over a reasonable range of probabilities of trial success. Conclusions Regulation restricting out‐of‐trial device use and extending limited insurance coverage to clinical trial participants may balance manufacturer and societal interests. PMID:25185975

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.

Adlayer structure dependent ultrafast desorption dynamics in carbon monoxide adsorbed on Pd (111)

NASA Astrophysics Data System (ADS)

Hong, Sung-Young; Xu, Pan; Camillone, Nina R.; White, Michael G.; Camillone, Nicholas

2016-07-01

We report our ultrafast photoinduced desorption investigation of the coverage dependence of substrate-adsorbate energy transfer in carbon monoxide adlayers on the (111) surface of palladium. As the CO coverage is increased, the adsorption site population shifts from all threefold hollows (up to 0.33 ML), to bridge and near bridge (>0.5 to 0.6 ML) and finally to mixed threefold hollow plus top site (at saturation at 0.75 ML). We show that between 0.24 and 0.75 ML this progression of binding site motifs is accompanied by two remarkable features in the ultrafast photoinduced desorption of the adsorbates: (i) the desorption probability increases roughly two orders magnitude, and (ii) the adsorbate-substrate energy transfer rate observed in two-pulse correlation experiments varies nonmonotonically, having a minimum at intermediate coverages. Simulations using a phenomenological model to describe the adsorbate-substrate energy transfer in terms of frictional coupling indicate that these features are consistent with an adsorption-site dependent electron-mediated energy coupling strength, ηel, that decreases with binding site in the order: three-fold hollow > bridge and near bridge > top site. This weakening of ηel largely counterbalances the decrease in the desorption activation energy that accompanies this progression of adsorption site motifs, moderating what would otherwise be a rise of several orders of magnitude in the desorption probability. Within this framework, the observed energy transfer rate enhancement at saturation coverage is due to interadsorbate energy transfer from the copopulation of molecules bound in three-fold hollows to their top-site neighbors.

Adlayer structure dependent ultrafast desorption dynamics in carbon monoxide adsorbed on Pd (111)

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

Hong, Sung-Young; Camillone, Nina R.; Camillone, Nicholas, E-mail: nicholas@bnl.gov

We report our ultrafast photoinduced desorption investigation of the coverage dependence of substrate–adsorbate energy transfer in carbon monoxide adlayers on the (111) surface of palladium. As the CO coverage is increased, the adsorption site population shifts from all threefold hollows (up to 0.33 ML), to bridge and near bridge (>0.5 to 0.6 ML) and finally to mixed threefold hollow plus top site (at saturation at 0.75 ML). We show that between 0.24 and 0.75 ML this progression of binding site motifs is accompanied by two remarkable features in the ultrafast photoinduced desorption of the adsorbates: (i) the desorption probability increasesmore » roughly two orders magnitude, and (ii) the adsorbate–substrate energy transfer rate observed in two-pulse correlation experiments varies nonmonotonically, having a minimum at intermediate coverages. Simulations using a phenomenological model to describe the adsorbate–substrate energy transfer in terms of frictional coupling indicate that these features are consistent with an adsorption-site dependent electron-mediated energy coupling strength, η{sub el}, that decreases with binding site in the order: three-fold hollow > bridge and near bridge > top site. This weakening of η{sub el} largely counterbalances the decrease in the desorption activation energy that accompanies this progression of adsorption site motifs, moderating what would otherwise be a rise of several orders of magnitude in the desorption probability. Within this framework, the observed energy transfer rate enhancement at saturation coverage is due to interadsorbate energy transfer from the copopulation of molecules bound in three-fold hollows to their top-site neighbors.« less

Affordable Care Act and Women

MedlinePlus

... quality care for older women, and ends the gender discrimination that requires women to pay more for the ... Coverage Preventive Health Services Improved Medicare Coverage Ending Gender Discrimination in Premiums Expanded Insurance Coverage Endnotes Download "rb. ...

Evaluation of some random effects methodology applicable to bird ringing data

USGS Publications Warehouse

Burnham, K.P.; White, Gary C.

2002-01-01

Existing models for ring recovery and recapture data analysis treat temporal variations in annual survival probability (S) as fixed effects. Often there is no explainable structure to the temporal variation in S1,..., Sk; random effects can then be a useful model: Si = E(S) + ??i. Here, the temporal variation in survival probability is treated as random with average value E(??2) = ??2. This random effects model can now be fit in program MARK. Resultant inferences include point and interval estimation for process variation, ??2, estimation of E(S) and var (E??(S)) where the latter includes a component for ??2 as well as the traditional component for v??ar(S??\\S??). Furthermore, the random effects model leads to shrinkage estimates, Si, as improved (in mean square error) estimators of Si compared to the MLE, S??i, from the unrestricted time-effects model. Appropriate confidence intervals based on the Si are also provided. In addition, AIC has been generalized to random effects models. This paper presents results of a Monte Carlo evaluation of inference performance under the simple random effects model. Examined by simulation, under the simple one group Cormack-Jolly-Seber (CJS) model, are issues such as bias of ??s2, confidence interval coverage on ??2, coverage and mean square error comparisons for inference about Si based on shrinkage versus maximum likelihood estimators, and performance of AIC model selection over three models: Si ??? S (no effects), Si = E(S) + ??i (random effects), and S1,..., Sk (fixed effects). For the cases simulated, the random effects methods performed well and were uniformly better than fixed effects MLE for the Si.

Predictors of medical and mental health care use in patients with irritable bowel syndrome in the United States.

PubMed

Gudleski, Gregory D; Satchidanand, Nikhil; Dunlap, Laura J; Tahiliani, Varnita; Li, Xiaohua; Keefer, Laurie; Lackner, Jeffrey M

2017-01-01

Because health care demand among IBS patients imposes a heavy economic burden, identifying high utilizers has potential for improving quality and efficiency of care. Previous research has not identified reliable predictors of utilization of IBS patients. We sought to identify factors predictive of health care utilization among severe IBS patients. 291 IBS patients completed testing whose content mapped onto the Andersen model of health care utilization. 2-stage hurdle models were used to determine predictors of health care use (probability and frequency). Separate analyses were conducted for mental health and medical services. Whether patients used any medical care was predicted by diet and insurance status. Tobacco use, education, and health insurance predicted the probability of using mental health care. The frequency of medical care was associated with alcohol use and physical health status, while frequency of mental health services was associated with marital status, tobacco use, education, distress, stress, and control beliefs over IBS symptoms. For IBS patients, the demand for health care involves a complex decision-making process influenced by many factors. Particularly strong determinants include predisposing characteristics (e.g., dietary pattern, tobacco use) and enabling factors (e.g., insurance coverage) that impede or facilitate demand. Which factors impact use depends on whether the focus is on the decision to use care or how much care is used. Decisions to use medical and mental health care are not simply influenced by symptom-specific factors but by a variety of lifestyle (e.g., dietary pattern, education, smoking) and economic (e.g., insurance coverage) factors. Copyright © 2016 Elsevier Ltd. All rights reserved.

Exact one-sided confidence limits for the difference between two correlated proportions.

PubMed

Lloyd, Chris J; Moldovan, Max V

2007-08-15

We construct exact and optimal one-sided upper and lower confidence bounds for the difference between two probabilities based on matched binary pairs using well-established optimality theory of Buehler. Starting with five different approximate lower and upper limits, we adjust them to have coverage probability exactly equal to the desired nominal level and then compare the resulting exact limits by their mean size. Exact limits based on the signed root likelihood ratio statistic are preferred and recommended for practical use.

Population-based coverage survey results following the mass drug administration of azithromycin for the treatment of trachoma in Amhara, Ethiopia.

PubMed

Astale, Tigist; Sata, Eshetu; Zerihun, Mulat; Nute, Andrew W; Stewart, Aisha E P; Gessese, Demelash; Ayenew, Gedefaw; Melak, Berhanu; Chanyalew, Melsew; Tadesse, Zerihun; Callahan, E Kelly; Nash, Scott D

2018-02-01

Trachoma is the leading infectious cause of blindness worldwide. In communities where the district level prevalence of trachomatous inflammation-follicular among children ages 1-9 years is ≥5%, WHO recommends annual mass drug administration (MDA) of antibiotics with the aim of at least 80% coverage. Population-based post-MDA coverage surveys are essential to understand the effectiveness of MDA programs, yet published reports from trachoma programs are rare. In the Amhara region of Ethiopia, a population-based MDA coverage survey was conducted 3 weeks following the 2016 MDA to estimate the zonal prevalence of self-reported drug coverage in all 10 administrative zones. Survey households were selected using a multi-stage cluster random sampling design and all individuals in selected households were presented with a drug sample and asked about taking the drug during the campaign. Zonal estimates were weighted and confidence intervals were calculated using survey procedures. Self-reported drug coverage was then compared with regional reported administrative coverage. Region-wide, 24,248 individuals were enumerated, of which, 20,942 (86.4%) individuals were present. The regional self-reported antibiotic coverage was 76.8% (95%Confidence Interval (CI):69.3-82.9%) in the population overall and 77.4% (95%CI = 65.7-85.9%) among children ages 1-9 years old. Zonal coverage ranged from 67.8% to 90.2%. Five out of 10 zones achieved a coverage >80%. In all zones, the reported administrative coverage was greater than 90% and was considerably higher than self-reported MDA coverage. Main reasons reported for MDA campaign non-attendance included being physically unable to get to MDA site (22.5%), traveling (20.6%), and not knowing about the campaign (21.0%). MDA refusal was low (2.8%) in this population. Although self-reported MDA coverage in Amhara was greater than 80% in some zones, programmatic improvements are warranted throughout Amhara to achieve higher coverage. These results will be used to enhance community mobilization and improve training for MDA distributors and supervisors to improve coverage in future MDAs.

Medicaid Coverage of Methadone Maintenance and the Use of Opioid Agonist Therapy Among Pregnant Women in Specialty Treatment.

PubMed

Bachhuber, Marcus A; Mehta, Pooja K; Faherty, Laura J; Saloner, Brendan

2017-12-01

Opioid agonist therapy (OAT) is the standard of care for pregnant women with opioid use disorder (OUD). Medicaid coverage policies may strongly influence OAT use in this group. To examine the association between Medicaid coverage of methadone maintenance and planned use of OAT in the publicly funded treatment system. Retrospective cross-sectional analysis of treatment admissions in 30 states extracted from the Treatment Episode Data Set (2013 and 2014). Medicaid-insured pregnant women with OUD (n=3354 treatment admissions). The main outcome measure was planned use of OAT on admission. The main exposure was state Medicaid coverage of methadone maintenance. Using multivariable logistic regression models adjusting for sociodemographic, substance use, and treatment characteristics, we compared the probability of planned OAT use in states with Medicaid coverage of methadone maintenance versus states without coverage. A total of 71% of pregnant women admitted to OUD treatment were 18-29 years old, 85% were white non-Hispanic, and 56% used heroin. Overall, 74% of admissions occurred in the 18 states with Medicaid coverage of methadone maintenance and 53% of admissions involved planned use of OAT. Compared with states without Medicaid coverage of methadone maintenance, admissions in states with coverage were significantly more likely to involve planned OAT use (adjusted difference: 32.9 percentage points, 95% confidence interval, 19.2-46.7). Including methadone maintenance in the Medicaid benefit is essential to increasing OAT among pregnant women with OUD and should be considered a key policy strategy to enhance outcomes for mothers and newborns.

Employee responses to health insurance premium increases.

PubMed

Goldman, Dana P; Leibowitz, Arleen A; Robalino, David A

2004-01-01

To determine the sensitivity of employees' health insurance decisions--including the decision to not choose health maintenance organization or fee-for-service coverage--during periods of rapidly escalating healthcare costs. A retrospective cohort study of employee plan choices at a single large firm with a "cafeteria-style" benefits plan wherein employees paid all the additional cost of purchasing more generous insurance. We modeled the probability that an employee would drop coverage or switch plans in response to employee premium increases using data from a single large US company with employees across 47 states during the 3-year period of 1989 through 1991, a time of large premium increases within and across plans. Premium increases induced substantial plan switching. Single employees were more likely to respond to premium increases by dropping coverage, whereas families tended to switch to another plan. Premium increases of 10% induced 7% of single employees to drop or severely cut back on coverage; 13% to switch to another plan; and 80% to remain in their existing plan. Similar figures for those with family coverage were 11%, 12%, and 77%, respectively. Simulation results that control for known covariates show similar increases. When faced with a dramatic increase in premiums--on the order of 20%--nearly one fifth of the single employees dropped coverage compared with 10% of those with family coverage. Employee coverage decisions are sensitive to rapidly increasing premiums, and single employees may be likely to drop coverage. This finding suggests that sustained premium increases could induce substantial increases in the number of uninsured individuals.

Volumetric modulated arc therapy of head-and-neck cancer on a fast-rotating O-ring linac: Plan quality and delivery time comparison with a C-arm linac.

PubMed

Michiels, Steven; Poels, Kenneth; Crijns, Wouter; Delombaerde, Laurence; De Roover, Robin; Vanstraelen, Bianca; Haustermans, Karin; Nuyts, Sandra; Depuydt, Tom

2018-05-05

Linac improvements in gantry speed, leaf speed and dose rate may increase the time-efficiency of volumetric modulated arc therapy (VMAT) delivery. The plan quality achievable with faster VMAT however remains to be investigated. In this study, a fast-rotating O-ring linac with fast-moving leaves is compared with a C-arm linac in terms of plan quality and delivery time for VMAT of head-and-neck cancer (HNC). For 30 patients with HNC, treatment planning was performed using dual-arc (HA2) and triple-arc (HA3) VMAT on a Halcyon fast-rotating O-ring linac and using dual-arc VMAT on a TrueBeam C-arm linac (TB2). Target coverage metrics and complication probabilities were compared. Plan delivery was verified using 3%/3 mm gamma-index analysis of helical diode array measurements. Volumetric image acquisition and plan delivery times were compared. All studied VMAT-techniques fulfilled the target coverage objectives. D 2% to the boost volume was higher for HA2 (median 103.7%, 1st-3rd quartile [103.5%;104.0%]) and HA3 (103.2% [103.0%;103.7%)] than for TB2 (102.6% [102.3%;103.0%)], resulting in an increased boost target dose heterogeneity for HA2 and HA3. Complication probabilities were comparable between HA2 and TB2, while HA3 showed a xerostomia probability reduction (0.8% [0.2%;1.8%]) and dysphagia probability reduction (1.0% [0.2%;1.8%]) compared with TB2. Gamma-index agreement scores were never below 93.0% for HA2, HA3 and TB2. Volumetric imaging and plan delivery time was shorter for HA2 (1 m 24 s ± 1 s) and HA3 (1 m 54 s ± 1 s) than for TB2 (2 m 47 s ± 1 s). For VMAT of HNC, the fast-rotating O-ring linac at least maintains the plan quality of two arcs on a C-arm linac while reducing the image acquisition and plan delivery time. Copyright © 2018 Elsevier B.V. All rights reserved.

Can Plan Recommendations Improve the Coverage Decisions of Vulnerable Populations in Health Insurance Marketplaces?

PubMed Central

Barnes, Andrew J.; Hanoch, Yaniv; Rice, Thomas

2016-01-01

Objective The Affordable Care Act’s marketplaces present an important opportunity for expanding coverage but consumers face enormous challenges in navigating through enrollment and re-enrollment. We tested the effectiveness of a behaviorally informed policy tool—plan recommendations—in improving marketplace decisions. Study Setting Data were gathered from a community sample of 656 lower-income, minority, rural residents of Virginia. Study Design We conducted an incentive-compatible, computer-based experiment using a hypothetical marketplace like the one consumers face in the federally-facilitated marketplaces, and examined their decision quality. Participants were randomly assigned to a control condition or three types of plan recommendations: social normative, physician, and government. For participants randomized to a plan recommendation condition, the plan that maximized expected earnings, and minimized total expected annual health care costs, was recommended. Data Collection Primary data were gathered using an online choice experiment and questionnaire. Principal Findings Plan recommendations resulted in a 21 percentage point increase in the probability of choosing the earnings maximizing plan, after controlling for participant characteristics. Two conditions, government or providers recommending the lowest cost plan, resulted in plan choices that lowered annual costs compared to marketplaces where no recommendations were made. Conclusions As millions of adults grapple with choosing plans in marketplaces and whether to switch plans during open enrollment, it is time to consider marketplace redesigns and leverage insights from the behavioral sciences to facilitate consumers’ decisions. PMID:27028008

The web and public confidence in MMR vaccination in Italy.

PubMed

Aquino, Francesco; Donzelli, Gabriele; De Franco, Emanuela; Privitera, Gaetano; Lopalco, Pier Luigi; Carducci, Annalaura

2017-08-16

Measles, mumps and rubella (MMR) vaccination coverage in Italy has been decreasing starting from 2012 and, at the present, none of the Italian regions has achieved the goal of 95% coverage target. A decision of the Court of Justice of Rimini in March 2012 that awarded vaccine-injury compensation for a case of autism has been indicated as a probable trigger event leading to a reduction of vaccine confidence in Italy. The aim of the study was to explore the relationship between MMR vaccination coverage to online search trends and social network activity on the topic "autism and MMR vaccine", during the period 2010-2015. A significant inverse correlation was found between MMR vaccination coverage and Internet search activity, tweets and Facebook posts. New media might have played a role in spreading misinformation. Media monitoring could be useful to assess the level of vaccine hesitancy and to plan and target effective information campaigns. Copyright © 2017 Elsevier Ltd. All rights reserved.

Take-up of public insurance and crowd-out of private insurance under recent CHIP expansions to higher income children.

PubMed

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

2012-10-01

To analyze the effects of states' expansions of Children's Health Insurance Program (CHIP) eligibility to children in higher income families on health insurance coverage outcomes. 2002-2009 Current Population Survey linked to multiple secondary data sources. Instrumental variables estimation of linear probability models. Outcomes are whether the child had any public insurance, any private insurance, or no insurance coverage during the year. Among children in families with incomes between two and four times the federal poverty line (FPL), four enrolled in CHIP for every 100 who became eligible. Roughly half of the newly eligible children who took up public insurance were previously uninsured. The upper bound "crowd-out" rate was estimated to be 46 percent. The CHIP expansions to children in higher income families were associated with limited uptake of public coverage. Our results additionally suggest that there was crowd-out of private insurance coverage. © Health Research and Educational Trust.

Analysis on the Change of Vegetation Coverage in Qinghai Province from 2000 TO 2012

NASA Astrophysics Data System (ADS)

Wang, J.; Yan, Q.; Liu, Z.; Luo, C.

2013-07-01

Qinghai Province is one of the important provinces on the Qinghai-Tibet Plateau in China. Its unique alpine meadow ecosystem makes it become the most concentrated areas of biodiversity in high altitudes in the world. Researching the vegetation coverage and changes of Qinghai province can reflect effectively and timely processing of changes and problems of ecological quality in the region. This research will give a long time series monitoring of the vegetation coverage of Qinghai province based on maximum value composite (MVC) and S-G filtering algorithm using MODIS data of the year of 2000-2012, then analyze the change using coefficient of variability(CV) and trend line analysis. According to research, during the past 13 years, more than half of Qinghai Province's vegetation coverage is well, both the east and south have a high coverage, while the northwest is lower. The changing of vegetation coverage also has showed a steady and improving trend in 13 years. The largest area is slight improved area is about 29.08% of the total area, and the second largest area is significant improved area is about 21.09% of the total area. In this research can learn directly the vegetation coverage and changes of Qinghai province and provide reference and scientific basis for the protection and governance of ecological environment.

Evaluation of the three-dimensional bony coverage before and after rotational acetabular osteotomy.

PubMed

Tanaka, Takeyuki; Moro, Toru; Takatori, Yoshio; Oshima, Hirofumi; Ito, Hideya; Sugita, Naohiko; Mitsuishi, Mamoru; Tanaka, Sakae

2018-02-26

Rotational acetabular osteotomy is a type of pelvic osteotomy that involves rotation of the acetabular bone to improve the bony coverage of the femoral head for patients with acetabular dysplasia. Favourable post-operative long-term outcomes have been reported in previous studies. However, there is a paucity of published data regarding three-dimensional bony coverage. The present study investigated the three-dimensional bony coverage of the acetabulum covering the femoral head in hips before and after rotational acetabular osteotomy and in normal hips. The computed tomography data of 40 hip joints (12 joints before and after rotational acetabular osteotomy; 16 normal joints) were analyzed. The three-dimensional bony coverage of each joint was evaluated using original software. The post-operative bony coverage improved significantly compared with pre-operative values. In particular, the anterolateral aspect of the acetabulum tended to be dysplastic in patients with acetabular dysplasia compared to those with normal hip joints. However, greater bony coverage at the anterolateral aspect was obtained after rotational acetabular osteotomy. Meanwhile, the results of the present study may indicate that the bony coverage in the anterior aspect may be excessive. Three-dimensional analysis indicated that rotational acetabular osteotomy achieved favorable bony coverage. Further investigations are necessary to determine the ideal bony coverage after rotational acetabular osteotomy.

States With Medically Needy Pathways: Differences in Long-Term and Temporary Medicaid Entry for Low-Income Medicare Beneficiaries.

PubMed

Keohane, Laura M; Trivedi, Amal; Mor, Vincent

2017-10-01

Medically needy pathways may provide temporary catastrophic coverage for low-income Medicare beneficiaries who do not otherwise qualify for full Medicaid benefits. Between January 2009 and June 2010, states with medically needy pathways had a higher percentage of low-income beneficiaries join Medicaid than states without such programs (7.5% vs. 4.1%, p < .01). However, among new full Medicaid participants, living in a state with a medically needy pathway was associated with a 3.8 percentage point (adjusted 95% confidence interval [1.8, 5.8]) increase in the probability of switching to partial Medicaid and a 4.5 percentage point (adjusted 95% confidence interval [2.9, 6.2]) increase in the probability of exiting Medicaid within 12 months. The predicted risk of leaving Medicaid was greatest when new Medicaid participants used only hospital services, rather than nursing home services, in their first month of Medicaid benefits. Alternative strategies for protecting low-income Medicare beneficiaries' access to care could provide more stable coverage.

Do medical out-of-pocket expenses thrust families into poverty?

PubMed

O'Hara, Brett

2004-02-01

This paper estimates the impact of medical out-of-pocket expenses on families' well-being using the Survey of Income and Program Participation. Medical out-of-pocket expenses include the out-of-pocket costs from medical services and the family's share of health insurance premiums. Demographic characteristics, insurance status, and medical usage of the family are analyzed to determine which characteristics are most likely to impoverish a family. Families impoverished because of medical out-of-pocket expenses are far more likely to have older heads of the family, at least one family member in poor health, or some adults without health insurance. Families without at least one person who worked full time for the entire year were also likely to be impoverished. However, children in the family had little effect on the probability that the family became impoverished. This odd result is probably due to the high correlation between parental health insurance coverage and the health insurance coverage of their children.

Welfare reform, labor supply, and health insurance in the immigrant population.

PubMed

Borjas, George J

2003-11-01

Although the 1996 welfare reform legislation limited the eligibility of immigrant households to receive assistance, many states chose to protect their immigrant populations by offering state-funded aid to these groups. I exploit these changes in eligibility rules to examine the link between the welfare cutbacks and health insurance coverage in the immigrant population. The data reveal that the cutbacks in the Medicaid program did not reduce health insurance coverage rates among targeted immigrants. The immigrants responded by increasing their labor supply, thereby raising the probability of being covered by employer-sponsored health insurance.

Do modern total knee replacements improve tibial coverage?

PubMed

Meier, Malin; Webb, Jonathan; Collins, Jamie E; Beckmann, Johannes; Fitz, Wolfgang

2018-01-25

The purpose of the present study is to compare newer designs of various symmetric and asymmetric tibial components and measure tibial bone coverage using the rotational safe zone defined by two commonly utilized anatomic rotational landmarks. Computed tomography scans (CT scans) of one hundred consecutive patients scheduled for total knee arthroplasty were obtained pre-operatively. A virtual proximal tibial cut was performed and two commonly used rotational axes were added for each image: the medio-lateral axis (ML-axis) and the medial 1/3 tibial tubercle axis (med-1/3-axis). Different symmetric and asymmetric implant designs were then superimposed in various rotational positions for best cancellous and cortical coverage. The images were imported to a public domain imaging software, and cancellous and cortical bone coverage was computed for each image, with each implant design in various rotational positions. One single implant type could not be identified that provided the best cortical and cancellous coverage of the tibia, irrespective of using the med-1/3-axis or the ML-axis for rotational alignment. However, it could be confirmed that the best bone coverage was dependent on the selected rotational landmark. Furthermore, improved bone coverage was observed when tibial implant positions were optimized between the two rotational axes. Tibial coverage is similar for symmetric and asymmetric designs, but depends on the rotational landmark for which the implant is designed. The surgeon has the option to improve tibial coverage by optimizing placement between the two anatomic rotational alignment landmarks, the medial 1/3 and the ML-axis. Surgeons should be careful assessing intraoperative rotational tibial placement using the described anatomic rotational landmarks to optimize tibial bony coverage without compromising patella tracking. III.

Infant immunization coverage in Italy: estimates by simultaneous EPI cluster surveys of regions. ICONA Study Group.

PubMed Central

Salmaso, S.; Rota, M. C.; Ciofi Degli Atti, M. L.; Tozzi, A. E.; Kreidl, P.

1999-01-01

In 1998, a series of regional cluster surveys (the ICONA Study) was conducted simultaneously in 19 out of the 20 regions in Italy to estimate the mandatory immunization coverage of children aged 12-24 months with oral poliovirus (OPV), diphtheria-tetanus (DT) and viral hepatitis B (HBV) vaccines, as well as optional immunization coverage with pertussis, measles and Haemophilus influenzae b (Hib) vaccines. The study children were born in 1996 and selected from birth registries using the Expanded Programme of Immunization (EPI) cluster sampling technique. Interviews with parents were conducted to determine each child's immunization status and the reasons for any missed or delayed vaccinations. The study population comprised 4310 children aged 12-24 months. Coverage for both mandatory and optional vaccinations differed by region. The overall coverage for mandatory vaccines (OPV, DT and HBV) exceeded 94%, but only 79% had been vaccinated in accord with the recommended schedule (i.e. during the first year of life). Immunization coverage for pertussis increased from 40% (1993 survey) to 88%, but measles coverage (56%) remained inadequate for controlling the disease; Hib coverage was 20%. These results confirm that in Italy the coverage of only mandatory immunizations is satisfactory. Pertussis immunization coverage has improved dramatically since the introduction of acellular vaccines. A greater effort to educate parents and physicians is still needed to improve the coverage of optional vaccinations in all regions. PMID:10593033

Infant immunization coverage in Italy: estimates by simultaneous EPI cluster surveys of regions. ICONA Study Group.

PubMed

Salmaso, S; Rota, M C; Ciofi Degli Atti, M L; Tozzi, A E; Kreidl, P

1999-01-01

In 1998, a series of regional cluster surveys (the ICONA Study) was conducted simultaneously in 19 out of the 20 regions in Italy to estimate the mandatory immunization coverage of children aged 12-24 months with oral poliovirus (OPV), diphtheria-tetanus (DT) and viral hepatitis B (HBV) vaccines, as well as optional immunization coverage with pertussis, measles and Haemophilus influenzae b (Hib) vaccines. The study children were born in 1996 and selected from birth registries using the Expanded Programme of Immunization (EPI) cluster sampling technique. Interviews with parents were conducted to determine each child's immunization status and the reasons for any missed or delayed vaccinations. The study population comprised 4310 children aged 12-24 months. Coverage for both mandatory and optional vaccinations differed by region. The overall coverage for mandatory vaccines (OPV, DT and HBV) exceeded 94%, but only 79% had been vaccinated in accord with the recommended schedule (i.e. during the first year of life). Immunization coverage for pertussis increased from 40% (1993 survey) to 88%, but measles coverage (56%) remained inadequate for controlling the disease; Hib coverage was 20%. These results confirm that in Italy the coverage of only mandatory immunizations is satisfactory. Pertussis immunization coverage has improved dramatically since the introduction of acellular vaccines. A greater effort to educate parents and physicians is still needed to improve the coverage of optional vaccinations in all regions.

Technical and scale efficiency in the delivery of child health services in Zambia: results from data envelopment analysis

PubMed Central

Achoki, Tom; Hovels, Anke; Masiye, Felix; Lesego, Abaleng; Leufkens, Hubert; Kinfu, Yohannes

2017-01-01

Objective Despite tremendous efforts to scale up key maternal and child health interventions in Zambia, progress has not been uniform across the country. This raises fundamental health system performance questions that require further investigation. Our study investigates technical and scale efficiency (SE) in the delivery of maternal and child health services in the country. Setting The study focused on all 72 health districts of Zambia. Methods We compiled a district-level database comprising health outcomes (measured by the probability of survival to 5 years of age), health outputs (measured by coverage of key health interventions) and a set of health system inputs, namely, financial resources and human resources for health, for the year 2010. We used data envelopment analysis to assess the performance of subnational units across Zambia with respect to technical and SE, controlling for environmental factors that are beyond the control of health system decision makers. Results Nationally, average technical efficiency with respect to improving child survival was 61.5% (95% CI 58.2% to 64.8%), which suggests that there is a huge inefficiency in resource use in the country and the potential to expand services without injecting additional resources into the system. Districts that were more urbanised and had a higher proportion of educated women were more technically efficient. Improved cooking methods and donor funding had no significant effect on efficiency. Conclusions With the pressing need to accelerate progress in population health, decision makers must seek efficient ways to deliver services to achieve universal health coverage. Understanding the factors that drive performance and seeking ways to enhance efficiency offer a practical pathway through which low-income countries could improve population health without necessarily seeking additional resources. PMID:28057650

[Impact of a targeted technical assistance to improve vaccine coverage in Cameroon, Côte d'Ivoire, and Mauritania in 2014].

PubMed

Ahanhanzo, Y Glèlè; Palenfo, D; Saussier, C; Gbèdonou, P; Tonda, A; Da Silva, A; Aplogan, A

2016-08-01

Within the framework of its strategic goal of vaccine coverage (VC) improvement, GAVI, The Vaccine Alliance has entrusted the Agence de médecine préventive (agency for preventive medicine, AMP) with technical assistance services to Cameroon, Cote d'Ivoire (Ivory Coast), and Mauritania. This support was provided to selected priority districts (PDs) with the worst Penta3 coverage performances. In 2014, PDs benefited from technical and management capacities in vaccinology strengthening for district medical officers, supportive supervisions and technical assistance in health logistics, data management and quality. We analyzed the effects of the AMP technical assistance on the improvement of the cumulative Penta3 coverage, which is the key performance indicator of the expanded programme on immunization (EPI) performance. We compared Penta3 coverage between PDs and other non-priority districts (NPDs), Penta3 coverage evolution within each PD, and the distribution of PDs and NPDs according to Penta3 coverage category between January and December 2014. Technical assistance had a positive effect on the EPI performance. Indeed Penta3 coverage progression was higher in PDs than in NPDs throughout the period. Besides, between January and December 2014, the Penta3 VC increased in 70%, 100% and 86% of DPs in Cameroon, Côte d'Ivoire and Mauritania, respectively. Furthermore, the increase in the number of PDs with a Penta3 coverage over 80% was higher in DPs than in NPDs: 20% versus 8% for Cameroon, 58% versus 29% for Côte d'Ivoire and 17% versus 8% for Mauritania. Despite positive and encouraging results, this technical assistance service can be improved and efforts are needed to ensure that all health districts have a VC above 80% for all EPI vaccines. The current challenge is for African countries to mobilize resources for maintaining the knowledge and benefits and scaling such interventions in the public health area.

Care 3 phase 2 report, maintenance manual

NASA Technical Reports Server (NTRS)

Bryant, L. A.; Stiffler, J. J.

1982-01-01

CARE 3 (Computer-Aided Reliability Estimation, version three) is a computer program designed to help estimate the reliability of complex, redundant systems. Although the program can model a wide variety of redundant structures, it was developed specifically for fault-tolerant avionics systems--systems distinguished by the need for extremely reliable performance since a system failure could well result in the loss of human life. It substantially generalizes the class of redundant configurations that could be accommodated, and includes a coverage model to determine the various coverage probabilities as a function of the applicable fault recovery mechanisms (detection delay, diagnostic scheduling interval, isolation and recovery delay, etc.). CARE 3 further generalizes the class of system structures that can be modeled and greatly expands the coverage model to take into account such effects as intermittent and transient faults, latent faults, error propagation, etc.

Uncritical and unbalanced coverage of synthetic biology in the Nordic press.

PubMed

Ancillotti, Mirko; Holmberg, Niklas; Lindfelt, Mikael; Eriksson, Stefan

2017-02-01

Synthetic biology will probably have a high impact on a variety of fields, such as healthcare, environment, biofuels, agriculture, and so on. A driving theme in European research policy is the importance of maintaining public legitimacy and support. Media can influence public attitudes and are therefore an important object of study. Through qualitative content analysis, this study investigates the press coverage of synthetic biology in the major Nordic countries between 2009 and 2014. The press coverage was found to be event-driven and there were striking similarities between countries when it comes to framing, language use, and treated themes. Reporters showed a marked dependence on their sources, mainly scientists and stakeholders, who thus drives the media agenda. The media portrayal was very positive, with an optimistic look at future benefits and very little discussion of possible risks.

Impact of Vaccination on 14 High-Risk HPV Type Infections: A Mathematical Modelling Approach

PubMed Central

Vänskä, Simopekka; Auranen, Kari; Leino, Tuija; Salo, Heini; Nieminen, Pekka; Kilpi, Terhi; Tiihonen, Petri; Apter, Dan; Lehtinen, Matti

2013-01-01

The development of high-risk human papillomavirus (hrHPV) infection to cervical cancer is a complicated process. We considered solely hrHPV infections, thus avoiding the confounding effects of disease progression, screening, and treatments. To analyse hrHPV epidemiology and to estimate the overall impact of vaccination against infections with hrHPVs, we developed a dynamic compartmental transmission model for single and multiple infections with 14 hrHPV types. The infection-related parameters were estimated using population-based sexual behaviour and hrHPV prevalence data from Finland. The analysis disclosed the important role of persistent infections in hrHPV epidemiology, provided further evidence for a significant natural immunity, and demonstrated the dependence of transmission probability estimates on the model structure. The model predicted that vaccinating girls at 80% coverage will result in a 55% reduction in the overall hrHPV prevalence and a higher 65% reduction in the prevalence of persistent hrHPV infections in females. In males, the reduction will be 42% in the hrHPV prevalence solely by the herd effect from the 80% coverage in girls. If such high coverage among girls is not reached, it is still possible to reduce the female hrHPV prevalence indirectly by the herd effect if also boys are included in the vaccination program. On the other hand, any herd effects in older unvaccinated cohorts were minor. Limiting the epidemiological model to infection yielded improved understanding of the hrHPV epidemiology and of mechanisms with which vaccination impacts on hrHPV infections. PMID:24009669

Mosquito-disseminated pyriproxyfen yields high breeding-site coverage and boosts juvenile mosquito mortality at the neighborhood scale.

PubMed

Abad-Franch, Fernando; Zamora-Perea, Elvira; Ferraz, Gonçalo; Padilla-Torres, Samael D; Luz, Sérgio L B

2015-04-01

Mosquito-borne pathogens pose major public health challenges worldwide. With vaccines or effective drugs still unavailable for most such pathogens, disease prevention heavily relies on vector control. To date, however, mosquito control has proven difficult, with low breeding-site coverage during control campaigns identified as a major drawback. A novel tactic exploits the egg-laying behavior of mosquitoes to have them disseminate tiny particles of a potent larvicide, pyriproxyfen (PPF), from resting to breeding sites, thus improving coverage. This approach has yielded promising results at small spatial scales, but its wider applicability remains unclear. We conducted a four-month trial within a 20-month study to investigate mosquito-driven dissemination of PPF dust-particles from 100 'dissemination stations' (DSs) deployed in a 7-ha sub-area to surveillance dwellings and sentinel breeding sites (SBSs) distributed over an urban neighborhood of about 50 ha. We assessed the impact of the trial by measuring juvenile mosquito mortality and adult mosquito emergence in each SBS-month. Using data from 1,075 dwelling-months, 2,988 SBS-months, and 29,922 individual mosquitoes, we show that mosquito-disseminated PPF yielded high coverage of dwellings (up to 100%) and SBSs (up to 94.3%). Juvenile mosquito mortality in SBSs (about 4% at baseline) increased by over one order of magnitude during PPF dissemination (about 75%). This led to a >10-fold decrease of adult mosquito emergence from SBSs, from approximately 1,000-3,000 adults/month before to about 100 adults/month during PPF dissemination. By expanding breeding-site coverage and boosting juvenile mosquito mortality, a strategy based on mosquito-disseminated PPF has potential to substantially enhance mosquito control. Sharp declines in adult mosquito emergence can lower vector/host ratios, reducing the risk of disease outbreaks. This approach is a very promising complement to current and novel mosquito control strategies; it will probably be especially relevant for the control of urban disease vectors, such as Aedes and Culex species, that often cause large epidemics.

Mosquito-Disseminated Pyriproxyfen Yields High Breeding-Site Coverage and Boosts Juvenile Mosquito Mortality at the Neighborhood Scale

PubMed Central

Abad-Franch, Fernando; Zamora-Perea, Elvira; Ferraz, Gonçalo; Padilla-Torres, Samael D.; Luz, Sérgio L. B.

2015-01-01

Background Mosquito-borne pathogens pose major public health challenges worldwide. With vaccines or effective drugs still unavailable for most such pathogens, disease prevention heavily relies on vector control. To date, however, mosquito control has proven difficult, with low breeding-site coverage during control campaigns identified as a major drawback. A novel tactic exploits the egg-laying behavior of mosquitoes to have them disseminate tiny particles of a potent larvicide, pyriproxyfen (PPF), from resting to breeding sites, thus improving coverage. This approach has yielded promising results at small spatial scales, but its wider applicability remains unclear. Methodology/Principal Findings We conducted a four-month trial within a 20-month study to investigate mosquito-driven dissemination of PPF dust-particles from 100 ‘dissemination stations’ (DSs) deployed in a 7-ha sub-area to surveillance dwellings and sentinel breeding sites (SBSs) distributed over an urban neighborhood of about 50 ha. We assessed the impact of the trial by measuring juvenile mosquito mortality and adult mosquito emergence in each SBS-month. Using data from 1,075 dwelling-months, 2,988 SBS-months, and 29,922 individual mosquitoes, we show that mosquito-disseminated PPF yielded high coverage of dwellings (up to 100%) and SBSs (up to 94.3%). Juvenile mosquito mortality in SBSs (about 4% at baseline) increased by over one order of magnitude during PPF dissemination (about 75%). This led to a >10-fold decrease of adult mosquito emergence from SBSs, from approximately 1,000–3,000 adults/month before to about 100 adults/month during PPF dissemination. Conclusions/Significance By expanding breeding-site coverage and boosting juvenile mosquito mortality, a strategy based on mosquito-disseminated PPF has potential to substantially enhance mosquito control. Sharp declines in adult mosquito emergence can lower vector/host ratios, reducing the risk of disease outbreaks. This approach is a very promising complement to current and novel mosquito control strategies; it will probably be especially relevant for the control of urban disease vectors, such as Aedes and Culex species, that often cause large epidemics. PMID:25849040

Determinants of National Health Insurance enrolment in Ghana across the life course: Are the results consistent between surveys?

PubMed

van der Wielen, Nele; Falkingham, Jane; Channon, Andrew Amos

2018-04-23

Ghana is currently undergoing a profound demographic transition, with large increases in the number of older adults in the population. Older adults require greater levels of healthcare as illness and disability increase with age. Ghana therefore provides an important and timely case study of policy implementation aimed at improving equal access to healthcare in the context of population ageing. This paper examines the determinants of National Health Insurance (NHIS) enrolment in Ghana, using two different surveys and distinguishing between younger and older adults. Two surveys are used in order to investigate consistency in insurance enrolment. The comparison between age groups is aimed at understanding whether determinants differ for older adults. Previous studies have mainly focused on the enrolment of young and middle aged adults; thus by widening the focus to include older adults and taking into account differences in their demographic and socio-economic characteristics this paper provides a unique contribution to the literature. Using data from the 2007-2008 Study on Global Ageing and Adult Health (SAGE) and the 2012-2013 Ghanaian Living Standards Survey (GLSS) the determinants of NHIS enrolment among younger adults (aged 18-49) and older adults (aged 50 and over) are compared. Logistic regression explores the socio-economic and demographic determinants of NHIS enrolment and multinomial logistic regression investigates the correlates of insurance drop out. Similar results for people aged 18-49 and people aged 50 plus were revealed, with older adults having a slightly lower probability of dropping out of insurance coverage compared to younger adults. Both surveys confirm that education and wealth increase the likelihood of NHIS affiliation. Further, residential differences in insurance coverage are found, with greater NHIS coverage in urban areas. The findings give assurance that both datasets (SAGE and GLSS) are suitable for research on insurance affiliation in Ghana. The paper indicates that although the gap in coverage among rich and poor and urban and rural residents appears to have decreased, these factors still determine NHIS coverage of younger and older adults. The same holds for education. Increasing efforts are needed to ensure equal access to healthcare.

Improving the Yule-Nielsen modified Neugebauer model by dot surface coverages depending on the ink superposition conditions

NASA Astrophysics Data System (ADS)

Hersch, Roger David; Crété, Frédérique

2004-12-01

Dot gain is different when dots are printed alone, printed in superposition with one ink or printed in superposition with two inks. In addition, the dot gain may also differ depending on which solid ink the considered halftone layer is superposed. In a previous research project, we developed a model for computing the effective surface coverage of a dot according to its superposition conditions. In the present contribution, we improve the Yule-Nielsen modified Neugebauer model by integrating into it our effective dot surface coverage computation model. Calibration of the reproduction curves mapping nominal to effective surface coverages in every superposition condition is carried out by fitting effective dot surfaces which minimize the sum of square differences between the measured reflection density spectra and reflection density spectra predicted according to the Yule-Nielsen modified Neugebauer model. In order to predict the reflection spectrum of a patch, its known nominal surface coverage values are converted into effective coverage values by weighting the contributions from different reproduction curves according to the weights of the contributing superposition conditions. We analyze the colorimetric prediction improvement brought by our extended dot surface coverage model for clustered-dot offset prints, thermal transfer prints and ink-jet prints. The color differences induced by the differences between measured reflection spectra and reflection spectra predicted according to the new dot surface estimation model are quantified on 729 different cyan, magenta, yellow patches covering the full color gamut. As a reference, these differences are also computed for the classical Yule-Nielsen modified spectral Neugebauer model incorporating a single halftone reproduction curve for each ink. Taking into account dot surface coverages according to different superposition conditions considerably improves the predictions of the Yule-Nielsen modified Neugebauer model. In the case of offset prints, the mean difference between predictions and measurements expressed in CIE-LAB CIE-94 ΔE94 values is reduced at 100 lpi from 1.54 to 0.90 (accuracy improvement factor: 1.7) and at 150 lpi it is reduced from 1.87 to 1.00 (accuracy improvement factor: 1.8). Similar improvements have been observed for a thermal transfer printer at 600 dpi, at lineatures of 50 and 75 lpi. In the case of an ink-jet printer at 600 dpi, the mean ΔE94 value is reduced at 75 lpi from 3.03 to 0.90 (accuracy improvement factor: 3.4) and at 100 lpi from 3.08 to 0.91 (accuracy improvement factor: 3.4).

Improving the Yule-Nielsen modified Neugebauer model by dot surface coverages depending on the ink superposition conditions

NASA Astrophysics Data System (ADS)

Hersch, Roger David; Crete, Frederique

2005-01-01

Dot gain is different when dots are printed alone, printed in superposition with one ink or printed in superposition with two inks. In addition, the dot gain may also differ depending on which solid ink the considered halftone layer is superposed. In a previous research project, we developed a model for computing the effective surface coverage of a dot according to its superposition conditions. In the present contribution, we improve the Yule-Nielsen modified Neugebauer model by integrating into it our effective dot surface coverage computation model. Calibration of the reproduction curves mapping nominal to effective surface coverages in every superposition condition is carried out by fitting effective dot surfaces which minimize the sum of square differences between the measured reflection density spectra and reflection density spectra predicted according to the Yule-Nielsen modified Neugebauer model. In order to predict the reflection spectrum of a patch, its known nominal surface coverage values are converted into effective coverage values by weighting the contributions from different reproduction curves according to the weights of the contributing superposition conditions. We analyze the colorimetric prediction improvement brought by our extended dot surface coverage model for clustered-dot offset prints, thermal transfer prints and ink-jet prints. The color differences induced by the differences between measured reflection spectra and reflection spectra predicted according to the new dot surface estimation model are quantified on 729 different cyan, magenta, yellow patches covering the full color gamut. As a reference, these differences are also computed for the classical Yule-Nielsen modified spectral Neugebauer model incorporating a single halftone reproduction curve for each ink. Taking into account dot surface coverages according to different superposition conditions considerably improves the predictions of the Yule-Nielsen modified Neugebauer model. In the case of offset prints, the mean difference between predictions and measurements expressed in CIE-LAB CIE-94 ΔE94 values is reduced at 100 lpi from 1.54 to 0.90 (accuracy improvement factor: 1.7) and at 150 lpi it is reduced from 1.87 to 1.00 (accuracy improvement factor: 1.8). Similar improvements have been observed for a thermal transfer printer at 600 dpi, at lineatures of 50 and 75 lpi. In the case of an ink-jet printer at 600 dpi, the mean ΔE94 value is reduced at 75 lpi from 3.03 to 0.90 (accuracy improvement factor: 3.4) and at 100 lpi from 3.08 to 0.91 (accuracy improvement factor: 3.4).

[Health insurance for infants and infant vaccination related to forced-displacement in Colombia].

PubMed

Ruiz-Rodríguez, Myriam; Vera-Cala, Lina M; López-Barbosa, Nahyr

2008-01-01

Determining vaccination coverage amongst children (<5 years old) having multiple socio-economic risk factors and their relationship to insurance status. This was a cross-sectional study of 514 families from urban settlements receiving people displaced by the armed conflict in 4 municipalities in the Santander department ( Colombia ). The households were selected by probabilistic sampling, using proportional modelling by municipality. Immunisation data was collected from vaccination cards; interviews provided socio-demographic data. The dependent variable consisted of having the complete vaccination scheme by age according to the official Ministry of Social Protection's programme. The probability of being vaccinated was modelled by a logistical regression, adjusted for sociodemographic variables. 369 children were studied, of whom 48,8 % belonged to families displaced by the armed conflict. 46,1 % of the people being interviewed presented their vaccination cards. Contrary to what had been expected, only 21,2 % of those having a vaccination card were insured and 22,9 % of them had a complete vaccination scheme for their age. The probability of having a complete vaccination scheme for those individuals who were covered by the subsidised health system was 2,4 times higher when compared to those who were not insured (p=0.042). Low vaccination coverage indicated barriers for people living in conditions of poverty and displacement obtaining health services and low insurance coverage suggested faults in health insurance policies addressing similar populations.

Household survey analysis of the impact of comprehensive strategies to improve the expanded programme on immunisation at the county level in western China, 2006–2010

PubMed Central

Zhou, Yuqing; Xing, Yi; Liang, Xiaofeng; Yue, Chenyan; Zhu, Xu; Hipgrave, David

2016-01-01

Objective To evaluate interventions to improve routine vaccination coverage and caregiver knowledge in China's remote west, where routine immunisation is relatively weak. Design Prospective pre–post (2006–2010) evaluation in project counties; retrospective comparison based on 2004 administrative data at baseline and surveyed post-intervention (2010) data in selected non-project counties. Setting Four project counties and one non-project county in each of four provinces. Participants 3390 children in project counties at baseline, and 3299 in project and 830 in non-project counties post-intervention; and 3279 caregivers at baseline, and 3389 in project and 830 in non-project counties post-intervention. Intervention Multicomponent inexpensive knowledge-strengthening and service-strengthening and innovative, multisectoral engagement. Data collection Standard 30-cluster household surveys of vaccine coverage and caregiver interviews pre-intervention and post-intervention in each project county. Similar surveys in one non-project county selected by local authorities in each province post-intervention. Administrative data on vaccination coverage in non-project counties at baseline. Primary outcome measures Changes in vaccine coverage between baseline and project completion (2010); comparative caregiver knowledge in all counties in 2010. Analysis Crude (χ2) analysis of changes and differences in vaccination coverage and related knowledge. Multiple logistic regression to assess associations with timely coverage. Results Timely coverage of four routine vaccines increased by 21% (p<0.001) and hepatitis B (HepB) birth dose by 35% (p<0.001) over baseline in project counties. Comparison with non-project counties revealed secular improvement in most provinces, except new vaccine coverage was mostly higher in project counties. Ethnicity, province, birthplace, vaccination site, dual-parental out-migration and parental knowledge had significant associations with coverage. Knowledge increased for all variables but one in project counties (highest p<0.05) and was substantially higher than in non-project counties (p<0.01). Conclusions Comprehensive but inexpensive strategies improved vaccination coverage and caretaker knowledge in western China. Establishing multisectoral leadership, involving the education sector and including immunisation in public-sector performance standards, are affordable and effective interventions. PMID:26966053

Severity of pain is associated with insufficient energy coverage in hospitalised patients: A cross-sectional study.

PubMed

Makhlouf, Anne-Marie; Kossovsky, Michel P; Gurba, France; Pautex, Sophie; Chikhi, Marinette; Pichard, Claude; Genton, Laurence

2018-03-17

The severity of pain is routinely assessed in hospitalised patients but the impact of pain and pain control on energy coverage has been poorly studied. This One-day cross-sectional observational study assessed the association between severity of pain and coverage of energy needs in hospitalised patients. Foods provided and consumed were assessed on one day by dedicated dieticians for unselected hospitalised patients receiving three meals per day. Severity of pain was evaluated by a visual analogue scale at the mealtimes, averaged over the study day, and categorized as no pain, slight, moderate or severe pain. The coverage of energy needs was expressed in percentage of predicted needs. Among the 755 included patients, 63% reported having pain. Severe pain was associated with a lower energy coverage than no pain (p = 0.001) or slight pain (p = 0.001). Insufficient energy coverage, defined as ≤70% of predicted needs, occurred in 13% of the patients. In univariate logistic regressions, predictors of insufficient energy coverage were severe pain as compared to no pain (OR 2.38; 95% CI 1.21, 4.64) and treatment with opioid drugs as compared to no pain killer (OR 1.73; 95% CI 1.07, 2.79). When including sex, age, body mass index, treatment with analgesics and severity of pain in a multivariate logistic regression, severe pain more than doubled the risk of insufficient energy coverage (OR 2.32; CI 1.15, 4.66). Patients experiencing severe pain have a high risk of insufficient energy coverage. Optimal pain control is probably critical to prevent underfeeding in the hospital. Identifier no NCT02463565 on www.ClinicalTrials.gov. Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Are "Sisters in Crime" Finally Being Booked? The Coverage of Women and Crime in Journals and Textbooks.

ERIC Educational Resources Information Center

Wright, Richard A.

1987-01-01

Compares coverage of women and crime in sociology journals published from 1956-1960 and from 1976-1980 with coverage in criminology texts published from 1956-1965 and from 1976-1985. Data shows despite recent increases in publication of research in journals, criminology texts show little improvement in their coverage of women and crime. Concludes…

Sensitivity of postplanning target and OAR coverage estimates to dosimetric margin distribution sampling parameters

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

Xu Huijun; Gordon, J. James; Siebers, Jeffrey V.

2011-02-15

Purpose: A dosimetric margin (DM) is the margin in a specified direction between a structure and a specified isodose surface, corresponding to a prescription or tolerance dose. The dosimetric margin distribution (DMD) is the distribution of DMs over all directions. Given a geometric uncertainty model, representing inter- or intrafraction setup uncertainties or internal organ motion, the DMD can be used to calculate coverage Q, which is the probability that a realized target or organ-at-risk (OAR) dose metric D{sub v} exceeds the corresponding prescription or tolerance dose. Postplanning coverage evaluation quantifies the percentage of uncertainties for which target and OAR structuresmore » meet their intended dose constraints. The goal of the present work is to evaluate coverage probabilities for 28 prostate treatment plans to determine DMD sampling parameters that ensure adequate accuracy for postplanning coverage estimates. Methods: Normally distributed interfraction setup uncertainties were applied to 28 plans for localized prostate cancer, with prescribed dose of 79.2 Gy and 10 mm clinical target volume to planning target volume (CTV-to-PTV) margins. Using angular or isotropic sampling techniques, dosimetric margins were determined for the CTV, bladder and rectum, assuming shift invariance of the dose distribution. For angular sampling, DMDs were sampled at fixed angular intervals {omega} (e.g., {omega}=1 deg., 2 deg., 5 deg., 10 deg., 20 deg.). Isotropic samples were uniformly distributed on the unit sphere resulting in variable angular increments, but were calculated for the same number of sampling directions as angular DMDs, and accordingly characterized by the effective angular increment {omega}{sub eff}. In each direction, the DM was calculated by moving the structure in radial steps of size {delta}(=0.1,0.2,0.5,1 mm) until the specified isodose was crossed. Coverage estimation accuracy {Delta}Q was quantified as a function of the sampling parameters {omega} or {omega}{sub eff} and {delta}. Results: The accuracy of coverage estimates depends on angular and radial DMD sampling parameters {omega} or {omega}{sub eff} and {delta}, as well as the employed sampling technique. Target |{Delta}Q|<1% and OAR |{Delta}Q|<3% can be achieved with sampling parameters {omega} or {omega}{sub eff}=20 deg., {delta}=1 mm. Better accuracy (target |{Delta}Q|<0.5% and OAR |{Delta}Q|<{approx}1%) can be achieved with {omega} or {omega}{sub eff}=10 deg., {delta}=0.5 mm. As the number of sampling points decreases, the isotropic sampling method maintains better accuracy than fixed angular sampling. Conclusions: Coverage estimates for post-planning evaluation are essential since coverage values of targets and OARs often differ from the values implied by the static margin-based plans. Finer sampling of the DMD enables more accurate assessment of the effect of geometric uncertainties on coverage estimates prior to treatment. DMD sampling with {omega} or {omega}{sub eff}=10 deg. and {delta}=0.5 mm should be adequate for planning purposes.« less

Sensitivity of postplanning target and OAR coverage estimates to dosimetric margin distribution sampling parameters.

PubMed

Xu, Huijun; Gordon, J James; Siebers, Jeffrey V

2011-02-01

A dosimetric margin (DM) is the margin in a specified direction between a structure and a specified isodose surface, corresponding to a prescription or tolerance dose. The dosimetric margin distribution (DMD) is the distribution of DMs over all directions. Given a geometric uncertainty model, representing inter- or intrafraction setup uncertainties or internal organ motion, the DMD can be used to calculate coverage Q, which is the probability that a realized target or organ-at-risk (OAR) dose metric D, exceeds the corresponding prescription or tolerance dose. Postplanning coverage evaluation quantifies the percentage of uncertainties for which target and OAR structures meet their intended dose constraints. The goal of the present work is to evaluate coverage probabilities for 28 prostate treatment plans to determine DMD sampling parameters that ensure adequate accuracy for postplanning coverage estimates. Normally distributed interfraction setup uncertainties were applied to 28 plans for localized prostate cancer, with prescribed dose of 79.2 Gy and 10 mm clinical target volume to planning target volume (CTV-to-PTV) margins. Using angular or isotropic sampling techniques, dosimetric margins were determined for the CTV, bladder and rectum, assuming shift invariance of the dose distribution. For angular sampling, DMDs were sampled at fixed angular intervals w (e.g., w = 1 degree, 2 degrees, 5 degrees, 10 degrees, 20 degrees). Isotropic samples were uniformly distributed on the unit sphere resulting in variable angular increments, but were calculated for the same number of sampling directions as angular DMDs, and accordingly characterized by the effective angular increment omega eff. In each direction, the DM was calculated by moving the structure in radial steps of size delta (=0.1, 0.2, 0.5, 1 mm) until the specified isodose was crossed. Coverage estimation accuracy deltaQ was quantified as a function of the sampling parameters omega or omega eff and delta. The accuracy of coverage estimates depends on angular and radial DMD sampling parameters omega or omega eff and delta, as well as the employed sampling technique. Target deltaQ/ < l% and OAR /deltaQ/ < 3% can be achieved with sampling parameters omega or omega eef = 20 degrees, delta =1 mm. Better accuracy (target /deltaQ < 0.5% and OAR /deltaQ < approximately 1%) can be achieved with omega or omega eff = 10 degrees, delta = 0.5 mm. As the number of sampling points decreases, the isotropic sampling method maintains better accuracy than fixed angular sampling. Coverage estimates for post-planning evaluation are essential since coverage values of targets and OARs often differ from the values implied by the static margin-based plans. Finer sampling of the DMD enables more accurate assessment of the effect of geometric uncertainties on coverage estimates prior to treatment. DMD sampling with omega or omega eff = 10 degrees and delta = 0.5 mm should be adequate for planning purposes.

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

FY11 Report on Metagenome Analysis using Pathogen Marker Libraries

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

Gardner, Shea N.; Allen, Jonathan E.; McLoughlin, Kevin S.

2011-06-02

A method, sequence library, and software suite was invented to rapidly assess whether any member of a pre-specified list of threat organisms or their near neighbors is present in a metagenome. The system was designed to handle mega- to giga-bases of FASTA-formatted raw sequence reads from short or long read next generation sequencing platforms. The approach is to pre-calculate a viral and a bacterial "Pathogen Marker Library" (PML) containing sub-sequences specific to pathogens or their near neighbors. A list of expected matches comparing every bacterial or viral genome against the PML sequences is also pre-calculated. To analyze a metagenome, readsmore » are compared to the PML, and observed PML-metagenome matches are compared to the expected PML-genome matches, and the ratio of observed relative to expected matches is reported. In other words, a 3-way comparison among the PML, metagenome, and existing genome sequences is used to quickly assess which (if any) species included in the PML is likely to be present in the metagenome, based on available sequence data. Our tests showed that the species with the most PML matches correctly indicated the organism sequenced for empirical metagenomes consisting of a cultured, relatively pure isolate. These runs completed in 1 minute to 3 hours on 12 CPU (1 thread/CPU), depending on the metagenome and PML. Using more threads on the same number of CPU resulted in speed improvements roughly proportional to the number of threads. Simulations indicated that detection sensitivity depends on both sequencing coverage levels for a species and the size of the PML: species were correctly detected even at ~0.003x coverage by the large PMLs, and at ~0.03x coverage by the smaller PMLs. Matches to true positive species were 3-4 orders of magnitude higher than to false positives. Simulations with short reads (36 nt and ~260 nt) showed that species were usually detected for metagenome coverage above 0.005x and coverage in the PML above 0.05x, and detection probability appears to be a function of both coverages. Multiple species could be detected simultaneously in a simulated low-coverage, complex metagenome, and the largest PML gave no false negative species and no false positive genera. The presence of multiple species was predicted in a complex metagenome from a human gut microbiome with 1.9 GB of short reads (75 nt); the species predicted were reasonable gut flora and no biothreat agents were detected, showing the feasibility of PML analysis of empirical complex metagenomes.« less

WE-AB-209-08: Novel Beam-Specific Adaptive Margins for Reducing Organ-At-Risk Doses

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

Tsang, H; Kamerling, CP; Ziegenhein, P

2016-06-15

Purpose: Current practice of using 3D margins in radiotherapy with high-energy photon beams provides larger-than-required target coverage. According to the photon depth-dose curve, target displacements in beam direction result in minute changes in dose delivered. We exploit this behavior by generating margins on a per-beam basis which simultaneously account for the relative distance of the target and adjacent organs-at-risk (OARs). Methods: For each beam, we consider only geometrical uncertainties of the target location perpendicular to beam direction. By weighting voxels based on its proximity to an OAR, we generate adaptive margins that yield similar overall target coverage probability and reducedmore » OAR dose-burden, at the expense of increased target volume. Three IMRT plans, using 3D margins and 2D per-beam margins with and without adaptation, were generated for five prostate patients with a prescription dose Dpres of 78Gy in 2Gy fractions using identical optimisation constraints. Systematic uncertainties of 1.1, 1.1, 1.5mm in the LR, SI, and AP directions, respectively, and 0.9, 1.1, 1.0mm for the random uncertainties, were assumed. A verification tool was employed to simulate the effects of systematic and random errors using a population size of 50,000. The fraction of the population that satisfies or violates a given DVH constraint was used for comparison. Results: We observe similar target coverage across all plans, with at least 97.5% of the population meeting the D98%>95%Dpres constraint. When looking at the probability of the population receiving D5<70Gy for the rectum, we observed median absolute increases of 23.61% (range, 2.15%–27.85%) and 6.97% (range, 0.65%–17.76%) using per-beam margins with and without adaptation, respectively, relative to using 3D margins. Conclusion: We observed sufficient and similar target coverage using per-beam margins. By adapting each per-beam margin away from an OAR, we can further reduce OAR dose without significantly lowering target coverage probability by irradiating more less-important tissues. This work is supported by Cancer Research UK under Programme C33589/A19908. Research at ICR is also supported by Cancer Research UK under Programme C33589/A19727 and NHS funding to the NIHR Biomedical Research Centre at RMH and ICR.« less

Association mapping identifies loci for canopy coverage in diverse soybean genotypes

USDA-ARS?s Scientific Manuscript database

Rapid establishment of canopy coverage decreases soil evaporation relative to transpiration (T), improves water use efficiency (WUE) and light interception, and increases soybean competitiveness against weeds. The objective of this study was to identify genomic loci associated with canopy coverage (...

38 CFR 71.45 - Revocation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... the Family Caregiver in transitioning to alternative health care coverage and with mental health... individual with transitioning to alternative health care coverage and with mental health services, unless one... health care coverage and with mental health services. If revocation is due to improvement in the eligible...

38 CFR 71.45 - Revocation.

Code of Federal Regulations, 2012 CFR

2012-07-01

... the Family Caregiver in transitioning to alternative health care coverage and with mental health... individual with transitioning to alternative health care coverage and with mental health services, unless one... health care coverage and with mental health services. If revocation is due to improvement in the eligible...

Quantitative colorectal cancer perfusion measurement by multidetector-row CT: does greater tumour coverage improve measurement reproducibility?

PubMed

Goh, V; Halligan, S; Gartner, L; Bassett, P; Bartram, C I

2006-07-01

The purpose of this study was to determine if greater z-axis tumour coverage improves the reproducibility of quantitative colorectal cancer perfusion measurements using CT. A 65 s perfusion study was acquired following intravenous contrast administration in 10 patients with proven colorectal cancer using a four-detector row scanner. This was repeated within 48 h using identical technical parameters to allow reproducibility assessment. Quantitative tumour blood volume, blood flow, mean transit time and permeability measurements were determined using commercially available software (Perfusion 3.0; GE Healthcare, Waukesha, WI) for data obtained from a 5 mm z-axis tumour coverage, and from a 20 mm z-axis tumour coverage. Measurement reproducibility was assessed using Bland-Altman statistics, for a 5 mm z-axis tumour coverage, and 20 mm z-axis tumour coverage, respectively. The mean difference (95% limits of agreement) for blood volume, blood flow, mean transit time and permeability were 0.04 (-2.50 to +2.43) ml/100 g tissue; +8.80 (-50.5 to +68.0) ml/100 g tissue/min; -0.99 (-8.19 to +6.20) seconds; and +1.20 (-5.42 to +7.83) ml/100 g tissue/min, respectively, for a 5 mm coverage, and -0.04 (-2.61 to +2.53) ml/100 g tissue; +7.40 (-50.3 to +65.0) ml/100 g tissue/min; -2.46 (-12.61 to +7.69) seconds; and -0.23 (-8.31 to +7.85) ml/100 g tissue/min, respectively, for a 20 mm coverage, indicating similar levels of agreement. In conclusion, increasing z-axis coverage does not improve reproducibility of quantitative colorectal cancer perfusion measurements.

Digital, Satellite-Based Aeronautical Communication

NASA Technical Reports Server (NTRS)

Davarian, F.

1989-01-01

Satellite system relays communication between aircraft and stations on ground. System offers better coverage with direct communication between air and ground, costs less and makes possible new communication services. Carries both voice and data. Because many data exchanged between aircraft and ground contain safety-related information, probability of bit errors essential.

Policy Changes and Improvements in Health Insurance Coverage Among MSM: 20 U.S. Cities, 2008-2014.

PubMed

Cooley, Laura A; Hoots, Brooke; Wejnert, Cyprian; Lewis, Rashunda; Paz-Bailey, Gabriela

2017-03-01

Recent policy changes have improved the ability of gay, bisexual, and other men who have sex with men (MSM) to secure health insurance. We wanted to assess changes over time in self-reported health insurance status among MSM participating in CDC's National HIV Behavioral Surveillance (NHBS) in 2008, 2011, and 2014. We analyzed NHBS data from sexually active MSM interviewed at venues in 20 U.S. cities. To determine if interview year was associated with health insurance status, we used a Poisson model with robust standard errors. Among included MSM, the overall percentage of MSM with health insurance rose 16 % from 2008 (68 %) to 2014 (79 %) (p value for trend < 0.001). The change in coverage over time was greatest in key demographic segments with lower health insurance coverage all three interview years, by age, education, and income. Corresponding with recent policy changes, health insurance improved among MSM participating in NHBS, with greater improvements in historically underinsured demographic segments. Despite these increases, improved coverage is still needed. Improved access to health insurance could lead to a reduction in health disparities among MSM over time.

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

Accelerating progress towards universal health coverage in Asia and Pacific: improving the future for women and children

PubMed Central

Beattie, Allison; Yates, Robert; Noble, Douglas J

2016-01-01

Universal health coverage generates significant health and economic benefits and enables governments to reduce inequity. Where universal health coverage has been implemented well, it can contribute to nation-building. This analysis reviews evidence from Asia and Pacific drawing out determinants of successful systems and barriers to progress with a focus on women and children. Access to healthcare is important for women and children and contributes to early childhood development. Universal health coverage is a political process from the start, and public financing is critical and directly related to more equitable health systems. Closing primary healthcare gaps should be the foundation of universal health coverage reforms. Recommendations for policy for national governments to improve universal health coverage are identified, including countries spending < 3% of gross domestic product in public expenditure on health committing to increasing funding by at least 0.3%/year to reach a minimum expenditure threshold of 3%. PMID:28588989

Time-Distance Helioseismology with the HMI Instrument

NASA Technical Reports Server (NTRS)

Duvall, Thomas L., Jr.

2010-01-01

We expect considerable improvement of time-distance results from the Helioseismic and Magnetic Imager (HMI) instrument as opposed to the earlier MDI and GONG data. The higher data rate makes possible several improvements, including faster temporal sampling (45 sec), smaller spatial pixels (0.5 arc sec), better wavelength coverage (6 samples across the line all transmitted to the ground), and year-round coverage of the full disk. The higher spatial resolution makes possible better longitude coverage of active regions and supergranulation and also better latitude coverage. Doppler, continuum, and line depth images have a strong granulation signal. Line core images show little granulation. Analyses to test the limits of these new capabilities will be presented.

Men who work at age 70 or older.

PubMed

Ozawa, Martha N; Lum, Terry Y

2005-01-01

The federal policy on older workers has shifted from the encouragement of early withdrawal from the labor force to the encouragement of continuous participation in the labor force. In this light, it is instructive to investigate the backgrounds of elderly people who work at age 70 or older. This article presents the findings of a study, using data from the 1993 Asset and Health Dynamics of the Oldest Old Study, that investigated the effects of health, economic conditions (net worth, employer-provided pensions, and supplemental medical insurance coverage), education, and spouse's work status on the probability of working among men aged 70 or older. The study addressed the probability of working, the probability of working fulltime and of working part-time, and the probability of being self-employed and of being employed by others. Implications for policy are discussed.

CORNAS: coverage-dependent RNA-Seq analysis of gene expression data without biological replicates.

PubMed

Low, Joel Z B; Khang, Tsung Fei; Tammi, Martti T

2017-12-28

In current statistical methods for calling differentially expressed genes in RNA-Seq experiments, the assumption is that an adjusted observed gene count represents an unknown true gene count. This adjustment usually consists of a normalization step to account for heterogeneous sample library sizes, and then the resulting normalized gene counts are used as input for parametric or non-parametric differential gene expression tests. A distribution of true gene counts, each with a different probability, can result in the same observed gene count. Importantly, sequencing coverage information is currently not explicitly incorporated into any of the statistical models used for RNA-Seq analysis. We developed a fast Bayesian method which uses the sequencing coverage information determined from the concentration of an RNA sample to estimate the posterior distribution of a true gene count. Our method has better or comparable performance compared to NOISeq and GFOLD, according to the results from simulations and experiments with real unreplicated data. We incorporated a previously unused sequencing coverage parameter into a procedure for differential gene expression analysis with RNA-Seq data. Our results suggest that our method can be used to overcome analytical bottlenecks in experiments with limited number of replicates and low sequencing coverage. The method is implemented in CORNAS (Coverage-dependent RNA-Seq), and is available at https://github.com/joel-lzb/CORNAS .

Stability of children's insurance coverage and implications for access to care: evidence from the Survey of Income and Program Participation.

PubMed

Buchmueller, Thomas; Orzol, Sean M; Shore-Sheppard, Lara

2014-06-01

Even as the number of children with health insurance has increased, coverage transitions--movement into and out of coverage and between public and private insurance--have become more common. Using data from 1996 to 2005, we examine whether insurance instability has implications for access to primary care. Because unobserved factors related to parental behavior and child health may affect both the stability of coverage and utilization, we estimate the relationship between insurance and the probability that a child has at least one physician visit per year using a model that includes child fixed effects to account for unobserved heterogeneity. Although we find that unobserved heterogeneity is an important factor influencing cross-sectional correlations, conditioning on child fixed effects we find a statistically and economically significant relationship between insurance coverage stability and access to care. Children who have part-year public or private insurance are more likely to have at least one doctor's visit than children who are uninsured for a full year, but less likely than children with full-year coverage. We find comparable effects for public and private insurance. Although cross-sectional analyses suggest that transitions directly between public and private insurance are associated with lower rates of utilization, the evidence of such an effect is much weaker when we condition on child fixed effects.

Universal health coverage in Latin American countries: how to improve solidarity-based schemes.

PubMed

Titelman, Daniel; Cetrángolo, Oscar; Acosta, Olga Lucía

2015-04-04

In this Health Policy we examine the association between the financing structure of health systems and universal health coverage. Latin American health systems encompass a wide range of financial sources, which translate into different solidarity-based schemes that combine contributory (payroll taxes) and non-contributory (general taxes) sources of financing. To move towards universal health coverage, solidarity-based schemes must heavily rely on countries' capacity to increase public expenditure in health. Improvement of solidarity-based schemes will need the expansion of mandatory universal insurance systems and strengthening of the public sector including increased fiscal expenditure. These actions demand a new model to integrate different sources of health-sector financing, including general tax revenue, social security contributions, and private expenditure. The extent of integration achieved among these sources will be the main determinant of solidarity and universal health coverage. The basic challenges for improvement of universal health coverage are not only to spend more on health, but also to reduce the proportion of out-of-pocket spending, which will need increased fiscal resources. Copyright © 2015 Elsevier Ltd. All rights reserved.

Ethnicity, education attainment, media exposure, and prenatal care in Vietnam.

PubMed

Trinh, Ha Ngoc; Korinek, Kim

2017-02-01

Prenatal care coverage in Vietnam has been improving, but ethnic minority women still lag behind in receiving adequate level and type of care. This paper examines ethnic disparities in prenatal care utilization by comparing two groups of ethnic minority and majority women. We examine the roots of ethnic disparity in prenatal care utilization, focusing on how education and media exposure change health behaviours and lessen disparities. We rely on the 2002 Vietnam Demographic and Health Survey to draw our sample, predictors and the three dimensions of prenatal care, including timing of onset, frequency of visits, and type of provider. Results from multinomial-, and binary-logistic regression provide evidence that ethnic minority women are less likely to obtain frequent prenatal care and seek care from professional providers than their majority counterparts. However, we find that ethnic minority women are more likely to obtain early care compared to ethnic majority women. Results for predicted probabilities suggest that education and media exposure positively influenced prenatal care behaviours with higher level of education and media exposure associating with accelerated probability of meeting prenatal care requirements. Our results imply the needs for expansion of media access and schools as well as positive health messages being broadcasted in culturally competent ways.

Comparison of treatment plans: a retrospective study by the method of radiobiological evaluation

NASA Astrophysics Data System (ADS)

Puzhakkal, Niyas; Kallikuzhiyil Kochunny, Abdullah; Manthala Padannayil, Noufal; Singh, Navin; Elavan Chalil, Jumanath; Kulangarakath Umer, Jamshad

2016-09-01

There are many situations in radiotherapy where multiple treatment plans need to be compared for selection of an optimal plan. In this study we performed the radiobiological method of plan evaluation to verify the treatment plan comparison procedure of our clinical practice. We estimated and correlated various radiobiological dose indices with physical dose metrics for a total of 30 patients representing typical cases of head and neck, prostate and brain tumors. Three sets of plans along with a clinically approved plan (final plan) treated by either Intensity Modulated Radiation Therapy (IMRT) or Rapid Arc (RA) techniques were considered. The study yielded improved target coverage for final plans, however, no appreciable differences in doses and the complication probabilities of organs at risk were noticed. Even though all four plans showed adequate dose distributions, from dosimetric point of view, the final plan had more acceptable dose distribution. The estimated biological outcome and dose volume histogram data showed least differences between plans for IMRT when compared to RA. Our retrospective study based on 120 plans, validated the radiobiological method of plan evaluation. The tumor cure or normal tissue complication probabilities were found to be correlated with the corresponding physical dose indices.

Why do boomers plan to work longer?

PubMed

Mermin, Gordon B T; Johnson, Richard W; Murphy, Dan P

2007-09-01

. Recent changes in retirement trends and patterns have raised questions about the likely retirement behavior of baby boomers, the large cohort born between 1946 and 1964. This study examined recent changes in retirement expectations and the factors that drove them. Using data from the Health and Retirement Study, the analysis compared self-reported probabilities of working full time past ages 62 and 65 among workers aged 51 to 56 in 1992 and 2004. The study modeled retirement expectations for both generations and used the estimated regression coefficients to identify the forces that accounted for generational differences. . Between 1992 and 2004, the mean self-reported probability of working full time past age 65 among workers aged 51 to 56 increased from 27% to 33%. Lower rates of retiree health insurance offers from employers, higher levels of educational attainment, and lower rates of defined benefit pension coverage accounted for most of the growth. Given the continued erosion in employer-sponsored retiree health benefits and defined benefit pension plans, boomers will likely remain at work longer than members of the previous generation. Lengthier careers will likely promote economic growth, increase government revenue, and improve individual financial security at older ages.

Spatial distribution of epibenthic molluscs on a sandstone reef in the Northeast of Brazil.

PubMed

Martinez, A S; Mendes, L F; Leite, T S

2012-05-01

The present study investigated the distribution and abundance of epibenthic molluscs and their feeding habits associated to substrate features (coverage and rugosity) in a sandstone reef system in the Northeast of Brazil. Rugosity, low coral cover and high coverage of zoanthids and fleshy alga were the variables that influenced a low richness and high abundance of a few molluscan species in the reef habitat. The most abundant species were generalist carnivores, probably associated to a lesser offer and variability of resources in this type of reef system, when compared to the coral reefs. The results found in this study could reflect a normal characteristic of the molluscan community distribution in sandstone reefs, with low coral cover, or could indicate a degradation state of this habitat if it is compared to coral reefs, once that the significantly high coverage of fleshy alga has been recognized as a negative indicator of reef ecosystems health.

Quality Improvement to Immunization Coverage in Primary Care Measured in Medical Record and Population-Based Registry Data.

PubMed

Harder, Valerie S; Barry, Sara E; Ahrens, Bridget; Davis, Wendy S; Shaw, Judith S

Despite the proven benefits of immunizations, coverage remains low in many states, including Vermont. This study measured the impact of a quality improvement (QI) project on immunization coverage in childhood, school-age, and adolescent groups. In 2013, a total of 20 primary care practices completed a 7-month QI project aimed to increase immunization coverage among early childhood (29-33 months), school-age (6 years), and adolescent (13 years) age groups. For this study, we examined random cross-sectional medical record reviews from 12 of the 20 practices within each age group in 2012, 2013, and 2014 to measure improvement in immunization coverage over time using chi-squared tests. We repeated these analyses on population-level data from Vermont's immunization registry for the 12 practices in each age group each year. We used difference-in-differences regressions in the immunization registry data to compare improvements over time between the 12 practices and those not participating in QI. Immunization coverage increased over 3 years for all ages and all immunization series (P ≤ .009) except one, as measured by medical record review. Registry results aligned partially with medical record review with increases in early childhood and adolescent series over time (P ≤ .012). Notably, the adolescent immunization series completion, including human papillomavirus, increased more than in the comparison practices (P = .037). Medical record review indicated that QI efforts led to increases in immunization coverage in pediatric primary care. Results were partially validated in the immunization registry particularly among early childhood and adolescent groups, with a population-level impact of the intervention among adolescents. Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

76 FR 37049 - Improving Wireless Coverage Through the Use of Signal Boosters

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-24

... FEDERAL COMMUNICATIONS COMMISSION 47 CFR Parts 1, 2, 22, 24, 27, 90 and 95 [WT Docket No. 10-4; DA 11-1078] Improving Wireless Coverage Through the Use of Signal Boosters AGENCY: Federal Communications Commission. ACTION: Proposed rule; extension of comment period. SUMMARY: The Federal...

Potential Improvements to VLBA UV-Coverages by the Addition of a 32-m Peruvian Antenna

NASA Astrophysics Data System (ADS)

Horiuchi, S.; Murphy, D. W.; Ishitsuka, J. K.; Ishitsuka, M.

2005-12-01

A plan is being currently developed to convert a 32-m telecomunications antenna in the Peruvian Andes into a radio astronomy facility. Significant improvements to stand-alone VLBA UV-coverages can be obtained with the addition of this southern hemisphere telescope to VLBA observations.

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

Universal health coverage in Turkey: enhancement of equity.

PubMed

Atun, Rifat; Aydın, Sabahattin; Chakraborty, Sarbani; Sümer, Safir; Aran, Meltem; Gürol, Ipek; Nazlıoğlu, Serpil; Ozgülcü, Senay; Aydoğan, Ulger; Ayar, Banu; Dilmen, Uğur; Akdağ, Recep

2013-07-06

Turkey has successfully introduced health system changes and provided its citizens with the right to health to achieve universal health coverage, which helped to address inequities in financing, health service access, and health outcomes. We trace the trajectory of health system reforms in Turkey, with a particular emphasis on 2003-13, which coincides with the Health Transformation Program (HTP). The HTP rapidly expanded health insurance coverage and access to health-care services for all citizens, especially the poorest population groups, to achieve universal health coverage. We analyse the contextual drivers that shaped the transformations in the health system, explore the design and implementation of the HTP, identify the factors that enabled its success, and investigate its effects. Our findings suggest that the HTP was instrumental in achieving universal health coverage to enhance equity substantially, and led to quantifiable and beneficial effects on all health system goals, with an improved level and distribution of health, greater fairness in financing with better financial protection, and notably increased user satisfaction. After the HTP, five health insurance schemes were consolidated to create a unified General Health Insurance scheme with harmonised and expanded benefits. Insurance coverage for the poorest population groups in Turkey increased from 2·4 million people in 2003, to 10·2 million in 2011. Health service access increased across the country-in particular, access and use of key maternal and child health services improved to help to greatly reduce the maternal mortality ratio, and under-5, infant, and neonatal mortality, especially in socioeconomically disadvantaged groups. Several factors helped to achieve universal health coverage and improve outcomes. These factors include economic growth, political stability, a comprehensive transformation strategy led by a transformation team, rapid policy translation, flexible implementation with continuous learning, and simultaneous improvements in the health system, on both the demand side (increased health insurance coverage, expanded benefits, and reduced cost-sharing) and the supply side (expansion of infrastructure, health human resources, and health services). Copyright © 2013 Elsevier Ltd. All rights reserved.

Using a Reduced Spot Size for Intensity-Modulated Proton Therapy Potentially Improves Salivary Gland-Sparing in Oropharyngeal Cancer

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

Water, Tara A. van de, E-mail: t.a.van.de.water@rt.umcg.nl; Lomax, Antony J.; Bijl, Hendrik P.

2012-02-01

Purpose: To investigate whether intensity-modulated proton therapy with a reduced spot size (rsIMPT) could further reduce the parotid and submandibular gland dose compared with previously calculated IMPT plans with a larger spot size. In addition, it was investigated whether the obtained dose reductions would theoretically translate into a reduction of normal tissue complication probabilities (NTCPs). Methods: Ten patients with N0 oropharyngeal cancer were included in a comparative treatment planning study. Both IMPT plans delivered simultaneously 70 Gy to the boost planning target volume (PTV) and 54 Gy to the elective nodal PTV. IMPT and rsIMPT used identical three-field beam arrangements.more » In the IMPT plans, the parotid and submandibular salivary glands were spared as much as possible. rsIMPT plans used identical dose-volume objectives for the parotid glands as those used by the IMPT plans, whereas the objectives for the submandibular glands were tightened further. NTCPs were calculated for salivary dysfunction and xerostomia. Results: Target coverage was similar for both IMPT techniques, whereas rsIMPT clearly improved target conformity. The mean doses in the parotid glands and submandibular glands were significantly lower for three-field rsIMPT (14.7 Gy and 46.9 Gy, respectively) than for three-field IMPT (16.8 Gy and 54.6 Gy, respectively). Hence, rsIMPT significantly reduced the NTCP of patient-rated xerostomia and parotid and contralateral submandibular salivary flow dysfunction (27%, 17%, and 43% respectively) compared with IMPT (39%, 20%, and 79%, respectively). In addition, mean dose values in the sublingual glands, the soft palate and oral cavity were also decreased. Obtained dose and NTCP reductions varied per patient. Conclusions: rsIMPT improved sparing of the salivary glands and reduced NTCP for xerostomia and parotid and submandibular salivary dysfunction, while maintaining similar target coverage results. It is expected that rsIMPT improves quality of life during and after radiotherapy treatment.« less

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.

Improving coverage measurement for reproductive, maternal, neonatal and child health: gaps and opportunities.

PubMed

Munos, Melinda K; Stanton, Cynthia K; Bryce, Jennifer

2017-06-01

Regular monitoring of coverage for reproductive, maternal, neonatal, and child health (RMNCH) is central to assessing progress toward health goals. The objectives of this review were to describe the current state of coverage measurement for RMNCH, assess the extent to which current approaches to coverage measurement cover the spectrum of RMNCH interventions, and prioritize interventions for a novel approach to coverage measurement linking household surveys with provider assessments. We included 58 interventions along the RMNCH continuum of care for which there is evidence of effectiveness against cause-specific mortality and stillbirth. We reviewed household surveys and provider assessments used in low- and middle-income countries (LMICs) to determine whether these tools generate measures of intervention coverage, readiness, or quality. For facility-based interventions, we assessed the feasibility of linking provider assessments to household surveys to provide estimates of intervention coverage. Fewer than half (24 of 58) of included RMNCH interventions are measured in standard household surveys. The periconceptional, antenatal, and intrapartum periods were poorly represented. All but one of the interventions not measured in household surveys are facility-based, and 13 of these would be highly feasible to measure by linking provider assessments to household surveys. We found important gaps in coverage measurement for proven RMNCH interventions, particularly around the time of birth. Based on our findings, we propose three sets of actions to improve coverage measurement for RMNCH, focused on validation of coverage measures and development of new measurement approaches feasible for use at scale in LMICs.

Genotype calling from next-generation sequencing data using haplotype information of reads

PubMed Central

Zhi, Degui; Wu, Jihua; Liu, Nianjun; Zhang, Kui

2012-01-01

Motivation: Low coverage sequencing provides an economic strategy for whole genome sequencing. When sequencing a set of individuals, genotype calling can be challenging due to low sequencing coverage. Linkage disequilibrium (LD) based refinement of genotyping calling is essential to improve the accuracy. Current LD-based methods use read counts or genotype likelihoods at individual potential polymorphic sites (PPSs). Reads that span multiple PPSs (jumping reads) can provide additional haplotype information overlooked by current methods. Results: In this article, we introduce a new Hidden Markov Model (HMM)-based method that can take into account jumping reads information across adjacent PPSs and implement it in the HapSeq program. Our method extends the HMM in Thunder and explicitly models jumping reads information as emission probabilities conditional on the states of adjacent PPSs. Our simulation results show that, compared to Thunder, HapSeq reduces the genotyping error rate by 30%, from 0.86% to 0.60%. The results from the 1000 Genomes Project show that HapSeq reduces the genotyping error rate by 12 and 9%, from 2.24% and 2.76% to 1.97% and 2.50% for individuals with European and African ancestry, respectively. We expect our program can improve genotyping qualities of the large number of ongoing and planned whole genome sequencing projects. Contact: dzhi@ms.soph.uab.edu; kzhang@ms.soph.uab.edu Availability: The software package HapSeq and its manual can be found and downloaded at www.ssg.uab.edu/hapseq/. Supplementary information: Supplementary data are available at Bioinformatics online. PMID:22285565

Health promotion and patient education benefits for employees.

PubMed

Mullen, P D

1988-01-01

One step that employers can take to assure that employees receive such education services is pursuing coverage of education as a separate service. For some time now, insurers have shown interest in patient education services (15-17, 61), but patient education "integral to care" is typically covered only as a part of the "per diem" in the case of hospitals or as part of the visit fee in the case of outpatient visits. Education for patients with diabetes is being covered experimentally as a separate service in at least 17 states. Physicians whose practice is composed largely of "cognitive services" rather than "procedures" are also interested in education as a reimbursable service. The same arguments as described in relation to coverage of risk reduction services generally apply to this case. Education programs for employees who are under medical care can improve their adherence to the recommended regimen and hence can improve the effectiveness of care. Education and counseling prior to surgical and other stressful procedures decrease stress and the need for pain medications, and they can shorten the length of hospital stays. Education is an important component of programs to substitute home care for hospital care or expensive outpatient care. Currently, however, a patient cannot rely on usual providers of medical care to offer adequate education. Reimbursement for patient education on a selected, experimental basis is probably warranted for chronic conditions requiring complex adjustments and regimens. Cases of asthma where there is a history of hospitalization or emergency room visits is an excellent possibility. The experience of covering diabetes education should be monitored to help resolve the debate.

Multiple Imputation in Two-Stage Cluster Samples Using The Weighted Finite Population Bayesian Bootstrap.

PubMed

Zhou, Hanzhi; Elliott, Michael R; Raghunathan, Trivellore E

2016-06-01

Multistage sampling is often employed in survey samples for cost and convenience. However, accounting for clustering features when generating datasets for multiple imputation is a nontrivial task, particularly when, as is often the case, cluster sampling is accompanied by unequal probabilities of selection, necessitating case weights. Thus, multiple imputation often ignores complex sample designs and assumes simple random sampling when generating imputations, even though failing to account for complex sample design features is known to yield biased estimates and confidence intervals that have incorrect nominal coverage. In this article, we extend a recently developed, weighted, finite-population Bayesian bootstrap procedure to generate synthetic populations conditional on complex sample design data that can be treated as simple random samples at the imputation stage, obviating the need to directly model design features for imputation. We develop two forms of this method: one where the probabilities of selection are known at the first and second stages of the design, and the other, more common in public use files, where only the final weight based on the product of the two probabilities is known. We show that this method has advantages in terms of bias, mean square error, and coverage properties over methods where sample designs are ignored, with little loss in efficiency, even when compared with correct fully parametric models. An application is made using the National Automotive Sampling System Crashworthiness Data System, a multistage, unequal probability sample of U.S. passenger vehicle crashes, which suffers from a substantial amount of missing data in "Delta-V," a key crash severity measure.

Multiple Imputation in Two-Stage Cluster Samples Using The Weighted Finite Population Bayesian Bootstrap

PubMed Central

Zhou, Hanzhi; Elliott, Michael R.; Raghunathan, Trivellore E.

2017-01-01

Multistage sampling is often employed in survey samples for cost and convenience. However, accounting for clustering features when generating datasets for multiple imputation is a nontrivial task, particularly when, as is often the case, cluster sampling is accompanied by unequal probabilities of selection, necessitating case weights. Thus, multiple imputation often ignores complex sample designs and assumes simple random sampling when generating imputations, even though failing to account for complex sample design features is known to yield biased estimates and confidence intervals that have incorrect nominal coverage. In this article, we extend a recently developed, weighted, finite-population Bayesian bootstrap procedure to generate synthetic populations conditional on complex sample design data that can be treated as simple random samples at the imputation stage, obviating the need to directly model design features for imputation. We develop two forms of this method: one where the probabilities of selection are known at the first and second stages of the design, and the other, more common in public use files, where only the final weight based on the product of the two probabilities is known. We show that this method has advantages in terms of bias, mean square error, and coverage properties over methods where sample designs are ignored, with little loss in efficiency, even when compared with correct fully parametric models. An application is made using the National Automotive Sampling System Crashworthiness Data System, a multistage, unequal probability sample of U.S. passenger vehicle crashes, which suffers from a substantial amount of missing data in “Delta-V,” a key crash severity measure. PMID:29226161

Suboptimal MMR2 vaccine coverage in six counties in Norway detected through the national immunisation registry, April 2014 to April 2017

PubMed Central

Hagerup-Jenssen, Maria; Kongsrud, Sigrun; Riise, Øystein Rolandsen

2017-01-01

In 2014, Norway became aware of potential low vaccination coverage for the second dose of measles-mumps-rubella vaccine (MMR2) in six of 19 counties. This was detected by comparing the national coverage (NC) for 16-year-olds extracted from the national immunisation registry SYSVAK with the annual status update for elimination of measles and rubella (ASU) reported to the World Health Organization (WHO). The existing method for calculating NC in 2014 did not show MMR2 coverage. ASU reporting on MMR2 was significantly lower then the NC and below the WHO-recommended 95% coverage. SYSVAK is based on the Norwegian personal identification numbers, which allows monitoring of vaccinations at aggregateded as well as individual level. It is an important tool for active surveillance of the performance of the Norwegian Childhood Immunisation Programme (NCIP). The method for calculating NC was improved in 2015 to reflect MMR2 coverage for 16-year-olds. As a result, Norway has improved its real-time surveillance and monitoring of the actual MMR2 coverage also through SYSVAK (the annual publication of NC). Vaccinators receive feedback for follow-up if 15-year-olds are missing MMR2. In 2017, only three counties had an MMR2 coverage below 90%. PMID:28489000

Increased immunization coverage addresses the equity gap in Nepal

PubMed Central

Nelin, Viktoria; Raaijmakers, Hendrikus; Kim, Hyung Joon; Singh, Chahana; Målqvist, Mats

2017-01-01

Abstract Objective To compare immunization coverage and equity distribution of coverage between 2001 and 2014 in Nepal. Methods We used data from the Demographic and Health Surveys carried out in 2001, 2006 and 2011 together with data from the 2014 Multiple Indicator Cluster Survey. We calculated the proportion, in mean percentage, of children who had received bacille Calmette–Guérin (BCG) vaccine, three doses of polio vaccine, three doses of diphtheria–pertussis–tetanus (DPT) vaccine and measles vaccine. To measure inequities between wealth quintiles, we calculated the slope index of inequality (SII) and relative index of inequality (RII) for all surveys. Findings From 2001 to 2014, the proportion of children who received all vaccines at the age of 12 months increased from 68.8% (95% confidence interval, CI: 67.5–70.1) to 82.4% (95% CI: 80.7–84.0). While coverage of BCG, DPT and measles immunization statistically increased during the study period, the proportion of children who received the third dose of polio vaccine decreased from 93.3% (95% CI: 92.7–93.9) to 88.1% (95% CI: 86.8–89.3). The poorest wealth quintile showed the greatest improvement in immunization coverage, from 58% to 77.9%, while the wealthiest quintile only improved from 84.8% to 86.0%. The SII for children who received all vaccines improved from 0.070 (95% CI: 0.061–0.078) to 0.026 (95% CI: 0.013–0.039) and RII improved from 1.13 to 1.03. Conclusion The improvement in immunization coverage between 2001 and 2014 in Nepal can mainly be attributed to the interventions targeting the disadvantaged populations. PMID:28479621

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.

The Effects of Child-Only Insurance Coverage and Family Coverage on Health Care Access and Use: Recent Findings among Low-Income Children in California

PubMed Central

Guendelman, Sylvia; Wier, Megan; Angulo, Veronica; Oman, Doug

2006-01-01

Objective To compare the extent with which child-only and family coverage (child and parent insured) ensure health care access and use for low income children in California and discuss the policy implications of extending the State Children's Health Insurance Program (California's Healthy Families) to uninsured parents of child enrollees. Data Sources/Setting We used secondary data from the 2001 California Health Interview Survey (CHIS), a representative telephone survey. Study Design We conducted a cross-sectional study of 5,521 public health insurance–eligible children and adolescents and their parents to examine the effects of insurance (family coverage, child-only coverage, and no coverage) on measures of health care access and utilization including emergency room visits and hospitalizations. Data Collection We linked the CHIS adult, child, and adolescent datasets, including the adolescent insurance supplement. Findings Among the sampled children, 13 percent were uninsured as were 22 percent of their parents. Children without insurance coverage were more likely than children with child-only coverage to lack a usual source of care and to have decreased use of health care. Children with child-only coverage fared worse than those with family coverage on almost every access indicator, but service utilization was comparable. Conclusions While extending public benefits to parents of children eligible for Healthy Families may not improve child health care utilization beyond the gains that would be obtained by exclusively insuring the children, family coverage would likely improve access to a regular source of care and private sector providers, and reduce perceived discrimination and breaks in coverage. These advantages should be considered by states that are weighing the benefits of expanding health insurance to parents. PMID:16430604

Do Patients With Borderline Dysplasia Have Inferior Outcomes After Hip Arthroscopic Surgery for Femoroacetabular Impingement Compared With Patients With Normal Acetabular Coverage?

PubMed

Cvetanovich, Gregory L; Levy, David M; Weber, Alexander E; Kuhns, Benjamin D; Mather, Richard C; Salata, Michael J; Nho, Shane J

2017-07-01

The literature contains conflicting reports regarding whether outcomes of hip arthroscopic surgery for patients with borderline dysplasia are inferior to outcomes in patients with normal acetabular coverage. To assess differences in the outcomes of hip arthroscopic surgery for femoroacetabular impingement (FAI) in groups of patients with borderline dysplasia and normal coverage. Cohort study; Level of evidence, 3. A registry of consecutive patients who had undergone primary hip arthroscopic surgery with capsular plication for FAI between January 2012 and January 2014 were divided based on the preoperative lateral center-edge angle (LCEA) into 2 distinct groups: (1) borderline dysplasia (LCEA 18°-25°) and (2) normal acetabular coverage (LCEA 25.1°-40°). There were 36 patients in the borderline dysplastic group and 312 patients in the normal coverage group. The primary outcome measure was the Hip Outcome Score-Activities of Daily Living (HOS-ADL) at a minimum of 2 years postoperatively. Secondary outcome measures included the HOS-Sports and modified Harris Hip Score (mHHS). The mean preoperative LCEA differed significantly between groups (23.4° ± 1.5° for borderline dysplastic, 32.5° ± 3.8° for normal coverage; P < .001). The borderline dysplastic group had a higher percentage of female patients than the normal coverage group (27/36 [75%] vs 177/312 [57%], respectively; P = .048). There were no differences in other preoperative demographics and radiographic parameters. At a minimum 2 years after hip arthroscopic surgery (mean follow-up, 2.6 ± 0.6 years), both groups demonstrated significant improvements in all patient-reported outcome scores ( P < .001 in all cases). There were no significant differences between the borderline dysplastic and normal coverage groups in final outcome scores, score improvements, or percentage of patients experiencing clinically significant improvements. One patient in the borderline dysplastic group (3%) underwent revision hip arthroscopic surgery, and none underwent total hip arthroplasty during the follow-up period. There were no differences between the borderline dysplastic and normal coverage groups with regard to subsequent surgery. Female patients in the borderline dysplastic group had greater improvements in the mean HOS-ADL (25.9 ± 16.3 vs 10.8 ± 18.5, respectively; P = .05) and mHHS (27.9 ± 12.9 vs 8.1 ± 19.0, respectively; P = .005) compared with male patients in the borderline dysplastic group, but male and female patients did not differ in outcomes for the normal coverage group. Patients who underwent hip arthroscopic surgery for FAI with capsular plication experienced significant clinical improvements with low rates of subsequent surgery, regardless of whether their acetabulum had borderline dysplasia or normal coverage.

The paradox of parity: limitations in the breakthrough law for mental health equality.

PubMed

Dowches, Jessica; West, Daniel J

2013-01-01

The intent of parity laws is to improve equity in private insurance coverage for mental health care. The groundbreaking legislation of the 1996 Mental Health Parity Act (MHPA) was initially hailed as a major achievement in improving mental health coverage. However, research suggests that because of political compromises and employer exemptions, the potential impact of the MHPA was weakened. This paper summarizes the extent and scope of the MHPA and the 2008 Mental Health Parity and Addiction Equity Act, highlighting the goals and accomplishments of each; examines limitations of the legislation, explicitly accounting for exemptions, uninsured Americans, and access to care; and provides recommendations for further improvement and implementation of mental health coverage.

Confidence Intervals for True Scores Using the Skew-Normal Distribution

ERIC Educational Resources Information Center

Garcia-Perez, Miguel A.

2010-01-01

A recent comparative analysis of alternative interval estimation approaches and procedures has shown that confidence intervals (CIs) for true raw scores determined with the Score method--which uses the normal approximation to the binomial distribution--have actual coverage probabilities that are closest to their nominal level. It has also recently…

Nonparametric Estimation of the Probability of Discovering a New Species.

DTIC Science & Technology

1986-01-01

see Good (1953, 1965), Good and Toulmin (1956), Goodman (1949), Harris (1959, 1968), Knott (1967) and Robbins (1968). We note that our model is not...and Toulmin , G. (1956). The number of new species and the increase of population coverage, when a sample is increased. Biometrika 43, 45-63. Goodman

Epidemiology of HPV 16 and Cervical Cancer in Finland and the Potential Impact of Vaccination: Mathematical Modelling Analyses

PubMed Central

Barnabas, Ruanne V; Laukkanen, Päivi; Koskela, Pentti; Kontula, Osmo; Lehtinen, Matti; Garnett, Geoff P

2006-01-01

Background Candidate human papillomavirus (HPV) vaccines have demonstrated almost 90%-100% efficacy in preventing persistent, type-specific HPV infection over 18 mo in clinical trials. If these vaccines go on to demonstrate prevention of precancerous lesions in phase III clinical trials, they will be licensed for public use in the near future. How these vaccines will be used in countries with national cervical cancer screening programmes is an important question. Methods and Findings We developed a transmission model of HPV 16 infection and progression to cervical cancer and calibrated it to Finnish HPV 16 seroprevalence over time. The model was used to estimate the transmission probability of the virus, to look at the effect of changes in patterns of sexual behaviour and smoking on age-specific trends in cancer incidence, and to explore the impact of HPV 16 vaccination. We estimated a high per-partnership transmission probability of HPV 16, of 0.6. The modelling analyses showed that changes in sexual behaviour and smoking accounted, in part, for the increase seen in cervical cancer incidence in 35- to 39-y-old women from 1990 to 1999. At both low (10% in opportunistic immunisation) and high (90% in a national immunisation programme) coverage of the adolescent population, vaccinating women and men had little benefit over vaccinating women alone. We estimate that vaccinating 90% of young women before sexual debut has the potential to decrease HPV type-specific (e.g., type 16) cervical cancer incidence by 91%. If older women are more likely to have persistent infections and progress to cancer, then vaccination with a duration of protection of less than 15 y could result in an older susceptible cohort and no decrease in cancer incidence. While vaccination has the potential to significantly reduce type-specific cancer incidence, its combination with screening further improves cancer prevention. Conclusions HPV vaccination has the potential to significantly decrease HPV type-specific cervical cancer incidence. High vaccine coverage of women alone, sustained over many decades, with a long duration of vaccine-conferred protection, would have the greatest impact on type-specific cancer incidence. This level of coverage could be achieved through national coordinated programmes, with surveillance to detect cancers caused by nonvaccine oncogenic HPV types. PMID:16573364

Monitoring health interventions – who's afraid of LQAS?

PubMed Central

Pezzoli, Lorenzo; Kim, Sung Hye

2013-01-01

Lot quality assurance sampling (LQAS) is used to evaluate health services. Subunits of a population (lots) are accepted or rejected according to the number of failures in a random sample (N) of a given lot. If failures are greater than decision value (d), we reject the lot and recommend corrective actions in the lot (i.e. intervention area); if they are equal to or less than d, we accept it. We used LQAS to monitor coverage during the last 3 days of a meningitis vaccination campaign in Niger. We selected one health area (lot) per day reporting the lowest administrative coverage in the previous 2 days. In the sampling plan we considered: N to be small enough to allow us to evaluate one lot per day, deciding to sample 16 individuals from the selected villages of each health area, using probability proportionate to population size; thresholds and d to vary according to administrative coverage reported; α ≤5% (meaning that, if we would have conducted the survey 100 times, we would have accepted the lot up to five times when real coverage was at an unacceptable level) and β ≤20% (meaning that we would have rejected the lot up to 20 times, when real coverage was equal or above the satisfactory level). We classified all three lots as with the acceptable coverage. LQAS appeared to be a rapid, simple, and statistically sound method for in-process coverage assessment. We encourage colleagues in the field to consider using LQAS in complement with other monitoring techniques such as house-to-house monitoring. PMID:24206650

Monitoring health interventions--who's afraid of LQAS?

PubMed

Pezzoli, Lorenzo; Kim, Sung Hye

2013-11-08

Lot quality assurance sampling (LQAS) is used to evaluate health services. Subunits of a population (lots) are accepted or rejected according to the number of failures in a random sample (N) of a given lot. If failures are greater than decision value (d), we reject the lot and recommend corrective actions in the lot (i.e. intervention area); if they are equal to or less than d, we accept it. We used LQAS to monitor coverage during the last 3 days of a meningitis vaccination campaign in Niger. We selected one health area (lot) per day reporting the lowest administrative coverage in the previous 2 days. In the sampling plan we considered: N to be small enough to allow us to evaluate one lot per day, deciding to sample 16 individuals from the selected villages of each health area, using probability proportionate to population size; thresholds and d to vary according to administrative coverage reported; α ≤5% (meaning that, if we would have conducted the survey 100 times, we would have accepted the lot up to five times when real coverage was at an unacceptable level) and β ≤20% (meaning that we would have rejected the lot up to 20 times, when real coverage was equal or above the satisfactory level). We classified all three lots as with the acceptable coverage. LQAS appeared to be a rapid, simple, and statistically sound method for in-process coverage assessment. We encourage colleagues in the field to consider using LQAS in complement with other monitoring techniques such as house-to-house monitoring.

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.

Improved measurement for mothers, newborns and children in the era of the Sustainable Development Goals.

PubMed

Marchant, Tanya; Bryce, Jennifer; Victora, Cesar; Moran, Allisyn C; Claeson, Mariam; Requejo, Jennifer; Amouzou, Agbessi; Walker, Neff; Boerma, Ties; Grove, John

2016-06-01

An urgent priority in maternal, newborn and child health is to accelerate the scale-up of cost-effective essential interventions, especially during labor, the immediate postnatal period and for the treatment of serious infectious diseases and acute malnutrition.  Tracking intervention coverage is a key activity to support scale-up and in this paper we examine priorities in coverage measurement, distinguishing between essential interventions that can be measured now and those that require methodological development. We conceptualized a typology of indicators related to intervention coverage that distinguishes access to care from receipt of an intervention by the population in need.  We then built on documented evidence on coverage measurement to determine the status of indicators for essential interventions and to identify areas for development. Contact indicators from pregnancy to childhood were identified as current indicators for immediate use, but indicators reflecting the quality of care provided during these contacts need development. At each contact point, some essential interventions can be measured now, but the need for development of indicators predominates around interventions at the time of birth and interventions to treat infections. Addressing this need requires improvements in routine facility based data capture, methods for linking provider and community-based data, and improved guidance for effective coverage measurement that reflects the provision of high-quality care. Coverage indicators for some essential interventions can be measured accurately through household surveys and be used to track progress in maternal, newborn and child health.  Other essential interventions currently rely on contact indicators as proxies for coverage but urgent attention is needed to identify new measurement approaches that directly and reliably measure their effective coverage.

Impact of Medicare Part D on Antidepressant Treatment, Medication Choice and Adherence among Older Adults with Depression

PubMed Central

Donohue, Julie M.; Zhang, Yuting; Men, Aiju; Perera, Subashan; Lave, Judith R.; Hanlon, Joseph T.; Reynolds, Charles F.

2010-01-01

Objectives Depression in older adults is often undertreated due, in part, to medication costs. We examined the impact of improved prescription drug coverage under Medicare Part D on use of antidepressants, medication choice and adherence. Design, Setting and Participants Observational claims-based study of older adults with depression (ICD-9: 296.2, 296.3, 311, 300.4) continuously enrolled in a Medicare managed care plan between 2004–2007. Three groups with limited ($150 or $350 quarterly caps) or no drug coverage in 2004–2005 obtained Part D benefits in 2006. A comparison group had stable employer-sponsored coverage throughout. Measurements Any antidepressant prescription fill, antidepressant choice (tricyclics or monoamine oxidase inhibitors vs. newer antidepressants), and adherence (80% of days covered) in the first 6 months of treatment. Results Part D was associated with increased odds of any antidepressant use among those who previously lacked coverage [Odds Ratio (OR) 1.61, 95% confidence interval (CI) 1.41–1.85] but odds of use did not change among those with limited prior coverage. Use of older antidepressant agents did not change with Part D. All three groups whose coverage improved with Part D had significantly higher odds of 80% of days covered with an antidepressant [OR=1.86 (95% CI, 1.44–2.39) for No coverage, 1.74 (95% CI, 1.25–3.42) for $150 cap; and 1.19 (95% CI 1.06–1.34) for the $350 cap groups]. Conclusions Medicare Part D was associated with improvements in antidepressant use and adherence in depressed older adults who previously had no or limited drug coverage but not with changes in use of older agents. PMID:22123272

Increasing Coverage of Hepatitis B Vaccination in China

PubMed Central

Wang, Shengnan; Smith, Helen; Peng, Zhuoxin; Xu, Biao; Wang, Weibing

2016-01-01

Abstract This study used a system evaluation method to summarize China's experience on improving the coverage of hepatitis B vaccine, especially the strategies employed to improve the uptake of timely birth dosage. Identifying successful methods and strategies will provide strong evidence for policy makers and health workers in other countries with high hepatitis B prevalence. We conducted a literature review included English or Chinese literature carried out in mainland China, using PubMed, the Cochrane databases, Web of Knowledge, China National Knowledge Infrastructure, Wanfang data, and other relevant databases. Nineteen articles about the effectiveness and impact of interventions on improving the coverage of hepatitis B vaccine were included. Strong or moderate evidence showed that reinforcing health education, training and supervision, providing subsidies for facility birth, strengthening the coordination among health care providers, and using out-of-cold-chain storage for vaccines were all important to improving vaccination coverage. We found evidence that community education was the most commonly used intervention, and out-reach programs such as out-of-cold chain strategy were more effective in increasing the coverage of vaccination in remote areas where the facility birth rate was respectively low. The essential impact factors were found to be strong government commitment and the cooperation of the different government departments. Public interventions relying on basic health care systems combined with outreach care services were critical elements in improving the hepatitis B vaccination rate in China. This success could not have occurred without exceptional national commitment. PMID:27175710

Increasing Coverage of Hepatitis B Vaccination in China: A Systematic Review of Interventions and Implementation Experiences.

PubMed

Wang, Shengnan; Smith, Helen; Peng, Zhuoxin; Xu, Biao; Wang, Weibing

2016-05-01

This study used a system evaluation method to summarize China's experience on improving the coverage of hepatitis B vaccine, especially the strategies employed to improve the uptake of timely birth dosage. Identifying successful methods and strategies will provide strong evidence for policy makers and health workers in other countries with high hepatitis B prevalence.We conducted a literature review included English or Chinese literature carried out in mainland China, using PubMed, the Cochrane databases, Web of Knowledge, China National Knowledge Infrastructure, Wanfang data, and other relevant databases.Nineteen articles about the effectiveness and impact of interventions on improving the coverage of hepatitis B vaccine were included. Strong or moderate evidence showed that reinforcing health education, training and supervision, providing subsidies for facility birth, strengthening the coordination among health care providers, and using out-of-cold-chain storage for vaccines were all important to improving vaccination coverage.We found evidence that community education was the most commonly used intervention, and out-reach programs such as out-of-cold chain strategy were more effective in increasing the coverage of vaccination in remote areas where the facility birth rate was respectively low. The essential impact factors were found to be strong government commitment and the cooperation of the different government departments.Public interventions relying on basic health care systems combined with outreach care services were critical elements in improving the hepatitis B vaccination rate in China. This success could not have occurred without exceptional national commitment.

Effect of insurance parity on substance abuse treatment.

PubMed

Azzone, Vanessa; Frank, Richard G; Normand, Sharon-Lise T; Burnam, M Audrey

2011-02-01

This study examined the impact of insurance parity on the use, cost, and quality of substance abuse treatment. The authors compared substance abuse treatment spending and utilization from 1999 to 2002 for continuously enrolled beneficiaries covered by Federal Employees Health Benefit (FEHB) plans, which require parity coverage of mental health and substance use disorders, with spending and utilization among beneficiaries in a matched set of health plans without parity coverage. Logistic regression models estimated the probability of any substance abuse service use. Conditional on use, linear models estimated total and out-of-pocket spending. Logistic regression models for three quality indicators for substance abuse treatment were also estimated: identification of adult enrollees with a new substance abuse diagnosis, treatment initiation, and treatment engagement. Difference-in-difference estimates were computed as (postparity - preparity) differences in outcomes in plans without parity subtracted from those in FEHB plans. There were no significant differences between FEHB and non-FEHB plans in rates of change in average utilization of substance abuse services. Conditional on service utilization, the rate of substance abuse treatment out-of-pocket spending declined significantly in the FEHB plans compared with the non-FEHB plans (mean difference=-$101.09, 95% confidence interval [CI]=-$198.06 to -$4.12), whereas changes in total plan spending per user did not differ significantly. With parity, more patients had new diagnoses of a substance use disorder (difference-in-difference risk=.10%, CI=.02% to .19%). No statistically significant differences were found for rates of initiation and engagement in substance abuse treatment. Findings suggest that for continuously enrolled populations, providing parity of substance abuse treatment coverage improved insurance protection but had little impact on utilization, costs for plans, or quality of care.

Knowledge as a Predictor of Insurance Coverage Under the Affordable Care Act.

PubMed

Hoerl, Maximiliane; Wuppermann, Amelie; Barcellos, Silvia H; Bauhoff, Sebastian; Winter, Joachim K; Carman, Katherine G

2017-04-01

The Affordable Care Act established policy mechanisms to increase health insurance coverage in the United States. While insurance coverage has increased, 10%-15% of the US population remains uninsured. To assess whether health insurance literacy and financial literacy predict being uninsured, covered by Medicaid, or covered by Marketplace insurance, holding demographic characteristics, attitudes toward risk, and political affiliation constant. Analysis of longitudinal data from fall 2013 and spring 2015 including financial and health insurance literacy and key covariates collected in 2013. A total of 2742 US residents ages 18-64, 525 uninsured in fall 2013, participating in the RAND American Life Panel, a nationally representative internet panel. Self-reported health insurance status and type as of spring 2015. Among the uninsured in 2013, higher financial and health insurance literacy were associated with greater probability of being insured in 2015. For a typical uninsured individual in 2013, the probability of being insured in 2015 was 8.3 percentage points higher with high compared with low financial literacy, and 9.2 percentage points higher with high compared with low health insurance literacy. For the general population, those with high financial and health insurance literacy were more likely to obtain insurance through Medicaid or the Marketplaces compared with being uninsured. The magnitude of coefficients for these predictors was similar to that of commonly used demographic covariates. A lack of understanding about health insurance concepts and financial illiteracy predict who remains uninsured. Outreach and consumer-education programs should consider these characteristics.

Pediatric ambulatory care sensitive conditions: Birth cohorts and the socio-economic gradient.

PubMed

Roos, Leslie L; Dragan, Roxana; Schroth, Robert J

2017-09-14

This study examines the socio-economic gradient in utilization and the risk factors associated with hospitalization for four pediatric ambulatory care sensitive conditions (dental conditions, asthma, gastroenteritis, and bacterial pneumonia). Dental conditions, where much care is provided by dentists and insurance coverage varies among different population segments, present special issues. A population registry, provider registry, physician ambulatory claims, and hospital discharge abstracts from 28 398 children born in 2003-2006 in urban centres in Manitoba, Canada were the main data sources. Physician visits and hospitalizations were compared across neighbourhood income groupings using rank correlations and logistic regressions. Very strong relationships between neighbourhood income and utilization were highlighted. Additional variables - family on income assistance, mother's age at first birth, breastfeeding - helped predict the probability of hospitalization. Despite the complete insurance coverage (including visits to dentists and physicians and for hospitalizations) provided, receiving income assistance was associated with higher probabilities of hospitalization. We found a socio-economic gradient in utilization for pediatric ambulatory care sensitive conditions, with higher rates of ambulatory visits and hospitalizations in the poorest neighbourhoods. Insurance coverage which varies between different segments of the population complicates matters. Providing funding for dental care for Manitobans on income assistance has not prevented physician visits or intensive treatment in high-cost facilities, specifically treatment under general anesthesia. When services from one type of provider (dentist) are not universally insured but those from another type (physician) are, using rates of hospitalization to indicate problems in the organization of care seems particularly difficult.

24 CFR 203.16a - Mortgagor and mortgagee requirement for maintaining flood insurance coverage.

Code of Federal Regulations, 2010 CFR

2010-04-01

... for maintaining flood insurance coverage. 203.16a Section 203.16a Housing and Urban Development... requirement for maintaining flood insurance coverage. (a) If the mortgage is to cover property improvements (dwelling and related structures/equipment essential to the value of the property and subject to flood...

Benefit Coverage and Employee Cost: Critical Factors in Explaining Compensation Satisfaction.

ERIC Educational Resources Information Center

Dreher, George F.; And Others

1988-01-01

Examined joint effects of benefit coverage and costs borne by employees on multiple dimensions of compensation satisfaction among 2,925 highway patrol, state police, and department of public safety employees in eight states. Found that satisfaction with benefits increased with improved coverage and decreased with higher employee costs. Employees…

Hospital Utilization and Universal Health Insurance Coverage: Evidence from the Massachusetts Health Care Reform Act.

PubMed

Cseh, Attila; Koford, Brandon C; Phelps, Ryan T

2015-12-01

The Affordable Care Act is currently in the roll-out phase. To gauge the likely implications of the national policy we analyze how the Massachusetts Health Care Reform Act impacted various hospitalization outcomes in each of the 25 major diagnostic categories (MDC). We utilize a difference-in-difference approach to identify the impact of the Massachusetts reform on insurance coverage and patient outcomes. This identification is achieved using six years of data from the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project. We report MDC-specific estimates of the impact of the reform on insurance coverage and type as well as length of stay, number of diagnoses, and number of procedures. The requirement of universal insurance coverage increased the probability of being covered by insurance. This increase was in part a result of an increase in the probability of being covered by Medicaid. The percentage of admissions covered by private insurance fell. The number of diagnoses rose as a result of the law in the vast majority of diagnostic categories. Our results related to length of stay suggest that looking at aggregate results hides a wealth of information. The most disparate outcomes were pregnancy related. The length of stay for new-born babies and neonates rose dramatically. In aggregate, this increase serves to mute decreases across other diagnoses. Also, the number of procedures fell within the MDCs for pregnancy and child birth and that for new-born babies and neonates. The Massachusetts Health Care Reform appears to have been effective at increasing insurance take-up rates. These increases may have come at the cost of lower private insurance coverage. The number of diagnoses per admission was increased by the policy across nearly all MDCs. Understanding the changes in length of stay as a result of the Massachusetts reform, and perhaps the Affordable Care Act, requires MDC-specific analysis. It appears that the most important distinction to make is to differentiate care related to new-born babies and neonates from that related to other diagnostic categories.

A spatial Bayesian network model to assess the benefits of early warning for urban flood risk to people

NASA Astrophysics Data System (ADS)

Balbi, Stefano; Villa, Ferdinando; Mojtahed, Vahid; Hegetschweiler, Karin Tessa; Giupponi, Carlo

2016-06-01

This article presents a novel methodology to assess flood risk to people by integrating people's vulnerability and ability to cushion hazards through coping and adapting. The proposed approach extends traditional risk assessments beyond material damages; complements quantitative and semi-quantitative data with subjective and local knowledge, improving the use of commonly available information; and produces estimates of model uncertainty by providing probability distributions for all of its outputs. Flood risk to people is modeled using a spatially explicit Bayesian network model calibrated on expert opinion. Risk is assessed in terms of (1) likelihood of non-fatal physical injury, (2) likelihood of post-traumatic stress disorder and (3) likelihood of death. The study area covers the lower part of the Sihl valley (Switzerland) including the city of Zurich. The model is used to estimate the effect of improving an existing early warning system, taking into account the reliability, lead time and scope (i.e., coverage of people reached by the warning). Model results indicate that the potential benefits of an improved early warning in terms of avoided human impacts are particularly relevant in case of a major flood event.

Measuring coverage in MNCH: design, implementation, and interpretation challenges associated with tracking vaccination coverage using household surveys.

PubMed

Cutts, Felicity T; Izurieta, Hector S; Rhoda, Dale A

2013-01-01

Vaccination coverage is an important public health indicator that is measured using administrative reports and/or surveys. The measurement of vaccination coverage in low- and middle-income countries using surveys is susceptible to numerous challenges. These challenges include selection bias and information bias, which cannot be solved by increasing the sample size, and the precision of the coverage estimate, which is determined by the survey sample size and sampling method. Selection bias can result from an inaccurate sampling frame or inappropriate field procedures and, since populations likely to be missed in a vaccination coverage survey are also likely to be missed by vaccination teams, most often inflates coverage estimates. Importantly, the large multi-purpose household surveys that are often used to measure vaccination coverage have invested substantial effort to reduce selection bias. Information bias occurs when a child's vaccination status is misclassified due to mistakes on his or her vaccination record, in data transcription, in the way survey questions are presented, or in the guardian's recall of vaccination for children without a written record. There has been substantial reliance on the guardian's recall in recent surveys, and, worryingly, information bias may become more likely in the future as immunization schedules become more complex and variable. Finally, some surveys assess immunity directly using serological assays. Sero-surveys are important for assessing public health risk, but currently are unable to validate coverage estimates directly. To improve vaccination coverage estimates based on surveys, we recommend that recording tools and practices should be improved and that surveys should incorporate best practices for design, implementation, and analysis.

Integrated management of childhood illness (IMCI) strategy for children under five.

PubMed

Gera, Tarun; Shah, Dheeraj; Garner, Paul; Richardson, Marty; Sachdev, Harshpal S

2016-06-22

More than 7.5 million children younger than age five living in low- and middle-income countries die every year. The World Health Organization (WHO) developed the integrated management of childhood illness (IMCI) strategy to reduce mortality and morbidity and to improve quality of care by improving the delivery of a variety of curative and preventive medical and behavioral interventions at health facilities, at home, and in the community. To evaluate the effects of programs that implement the IMCI strategy in terms of death, nutritional status, quality of care, coverage with IMCI deliverables, and satisfaction of beneficiaries. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register; MEDLINE; EMBASE, Ovid; the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EbscoHost; the Latin American Caribbean Health Sciences Literature (LILACS), Virtual Health Library (VHL); the WHO Library & Information Networks for Knowledge Database (WHOLIS); the Science Citation Index and Social Sciences Citation Index, Institute for Scientific Information (ISI) Web of Science; Population Information Online (POPLINE); the WHO International Clinical Trials Registry Platform (WHO ICTRP); and the Global Health, Ovid and Health Management, ProQuest database. We performed searches until 30 June 2015 and supplemented these by searching revised bibliographies and by contacting experts to identify ongoing and unpublished studies. We sought to include randomised controlled trials (RCTs) and controlled before-after (CBA) studies with at least two intervention and two control sites evaluating the generic IMCI strategy or its adaptation in children younger than age five, and including at minimum efforts to improve health care worker skills for case management. We excluded studies in which IMCI was accompanied by other interventions including conditional cash transfers, food supplementation, and employment. The comparison group received usual health services without provision of IMCI. Two review authors independently screened searches, selected trials, and extracted, analysed and tabulated data. We used inverse variance for cluster trials and an intracluster co-efficient of 0.01 when adjustment had not been made in the primary study. We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation Working Group) approach to assess the certainty of evidence. Two cluster-randomised trials (India and Bangladesh) and two controlled before-after studies (Tanzania and India) met our inclusion criteria. Strategies included training of health care staff, management strengthening of health care systems (all four studies), and home visiting (two studies). The two studies from India included care packages targeting the neonatal period.One trial in Bangladesh estimated that child mortality may be 13% lower with IMCI, but the confidence interval (CI) included no effect (risk ratio (RR) 0.87, 95% CI 0.68 to 1.10; 5090 participants; low-certainty evidence). One CBA study in Tanzania gave almost identical estimates (RR 0.87, 95% CI 0.72 to 1.05; 1932 participants).One trial in India examined infant and neonatal mortality by implementing the integrated management of neonatal and childhood illness (IMNCI) strategy including post-natal home visits. Neonatal and infant mortality may be lower in the IMNCI group compared with the control group (infant mortality hazard ratio (HR) 0.85, 95% CI 0.77 to 0.94; neonatal mortality HR 0.91, 95% CI 0.80 to 1.03; one trial, 60,480 participants; low-certainty evidence).We estimated the effect of IMCI on any mortality measured by combining infant and child mortality in the one IMCI and the one IMNCI trial. Mortality may be reduced by IMCI (RR 0.85, 95% CI 0.78 to 0.93; two trials, 65,570 participants; low-certainty evidence).Two trials (India, Bangladesh) evaluated nutritional status and noted that there may be little or no effect on stunting (RR 0.94, 95% CI 0.84 to 1.06; 5242 participants, two trials; low-certainty evidence) and there is probably little or no effect on wasting (RR 1.04, 95% CI 0.87 to 1.25; two trials, 4288 participants; moderate-certainty evidence).The Tanzania CBA study showed similar results.Investigators measured quality of care by observing prescribing for common illnesses at health facilities (727 observations, two studies; very low-certainty evidence) and by observing prescribing by lay health care workers (1051 observations, three studies; very low-certainty evidence). We could not confirm a consistent effect on prescribing at health facilities or by lay health care workers, as certainty of the evidence was very low.For coverage of IMCI deliverables, we examined vaccine and vitamin A coverage, appropriate care seeking, and exclusive breast feeding. Two trials (India, Bangladesh) estimated vaccine coverage for measles and reported that there is probably little or no effect on measles vaccine coverage (RR 0.92, 95% CI 0.80 to 1.05; two trials, 4895 participants; moderate-certainty evidence), with similar effects seen in the Tanzania CBA study. Two studies measured the third dose of diphtheria, pertussis, and tetanus vaccine; and two measured vitamin A coverage, all providing little or no evidence of increased coverage with IMCI.Four studies (2 from India, and 1 each from Tanzania and Bangladesh) reported appropriate care seeking and derived information from careful questioning of mothers about recent illness. Some studies on effects of IMCI may report better care seeking behavior, but others do not report this.All four studies recorded maternal responses on exclusive breast feeding. They provided mixed results and very low-certainty evidence. Therefore, we do not know whether IMCI impacts exclusive breast feeding.No studies reported on the satisfaction of mothers and service users. The mix of interventions examined in research studies evaluating the IMCI strategy varies, and some studies include specific inputs to improve neonatal health. Most studies were conducted in South Asia. Implementing the integrated management of childhood illness strategy may reduce child mortality, and packages that include interventions for the neonatal period may reduce infant mortality. IMCI may have little or no effect on nutritional status and probably has little or no effect on vaccine coverage. Maternal care seeking behavior may be more appropriate with IMCI, but study results have been mixed, providing evidence of very low certainty about whether IMCI has effects on adherence to exclusive breast feeding.

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.

A new role for primary care teams in the United States after “Obamacare:” Track and improve health insurance coverage rates

PubMed Central

DeVoe, Jennifer; Angier, Heather; Hoopes, Megan; Gold, Rachel

2017-01-01

Maintaining continuous health insurance coverage is important. With recent expansions in access to coverage in the United States after “Obamacare,” primary care teams have a new role in helping to track and improve coverage rates and to provide outreach to patients. We describe efforts to longitudinally track health insurance rates using data from the electronic health record (EHR) of a primary care network and to use these data to support practice-based insurance outreach and assistance. Although we highlight a few examples from one network, we believe there is great potential for doing this type of work in a broad range of family medicine and community health clinics that provide continuity of care. By partnering with researchers through practice-based research networks and other similar collaboratives, primary care practices can greatly expand the use of EHR data and EHR-based tools targeting improvements in health insurance and quality health care. PMID:28966926

Suboptimal MMR2 vaccine coverage in six counties in Norway detected through the national immunisation registry, April 2014 to April 2017.

PubMed

Hagerup-Jenssen, Maria; Kongsrud, Sigrun; Riise, Øystein Rolandsen

2017-04-27

In 2014, Norway became aware of potential low vaccination coverage for the second dose of measles-mumps-rubella vaccine (MMR2) in six of 19 counties. This was detected by comparing the national coverage (NC) for 16-year-olds extracted from the national immunisation registry SYSVAK with the annual status update for elimination of measles and rubella (ASU) reported to the World Health Organization (WHO). The existing method for calculating NC in 2014 did not show MMR2 coverage. ASU reporting on MMR2 was significantly lower then the NC and below the WHO-recommended 95% coverage. SYSVAK is based on the Norwegian personal identification numbers, which allows monitoring of vaccinations at aggregateded as well as individual level. It is an important tool for active surveillance of the performance of the Norwegian Childhood Immunisation Programme (NCIP). The method for calculating NC was improved in 2015 to reflect MMR2 coverage for 16-year-olds. As a result, Norway has improved its real-time surveillance and monitoring of the actual MMR2 coverage also through SYSVAK (the annual publication of NC). Vaccinators receive feedback for follow-up if 15-year-olds are missing MMR2. In 2017, only three counties had an MMR2 coverage below 90%. This article is copyright of The Authors, 2017.

Electrochemical and pitting corrosion resistance of AISI 4145 steel subjected to massive laser shock peening treatment with different coverage layers

NASA Astrophysics Data System (ADS)

Lu, J. Z.; Han, B.; Cui, C. Y.; Li, C. J.; Luo, K. Y.

2017-02-01

The effects of massive laser shock peening (LSP) treatment with different coverage layers on residual stress, pitting morphologies in a standard corrosive solution and electrochemical corrosion resistance of AISI 4145 steel were investigated by pitting corrosion test, potentiodynamic polarisation test, and SEM observations. Results showed massive LSP treatment can effectively cause an obvious improvement of pitting corrosion resistance of AISI 4145 steel, and increased coverage layer can also gradually improve its corrosion resistance. Massive LSP treatment with multiple layers was shown to influence pitting corrosion behaviour in a standard corrosive solution.

Effect Sizes and their Intervals: The Two-Level Repeated Measures Case

ERIC Educational Resources Information Center

Algina, James; Keselman, H. J.; Penfield, Randall D.

2005-01-01

Probability coverage for eight different confidence intervals (CIs) of measures of effect size (ES) in a two-level repeated measures design was investigated. The CIs and measures of ES differed with regard to whether they used least squares or robust estimates of central tendency and variability, whether the end critical points of the interval…

Does the Availability of Parental Health Insurance Affect the College Enrollment Decision of Young Americans?

ERIC Educational Resources Information Center

Jung, Juergen; Hall, Diane M. Harnek; Rhoads, Thomas

2013-01-01

The present study examines whether the college enrollment decision of young individuals (student full-time, student part-time, and non-student) depends on health insurance coverage via a parent's family health plan. Our findings indicate that the availability of parental health insurance can have significant effects on the probability that a young…

Optimal and Most Exact Confidence Intervals for Person Parameters in Item Response Theory Models

ERIC Educational Resources Information Center

Doebler, Anna; Doebler, Philipp; Holling, Heinz

2013-01-01

The common way to calculate confidence intervals for item response theory models is to assume that the standardized maximum likelihood estimator for the person parameter [theta] is normally distributed. However, this approximation is often inadequate for short and medium test lengths. As a result, the coverage probabilities fall below the given…

Tracker implementation for the orbiter Ku-band communications antenna

NASA Technical Reports Server (NTRS)

Rudnicki, J. F.; Lindsey, J. F.

1976-01-01

Possible implementations and recommendations for the Space Shuttle Ku-Band integrated communications/radar antenna tracking system were evaluated. Communication aspects involving the Tracking Data Relay Satellite (TDRS)/Orbiter Ku-Band link are emphasized. Detailed analysis of antenna sizes, gains and signal-to-noise ratios shows the desirability of using maximum size 36-inch diameter dish and a triple channel monopulse. The use of the original baselined 20 inch dish is found to result in excessive acquisition time since the despread signal would be used in the tracking loop. An evaluation of scan procedures which includes vehicle dynamics, designation error, time for acquisition and probability of acquisition shows that the conical scan is preferred since the time for lock-on for relatively slow look angle rates will be significantly shorter than the raster scan. Significant improvement in spherical coverage may be obtained by reorienting the antenna gimbal to obtain maximum blockage overlap.

Enhancing managerial effectiveness in dietetics.

PubMed

Hoover, L W

1983-01-01

Environmental pressures from such sources as economic conditions, the government, third-party payers, and inter-institutional competition create managerial challenges. Although cost-containment has received considerable attention, long-term cost-effectiveness is probably the significant issue. Dietitians must become more cost-conscious and effective in resource management to attain desired performance outcomes. Some of the skills and characteristics essential to managerial effectiveness are a marketing orientation, systems design skill, quantitative operations management techniques, financial expertise, and leadership. These abilities facilitate decision-making and achievement of long-term cost-effectiveness. Curriculum enhancement and continuing education are two strategies for improving managerial competency in the dietetics profession. In dietetics education, study of management topics should be enhanced to provide more advanced coverage of management theories and quantitative models so that managerial performance can be at a higher level of sophistication and competency. To assure the viability of the dietetics profession, the emphasis on management must be more comprehensive and rigorous.

Mandatory universal drug plan, access to health care and health: Evidence from Canada.

PubMed

Wang, Chao; Li, Qing; Sweetman, Arthur; Hurley, Jeremiah

2015-12-01

This paper examines the impacts of a mandatory, universal prescription drug insurance program on health care utilization and health outcomes in a public health care system with free physician and hospital services. Using the Canadian National Population Health Survey from 1994 to 2003 and implementing a difference-in-differences estimation strategy, we find that the mandatory program substantially increased drug coverage among the general population. The program also increased medication use and general practitioner visits but had little effect on specialist visits and hospitalization. Findings from quantile regressions suggest that there was a large improvement in the health status of less healthy individuals. Further analysis by pre-policy drug insurance status and the presence of chronic conditions reveals a marked increase in the probability of taking medication and visiting a general practitioner among the previously uninsured and those with a chronic condition. Copyright © 2015 Elsevier B.V. All rights reserved.

Estimation of group means when adjusting for covariates in generalized linear models.

PubMed

Qu, Yongming; Luo, Junxiang

2015-01-01

Generalized linear models are commonly used to analyze categorical data such as binary, count, and ordinal outcomes. Adjusting for important prognostic factors or baseline covariates in generalized linear models may improve the estimation efficiency. The model-based mean for a treatment group produced by most software packages estimates the response at the mean covariate, not the mean response for this treatment group for the studied population. Although this is not an issue for linear models, the model-based group mean estimates in generalized linear models could be seriously biased for the true group means. We propose a new method to estimate the group mean consistently with the corresponding variance estimation. Simulation showed the proposed method produces an unbiased estimator for the group means and provided the correct coverage probability. The proposed method was applied to analyze hypoglycemia data from clinical trials in diabetes. Copyright © 2014 John Wiley & Sons, Ltd.

Node Self-Deployment Algorithm Based on Pigeon Swarm Optimization for Underwater Wireless Sensor Networks

PubMed Central

Yu, Shanen; Xu, Yiming; Jiang, Peng; Wu, Feng; Xu, Huan

2017-01-01

At present, free-to-move node self-deployment algorithms aim at event coverage and cannot improve network coverage under the premise of considering network connectivity, network reliability and network deployment energy consumption. Thus, this study proposes pigeon-based self-deployment algorithm (PSA) for underwater wireless sensor networks to overcome the limitations of these existing algorithms. In PSA, the sink node first finds its one-hop nodes and maximizes the network coverage in its one-hop region. The one-hop nodes subsequently divide the network into layers and cluster in each layer. Each cluster head node constructs a connected path to the sink node to guarantee network connectivity. Finally, the cluster head node regards the ratio of the movement distance of the node to the change in the coverage redundancy ratio as the target function and employs pigeon swarm optimization to determine the positions of the nodes. Simulation results show that PSA improves both network connectivity and network reliability, decreases network deployment energy consumption, and increases network coverage. PMID:28338615

Sanitation and water supply coverage thresholds associated with active trachoma: Modeling cross-sectional data from 13 countries

PubMed Central

Boisson, Sophie; Willis, Rebecca; Bakhtiari, Ana; al-Khatib, Tawfik; Amer, Khaled; Batcho, Wilfrid; Courtright, Paul; Dejene, Michael; Goepogui, Andre; Kalua, Khumbo; Kebede, Biruck; Macleod, Colin K.; Madeleine, Kouakou IIunga Marie; Mbofana, Mariamo Saide Abdala; Mpyet, Caleb; Ndjemba, Jean; Olobio, Nicholas; Pavluck, Alexandre L.; Sokana, Oliver; Southisombath, Khamphoua; Taleo, Fasihah

2018-01-01

Background Facial cleanliness and sanitation are postulated to reduce trachoma transmission, but there are no previous data on community-level herd protection thresholds. We characterize associations between active trachoma, access to improved sanitation facilities, and access to improved water sources for the purpose of face washing, with the aim of estimating community-level or herd protection thresholds. Methods and findings We used cluster-sampled Global Trachoma Mapping Project data on 884,850 children aged 1–9 years from 354,990 households in 13 countries. We employed multivariable mixed-effects modified Poisson regression models to assess the relationships between water and sanitation coverage and trachomatous inflammation—follicular (TF). We observed lower TF prevalence among those with household-level access to improved sanitation (prevalence ratio, PR = 0.87; 95%CI: 0.83–0.91), and household-level access to an improved washing water source in the residence/yard (PR = 0.81; 95%CI: 0.75–0.88). Controlling for household-level water and latrine access, we found evidence of community-level protection against TF for children living in communities with high sanitation coverage (PR80–90% = 0.87; 95%CI: 0.73–1.02; PR90–100% = 0.76; 95%CI: 0.67–0.85). Community sanitation coverage levels greater than 80% were associated with herd protection against TF (PR = 0.77; 95%CI: 0.62–0.97)—that is, lower TF in individuals whose households lacked individual sanitation but who lived in communities with high sanitation coverage. For community-level water coverage, there was no apparent threshold, although we observed lower TF among several of the higher deciles of community-level water coverage. Conclusions Our study provides insights into the community water and sanitation coverage levels that might be required to best control trachoma. Our results suggest access to adequate water and sanitation can be important components in working towards the 2020 target of eliminating trachoma as a public health problem. PMID:29357365

[Strategies to improve influenza vaccination coverage in Primary Health Care].

PubMed

Antón, F; Richart, M J; Serrano, S; Martínez, A M; Pruteanu, D F

2016-04-01

Vaccination coverage reached in adults is insufficient, and there is a real need for new strategies. To compare strategies for improving influenza vaccination coverage in persons older than 64 years. New strategies were introduced in our health care centre during 2013-2014 influenza vaccination campaign, which included vaccinating patients in homes for the aged as well as in the health care centre. A comparison was made on vaccination coverage over the last 4 years in 3 practices of our health care centre: P1, the general physician vaccinated patients older than 64 that came to the practice; P2, the general physician systematically insisted in vaccination in elderly patients, strongly advising to book appointments, and P3, the general physician did not insist. These practices looked after P1: 278; P2: 320; P3: 294 patients older than 64 years. Overall/P1/P2/P3 coverages in 2010: 51.2/51.4/55/46.9% (P=NS), in 2011: 52.4/52.9/53.8/50.3% (P=NS), in 2012: 51.9/52.5/55.3/47.6% (P=NS), and in 2013: 63.5/79.1/59.7/52.7 (P=.000, P1 versus P2 and P3; P=NS between P2 and P3). Comparing the coverages in 2012-2013 within each practice P1 (P=.000); P2 (P=.045); P3 (P=.018). In P2 and P3 all vaccinations were given by the nurses as previously scheduled. In P3, 55% of the vaccinations were given by the nurses, 24.1% by the GP, 9.7% rejected vaccination, and the remainder did not come to the practice during the vaccination period (October 2013-February 2014). The strategy of vaccinating in the homes for the aged improved the vaccination coverage by 5% in each practice. The strategy of "I've got you here, I jab you here" in P1 improved the vaccination coverage by 22%. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Carlsberg alibi marketing in the UEFA euro 2016 football finals: implications of Probably inappropriate alcohol advertising.

PubMed

Murray, Rachael; Breton, Magdalena Opazo; Britton, John; Cranwell, Jo; Grant-Braham, Bruce

2018-04-25

Alcohol advertising is a key driver of alcohol consumption, and is prohibited in France by the Loi Evin. In 2016 the Danish brewer Carlsberg sponsored the UEFA Euro 2016 finals, held in France, and used the alibis 'Probably' and '…the best in the world' in place of Carlsberg in pitch-side advertising. We have quantified the advertising exposure achieved during the final seven games in the UEFA Euro 2016 championship. Appearances of the Carlsberg alibis 'Probably' and 'the best in the world' were counted and timed to the nearest second during all active play in live coverage of quarter final, semi-final and final matches broadcast in the UK. We used census data and viewing figures from Kantar Media to estimate gross and per capita impressions of these advertisements in the UK population. In 796 min, 29 s of active play there were 746 alibi appearances, totalling 68 min 35 s duration and representing 8.6% of active playing time. Appearances were particularly frequent at the end of normal time, extra time and penalties. The seven matches delivered up to 7.43 billion Carlsberg alibi impressions to UK adults and 163.3 million to children. In the only match involving a second country with laws prohibiting alcohol advertising (France versus Iceland), exposure occurred for only 1.8% of playing time. Alibi marketing achieved significant advertising coverage during the final seven EURO 2016 championship games, particularly to children. Since 'Probably' is registered by Carlsberg as a wordmark this advertising appears to contravene the Loi Evin, though Carlsberg have defended their marketing actions.

Paid maternity leave and childhood vaccination uptake: Longitudinal evidence from 20 low-and-middle-income countries.

PubMed

Hajizadeh, Mohammad; Heymann, Jody; Strumpf, Erin; Harper, Sam; Nandi, Arijit

2015-09-01

The availability of maternity leave might remove barriers to improved vaccination coverage by increasing the likelihood that parents are available to bring a child to the clinic for immunizations. Using information from 20 low-and-middle-income countries (LMICs) we estimated the effect of paid maternity leave policies on childhood vaccination uptake. We used birth history data collected via Demographic and Health Surveys (DHS) to assemble a multilevel panel of 258,769 live births in 20 countries from 2001 to 2008; these data were merged with longitudinal information on the number of full-time equivalent (FTE) weeks of paid maternity leave guaranteed by each country. We used Logistic regression models that included country and year fixed effects to estimate the impact of increases in FTE paid maternity leave policies in the prior year on the receipt of the following vaccines: Bacillus Calmette-Guérin (BCG) commonly given at birth, diphtheria, tetanus, and pertussis (DTP, 3 doses) commonly given in clinic visits and Polio (3 doses) given in clinic visits or as part of campaigns. We found that extending the duration of paid maternity leave had a positive effect on immunization rates for all three doses of the DTP vaccine; each additional FTE week of paid maternity leave increased DTP1, 2 and 3 coverage by 1.38 (95% CI = 1.18, 1.57), 1.62 (CI = 1.34, 1.91) and 2.17 (CI = 1.76, 2.58) percentage points, respectively. Estimates were robust to adjustment for birth characteristics, household-level covariates, attendance of skilled health personnel at birth and time-varying country-level covariates. We found no evidence for an effect of maternity leave on the probability of receiving vaccinations for BCG or Polio after adjustment for the above-mentioned covariates. Our findings were consistent with the hypothesis that more generous paid leave policies have the potential to improve DTP immunization coverage. Further work is needed to understand the health effects of paid leave policies in LMICs. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cancer care coordinators in stage III colon cancer: a cost-utility analysis.

PubMed

Blakely, Tony; Collinson, Lucie; Kvizhinadze, Giorgi; Nair, Nisha; Foster, Rachel; Dennett, Elizabeth; Sarfati, Diana

2015-08-05

There is momentum internationally to improve coordination of complex care pathways. Robust evaluations of such interventions are scarce. This paper evaluates the cost-utility of cancer care coordinators for stage III colon cancer patients, who generally require surgery followed by chemotherapy. We compared a hospital-based nurse cancer care coordinator (CCC) with 'business-as-usual' (no dedicated coordination service) in stage III colon cancer patients in New Zealand. A discrete event microsimulation model was constructed to estimate quality-adjusted life-years (QALYs) and costs from a health system perspective. We used New Zealand data on colon cancer incidence, survival, and mortality as baseline input parameters for the model. We specified intervention input parameters using available literature and expert estimates. For example, that a CCC would improve the coverage of chemotherapy by 33% (ranging from 9 to 65%), reduce the time to surgery by 20% (3 to 48%), reduce the time to chemotherapy by 20% (3 to 48%), and reduce patient anxiety (reduction in disability weight of 33%, ranging from 0 to 55%). Much of the direct cost of a nurse CCC was balanced by savings in business-as-usual care coordination. Much of the health gain was through increased coverage of chemotherapy with a CCC (especially older patients), and reduced time to chemotherapy. Compared to 'business-as-usual', the cost per QALY of the CCC programme was $NZ 18,900 (≈ $US 15,600; 95% UI: $NZ 13,400 to 24,600). By age, the CCC intervention was more cost-effective for colon cancer patients < 65 years ($NZ 9,400 per QALY). By ethnicity, the health gains were larger for Māori, but so too were the costs, meaning the cost-effectiveness was roughly comparable between ethnic groups. Such a nurse-led CCC intervention in New Zealand has acceptable cost-effectiveness for stage III colon cancer, meaning it probably merits funding. Each CCC programme will differ in its likely health gains and costs, making generalisation from this evaluation to other CCC interventions difficult. However, this evaluation suggests that CCC interventions that increase coverage of, and reduce time to, effective treatments may be cost-effective.

Theoretical aspects of 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.; Reed, J. A.

2011-03-01

The study of adsorption of oxygen on transition metal surface is important for the understanding of oxidation, heterogeneous catalysis, and metal corrosion. The structures formed on transition metal surfaces vary from simple adlayers of chemisorbed oxygen to more complex structures which results from diffusion of oxygen into the sub-surface regions. In this work we present the results of an ab-initio investigation of positron surface and bulk states and annihilation probabilities of surface-trapped positrons with relevant core electrons at the Cu(100) missing row reconstructed surface under conditions of high oxygen coverage. Calculations are performed for various surface and subsurface oxygen coverages ranging from 0.50 to 1.50 monolayers. Calculations are also performed for the on-surface adsorption of oxygen on the unreconstructed Cu(001) surface for coverages up to one monolayer to use for comparison. Estimates of the positron binding energy, positron work function, and annihilation characteristics reveal their sensitivity to atomic structure of the topmost layers of the surface and charge transfer. Theoretical results are compared with experimental data obtained from studies of oxidation of the Cu(100) surface using positron annihilation induced Auger electron spectroscopy.

Achieving Crossed Strong Barrier Coverage in Wireless Sensor Network.

PubMed

Han, Ruisong; Yang, Wei; Zhang, Li

2018-02-10

Barrier coverage has been widely used to detect intrusions in wireless sensor networks (WSNs). It can fulfill the monitoring task while extending the lifetime of the network. Though barrier coverage in WSNs has been intensively studied in recent years, previous research failed to consider the problem of intrusion in transversal directions. If an intruder knows the deployment configuration of sensor nodes, then there is a high probability that it may traverse the whole target region from particular directions, without being detected. In this paper, we introduce the concept of crossed barrier coverage that can overcome this defect. We prove that the problem of finding the maximum number of crossed barriers is NP-hard and integer linear programming (ILP) is used to formulate the optimization problem. The branch-and-bound algorithm is adopted to determine the maximum number of crossed barriers. In addition, we also propose a multi-round shortest path algorithm (MSPA) to solve the optimization problem, which works heuristically to guarantee efficiency while maintaining near-optimal solutions. Several conventional algorithms for finding the maximum number of disjoint strong barriers are also modified to solve the crossed barrier problem and for the purpose of comparison. Extensive simulation studies demonstrate the effectiveness of MSPA.

Successful Control of Ebola Virus Disease: Analysis of Service Based Data from Rural Sierra Leone

PubMed Central

Lokuge, Kamalini; Caleo, Grazia; Greig, Jane; Duncombe, Jennifer; McWilliam, Nicholas; Squire, James; Lamin, Manjo; Veltus, Emily; Wolz, Anja; Kobinger, Gary; de la Vega, Marc-Antoine; Gbabai, Osman; Nabieu, Sao; Lamin, Mohammed; Kremer, Ronald; Danis, Kostas; Banks, Emily; Glass, Kathryn

2016-01-01

Introduction The scale and geographical distribution of the current outbreak in West Africa raised doubts as to the effectiveness of established methods of control. Ebola Virus Disease (EVD) was first detected in Sierra Leone in May 2014 in Kailahun district. Despite high case numbers elsewhere in the country, transmission was eliminated in the district by December 2014. We describe interventions underpinning successful EVD control in Kailahun and implications for EVD control in other areas. Methods Internal service data and published reports from response agencies were analysed to describe the structure and type of response activities, EVD case numbers and epidemic characteristics. This included daily national situation reports and District-level data and reports of the Sierra Leone Ministry of Health and Sanitation, and Médecins Sans Frontières (MSF) patient data and internal epidemiological reports. We used EVD case definitions provided by the World Health Organisation over the course of the outbreak. Characteristics assessed included level of response activities and epidemiological features such as reported exposure (funeral-related or not), time interval between onset of illness and admission to the EVD Management Centre (EMC), work-related exposures (health worker or not) and mortality. We compared these characteristics between two time periods—June to July (the early period of response), and August to December (when coverage and quality of response had improved). A stochastic model was used to predict case numbers per generation with different numbers of beds and a varying percentage of community cases detected. Results There were 652 probable/confirmed EVD cases from June-December 2014 in Kailahun. An EMC providing patient care opened in June. By August 2014 an integrated detection, treatment, and prevention strategy was in place across the district catchment zone. From June-July to August-December 2014 surveillance and contact tracing staff increased from 1.0 to 8.8 per confirmed EVD case, EMC capacity increased from 32 to 100 beds, the number of burial teams doubled, and health promotion activities increased in coverage. These improvements in response were associated with the following changes between the same periods: the proportion of confirmed/probable cases admitted to the EMC increased from 35% to 83% (χ2 p-value<0·001), the proportion of confirmed patients admitted to the EMC <3 days of symptom onset increased from 19% to 37% (χ2 p-value <0·001), and reported funeral contact in those admitted decreased from 33% to 16% (χ2 p-value <0·001). Mathematical modelling confirmed the importance of both patient management capacity and surveillance and contact tracing for EVD control. Discussion Our findings demonstrate that control of EVD can be achieved using established interventions based on identification and appropriate management of those who are at risk of and develop EVD, including in the context of ongoing transmission in surrounding regions. Key attributes in achieving control were sufficient patient care capacity (including admission to specialist facilities of suspect and probable cases for assessment), integrated with adequate staffing and resourcing of community-based case detection and prevention activities. The response structure and coverage targets we present are of value in informing effective control in current and future EVD outbreaks. PMID:26959413

Successful Control of Ebola Virus Disease: Analysis of Service Based Data from Rural Sierra Leone.

PubMed

Lokuge, Kamalini; Caleo, Grazia; Greig, Jane; Duncombe, Jennifer; McWilliam, Nicholas; Squire, James; Lamin, Manjo; Veltus, Emily; Wolz, Anja; Kobinger, Gary; de la Vega, Marc-Antoine; Gbabai, Osman; Nabieu, Sao; Lamin, Mohammed; Kremer, Ronald; Danis, Kostas; Banks, Emily; Glass, Kathryn

2016-03-01

The scale and geographical distribution of the current outbreak in West Africa raised doubts as to the effectiveness of established methods of control. Ebola Virus Disease (EVD) was first detected in Sierra Leone in May 2014 in Kailahun district. Despite high case numbers elsewhere in the country, transmission was eliminated in the district by December 2014. We describe interventions underpinning successful EVD control in Kailahun and implications for EVD control in other areas. Internal service data and published reports from response agencies were analysed to describe the structure and type of response activities, EVD case numbers and epidemic characteristics. This included daily national situation reports and District-level data and reports of the Sierra Leone Ministry of Health and Sanitation, and Médecins Sans Frontières (MSF) patient data and internal epidemiological reports. We used EVD case definitions provided by the World Health Organisation over the course of the outbreak. Characteristics assessed included level of response activities and epidemiological features such as reported exposure (funeral-related or not), time interval between onset of illness and admission to the EVD Management Centre (EMC), work-related exposures (health worker or not) and mortality. We compared these characteristics between two time periods--June to July (the early period of response), and August to December (when coverage and quality of response had improved). A stochastic model was used to predict case numbers per generation with different numbers of beds and a varying percentage of community cases detected. There were 652 probable/confirmed EVD cases from June-December 2014 in Kailahun. An EMC providing patient care opened in June. By August 2014 an integrated detection, treatment, and prevention strategy was in place across the district catchment zone. From June-July to August-December 2014 surveillance and contact tracing staff increased from 1.0 to 8.8 per confirmed EVD case, EMC capacity increased from 32 to 100 beds, the number of burial teams doubled, and health promotion activities increased in coverage. These improvements in response were associated with the following changes between the same periods: the proportion of confirmed/probable cases admitted to the EMC increased from 35% to 83% (χ(2) p-value<0·001), the proportion of confirmed patients admitted to the EMC <3 days of symptom onset increased from 19% to 37% (χ(2) p-value <0·001), and reported funeral contact in those admitted decreased from 33% to 16% (χ(2) p-value <0·001). Mathematical modelling confirmed the importance of both patient management capacity and surveillance and contact tracing for EVD control. Our findings demonstrate that control of EVD can be achieved using established interventions based on identification and appropriate management of those who are at risk of and develop EVD, including in the context of ongoing transmission in surrounding regions. Key attributes in achieving control were sufficient patient care capacity (including admission to specialist facilities of suspect and probable cases for assessment), integrated with adequate staffing and resourcing of community-based case detection and prevention activities. The response structure and coverage targets we present are of value in informing effective control in current and future EVD outbreaks.

Remaining missed opportunities of child survival in Peru: modelling mortality impact of universal and equitable coverage of proven interventions.

PubMed

Tam, Yvonne; Huicho, Luis; Huayanay-Espinoza, Carlos A; Restrepo-Méndez, María Clara

2016-10-04

Peru has made great improvements in reducing stunting and child mortality in the past decade, and has reached the Millennium Development Goals 1 and 4. The remaining challenges or missed opportunities for child survival needs to be identified and quantified, in order to guide the next steps to further improve child survival in Peru. We used the Lives Saved Tool (LiST) to project the mortality impact of proven interventions reaching every women and child in need, and the mortality impact of eliminating inequalities in coverage distribution between wealth quintiles and urban-rural residence. Our analyses quantified the remaining missed opportunities in Peru, where prioritizing scale-up of facility-based case management for all small and sick babies will be most effective in mortality reduction, compared to other evidenced-based interventions that prevent maternal and child deaths. Eliminating coverage disparities between the poorest quintiles and the richest will reduce under-five and neonatal mortality by 22.0 and 40.6 %, while eliminating coverage disparities between those living in rural and urban areas will reduce under-five and neonatal mortality by 29.3 and 45.2 %. This projected neonatal mortality reduction achieved by eliminating coverage disparities is almost comparable to that already achieved by Peru over the past decade. Although Peru has made great strides in improving child survival, further improvement in child health, especially in newborn health can be achieved if there is universal and equitable coverage of proven, quality health facility-based interventions. The magnitude of reduction in mortality will be similar to what has been achieved in the past decade. Strengthening health system to identify, understand, and direct resources to the poor and rural areas will ensure that Peru achieve the Sustainable Development Goals by 2030.

2 CFR 200.310 - Insurance coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

.... The non-Federal entity must, at a minimum, provide the equivalent insurance coverage for real property and equipment acquired or improved with Federal funds as provided to property owned by the non-Federal...

Factors predictive of increased influenza and pneumococcal vaccination coverage in long-term care facilities: the CMS-CDC standing orders program Project.

PubMed

Bardenheier, Barbara H; Shefer, Abigail; McKibben, Linda; Roberts, Henry; Rhew, David; Bratzler, Dale

2005-01-01

Between 1999 and 2002, a multistate demonstration project was conducted in long-term care facilities (LTCFs) to encourage implementation of standing orders programs (SOP) as evidence-based vaccine delivery strategies to increase influenza and pneumococcal vaccination coverage in LTCFs. Examine predictors of increase in influenza and pneumococcal vaccination coverage in LTCFs. Intervention study. Self-administered surveys of LTCFs merged with data from OSCAR (On-line Survey Certification and Reporting System) and immunization coverage was abstracted from residents' medical charts in LTCFs. Twenty LTCFs were sampled from 9 intervention and 5 control states in the 2000 to 2001 influenza season for baseline and during the 2001 to 2002 influenza season for postintervention. Each state's quality improvement organization (QIO) promoted the use of standing orders for immunizations as well as other strategies to increase immunization coverage among LTCF residents. Multivariate analysis included Poisson regression to determine independent predictors of at least a 10 percentage-point increase in facility influenza and pneumococcal vaccination coverage. Forty-two (20%) and 59 (28%) of the facilities had at least a 10 percentage-point increase in influenza and pneumococcal immunizations, respectively. In the multivariate analysis, predictors associated with increase in influenza vaccination coverage included adoption of requirement in written immunization protocol to document refusals, less-demanding consent requirements, lower baseline influenza coverage, and small facility size. Factors associated with increase in pneumococcal vaccination coverage included adoption of recording pneumococcal immunizations in a consistent place, affiliation with a multifacility chain, and provision of resource materials. To improve the health of LTCF residents, strategies should be considered that increase immunization coverage, including written protocol for immunizations and documentation of refusals, documenting vaccination status in a consistent place in medical records, and minimal consent requirements for vaccinations.

The Association Between Primary Source of Healthcare Coverage and Colorectal Cancer Screening Among US Veterans.

PubMed

May, Folasade P; Yano, Elizabeth M; Provenzale, Dawn; Neil Steers, W; Washington, Donna L

2017-08-01

Colorectal cancer (CRC) is a deadly but largely preventable disease. Screening improves outcomes, but screening rates vary across healthcare coverage models. In the Veterans Health Administration (VA), screening rates are high; however, it is unknown how CRC screening rates compare for Veterans with other types of healthcare coverage. To determine whether Veterans with Veteran-status-related coverage (VA, military, TRICARE) have higher rates of CRC screening than Veterans with alternate sources of healthcare coverage. We conducted a cross-sectional analysis of Veterans 50-75 years from the 2014 Behavioral Risk Factor Surveillance System survey. We examined CRC screening rates and screening modalities. We performed multivariable logistic regression to identify the role of coverage type, demographics, and clinical factors on screening status. The cohort included 22,138 Veterans. Of these, 76.7% reported up-to-date screening. Colonoscopy was the most common screening modality (83.7%). Screening rates were highest among Veterans with Veteran-status-related coverage (82.3%), as was stool-based screening (10.8%). The adjusted odds of up-to-date screening among Veterans with Veteran-status-related coverage were 83% higher than among Veterans with private coverage (adjusted OR = 1.83, 95% CI = 1.52-2.22). Additional predictors of screening included older age, black race, high income, access to medical care, frequent medical visits, and employed or married status. CRC screening rates were highest among Veterans with Veteran-status-related coverage. High CRC screening rates among US Veterans may be related to system-level characteristics of VA and military care. Insight to these system-level characteristics may inform mechanisms to improve CRC screening in non-VA settings.

Measuring Coverage in MNCH: Design, Implementation, and Interpretation Challenges Associated with Tracking Vaccination Coverage Using Household Surveys

PubMed Central

Cutts, Felicity T.; Izurieta, Hector S.; Rhoda, Dale A.

2013-01-01

Vaccination coverage is an important public health indicator that is measured using administrative reports and/or surveys. The measurement of vaccination coverage in low- and middle-income countries using surveys is susceptible to numerous challenges. These challenges include selection bias and information bias, which cannot be solved by increasing the sample size, and the precision of the coverage estimate, which is determined by the survey sample size and sampling method. Selection bias can result from an inaccurate sampling frame or inappropriate field procedures and, since populations likely to be missed in a vaccination coverage survey are also likely to be missed by vaccination teams, most often inflates coverage estimates. Importantly, the large multi-purpose household surveys that are often used to measure vaccination coverage have invested substantial effort to reduce selection bias. Information bias occurs when a child's vaccination status is misclassified due to mistakes on his or her vaccination record, in data transcription, in the way survey questions are presented, or in the guardian's recall of vaccination for children without a written record. There has been substantial reliance on the guardian's recall in recent surveys, and, worryingly, information bias may become more likely in the future as immunization schedules become more complex and variable. Finally, some surveys assess immunity directly using serological assays. Sero-surveys are important for assessing public health risk, but currently are unable to validate coverage estimates directly. To improve vaccination coverage estimates based on surveys, we recommend that recording tools and practices should be improved and that surveys should incorporate best practices for design, implementation, and analysis. PMID:23667334

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.

Strategies to improve treatment coverage in community-based public health programs: A systematic review of the literature.

PubMed

Deardorff, Katrina V; Rubin Means, Arianna; Ásbjörnsdóttir, Kristjana H; Walson, Judd

2018-02-01

Community-based public health campaigns, such as those used in mass deworming, vitamin A supplementation and child immunization programs, provide key healthcare interventions to targeted populations at scale. However, these programs often fall short of established coverage targets. The purpose of this systematic review was to evaluate the impact of strategies used to increase treatment coverage in community-based public health campaigns. We systematically searched CAB Direct, Embase, and PubMed archives for studies utilizing specific interventions to increase coverage of community-based distribution of drugs, vaccines, or other public health services. We identified 5,637 articles, from which 79 full texts were evaluated according to pre-defined inclusion and exclusion criteria. Twenty-eight articles met inclusion criteria and data were abstracted regarding strategy-specific changes in coverage from these sources. Strategies used to increase coverage included community-directed treatment (n = 6, pooled percent change in coverage: +26.2%), distributor incentives (n = 2, +25.3%), distribution along kinship networks (n = 1, +24.5%), intensified information, education, and communication activities (n = 8, +21.6%), fixed-point delivery (n = 1, +21.4%), door-to-door delivery (n = 1, +14.0%), integrated service distribution (n = 9, +12.7%), conversion from school- to community-based delivery (n = 3, +11.9%), and management by a non-governmental organization (n = 1, +5.8%). Strategies that target improving community member ownership of distribution appear to have a large impact on increasing treatment coverage. However, all strategies used to increase coverage successfully did so. These results may be useful to National Ministries, programs, and implementing partners in optimizing treatment coverage in community-based public health programs.

Strategies to improve treatment coverage in community-based public health programs: A systematic review of the literature

PubMed Central

2018-01-01

Background Community-based public health campaigns, such as those used in mass deworming, vitamin A supplementation and child immunization programs, provide key healthcare interventions to targeted populations at scale. However, these programs often fall short of established coverage targets. The purpose of this systematic review was to evaluate the impact of strategies used to increase treatment coverage in community-based public health campaigns. Methodology/ principal findings We systematically searched CAB Direct, Embase, and PubMed archives for studies utilizing specific interventions to increase coverage of community-based distribution of drugs, vaccines, or other public health services. We identified 5,637 articles, from which 79 full texts were evaluated according to pre-defined inclusion and exclusion criteria. Twenty-eight articles met inclusion criteria and data were abstracted regarding strategy-specific changes in coverage from these sources. Strategies used to increase coverage included community-directed treatment (n = 6, pooled percent change in coverage: +26.2%), distributor incentives (n = 2, +25.3%), distribution along kinship networks (n = 1, +24.5%), intensified information, education, and communication activities (n = 8, +21.6%), fixed-point delivery (n = 1, +21.4%), door-to-door delivery (n = 1, +14.0%), integrated service distribution (n = 9, +12.7%), conversion from school- to community-based delivery (n = 3, +11.9%), and management by a non-governmental organization (n = 1, +5.8%). Conclusions/significance Strategies that target improving community member ownership of distribution appear to have a large impact on increasing treatment coverage. However, all strategies used to increase coverage successfully did so. These results may be useful to National Ministries, programs, and implementing partners in optimizing treatment coverage in community-based public health programs. PMID:29420534

The Effect of the Affordable Care Act's Young Adult Insurance Expansions on Hospital-Based Behavioral Health Care

PubMed Central

Golberstein, Ezra; Busch, Susan H.; Zaha, Rebecca; Greenfield, Shelly F.; Beardslee, William R.; Meara, Ellen

2014-01-01

Objective Insurance coverage for young adults has increased since 2010, when the Affordable Care Act (ACA) required insurers to permit children on parental policies until age 26 as dependents. This study estimated changes in young adults’ use of hospital-based services with diagnosis codes for mental illness and substance abuse associated with the dependent coverage provision. Method Quasi-experimental comparison of national sample of non-birth hospital inpatient admissions to general hospitals (n=2,670,463 total, n=430,583 with primary behavioral health diagnosis) and California emergency department (ED) visits with behavioral health diagnoses (n=11,139,689). Data spanned 2005 to 2011. Estimates compared young adults who were and were not targeted by the ACA dependent coverage provision (19 to 25 versus 26 to 29 year olds), estimating changes in utilization before and after 2010. Primary outcomes included: quarterly inpatient admissions for primary diagnosis of any behavioral health disorder per 1000 population; ED visits with any behavioral health diagnosis per 1000 population; and payer source. Results Dependent coverage expansion was associated with 0.14 per 1000 more (p<0.001) inpatient admissions for behavioral health for 19-25 (ACA covered) versus 26-29 (then ACA uncovered) year olds. The coverage expansion was associated with 0.45 fewer behavioral health ED visits per 1000 (p=0.001) in California. The probability that inpatient admissions nationally, and ED visits in California were uninsured, decreased significantly (p<0.001). Conclusions ACA dependent coverage provisions produced modest increases in general hospital psychiatric inpatient admissions and higher rates of insurance coverage for young adult children nationally. Lower ED visit rates were observed in California. PMID:25263817

[Analysis on coverage rate of primary immunization of measles vaccine among migrant children in Yiwu, Zhejiang province from 2007 to 2010].

PubMed

Li, Qian; Hu, Yu; Qi, Xiao-hua; Lou, Ling-qiao; Luo, Shu-ying; Tang, Xue-wen; Chen, En-fu

2013-06-01

To investigate the coverage rate of primary immunization of measles containing vaccine (MCV1) among migrant children in Yiwu,Zhejiang province. Household cluster sampling survey and probability proportion to size sampling method were adopted. A total of 967 migrant children born from 1st July 2007 to 1st July 2010 and their caregivers were selected as target population. Standard face-to-face interviews were conducted to investigate the subjects' knowledge, attitude, practice (KAP) of immunization, MCV1 vaccination and determinants. Multi-variable weighted average score method was adopted to evaluate the result of our survey on KAP. Kaplan-Meier analysis was adopted to assess the coverage of MCV1 and Cox regression analysis was adopted to explore the influencing factors associated with the coverage of MCV1. Out of the 967 children, 104 were born in 2007, accounting for 10.8%; 301 were born in 2008, accounting for 31.1%; 343 were born in 2009, accounting for 35.5% and 219 were born in 2010, accounting for 22.6%. Among the surveyed caregivers, 71.9% (695/967) were mothers and 90.2% (872/976) were migrant from other provinces. According to the result of survey on KAP among caregivers, 56.2% (543/967) scored ≥ 4 points on knowledge, 75.8% (734/967) scored ≥ 4 points on attitude and 48.7% (471/967) scored ≥ 4 points on behavior. 86.6% (838/967) of surveyed caregivers' education levels were under junior middle school.85.9% (831/967) of the migrant children were born in hospitals.36.3% (351/967) of the surveyed families' household income were under 2000 yuan per month.32.7% (316/967) of surveyed caregivers waited less than 15 min for immunization for each time. Coverage rate of MCV1 was 85.9% (831/967; 95%CI: 83.7%-88.1%). The timely coverage rates at 8 months, 12 months, and 24 months were 58.8% (569/967; 95%CI: 55.5%-62.1%), 88.2% (853/967; 95%CI: 86.0%-90.4%) and 98.6% (953/967; 95%CI: 97.8%-99.4%), respectively. The average age of MCV1 immunization for each birth cohort between 2007 and 2010 were 10.4, 10.1, 10.1 and 9.3 month, respectively; without statistical significance (χ(2) = 0.722, P = 0.398). According to the analysis by Cox regression, the caregivers aged ≤ 25 years (24.3% (235/967), RR = 1.520 (95%CI: 1.280-1.800)), the caregivers' education level above college (2.8% (27/967), RR = 3.841 (95%CI: 2.287-6.451)), delivered in county-level hospital (49.4% (478/967), RR = 6.048 (95%CI: 4.311-8.485)), household income > 4000 yuan per month (21.7% (210/967), RR = 1.366 (95%CI:1.163-1.604)), the average score of attitude towards immunization ≥ 4 points (75.9%(734/967), RR = 2.613 (95%CI: 1.026-6.655)), the average waiting time for each vaccination ≤ 15 min (32.7% (316/967), RR = 2.116 (95%CI: 1.341-3.339)) were the important factors to improve the timely immunization coverage rate of MCV1 among migrant children. The coverage of MCV1 were obviously delayed among migrant children in Yiwu, Zhejiang province. We suggest that the investigation of migrant children should be strengthened and remind or recall mechanism for immunization should be established. Increasing the open days for immunization clinics and reducing the waiting time for vaccination could also improve the coverage and timeliness of the MCV vaccination.

Ear reconstruction using a porous polyethylene framework and temporoparietal fascia flap.

PubMed

Reinisch, John F; Lewin, Sheryl

2009-08-01

Ear reconstruction is a difficult procedure requiring a framework and soft tissue covering. The traditional method uses a rib cartilage framework placed beneath scalp skin. This method has been used for 50 years despite inherent problems with both harvesting rib cartilage and using scalp for coverage. The authors describe a method using a porous polyethylene (PPE) framework covered by a large temporoparietal fascia (TFP) flap raised with the underlying subgaleal fascia (SGF). The entire implant is covered by the two-layered flap, which can be raised without any scalp incision. The skin grafts applied to the covered implant lie on the SGF. The trilaminar structure of the SGF allows the skin to move independently over the implant, resisting shear forces and reducing the probability of implant exposure. Ear reconstruction using the PPE framework was performed on 786 ears over an 18-year period. Initial complications were common. With improved implant design and complete coverage of the implant with both the TPF and SGF, exposure rate dropped to 7% with a 12-year follow-up. Implant fractures decreased to less than 3%. The PPE/TPF method allows earlier ear reconstruction in children with minimal scarring and discomfort. The reconstructed ear can closely mimic the shape and projection of the natural contralateral ear in fewer stages and with a shorter learning curve. Copyright Thieme Medical Publishers.

A longitudinal study of medicaid coverage for tobacco dependence treatments in Massachusetts and associated decreases in hospitalizations for cardiovascular disease.

PubMed

Land, Thomas; Rigotti, Nancy A; Levy, Douglas E; Paskowsky, Mark; Warner, Donna; Kwass, Jo-Ann; Wetherell, Leann; Keithly, Lois

2010-12-07

Insurance coverage of tobacco cessation medications increases their use and reduces smoking prevalence in a population. However, uncertainty about the impact of this coverage on health care utilization and costs is a barrier to the broader adoption of this policy, especially by publicly funded state Medicaid insurance programs. Whether a publicly funded tobacco cessation benefit leads to decreased medical claims for tobacco-related diseases has not been studied. We examined the experience of Massachusetts, whose Medicaid program adopted comprehensive coverage of tobacco cessation medications in July 2006. Over 75,000 Medicaid subscribers used the benefit in the first 2.5 years. On the basis of earlier secondary survey work, it was estimated that smoking prevalence declined among subscribers by 10% during this period. Using claims data, we compared the probability of hospitalization prior to use of the tobacco cessation pharmacotherapy benefit with the probability of hospitalization after benefit use among Massachusetts Medicaid beneficiaries, adjusting for demographics, comorbidities, seasonality, influenza cases, and the implementation of the statewide smoke-free air law using generalized estimating equations. Statistically significant annualized declines of 46% (95% confidence interval 2%-70%) and 49% (95% confidence interval 6%-72%) were observed in hospital admissions for acute myocardial infarction and other acute coronary heart disease diagnoses, respectively. There were no significant decreases in hospitalizations rates for respiratory diagnoses or seven other diagnostic groups evaluated. Among Massachusetts Medicaid subscribers, use of a comprehensive tobacco cessation pharmacotherapy benefit was associated with a significant decrease in claims for hospitalizations for acute myocardial infarction and acute coronary heart disease, but no significant change in hospital claims for other diagnoses. For low-income smokers, removing the barriers to the use of smoking cessation pharmacotherapy has the potential to decrease short-term utilization of hospital services.

A Longitudinal Study of Medicaid Coverage for Tobacco Dependence Treatments in Massachusetts and Associated Decreases in Hospitalizations for Cardiovascular Disease

PubMed Central

Land, Thomas; Rigotti, Nancy A.; Levy, Douglas E.; Paskowsky, Mark; Warner, Donna; Kwass, Jo-Ann; Wetherell, LeAnn; Keithly, Lois

2010-01-01

Background Insurance coverage of tobacco cessation medications increases their use and reduces smoking prevalence in a population. However, uncertainty about the impact of this coverage on health care utilization and costs is a barrier to the broader adoption of this policy, especially by publicly funded state Medicaid insurance programs. Whether a publicly funded tobacco cessation benefit leads to decreased medical claims for tobacco-related diseases has not been studied. We examined the experience of Massachusetts, whose Medicaid program adopted comprehensive coverage of tobacco cessation medications in July 2006. Over 75,000 Medicaid subscribers used the benefit in the first 2.5 years. On the basis of earlier secondary survey work, it was estimated that smoking prevalence declined among subscribers by 10% during this period. Methods and Findings Using claims data, we compared the probability of hospitalization prior to use of the tobacco cessation pharmacotherapy benefit with the probability of hospitalization after benefit use among Massachusetts Medicaid beneficiaries, adjusting for demographics, comorbidities, seasonality, influenza cases, and the implementation of the statewide smoke-free air law using generalized estimating equations. Statistically significant annualized declines of 46% (95% confidence interval 2%–70%) and 49% (95% confidence interval 6%–72%) were observed in hospital admissions for acute myocardial infarction and other acute coronary heart disease diagnoses, respectively. There were no significant decreases in hospitalizations rates for respiratory diagnoses or seven other diagnostic groups evaluated. Conclusions Among Massachusetts Medicaid subscribers, use of a comprehensive tobacco cessation pharmacotherapy benefit was associated with a significant decrease in claims for hospitalizations for acute myocardial infarction and acute coronary heart disease, but no significant change in hospital claims for other diagnoses. For low-income smokers, removing the barriers to the use of smoking cessation pharmacotherapy has the potential to decrease short-term utilization of hospital services. Please see later in the article for the Editors' Summary PMID:21170313

Health-system reform and universal health coverage in Latin America.

PubMed

Atun, Rifat; de Andrade, Luiz Odorico Monteiro; Almeida, Gisele; Cotlear, Daniel; Dmytraczenko, T; Frenz, Patricia; Garcia, Patrícia; Gómez-Dantés, Octavio; Knaul, Felicia M; Muntaner, Carles; de Paula, Juliana Braga; Rígoli, Felix; Serrate, Pastor Castell-Florit; Wagstaff, Adam

2015-03-28

Starting in the late 1980s, many Latin American countries began social sector reforms to alleviate poverty, reduce socioeconomic inequalities, improve health outcomes, and provide financial risk protection. In particular, starting in the 1990s, reforms aimed at strengthening health systems to reduce inequalities in health access and outcomes focused on expansion of universal health coverage, especially for poor citizens. In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries studied, government financing enabled the introduction of supply-side interventions to expand insurance coverage for uninsured citizens--with defined and enlarged benefits packages--and to scale up delivery of health services. Countries such as Brazil and Cuba introduced tax-financed universal health systems. These changes were combined with demand-side interventions aimed at alleviating poverty (targeting many social determinants of health) and improving access of the most disadvantaged populations. Hence, the distinguishing features of health-system strengthening for universal health coverage and lessons from the Latin American experience are relevant for countries advancing universal health coverage. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Novel Deployment Scheme Based on Three-Dimensional Coverage Model for Wireless Sensor Networks

PubMed Central

Xiao, Fu; Yang, Yang; Wang, Ruchuan; Sun, Lijuan

2014-01-01

Coverage pattern and deployment strategy are directly related to the optimum allocation of limited resources for wireless sensor networks, such as energy of nodes, communication bandwidth, and computing power, and quality improvement is largely determined by these for wireless sensor networks. A three-dimensional coverage pattern and deployment scheme are proposed in this paper. Firstly, by analyzing the regular polyhedron models in three-dimensional scene, a coverage pattern based on cuboids is proposed, and then relationship between coverage and sensor nodes' radius is deduced; also the minimum number of sensor nodes to maintain network area's full coverage is calculated. At last, sensor nodes are deployed according to the coverage pattern after the monitor area is subdivided into finite 3D grid. Experimental results show that, compared with traditional random method, sensor nodes number is reduced effectively while coverage rate of monitor area is ensured using our coverage pattern and deterministic deployment scheme. PMID:25045747

Comparison of IMRT planning with two-step and one-step optimization: a strategy for improving therapeutic gain and reducing the integral dose

NASA Astrophysics Data System (ADS)

Abate, A.; Pressello, M. C.; Benassi, M.; Strigari, L.

2009-12-01

The aim of this study was to evaluate the effectiveness and efficiency in inverse IMRT planning of one-step optimization with the step-and-shoot (SS) technique as compared to traditional two-step optimization using the sliding windows (SW) technique. The Pinnacle IMRT TPS allows both one-step and two-step approaches. The same beam setup for five head-and-neck tumor patients and dose-volume constraints were applied for all optimization methods. Two-step plans were produced converting the ideal fluence with or without a smoothing filter into the SW sequence. One-step plans, based on direct machine parameter optimization (DMPO), had the maximum number of segments per beam set at 8, 10, 12, producing a directly deliverable sequence. Moreover, the plans were generated whether a split-beam was used or not. Total monitor units (MUs), overall treatment time, cost function and dose-volume histograms (DVHs) were estimated for each plan. PTV conformality and homogeneity indexes and normal tissue complication probability (NTCP) that are the basis for improving therapeutic gain, as well as non-tumor integral dose (NTID), were evaluated. A two-sided t-test was used to compare quantitative variables. All plans showed similar target coverage. Compared to two-step SW optimization, the DMPO-SS plans resulted in lower MUs (20%), NTID (4%) as well as NTCP values. Differences of about 15-20% in the treatment delivery time were registered. DMPO generates less complex plans with identical PTV coverage, providing lower NTCP and NTID, which is expected to reduce the risk of secondary cancer. It is an effective and efficient method and, if available, it should be favored over the two-step IMRT planning.

A stochastic model for tumor geometry evolution during radiation therapy in cervical cancer

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

Liu, Yifang; Lee, Chi-Guhn; Chan, Timothy C. Y., E-mail: tcychan@mie.utoronto.ca

2014-02-15

Purpose: To develop mathematical models to predict the evolution of tumor geometry in cervical cancer undergoing radiation therapy. Methods: The authors develop two mathematical models to estimate tumor geometry change: a Markov model and an isomorphic shrinkage model. The Markov model describes tumor evolution by investigating the change in state (either tumor or nontumor) of voxels on the tumor surface. It assumes that the evolution follows a Markov process. Transition probabilities are obtained using maximum likelihood estimation and depend on the states of neighboring voxels. The isomorphic shrinkage model describes tumor shrinkage or growth in terms of layers of voxelsmore » on the tumor surface, instead of modeling individual voxels. The two proposed models were applied to data from 29 cervical cancer patients treated at Princess Margaret Cancer Centre and then compared to a constant volume approach. Model performance was measured using sensitivity and specificity. Results: The Markov model outperformed both the isomorphic shrinkage and constant volume models in terms of the trade-off between sensitivity (target coverage) and specificity (normal tissue sparing). Generally, the Markov model achieved a few percentage points in improvement in either sensitivity or specificity compared to the other models. The isomorphic shrinkage model was comparable to the Markov approach under certain parameter settings. Convex tumor shapes were easier to predict. Conclusions: By modeling tumor geometry change at the voxel level using a probabilistic model, improvements in target coverage and normal tissue sparing are possible. Our Markov model is flexible and has tunable parameters to adjust model performance to meet a range of criteria. Such a model may support the development of an adaptive paradigm for radiation therapy of cervical cancer.« less

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

Dynamic Target Definition: a novel approach for PTV definition in ion beam therapy.

PubMed

Cabal, Gonzalo A; Jäkel, Oliver

2013-05-01

To present a beam arrangement specific approach for PTV definition in ion beam therapy. By means of a Monte Carlo error propagation analysis a criteria is formulated to assess whether a voxel is safely treated. Based on this a non-isotropical expansion rule is proposed aiming to minimize the impact of uncertainties on the dose delivered. The method is exemplified in two cases: a Head and Neck case and a Prostate case. In both cases the modality used is proton beam irradiation and the sources of uncertainties taken into account are positioning (set up) errors and range uncertainties. It is shown how different beam arrangements have an impact on plan robustness which leads to different target expansions necessary to assure a predefined level of plan robustness. The relevance of appropriate beam angle arrangements as a way to minimize uncertainties is demonstrated. A novel method for PTV definition in on beam therapy is presented. The method show promising results by improving the probability of correct dose CTV coverage while reducing the size of the PTV volume. In a clinical scenario this translates into an enhanced tumor control probability while reducing the volume of healthy tissue being irradiated. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Human resources for treating HIV/AIDS: needs, capacities, and gaps.

PubMed

Bärnighausen, Till; Bloom, David E; Humair, Salal

2007-11-01

Despite recent international efforts to scale-up antiretroviral treatment (ART), more than 5 million people needing ART in low- and middle-income countries (LMIC) do not receive it. Limited human resources to treat HIV/AIDS (HRHA) are one of the main constraints to achieving universal ART coverage. We model the gap between needed and available HRHA to quantify the challenge of achieving and sustaining universal ART coverage by 2017. We estimate the HRHA gap in LMIC using recently published estimates of ART coverage, HIV incidence, health-worker emigration rates, mortality rates of people needing ART, and numbers of HRHA needed to treat 1000 ART patients (based on review studies, 2006). We project the HRHA gap in 10 years (2017) using a simple discrete-time model with a health worker pool replenished through education and depleted through emigration/death; a population needing ART replenished with a given HIV incidence rate; and higher survival rates for treated populations. We analyze the effects of varying assumptions about HRHA inflows and outflows and the evolution of the HIV pandemic in three different regional base cases (sub-Saharan Africa, non-sub-Saharan African LMIC, and South Africa). Current ART coverage for LMIC is around 28%-32% and, other things equal, will drop to 16%-19% by 2017 with constant current HRHA production rates. A naive model, ignoring the increased survival probability resulting from ART, suggests that approximately the current number of HRHA in ART services needs to be added every year for the next ten years to achieve universal coverage by 2017. In a model accounting for increased survival of treated patients, outcomes vary by region; sub-Saharan Africa requires two times, non-sub-Saharan African LMIC require 1.5 times and South Africa requires more than three times their respective current HRHA population to be added every year for the next 10 years to achieve universal coverage by 2017. Even if achieved by 2017, sustaining universal coverage requires further HRHA increases until the system reaches steady state. ART coverage is sensitive to HRHA inflow and emigration. Our model quantifies the challenge of closing the HRHA gap in LMIC. It shows that strategies to achieve universal ART coverage must account for feedback due to higher survival probabilities of people receiving ART. It suggests that universal ART coverage is unlikely to be achieved and sustained with increased HRHA inflows alone, but will require decreased HRHA outflows, substantially reduced HIV incidence, or changes in the nature or organization of care. Means to decrease HRHA emigration outflows include scholarships for healthcare education that are conditional on the recipient delivering ART in a country with high ART need for a number of years, training health workers who are not internationally mobile, or changing recruitment policies in countries receiving health workers from the developing world. Effective organizational changes include those that reduce the number of HRHA required to treat a fixed number of patients. Given the large number of health workers that even optimistic assumptions suggest will be needed in ART services in the coming decades, policymakers must ensure that the flow of workers into ART programs does not jeopardize the provision of other important health services.

SU-E-T-471: Improvement of Gamma Knife Treatment Planning Through Tumor Control Probability for Metastatic Brain Tumors

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

Huang, Z; Feng, Y; Lo, S

2015-06-15

Purpose: The dose–volume histogram (DVH) has been normally accepted as a tool for treatment plan evaluation. However, spatial information is lacking in DVH. As a supplement to the DVH in three-dimensional treatment planning, the differential DVH (DDVH) provides the spatial variation, the size and magnitude of the different dose regions within a region of interest, which can be incorporated into tumor control probability model. This study was to provide a method in evaluating and improving Gamma Knife treatment planning. Methods: 10 patients with brain metastases from different primary tumors including melanoma (#1,#4,#5, #10), breast cancer (#2), prostate cancer (#3) andmore » lung cancer (#6–9) were analyzed. By using Leksell GammaPlan software, two plans were prepared for each patient. Special attention was given to the DDVHs that were different for different plans and were used for a comparison between two plans. Dose distribution inside target and tumor control probability (TCP) based on DDVH were calculated, where cell density and radiobiological parameters were adopted from literature. The plans were compared based on DVH, DDVH and TCP. Results: Using DVH, the coverage and selectivity were the same between plans for 10 patients. DDVH were different between two plans for each patient. The paired t-test showed no significant difference in TCP between the two plans. For brain metastases from melanoma (#1, #4–5), breast cancer (#2) and lung cancer (#6–8), the difference in TCP was less than 5%. But the difference in TCP was about 6.5% for patient #3 with the metastasis from prostate cancer, 10.1% and 178.7% for two patients (#9–10) with metastasis from lung cancer. Conclusion: Although DVH provides average dose–volume information, DDVH provides differential dose– volume information with respect to different regions inside the tumor. TCP provides radiobiological information and adds additional information on improving treatment planning as well as adaptive radiotherapy. Further clinical validation is necessary.« less

Knowledge as a predictor of insurance coverage under the Affordable Care Act

PubMed Central

Hoerl, Maximiliane; Wuppermann, Amelie; Barcellos, Silvia H.; Bauhoff, Sebastian; Winter, Joachim K.

2016-01-01

Background The Affordable Care Act established policy mechanisms to increase health insurance coverage in the United States. While insurance coverage has increased, 10 to 15% of the U.S. population remains uninsured. Objectives To assess whether health insurance literacy and financial literacy predict being uninsured, covered by Medicaid, or covered by Marketplace insurance, holding demographic characteristics, attitudes toward risk, and political affiliation constant. Research Design Analysis of longitudinal data from fall 2013 and spring 2015 including financial and health insurance literacy and key covariates collected in 2013. Subjects 2,742 U.S. residents ages 18-64, 525 uninsured in fall 2013, participating in the RAND American Life Panel, a nationally representative internet panel. Measures Self-reported health insurance status and type as of spring 2015. Results Among the uninsured in 2013, higher financial and health insurance literacy were associated with greater probability of being insured in 2015. For a typical uninsured individual in 2013, the probability of being insured in 2015 was 8.3 percentage points higher with high compared to low financial literacy, and 9.2 percentage points higher with high compared to low health insurance literacy. For the general population, those with high financial and health insurance literacy were more likely to obtain insurance via Medicaid or the Marketplaces compared to being uninsured. The magnitude of coefficients for these predictors was similar to that of commonly used demographic covariates. Conclusions A lack of understanding about health insurance concepts and financial illiteracy predict who remains uninsured. Outreach and consumer-education programs should consider these characteristics. PMID:27820594

The impact of race, income, drug abuse and dependence on health insurance coverage among US adults.

PubMed

Wang, Nianyang; Xie, Xin

2017-06-01

Little is known about the impact of drug abuse/dependence on health insurance coverage, especially by race groups and income levels. In this study, we examine the disparities in health insurance predictors and investigate the impact of drug use (alcohol abuse/dependence, nicotine dependence, and illicit drug abuse/dependence) on lack of insurance across different race and income groups. To perform the analysis, we used insurance data (8057 uninsured and 28,590 insured individual adults) from the National Surveys on Drug Use and Health (NSDUH 2011). To analyze the likelihood of being uninsured we performed weighted binomial logistic regression analyses. The results show that the overall prevalence of lacking insurance was 19.6 %. However, race differences in lack of insurance exist, especially for Hispanics who observe the highest probability of being uninsured (38.5 %). Furthermore, we observe that the lowest income level bracket (annual income <$20,000) is associated with the highest likelihood of being uninsured (37.3 %). As the result of this investigation, we observed the following relationship between drug use and lack of insurance: alcohol abuse/dependence and nicotine dependence tend to increase the risk of lack of insurance for African Americans and whites, respectively; illicit drug use increases such risk for whites; alcohol abuse/dependence increases the likelihood of lack of insurance for the group with incomes $20,000-$49,999, whereas nicotine dependence is associated with higher probability of lack of insurance for most income groups. These findings provide some useful insights for policy makers in making decisions regarding unmet health insurance coverage.

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

44 CFR 64.5 - Relationship of rates to zone designations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... the entire community at chargeable rates (i.e., subsidized) for first layer coverage of existing... improvements. Upon the effective date of a FIRM, second layer coverage is available only at risk premium rates...

Technical and scale efficiency in the delivery of child health services in Zambia: results from data envelopment analysis.

PubMed

Achoki, Tom; Hovels, Anke; Masiye, Felix; Lesego, Abaleng; Leufkens, Hubert; Kinfu, Yohannes

2017-01-05

Despite tremendous efforts to scale up key maternal and child health interventions in Zambia, progress has not been uniform across the country. This raises fundamental health system performance questions that require further investigation. Our study investigates technical and scale efficiency (SE) in the delivery of maternal and child health services in the country. The study focused on all 72 health districts of Zambia. We compiled a district-level database comprising health outcomes (measured by the probability of survival to 5 years of age), health outputs (measured by coverage of key health interventions) and a set of health system inputs, namely, financial resources and human resources for health, for the year 2010. We used data envelopment analysis to assess the performance of subnational units across Zambia with respect to technical and SE, controlling for environmental factors that are beyond the control of health system decision makers. Nationally, average technical efficiency with respect to improving child survival was 61.5% (95% CI 58.2% to 64.8%), which suggests that there is a huge inefficiency in resource use in the country and the potential to expand services without injecting additional resources into the system. Districts that were more urbanised and had a higher proportion of educated women were more technically efficient. Improved cooking methods and donor funding had no significant effect on efficiency. With the pressing need to accelerate progress in population health, decision makers must seek efficient ways to deliver services to achieve universal health coverage. Understanding the factors that drive performance and seeking ways to enhance efficiency offer a practical pathway through which low-income countries could improve population health without necessarily seeking additional resources. 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/.

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.

Mapping the Distribution and Biomass of Emergent Aquatic Plants in the Sacramento-San Joaquin River Delta of California Using Landsat Imagery Analysis

NASA Technical Reports Server (NTRS)

Potter, Christopher

2015-01-01

This study evaluated the cost-effective and timely use of Landsat imagery to map and monitor emergent aquatic plant biomass and to filter satellite image products for the most probable locations of water hyacinth coverage in the Delta based on field observations collected immediately after satellite image acquisition.

Comparative analysis of old-age mortality estimations in Africa.

PubMed

Bendavid, Eran; Seligman, Benjamin; Kubo, Jessica

2011-01-01

Survival to old ages is increasing in many African countries. While demographic tools for estimating mortality up to age 60 have improved greatly, mortality patterns above age 60 rely on models based on little or no demographic data. These estimates are important for social planning and demographic projections. We provide direct estimations of older-age mortality using survey data. Since 2005, nationally representative household surveys in ten sub-Saharan countries record counts of living and recently deceased household members: Burkina Faso, Côte d'Ivoire, Ethiopia, Namibia, Nigeria, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. After accounting for age heaping using multiple imputation, we use this information to estimate probability of death in 5-year intervals ((5)q(x)). We then compare our (5)q(x) estimates to those provided by the World Health Organization (WHO) and the United Nations Population Division (UNPD) to estimate the differences in mortality estimates, especially among individuals older than 60 years old. We obtained information on 505,827 individuals (18.4% over age 60, 1.64% deceased). WHO and UNPD mortality models match our estimates closely up to age 60 (mean difference in probability of death -1.1%). However, mortality probabilities above age 60 are lower using our estimations than either WHO or UNPD. The mean difference between our sample and the WHO is 5.9% (95% CI 3.8-7.9%) and between our sample is UNPD is 13.5% (95% CI 11.6-15.5%). Regardless of the comparator, the difference in mortality estimations rises monotonically above age 60. Mortality estimations above age 60 in ten African countries exhibit large variations depending on the method of estimation. The observed patterns suggest the possibility that survival in some African countries among adults older than age 60 is better than previously thought. Improving the quality and coverage of vital information in developing countries will become increasingly important with future reductions in mortality.

Photometric transit search for planets around cool stars from the western Italian Alps: a pilot study

NASA Astrophysics Data System (ADS)

Giacobbe, P.; Damasso, M.; Sozzetti, A.; Toso, G.; Perdoncin, M.; Calcidese, P.; Bernagozzi, A.; Bertolini, E.; Lattanzi, M. G.; Smart, R. L.

2012-08-01

We present the results of a year-long photometric monitoring campaign of a sample of 23 nearby (d < 60 pc), bright (J < 12) dM stars carried out at the Astronomical Observatory of the Autonomous Region of the Aosta Valley, in the western Italian Alps. This programme represents a 'pilot study' for a long-term photometric transit search for planets around a large sample of nearby M dwarfs, due to start with an array of identical 40-cm class telescopes by the Spring of 2012. In this study, we set out to (i) demonstrate the sensitivity to <4 R⊕ transiting planets with periods of a few days around our programme stars, through a two-fold approach that combines a characterization of the statistical noise properties of our photometry with the determination of transit detection probabilities via simulations; and (ii) where possible, improve our knowledge of some astrophysical properties (e.g. activity, rotation) of our targets by combining spectroscopic information and our differential photometric measurements. We achieve a typical nightly root mean square (RMS) photometric precision of ˜5 mmag, with little or no dependence on the instrumentation used or on the details of the adopted methods for differential photometry. The presence of correlated (red) noise in our data degrades the precision by a factor of ˜1.3 with respect to a pure white noise regime. Based on a detailed stellar variability analysis (i) we detected no transit-like events (an expected result, given the sample size); (ii) we determined photometric rotation periods of ˜0.47 and ˜0.22 d for LHS 3445 and GJ 1167A, respectively; (iii) these values agree with the large projected rotational velocities (˜25 and ˜33 km s-1, respectively) inferred for both stars based on the analysis of archival spectra; (iv) the estimated inclinations of the stellar rotation axes for LHS 3445 and GJ 1167A are consistent with those derived using a simple spot model; and (v) short-term, low-amplitude flaring events were recorded for LHS 3445 and LHS 2686. Finally, based on simulations of transit signals of given period and amplitude injected in the actual (nightly reduced) photometric data for our sample, we derive a relationship between transit detection probability and phase coverage. We find that, using the Box-fitting Least Squares search algorithm, even when the phase coverage approaches 100 per cent, there is a limit to the detection probability of ≈90 per cent. Around programme stars with phase coverage > 50 per cent, we would have had >80 per cent chances of detecting planets with P < 1 d inducing fractional transit depths > 0.5 per cent, corresponding to minimum detectable radii in the range ˜1.0-2.2 R⊕. These findings are illustrative of our high readiness level ahead of the main survey start.

Clinical perspectives on medical marijuana (cannabis) for neurologic disorders

PubMed Central

Fife, Terry D.; Moawad, Heidi; Moschonas, Constantine; Hammond, Nancy

2015-01-01

Summary The American Academy of Neurology published an evidence-based systematic review of randomized controlled trials using marijuana (Cannabis sativa) or cannabinoids in neurologic disorders. Several cannabinoids showed effectiveness or probable effectiveness for spasticity, central pain, and painful spasms in multiple sclerosis. The review justifies insurance coverage for dronabinol and nabilone for these indications. Many insurance companies already cover these medications for other indications. It is unlikely that the review will alter coverage for herbal marijuana. Currently, no payers cover the costs of herbal medical marijuana because it is illegal under federal law and in most states. Cannabinoid preparations currently available by prescription may have a role in other neurologic conditions, but quality scientific evidence is lacking at this time. PMID:26336632

Clinical perspectives on medical marijuana (cannabis) for neurologic disorders.

PubMed

Fife, Terry D; Moawad, Heidi; Moschonas, Constantine; Shepard, Katie; Hammond, Nancy

2015-08-01

The American Academy of Neurology published an evidence-based systematic review of randomized controlled trials using marijuana ( Cannabis sativa ) or cannabinoids in neurologic disorders. Several cannabinoids showed effectiveness or probable effectiveness for spasticity, central pain, and painful spasms in multiple sclerosis. The review justifies insurance coverage for dronabinol and nabilone for these indications. Many insurance companies already cover these medications for other indications. It is unlikely that the review will alter coverage for herbal marijuana. Currently, no payers cover the costs of herbal medical marijuana because it is illegal under federal law and in most states. Cannabinoid preparations currently available by prescription may have a role in other neurologic conditions, but quality scientific evidence is lacking at this time.

SU-F-T-404: Dosimetric Advantages of Flattening Free Beams to Prone Accelerated Partial Breast Irradiation

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

Galavis, P; Barbee, D; Jozsef, G

2016-06-15

Purpose: Prone accelerated partial breast irradiation (APBI) results in dose reduction to the heart and lung. Flattening filter free beams (FFF) reduce out of field dose due to the reduced scatter from the removal of the flattening filter and reduce the buildup region. The aim of this work is to evaluate the dosimetric advantages of FFF beams to prone APBI target coverage and reduction in dose to organs at risk. Methods: Fifteen clinical prone APBI cases using flattened photon beams were retrospectively re-planned in Eclipse-TPS using FFF beams. FFF plans were designed to provide equivalent target coverage with similar hotspotsmore » using the same field arrangements, resulting in comparable target DVHs. Both plans were transferred to a prone breast phantom and delivered on Varian-Edge-Linac. GafChromic-film was placed in the coronal plane of the phantom, partially overlapping the treatment field and extending into OARs to compare dose profiles from both plans. Results: FFF plans were comparable to the clinical plans with maximum doses of (108.3±2.3)% and (109.2±2.4)% and mean doses of (104.5±1.0)% and (104.6±1.2)%, respectively. Similar mean dose doses to the heart and contralateral lungs were observed from both plans, whereas the mean dose to the contra-lateral breast was (2.79±1.18) cGy and (2.86±1.40) cGy for FFF and clinical plans respectively. However for both plans the error between calculated and measured doses at 4 cm from the field edge was 10%. Conclusion: The results showed that FFF beams in prone APBI provide dosimetrically equivalent target coverage and improved coverage in superficial target due to softer energy spectra. Film analysis showed that the TPS underestimates dose outside field edges for both cases. The FFF measured plans showed less dose outside the beam that might reduce the probability of secondary cancers in the contralateral breast.« less

Overcoming Spatial and Temporal Barriers to Public Access Defibrillators Via Optimization

PubMed Central

Sun, Christopher L. F.; Demirtas, Derya; Brooks, Steven C.; Morrison, Laurie J.; Chan, Timothy C.Y.

2016-01-01

BACKGROUND Immediate access to an automated external defibrillator (AED) increases the chance of survival from out-of-hospital cardiac arrest (OHCA). Current deployment usually considers spatial AED access, assuming AEDs are available 24 h a day. OBJECTIVES We sought to develop an optimization model for AED deployment, accounting for spatial and temporal accessibility, to evaluate if OHCA coverage would improve compared to deployment based on spatial accessibility alone. METHODS This was a retrospective population-based cohort study using data from the Toronto Regional RescuNET cardiac arrest database. We identified all nontraumatic public-location OHCAs in Toronto, Canada (January 2006 through August 2014) and obtained a list of registered AEDs (March 2015) from Toronto emergency medical services. We quantified coverage loss due to limited temporal access by comparing the number of OHCAs that occurred within 100 meters of a registered AED (assumed 24/7 coverage) with the number that occurred both within 100 meters of a registered AED and when the AED was available (actual coverage). We then developed a spatiotemporal optimization model that determined AED locations to maximize OHCA actual coverage and overcome the reported coverage loss. We computed the coverage gain between the spatiotemporal model and a spatial-only model using 10-fold cross-validation. RESULTS We identified 2,440 atraumatic public OHCAs and 737 registered AED locations. A total of 451 OHCAs were covered by registered AEDs under assumed 24/7 coverage, and 354 OHCAs under actual coverage, representing a coverage loss of 21.5% (p < 0.001). Using the spatiotemporal model to optimize AED deployment, a 25.3% relative increase in actual coverage was achieved over the spatial-only approach (p < 0.001). CONCLUSIONS One in 5 OHCAs occurred near an inaccessible AED at the time of the OHCA. Potential AED use was significantly improved with a spatiotemporal optimization model guiding deployment. PMID:27539176

Macroeconomic Analysis of Universal Coverage in the U.S.

NASA Astrophysics Data System (ADS)

Feng, Zhigang

In this paper I employ a dynamic general equilibrium model to study macroeconomic effects and welfare implications of health policies for universal coverage in the U.S. The model is calibrated to the U.S. data. Numerical simulations indicate that adopting universal coverage has several important macroeconomic effects on health expenditures, hours worked, and increases welfare by improving aggregate health status, and removing adverse selection.

The impact of varicella vaccination on varicella-related hospitalization rates: global data review

PubMed Central

Hirose, Maki; Gilio, Alfredo Elias; Ferronato, Angela Esposito; Ragazzi, Selma Lopes Betta

2016-01-01

Abstract Objective: To describe the impact of varicella vaccination on varicella-related hospitalization rates in countries that implemented universal vaccination against the disease. Data source: We identified countries that implemented universal vaccination against varicella at the http://apps.who.int/immunization_monitoring/globalsummary/schedules site of the World Health Organization and selected articles in Pubmed describing the changes (pre/post-vaccination) in the varicella-related hospitalization rates in these countries, using the Keywords "varicella", "vaccination/vaccine" and "children" (or) "hospitalization". Publications in English published between January 1995 and May 2015 were included. Data synthesis: 24 countries with universal vaccination against varicella and 28 articles describing the impact of the vaccine on varicella-associated hospitalizations rates in seven countries were identified. The US had 81.4%–99.2% reduction in hospitalization rates in children younger than four years, 6–14 years after the onset of universal vaccination (1995), with vaccination coverage of 90%; Uruguay: 94% decrease (children aged 1–4 years) in six years, vaccination coverage of 90%; Canada: 93% decrease (age 1–4 years) in 10 years, coverage of 93%; Germany: 62.4% decrease (age 1–4 years) in 8 years, coverage of 78.2%; Australia: 76.8% decrease (age 1–4 years) in 5 years, coverage of 90%; Spain: 83.5% decrease (age <5 years) in four years, coverage of 77.2% and Italy 69.7%–73.8% decrease (general population), coverage of 60%–95%. Conclusions: The publications showed variations in the percentage of decrease in varicella-related hospitalization rates after universal vaccination in the assessed countries; the results probably depend on the time since the implementation of universal vaccination, differences in the studied age group, hospital admission criteria, vaccination coverage and strategy, which does not allow direct comparison between data. PMID:26965075

The impact of varicella vaccination on varicella-related hospitalization rates: global data review.

PubMed

Hirose, Maki; Gilio, Alfredo Elias; Ferronato, Angela Esposito; Ragazzi, Selma Lopes Betta

2016-09-01

to describe the impact of varicella vaccination on varicella-related hospitalization rates in countries that implemented universal vaccination against the disease. we identified countries that implemented universal vaccination against varicella at the http://apps.who.int/immunization_monitoring/globalsummary/schedules site of the World Health Organization and selected articles in Pubmed describing the changes (pre/post-vaccination) in the varicella-related hospitalization rates in these countries, using the Keywords "varicella", "vaccination/vaccine" and "children" (or) "hospitalization". Publications in English published between January 1995 and May 2015 were included. 24 countries with universal vaccination against varicella and 28 articles describing the impact of the vaccine on varicella-associated hospitalizations rates in seven countries were identified. The US had 81.4% -99.2% reduction in hospitalization rates in children younger than four years after 6-14 years after the onset of universal vaccination (1995), with vaccination coverage of 90%; Uruguay: 94% decrease (children aged 1-4 years) in six years, vaccination coverage of 90%; Canada: 93% decrease (age 1-4 years) in 10 years, coverage of 93%; Germany: 62.4% decrease (age 1-4 years) in 8 years, coverage of 78.2%; Australia: 76.8% decrease (age 1-4 years) in 5 years, coverage of 90%; Spain: 83.5% decrease (age <5 years) in four years, coverage of 77.2% and Italy 69.7% -73.8% decrease (general population), coverage of 60%-95%. The publications showed variations in the percentage of decrease in varicella-related hospitalization rates after universal vaccination in the assessed countries; the results probably depend on the time since the implementation of universal vaccination, differences in the studied age group, hospital admission criteria, vaccination coverage and strategy, which does not allow direct comparison between data. Copyright © 2016 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

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).

Uninsurance, underinsurance, and health care utilization in Mexico by US border residents.

PubMed

Su, Dejun; Pratt, William; Stimpson, Jim P; Wong, Rebeca; Pagán, José A

2014-08-01

Using data from the 2008 Cross-Border Utilization of Health Care Survey, we examined the relationship between United States (US) health insurance coverage plans and the use of health care services in Mexico by US residents of the US-Mexico border region. We found immigrants were far more likely to be uninsured than their native-born counterparts (63 vs. 27.8 %). Adults without health insurance coverage were more likely to purchase medications or visit physicians in Mexico compared to insured adults. However, adults with Medicaid coverage were more likely to visit dentists in Mexico compared to uninsured adults. Improving health care access for US residents in the southwestern border region of the country will require initiatives that target not only providing coverage to the large uninsured population but also improving access to health care services for the large underinsured population.

Increased Transparency and Consumer Protections for 2016 Marketplace Plans.

PubMed

Brooks-LaSure, Chiquita

2015-12-01

The open enrollment period that ends in December 2015 for coverage begin­ning January 2016 marks the third year of the health care exchanges or marketplaces and of coverage through new qualified health plans. This issue brief investigates several key changes to the qualified health plans, with a focus on increased transparency and consumer protections. A new out-of-pocket costs calculator, requirements regarding provider networks, and prescription drug cost-sharing requirements should serve to better inform and improve consumer selection. In addition, several policy changes will help individuals with more severe health needs. These include: improved prescription drug coverage for HIV/ AIDS and other conditions, allowing prescription drugs that are obtained through the "exceptions" process to count toward the out-of-pocket spending cap, more comprehensive and consistent habilitative coverage, and an individual out-of-pocket spending cap within the family out-of-pocket maximum.

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.

Experiences and Lessons From Polio Eradication Applied to Immunization in 10 Focus Countries of the Polio Endgame Strategic Plan

PubMed Central

Mallya, Apoorva; Sandhu, Hardeep; Anya, Blanche-Philomene; Yusuf, Nasir; Ntakibirora, Marcelline; Hasman, Andreas; Fahmy, Kamal; Agbor, John; Corkum, Melissa; Sumaili, Kyandindi; Siddique, Anisur Rahman; Bammeke, Jane; Braka, Fiona; Andriamihantanirina, Rija; Ziao, Antoine-Marie C.; Djumo, Clement; Yapi, Moise Desire; Sosler, Stephen; Eggers, Rudolf

2017-01-01

Abstract Nine polio areas of expertise were applied to broader immunization and mother, newborn and child health goals in ten focus countries of the Polio Eradication Endgame Strategic Plan: policy & strategy development, planning, management and oversight (accountability framework), implementation & service delivery, monitoring, communications & community engagement, disease surveillance & data analysis, technical quality & capacity building, and partnerships. Although coverage improvements depend on multiple factors and increased coverage cannot be attributed to the use of polio assets alone, 6 out of the 10 focus countries improved coverage in three doses of diphtheria tetanus pertussis containing vaccine between 2013 and 2015. Government leadership, evidence-based programming, country-driven comprehensive operational annual plans, community partnership and strong accountability systems are critical for all programs and polio eradication has illustrated these can be leveraged to increase immunization coverage and equity and enhance global health security in the focus countries. PMID:28838187

Heart failure rehospitalization of the Medicare FFS patient: a state-level analysis exploring 30-day readmission factors.

PubMed

Schmeida, Mary; Savrin, Ronald A

2012-01-01

Heart failure readmission among the elderly is frequent and costly to both the patient and the Medicare trust fund. In this study, the authors explore the factors that are associated with states having heart failure readmission rates that are higher than the U.S. national rate. Acute inpatient hospital settings. 50 state-level data and multivariate regression analysis is used. The dependent variable Heart Failure 30-day Readmission Worse than U.S. Rate is based on adult Medicare Fee-for-Service patients hospitalized with a primary discharge diagnosis of heart failure and for which a subsequent inpatient readmission occurred within 30 days of their last discharge. One key variable found--states with a higher resident population speaking a primary language other than English at home--that is significantly associated with a decrease in probability in states ranking "worse" on heart failure 30-day readmission. Whereas, states with a higher median income, more total days of care per 1,000 Medicare enrollees, and a greater percentage of Medicare enrollees with prescription drug coverage have a greater probability for heart failure 30-day readmission to be "worse" than the U.S. national rate. Case management interventions targeting health literacy may be more effective than other factors to improve state-level hospital status on heart failure 30-day readmission. Factors such as total days of care per 1,000 Medicare enrollees and improving patient access to postdischarge medication(s) may not be as important as literacy. Interventions aimed to prevent disparities should consider higher income population groups as vulnerable for readmission.

Volumetric Image Guidance Using Carina vs Spine as Registration Landmarks for Conventionally Fractionated Lung Radiotherapy

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

Lavoie, Caroline; Higgins, Jane; Bissonnette, Jean-Pierre

2012-12-01

Purpose: To compare the relative accuracy of 2 image guided radiation therapy methods using carina vs spine as landmarks and then to identify which landmark is superior relative to tumor coverage. Methods and Materials: For 98 lung patients, 2596 daily image-guidance cone-beam computed tomography scans were analyzed. Tattoos were used for initial patient alignment; then, spine and carina registrations were performed independently. A separate analysis assessed the adequacy of gross tumor volume, internal target volume, and planning target volume coverage on cone-beam computed tomography using the initial, middle, and final fractions of radiation therapy. Coverage was recorded for primary tumormore » (T), nodes (N), and combined target (T+N). Three scenarios were compared: tattoos alignment, spine registration, and carina registration. Results: Spine and carina registrations identified setup errors {>=}5 mm in 35% and 46% of fractions, respectively. The mean vector difference between spine and carina matching had a magnitude of 3.3 mm. Spine and carina improved combined target coverage, compared with tattoos, in 50% and 34% (spine) to 54% and 46% (carina) of the first and final fractions, respectively. Carina matching showed greater combined target coverage in 17% and 23% of fractions for the first and final fractions, respectively; with spine matching, this was only observed in 4% (first) and 6% (final) of fractions. Carina matching provided superior nodes coverage at the end of radiation compared with spine matching (P=.0006), without compromising primary tumor coverage. Conclusion: Frequent patient setup errors occur in locally advanced lung cancer patients. Spine and carina registrations improved combined target coverage throughout the treatment course, but carina matching provided superior combined target coverage.« less

Electrode Coverage Optimization for Piezoelectric Energy Harvesting from Tip Excitation

PubMed Central

Chen, Guangzhu; Bai, Nan

2018-01-01

Piezoelectric energy harvesting using cantilever-type structures has been extensively investigated due to its potential application in providing power supplies for wireless sensor networks, but the low output power has been a bottleneck for its further commercialization. To improve the power conversion capability, a piezoelectric beam with different electrode coverage ratios is studied theoretically and experimentally in this paper. A distributed-parameter theoretical model is established for a bimorph piezoelectric beam with the consideration of the electrode coverage area. The impact of the electrode coverage on the capacitance, the output power and the optimal load resistance are analyzed, showing that the piezoelectric beam has the best performance with an electrode coverage of 66.1%. An experimental study was then carried out to validate the theoretical results using a piezoelectric beam fabricated with segmented electrodes. The experimental results fit well with the theoretical model. A 12% improvement on the Root-Mean-Square (RMS) output power was achieved with the optimized electrode converge ratio (66.1%). This work provides a simple approach to utilizing piezoelectric beams in a more efficient way. PMID:29518934

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

Chau, Ricky; Teo, Peter; Kam, Michael

The aim of this study is to evaluate the deficiencies in target coverage and organ protection of 2-dimensional radiation therapy (2DRT) in the treatment of advanced T-stage (T3-4) nasopharyngeal carcinoma (NPC), and assess the extent of improvement that could be achieved with intensity modulated radiation therapy (IMRT), with special reference to of the dose to the planning organ-at-risk volume (PRV) of the brainstem and spinal cord. A dosimetric study was performed on 10 patients with advanced T-stage (T3-4 and N0-2) NPC. Computer tomography (CT) images of 2.5-mm slice thickness of the head and neck were acquired with the patient immobilizedmore » in semi-extended-head position. A 2D plan based on Ho's technique, and an IMRT plan based on a 7-coplanar portals arrangement, were established for each patient. 2DRT was planned with the field borders and shielding drawn on the simulator radiograph with reference to bony landmarks, digitized, and entered into a planning computer for reconstruction of the 3D dose distribution. The 2DRT and IMRT treatment plans were evaluated and compared with respect to the dose-volume histograms (DVHs) of the targets and the organs-at-risk (OARs), tumor control probability (TCP), and normal tissue complication probabilities (NTCPs). With IMRT, the dose coverage of the target was superior to that of 2DRT. The mean minimum dose of the GTV and PTV were increased from 33.7 Gy (2DRT) to 62.6 Gy (IMRT), and 11.9 Gy (2DRT) to 47.8 Gy (IMRT), respectively. The D{sub 95} of the GTV and PTV were also increased from 57.1 Gy (2DRT) to 67 Gy (IMRT), and 45 Gy (2DRT) to 63.6 Gy (IMRT), respectively. The TCP was substantially increased to 78.5% in IMRT. Better protection of the critical normal organs was also achieved with IMRT. The mean maximum dose delivered to the brainstem and spinal cord were reduced significantly from 61.8 Gy (2DRT) to 52.8 Gy (IMRT) and 56 Gy (2DRT) to 43.6 Gy (IMRT), respectively, which were within the conventional dose limits of 54 Gy for brainstem and of 45 Gy for spinal cord. The mean maximum doses deposited on the PRV of the brainstem and spinal cord were 60.7 Gy and 51.6 Gy respectively, which were above the conventional dose limits. For the chiasm, the mean dose maximum and the dose to 5% of its volume were reduced from 64.3 Gy (2DRT) to 53.7 Gy (IMRT) and from 62.8 Gy (2DRT) to 48.7 Gy (IMRT), respectively, and the corresponding NTCP was reduced from 18.4% to 2.1%. For the temporal lobes, the mean dose to 10% of its volume (about 4.6 cc) was reduced from 63.8 Gy (2DRT) to 55.4 Gy (IMRT) and the NTCP was decreased from 11.7% to 3.4%. The therapeutic ratio for T3-4 NPC tumors can be significantly improved with IMRT treatment technique due to improvement both in target coverage and the sparing of the critical normal organ. Although the maximum doses delivered to the brainstem and spinal cord in IMRT can be kept at or below their conventional dose limits, the maximum doses deposited on the PRV often exceed these limits due to the close proximity between the target and OARs. In other words, ideal dosimetric considerations cannot be fulfilled in IMRT planning for T3-4 NPC tumors. A compromise of the maximal dose limit to the PRV of the brainstem and spinal cord would need be accepted if dose coverage to the targets is not to be unacceptably compromised. Dosimetric comparison with 2DRT plans show that these dose limits to PRV were also frequently exceeded in 2DRT plans for locally advanced NPC. A dedicated retrospective study on the incidence of clinical injury to neurological organs in a large series of patients with T3-4 NPC treated by 2DRT may provide useful reference data in exploring how far the PRV dose constraints may be relaxed, to maximize the target coverage without compromising the normal organ function.« less

Drug Coverage Surveys for Neglected Tropical Diseases: 10 Years of Field Experience

PubMed Central

Worrell, Caitlin; Mathieu, Els

2012-01-01

Mass drug administration is one of the public health strategies recommended by the World Health Organization for the control and elimination of seven neglected tropical diseases (NTDs). Because adequate coverage is vital to achieve program goals, periodically conducting surveys to validate reported coverage to guide NTD programs is recommended. Over the past decade, the Centers for Disease Control and Prevention (CDC) and collaborators conducted more than 30 two-stage cluster household surveys across three continents. The questionnaires gathered coverage data and information relevant to improving NTD programs including NTD-related attitudes and practices. From the 37 coverage survey estimates obtained in those surveys, 73.3% indicated an over reporting of coverage, including all three that assessed school-based distributions. It took an average of 1 week to conduct a survey. Our experiences led us to conclude that coverage surveys are useful and feasible tools to ensure NTD elimination and control goals are reached. PMID:22855750

Compound Event Barrier Coverage in Wireless Sensor Networks under Multi-Constraint Conditions.

PubMed

Zhuang, Yaoming; Wu, Chengdong; Zhang, Yunzhou; Jia, Zixi

2016-12-24

It is important to monitor compound event by barrier coverage issues in wireless sensor networks (WSNs). Compound event barrier coverage (CEBC) is a novel coverage problem. Unlike traditional ones, the data of compound event barrier coverage comes from different types of sensors. It will be subject to multiple constraints under complex conditions in real-world applications. The main objective of this paper is to design an efficient algorithm for complex conditions that can combine the compound event confidence. Moreover, a multiplier method based on an active-set strategy (ASMP) is proposed to optimize the multiple constraints in compound event barrier coverage. The algorithm can calculate the coverage ratio efficiently and allocate the sensor resources reasonably in compound event barrier coverage. The proposed algorithm can simplify complex problems to reduce the computational load of the network and improve the network efficiency. The simulation results demonstrate that the proposed algorithm is more effective and efficient than existing methods, especially in the allocation of sensor resources.

Compound Event Barrier Coverage in Wireless Sensor Networks under Multi-Constraint Conditions

PubMed Central

Zhuang, Yaoming; Wu, Chengdong; Zhang, Yunzhou; Jia, Zixi

2016-01-01

It is important to monitor compound event by barrier coverage issues in wireless sensor networks (WSNs). Compound event barrier coverage (CEBC) is a novel coverage problem. Unlike traditional ones, the data of compound event barrier coverage comes from different types of sensors. It will be subject to multiple constraints under complex conditions in real-world applications. The main objective of this paper is to design an efficient algorithm for complex conditions that can combine the compound event confidence. Moreover, a multiplier method based on an active-set strategy (ASMP) is proposed to optimize the multiple constraints in compound event barrier coverage. The algorithm can calculate the coverage ratio efficiently and allocate the sensor resources reasonably in compound event barrier coverage. The proposed algorithm can simplify complex problems to reduce the computational load of the network and improve the network efficiency. The simulation results demonstrate that the proposed algorithm is more effective and efficient than existing methods, especially in the allocation of sensor resources. PMID:28029118

Feasibility of using global system for mobile communication (GSM)-based tracking for vaccinators to improve oral poliomyelitis vaccine campaign coverage in rural Pakistan.

PubMed

Chandir, Subhash; Dharma, Vijay Kumar; Siddiqi, Danya Arif; Khan, Aamir Javed

2017-09-05

Despite multiple rounds of immunization campaigns, it has not been possible to achieve optimum immunization coverage for poliovirus in Pakistan. Supplementary activities to improve coverage of immunization, such as door-to-door campaigns are constrained by several factors including inaccurate hand-drawn maps and a lack of means to objectively monitor field teams in real time, resulting in suboptimal vaccine coverage during campaigns. Global System for Mobile Communications (GSM) - based tracking of mobile subscriber identity modules (SIMs) of vaccinators provides a low-cost solution to identify missed areas and ensure effective immunization coverage. We conducted a pilot study to investigate the feasibility of using GSM technology to track vaccinators through observing indicators including acceptability, ease of implementation, costs and scalability as well as the likelihood of ownership by District Health Officials. The real-time location of the field teams was displayed on a GSM tracking web dashboard accessible by supervisors and managers for effective monitoring of workforce attendance including 'time in-time out', and discerning if all target areas - specifically remote and high-risk locations - had been reached. Direct access to this information by supervisors eliminated the possibility of data fudging and inaccurate reporting by workers regarding their mobility. The tracking cost per vaccinator was USD 0.26/month. Our study shows that GSM-based tracking is potentially a cost-efficient approach, results in better monitoring and accountability, is scalable and provides the potential for improved geographic coverage of health services. Copyright © 2017 Elsevier Ltd. All rights reserved.

Human resources for health and universal health coverage: fostering equity and effective coverage.

PubMed

Campbell, James; Buchan, James; Cometto, Giorgio; David, Benedict; Dussault, Gilles; Fogstad, Helga; Fronteira, Inês; Lozano, Rafael; Nyonator, Frank; Pablos-Méndez, Ariel; Quain, Estelle E; Starrs, Ann; Tangcharoensathien, Viroj

2013-11-01

Achieving universal health coverage (UHC) involves distributing resources, especially human resources for health (HRH), to match population needs. This paper explores the policy lessons on HRH from four countries that have achieved sustained improvements in UHC: Brazil, Ghana, Mexico and Thailand. Its purpose is to inform global policy and financial commitments on HRH in support of UHC. The paper reports on country experiences using an analytical framework that examines effective coverage in relation to the availability, accessibility, acceptability and quality (AAAQ) of HRH. The AAAQ dimensions make it possible to perform tracing analysis on HRH policy actions since 1990 in the four countries of interest in relation to national trends in workforce numbers and population mortality rates. The findings inform key principles for evidence-based decision-making on HRH in support of UHC. First, HRH are critical to the expansion of health service coverage and the package of benefits; second, HRH strategies in each of the AAAQ dimensions collectively support achievements in effective coverage; and third, success is achieved through partnerships involving health and non-health actors. Facing the unprecedented health and development challenges that affect all countries and transforming HRH evidence into policy and practice must be at the heart of UHC and the post-2015 development agenda. It is a political imperative requiring national commitment and leadership to maximize the impact of available financial and human resources, and improve healthy life expectancy, with the recognition that improvements in health care are enabled by a health workforce that is fit for purpose.

Human resources for health and universal health coverage: fostering equity and effective coverage

PubMed Central

Buchan, James; Cometto, Giorgio; David, Benedict; Dussault, Gilles; Fogstad, Helga; Fronteira, Inês; Lozano, Rafael; Nyonator, Frank; Pablos-Méndez, Ariel; Quain, Estelle E; Starrs, Ann; Tangcharoensathien, Viroj

2013-01-01

Abstract Achieving universal health coverage (UHC) involves distributing resources, especially human resources for health (HRH), to match population needs. This paper explores the policy lessons on HRH from four countries that have achieved sustained improvements in UHC: Brazil, Ghana, Mexico and Thailand. Its purpose is to inform global policy and financial commitments on HRH in support of UHC. The paper reports on country experiences using an analytical framework that examines effective coverage in relation to the availability, accessibility, acceptability and quality (AAAQ) of HRH. The AAAQ dimensions make it possible to perform tracing analysis on HRH policy actions since 1990 in the four countries of interest in relation to national trends in workforce numbers and population mortality rates. The findings inform key principles for evidence-based decision-making on HRH in support of UHC. First, HRH are critical to the expansion of health service coverage and the package of benefits; second, HRH strategies in each of the AAAQ dimensions collectively support achievements in effective coverage; and third, success is achieved through partnerships involving health and non-health actors. Facing the unprecedented health and development challenges that affect all countries and transforming HRH evidence into policy and practice must be at the heart of UHC and the post-2015 development agenda. It is a political imperative requiring national commitment and leadership to maximize the impact of available financial and human resources, and improve healthy life expectancy, with the recognition that improvements in health care are enabled by a health workforce that is fit for purpose. PMID:24347710

Improvements in prenatal insurance coverage and utilization of care in California: an unsung public health victory.

PubMed

Rittenhouse, Diane R; Braveman, Paula; Marchi, Kristen

2003-06-01

To examine trends in prenatal insurance coverage and utilization of care in California over two decades in the context of expansions in Medi-Cal (California's Medicaid) and other public efforts to increase prenatal care utilization. Retrospective univariate and bivariate analysis of prenatal care coverage and utilization data from 10,192,165 California birth certificates, 1980-99; descriptive analysis of California poverty and unemployment data from the U.S. Census Bureau Current Population Survey; review of public health and social policy literature. The proportion of mothers with Medi-Cal coverage for prenatal care increased from 28.2 to 47.5% between 1989 and 1994, and the proportion uninsured throughout pregnancy decreased from 13.2 to 3.2%. Since the mid-1990s, fewer than 3% of women have had no insurance coverage for prenatal care. Between 1989 and 1999, the proportion of women with first trimester initiation of prenatal care increased from 72.6 to 83.6%, reversing the previous decade's trend, and the proportion of women with adequate numbers of visits rose from 70.7 to 83.1%. Improvements in utilization measures were greater among disadvantaged social groups. Improvements in California during the 1990s coincided with a multifaceted public health effort to increase both prenatal care coverage and utilization, and do not appear to be explained by changes in the economy, maternal characteristics, the overall organization/delivery of health care, or other social policies. While this ecologic study cannot produce definitive conclusions regarding causality, these results suggest an important victory for public health in California.

Household Coverage with Adequately Iodized Salt Varies Greatly between Countries and by Residence Type and Socioeconomic Status within Countries: Results from 10 National Coverage Surveys123

PubMed Central

Knowles, Jacky M; Garrett, Greg S; Gorstein, Jonathan; Kupka, Roland; Situma, Ruth; Yadav, Kapil; Yusufali, Rizwan; Pandav, Chandrakant; Aaron, Grant J

2017-01-01

Background: Household coverage with iodized salt was assessed in 10 countries that implemented Universal Salt Iodization (USI). Objective: The objective of this paper was to summarize household coverage data for iodized salt, including the relation between coverage and residence type and socioeconomic status (SES). Methods: A review was conducted of results from cross-sectional multistage household cluster surveys with the use of stratified probability proportional to size design in Bangladesh, Ethiopia, Ghana, India, Indonesia, Niger, the Philippines, Senegal, Tanzania, and Uganda. Salt iodine content was assessed with quantitative methods in all cases. The primary indicator of coverage was percentage of households that used adequately iodized salt, with an additional indicator for salt with some added iodine. Indicators of risk were SES and residence type. We used 95% CIs to determine significant differences in coverage. Results: National household coverage of adequately iodized salt varied from 6.2% in Niger to 97.0% in Uganda. For salt with some added iodine, coverage varied from 52.4% in the Philippines to 99.5% in Uganda. Coverage with adequately iodized salt was significantly higher in urban than in rural households in Bangladesh (68.9% compared with 44.3%, respectively), India (86.4% compared with 69.8%, respectively), Indonesia (59.3% compared with 51.4%, respectively), the Philippines (31.5% compared with 20.2%, respectively), Senegal (53.3% compared with 19.0%, respectively), and Tanzania (89.2% compared with 57.6%, respectively). In 7 of 8 countries with data, household coverage of adequately iodized salt was significantly higher in high- than in low-SES households in Bangladesh (58.8% compared with 39.7%, respectively), Ghana (36.2% compared with 21.5%, respectively), India (80.6% compared with 70.5%, respectively), Indonesia (59.9% compared with 45.6%, respectively), the Philippines (39.4% compared with 17.3%, respectively), Senegal (50.7% compared with 27.6%, respectively) and Tanzania (80.9% compared with 51.3%, respectively). Conclusions: Uganda has achieved USI. In other countries, access to iodized salt is inequitable. Quality control and regulatory enforcement of salt iodization remain challenging. Notable progress toward USI has been made in Ethiopia and India. Assessing progress toward USI only through household salt does not account for potentially iodized salt consumed through processed foods. PMID:28404840

Household Coverage with Adequately Iodized Salt Varies Greatly between Countries and by Residence Type and Socioeconomic Status within Countries: Results from 10 National Coverage Surveys.

PubMed

Knowles, Jacky M; Garrett, Greg S; Gorstein, Jonathan; Kupka, Roland; Situma, Ruth; Yadav, Kapil; Yusufali, Rizwan; Pandav, Chandrakant; Aaron, Grant J

2017-05-01

Background: Household coverage with iodized salt was assessed in 10 countries that implemented Universal Salt Iodization (USI). Objective: The objective of this paper was to summarize household coverage data for iodized salt, including the relation between coverage and residence type and socioeconomic status (SES). Methods: A review was conducted of results from cross-sectional multistage household cluster surveys with the use of stratified probability proportional to size design in Bangladesh, Ethiopia, Ghana, India, Indonesia, Niger, the Philippines, Senegal, Tanzania, and Uganda. Salt iodine content was assessed with quantitative methods in all cases. The primary indicator of coverage was percentage of households that used adequately iodized salt, with an additional indicator for salt with some added iodine. Indicators of risk were SES and residence type. We used 95% CIs to determine significant differences in coverage. Results: National household coverage of adequately iodized salt varied from 6.2% in Niger to 97.0% in Uganda. For salt with some added iodine, coverage varied from 52.4% in the Philippines to 99.5% in Uganda. Coverage with adequately iodized salt was significantly higher in urban than in rural households in Bangladesh (68.9% compared with 44.3%, respectively), India (86.4% compared with 69.8%, respectively), Indonesia (59.3% compared with 51.4%, respectively), the Philippines (31.5% compared with 20.2%, respectively), Senegal (53.3% compared with 19.0%, respectively), and Tanzania (89.2% compared with 57.6%, respectively). In 7 of 8 countries with data, household coverage of adequately iodized salt was significantly higher in high- than in low-SES households in Bangladesh (58.8% compared with 39.7%, respectively), Ghana (36.2% compared with 21.5%, respectively), India (80.6% compared with 70.5%, respectively), Indonesia (59.9% compared with 45.6%, respectively), the Philippines (39.4% compared with 17.3%, respectively), Senegal (50.7% compared with 27.6%, respectively) and Tanzania (80.9% compared with 51.3%, respectively). Conclusions: Uganda has achieved USI. In other countries, access to iodized salt is inequitable. Quality control and regulatory enforcement of salt iodization remain challenging. Notable progress toward USI has been made in Ethiopia and India. Assessing progress toward USI only through household salt does not account for potentially iodized salt consumed through processed foods.

Evaluation of a pilot intervention to redesign the decentralised vaccine supply chain system in Nigeria.

PubMed

Molemodile, Shola; Wotogbe, Maruchi; Abimbola, Seye

2017-05-01

Responsibility for immunisation in Nigeria is decentralised to sub-national governments. So far, they have failed to achieve optimal coverage for their populations. We evaluated a pilot intervention implemented between 2013 and 2014 to redesign a vaccine supply chain management system in Kano, Nigeria. The intervention included financing immunisation services from a designated pool of government and donor funds, a visibility tool to track vaccine stock, and a private vendor engaged to deliver vaccines directly to health facilities. The number of local government areas within the state with adequate vaccine stock increased from 21% to 98% after 10 months. To understand how the intervention achieved this outcome, we analysed immunisation coverage for the period and interviewed 18 respondents across different levels of government. We found that the intervention worked by improving ownership and accountability for immunisation by sub-national governments and their capacity for generating resources and management (of data and the supply chain). While the intervention focused on improving immunisation coverage, we identified gaps in the demand for services. Efforts to improve immunisation coverage and vaccine supply systems should streamline decentralised structures, empower sub-national governments with financial and technical capacity, and promote strategies to improve the demand and use of services.

A portable back massage robot based on Traditional Chinese Medicine.

PubMed

Wang, Wendong; Liang, Chaohong; Zhang, Peng; Shi, Yikai

2018-05-30

A portable back massage robot which can complete the massage operations such as tapping, kneading and rolling was designed to improve the level of intelligence and massage effect. An efficient full covered path planning algorithm was put forward for a portable back massage robot to improve the coverage. Currently, massage robots has become one of important research focuses with the increasing requirements for healthcare. The massage robot is difficult to be widely accepted as there are problems of massage robot in control, structure, and coverage path planning. The 3D electromagnetic simulation model was established to optimize electromagnetic force. By analyzing the Traditional Chinese Medicine massage operation and the demands, the path planning algorithm models were established. The experimental platform of the massage robot was built. The simulation results show presented path planning algorithm is suitable for back massage, which ensures that the massage robot traverse the entire back area with improved massage coverage. The tested results show that the massage effect is best when the duty cycle is in the range of 1/8 to 1/2, and the massage force increases with the increase of the input voltage. The massage robot eventually achieved the desired massage effect, and the proposed efficient algorithm can effectively improve the coverage and promote the massage effect.

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

Health Care Reform for Children with Public Coverage: How Can Policymakers Maximize Gains and Prevent Harm? Timely Analysis of Immediate Health Policy Issues

ERIC Educational Resources Information Center

Kenney, Genevieve M.; Dorn, Stan

2009-01-01

Moving toward universal coverage has the potential to increase access to care and improve the health and well-being of uninsured children and adults. The effects of health care reform on the more than 25 million children who currently have coverage under Medicaid or the Children's Health Insurance Program (CHIP) are less clear. Increased parental…

Health workers' attitudes, perceptions and knowledge of influenza immunization in Lima, Peru: A mixed methods study.

PubMed

Bazán, Magdalena; Villacorta, Erika; Barbagelatta, Gisella; Jimenez, M Michelle; Goya, Cecilia; Bartolini, Rosario M; Penny, Mary E

2017-05-19

Vaccination against seasonal influenza in health workers is recommended but coverage is variable. This study aimed to determine coverage of influenza vaccination among health workers in Lima, Peru in 2010; explore barriers and enabling elements for vaccination; and suggest strategies to improve coverage. Qualitative interviews informed the development of a survey instrument that consisted of open and close-ended questions. Sub-analyses were done by occupational group and results were calculated as percentages for each possible response with confidence intervals of 95%. Coverage of the influenza vaccination was 77.2%. Vaccinated staff were less likely to have permanent contracts (p=0.0150) and vaccination coverage was lower in physicians (p=0.0001). Over 90% cited protection of themselves, families and patients as reasons for vaccination and 48% mentioned peer encouragement. Fear of adverse events (47%) and organizational barriers (>30%) were reasons for non-vaccination. To improve coverage, highest priority was given to strategies providing more information. Key factors in driving health worker vaccination include desire for protection and peer encouragement. Perceptual barriers based on a misunderstanding of the epidemiology of influenza and vaccination could be overcome by targeted education and information. Organizational barriers require attention to how vaccination is implemented within health facilities. Copyright © 2017 Elsevier Ltd. All rights reserved.

Count every newborn; a measurement improvement roadmap for coverage data.

PubMed

Moxon, Sarah G; Ruysen, Harriet; Kerber, Kate J; Amouzou, Agbessi; Fournier, Suzanne; Grove, John; Moran, Allisyn C; Vaz, Lara M E; Blencowe, Hannah; Conroy, Niall; Gülmezoglu, A; Vogel, Joshua P; Rawlins, Barbara; Sayed, Rubayet; Hill, Kathleen; Vivio, Donna; Qazi, Shamim A; Sitrin, Deborah; Seale, Anna C; Wall, Steve; Jacobs, Troy; Ruiz Peláez, Juan; Guenther, Tanya; Coffey, Patricia S; Dawson, Penny; Marchant, Tanya; Waiswa, Peter; Deorari, Ashok; Enweronu-Laryea, Christabel; Arifeen, Shams; Lee, Anne C C; Mathai, Matthews; Lawn, Joy E

2015-01-01

The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout. ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks.

Coverage criteria for test case generation using UML state chart diagram

NASA Astrophysics Data System (ADS)

Salman, Yasir Dawood; Hashim, Nor Laily; Rejab, Mawarny Md; Romli, Rohaida; Mohd, Haslina

2017-10-01

To improve the effectiveness of test data generation during the software test, many studies have focused on the automation of test data generation from UML diagrams. One of these diagrams is the UML state chart diagram. Test cases are generally evaluated according to coverage criteria. However, combinations of multiple criteria are required to achieve better coverage. Different studies used various number and types of coverage criteria in their methods and approaches. The objective of this paper to propose suitable coverage criteria for test case generation using UML state chart diagram especially in handling loops. In order to achieve this objective, this work reviewed previous studies to present the most practical coverage criteria combinations, including all-states, all-transitions, all-transition-pairs, and all-loop-free-paths coverage. Calculation to determine the coverage percentage of the proposed coverage criteria were presented together with an example has they are applied on a UML state chart diagram. This finding would be beneficial in the area of test case generating especially in handling loops in UML state chart diagram.

Variation in rotavirus vaccine coverage by sub-counties in Kenya.

PubMed

Wandera, Ernest Apondi; Mohammad, Shah; Ouko, John Odhiambo; Yatitch, James; Taniguchi, Koki; Ichinose, Yoshio

2017-01-01

Rotavirus gastroenteritis is an important cause of childhood morbidity and mortality in Kenya. In July 2014, Kenya introduced the rotavirus vaccine into her national immunization program. Although immunization coverage is crucial in assessing the real-world impact of this vaccine, variability in the vaccine coverage across the country is likely to occur. In view of this, we estimated the extent of coverage for the rotavirus vaccine at two socio-economically different sub-counties using the administrative data. The findings indicate disparities in vaccine coverage and access between the sub-counties and, thus, underscore the need to strengthen immunization systems to facilitate timely, accessible, and equitable vaccine delivery across the country. Both sub-counties recorded high vaccine dropout, suggestive of poor utilization of the vaccine. In this regard, increased social mobilization is needed to encourage vaccine compliance and to enhance tracking of vaccine defaulters. While efforts to improve the accuracy of the administrative coverage estimates are crucial, vaccination coverage surveys will be needed to verify the administrative coverage data and help identify specific factors relating to rotavirus vaccine coverage in the country.

Realistic respiratory motion margins for external beam partial breast irradiation

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

Conroy, Leigh; Quirk, Sarah; Department of Physics and Astronomy, University of Calgary, Calgary, Alberta T2N 1N4

Purpose: Respiratory margins for partial breast irradiation (PBI) have been largely based on geometric observations, which may overestimate the margin required for dosimetric coverage. In this study, dosimetric population-based respiratory margins and margin formulas for external beam partial breast irradiation are determined. Methods: Volunteer respiratory data and anterior–posterior (AP) dose profiles from clinical treatment plans of 28 3D conformal radiotherapy (3DCRT) PBI patient plans were used to determine population-based respiratory margins. The peak-to-peak amplitudes (A) of realistic respiratory motion data from healthy volunteers were scaled from A = 1 to 10 mm to create respiratory motion probability density functions. Dosemore » profiles were convolved with the respiratory probability density functions to produce blurred dose profiles accounting for respiratory motion. The required margins were found by measuring the distance between the simulated treatment and original dose profiles at the 95% isodose level. Results: The symmetric dosimetric respiratory margins to cover 90%, 95%, and 100% of the simulated treatment population were 1.5, 2, and 4 mm, respectively. With patient set up at end exhale, the required margins were larger in the anterior direction than the posterior. For respiratory amplitudes less than 5 mm, the population-based margins can be expressed as a fraction of the extent of respiratory motion. The derived formulas in the anterior/posterior directions for 90%, 95%, and 100% simulated population coverage were 0.45A/0.25A, 0.50A/0.30A, and 0.70A/0.40A. The differences in formulas for different population coverage criteria demonstrate that respiratory trace shape and baseline drift characteristics affect individual respiratory margins even for the same average peak-to-peak amplitude. Conclusions: A methodology for determining population-based respiratory margins using real respiratory motion patterns and dose profiles in the AP direction was described. It was found that the currently used respiratory margin of 5 mm in partial breast irradiation may be overly conservative for many 3DCRT PBI patients. Amplitude alone was found to be insufficient to determine patient-specific margins: individual respiratory trace shape and baseline drift both contributed to the dosimetric target coverage. With respiratory coaching, individualized respiratory margins smaller than the full extent of motion could reduce planning target volumes while ensuring adequate coverage under respiratory motion.« less

A spatial Bayesian network model to assess the benefits of early warning for urban flood risk to people

NASA Astrophysics Data System (ADS)

Balbi, S.; Villa, F.; Mojtahed, V.; Hegetschweiler, K. T.; Giupponi, C.

2015-10-01

This article presents a novel methodology to assess flood risk to people by integrating people's vulnerability and ability to cushion hazards through coping and adapting. The proposed approach extends traditional risk assessments beyond material damages; complements quantitative and semi-quantitative data with subjective and local knowledge, improving the use of commonly available information; produces estimates of model uncertainty by providing probability distributions for all of its outputs. Flood risk to people is modeled using a spatially explicit Bayesian network model calibrated on expert opinion. Risk is assessed in terms of: (1) likelihood of non-fatal physical injury; (2) likelihood of post-traumatic stress disorder; (3) likelihood of death. The study area covers the lower part of the Sihl valley (Switzerland) including the city of Zurich. The model is used to estimate the benefits of improving an existing Early Warning System, taking into account the reliability, lead-time and scope (i.e. coverage of people reached by the warning). Model results indicate that the potential benefits of an improved early warning in terms of avoided human impacts are particularly relevant in case of a major flood event: about 75 % of fatalities, 25 % of injuries and 18 % of post-traumatic stress disorders could be avoided.

Has decentralisation affected child immunisation status in Indonesia?

PubMed

Maharani, Asri; Tampubolon, Gindo

2014-01-01

The past two decades have seen many countries, including a number in Southeast Asia, decentralising their health system with the expectation that this reform will improve their citizens' health. However, the consequences of this reform remain largely unknown. This study analyses the effects of fiscal decentralisation on child immunisation status in Indonesia. We used multilevel logistic regression analysis to estimate these effects, and multilevel multiple imputation to manage missing data. The 2011 publication of Indonesia's national socio-economic survey (Susenas) is the source of household data, while the Podes village census survey from the same year provides village-level data. We supplement these with local government fiscal data from the Ministry of Finance. The findings show that decentralising the fiscal allocation of responsibilities to local governments has a lack of association with child immunisation status and the results are robust. The results also suggest that increasing the number of village health centres (posyandu) per 1,000 population improves probability of children to receive full immunisation significantly, while increasing that of hospitals and health centres (puskesmas) has no significant effect. These findings suggest that merely decentralising the health system does not guarantee improvement in a country's immunisation coverage. Any successful decentralisation demands good capacity and capability of local governments.

Has decentralisation affected child immunisation status in Indonesia?

PubMed Central

Maharani, Asri; Tampubolon, Gindo

2014-01-01

Background The past two decades have seen many countries, including a number in Southeast Asia, decentralising their health system with the expectation that this reform will improve their citizens’ health. However, the consequences of this reform remain largely unknown. Objective This study analyses the effects of fiscal decentralisation on child immunisation status in Indonesia. Design We used multilevel logistic regression analysis to estimate these effects, and multilevel multiple imputation to manage missing data. The 2011 publication of Indonesia's national socio-economic survey (Susenas) is the source of household data, while the Podes village census survey from the same year provides village-level data. We supplement these with local government fiscal data from the Ministry of Finance. Results The findings show that decentralising the fiscal allocation of responsibilities to local governments has a lack of association with child immunisation status and the results are robust. The results also suggest that increasing the number of village health centres (posyandu) per 1,000 population improves probability of children to receive full immunisation significantly, while increasing that of hospitals and health centres (puskesmas) has no significant effect. Conclusion These findings suggest that merely decentralising the health system does not guarantee improvement in a country's immunisation coverage. Any successful decentralisation demands good capacity and capability of local governments. PMID:25160515

Distribution of alcohol consumption and expenditures and the impact of improved measurement on coverage of alcohol sales in the 2000 National Alcohol Survey.

PubMed

Kerr, William C; Greenfield, Thomas K

2007-10-01

To validate improved survey estimates of alcohol volume and new expenditures questions, these measures were aggregated and evaluated through comparison to sales data. Using the new measures, we examined their distributions by estimating the proportion of mean intake, heavy drinking days, and alcohol expenditures among drinkers grouped by volume. The 2000 National Alcohol Survey is a random digit dialed telephone survey of the United States with 7,612 respondents including 323 who were recontacted for drink ethanol measurement. Among drinkers, we utilized improved drink ethanol content estimates and beverage-specific graduated frequency measures to assess alcohol consumption and past month beverage-specific spending reports to estimate expenditures. Coverage of alcohol sales by the new measures was estimated to be 52.3% for consumption and 59.3% for expenditures. Coverage was best for wine at 92.1% of sales, but improved most for spirits from 37.2% to 55.2%, when empirical drink ethanol content was applied. Distribution estimates showed that the top 10% of drinkers drank 55.3% of the total alcohol consumed, accounted for 61.6% of all 5+ and nearly 80% of all 12+ drinking days. Spirits consumption was the most concentrated with the top decile consuming 62.9% of the total for this beverage. This decile accounted for 33% of total expenditures, even though its mean expenditure per drink was considerably lower ($0.79) than the bottom 50% of drinkers ($4.75). The distributions of mean alcohol intake and heavy drinking days are highly concentrated in the U.S. population. Lower expenditures per drink by the heaviest drinkers suggest substantial downward quality substitution, drinking in cheaper contexts or other bargain pricing strategies. Empirical drink ethanol estimates improved survey coverage of sales particularly for spirits, but significant under-coverage remains, highlighting need for further self-report measurement improvement.

Evaluating Childhood Vaccination Coverage of NIP Vaccines: Coverage Survey versus Zhejiang Provincial Immunization Information System.

PubMed

Hu, Yu; Chen, Yaping

2017-07-11

Vaccination coverage in Zhejiang province, east China, is evaluated through repeated coverage surveys. The Zhejiang provincial immunization information system (ZJIIS) was established in 2004 with links to all immunization clinics. ZJIIS has become an alternative to quickly assess the vaccination coverage. To assess the current completeness and accuracy on the vaccination coverage derived from ZJIIS, we compared the estimates from ZJIIS with the estimates from the most recent provincial coverage survey in 2014, which combined interview data with verified data from ZJIIS. Of the enrolled 2772 children in the 2014 provincial survey, the proportions of children with vaccination cards and registered in ZJIIS were 94.0% and 87.4%, respectively. Coverage estimates from ZJIIS were systematically higher than the corresponding estimates obtained through the survey, with a mean difference of 4.5%. Of the vaccination doses registered in ZJIIS, 16.7% differed from the date recorded in the corresponding vaccination cards. Under-registration in ZJIIS significantly influenced the coverage estimates derived from ZJIIS. Therefore, periodic coverage surveys currently provide more complete and reliable results than the estimates based on ZJIIS alone. However, further improvement of completeness and accuracy of ZJIIS will likely allow more reliable and timely estimates in future.

Bayesian network meta-analysis of root coverage procedures: ranking efficacy and identification of best treatment.

PubMed

Buti, Jacopo; Baccini, Michela; Nieri, Michele; La Marca, Michele; Pini-Prato, Giovan P

2013-04-01

The aim of this work was to conduct a Bayesian network meta-analysis (NM) of randomized controlled trials (RCTs) to establish a ranking in efficacy and the best technique for coronally advanced flap (CAF)-based root coverage procedures. A literature search on PubMed, Cochrane libraries, EMBASE, and hand-searched journals until June 2012 was conducted to identify RCTs on treatments of Miller Class I and II gingival recessions with at least 6 months of follow-up. The treatment outcomes were recession reduction (RecRed), clinical attachment gain (CALgain), keratinized tissue gain (KTgain), and complete root coverage (CRC). Twenty-nine studies met the inclusion criteria, 20 of which were classified as at high risk of bias. The CAF+connective tissue graft (CTG) combination ranked highest in effectiveness for RecRed (Probability of being the best = 40%) and CALgain (Pr = 33%); CAF+enamel matrix derivative (EMD) was slightly better for CRC; CAF+Collagen Matrix (CM) appeared effective for KTgain (Pr = 69%). Network inconsistency was low for all outcomes excluding CALgain. CAF+CTG might be considered the gold standard in root coverage procedures. The low amount of inconsistency gives support to the reliability of the present findings. © 2012 John Wiley & Sons A/S.

Potential Standards and Methods for the National Guard’s Homeland Response Force

DTIC Science & Technology

2011-09-01

rapidly determine a missile launch and probable impact area ( Opall -Rome, 2009). Since 2006, Color Red coverage has expanded throughout the country...Manportable Air Defense (MANPAD) systems, land mines , advanced communication systems, mortars, unmanned air systems (UAS), frequency-hopping...Consequence Management Response Force (CCMRF). Internal document. Opall -Rome, B. (2009, January19). In Israel: Anti-sniper gear spots rockets

An Alternative to Cohen's Standardized Mean Difference Effect Size: A Robust Parameter and Confidence Interval in the Two Independent Groups Case

ERIC Educational Resources Information Center

Algina, James; Keselman, H. J.; Penfield, Randall D.

2005-01-01

The authors argue that a robust version of Cohen's effect size constructed by replacing population means with 20% trimmed means and the population standard deviation with the square root of a 20% Winsorized variance is a better measure of population separation than is Cohen's effect size. The authors investigated coverage probability for…

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.

Differential impacts of public health insurance expansions at the local level.

PubMed

Baughman, Reagan

2007-03-01

Dramatic expansions in public health insurance eligibility for U.S. children have only modestly reduced the aggregate number of uninsured at the national level. This paper shows that Medicaid and SCHIP expansions had different impacts on child health insurance coverage patterns based upon local labor market characteristics. Metropolitan areas with high levels of unemployment were most likely to have seen improvements in overall insurance coverage for children between 1990 and 2001. Areas with greater fractions of employment in services, retail or wholesale trade were more likely to have experienced increases in public coverage but not overall coverage rates.

Affordable Care Act and Diabetes Mellitus.

PubMed

Shi, Qian; Nellans, Frank P; Shi, Lizheng

2015-12-01

The Affordable Care Act (ACA) has the potential for great impact on U.S. health care, especially for chronic disease patients requiring long-term care and management. The act was designed to improve insurance coverage, health care access, and quality of care for all Americans, which will assist patients with diabetes mellitus in acquiring routine monitoring and diabetes-related complication screening for better health management and outcomes. There is great potential for patients with diabetes to benefit from the new policy mandating health insurance coverage and plan improvement, Medicaid expansion, minimum coverage guarantees, and free preventative care. However, policy variability among states and ACA implementation present challenges to people with diabetes in understanding and optimizing ACA impact. This paper aims to select the most influential components of the ACA as relates to people with diabetes and discuss how the ACA may improve health care for this vulnerable population.

Strategies for expanding health insurance coverage in vulnerable populations

PubMed Central

Jia, Liying; Yuan, Beibei; Huang, Fei; Lu, Ying; Garner, Paul; Meng, Qingyue

2014-01-01

Background Health insurance has the potential to improve access to health care and protect people from the financial risks of diseases. However, health insurance coverage is often low, particularly for people most in need of protection, including children and other vulnerable populations. Objectives To assess the effectiveness of strategies for expanding health insurance coverage in vulnerable populations. Search methods We searched Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library. www.thecochranelibrary.com (searched 2 November 2012), PubMed (searched 1 November 2012), EMBASE (searched 6 July 2012), Global Health (searched 6 July 2012), IBSS (searched 6 July 2012), WHO Library Database (WHOLIS) (searched 1 November 2012), IDEAS (searched 1 November 2012), ISI-Proceedings (searched 1 November 2012),OpenGrey (changed from OpenSIGLE) (searched 1 November 2012), African Index Medicus (searched 1 November 2012), BLDS (searched 1 November 2012), Econlit (searched 1 November 2012), ELDIS (searched 1 November 2012), ERIC (searched 1 November 2012), HERDIN NeON Database (searched 1 November 2012), IndMED (searched 1 November 2012), JSTOR (searched 1 November 2012), LILACS(searched 1 November 2012), NTIS (searched 1 November 2012), PAIS (searched 6 July 2012), Popline (searched 1 November 2012), ProQuest Dissertation &Theses Database (searched 1 November 2012), PsycINFO (searched 6 July 2012), SSRN (searched 1 November 2012), Thai Index Medicus (searched 1 November 2012), World Bank (searched 2 November 2012), WanFang (searched 3 November 2012), China National Knowledge Infrastructure (CHKD-CNKI) (searched 2 November 2012). In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via Web of Science to find other potentially relevant studies. Selection criteria Randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) studies and Interrupted time series (ITS) studies that evaluated the effects of strategies on increasing health insurance coverage for vulnerable populations. We defined strategies as measures to improve the enrolment of vulnerable populations into health insurance schemes. Two categories and six specified strategies were identified as the interventions. Data collection and analysis At least two review authors independently extracted data and assessed the risk of bias. We undertook a structured synthesis. Main results We included two studies, both from the United States. People offered health insurance information and application support by community-based case managers were probably more likely to enrol their children into health insurance programmes (risk ratio (RR) 1.68, 95% confidence interval (CI) 1.44 to 1.96, moderate quality evidence) and were probably more likely to continue insuring their children (RR 2.59, 95% CI 1.95 to 3.44, moderate quality evidence). Of all the children that were insured, those in the intervention group may have been insured quicker (47.3 fewer days, 95% CI 20.6 to 74.0 fewer days, low quality evidence) and parents may have been more satisfied on average (satisfaction score average difference 1.07, 95% CI 0.72 to 1.42, low quality evidence). In the second study applications were handed out in emergency departments at hospitals, compared to not handing out applications, and may have had an effect on enrolment (RR 1.5, 95% CI 1.03 to 2.18, low quality evidence). Authors' conclusions Community-based case managers who provide health insurance information, application support, and negotiate with the insurer probably increase enrolment of children in health insurance schemes. However, the transferability of this intervention to other populations or other settings is uncertain. Handing out insurance application materials in hospital emergency departments may help increase the enrolment of children in health insurance schemes. Further studies evaluating the effectiveness of different strategies for expanding health insurance coverage in vulnerable population are needed in different settings, with careful attention given to study design. PLAIN LANGUAGE SUMMARY Strategies for expanding health insurance coverage in vulnerable populations Researchers in The Cochrane Collaboration conducted a review of the effect of strategies to increase the number of people from vulnerable populations that are enrolled into health insurance programmes. They searched for all relevant studies and found two studies. Their findings are summarised below. What is a health insurance programme? Governments in many countries offer healthcare services at low rates or free of charge to all their citizens, often paying for these services through taxes. However, in many developing countries and some developed countries this is not the case. In these countries, many people get their healthcare expenses covered through government health insurance programmes, which are often paid for through membership fees. But certain groups of people, such as children, the elderly, women, people with low incomes, people living in rural areas, racial and ethnic minorities, immigrants, and people with chronic diseases or disabilities, are less likely to be members of these programmes even though they are more likely to have health problems. In some of these countries governments have tried to make sure that health insurance programmes cover these vulnerable groups. One way of doing this is to improve the design of the programme. For instance, governments can change the rules for who can join the programme or they can make it cheaper to join. But even if a programme is well-designed, people may still not join it. For instance, they may not know that they can become members or they may find the application process too difficult. To address these problems, for instance, governments can give people more information about the programme and who can join, or can make the application process easier. What this research says Both studies in this review took place in the USA and were aimed at uninsured children. In the first study, case managers contacted the families of uninsured Latin American children, gave them information about health insurance, helped them apply, and helped them appeal when a wrong decision was made. In the second study, insurance application forms were handed out to the families of children visiting hospital emergency departments. In both studies, these families were compared to families who were not given additional information or support. The studies showed the following: People who are offered health insurance information and application support: - are probably more likely to enrol their children into health insurance programmes (moderate quality evidence); - are probably more likely to continue insuring their children (moderate quality evidence); - may be quicker at getting insurance (low quality evidence); - may be more satisfied with the process of enrolment (low quality evidence). People who are given insurance application forms in the emergency departments of hospitals: - may be more likely to enrol their children into health insurance programmes (low quality evidence). No unwanted effects were reported in the studies. A possible unwanted effect might be that people could experience the information and support as annoying or unhelpful. However, in the one study that measured the parents' satisfaction, people were more satisfied when given information and support. PMID:25425010

A Distributed and Energy-Efficient Algorithm for Event K-Coverage in Underwater Sensor Networks

PubMed Central

Jiang, Peng; Xu, Yiming; Liu, Jun

2017-01-01

For event dynamic K-coverage algorithms, each management node selects its assistant node by using a greedy algorithm without considering the residual energy and situations in which a node is selected by several events. This approach affects network energy consumption and balance. Therefore, this study proposes a distributed and energy-efficient event K-coverage algorithm (DEEKA). After the network achieves 1-coverage, the nodes that detect the same event compete for the event management node with the number of candidate nodes and the average residual energy, as well as the distance to the event. Second, each management node estimates the probability of its neighbor nodes’ being selected by the event it manages with the distance level, the residual energy level, and the number of dynamic coverage event of these nodes. Third, each management node establishes an optimization model that uses expectation energy consumption and the residual energy variance of its neighbor nodes and detects the performance of the events it manages as targets. Finally, each management node uses a constrained non-dominated sorting genetic algorithm (NSGA-II) to obtain the Pareto set of the model and the best strategy via technique for order preference by similarity to an ideal solution (TOPSIS). The algorithm first considers the effect of harsh underwater environments on information collection and transmission. It also considers the residual energy of a node and a situation in which the node is selected by several other events. Simulation results show that, unlike the on-demand variable sensing K-coverage algorithm, DEEKA balances and reduces network energy consumption, thereby prolonging the network’s best service quality and lifetime. PMID:28106837

Sci—Thur PM: Planning and Delivery — 04: Respiratory margin derivation and verification in partial breast irradiation

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

Quirk, S; Conroy, L; Smith, WL

Partial breast irradiation (PBI) following breast-conserving surgery is emerging as an effective means to achieve local control and reduce irradiated breast volume. Patients are planned on a static CT image; however, treatment is delivered while the patient is free-breathing. Respiratory motion can degrade plan quality by reducing target coverage and/or dose homogeneity. A variety of methods can be used to determine the required margin for respiratory motion in PBI. We derive geometric and dosimetric respiratory 1D margin. We also verify the adequacy of the typical 5 mm respiratory margin in 3D by evaluating plan quality for increasing respiratory amplitudes (2–20more » mm). Ten PBI plans were used for dosimetric evaluation. A database of volunteer respiratory data, with similar characteristics to breast cancer patients, was used for this study. We derived a geometric 95%-margin of 3 mm from the population respiratory data. We derived a dosimetric 95%-margin of 2 mm by convolving 1D dose profiles with respiratory probability density functions. The 5 mm respiratory margin is possibly too large when 1D coverage is assessed and could lead to unnecessary normal tissue irradiation. Assessing margins only for coverage may be insufficient; 3D dosimetric assessment revealed degradation in dose homogeneity is the limiting factor, not target coverage. Hotspots increased even for the smallest respiratory amplitudes, while target coverage only degraded at amplitudes greater than 10 mm. The 5 mm respiratory margin is adequate for coverage, but due to plan quality degradation, respiratory management is recommended for patients with respiratory amplitudes greater than 10 mm.« less

A Distributed and Energy-Efficient Algorithm for Event K-Coverage in Underwater Sensor Networks.

PubMed

Jiang, Peng; Xu, Yiming; Liu, Jun

2017-01-19

For event dynamic K-coverage algorithms, each management node selects its assistant node by using a greedy algorithm without considering the residual energy and situations in which a node is selected by several events. This approach affects network energy consumption and balance. Therefore, this study proposes a distributed and energy-efficient event K-coverage algorithm (DEEKA). After the network achieves 1-coverage, the nodes that detect the same event compete for the event management node with the number of candidate nodes and the average residual energy, as well as the distance to the event. Second, each management node estimates the probability of its neighbor nodes' being selected by the event it manages with the distance level, the residual energy level, and the number of dynamic coverage event of these nodes. Third, each management node establishes an optimization model that uses expectation energy consumption and the residual energy variance of its neighbor nodes and detects the performance of the events it manages as targets. Finally, each management node uses a constrained non-dominated sorting genetic algorithm (NSGA-II) to obtain the Pareto set of the model and the best strategy via technique for order preference by similarity to an ideal solution (TOPSIS). The algorithm first considers the effect of harsh underwater environments on information collection and transmission. It also considers the residual energy of a node and a situation in which the node is selected by several other events. Simulation results show that, unlike the on-demand variable sensing K-coverage algorithm, DEEKA balances and reduces network energy consumption, thereby prolonging the network's best service quality and lifetime.

Activated adsorption of methane on clean and oxygen-modified Pt?111? and Pd?110?

NASA Astrophysics Data System (ADS)

Valden, M.; Pere, J.; Hirsimäki, M.; Suhonen, S.; Pessa, M.

1997-04-01

Activated adsorption of CH 4 on clean and oxygen modified Pt{111} and Pd{110} has been studied using molecular beam surface scattering. The absolute dissociation probability of CH 4 was measured as a function of the incident normal energy ( E) and the surface temperature ( Ts). The results from clean Pt{111} and Pd{110} are consistent with a direct dissociation mechanism. The dissociative chemisorption dynamics of CH 4 is addressed by using quantum mechanical and statistical models. The influence of adsorbed oxygen on the dissociative adsorption of CH 4 on both Pt{111} and Pd{110} shows that the dissociation probability decreases linearly with increasing oxygen coverage.

Public finance policy strategies to increase access to preconception care.

PubMed

Johnson, Kay A

2006-09-01

Policy and finance barriers reduce access to preconception care and, reportedly, limit professional practice changes that would improve the availability of needed services. Millions of women of childbearing age (15-44) lack adequate health coverage (i.e., uninsured or underinsured), and others live in medically underserved areas. Service delivery fragmentation and lack of professional guidelines are additional barriers. This paper reviews barriers and opportunities for financing preconception care, based on a review and analysis of state and federal policies. We describe states' experiences with and opportunities to improve health coverage, through public programs such as Medicaid, Medicaid waivers, and the State Children's Health Insurance Program (SCHIP). The potential role of Title V and of community health centers in providing primary and preventive care to women also is discussed. In these and other public health and health coverage programs, opportunities exist to finance preconception care for low-income women. Three major policy directions are discussed. To increase access to preconception care among women of childbearing age, the federal and state governments have opportunities to: (1) improve health care coverage, (2) increase the supply of publicly subsidized health clinics, and (3) direct delivery of preconception screening and interventions in the context of public health programs.

Recent Changes in Health Insurance Coverage for Urban and Rural Veterans: Evidence from the First Year of the Affordable Care Act.

PubMed

Boudreaux, Michel; Barath, Deanna; Blewett, Lynn A

2018-04-25

Prior to the Affordable Care Act, as many as 1.3 million veterans lacked health insurance. With the passage of the Affordable Care Act, veterans now have new pathways to coverage through Medicaid expansion in those states that chose to expand Medicaid and through private coverage options offered through the Health Insurance Marketplace. We examined the impact of the ACA on health insurance coverage for veterans in expansion and non-expansion states and for urban and rural veterans. We examined changes in veterans' health insurance coverage following the first year of the ACA, focusing on whether they lived in an urban or rural area and whether they live in a Medicaid expansion state. We used data on approximately 200,000 non-elderly community-dwelling veterans, obtained from the 2013-2014 American Community Survey and estimated differences in the adjusted probability of being uninsured between 2013 and 2014 for both urban and rural areas. Adjusted probabilities were computed by fitting logistic regressions controlling for age, gender, race, marital status, poverty status, education, and employment. There were an estimated 10.1 million U.S. non-elderly veterans in 2013; 82% lived in predominantly urban areas (8.3 million), and the remaining 18% (1.8 million) lived in predominately rural areas. Most veterans lived in the South (43.6%), and rural veterans were more likely to be Southerners than their urban counterparts. On every marker of economic well-being, rural veterans fared worse than urban veterans. They had a statistically significant higher chance of having incomes below 138% of FPG (20.0% versus 17.0%), of being out of the labor force (29.1% versus 23.0%), and of having no more than a high school education (39.6% versus 28.8%). Rural veterans were also more likely to experience at least one functional limitation. Overall, veterans in Medicaid expansion states experienced a significantly larger increase in insurance compared to veterans living in non-expansion states. For rural veterans in Medicaid expansion states, the increase in insurance was 3.5 percentage points, compared with 1.2 percentage points in non-expansion states. Our analysis found a substantial 24% relative decline in the rate of uninsurance for U.S. Veterans, from 9.3 to 7.1% between 2013 and 2014. We found that coverage gains in rural areas were due to gains in Medicaid and individual market coverage. Residence in a Medicaid expansion state was particularly influential for rural veterans - the increase in the insured rate was three times larger in Medicaid expansion states versus non-expansion states. The ACA has had a positive and significant impact on the ability of U.S. Veterans to obtain health insurance coverage specifically for low-income veterans living in rural areas. The poverty rate among Veterans is rising and is particularly an issue for the more recent Gulf War veterans. Providing affordable and accessible health insurance options is part of our commitment to those who have served our country. Our analysis also presents yet another reason for the 17 non-expansion states to consider a Medicaid expansion.

Public and private health insurance premiums: how do they affect the health insurance status of low-income childless adults?

PubMed

Guy, Gery P; Adams, E Kathleen; Atherly, Adam

2012-01-01

The Patient Protection and Affordable Care Act (ACA) will substantially increase public health insurance eligibility and alter the costs of insurance coverage. Using Current Population Survey (CPS) data from the period 2000-2008, we examine the effects of public and private health insurance premiums on the insurance status of low-income childless adults, a population substantially affected by the ACA. Results show higher public premiums to be associated with a decrease in the probability of having public insurance and an increase in the probability of being uninsured, while increased private premiums decrease the probability of having private insurance. Eligibility for premium assistance programs and increased subsidy levels are associated with lower rates of uninsurance. The magnitudes of the effects are quite modest and provide important implications for insurance expansions for childless adults under the ACA.

A quantum probability perspective on borderline vagueness.

PubMed

Blutner, Reinhard; Pothos, Emmanuel M; Bruza, Peter

2013-10-01

The term "vagueness" describes a property of natural concepts, which normally have fuzzy boundaries, admit borderline cases, and are susceptible to Zeno's sorites paradox. We will discuss the psychology of vagueness, especially experiments investigating the judgment of borderline cases and contradictions. In the theoretical part, we will propose a probabilistic model that describes the quantitative characteristics of the experimental finding and extends Alxatib's and Pelletier's () theoretical analysis. The model is based on a Hopfield network for predicting truth values. Powerful as this classical perspective is, we show that it falls short of providing an adequate coverage of the relevant empirical results. In the final part, we will argue that a substantial modification of the analysis put forward by Alxatib and Pelletier and its probabilistic pendant is needed. The proposed modification replaces the standard notion of probabilities by quantum probabilities. The crucial phenomenon of borderline contradictions can be explained then as a quantum interference phenomenon. © 2013 Cognitive Science Society, Inc.

Signal coverage approach to the detection probability of hypothetical extraterrestrial emitters in the Milky Way.

PubMed

Grimaldi, Claudio

2017-04-12

The lack of evidence for the existence of extraterrestrial life, even the simplest forms of animal life, makes it is difficult to decide whether the search for extraterrestrial intelligence (SETI) is more a high-risk, high-payoff endeavor than a futile attempt. Here we insist that even if extraterrestrial civilizations do exist and communicate, the likelihood of detecting their signals crucially depends on whether the Earth lies within a region of the galaxy covered by such signals. By considering possible populations of independent emitters in the galaxy, we build a statistical model of the domain covered by hypothetical extraterrestrial signals to derive the detection probability that the Earth is within such a domain. We show that for general distributions of the signal longevity and directionality, the mean number of detectable emitters is less than one even for detection probabilities as large as 50%, regardless of the number of emitters in the galaxy.

Signal coverage approach to the detection probability of hypothetical extraterrestrial emitters in the Milky Way

NASA Astrophysics Data System (ADS)

Grimaldi, Claudio

2017-04-01

The lack of evidence for the existence of extraterrestrial life, even the simplest forms of animal life, makes it is difficult to decide whether the search for extraterrestrial intelligence (SETI) is more a high-risk, high-payoff endeavor than a futile attempt. Here we insist that even if extraterrestrial civilizations do exist and communicate, the likelihood of detecting their signals crucially depends on whether the Earth lies within a region of the galaxy covered by such signals. By considering possible populations of independent emitters in the galaxy, we build a statistical model of the domain covered by hypothetical extraterrestrial signals to derive the detection probability that the Earth is within such a domain. We show that for general distributions of the signal longevity and directionality, the mean number of detectable emitters is less than one even for detection probabilities as large as 50%, regardless of the number of emitters in the galaxy.

Vestibular deepening by periosteal fenestration and its use as a periosteal pedicle flap for root coverage

PubMed Central

Rajpal, Jaisika; Gupta, Krishna K.; Srivastava, Ruchi; Arora, Aakash

2013-01-01

Gingival recession along with reduced width of attached gingiva and inadequate vestibular depth is a very common finding. Multiple techniques have been developed to obtain predictable root coverage and to increase the width of attached gingiva. Usually, the width of gingiva is first increased and then the second surgery is caried out for root coverage. The newer methods of root coverage are needed, not only to reconstruct the lost periodontal tissues but also to increase predictability, reduce the number of surgical sites, reduce the number of surgeries and improve patient comfort. Hence, this paper describes a single stage technique for increasing the width of attached gingiva and root coverage by using the periosteal pedicle flap. PMID:23869140

[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.

Magazine coverage of child sexual abuse, 1992-2004.

PubMed

Cheit, Ross E; Shavit, Yael; Reiss-Davis, Zachary

2010-01-01

This article analyzes trends in the coverage of child sexual abuse in popular magazines since the early 1990s. The article employs systematic analysis to identify and analyze articles in four popular magazines. Articles are analyzed by subject, length, and publication. The results affirm established theories of newsworthiness related to the coverage of specific stories over time. However, interest in the subject waned in the past 10 years, with the brief and dramatic exception of coverage connected to the Catholic Church in 2002. The findings demonstrate systematic differences between the slants of the four magazines studied. The findings also suggest that child abuse professionals could improve the quality of coverage by agreeing to interviews in connection with articles about childhood sexual abuse.

A modified Wald interval for the area under the ROC curve (AUC) in diagnostic case-control studies

PubMed Central

2014-01-01

Background The area under the receiver operating characteristic (ROC) curve, referred to as the AUC, is an appropriate measure for describing the overall accuracy of a diagnostic test or a biomarker in early phase trials without having to choose a threshold. There are many approaches for estimating the confidence interval for the AUC. However, all are relatively complicated to implement. Furthermore, many approaches perform poorly for large AUC values or small sample sizes. Methods The AUC is actually a probability. So we propose a modified Wald interval for a single proportion, which can be calculated on a pocket calculator. We performed a simulation study to compare this modified Wald interval (without and with continuity correction) with other intervals regarding coverage probability and statistical power. Results The main result is that the proposed modified Wald intervals maintain and exploit the type I error much better than the intervals of Agresti-Coull, Wilson, and Clopper-Pearson. The interval suggested by Bamber, the Mann-Whitney interval without transformation and also the interval of the binormal AUC are very liberal. For small sample sizes the Wald interval with continuity has a comparable coverage probability as the LT interval and higher power. For large sample sizes the results of the LT interval and of the Wald interval without continuity correction are comparable. Conclusions If individual patient data is not available, but only the estimated AUC and the total sample size, the modified Wald intervals can be recommended as confidence intervals for the AUC. For small sample sizes the continuity correction should be used. PMID:24552686

A modified Wald interval for the area under the ROC curve (AUC) in diagnostic case-control studies.

PubMed

Kottas, Martina; Kuss, Oliver; Zapf, Antonia

2014-02-19

The area under the receiver operating characteristic (ROC) curve, referred to as the AUC, is an appropriate measure for describing the overall accuracy of a diagnostic test or a biomarker in early phase trials without having to choose a threshold. There are many approaches for estimating the confidence interval for the AUC. However, all are relatively complicated to implement. Furthermore, many approaches perform poorly for large AUC values or small sample sizes. The AUC is actually a probability. So we propose a modified Wald interval for a single proportion, which can be calculated on a pocket calculator. We performed a simulation study to compare this modified Wald interval (without and with continuity correction) with other intervals regarding coverage probability and statistical power. The main result is that the proposed modified Wald intervals maintain and exploit the type I error much better than the intervals of Agresti-Coull, Wilson, and Clopper-Pearson. The interval suggested by Bamber, the Mann-Whitney interval without transformation and also the interval of the binormal AUC are very liberal. For small sample sizes the Wald interval with continuity has a comparable coverage probability as the LT interval and higher power. For large sample sizes the results of the LT interval and of the Wald interval without continuity correction are comparable. If individual patient data is not available, but only the estimated AUC and the total sample size, the modified Wald intervals can be recommended as confidence intervals for the AUC. For small sample sizes the continuity correction should be used.

Saturn's Misbegotten Moonlets

NASA Astrophysics Data System (ADS)

Spitale, Joseph N.

2017-06-01

Saturn's rings are interspersed with numerous narrow (tens of km wide) gaps. Two of the largest of these gaps -- Encke and Keeler -- contain satellites -- Pan and Daphnis -- that maintain their respective gaps via the classical Goldreich/Tremaine-style shepherding mechanism wherein angular momentum is transferred across the essentially empty gap via torques acting between the satellites and the ring. Other prominent gaps are shepherded by resonances with external satellites or planetary modes: Mimas shepherds the outer edge of the B ring, clearing the inner part of the Cassini Division, Titan shepherds the Columbo ringlet / gap, and the Maxwell ringlet / gap is likely maintained by a resonance with a planetary mode. Prior to Cassini, it was expected that all of the gaps would be shepherded in a similar manner.However, many small gaps do not correspond with known resonances, and no satellites were spotted within those gaps during Cassini's prime and extended mission. To address this issue, a series of Cassini imaging observations were planned to examine 11 gaps in the C ring and Cassini division at a resolution and longitudinal coverage sufficient to either discover the shepherds or rule out their presence. The survey discovered no embedded satellites. Longitudinal coverage was incomplete, but within longitudes covered by the survey, satellites are ruled out to sizes in the 100-m range, far too small keep the observed gaps open. It is possible (about even odds) that there could be a larger satellite residing at a longitude not covered in the survey, but the probability that the survey was unfortunate enough to miss significant satellites in all 11 gaps is exceedingly small (~0.002%). Moreover, these gaps appear in earlier imaging sequences, with some high-resolution coverage, so the true probability is smaller yet. Therefore, a new theory is likely needed to explain the presence of the gaps.

Developing a Scorecard to Assess Global Progress in Scaling Up Diarrhea Control Tools: A Qualitative Study of Academic Leaders and Implementers

PubMed Central

Rosinski, Alexander Anthony; Narine, Steven; Yamey, Gavin

2013-01-01

Background In 2010, diarrhea caused 0.75 million child deaths, accounting for nearly 12% of all under-five mortality worldwide. Many evidence-based interventions can reduce diarrhea mortality, including oral rehydration solution (ORS), zinc, and improved sanitation. Yet global coverage levels of such interventions remain low. A new scorecard of diarrhea control, showing how different countries are performing in their control efforts, could draw greater attention to the low coverage levels of proven interventions. Methods We conducted in-depth qualitative interviews with 21 experts, purposively sampled for their relevant academic or implementation expertise, to explore their views on (a) the value of a scorecard of global diarrhea control and (b) which indicators should be included in such a scorecard. We then conducted a ranking exercise in which we compiled a list of all 49 indicators suggested by the experts, sent the list to the 21 experts, and asked them to choose 10 indicators that they would include and 10 that they would exclude from such a scorecard. Finally, we created a “prototype” scorecard based on the 9 highest-ranked indicators. Results Key themes that emerged from coding the interview transcripts were: a scorecard could facilitate country comparisons; it could help to identify best practices, set priorities, and spur donor action; and it could help with goal-setting and accountability in diarrhea control. The nine highest ranking indicators, in descending order, were ORS coverage, rotavirus vaccine coverage, zinc coverage, diarrhea-specific mortality rate, diarrhea prevalence, proportion of population with access to improved sanitation, proportion with access to improved drinking water, exclusive breastfeeding coverage, and measles vaccine coverage. Conclusion A new scorecard of global diarrhea control could help track progress, focus prevention and treatment efforts on the most effective interventions, establish transparency and accountability, and alert donors and ministries of health to inadequacies in diarrhea control efforts. PMID:23874412

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.

Overcoming Spatial and Temporal Barriers to Public Access Defibrillators Via Optimization.

PubMed

Sun, Christopher L F; Demirtas, Derya; Brooks, Steven C; Morrison, Laurie J; Chan, Timothy C Y

2016-08-23

Immediate access to an automated external defibrillator (AED) increases the chance of survival for out-of-hospital cardiac arrest (OHCA). Current deployment usually considers spatial AED access, assuming AEDs are available 24 h a day. The goal of this study was to develop an optimization model for AED deployment, accounting for spatial and temporal accessibility, to evaluate if OHCA coverage would improve compared with deployment based on spatial accessibility alone. This study was a retrospective population-based cohort trial using data from the Toronto Regional RescuNET Epistry cardiac arrest database. We identified all nontraumatic public location OHCAs in Toronto, Ontario, Canada (January 2006 through August 2014) and obtained a list of registered AEDs (March 2015) from Toronto Paramedic Services. Coverage loss due to limited temporal access was quantified by comparing the number of OHCAs that occurred within 100 meters of a registered AED (assumed coverage 24 h per day, 7 days per week) with the number that occurred both within 100 meters of a registered AED and when the AED was available (actual coverage). A spatiotemporal optimization model was then developed that determined AED locations to maximize OHCA actual coverage and overcome the reported coverage loss. The coverage gain between the spatiotemporal model and a spatial-only model was computed by using 10-fold cross-validation. A total of 2,440 nontraumatic public OHCAs and 737 registered AED locations were identified. A total of 451 OHCAs were covered by registered AEDs under assumed coverage 24 h per day, 7 days per week, and 354 OHCAs under actual coverage, representing a coverage loss of 21.5% (p < 0.001). Using the spatiotemporal model to optimize AED deployment, a 25.3% relative increase in actual coverage was achieved compared with the spatial-only approach (p < 0.001). One in 5 OHCAs occurred near an inaccessible AED at the time of the OHCA. Potential AED use was significantly improved with a spatiotemporal optimization model guiding deployment. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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

I get height with a little help from my friends: herd protection from sanitation on child growth in rural Ecuador

PubMed Central

Fuller, James A; Villamor, Eduardo; Cevallos, William; Trostle, James; Eisenberg, Joseph NS

2016-01-01

Abstract Background: Infectious disease interventions, such as vaccines and bed nets, have the potential to provide herd protection to non-recipients. Similarly, improved sanitation in one household may provide community-wide benefits if it reduces contamination in the shared environment. Sanitation at the household level is an important predictor of child growth, but less is known about the effect of sanitation coverage in the community. Methods: From 2008 to 2013, we took repeated anthropometric measurements on 1314 children under 5 years of age in 24 rural Ecuadorian villages. Using mixed effects regression, we estimated the association between sanitation coverage in surrounding households and child growth. Results: Sanitation coverage in the surrounding households was strongly associated with child height, as those with 100% coverage in their surroundings had a 67% lower prevalence of stunting [prevalence ratio (PR) 0.32, 95% CI 0.15-0.69] compared with those with 0% coverage. Children from households with improved sanitation had a lower prevalence of stunting (PR 0.86, 95% CI 0.64-1.15). When analysing height as a continuous outcome, the protective effect of sanitation coverage is manifested primarily among girls during the second year of life, the time at which growth faltering is most likely to occur. Conclusions: Our study highlights that a household’s sanitation practices can provide herd protection to the overall community. Studies which fail to account for the positive externalities that sanitation provides will underestimate the overall protective effect. Future studies could seek to identify a threshold of sanitation coverage, similar to a herd immunity threshold, to provide coverage and compliance targets. PMID:26936912

Health Insurance Coverage and Take-Up: Lessons from Behavioral Economics

PubMed Central

Baicker, Katherine; Congdon, William J; Mullainathan, Sendhil

2012-01-01

Context Millions of uninsured Americans ostensibly have insurance available to them—many at very low cost—but do not take it up. Traditional economic analysis is based on the premise that these are rational decisions, but it is hard to reconcile observed enrollment patterns with this view. The policy prescriptions that the traditional model generates may thus fail to achieve their goals. Behavioral economics, which integrates insights from psychology into economic analysis, identifies important deviations from the traditional assumptions of rationality and can thus improve our understanding of what drives health insurance take-up and improved policy design. Methods Rather than a systematic review of the coverage literature, this article is a primer for considering issues in health insurance coverage from a behavioral economics perspective, supplementing the standard model. We present relevant evidence on decision making and insurance take-up and use it to develop a behavioral approach to both the policy problem posed by the lack of health insurance coverage and possible policy solutions to that problem. Findings We found that evidence from behavioral economics can shed light on both the sources of low take-up and the efficacy of different policy levers intended to expand coverage. We then applied these insights to policy design questions for public and private insurance coverage and to the implementation of the recently enacted health reform, focusing on the use of behavioral insights to maximize the value of spending on coverage. Conclusions We concluded that the success of health insurance coverage reform depends crucially on understanding the behavioral barriers to take-up. The take-up process is likely governed by psychology as much as economics, and public resources can likely be used much more effectively with behaviorally informed policy design. PMID:22428694

Effectiveness of Muskaan Ek Abhiyan (the smile campaign) for strengthening routine immunization in bihar, India.

PubMed

Goel, Sonu; Dogra, Vishal; Gupta, Satish Kumar; Lakshmi, P Vm; Varkey, Sherin; Pradhan, Narottam; Krishna, Gopal; Kumar, Rajesh

2012-02-01

In Bihar State, proportion of fully immunized children was only 19% ;in Coverage Evaluation Survey of 2005. In October 2007, a special campaign called Muskaan Ek Abhiyan (The Smile Campaign) was launched under National Rural Health Mission to give a fillip to the immunization program. To evaluate improvement in the performance and coverage of the Routine Immunization Program consequent to the launch of Muskaan Ek Abhiyan The main strategies of the Muskaan campaign were reviewing and strengthening immunization micro-plans, enhanced inter-sectoral coordination between the Departments of Health, and Women and Child Development, increased involvement of women groups in awareness generation, enhanced political commitment and budgetary support, strengthening of monitoring and supervision mechanisms, and provision of performance based incentive to service providers. Immunization Coverage Evaluation Surveys conducted in various states of India during 2005 and 2009 were used for evaluation of the effect of Muskaan campaign by measuring the increase in immunization coverage in Bihar in comparison to other Empowered Action Group (EAG) states using the difference-in-difference method. Interviews of the key stakeholders were also done to substantiate the findings. The proportion of fully immunized 12-23 month old children in Bihar has increased significantly from 19% ;in 2005 to 49% ;in 2009. The coverage of BCG also increased significantly from 52.8% to 82.3%, DPT-3 from 36.5 to 59.3%, OPV-3 from 27.1% ;to 61.6% ;and measles from 28.4 to 58.2%. In comparison to other states, the coverage of fully immunized children increased significantly from 16 to 26% ;in Bihar. There was a marked improvement in immunization coverage after the launch of the Campaign in Bihar. Therefore, best practices of the Campaign may be replicated in other areas where full immunization coverage is low.

Modeling and validating Bayesian accrual models on clinical data and simulations using adaptive priors.

PubMed

Jiang, Yu; Simon, Steve; Mayo, Matthew S; Gajewski, Byron J

2015-02-20

Slow recruitment in clinical trials leads to increased costs and resource utilization, which includes both the clinic staff and patient volunteers. Careful planning and monitoring of the accrual process can prevent the unnecessary loss of these resources. We propose two hierarchical extensions to the existing Bayesian constant accrual model: the accelerated prior and the hedging prior. The new proposed priors are able to adaptively utilize the researcher's previous experience and current accrual data to produce the estimation of trial completion time. The performance of these models, including prediction precision, coverage probability, and correct decision-making ability, is evaluated using actual studies from our cancer center and simulation. The results showed that a constant accrual model with strongly informative priors is very accurate when accrual is on target or slightly off, producing smaller mean squared error, high percentage of coverage, and a high number of correct decisions as to whether or not continue the trial, but it is strongly biased when off target. Flat or weakly informative priors provide protection against an off target prior but are less efficient when the accrual is on target. The accelerated prior performs similar to a strong prior. The hedging prior performs much like the weak priors when the accrual is extremely off target but closer to the strong priors when the accrual is on target or only slightly off target. We suggest improvements in these models and propose new models for future research. Copyright © 2014 John Wiley & Sons, Ltd.

Achieving the Millennium Development Goal for Under-five Mortality in Bangladesh: Current Status and Lessons for Issues and Challenges for Further Improvements

PubMed Central

Nury, Abu Taher Md. Sanaullah; Hossain, Md. Delwar

2011-01-01

The study assessed the achievements in, critically reviewed the relevant issues of, and put forward recommendations for achieving the target of the Millennium Development Goal relating to mortality of children aged less than five years (under-five mortality) in Bangladesh within 2015. To materialize the study objectives, a thorough literature review was done. Mortality of under-five children and infants decreased respectively to 65 from 151 and to 52 from 94 per 1,000 livebirths during 1990-2006. The immunization coverage increased from 54% to 81.9% during the same period. The projection shows that Bangladesh will achieve targeted reduction in under-five mortality and infant mortality within the time limit, except immunization coverage. Neonatal mortality contributed to the majority of childhood deaths. Contribution of neonatal mortality to child mortality was the highest. There were remarkable differences in child mortality by sex, division, and residence. To progress further for achieving the target of MDG relating to child mortality, some issues, such as lower use of maternal healthcare services, hazardous environmental effects on childhood illness, high malnutrition among children, shorter duration of exclusive breastfeeding practices, various child injuries leading to death, low healthcare-use of children, probable future threat of financial shortage, and strategies lacking area-wise focus on child mortality, need to be considered. Without these, the achievement of MDG relating to child mortality may not be possible within 2015. PMID:21608418

Testing the molecular clock using mechanistic models of fossil preservation and molecular evolution

PubMed Central

2017-01-01

Molecular sequence data provide information about relative times only, and fossil-based age constraints are the ultimate source of information about absolute times in molecular clock dating analyses. Thus, fossil calibrations are critical to molecular clock dating, but competing methods are difficult to evaluate empirically because the true evolutionary time scale is never known. Here, we combine mechanistic models of fossil preservation and sequence evolution in simulations to evaluate different approaches to constructing fossil calibrations and their impact on Bayesian molecular clock dating, and the relative impact of fossil versus molecular sampling. We show that divergence time estimation is impacted by the model of fossil preservation, sampling intensity and tree shape. The addition of sequence data may improve molecular clock estimates, but accuracy and precision is dominated by the quality of the fossil calibrations. Posterior means and medians are poor representatives of true divergence times; posterior intervals provide a much more accurate estimate of divergence times, though they may be wide and often do not have high coverage probability. Our results highlight the importance of increased fossil sampling and improved statistical approaches to generating calibrations, which should incorporate the non-uniform nature of ecological and temporal fossil species distributions. PMID:28637852

Diversity Performance Analysis on Multiple HAP Networks.

PubMed

Dong, Feihong; Li, Min; Gong, Xiangwu; Li, Hongjun; Gao, Fengyue

2015-06-30

One of the main design challenges in wireless sensor networks (WSNs) is achieving a high-data-rate transmission for individual sensor devices. The high altitude platform (HAP) is an important communication relay platform for WSNs and next-generation wireless networks. Multiple-input multiple-output (MIMO) techniques provide the diversity and multiplexing gain, which can improve the network performance effectively. In this paper, a virtual MIMO (V-MIMO) model is proposed by networking multiple HAPs with the concept of multiple assets in view (MAV). In a shadowed Rician fading channel, the diversity performance is investigated. The probability density function (PDF) and cumulative distribution function (CDF) of the received signal-to-noise ratio (SNR) are derived. In addition, the average symbol error rate (ASER) with BPSK and QPSK is given for the V-MIMO model. The system capacity is studied for both perfect channel state information (CSI) and unknown CSI individually. The ergodic capacity with various SNR and Rician factors for different network configurations is also analyzed. The simulation results validate the effectiveness of the performance analysis. It is shown that the performance of the HAPs network in WSNs can be significantly improved by utilizing the MAV to achieve overlapping coverage, with the help of the V-MIMO techniques.

Surfing the web during pandemic flu: availability of World Health Organization recommendations on prevention

PubMed Central

2010-01-01

Background People often search for information on influenza A(H1N1)v prevention on the web. The extent to which information found on the Internet is consistent with recommendations issued by the World Health Organization is unknown. Methods We conducted a search for "swine flu" accessing 3 of the most popular search engines through different proxy servers located in 4 English-speaking countries (Australia, Canada, UK, USA). We explored each site resulting from the searches, up to 4 clicks starting from the search engine page, analyzing availability of World Health Organization recommendations for swine flu prevention. Results Information on hand cleaning was reported on 79% of the 147 websites analyzed; staying home when sick was reported on 77.5% of the websites; disposing tissues after sneezing on 75.5% of the websites. Availability of other recommendations was lower. The probability of finding preventative recommendations consistent with World Health Organization varied by country, type of website, and search engine. Conclusions Despite media coverage on H1N1 influenza, relevant information for prevention is not easily found on the web. Strategies to improve information delivery to the general public through this channel should be improved. PMID:20854690

Surfing the web during pandemic flu: availability of World Health Organization recommendations on prevention.

PubMed

Gesualdo, Francesco; Romano, Mariateresa; Pandolfi, Elisabetta; Rizzo, Caterina; Ravà, Lucilla; Lucente, Daniela; Tozzi, Alberto E

2010-09-20

People often search for information on influenza A(H1N1)v prevention on the web. The extent to which information found on the Internet is consistent with recommendations issued by the World Health Organization is unknown. We conducted a search for "swine flu" accessing 3 of the most popular search engines through different proxy servers located in 4 English-speaking countries (Australia, Canada, UK, USA). We explored each site resulting from the searches, up to 4 clicks starting from the search engine page, analyzing availability of World Health Organization recommendations for swine flu prevention. Information on hand cleaning was reported on 79% of the 147 websites analyzed; staying home when sick was reported on 77.5% of the websites; disposing tissues after sneezing on 75.5% of the websites. Availability of other recommendations was lower. The probability of finding preventative recommendations consistent with World Health Organization varied by country, type of website, and search engine. Despite media coverage on H1N1 influenza, relevant information for prevention is not easily found on the web. Strategies to improve information delivery to the general public through this channel should be improved.

Long-term changes in abundance and diversity of macrophyte and waterfowl populations in an estuary with exotic macrophytes and improving water quality

USGS Publications Warehouse

Rybicki, N.B.; Landwehr, J.M.

2007-01-01

We assessed species-specific coverage (km2) of a submerged aquatic vegetation (SAV) community in the fresh and upper oligohaline Potomac Estuary from 1985 to 2001 using a method combining field observations of species-proportional coverage data with congruent remotely sensed coverage and density (percent canopy cover) data. Biomass (estimated by density-weighted coverage) of individual species was calculated. Under improving water quality conditions, exotic SAV species did not displace native SAV; rather, the percent of natives increased over time. While coverage-based diversity did fluctuate and increased, richness-based community turnover rates were not significantly different from zero. SAV diversity was negatively related to nitrogen concentration. Differences in functional traits, such as reproductive potential, between the dominant native and exotic species may explain some interannual patterns in SAV. Biomass of native, as well as exotic, SAV species varied with factors affecting water column light attenuation. We also show a positive response by a higher trophic level, waterfowl, to SAV communities dominated by exotic SAV from 1959 to 2001. ?? 2007, by the American Society of Limnology and Oceanography, Inc.

Improving Medicare coverage of psychological services for older Americans.

PubMed

Karlin, Bradley E; Humphreys, Keith

2007-10-01

Professional psychology's ability to meet older Americans' psychological needs and to simultaneously thrive as a profession will be closely tied to the federal Medicare program over the coming decades. Despite legislative changes in the 1980s providing professional autonomy to psychologists and expanding coverage for mental health services, Medicare coverage policies, reimbursement mechanisms, and organizational traditions continue to limit older Americans' access to psychological services. This article describes how psychologists can influence Medicare coverage policy. Specifically, the authors examine widely unrecognized policy processes and recent political developments and analyze the recent creation of a new Medicare counseling benefit, applying J. W. Kingdon's (1995) well-known model of policy change. These recent developments offer new opportunities for expanding Medicare coverage of psychological services, particularly in the areas of prevention, screening, and early intervention. The article provides an analysis to guide psychologists in engaging in strategic advocacy and incorporating psychological prevention and early intervention services into Medicare. As Medicare policy entrepreneurs, psychologists can improve the well-being of millions of Americans who rely on the national health insurance program and, in so doing, can help shape the future practice of psychology. Copyright 2007 APA, all rights reserved.

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

45 CFR 144.101 - Basis and purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE General Provisions § 144.101 Basis and purpose. (a) Part 146 of this... is to improve access to individual health insurance coverage for certain individuals who previously...

45 CFR 144.101 - Basis and purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE General Provisions § 144.101 Basis and purpose. (a) Part 146 of this... is to improve access to individual health insurance coverage for certain individuals who previously...

45 CFR 144.101 - Basis and purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE General Provisions § 144.101 Basis and purpose. (a) Part 146 of this... is to improve access to individual health insurance coverage for certain individuals who previously...

Bayesian alternative to the ISO-GUM's use of the Welch Satterthwaite formula

NASA Astrophysics Data System (ADS)

Kacker, Raghu N.

2006-02-01

In certain disciplines, uncertainty is traditionally expressed as an interval about an estimate for the value of the measurand. Development of such uncertainty intervals with a stated coverage probability based on the International Organization for Standardization (ISO) Guide to the Expression of Uncertainty in Measurement (GUM) requires a description of the probability distribution for the value of the measurand. The ISO-GUM propagates the estimates and their associated standard uncertainties for various input quantities through a linear approximation of the measurement equation to determine an estimate and its associated standard uncertainty for the value of the measurand. This procedure does not yield a probability distribution for the value of the measurand. The ISO-GUM suggests that under certain conditions motivated by the central limit theorem the distribution for the value of the measurand may be approximated by a scaled-and-shifted t-distribution with effective degrees of freedom obtained from the Welch-Satterthwaite (W-S) formula. The approximate t-distribution may then be used to develop an uncertainty interval with a stated coverage probability for the value of the measurand. We propose an approximate normal distribution based on a Bayesian uncertainty as an alternative to the t-distribution based on the W-S formula. A benefit of the approximate normal distribution based on a Bayesian uncertainty is that it greatly simplifies the expression of uncertainty by eliminating altogether the need for calculating effective degrees of freedom from the W-S formula. In the special case where the measurand is the difference between two means, each evaluated from statistical analyses of independent normally distributed measurements with unknown and possibly unequal variances, the probability distribution for the value of the measurand is known to be a Behrens-Fisher distribution. We compare the performance of the approximate normal distribution based on a Bayesian uncertainty and the approximate t-distribution based on the W-S formula with respect to the Behrens-Fisher distribution. The approximate normal distribution is simpler and better in this case. A thorough investigation of the relative performance of the two approximate distributions would require comparison for a range of measurement equations by numerical methods.

Impact of low altitude coverage requirements on air-ground communications

NASA Astrophysics Data System (ADS)

Magenheim, B.

1981-03-01

A representative area of Appalachia surrounding Charleston, West Virginia is analyzed in terms of existing helicopter traffic patterns and communications facilities. Traffic patterns were established from telephone interviews with pilots flying this area regularly. Communications coverage was established from computer generated coverage contours obtained from the Electromagnetic Compatibility Analysis Center (ECAC) and verified by pilot interviews and one flight test (as reported by the FAA Technical Center). Techniques for improving coverage are discussed. These include two new remote communication outlets located in the mountains west and south of Beckley, W. Va., a high gain antenna at Charleston pointed in a southerly direction, the use of mobile radio telephone to permit pilots to access nearby telephone facilities when on the ground at a remote site, short range less than 150 miles, hf radio, and a discrete frequency for exclusive use by low-flying aircraft. FAA activities directed at improving communications to helicopter flying to and from offshore oil and gas platforms in the Gulf of Mexico is presented in an Appendix.

Experiences and Lessons From Polio Eradication Applied to Immunization in 10 Focus Countries of the Polio Endgame Strategic Plan.

PubMed

van den Ent, Maya M V X; Mallya, Apoorva; Sandhu, Hardeep; Anya, Blanche-Philomene; Yusuf, Nasir; Ntakibirora, Marcelline; Hasman, Andreas; Fahmy, Kamal; Agbor, John; Corkum, Melissa; Sumaili, Kyandindi; Siddique, Anisur Rahman; Bammeke, Jane; Braka, Fiona; Andriamihantanirina, Rija; Ziao, Antoine-Marie C; Djumo, Clement; Yapi, Moise Desire; Sosler, Stephen; Eggers, Rudolf

2017-07-01

Nine polio areas of expertise were applied to broader immunization and mother, newborn and child health goals in ten focus countries of the Polio Eradication Endgame Strategic Plan: policy & strategy development, planning, management and oversight (accountability framework), implementation & service delivery, monitoring, communications & community engagement, disease surveillance & data analysis, technical quality & capacity building, and partnerships. Although coverage improvements depend on multiple factors and increased coverage cannot be attributed to the use of polio assets alone, 6 out of the 10 focus countries improved coverage in three doses of diphtheria tetanus pertussis containing vaccine between 2013 and 2015. Government leadership, evidence-based programming, country-driven comprehensive operational annual plans, community partnership and strong accountability systems are critical for all programs and polio eradication has illustrated these can be leveraged to increase immunization coverage and equity and enhance global health security in the focus countries. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

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.

Health Insurance Coverage and Its Impact on Medical Cost: Observations from the Floating Population in China

PubMed Central

Zhao, Yinjun; Kang, Bowei; Liu, Yawen; Li, Yichong; Shi, Guoqing; Shen, Tao; Jiang, Yong; Zhang, Mei; Zhou, Maigeng; Wang, Limin

2014-01-01

Background China has the world's largest floating (migrant) population, which has characteristics largely different from the rest of the population. Our goal is to study health insurance coverage and its impact on medical cost for this population. Methods A telephone survey was conducted in 2012. 644 subjects were surveyed. Univariate and multivariate analysis were conducted on insurance coverage and medical cost. Results 82.2% of the surveyed subjects were covered by basic insurance at hometowns with hukou or at residences. Subjects' characteristics including age, education, occupation, and presence of chronic diseases were associated with insurance coverage. After controlling for confounders, insurance coverage was not significantly associated with gross or out-of-pocket medical cost. Conclusion For the floating population, health insurance coverage needs to be improved. Policy interventions are needed so that health insurance can have a more effective protective effect on cost. PMID:25386914

Five years later: poor women's health care coverage after welfare reform.

PubMed

Mann, Cindy; Hudman, Julie; Salganicoff, Alina; Folsom, Amanda

2002-01-01

The 1996 welfare reform law aims to increase poor women's participation in the work force and encourage their financial independence. Because women's ability to obtain and retain employment is affected by their health status, welfare reform's success is fundamentally tied to poor women's access to health care and to health insurance. Despite this, the rate of uninsurance among poor women with children has grown by half in recent years, leaving 37% of poor mothers uninsured in 2000. Coverage through employer-sponsored insurance has increased only slightly, and Medicaid participation has dropped. Although many factors contributed to this, welfare policies and procedures and low Medicaid eligibility levels had unintended yet significant negative effects on women's health care coverage. The sharp decline in poor women's health care coverage is likely to be one of several health-related issues that Congress will consider as it debates the reauthorization of the welfare law in 2002. Both public and private efforts will be necessary to improve coverage for poor women with children. Much progress has been made during the past 5 years in covering poor and near-poor children, but their parents have been left behind. The same efforts that proved successful for children, including broadening eligibility for coverage and simplifying the application process, can be used to improve the health and well-being of parents and to strengthen their ability to care for and support their families.

[Payment by performance to improve the nutritional status of children: impact of budget support agreements in three peruvian regions with a high prevalence of chronic malnutrition in children in 2010-2014].

PubMed

Cruzado de la Vega, Viviana

2017-01-01

To estimate the impact of a payment scheme by performance, known as a budget support agreement, applied by the government in three regions in Peru with the highest rates of chronic malnutrition (CM) in children in 2008-Apurimac, Ayacucho, and Huancavelica-on indicators of health service coverage (immunization, childhood growth and development, and iron supplementation) and the nutritional status of children (malnutrition, anemia, and diarrhea). These agreements were used to transfer resources to the budgets of these regions with the condition of fulfilling management commitments and coverage goals with a view toward improving the nutritional status of children. Based on data from the Demographic and Family Health Survey conducted from 2008 to 2014, evolution of the indicators in a sample of children residing in the areas where the support programs were signed was compared to that of a control sample in the period in which the agreements were in force and in the subsequent years to estimate differences in the impact of this support strategy. There was a positive impact of the programs on the increase in vaccination coverage provided by the basic health system and rotavirus vaccination, which consequently reduced the rates of diarrhea and malnutrition. The scheme was effective in increasing the vaccination coverage and reducing CM but did not seem to improve the coverage of other benefits, including childhood growth and iron supplementation to children and mothers.

Evaluating Childhood Vaccination Coverage of NIP Vaccines: Coverage Survey versus Zhejiang Provincial Immunization Information System

PubMed Central

Hu, Yu; Chen, Yaping

2017-01-01

Vaccination coverage in Zhejiang province, east China, is evaluated through repeated coverage surveys. The Zhejiang provincial immunization information system (ZJIIS) was established in 2004 with links to all immunization clinics. ZJIIS has become an alternative to quickly assess the vaccination coverage. To assess the current completeness and accuracy on the vaccination coverage derived from ZJIIS, we compared the estimates from ZJIIS with the estimates from the most recent provincial coverage survey in 2014, which combined interview data with verified data from ZJIIS. Of the enrolled 2772 children in the 2014 provincial survey, the proportions of children with vaccination cards and registered in ZJIIS were 94.0% and 87.4%, respectively. Coverage estimates from ZJIIS were systematically higher than the corresponding estimates obtained through the survey, with a mean difference of 4.5%. Of the vaccination doses registered in ZJIIS, 16.7% differed from the date recorded in the corresponding vaccination cards. Under-registration in ZJIIS significantly influenced the coverage estimates derived from ZJIIS. Therefore, periodic coverage surveys currently provide more complete and reliable results than the estimates based on ZJIIS alone. However, further improvement of completeness and accuracy of ZJIIS will likely allow more reliable and timely estimates in future. PMID:28696387

Experimentally, How Dark Are Black Hole Mergers?

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

Annis, James; Soares-Santos, Marcelle

2016-09-29

The first Advanced LIGO observing run detected two black hole merger events with confidence and likely a third. Many groups organized to followup the events in the optical even though the strong theoretical prior that no optical emission should be seen. We carry through the logic of this by asking about the experimental upper limits to the optical light from Advanced LIGO black hole mergere events. We inventory the published optical searches for transient events associated with the black hole mergers. We describe the factors that go into a formal limit on the visibility of an event (sky area coverage,more » the coverage factor of the camera, the fraction of sky not covered by intervening objects), and list what is known from the literature of the followup teams quantitative assessment of each factor. Where possible we calculate the total probability from each group that the source was imaged. The calculation of confidence level is reviewed for the case of no background. We find that an experimental 95% upper limit on the magnitude of a black hole requires the sum of the total probabilities over all events to be more than 3. In the first Advanced LIGO observing run we were far from reaching that threshold.« less

Who uses flexible spending accounts: effects of employee characteristics and employer strategies.

PubMed

Feldman, R; Schultz, J

2001-07-01

Many large employers offer flexible spending accounts (FSAs) to shelter their employees' out-of-pocket medical expenses from taxes and thereby to encourage the purchase of health insurance policies with higher cost sharing. However, very little empirical research has examined the individual employee's decision to contribute to an FSA. To estimate equations for the probability that single employees with no dependents and employees with family health insurance coverage will contribute to FSAs, and the amounts contributed by those with FSAs. An observational study of randomly-selected employees in 15 Minnesota firms matched with information on the strategies those firms use to promote FSAs. Measures of FSA participation were regressed on expected health care spending, employee socio-demographics, and employer strategies. 779 single employees with no dependents and 679 employees with family coverage. Education beyond high school increases the probability that both types of subjects will contribute to FSAs, with marginal effects ranging from 16 to 48 percent. The FSA contribution rate for families doubles when the family's marginal federal income tax rate increases from 15 to 28 percent. Employer strategies to encourage participation are also effective in promoting FSAs. FSAs are used mainly by high-income and highly-educated workers. We question whether this is an equitable use of the income tax code.

Potential for Rabies Control through Dog Vaccination in Wildlife-Abundant Communities of Tanzania

PubMed Central

Fitzpatrick, Meagan C.; Hampson, Katie; Cleaveland, Sarah; Meyers, Lauren Ancel; Townsend, Jeffrey P.; Galvani, Alison P.

2012-01-01

Canine vaccination has been successful in controlling rabies in diverse settings worldwide. However, concerns remain that coverage levels which have previously been sufficient might be insufficient in systems where transmission occurs both between and within populations of domestic dogs and other carnivores. To evaluate the effectiveness of vaccination targeted at domestic dogs when wildlife also contributes to transmission, we applied a next-generation matrix model based on contract tracing data from the Ngorongoro and Serengeti Districts in northwest Tanzania. We calculated corresponding values of R 0, and determined, for policy purposes, the probabilities that various annual vaccination targets would control the disease, taking into account the empirical uncertainty in our field data. We found that transition rate estimates and corresponding probabilities of vaccination-based control indicate that rabies transmission in this region is driven by transmission within domestic dogs. Different patterns of rabies transmission between the two districts exist, with wildlife playing a more important part in Ngorongoro and leading to higher recommended coverage levels in that district. Nonetheless, our findings indicate that an annual dog vaccination campaign achieving the WHO-recommended target of 70% will control rabies in both districts with a high level of certainty. Our results support the feasibility of controlling rabies in Tanzania through dog vaccination. PMID:22928056

Full prescription coverage versus usual prescription coverage after coronary artery bypass graft surgery: analysis from the post-myocardial infarction free Rx event and economic evaluation (FREEE) randomized trial.

PubMed

Kulik, Alexander; Desai, Nihar R; Shrank, William H; Antman, Elliott M; Glynn, Robert J; Levin, Raisa; Reisman, Lonny; Brennan, Troyen; Choudhry, Niteesh K

2013-09-10

Eliminating out-of-pocket costs for patients after myocardial infarction (MI) improves adherence to preventive therapies and reduces clinical events. Because adherence to medical therapy is low among patients treated with coronary artery bypass graft surgery (CABG), we evaluated the impact of providing full prescription coverage to this patient subgroup. The MI Free Rx Event and Economic Evaluation (FREEE) trial randomly assigned 5855 patients with MI to full prescription coverage or usual formulary coverage for all statins, β-blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers. We assessed the impact of full prescription coverage on adherence, clinical outcomes, and healthcare costs using adjusted models among the 1052 patients who underwent CABG at the index hospitalization and 4803 who did not. CABG patients were older and had more comorbid illness (P<0.01). After MI, CABG patients were significantly more likely to receive β-blockers and statins but were less likely to receive angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy (P<0.01). Receiving full drug coverage increased rates of adherence to all preventative medications after CABG (all P<0.05). Full coverage was also associated with nonsignificant reductions in the rate of major vascular events or revascularization for patients treated with CABG (hazard ratio, 0.91; 95% confidence interval, 0.66-1.25) or without CABG (hazard ratio, 0.93; 95% confidence interval, 0.82-1.06), with no interaction noted (Pint=NS). After CABG, full prescription coverage significantly reduced patient out-of-pocket spending for drugs (P=0.001) without increasing overall health expenditures (P=NS). Eliminating drug copayments after MI provides consistent benefits to patients treated with or without CABG, leading to increased medication adherence, trends toward improved clinical outcomes, and reduced patient out-of-pocket expenses.

An improved rainfall disaggregation technique for GCMs

NASA Astrophysics Data System (ADS)

Onof, C.; Mackay, N. G.; Oh, L.; Wheater, H. S.

1998-08-01

Meteorological models represent rainfall as a mean value for a grid square so that when the latter is large, a disaggregation scheme is required to represent the spatial variability of rainfall. In general circulation models (GCMs) this is based on an assumption of exponentiality of rainfall intensities and a fixed value of areal rainfall coverage, dependent on rainfall type. This paper examines these two assumptions on the basis of U.K. and U.S. radar data. Firstly, the coverage of an area is strongly dependent on its size, and this dependence exhibits a scaling law over a range of sizes. Secondly, the coverage is, of course, dependent on the resolution at which it is measured, although this dependence is weak at high resolutions. Thirdly, the time series of rainfall coverages has a long-tailed autocorrelation function which is comparable to that of the mean areal rainfalls. It is therefore possible to reproduce much of the temporal dependence of coverages by using a regression of the log of the mean rainfall on the log of the coverage. The exponential assumption is satisfactory in many cases but not able to reproduce some of the long-tailed dependence of some intensity distributions. Gamma and lognormal distributions provide a better fit in these cases, but they have their shortcomings and require a second parameter. An improved disaggregation scheme for GCMs is proposed which incorporates the previous findings to allow the coverage to be obtained for any area and any mean rainfall intensity. The parameters required are given and some of their seasonal behavior is analyzed.

To expand coverage, or increase frequency: Quantifying the tradeoffs between equity and efficiency facing cervical cancer screening programs in low‐resource settings

PubMed Central

Tsu, Vivien; Jeronimo, Jose; Mvundura, Mercy; Lee, Kyueun; Kim, Jane J.

2017-01-01

Cervical cancer is a leading cause of cancer death worldwide, with 85% of the disease burden residing in less developed regions. To inform evidence‐based decision‐making as cervical cancer screening programs are planned, implemented, and scaled in low‐ and middle‐income countries, we used cost and test performance data from the START‐UP demonstration project in Uganda and a microsimulation model of HPV infection and cervical carcinogenesis to quantify the health benefits, distributional equity, cost‐effectiveness, and financial impact of either (1) improving access to cervical cancer screening or (2) increasing the number of lifetime screening opportunities for women who already have access. We found that when baseline screening coverage was low (i.e., 30%), expanding coverage of screening once in a lifetime to 50% can yield comparable reductions in cancer risk to screening two or three times in a lifetime at 30% coverage, lead to greater reductions in health disparities, and cost 150 international dollars (I$) per year of life saved (YLS). At higher baseline screening coverage levels (i.e., 70%), screening three times in a lifetime yielded greater health benefits than expanding screening once in a lifetime to 90% coverage, and would have a cost‐effectiveness ratio (I$590 per YLS) below Uganda's per capita GDP. Given very low baseline coverage at present, we conclude that a policy focus on increasing access for previously unscreened women appears to be more compatible with improving both equity and efficiency than a focus on increasing frequency for a small subset of women. PMID:27925175

Two Hop Adaptive Vector Based Quality Forwarding for Void Hole Avoidance in Underwater WSNs

PubMed Central

Javaid, Nadeem; Ahmed, Farwa; Wadud, Zahid; Alrajeh, Nabil; Alabed, Mohamad Souheil; Ilahi, Manzoor

2017-01-01

Underwater wireless sensor networks (UWSNs) facilitate a wide range of aquatic applications in various domains. However, the harsh underwater environment poses challenges like low bandwidth, long propagation delay, high bit error rate, high deployment cost, irregular topological structure, etc. Node mobility and the uneven distribution of sensor nodes create void holes in UWSNs. Void hole creation has become a critical issue in UWSNs, as it severely affects the network performance. Avoiding void hole creation benefits better coverage over an area, less energy consumption in the network and high throughput. For this purpose, minimization of void hole probability particularly in local sparse regions is focused on in this paper. The two-hop adaptive hop by hop vector-based forwarding (2hop-AHH-VBF) protocol aims to avoid the void hole with the help of two-hop neighbor node information. The other protocol, quality forwarding adaptive hop by hop vector-based forwarding (QF-AHH-VBF), selects an optimal forwarder based on the composite priority function. QF-AHH-VBF improves network good-put because of optimal forwarder selection. QF-AHH-VBF aims to reduce void hole probability by optimally selecting next hop forwarders. To attain better network performance, mathematical problem formulation based on linear programming is performed. Simulation results show that by opting these mechanisms, significant reduction in end-to-end delay and better throughput are achieved in the network. PMID:28763014

Two Hop Adaptive Vector Based Quality Forwarding for Void Hole Avoidance in Underwater WSNs.

PubMed

Javaid, Nadeem; Ahmed, Farwa; Wadud, Zahid; Alrajeh, Nabil; Alabed, Mohamad Souheil; Ilahi, Manzoor

2017-08-01

Underwater wireless sensor networks (UWSNs) facilitate a wide range of aquatic applications in various domains. However, the harsh underwater environment poses challenges like low bandwidth, long propagation delay, high bit error rate, high deployment cost, irregular topological structure, etc. Node mobility and the uneven distribution of sensor nodes create void holes in UWSNs. Void hole creation has become a critical issue in UWSNs, as it severely affects the network performance. Avoiding void hole creation benefits better coverage over an area, less energy consumption in the network and high throughput. For this purpose, minimization of void hole probability particularly in local sparse regions is focused on in this paper. The two-hop adaptive hop by hop vector-based forwarding (2hop-AHH-VBF) protocol aims to avoid the void hole with the help of two-hop neighbor node information. The other protocol, quality forwarding adaptive hop by hop vector-based forwarding (QF-AHH-VBF), selects an optimal forwarder based on the composite priority function. QF-AHH-VBF improves network good-put because of optimal forwarder selection. QF-AHH-VBF aims to reduce void hole probability by optimally selecting next hop forwarders. To attain better network performance, mathematical problem formulation based on linear programming is performed. Simulation results show that by opting these mechanisms, significant reduction in end-to-end delay and better throughput are achieved in the network.

Reduced rates of non-union with modified periacetabular osteotomy using peracetic-acid sterilized cancellous allografts.

PubMed

Wassilew, Georgi I; Janz, Viktor; Renner, Lisa; Perka, Carsten; Pruss, Axel

2016-12-01

The objective of the present study was to analyze the clinical and radiological results of periacetabular osteotomies (PAO) using Kirschner wire fixation and an allogeneic cancellous bone graft. This retrospective cohort study included 73 patients (85 PAOs). The allografts were processed from distal femur of cadaveric donors, defatted, sterilized with a peracetic-acid ethanol solution and freeze-dried. The clinical outcome, as measured by the Harris Hip Scores (HHS), the complication rate and the acetabular correction, as measured by radiological parameters, were compared. The postoperative femoral head coverage and HSS were significantly improved. Major complications occurred in five cases (6 %), but in no case did we observe a non-union or a graft-associated adverse effect. Fixation of the acetabular fragment with Kirschner wires in combination with an allogeneic cancellous bone graft is a safe method, with a low complication rate, no loss of correction and can prevent the occurrence of non-union with a high degree of probability.

Kappa statistic for clustered matched-pair data.

PubMed

Yang, Zhao; Zhou, Ming

2014-07-10

Kappa statistic is widely used to assess the agreement between two procedures in the independent matched-pair data. For matched-pair data collected in clusters, on the basis of the delta method and sampling techniques, we propose a nonparametric variance estimator for the kappa statistic without within-cluster correlation structure or distributional assumptions. The results of an extensive Monte Carlo simulation study demonstrate that the proposed kappa statistic provides consistent estimation and the proposed variance estimator behaves reasonably well for at least a moderately large number of clusters (e.g., K ≥50). Compared with the variance estimator ignoring dependence within a cluster, the proposed variance estimator performs better in maintaining the nominal coverage probability when the intra-cluster correlation is fair (ρ ≥0.3), with more pronounced improvement when ρ is further increased. To illustrate the practical application of the proposed estimator, we analyze two real data examples of clustered matched-pair data. Copyright © 2014 John Wiley & Sons, Ltd.

Simulation of parametric model towards the fixed covariate of right censored lung cancer data

NASA Astrophysics Data System (ADS)

Afiqah Muhamad Jamil, Siti; Asrul Affendi Abdullah, M.; Kek, Sie Long; Ridwan Olaniran, Oyebayo; Enera Amran, Syahila

2017-09-01

In this study, simulation procedure was applied to measure the fixed covariate of right censored data by using parametric survival model. The scale and shape parameter were modified to differentiate the analysis of parametric regression survival model. Statistically, the biases, mean biases and the coverage probability were used in this analysis. Consequently, different sample sizes were employed to distinguish the impact of parametric regression model towards right censored data with 50, 100, 150 and 200 number of sample. R-statistical software was utilised to develop the coding simulation with right censored data. Besides, the final model of right censored simulation was compared with the right censored lung cancer data in Malaysia. It was found that different values of shape and scale parameter with different sample size, help to improve the simulation strategy for right censored data and Weibull regression survival model is suitable fit towards the simulation of survival of lung cancer patients data in Malaysia.

Vaccinating healthcare workers: Level of implementation, barriers and proposal for evidence-based policies in Turkey

PubMed Central

Tanriover, Mine Durusu; Altınel, Serdar; Unal, Serhat

2017-01-01

ABSTRACT The role of healthcare workers in life-long vaccination is very important in the means of 2 sided infection, rising patient awareness and being a role model for the patients. Numerous organizations publish guidelines for vaccination of HCWs, while healthcare facilities develop vaccination policies according to the accreditation standards. Nevertheless, vaccination rates among HCWs are far below targets. The obstacles to getting vaccinated or recommending vaccination may include rather universal factors such as the vaccine paradox, however in the case of HCWs, probably a different set of factors are included. The aims of this article are to gain an overview of vaccination strategies for HCWs, to assess the coverage rates of HCWs and make in-depth analyses of the potential barriers to vaccination and potential factors to motivate HCWs for vaccination in Turkey and to compare them with the global picture to improve implementation of policies concerning vaccination of HCWs. PMID:28059668

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.

Accuracy of indexing coverage information as reported by serials sources.

PubMed Central

Eldredge, J D

1993-01-01

This article reports on the accuracy of indexing service coverage information listed in three serials sources: Ulrich's International Periodicals Directory, SERLINE, and The Serials Directory. The titles studied were randomly selected journals that began publication in either 1981 or 1986. Aggregate results reveal that these serials sources perform at 92%, 97%, and 95% levels of accuracy respectively. When the results are analyzed by specific indexing services by year, the performance scores ranged from 80% to 100%. All three serials sources tend to underreport index coverage. The author advances five recommendations for improving index coverage accuracy and four specific proposals for future research. The results suggest that, for the immediate future, librarians should treat index coverage information reported in these three serials sources with some skepticism. PMID:8251971

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

Count every newborn; a measurement improvement roadmap for coverage data

PubMed Central

2015-01-01

Background The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. Methods In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout. Results ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. Conclusions The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks. PMID:26391444

New options for national population surveys: The implications of internet and smartphone coverage.

PubMed

Couper, Mick P; Gremel, Garret; Axinn, William; Guyer, Heidi; Wagner, James; West, Brady T

2018-07-01

Challenges to survey data collection have increased the costs of social research via face-to-face surveys so much that it may become extremely difficult for social scientists to continue using these methods. A key drawback to less expensive Internet-based alternatives is the threat of biased results from coverage errors in survey data. The rise of Internet-enabled smartphones presents an opportunity to re-examine the issue of Internet coverage for surveys and its implications for coverage bias. Two questions (on Internet access and smartphone ownership) were added to the National Survey of Family Growth (NSFG), a U.S. national probability survey of women and men age 15-44, using a continuous sample design. We examine 16 quarters (4 years) of data, from September 2012 to August 2016. Overall, we estimate that 82.9% of the target NSFG population has Internet access, and 81.6% has a smartphone. Combined, this means that about 90.7% of U.S. residents age 15-44 have Internet access, via either traditional devices or a smartphone. We find some evidence of compensatory coverage when looking at key race/ethnicity and age subgroups. For instance, while Black teens (15-18) have the lowest estimated rate of Internet access (81.9%) and the lowest rate of smartphone usage (72.6%), an estimated 88.0% of this subgroup has some form of Internet access. We also examine the socio-demographic correlates of Internet and smartphone coverage, separately and combined, as indicators of technology access in this population. In addition, we look at the effect of differential coverage on key estimates produced by the NSFG, related to fertility, family formation, and sexual activity. While this does not address nonresponse or measurement biases that may differ for alternative modes, our paper has implications for possible coverage biases that may arise when switching to a Web-based mode of data collection, either for follow-up surveys or to replace the main face-to-face data collection. Copyright © 2018. Published by Elsevier Inc.

Societal implications of medical insurance coverage for imatinib as first-line treatment of chronic myeloid leukemia in China: a cost-effectiveness analysis.

PubMed

Sheng, Guangying; Chen, Suning; Dong, Chaohui; Zhang, Ri; Miao, Miao; Wu, Depei; Tan, Seng Chuen; Liu, Chao; Xiong, Tengbin

2017-04-01

Imatinib (Glivec) and nilotinib (Tasigna) have been covered by critical disease insurance in Jiangsu province of China since 2013, which changed local treatment patterns and outcomes of patients with chronic myeloid leukemia (CML). This study evaluated the long-term cost-effectiveness of insurance coverage with imatinib as the first-line treatment for patients with CML in China from a societal perspective. A decision-analytic model based on previously published and real-world evidence was applied to simulate and evaluate the lifetime clinical and economic outcomes associated with CML treatments before and after imatinib was covered by medical insurance. Incremental cost-effectiveness ratio (ICER) was calculated with both costs and quality-adjusted life years (QALYs) discounted at 3% annually. Different assumptions of treatment benefits and costs were taken to address uncertainties and were tested with sensitivity analyses. In base case analysis, both cost and effectiveness of CML treatments increased after imatinib was covered by the medical insurance; on average, the incremental QALY and cost were 5.5 and ¥277,030 per patient in lifetime, respectively. The ICER of insurance coverage with imatinib was ¥50,641, which is less than the GDP per capita of China. Monte Carlo simulation resulted in the estimate of 100% probability that the insurance coverage of imatinib is cost-effective. Total cost was substantially saved at 5 years after patients initiated imatinib treatment with insurance coverage compared to no insurance coverage, the saved cost at 5 years was ¥99,565, which included the cost savings from both direct (e.g. cost of bone marrow or stem cell transplant) and indirect costs (e.g. productivity loss of patients and care-givers). The insurance coverage of imatinib is very cost-effective in China, according to the local cost and clinical data in Jiangsu province. More importantly, the insurance coverage of imatinib and nilotinib have changed the treatment patterns of CML patients, thus dramatically increasing life expectancy and quality-of-life (QoL) saving on productivity losses for both CML patients and their caregivers.

Molecular diagnostics using magnetic nanobeads

NASA Astrophysics Data System (ADS)

Zardán Gómez de la Torre, Teresa; Strömberg, Mattias; Göransson, Jenny; Gunnarsson, Klas; Nilsson, Mats; Svedlindh, Peter; Strømme, Maria

2010-01-01

In this paper, we investigate the volume-amplified magnetic nanobead detection assay with respect to bead size, bead concentration and bead oligonucleotide surface coverage in order to improve the understanding of the underlying microscopic mechanisms. It has been shown that: (i) the immobilization efficiency of the beads depends on the surface coverage of oligonucleotides, (ii) by using lower amounts of probe-tagged beads, detection sensitivity can be improved and (iii) using small enough beads enables both turn-off and turn-on detection. Finally, biplex detection was demonstrated.

NEA impactors: what direction to they come from?

NASA Astrophysics Data System (ADS)

Harris, Alan

2018-04-01

One might expect, if Earth-crossing NEAs are "thermalized" by prior close scattering encounters with the Earth, that final impact trajectories would be isotropic in direction. But orbital perturbations and other sources of entry and exit to the Earth-crossing zone are faster acting that thermalization, so the actual distribution of impacting orbits is quite anisotropic. I have studied impactor directions by adjusting the orbits of known Earth-crossing PHAs slightly to put them on intersecting orbits and then computed the direction of approach to the Earth. This arguably suffers from "looking under the lamp post", since NEAs are mostly discovered close to the opposition direction, so I also took the distribution of NEA orbits recently derived by Granvik and others and extracted, from a set of 100,000 synthetic orbits they provided, a subset of Earth-crossing PHAs and similarly adjusted them to be intersecting orbits. This should represent an unbiased set of orbits. I then weighted the impact directions by the individual Opik impact probability to obtain a distribution of impact directions weighted by actual impact probabilities. The result was that more than 40% of incoming trajectories clustered within 60 degrees of the opposition direction, and a similar fraction come from within 60 degrees of the solar direction. Thus ~80% of impactors come from only about 1/3 of the sky area, with almost none coming from 60-120 degrees solar elongation. The message is that existing ground-based surveys can hardly be improved upon by greater sky coverage with respect to detecting "death plunge" objects, and even space-based instruments offer very little improvement due to the very low solar elongation of most objects approaching from the solar direction.

Cost-effectiveness of canine vaccination to prevent human rabies in rural Tanzania.

PubMed

Fitzpatrick, Meagan C; Hampson, Katie; Cleaveland, Sarah; Mzimbiri, Imam; Lankester, Felix; Lembo, Tiziana; Meyers, Lauren A; Paltiel, A David; Galvani, Alison P

2014-01-21

The annual mortality rate of human rabies in rural Africa is 3.6 deaths per 100 000 persons. Rabies can be prevented with prompt postexposure prophylaxis, but this is costly and often inaccessible in rural Africa. Because 99% of human exposures occur through rabid dogs, canine vaccination also prevents transmission of rabies to humans. To evaluate the cost-effectiveness of rabies control through annual canine vaccination campaigns in rural sub-Saharan Africa. We model transmission dynamics in dogs and wildlife and assess empirical uncertainty in the biological variables to make probability-based evaluations of cost-effectiveness. Epidemiologic variables from a contact-tracing study and literature and cost data from ongoing vaccination campaigns. Two districts of rural Tanzania: Ngorongoro and Serengeti. 10 years. Health policymaker. Vaccination coverage ranging from 0% to 95% in increments of 5%. Life-years for health outcomes and 2010 U.S. dollars for economic outcomes. Annual canine vaccination campaigns were very cost-effective in both districts compared with no canine vaccination. In Serengeti, annual campaigns with as much as 70% coverage were cost-saving. Across a wide range of variable assumptions and levels of societal willingness to pay for life-years, the optimal vaccination coverage for Serengeti was 70%. In Ngorongoro, although optimal coverage depended on willingness to pay, vaccination campaigns were always cost-effective and lifesaving and therefore preferred. Canine vaccination was very cost-effective in both districts, but there was greater uncertainty about the optimal coverage in Ngorongoro. Annual canine rabies vaccination campaigns conferred extraordinary value and dramatically reduced the health burden of rabies. National Institutes of Health.

Elimination of African onchocerciasis: modeling the impact of increasing the frequency of ivermectin mass treatment.

PubMed

Coffeng, Luc E; Stolk, Wilma A; Hoerauf, Achim; Habbema, Dik; Bakker, Roel; Hopkins, Adrian D; de Vlas, Sake J

2014-01-01

The African Programme for Onchocerciasis Control (APOC) is currently shifting its focus from morbidity control to elimination of infection. To enhance the likelihood of elimination and speed up its achievement, programs may consider to increase the frequency of ivermectin mass treatment from annual to 6-monthly or even higher. In a computer simulation study, we examined the potential impact of increasing the mass treatment frequency for different settings. With the ONCHOSIM model, we simulated 92,610 scenarios pertaining to different assumptions about transmission conditions, history of mass treatment, the future mass treatment strategy, and ivermectin efficacy. Simulation results were used to determine the minimum remaining program duration and number of treatment rounds required to achieve 99% probability of elimination. Doubling the frequency of treatment from yearly to 6-monthly or 3-monthly was predicted to reduce remaining program duration by about 40% or 60%, respectively. These reductions come at a cost of additional treatment rounds, especially in case of 3-monthly mass treatment. Also, aforementioned reductions are highly dependent on maintained coverage, and could be completely nullified if coverage of mass treatment were to fall in the future. In low coverage settings, increasing treatment coverage is almost just as effective as increasing treatment frequency. We conclude that 6-monthly mass treatment may only be worth the effort in situations where annual treatment is expected to take a long time to achieve elimination in spite of good treatment coverage, e.g. because of unfavorable transmission conditions or because mass treatment started recently.

A stochastic model for the probability of malaria extinction by mass drug administration.

PubMed

Pemberton-Ross, Peter; Chitnis, Nakul; Pothin, Emilie; Smith, Thomas A

2017-09-18

Mass drug administration (MDA) has been proposed as an intervention to achieve local extinction of malaria. Although its effect on the reproduction number is short lived, extinction may subsequently occur in a small population due to stochastic fluctuations. This paper examines how the probability of stochastic extinction depends on population size, MDA coverage and the reproduction number under control, R c . A simple compartmental model is developed which is used to compute the probability of extinction using probability generating functions. The expected time to extinction in small populations after MDA for various scenarios in this model is calculated analytically. The results indicate that mass drug administration (Firstly, R c must be sustained at R c  < 1.2 to avoid the rapid re-establishment of infections in the population. Secondly, the MDA must produce effective cure rates of >95% to have a non-negligible probability of successful elimination. Stochastic fluctuations only significantly affect the probability of extinction in populations of about 1000 individuals or less. The expected time to extinction via stochastic fluctuation is less than 10 years only in populations less than about 150 individuals. Clustering of secondary infections and of MDA distribution both contribute positively to the potential probability of success, indicating that MDA would most effectively be administered at the household level. There are very limited circumstances in which MDA will lead to local malaria elimination with a substantial probability.

Effectiveness of a smartphone app on improving immunization of children in rural Sichuan Province, China: a cluster randomized controlled trial.

PubMed

Chen, Li; Du, Xiaozhen; Zhang, Lin; van Velthoven, Michelle Helena; Wu, Qiong; Yang, Ruikan; Cao, Ying; Wang, Wei; Xie, Lihui; Rao, Xiuqin; Zhang, Yanfeng; Koepsell, Jeanne Catherine

2016-08-31

The aim of this study was to assess the effectiveness of an EPI smartphone application (EPI app) on improving vaccination coverage in rural Sichuan Province, China. This matched-pair cluster randomized controlled study included 32 village doctors, matched in 16 pairs, and took place from 2013 to 2015. Village doctors in the intervention group used the EPI app and reminder text messages while village doctors in the control group used their usual procedures and text messages. The primary outcome was full vaccination coverage with all five vaccines (1 dose of BCG, 3 doses of hepatitis B, 3 doses of OPV, 3 doses of DPT and 1 dose of measles vaccine), and the secondary outcome was coverage with each dose of the five individual vaccines. We also conducted qualitative interviews with village doctors to understand perceptions on using the EPI app and how this changed their vaccination work. The full vaccination coverage increased statistically significant from baseline to end-line in both the intervention (67 % [95 % CI:58-75 %] to 84 % [95 % CI:76-90 %], P = 0.028) and control group (71 % [95 % CI:62-79 %] to 82 % [95 % CI:74-88 %], P = 0.014). The intervention group had higher increase in full vaccination coverage from baseline to end-line compared to the control group (17 % vs 10 %), but this was not statistically significant (P = 0.164). Village doctors found it more convenient to use the EPI app to manage child vaccination and also reported saving time by looking up information of caregivers and contacting caregivers for overdue vaccinations quicker. However, village doctors found it hard to manage children who migrated out of the counties. This study showed that an app and text messages can be used by village doctors to improve full vaccination coverage, though no significant increase in vaccination coverage was found when assessing the effect of the app on its own. Village doctors using EPI app reported having improved their working efficiency of managing childhood vaccination. Future studies should be conducted to evaluate the impact of more integrated approach of mHealth intervention on child immunization. Chinese Clinical Trials Registry (ChiCTR): ChiCTR-TRC- 13003960 , registered on December 6, 2013.

NGO facilitation of a government community-based maternal and neonatal health programme in rural India: improvements in equity.

PubMed

Baqui, Abdullah H; Rosecrans, Amanda M; Williams, Emma K; Agrawal, Praween K; Ahmed, Saifuddin; Darmstadt, Gary L; Kumar, Vishwajeet; Kiran, Usha; Panwar, Dharmendra; Ahuja, Ramesh C; Srivastava, Vinod K; Black, Robert E; Santosham, Mathuram

2008-07-01

Socio-economic disparities in health have been well documented around the world. This study examines whether NGO facilitation of the government's community-based health programme improved the equity of maternal and newborn health in rural Uttar Pradesh, India. A quasi-experimental study design included one intervention district and one comparison district of rural Uttar Pradesh. A household survey conducted between January and June 2003 established baseline rates of programme coverage, maternal and newborn care practices, and health care utilization during 2001-02. An endline household survey was conducted after 30 months of programme implementation between January and March 2006 to measure the same indicators during 2004-05. The changes in the indicators from baseline to endline in the intervention and comparison districts were calculated by socio-economic quintiles, and concentration indices were constructed to measure the equity of programme indicators. The equity of programme coverage and antenatal and newborn care practices improved from baseline to endline in the intervention district while showing little change in the comparison district. Equity in health care utilization for mothers and newborns also showed some improvements in the intervention district, but notable socio-economic differentials remained, with the poor demonstrating less ability to access health services. NGO facilitation of government programmes is a feasible strategy to improve equity of maternal and neonatal health programmes. Improvements in equity were most pronounced for household practices, and inequities were still apparent in health care utilization. Furthermore, overall programme coverage remained low, limiting the ability to address equity. Programmes need to identify and address barriers to universal coverage and care utilization, particularly in the poorest segments of the population.

Teaching Critical Analysis of Election Coverage with Video Tape in the Introductory Course

ERIC Educational Resources Information Center

Eisenstein, James; Greenberg, George Douglas

1976-01-01

Improved understanding of political events and increased analytical skills are two contributions of a study of video taped media coverage of important political events, such as national elections. An appendix presents excerpts from the three major television networks' commentaries on election night 1972. (Author/DB)

Utilization of sequence on relatives to improve analysis of individuals' low-coverage NGS data

USDA-ARS?s Scientific Manuscript database

Low-coverage sequence data is expected to have low call rates under the prevailing paradigm that genotypes are first “called” from sequence data of each individual independently and subsequent analyses (including determination of haplotypes) are dependent on those called genotypes. However, provide...

Effects of Mandating Benefits Packages. Background Paper No. 32.

ERIC Educational Resources Information Center

Mitchell, Olivia S.

This study of the potential labor market consequences of government mandating of employee benefits suggests that mandating benefits will increase benefit coverage and generosity for insurance coverage will not be helped; even when mandating benefits does improve benefit provision, there will be other offsetting effects, including wage and other…

Cost-effective solutions to maintaining smart grid reliability

NASA Astrophysics Data System (ADS)

Qin, Qiu

As the aging power systems are increasingly working closer to the capacity and thermal limits, maintaining an sufficient reliability has been of great concern to the government agency, utility companies and users. This dissertation focuses on improving the reliability of transmission and distribution systems. Based on the wide area measurements, multiple model algorithms are developed to diagnose transmission line three-phase short to ground faults in the presence of protection misoperations. The multiple model algorithms utilize the electric network dynamics to provide prompt and reliable diagnosis outcomes. Computational complexity of the diagnosis algorithm is reduced by using a two-step heuristic. The multiple model algorithm is incorporated into a hybrid simulation framework, which consist of both continuous state simulation and discrete event simulation, to study the operation of transmission systems. With hybrid simulation, line switching strategy for enhancing the tolerance to protection misoperations is studied based on the concept of security index, which involves the faulted mode probability and stability coverage. Local measurements are used to track the generator state and faulty mode probabilities are calculated in the multiple model algorithms. FACTS devices are considered as controllers for the transmission system. The placement of FACTS devices into power systems is investigated with a criterion of maintaining a prescribed level of control reconfigurability. Control reconfigurability measures the small signal combined controllability and observability of a power system with an additional requirement on fault tolerance. For the distribution systems, a hierarchical framework, including a high level recloser allocation scheme and a low level recloser placement scheme, is presented. The impacts of recloser placement on the reliability indices is analyzed. Evaluation of reliability indices in the placement process is carried out via discrete event simulation. The reliability requirements are described with probabilities and evaluated from the empirical distributions of reliability indices.

Socioeconomic disparities in coverage of full immunisation among children of adolescent mothers in India, 1990–2006: a repeated cross-sectional analysis

PubMed Central

Kumar, Chandan; Singh, Prashant Kumar; Singh, Lucky; Rai, Rajesh Kumar

2016-01-01

Objective Studies have highlighted that children of adolescent (aged 15–19 years) mothers are likely to receive relatively poor healthcare. With an unacceptably high adolescent birth rate, India houses the highest number of adolescent mothers globally, putting children at risk of inadequate vaccination. This paper assesses trends and extent of socioeconomic disparities in the coverage of full immunisation among children of adolescent mothers in India. Design Repeated cross-sectional analytical study. Data sources 3 consecutive rounds of the National Family Health Survey (NFHS) conducted during 1992–1993, 1998–1999 and 2005–2006 were used. Besides, the required information is also extracted from the 2011 Indian Census. Participants Children (aged 12–23 months) of adolescent (aged 15–19 years) mothers. Sample inclusion criteria involved the last child of the adolescent eligible to avail full immunisation. Setting Nationally representative sample. Data analysis The Cochran-Armitage test, χ2 test and binary logistic regression methods were applied to attain the study objective. Results Between 1990 and 2006, a non-significant increase of 4 percentage points in full immunisation of children of adolescent mothers was estimated. During the same period, a large difference between the probability of children of adolescent mothers receiving full immunisation belonging to the least (predicted probability (PP): 0.196 in 1990–1993, and PP: 0.213 in 2003–2006) and the most (PP: 0.589 in 1990–1993, and PP: 0.645 in 2003–2006) socioeconomically privileged group was estimated, and this disparity persisted over the survey period. Conclusions During 1990–2006, an insufficient improvement in provision of full immunisation to children born to adolescent mothers was recorded. The study underscored the suboptimum immunisation of rural, illiterate and poor children of adolescent women. The programme and policymakers could focus on district-wise concentration of adolescent women, especially those belonging to the underprivileged groups, to design a targeted intervention to elevate the level of immunisation of children of adolescent mothers. PMID:27519918

What Is Threatening the Effectiveness of Insecticide-Treated Bednets? A Case-Control Study of Environmental, Behavioral, and Physical Factors Associated with Prevention Failure.

PubMed

Obala, Andrew A; Mangeni, Judith Nekesa; Platt, Alyssa; Aswa, Daniel; Abel, Lucy; Namae, Jane; Prudhomme O'Meara, Wendy

2015-01-01

Insecticide-treated nets are the cornerstone of global malaria control and have been shown to reduce malaria morbidity by 50-60%. However, some areas are experiencing a resurgence in malaria following successful control. We describe an efficacy decay framework to understand why high malaria burden persists even under high ITN coverage in a community in western Kenya. We enrolled 442 children hospitalized with malaria and paired them with age, time, village and gender-matched controls. We completed comprehensive household and neighborhood assessments including entomological surveillance. The indicators are grouped into five domains in an efficacy decay framework: ITN ownership, compliance, physical integrity, vector susceptibility and facilitating factors. After variable selection, case-control data were analyzed using conditional logistic regression models and mosquito data were analyzed using negative binomial regression. Predictive margins were calculated from logistic regression models. Measures of ITN coverage and physical integrity were not correlated with hospitalized malaria in our study. However, consistent ITN use (Adjusted Odds Ratio (AOR) = 0.23, 95%CI: 0.12-0.43), presence of nearby larval sites (AOR = 1.137, 95%CI: 1.02-1.27), and specific types of crops (AOR (grains) = 0.446, 95%CI: 0.24-0.82) were significantly correlated with malaria amongst children who owned an ITN. The odds of hospitalization for febrile malaria nearly tripled when one other household member had symptomatic malaria infection (AOR-2.76, 95%CI:1.83-4.18). Overall, perfect household adherence could reduce the probability of hospitalization for malaria to less than 30% (95%CI:0.12-0.46) and adjusting environmental factors such as elimination of larval sites and growing grains nearby could reduce the probability of hospitalization for malaria to less than 20% (95%CI:0.04-0.31). Availability of ITNs is not the bottleneck for malaria prevention in this community. Behavior change interventions to improve compliance and environmental management of mosquito breeding habitats may greatly enhance ITN efficacy. A better understanding of the relationship between agriculture and mosquito survival and feeding success is needed.

42 CFR 486.348 - Condition: Quality assessment and performance improvement (QAPI).

Code of Federal Regulations, 2011 CFR

2011-10-01

... OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS FOR COVERAGE OF... result in performance improvements and track performance to ensure that improvements are sustained. (b...

Vaccination and All-Cause Child Mortality From 1985 to 2011: Global Evidence From the Demographic and Health Surveys

PubMed Central

McGovern, Mark E.; Canning, David

2015-01-01

Based on models with calibrated parameters for infection, case fatality rates, and vaccine efficacy, basic childhood vaccinations have been estimated to be highly cost effective. We estimated the association of vaccination with mortality directly from survey data. Using 149 cross-sectional Demographic and Health Surveys, we determined the relationship between vaccination coverage and the probability of dying between birth and 5 years of age at the survey cluster level. Our data included approximately 1 million children in 68,490 clusters from 62 countries. We considered the childhood measles, bacillus Calmette-Guérin, diphtheria-pertussis-tetanus, polio, and maternal tetanus vaccinations. Using modified Poisson regression to estimate the relative risk of child mortality in each cluster, we also adjusted for selection bias that resulted from the vaccination status of dead children not being reported. Childhood vaccination, and in particular measles and tetanus vaccination, is associated with substantial reductions in childhood mortality. We estimated that children in clusters with complete vaccination coverage have a relative risk of mortality that is 0.73 (95% confidence interval: 0.68, 0.77) times that of children in a cluster with no vaccinations. Although widely used, basic vaccines still have coverage rates well below 100% in many countries, and our results emphasize the effectiveness of increasing coverage rates in order to reduce child mortality. PMID:26453618

Primary Health Care Utilization by the Mexican Indigenous Population: The Role of the Seguro Popular in Socially Inequitable Contexts

PubMed Central

Leyva-Flores, Rene; Servan-Mori, Edson; Infante-Xibille, Cesar; Pelcastre-Villafuerte, Blanca Estela; Gonzalez, Tonatiuh

2014-01-01

Objective To analyze the relationship between primary health care utilization and extended health insurance coverage under the Seguro Popular (SP) among Mexican indigenous people. Methodology A cross-sectional analysis was conducted using data from the Mexican National Nutrition Survey 2012 (n = 194,758). Quasi-experimental matching methods and nonlinear regression probit models were used to estimate the influence of SP on primary health care utilization. Results 25% of the Mexican population reported having no health insurance coverage, while 59% of indigenous versus 35% of non-indigenous reported having SP coverage. Health problems were reported by 13.9% of indigenous vs. 10.5% of non-indigenous; of these, 52.8% and 57.7% respectively, received primary health care (p<0.05). Economic barriers were the most frequent reasons for not using primary health care services. The probability of utilizing primary health care services was 11.5 percentage points higher (p<0.01) for indigenous SP affiliates in comparison with non-indigenous, in similar socioeconomic conditions. Conclusion Socioeconomic conditions, not ethnicity per-se, determine whether people utilize primary health care services. Therefore, SP can be conceived as a public policy strategy which acts as a social buffer by enhancing health care utilization regardless of ethnicity. Further analysis is required to explore the potential gaps as a result of SP coverage among socially vulnerable groups. PMID:25099399

Convective Weather Forecast Quality Metrics for Air Traffic Management Decision-Making

NASA Technical Reports Server (NTRS)

Chatterji, Gano B.; Gyarfas, Brett; Chan, William N.; Meyn, Larry A.

2006-01-01

Since numerical weather prediction models are unable to accurately forecast the severity and the location of the storm cells several hours into the future when compared with observation data, there has been a growing interest in probabilistic description of convective weather. The classical approach for generating uncertainty bounds consists of integrating the state equations and covariance propagation equations forward in time. This step is readily recognized as the process update step of the Kalman Filter algorithm. The second well known method, known as the Monte Carlo method, consists of generating output samples by driving the forecast algorithm with input samples selected from distributions. The statistical properties of the distributions of the output samples are then used for defining the uncertainty bounds of the output variables. This method is computationally expensive for a complex model compared to the covariance propagation method. The main advantage of the Monte Carlo method is that a complex non-linear model can be easily handled. Recently, a few different methods for probabilistic forecasting have appeared in the literature. A method for computing probability of convection in a region using forecast data is described in Ref. 5. Probability at a grid location is computed as the fraction of grid points, within a box of specified dimensions around the grid location, with forecast convection precipitation exceeding a specified threshold. The main limitation of this method is that the results are dependent on the chosen dimensions of the box. The examples presented Ref. 5 show that this process is equivalent to low-pass filtering of the forecast data with a finite support spatial filter. References 6 and 7 describe the technique for computing percentage coverage within a 92 x 92 square-kilometer box and assigning the value to the center 4 x 4 square-kilometer box. This technique is same as that described in Ref. 5. Characterizing the forecast, following the process described in Refs. 5 through 7, in terms of percentage coverage or confidence level is notionally sound compared to characterizing in terms of probabilities because the probability of the forecast being correct can only be determined using actual observations. References 5 through 7 only use the forecast data and not the observations. The method for computing the probability of detection, false alarm ratio and several forecast quality metrics (Skill Scores) using both the forecast and observation data are given in Ref. 2. This paper extends the statistical verification method in Ref. 2 to determine co-occurrence probabilities. The method consists of computing the probability that a severe weather cell (grid location) is detected in the observation data in the neighborhood of the severe weather cell in the forecast data. Probabilities of occurrence at the grid location and in its neighborhood with higher severity, and with lower severity in the observation data compared to that in the forecast data are examined. The method proposed in Refs. 5 through 7 is used for computing the probability that a certain number of cells in the neighborhood of severe weather cells in the forecast data are seen as severe weather cells in the observation data. Finally, the probability of existence of gaps in the observation data in the neighborhood of severe weather cells in forecast data is computed. Gaps are defined as openings between severe weather cells through which an aircraft can safely fly to its intended destination. The rest of the paper is organized as follows. Section II summarizes the statistical verification method described in Ref. 2. The extension of this method for computing the co-occurrence probabilities in discussed in Section HI. Numerical examples using NCWF forecast data and NCWD observation data are presented in Section III to elucidate the characteristics of the co-occurrence probabilities. This section also discusses the procedure for computing throbabilities that the severity of convection in the observation data will be higher or lower in the neighborhood of grid locations compared to that indicated at the grid locations in the forecast data. The probability of coverage of neighborhood grid cells is also described via examples in this section. Section IV discusses the gap detection algorithm and presents a numerical example to illustrate the method. The locations of the detected gaps in the observation data are used along with the locations of convective weather cells in the forecast data to determine the probability of existence of gaps in the neighborhood of these cells. Finally, the paper is concluded in Section V.

Electrical characteristics and step coverage of ZrO2 films deposited by atomic layer deposition for through-silicon via and metal-insulator-metal applications

NASA Astrophysics Data System (ADS)

Choi, Kyeong-Keun; Park, Chan-Gyung; Kim, Deok-kee

2016-01-01

The electrical characteristics and step coverage of ZrO2 films deposited by atomic layer deposition were investigated for through-silicon via (TSV) and metal-insulator-metal applications at temperatures below 300 °C. ZrO2 films were able to be conformally deposited on the scallops of 50-µm-diameter, 100-µm-deep TSV holes. The mean breakdown field of 30-nm-thick ZrO2 films on 30-nm-thick Ta(N) increased about 41% (from 2.7 to 3.8 MV/cm) upon H2 plasma treatment. With the plasma treatment, the breakdown field of the film increased and the temperature coefficient of capacitance decreased significantly, probably as a result of the decreased carbon concentration in the film.

Application of mobile technology for improving expanded program on immunization among highland minority and stateless populations in northern Thailand border.

PubMed

Kaewkungwal, Jaranit; Apidechkul, Tawatchai; Jandee, Kasemsak; Khamsiriwatchara, Amnat; Lawpoolsri, Saranath; Sawang, Surasak; Sangvichean, Aumnuyphan; Wansatid, Peerawat; Krongrungroj, Sarinya

2015-01-14

Studies of undervaccinated children of minority/stateless populations have highlighted significant barriers at individual, community, and state levels. These include geography-related difficulties, poverty, and social norms/beliefs. The objective of this study was to assess project outcomes regarding immunization coverage, as well as maternal attitudes and practices toward immunization. The "StatelessVac" project was conducted in Thailand-Myanmar-Laos border areas using cell phone-based mechanisms to increase immunization coverage by incorporating phone-to-phone information sharing for both identification and prevention. With limitation of the study among vulnerable populations in low-resource settings, the pre/post assessments without comparison group were conducted. Immunization coverage was collected from routine monthly reports while behavior-change outcomes were from repeat surveys. This study revealed potential benefits of the initiative for case identification; immunization coverage showed an improved trend. Prevention strategies were successfully integrated into the routine health care workflows of immunization activities at point-of-care. A behavior-change-communication package contributes significantly in raising both concern and awareness in relation to child care. The mobile technology has proven to be an effective mechanism in improving a children's immunization program among these hard-to-reach populations. Part of the intervention has now been revised for use at health centers across the country.

Public Finance Policy Strategies to Increase Access to Preconception Care

PubMed Central

2006-01-01

Policy and finance barriers reduce access to preconception care and, reportedly, limit professional practice changes that would improve the availability of needed services. Millions of women of childbearing age (15–44) lack adequate health coverage (i.e., uninsured or underinsured), and others live in medically underserved areas. Service delivery fragmentation and lack of professional guidelines are additional barriers. This paper reviews barriers and opportunities for financing preconception care, based on a review and analysis of state and federal policies. We describe states’ experiences with and opportunities to improve health coverage, through public programs such as Medicaid, Medicaid waivers, and the State Children's Health Insurance Program (SCHIP). The potential role of Title V and of community health centers in providing primary and preventive care to women also is discussed. In these and other public health and health coverage programs, opportunities exist to finance preconception care for low-income women. Three major policy directions are discussed. To increase access to preconception care among women of childbearing age, the federal and state governments have opportunities to: (1) improve health care coverage, (2) increase the supply of publicly subsidized health clinics, and (3) direct delivery of preconception screening and interventions in the context of public health programs. PMID:16802188

Interaction initiatives between regulatory, health technology assessment and coverage bodies, and industry.

PubMed

Frønsdal, Katrine; Pichler, Franz; Mardhani-Bayne, Logan; Henshall, Chris; Røttingen, John-Arne; Mørland, Berit; Klemp, Marianne

2012-10-01

There has been an increased focus on the relationship between health technology assessment (HTA) and regulatory assessments and how regulatory, HTA and coverage bodies, and industry can work better together to improve efficiency and alignment of processes. There is increasingly agreement across sectors that improved communication and coordination could contribute to facilitating timely patient access to effective, affordable treatments that offer value to the health system. Discussions on aspects of this relationship are being held in different forums and various forms of coordination and collaboration are being developed or piloted within several jurisdictions. It is therefore both timely and of value to stakeholders to describe and reflect on current initiatives intended to improve interactions between regulatory, HTA and coverage bodies, and industry. Drawing on 2011 meetings of the HTAi Policy Forum and the Center for Innovation in Regulatory Science (CIRS), this study aims to describe and compare initiatives, and point to success factors and challenges that are likely to inform future work and collaboration.

Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010.

PubMed

Bishai, David M; Cohen, Robert; Alfonso, Y Natalia; Adam, Taghreed; Kuruvilla, Shyama; Schweitzer, Julian

2016-01-01

From 1990-2010, worldwide child mortality declined by 43%, and maternal mortality declined by 40%. This paper compares two sources of progress: improvements in societal coverage of health determinants versus improvements in the impact of health determinants as a result of technical change. This paper decomposes the progress made by 146 low- and middle-income countries (LMICs) in lowering childhood and maternal mortality into one component due to better health determinants like literacy, income, and health coverage and a second component due to changes in the impact of these health determinants. Health determinants were selected from eight distinct health-impacting sectors. Health determinants were selected from eight distinct health-impacting sectors. Regression models are used to estimate impact size in 1990 and again in 2010. Changes in the levels of health determinants were measured using secondary data. The model shows that respectively 100% and 89% of the reductions in maternal and child mortality since 1990 were due to improvements in nationwide coverage of health determinants. The relative share of overall improvement attributable to any single determinant varies by country and by model specification. However, in aggregate, approximately 50% of the mortality reductions were due to improvements in the health sector, and the other 50% of the mortality reductions were due to gains outside the health sector. Overall, countries improved maternal and child health (MCH) from 1990 to 2010 mainly through improvements in the societal coverage of a broad array of health system, social, economic and environmental determinants of child health. These findings vindicate efforts by the global community to obtain such improvements, and align with the post-2015 development agenda that builds on the lessons from the MDGs and highlights the importance of promoting health and sustainable development in a more integrated manner across sectors.

Racial and Ethnic Disparities in Services and the Patient Protection and Affordable Care Act

PubMed Central

Abdus, Salam; Mistry, Kamila B.

2015-01-01

Objectives. We examined prereform patterns in insurance coverage, access to care, and preventive services use by race/ethnicity in adults targeted by the coverage expansions of the Patient Protection and Affordable Care Act (ACA). Methods. We used pre-ACA household data from the Medical Expenditure Panel Survey to identify groups targeted by the coverage provisions of the Act (Medicaid expansions and subsidized Marketplace coverage). We examined racial/ethnic differences in coverage, access to care, and preventive service use, across and within ACA relevant subgroups from 2005 to 2010. The study took place at the Agency for Healthcare Research and Quality in Rockville, Maryland. Results. Minorities were disproportionately represented among those targeted by the coverage provisions of the ACA. Targeted groups had lower rates of coverage, access to care, and preventive services use, and racial/ethnic disparities were, in some cases, widest within these targeted groups. Conclusions. Our findings highlighted the opportunity of the ACA to not only to improve coverage, access, and use for all racial/ethnic groups, but also to narrow racial/ethnic disparities in these outcomes. Our results might have particular importance for states that are deciding whether to implement the ACA Medicaid expansions. PMID:26447920

Racial and Ethnic Disparities in Services and the Patient Protection and Affordable Care Act.

PubMed

Abdus, Salam; Mistry, Kamila B; Selden, Thomas M

2015-11-01

We examined prereform patterns in insurance coverage, access to care, and preventive services use by race/ethnicity in adults targeted by the coverage expansions of the Patient Protection and Affordable Care Act (ACA). We used pre-ACA household data from the Medical Expenditure Panel Survey to identify groups targeted by the coverage provisions of the Act (Medicaid expansions and subsidized Marketplace coverage). We examined racial/ethnic differences in coverage, access to care, and preventive service use, across and within ACA relevant subgroups from 2005 to 2010. The study took place at the Agency for Healthcare Research and Quality in Rockville, Maryland. Minorities were disproportionately represented among those targeted by the coverage provisions of the ACA. Targeted groups had lower rates of coverage, access to care, and preventive services use, and racial/ethnic disparities were, in some cases, widest within these targeted groups. Our findings highlighted the opportunity of the ACA to not only to improve coverage, access, and use for all racial/ethnic groups, but also to narrow racial/ethnic disparities in these outcomes. Our results might have particular importance for states that are deciding whether to implement the ACA Medicaid expansions.

Reported community-level indoor residual spray coverage from two-stage cluster surveys in sub-Saharan Africa.

PubMed

Larsen, David A; Borrill, Lauren; Patel, Ryan; Fregosi, Lauren

2017-06-13

Malaria is an important cause of morbidity and mortality in malaria-endemic areas. Indoor residual spray is an effective intervention to control malaria, but high community-level coverage is needed to maximize its impact. Using thirty-four two-stage cluster surveys (e.g., demographic and health surveys) and lot quality assurance sampling, indoor residual spray was estimated at the community level (i.e. enumeration-area) across sub-Saharan Africa since 2010. For communities receiving indoor residual spray a logistic regression predicted whether community-level coverage exceeded 50% or not. Household-level coverage was equitable both in terms of wealth and urban/rural, with poorer and rural houses more likely to be sprayed than richer and urban houses. Coverage of indoor residual spray at the community level is poor across the continent, with 54% of communities receiving the intervention not reaching 50% coverage. Having >50% coverage at the community-level was not associated with increasing the number of houses sprayed in the country. Implementation and monitoring of indoor residual coverage at small geographical scales need to improve greatly to receive maximum benefit of the intervention.

NSW annual immunisation coverage report, 2010.

PubMed

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

2011-11-01

This annual report, the second in the series, documents trends in immunisation coverage in NSW for children, adolescents and the elderly, to the end of 2010. Data from the Australian Childhood Immunisation Register, the NSW School Immunisation Program and the NSW Population Health Survey were used to calculate various measures of population coverage, coverage for Aboriginal children and vaccination timeliness for all children. Over 90% coverage has been reached for children at 12 and 24 months of age. For children at 5 years of age there was an improvement during 2010 in timeliness for vaccines due at 4 years and coverage almost reached 90%. Delayed receipt of vaccines is still an issue for Aboriginal children. For adolescents, there is good coverage for the first and second doses of human papillomavirus vaccine and the dose of diphtheria, tetanus and acellular pertussis. The pneumococcal vaccination rate in the elderly has been steadily rising, although it has remained lower than the influenza coverage estimates. Completion of the recommended immunisation schedule at the earliest appropriate age should be the next public health goal at both the state and local health district level. Official coverage assessments for 'fully immunised' should include the 7-valent pneumococcal conjugate and meningococcal C vaccines, and wider dissemination should be considered.

An evaluation of voluntary 2-dose varicella vaccination coverage in New York City public schools.

PubMed

Doll, Margaret K; Rosen, Jennifer B; Bialek, Stephanie R; Szeto, Hiram; Zimmerman, Christopher M

2015-05-01

We assessed coverage for 2-dose varicella vaccination, which is not required for school entry, among New York City public school students and examined characteristics associated with receipt of 2 doses. We measured receipt of either at least 1 or 2 doses of varicella vaccine among students aged 4 years and older in a sample of 336 public schools (n = 223 864 students) during the 2010 to 2011 school year. Data came from merged student vaccination records from 2 administrative data systems. We conducted multivariable regression to assess associations of age, gender, race/ethnicity, and school location with 2-dose prevalence. Coverage with at least 1 varicella dose was 96.2% (95% confidence interval [CI] = 96.2%, 96.3%); coverage with at least 2 doses was 64.8% (95% CI = 64.6%, 64.9%). Increasing student age, non-Hispanic White race/ethnicity, and attendance at school in Staten Island were associated with lower 2-dose coverage. A 2-dose varicella vaccine requirement for school entry would likely improve 2-dose coverage, eliminate coverage disparities, and prevent disease.

Marine Microcosm Experiments on Effects of Copper and Tributylin-Based Antifouling Paint Leachates

DTIC Science & Technology

1988-06-01

consumers in HliOrg microcosms were probably the thick carpets of green algae ( Cladophora socialis) that developed in those tanks during leachate and...and bottom substrate in the SPG-4 tanks were dominated by a low-diversity community composed primarily of Cladophora socialis, a filamentous green...coverage and diversity of species after 4 weeks of’ exposure. Moderate to thick growths of filamentous green algae ( Cladophora socialis) covered with

Immunisation coverage, 2012.

PubMed

Hull, Brynley P; Dey, Aditi; Menzies, Rob I; Brotherton, Julia M; McIntyre, Peter B

2014-09-30

This, the 6th annual immunisation coverage report, documents trends during 2012 for a range of standard measures derived from Australian Childhood Immunisation Register (ACIR) data, and National Human Papillomavirus (HPV) Vaccination Program Register data. These include coverage at standard age milestones and for individual vaccines included on the National Immunisation Program (NIP) and coverage in adolescents and adults. The proportion of Australian children 'fully vaccinated' at 12, 24 and 60 months of age was 91.7%, 92.5% and 91.2%, respectively. For vaccines available on the NIP but not assessed during 2012 for 'fully vaccinated' status or for eligibility for incentive payments (rotavirus and pneumococcal at 12 months and meningococcal C and varicella at 24 months) coverage varied. Although pneumococcal vaccine had similar coverage at 12 months to other vaccines, coverage was lower for rotavirus at 12 months (83.6%) and varicella at 24 months (84.4%). Although 'fully vaccinated' coverage at 12 months of age was lower among Indigenous children than non-Indigenous children in all jurisdictions, the extent of the difference varied, reaching a 15 percentage point differential in South Australia but only a 0.4 percentage point differential in the Northern Territory. Overall, Indigenous coverage at 24 months of age exceeded that at 12 months of age nationally and for all jurisdictions, but as receipt of varicella vaccine at 18 months is excluded from calculations, this represents delayed immunisation, with some contribution from immunisation incentives. The 'fully vaccinated' coverage estimates for vaccinations due by 60 months of age for Indigenous children exceeded 90% at 91% in 2012. Unlike in 2011, at 60 months of age, there was no dramatic variation in coverage between Indigenous and non-Indigenous children for individual jurisdictions. As previously documented, vaccines recommended for Indigenous children only, hepatitis A and pneumococcal vaccine, had suboptimal coverage at 60.1% and 73.1%, respectively, although there was a considerable improvement in coverage from 2011, 57.7% and 68.2% respectively. On-time receipt (before 49 months of age) of vaccines by Indigenous children at the 60-month milestone age improved substantially between 2011 (19%) and 2012 (38%) but the disparity in on-time vaccination between Indigenous and non-Indigenous children worsened at the 60-month age milestone from 2011 (from 1.8 to 5.4 percentage points) and remained the same for the 12 and 24-month age milestones. By late 2012, the percentage of children who received the 1st dose of DTPa vaccine dose at less than 8 weeks of age was greater than 50% in all but 1 jurisdiction and greater than 70% for New South Wales, the Australian Capital Territory and Tasmania. Further, by late 2012, the percentage of children who received the 4th dose of DTPa vaccine dose at less than 4 years of age was greater than 30% in 3 jurisdictions. The percentage of children whose parents officially objected to vaccination in Australia was 1.7% and this figure varied by jurisdiction. However, there is a further 2.1% of children whose parents don't officially object but whose children have no vaccines recorded on the ACIR. Coverage data for the 3rd dose of HPV from the national HPV register in the school catch up program was similar to 2011 at 71% but was substantially lower for the catch up program for females outside school (44%-69%), although this was an improvement from 2011.

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

Zhang, JY; Hong, DL

Purpose: The purpose of this study is to investigate the patient set-up error and interfraction target coverage in cervical cancer using image-guided adaptive radiotherapy (IGART) with cone-beam computed tomography (CBCT). Methods: Twenty cervical cancer patients undergoing intensity modulated radiotherapy (IMRT) were randomly selected. All patients were matched to the isocenter using laser with the skin markers. Three dimensional CBCT projections were acquired by the Varian Truebeam treatment system. Set-up errors were evaluated by radiation oncologists, after CBCT correction. The clinical target volume (CTV) was delineated on each CBCT, and the planning target volume (PTV) coverage of each CBCT-CTVs was analyzed.more » Results: A total of 152 CBCT scans were acquired from twenty cervical cancer patients, the mean set-up errors in the longitudinal, vertical, and lateral direction were 3.57, 2.74 and 2.5mm respectively, without CBCT corrections. After corrections, these were decreased to 1.83, 1.44 and 0.97mm. For the target coverage, CBCT-CTV coverage without CBCT correction was 94% (143/152), and 98% (149/152) with correction. Conclusion: Use of CBCT verfication to measure patient setup errors could be applied to improve the treatment accuracy. In addition, the set-up error corrections significantly improve the CTV coverage for cervical cancer patients.« less

Development and enrolee satisfaction with basic medical insurance in China: A systematic review and stratified cluster sampling survey.

PubMed

Jing, Limei; Chen, Ru; Jing, Lisa; Qiao, Yun; Lou, Jiquan; Xu, Jing; Wang, Junwei; Chen, Wen; Sun, Xiaoming

2017-07-01

Basic Medical Insurance (BMI) has changed remarkably over time in China because of health reforms that aim to achieve universal coverage and better health care with adequate efforts by increasing subsidies, reimbursement, and benefits. In this paper, we present the development of BMI, including financing and operation, with a systematic review. Meanwhile, Pudong New Area in Shanghai was chosen as a typical BMI sample for its coverage and management; a stratified cluster sampling survey together with an ordinary logistic regression model was used for the analysis. Enrolee satisfaction and the factors associated with enrolee satisfaction with BMI were analysed. We found that the reenrolling rate superficially improved the BMI coverage and nearly achieved universal coverage. However, BMI funds still faced dual contradictions of fund deficit and insured under compensation, and a long-term strategy is needed to realize the integration of BMI schemes with more homogeneous coverage and benefits. Moreover, Urban Resident Basic Medical Insurance participants reported a higher rate of dissatisfaction than other participants. The key predictors of the enrolees' satisfaction were awareness of the premium and compensation, affordability of out-of-pocket costs, and the proportion of reimbursement. These results highlight the importance that the Chinese government takes measures, such as strengthening BMI fund management, exploring mixed payment methods, and regulating sequential medical orders, to develop an integrated medical insurance system of universal coverage and vertical equity while simultaneously improving enrolee satisfaction. Copyright © 2017 John Wiley & Sons, Ltd.

An Optimized Hidden Node Detection Paradigm for Improving the Coverage and Network Efficiency in Wireless Multimedia Sensor Networks

PubMed Central

Alanazi, Adwan; Elleithy, Khaled

2016-01-01

Successful transmission of online multimedia streams in wireless multimedia sensor networks (WMSNs) is a big challenge due to their limited bandwidth and power resources. The existing WSN protocols are not completely appropriate for multimedia communication. The effectiveness of WMSNs varies, and it depends on the correct location of its sensor nodes in the field. Thus, maximizing the multimedia coverage is the most important issue in the delivery of multimedia contents. The nodes in WMSNs are either static or mobile. Thus, the node connections change continuously due to the mobility in wireless multimedia communication that causes an additional energy consumption, and synchronization loss between neighboring nodes. In this paper, we introduce an Optimized Hidden Node Detection (OHND) paradigm. The OHND consists of three phases: hidden node detection, message exchange, and location detection. These three phases aim to maximize the multimedia node coverage, and improve energy efficiency, hidden node detection capacity, and packet delivery ratio. OHND helps multimedia sensor nodes to compute the directional coverage. Furthermore, an OHND is used to maintain a continuous node– continuous neighbor discovery process in order to handle the mobility of the nodes. We implement our proposed algorithms by using a network simulator (NS2). The simulation results demonstrate that nodes are capable of maintaining direct coverage and detecting hidden nodes in order to maximize coverage and multimedia node mobility. To evaluate the performance of our proposed algorithms, we compared our results with other known approaches. PMID:27618048

An Optimized Hidden Node Detection Paradigm for Improving the Coverage and Network Efficiency in Wireless Multimedia Sensor Networks.

PubMed

Alanazi, Adwan; Elleithy, Khaled

2016-09-07

Successful transmission of online multimedia streams in wireless multimedia sensor networks (WMSNs) is a big challenge due to their limited bandwidth and power resources. The existing WSN protocols are not completely appropriate for multimedia communication. The effectiveness of WMSNs varies, and it depends on the correct location of its sensor nodes in the field. Thus, maximizing the multimedia coverage is the most important issue in the delivery of multimedia contents. The nodes in WMSNs are either static or mobile. Thus, the node connections change continuously due to the mobility in wireless multimedia communication that causes an additional energy consumption, and synchronization loss between neighboring nodes. In this paper, we introduce an Optimized Hidden Node Detection (OHND) paradigm. The OHND consists of three phases: hidden node detection, message exchange, and location detection. These three phases aim to maximize the multimedia node coverage, and improve energy efficiency, hidden node detection capacity, and packet delivery ratio. OHND helps multimedia sensor nodes to compute the directional coverage. Furthermore, an OHND is used to maintain a continuous node- continuous neighbor discovery process in order to handle the mobility of the nodes. We implement our proposed algorithms by using a network simulator (NS2). The simulation results demonstrate that nodes are capable of maintaining direct coverage and detecting hidden nodes in order to maximize coverage and multimedia node mobility. To evaluate the performance of our proposed algorithms, we compared our results with other known approaches.

Federal Parity and Access to Behavioral Health Care in Private Health Plans.

PubMed

Hodgkin, Dominic; Horgan, Constance M; Stewart, Maureen T; Quinn, Amity E; Creedon, Timothy B; Reif, Sharon; Garnick, Deborah W

2018-04-01

The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) sought to improve access to behavioral health care by regulating health plans' coverage and management of services. Health plans have some discretion in how to achieve compliance with MHPAEA, leaving questions about its likely effects on health plan policies. In this study, the authors' objective was to determine how private health plans' coverage and management of behavioral health treatment changed after the federal parity law's full implementation. A nationally representative survey of commercial health plans was conducted in 60 market areas across the continental United States, achieving response rates of 89% in 2010 (weighted N=8,431) and 80% in 2014 (weighted N=6,974). Senior executives at responding plans were interviewed regarding behavioral health services in each year and (in 2014) regarding changes. Student's t tests were used to examine changes in services covered, cost-sharing, and prior authorization requirements for both behavioral health and general medical care. In 2014, 68% of insurance products reported having expanded behavioral health coverage since 2010. Exclusion of eating disorder coverage was eliminated between 2010 (23%) and 2014 (0%). However, more products reported excluding autism treatment in 2014 (24%) than 2010 (8%). Most plans reported no change to prior-authorization requirements between 2010 and 2014. Implementation of federal parity legislation appears to have been accompanied by continuing improvement in behavioral health coverage. The authors did not find evidence of widespread noncompliance or of unintended effects, such as dropping coverage of behavioral health care altogether.

[Effective coverage to manage domestic violence against women in Mexican municipalities: limits of metrics].

PubMed

Viviescas-Vargas, Diana P; Idrovo, Alvaro Javier; López-López, Erika; Uicab-Pool, Gloria; Herrera-Trujillo, Mónica; Balam-Gómez, Maricela; Hidalgo-Solórzano, Elisa

2013-08-01

The study estimated the effective coverage of health services in primary care for the management of domestic violence against women in three municipalities in Mexico. We estimated the prevalence and severity of violence using a validated scale, and the effective coverage proposed by Shengelia and partners with any modifications. Quality care was considered when there was a suggestion to report it to authorities. The use and quality of care was low in the three municipalities analyzed, used most frequently when there was sexual or physical violence. Effective coverage was 29.41%, 16.67% and zero in Guachochi, Jojutla and Tizimín, respectively. The effective coverage indicator had difficulties in measuring events and responses that were not based on biomedical models. Findings suggest that the indicator can be improved by incorporating other dimensions of quality.

Women and health coverage: the affordability gap.

PubMed

Patchias, Elizabeth M; Waxman, Judy

2007-04-01

Although men and women have some similar challenges with regard to health insurance, women face unique barriers to becoming insured. More significantly, women have greater difficulty affording health care services even once they are insured. On average, women have lower incomes than men and therefore have greater difficulty paying premiums. Women also are less likely than men to have coverage through their own employer and more likely to obtain coverage through their spouses; are more likely than men to have higher out-of-pocket health care expenses; and use more healthcare services than men and consequently are in greater need of comprehensive coverage. Proposals for improving health policy need to address these disparities.

Health care access among Mexican Americans with different health insurance coverage.

PubMed

Treviño, R P; Treviño, F M; Medina, R; Ramirez, G; Ramirez, R R

1996-05-01

This study describes the rates of health care access among Mexican Americans with different health insurance coverage. An interview questionnaire was used to collect information regarding sociodemographics, perceived health status, health insurance coverage, and sources of health care from a random sample of 501 Mexican Americans from San Antonio, Texas. Health care access was determined more by having health insurance coverage than by health care needs. Poor Mexican Americans with health insurance had higher health care access rates than did poor Mexican Americans without health insurance. Health care access may improve health care outcomes, but more comprehensive community-based campaigns to promote health and better use of health services in underprivileged populations should be developed.

Variance estimation when using inverse probability of treatment weighting (IPTW) with survival analysis.

PubMed

Austin, Peter C

2016-12-30

Propensity score methods are used to reduce the effects of observed confounding when using observational data to estimate the effects of treatments or exposures. A popular method of using the propensity score is inverse probability of treatment weighting (IPTW). When using this method, a weight is calculated for each subject that is equal to the inverse of the probability of receiving the treatment that was actually received. These weights are then incorporated into the analyses to minimize the effects of observed confounding. Previous research has found that these methods result in unbiased estimation when estimating the effect of treatment on survival outcomes. However, conventional methods of variance estimation were shown to result in biased estimates of standard error. In this study, we conducted an extensive set of Monte Carlo simulations to examine different methods of variance estimation when using a weighted Cox proportional hazards model to estimate the effect of treatment. We considered three variance estimation methods: (i) a naïve model-based variance estimator; (ii) a robust sandwich-type variance estimator; and (iii) a bootstrap variance estimator. We considered estimation of both the average treatment effect and the average treatment effect in the treated. We found that the use of a bootstrap estimator resulted in approximately correct estimates of standard errors and confidence intervals with the correct coverage rates. The other estimators resulted in biased estimates of standard errors and confidence intervals with incorrect coverage rates. Our simulations were informed by a case study examining the effect of statin prescribing on mortality. © 2016 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd. © 2016 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.

SU-E-T-589: Optimization of Patient Head Angle Position to Spare Hippocampus During the Brain Radiation Therapy

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

Cheon, G; Kang, Y; Kang, S

Purpose: Hippocampus is one of the important organs which controls emotions, behaviors, movements the memorizing and learning ability. In the conventional head & neck therapy position, it is difficult to perform the hippocampal-sparing brain radiation therapy. The purpose of this study is to investigate optimal head angle which can save the hippocampal-sparing and organ at risk (OAR) in conformal radiation therapy (CRT), Intensity modulation radiation therapy (IMRT) and helical tomotherapy (HT). Methods: Three types of radiation treatment plans, CRT, IMRT and Tomotherapy plans, were performed for 10 brain tumor patients. The image fusion between CT and MRI data were usedmore » in the contour due to the limited delineation of the target and OAR in the CT scan. The optimal condition plan was determined by comparing the dosimetric performance of the each plan with the use of various parameters which include three different techniques (CRT, IMRT, HT) and 4 angle (0, 15, 30, 40 degree). The each treatment plans of three different techniques were compared with the following parameters: conformity index (CI), homogeneity index (HI), target coverage, dose in the OARs, monitor units (MU), beam on time and the normal tissue complication probability (NTCP). Results: HI, CI and target coverage was most excellent in head angle 30 degree among all angle. When compared by modality, target coverage and CI showed good results in IMRT and TOMO than compared to the CRT. HI at the head angle 0 degrees is 1.137±0.17 (CRT), 1.085±0.09 (IMRT) and 1.077±0.06 (HT). HI at the head angle 30 degrees is 1.056±0.08 (CRT), 1.020±0.05 (IMRT) and 1.022±0.07 (HT). Conclusion: The results of our study show that when head angle tilted at 30 degree, target coverage, HI, CI were improved, and the dose delivered to OAR was reduced compared with conventional supine position in brain radiation therapy. This work was supported by the Radiation Technology R&D program (No. 2013M2A2A7043498) and the Mid-career Researcher Program (2014R1A2A1A10050270) through the National Research Foundation of Korea funded by the Ministry of Science, ICT&Future Planning.« less

An evaluation of the cost-effectiveness of policy navigators to improve access to care for the poor in the Philippines.

PubMed

Solon, Orville; Peabody, John W; Woo, Kimberly; Quimbo, Stella A; Florentino, Jhiedon; Shimkhada, Riti

2009-09-01

Even when health insurance coverage is available, health policies may not be effective at increasing coverage among vulnerable populations. New approaches are needed to improve access to care. We experimentally introduced a novel intervention that uses Policy Navigators to increase health insurance enrollment in a poor population. We used data from the Quality Improvement Demonstration Study (QIDS), a randomized experiment taking place at the district level in the Visayas region of the Philippines. In two arms of the study, we compared the effects of introducing Policy Navigators to controls. The Policy Navigators advocated for improved access to care by providing regular system-level expertise directly to the policy-makers, municipal mayors and governors responsible for paying for and enrolling poor households into the health insurance program. Using regression models, we compared levels of enrollment in our intervention versus control sites. We also assessed the cost-effectiveness of marginal increases in enrollment. We found that Policy Navigators improved enrollment in health insurance between 39% and 102% compared to the controls. Policy navigators were cost-effective at 0.86 USD per enrollee. However, supplementary national government campaigns, which were implemented to further increase coverage, attenuated normal enrollment efforts. Policy Navigators appear to be effective in improving access to care and their success underscores the importance of local-level strategies for improving enrollment.

An Evaluation of the Cost-effectiveness of Policy Navigators to Improve Access to Care for the Poor in the Philippines

PubMed Central

Solon, Orville; Peabody, John W.; Woo, Kimberly; Quimbo, Stella A.; Florentino, Jhiedon; Shimkhada, Riti

2009-01-01

Objectives Even when health insurance coverage is available, health policies may not be effective at increasing coverage among vulnerable populations. New approaches are needed to improve access to care. We experimentally introduced a novel intervention that uses Policy Navigators to increase health insurance enrollment in a poor population. Methods We used data from the Quality Improvement Demonstration Study (QIDS), a randomized experiment taking place at the district level in the Visayas region of the Philippines. In two arms of the study, we compared the effects of introducing Policy Navigators to controls. The Policy Navigators advocated for improved access to care by providing regular system-level expertise directly to the policy-makers, municipal mayors and governors responsible for paying for and enrolling poor households into the health insurance program. Using regression models, we compared levels of enrollment in our intervention versus control sites. We also assessed the cost effectiveness of marginal increases in enrollment. Results We found that Policy Navigators improved enrollment in health insurance between 39 and 102% compared to the controls. Policy navigators were cost-effective at $0.86 USD per enrollee. However, supplementary national government campaigns, which were implemented to further increase coverage, attenuated normal enrollment efforts. Conclusion Policy Navigators appear to be effective in improving access to care and their success underscores the importance of local-level strategies for improving enrollment. PMID:19349090

An Anatomic and Biomechanical Comparison of Bankart Repair Configurations.

PubMed

Judson, Christopher H; Voss, Andreas; Obopilwe, Elifho; Dyrna, Felix; Arciero, Robert A; Shea, Kevin P

2017-11-01

Suture anchor repair for anterior shoulder instability can be performed using a number of different repair techniques, but none has been proven superior in terms of anatomic and biomechanical properties. Purpose/Hypothesis: The purpose was to compare the anatomic footprint coverage and biomechanical characteristics of 4 different Bankart repair techniques: (1) single row with simple sutures, (2) single row with horizontal mattress sutures, (3) double row with sutures, and (4) double row with labral tape. The hypotheses were as follows: (1) double-row techniques would improve the footprint coverage and biomechanical properties compared with single-row techniques, (2) horizontal mattress sutures would increase the footprint coverage compared with simple sutures, and (3) repair techniques with labral tape and sutures would not show different biomechanical properties. Controlled laboratory study. Twenty-four fresh-frozen cadaveric specimens were dissected. The native labrum was removed and the footprint marked and measured. Repair for each of the 4 groups was performed, and the uncovered footprint was measured using a 3-dimensional digitizer. The strength of the repair sites was assessed using a servohydraulic testing machine and a digital video system to record load to failure, cyclic displacement, and stiffness. The double-row repair techniques with sutures and labral tape covered 73.4% and 77.0% of the footprint, respectively. These percentages were significantly higher than the footprint coverage achieved by single-row repair techniques using simple sutures (38.1%) and horizontal mattress sutures (32.8%) ( P < .001). The footprint coverage of the simple suture and horizontal mattress suture groups was not significantly different ( P = .44). There were no significant differences in load to failure, cyclic displacement, or stiffness between the single-row and double-row groups or between the simple suture and horizontal mattress suture techniques. Likewise, there was no difference in the biomechanical properties of the double-row repair techniques with sutures versus labral tape. Double-row repair techniques provided better coverage of the native footprint of the labrum but did not provide superior biomechanical properties compared with single-row repair techniques. There was no difference in footprint coverage or biomechanical strength between the simple suture and horizontal mattress suture repair techniques. Although the double-row repair techniques had no difference in initial strength, they may improve healing in high-risk patients by improving the footprint coverage.

Environmental conditions in health care facilities in low- and middle-income countries: Coverage and inequalities.

PubMed

Cronk, Ryan; Bartram, Jamie

2018-04-01

Safe environmental conditions and the availability of standard precaution items are important to prevent and treat infection in health care facilities (HCFs) and to achieve Sustainable Development Goal (SDG) targets for health and water, sanitation, and hygiene. Baseline coverage estimates for HCFs have yet to be formed for the SDGs; and there is little evidence describing inequalities in coverage. To address this, we produced the first coverage estimates of environmental conditions and standard precaution items in HCFs in low- and middle-income countries (LMICs); and explored factors associated with low coverage. Data from monitoring reports and peer-reviewed literature were systematically compiled; and information on conditions, service levels, and inequalities tabulated. We used logistic regression to identify factors associated with low coverage. Data for 21 indicators of environmental conditions and standard precaution items were compiled from 78 LMICs which were representative of 129,557 HCFs. 50% of HCFs lack piped water, 33% lack improved sanitation, 39% lack handwashing soap, 39% lack adequate infectious waste disposal, 73% lack sterilization equipment, and 59% lack reliable energy services. Using nationally representative data from six countries, 2% of HCFs provide all four of water, sanitation, hygiene, and waste management services. Statistically significant inequalities in coverage exist between HCFs by: urban-rural setting, managing authority, facility type, and sub-national administrative unit. We identified important, previously undocumented inequalities and environmental health challenges faced by HCFs in LMICs. The information and analyses provide evidence for those engaged in improving HCF conditions to develop evidence-based policies and efficient programs, enhance service delivery systems, and make better use of available resources. Copyright © 2018 The Authors. Published by Elsevier GmbH.. All rights reserved.

The Utility and Versatility of Perforator-Based Propeller Flaps in Burn Care.

PubMed

Teven, Chad M; Mhlaba, Julie; O'Connor, Annemarie; Gottlieb, Lawrence J

The majority of surgical burn care involves the use of skin grafts. However, there are cases when flaps are required or provide superior outcomes both in the acute setting and for postburn reconstruction. Rarely discussed in the context of burn care, the perforator-based propeller flap is an important option to consider. We describe our experience with perforator-based propeller flaps in the acute and reconstructive phases of burn care. We reviewed demographics, indications, operative details, and outcomes for patients whose burn care included the use of a perforator-based propeller flap at our institution from May 2007 to April 2015. Details of the surgical technique and individual cases are also discussed. Twenty-one perforator-based propeller flaps were used in the care of 17 burn patients. Six flaps (29%) were used in the acute phase for coverage of exposed joints, tendons, cartilage, and bone; coverage of open wounds; and preservation of range of motion (ROM) by minimizing scar contracture. Fifteen flaps (71%) were used for reconstruction of postburn deformities including coverage of chronic wounds, for coverage after scar contracture release, and to improve ROM. The majority of flaps (94% at follow-up) exhibited stable soft tissue coverage and good or improved ROM of adjacent joints. Three cases of partial flap loss and one case of total flap loss occurred. Perforator-based propeller flaps provide reliable vascularized soft tissue for coverage of vital structures and wounds, contracture release, and preservation of ROM across joints. Despite a relatively significant risk of minor complications particularly in the coverage of chronic wounds, our study supports their utility in both the acute and reconstructive phases of burn care.

Incentives Increase Participation in Mass Dog Rabies Vaccination Clinics and Methods of Coverage Estimation Are Assessed to Be Accurate

PubMed Central

Steinmetz, Melissa; Czupryna, Anna; Bigambo, Machunde; Mzimbiri, Imam; Powell, George; Gwakisa, Paul

2015-01-01

In this study we show that incentives (dog collars and owner wristbands) are effective at increasing owner participation in mass dog rabies vaccination clinics and we conclude that household questionnaire surveys and the mark-re-sight (transect survey) method for estimating post-vaccination coverage are accurate when all dogs, including puppies, are included. Incentives were distributed during central-point rabies vaccination clinics in northern Tanzania to quantify their effect on owner participation. In villages where incentives were handed out participation increased, with an average of 34 more dogs being vaccinated. Through economies of scale, this represents a reduction in the cost-per-dog of $0.47. This represents the price-threshold under which the cost of the incentive used must fall to be economically viable. Additionally, vaccination coverage levels were determined in ten villages through the gold-standard village-wide census technique, as well as through two cheaper and quicker methods (randomized household questionnaire and the transect survey). Cost data were also collected. Both non-gold standard methods were found to be accurate when puppies were included in the calculations, although the transect survey and the household questionnaire survey over- and under-estimated the coverage respectively. Given that additional demographic data can be collected through the household questionnaire survey, and that its estimate of coverage is more conservative, we recommend this method. Despite the use of incentives the average vaccination coverage was below the 70% threshold for eliminating rabies. We discuss the reasons and suggest solutions to improve coverage. Given recent international targets to eliminate rabies, this study provides valuable and timely data to help improve mass dog vaccination programs in Africa and elsewhere. PMID:26633821

Routine Vaccination Coverage in Northern Nigeria: Results from 40 District-Level Cluster Surveys, 2014-2015

PubMed Central

Ogbuanu, Ikechukwu U.; Adegoke, Oluwasegun J.; Scobie, Heather M.; Uba, Belinda V.; Wannemuehler, Kathleen A.; Ruiz, Alicia; Elmousaad, Hashim; Ohuabunwo, Chima J.; Mustafa, Mahmud; Nguku, Patrick; Waziri, Ndadilnasiya Endie; Vertefeuille, John F.

2016-01-01

Background Despite recent success towards controlling poliovirus transmission, Nigeria has struggled to achieve uniformly high routine vaccination coverage. A lack of reliable vaccination coverage data at the operational level makes it challenging to target program improvement. To reliably estimate vaccination coverage, we conducted district-level vaccine coverage surveys using a pre-existing infrastructure of polio technical staff in northern Nigeria. Methods Household-level cluster surveys were conducted in 40 polio high risk districts of Nigeria during 2014–2015. Global positioning system technology and intensive supervision by a pool of qualified technical staff were used to ensure high survey quality. Vaccination status of children aged 12–23 months was documented based on vaccination card or caretaker’s recall. District-level coverage estimates were calculated using survey methods. Results Data from 7,815 children across 40 districts were analyzed. District-level coverage with the third dose of diphtheria-pertussis-tetanus vaccine (DPT3) ranged widely from 1–63%, with all districts having DPT3 coverage below the target of 80%. Median coverage across all districts for each of eight vaccine doses (1 Bacille Calmette-Guérin dose, 3 DPT doses, 3 oral poliovirus vaccine doses, and 1 measles vaccine dose) was <50%. DPT3 coverage by survey was substantially lower (range: 28%–139%) than the 2013 administrative coverage reported among children aged <12 months. Common reported reasons for non-vaccination included lack of knowledge about vaccines and vaccination services (50%) and factors related to access to routine immunization services (15%). Conclusions Survey results highlighted vaccine coverage gaps that were systematically underestimated by administrative reporting across 40 polio high risk districts in northern Nigeria. Given the limitations of administrative coverage data, our approach to conducting quality district-level coverage surveys and providing data to assess and remediate issues contributing to poor vaccination coverage could serve as an example in countries with sub-optimal vaccination coverage, similar to Nigeria. PMID:27936077

Routine Vaccination Coverage in Northern Nigeria: Results from 40 District-Level Cluster Surveys, 2014-2015.

PubMed

Gunnala, Rajni; Ogbuanu, Ikechukwu U; Adegoke, Oluwasegun J; Scobie, Heather M; Uba, Belinda V; Wannemuehler, Kathleen A; Ruiz, Alicia; Elmousaad, Hashim; Ohuabunwo, Chima J; Mustafa, Mahmud; Nguku, Patrick; Waziri, Ndadilnasiya Endie; Vertefeuille, John F

2016-01-01

Despite recent success towards controlling poliovirus transmission, Nigeria has struggled to achieve uniformly high routine vaccination coverage. A lack of reliable vaccination coverage data at the operational level makes it challenging to target program improvement. To reliably estimate vaccination coverage, we conducted district-level vaccine coverage surveys using a pre-existing infrastructure of polio technical staff in northern Nigeria. Household-level cluster surveys were conducted in 40 polio high risk districts of Nigeria during 2014-2015. Global positioning system technology and intensive supervision by a pool of qualified technical staff were used to ensure high survey quality. Vaccination status of children aged 12-23 months was documented based on vaccination card or caretaker's recall. District-level coverage estimates were calculated using survey methods. Data from 7,815 children across 40 districts were analyzed. District-level coverage with the third dose of diphtheria-pertussis-tetanus vaccine (DPT3) ranged widely from 1-63%, with all districts having DPT3 coverage below the target of 80%. Median coverage across all districts for each of eight vaccine doses (1 Bacille Calmette-Guérin dose, 3 DPT doses, 3 oral poliovirus vaccine doses, and 1 measles vaccine dose) was <50%. DPT3 coverage by survey was substantially lower (range: 28%-139%) than the 2013 administrative coverage reported among children aged <12 months. Common reported reasons for non-vaccination included lack of knowledge about vaccines and vaccination services (50%) and factors related to access to routine immunization services (15%). Survey results highlighted vaccine coverage gaps that were systematically underestimated by administrative reporting across 40 polio high risk districts in northern Nigeria. Given the limitations of administrative coverage data, our approach to conducting quality district-level coverage surveys and providing data to assess and remediate issues contributing to poor vaccination coverage could serve as an example in countries with sub-optimal vaccination coverage, similar to Nigeria.

Modeling coverage gaps in haplotype frequencies via Bayesian inference to improve stem cell donor selection.

PubMed

Louzoun, Yoram; Alter, Idan; Gragert, Loren; Albrecht, Mark; Maiers, Martin

2018-05-01

Regardless of sampling depth, accurate genotype imputation is limited in regions of high polymorphism which often have a heavy-tailed haplotype frequency distribution. Many rare haplotypes are thus unobserved. Statistical methods to improve imputation by extending reference haplotype distributions using linkage disequilibrium patterns that relate allele and haplotype frequencies have not yet been explored. In the field of unrelated stem cell transplantation, imputation of highly polymorphic human leukocyte antigen (HLA) genes has an important application in identifying the best-matched stem cell donor when searching large registries totaling over 28,000,000 donors worldwide. Despite these large registry sizes, a significant proportion of searched patients present novel HLA haplotypes. Supporting this observation, HLA population genetic models have indicated that many extant HLA haplotypes remain unobserved. The absent haplotypes are a significant cause of error in haplotype matching. We have applied a Bayesian inference methodology for extending haplotype frequency distributions, using a model where new haplotypes are created by recombination of observed alleles. Applications of this joint probability model offer significant improvement in frequency distribution estimates over the best existing alternative methods, as we illustrate using five-locus HLA frequency data from the National Marrow Donor Program registry. Transplant matching algorithms and disease association studies involving phasing and imputation of rare variants may benefit from this statistical inference framework.

78 FR 71817 - Liquidity Coverage Ratio: Liquidity Risk Measurement, Standards, and Monitoring

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-29

... arising from financial and economic stress, as well as improvements in the measurement and management of... on a 21- calendar day stress scenario rather than a 30 calendar-day stress scenario for bank holding... economic stress. Subsequently, in January 2013, the BCBS issued ``Basel III: The Liquidity Coverage Ratio...

Efficient Deployment of Key Nodes for Optimal Coverage of Industrial Mobile Wireless Networks

PubMed Central

Li, Xiaomin; Li, Di; Dong, Zhijie; Hu, Yage; Liu, Chengliang

2018-01-01

In recent years, industrial wireless networks (IWNs) have been transformed by the introduction of mobile nodes, and they now offer increased extensibility, mobility, and flexibility. Nevertheless, mobile nodes pose efficiency and reliability challenges. Efficient node deployment and management of channel interference directly affect network system performance, particularly for key node placement in clustered wireless networks. This study analyzes this system model, considering both industrial properties of wireless networks and their mobility. Then, static and mobile node coverage problems are unified and simplified to target coverage problems. We propose a novel strategy for the deployment of clustered heads in grouped industrial mobile wireless networks (IMWNs) based on the improved maximal clique model and the iterative computation of new candidate cluster head positions. The maximal cliques are obtained via a double-layer Tabu search. Each cluster head updates its new position via an improved virtual force while moving with full coverage to find the minimal inter-cluster interference. Finally, we develop a simulation environment. The simulation results, based on a performance comparison, show the efficacy of the proposed strategies and their superiority over current approaches. PMID:29439439

Improved candidate generation and coverage analysis methods for design optimization of symmetric multi-satellite constellations

NASA Astrophysics Data System (ADS)

Matossian, Mark G.

1997-01-01

Much attention in recent years has focused on commercial telecommunications ventures involving constellations of spacecraft in low and medium Earth orbit. These projects often require investments on the order of billions of dollars (US$) for development and operations, but surprisingly little work has been published on constellation design optimization for coverage analysis, traffic simulation and launch sequencing for constellation build-up strategies. This paper addresses the two most critical aspects of constellation orbital design — efficient constellation candidate generation and coverage analysis. Inefficiencies and flaws in the current standard algorithm for constellation modeling are identified, and a corrected and improved algorithm is presented. In the 1970's, John Walker and G. V. Mozhaev developed innovative strategies for continuous global coverage using symmetric non-geosynchronous constellations. (These are sometimes referred to as rosette, or Walker constellations. An example is pictured above.) In 1980, the late Arthur Ballard extended and generalized the work of Walker into a detailed algorithm for the NAVSTAR/GPS program, which deployed a 24 satellite symmetric constellation. Ballard's important contribution was published in his "Rosette Constellations of Earth Satellites."

Specialist availability in emergencies: contributions of response times and the use of ad hoc coverage in New York State.

PubMed

Rabin, Elaine; Patrick, Lisa

2016-04-01

Nationwide, hospitals struggle to maintain specialist on-call coverage for emergencies. We seek to further understand the issue by examining reliability of scheduled coverage and the role of ad hoc coverage when none is scheduled. An anonymous electronic survey of all emergency department (ED) directors of a large state. Overall and for 10 specialties, respondents were asked to estimate on-call coverage extent and "reliability" (frequency of emergency response in a clinically useful time frame: 2 hours), and use and effect of ad hoc emergency coverage to fill gaps. Descriptive statistics were performed using Fisher exact and Wilcoxon sign rank tests for significance. Contact information was obtained for 125 of 167 ED directors. Sixty responded (48%), representing 36% of EDs. Forty-six percent reported full on-call coverage scheduled for all specialties. Forty-six percent reported consistent reliability. Coverage and reliability were strongly related (P<.01; 33% reported both), and larger ED volume correlated with both (P<.01). Ninety percent of hospitals that had gaps in either employed ad hoc coverage, significantly improving coverage for 8 of 10 specialties. For all but 1 specialty, more than 20% of hospitals reported that specialists are "Never", "Rarely" or "Sometimes" reliable (more than 50% for cardiovascular surgery, hand surgery and ophthalmology). Significant holes in scheduled on-call specialist coverage are compounded by frequent unreliability of on-call specialists, but partially ameliorated by ad hoc specialist coverage. Regionalization may help because a 2-tiered system may exist: larger hospitals have more complete, reliable coverage. Better understanding of specialists' willingness to treat emergencies ad hoc without taking formal call will suggest additional remedies. Copyright © 2015 Elsevier Inc. All rights reserved.

SU-F-T-87: Comparison of Advanced Radiotherapy Techniques for Post- Mastectomy Breast Cancer Patients

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

Heins, D; Zhang, R; Hogstrom, K

2016-06-15

Purpose: To determine if bolus electron conformal therapy (Bolus-ECT) combined with intensity modulated x-ray therapy (IMXT) and flattening filter free volumetric modulated arc therapy (FFF-VMAT (6x and 10x)) can maintain equal or better dose coverage than standard volumetric modulated arc therapy (Std-VMAT) while reducing doses to organs at risk (OARs). Methods: Bolus-ECT with IMXT, FFF-VMAT, and Std-VMAT treatment plans were produced for ten post-mastectomy radiotherapy (PMRT) patients previously treated at our clinic. The treatment plans were created on commercially available treatment planning system (TPS) and all completed treatment plans were reviewed and approved by a radiation oncologist. The plans weremore » evaluated based on planning target volume (PTV) coverage, tumor control probability (TCP), dose homogeneity index (DHI), conformity index (CI), and dose to organs at risk (OAR). Results: All techniques produced clinically acceptable PMRT plans. Overall, Bolus-ECT with IMXT exhibited higher maximum dose compared to all VMAT techniques. Bolus-ECT with IMXT and FFF-VMAT10x had slightly improved TCP over FFF-VMAT6x and Std-VMAT. However, all VMAT techniques showed improved CI and DHI over Bolus-ECT with IMXT. All techniques showed very similar mean lung dose. Bolus-ECT with IMXT exhibited a reduced mean heart dose over Std-VMAT. Both FFF-VMAT techniques had higher mean heart dose compared to Std-VMAT. In addition, Bolus-ECT with IMXT was able to reduce mean dose to the contralateral breast compared to Std-VMAT and both FFF-VMAT techniques had comparable but slightly reduced dose compared to Std-VMAT. Conclusion: This work has shown that Bolus-ECT with IMXT produces clinically acceptable plans while reducing OAR doses. Both FFF-VMAT techniques are comparable to Std-VMAT with slight improvements. Even though all VMAT techniques produce more homogenous and conformal dose distributions, Bolus-ECT with IMXT is a viable option for treating post-mastectomy patients possibly leading to reduced risks of normal tissue complications.« less

On-Line Electrochemical Reduction of Disulfide Bonds: Improved FTICR-CID and -ETD Coverage of Oxytocin and Hepcidin

NASA Astrophysics Data System (ADS)

Nicolardi, Simone; Giera, Martin; Kooijman, Pieter; Kraj, Agnieszka; Chervet, Jean-Pierre; Deelder, André M.; van der Burgt, Yuri E. M.

2013-12-01

Particularly in the field of middle- and top-down peptide and protein analysis, disulfide bridges can severely hinder fragmentation and thus impede sequence analysis (coverage). Here we present an on-line/electrochemistry/ESI-FTICR-MS approach, which was applied to the analysis of the primary structure of oxytocin, containing one disulfide bridge, and of hepcidin, containing four disulfide bridges. The presented workflow provided up to 80 % (on-line) conversion of disulfide bonds in both peptides. With minimal sample preparation, such reduction resulted in a higher number of peptide backbone cleavages upon CID or ETD fragmentation, and thus yielded improved sequence coverage. The cycle times, including electrode recovery, were rapid and, therefore, might very well be coupled with liquid chromatography for protein or peptide separation, which has great potential for high-throughput analysis.

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

Improving antiretroviral therapy scale-up and effectiveness through service integration and decentralization.

PubMed

Suthar, Amitabh B; Rutherford, George W; Horvath, Tara; Doherty, Meg C; Negussie, Eyerusalem K

2014-03-01

Current service delivery systems do not reach all people in need of antiretroviral therapy (ART). In order to inform the operational and service delivery section of the WHO 2013 consolidated antiretroviral guidelines, our objective was to summarize systematic reviews on integrating ART delivery into maternal, newborn, and child health (MNCH) care settings in countries with generalized epidemics, tuberculosis (TB) treatment settings in which the burden of HIV and TB is high, and settings providing opiate substitution therapy (OST); and decentralizing ART into primary health facilities and communities. A summary of systematic reviews. The reviewers searched PubMed, Embase, PsycINFO, Web of Science, CENTRAL, and the WHO Index Medicus databases. Randomized controlled trials and observational cohort studies were included if they compared ART coverage, retention in HIV care, and/or mortality in MNCH, TB, or OST facilities providing ART with MNCH, TB, or OST facilities providing ART services separately; or primary health facilities or communities providing ART with hospitals providing ART. The reviewers identified 28 studies on integration and decentralization. Antiretroviral therapy integration into MNCH facilities improved ART coverage (relative risk [RR] 1.37, 95% confidence interval [CI] 1.05-1.79) and led to comparable retention in care. ART integration into TB treatment settings improved ART coverage (RR 1.83, 95% CI 1.48-2.23) and led to a nonsignificant reduction in mortality (RR 0.55, 95% CI 0.29-1.05). The limited data on ART integration into OST services indicated comparable rates of ART coverage, retention, and mortality. Partial decentralization into primary health facilities improved retention (RR 1.05, 95% CI 1.01-1.09) and reduced mortality (RR 0.34, 95% CI 0.13-0.87). Full decentralization improved retention (RR 1.12, 95% CI 1.08-1.17) and led to comparable mortality. Community-based ART led to comparable rates of retention and mortality. Integrating ART into MNCH, TB, and OST services was often associated with improvements in ART coverage, and decentralization of ART into primary health facilities and communities was often associated with improved retention. Neither integration nor decentralization was associated with adverse outcomes. These data contributed to recommendations in the WHO 2013 consolidated antiretroviral guidelines to integrate ART delivery into MNCH, TB, and OST services and to decentralize ART.

Inspecting the Mechanism: A Longitudinal Analysis of Socioeconomic Status Differences in Perceived Influenza Risks, Vaccination Intentions, and Vaccination Behaviors during the 2009-2010 Influenza Pandemic.

PubMed

Maurer, Jürgen

2016-10-01

Influenza vaccination is strongly associated with socioeconomic status, but there is only limited evidence on the respective roles of socioeconomic differences in vaccination intentions versus corresponding differences in follow-through on initial vaccination plans for subsequent socioeconomic differences in vaccine uptake. Nonparametric mean smoothing, linear regression, and probit models were used to analyze longitudinal survey data on perceived influenza risks, behavioral vaccination intentions, and vaccination behavior of adults during the 2009-2010 influenza A/H1N1 ("swine flu") pandemic in the United States. Perceived influenza risks and behavioral vaccination intentions were elicited prior to the availability of H1N1 vaccine using a probability scale question format. H1N1 vaccine uptake was assessed at the end of the pandemic. Education, income, and health insurance coverage displayed positive associations with behavioral intentions to get vaccinated for pandemic influenza while employment was negatively associated with stated H1N1 vaccination intentions. Education and health insurance coverage also displayed significant positive associations with pandemic vaccine uptake. Moreover, behavioral vaccination intentions showed a strong and statistically significant positive partial association with later H1N1 vaccination. Incorporating vaccination intentions in a statistical model for H1N1 vaccine uptake further highlighted higher levels of follow-through on initial vaccination plans among persons with higher education levels and health insurance. Sampling bias, misreporting in self-reported data, and limited generalizability to nonpandemic influenza are potential limitations of the analysis. Closing the socioeconomic gap in influenza vaccination requires multipronged strategies that not only increase vaccination intentions by improving knowledge, attitudes, and beliefs but also facilitate follow-through on initial vaccination plans by improving behavioral control and access to vaccination for individuals with low education, employed persons, and the uninsured. © The Author(s) 2015.

Inspecting the Mechanism: A Longitudinal Analysis of Socioeconomic Status Differences in Perceived Influenza Risks, Vaccination Intentions and Vaccination Behaviors during the 2009-2010 Influenza Pandemic

PubMed Central

Maurer, Jürgen

2015-01-01

Background Influenza vaccination is strongly associated with socioeconomic status, but there is only limited evidence on the respective roles of socioeconomic differences in vaccination intentions vs. corresponding differences in follow through on initial vaccination plans for subsequent socioeconomic differences in vaccine uptake. Methods Nonparametric mean smoothing, linear regression and Probit models were used to analyze longitudinal survey data on perceived influenza risks, behavioral vaccination intentions and vaccination behavior of adults during the 2009-10 influenza A/H1N1 (“Swine Flu”) pandemic in the United States. Perceived influenza risks and behavioral vaccination intentions were elicited prior to the availability of H1N1 vaccine using a probability scale question format. H1N1 vaccine uptake was assessed at the end of the pandemic. Results Education, income and health insurance coverage displayed positive associations with behavioral intentions to get vaccinated for pandemic influenza while employment was negatively associated with stated H1N1 vaccination intentions. Education and health insurance coverage also displayed significant positive associations with pandemic vaccine uptake. Moreover, behavioral vaccination intentions showed a strong and statistically significant positive partial association with later H1N1 vaccination. Incorporating vaccination intentions in a statistical model for H1N1 vaccine uptake further highlighted higher levels of follow through on initial vaccination plans among persons with higher education levels and health insurance. Limitations Sampling bias, misreporting in self-reported data, and limited generalizability to non-pandemic influenza are potential limitations of the analysis. Conclusions Closing the socioeconomic gap in influenza vaccination requires multi-pronged strategies that not only increase vaccination intentions by improving knowledge, attitudes and beliefs but also facilitate follow through on initial vaccination plans by improving behavioral control and access to vaccination for individuals with low education, employed persons and the uninsured. PMID:26416814

Trends in Adult Chlamydia and Gonorrhea Prevalence, Incidence and Urethral Discharge Case Reporting in Morocco over 1995-2015-Estimates Using the Spectrum-Sexually Transmitted Infection Model.

PubMed

El-Kettani, Amina; Mahiané, Guy; Bennani, Aziza; Abu-Raddad, Laith; Smolak, Alex; Rowley, Jane; Nagelkerke, Nico; El-Rhilani, Houssine; Alami, Kamal; Hançali, Amina; Korenromp, Eline

2017-09-01

Evolving health priorities and resource constraints mean that countries require data on sexually transmitted infections (STI) trends to inform program planning and resource allocation. The Spectrum modeling tool estimated prevalence and incidence of gonorrhea and chlamydia in Morocco's 15- to 49-year-old population, based on prevalence surveys. Incident cases, broken down between symptomatic and asymptomatic, and treated versus untreated, were compared with urethral discharge (UD) case reports, to estimate reporting completeness among treated UD cases. Gonorrhea prevalence was estimated at 0.37% (95% confidence interval [CI], 0.14-1.0%) in women and 0.32% (0.12-0.87%) in men in 2015; chlamydia prevalences were 3.8% (95% CI, 2.1-6.4%) and 3.0% (95% CI, 1.7-5.1%). Corresponding estimated numbers of new cases in women and men in 2015 were 79,598 (95% CI, 23,918-256,206) and 112,013 (95% CI, 28,700-307,433) for gonorrhea, and 291,908 (95% CI, 161,064-524,270) and 314,032 (95% CI, 186,076-559,133) for chlamydia. Gonorrhea and chlamydia prevalence had declined by an estimated 41% and 27%, respectively, over 1995 to 2015. Prevalence declines probably related to improved STI treatment coverage, and decreasing risk behaviors. Reporting completeness among treated UD cases was estimated at 46% to 77% in 2015. Reported UD cases corresponded to 13% of all estimated (symptomatic and asymptomatic) gonorrhea and chlamydia cases. STI declines and improvements in treatment coverage are consistent with Morocco's introduction of syndromic management in 2000, scale-up of prevention, and declining human immunodeficiency virus incidence. While gonorrhea is four-fold more common as cause of clinical UD cases than chlamydia, Morocco continues to suffer a large, untreated burden of chlamydia. Reliable monitoring of both STIs requires new periodic surveys and/or novel forms of affordable surveillance beyond high-risk populations.

Quad-Tree Visual-Calculus Analysis of Satellite Coverage

NASA Technical Reports Server (NTRS)

Lo, Martin W.; Hockney, George; Kwan, Bruce

2003-01-01

An improved method of analysis of coverage of areas of the Earth by a constellation of radio-communication or scientific-observation satellites has been developed. This method is intended to supplant an older method in which the global-coverage-analysis problem is solved from a ground-to-satellite perspective. The present method provides for rapid and efficient analysis. This method is derived from a satellite-to-ground perspective and involves a unique combination of two techniques for multiresolution representation of map features on the surface of a sphere.

Sampling considerations for disease surveillance in wildlife populations

USGS Publications Warehouse

Nusser, S.M.; Clark, W.R.; Otis, D.L.; Huang, L.

2008-01-01

Disease surveillance in wildlife populations involves detecting the presence of a disease, characterizing its prevalence and spread, and subsequent monitoring. A probability sample of animals selected from the population and corresponding estimators of disease prevalence and detection provide estimates with quantifiable statistical properties, but this approach is rarely used. Although wildlife scientists often assume probability sampling and random disease distributions to calculate sample sizes, convenience samples (i.e., samples of readily available animals) are typically used, and disease distributions are rarely random. We demonstrate how landscape-based simulation can be used to explore properties of estimators from convenience samples in relation to probability samples. We used simulation methods to model what is known about the habitat preferences of the wildlife population, the disease distribution, and the potential biases of the convenience-sample approach. Using chronic wasting disease in free-ranging deer (Odocoileus virginianus) as a simple illustration, we show that using probability sample designs with appropriate estimators provides unbiased surveillance parameter estimates but that the selection bias and coverage errors associated with convenience samples can lead to biased and misleading results. We also suggest practical alternatives to convenience samples that mix probability and convenience sampling. For example, a sample of land areas can be selected using a probability design that oversamples areas with larger animal populations, followed by harvesting of individual animals within sampled areas using a convenience sampling method.

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.

The quest for universal health coverage: achieving social protection for all in Mexico.

PubMed

Knaul, Felicia Marie; González-Pier, Eduardo; Gómez-Dantés, Octavio; García-Junco, David; Arreola-Ornelas, Héctor; Barraza-Lloréns, Mariana; Sandoval, Rosa; Caballero, Francisco; Hernández-Avila, Mauricio; Juan, Mercedes; Kershenobich, David; Nigenda, Gustavo; Ruelas, Enrique; Sepúlveda, Jaime; Tapia, Roberto; Soberón, Guillermo; Chertorivski, Salomón; Frenk, Julio

2012-10-06

Mexico is reaching universal health coverage in 2012. A national health insurance programme called Seguro Popular, introduced in 2003, is providing access to a package of comprehensive health services with financial protection for more than 50 million Mexicans previously excluded from insurance. Universal coverage in Mexico is synonymous with social protection of health. This report analyses the road to universal coverage along three dimensions of protection: against health risks, for patients through quality assurance of health care, and against the financial consequences of disease and injury. We present a conceptual discussion of the transition from labour-based social security to social protection of health, which implies access to effective health care as a universal right based on citizenship, the ethical basis of the Mexican reform. We discuss the conditions that prompted the reform, as well as its design and inception, and we describe the 9-year, evidence-driven implementation process, including updates and improvements to the original programme. The core of the report concentrates on the effects and impacts of the reform, based on analysis of all published and publically available scientific literature and new data. Evidence indicates that Seguro Popular is improving access to health services and reducing the prevalence of catastrophic and impoverishing health expenditures, especially for the poor. Recent studies also show improvement in effective coverage. This research then addresses persistent challenges, including the need to translate financial resources into more effective, equitable and responsive health services. A next generation of reforms will be required and these include systemic measures to complete the reorganisation of the health system by functions. The paper concludes with a discussion of the implications of the Mexican quest to achieve universal health coverage and its relevance for other low-income and middle-income countries. Copyright © 2012 Elsevier Ltd. All rights reserved.

Surveillance of influenza vaccination coverage--United States, 2007-08 through 2011-12 influenza seasons.

PubMed

Lu, Peng-jun; Santibanez, Tammy A; Williams, Walter W; Zhang, Jun; Ding, Helen; Bryan, Leah; O'Halloran, Alissa; Greby, Stacie M; Bridges, Carolyn B; Graitcer, Samuel B; Kennedy, Erin D; Lindley, Megan C; Ahluwalia, Indu B; LaVail, Katherine; Pabst, Laura J; Harris, LaTreace; Vogt, Tara; Town, Machell; Singleton, James A

2013-10-25

Substantial improvement in annual influenza vaccination of recommended groups is needed to reduce the health effects of influenza and reach Healthy People 2020 targets. No single data source provides season-specific estimates of influenza vaccination coverage and related information on place of influenza vaccination and concerns related to influenza and influenza vaccination. 2007-08 through 2011-12 influenza seasons. CDC uses multiple data sources to obtain estimates of vaccination coverage and related data that can guide program and policy decisions to improve coverage. These data sources include the National Health Interview Survey (NHIS), the Behavioral Risk Factor Surveillance System (BRFSS), the National Flu Survey (NFS), the National Immunization Survey (NIS), the Immunization Information Systems (IIS) eight sentinel sites, Internet panel surveys of health-care personnel and pregnant women, and the Pregnancy Risk Assessment and Monitoring System (PRAMS). National influenza vaccination coverage among children aged 6 months-17 years increased from 31.1% during 2007-08 to 56.7% during the 2011-12 influenza season as measured by NHIS. Vaccination coverage among children aged 6 months-17 years varied by state as measured by NIS. Changes from season to season differed as measured by NIS and NHIS. According to IIS sentinel site data, full vaccination (having either one or two seasonal influenza vaccinations, as recommended by the Advisory Committee on Immunization Practices for each influenza season, based on the child's influenza vaccination history) with up to two recommended doses for the 2011-12 season was 27.1% among children aged 6 months-8 years and was 44.3% for the youngest children (aged 6-23 months). Influenza vaccination coverage among adults aged ≥18 years increased from 33.0% during 2007-08 to 38.3% during the 2011-12 influenza season as measured by NHIS. Vaccination coverage by age group for the 2011-12 season as measured by BRFSS was <5 percentage points different from NHIS estimates, whereas NFS estimates were 6-8 percentage points higher than BRFSS estimates. Vaccination coverage among persons aged ≥18 years varied by state as measured by BRFSS. For adults aged ≥18 years, a doctor's office was the most common place for receipt of influenza vaccination (38.4%, BRFSS; 32.5%, NFS) followed by a pharmacy (20.1%, BRFSS; 19.7%, NFS). Overall, 66.9% of health-care personnel (HCP) reported having been vaccinated during the 2011-12 season, as measured by an Internet panel survey of HCP, compared with 62.4%, as estimated through NHIS. Vaccination coverage among pregnant women was 47.0%, as measured by an Internet panel survey of women pregnant during the influenza season, and 43.0%, as measured by BRFSS during the 2011-12 influenza season. Overall, as measured by NFS, 86.8% of adults aged ≥18 years rated the influenza vaccine as very or somewhat effective, and 46.5% of adults aged ≥18 years believed their risk for getting sick with influenza if unvaccinated was high or somewhat high. During the 2011-12 season, influenza vaccination coverage varied by state, age group, and selected populations (e.g., HCP and pregnant women), with coverage estimates well below the Healthy People 2020 goal of 70% for children aged 6 months-17 years, 70% for adults aged ≥18 years, and 90% for HCP. Continued efforts are needed to encourage health-care providers to offer influenza vaccination and to promote public health education efforts among various populations to improve vaccination coverage. Ongoing surveillance to obtain coverage estimates and information regarding other issues related to influenza vaccination (e.g., knowledge, attitudes, and beliefs) is needed to guide program and policy improvements to reduce morbidity and mortality associated with influenza by increasing vaccination rates. Ongoing comparisons of telephone and Internet panel surveys with in-person surveys such as NHIS are needed for appropriate interpretation of data and resulting public health actions. Examination of results from all data sources is necessary to fully assess the various components of influenza vaccination coverage among different populations in the United States.

Think globally, act locally: the role of local demographics and vaccination coverage in the dynamic response of measles infection to control.

PubMed

Ferrari, M J; Grenfell, B T; Strebel, P M

2013-08-05

The global reduction of the burden of morbidity and mortality owing to measles has been a major triumph of public health. However, the continued persistence of measles infection probably not only reflects local variation in progress towards vaccination target goals, but may also reflect local variation in dynamic processes of transmission, susceptible replenishment through births and stochastic local extinction. Dynamic models predict that vaccination should increase the mean age of infection and increase inter-annual variability in incidence. Through a comparative approach, we assess national-level patterns in the mean age of infection and measles persistence. We find that while the classic predictions do hold in general, the impact of vaccination on the age distribution of cases and stochastic fadeout are mediated by local birth rate. Thus, broad-scale vaccine coverage goals are unlikely to have the same impact on the interruption of measles transmission in all demographic settings. Indeed, these results suggest that the achievement of further measles reduction or elimination goals is likely to require programmatic and vaccine coverage goals that are tailored to local demographic conditions.

Walking peptide on Au(110) surface: Origin and nature of interfacial process

NASA Astrophysics Data System (ADS)

Humblot, V.; Tejeda, A.; Landoulsi, J.; Vallée, A.; Naitabdi, A.; Taleb, A.; Pradier, C.-M.

2014-10-01

IGF tri-peptide adsorption on Au(110)-(1 × 2) under Ultra High Vacuum (UHV) conditions has been investigated using surface science techniques such as synchrotron based Angle Resolved X-ray Photoemission Spectroscopy (AR-PES or AR-XPS), Low Energy Electron Diffraction (LEED) and Scanning Tunnelling Microscopy (STM). The behaviour of IGF molecules has been revealed to be coverage dependent; at low coverage, there is formation of islands presenting a chiral self-organised molecular network with a (4 2, - 3 2) symmetry as shown by Low Energy Electron Diffraction (LEED) and Scanning Tunnelling Microscopy (STM) on the unaltered Au(110)-(1 × 2) reconstruction, suggesting significant intermolecular interactions. When the coverage is increased, the islands grow bigger, and one can observe the disappearance of the self-organised network, along with a remarkable destruction of the (1 × 2) substrate reconstruction, as shown by STM. The effect of IGF on the surface gold atoms has been further confirmed by angle-resolved photoemission measurements which suggest a modification of the electronic states with the (1 × 2) symmetry. The resulting molecular organisation, and overall the gold surface disorganisation, prove a strong surface-molecule interaction, which may be probably be explained by a covalent bonding.

One- and two-stage Arrhenius models for pharmaceutical shelf life prediction.

PubMed

Fan, Zhewen; Zhang, Lanju

2015-01-01

One of the most challenging aspects of the pharmaceutical development is the demonstration and estimation of chemical stability. It is imperative that pharmaceutical products be stable for two or more years. Long-term stability studies are required to support such shelf life claim at registration. However, during drug development to facilitate formulation and dosage form selection, an accelerated stability study with stressed storage condition is preferred to quickly obtain a good prediction of shelf life under ambient storage conditions. Such a prediction typically uses Arrhenius equation that describes relationship between degradation rate and temperature (and humidity). Existing methods usually rely on the assumption of normality of the errors. In addition, shelf life projection is usually based on confidence band of a regression line. However, the coverage probability of a method is often overlooked or under-reported. In this paper, we introduce two nonparametric bootstrap procedures for shelf life estimation based on accelerated stability testing, and compare them with a one-stage nonlinear Arrhenius prediction model. Our simulation results demonstrate that one-stage nonlinear Arrhenius method has significant lower coverage than nominal levels. Our bootstrap method gave better coverage and led to a shelf life prediction closer to that based on long-term stability data.

Sociodemographic predictors of variation in coverage of the national shingles vaccination programme in England, 2014/15.

PubMed

Ward, Charlotte; Byrne, Lisa; White, Joanne M; Amirthalingam, Gayatri; Tiley, Karen; Edelstein, Michael

2017-04-25

In September 2013, England introduced a shingles vaccination programme to reduce incidence and severity of shingles in the elderly. This study aims to assess variation in vaccine coverage with regards to selected sociodemographic factors to inform activities for improving equity of the programme. Eligible 70year-olds were identified from a national vaccine coverage dataset in 2014/15 that includes 95% of GPs in England. NHS England Local Team (LT) and index of multiple deprivation (IMD) scores were assigned to patients based on GP-postcode. Vaccine coverage (%) with 95% confidence intervals (CIs), were calculated overall and by LT, ethnicity and IMD, using binomial regression. Of 502,058 eligible adults, 178,808 (35.6%) had ethnicity recorded. Crude vaccine coverage was 59.5% (95%CI: 59.3-59.7). Coverage was lowest in London (49.6% coverage, 95%CI: 49.0-50.2), and compared to this coverage was significantly higher in all other LTs (+6.3 to +10.4, p<0.001) after adjusting for ethnicity and IMD. Coverage decreased with increasing deprivation and was 8.2% lower in the most deprived (95%CI: 7.3-9.1) compared with the least deprived IMD quintile (64.1% coverage, 95%CI: 63.6-64.6), after adjustment for ethnicity and LT. Compared with White-British (60.7% coverage, 95%CI: 60.5-61.0), other ethnic groups had between 4.0% (Indian) and 21.8% (Mixed: White and Black African) lower coverage. After adjusting for IMD and LT, significantly lower coverage by ethnicity persisted in all groups, except in Mixed: Other, Indian and Bangladeshi compared with White-British. After taking geography and deprivation into account, shingles vaccine coverage varied by ethnicity. White-British, Indian and Bangladeshi groups had highest coverage; Mixed: White and Black African, and Black-other ethnicities had the lowest. Patients' ethnicity and IMD are predictors of coverage which contribute to, but do not wholly account for, geographical variation coverage. Interventions to address service-related, sociodemographic and ethnic inequalities in shingles vaccine coverage are required. Copyright © 2017 Elsevier Ltd. All rights reserved.

Whooping cough—where are we now? A review.

PubMed

Kiedrzynski, Tomasz; Bissielo, Ange; Suryaprakash, Mishra; Bandaranayake, Don

2015-06-12

This paper describes the recent trends of pertussis and vaccine uptake in New Zealand based on notifications and immunisation registration information since 2011. It highlights the current risk for the infant in the first months after birth and the crucial role a pertussis booster in pregnancy could play. It also aims to show that protection of infants by the acellular pertussis vaccine can be improved by timely immunisation even in a situation of improving overall uptake rates that are nearing the national target of 95%. We analysed New Zealand notification data for pertussis, extracted from EpiSurv between August 2011 and December 2013, which included the period of the last epidemic. Pertussis immunisation coverage data were extracted from the National Immunisation Register (NIR). Population estimates were based on 2006 census data. Deprivation was analysed using the New Zealand Deprivation Index 2006. Despite immunisation coverage at 12 months having exceeded 90% New Zealand experienced a large epidemic from 2011 to 2014, with several hundred infant hospitalisations and three deaths. Notification data indicated an average annual rate of pertussis in the New Zealand population of 102 per 100,000 with the highest rates in the youngest age groups. While an overall increase in immunisation coverage in New Zealand was evident and the timeliness showed improvement across ethnic groups and deprivation deciles, there was a marked geographical variation within DHBs and between ethnic groups. Given the recent published evidence, pertussis vaccination should be offered to all mothers between weeks 28 and 38 of pregnancy. Further improvements are still possible in coverage at 6 months, particularly in Māori and but also in Pacific populations, as well as in more deprived populations. DHBs work towards achieving the 95% target can contribute to the improvement in the timeliness of immunisation.

Performance-based financing for improving HIV/AIDS service delivery: a systematic review.

PubMed

Suthar, Amitabh B; Nagata, Jason M; Nsanzimana, Sabin; Bärnighausen, Till; Negussie, Eyerusalem K; Doherty, Meg C

2017-01-04

Although domestic HIV/AIDS financing is increasing, international HIV/AIDS financing has plateaued. Providing incentives for the health system (i.e. performance-based financing [PBF]) may help countries achieve more with available resources. We systematically reviewed effects of PBF on HIV/AIDS service delivery to inform WHO guidelines. PubMed, WHO Index Medicus, conference databases, and clinical trial registries were searched in April 2015 for randomised trials, comparative contemporaneous studies, or time-series studies. Studies evaluating PBF in people with HIV were included when they reported service quality, access, or cost. Meta-analyses were not possible due to limited data. This study is registered with PROSPERO, number CRD42015023207. Four studies, published from 2009 to 2015 and including 173,262 people, met the eligibility criteria. All studies were from Sub-Saharan Africa. PBF did not improve individual testing coverage (relative risk [RR], 1.00, 95% confidence interval [CI] 0.89 to 1.13), improved couples testing coverage (RR 1.11, 95% CI 1.02 to 1.20), and improved pregnant women testing coverage (RR 1.29, 95% CI 1.28-1.30). PBF improved coverage of antiretrovirals in pregnant women (RR 1.55, 95% CI 1.50 to 1.59), infants (RR 1.92, 95% CI 1.84 to 2.01), and adults (RR 1.74, 1.64 to 1.85). PBF reduced attrition (RR 0.84, 95% CI 0.74 to 0.96) and treatment failure (odds ratio 0.55, 95% CI 0.32 to 0.97). Potential harms were not reported. Although the limited data suggests PBF positively affected HIV service access and quality, critical health system and governance knowledge gaps remain. More research is needed to inform national policymaking.

Perceptions of randomized security schedules.

PubMed

Scurich, Nicholas; John, Richard S

2014-04-01

Security of infrastructure is a major concern. Traditional security schedules are unable to provide omnipresent coverage; consequently, adversaries can exploit predictable vulnerabilities to their advantage. Randomized security schedules, which randomly deploy security measures, overcome these limitations, but public perceptions of such schedules have not been examined. In this experiment, participants were asked to make a choice between attending a venue that employed a traditional (i.e., search everyone) or a random (i.e., a probability of being searched) security schedule. The absolute probability of detecting contraband was manipulated (i.e., 1/10, 1/4, 1/2) but equivalent between the two schedule types. In general, participants were indifferent to either security schedule, regardless of the probability of detection. The randomized schedule was deemed more convenient, but the traditional schedule was considered fairer and safer. There were no differences between traditional and random schedule in terms of perceived effectiveness or deterrence. Policy implications for the implementation and utilization of randomized schedules are discussed. © 2013 Society for Risk Analysis.

Signal coverage approach to the detection probability of hypothetical extraterrestrial emitters in the Milky Way

PubMed Central

Grimaldi, Claudio

2017-01-01

The lack of evidence for the existence of extraterrestrial life, even the simplest forms of animal life, makes it is difficult to decide whether the search for extraterrestrial intelligence (SETI) is more a high-risk, high-payoff endeavor than a futile attempt. Here we insist that even if extraterrestrial civilizations do exist and communicate, the likelihood of detecting their signals crucially depends on whether the Earth lies within a region of the galaxy covered by such signals. By considering possible populations of independent emitters in the galaxy, we build a statistical model of the domain covered by hypothetical extraterrestrial signals to derive the detection probability that the Earth is within such a domain. We show that for general distributions of the signal longevity and directionality, the mean number of detectable emitters is less than one even for detection probabilities as large as 50%, regardless of the number of emitters in the galaxy. PMID:28401943

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

Newspaper coverage of mental illness in England 2008-2011.

PubMed

Thornicroft, Amalia; Goulden, Robert; Shefer, Guy; Rhydderch, Danielle; Rose, Diana; Williams, Paul; Thornicroft, Graham; Henderson, Claire

2013-04-01

Better newspaper coverage of mental health-related issues is a target for the Time to Change (TTC) anti-stigma programme in England, whose population impact may be influenced by how far concurrent media coverage perpetuates stigma and discrimination. To compare English newspaper coverage of mental health-related topics each year of the TTC social marketing campaign (2009-2011) with baseline coverage in 2008. Content analysis was performed on articles in 27 local and national newspapers on two randomly chosen days each month. There was a significant increase in the proportion of anti-stigmatising articles between 2008 and 2011. There was no concomitant proportional decrease in stigmatising articles, and the contribution of mixed or neutral elements decreased. These findings provide promising results on improvements in press reporting of mental illness during the TTC programme in 2009-2011, and a basis for guidance to newspaper journalists and editors on reporting mental illness.

Implementing the Affordable Care Act: Revisiting the ACA's Essential Health Benefits Requirements.

PubMed

Giovannelli, Justin; Lucia, Kevin W; Corlette, Sabrina

2014-10-01

The Affordable Care Act broadens and strengthens the health insurance benefits available to consumers by requiring insurers to provide coverage of a minimum set of medical services known as "essential health benefits." Federal officials implemented this reform using transitional policies that left many important decisions to the states, while pledging to reassess that approach in time for the 2016 coverage year. This issue brief examines how states have exercised their options under the initial federal essential health benefits framework. We find significant variation in how states have developed their essential health benefits packages, including their approaches to benefit substitution and coverage of habilitative services. Federal regulators should use insurance company data describing enrollees' experiences with their coverage--information called for under the law's delayed transparency requirements--to determine whether states' differing strategies are producing the coverage improvements promised by reform.

Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: Randomized trial assessing non-inferiority in root coverage and superiority in oral health-related quality of life.

PubMed

Tonetti, Maurizio S; Cortellini, Pierpaolo; Pellegrini, Gaia; Nieri, Michele; Bonaccini, Daniele; Allegri, Mario; Bouchard, Philippe; Cairo, Francesco; Conforti, Gianpaolo; Fourmousis, Ioannis; Graziani, Filippo; Guerrero, Adrian; Halben, Jan; Malet, Jacques; Rasperini, Giulio; Topoll, Heinz; Wachtel, Hannes; Wallkamm, Beat; Zabalegui, Ion; Zuhr, Otto

2018-01-01

To evaluate the non-inferiority of the adjunct of a xenogeneic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions and compare superiority in patient-reported outcomes (PROM). One hundred and eighty-seven subjects (92 CMX) with 485 recessions in 14 centres were randomized and followed up for 6 months. Patients filled daily diaries for 15 days to monitor patient-reported experience. The primary outcome was changed in position of the gingival margin. Multilevel analysis used centre, subject and tooth as levels and baseline parameters as covariates. Average baseline recession was 2.5 ± 1.0 mm. The surgery was 15.7 min shorter (95%CI from 11.9 to 19.6, p < .0001) and perceived lighter (11.9 VAS units, 95%CI from 4.6 to 19.1, p = .0014) in CMX subjects. Time to recovery was 1.8 days shorter in CMX. Six-month root coverage was 1.7 ± 1.1 mm for CMX and 2.1 ± 1.0 mm for CTG (difference of 0.44 mm, 95%CI from 0.25 to 0.63 mm). The upper limit of the confidence interval was over the non-inferiority margin of 0.25 mm. Odds of complete root coverage were significantly higher for CTG (OR = 4.0, 95% CI 1.8-8.8). Replacing CTG with CMX shortens time to recovery and decreases morbidity, but the tested generation of devices is probably inferior to autologous CTG in terms of root coverage. Significant variability in PROMs was observed among centres. © 2017 The Authors. Journal of Clinical Periodontology Published by John Wiley & Sons Ltd.

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.

Evaluation of programs to improve complementary feeding in infants and young children.

PubMed

Frongillo, Edward A

2017-10-01

Evaluation of complementary feeding programs is needed to enhance knowledge on what works, to document responsible use of resources, and for advocacy. Evaluation is done during program conceptualization and design, implementation, and determination of effectiveness. This paper explains the role of evaluation in the advancement of complementary feeding programs, presenting concepts and methods and illustrating them through examples. Planning and investments for evaluations should occur from the beginning of the project life cycle. Essential to evaluation is articulation of a program theory on how change would occur and what program actions are required for change. Analysis of program impact pathways makes explicit the dynamic connections in the program theory and accounts for contextual factors that could influence program effectiveness. Evaluating implementation functioning is done through addressing questions about needs, coverage, provision, and utilization using information obtained from process evaluation, operations research, and monitoring. Evaluating effectiveness is done through assessing impact, efficiency, coverage, process, and causality. Plausibility designs ask whether the program seemed to have an effect above and beyond external influences, often using a nonrandomized control group and baseline and end line measures. Probability designs ask whether there was an effect using a randomized control group. Evaluations may not be able to use randomization, particularly for programs implemented at a large scale. Plausibility designs, innovative designs, or innovative combinations of designs sometimes are best able to provide useful information. Further work is needed to develop practical designs for evaluation of large-scale country programs on complementary feeding. © 2017 John Wiley & Sons Ltd.

Proton therapy for locally advanced breast cancer: A systematic review of the literature.

PubMed

Kammerer, Emmanuel; Guevelou, Jennifer Le; Chaikh, Abdulhamid; Danhier, Serge; Geffrelot, Julien; Levy, Christelle; Saloux, Eric; Habrand, Jean-Louis; Thariat, Juliette

2018-02-01

Radiation therapy plays a major role in the management of adjuvant breast cancer with nodal involvement, with an iatrogenic increase of cardio-vascular risk. Photon therapy, even with intensity modulation, has the downsides of high mean heart dose and heterogeneous target coverage, particularly in the case of internal mammary irradiation. This systematic review of the literature aims to evaluate proton therapy in locally advanced breast cancer. PubMed was searched for original full-text articles with the following search terms: «Proton Therapy» and «Breast Cancer». On-going trials were collected using the words "Breast Cancer" and "Protons". 13 articles met the criteria: 6 with passive proton therapy (Double Scattering), 5 with Pencil Beam Scanning (PBS) and 2 with a combination of both. Proton therapy offered a better target coverage than photons, even compared with intensity modulation radiation therapy (including static or rotational IMRT or tomotherapy). With proton therapy, volumes receiving 95% of the dose were around 98%, with low volumes receiving 105% of the dose. Proton therapy often decreased mean heart dose by a factor of 2 or 3, i.e. 1 Gy with proton therapy versus 3 Gy with conventional 3D, and 6 Gy for IMRT. Lungs were better spared with proton therapy than with photon therapy. Cutaneous toxicity observed with double scattering is improved with PBS. Proton therapy reduces mean heart dose in breast cancer irradiation, probably reducing late cardio-vascular toxicity. Large clinical studies will likely confirm a clinical benefit of proton therapy. Copyright © 2017 Elsevier Ltd. All rights reserved.

Impact of m-health application used by community health volunteers on improving utilisation of maternal, new-born and child health care services in a rural area of Uttar Pradesh, India.

PubMed

Prinja, Shankar; Nimesh, Ruby; Gupta, Aditi; Bahuguna, Pankaj; Gupta, Madhu; Thakur, Jarnail Singh

2017-07-01

To raise the quality of counselling by community health volunteers resulting in improved uptake of maternal, neonatal and child health services (MNCH), an m-health application was introduced under a project named 'Reducing Maternal and Newborn Deaths (ReMiND)' in district Kaushambi in India. We report the impact of this project on coverage of key MNCH services. A pre- and post-quasi-experimental design was undertaken to assess the impact of intervention. This project was introduced in two community development blocks in Kaushambi district in 2012. Two other blocks from the same district were selected as controls after matching for coverage of two indicators at baseline - antenatal care and institutional deliveries. The Annual Health Survey conducted by the Ministry of Health and Family Welfare in 2011 served as pre-intervention data, whereas a household survey in four blocks of Kaushambi district in 2015 provided post-intervention coverage of key services. Propensity score matched samples from intervention and control areas in pre-intervention and post-intervention periods were analysed using difference-in-difference method to estimate the impact of ReMiND project. We found a statistically significant increase in coverage of iron-folic acid supplementation (12.58%), self-reporting of complication during pregnancy (13.11%) and after delivery (19.6%) in the intervention area. The coverage of three or more antenatal care visits, tetanus toxoid vaccination, full antenatal care and ambulance usage increased in intervention area by 10.3%, 4.28%, 1.1% and 2.06%, respectively; however, the changes were statistically insignificant. Three of eight services which were targeted for improvement under ReMiND project registered a significant improvement as result of m-health intervention. © 2017 John Wiley & Sons Ltd.

Community-based intervention packages facilitated by NGOs demonstrate plausible evidence for child mortality impact.

PubMed

Ricca, Jim; Kureshy, Nazo; LeBan, Karen; Prosnitz, Debra; Ryan, Leo

2014-03-01

Evidence exists that community-based intervention packages can have substantial child and newborn mortality impact, and may help more countries meet Millennium Development Goal 4 (MDG 4) targets. A non-governmental organization (NGO) project using such programming in Mozambique documented an annual decline in under-five mortality rate (U5MR) of 9.3% in a province in which Demographic and Health Survey (DHS) data showed a 4.2% U5MR decline during the same period. To test the generalizability of this finding, the same analysis was applied to a group of projects funded by the US Agency for International Development. Projects supported implementation of community-based intervention packages aimed at increasing use of health services while improving preventive and home-care practices for children under five. All projects collect baseline and endline population coverage data for key child health interventions. Twelve projects fitted the inclusion criteria. U5MR decline was estimated by modelling these coverage changes in the Lives Saved Tool (LiST) and comparing with concurrent measured DHS mortality data. Average coverage changes for all interventions exceeded average concurrent trends. When population coverage changes were modelled in LiST, they were estimated to give a child mortality improvement in the project area that exceeded concurrent secular trend in the subnational DHS region in 11 of 12 cases. The average improvement in modelled U5MR (5.8%) was more than twice the concurrent directly measured average decline (2.5%). NGO projects implementing community-based intervention packages appear to be effective in reducing child mortality in diverse settings. There is plausible evidence that they raised coverage for a variety of high-impact interventions and improved U5MR by more than twice the concurrent secular trend. All projects used community-based strategies that achieved frequent interpersonal contact for health behaviour change. Further study of the effectiveness and scalability of similar packages should be part of the effort to accelerate progress towards MDG 4.

Health Reform and Utilization of High-Volume Hospitals for Complex Cancer Operations.

PubMed

Loehrer, Andrew P; Chang, David C; Song, Zirui; Chang, George J

2018-01-01

Underinsured patients are less likely to receive complex cancer operations at hospitals with high surgical volumes (high-volume hospitals, or HVHs), which contributes to disparities in care. To date, the impact of insurance coverage expansion on site of complex cancer surgery remains unknown. Using the 2006 Massachusetts coverage expansion as a natural experiment, we searched the Hospital Cost and Utilization Project state inpatient databases for Massachusetts and control states (New York, New Jersey, and Florida) between 2001 and 2011 to evaluate changes in the utilization of HVHs for resections of bladder, esophageal, stomach, pancreatic, rectal, or lung cancer after the expansion of insurance coverage. We studied nonelderly, adult patients with private insurance and those with government-subsidized or self-pay (GSSP) coverage with a difference-in-differences framework. We studied 11,687 patients in Massachusetts and 56,300 patients in control states. Compared with control states, the 2006 Massachusetts insurance expansion was associated with a 14% increased rate of surgical intervention for GSSP patients (incident rate ratio, 1.14; P = .015), but there was no significant change in the probability of GSSP patients undergoing surgery at an HVH (1.0 percentage-point increase; P = .710). The reform was associated with no change in the uninsured payer-mix at HVHs (0.6 percentage-point increase; P = .244) and with a 5.1 percentage-point decrease for the uninsured payer mix at low-volume hospitals ( P < .001). The 2006 Massachusetts insurance expansion, a model for the Affordable Care Act, was associated with increased rates of complex cancer operations and increased insurance coverage but with no change in utilization of HVH for complex cancer operations.