Low earth orbit satellite/terrestrial mobile service compatibility

NASA Technical Reports Server (NTRS)

Sheriff, R. E.; Gardiner, J. G.

1993-01-01

Digital cellular mobile 'second generation' systems are now gradually being introduced into service; one such example is GSM, which will provide a digital voice and data service throughout Europe. Total coverage is not expected to be achieved until the mid '90's, which has resulted in several proposals for the integration of GSM with a geostationary satellite service. Unfortunately, because terrestrial and space systems have been designed to optimize their performance for their particular environment, integration between a satellite and terrestrial system is unlikely to develop further than the satellite providing a back-up service. This lack of system compatibility is now being addressed by system designers of third generation systems. The next generation of mobile systems, referred to as FPLMTS (future public land mobile telecommunication systems) by CCIR and UMTS (universal mobile telecommunication system) in European research programs, are intended to provide inexpensive, hand-held terminals that can operate in either satellite, cellular, or cordless environments. This poses several challenges for system designers, not least in terms of the choice of multiple access technique and power requirements. Satellite mobile services have been dominated by the geostationary orbital type. Recently, however, a number of low earth orbit configurations have been proposed, for example Iridium. These systems are likely to be fully operational by the turn of the century, in time for the implementation of FPLMTS. The developments in LEO mobile satellite service technology were recognized at WARC-92 with the allocation of specific frequency bands for 'big' LEO's, as well as a frequency allocation for FPLMTS which included a specific satellite allocation. When considering integrating a space service into the terrestrial network, LEO's certainly appear to have their attractions: they can provide global coverage, the round trip delay is of the order of tens of milliseconds, and good visibility to the satellite is usually possible. This has resulted in their detailed investigation in the European COST 227 program and in the work program of the European Telecommunications Standards Institute (ETSI). This paper will consider the system implications of integrating a LEO mobile service with a terrestrial service. Results will be presented from simulation software to show how a particular orbital configuration affects the performance of the system in terms of area coverage and visibility to a terminal for various locations and minimum elevation angle. Possible network topologies are then proposed for an integrated satellite/terrestrial network.

Sensor-driven area coverage for an autonomous fixed-wing unmanned aerial vehicle.

PubMed

Paull, Liam; Thibault, Carl; Nagaty, Amr; Seto, Mae; Li, Howard

2014-09-01

Area coverage with an onboard sensor is an important task for an unmanned aerial vehicle (UAV) with many applications. Autonomous fixed-wing UAVs are more appropriate for larger scale area surveying since they can cover ground more quickly. However, their non-holonomic dynamics and susceptibility to disturbances make sensor coverage a challenging task. Most previous approaches to area coverage planning are offline and assume that the UAV can follow the planned trajectory exactly. In this paper, this restriction is removed as the aircraft maintains a coverage map based on its actual pose trajectory and makes control decisions based on that map. The aircraft is able to plan paths in situ based on sensor data and an accurate model of the on-board camera used for coverage. An information theoretic approach is used that selects desired headings that maximize the expected information gain over the coverage map. In addition, the branch entropy concept previously developed for autonomous underwater vehicles is extended to UAVs and ensures that the vehicle is able to achieve its global coverage mission. The coverage map over the workspace uses the projective camera model and compares the expected area of the target on the ground and the actual area covered on the ground by each pixel in the image. The camera is mounted on a two-axis gimbal and can either be stabilized or optimized for maximal coverage. Hardware-in-the-loop simulation results and real hardware implementation on a fixed-wing UAV show the effectiveness of the approach. By including the already developed automatic takeoff and landing capabilities, we now have a fully automated and robust platform for performing aerial imagery surveys.

National health expenditure projections: modest annual growth until coverage expands and economic growth accelerates.

PubMed

Keehan, Sean P; Cuckler, Gigi A; Sisko, Andrea M; Madison, Andrew J; Smith, Sheila D; Lizonitz, Joseph M; Poisal, John A; Wolfe, Christian J

2012-07-01

For 2011-13, US health spending is projected to grow at 4.0 percent, on average--slightly above the historically low growth rate of 3.8 percent in 2009. Preliminary data suggest that growth in consumers' use of health services remained slow in 2011, and this pattern is expected to continue this year and next. In 2014, health spending growth is expected to accelerate to 7.4 percent as the major coverage expansions from the Affordable Care Act begin. For 2011 through 2021, national health spending is projected to grow at an average rate of 5.7 percent annually, which would be 0.9 percentage point faster than the expected annual increase in the gross domestic product during this period. By 2021, federal, state, and local government health care spending is projected to be nearly 50 percent of national health expenditures, up from 46 percent in 2011, with federal spending accounting for about two-thirds of the total government share. Rising government spending on health care is expected to be driven by faster growth in Medicare enrollment, expanded Medicaid coverage, and the introduction of premium and cost-sharing subsidies for health insurance exchange plans.

MULTI-RESOLUTION LAND CHARACTERISTICS FOR THE MID-ATLANTIC INTEGRATED ASSESMENT (MAIA) STUDY AREA

EPA Science Inventory

This data set is a Geographic Information System (GIS) coverage of the land use and land cover for the United States Environmental Protection Agency (USEPA) Mid-Atlantic Integrated Assessment (MAIA) Project region. The coverage was produced using 1988, 1989, 1991,1992, and 1993...

PIPELINES, TRANSMISSION LINES, AND MISCELLANEOUS TRANSPORTATION FEATURES DIGITAL LINE GRAPHS FOR THE MID-ATLANTIC INTEGRATED ASSESSMENT (MAIA) STUDY AREA

EPA Science Inventory

This data set is a geographic information system (GIS) coverage of pipelines, transmission lines, and miscellaneous transportation features for the United States Environmental Protection Agency (USEPA) Mid-Atlantic Integrated Assessment (MAIA) Project region. The coverage was p...

ROAD CLASS 5 TRANSPORTATION DIGITAL LINE GRAPHS FOR THE MID-ATLANTIC INTEGRATED ASSESSMENT (MAIA) STUDY AREA

EPA Science Inventory

This data set is a geographic information system (GIS) coverage of the trails, footbridges, and perimeters of parking areas (Class 5 Roads) for the United States Environmental Protection Agency (USEPA) Mid-Atlantic Integrated Assessment (MAIA) Project region. The coverage was p...

ROAD CLASS 3 TRANSPORTATION DIGITAL LINE GRAPHS FOR THE MID-ATLANTIC INTEGRATED ASSESSMENT (MAIA) STUDY AREA

EPA Science Inventory

This data set is a geographic information system (GIS) coverage of the lower level divided roads and streets (Class 3 Roads) for the United States Environmental Protection Agency (USEPA) Mid-Atlantic Integrated Assessment (MAIA) Project region. The coverage was produced using U...

ROAD CLASS 1 TRANSPORTATION DIGITAL LINE GRAPHS FOR THE MID-ATLANTIC INTEGRATED ASSESSMENT (MAIA) STUDY AREA

EPA Science Inventory

This data set is a geographic information system (GIS) coverage of the Interstate and United States Highways (Class 1 Roads) for the United States Environmental Protection Agency (USEPA) Mid-Atlantic Integrated Assessment (MAIA) Project region. The coverage was produced using U...

ROAD CLASS 4 TRANSPORTATION DIGITAL LINE GRAPHS FOR THE MID-ATLANTIC INTEGRATED ASSESSMENT (MAIA) STUDY AREA

EPA Science Inventory

This data set is a geographic information system (GIS) coverage of the lower level roads and streets (Class 4 Roads) for the United States Environmental Protection Agency (USEPA) Mid-Atlantic Integrated Assessment (MAIA) Project region. The coverage was produced using US Geolog...

ROAD CLASS 2 TRANSPORTATION DIGITAL LINE GRAPHS FOR THE MID-ATLANTIC INTEGRATED ASSESSMENT (MAIA) STUDY AREA

EPA Science Inventory

This data set is a geographic information system (GIS) coverage of the state and county highways (Class 2 Roads) for the United States Environmental Protection Agency (USEPA) Mid-Atlantic Integrated Assessment (MAIA) Project region. The coverage was produced using US Geological...

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

PubMed

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

2011-03-16

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

Less than Expected? How Media Cover Demonstration Turnout

PubMed Central

Wouters, Ruud; Van Camp, Kirsten

2017-01-01

Demonstration turnout is a crucial political resource for social movements. In this article, we investigate how mass media cover demonstration size. We develop a typology of turnout coverage and scrutinize the factors that drive turnout coverage. In addition, we test whether media coverage underestimates, reflects, or exaggerates “guesstimates” by organizers and police forces. Together, these analyses shed light on whether turnout coverage fits a logic of normalization or marginalization. We rely on a unique dataset of 428 demonstrations organized in Brussels (2003–2010). For these demonstrations, we have information on the turnout as reported in national television news, as counted by the police, and as expected by the organizers. We find that media present turnout most often as a fact, rarely as contentious (10 percent). Although few demonstrations pass the media gates, our study yields little to no evidence for a logic of turnout marginalization. Media coverage does not systematically underestimate demonstration size, nor does it blindly follow police counts. Rather, turnout coverage attests of a logic of normalization, following standard news-making practices. The more important the demonstration (size, lead item) and the larger the gap between police and organizer guesstimates, the more attention is paid to turnout in the news. Discussion centers on the generalizability and normative interpretation of the results. PMID:29081881

Modeling the SHG activities of diverse protein crystals

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

Haupert, Levi M.; DeWalt, Emma L.; Simpson, Garth J., E-mail: gsimpson@purdue.edu

2012-11-01

The origins of the diversity in the SHG signal from protein crystals are investigated and potential protein-crystal coverage by SHG microscopy is assessed. A symmetry-additive ab initio model for second-harmonic generation (SHG) activity of protein crystals was applied to assess the likely protein-crystal coverage of SHG microscopy. Calculations were performed for 250 proteins in nine point-group symmetries: a total of 2250 crystals. The model suggests that the crystal symmetry and the limit of detection of the instrument are expected to be the strongest predictors of coverage of the factors considered, which also included secondary-structural content and protein size. Much ofmore » the diversity in SHG activity is expected to arise primarily from the variability in the intrinsic protein response as well as the orientation within the crystal lattice. Two or more orders-of-magnitude variation in intensity are expected even within protein crystals of the same symmetry. SHG measurements of tetragonal lysozyme crystals confirmed detection, from which a protein coverage of ∼84% was estimated based on the proportion of proteins calculated to produce SHG responses greater than that of tetragonal lysozyme. Good agreement was observed between the measured and calculated ratios of the SHG intensity from lysozyme in tetragonal and monoclinic lattices.« less

Addressable-Matrix Integrated-Circuit Test Structure

NASA Technical Reports Server (NTRS)

Sayah, Hoshyar R.; Buehler, Martin G.

1991-01-01

Method of quality control based on use of row- and column-addressable test structure speeds collection of data on widths of resistor lines and coverage of steps in integrated circuits. By use of straightforward mathematical model, line widths and step coverages deduced from measurements of electrical resistances in each of various combinations of lines, steps, and bridges addressable in test structure. Intended for use in evaluating processes and equipment used in manufacture of application-specific integrated circuits.

The need for consumer behavior analysis in health care coverage decisions.

PubMed

Thompson, A M; Rao, C P

1990-01-01

Demographic analysis has been the primary form of analysis connected with health care coverage decisions. This paper reviews past demographic research and shows the need to use behavioral analyses for health care coverage policy decisions. A behavioral model based research study is presented and a case is made for integrated study into why consumers make health care coverage decisions.

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...

Modeling the SHG activities of diverse protein crystals

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

Haupert, Levi M.; DeWalt, Emma L.; Simpson, Garth J.

2012-10-18

A symmetry-additiveab initiomodel for second-harmonic generation (SHG) activity of protein crystals was applied to assess the likely protein-crystal coverage of SHG microscopy. Calculations were performed for 250 proteins in nine point-group symmetries: a total of 2250 crystals. The model suggests that the crystal symmetry and the limit of detection of the instrument are expected to be the strongest predictors of coverage of the factors considered, which also included secondary-structural content and protein size. Much of the diversity in SHG activity is expected to arise primarily from the variability in the intrinsic protein response as well as the orientation within themore » crystal lattice. Two or more orders-of-magnitude variation in intensity are expected even within protein crystals of the same symmetry. SHG measurements of tetragonal lysozyme crystals confirmed detection, from which a protein coverage of ~84% was estimated based on the proportion of proteins calculated to produce SHG responses greater than that of tetragonal lysozyme. Good agreement was observed between the measured and calculated ratios of the SHG intensity from lysozyme in tetragonal and monoclinic lattices.« less

Sensitivity of the orbiting JEM-EUSO mission to large-scale anisotropies

NASA Astrophysics Data System (ADS)

Weiler, Thomas; Anchordoqui, Luis; Denton, Peter

2013-04-01

Uniform sky coverage and very large apertures are advantages of future extreme-energy, space-based cosmic-ray observatories. In this talk we will quantify the advantage of an all-sky/4pi observatory such as JEM-EUSO over the one to two steradian coverage of a ground-based observatory such as Auger. We exploit the availability of spherical harmonics in the case of 4pi coverage. The resulting Y(lm) coefficients will likely become a standard analysis tool for near-future, space-based, cosmic-ray astronomy. We demonstrate the use of Y(lm)'s with extractions of simulated dipole and quadrupole anisotropies. (A dipole anisotropy is expected if a single source-region such as Cen A dominates the sky, while a quadrupole moment is expected if a 2D source region such as the Supergalactic Plane dominates the sky.)

Integrating antiretroviral therapy into antenatal care and maternal and child health settings: a systematic review and meta-analysis

PubMed Central

Hoos, David; Beqiri, Alba; Lorenz-Dehne, Karl; McClure, Craig; Duncombe, Chris

2013-01-01

Abstract Objective To determine whether integrating antiretroviral therapy (ART) into antenatal care (ANC) and maternal and child health (MCH) clinics could improve programmatic and patient outcomes. Methods The authors systematically searched PubMed, Embase, African Index Medicus and LiLACS for randomized controlled trials, prospective cohort studies, or retrospective cohort studies comparing outcomes in ANC or MCH clinics that had and had not integrated ART. The outcomes of interest were ART coverage, ART enrolment, ART retention, mortality and transmission of human immunodeficiency virus (HIV). Findings Four studies met the inclusion criteria. All were conducted in ANC clinics. Increased enrolment of pregnant women in ART was observed in ANC clinics that had integrated ART (relative risk, RR: 2.09; 95% confidence interval, CI; 1.78–2.46; I2: 15%). Increased ART coverage was also noted in such clinics (RR: 1.37; 95% CI: 1.05–1.79; I2: 83%). Sensitivity analyses revealed a trend for the national prevalence of HIV infection to explain the heterogeneity in the size of the effect of ART integration on ART coverage (P = 0.13). Retention in ART was similar in ANC clinics with and without ART integration. Conclusion Although few data were available, ART integration in ANC clinics appears to lead to higher rates of ART enrolment and ART coverage. Rates of retention in ART remain similar to those observed in referral-based models. PMID:23397350

An integrated hyperspectral and SAR satellite constellation for environment monitoring

NASA Astrophysics Data System (ADS)

Wang, Jinnian; Ren, Fuhu; Xie, Chou; An, Jun; Tong, Zhanbo

2017-09-01

A fully-integrated, Hyperspectral optical and SAR (Synthetic Aperture Radar) constellation of small earth observation satellites will be deployed over multiple launches from last December to next five years. The Constellation is expected to comprise a minimum of 16 satellites (8 SAR and 8 optical ) flying in two orbital planes, with each plane consisting of four satellite pairs, equally-spaced around the orbit plane. Each pair of satellites will consist of a hyperspectral/mutispectral optical satellite and a high-resolution SAR satellite (X-band) flying in tandem. The constellation is expected to offer a number of innovative capabilities for environment monitoring. As a pre-launch experiment, two hyperspectral earth observation minisatellites, Spark 01 and 02 were launched as secondary payloads together with Tansat in December 2016 on a CZ-2D rocket. The satellites feature a wide-range hyperspectral imager. The ground resolution is 50 m, covering spectral range from visible to near infrared (420 nm - 1000 nm) and a swath width of 100km. The imager has an average spectral resolution of 5 nm with 148 channels, and a single satellite could obtain hyperspectral imagery with 2.5 million km2 per day, for global coverage every 16 days. This paper describes the potential applications of constellation image in environment monitoring.

Use of Vertically Integrated Ice in WRF-Based Forecasts of Lightning Threat

NASA Technical Reports Server (NTRS)

McCaul, E. W., jr.; Goodman, S. J.

2008-01-01

Previously reported methods of forecasting lightning threat using fields of graupel flux from WRF simulations are extended to include the simulated field of vertically integrated ice within storms. Although the ice integral shows less temporal variability than graupel flux, it provides more areal coverage, and can thus be used to create a lightning forecast that better matches the areal coverage of the lightning threat found in observations of flash extent density. A blended lightning forecast threat can be constructed that retains much of the desirable temporal sensitivity of the graupel flux method, while also incorporating the coverage benefits of the ice integral method. The graupel flux and ice integral fields contributing to the blended forecast are calibrated against observed lightning flash origin density data, based on Lightning Mapping Array observations from a series of case studies chosen to cover a wide range of flash rate conditions. Linear curve fits that pass through the origin are found to be statistically robust for the calibration procedures.

Optimization of Self-Directed Target Coverage in Wireless Multimedia Sensor Network

PubMed Central

Yang, Yang; Wang, Yufei; Pi, Dechang; Wang, Ruchuan

2014-01-01

Video and image sensors in wireless multimedia sensor networks (WMSNs) have directed view and limited sensing angle. So the methods to solve target coverage problem for traditional sensor networks, which use circle sensing model, are not suitable for WMSNs. Based on the FoV (field of view) sensing model and FoV disk model proposed, how expected multimedia sensor covers the target is defined by the deflection angle between target and the sensor's current orientation and the distance between target and the sensor. Then target coverage optimization algorithms based on expected coverage value are presented for single-sensor single-target, multisensor single-target, and single-sensor multitargets problems distinguishingly. Selecting the orientation that sensor rotated to cover every target falling in the FoV disk of that sensor for candidate orientations and using genetic algorithm to multisensor multitargets problem, which has NP-complete complexity, then result in the approximated minimum subset of sensors which covers all the targets in networks. Simulation results show the algorithm's performance and the effect of number of targets on the resulting subset. PMID:25136667

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

Implementing Preventive Chemotherapy through an Integrated National Neglected Tropical Disease Control Program in Mali

PubMed Central

Dembélé, Massitan; Bamani, Sanoussi; Dembélé, Robert; Traoré, Mamadou O.; Goita, Seydou; Traoré, Mamadou Namory; Sidibe, Abdoul Karim; Sam, Letitia; Tuinsma, Marjon; Toubali, Emily; MacArthur, Chad; Baker, Shawn K.; Zhang, Yaobi

2012-01-01

Background Mali is endemic for all five targeted major neglected tropical diseases (NTDs). As one of the five ‘fast-track’ countries supported with the United States Agency for International Development (USAID) funds, Mali started to integrate the activities of existing disease-specific national control programs on these diseases in 2007. The ultimate objectives are to eliminate lymphatic filariasis, onchocerciasis and trachoma as public health problems and to reduce morbidity caused by schistosomiasis and soil-transmitted helminthiasis through regular treatment to eligible populations, and the specific objectives were to achieve 80% program coverage and 100% geographical coverage yearly. The paper reports on the implementation of the integrated mass drug administration and the lessons learned. Methodology/Principal Findings The integrated control program was led by the Ministry of Health and coordinated by the national NTD Control Program. The drug packages were designed according to the disease endemicity in each district and delivered through various platforms to eligible populations involving the primary health care system. Treatment data were recorded and reported by the community drug distributors. After a pilot implementation of integrated drug delivery in three regions in 2007, the treatment for all five targeted NTDs was steadily scaled up to 100% geographical coverage by 2009, and program coverage has since been maintained at a high level: over 85% for lymphatic filariasis, over 90% for onchocerciasis and soil-transmitted helminthiasis, around 90% in school-age children for schistosomiasis, and 76–97% for trachoma. Around 10 million people have received one or more drug packages each year since 2009. No severe cases of adverse effects were reported. Conclusions/Significance Mali has scaled up the drug treatment to national coverage through integrated drug delivery involving the primary health care system. The successes and lessons learned in Mali can be valuable assets to other countries starting up their own integrated national NTD control programs. PMID:22448294

Health Gains and Financial Protection Provided by the Ethiopian Mental Health Strategy: an Extended Cost-Effectiveness Analysis

PubMed Central

Strand, Kirsten Bjerkreim; Fekadu, Abebaw; Chisholm, Dan

2017-01-01

Abstract Background: Mental and neurological (MN) health care has long been neglected in low-income settings. This paper estimates health and non-health impacts of fully publicly financed care for selected key interventions in the National Mental Health Strategy in Ethiopia for depression, bipolar disorder, schizophrenia and epilepsy. Methods: A methodology of extended cost-effectiveness analysis (ECEA) is applied to MN health care in Ethiopia. The impact of providing a package of selected MN interventions free of charge in Ethiopia is estimated for: epilepsy (75% coverage, phenobarbital), depression (30% coverage, fluoxetine, cognitive therapy and proactive case management), bipolar affective disorder (50% coverage, valproate and psychosocial therapy) and schizophrenia (75% coverage, haloperidol plus psychosocial treatment). Multiple outcomes are estimated and disaggregated across wealth quintiles: (1) healthy-life-years (HALYs) gained; (2) household out-of-pocket (OOP) expenditures averted; (3) expected financial risk protection (FRP); and (4) productivity impact. Results: The MN package is expected to cost US$177 million and gain 155,000 HALYs (epilepsy US$37m and 64,500 HALYs; depression US$65m and 61,300 HALYs; bipolar disorder US$44m and 20,300 HALYs; and schizophrenia US$31m and 8,900 HALYs) annually. The health benefits would be concentrated among the poorest groups for all interventions. Universal public finance averts little household OOP expenditures and provides minimal FRP because of the low current utilization of these MN services in Ethiopia. In addition, economic benefits of US$ 51 million annually are expected from depression treatment in Ethiopia as a result of productivity gains, equivalent to 78% of the investment cost. Conclusions: The total MN package in Ethiopia is estimated to cost equivalent to US$1.8 per capita and yields large progressive health benefits. The expected productivity gain is substantially higher than the expected FRP. The ECEA approach seems to fit well with the current policy challenges and captures important equity concerns of scaling up MN programmes. PMID:27935798

High Coverages of Hydrogen on a (10,0) Carbon Nanotube

NASA Technical Reports Server (NTRS)

Bauschlicher, Charles W., Jr.; Arnold, James (Technical Monitor)

2001-01-01

The binding energy of H to a (10,0) carbon nanotube is calculated at 24, 50, and 100% coverage. Several different bonding configurations are considered for the 50% coverage case. Using the ONIOM (our own n-layered integrated molecular orbital and molecular mechanics) approach, the average C-H bond energy for the most stable 50% coverage and for the 100% coverage are 57.3 and 38.6 kcal/mol, respectively. Considering the size of the bond energy of H2, these values suggest that it will be difficult to achieve 100% atomic H coverage on a (10,0) nanotube.

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

PubMed

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

2014-12-01

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

Malawi three district evaluation: Community-based maternal and newborn care economic analysis.

PubMed

Greco, Giulia; Daviaud, Emmanuelle; Owen, Helen; Ligowe, Reuben; Chimbalanga, Emmanuel; Guenther, Tanya; Gamache, Nathalie; Zimba, Evelyn; Lawn, Joy E

2017-10-01

Malawi is one of few low-income countries in sub-Saharan Africa to have met the fourth Millennium Development Goal for child survival (MDG 4). To accelerate progress towards MDGs, the Malawi Ministry of Health's Reproductive Health Unit - in partnership with Save the Children, UNICEF and others - implemented a Community Based Maternal and Newborn Care (CBMNC) package, integrated within the existing community-based system. Multi-purpose Health Surveillance Assistants (HSAs) already employed by the local government were trained to conduct five core home visits. The additional financial costs, including donated items, incurred by the CBMNC package were analysed from the perspective of the provider. The coverage level of HSA home visits (35%) was lower than expected: mothers received an average of 2.8 visits rather than the programme target of five, or the more reasonable target of four given the number of women who would go away from the programme area to deliver. Two were home pregnancy and less than one, postnatal, reflecting greater challenges for the tight time window to achieve postnatal home visits. As a proportion of a 40 hour working week, CBMNC related activities represented an average of 13% of the HSA work week. Modelling for 95% coverage in a population of 100,000, the same number of HSAs could achieve this high coverage and financial programme cost could remain the same. The cost per mother visited would be US$6.6, or US$1.6 per home visit. The financial cost of universal coverage in Malawi would stand at 1.3% of public health expenditure if the programme is rolled out across the country. Higher coverage would increase efficiency of financial investment as well as achieve greater effectiveness. The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Accuracy and coverage of the modernized Polish Maritime differential GPS system

NASA Astrophysics Data System (ADS)

Specht, Cezary

2011-01-01

The DGPS navigation service augments The NAVSTAR Global Positioning System by providing localized pseudorange correction factors and ancillary information which are broadcast over selected marine reference stations. The DGPS service position and integrity information satisfy requirements in coastal navigation and hydrographic surveys. Polish Maritime DGPS system has been established in 1994 and modernized (in 2009) to meet the requirements set out in IMO resolution for a future GNSS, but also to preserve backward signal compatibility of user equipment. Having finalized installation of the new technology L1, L2 reference equipment performance tests were performed.The paper presents results of the coverage modeling and accuracy measuring campaign based on long-term signal analyses of the DGPS reference station Rozewie, which was performed for 26 days in July 2009. Final results allowed to verify the coverage area of the differential signal from reference station and calculated repeatable and absolute accuracy of the system, after the technical modernization. Obtained field strength level area and position statistics (215,000 fixes) were compared to past measurements performed in 2002 (coverage) and 2005 (accuracy), when previous system infrastructure was in operation.So far, no campaigns were performed on differential Galileo. However, as signals, signal processing and receiver techniques are comparable to those know from DGPS. Because all satellite differential GNSS systems use the same transmission standard (RTCM), maritime DGPS Radiobeacons are standardized in all radio communication aspects (frequency, binary rate, modulation), then the accuracy results of differential Galileo can be expected as a similar to DGPS.Coverage of the reference station was calculated based on unique software, which calculate the signal strength level based on transmitter parameters or field signal strength measurement campaign, done in the representative points. The software works based on Baltic sea vector map, ground electric parameters and models atmospheric noise level in the transmission band.

Aerosol Mapping From Space: Strengths, Limitations, and Applications

NASA Technical Reports Server (NTRS)

Kahn, Ralph

2010-01-01

The aerosol data products from the NASA Earth Observing System's MISR and MODIS instruments provide significant advances in regional and global aerosol optical depth (AOD) mapping, aerosol type measurement, and source plume characterization from space. These products have been and are being used for many applications, ranging from regional air quality assessment, to aerosol air mass type identification and evolution, to wildfire smoke injection height and aerosol transport model validation. However, retrieval uncertainties and coverage gaps still limit the quantitative constraints these satellite data place on some important questions, such as global-scale long-term trends and direct aerosol radiative forcing. Major advances in these areas seem to require a different paradigm, involving the integration of satellite with suborbital data and with models. This presentation will briefly summarize where we stand, and what incremental improvements we can expect, with the current MISR and MODIS aerosol products, and will then elaborate on some initial steps aimed at the necessary integration of satellite data with data from other sources and with chemical transport models.

A New Curriculum for Physics Graduate Students

NASA Astrophysics Data System (ADS)

Griesshammer, Harald W.

2012-03-01

Effective Fall 2008, GW Physics implemented a new graduate curriculum, addressing nation-wide problems: (1) wide gap between 50-year-old curricula and the proficiencies expected to start research; (2) high attrition rates and long times to degree; (3) limited resources in small departments to cover all topics deemed essential. The new curriculum: (1) extends each course to 4 hours weekly for better in-depth coverage and cautious additions; (2) decreases the number of core-courses per semester to 2, with less ``parallel-processing'' of only loosely correlated lectures; (3) increases synergies by stricter logical ordering and synchronisation of courses; (4) frees faculty to regularly offer advanced courses; (5) integrates examples tied to ongoing research in our department; (6) integrates computational methods into core-lectures; (7) encourages focusing on concepts and ``meta-cognitive skills'' in studio-like settings. The new curriculum and qualifying exam, its rationale and assessment criteria will be discussed. This concept is tailored to the needs of small departments with only a few research fields and a close student-teacher relationship.

Tertiary Institutions in Ghana Curriculum Coverage on Climate Change: Implications for Climate Change Awareness

ERIC Educational Resources Information Center

Boateng, C. A.

2015-01-01

Global problems such as climate change, which have deeper implications for survival of mankind on this planet, needs to be given wider attention in the quest for knowledge. It is expected that, improved knowledge derived from curriculum coverage may promote greater public awareness of such important global issue. This research aims at examining…

Inaccuracies in Media Coverage of the 1996 and 2000 Presidential Debates.

ERIC Educational Resources Information Center

Benoit, William L.; Currie, Heather

2001-01-01

Compares data from a content analysis of the 1996 and 2000 presidential debates with news coverage of those debates. Concludes that the average newspaper story in 2000 only reported 7% of what the candidates said in a debate. Suggests that voters cannot expect to obtain an accurate or complete representation of presidential debates from media…

National health expenditure projections, 2013-23: faster growth expected with expanded coverage and improving economy.

PubMed

Sisko, Andrea M; Keehan, Sean P; Cuckler, Gigi A; Madison, Andrew J; Smith, Sheila D; Wolfe, Christian J; Stone, Devin A; Lizonitz, Joseph M; Poisal, John A

2014-10-01

In 2013 health spending growth is expected to have remained slow, at 3.6 percent, as a result of the sluggish economic recovery, the effects of sequestration, and continued increases in private health insurance cost-sharing requirements. The combined effects of the Affordable Care Act's coverage expansions, faster economic growth, and population aging are expected to fuel health spending growth this year and thereafter (5.6 percent in 2014 and 6.0 percent per year for 2015-23). However, the average rate of increase through 2023 is projected to be slower than the 7.2 percent average growth experienced during 1990-2008. Because health spending is projected to grow 1.1 percentage points faster than the average economic growth during 2013-23, the health share of the gross domestic product is expected to rise from 17.2 percent in 2012 to 19.3 percent in 2023. Project HOPE—The People-to-People Health Foundation, Inc.

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.

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.

47 CFR 90.743 - Renewal expectancy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... showing must include: (1) A description of its current service in terms of geographic coverage and... relate to any matter described in this paragraph. (c) Phase I non-nationwide licensees have license terms... authorization in order to receive a renewal expectancy. Phase I nationwide licensees and all Phase II licensees...

47 CFR 90.743 - Renewal expectancy.

Code of Federal Regulations, 2011 CFR

2011-10-01

... showing must include: (1) A description of its current service in terms of geographic coverage and... relate to any matter described in this paragraph. (c) Phase I non-nationwide licensees have license terms... authorization in order to receive a renewal expectancy. Phase I nationwide licensees and all Phase II licensees...

PuLSE: Quality control and quantification of peptide sequences explored by phage display libraries.

PubMed

Shave, Steven; Mann, Stefan; Koszela, Joanna; Kerr, Alastair; Auer, Manfred

2018-01-01

The design of highly diverse phage display libraries is based on assumption that DNA bases are incorporated at similar rates within the randomized sequence. As library complexity increases and expected copy numbers of unique sequences decrease, the exploration of library space becomes sparser and the presence of truly random sequences becomes critical. We present the program PuLSE (Phage Library Sequence Evaluation) as a tool for assessing randomness and therefore diversity of phage display libraries. PuLSE runs on a collection of sequence reads in the fastq file format and generates tables profiling the library in terms of unique DNA sequence counts and positions, translated peptide sequences, and normalized 'expected' occurrences from base to residue codon frequencies. The output allows at-a-glance quantitative quality control of a phage library in terms of sequence coverage both at the DNA base and translated protein residue level, which has been missing from toolsets and literature. The open source program PuLSE is available in two formats, a C++ source code package for compilation and integration into existing bioinformatics pipelines and precompiled binaries for ease of use.

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.

Health Gains and Financial Protection Provided by the Ethiopian Mental Health Strategy: an Extended Cost-Effectiveness Analysis.

PubMed

Johansson, Kjell Arne; Strand, Kirsten Bjerkreim; Fekadu, Abebaw; Chisholm, Dan

2017-04-01

Mental and neurological (MN) health care has long been neglected in low-income settings. This paper estimates health and non-health impacts of fully publicly financed care for selected key interventions in the National Mental Health Strategy in Ethiopia for depression, bipolar disorder, schizophrenia and epilepsy. A methodology of extended cost-effectiveness analysis (ECEA) is applied to MN health care in Ethiopia. The impact of providing a package of selected MN interventions free of charge in Ethiopia is estimated for: epilepsy (75% coverage, phenobarbital), depression (30% coverage, fluoxetine, cognitive therapy and proactive case management), bipolar affective disorder (50% coverage, valproate and psychosocial therapy) and schizophrenia (75% coverage, haloperidol plus psychosocial treatment). Multiple outcomes are estimated and disaggregated across wealth quintiles: (1) healthy-life-years (HALYs) gained; (2) household out-of-pocket (OOP) expenditures averted; (3) expected financial risk protection (FRP); and (4) productivity impact. The MN package is expected to cost US$177 million and gain 155,000 HALYs (epilepsy US$37m and 64,500 HALYs; depression US$65m and 61,300 HALYs; bipolar disorder US$44m and 20,300 HALYs; and schizophrenia US$31m and 8,900 HALYs) annually. The health benefits would be concentrated among the poorest groups for all interventions. Universal public finance averts little household OOP expenditures and provides minimal FRP because of the low current utilization of these MN services in Ethiopia. In addition, economic benefits of US$ 51 million annually are expected from depression treatment in Ethiopia as a result of productivity gains, equivalent to 78% of the investment cost. The total MN package in Ethiopia is estimated to cost equivalent to US$1.8 per capita and yields large progressive health benefits. The expected productivity gain is substantially higher than the expected FRP. The ECEA approach seems to fit well with the current policy challenges and captures important equity concerns of scaling up MN programmes. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Nonlinear Pricing in Drug Benefits and Medication Use: The Case of Statin Compliance in Medicare Part D

PubMed Central

Jung, Kyoungrae; Feldman, Roger; McBean, A Marshall

2014-01-01

Objective To examine how enrollees' statin compliance responds to expected prices in Medicare Part D, which features a nonlinear price schedule due to a coverage gap. Data Sources/Study Setting Prescription Drug Event data for a 5 percent random sample of Medicare Advantage Prescription Drug Plan enrollees in 2008 who did not receive a low-income subsidy. Study Design We analyze statin compliance prior to the coverage gap, where the “effective price” is higher than the actual copayment for drugs because consumers anticipate that more spending will make them more likely to reach the gap. We construct each enrollee's effective price as her expected price at the end of the year, which is the weighted average between pre-gap and in-gap copayments with the weight being the predicted probability of hitting the gap. Compliance is defined as at least 80 percent of days covered. Principal Findings Part D enrollees' pre-gap statin compliance decreases by 3.7–4.7 percentage points for a $10 increase in the effective price. Conclusion The presence of a coverage gap decreases statin compliance prior to the gap, suggesting that incorporating expected future prices is important to assess the full impact of cost sharing on drug compliance under nonlinear price schedules. PMID:24354765

Positron states on the Cs/Cu(100) surface

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

Koeymen, A.R.; Lee, K.H.; Mehl, D.

1991-02-01

The attenuation of the CuM{sub 23}VV Auger peak with Cs coverage on Cu(100) is measured using both positron-annihilation-induced Auger electron emission (PAES) and conventional (electron induced) Auger electron spectroscopy (EAES). The Cs coverage varies from 0 to 1 physical monolayer (ML). The data indicates that below 0.5 ML in agreement with first order theoretical calculations the positrons are trapped at the Cu/Cs interface. At higher Cs coverages the thermal desorption of the positrons as positronium drops the PAES intensity to zero whereas the EAES signal changes linearly as expected.

Improving information retrieval with multiple health terminologies in a quality-controlled gateway.

PubMed

Soualmia, Lina F; Sakji, Saoussen; Letord, Catherine; Rollin, Laetitia; Massari, Philippe; Darmoni, Stéfan J

2013-01-01

The Catalog and Index of French-language Health Internet resources (CISMeF) is a quality-controlled health gateway, primarily for Web resources in French (n=89,751). Recently, we achieved a major improvement in the structure of the catalogue by setting-up multiple terminologies, based on twelve health terminologies available in French, to overcome the potential weakness of the MeSH thesaurus, which is the main and pivotal terminology we use for indexing and retrieval since 1995. The main aim of this study was to estimate the added-value of exploiting several terminologies and their semantic relationships to improve Web resource indexing and retrieval in CISMeF, in order to provide additional health resources which meet the users' expectations. Twelve terminologies were integrated into the CISMeF information system to set up multiple-terminologies indexing and retrieval. The same sets of thirty queries were run: (i) by exploiting the hierarchical structure of the MeSH, and (ii) by exploiting the additional twelve terminologies and their semantic links. The two search modes were evaluated and compared. The overall coverage of the multiple-terminologies search mode was improved by comparison to the coverage of using the MeSH (16,283 vs. 14,159) (+15%). These additional findings were estimated at 56.6% relevant results, 24.7% intermediate results and 18.7% irrelevant. The multiple-terminologies approach improved information retrieval. These results suggest that integrating additional health terminologies was able to improve recall. Since performing the study, 21 other terminologies have been added which should enable us to make broader studies in multiple-terminologies information retrieval.

Faith-based organizations and the Affordable Care Act: Reducing Latino mental health care disparities.

PubMed

Villatoro, Alice P; Dixon, Elizabeth; Mays, Vickie M

2016-02-01

The Patient Protection and Affordable Care Act (ACA; 2010) is expected to increase access to mental health care through provisions aimed at increasing health coverage among the nation's uninsured, including 10.2 million eligible Latino adults. The ACA will increase health coverage by expanding Medicaid eligibility to individuals living below 138% of the federal poverty level, subsidizing the purchase of private insurance among individuals not eligible for Medicaid, and requiring employers with 50 or more employees to offer health insurance. An anticipated result of this landmark legislation is improvement in the screening, diagnosis, and treatment of mental disorders in racial/ethnic minorities, particularly for Latinos, who traditionally have had less access to these services. However, these efforts alone may not sufficiently ameliorate mental health care disparities for Latinos. Faith-based organizations (FBOs) could play an integral role in the mental health care of Latinos by increasing help seeking, providing religion-based mental health services, and delivering supportive services that address common access barriers among Latinos. Thus, in determining ways to eliminate Latino mental health care disparities under the ACA, examining pathways into care through the faith-based sector offers unique opportunities to address some of the cultural barriers confronted by this population. We examine how partnerships between FBOs and primary care patient-centered health homes may help reduce the gap of unmet mental health needs among Latinos in this era of health reform. We also describe the challenges FBOs and primary care providers need to overcome to be partners in integrated care efforts. (c) 2016 APA, all rights reserved).

Faith-Based Organizations and the Affordable Care Act: Reducing Latino Mental Healthcare Disparities

PubMed Central

Villatoro, Alice P.; Dixon, Elizabeth; Mays, Vickie M.

2014-01-01

The Patient Protection and Affordable Care Act (ACA) is expected to increase access to mental healthcare through provisions aimed at increasing health coverage among the nation's uninsured, including 10.2 million eligible Latino non-elderly adults. The ACA will increase health coverage by expanding Medicaid eligibility to individuals living below 138% of the federal poverty level, subsidizing the purchase of private insurance among individuals not eligible for Medicaid, and requiring employers with 50 or more employees to offer health insurance. An anticipated result of this landmark legislation is improvement in the screening, diagnosis, and treatment of mental disorders in racial/ethnic minorities, particularly for Latinos, who traditionally have had less access to these services. However, these efforts alone may not sufficiently ameliorate mental healthcare disparities for Latinos. Faith-based organizations (FBOs) could play an integral role in the mental healthcare of Latinos by increasing help-seeking, providing religion-based mental health services, and delivering supportive services that address common access barriers among Latinos. Thus, in determining ways to eliminate Latino mental healthcare disparities under the ACA, examining pathways into care through the faith-based sector offers unique opportunities to address some of the cultural barriers confronted by this population. We examine how partnerships between FBOs and primary care patient-centered medical homes (PCMH) may help reduce the gap of unmet mental health needs among Latinos in this era of health reform. We also describe the challenges FBOs and PCMH providers need to overcome in order to be partners in integrated care efforts. PMID:26845492

Evolving provider payment models and patient access to innovative medical technology.

PubMed

Long, Genia; Mortimer, Richard; Sanzenbacher, Geoffrey

2014-12-01

Abstract Objective: To investigate the evolving use and expected impact of pay-for-performance (P4P) and risk-based provider reimbursement on patient access to innovative medical technology. Structured interviews with leading private payers representing over 110 million commercially-insured lives exploring current and planned use of P4P provider payment models, evidence requirements for technology assessment and new technology coverage, and the evolving relationship between the two topics. Respondents reported rapid increases in the use of P4P and risk-sharing programs, with roughly half of commercial lives affected 3 years ago, just under two-thirds today, and an expected three-quarters in 3 years. All reported well-established systems for evaluating new technology coverage. Five of nine reported becoming more selective in the past 3 years in approving new technologies; four anticipated that in the next 3 years there will be a higher evidence requirement for new technology access. Similarly, four expected it will become more difficult for clinically appropriate but costly technologies to gain coverage. All reported planning to rely more on these types of provider payment incentives to control costs, but didn't see them as a substitute for payer technology reviews and coverage limitations; they each have a role to play. Interviews limited to nine leading payers with models in place; self-reported data. Likely implications include a more uncertain payment environment for providers, and indirectly for innovative medical technology and future investment, greater reliance on quality and financial metrics, and increased evidence requirements for favorable coverage and utilization decisions. Increasing provider financial risk may challenge the traditional technology adoption paradigm, where payers assumed a 'gatekeeping' role and providers a countervailing patient advocacy role with regard to access to new technology. Increased provider financial risk may result in an additional hurdle to the adoption of new technology, rather than substitution of provider- for payer-based gatekeeping.

Education, leadership and partnerships: nursing potential for Universal Health Coverage

PubMed Central

Mendes, Isabel Amélia Costa; Ventura, Carla Aparecida Arena; Trevizan, Maria Auxiliadora; Marchi-Alves, Leila Maria; de Souza-Junior, Valtuir Duarte

2016-01-01

Objective: to discuss possibilities of nursing contribution for universal health coverage. Method: a qualitative study, performed by means of document analysis of the World Health Organization publications highlighting Nursing and Midwifery within universal health coverage. Results: documents published by nursing and midwifery leaders point to the need for coordinated and integrated actions in education, leadership and partnership development. Final Considerations: this article represents a call for nurses, in order to foster reflection and understanding of the relevance of their work on the consolidation of the principles of universal health coverage. PMID:26959333

LEVEL III ECOREGION:ECOREGIONS FOR THE MAIA STUDY REGION

EPA Science Inventory

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

Expansion of Coverage under the Patient Protection and Affordable Care Act and Primary Care Utilization

PubMed Central

Hofer, Adam N; Abraham, Jean Marie; Moscovice, Ira

2011-01-01

Context: Provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA) expand Medicaid to all individuals in families earning less than 133 percent of the federal poverty level (FPL) and make available subsidies to uninsured lower-income Americans (133 to 400 percent of FPL) without access to employer-based coverage to purchase insurance in new exchanges. Since primary care physicians typically serve as the point of entry into the health care delivery system, an adequate supply of them is critical to meeting the anticipated increase in demand for medical care resulting from the expansion of coverage. This article provides state-level estimates of the anticipated increases in primary care utilization given the PPACA's provisions for expanded coverage. Methods: Using the Medical Expenditure Panel Survey, this article estimates a multivariate regression model of annual primary care utilization. Using the model estimates and state-level information regarding the number of uninsured, it predicts, by state, the change in primary care visits expected from the expanded coverage. Finally, the article predicts the number of primary care physicians needed to accommodate this change in utilization. Findings: This expanded coverage is predicted to increase by 2019 the number of annual primary care visits between 15.07 million and 24.26 million. Assuming stable levels of physicians’ productivity, between 4,307 and 6,940 additional primary care physicians would be needed to accommodate this increase. Conclusions: The PPACA's health insurance expansion parameters are expected to significantly increase the use of primary care. Two strategies that policymakers may consider are creating stronger financial incentives to attract medical school students to primary care and changing the delivery of care in ways that lead to operational improvements, higher throughput, and better quality of care. PMID:21418313

Benefit-Risk Monitoring of Vaccines Using an Interactive Dashboard: A Methodological Proposal from the ADVANCE Project.

PubMed

Bollaerts, Kaatje; De Smedt, Tom; Donegan, Katherine; Titievsky, Lina; Bauchau, Vincent

2018-03-26

New vaccines are launched based on their benefit-risk (B/R) profile anticipated from clinical development. Proactive post-marketing surveillance is necessary to assess whether the vaccination uptake and the B/R profile are as expected and, ultimately, whether further public health or regulatory actions are needed. There are several, typically not integrated, facets of post-marketing vaccine surveillance: the surveillance of vaccination coverage, vaccine safety, effectiveness and impact. With this work, we aim to assess the feasibility and added value of using an interactive dashboard as a potential methodology for near real-time monitoring of vaccine coverage and pre-specified health benefits and risks of vaccines. We developed a web application with an interactive dashboard for B/R monitoring. The dashboard is demonstrated using simulated electronic healthcare record data mimicking the introduction of rotavirus vaccination in the UK. The interactive dashboard allows end users to select certain parameters, including expected vaccine effectiveness, age groups, and time periods and allows calculation of the incremental net health benefit (INHB) as well as the incremental benefit-risk ratio (IBRR) for different sets of preference weights. We assessed the potential added value of the dashboard by user testing amongst a range of stakeholders experienced in the post-marketing monitoring of vaccines. The dashboard was successfully implemented and demonstrated. The feedback from the potential end users was generally positive, although reluctance to using composite B/R measures was expressed. The use of interactive dashboards for B/R monitoring is promising and received support from various stakeholders. In future research, the use of such an interactive dashboard will be further tested with real-life data as opposed to simulated data.

Implementation of the Integrated Management of Childhood Illnesses strategy: challenges and recommendations in Botswana.

PubMed

Mupara, Lucia U; Lubbe, Johanna C

2016-01-01

Under-five mortality has been a major public health challenge from time immemorial. In response to this challenge, the World Health Organization and the United Nations Children's Fund developed the Integrated Management of Childhood Illnesses (IMCI) strategy and presented it to the whole world as a key approach to reduce child morbidity and mortality. Botswana started to implement the IMCI strategy in 1998. Reductions in the under-five mortality rate (U5MR) have been documented, although the reduction is not on par with the expected Millennium Development Goal 4 predictions. A quantitative study was done to identify the problems IMCI implementers face when tending children under 5 years in the Gaborone Health District of Botswana. The study population was made up of all the IMCI-trained and registered nurses, and systematic sampling was used to randomly select study participants. Questionnaires were used to collect data. The study findings indicated challenges related to low training coverage, health systems, and the unique features of the IMCI strategy. The comprehensive implementation of the IMCI strategy has the potential to significantly influence the U5MR in Botswana.

Care Utilization with China's New Rural Cooperative Medical Scheme: Updated Evidence from the China Health and Retirement Longitudinal Study 2011-2012.

PubMed

Zhang, Donglan; Shi, Lu; Tian, Fang; Zhang, Lingling

2016-12-01

China's New Rural Cooperative Medical Scheme (NRCMS), a healthcare financing system for rural residents in China, underwent significant enhancement since 2008. Studies based on pre-2008 NRCMS data showed an increase in inpatient care utilization after NRCMS coverage. However evidence was mixed for the relationship between outpatient care use and NRCMS coverage. We assessed whether enrollment in the enhanced NRCMS was associated with less delaying or foregoing medical care, as a reduction in foregoing needed care signals about removing liquidity constraint among the enrollees. Using a national sample of rural residents (N = 12,740) from the 2011-2012 wave of China Health and Retirement Longitudinal Study, we examined the association between NRCMS coverage and the likelihood of delaying or foregoing medical care (outpatient and inpatient) by survey-weighted regression models controlling for demographics, education, geographic regions, household expenditures, pre-existing chronic diseases, and access to local healthcare facilities. Zero-inflated negative binomial model was used to estimate the association between NRCMS coverage and number of medical visits. NRCMS coverage was significantly associated with lower odds of delaying or foregoing inpatient care (OR: 0.42, 95 % CI: 0.22-0.81). A negative but insignificant association was found between NRCMS coverage and delaying/foregoing outpatient care when ill. Among those who needed health care, the expected number of outpatient visits for NRCMS enrollees was 1.35 (95 % CI: 1.03-1.77) times of those uninsured, and the expected number of inpatient visits for NRCMS enrollees was 1.83 (95 % CI: 1.16-2.88) times of those uninsured. This study shows that the enhanced NRCMS coverage was associated with less delaying or foregoing inpatient care deemed as necessary by health professionals, which is likely to result from improved financial reimbursement of the NRCMS.

Benefit-Cost Analysis of Integrated Paratransit Systems : Volume 1. Executive Summary.

DOT National Transportation Integrated Search

1979-09-01

Integrated Paratransit (IP) is a concept which involves the integration of conventional fixed-route transit with flexibly routed paratransit services to provide the most effective area-wide transit coverage. The report estimates the benefits and cost...

Hadoop-BAM: directly manipulating next generation sequencing data in the cloud.

PubMed

Niemenmaa, Matti; Kallio, Aleksi; Schumacher, André; Klemelä, Petri; Korpelainen, Eija; Heljanko, Keijo

2012-03-15

Hadoop-BAM is a novel library for the scalable manipulation of aligned next-generation sequencing data in the Hadoop distributed computing framework. It acts as an integration layer between analysis applications and BAM files that are processed using Hadoop. Hadoop-BAM solves the issues related to BAM data access by presenting a convenient API for implementing map and reduce functions that can directly operate on BAM records. It builds on top of the Picard SAM JDK, so tools that rely on the Picard API are expected to be easily convertible to support large-scale distributed processing. In this article we demonstrate the use of Hadoop-BAM by building a coverage summarizing tool for the Chipster genome browser. Our results show that Hadoop offers good scalability, and one should avoid moving data in and out of Hadoop between analysis steps.

Trip-oriented travel time prediction (TOTTP) with historical vehicle trajectories

NASA Astrophysics Data System (ADS)

Xu, Tao; Li, Xiang; Claramunt, Christophe

2018-06-01

Accurate travel time prediction is undoubtedly of importance to both traffic managers and travelers. In highly-urbanized areas, trip-oriented travel time prediction (TOTTP) is valuable to travelers rather than traffic managers as the former usually expect to know the travel time of a trip which may cross over multiple road sections. There are two obstacles to the development of TOTTP, including traffic complexity and traffic data coverage.With large scale historical vehicle trajectory data and meteorology data, this research develops a BPNN-based approach through integrating multiple factors affecting trip travel time into a BPNN model to predict trip-oriented travel time for OD pairs in urban network. Results of experiments demonstrate that it helps discover the dominate trends of travel time changes daily and weekly, and the impact of weather conditions is non-trivial.

Influence of different cusp coverage methods for the extension of ceramic inlays on marginal integrity and enamel crack formation in vitro.

PubMed

Krifka, Stephanie; Stangl, Martin; Wiesbauer, Sarah; Hiller, Karl-Anton; Schmalz, Gottfried; Federlin, Marianne

2009-09-01

No information is available to date about cusp design of thin (1.0 mm) non-functional cusps and its influence upon (1) marginal integrity of ceramic inlays (CI) and partial ceramic crowns (PCC) and (2) crack formation of dental tissues. The aim of this in vitro study was to investigate the effect of cusp coverage of thin non-functional cusps on marginal integrity and enamel crack formation. CI and PCC preparations were performed on extracted human molars. Non-functional cusps were adjusted to 1.0-mm wall thickness and 1.0-mm wall thickness with horizontal reduction of about 2.0 mm. Ceramic restorations (Vita Mark II, Cerec3 System) were adhesively luted with Excite/Variolink II. The specimens were exposed to thermocycling and central mechanical loading. Marginal integrity was assessed by evaluating dye penetration after thermal cycling and mechanical loading. Enamel cracks were documented under a reflective-light microscope. The data were statistically analysed with the Mann-Whitney U test, the Fishers exact test (alpha = 0.05) and the error rates method. PCC with horizontal reduction of non-functional cusps showed statistically significant less microleakage than PCC without such a cusp coverage. Preparation designs with horizontal reduction of non-functional cusps showed a tendency to less enamel crack formation than preparation designs without cusp coverage. Thin non-functional cusp walls of adhesively bonded restorations should be completely covered or reduced to avoid enamel cracks and marginal deficiency.

Engineering Trade-off Considerations Regarding Design-for-Security, Design-for-Verification, and Design-for-Test

NASA Technical Reports Server (NTRS)

Berg, Melanie; Label, Kenneth

2018-01-01

The United States government has identified that application specific integrated circuit (ASIC) and field programmable gate array (FPGA) hardware are at risk from a variety of adversary attacks. This finding affects system security and trust. Consequently, processes are being developed for system mitigation and countermeasure application. The scope of this tutorial pertains to potential vulnerabilities and countermeasures within the ASIC/FPGA design cycle. The presentation demonstrates how design practices can affect the risk for the adversary to: change circuitry, steal intellectual property, and listen to data operations. An important portion of the design cycle is assuring the design is working as specified or as expected. This is accomplished by exhaustive testing of the target design. Alternatively, it has been shown that well established schemes for test coverage enhancement (design-for-verification (DFV) and design-for-test (DFT)) can create conduits for adversary accessibility. As a result, it is essential to perform a trade between robust test coverage versus reliable design implementation. The goal of this tutorial is to explain the evolution of design practices; review adversary accessibility points due to DFV and DFT circuitry insertion (back door circuitry); and to describe common engineering trade-off considerations for test versus adversary threats.

Immobilized Pepsin Microreactor for Rapid Peptide Mapping with Nanoelectrospray Ionization Mass Spectrometry

NASA Astrophysics Data System (ADS)

Long, Ying; Wood, Troy D.

2015-01-01

Most enzymatic microreactors for protein digestion are based on trypsin, but proteins with hydrophobic segments may be difficult to digest because of the paucity of Arg and Lys residues. Microreactors based on pepsin, which is less specific than trypsin, can overcome this challenge. Here, an integrated immobilized pepsin microreactor (IPMR)/nanoelectrospray emitter is examined for its potential for peptide mapping. For myoglobin, equivalent sequence coverage is obtained in a thousandth the time of solution digestion with better sequence coverage. While sequence coverage of cytochrome c is lesser than solution in this short duration, more highly-charged peptic peptides are produced and a number of peaks are unidentified at low-resolution, suggesting that high-resolution mass spectrometry is needed to take full advantage of integrated IPMR/nanoelectrospray devices.

Are country reputations for good and bad leadership on AIDS deserved? An exploratory quantitative analysis.

PubMed

Nattrass, Nicoli

2008-12-01

Some countries (e.g. Brazil) have good reputations on AIDS policy, whereas others, (notably South Africa) have been criticized for inadequate leadership. Cross-country regression analysis reveals that these 'poster children' for AIDS leadership have indeed performed better or worse than expected given their economic and institutional constraints and the demographic and health challenges facing them. Regressions were run on HAART coverage (number on highly active antiretroviral therapy as percentage of total need) and MTCTP coverage (pregnant HIV+ women accessing mother-to-child-transmission prevention services as percentage of total need). Brazil, Cambodia, Thailand and Uganda (all of whom have established reputations for good leadership on AIDS performed consistently better than expected-as did Burkina-Faso, Suriname, Paraguay Costa Rica, Mali and Namibia. South Africa, which has the worst reputation for AIDS leadership, performed significantly below expectations-as did Uruguay and Trinidad and Tobago. The paper thus confirms much of the conventional wisdom on AIDS leadership at country level and suggests new areas for research.

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

PAGER 2.0: an update to the pathway, annotated-list and gene-signature electronic repository for Human Network Biology

PubMed Central

Yue, Zongliang; Zheng, Qi; Neylon, Michael T; Yoo, Minjae; Shin, Jimin; Zhao, Zhiying; Tan, Aik Choon

2018-01-01

Abstract Integrative Gene-set, Network and Pathway Analysis (GNPA) is a powerful data analysis approach developed to help interpret high-throughput omics data. In PAGER 1.0, we demonstrated that researchers can gain unbiased and reproducible biological insights with the introduction of PAGs (Pathways, Annotated-lists and Gene-signatures) as the basic data representation elements. In PAGER 2.0, we improve the utility of integrative GNPA by significantly expanding the coverage of PAGs and PAG-to-PAG relationships in the database, defining a new metric to quantify PAG data qualities, and developing new software features to simplify online integrative GNPA. Specifically, we included 84 282 PAGs spanning 24 different data sources that cover human diseases, published gene-expression signatures, drug–gene, miRNA–gene interactions, pathways and tissue-specific gene expressions. We introduced a new normalized Cohesion Coefficient (nCoCo) score to assess the biological relevance of genes inside a PAG, and RP-score to rank genes and assign gene-specific weights inside a PAG. The companion web interface contains numerous features to help users query and navigate the database content. The database content can be freely downloaded and is compatible with third-party Gene Set Enrichment Analysis tools. We expect PAGER 2.0 to become a major resource in integrative GNPA. PAGER 2.0 is available at http://discovery.informatics.uab.edu/PAGER/. PMID:29126216

CMB-S4 and the hemispherical variance anomaly

NASA Astrophysics Data System (ADS)

O'Dwyer, Márcio; Copi, Craig J.; Knox, Lloyd; Starkman, Glenn D.

2017-09-01

Cosmic microwave background (CMB) full-sky temperature data show a hemispherical asymmetry in power nearly aligned with the Ecliptic. In real space, this anomaly can be quantified by the temperature variance in the Northern and Southern Ecliptic hemispheres, with the Northern hemisphere displaying an anomalously low variance while the Southern hemisphere appears unremarkable [consistent with expectations from the best-fitting theory, Lambda Cold Dark Matter (ΛCDM)]. While this is a well-established result in temperature, the low signal-to-noise ratio in current polarization data prevents a similar comparison. This will change with a proposed ground-based CMB experiment, CMB-S4. With that in mind, we generate realizations of polarization maps constrained by the temperature data and predict the distribution of the hemispherical variance in polarization considering two different sky coverage scenarios possible in CMB-S4: full Ecliptic north coverage and just the portion of the North that can be observed from a ground-based telescope at the high Chilean Atacama plateau. We find that even in the set of realizations constrained by the temperature data, the low Northern hemisphere variance observed in temperature is not expected in polarization. Therefore, observing an anomalously low variance in polarization would make the hypothesis that the temperature anomaly is simply a statistical fluke more unlikely and thus increase the motivation for physical explanations. We show, within ΛCDM, how variance measurements in both sky coverage scenarios are related. We find that the variance makes for a good statistic in cases where the sky coverage is limited, however, full northern coverage is still preferable.

Constellation analysis of an integrated AIS/remote sensing spaceborne system for ship detection

NASA Astrophysics Data System (ADS)

Graziano, Maria Daniela; D'Errico, Marco; Razzano, Elena

2012-08-01

A future system integrating data from remote sensing and upcoming AIS satellites is analyzed through the development of a novel design method for global, discontinuous coverage constellations. It is shown that 8 AIS satellites suffice to guarantee global coverage and a ship location update of 50 min if the spaceborne AIS receiver has a swath of 2800 nm. Furthermore, synergic utilization of COSMO/SkyMed and Radarsat-C data would provide a mean revisit time of 7 h, with AIS information available within 25 min from SAR data acquisition.

46 CFR 349.5 - Reemployment rights and benefits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... and there was not at the time of leaving such employment any reasonable expectation that such... plan, insurance coverage and awards, bonuses, severance pay, supplemental unemployment and benefits...

Trend of hepatocellular carcinoma incidence after Bayesian correction for misclassified data in Iranian provinces.

PubMed

Hajizadeh, Nastaran; Baghestani, Ahmad Reza; Pourhoseingholi, Mohamad Amin; Ashtari, Sara; Fazeli, Zeinab; Vahedi, Mohsen; Zali, Mohammad Reza

2017-05-28

To study the trend of hepatocellular carcinoma incidence after correcting the misclassification in registering cancer incidence across Iranian provinces in cancer registry data. Incidence data of hepatocellular carcinoma were extracted from Iranian annual of national cancer registration reports 2004 to 2008. A Bayesian method was implemented to estimate the rate of misclassification in registering cancer incidence in neighboring province. A beta prior is considered for misclassification parameter. Each time two neighboring provinces were selected to be entered in the Bayesian model based on their expected coverage of cancer cases which is reported by medical university of the province. It is assumed that some cancer cases from a province that has an expected coverage of cancer cases lower than 100% are registered in their neighboring facilitate province with more than 100% expected coverage. There is an increase in the rate of hepatocellular carcinoma in Iran. Among total of 30 provinces of Iran, 21 provinces were selected to be entered to the Bayesian model for correcting the existed misclassification. Provinces with more medical facilities of Iran are Tehran (capital of the country), Razavi Khorasan in north-east of Iran, East Azerbaijan in north-west of the country, Isfahan in central part and near to Tehran, Khozestan and Fars in south and Mazandaran in north of the Iran, had an expected coverage more than their expectation. Those provinces had significantly higher rates of hepatocellular carcinoma than their neighboring provinces. In years 2004 to 2008, it was estimated to be on average 34% misclassification between North Khorasan province and Razavi Khorasan, 43% between South Khorasan province and Razavi Khorasan, 47% between Sistan and balochestan province and Razavi Khorasan, 23% between West Azerbaijan province and East Azerbaijan province, 25% between Ardebil province and East Azerbaijan province, 41% between Hormozgan province and Fars province, 22% betweenChaharmahal and bakhtyari province and Isfahan province, 22% between Kogiloye and boyerahmad province and Isfahan, 22% between Golestan province and Mazandaran province, 43% between Bushehr province and Khozestan province, 41% between Ilam province and Khuzestan province, 42% between Qazvin province and Tehran province, 44% between Markazi province and Tehran, and 30% between Qom province and Tehran. Accounting and correcting the regional misclassification is necessary for identifying high risk areas and planning for reducing the cancer incidence.

The Paralympic Movement: using sports to promote health, disability rights, and social integration for athletes with disabilities.

PubMed

Blauwet, Cheri; Willick, Stuart E

2012-11-01

Competitive sports for people with disabilities has grown rapidly over the past several decades, and opportunities for participation are increasingly available throughout the spectrum from developmental to elite. The Paralympic Games, seen as the pinnacle sporting event that represents the broader Paralympic Movement, has provided a platform to showcase the abilities of people with disabilities while also serving as a catalyst for disability rights through ensuring integration, equality of opportunity, and accessibility of the built environment. Concurrently, media coverage of the Paralympic Games has led to an increased awareness of opportunities for sport participation for individuals with disabilities and, with it, the adjustment of norms regarding expectations for exercise as a component of preventive health. In addition, there is evidence of the power of sports to stimulate confidence, self-efficacy, and a self-perceived high quality of life for individuals with disabilities above and beyond the basic benefits to cardiometabolic fitness. When taken together, the promotion of health, disability rights, and social integration through sports has the power to transform the lives of those who participate and to further stimulate the expansion of opportunities available to the next generation of athletes with disabilities. Copyright © 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

The effect of the illness episode approach on Medicare beneficiaries' health insurance decisions.

PubMed Central

Sofaer, S; Kenney, E; Davidson, B

1992-01-01

This article reports on a quasi-experimental test of the Illness Episode Approach (IEA), a new approach to providing Medicare beneficiaries with information about the financial consequences of alternative health care coverage decisions. Beneficiaries were randomly assigned to free, three-hour workshops, half using materials developed through application of the IEA, half using traditional comparative information on insurance options. Analysis of data collected before and after the workshops indicates that participants in the Illness Episode sessions were more likely to drop duplicative coverage, to spend less on premiums, and to report that their decisions to change coverage had met their expectations. The entire sample of workshop participants showed significant increases in knowledge of Medicare and their own insurance, as well as improved satisfaction with the cost of their health care coverage. PMID:1464539

The likely effects of employer-mandated complementary health insurance on health coverage in France.

PubMed

Pierre, Aurélie; Jusot, Florence

2017-03-01

In France, access to health care greatly depends on having a complementary health insurance coverage (CHI). Thus, the generalisation of CHI became a core factor in the national health strategy created by the government in 2013. The first measure has been to compulsorily extend employer-sponsored CHI to all private sector employees on January 1st, 2016 and improve its portability coverage for unemployed former employees for up to 12 months. Based on data from the 2012 Health, Health Care and Insurance survey, this article provides a simulation of the likely effects of this mandate on CHI coverage and related inequalities in the general population by age, health status, socio-economic characteristics and time and risk preferences. We show that the non-coverage rate that was estimated to be 5% in 2012 will drop to 4% following the generalisation of employer-sponsored CHI and to 3.7% after accounting for portability coverage. The most vulnerable populations are expected to remain more often without CHI whereas non coverage will significantly decrease among the less risk averse and the more present oriented. With its focus on private sector employees, the policy is thus likely to do little for populations that would benefit most from additional insurance coverage while expanding coverage for other populations that appear to place little value on CHI. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Geodetic integration of Sentinel-1A IW data using PSInSAR in Hungary

NASA Astrophysics Data System (ADS)

Farkas, Péter; Hevér, Renáta; Grenerczy, Gyula

2015-04-01

ESA's latest Synthetic Aperture Radar (SAR) mission Sentinel-1 is a huge step forward in SAR interferometry. With its default acquisition mode called the Interferometric Wide Swath Mode (IW) areas through all scales can be mapped with an excellent return time of 12 days (while only the Sentinel-1A is in orbit). Its operational data policy is also a novelty, it allows scientific users free and unlimited access to data. It implements a new type of ScanSAR mode called Terrain Observation with Progressive Scan (TOPS) SAR. It has the same resolution as ScanSAR but with better signal-to-noise ratio distribution. The bigger coverage is achieved by rotation of the antenna in the azimuth direction, therefore it requires very precise co-registration because even errors under a pixel accuracy can introduce azimuth phase variations caused by differences in Doppler-centroids. In our work we will summarize the benefits and the drawbacks of the IW mode. We would like to implement the processing chain of GAMMA Remote Sensing of such data for mapping surface motion with special attention to the co-registration step. Not only traditional InSAR but the advanced method of Persistent Scatterer InSAR (PSInSAR) will be performed and presented as well. PS coverage, along with coherence, is expected to be good due to the small perpendicular and temporal baselines. We would also like to integrate these measurements into national geodetic networks using common reference points. We have installed trihedral corner reflectors at some selected sites to aid precise collocation. Thus, we aim to demonstrate that Sentinel-1 can be effectively used for surface movement detection and monitoring and it can also provide valuable information for the improvement of our networks.

Modular biological function is most effectively captured by combining molecular interaction data types.

PubMed

Ames, Ryan M; Macpherson, Jamie I; Pinney, John W; Lovell, Simon C; Robertson, David L

2013-01-01

Large-scale molecular interaction data sets have the potential to provide a comprehensive, system-wide understanding of biological function. Although individual molecules can be promiscuous in terms of their contribution to function, molecular functions emerge from the specific interactions of molecules giving rise to modular organisation. As functions often derive from a range of mechanisms, we demonstrate that they are best studied using networks derived from different sources. Implementing a graph partitioning algorithm we identify subnetworks in yeast protein-protein interaction (PPI), genetic interaction and gene co-regulation networks. Among these subnetworks we identify cohesive subgraphs that we expect to represent functional modules in the different data types. We demonstrate significant overlap between the subgraphs generated from the different data types and show these overlaps can represent related functions as represented by the Gene Ontology (GO). Next, we investigate the correspondence between our subgraphs and the Gene Ontology. This revealed varying degrees of coverage of the biological process, molecular function and cellular component ontologies, dependent on the data type. For example, subgraphs from the PPI show enrichment for 84%, 58% and 93% of annotated GO terms, respectively. Integrating the interaction data into a combined network increases the coverage of GO. Furthermore, the different annotation types of GO are not predominantly associated with one of the interaction data types. Collectively our results demonstrate that successful capture of functional relationships by network data depends on both the specific biological function being characterised and the type of network data being used. We identify functions that require integrated information to be accurately represented, demonstrating the limitations of individual data types. Combining interaction subnetworks across data types is therefore essential for fully understanding the complex and emergent nature of biological function.

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.

Ultra-thin GaAs single-junction solar cells integrated with a reflective back scattering layer

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

Yang, Weiquan; Becker, Jacob; Liu, Shi

2014-05-28

This paper reports the proposal, design, and demonstration of ultra-thin GaAs single-junction solar cells integrated with a reflective back scattering layer to optimize light management and minimize non-radiative recombination. According to our recently developed semi-analytical model, this design offers one of the highest potential achievable efficiencies for GaAs solar cells possessing typical non-radiative recombination rates found among commercially available III-V arsenide and phosphide materials. The structure of the demonstrated solar cells consists of an In{sub 0.49}Ga{sub 0.51}P/GaAs/In{sub 0.49}Ga{sub 0.51}P double-heterostructure PN junction with an ultra-thin 300 nm thick GaAs absorber, combined with a 5 μm thick Al{sub 0.52}In{sub 0.48}P layer with amore » textured as-grown surface coated with Au used as a reflective back scattering layer. The final devices were fabricated using a substrate-removal and flip-chip bonding process. Solar cells with a top metal contact coverage of 9.7%, and a MgF{sub 2}/ZnS anti-reflective coating demonstrated open-circuit voltages (V{sub oc}) up to 1.00 V, short-circuit current densities (J{sub sc}) up to 24.5 mA/cm{sup 2}, and power conversion efficiencies up to 19.1%; demonstrating the feasibility of this design approach. If a commonly used 2% metal grid coverage is assumed, the anticipated J{sub sc} and conversion efficiency of these devices are expected to reach 26.6 mA/cm{sup 2} and 20.7%, respectively.« less

Integration of Mobil Satellite and Cellular Systems

NASA Technical Reports Server (NTRS)

Drucker, E. H.; Estabrook, P.; Pinck, D.; Ekroot, L.

1993-01-01

By integrating the ground based infrastructure component of a mobile satellite system with the infrastructure systems of terrestrial 800 MHz cellular service providers, a seamless network of universal coverage can be established.

Survey results show that adults are willing to pay higher insurance premiums for generous coverage of specialty drugs.

PubMed

Romley, John A; Sanchez, Yuri; Penrod, John R; Goldman, Dana P

2012-04-01

Generous coverage of specialty drugs for cancer and other diseases may be valuable not only for sick patients currently using these drugs, but also for healthy people who recognize the potential need for them in the future. This study estimated how healthy people value insurance coverage of specialty drugs, defined as high-cost drugs that treat cancer and other serious health conditions like multiple sclerosis, by quantifying willingness to pay via a survey. US adults were estimated to be willing to pay an extra $12.94 on average in insurance premiums per month for generous specialty-drug coverage--in effect, $2.58 for every dollar in out-of-pocket costs that they would expect to pay with a less generous insurance plan. Given the value that people assign to generous coverage of specialty drugs, having high cost sharing on these drugs seemingly runs contrary to what people value in their health insurance.

Moving towards Universal Health Coverage through the Development of Integrated Service Delivery Packages for Primary Health Care in the Solomon Islands

PubMed Central

Whiting, Stephen; Postma, Sjoerd; Jamshaid de Lorenzo, Ayesha; Aumua, Audrey

2016-01-01

The Solomon Islands Government is pursuing integrated care with the goal of improving the quality of health service delivery to rural populations. Under the auspices of Universal Health Coverage, integrated service delivery packages were developed which defined the clinical and public health services that should be provided at different levels of the health system. The process of developing integrated service delivery packages helped to identify key policy decisions the government needed to make in order to improve service quality and efficiency. The integrated service delivery packages have instigated the revision of job descriptions and are feeding into the development of a human resource plan for health. They are also being used to guide infrastructure development and health system planning and should lead to better management of resources. The integrated service delivery packages have become a key tool to operationalise the government’s policy to move towards a more efficient, equitable, quality and sustainable health system. PMID:28321177

Comprehensive molecular characterization of human colon and rectal cancer.

PubMed

2012-07-18

To characterize somatic alterations in colorectal carcinoma, we conducted a genome-scale analysis of 276 samples, analysing exome sequence, DNA copy number, promoter methylation and messenger RNA and microRNA expression. A subset of these samples (97) underwent low-depth-of-coverage whole-genome sequencing. In total, 16% of colorectal carcinomas were found to be hypermutated: three-quarters of these had the expected high microsatellite instability, usually with hypermethylation and MLH1 silencing, and one-quarter had somatic mismatch-repair gene and polymerase ε (POLE) mutations. Excluding the hypermutated cancers, colon and rectum cancers were found to have considerably similar patterns of genomic alteration. Twenty-four genes were significantly mutated, and in addition to the expected APC, TP53, SMAD4, PIK3CA and KRAS mutations, we found frequent mutations in ARID1A, SOX9 and FAM123B. Recurrent copy-number alterations include potentially drug-targetable amplifications of ERBB2 and newly discovered amplification of IGF2. Recurrent chromosomal translocations include the fusion of NAV2 and WNT pathway member TCF7L1. Integrative analyses suggest new markers for aggressive colorectal carcinoma and an important role for MYC-directed transcriptional activation and repression.

Surviving the Current Hard Insurance Market.

ERIC Educational Resources Information Center

Shoaf, Lawrence G.

1986-01-01

School districts can expect to see significant increases in insurance renewal premiums. Advice is offered on safety and loss control procedures, dealing with an insurance broker, and bidding for insurance coverage. (MLF)

Watchdog activity monitor (WAM) for use wth high coverage processor self-test

NASA Technical Reports Server (NTRS)

Tulpule, Bhalchandra R. (Inventor); Crosset, III, Richard W. (Inventor); Versailles, Richard E. (Inventor)

1988-01-01

A high fault coverage, instruction modeled self-test for a signal processor in a user environment is disclosed. The self-test executes a sequence of sub-tests and issues a state transition signal upon the execution of each sub-test. The self-test may be combined with a watchdog activity monitor (WAM) which provides a test-failure signal in the presence of a counted number of state transitions not agreeing with an expected number. An independent measure of time may be provided in the WAM to increase fault coverage by checking the processor's clock. Additionally, redundant processor systems are protected from inadvertent unsevering of a severed processor using a unique unsever arming technique and apparatus.

Internationalizing the Principles of Economics Course: A Survey of Textbooks.

ERIC Educational Resources Information Center

Lee, Daniel Y.

1992-01-01

Examines some widely used introductory economics textbooks. Documents how much international coverage they contain. Seeks any emerging patterns of integration among the texts. Concludes that visible efforts are being made to enhance the coverage of international issues in texts. Suggests that many authors do not live up to claims that…

Past, present and future of Integrated Child Development Services (I.C.D.S.).

PubMed

Lal, S; Sachar, R K

1993-01-01

India's Integrated Child Development Services (ICDS) was established in 33 projects in 1975 and is spread over 22 states; 67 additional projects were begun in 1977, and over the next 2 years; 100 additional projects were added. By 1991=92, coverage was almost 50% of the country with 2696 projects; the expectation is for 100% coverage by the year 2000. An infrastructure chart identifies the organization and integration between level and social welfare and health departments. Objectives are clearly identified and the departments functionally linked. Linkages are achieved by shared space and activities at various levels. Over the past 17 years, services have included minimum needs programs, integrated rural development and poverty alleviation, national health policy and education policy, universal immunization, and the development of women and children in rural areas. ICDS is sponsored 100% by the status and uniquely relies on the honorary anganwadi worker (AWW), who is a woman, recruited and chosen by the community, aged 21-45 years and middle-school educated. The AWW was responsibility for 2000 households or 1000 persons in rural areas and 700 persons in tribal areas. The AWW is crucial to the functioning of the program and receives an honorarium of Rs. 225-275/month for implementing the ICDs program; AWWs have helpers who are paid Rs. 110/month. Training over a 3-year period is conducted at the Bal Sevika Training Institute by the Indian Council of Child Welfare. Additional health personnel and their role and the number of persons/per area AWWS are responsible for, equipment, and functions are also described. The AWW is responsible for nonformal preschool education, organization of supplementary nutrition feeding, health and nutrition education of women and families, immunization of women and children, treatment and referral of common illnesses, growing monitoring, and community participation. Presently, there are 2506 central sector projects and 190 state sector projects and 250,000 AWWs. The preschool education, health, and nutrition programs are summarized. Future directions will encompass future child and mother development and expansion to cover all 90 districts having a birth rate higher than 39/1000. Lessons learned from the past will be integrated and may involve cost containment, acceleration of development of services, alternative services, and giving mothers more responsibility for improving health and nutrition.

X-33 Flight Visualization

NASA Technical Reports Server (NTRS)

Laue, Jay H.

1998-01-01

The X-33 flight visualization effort has resulted in the integration of high-resolution terrain data with vehicle position and attitude data for planned flights of the X-33 vehicle from its launch site at Edwards AFB, California, to landings at Michael Army Air Field, Utah, and Maelstrom AFB, Montana. Video and Web Site representations of these flight visualizations were produced. In addition, a totally new module was developed to control viewpoints in real-time using a joystick input. Efforts have been initiated, and are presently being continued, for real-time flight coverage visualizations using the data streams from the X-33 vehicle flights. The flight visualizations that have resulted thus far give convincing support to the expectation that the flights of the X-33 will be exciting and significant space flight milestones... flights of this nation's one-half scale predecessor to its first single-stage-to-orbit, fully-reusable launch vehicle system.

Acquiring Spectra of Solar System Objects with the NIRSpec Instrument on the James Webb Space Telescope

NASA Astrophysics Data System (ADS)

Proffitt, Charles R.; Birkmann, Stephan; Ferruit, Pierre; Guilbert, Aurelie; Holler, Bryan J.; Stansberry, John

2017-10-01

The NIRSpec Instrument on the James Webb Space Telescope will allow near-IR spectroscopy in the wavelength range between 0.6 and 5.3 microns with resolving power of ~100, 1000, or 2700. We review strategies for performing spectral observations of solar system objects using each of NIRSpec's available observing modes, including the integral field unit (IFU), multi-Object Spectroscopy (MOS), and fixed slit (FS) templates, and discuss how the choice of mode affects the limiting target brightness as well as the detailed wavelength and spatial coverage obtained. We also discuss the expected pointing accuracy and target acquisition options for moving targets, including the use and limitations of the Wide Aperture Target Acquisition (WATA) capability and of the pre-defined field points that will be available for use with the MOS template to enable the use of custom micro-shutter patterns including ones emulating very long slits.

Early changes in intervention coverage and mortality rates following the implementation of an integrated health system intervention in Madagascar.

PubMed

Garchitorena, Andres; Miller, Ann C; Cordier, Laura F; Rabeza, Victor R; Randriamanambintsoa, Marius; Razanadrakato, Hery-Tiana R; Hall, Lara; Gikic, Djordje; Haruna, Justin; McCarty, Meg; Randrianambinina, Andriamihaja; Thomson, Dana R; Atwood, Sidney; Rich, Michael L; Murray, Megan B; Ratsirarson, Josea; Ouenzar, Mohammed Ali; Bonds, Matthew H

2018-01-01

The Sustainable Development Goals framed an unprecedented commitment to achieve global convergence in child and maternal mortality rates through 2030. To meet those targets, essential health services must be scaled via integration with strengthened health systems. This is especially urgent in Madagascar, the country with the lowest level of financing for health in the world. Here, we present an interim evaluation of the first 2 years of a district-level health system strengthening (HSS) initiative in rural Madagascar, using estimates of intervention coverage and mortality rates from a district-wide longitudinal cohort. We carried out a district representative household survey at baseline of the HSS intervention in over 1500 households in Ifanadiana district. The first follow-up was after the first 2 years of the initiative. For each survey, we estimated maternal, newborn and child health (MNCH) coverage, healthcare inequalities and child mortality rates both in the initial intervention catchment area and in the rest of the district. We evaluated changes between the two areas through difference-in-differences analyses. We estimated annual changes in health centre per capita utilisation from 2013 to 2016. The intervention was associated with 19.1% and 36.4% decreases in under-five and neonatal mortality, respectively, although these were not statistically significant. The composite coverage index (a summary measure of MNCH coverage) increased by 30.1%, with a notable 63% increase in deliveries in health facilities. Improvements in coverage were substantially larger in the HSS catchment area and led to an overall reduction in healthcare inequalities. Health centre utilisation rates in the catchment tripled for most types of care during the study period. At the earliest stages of an HSS intervention, the rapid improvements observed for Ifanadiana add to preliminary evidence supporting the untapped and poorly understood potential of integrated HSS interventions on population health.

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

PubMed

Basu, Sanjay; Bendavid, Eran; Sood, Neeraj

2015-11-01

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

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.

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.

The role of television advertising in increasing pneumococcal vaccination coverage among the elderly, North Coast, New South Wales, 2006.

PubMed

Wallace, Cate; Corben, Paul; Turahui, John; Gilmour, Robin

2008-10-01

North Coast Area Health Service (NCAHS) conducted a seven week television advertising campaign to raise community awareness of the availability of free adult pneumococcal vaccination and to increase coverage among North Coast residents in high risk groups. Effectiveness of the campaign was evaluated by examining vaccine ordering patterns of North Coast vaccination providers from 2005/2006 as a proxy for vaccination coverage. In the months during and immediately following (June-September 2006) the advertising campaign, a significantly higher proportion of vaccines were despatched to North Coast immunisation service providers. The advertising campaign was an effective strategy to promote vaccination among NCAHS residents not immunised in the first year of the National Pneumococcal Program for Older Australians. This higher immunisation coverage is expected to contribute to the statewide trend of significant reductions in invasive pneumococcal disease (IPD) notifications.

Expected antenna utilization and overload

NASA Technical Reports Server (NTRS)

Posner, Edward C.

1991-01-01

The trade-offs between the number of antennas at Deep Space Network (DSN) Deep-Space Communications Complex and the fraction of continuous coverage provided to a set of hypothetical spacecraft, assuming random placement of the space craft passes during the day. The trade-offs are fairly robust with respect to the randomness assumption. A sample result is that a three-antenna complex provides an average of 82.6 percent utilization of facilities and coverage of nine spacecraft that each have 8-hour passes, whereas perfect phasing of the passes would yield 100 percent utilization and coverage. One key point is that sometimes fewer than three spacecraft are visible, so an antenna is idle, while at other times, there aren't enough antennas, and some spacecraft do without service. This point of view may be useful in helping to size the network or to develop a normalization for a figure of merit of DSN coverage.

Health Insurance family style: public approaches to reaching the uninsured.

PubMed

Ryan, J M

2001-09-24

This issue brief explores existing and potential opportunities to further expand the availability of health coverage for the uninsured and the under insured, given the current economy and the resulting state budget shortfalls. It also considers the implications of the Health Insurance Flexibility and Accountability initiative recently announced by the Centers for Medicare and Medicaid Services and the legislative options for health care reform being debated in Washington, including tax-credit incentives and additional federal funding for public coverage expansions through Medicaid and the State Children's Health Insurance Program. The Forum session will explore state, federal, and academic perspectives on public coverage expansions and the variety of paths available to support such expansions. The meeting will also address the cost implications of the differing perspectives in the context of the shifting economy. This is expected to lead to a discussion among presenters and participants of the future of and priorities for public financing of health insurance coverage.

Progressive or regressive? A second look at the tax exemption for employer-sponsored health insurance premiums.

PubMed

Schoen, Cathy; Stremikis, Kristof; Collins, Sara; Davis, Karen

2009-05-01

The major argument for capping the exemption of health insurance benefits from income tax is that doing so will generate significant revenue that can be used to finance an expansion of health coverage. This analysis finds that given the state of insurance markets and current variations in premiums, limiting the current exemption could adversely affect individuals who are already at high risk of losing their health coverage. Evidence suggests that capping the exemption for employment-based health insurance could disproportionately affect workers in small firms, older workers, and wage-earners in industries with high expected claims costs. To avoid putting many families at increased health and financial risk, and to avoid undermining employer-sponsored group coverage, any consideration of a cap would have to be combined with coverage for all, changes in insurance market rules, and shared responsibility for financing.

Interactive computation of coverage regions for indoor wireless communication

NASA Astrophysics Data System (ADS)

Abbott, A. Lynn; Bhat, Nitin; Rappaport, Theodore S.

1995-12-01

This paper describes a system which assists in the strategic placement of rf base stations within buildings. Known as the site modeling tool (SMT), this system allows the user to display graphical floor plans and to select base station transceiver parameters, including location and orientation, interactively. The system then computes and highlights estimated coverage regions for each transceiver, enabling the user to assess the total coverage within the building. For single-floor operation, the user can choose between distance-dependent and partition- dependent path-loss models. Similar path-loss models are also available for the case of multiple floors. This paper describes the method used by the system to estimate coverage for both directional and omnidirectional antennas. The site modeling tool is intended to be simple to use by individuals who are not experts at wireless communication system design, and is expected to be very useful in the specification of indoor wireless systems.

Successful introduction of an underutilized elderly pneumococcal vaccine in a national immunization program by integrating the pre-existing public health infrastructure.

PubMed

Yang, Tae Un; Kim, Eunsung; Park, Young-Joon; Kim, Dongwook; Kwon, Yoon Hyung; Shin, Jae Kyong; Park, Ok

2016-03-18

Although pneumococcal vaccines had been recommended for the elderly population in South Korea for a considerable period of time, the coverage has been well below the optimal level. To increase the vaccination rate with integrating the pre-existing public health infrastructure and governmental funding, the Korean government introduced an elderly pneumococcal vaccination into the national immunization program with a 23-valent pneumococcal polysaccharide vaccine in May 2013. The aim of this study was to assess the performance of the program in increasing the vaccine coverage rate and maintaining stable vaccine supply and safe vaccination during the 20 months of the program. We qualitatively and quantitatively analyzed the process of introducing and the outcomes of the program in terms of the systematic organization, efficiency, and stability at the national level. A staggered introduction during the first year utilizing the public sector, with a target coverage of 60%, was implemented based on the public demand for an elderly pneumococcal vaccination, vaccine supply capacity, vaccine delivery capacity, safety, and sustainability. During the 20-month program period, the pneumococcal vaccine coverage rate among the population aged ≥65 years increased from 5.0% to 57.3% without a noticeable vaccine shortage or safety issues. A web-based integrated immunization information system, which includes the immunization registry, vaccine supply chain management, and surveillance of adverse events following immunization, reduced programmatic errors and harmonized the overall performance of the program. Introduction of an elderly pneumococcal vaccination in the national immunization program based on strong government commitment, meticulous preparation, financial support, and the pre-existing public health infrastructure resulted in an efficient, stable, and sustainable increase in vaccination coverage. Copyright © 2016. Published by Elsevier Ltd.

Social Gerontology--Integrative and Territorial Aspects: A Citation Analysis of Subject Scatter and Database Coverage

ERIC Educational Resources Information Center

Lasda Bergman, Elaine M.

2011-01-01

To determine the mix of resources used in social gerontology research, a citation analysis was conducted. A representative sample of citations was selected from three prominent gerontology journals and information was added to determine subject scatter and database coverage for the cited materials. Results indicate that a significant portion of…

Integration of lidar and Landsat ETM+ data for estimating and mapping forest canopy height.

Treesearch

Andrew T. Hudak; Michael A. Lefsky; Warren B. Cohen; Mercedes Berterretche

2002-01-01

Light detection and ranging (LIDAR) data provide accurate measurements of forest canopy structure in the vertical plane; however, current LIDAR sensors have limited coverage in the horizontal plane. Landsat data provide extensive coverage of generalized forest structural classes in the horizontal plane but are relatively insensitive to variation in forest canopy height...

Integrating stations from the North America Gravity Database into a local GPS-based land gravity survey

USGS Publications Warehouse

Shoberg, Thomas G.; Stoddard, Paul R.

2013-01-01

The ability to augment local gravity surveys with additional gravity stations from easily accessible national databases can greatly increase the areal coverage and spatial resolution of a survey. It is, however, necessary to integrate such data seamlessly with the local survey. One challenge to overcome in integrating data from national databases is that these data are typically of unknown quality. This study presents a procedure for the evaluation and seamless integration of gravity data of unknown quality from a national database with data from a local Global Positioning System (GPS)-based survey. The starting components include the latitude, longitude, elevation and observed gravity at each station location. Interpolated surfaces of the complete Bouguer anomaly are used as a means of quality control and comparison. The result is an integrated dataset of varying quality with many stations having GPS accuracy and other reliable stations of unknown origin, yielding a wider coverage and greater spatial resolution than either survey alone.

42 CFR 486.308 - Designation of one OPO for each service area.

Code of Federal Regulations, 2010 CFR

2010-10-01

... CMS establishing that— (1) The waiver is expected to increase organ donations; and (2) The waiver will... FURNISHED BY SUPPLIERS Requirements for Certification and Designation and Conditions for Coverage: Organ...

How to Integrate HIV and Sexual and Reproductive Health Services in Namibia, the Epako Clinic Case Study

PubMed Central

Forster, Norbert; Campuzano, Pedro; Kambapani, Rejoice; Brahmbhatt, Heena; Hidinua, Grace; Turay, Mohamed; Ikandi, Simon Kimathi; Kabongo, Leonard; Zariro, Farai

2017-01-01

Introduction: During the past two decades, HIV and Sexual and Reproductive Health services in Namibia have been provided in silos, with high fragmentation. As a consequence of this, quality and efficiency of services in Primary Health Care has been compromised. Methods: We conducted an operational research (observational pre-post study) in a public health facility in Namibia. A health facility assessment was conducted before and after the integration of health services. A person-centred integrated model was implemented to integrate all health services provided at the health facility in addition to HIV and Sexual and Reproductive Health services. Comprehensive services are provided by each health worker to the same patients over time (longitudinality), on a daily basis (accessibility) and with a good external referral system (coordination). Prevalence rates of time flows and productivity were done. Results: Integrated services improved accessibility, stigma and quality of antenatal care services by improving the provider-patient communication, reducing the time that patients stay in the clinic in 16% and reducing the waiting times in 14%. In addition, nurse productivity improved 85% and the expected time in the health facility was reduced 24% without compromising the uptake of TB, HIV, outpatient, antenatal care or first visit family planning services. Given the success on many indicators resulting from integration of services, the goal of this paper was to describe “how” health services have been integrated, the “process” followed and presenting some “results” from the integrated clinic. Conclusions: Our study shows that HIV and SRH services can be effectively integrated by following the person-centred integrated model. Based on the Namibian experience on “how” to integrate health services and the “process” to achieve it, other African countries can replicate the model to move away from the silo approach and contribute to the achievement of Universal Health Coverage. PMID:28970759

Misconceptions on Missing Data in RAD-seq Phylogenetics with a Deep-scale Example from Flowering Plants.

PubMed

Eaton, Deren A R; Spriggs, Elizabeth L; Park, Brian; Donoghue, Michael J

2017-05-01

Restriction-site associated DNA (RAD) sequencing and related methods rely on the conservation of enzyme recognition sites to isolate homologous DNA fragments for sequencing, with the consequence that mutations disrupting these sites lead to missing information. There is thus a clear expectation for how missing data should be distributed, with fewer loci recovered between more distantly related samples. This observation has led to a related expectation: that RAD-seq data are insufficiently informative for resolving deeper scale phylogenetic relationships. Here we investigate the relationship between missing information among samples at the tips of a tree and information at edges within it. We re-analyze and review the distribution of missing data across ten RAD-seq data sets and carry out simulations to determine expected patterns of missing information. We also present new empirical results for the angiosperm clade Viburnum (Adoxaceae, with a crown age >50 Ma) for which we examine phylogenetic information at different depths in the tree and with varied sequencing effort. The total number of loci, the proportion that are shared, and phylogenetic informativeness varied dramatically across the examined RAD-seq data sets. Insufficient or uneven sequencing coverage accounted for similar proportions of missing data as dropout from mutation-disruption. Simulations reveal that mutation-disruption, which results in phylogenetically distributed missing data, can be distinguished from the more stochastic patterns of missing data caused by low sequencing coverage. In Viburnum, doubling sequencing coverage nearly doubled the number of parsimony informative sites, and increased by >10X the number of loci with data shared across >40 taxa. Our analysis leads to a set of practical recommendations for maximizing phylogenetic information in RAD-seq studies. [hierarchical redundancy; phylogenetic informativeness; quartet informativeness; Restriction-site associated DNA (RAD) sequencing; sequencing coverage; Viburnum.]. © The authors 2016. Published by Oxford University Press, on behalf of the Society of Systematic Biologists. All rights reserved. For permissions, please e-mail: journals.permission@oup.com.

IODP Expedition 340T: Borehole Logging at Atlantis Massif Oceanic Core Complex

NASA Astrophysics Data System (ADS)

Blackman, D.; Slagle, A.; Harding, A.; Guerin, G.; McCaig, A.

2013-03-01

Integrated Ocean Drilling Program (IODP) Expedition 340T returned to the 1.4-km-deep Hole U1309D at Atlantis Massif to carry out borehole logging including vertical seismic profiling (VSP). Seismic, resistivity, and temperature logs were obtained throughout the geologic section in the footwall of this oceanic core complex. Reliable downhole temperature measurements throughout and the first seismic coverage of the 800-1400 meters below seafloor (mbsf) portion of the section were obtained. Distinct changes in velocity, resistivity, and magnetic susceptibility characterize the boundaries of altered, olivine-rich troctolite intervals within the otherwise dominantly gabbroic se-quence. Some narrow fault zones also are associated with downhole resistivity or velocity excursions. Small deviations in temperature were measured in borehole fluid adjacent to known faults at 750 mbsf and 1100 mbsf. This suggests that flow of seawater remains active along these zones of faulting and rock alteration. Vertical seismic profile station coverage at zero offset now extends the full length of the hole, including the uppermost 150 mbsf, where detachment processes are expected to have left their strongest imprint. Analysis of wallrock properties, together with alteration and structural characteristics of the cores from Site U1309, highlights the likely interplay between lithology, structure, lithospheric hydration, and core complex evolution. doi:10.2204/iodp.sd.15.04.2013

ICESat-2: An overview of science objectives, status, data products and expected performance

NASA Astrophysics Data System (ADS)

Neumann, T.; Markus, T.; Anthony, M.

2016-12-01

NASA's Ice, Cloud, and land Elevation Satellite-2's (ICESat-2) mission objectives are to quantify polar ice sheet contributions to sea level change, quantify regional signatures of ice sheet changes to assess driving mechanisms, estimate sea ice thickness, and to enable measurements of canopy height as a basis for estimating large-scale biomass. With a scheduled launch date in late 2017 most of the flight hardware has been assembled, integrated and tested and algorithm implementation for its standard geophysical products is well underway. The spacecraft, built by Orbital ATK, is completed and is undergoing testing. ICESat-2's single instrument, the Advanced Topographic Laser Altimeter System (ATLAS), is built by NASA Goddard Space Flight Center and by the time of the Fall Meeting will be undergoing integration and testing with the spacecraft, becoming the ICESat-2 observatory. In parallel, high level geophysical data products and associated algorithms are in development using airborne laser altimeter data. This presentation will give an overview of the design of ICESat-2, of its hardware and software status, as well as examples of ICESat-2's coverage and what the data will look like.

Implementation of the Integrated Management of Childhood Illnesses strategy: challenges and recommendations in Botswana

PubMed Central

Mupara, Lucia U.; Lubbe, Johanna C.

2016-01-01

Background Under-five mortality has been a major public health challenge from time immemorial. In response to this challenge, the World Health Organization and the United Nations Children's Fund developed the Integrated Management of Childhood Illnesses (IMCI) strategy and presented it to the whole world as a key approach to reduce child morbidity and mortality. Botswana started to implement the IMCI strategy in 1998. Reductions in the under-five mortality rate (U5MR) have been documented, although the reduction is not on par with the expected Millennium Development Goal 4 predictions. Design A quantitative study was done to identify the problems IMCI implementers face when tending children under 5 years in the Gaborone Health District of Botswana. The study population was made up of all the IMCI-trained and registered nurses, and systematic sampling was used to randomly select study participants. Questionnaires were used to collect data. Results The study findings indicated challenges related to low training coverage, health systems, and the unique features of the IMCI strategy. Conclusions The comprehensive implementation of the IMCI strategy has the potential to significantly influence the U5MR in Botswana. PMID:26899774

Building the Coverage Continuum: The Role of State Medicaid Directors and Insurance Commissioners.

PubMed

Ario, Joel; Bachrach, Deborah

2017-02-01

Issue: The Affordable Care Act has expanded coverage to 20 million newly insured individuals, split between state Medicaid programs and commercially insured marketplaces, with limited integration between the two. The seamless continuum of coverage envisioned by the law is central to achieving the full potential of the Affordable Care Act, but it remains an elusive promise. Goals: To examine the historical and cultural differences between state Medicaid agencies and insurance departments that contribute to this lack of coordination. Findings and Conclusions: Historical and cultural differences must be overcome to ensure continuing access to coverage and care. The authors present two opportunities for insurance and Medicaid officials to work together to advance the continuum of coverage: alignment of regulations for insurers participating in both markets and collaboration on efforts to reform the health care delivery system.

The three-dimensional genome organization of Drosophila melanogaster through data integration.

PubMed

Li, Qingjiao; Tjong, Harianto; Li, Xiao; Gong, Ke; Zhou, Xianghong Jasmine; Chiolo, Irene; Alber, Frank

2017-07-31

Genome structures are dynamic and non-randomly organized in the nucleus of higher eukaryotes. To maximize the accuracy and coverage of three-dimensional genome structural models, it is important to integrate all available sources of experimental information about a genome's organization. It remains a major challenge to integrate such data from various complementary experimental methods. Here, we present an approach for data integration to determine a population of complete three-dimensional genome structures that are statistically consistent with data from both genome-wide chromosome conformation capture (Hi-C) and lamina-DamID experiments. Our structures resolve the genome at the resolution of topological domains, and reproduce simultaneously both sets of experimental data. Importantly, this data deconvolution framework allows for structural heterogeneity between cells, and hence accounts for the expected plasticity of genome structures. As a case study we choose Drosophila melanogaster embryonic cells, for which both data types are available. Our three-dimensional genome structures have strong predictive power for structural features not directly visible in the initial data sets, and reproduce experimental hallmarks of the D. melanogaster genome organization from independent and our own imaging experiments. Also they reveal a number of new insights about genome organization and its functional relevance, including the preferred locations of heterochromatic satellites of different chromosomes, and observations about homologous pairing that cannot be directly observed in the original Hi-C or lamina-DamID data. Our approach allows systematic integration of Hi-C and lamina-DamID data for complete three-dimensional genome structure calculation, while also explicitly considering genome structural variability.

Impact of Adverse Events Following Immunization in Viet Nam in 2013 on chronic hepatitis B infection.

PubMed

Li, Xi; Wiesen, Eric; Diorditsa, Sergey; Toda, Kohei; Duong, Thi Hong; Nguyen, Lien Huong; Nguyen, Van Cuong; Nguyen, Tran Hien

2016-02-03

Adverse Events Following Immunization in Viet Nam in 2013 led to substantial reductions in hepatitis B vaccination coverage (both the birth dose and the three-dose series). In order to estimate the impact of the reduction in vaccination coverage on hepatitis B transmission and future mortality, a widely-used mathematical model was applied to the data from Viet Nam. Using the model, we estimated the number of chronic infections and deaths that are expected to occur in the birth cohort in 2013 and the number of excessive infections and deaths attributable to the drop in immunization coverage in 2013. An excess of 90,137 chronic infections and 17,456 future deaths were estimated to occur in the 2013 birth cohort due to the drop in vaccination coverage. This analysis highlights the importance of maintaining high vaccination coverage and swiftly responding to reported Adverse Events Following Immunization in order to regain consumer confidence in the hepatitis B vaccine. Copyright © 2015 World Health Organization; licensee Elsevier. Published by Elsevier Ltd.. All rights reserved.

Coverage of genetic technologies under national health reform.

PubMed Central

Mehlman, M. J.; Botkin, J. R.; Scarrow, A.; Woodhall, A.; Kass, J.; Siebenschuh, E.

1994-01-01

This article examines the extent to which the technologies expected to emerge from genetic research are likely to be covered under Government-mandated health insurance programs such as those being proposed by advocates of national health reform. Genetic technologies are divided into three broad categories; genetic information services, including screening, testing, and counseling; experimental technologies; and gene therapy. This article concludes that coverage of these technologies under national health reform is uncertain. The basic benefits packages provided for in the major health reform plans are likely to provide partial coverage of experimental technologies; relatively broad coverage of information services; and varying coverage of gene therapies, on the basis of an evaluation of their costs, benefits, and the degree to which they raise objections on political and religious grounds. Genetic services that are not included in the basic benefits package will be available only to those who can purchase supplemental insurance or to those who can purchase the services with personal funds. The resulting multitiered system of access to genetic services raises serious questions of fairness. PMID:7977343

Combining GOES-16 Geostationary Lightning Mapper with the ground based Earth Networks Total Lightning Network

NASA Astrophysics Data System (ADS)

Stock, M.; Lapierre, J. L.; Zhu, Y.

2017-12-01

Recently, the Geostationary Lightning Mapper (GLM) began collecting optical data to locate lightning events and flashes over the North and South American continents. This new instrument promises uniformly high detection efficiency (DE) over its entire field of view, with location accuracy on the order of 10 km. In comparison, Earth Networks Total Lightning Networks (ENTLN) has a less uniform coverage, with higher DE in regions with dense sensor coverage, and lower DE with sparse sensor coverage. ENTLN also offers better location accuracy, lightning classification, and peak current estimation for their lightning locations. It is desirable to produce an integrated dataset, combining the strong points of GLM and ENTLN. The easiest way to achieve this is to simply match located lightning processes from each system using time and distance criteria. This simple method will be limited in scope by the uneven coverage of the ground based network. Instead, we will use GLM group locations to look up the electric field change data recorded by ground sensors near each GLM group, vastly increasing the coverage of the ground network. The ground waveforms can then be used for: improvements to differentiation between glint and lightning for GLM, higher precision lighting location, current estimation, and lightning process classification. Presented is an initial implementation of this type of integration using preliminary GLM data, and waveforms from ENTLN.

The Press Relations of a Local School District: An Analysis of the Emergence of School Issues.

ERIC Educational Resources Information Center

Morris, Jon R.; Guenter, Cornelius

Press coverage of a suburban midwest school district is analyzed as a set of time series of observations including the amount and quality of coverage. Possible shifts in these series because of the emergence of controversial issues are analyzed statistically using the Integrated Moving Average Time Series Model. Evidence of significant shifts in…

Applications of Ergodic Theory to Coverage Analysis

NASA Technical Reports Server (NTRS)

Lo, Martin W.

2003-01-01

The study of differential equations, or dynamical systems in general, has two fundamentally different approaches. We are most familiar with the construction of solutions to differential equations. Another approach is to study the statistical behavior of the solutions. Ergodic Theory is one of the most developed methods to study the statistical behavior of the solutions of differential equations. In the theory of satellite orbits, the statistical behavior of the orbits is used to produce 'Coverage Analysis' or how often a spacecraft is in view of a site on the ground. In this paper, we consider the use of Ergodic Theory for Coverage Analysis. This allows us to greatly simplify the computation of quantities such as the total time for which a ground station can see a satellite without ever integrating the trajectory, see Lo 1,2. More over, for any quantity which is an integrable function of the ground track, its average may be computed similarly without the integration of the trajectory. For example, the data rate for a simple telecom system is a function of the distance between the satellite and the ground station. We show that such a function may be averaged using the Ergodic Theorem.

US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity.

PubMed

Gomez, G; Stanford, F C

2018-03-01

Obesity is now the most prevalent chronic disease in the United States, which amounts to an estimated $147 billion in health care spending annually. The Affordable Care Act (ACA) enacted in 2010 included provisions for private and public health insurance plans that expanded coverage for lifestyle/behavior modification and bariatric surgery for the treatment of obesity. Pharmacotherapy, however, has not been included despite their evidence-based efficacy. We set out to investigate the coverage of Food and Drug Administration-approved medications for obesity within Medicare, Medicaid and ACA-established marketplace health insurance plans. We examined coverage for phentermine, diethylpropion, phendimetrazine, Benzphentamine, Lorcaserin, Phentermine/Topiramate (Qysmia), Liraglutide (Saxenda) and Buproprion/Naltrexone (Contrave) among Medicare, Medicaid and marketplace insurance plans in 34 states. Among 136 marketplace health insurance plans, 11% had some coverage for the specified drugs in only nine states. Medicare policy strictly excludes drug therapy for obesity. Only seven state Medicaid programs have drug coverage. Obesity requires an integrated approach to combat its public health threat. Broader coverage of pharmacotherapy can make a significant contribution to fighting this complex and chronic disease.

Smoking behaviour and health care costs coverage: a European cross-country comparison.

PubMed

Rezayatmand, Reza; Groot, Wim; Pavlova, Milena

2017-12-01

The empirical evidence about the effect of smoking on health care cost coverage is not consistent with the expectations based on the notion of adverse selection. This evidence is mostly based on correlational studies which cannot isolate the adverse selection effect from the moral hazard effect. Exploiting data from the Survey of Health, Aging, and Retirement in Europe, this study uses an instrumental variable strategy to identify the causal effect of daily smoking on perceived health care cost coverage of those at age 50 or above in 12 European countries. Daily smoking is instrumented by a variable indicating whether or not there is any other daily smoker in the household. A self-assessment of health care cost coverage is used as the outcome measure. Among those who live with a partner (72% of the sample), the result is not statistically significant which means we find no effect of smoking on perceived health care cost coverage. However, among those who live without a partner, the results show that daily smokers have lower self-assessed perceived health care cost coverage. This finding replicates the same counter-intuitive relationship between smoking and health insurance presented in previous studies, but in a language of causality. In addition to this, we contribute to previous studies by a cross-country comparison which brings in different institutional arrangements, and by using the self-assessed perceived health care cost coverage which is broader than health insurance coverage.

High Coverage and Utilization of Fortified Take-Home Rations among Children 6-35 Months of Age Provided through the Integrated Child Development Services Program: Findings from a Cross-Sectional Survey in Telangana, India.

PubMed

Leyvraz, Magali; Wirth, James P; Woodruff, Bradley A; Sankar, Rajan; Sodani, Prahlad R; Sharma, Narottam D; Aaron, Grant J

2016-01-01

The Integrated Child Development Services (ICDS) in the State of Telangana, India, freely provides a fortified complementary food product, Bal Amrutham, as a take-home ration to children 6-35 months of age. In order to understand the potential for impact of any intervention, it is essential to assess coverage and utilization of the program and to address the barriers to its coverage and utilization. A two-stage, stratified cross-sectional cluster survey was conducted to estimate the coverage and utilization of Bal Amrutham and to identify their barriers and drivers. In randomly selected catchment areas of ICDS centers, children under 36 months of age were randomly selected. A questionnaire, constructed from different validated and standard modules and designed to collect coverage data on nutrition programs, was administered to caregivers. A total of 1,077 children were enrolled in the survey. The coverage of the fortified take-home ration was found to be high among the target population. Nearly all caregivers (93.7%) had heard of Bal Amrutham and 86.8% had already received the product for the target child. Among the children surveyed, 57.2% consumed the product regularly. The ICDS program's services were not found to be a barrier to product coverage. In fact, the ICDS program was found to be widely available, accessible, accepted, and utilized by the population in both urban and rural catchment areas, as well as among poor and non-poor households. However, two barriers to optimal coverage were found: the irregular supply of the product to the beneficiaries and the intra-household sharing of the product. Although sharing was common, the product was estimated to provide the target children with significant proportions of the daily requirements of macro- and micronutrients. Bal Amrutham is widely available, accepted, and consumed among the target population in the catchment areas of ICDS centers. The coverage of the product could be further increased by improving the supply chain.

A Differential GPS Aided Ins for Aircraft Landings

DTIC Science & Technology

1995-12-01

Pseudolite during the Landing A pproach .................................................................................................. 4-9 4.2.1...for precision approaches, areas associated with accuracy, coverage, integrity availability, and aircraft integration must be studied and 1-3...publications [13,20,27,30,57,59] suggests very few studies have been performed which use an integrated INS/GPS for precision approaches. The majority of

Evidence-based coverage decisions? Primum non nocere.

PubMed

McElwee, Newell E; Ho, S Yin; McGuigan, Kimberly A; Horn, Mark L

2006-01-01

Drug class reviews are blunt tools for medical decision making. The practice of evidence-based medicine is far more than simply systematic reviews: The patient and doctor are integral. Here we highlight areas of evidence-based coverage decision making where greater balance and transparency could serve to improve the current process, and we recommend elements of a more positive approach that could optimize patient outcomes under resource constraints.

Emergency room coverage: an evolving crisis.

PubMed

Davison, Steven P

2004-08-01

Historically, a newly graduated plastic surgeon in the United States could build a practice from his or her emergency room coverage. The historical cliche was for the surgeon to be affable, able, and available, and from that basis one's practice would grow. Emergency room exposure was an avenue for starting a practice, developing recognition, and, after that, building a referral pattern. Recently, the cross-shifting influence of management care, rising malpractice insurance costs, and risk ratio are changing this cliche to a crisis. An evaluation of a 2 1/2-year exposure to emergency room coverage has revealed a completely different profile. A total of 300 patient visits resulting in 69 surgical operations were evaluated for insurance and remuneration history. The findings indicated a significant remuneration dilemma for emergency room coverage. Interestingly, a remuneration problem exists in a market different from what one would expect. In this study, a sample from a suburban hospital, rather than an inner-city university hospital, is the greater problem.

Global warming not so harmful for all plants - response of holomycotrophic orchid species for the future climate change.

PubMed

Kolanowska, Marta; Kras, Marta; Lipińska, Monika; Mystkowska, Katarzyna; Szlachetko, Dariusz L; Naczk, Aleksandra M

2017-10-05

Current and expected changes in global climate are major threat for biological diversity affecting individuals, communities and ecosystems. However, there is no general trend in the plants response to the climate change. The aim of present study was to evaluate impact of the future climate changes on the distribution of holomycotrophic orchid species using ecological niche modeling approach. Three different scenarios of future climate changes were tested to obtain the most comprehensive insight in the possible habitat loss of 16 holomycotrophic orchids. The extinction of Cephalanthera austiniae was predicted in all analyses. The coverage of suitable niches of Pogoniopsis schenckii will decrease to 1-30% of its current extent. The reduction of at least 50% of climatic niche of Erythrorchis cassythoides and Limodorum abortivum will be observed. In turn, the coverage of suitable niches of Hexalectris spicata, Uleiorchis ulaei and Wullschlaegelia calcarata may be even 16-74 times larger than in the present time. The conducted niche modeling and analysis of the similarity of their climatic tolerance showed instead that the future modification of the coverage of their suitable niches will not be unified and the future climate changes may be not so harmful for holomycotrophic orchids as expected.

Strengthening routine immunization systems to improve global vaccination coverage.

PubMed

Sodha, S V; Dietz, V

2015-03-01

Global coverage with the third dose of diphtheria-tetanus-pertussis vaccine among children under 1 year of age stagnated at ∼ 83-84% during 2008-13. Annual World Health Organization and UNICEF-derived national vaccination coverage estimates. Incomplete vaccination is associated with poor socioeconomic status, lower education, non-use of maternal-child health services, living in conflict-affected areas, missed immunization opportunities and cancelled vaccination sessions. Vaccination platforms must expand to include older ages including the second year of life. Immunization programmes, including eradication and elimination initiatives such as those for polio and measles, must integrate within the broader health system. The Global Vaccine Action Plan (GVAP) 2011-20 is a framework for strengthening immunization systems, emphasizing country ownership, shared responsibility, equity, integration, sustainability and innovation. Immunization programmes should identify, monitor and evaluate gaps and interventions within the GVAP framework. Published by Oxford University Press 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

A methodology for extending domain coverage in SemRep.

PubMed

Rosemblat, Graciela; Shin, Dongwook; Kilicoglu, Halil; Sneiderman, Charles; Rindflesch, Thomas C

2013-12-01

We describe a domain-independent methodology to extend SemRep coverage beyond the biomedical domain. SemRep, a natural language processing application originally designed for biomedical texts, uses the knowledge sources provided by the Unified Medical Language System (UMLS©). Ontological and terminological extensions to the system are needed in order to support other areas of knowledge. We extended SemRep's application by developing a semantic representation of a previously unsupported domain. This was achieved by adapting well-known ontology engineering phases and integrating them with the UMLS knowledge sources on which SemRep crucially depends. While the process to extend SemRep coverage has been successfully applied in earlier projects, this paper presents in detail the step-wise approach we followed and the mechanisms implemented. A case study in the field of medical informatics illustrates how the ontology engineering phases have been adapted for optimal integration with the UMLS. We provide qualitative and quantitative results, which indicate the validity and usefulness of our methodology. Published by Elsevier Inc.

Medicare Prescription Drug Plan Enrollees Report Less Positive Experiences Than Their Medicare Advantage Counterparts.

PubMed

Elliott, Marc N; Landon, Bruce E; Zaslavsky, Alan M; Edwards, Carol; Orr, Nathan; Beckett, Megan K; Mallett, Joshua; Cleary, Paul D

2016-03-01

Since 2006, Medicare beneficiaries have been able to obtain prescription drug coverage through standalone prescription drug plans or their Medicare Advantage (MA) health plan, options exercised in 2015 by 72 percent of beneficiaries. Using data from community-dwelling Medicare beneficiaries older than age sixty-four in 700 plans surveyed from 2007 to 2014, we compared beneficiaries' assessments of Medicare prescription drug coverage when provided by standalone plans or integrated into an MA plan. Beneficiaries in standalone plans consistently reported less positive experiences with prescription drug plans (ease of getting medications, getting coverage information, and getting cost information) than their MA counterparts. Because MA plans are responsible for overall health care costs, they might have more integrated systems and greater incentives than standalone prescription drug plans to provide enrollees medications and information effectively, including, since 2010, quality bonus payments to these MA plans under provisions of the Affordable Care Act. Project HOPE—The People-to-People Health Foundation, Inc.

Evaluation of staff performance and material resources for integrated schistosomiasis control in northern Senegal.

PubMed

van der Werf, Marieke J; Mbaye, Amadou; Sow, Seydou; Gryseels, Bruno; de Vlas, Sake J

2002-01-01

A project to improve integrated control of schistosomiasis in the primary health care system of northern Senegal was implemented from February 1995 until September 1999, shortly after a Schistosoma mansoni outbreak. The activities included additional training of doctors and nurses in symptom-based treatment and making praziquantel (PZQ) available for an affordable price. To investigate staff performance and the availability and costs of diagnostic materials and PZQ at the end of this intervention project. We performed structured interviews with staff from 55 health care facilities in five districts. Respondents from 23 health care facilities reported both S. haematobium and S. mansoni in the coverage area, 32 reported only S. haematobium and three only S. mansoni. The average cost to patients for consultation, diagnosis, treatment and transportation to a referral health care facility was approximately 1.60 Euro. Fifty-seven per cent of the health care facilities with reported S. haematobium in the coverage area treated patients presenting with haematuria on symptoms; 56% of the health care facilities with reported S. mansoni in the coverage area treated patients presenting with blood in stool on symptoms. Thirteen per cent performed a diagnostic test for patients presenting with haematuria and 12% for patients presenting with blood in stool. The remainder, approximately one-third of the health care facilities, referred their patients to another facility for a diagnostic test. Implementation of symptom-based treatment in all health care facilities will reduce the total costs by 0.43 Euro (29%) for patients infected with S. haematobium and 0.78 Euro (46%) for patients infected with S. mansoni. Of the 53 health care facilities with schistosomiasis in their area, 37 had PZQ in stock of which 33 (88%) sold PZQ for the recommended retail price of 0.15 Euro per tablet (or 0.60 Euro per course of four tablets) or lower. Four years after the start of the intervention project, patients presenting with schistosomiasis related symptoms can generally expect proper diagnosis and treatment at all levels of the health care system in Northern Senegal, either at the initial visited health care facility or after referral. However, a further reduction of the total costs of treatment is still possible by a better implementation of symptom-based treatment and further reduction of the costs of PZQ.

Family planning, abortion, and HIV in Ghanaian print media: a 15-month content analysis of a national Ghanaian newspaper.

PubMed

Laar, Amos K

2010-12-01

This study assessed coverage of reproductive health (RH) issues--family planning (FP), abortion, and HIV--in the Ghanaian Daily Graphic newspaper. Using the composite week sampling technique, the researcher analyzed the contents of 62 editions of the paper. Prominence was measured using various attributes, and differences in mean coverage over time were assessed using analysis of variance. This review shows that coverage of RH issues was extraordinarily poor, less than 1 percent each for FP, abortion, and HIV. RH news that was covered was given little prominence. These findings support the popular impression that the Daily Graphic does not give priority to reproductive health issues in its coverage. RH advocates need to develop innovative means of integrating RH content into existing media outlets.

Looking at CER from Medicare's perspective.

PubMed

Mohr, Penny

2012-05-01

Comparative effectiveness research (CER) is rapidly adding to the amount of data available to health care coverage and payment decision makers. Medicare's decisions have a large effect on coverage and reimbursement policies throughout the health insurance industry and will likely influence the entire U.S. health care system; thus, examining its role in integrating CER into policy is crucial. To describe the potential benefits of CER to support payment and coverage decisions in the Medicare program, limitations on its use,the role of the Centers for Medicare & Medicaid Services (CMS) in improving the infrastructure for CER, and to discuss challenges that must be addressed to integrate CER into CMS's decision-making process. A defining feature of CER is that it provides the type of evidence that will help decision makers, such as patients, clinicians, and payers,make more informed treatment and policy decisions. Because CMS is responsible for more than 47 million elderly and disabled beneficiaries, the way that Medicare uses CER has the potential to have a large impact on public and individual health. Currently many critical payment and coverage decisions within the Medicare program are made on the basis of poor quality evidence, and CER has the potential to greatly improve the quality of decision making. Despite common misconceptions, CMS is not prohibited by law from using CER apart from some reasonable limitations. CMS is,however, required to support the development of the CER infrastructure by making their data more readily available to researchers. While CER has substantial potential to improve the quality of the agency's policy decisions,challenges remain to integrate CER into Medicare's processes. These challenges include statutory ambiguities, lack of sufficient staff and internal resources to take advantage of CER, and the lack of an active voice in setting priorities for CER and study design. Although challenges exist, CER has the potential to greatly enhance CMS's ability to make decisions regarding coverage and payment that will benefit both the agency and their patient population.

CEOS Ocean Variables Enabling Research and Applications for Geo (COVERAGE)

NASA Astrophysics Data System (ADS)

Tsontos, V. M.; Vazquez, J.; Zlotnicki, V.

2017-12-01

The CEOS Ocean Variables Enabling Research and Applications for GEO (COVERAGE) initiative seeks to facilitate joint utilization of different satellite data streams on ocean physics, better integrated with biological and in situ observations, including near real-time data streams in support of oceanographic and decision support applications for societal benefit. COVERAGE aligns with programmatic objectives of CEOS (the Committee on Earth Observation Satellites) and the missions of GEO-MBON (Marine Biodiversity Observation Network) and GEO-Blue Planet, which are to advance and exploit synergies among the many observational programs devoted to ocean and coastal waters. COVERAGE is conceived of as 3 year pilot project involving international collaboration. It focuses on implementing technologies, including cloud based solutions, to provide a data rich, web-based platform for integrated ocean data delivery and access: multi-parameter observations, easily discoverable and usable, organized by disciplines, available in near real-time, collocated to a common grid and including climatologies. These will be complemented by a set of value-added data services available via the COVERAGE portal including an advanced Web-based visualization interface, subsetting/extraction, data collocation/matchup and other relevant on demand processing capabilities. COVERAGE development will be organized around priority use cases and applications identified by GEO and agency partners. The initial phase will be to develop co-located 25km products from the four Ocean Virtual Constellations (VCs), Sea Surface Temperature, Sea Level, Ocean Color, and Sea Surface Winds. This aims to stimulate work among the ocean VCs while developing products and system functionality based on community recommendations. Such products as anomalies from a time mean, would build on the theme of applications with a relevance to CEOS/GEO mission and vision. Here we provide an overview of the COVERAGE initiative with an emphasis on international collaborative aspects entailed with the intent of soliciting community feedback as we develop and implement

STREAM FLOW BASIN CHARACTERISTICS FOR THE MID-ATLANTIC INTEGRATED ASSESSMENT (MAIA) STUDY AREA

EPA Science Inventory

This data set is a GIS coverage of the stream flow basin characteristics for drainage basins of selected US Geological Survey (USGS) gauging stations the United States Environmental Protection Agency (USEPA) Mid-Atlantic Integrated Assessment (MAIA) Project region. This data se...

Locations of Sampling Stations for Water Quality Monitoring in Water Distribution Networks.

PubMed

Rathi, Shweta; Gupta, Rajesh

2014-04-01

Water quality is required to be monitored in the water distribution networks (WDNs) at salient locations to assure the safe quality of water supplied to the consumers. Such monitoring stations (MSs) provide warning against any accidental contaminations. Various objectives like demand coverage, time for detection, volume of water contaminated before detection, extent of contamination, expected population affected prior to detection, detection likelihood and others, have been independently or jointly considered in determining optimal number and location of MSs in WDNs. "Demand coverage" defined as the percentage of network demand monitored by a particular monitoring station is a simple measure to locate MSs. Several methods based on formulation of coverage matrix using pre-specified coverage criteria and optimization have been suggested. Coverage criteria is defined as some minimum percentage of total flow received at the monitoring stations that passed through any upstream node included then as covered node of the monitoring station. Number of monitoring stations increases with the increase in the value of coverage criteria. Thus, the design of monitoring station becomes subjective. A simple methodology is proposed herein which priority wise iteratively selects MSs to achieve targeted demand coverage. The proposed methodology provided the same number and location of MSs for illustrative network as an optimization method did. Further, the proposed method is simple and avoids subjectivity that could arise from the consideration of coverage criteria. The application of methodology is also shown on a WDN of Dharampeth zone (Nagpur city WDN in Maharashtra, India) having 285 nodes and 367 pipes.

Cost-Effectiveness of Enhanced Syphilis Screening among HIV-Positive Men Who Have Sex with Men: A Microsimulation Model

PubMed Central

Tuite, Ashleigh R.; Burchell, Ann N.; Fisman, David N.

2014-01-01

Background Syphilis co-infection risk has increased substantially among HIV-infected men who have sex with men (MSM). Frequent screening for syphilis and treatment of men who test positive might be a practical means of controlling the risk of infection and disease sequelae in this population. Purpose We evaluated the cost-effectiveness of strategies that increased the frequency and population coverage of syphilis screening in HIV-infected MSM receiving HIV care, relative to current standard of care. Methods We developed a state-transition microsimulation model of syphilis natural history and medical care in HIV-infected MSM receiving care for HIV. We performed Monte Carlo simulations using input data derived from a large observational cohort in Ontario, Canada, and from published biomedical literature. Simulations compared usual care (57% of the population screened annually) to different combinations of more frequent (3- or 6-monthly) screening and higher coverage (100% screened). We estimated expected disease-specific outcomes, quality-adjusted survival, costs, and cost-effectiveness associated with each strategy from the perspective of a public health care payer. Results Usual care was more costly and less effective than strategies with more frequent or higher coverage screening. Higher coverage strategies (with screening frequency of 3 or 6 months) were expected to be cost-effective based on usually cited willingness-to-pay thresholds. These findings were robust in the face of probabilistic sensitivity analyses, alternate cost-effectiveness thresholds, and alternate assumptions about duration of risk, program characteristics, and management of underlying HIV. Conclusions We project that higher coverage and more frequent syphilis screening of HIV-infected MSM would be a highly cost-effective health intervention, with many potentially viable screening strategies projected to both save costs and improve health when compared to usual care. The baseline requirement for regular blood testing in this group (i.e., for viral load monitoring) makes intensification of syphilis screening appear readily practicable. PMID:24983455

Post-Correlation Semi-Coherent Integration for High-Dynamic and Weak GPS Signal Acquisition (Preprint)

DTIC Science & Technology

2008-06-01

provide the coverage. To enable weak GPS signal acquisition , one known technique at the receiver end is to extend the signal integration time...Han, “Block Accumulating Coherent Integration Over Extended Interval (BACIX) for Weak GPS Signal Acquisition ,” Proc. of ION-GNSS’06, Ft. Worth, TX...AFRL-RY-WP-TP-2008-1158 POST-CORRELATION SEMI-COHERENT INTEGRATION FOR HIGH-DYNAMIC AND WEAK GPS SIGNAL ACQUISITION (PREPRINT) Chun Yang

Implementing CER: what will it take?

PubMed

Biskupiak, Joseph E; Dunn, Jeffrey D; Holtorf, Anke-Peggy

2012-06-01

Comparative effectiveness research (CER) is undeniably changing how drugs are developed, launched, priced, and reimbursed in the United States. But most organizations are still evaluating what CER can do for them and how and when they can utilize the data. A roundtable of stakeholders, including formulary decision makers, evaluated CER's possible effects on managed care organizations (MCOs) and what it may take to fully integrate CER into decision making. To examine the role of CER in current formulary decision making, compare CER to modeling, discuss ways CER may be used in the future, and describe CER funding sources. While decision makers from different types of organizations, such as pharmacy benefit management (PBM) companies and MCOs, may have varying definitions and expectations of CER, most thought leaders from a roundtable of stakeholders, including formulary decision makers, see value in CER's ability to enhance their formulary decision making. Formulary decision makers may be able to use CER to better inform their coverage decisions in areas such as benefit design, contracting, conditional reimbursement, pay for performance, and other alternative pricing arrangements. Real-world CER will require improvement in the health information technology infrastructure to better capture value-related information. The federal government is viewed as a key driver and funding source behind CER, especially for infrastructure and methods development, while industry will adapt the clinical development and create increasing CER evidence. CER then needs to be applied to determining value (or cost efficacy). It is expected that CER will continue to grow as a valuable component of formulary decision making. Future integration of CER into formulary decision making will require federal government and academic leadership, improvements in the health information technology infrastructure, ongoing funding, and improved and more consistent methodologies.

A Framework for Dimensioning VDL-2 Air-Ground Networks

NASA Technical Reports Server (NTRS)

Ribeiro, Leila Z.; Monticone, Leone C.; Snow, Richard E.; Box, Frank; Apaza, Rafel; Bretmersky, Steven

2014-01-01

This paper describes a framework developed at MITRE for dimensioning a Very High Frequency (VHF) Digital Link Mode 2 (VDL-2) Air-to-Ground network. This framework was developed to support the FAA's Data Communications (Data Comm) program by providing estimates of expected capacity required for the air-ground network services that will support Controller-Pilot-Data-Link Communications (CPDLC), as well as the spectrum needed to operate the system at required levels of performance. The Data Comm program is part of the FAA's NextGen initiative to implement advanced communication capabilities in the National Airspace System (NAS). The first component of the framework is the radio-frequency (RF) coverage design for the network ground stations. Then we proceed to describe the approach used to assess the aircraft geographical distribution and the data traffic demand expected in the network. The next step is the resource allocation utilizing optimization algorithms developed in MITRE's Spectrum ProspectorTM tool to propose frequency assignment solutions, and a NASA-developed VDL-2 tool to perform simulations and determine whether a proposed plan meets the desired performance requirements. The framework presented is capable of providing quantitative estimates of multiple variables related to the air-ground network, in order to satisfy established coverage, capacity and latency performance requirements. Outputs include: coverage provided at different altitudes; data capacity required in the network, aggregated or on a per ground station basis; spectrum (pool of frequencies) needed for the system to meet a target performance; optimized frequency plan for a given scenario; expected performance given spectrum available; and, estimates of throughput distributions for a given scenario. We conclude with a discussion aimed at providing insight into the tradeoffs and challenges identified with respect to radio resource management for VDL-2 air-ground networks.

The impact of palliative care training for oncologists and integrative palliative service in a public-funded hospital cluster-a retrospective cohort study.

PubMed

Lam, Pak-Lun; Lam, Tai-Chung; Choi, Cheuk-Wai; Lee, Anne Wing-Mui; Yuen, Kwok-Keung; Leung, To-Wai

2018-05-01

Oncological care of advanced cancer patients was provided by multiple departments in Hong Kong. One of these departments, the clinical oncology department (COD), introduced systematic palliative care training for its oncologists since 2002. The COD was recognized as a European Society for Medical Oncology (ESMO) Designated Centre of Integrated Oncology and Palliative Care since 2009. This retrospective cohort study aims to review the impact of integrative training and service on palliative care coverage and outcome. Clinical information, palliative service provision, and end-of-life outcomes of patients who passed away from lung, colorectal, liver, stomach, or breast cancer in the Hong Kong West public hospital network during July 2015 to December 2015 were collected. A total of 307 patients were analyzed. Around half (49.2%) were attended primarily by COD, and 68.9% received palliative service. There are significantly fewer patients referred to palliative care from other departments (p < 0.001), with only 19.9% of this patient group receiving palliative referral. COD patients had longer palliative coverage before death (median 65 days versus 24 days, p < 0.001), higher chance of receiving end-of-life care at hospice units (36.4 versus 21.2%, p = 0.003), lower ICU admission (0.66 versus 5.1%, p = 0.02), and higher percentage of receiving strong opioid in the last 30 days of life (51.0 versus 28.9%, p < 0.001) compared to other departments. In multivariable analysis, COD being the primary care team (odds ratio 12.2, p < 0.001) was associated with higher palliative care coverage. The study results suggested that systematic palliative care training of oncologists and integrative palliative service model was associated with higher palliative service coverage and improved palliative care outcomes.

Prospects for the future investigations of Mercury by the BepiColombo Laser Altimeter (BELA)

NASA Astrophysics Data System (ADS)

Steinbrügge, Gregor; Stark, Alexander; Hussmann, Hauke; Wickhusen, Kai; Oberst, Jürgen

2017-04-01

The flight model of the BepiColombo Laser Altimeter (BELA) has recently been delivered for integration on the Mercury Planetary Orbiter (MPO). We performed numerical simulations of the instrument performance expected in flight based on the measured BELA flight model (FM) parameters. In particular, we study measurement performance of topography, slopes, albedo, and roughness. Further, we analyzed the orbit evolution of the MPO based on most recent Mercury gravity data from MESSENGER. This allows us to estimate local and global topographic coverage, as well as the potential for estimates of the tidal Love number h2. Also possible implications of BELA science data on Mercury's interior structure, especially on the core radius and the mantle rheology, will be assessed. BELA is built by the Institute of Physics of the University of Bern and the DLR Institute of Planetary Research in cooperation with the Instituto de Astrofisica de Andalucia of the Consejo Superior de Investigaciones Cientificas (CSIC) and the Max-Planck-Institute for Solar System Research (MPS).

Precise detection of chromosomal translocation or inversion breakpoints by whole-genome sequencing.

PubMed

Suzuki, Toshifumi; Tsurusaki, Yoshinori; Nakashima, Mitsuko; Miyake, Noriko; Saitsu, Hirotomo; Takeda, Satoru; Matsumoto, Naomichi

2014-12-01

Structural variations (SVs), including translocations, inversions, deletions and duplications, are potentially associated with Mendelian diseases and contiguous gene syndromes. Determination of SV-related breakpoints at the nucleotide level is important to reveal the genetic causes for diseases. Whole-genome sequencing (WGS) by next-generation sequencers is expected to determine structural abnormalities more directly and efficiently than conventional methods. In this study, 14 SVs (9 balanced translocations, 1 inversion and 4 microdeletions) in 9 patients were analyzed by WGS with a shallow (5 × ) to moderate read coverage (20 × ). Among 28 breakpoints (as each SV has two breakpoints), 19 SV breakpoints had been determined previously at the nucleotide level by any other methods and 9 were uncharacterized. BreakDancer and Integrative Genomics Viewer determined 20 breakpoints (16 translocation, 2 inversion and 2 deletion breakpoints), but did not detect 8 breakpoints (2 translocation and 6 deletion breakpoints). These data indicate the efficacy of WGS for the precise determination of translocation and inversion breakpoints.

Magellan radar to reveal secrets of enshrouded Venus

NASA Technical Reports Server (NTRS)

Saunders, R. Stephen

1990-01-01

Imaging Venus with a synthetic aperture radar (SAR) with 70 percent global coverage at 1-km optical line-pair resolution to provide a detailed global characterization of the volcanic land-forms on Venus by an integration of image data with altimetry is discussed. The Magellan radar system uses navigation predictions to preset the radar data collection parameters. The data are collected in such a way as to preserve the Doppler signature of surface elements and later they are transmitted to the earth for processing into high-resolution radar images. To maintain high accuracy, a complex on-board filter algorithm allows the altitude control logic to respond only to a narrow range of expected photon intensity levels and only to signals that occur within a small predicted interval of time. Each mapping pass images a swath of the planet that varies in width from 20 to 25 km. Since the orbital plane of the spacecraft remains fixed in the inertial space, the slow rotation of Venus continually brings new areas into view of the spacecraft.

Hadoop-BAM: directly manipulating next generation sequencing data in the cloud

PubMed Central

Niemenmaa, Matti; Kallio, Aleksi; Schumacher, André; Klemelä, Petri; Korpelainen, Eija; Heljanko, Keijo

2012-01-01

Summary: Hadoop-BAM is a novel library for the scalable manipulation of aligned next-generation sequencing data in the Hadoop distributed computing framework. It acts as an integration layer between analysis applications and BAM files that are processed using Hadoop. Hadoop-BAM solves the issues related to BAM data access by presenting a convenient API for implementing map and reduce functions that can directly operate on BAM records. It builds on top of the Picard SAM JDK, so tools that rely on the Picard API are expected to be easily convertible to support large-scale distributed processing. In this article we demonstrate the use of Hadoop-BAM by building a coverage summarizing tool for the Chipster genome browser. Our results show that Hadoop offers good scalability, and one should avoid moving data in and out of Hadoop between analysis steps. Availability: Available under the open-source MIT license at http://sourceforge.net/projects/hadoop-bam/ Contact: matti.niemenmaa@aalto.fi Supplementary information: Supplementary material is available at Bioinformatics online. PMID:22302568

Market-implied spread for earthquake CAT bonds: financial implications of engineering decisions.

PubMed

Damnjanovic, Ivan; Aslan, Zafer; Mander, John

2010-12-01

In the event of natural and man-made disasters, owners of large-scale infrastructure facilities (assets) need contingency plans to effectively restore the operations within the acceptable timescales. Traditionally, the insurance sector provides the coverage against potential losses. However, there are many problems associated with this traditional approach to risk transfer including counterparty risk and litigation. Recently, a number of innovative risk mitigation methods, termed alternative risk transfer (ART) methods, have been introduced to address these problems. One of the most important ART methods is catastrophe (CAT) bonds. The objective of this article is to develop an integrative model that links engineering design parameters with financial indicators including spread and bond rating. The developed framework is based on a four-step structural loss model and transformed survival model to determine expected excess returns. We illustrate the framework for a seismically designed bridge using two unique CAT bond contracts. The results show a nonlinear relationship between engineering design parameters and market-implied spread. © 2010 Society for Risk Analysis.

Assessing Pre-Service Candidates' Web-Based Electronic Portfolios.

ERIC Educational Resources Information Center

Lamson, Sharon; Thomas, Kelli R.; Aldrich, Jennifer; King, Andy

This paper describes processes undertaken by Central Missouri State University's Department of Curriculum and Instruction to prepare teacher candidates to create Web-based professional portfolios, Central's expectations for content coverage within the electronic portfolios, and evaluation procedures. It also presents data on portfolio construction…

Tax and Financial Considerations at Retirement.

ERIC Educational Resources Information Center

Parsons, Chris B.; Falkenhagen, Marilyn

1992-01-01

Because of longer life expectancies and individually managed supplements to monthly pension checks, planning at retirement is becoming as important as planning for retirement. This article provides advice for retiring administrators concerning personal budgeting, setting goals, estate and tax planning, choosing medical coverage, converting assets,…

Reaching Hard-to-Reach Individuals: Nonselective Versus Targeted Outbreak Response Vaccination for Measles

PubMed Central

Minetti, Andrea; Hurtado, Northan; Grais, Rebecca F.; Ferrari, Matthew

2014-01-01

Current mass vaccination campaigns in measles outbreak response are nonselective with respect to the immune status of individuals. However, the heterogeneity in immunity, due to previous vaccination coverage or infection, may lead to potential bias of such campaigns toward those with previous high access to vaccination and may result in a lower-than-expected effective impact. During the 2010 measles outbreak in Malawi, only 3 of the 8 districts where vaccination occurred achieved a measureable effective campaign impact (i.e., a reduction in measles cases in the targeted age groups greater than that observed in nonvaccinated districts). Simulation models suggest that selective campaigns targeting hard-to-reach individuals are of greater benefit, particularly in highly vaccinated populations, even for low target coverage and with late implementation. However, the choice between targeted and nonselective campaigns should be context specific, achieving a reasonable balance of feasibility, cost, and expected impact. In addition, it is critical to develop operational strategies to identify and target hard-to-reach individuals. PMID:24131555

A Research Agenda for Malaria Eradication: Modeling

PubMed Central

2011-01-01

Malaria modeling can inform policy and guide research for malaria elimination and eradication from local implementation to global policy. A research and development agenda for malaria modeling is proposed, to support operations and to enhance the broader eradication research agenda. Models are envisioned as an integral part of research, planning, and evaluation, and modelers should ideally be integrated into multidisciplinary teams to update the models iteratively, communicate their appropriate use, and serve the needs of other research scientists, public health specialists, and government officials. A competitive and collaborative framework will result in policy recommendations from multiple, independently derived models and model systems that share harmonized databases. As planned, modeling results will be produced in five priority areas: (1) strategic planning to determine where and when resources should be optimally allocated to achieve eradication; (2) management plans to minimize the evolution of drug and pesticide resistance; (3) impact assessments of new and needed tools to interrupt transmission; (4) technical feasibility assessments to determine appropriate combinations of tools, an associated set of target intervention coverage levels, and the expected timelines for achieving a set of goals in different socio-ecological settings and different health systems; and (5) operational feasibility assessments to weigh the economic costs, capital investments, and human resource capacities required. PMID:21283605

Enhanced Positioning Algorithm of ARPS for Improving Accuracy and Expanding Service Coverage

PubMed Central

Lee, Kyuman; Baek, Hoki; Lim, Jaesung

2016-01-01

The airborne relay-based positioning system (ARPS), which employs the relaying of navigation signals, was proposed as an alternative positioning system. However, the ARPS has limitations, such as relatively large vertical error and service restrictions, because firstly, the user position is estimated based on airborne relays that are located in one direction, and secondly, the positioning is processed using only relayed navigation signals. In this paper, we propose an enhanced positioning algorithm to improve the performance of the ARPS. The main idea of the enhanced algorithm is the adaptable use of either virtual or direct measurements of reference stations in the calculation process based on the structural features of the ARPS. Unlike the existing two-step algorithm for airborne relay and user positioning, the enhanced algorithm is divided into two cases based on whether the required number of navigation signals for user positioning is met. In the first case, where the number of signals is greater than four, the user first estimates the positions of the airborne relays and its own initial position. Then, the user position is re-estimated by integrating a virtual measurement of a reference station that is calculated using the initial estimated user position and known reference positions. To prevent performance degradation, the re-estimation is performed after determining its requirement through comparing the expected position errors. If the navigation signals are insufficient, such as when the user is outside of airborne relay coverage, the user position is estimated by additionally using direct signal measurements of the reference stations in place of absent relayed signals. The simulation results demonstrate that a higher accuracy level can be achieved because the user position is estimated based on the measurements of airborne relays and a ground station. Furthermore, the service coverage is expanded by using direct measurements of reference stations for user positioning. PMID:27529252

Assessing a computerized routine health information system in Mali using LQAS.

PubMed

Stewart, J C; Schroeder, D G; Marsh, D R; Allhasane, S; Kone, D

2001-09-01

Between 1987 and 1998 Save the Children conducted a child survival programme in Mali with the goal of reducing maternal and child morbidity and mortality. An integral part of this programme was a computerized demographic surveillance and health information system (HIS) that gathered data on individuals on an on-going basis. To assess the overall coverage and quality of the data in the HIS, to identify specific health districts that needed improvements in data collection methods, and to determine particular areas of weakness in data collection. Random samples of 20 mothers with children <5 years were selected in each of 14 health districts. Mothers were interviewed about pregnancies, live births, deaths of children <5, and children's growth monitoring and immunization status. The Lot Quality Assurance Method (LQAS) was used to identify districts in which records and interview results did not meet predetermined levels of acceptability. Data collected in the interviews were combined to estimate overall coverage and quality. When all variables were analyzed, all 14 lots were rejected, and it was estimated that 52% of all events occurring in the community were registered in ProMIS. Much of this poor performance was due to immunization and growth monitoring data, which were not updated due to printer problems. Coverage of events increased (92%) when immunizations and growth monitoring were excluded, and no lots were rejected. When all variables were analyzed for quality of data recorded, six lots were rejected and the overall estimation was 83%. With immunizations and growth monitoring excluded, overall quality was 86% and no lots were rejected. The comprehensive computerized HIS did not meet expectations. This may be due, in part, to the ambitious objective of complete and intensive monitoring of a large population without adequate staff and equipment. Future efforts should consider employing a more targeted and streamlined HIS so that data can be more complete and useful.

Enhanced Positioning Algorithm of ARPS for Improving Accuracy and Expanding Service Coverage.

PubMed

Lee, Kyuman; Baek, Hoki; Lim, Jaesung

2016-08-12

The airborne relay-based positioning system (ARPS), which employs the relaying of navigation signals, was proposed as an alternative positioning system. However, the ARPS has limitations, such as relatively large vertical error and service restrictions, because firstly, the user position is estimated based on airborne relays that are located in one direction, and secondly, the positioning is processed using only relayed navigation signals. In this paper, we propose an enhanced positioning algorithm to improve the performance of the ARPS. The main idea of the enhanced algorithm is the adaptable use of either virtual or direct measurements of reference stations in the calculation process based on the structural features of the ARPS. Unlike the existing two-step algorithm for airborne relay and user positioning, the enhanced algorithm is divided into two cases based on whether the required number of navigation signals for user positioning is met. In the first case, where the number of signals is greater than four, the user first estimates the positions of the airborne relays and its own initial position. Then, the user position is re-estimated by integrating a virtual measurement of a reference station that is calculated using the initial estimated user position and known reference positions. To prevent performance degradation, the re-estimation is performed after determining its requirement through comparing the expected position errors. If the navigation signals are insufficient, such as when the user is outside of airborne relay coverage, the user position is estimated by additionally using direct signal measurements of the reference stations in place of absent relayed signals. The simulation results demonstrate that a higher accuracy level can be achieved because the user position is estimated based on the measurements of airborne relays and a ground station. Furthermore, the service coverage is expanded by using direct measurements of reference stations for user positioning.

Clinical uptake of antimicrobial stewardship recommendations following Nanosphere Verigene Blood Culture Gram-negative reporting

PubMed Central

Belknap, Aaron; Grosser, Daniel S.; Hale, Daniel A.; Lang, Benjamin J.; Colley, Peter; Benavides, Raul

2017-01-01

We performed a retrospective chart review of patients to determine if the Verigene Gram-negative blood culture (BC-GN) results would lead to earlier deescalation of empiric therapy for inpatients with GN bacteremia with Citrobacter spp., Enterobacter spp., Klebsiella spp., and Escherichia coli to appropriate targeted coverage. A total of 899 records were reviewed from April 2014 to February 2016 from three institutions within the Baylor Scott & White Health network. The cases were reviewed for initial antibiotic coverage, timing of Verigene results, change in antibiotic coverage, and how these changes related to the timing of Verigene results. The lab reported the BC-GN results and final conventional susceptibility results within 2.5 ± 1.3 and 73.6 ± 40.0 hours from the Gram stain, respectively. Overall, 29.1% of patients were transitioned from empiric to targeted therapy at 12.2 ± 13.5 hours in response to BC-GN results, which was significantly earlier (P < 0.001) than results by conventional methods. After accounting for patients already on targeted therapy, polymicrobial infections, and patients deceased or lost to follow-up, we identified antibiotic stewardship opportunities in ∼28% of GN infections. Further subanalysis demonstrated site-specific differences in the uptake of stewardship recommendations, whereby 32.4%, 50.5%, and 15.0% of cases at different hospitals demonstrated the expected change in antibiotics. These results suggest that Verigene had the expected impact in a third of the cases and the results reporting algorithm minimized the real-time involvement of the pharmacist while maintaining optimal patient management. However, this impact varied substantially by clinical site and was tempered by variable initial antibiotic coverage and clinician response. PMID:28966443

Ground-Based VIS/NIR Reflectance Spectra of 25143 Itokawa: What Hayabusa will See and How Ground-Based Data can Augment Analyses

NASA Technical Reports Server (NTRS)

Vilas, Faith; Abell, P. A.; Jarvis, K. S.

2004-01-01

Planning for the arrival of the Hayabusa spacecraft at asteroid 25143 Itokawa includes consideration of the expected spectral information to be obtained using the AMICA and NIRS instruments. The rotationally-resolved spatial coverage the asteroid we have obtained with ground-based telescopic spectrophotometry in the visible and near-infrared can be utilized here to address expected spacecraft data. We use spectrophotometry to simulate the types of data that Hayabusa will receive with the NIRS and AMICA instruments, and will demonstrate them here. The NIRS will cover a wavelength range from 0.85 m, and have a dispersion per element of 250 Angstroms. Thus, we are limited in coverage of the 1.0 micrometer and 2.0 micrometer mafic silicate absorption features. The ground-based reflectance spectra of Itokawa show a large component of olivine in its surface material, and the 2.0 micrometer feature is shallow. Determining the olivine to pyroxene abundance ratio is critically dependent on the attributes of the 1.0- and 2.0 micrometer features. With a cut-off near 2,1 micrometer the longer edge of the 2.0- feature will not be obtained by NIRS. Reflectance spectra obtained using ground-based telescopes can be used to determine the regional composition around space-based spectral observations, and possibly augment the longer wavelength spectral attributes. Similarly, the shorter wavelength end of the 1.0 micrometer absorption feature will be partially lost to the NIRS. The AMICA filters mimic the ECAS filters, and have wavelength coverage overlapping with the NIRS spectral range. We demonstrate how merging photometry from AMICA will extend the spectral coverage of the NIRS. Lessons learned from earlier spacecraft to asteroids should be considered.

House subcommittee rejects effort to remove abortion coverage.

PubMed

1994-05-27

On May 12, (1994) a subcommittee of the House Education and Labor Committee voted 16-11 in support of retaining abortion coverage in the President's proposed health care plan. With its vote, the Labor/Management Relations subcommittee rejected an amendment by Representative Ron Klink (D-PA), which would have allowed insurers to cover abortions only in cases of forcible rape or incest, or life endangerment. Two Republican Representatives joined 14 Democrats voting against the amendment, while 3 Democratic Representatives were among the 11 people supporting the Klink amendment. The subcommittee also defeated an amendment introduced by Representative Dick Armey (R-TX), which would have prohibited any language in a health care reform bill from overruling constitutional state laws restricting abortion. 14 subcommittee members voted against the Armey amendment; 11 voted in favor. The subcommittee is not expected to act on a final health care measure before the Memorial Day recess. In related news, a Veterans' Affairs House subcommittee voted 11-8 on May 11 to prohibit the performance of abortions at Department of Veterans' Affairs Hospitals or the coverage of abortion services by VA funds. The amendment was introduced in the Hospitals and Health Care subcommittee by Representative Chris Smith (R-NJ). Neither subcommittee action represents a final decision on abortion coverage in health care reform and none of the 5 Congressional committees considering health reform is expected to finalize their proposals before the Memorial Day recess. The Senate Labor and Human Resources Committee and the House Ways and Means Committee started work on health care reform on May 18. The Senate Finance Committee has only been meeting privately thus far, while neither the full House Education and Labor Committee nor the House Energy and Commerce Committee has met. full text

Increasing cellular coverage within integrated terrestrial/satellite mobile networks

NASA Technical Reports Server (NTRS)

Castro, Jonathan P.

1995-01-01

When applying the hierarchical cellular concept, the satellite acts as giant umbrella cell covering a region with some terrestrial cells. If a mobile terminal traversing the region arrives to the border-line or limits of a regular cellular ground service, network transition occurs and the satellite system continues the mobile coverage. To adequately assess the boundaries of service of a mobile satellite system an a cellular network within an integrated environment, this paper provides an optimized scheme to predict when a network transition may be necessary. Under the assumption of a classified propagation phenomenon and Lognormal shadowing, the study applies an analytical approach to estimate the location of a mobile terminal based on a reception of the signal strength emitted by a base station.

Cost-Effectiveness of Providing Full Drug Coverage to Increase Medication Adherence in Post–Myocardial Infarction Medicare Beneficiaries

PubMed Central

Choudhry, Niteesh K.; Patrick, Amanda R.; Antman, Elliott M.; Avorn, Jerry; Shrank, William H.

2009-01-01

Background Effective therapies for the secondary prevention of coronary heart disease–related events are significantly underused, and attempts to improve adherence have often yielded disappointing results. Elimination of patient out-of-pocket costs may be an effective strategy to enhance medication use. We sought to estimate the incremental cost-effectiveness of providing full coverage for aspirin, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins (combination pharmacotherapy) to individuals enrolled in the Medicare drug benefit program after acute myocardial infarction. Methods and Results We created a Markov cost-effectiveness model to estimate the incremental cost-effectiveness of providing Medicare beneficiaries with full coverage for combination pharmacotherapy compared with current coverage under the Medicare Part D program. Our analysis was conducted from the societal perspective and considered a lifetime time horizon. In a sensitivity analysis, we repeated our analysis from the perspective of Medicare. In the model, post–myocardial infarction Medicare beneficiaries who received usual prescription drug coverage under the Part D program lived an average of 8.21 quality-adjusted life-years after their initial event, incurring coronary heart disease–related medical costs of $114 000. Those who received prescription drug coverage without deductibles or copayments lived an average of 8.56 quality-adjusted life-years and incurred $111 600 in coronary heart disease–related costs. Compared with current prescription drug coverage, full coverage for post–myocardial infarction secondary prevention therapies would result in greater functional life expectancy (0.35 quality-adjusted life-year) and less resource use ($2500). From the perspective of Medicare, full drug coverage was highly cost-effective ($7182/quality-adjusted life-year) but not cost saving. Conclusions Our analysis suggests that providing full coverage for combination therapy to post–myocardial infarction Medicare beneficiaries would save both lives and money from the societal perspective. PMID:18285564

Trends in insurance coverage and source of private coverage among young adults aged 19-25: United States, 2008-2012.

PubMed

Kirzinger, Whitney K; Cohen, Robin A; Gindi, Renee M

2013-12-01

Data from the National Health Interview Survey, 2008-2012. The percentage of young adults with private health insurance coverage increased from the last 6 months of 2010 through the last 6 months of 2012 (52.0% to 57.9%). Except for an increase in the first 6 months of 2011, the percentage of privately insured young adults who had a gap in coverage during the past 12 months decreased from the first 6 months of 2008 through the last 6 months of 2012 (10.5% to 7.8%). The percentage of privately insured young adults with coverage in their own name decreased from 40.8% in the last 6 months of 2010 to 27.2% in the last 6 months of 2012. The percentage of privately insured young adults with employer-sponsored health insurance increased from the last 6 months of 2010 to the last 6 months of 2012 (85.6% to 92.5%). Young adults often experience instability with regard to work, school, residential status, and financial independence. This could contribute to a lack of or gaps in insurance coverage (1,2). In September 2010, the Affordable Care Act (ACA) extended dependent health coverage to young adults up to age 26. This provision was expected to lead to increases in private coverage for young adults aged 19-25 when they became eligible for coverage through their parents' employment (3,4). This report provides estimates describing the previous insurance status and sources of coverage among privately insured young adults aged 19-25, using data from the 2008-2012 National Health Interview Survey (NHIS). Comparisons are made with adults aged 26-34, the most similar age group that was not affected by the ACA provision. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Association of Health Insurance Status and Vaccination Coverage among Adolescents 13-17 Years of Age.

PubMed

Lu, Peng-Jun; Yankey, David; Jeyarajah, Jenny; O'Halloran, Alissa; Fredua, Benjamin; Elam-Evans, Laurie D; Reagan-Steiner, Sarah

2018-04-01

To assess selected vaccination coverage among adolescents by health insurance status and other access-to-care characteristics. The 2015 National Immunization Survey-Teen data were used to assess vaccination coverage disparities among adolescents by health insurance status and other access-to-care variables. Multivariable logistic regression analysis and a predictive marginal modeling were conducted to evaluate associations between health insurance status and vaccination coverage. Overall, vaccination coverage was significantly lower among uninsured compared with insured adolescents for all vaccines assessed for except ≥3 doses of human papillomavirus vaccine (HPV) among male adolescents. Among adolescents 13-17 years of age, vaccination of uninsured compared with insured adolescents, respectively, for tetanus toxoid, reduced content diphtheria toxoid, and acellular pertussis vaccine was 77.4% vs 86.8%; for ≥1 dose of meningococcal conjugate vaccine was 72.9% vs 81.7%; for ≥1 dose of HPV was 38.8% vs 50.2% among male and 42.9% vs 63.8% among female adolescents; for 3 doses of HPV was 24.9% vs 42.8% among female adolescents. In addition, vaccination coverage differed by the following: type of insurance among insured adolescents, having a well-child visit at 11-12 years of age, and number of healthcare provider contacts in the past year. Uninsured were less likely than insured adolescents to be vaccinated for HPV (female: ≥1 dose and 3 doses; and male: ≥1 doses) after adjusting for confounding variables. Overall, vaccination coverage was lower among uninsured adolescents. HPV vaccination coverage was lower than tetanus toxoid, reduced content diphtheria toxoid, and acellular pertussis vaccine Tdap and meningococcal conjugate vaccine in both insured and uninsured adolescents. Wider implementation of effective evidence-based strategies is needed to help improve vaccination coverage among adolescents, particularly for those who are uninsured. Limitation of current federally funded vaccination programs or access to healthcare would be expected to erode vaccine coverage of adolescents. Published by Elsevier Inc.

Are we expecting too much from print media? An analysis of newspaper coverage of the 2002 Canadian healthcare reform debate.

PubMed

Collins, Patricia A; Abelson, Julia; Pyman, Heather; Lavis, John N

2006-07-01

News media effects on their audiences are complex. Four commonly cited effects are: informing audiences; agenda-setting; framing; and persuading. The release in autumn 2002 of two reports on options for reforming Canada's healthcare system attracted widespread media attention. We explored the potential for each of the four media effects by examining Canadian newspaper representation of this healthcare policy debate. Clippings were gathered from regional and national newspapers. Two data collection methodologies were employed: the first involved two staggered "constructed weeks" designed to capture thematic news framing styles; the second collected "intensive" or episodic coverage immediately following the report releases. Health reform articles with a financing and/or delivery focus were included. Using a codebook, articles were coded to track article characteristics, tone, healthcare sector and reform themes, and key actors. A greater quantity of episodic (n=341 clippings) versus thematic coverage (n=77) was documented. Coverage type did not vary significantly by newspaper, reporting source (e.g., staff reporter versus staff editorialist) or article type (e.g., news versus letter). Thematic articles were significantly shorter in length compared to episodic clippings. Episodic coverage tended to have a positive tone, while thematic coverage ranged in tone. Most coverage was general in scope. Sector-specific coverage favoured physician and hospital care--the two providers accorded privileged financing arrangements under Canada's universal, provincially administered health-insurance plans. Coverage of healthcare financing arrangements favoured broad discussions of publicly financed healthcare, federal-provincial governmental relations, and the Canada Health Act that governs provincial plans. Governmental actors and the political institutions that they represent were the dominant actors. Professional associations were also visible, but played a less dominant role. Given its non-specific scope, it is unclear how informative this coverage was. The large quantity and short duration of the episodic coverage, and the preponderance of governmental actors, suggests these newspapers acted as conduits for the policy agenda. Differences in framing styles were observed by coverage type, newspaper, reporting source, article length and type of article. Finally, the dominance of governmental actors provided these actors with numerous opportunities to persuade the public.

A mathematical model of the impact of present and future malaria vaccines.

PubMed

Wenger, Edward A; Eckhoff, Philip A

2013-04-15

With the encouraging advent of new malaria vaccine candidates, mathematical modelling of expected impacts of present and future vaccines as part of multi-intervention strategies is especially relevant. The impact of potential malaria vaccines is presented utilizing the EMOD model, a comprehensive model of the vector life cycle coupled to a detailed mechanistic representation of intra-host parasite and immune dynamics. Values of baseline transmission and vector feeding behaviour parameters are identified, for which local elimination is enabled by layering pre-erythrocytic vaccines of various efficacies on top of high and sustained insecticide-treated net coverage. The expected reduction in clinical cases is further explored in a scenario that targets children by adding a pre-erythrocytic vaccine to the EPI programme for newborns. At high transmission, there is a minimal reduction in clinical disease cases, as the time to infection is only slightly delayed. At lower transmission, there is an accelerating community-level protection that has subtle dependences on heterogeneities in vector behaviour, ecology, and intervention coverage. At very low transmission, the trend reverses as many children are vaccinated to prevent few cases. The maximum-impact setting is one in which the impact of increasing bed net coverage has saturated, vector feeding is primarily outdoors, and transmission is just above the threshold where small perturbations from a vaccine intervention result in large community benefits.

Barriers to and Budget Impact of Lumbar Total Disc Replacement Utilization.

PubMed

Sandhu, Faheem; Blumenthal, Scott; Grunch, Betsy; Kimball, Bent; Ferko, Nicole; Hollmann, Sarah

2017-12-15

: Evidence on the favorable efficacy, safety, and cost effectiveness of lumbar total disc replacement (TDR) compared with fusion for lumbar degenerative disc disease is mounting; however, a key barrier identified for TDR utilization is lack of coverage by US health insurers. Although economic considerations in a fee-for-service model should not be a determining factor in patient access, concerns regarding the budget impact of lumbar TDR surgery may unfortunately underlie coverage decisions. On the basis of the data available and economic modeling, the panel agreed that there is no indication that there would be a dramatic increase in patients seeking lumbar TDR. Considering several possible scenarios on potential growth in TDR utilization with coverage, as well as growth in the overall surgical pool of patients, economic modeling demonstrated that adoption of lumbar TDR would result in minimal or no budget impact for commercial insurance plans. Considering these model results and the economic literature, the panel concluded that adopting lumbar TDR within a coverage policy is expected to remain cost neutral for the insurer.

Coverage-guaranteed sensor node deployment strategies for wireless sensor networks.

PubMed

Fan, Gaojuan; Wang, Ruchuan; Huang, Haiping; Sun, Lijuan; Sha, Chao

2010-01-01

Deployment quality and cost are two conflicting aspects in wireless sensor networks. Random deployment, where the monitored field is covered by randomly and uniformly deployed sensor nodes, is an appropriate approach for large-scale network applications. However, their successful applications depend considerably on the deployment quality that uses the minimum number of sensors to achieve a desired coverage. Currently, the number of sensors required to meet the desired coverage is based on asymptotic analysis, which cannot meet deployment quality due to coverage overestimation in real applications. In this paper, we first investigate the coverage overestimation and address the challenge of designing coverage-guaranteed deployment strategies. To overcome this problem, we propose two deployment strategies, namely, the Expected-area Coverage Deployment (ECD) and BOundary Assistant Deployment (BOAD). The deployment quality of the two strategies is analyzed mathematically. Under the analysis, a lower bound on the number of deployed sensor nodes is given to satisfy the desired deployment quality. We justify the correctness of our analysis through rigorous proof, and validate the effectiveness of the two strategies through extensive simulation experiments. The simulation results show that both strategies alleviate the coverage overestimation significantly. In addition, we also evaluate two proposed strategies in the context of target detection application. The comparison results demonstrate that if the target appears at the boundary of monitored region in a given random deployment, the average intrusion distance of BOAD is considerably shorter than that of ECD with the same desired deployment quality. In contrast, ECD has better performance in terms of the average intrusion distance when the invasion of intruder is from the inside of monitored region.

Identification of copy number variants in whole-genome data using Reference Coverage Profiles

PubMed Central

Glusman, Gustavo; Severson, Alissa; Dhankani, Varsha; Robinson, Max; Farrah, Terry; Mauldin, Denise E.; Stittrich, Anna B.; Ament, Seth A.; Roach, Jared C.; Brunkow, Mary E.; Bodian, Dale L.; Vockley, Joseph G.; Shmulevich, Ilya; Niederhuber, John E.; Hood, Leroy

2015-01-01

The identification of DNA copy numbers from short-read sequencing data remains a challenge for both technical and algorithmic reasons. The raw data for these analyses are measured in tens to hundreds of gigabytes per genome; transmitting, storing, and analyzing such large files is cumbersome, particularly for methods that analyze several samples simultaneously. We developed a very efficient representation of depth of coverage (150–1000× compression) that enables such analyses. Current methods for analyzing variants in whole-genome sequencing (WGS) data frequently miss copy number variants (CNVs), particularly hemizygous deletions in the 1–100 kb range. To fill this gap, we developed a method to identify CNVs in individual genomes, based on comparison to joint profiles pre-computed from a large set of genomes. We analyzed depth of coverage in over 6000 high quality (>40×) genomes. The depth of coverage has strong sequence-specific fluctuations only partially explained by global parameters like %GC. To account for these fluctuations, we constructed multi-genome profiles representing the observed or inferred diploid depth of coverage at each position along the genome. These Reference Coverage Profiles (RCPs) take into account the diverse technologies and pipeline versions used. Normalization of the scaled coverage to the RCP followed by hidden Markov model (HMM) segmentation enables efficient detection of CNVs and large deletions in individual genomes. Use of pre-computed multi-genome coverage profiles improves our ability to analyze each individual genome. We make available RCPs and tools for performing these analyses on personal genomes. We expect the increased sensitivity and specificity for individual genome analysis to be critical for achieving clinical-grade genome interpretation. PMID:25741365

Engineering design skills coverage in K-12 engineering program curriculum materials in the USA

NASA Astrophysics Data System (ADS)

Chabalengula, Vivien M.; Mumba, Frackson

2017-11-01

The current K-12 Science Education framework and Next Generation Science Standards (NGSS) in the United States emphasise the integration of engineering design in science instruction to promote scientific literacy and engineering design skills among students. As such, many engineering education programmes have developed curriculum materials that are being used in K-12 settings. However, little is known about the nature and extent to which engineering design skills outlined in NGSS are addressed in these K-12 engineering education programme curriculum materials. We analysed nine K-12 engineering education programmes for the nature and extent of engineering design skills coverage. Results show that developing possible solutions and actual designing of prototypes were the highly covered engineering design skills; specification of clear goals, criteria, and constraints received medium coverage; defining and identifying an engineering problem; optimising the design solution; and demonstrating how a prototype works, and making iterations to improve designs were lowly covered. These trends were similar across grade levels and across discipline-specific curriculum materials. These results have implications on engineering design-integrated science teaching and learning in K-12 settings.

26 CFR 1.410(b)-1 - Minimum coverage requirements (before 1994).

Code of Federal Regulations, 2010 CFR

2010-04-01

....410(b)-1(b)(2). (6) Integration with Social Security Act. See section 401(a)(5) and the regulations thereunder for rules relating to integration of plans with the Social Security Act. (7) Different age and..., all the employees of corporations or trades and businesses whose employees are treated as employed by...

The WAGGS project - I. The WiFeS Atlas of Galactic Globular cluster Spectra

NASA Astrophysics Data System (ADS)

Usher, Christopher; Pastorello, Nicola; Bellstedt, Sabine; Alabi, Adebusola; Cerulo, Pierluigi; Chevalier, Leonie; Fraser-McKelvie, Amelia; Penny, Samantha; Foster, Caroline; McDermid, Richard M.; Schiavon, Ricardo P.; Villaume, Alexa

2017-07-01

We present the WiFeS Atlas of Galactic Globular cluster Spectra, a library of integrated spectra of Milky Way and Local Group globular clusters. We used the WiFeS integral field spectrograph on the Australian National University 2.3 m telescope to observe the central regions of 64 Milky Way globular clusters and 22 globular clusters hosted by the Milky Way's low-mass satellite galaxies. The spectra have wider wavelength coverage (3300-9050 Å) and higher spectral resolution (R = 6800) than existing spectral libraries of Milky Way globular clusters. By including Large and Small Magellanic Cloud star clusters, we extend the coverage of parameter space of existing libraries towards young and intermediate ages. While testing stellar population synthesis models and analysis techniques is the main aim of this library, the observations may also further our understanding of the stellar populations of Local Group globular clusters and make possible the direct comparison of extragalactic globular cluster integrated light observations with well-understood globular clusters in the Milky Way. The integrated spectra are publicly available via the project website.

UCAC1: New Proper Motions for 27 Million Stars on the Southern Hemisphere

NASA Astrophysics Data System (ADS)

Zacharias, N.; Monet, S. Urban D. G.; Platais, I.; Wycoff, G. L.; Zacharias, M. I.; Rafferty, T. J.

The big impact of UCAC on galactic kinematics and dynamics studies will be outlined. The USNO CCD Astrograph (UCA) started an astrometric sky survey in February 1998 at Cerro Tololo, Chile. By January 2000 about 90% of the Southern Hemisphere has been observed and full sky coverage is expected by early 2003. In addition, calibration fields around extragalactic reference frame sources and selected open clusters are observed frequently. The UCAC project is a huge dedicated astrometric survey similar to the AGK2 and AGK3 projects but vastly exceeding those with respect to higher accuracy, limiting magnitude (16th) and full sky coverage. A first catalog (UCAC1) is being published in early 2000 for 27 million stars. Stars in the range of 9 to 14th magnitude have a positional precision of 20 mas. The UCAC1 will utilize positions from the USNO A2.0 catalog for determining proper motions, which are expected to be about 8 mas/yr for this initial release. Higher precision proper motions, expected to be in the 3 to 4 mas/yr range, will be derived utilizing a variety of early epoch data, including re-measuring of the Southern Proper Motion (SPM) survey first epoch plates.

A new low-profile visualized intraluminal support (LVIS) device, LVIS Blue: laboratory comparison between old and new LVIS.

PubMed

Chung, Joonho; Matsuda, Yoshikazu; Nelson, Jessica; Keigher, Kiffon; Lopes, Demetrius K

2018-01-01

Objectives The Low-profile Visualized Intraluminal Support (LVIS) device is a flexible intracranial stent. The first generation of this system had significant challenges in consistently providing good wall apposition and aneurysm neck coverage. A new modified LVIS, LVIS Blue (Blue), has been developed to address these issues. The purpose of this study is to report a laboratory comparison of wall apposition and aneurysm neck coverage between the original LVIS and Blue. Methods In bench-top experiments, we noted the visual appearance of the devices and evaluated changes in stent cell angles, neck coverage surface area (%), and stent cell crossing profile for microcatheters using a fusiform aneurysm model. Our in vitro experiments included evaluation of wall apposition and aneurysm neck coverage of the devices under direct radiographic visualization. Results Blue showed three definite different zones (a mid-zone, a high-density zone, and a transitional zone) and higher metal coverage in the straight fusiform aneurysm model compared to LVIS. Two commercially available microcatheters easily crossed the stent cell at the greater curvature for both devices. In in vitro experiments, Blue showed better wall apposition in tortuous arteries and achieved higher neck coverage in the bifurcation aneurysm compared to LVIS. Discussion Blue achieved better wall apposition in tortuous arteries and higher aneurysm neck coverage (higher metal-to-artery ratio) in bifurcation aneurysms than LVIS. Our results may provide informative physical properties of LVIS and Blue to be expected when those are used for stent-assisted coil embolization of a large-giant fusiform aneurysm or a bifurcation saccular aneurysm clinically.

A preliminary analysis of library holdings as compared to the basic resources for pharmacy education list.

PubMed

Vaughan, K T L V; Lerner, Rachel C

2013-01-01

The catalogs of 11 university libraries were analyzed against the Basic Resources for Pharmaceutical Education (BRPE) to measure the percent coverage of the core total list as well as the core sublist. There is no clear trend in this data to link school age, size, or rank with percentage of coverage of the total list or the "First Purchase" core list when treated as independent variables. Approximately half of the schools have significantly higher percentages of core titles than statistically expected. Based on this data, it is difficult to predict what percentage of titles on the BRPE a library will contain.

A Practical Approach to Modified Condition/Decision Coverage

NASA Technical Reports Server (NTRS)

Hayhurst, Kelly J.; Veerhusem, Dan S.

2001-01-01

Testing of software intended for safety-critical applications in commercial transport aircraft must achieve modified condition/decision coverage (MC/DC) of the software structure. This requirement causes anxiety for many within the aviation software community. Results of a survey of the aviation software industry indicate that many developers believe that meeting the MC/DC requirement is difficult, and the cost is exorbitant. Some of the difficulties stem, no doubt, from the scant information available on the subject. This paper provides a practical 5-step approach for assessing MC/DC for aviation software products, and an analysis of some types of errors expected to be caught when MC/DC is achieved1.

Integrated Computational Solution for Predicting Skin Sensitization Potential of Molecules

PubMed Central

Desai, Aarti; Singh, Vivek K.; Jere, Abhay

2016-01-01

Introduction Skin sensitization forms a major toxicological endpoint for dermatology and cosmetic products. Recent ban on animal testing for cosmetics demands for alternative methods. We developed an integrated computational solution (SkinSense) that offers a robust solution and addresses the limitations of existing computational tools i.e. high false positive rate and/or limited coverage. Results The key components of our solution include: QSAR models selected from a combinatorial set, similarity information and literature-derived sub-structure patterns of known skin protein reactive groups. Its prediction performance on a challenge set of molecules showed accuracy = 75.32%, CCR = 74.36%, sensitivity = 70.00% and specificity = 78.72%, which is better than several existing tools including VEGA (accuracy = 45.00% and CCR = 54.17% with ‘High’ reliability scoring), DEREK (accuracy = 72.73% and CCR = 71.44%) and TOPKAT (accuracy = 60.00% and CCR = 61.67%). Although, TIMES-SS showed higher predictive power (accuracy = 90.00% and CCR = 92.86%), the coverage was very low (only 10 out of 77 molecules were predicted reliably). Conclusions Owing to improved prediction performance and coverage, our solution can serve as a useful expert system towards Integrated Approaches to Testing and Assessment for skin sensitization. It would be invaluable to cosmetic/ dermatology industry for pre-screening their molecules, and reducing time, cost and animal testing. PMID:27271321

Community Colleges and the Media: Getting Effective Coverage for Your Institution.

ERIC Educational Resources Information Center

Thornton, Tim

2000-01-01

Looks at college marketing and promotion from the media's point of view, and addresses the challenges media personnel face in retrieving timely information from colleges and in establishing working relationships with marketing and public relations practitioners in community colleges. Describes what journalists expect from community colleges and…

5 CFR 890.302 - Coverage of family members.

Code of Federal Regulations, 2010 CFR

2010-01-01

... of inclusion of the child as a dependent on the enrollee's income tax returns; (iii) Canceled checks... require such enrollee to submit a physician's certificate verifying the child's disability. The... disability that existed before the child became 22 years of age and that can be expected to continue for more...

Shared Focal Plane Investigation for Serial Frame Cameras.

DTIC Science & Technology

1980-03-01

capability will be restored. 41. -.. TrABLE 1-1 SYSTEM LEADING P) ARTICULARS Lens Focal Length (inches) Range (ft) Contrast 12 18 24 Coverage 22.1...can be expected that signature bands will be apparent in the imagery. Such bands are at best distracting and at worst hindrances to image interpretation

Internet of Things

ERIC Educational Resources Information Center

Ritz, John; Knaack, Zane

2017-01-01

In the 21st century, electronic connectivity is a major component of everyday life. One expects to have mobile phone coverage and to have access to log a computer or tablet onto the internet. This connectivity enables users to keep track of personal affairs and conduct work from remote locations. Designers and manufacturers are also connecting…

Expected and Unexpected Consequences of the Affordable Care Act: The Impact on Patients and Surgeons-Pro and Con Arguments.

PubMed

Rudnicki, Marek; Armstrong, John H; Clark, Clancy; Marcus, Stuart G; Sacks, Lee; Moser, A James; Reid-Lombardo, K Marie

2016-02-01

The Patient Protection and Affordable Care Act (PPACA), called the Affordable Care Act (ACA) or "ObamaCare" for short, was enacted in 2010. The Public Policy and Advocacy Committee of the Society for Surgery of the Alimentary Tract (SSAT) hosted a debate with an expert panel to discuss the ACA and its impact on surgical care after the first year of patient enrollment. The purpose of this debate was to focus on the impact of ACA on the public and surgeons. At the core of the ACA are insurance industry reforms and expanded coverage, with a goal of improved clinical outcomes and reduced costs of care. We have observed supportive and opposing views on ACA. Nonetheless, we will witness major shifts in health care delivery as well as restructuring of our relationship with payers, institutions, and patients. With the rapidly changing health care landscape, surgeons will become key members of health systems and will likely need to lead transition from solo-practice to integrated care systems. The full effects of the ACA remain unrealized, but its implementation has begun to change the map of the American health care system and will surely impact the practice of surgery. Herein, we provide a synopsis of the "pro" and "con" arguments for the expected and unexpected consequences of the ACA on society and surgeons.

A Comprehensive Algorithm for Approval of Health Technologies With, Without, or Only in Research: The Key Principles for Informing Coverage Decisions.

PubMed

Claxton, Karl; Palmer, Stephen; Longworth, Louise; Bojke, Laura; Griffin, Susan; Soares, Marta; Spackman, Eldon; Rothery, Claire

The value of evidence about the performance of a technology and the value of access to a technology are central to policy decisions regarding coverage with, without, or only in research and managed entry (or risk-sharing) agreements. We aim to outline the key principles of what assessments are needed to inform "only in research" (OIR) or "approval with research" (AWR) recommendations, in addition to approval or rejection. We developed a comprehensive algorithm to inform the sequence of assessments and judgments that lead to different types of guidance: OIR, AWR, Approve, or Reject. This algorithm identifies the order in which assessments might be made, how similar guidance might be arrived at through different combinations of considerations, and when guidance might change. The key principles are whether the technology is expected to be cost-effective; whether the technology has significant irrecoverable costs; whether additional research is needed; whether research is possible with approval and whether there are opportunity costs that once committed by approval cannot be recovered; and whether there are effective price reductions. Determining expected cost-effectiveness is only a first step. In addition to AWR for technologies expected to be cost-effective and OIR for those not expected to be cost-effective, there are other important circumstances when OIR should be considered. These principles demonstrate that cost-effectiveness is a necessary but not sufficient condition for approval. Even when research is possible with approval, OIR may be appropriate when a technology is expected to be cost-effective due to significant irrecoverable costs. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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

PubMed Central

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

2011-01-01

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

Time management in health care social work.

PubMed

Sheridan, M S

1988-01-01

Health care social workers face significant problems in controlling and managing time. Among the causes are increased demands for service, economy measures in health care, and the concurrent responsibility which social workers often have for both ongoing case management and crisis coverage. Individuals and social work departments can increase productivity through streamlining case management, increasing use of available resources, and generating new resources. With planning and preparation, many emergencies can be moved into the expected work flow. The social work profession needs to address time management problems and expectations in a more realistic and systematic way.

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

Universal Health Coverage and Primary Healthcare: Lessons From Japan

PubMed Central

Bloom, Gerald

2017-01-01

A recent editorial by Naoki Ikegami has proposed three key lessons from Japan’s experience of achieving virtually universal coverage with primary healthcare services: the need to integrate the existing providers of primary healthcare services into the organised health system; the need to limit government commitments to finance hospital services and the need to empower providers of primary healthcare to influence decisions that influence their livelihoods. Although the context of low- and middle-income countries (LMICs) differs in many ways from Japan in the late 19th and early 20th centuries, the lesson that short-term initiatives to achieve universal coverage need to be complemented by an understanding of the factors influencing long-term change management remains highly relevant. PMID:28812806

Identifying micro-inversions using high-throughput sequencing reads.

PubMed

He, Feifei; Li, Yang; Tang, Yu-Hang; Ma, Jian; Zhu, Huaiqiu

2016-01-11

The identification of inversions of DNA segments shorter than read length (e.g., 100 bp), defined as micro-inversions (MIs), remains challenging for next-generation sequencing reads. It is acknowledged that MIs are important genomic variation and may play roles in causing genetic disease. However, current alignment methods are generally insensitive to detect MIs. Here we develop a novel tool, MID (Micro-Inversion Detector), to identify MIs in human genomes using next-generation sequencing reads. The algorithm of MID is designed based on a dynamic programming path-finding approach. What makes MID different from other variant detection tools is that MID can handle small MIs and multiple breakpoints within an unmapped read. Moreover, MID improves reliability in low coverage data by integrating multiple samples. Our evaluation demonstrated that MID outperforms Gustaf, which can currently detect inversions from 30 bp to 500 bp. To our knowledge, MID is the first method that can efficiently and reliably identify MIs from unmapped short next-generation sequencing reads. MID is reliable on low coverage data, which is suitable for large-scale projects such as the 1000 Genomes Project (1KGP). MID identified previously unknown MIs from the 1KGP that overlap with genes and regulatory elements in the human genome. We also identified MIs in cancer cell lines from Cancer Cell Line Encyclopedia (CCLE). Therefore our tool is expected to be useful to improve the study of MIs as a type of genetic variant in the human genome. The source code can be downloaded from: http://cqb.pku.edu.cn/ZhuLab/MID .

Sentinel-1 automatic processing chain for volcanic and seismic areas monitoring within the Geohazards Exploitation Platform (GEP)

NASA Astrophysics Data System (ADS)

De Luca, Claudio; Zinno, Ivana; Manunta, Michele; Lanari, Riccardo; Casu, Francesco

2016-04-01

The microwave remote sensing scenario is rapidly evolving through development of new sensor technology for Earth Observation (EO). In particular, Sentinel-1A (S1A) is the first of a sensors' constellation designed to provide a satellite data stream for the Copernicus European program. Sentinel-1A has been specifically designed to provide, over land, Differential Interferometric Synthetic Aperture Radar (DInSAR) products to analyze and investigate Earth's surface displacements. S1A peculiarities include wide ground coverage (250 km of swath), C-band operational frequency and short revisit time (that will reduce from 12 to 6 days when the twin system Sentinel-1B will be placed in orbit during 2016). Such characteristics, together with the global coverage acquisition policy, make the Sentinel-1 constellation to be extremely suitable for volcanic and seismic areas studying and monitoring worldwide, thus allowing the generation of both ground displacement information with increasing rapidity and new geological understanding. The main acquisition mode over land is the so called Interferometric Wide Swath (IWS) that is based on the Terrain Observation by Progressive Scans (TOPS) technique and that guarantees the mentioned S1A large coverage characteristics at expense of a not trivial interferometric processing. Moreover, the satellite spatial coverage and the reduced revisit time will lead to an exponential increase of the data archives that, after the launch of Sentine-1B, will reach about 3TB per day. Therefore, the EO scientific community needs from the one hand automated and effective DInSAR tools able to address the S1A processing complexity, and from the other hand the computing and storage capacities to face out the expected large amount of data. Then, it is becoming more crucial to move processors and tools close to the satellite archives, being not efficient anymore the approach of downloading and processing data with in-house computing facilities. To address these issues, ESA recently funded the development of the Geohazards Exploitation Platform (GEP), a project aimed at putting together data, processing tools and results to make them accessible to the EO scientific community, with particular emphasis to the Geohazard Supersites & Natural Laboratories and the CEOS Seismic Hazards and Volcanoes Pilots. In this work we present the integration of the parallel version of a well-known DInSAR algorithm referred to as Small BAseline Subset (P-SBAS) within the GEP platform for processing Sentinel-1 data. The integration allowed us to set up an operational on-demand web tool, open to every user, aimed at automatically processing S1A data for the generation of SBAS displacement time-series. Main characteristics as well as a number of experimental results obtained by using the implemented web tool will be also shown. This work is partially supported by: the RITMARE project of Italian MIUR, the DPC-CNR agreement and the ESA GEP project.

Homicides In Mexico Reversed Life Expectancy Gains For Men And Slowed Them For Women, 2000–10

PubMed Central

Aburto, José Manuel; Beltrán-Sánchez, Hiram; García-Guerrero, Victor Manuel; Canudas-Romo, Vladimir

2017-01-01

Life expectancy in Mexico increased for more than six decades but then stagnated in the period 2000–10. This decade was characterized by the enactment of a major health care reform—the implementation of the Seguro Popular de Salud (Popular Health Insurance), which was intended to provide coverage to the entire Mexican population—and by an unexpected increase in homicide mortality. We assessed the impact on life expectancy of conditions amenable to medical service—those sensitive to public health policies and changes in behaviors, homicide, and diabetes—by analyzing mortality trends at the state level. We found that life expectancy among males deteriorated from 2005 to 2010, compared to increases from 2000 to 2005. Females in most states experienced small gains in life expectancy between 2000 and 2010. The unprecedented rise in homicides after 2005 led to a reversal in life expectancy increases among males and a slowdown among females in most states in the first decade of the twenty-first century. PMID:26733705

Is belief larger than fact: expectations, optimism and reality for translational stem cell research.

PubMed

Bubela, Tania; Li, Matthew D; Hafez, Mohamed; Bieber, Mark; Atkins, Harold

2012-11-06

Stem cell (SC) therapies hold remarkable promise for many diseases, but there is a significant gulf between public expectations and the reality of progress toward clinical application. Public expectations are fueled by stakeholder arguments for research and public funding, coupled with intense media coverage in an ethically charged arena. We examine media representations in light of the expanding global landscape of SC clinical trials, asking what patients may realistically expect by way of timelines for the therapeutic and curative potential of regenerative medicine? We built 2 international datasets: (1) 3,404 clinical trials (CT) containing 'stem cell*' from ClinicalTrials.gov and the World Health Organization's International Clinical Trials Registry Search Portal; and (2) 13,249 newspaper articles on SC therapies using Factiva.com. We compared word frequencies between the CT descriptions and full-text newspaper articles for the number containing terms for SC type and diseases/conditions. We also developed inclusion and exclusion criteria to identify novel SC CTs, mainly regenerative medicine applications. Newspaper articles focused on human embryonic SCs and neurological conditions with significant coverage as well of cardiovascular disease and diabetes. In contrast, CTs used primarily hematopoietic SCs, with an increase in CTs using mesenchymal SCs since 2007. The latter dominated our novel classification for CTs, most of which are in phases I and II. From the perspective of the public, expecting therapies for neurological conditions, there is limited activity in what may be considered novel applications of SC therapies. Given the research, regulatory, and commercialization hurdles to the clinical translation of SC research, it seems likely that patients and political supporters will become disappointed and disillusioned. In this environment, proponents need to make a concerted effort to temper claims. Even though the field is highly promising, it lacks significant private investment and is largely reliant on public support, requiring a more honest acknowledgement of the expected therapeutic benefits and the timelines to achieving them.

Is belief larger than fact: expectations, optimism and reality for translational stem cell research

PubMed Central

2012-01-01

Background Stem cell (SC) therapies hold remarkable promise for many diseases, but there is a significant gulf between public expectations and the reality of progress toward clinical application. Public expectations are fueled by stakeholder arguments for research and public funding, coupled with intense media coverage in an ethically charged arena. We examine media representations in light of the expanding global landscape of SC clinical trials, asking what patients may realistically expect by way of timelines for the therapeutic and curative potential of regenerative medicine? Methods We built 2 international datasets: (1) 3,404 clinical trials (CT) containing 'stem cell*' from ClinicalTrials.gov and the World Health Organization's International Clinical Trials Registry Search Portal; and (2) 13,249 newspaper articles on SC therapies using Factiva.com. We compared word frequencies between the CT descriptions and full-text newspaper articles for the number containing terms for SC type and diseases/conditions. We also developed inclusion and exclusion criteria to identify novel SC CTs, mainly regenerative medicine applications. Results Newspaper articles focused on human embryonic SCs and neurological conditions with significant coverage as well of cardiovascular disease and diabetes. In contrast, CTs used primarily hematopoietic SCs, with an increase in CTs using mesenchymal SCs since 2007. The latter dominated our novel classification for CTs, most of which are in phases I and II. From the perspective of the public, expecting therapies for neurological conditions, there is limited activity in what may be considered novel applications of SC therapies. Conclusions Given the research, regulatory, and commercialization hurdles to the clinical translation of SC research, it seems likely that patients and political supporters will become disappointed and disillusioned. In this environment, proponents need to make a concerted effort to temper claims. Even though the field is highly promising, it lacks significant private investment and is largely reliant on public support, requiring a more honest acknowledgement of the expected therapeutic benefits and the timelines to achieving them. PMID:23131007

Public insurance expansions and crowd out of private coverage.

PubMed

Marquis, M Susan; Long, Stephen H

2003-03-01

The extent to which persons enrolling in new public insurance programs substitute the public coverage for private insurance is of concern to policy makers. To look at the extent of the substitution resulting from new state programs that cover a broad base of the low-income population and to look at the responses of both families and employers. The March CPS for 1991-1993 and 1997-1998 were used to study the responses of families. Two large national surveys of employers with information about the employment-based system in 1993 and 1997 were used to study employer responses. The analysis looks at changes in coverage and employer offer rates before and after the public insurance expansions in selected states and compares these changes to those in a control group in states without expansions. Coverage by private insurance for low-income persons in states with expansions fell by more than expected based on the control states, indicating some substitution of public coverage for private insurance. Changes in employee coverage in own-employer sponsored insurance accord with this result. The expansion of public insurance has a bigger effect on employer offer decisions when a large share of its workers is eligible for public programs. The results show a significant substitution of public insurance for private coverage in the expansions studied. However, endogeneity of state expansion policies and possible confounding with other policy changes temper the conclusions. More recent public insurance expansions as part of the State Childrens' Health Insurance Program have adopted a range of methods to limit crowd out. Future research is needed to evaluate whether these procedures and rules have succeeded.

Challenges in Estimating Vaccine Coverage in Refugee and Displaced Populations: Results From Household Surveys in Jordan and Lebanon

PubMed Central

Roberton, Timothy; Weiss, William; Doocy, Shannon

2017-01-01

Ensuring the sustained immunization of displaced persons is a key objective in humanitarian emergencies. Typically, humanitarian actors measure coverage of single vaccines following an immunization campaign; few measure routine coverage of all vaccines. We undertook household surveys of Syrian refugees in Jordan and Lebanon, outside of camps, using a mix of random and respondent-driven sampling, to measure coverage of all vaccinations included in the host country’s vaccine schedule. We analyzed the results with a critical eye to data limitations and implications for similar studies. Among households with a child aged 12–23 months, 55.1% of respondents in Jordan and 46.6% in Lebanon were able to produce the child’s EPI card. Only 24.5% of Syrian refugee children in Jordan and 12.5% in Lebanon were fully immunized through routine vaccination services (having received from non-campaign sources: measles, polio 1–3, and DPT 1–3 in Jordan and Lebanon, and BCG in Jordan). Respondents in Jordan (33.5%) and Lebanon (40.1%) reported difficulties obtaining child vaccinations. Our estimated immunization rates were lower than expected and raise serious concerns about gaps in vaccine coverage among Syrian refugees. Although our estimates likely under-represent true coverage, given the additional benefit of campaigns (not captured in our surveys), there is a clear need to increase awareness, accessibility, and uptake of immunization services. Current methods to measure vaccine coverage in refugee and displaced populations have limitations. To better understand health needs in such groups, we need research on: validity of recall methods, links between campaigns and routine immunization programs, and improved sampling of hard-to-reach populations. PMID:28805672

Workforce strategies to improve children's oral health.

PubMed

Goodwin, Kristine

2014-12-01

(1) Tooth decay is the most common chronic disease for children. (2) As millions receive dental coverage under the Affordable Care Act, the demand for dental services is expected to strain the current workforce's ability to meet their needs. (3) States have adopted various workforce approaches to improve access to dental care for underserved populations.

5 CFR 890.102 - Coverage.

Code of Federal Regulations, 2010 CFR

2010-01-01

... less. (2) An employee who is expected to work less than 6 months in each year, except for an employee who is employed under an OPM approved career-related work-study program under Schedule B of at least 1... time from the date of the first appointment to the completion of the work-study program. (3) An...

The Law and the IEP: Establishing and Maintaining High Expectations for Deaf Students with Disabilities

ERIC Educational Resources Information Center

Fitzpatrick, Michael; Theoharis, Raschelle

2014-01-01

The No Child Left Behind Act (NCLB) and the Individuals with Disabilities Education Improvement Act (IDEIA) have significant implications for students with and without disabilities. Despite extensive research, journal articles, editorials, media coverage, and litigation, deaf and hard of hearing students with additional disabilities continue to be…

Teaching Business Ethics: A Quandary for Accounting Educators

ERIC Educational Resources Information Center

Frank, Gary; Ofobike, Emeka; Gradisher, Suzanne

2010-01-01

The authors discuss the pressures that accounting educators face in meeting expectations to include ethics in the accounting curriculum. Most schools still do not require discrete ethics courses for accounting students; ethics coverage is on a course-by-course basis. However, not all professors are equally comfortable or knowledgeable of models of…

40 CFR Appendix W to Part 51 - Guideline on Air Quality Models

Code of Federal Regulations, 2011 CFR

2011-07-01

... sufficient spatial and temporal coverage are available. c. It would be advantageous to categorize the various... control strategies. These are referred to as refined models. c. The use of screening techniques followed... location of the source in question and its expected impacts. c. In all regulatory analyses, especially if...

Weighing conservation objectives: maximum expected coverage versus endangered species protection

Treesearch

Jeffrey L. Arthur; Jeffrey D. Camm; Robert G. Haight; Claire A. Montgomery; Stephen Polasky

2004-01-01

Decision makers involved in land acquisition and protection often have multiple conservation objectives and are uncertain about the occurrence of species or other features in candidate sites. Model informing decisions on selection of sites for reserves need to provide information about cost-efficient trade-offs between objectives and account for incidence uncertainty...

Business and Breakthrough: Framing (Expanded) Genetic Carrier Screening for the Public.

PubMed

Holton, Avery E; Canary, Heather E; Wong, Bob

2017-09-01

A growing body of research has given attention to issues surrounding genetic testing, including expanded carrier screening (ECS), an elective medical test that allows planning or expecting parents to consider the potential occurrence of genetic diseases and disorders in their children. These studies have noted the role of the mass media in driving public perceptions about such testing, giving particular attention to ways in which coverage of genetics and genetic testing broadly may drive public attitudes and choices concerning the morality, legality, ethics, and parental well-being involved in genetic technologies. However, few studies have explored how mass media are covering the newer test, ECS. Drawing on health-related framing studies that have shown in varying degrees the impact particular frames such as gain/loss and thematic/episodic can have on the public, this study examines the frame selection employed by online media in its coverage of ECS. This analysis-combined with an analysis of the sources and topics used in such coverage and how they relate to selected frames-helps to clarify how mass media are covering an increasingly important medical test and offers considerations of how such coverage may inform mass media scholarship as well as health-related practices.

Business and Breakthrough: Framing (Expanded) Genetic Carrier Screening for the Public

PubMed Central

Holton, Avery E.; Canary, Heather E.; Wong, Bob

2018-01-01

A growing body of research has given attention to issues surrounding genetic testing, including expanded carrier screening (ECS), an elective medical test that allows planning or expecting parents to consider the potential occurrence of genetic diseases and disorders in their children. These studies have noted the role of the mass media in driving public perceptions about such testing, giving particular attention to ways in which coverage of genetics and genetic testing broadly may drive public attitudes and choices concerning the morality, legality, ethics, and parental well-being involved in genetic technologies. However, few studies have explored how mass media are covering the newer test, ECS. Drawing on health-related framing studies that have shown in varying degrees the impact particular frames such as gain/loss and thematic/episodic can have on the public, this study examines the frame selection employed by online media in its coverage of ECS. This analysis—combined with an analysis of the sources and topics used in such coverage and how they relate to selected frames—helps to clarify how mass media are covering an increasingly important medical test and offers considerations of how such coverage may inform mass media scholarship as well as health-related practices. PMID:27483980

Tension-Enhanced Hydrogen Evolution Reaction on Vanadium Disulfide Monolayer

NASA Astrophysics Data System (ADS)

Pan, Hui

2016-02-01

Water electrolysis is an efficient way for hydrogen production. Finding efficient, cheap, and eco-friendly electrocatalysts is essential to the development of this technology. In the work, we present a first-principles study on the effects of tension on the hydrogen evolution reaction of a novel electrocatalyst, vanadium disulfide (VS2) monolayer. Two electrocatalytic processes, individual and collective processes, are investigated. We show that the catalytic ability of VS2 monolayer at higher hydrogen coverage can be efficiently improved by escalating tension. We find that the individual process is easier to occur in a wide range of hydrogen coverage and the collective process is possible at a certain hydrogen coverage under the same tension. The best hydrogen evolution reaction with near-zero Gibbs free energy can be achieved by tuning tension. We further show that the change of catalytic activity with tension and hydrogen coverage is induced by the change of free carrier density around the Fermi level, that is, higher carrier density, better catalytic performance. It is expected that tension can be a simple way to improve the catalytic activity, leading to the design of novel electrocatalysts for efficient hydrogen production from water electrolysis.

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

Pattern of susceptibility to measles in Italy. Serological Study Group.

PubMed Central

Salmaso, S.; Gabutti, G.; Rota, M. C.; Giordano, C.; Penna, C.; Mandolini, D.; Crovari, P.

2000-01-01

On the basis of seroprevalence and incidence data we describe the distribution of individuals susceptible and immune to measles in Italy in 1996-97. In regions where vaccination coverage was at least 70%, approximately 10% of 3-year-old children were susceptible to measles, whereas 40% were in this category in regions with lower vaccination coverage. Seroprevalence among children older than 4 years was similar for the two groups of regions; in the age group 20-39 years it was approximately 95%. During 1990-96 in the regions with lower vaccination coverage the incidence was highest among children aged 4-6 years, and the median age of cases was 7 years; in the regions with higher vaccination coverage, however, the incidence remained at around 5% for the age group 4-16 years, and the overall median age was 10 years. These data confirm the partial reduction in measles incidence in Italy, although transmission has still not been interrupted. The size and geographical distribution of the current pool of susceptible individuals can be expected to present an obstacle to measles elimination if appropriate vaccination strategies, such as catch-up campaigns, are not adopted. PMID:10994277

Trends in structural coverage of the protein universe and the impact of the Protein Structure Initiative

PubMed Central

Khafizov, Kamil; Madrid-Aliste, Carlos; Almo, Steven C.; Fiser, Andras

2014-01-01

The exponential growth of protein sequence data provides an ever-expanding body of unannotated and misannotated proteins. The National Institutes of Health-supported Protein Structure Initiative and related worldwide structural genomics efforts facilitate functional annotation of proteins through structural characterization. Recently there have been profound changes in the taxonomic composition of sequence databases, which are effectively redefining the scope and contribution of these large-scale structure-based efforts. The faster-growing bacterial genomic entries have overtaken the eukaryotic entries over the last 5 y, but also have become more redundant. Despite the enormous increase in the number of sequences, the overall structural coverage of proteins—including proteins for which reliable homology models can be generated—on the residue level has increased from 30% to 40% over the last 10 y. Structural genomics efforts contributed ∼50% of this new structural coverage, despite determining only ∼10% of all new structures. Based on current trends, it is expected that ∼55% structural coverage (the level required for significant functional insight) will be achieved within 15 y, whereas without structural genomics efforts, realizing this goal will take approximately twice as long. PMID:24567391

Trends in structural coverage of the protein universe and the impact of the Protein Structure Initiative.

PubMed

Khafizov, Kamil; Madrid-Aliste, Carlos; Almo, Steven C; Fiser, Andras

2014-03-11

The exponential growth of protein sequence data provides an ever-expanding body of unannotated and misannotated proteins. The National Institutes of Health-supported Protein Structure Initiative and related worldwide structural genomics efforts facilitate functional annotation of proteins through structural characterization. Recently there have been profound changes in the taxonomic composition of sequence databases, which are effectively redefining the scope and contribution of these large-scale structure-based efforts. The faster-growing bacterial genomic entries have overtaken the eukaryotic entries over the last 5 y, but also have become more redundant. Despite the enormous increase in the number of sequences, the overall structural coverage of proteins--including proteins for which reliable homology models can be generated--on the residue level has increased from 30% to 40% over the last 10 y. Structural genomics efforts contributed ∼50% of this new structural coverage, despite determining only ∼10% of all new structures. Based on current trends, it is expected that ∼55% structural coverage (the level required for significant functional insight) will be achieved within 15 y, whereas without structural genomics efforts, realizing this goal will take approximately twice as long.

Great expectations for the World Health Organization: a Framework Convention on Global Health to achieve universal health coverage.

PubMed

Ooms, G; Marten, R; Waris, A; Hammonds, R; Mulumba, M; Friedman, E A

2014-02-01

Establishing a reform agenda for the World Health Organization (WHO) requires understanding its role within the wider global health system and the purposes of that wider global health system. In this paper, the focus is on one particular purpose: achieving universal health coverage (UHC). The intention is to describe why achieving UHC requires something like a Framework Convention on Global Health (FCGH) that have been proposed elsewhere,(1) why WHO is in a unique position to usher in an FCGH, and what specific reforms would help enable WHO to assume this role. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

HIFOGS: Its design, operations and calibration

NASA Astrophysics Data System (ADS)

Witteborn, Fred C.; Cohen, Martin; Bregman, Jesse D.; Heere, Karen R.; Greene, Thomas P.; Wooden, Diane H.

The High-efficiency, Infrared Faint Object Grating Spectrometer (HIFOGS) provides spectral coverage of selectable portions of the 3 to 18 micron range at resolving powers from 00 to 1000 using 120 Si/Bi detectors. Additional coverage to 30 microns is provided by a bank of 32 Si:P detectors. Selectable apertures, gratings and band-pass filters provide flexibility to this system. Software for operation of HIFOGS and reduction of the data runs on a MacIntosh computer. HIFOGS has been used to establish celestial flux standards using 3 independent approaches: comparison to star models, comparisons to asteroid models and comparisons to laboratory blackbodies. These standards are expected to have wide application in astronomical thermal-infrared spectroscopy.

A community survey on maternal and child health services utilization in rural Ethiopia.

PubMed

Materia, E; Mehari, W; Mele, A; Rosmini, F; Stazi, M A; Damen, H M; Basile, G; Miuccio, G; Ferrigno, L; Miozzo, A

1993-09-01

A household health interview survey on MCH services utilization was carried out in 22 villages of a rural district of Arsi region, Ethiopia, before the launching of an integrated MCH programme. Coverage of antenatal services was 26%, and 61% of the women who received antenatal care reported having had 3 or more visits. Antenatal care was positively associated with living within 10 km of the Health Centre. Twenty-eight percent of the mothers attended the under-5 clinic and most returned for 3 or more visits. In addition, 99% reported having breast-fed their last child but more than 25% started weaning only after the seventh month of age. Differences in practice of treating diarrhoea according to knowledge of ORS were found. Of the 33% of those with knowledge of ORS, almost 90% reported use of ORS for treating child's diarrhoea, showing a positive attitude towards modern health care. The proportion of women using family planning was 5%, with no difference found between Christians and Muslims. Results on EPI coverage validated data from routine reporting. Integration of MCH services including out-reach activities may increase access and coverage of MCH services.

Political leaders and the media. Can we measure political leadership images in newspapers using computer-assisted content analysis?

PubMed

Aaldering, Loes; Vliegenthart, Rens

Despite the large amount of research into both media coverage of politics as well as political leadership, surprisingly little research has been devoted to the ways political leaders are discussed in the media. This paper studies whether computer-aided content analysis can be applied in examining political leadership images in Dutch newspaper articles. It, firstly, provides a conceptualization of political leader character traits that integrates different perspectives in the literature. Moreover, this paper measures twelve political leadership images in media coverage, based on a large-scale computer-assisted content analysis of Dutch media coverage (including almost 150.000 newspaper articles), and systematically tests the quality of the employed measurement instrument by assessing the relationship between the images, the variance in the measurement, the over-time development of images for two party leaders and by comparing the computer results with manual coding. We conclude that the computerized content analysis provides a valid measurement for the leadership images in Dutch newspapers. Moreover, we find that the dimensions political craftsmanship, vigorousness, integrity, communicative performances and consistency are regularly applied in discussing party leaders, but that portrayal of party leaders in terms of responsiveness is almost completely absent in Dutch newspapers.

Integration of satellite-induced fluorescence and vegetation optical depth to improve the retrieval of land evaporation

NASA Astrophysics Data System (ADS)

Pagán, B. R.; Martens, B.; Maes, W. H.; Miralles, D. G.

2017-12-01

Global satellite-based data sets of land evaporation overcome limitations in coverage of in situ measurements while retaining some observational nature. Although their potential for real world applications are promising, their value during dry conditions is still poorly understood. Most evaporation retrieval algorithms are not directly sensitive to soil moisture. An exception is the Global Land Evaporation Amsterdam Model (GLEAM), which uses satellite surface soil moisture and precipitation to account for land water availability. The existing methodology may greatly benefit from the optimal integration of novel observations of the land surface. Microwave vegetation optical depth (VOD) and near-infrared solar-induced fluorescence (SIF) are expected to reflect different aspects of evaporative stress. While the former is considered to be a proxy of vegetation water content, the latter is indicative of the activity of photosynthetic machinery. As stomata regulate both photosynthesis and transpiration, we expect a relationship between SIF and transpiration. An important motivation to incorporate observations in land evaporation calculations is that plant transpiration - usually the largest component of the flux - is extremely challenging to model due to species-dependent responses to drought. Here we present an innovative integration of VOD and SIF into the GLEAM evaporative stress function. VOD is utilized as a measurement of isohydricity to improve the representation of species specific drought responses. SIF is used for transpiration modelling, a novel application, and standardized by incoming solar radiation to better account for radiation-limited periods. Results are validated with global FLUXNET and International Soil Moisture Network data and demonstrate that the incorporation of VOD and SIF can yield accurate estimates of transpiration over large-scales, which are essential to further understand ecosystem-atmosphere feedbacks and the response of terrestrial hydrology and ecology to meteorological drought. The resulting retrievals of land evaporation can be used to benchmark climate model representation of turbulent fluxes, at a time when these models still consider water stress rudimentarily, and typically assume the same sensitivity for all vegetation types to drought stress.

Transplant recipients are vulnerable to coverage denial under Medicare Part D.

PubMed

Potter, Lisa M; Maldonado, Angela Q; Lentine, Krista L; Schnitzler, Mark A; Zhang, Zidong; Hess, Gregory P; Garrity, Edward; Kasiske, Bertram L; Axelrod, David A

2018-02-15

Transplant immunosuppressants are often used off-label because of insufficient randomized prospective trial data to achieve organ-specific US Food and Drug Administration (FDA) approval. Transplant recipients who rely on Medicare Part D for immunosuppressant drug coverage are vulnerable to coverage denial for off-label prescriptions, unless use is supported by Centers for Medicare & Medicaid Services (CMS)-approved compendia. An integrated dataset including national transplant registry data and 3 years of dispensed pharmacy records was used to identify the prevalence of immunosuppression use that is both off-label and not supported by CMS-approved compendia. Numbers of potentially vulnerable transplant recipients were identified. Off-label and off-compendia immunosuppression regimens are frequently prescribed (3-year mean: lung 66.5%, intestine 34.2%, pancreas 33.4%, heart 21.8%, liver 16.5%, kidney 0%). The annual retail cost of these at-risk medications exceeds $30 million. This population-based study of transplant immunosuppressants vulnerable to claim denials under Medicare Part D coverage demonstrates a substantial gap between clinical practice, current FDA approval processes, and policy mandates for pharmaceutical coverage. This coverage barrier reduces access to life-saving medications for patients without alternative resources and may increase the risk of graft loss and death from medication nonadherence. © 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.

Insurance Churning Rates For Low-Income Adults Under Health Reform: Lower Than Expected But Still Harmful For Many.

PubMed

Sommers, Benjamin D; Gourevitch, Rebecca; Maylone, Bethany; Blendon, Robert J; Epstein, Arnold M

2016-10-01

Changes in insurance coverage over time, or "churning," may have adverse consequences, but there has been little evidence on churning since implementation of the major coverage expansions in the Affordable Care Act (ACA) in 2014. We explored the frequency and implications of churning through surveying 3,011 low-income adults in Kentucky, which used a traditional expansion of Medicaid; Arkansas, which chose a "private option" expansion that enrolled beneficiaries in private Marketplace plans; and Texas, which opted not to expand. We also compared 2015 churning rates in these states to survey data from 2013, before the coverage expansions. Nearly 25 percent of respondents in 2015 changed coverage during the previous twelve months-a rate lower than some previous predictions. We did not find significantly different churning rates in the three states over time. Common causes of churning were job-related changes and loss of eligibility for Medicaid or Marketplace subsidies. Churning was associated with disruptions in physician care and medication adherence, increased emergency department use, and worsening self-reported quality of care and health status. Even churning without gaps in coverage had negative effects. Churning remains a challenge for many Americans, and policies are needed to reduce its frequency and mitigate its negative impacts. Project HOPE—The People-to-People Health Foundation, Inc.

RefCNV: Identification of Gene-Based Copy Number Variants Using Whole Exome Sequencing.

PubMed

Chang, Lun-Ching; Das, Biswajit; Lih, Chih-Jian; Si, Han; Camalier, Corinne E; McGregor, Paul M; Polley, Eric

2016-01-01

With rapid advances in DNA sequencing technologies, whole exome sequencing (WES) has become a popular approach for detecting somatic mutations in oncology studies. The initial intent of WES was to characterize single nucleotide variants, but it was observed that the number of sequencing reads that mapped to a genomic region correlated with the DNA copy number variants (CNVs). We propose a method RefCNV that uses a reference set to estimate the distribution of the coverage for each exon. The construction of the reference set includes an evaluation of the sources of variability in the coverage distribution. We observed that the processing steps had an impact on the coverage distribution. For each exon, we compared the observed coverage with the expected normal coverage. Thresholds for determining CNVs were selected to control the false-positive error rate. RefCNV prediction correlated significantly (r = 0.96-0.86) with CNV measured by digital polymerase chain reaction for MET (7q31), EGFR (7p12), or ERBB2 (17q12) in 13 tumor cell lines. The genome-wide CNV analysis showed a good overall correlation (Spearman's coefficient = 0.82) between RefCNV estimation and publicly available CNV data in Cancer Cell Line Encyclopedia. RefCNV also showed better performance than three other CNV estimation methods in genome-wide CNV analysis.

Susceptibility to measles in migrant population: implication for policy makers.

PubMed

Ceccarelli, Giancarlo; Vita, Serena; Riva, Elisabetta; Cella, Eleonora; Lopalco, Maurizio; Antonelli, Francesca; De Cesaris, Marina; Fogolari, Marta; Dicuonzo, Giordano; Ciccozzi, Massimo; Angeletti, Silvia

2018-01-01

Despite a large measles outbreak is taking place in WHO European region, currently no data are available on measles immunization coverage in the asylum seeker and migrants hosted in this area. Two hundred and fifty-six migrants upon their arrival in Italy on March, April and May 2016 were screened for measles virus IgG antibodies by chemiluminescence immunoassay (Liaison XL analyzer, Diasorin, Italy). The virus susceptibility in this cohort, the differences between the official country reported and the observed measles immunization coverage and the impact of current measles outbreak on the asylum seekers hosted in the largest Asylum Seeker centres of Italy, were evaluated. The prevalence of subjects with positive result for measles IgG antibodies ranged between 79.9% and 100%. In Senegal, Mali, Nigeria, Pakistan and Bangladesh, the measles IgG seroprevalence observed was greater than the vaccinal coverage reported by WHO after I dose of vaccine. Based on data regarding the II dose coverage, the ASs population presented a seroprevalence greater to that expected. On the basis of the results obtained, extraordinary screening and vaccination campaigns in the migrant population, especially in the course of large outbreaks, could represent a resource to reach an adequate measles immunization coverage and to control this infectious disease. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Evaluating the Ozioma cancer news service: A community randomized trial in 24 U.S. cities

PubMed Central

Caburnay, Charlene A.; Luke, Douglas A.; Cameron, Glen T.; Cohen, Elisia L.; Fu, Qiang; Lai, Choi L.; Stemmle, Jonathan; Paulen, Melissa; McDaniels-Jackson, Lillie; Kreuter, Matthew W.

2012-01-01

Objective This community randomized trial evaluated effects of the Ozioma News Service on the amount and quality of cancer coverage in Black weekly newspapers in 24 U.S. cities. Method We created and operated Ozioma, the first cancer information news service specifically for Black newspapers. Over 21 months, Ozioma developed community- and race-specific cancer news releases for each of 12 Black weekly newspapers in intervention communities. Cancer coverage in these papers was tracked before and during the intervention and compared to 12 Black newspapers in control communities. Results From 2004-2007, we coded 9,257 health and cancer stories from 3,178 newspaper issues. Intervention newspapers published approximately 4 times the expected number of cancer stories compared to control newspapers (p12&21mo<.01), and also saw an increase in graphics (p12&21mo<.01), local relevance (p12mo=.01), and personal mobilization (p12mo<.10). However, this increased coverage supplanted other health topics and had smaller graphics (NS), had less community mobilization (p21mo=.01), and less likely to be from a local source (NS). Conclusion Providing news releases with localized and race-specific features to minority-serving media outlets can increase the quantity of cancer coverage. Results are mixed for the journalistic and public health quality of this increased cancer coverage in Black newspapers. PMID:22546317

Human Papillomavirus Vaccine Coverage and Prevalence of Missed Opportunities for Vaccination in an Integrated Healthcare System.

PubMed

Irving, Stephanie A; Groom, Holly C; Stokley, Shannon; McNeil, Michael M; Gee, Julianne; Smith, Ning; Naleway, Allison L

2018-03-01

Human papillomavirus (HPV) vaccination has been recommended in the United States for female and male adolescents since 2006 and 2011, respectively. Coverage rates are lower than those for other adolescent vaccines. The objective of this study was to evaluate an assessment and feedback intervention designed to increase HPV vaccination coverage and quantify missed opportunities for HPV vaccine initiation at preventive care visits. We examined changes in HPV vaccination coverage and missed opportunities within the adolescent (11-17 years) population at 9 Oregon-based Kaiser Permanente Northwest outpatient clinics after an assessment and feedback intervention. Quarterly coverage rates were calculated for the adolescent populations at the clinics, according to age group (11-12 and 13-17 years), sex, and department (Pediatrics and Family Medicine). Comparison coverage assessments were calculated at 3 nonintervention (control) clinics. Missed opportunities for HPV vaccine initiation, defined as preventive care visits in which a patient eligible for HPV dose 1 remained unvaccinated, were examined according to sex and age group. An average of 29,021 adolescents were included in coverage assessments. Before the intervention, 1-dose and 3-dose quarterly coverage rates were increasing at intervention as well as at control clinics in both age groups. Postimplementation quarterly trends in 1-dose or 3-dose coverage did not differ significantly between intervention and control clinics for either age group. One-dose coverage rates among adolescents with Pediatrics providers were significantly higher than those with Family Medicine providers (56% vs 41% for 11- to 12-year-old and 82% vs 69% for 13- to 17-year-old girls; 55% vs 40% for 11- to 12-year-old and 78% vs 62% for 13- to 17-year-old boys). No significant differences in HPV vaccine coverage were identified at intervention clinics. However, coverage rates were increasing before the start of the intervention and might have been influenced by ongoing health system best practices. HPV vaccine coverage rates varied significantly according to department, which could allow for targeted improvement opportunities. Copyright © 2017 Academic Pediatric Association. All rights reserved.

An experimental system for flood risk forecasting at global scale

NASA Astrophysics Data System (ADS)

Alfieri, L.; Dottori, F.; Kalas, M.; Lorini, V.; Bianchi, A.; Hirpa, F. A.; Feyen, L.; Salamon, P.

2016-12-01

Global flood forecasting and monitoring systems are nowadays a reality and are being applied by an increasing range of users and practitioners in disaster risk management. Furthermore, there is an increasing demand from users to integrate flood early warning systems with risk based forecasts, combining streamflow estimations with expected inundated areas and flood impacts. To this end, we have developed an experimental procedure for near-real time flood mapping and impact assessment based on the daily forecasts issued by the Global Flood Awareness System (GloFAS). The methodology translates GloFAS streamflow forecasts into event-based flood hazard maps based on the predicted flow magnitude and the forecast lead time and a database of flood hazard maps with global coverage. Flood hazard maps are then combined with exposure and vulnerability information to derive flood risk. Impacts of the forecasted flood events are evaluated in terms of flood prone areas, potential economic damage, and affected population, infrastructures and cities. To further increase the reliability of the proposed methodology we integrated model-based estimations with an innovative methodology for social media monitoring, which allows for real-time verification of impact forecasts. The preliminary tests provided good results and showed the potential of the developed real-time operational procedure in helping emergency response and management. In particular, the link with social media is crucial for improving the accuracy of impact predictions.

Berufsbildung in Lateinamerika

NASA Astrophysics Data System (ADS)

Arnold, Rolf

1989-06-01

The article is concerned with the current trends in vocational education in Latin American countries, where it is increasingly integrated into attempts to solve the social question. The main point of the investigation is to establish what are the experiences gathered from development cooperation with the vocational education organizations of Latin America, and what strategies have proved effective with regard to the social and economic problems of the region. In answer to these questions six propositions are presented and substantiated: (1) Vocational education is a necessary, but on its own by no means sufficient precondition for economic and social progress. (2) Models where vocational education is integrated into the formal education system have not as a rule met expectations. Through de-schooling approaches, the vocational education organizations are nowadays used primarily as institutions for vocational continuing education. (3) Vocational education must reach those who are genuinely aiming for a skilled trade. (4) Only by involving the enterprises in training can a vocational education system be created which offers the possibility of unlimited growth and effective coverage. (5) Latin American vocational education organizations are, to an increasing extent, caught up in implementing the social policies of governments. Of major importance are programmes that support existing small and medium-size businesses and initiate the foundation of new businesses. (6) As a consequence of the socio-political change in vocational training, the trainer or instructor becomes a key figure.

Perceptions of 24/7 In-house Attending Coverage on Fellow Education and Autonomy in a Pediatric Cardiothoracic Intensive Care Unit.

PubMed

Owens, Sonal T; Owens, Gabe E; Rajput, Shaili H; Charpie, John R; Kidwell, Kelley M; Mullan, Patricia B

2015-01-01

The 24/7 in-house attending coverage is emerging as the standard of care in intensive care units. Implementation costs, workforce feasibility, and patient outcomes resulting from changes in physician staffing are widely debated topics. Understanding the impact of staffing models on the learning environment for medical trainees and faculty is equally warranted, particularly with respect to trainee education and autonomy. This study aims to elicit the perceptions of pediatric cardiology fellows and attendings toward 24/7 in-house attending coverage and its effect on fellow education and autonomy. We surveyed pediatric cardiology fellows and attendings practicing in the pediatric cardiothoracic intensive care unit (PCTU) of a large, university-affiliated medical center, using structured Likert response items and open-ended questions, prior to and following the transition to 24/7 in-house attending coverage. All (100%) trainees and faculty completed all surveys. Both prior to and following transition to 24/7 in-house attending coverage, all fellows, and the majority of attendings agreed that the overnight call experience benefited fellow education. At baseline, trainees identified limited circumstances in which on-site attending coverage would be critical. Preimplementation concerns that 24/7 in-house attending coverage would negatively affect the education of fellows were not reflected following actual implementation of the new staffing policy. However, based upon open-ended questions, fellow autonomy was affected by the new paradigm, with fellows and attendings reporting decreased "appropriateness" of autonomy after implementation. Our prospective study, showing initial concerns about limiting the learning environment in transitioning to 24/7 in-house attending coverage did not result in diminished perceptions of the educational experience for our fellows but revealed an expected decrease in fellow autonomy. The study indirectly facilitated open discussions about methods to preserve fellow education and warranted autonomy in our PCTU; however, continued efforts are needed to achieve the optimal balance between supervised training and the transition to autonomous practice. © 2015 Wiley Periodicals, Inc.

Balancing Evidence and Uncertainty when Considering Rubella Vaccine Introduction

PubMed Central

Lessler, Justin; Metcalf, C. Jessica E.

2013-01-01

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

Balancing evidence and uncertainty when considering rubella vaccine introduction.

PubMed

Lessler, Justin; Metcalf, C Jessica E

2013-01-01

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

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

Public Views of Health Insurance in Japan During the Era of Attaining Universal Health Coverage: A Secondary Analysis of an Opinion Poll on Health Insurance in 1967.

PubMed

Nozaki, Ikuma; Wada, Koji; Utsunomiya, Osamu

2017-04-13

While Japan's success in achieving universal health insurance over a short period with controlled healthcare costs has been studied from various perspectives, that of beneficiaries have been overlooked. We conducted a secondary analysis of an opinion poll on health insurance in 1967, immediately after reaching universal coverage. We found that people continued to face a slight barrier to healthcare access (26.8% felt medical expenses were a heavy burden) and had high expectations for health insurance (60.5% were satisfied with insured medical services and 82.4% were willing to pay a premium). In our study, younger age, having children before school age, lower living standards, and the health insurance scheme were factors that were associated with a willingness to pay premiums. Involving high-income groups in public insurance is considered to be the key to ensuring universal coverage of social insurance.

Effect of Doping on Hydrogen Evolution Reaction of Vanadium Disulfide Monolayer.

PubMed

Qu, Yuanju; Pan, Hui; Kwok, Chi Tat; Wang, Zisheng

2015-12-01

As cheap and abundant materials, transitional metal dichalcogenide monolayers have attracted increasing interests for their application as catalysts in hydrogen production. In this work, the hydrogen evolution reduction of doped vanadium disulfide monolayers is investigated based on first-principles calculations. We find that the doping elements and concentration affect strongly the catalytic ability of the monolayer. We show that Ti-doping can efficiently reduce the Gibbs free energy of hydrogen adsorption in a wide range of hydrogen coverage. The catalytic ability of the monolayer at high hydrogen coverage can be improved by low Ti-density doping, while that at low hydrogen coverage is enhanced by moderate Ti-density doping. We further show that it is much easier to substitute the Ti atom to the V atom in the vanadium disulfide (VS2) monolayer than other transitional metal atoms considered here due to its lowest and negative formation energy. It is expected that the Ti-doped VS2 monolayer may be applicable in water electrolysis with improved efficiency.

Educating the humanitarian engineer.

PubMed

Passino, Kevin M

2009-12-01

The creation of new technologies that serve humanity holds the potential to help end global poverty. Unfortunately, relatively little is done in engineering education to support engineers' humanitarian efforts. Here, various strategies are introduced to augment the teaching of engineering ethics with the goal of encouraging engineers to serve as effective volunteers for community service. First, codes of ethics, moral frameworks, and comparative analysis of professional service standards lay the foundation for expectations for voluntary service in the engineering profession. Second, standard coverage of global issues in engineering ethics educates humanitarian engineers about aspects of the community that influence technical design constraints encountered in practice. Sample assignments on volunteerism are provided, including a prototypical design problem that integrates community constraints into a technical design problem in a novel way. Third, it is shown how extracurricular engineering organizations can provide a theory-practice approach to education in volunteerism. Sample completed projects are described for both undergraduates and graduate students. The student organization approach is contrasted with the service-learning approach. Finally, long-term goals for establishing better infrastructure are identified for educating the humanitarian engineer in the university, and supporting life-long activities of humanitarian engineers.

Are Alcohol Expectancies Associations? Comment on Moss and Albery (2009)

ERIC Educational Resources Information Center

Wiers, Reinout W.; Stacy, Alan W.

2010-01-01

Moss and Albery (2009) presented a dual-process model of the alcohol-behavior link, integrating alcohol expectancy and alcohol myopia theory. Their integrative theory rests on a number of assumptions including, first, that alcohol expectancies are associations that can be activated automatically by an alcohol-relevant context, and second, that…

Acceptability and Perceived Benefits and Risks of Public and Patient Involvement in Health Care Policy: A Delphi Survey in Belgian Stakeholders.

PubMed

Cleemput, Irina; Christiaens, Wendy; Kohn, Laurence; Léonard, Christian; Daue, François; Denis, Alain

2015-06-01

In systems with public health insurance, coverage decisions should reflect social values. Deliberation among stakeholders could achieve this goal, but rarely involves patients and citizens directly. This study aimed at evaluating the acceptability, and the perceived benefits and risks, of public and patient involvement (PPI) in coverage decision making to Belgian stakeholders. A two-round Delphi survey was conducted among all stakeholder groups. The survey was constructed on the basis of interviews with 10 key stakeholders and a review of the literature on participation models. Consensus was defined as 65% or more of the respondents agreeing with a statement and less than 15% disagreeing. Eighty stakeholders participated in both rounds. They were defined as the Delphi panel. Belgian stakeholders are open toward PPI in coverage decision processes. Benefits are expected to exceed risks. The preferred model for involvement is to consult citizens or patients, within the existing decision-making structures and at specific milestones in the process. Consulting citizens and patients is a higher level of involvement than merely informing them and a lower level than letting them participate actively. Consultation involves asking nonbinding advice on (parts of) the decision problem. According to the Delphi panel, the benefits of PPI could be increasing awareness among members of the general public and patients about the challenges and costs of health care, and enriched decision processes with expertise by experience from patients. Potential risks include subjectivity, insufficient resources to participate and weigh on the process, difficulties in finding effective ways to express a collective opinion, the risk of manipulation, and lobbying or power games of other stakeholders. PPI in coverage decision-making processes is acceptable to Belgian stakeholders, be it in different ways for different types of decisions. Benefits are expected to outweigh risks. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Demographic Change, Social Security Systems, and Savings1

PubMed Central

Bloom, David E.; Canning, David; Mansfield, Richard K.; Moore, Michael

2009-01-01

In theory, improvements in healthy life expectancy should generate increases in the average age of retirement, with little effect on savings rates. In many countries, however, retirement incentives in social security programs prevent retirement ages from keeping pace with changes in life expectancy, leading to an increased need for life-cycle savings. Analyzing a cross-country panel of macroeconomic data, we find that increased longevity raises aggregate savings rates in countries with universal pension coverage and retirement incentives, though the effect disappears in countries with pay-as-you-go systems and high replacement rates. PMID:19865594

Minimizing shrinkage of interdental papilla height when treating multiple Miller Class III gingival recession defects.

PubMed

Mahn, Douglas H

2015-04-01

Miller Class III and IV gingival recession defects have interdental bone and soft-tissue loss that limit root coverage. Given the importance of the interdental papilla, protecting the integrity of this structure would seem prudent. Tunnel techniques have been successfully used to protect the interdental papilla. This article discusses the results of two cases in which multiple Miller Class III gingival recession defects were treated using tunnel-grafting techniques and an acellular dermal matrix. In both cases, root coverage was achieved while protecting the interdental papilla height.

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

PubMed

Fronstin, Paul

2011-09-01

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

Len Gen: The international lentil genome sequencing project

USDA-ARS?s Scientific Manuscript database

We have been sequencing CDC Redberry using NGS of paired-end and mate-pair libraries over a wide range of sizes and technologies. The most recent draft (v0.7) of approximately 150x coverage produced scaffolds covering over half the genome (2.7 Gb of the expected 4.3 Gb). Long reads from PacBio sequ...

Optimal allocation of invasive species surveillance with the maximum expected coverage concept

Treesearch

Denys Yemshanov; Robert G. Haight; Frank H. Koch; Bo Lu; Robert Venette; D. Barry Lyons; Taylor Scarr; Krista Ryall; Brian. Leung

2015-01-01

We address the problem of geographically allocating scarce survey resources to detect pests in their pathways of introduction given information about their likelihood of movement between origins and destinations. We introduce a model for selecting destination sites for survey that departs from the aim of reducing propagule pressure (PP) in pest destinations and instead...

Who's in the Picture: Comparing Census Data with Newspaper Coverage

ERIC Educational Resources Information Center

Hill, Myleea D.

2016-01-01

Discussions of what images are portrayed in newspapers and their proportion in comparison to the actual census data provide an opportunity for consideration of how the agenda setting and framing theories of media could affect perceptions of a community and population. In the exercise described here, students are expected to learn a research skill…

The Language of Entertainment News Is a Serious Business

ERIC Educational Resources Information Center

Marjanovic, Tatjana

2013-01-01

An essentially qualitative structural and semantic analysis is performed on the text of an "American Idol" coverage posted on yahoo.com January 24, 2013, constituting a micro-corpus of 2,739 words. Since such stories feature entertainment laced with a shot of drama and scandal, most of us share similar expectations as to what packaging…

VizieR Online Data Catalog: Update of INTEGRAL/IBIS AGN catalogue (Malizia+, 2016)

NASA Astrophysics Data System (ADS)

Malizia, A.; Landi, R.; Molina, M.; Bassani, L.; Bazzano, A.; Bird, A. J.; Ubertini, P.

2017-09-01

In this paper we present the X-ray and optical follow-up work on 107 new AGN recently detected by INTEGRAL. Luckily, we have been able to obtain full X-ray coverage of the entire sample making use of data from Swift/XRT, Newton-XMM and NuSTAR archives or through Swift/XRT follow up observations triggered by us. (2 data files).

Characterization of Earth as an exoplanet on the basis of VIRTIS-Venus Express data analysis.

NASA Astrophysics Data System (ADS)

Oliva, Fabrizio; Piccioni, Giuseppe; D'Aversa, Emiliano; Bellucci, Giancarlo; Sindoni, Giuseppe; Grassi, Davide; Filacchione, Gianrico; Tosi, Federico; Capaccioni, Fabrizio

2017-04-01

The Visible and InfraRed Thermal Imaging Spectrometer (VIRTIS, Piccioni et al., 2007) on board the Venus Express spacecraft observed the planet Earth several times in the course of the mission. In particular, a subset of 48 observations has been taken from a distance at which our planet is imaged at sub-pixel size, as exoplanets are observed using current technologies. We studied this full subset to understand which spectral signatures, related to different surface and cloud types, can be identified from the integrated planet spectrum. As expected, we found that the cloud coverage has a key role in the identification of surface features and that vegetation is very difficult to be detected. To validate our results we built a simple tool capable to simulate observations of an Earth-like planet as seen from a VIRTIS-like spectrometer in the 0.3 - 5.0 μm range. The illumination and viewing geometries, along with the spectrometer instantaneous field of view and spectral grid and sampling, can be defined by the user. The spectral endmembers used to generate the planet have been selected from an observation of Earth registered from the instrument VIRTIS on board the ESA mission Rosetta, with similar characteristics, during the third flyby of the spacecraft around our planet, occurred in November 2009. Hence, we simulated planets made of: vegetation, desert, ocean, water ice clouds and liquid water clouds. Using different amounts for each spectral class we inferred the percentages that are required to identify each class when all the spectral information is integrated into a single pixel. The outcome of this analysis confirms that clouds are not a negligible issue in the research for spectral signatures, in particular those related to the habitability of a planet and its climate conditions, even when the cloud coverage is not so high. Acknowledgements: This study has been performed within the WOW project financed by INAF and thanks to the support from the Italian Space Agency to VIRTIS Venus Express and Rosetta. References Piccioni, G., et al., 2007. VIRTIS: The Visible and Infrared Thermal Imaging Spectrometer. ESA Special Publication, SP-1295, 1-27.

A task shifting approach to primary mental health care for adults in South Africa: human resource requirements and costs for rural settings.

PubMed

Petersen, Inge; Lund, Crick; Bhana, Arvin; Flisher, Alan J

2012-01-01

BACKGROUND A recent situational analysis suggests that post-apartheid South Africa has made some gains with respect to the decentralization and integration of mental health into primary health care. However, service gaps within and between provinces remain, with rural areas particularly underserved. Aim This study aims to calculate and cost a hypothetical human resource mix required to populate a framework for district adult mental health services. This framework embraces the concept of task shifting, where dedicated low cost mental health workers at the community and clinic levels supplement integrated care. METHOD The expected number and cost of human resources was based on: (a) assumptions of service provision derived from existing services in a sub-district demonstration site and a literature review of evidence-based packages of care in low- and middle-income countries; and (b) assumptions of service needs derived from other studies. RESULTS For a nominal population of 100 000, minimal service coverage estimates of 50% for schizophrenia, bipolar affective disorder, major depressive disorder and 30% for post-traumatic stress disorder and maternal depression would require that the primary health care staffing package include one post for a mental health counsellor or equivalent and 7.2 community mental health worker posts. The cost of these personnel amounts to £28 457 per 100 000 population. This cost can be offset by a reduction in the number of other specialist and non-specialist health personnel required to close service gaps at primary care level. CONCLUSION The adoption of the concept of task shifting can substantially reduce the expected number of health care providers otherwise needed to close mental health service gaps at primary health care level in South Africa at minimal cost and may serve as a model for other middle-income countries.

VizieR Online Data Catalog: LOFAR Bootes and 3C295 field sources (van Weeren+, 2014)

NASA Astrophysics Data System (ADS)

van Weeren, R. J.; Williams, W. L.; Tasse, C.; Rottgering, H. J. A.; Rafferty, D. A.; van der Tol, S.; Heald, G.; White, G. J.; Shulevski, A.; Best, P.; Intema, H. T.; Bhatnagar, S.; Reich, W.; Steinmetz, M.; van Velzen, S.; Ensslin, T. A.; Prandoni, I.; de Gasperin, F.; Jamrozy, M.; Brunetti, G.; Jarvis, M. J.; McKean, J. P.; Wise, M. W.; Ferrari, C.; Harwood, J.; Oonk, J. B. R.; Hoeft, M.; Kunert-Bajraszewska, M.; Horellou, C.; Wucknitz, O.; Bonafede, A.; Mohan, N. R.; Scaife, A. M. M.; Klockner, H.-R.; van Bemmel, I. M.; Merloni, A.; Chyzy, K. T.; Engels, D.; Falcke, H.; Pandey-Pommier, M.; Alexov, A.; Anderson, J.; Avruch, I. M.; Beck, R.; Bell, M. E.; Bentum, M. J.; Bernardi, G.; Breitling, F.; Broderick, J.; Brouw, W. N.; Bruggen, M.; Butcher, H. R.; Ciardi, B.; de Geus, E.; de Vos, M.; Deller, A.; Duscha, S.; Eisloffel, J.; Fallows, R. A.; Frieswijk, W.; Garrett, M. A.; Griessmeier, J.; Gunst, A. W.; Hamaker, J. P.; Hassall, T. E.; Horandel, J.; van der Horst, A.; Iacobelli, M.; Jackson, N. J.; Juette, E.; Kondratiev, V. I.; Kuniyoshi, M.; Maat, P.; Mann, G.; McKay-Bukowski, D.; Mevius, M.; Morganti, R.; Munk, H.; Offringa, A. R.; Orru, E.; Paas, H.; Pandey, V. N.; Pietka, G.; Pizzo, R.; Polatidis, A. G.; Renting, A.; Rowlinson, A.; Schwarz, D.; Serylak, M.; Sluman, J.; Smirnov, O.; Stappers, B. W.; Stewart, A.; Swinbank, J.; Tagger, M.; Tang, Y.; Thoudam, S.; Toribio, C.; Vermeulen, R.; Vocks, C.; Zarka, P.

2017-04-01

The Bootes and 3C 295 fields were simultaneously observed on 2012 April 12 as part of a multi-beam observation with the LOFAR LBA stations. The idea behind the multi-beam setup is that we use the 3C 295 observations as a calibrator field to transfer the gain amplitudes to the (target) Bootes field. The total integration time on both fields was 10.25 hr. Complete frequency coverage was obtained between 54 and 70 MHz for both fields, while non-contiguous frequency coverage was obtained between 30 and 54 MHz for the 3C 295 only. All four correlation products were recorded. By default, the frequency band was divided into sub-bands, each 195.3125 kHz wide. Each sub-band was further divided in 64 channels and the integration time was 1 s. (1 data file).

Integrated vector management: the Zambian experience.

PubMed

Chanda, Emmanuel; Masaninga, Fred; Coleman, Michael; Sikaala, Chadwick; Katebe, Cecilia; Macdonald, Michael; Baboo, Kumar S; Govere, John; Manga, Lucien

2008-08-27

The Zambian Malaria Control Programme with the Roll Back Malaria (RBM) partners have developed the current National Malaria Strategic Plan (NMSP 2006-2011) which focuses on prevention based on the Integrated Vector Management (IVM) strategy. The introduction and implementation of an IVM strategy was planned in accordance with the World Health Organization (WHO) steps towards IVM implementation namely Introduction Phase, Consolidation Phase and Expansion Phase. IVM has created commitment for Legal and Regulatory policy review, monitoring, Research and a strong stewardship by the chemical suppliers. It has also leveraged additional resources, improved inter-sectoral collaboration, capacity building and enhanced community participation which facilitated a steady scaling up in coverage and utilisation of key preventive interventions. Thus, markedly reducing malaria incidence and case fatalities in the country. Zambia has successfully introduced, consolidated and expanded IVM activities. Resulting in increased coverage and utilization of interventions and markedly reducing malaria-related morbidity and mortality while ensuring a better protection of the environment.

Comparative homology agreement search: An effective combination of homology-search methods

PubMed Central

Alam, Intikhab; Dress, Andreas; Rehmsmeier, Marc; Fuellen, Georg

2004-01-01

Many methods have been developed to search for homologous members of a protein family in databases, and the reliability of results and conclusions may be compromised if only one method is used, neglecting the others. Here we introduce a general scheme for combining such methods. Based on this scheme, we implemented a tool called comparative homology agreement search (chase) that integrates different search strategies to obtain a combined “E value.” Our results show that a consensus method integrating distinct strategies easily outperforms any of its component algorithms. More specifically, an evaluation based on the Structural Classification of Proteins database reveals that, on average, a coverage of 47% can be obtained in searches for distantly related homologues (i.e., members of the same superfamily but not the same family, which is a very difficult task), accepting only 10 false positives, whereas the individual methods obtain a coverage of 28–38%. PMID:15367730

EARLY EVALUATION OF NEW HEALTH TECHNOLOGIES: THE CASE FOR PREMARKET STUDIES THAT HARMONIZE REGULATORY AND COVERAGE PERSPECTIVES.

PubMed

Levin, Leslie

2015-01-01

With an increasing awareness that active engagement between policy decision makers, HTA agencies, regulators and payers with industry in the premarket space is needed, a disruptive comprehensive approach is described which moves the evidentiary process exclusively into this space. Single harmonized studies pre-market to address regulatory and coverage needs and expectations are more likely to be efficient and less costly and position evidence to drive rather than test innovation. An example of such a process through the MaRS EXCITE program in Ontario, Canada, now undergoing proof of concept, is briefly discussed. Other examples of dialogue between decision makers and industry pre-market are provided though these are less robust than a comprehensive evidentiary approach.

Spillover effects of state mandated benefit laws: the case of outpatient breast cancer surgery.

PubMed

Bian, John; Lipscomb, Joseph; Mello, Michelle M

This paper examines the "spillover effects" of state laws that mandate inpatient coverage for breast cancer surgery. It looks at outpatient utilization of two types of breast cancer surgery among Medicare fee-for-service patients, who are exempt from state regulation. Using data from the Surveillance, Epidemiology and End Results cancer registries and Medicare claims, we performed difference-in-differences analyses of patients in nine states from 1993 to 2002. The analyses show that state laws had a significant impact on only the likelihood of outpatient mastectomy, which was reduced by five percentage points. Such a spillover effect may diminish the expected impact of federal coverage laws for inpatient breast cancer surgery, which have been proposed to achieve similar ends.

How will transitioning from cytology to HPV testing change the balance between the benefits and harms of cervical cancer screening? Estimates of the impact on cervical cancer, treatment rates and adverse obstetric outcomes in Australia, a high vaccination coverage country.

PubMed

Velentzis, Louiza S; Caruana, Michael; Simms, Kate T; Lew, Jie-Bin; Shi, Ju-Fang; Saville, Marion; Smith, Megan A; Lord, Sarah J; Tan, Jeffrey; Bateson, Deborah; Quinn, Michael; Canfell, Karen

2017-12-15

Primary HPV screening enables earlier diagnosis of cervical lesions compared to cytology, however, its effect on the risk of treatment and adverse obstetric outcomes has not been extensively investigated. We estimated the cumulative lifetime risk (CLR) of cervical cancer and excisional treatment, and change in adverse obstetric outcomes in HPV unvaccinated women and cohorts offered vaccination (>70% coverage in 12-13 years) for the Australian cervical screening program. Two-yearly cytology screening (ages 18-69 years) was compared to 5-yearly primary HPV screening with partial genotyping for HPV16/18 (ages 25-74 years). A dynamic model of HPV transmission, vaccination, cervical screening and treatment for precancerous lesions was coupled with an individual-based simulation of obstetric complications. For cytology screening, the CLR of cervical cancer diagnosis, death and treatment was estimated to be 0.649%, 0.198% and 13.4% without vaccination and 0.182%, 0.056% and 6.8%, in vaccinated women, respectively. For HPV screening, relative reductions of 33% and 22% in cancer risk for unvaccinated and vaccinated women are predicted, respectively, compared to cytology. Without the implementation of vaccination, a 4% increase in treatment risk for HPV versus cytology screening would have been expected, implying a possible increase in pre-term delivery (PTD) and low birth weight (LBW) events of 19 to 35 and 14 to 37, respectively, per 100,000 unvaccinated women. However, in vaccinated women, treatment risk will decrease by 13%, potentially leading to 4 to 41 fewer PTD events and from 2 more to 52 fewer LBW events per 100,000 vaccinated women. In unvaccinated women in cohorts offered vaccination as 12-13 year olds, no change to lifetime treatment risk is expected with HPV screening. In unvaccinated women in cohorts offered vaccination as 12-13 year olds, no change to lifetime treatment risk is expected with HPV screening. HPV screening starting at age 25 in populations with high vaccination coverage, is therefore expected to both improve the benefits (further decrease risk of cervical cancer) and reduce the harms (reduce treatments and possible obstetric complications) associated with cervical cancer screening. © 2017 UICC.

Universal health coverage in 'One ASEAN': are migrants included?

PubMed

Guinto, Ramon Lorenzo Luis R; Curran, Ufara Zuwasti; Suphanchaimat, Rapeepong; Pocock, Nicola S

2015-01-01

As the Association of South East Asian Nations (ASEAN) gears toward full regional integration by 2015, the cross-border mobility of workers and citizens at large is expected to further intensify in the coming years. While ASEAN member countries have already signed the Declaration on the Protection and Promotion of the Rights of Migrant Workers, the health rights of migrants still need to be addressed, especially with ongoing universal health coverage (UHC) reforms in most ASEAN countries. This paper seeks to examine the inclusion of migrants in the UHC systems of five ASEAN countries which exhibit diverse migration profiles and are currently undergoing varying stages of UHC development. A scoping review of current migration trends and policies as well as ongoing UHC developments and migrant inclusion in UHC in Indonesia, Malaysia, Philippines, Singapore, and Thailand was conducted. In general, all five countries, whether receiving or sending, have schemes that cover migrants to varying extents. Thailand even allows undocumented migrants to opt into its Compulsory Migrant Health Insurance scheme, while Malaysia and Singapore are still yet to consider including migrants in their government-run UHC systems. In terms of predominantly sending countries, the Philippines's social health insurance provides outbound migrants with portable insurance yet with limited benefits, while Indonesia still needs to strengthen the implementation of its compulsory migrant insurance which has a health insurance component. Overall, the five ASEAN countries continue to face implementation challenges, and will need to improve on their UHC design in order to ensure genuine inclusion of migrants, including undocumented migrants. However, such reforms will require strong political decisions from agencies outside the health sector that govern migration and labor policies. Furthermore, countries must engage in multilateral and bilateral dialogue as they redefine UHC beyond the basis of citizenship and reimagine UHC systems that transcend national borders. By enhancing migrant coverage, ASEAN countries can make UHC systems truly 'universal'. Migrant inclusion in UHC is a human rights imperative, and it is in ASEAN's best interest to protect the health of migrants as it pursues the path toward collective social progress and regional economic prosperity.

Universal health coverage in ‘One ASEAN’: are migrants included?

PubMed Central

Guinto, Ramon Lorenzo Luis R.; Curran, Ufara Zuwasti; Suphanchaimat, Rapeepong; Pocock, Nicola S.

2015-01-01

Background As the Association of South East Asian Nations (ASEAN) gears toward full regional integration by 2015, the cross-border mobility of workers and citizens at large is expected to further intensify in the coming years. While ASEAN member countries have already signed the Declaration on the Protection and Promotion of the Rights of Migrant Workers, the health rights of migrants still need to be addressed, especially with ongoing universal health coverage (UHC) reforms in most ASEAN countries. This paper seeks to examine the inclusion of migrants in the UHC systems of five ASEAN countries which exhibit diverse migration profiles and are currently undergoing varying stages of UHC development. Design A scoping review of current migration trends and policies as well as ongoing UHC developments and migrant inclusion in UHC in Indonesia, Malaysia, Philippines, Singapore, and Thailand was conducted. Results In general, all five countries, whether receiving or sending, have schemes that cover migrants to varying extents. Thailand even allows undocumented migrants to opt into its Compulsory Migrant Health Insurance scheme, while Malaysia and Singapore are still yet to consider including migrants in their government-run UHC systems. In terms of predominantly sending countries, the Philippines's social health insurance provides outbound migrants with portable insurance yet with limited benefits, while Indonesia still needs to strengthen the implementation of its compulsory migrant insurance which has a health insurance component. Overall, the five ASEAN countries continue to face implementation challenges, and will need to improve on their UHC design in order to ensure genuine inclusion of migrants, including undocumented migrants. However, such reforms will require strong political decisions from agencies outside the health sector that govern migration and labor policies. Furthermore, countries must engage in multilateral and bilateral dialogue as they redefine UHC beyond the basis of citizenship and reimagine UHC systems that transcend national borders. Conclusions By enhancing migrant coverage, ASEAN countries can make UHC systems truly ‘universal’. Migrant inclusion in UHC is a human rights imperative, and it is in ASEAN's best interest to protect the health of migrants as it pursues the path toward collective social progress and regional economic prosperity. PMID:25626624

Homicides In Mexico Reversed Life Expectancy Gains For Men And Slowed Them For Women, 2000-10.

PubMed

Aburto, José Manuel; Beltrán-Sánchez, Hiram; García-Guerrero, Victor Manuel; Canudas-Romo, Vladimir

2016-01-01

Life expectancy in Mexico increased for more than six decades but then stagnated in the period 2000-10. This decade was characterized by the enactment of a major health care reform-the implementation of the Seguro Popular de Salud (Popular Health Insurance), which was intended to provide coverage to the entire Mexican population-and by an unexpected increase in homicide mortality. We assessed the impact on life expectancy of conditions amenable to medical service-those sensitive to public health policies and changes in behaviors, homicide, and diabetes-by analyzing mortality trends at the state level. We found that life expectancy among males deteriorated from 2005 to 2010, compared to increases from 2000 to 2005. Females in most states experienced small gains in life expectancy between 2000 and 2010. The unprecedented rise in homicides after 2005 led to a reversal in life expectancy increases among males and a slowdown among females in most states in the first decade of the twenty-first century. Project HOPE—The People-to-People Health Foundation, Inc.

Influenza vaccine coverage, influenza-associated morbidity and all-cause mortality in Catalonia (Spain).

PubMed

Muñoz, M Pilar; Soldevila, Núria; Martínez, Anna; Carmona, Glòria; Batalla, Joan; Acosta, Lesly M; Domínguez, Angela

2011-07-12

The objective of this work was to study the behaviour of influenza with respect to morbidity and all-cause mortality in Catalonia, and their association with influenza vaccination coverage. The study was carried out over 13 influenza seasons, from epidemiological week 40 of 1994 to week 20 of 2007, and included confirmed cases of influenza and all-cause mortality. Two generalized linear models were fitted: influenza-associated morbidity was modelled by Poisson regression and all-cause mortality by negative binomial regression. The seasonal component was modelled with the periodic function formed by the sum of the sinus and cosines. Expected influenza mortality during periods of influenza virus circulation was estimated by Poisson regression and its confidence intervals using the Bootstrap approach. Vaccination coverage was associated with a reduction in influenza-associated morbidity (p<0.001), but not with a reduction in all-cause mortality (p=0.149). In the case of influenza-associated morbidity, an increase of 5% in vaccination coverage represented a reduction of 3% in the incidence rate of influenza. There was a positive association between influenza-associated morbidity and all-cause mortality. Excess mortality attributable to influenza epidemics was estimated as 34.4 (95% CI: 28.4-40.8) weekly deaths. In conclusion, all-cause mortality is a good indicator of influenza surveillance and vaccination coverage is associated with a reduction in influenza-associated morbidity but not with all-cause mortality. Copyright © 2011 Elsevier Ltd. All rights reserved.

Adsorption energies and prefactor determination for CH3OH adsorption on graphite.

PubMed

Doronin, M; Bertin, M; Michaut, X; Philippe, L; Fillion, J-H

2015-08-28

In this paper, we have studied adsorption and thermal desorption of methanol CH3OH on graphite surface, with the specific aim to derive from experimental data quantitative parameters that govern the desorption, namely, adsorption energy Eads and prefactor ν of the Polanyi-Wigner law. In low coverage regime, these two values are interconnected and usually the experiments can be reproduced with any couple (Eads, ν), which makes intercomparison between studies difficult since the results depend on the extraction method. Here, we use a method for determining independently the average adsorption energy and a prefactor value that works over a large range of incident methanol coverage, from a limited set of desorption curves performed at different heating rates. In the low coverage regime the procedure is based on a first order kinetic law, and considers an adsorption energy distribution which is not expected to vary with the applied heating rate. In the case of CH3OH multilayers, Eads is determined as 430 meV with a prefactor of 5 × 10(14) s(-1). For CH3OH submonolayers on graphite, adsorption energy of 470 ± 30 meV and a prefactor of (8 ± 3) × 10(16) s(-1) have been found. These last values, which do not change between 0.09 ML and 1 ML initial coverage, suggest that the methanol molecules form island-like structure on the graphite even at low coverage.

Effects of Frothers and Oil at Saltwater–Air Interfaces for Oil Separation: Molecular Dynamics Simulations and Experimental Measurements

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

Chong, Leebyn; Lai, Yungchieh; Gray, McMahan

Separating oil from saltwater is a process relevant to some industries and may be aided by bubble and froth generation. Simulating saltwater–air interfaces adsorbed with surfactants and oil molecules can assist in understanding froth stability to improve separation. Here, combining with surface tension experimental measurements, in this work we employ molecular dynamics with a united-atom force field to linear alkane oil and three surfactant frothers, methyl isobutyl carbinol (MIBC), terpineol, and ethyl glycol butyl ether (EGBE), to investigate their synergistic behaviors for oil separation. The interfacial phenomena were measured for a range of frother surface coverages on saltwater. Density profilesmore » of the hydrophilic and hydrophobic portions of the frothers show an expected orientation of alcohol groups adsorbing to the polar water. A decrease in surface tension with increasing surface coverage of MIBC and terpineol was observed and reflected in experiments where the frother concentration increased. Relations between surface coverage and bulk concentration were observed by comparing the surface tension decreases. Additionally, a range of oil surface coverages was explored when the interface has a thin layer of adsorbed frother molecules. Finally, the obtained results indicate that an increase in surface coverage of oil molecules led to an increase in surface tension for all frother types and the pair correlation functions depicted MIBC and terpineol as having higher distributions with water at closer distances than with oil.« less

Effects of Frothers and Oil at Saltwater–Air Interfaces for Oil Separation: Molecular Dynamics Simulations and Experimental Measurements

DOE PAGES

Chong, Leebyn; Lai, Yungchieh; Gray, McMahan; ...

2017-06-16

Separating oil from saltwater is a process relevant to some industries and may be aided by bubble and froth generation. Simulating saltwater–air interfaces adsorbed with surfactants and oil molecules can assist in understanding froth stability to improve separation. Here, combining with surface tension experimental measurements, in this work we employ molecular dynamics with a united-atom force field to linear alkane oil and three surfactant frothers, methyl isobutyl carbinol (MIBC), terpineol, and ethyl glycol butyl ether (EGBE), to investigate their synergistic behaviors for oil separation. The interfacial phenomena were measured for a range of frother surface coverages on saltwater. Density profilesmore » of the hydrophilic and hydrophobic portions of the frothers show an expected orientation of alcohol groups adsorbing to the polar water. A decrease in surface tension with increasing surface coverage of MIBC and terpineol was observed and reflected in experiments where the frother concentration increased. Relations between surface coverage and bulk concentration were observed by comparing the surface tension decreases. Additionally, a range of oil surface coverages was explored when the interface has a thin layer of adsorbed frother molecules. Finally, the obtained results indicate that an increase in surface coverage of oil molecules led to an increase in surface tension for all frother types and the pair correlation functions depicted MIBC and terpineol as having higher distributions with water at closer distances than with oil.« less

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

PubMed Central

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

2007-01-01

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

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

[Modeling integrative oncology care program for Arab patients in north Israel: towards quality of life improvement during chemotherapy].

PubMed

Ben-Arye, Eran; Dagash, Jamal; Silbermann, Michael; Saad, Bashar; Steiner, Mariana; Popper-Giveon, Ariela; Lev, Efraim; Agbarya, Abed; Sela, Gil Bar; Karkabi, Khaled; Schiff, Elad

2015-01-01

In the last decade, a number of integrative oncology programs have been established within leading oncology departments in Israel aiming to provide consultations that address patients' concerns and improve their quality of life (QOL). To identify Arab cancer patients' attitudes, needs and expectations concerning integration of complementary and traditional medicine (CTM) in their supportive oncology care. This article presents studies based on both qualitative (including interviews with patients, oncologists and CTM practitioners) and quantitative studies which were designed to evaluate patients' attitudes, needs and expectations regarding CTM integration in supportive oncology care. Of the 313 Arab respondents, 109 reported on the use of herbal medicine for cancer-associated outcomes. Over 78% of respondents considered QOL improvement as their main expectation of integrated CM consultation. Similar expectations were expressed in studies exploring 155 cancer care practitioners in Israel and Arab countries, 27 CTM-trained Arab practitioners, and a sample of 15 Arab patients referred to integrative medicine consultation. Arab cancer patients support QOL-oriented integrated medicine programs provided in oncology settings. Integrative medicine consultation should provide patients with an evidence-based recommendation on efficacy and safety of herbs commonly used concomitant with chemotherapy. We recommend designing integrative oncology training courses for physicians who will provide evidence-based consultation attuned with Arab patients' needs, concerns and cultural-sensitive orientation.

Towards Universal Health Coverage via Social Health Insurance in China: Systemic Fragmentation, Reform Imperatives, and Policy Alternatives.

PubMed

He, Alex Jingwei; Wu, Shaolong

2017-12-01

China's remarkable progress in building a comprehensive social health insurance (SHI) system was swift and impressive. Yet the country's decentralized and incremental approach towards universal coverage has created a fragmented SHI system under which a series of structural deficiencies have emerged with negative impacts. First, contingent on local conditions and financing capacity, benefit packages vary considerably across schemes, leading to systematic inequity. Second, the existence of multiple schemes, complicated by massive migration, has resulted in weak portability of SHI, creating further barriers to access. Third, many individuals are enrolled on multiple schemes, which causes inefficient use of government subsidies. Moral hazard and adverse selection are not effectively managed. The Chinese government announced its blueprint for integrating the urban and rural resident schemes in early 2016, paving the way for the ultimate consolidation of all SHI schemes and equal benefits for all. This article proposes three policy alternatives to inform the consolidation: (1) a single-pool system at the prefectural level with significant government subsidies, (2) a dual-pool system at the prefectural level with risk-equalization mechanisms, and (3) a household approach without merging existing pools. Vertical integration to the provincial level is unlikely to happen in the near future. Two caveats are raised to inform this transition towards universal health coverage.

Integrality in cervical cancer care: evaluation of access

PubMed Central

Brito-Silva, Keila; Bezerra, Adriana Falangola Benjamin; Chaves, Lucieli Dias Pedreschi; Tanaka, Oswaldo Yoshimi

2014-01-01

OBJECTIVE To evaluate integrity of access to uterine cervical cancer prevention, diagnosis and treatment services. METHODS The tracer condition was analyzed using a mixed quantitative and qualitative approach. The quantitative approach was based on secondary data from the analysis of cytology and biopsy exams performed between 2008 and 2010 on 25 to 59 year-old women in a municipality with a large population and with the necessary technological resources. Data were obtained from the Health Information System and the Regional Cervical Cancer Information System. Statistical analysis was performed using PASW statistic 17.0 software. The qualitative approach involved semi-structured interviews with service managers, health care professionals and users. NVivo 9.0 software was used for the content analysis of the primary data. RESULTS Pap smear coverage was low, possible due to insufficient screening and the difficulty of making appointments in primary care. The numbers of biopsies conducted are similar to those of abnormal cytologies, reflecting easy access to the specialized services. There was higher coverage among younger women. More serious diagnoses, for both cytologies and biopsies, were more prevalent in older women. CONCLUSIONS Insufficient coverage of cytologies, reported by the interviewees allows us to understand access difficulties in primary care, as well as the fragility of screening strategies. PMID:24897045

Effective case/infection ratio of poliomyelitis in vaccinated populations.

PubMed

Bencskó, G; Ferenci, T

2016-07-01

Recent polio outbreaks in Syria and Ukraine, and isolation of poliovirus from asymptomatic carriers in Israel have raised concerns that polio might endanger Europe. We devised a model to calculate the time needed to detect the first case should the disease be imported into Europe, taking the effect of vaccine coverage - both from inactivated and oral polio vaccines, also considering their differences - on the length of silent transmission into account by deriving an 'effective' case/infection ratio that is applicable for vaccinated populations. Using vaccine coverage data and the newly developed model, the relationship between this ratio and vaccine coverage is derived theoretically and is also numerically determined for European countries. This shows that unnoticed transmission is longer for countries with higher vaccine coverage and a higher proportion of IPV-vaccinated individuals among those vaccinated. Assuming borderline transmission (R = 1·1), the expected time to detect the first case is between 326 days and 512 days in different countries, with the number of infected individuals between 235 and 1439. Imperfect surveillance further increases these numbers, especially the number of infected until detection. While longer silent transmission does not increase the number of clinical diseases, it can make the application of traditional outbreak response methods more complicated, among others.

A "Cap" on Medicaid: How Block Grants, Per Capita Caps, and Capped Allotments Might Fundamentally Change the Safety Net.

PubMed

Mager-Mardeusz, Haleigh; Lenz, Cosima; Kominski, Gerald F

2017-04-01

Changing the Medicaid program is a top priority for the Republican party. Common themes from GOP proposals include converting Medicaid from a jointly financed entitlement benefit to a form of capped federal financing. While proponents of this reform argue that it would provide greater flexibility and a more predictable budget for state governments, serious consequences would likely result for Medicaid enrollees and state governments. Under all three scenarios promoted by Republicans--block grants, capped allotments, and per capita caps—most states would face increased costs. For all three scenarios, the capped nature of the funding guarantees that the real value of funds would decrease in future years relative to what would be expected from growth under the current program. Although the federal government would undoubtedly realize savings from all three scenarios, the impact might lead states to reduce benefits and services, create waiting lists, impose cost-sharing on a traditionally low-income enrollee population, or impose other obstacles to coverage. Nationally, as many as 20.5 million Americans stand to lose coverage under the proposed Medicaid changes. In California, up to 6 million people could lose coverage if changes to the Medicaid program were coupled with the repeal of coverage for the expansion population.

Mapping the literature of home health nursing.

PubMed

Friedman, Yelena

2006-04-01

The purpose of this study was to identify core journals in home health nursing and to determine how well these journals were covered by indexing and abstracting services. The study was part of the project for mapping the nursing literature of the Medical Library Association's Nursing and Allied Health Resource Section. A citation analysis of two core journals was done to determine distribution of references by format types and age of citations and dispersion of the literature, according to Bradford's Law of Scattering. The analysis of indexing coverage for Zone 1 and 2 was also provided. The study showed that 64.2% of citations came from journals, versus 22.9% from books and 12.9% from other publications. PubMed/ MEDLINE rated highest in average indexing coverage of Zone 1 and 2 journals, followed by CINAHL. PsycINFO, SocioAbstracts, and EBSCO Health Business FullTEXT showed practically no coverage for the home health nursing literature. As expected, journal articles were found to be the primary source for referencing and books, the secondary source. In regard to bibliographic control, no databases provided full coverage of the journals in the field of home health nursing. PubMed/MEDLINE and CINAHL gave better results in combination, because CINAHL tended to cover more nursing journals, while PubMed/MEDLINE did better with medical titles.

Multiscale Drivers of Global Environmental Health

NASA Astrophysics Data System (ADS)

Desai, Manish Anil

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

The exploitation of "Exploitation" in the tenofovir prep trial in Cameroon: Lessons learned from media coverage of an HIV prevention trial.

PubMed

Mack, Natasha; Robinson, Elizabeth T; MacQueen, Kathleen M; Moffett, Jill; Johnson, Laura M

2010-06-01

media coverage influences how clinical trials are perceived internationally and in communities where trials occur, affecting recruitment, retention, and political support for research. We conducted a discourse analysis of news coverage from 2004-2005 of a trial in Cameroon on oral PrEP for HIV prevention, to identify messages, communication techniques, and sources of messages that were amplified via media. We identified two parallel discourses: one on ethical concerns about the Cameroon trial, and a second, more general "science exploitation" discourse concerned with the potential for trials with vulnerable participant populations to be conducted unethically, benefiting only wealthy populations. Researchers should overtly address exploitation as an integral, ongoing component of research, particularly where historical or cultural conditions set the stage for controversy to emerge.

Thematic mapper flight model preshipment review data package. Volume 3, part B: System data

NASA Technical Reports Server (NTRS)

1982-01-01

Procedures and results are presented for performance and systems integration tests of flight model-1 thematic mapper. Aspects considered cover electronic module integration, radiometric calibration, spectral matching, spatial coverage, radiometric calibration of the calibrator, coherent noise, dynamic square wave response, band to band registration, geometric accuracy, and self induced vibration. Thermal vacuum tests, EMI/EMS, and mass properties are included. Liens are summarized.

LEOPACK The integrated services communications system based on LEO satellites

NASA Astrophysics Data System (ADS)

Negoda, A.; Bunin, S.; Bushuev, E.; Dranovsky, V.

LEOPACK is yet another LEO satellite project which provides global integrated services for 'business' communications. It utilizes packet rather then circuit switching in both terrestrial and satellite chains as well as cellular approach for frequencies use. Original multiple access protocols and decentralized network control make it possible to organize regionally or logically independent and world-wide networks. Relatively small number of satellites (28) provides virtually global network coverage.

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.

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

RNA-seq: technical variability and sampling

PubMed Central

2011-01-01

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

Repeat retail clinic visits: impact of insurance coverage and age of patient.

PubMed

Angstman, Kurt B; Bernard, Matthew E; Rohrer, James E; Garrison, Gregory M; Maclaughlin, Kathy L

2012-12-01

As retail clinics provide a less costly alternative for health care, it would be reasonable to expect an increase in multiple (repeat) retail visits by those patients who may have expenses for receiving primary care. If costs were not a significant factor, then repeat visits should not be significantly different between these patients and those with coverage for primary care visits. The hypothesis for this study was that patients with the potential for out-of-pocket expenses would have a higher frequency of repeat retail clinic visits within 180 days compared to those with primary care coverage. A retrospective chart review was conducted of 5703 patients utilizing a retail clinic in Rochester, Minnesota from January 1, 2009 through June 30, 2009. The first visit to the retail clinic was considered the index visit and the chart was reviewed for repeat retail clinic visits within the next 180 days. Using a multiple logistic regression model, the odds of a pediatric patient (N=2344) having a repeat retail visit within 180 days of the index visit were not significantly impacted by insurance coverage (P=0.4209). Of the 3359 adult patients, those with unknown coverage had a 25.6% higher odds ratio of repeat retail clinic visits than those with insurance coverage (odds ratio 1.2557, confidence interval 1.0421-1.5131). This study suggested that when cost is an issue, the adult patient may favor retail clinics for episodic, low-acuity health care. In contrast, the pediatric population did not, suggesting that other factors, such as convenience, may play more of a role in the choice of episodic health care for this age group.

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.

Flexible Graphene Composites for Human Space Flight Applications

NASA Technical Reports Server (NTRS)

Sosa, Edward D.

2013-01-01

Graphene oxide allows for better dispersion stability in aqueous and organic solvents. Stabilizers provide dispersion of pristine graphene. Roll coating provide the best coverage of polyurethane sheets. Graphene and GO coated polyurethane used to fabricate flexible laminate composite. Permeation testing indicates that pristine graphene acts as a better gas barrier material. Continuous graphene films are expected to provide even better gas barrier properties.

The Global Challenge in Basic Education: Why Continued Investment in Basic Education Is Important

ERIC Educational Resources Information Center

Mertaugh, Michael T.; Jimenez, Emmanuel Y.; Patrinos, Harry A.

2009-01-01

This paper documents the importance of continued investment in basic education and argues that investments need to be carefully targeted to address the constraints that limit the coverage and quality of education if they are to provide expected benefits. Part I begins with a discussion of the returns to investment in education. Part II then…

Journalism and Urban School Reform: Versions of Democratic Decision Making in Two American Cities

ERIC Educational Resources Information Center

Shipps, Dorothy; Fowlkes, Elizabeth; Peltzman, Alissa

2006-01-01

School reform involves the public: its expectation of participation and its support for a reform agenda. In theory, the press influences both. To explore this link, we compare education coverage in four press outlets, two each in Chicago and Cleveland. Articles and editors are interrogated for (1) style of journalism and (2) assumptions about the…

Deep brain stimulation in the media: over-optimistic portrayals call for a new strategy involving journalists and scientists in ethical debates.

PubMed

Gilbert, Frédéric; Ovadia, Daniela

2011-01-01

Deep brain stimulation (DBS) is optimistically portrayed in contemporary media. This already happened with psychosurgery during the first half of the twentieth century. The tendency of popular media to hype the benefits of DBS therapies, without equally highlighting risks, fosters public expectations also due to the lack of ethical analysis in the scientific literature. Media are not expected (and often not prepared) to raise the ethical issues which remain unaddressed by the scientific community. To obtain a more objective portrayal of DBS in the media, a deeper collaboration between the science community and journalists, and particularly specialized ones, must be promoted. Access to databases and articles, directly or through science media centers, has also been proven effective in increasing the quality of reporting. This article has three main objectives. Firstly, to explore the past media coverage of leukotomy, and to examine its widespread acceptance and the neglect of ethical issues in its depiction. Secondly, to describe how current enthusiastic coverage of DBS causes excessive optimism and neglect of ethical issues in patients. Thirdly, to discuss communication models and strategies to enhance media and science responsibility.

Deep Brain Stimulation in the Media: Over-Optimistic Portrayals Call for a New Strategy Involving Journalists and Scientists in Ethical Debates

PubMed Central

Gilbert, Frédéric; Ovadia, Daniela

2011-01-01

Deep brain stimulation (DBS) is optimistically portrayed in contemporary media. This already happened with psychosurgery during the first half of the twentieth century. The tendency of popular media to hype the benefits of DBS therapies, without equally highlighting risks, fosters public expectations also due to the lack of ethical analysis in the scientific literature. Media are not expected (and often not prepared) to raise the ethical issues which remain unaddressed by the scientific community. To obtain a more objective portrayal of DBS in the media, a deeper collaboration between the science community and journalists, and particularly specialized ones, must be promoted. Access to databases and articles, directly or through science media centers, has also been proven effective in increasing the quality of reporting. This article has three main objectives. Firstly, to explore the past media coverage of leukotomy, and to examine its widespread acceptance and the neglect of ethical issues in its depiction. Secondly, to describe how current enthusiastic coverage of DBS causes excessive optimism and neglect of ethical issues in patients. Thirdly, to discuss communication models and strategies to enhance media and science responsibility. PMID:21617733

Media Coverage of Alcohol Issues: A Critical Political Economy Framework—A Case Study from Ireland

PubMed Central

Mercille, Julien

2017-01-01

There is a growing literature on news media representations of alcohol-related issues. However, current scholarship has neglected critical political economic frameworks to interpret media coverage of alcohol. This paper presents such a framework that conceives of news organisations as corporations that share the values and interests of political and economic elites. The media are thus expected to present viewpoints that are more aligned with the alcohol industry than the scientific consensus on public health policy would warrant. The media are also expected, but to a lesser extent, to present a certain amount of support for public health perspectives because these are supported by a few socioeconomic elite groups (the medical professions, progressive politicians). The case of Ireland from 2012 to 2017 illustrates the framework empirically. Four main newspapers’ coverage of the Public Health (Alcohol) Bill and related policies is examined. Results show that, overall, 44.0% of articles support public health measures and 56.0% are opposed or remain neutral. It is argued that the media are not strong proponents of public health for multiple reasons: there are more articles opposed to or neutral toward public health measures than supporting them; the number of supportive articles remains relatively small and there are still many pieces presenting drinks industry views; there are virtually no calls in the media for stronger measures; supportive coverage is partially explained by the pub owners lobby’s support for minimum unit pricing; the media often downplay or ignore the negative consequences of alcohol, such as its role in accidents; many news articles normalise drinking and promote events sponsored by the industry; there is not a single Irish journalist covering alcohol issues systematically; and other policy issues that are prioritised by elites receive multiple times more media coverage than public health measures. In short, the media reflect the views of the political and economic establishment on public health measures: there is some support from the medical professions and progressive politicians, but overall, there is a clear reluctance to support strong public health strategies. One main recommendation for public health advocates to promote their perspectives is to diversify the mass media and make them less commercial in nature, as well as to engage with non-corporate, so-called progressive “alternative media” outlets. PMID:28621753

Media Coverage of Alcohol Issues: A Critical Political Economy Framework-A Case Study from Ireland.

PubMed

Mercille, Julien

2017-06-16

There is a growing literature on news media representations of alcohol-related issues. However, current scholarship has neglected critical political economic frameworks to interpret media coverage of alcohol. This paper presents such a framework that conceives of news organisations as corporations that share the values and interests of political and economic elites. The media are thus expected to present viewpoints that are more aligned with the alcohol industry than the scientific consensus on public health policy would warrant. The media are also expected, but to a lesser extent, to present a certain amount of support for public health perspectives because these are supported by a few socioeconomic elite groups (the medical professions, progressive politicians). The case of Ireland from 2012 to 2017 illustrates the framework empirically. Four main newspapers' coverage of the Public Health (Alcohol) Bill and related policies is examined. Results show that, overall, 44.0% of articles support public health measures and 56.0% are opposed or remain neutral. It is argued that the media are not strong proponents of public health for multiple reasons: there are more articles opposed to or neutral toward public health measures than supporting them; the number of supportive articles remains relatively small and there are still many pieces presenting drinks industry views; there are virtually no calls in the media for stronger measures; supportive coverage is partially explained by the pub owners lobby's support for minimum unit pricing; the media often downplay or ignore the negative consequences of alcohol, such as its role in accidents; many news articles normalise drinking and promote events sponsored by the industry; there is not a single Irish journalist covering alcohol issues systematically; and other policy issues that are prioritised by elites receive multiple times more media coverage than public health measures. In short, the media reflect the views of the political and economic establishment on public health measures: there is some support from the medical professions and progressive politicians, but overall, there is a clear reluctance to support strong public health strategies. One main recommendation for public health advocates to promote their perspectives is to diversify the mass media and make them less commercial in nature, as well as to engage with non-corporate, so-called progressive "alternative media" outlets.

Universal health coverage and the health Sustainable Development Goal: achievements and challenges for Sri Lanka.

PubMed

de Silva, Amala; Ranasinghe, Thushara; Abeykoon, Palitha

2016-09-01

With state-funded health care that is free at the point of delivery, a sound primary health-care policy and widespread health-care services, Sri Lanka seems a good example of universal health coverage. Yet, health transition and disparities in provision and financing threaten this situation. Sri Lanka did well on the Millennium Development Goal health indicators, but the Sustainable Development Goal (SDG) for health has a wider purview, which is to "ensure healthy lives and promote well-being for all at all ages". The gender gap in life expectancy and the gap between life expectancy and healthy life expectancy make achievement of the health SDG more challenging. Although women and children do well overall, the comparative health disadvantage for men in Sri Lanka is a cause for concern. From a financing perspective, high out-of-pocket expenditure and high utilization of the private sector, even by those in the lowest income quintile, are concerns, as is the emerging "third tier", where some individuals accessing state health care that is free at the point of delivery actually bear some of the costs of drugs, investigations and surgery. This cost sharing is resulting in catastrophic health expenditure for individuals, and delays in and non-compliance with treatment. These concerns about provision and financing must be addressed, as health transition will intensify the morbidity burden and loss of well-being, and could derail plans to achieve the health SDG.

The Economic Value of Long-Lasting Insecticidal Nets and Indoor Residual Spraying Implementation in Mozambique.

PubMed

Lee, Bruce Y; Bartsch, Sarah M; Stone, Nathan T B; Zhang, Shufang; Brown, Shawn T; Chatterjee, Chandrani; DePasse, Jay V; Zenkov, Eli; Briët, Olivier J T; Mendis, Chandana; Viisainen, Kirsi; Candrinho, Baltazar; Colborn, James

2017-06-01

AbstractMalaria-endemic countries have to decide how much of their limited resources for vector control to allocate toward implementing long-lasting insecticidal nets (LLINs) versus indoor residual spraying (IRS). To help the Mozambique Ministry of Health use an evidence-based approach to determine funding allocation toward various malaria control strategies, the Global Fund convened the Mozambique Modeling Working Group which then used JANUS, a software platform that includes integrated computational economic, operational, and clinical outcome models that can link with different transmission models (in this case, OpenMalaria) to determine the economic value of vector control strategies. Any increase in LLINs (from 80% baseline coverage) or IRS (from 80% baseline coverage) would be cost-effective (incremental cost-effectiveness ratios ≤ $114/disability-adjusted life year averted). However, LLIN coverage increases tend to be more cost-effective than similar IRS coverage increases, except where both pyrethroid resistance is high and LLIN usage is low. In high-transmission northern regions, increasing LLIN coverage would be more cost-effective than increasing IRS coverage. In medium-transmission central regions, changing from LLINs to IRS would be more costly and less effective. In low-transmission southern regions, LLINs were more costly and less effective than IRS, due to low LLIN usage. In regions where LLINs are more cost-effective than IRS, it is worth considering prioritizing LLIN coverage and use. However, IRS may have an important role in insecticide resistance management and epidemic control. Malaria intervention campaigns are not a one-size-fits-all solution, and tailored approaches are necessary to account for the heterogeneity of malaria epidemiology.

Handover procedures in integrated satellite and terrestrial mobile systems

NASA Technical Reports Server (NTRS)

Corazza, G. E.; Ruggieri, M.; Santucci, F.; Vatalaro, F.

1993-01-01

The integration of satellite and terrestrial mobile systems is investigated in terms of the strategies for handover across the integrated cellular coverage. The handover procedure is subdivided into an initialization phase, where the need for issuing a handover request must be identified, and an execution phase, where the request must be satisfied, if possible, according to a certain channel assignment strategy. A modeling approach that allows the design of the parameters that influence the performance of the overall handover procedure is presented, along with a few numerical results.

Integrated testing system FiTest for diagnosis of PCBA

NASA Astrophysics Data System (ADS)

Bogdan, Arkadiusz; Lesniak, Adam

2016-12-01

This article presents the innovative integrated testing system FiTest for automatic, quick inspection of printed circuit board assemblies (PCBA) manufactured in Surface Mount Technology (SMT). Integration of Automatic Optical Inspection (AOI), In-Circuit Tests (ICT) and Functional Circuit Tests (FCT) resulted in universal hardware platform for testing variety of electronic circuits. The platform provides increased test coverage, decreased level of false calls and optimization of test duration. The platform is equipped with powerful algorithms performing tests in a stable and repetitive way and providing effective management of diagnosis.

Measuring the degree of integration for an integrated service network

PubMed Central

Ye, Chenglin; Browne, Gina; Grdisa, Valerie S; Beyene, Joseph; Thabane, Lehana

2012-01-01

Background Integration involves the coordination of services provided by autonomous agencies and improves the organization and delivery of multiple services for target patients. Current measures generally do not distinguish between agencies’ perception and expectation. We propose a method for quantifying the agencies’ service integration. Using the data from the Children’s Treatment Network (CTN), we aimed to measure the degree of integration for the CTN agencies in York and Simcoe. Theory and methods We quantified the integration by the agreement between perceived and expected levels of involvement and calculated four scores from different perspectives for each agency. We used the average score to measure the global network integration and examined the sensitivity of the global score. Results Most agencies’ integration scores were <65%. As measured by the agreement between every other agency’s perception and expectation, the overall integration of CTN in Simcoe and York was 44% (95% CI: 39%–49%) and 52% (95% CI: 48%–56%), respectively. The sensitivity analysis showed that the global scores were robust. Conclusion Our method extends existing measures of integration and possesses a good extent of validity. We can also apply the method in monitoring improvement and linking integration with other outcomes. PMID:23593050

RCT: Module 2.11, Radiological Work Coverage, Course 8777

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

Hillmer, Kurt T.

2017-07-20

Radiological work is usually approved and controlled by radiation protection personnel by using administrative and procedural controls, such as radiological work permits (RWPs). In addition, some jobs will require working in, or will have the potential for creating, very high radiation, contamination, or airborne radioactivity areas. Radiological control technicians (RCTs) providing job coverage have an integral role in controlling radiological hazards. This course will prepare the student with the skills necessary for RCT qualification by passing quizzes, tests, and the RCT Comprehensive Phase 1, Unit 2 Examination (TEST 27566) and will provide in-the-field skills.

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

PubMed

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

2012-06-07

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

High resolution age-structured mapping of childhood vaccination coverage in low and middle income countries.

PubMed

Utazi, C Edson; Thorley, Julia; Alegana, Victor A; Ferrari, Matthew J; Takahashi, Saki; Metcalf, C Jessica E; Lessler, Justin; Tatem, Andrew J

2018-03-14

The expansion of childhood vaccination programs in low and middle income countries has been a substantial public health success story. Indicators of the performance of intervention programmes such as coverage levels and numbers covered are typically measured through national statistics or at the scale of large regions due to survey design, administrative convenience or operational limitations. These mask heterogeneities and 'coldspots' of low coverage that may allow diseases to persist, even if overall coverage is high. Hence, to decrease inequities and accelerate progress towards disease elimination goals, fine-scale variation in coverage should be better characterized. Using measles as an example, cluster-level Demographic and Health Surveys (DHS) data were used to map vaccination coverage at 1 km spatial resolution in Cambodia, Mozambique and Nigeria for varying age-group categories of children under five years, using Bayesian geostatistical techniques built on a suite of publicly available geospatial covariates and implemented via Markov Chain Monte Carlo (MCMC) methods. Measles vaccination coverage was found to be strongly predicted by just 4-5 covariates in geostatistical models, with remoteness consistently selected as a key variable. The output 1 × 1 km maps revealed significant heterogeneities within the three countries that were not captured using province-level summaries. Integration with population data showed that at the time of the surveys, few districts attained the 80% coverage, that is one component of the WHO Global Vaccine Action Plan 2020 targets. The elimination of vaccine-preventable diseases requires a strong evidence base to guide strategies and inform efficient use of limited resources. The approaches outlined here provide a route to moving beyond large area summaries of vaccination coverage that mask epidemiologically-important heterogeneities to detailed maps that capture subnational vulnerabilities. The output datasets are built on open data and methods, and in flexible format that can be aggregated to more operationally-relevant administrative unit levels. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Integrating social determinants of health in the universal health coverage monitoring framework.

PubMed

Vega, Jeanette; Frenz, Patricia

2013-12-01

Underpinning the global commitment to universal health coverage (UHC) is the fundamental role of health for well-being and sustainable development. UHC is proposed as an umbrella health goal in the post-2015 sustainable development agenda because it implies universal and equitable effective delivery of comprehensive health services by a strong health system, aligned with multiple sectors around the shared goal of better health. In this paper, we argue that social determinants of health (SDH) are central to both the equitable pursuit of healthy lives and the provision of health services for all and, therefore, should be expressly incorporated into the framework for monitoring UHC. This can be done by: (a) disaggregating UHC indicators by different measures of socioeconomic position to reflect the social gradient and the complexity of social stratification; and (b) connecting health indicators, both outcomes and coverage, with SDH and policies within and outside of the health sector. Not locating UHC in the context of action on SDH increases the risk of going down a narrow route that limits the right to health to coverage of services and financial protection.

Relative Affordability of Health Insurance Premiums under CHIP Expansion Programs and the ACA.

PubMed

Gresenz, Carole Roan; Laugesen, Miriam J; Yesus, Ambeshie; Escarce, José J

2011-10-01

Affordability is integral to the success of health care reforms aimed at ensuring universal access to health insurance coverage, and affordability determinations have major policy and practical consequences. This article describes factors that influenced the determination of affordability benchmarks and premium-contribution requirements for Children's Health Insurance Program (CHIP) expansions in three states that sought to universalize access to coverage for youth. It also compares subsidy levels developed in these states to the premium subsidy schedule under the Affordable Care Act (ACA) for health insurance plans purchased through an exchange. We find sizeable variability in premium-contribution requirements for children's coverage as a percentage of family income across the three states and in the progressivity and regressivity of the premium-contribution schedules developed. These findings underscore the ambiguity and subjectivity of affordability standards. Further, our analyses suggest that while the ACA increases the affordability of family coverage for families with incomes below 400 percent of the federal poverty level, the evolution of CHIP over the next five to ten years will continue to have significant implications for low-income families.

A way to improve dose rate laser simulation adequacy

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

Skorobogatov, P.K.; Nikiforov, A.Y.; Demidov, A.A.

1998-12-01

A method for improving laser simulation of dose rate radiation in silicon IC`s (Integrated Circuit) is analyzed based on the application of noncoherent laser radiation. Experimental validation was performed using test structures with up to 90% surface metallization coverage.

Nursing challenges for universal health coverage: a systematic review1

PubMed Central

Schveitzer, Mariana Cabral; Zoboli, Elma Lourdes Campos Pavone; Vieira, Margarida Maria da Silva

2016-01-01

Objectives to identify nursing challenges for universal health coverage, based on the findings of a systematic review focused on the health workforce' understanding of the role of humanization practices in Primary Health Care. Method systematic review and meta-synthesis, from the following information sources: PubMed, CINAHL, Scielo, Web of Science, PsycInfo, SCOPUS, DEDALUS and Proquest, using the keyword Primary Health Care associated, separately, with the following keywords: humanization of assistance, holistic care/health, patient centred care, user embracement, personal autonomy, holism, attitude of health personnel. Results thirty studies between 1999-2011. Primary Health Care work processes are complex and present difficulties for conducting integrative care, especially for nursing, but humanizing practices have showed an important role towards the development of positive work environments, quality of care and people-centered care by promoting access and universal health coverage. Conclusions nursing challenges for universal health coverage are related to education and training, to better working conditions and clear definition of nursing role in primary health care. It is necessary to overcome difficulties such as fragmented concepts of health and care and invest in multidisciplinary teamwork, community empowerment, professional-patient bond, user embracement, soft technologies, to promote quality of life, holistic care and universal health coverage. PMID:27143536

GFam: a platform for automatic annotation of gene families.

PubMed

Sasidharan, Rajkumar; Nepusz, Tamás; Swarbreck, David; Huala, Eva; Paccanaro, Alberto

2012-10-01

We have developed GFam, a platform for automatic annotation of gene/protein families. GFam provides a framework for genome initiatives and model organism resources to build domain-based families, derive meaningful functional labels and offers a seamless approach to propagate functional annotation across periodic genome updates. GFam is a hybrid approach that uses a greedy algorithm to chain component domains from InterPro annotation provided by its 12 member resources followed by a sequence-based connected component analysis of un-annotated sequence regions to derive consensus domain architecture for each sequence and subsequently generate families based on common architectures. Our integrated approach increases sequence coverage by 7.2 percentage points and residue coverage by 14.6 percentage points higher than the coverage relative to the best single-constituent database within InterPro for the proteome of Arabidopsis. The true power of GFam lies in maximizing annotation provided by the different InterPro data sources that offer resource-specific coverage for different regions of a sequence. GFam's capability to capture higher sequence and residue coverage can be useful for genome annotation, comparative genomics and functional studies. GFam is a general-purpose software and can be used for any collection of protein sequences. The software is open source and can be obtained from http://www.paccanarolab.org/software/gfam/.

Bayou Choctaw Well Integrity Grading Component Based on Geomechanical Simulation

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

Park, Byoung

2016-09-08

This letter report provides a Bayou Choctaw (BC) Strategic Petroleum Reserve (SPR) well grading system based on the geomechanical simulation. The analyses described in this letter were used to evaluate the caverns’ geomechanical effect on wellbore integrity, which is an important component in the well integrity grading system recently developed by Roberts et al. [2015]. Using these analyses, the wellbores for caverns BC-17 and 20 are expected to be significantly impacted by cavern geomechanics, BC-18 and 19 are expected to be medium impacted; and the other caverns are expected to be less impacted.

Integration of mobile satellite and cellular systems

NASA Technical Reports Server (NTRS)

Drucker, Elliott H.; Estabrook, Polly; Pinck, Deborah; Ekroot, Laura

1993-01-01

By integrating the ground based infrastructure component of a mobile satellite system with the infrastructure systems of terrestrial 800 MHz cellular service providers, a seamless network of universal coverage can be established. Users equipped for both cellular and satellite service can take advantage of a number of features made possible by such integration, including seamless handoff and universal roaming. To provide maximum benefit at lowest posible cost, the means by which these systems are integrated must be carefully considered. Mobile satellite hub stations must be configured to efficiently interface with cellular Mobile Telephone Switching Offices (MTSO's), and cost effective mobile units that provide both cellular and satellite capability must be developed.

Integration of mobile satellite and cellular systems

NASA Astrophysics Data System (ADS)

Drucker, Elliott H.; Estabrook, Polly; Pinck, Deborah; Ekroot, Laura

By integrating the ground based infrastructure component of a mobile satellite system with the infrastructure systems of terrestrial 800 MHz cellular service providers, a seamless network of universal coverage can be established. Users equipped for both cellular and satellite service can take advantage of a number of features made possible by such integration, including seamless handoff and universal roaming. To provide maximum benefit at lowest posible cost, the means by which these systems are integrated must be carefully considered. Mobile satellite hub stations must be configured to efficiently interface with cellular Mobile Telephone Switching Offices (MTSO's), and cost effective mobile units that provide both cellular and satellite capability must be developed.

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.

Bowel sparing in pediatric cranio-spinal radiotherapy: a comparison of combined electron and photon and helical TomoTherapy techniques to a standard photon method

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

Harron, Elizabeth, E-mail: elizabeth.harron@nuh.nhs.uk; Lewis, Joanne

2012-07-01

The aim of this study was to compare the dose to organs at risk (OARs) from different craniospinal radiotherapy treatment approaches available at the Northern Centre for Cancer Care (NCCC), with a particular emphasis on sparing the bowel. Method: Treatment plans were produced for a pediatric medulloblastoma patient with inflammatory bowel disease using 3D conformal 6-MV photons (3DCP), combined 3D 6-MV photons and 18-MeV electrons (3DPE), and helical photon TomoTherapy (HT). The 3DPE plan was a modification of the standard 3DCP technique, using electrons to treat the spine inferior to the level of the diaphragm. The plans were compared inmore » terms of the dose-volume data to OARs and the nontumor integral dose. Results: The 3DPE plan was found to give the lowest dose to the bowel and the lowest nontumor integral dose of the 3 techniques. However, the coverage of the spine planning target volume (PTV) was least homogeneous using this technique, with only 74.6% of the PTV covered by 95% of the prescribed dose. HT was able to achieve the best coverage of the PTVs (99.0% of the whole-brain PTV and 93.1% of the spine PTV received 95% of the prescribed dose), but delivered a significantly higher integral dose. HT was able to spare the heart, thyroid, and eyes better than the linac-based techniques, but other OARs received a higher dose. Conclusions: Use of electrons was the best method for reducing the dose to the bowel and the integral dose, at the expense of compromised spine PTV coverage. For some patients, HT may be a viable method of improving dose homogeneity and reducing selected OAR doses.« less

Optimization of Archeological Anomalies using GIS method for Magnetic and Resistivity Study at Sungai Batu, Lembah Bujang, Kedah (Malaysia)

NASA Astrophysics Data System (ADS)

Yusoh, R.; Saad, R.; Saidin, M.; Anda, S. T.; Muhammad, S. B.; Ashraf, M. I. M.; Hazreek, Z. A. M.

2018-04-01

Magnetic and resistivity method has become a reliable option in archeological exploration. The use of both method has become popular these day. However, both method gives different type of sensing in detecting anomalies and direct interpret from the anomalies will result large coverage area for excavation. Therefore, to overcome this issue, both anomalies can be extracted using ArcGIS software to reduce excavated coverage area. The case study located at Sungai Batu, Lembah Bujang near SB2ZZ lot expected buried clay brick monument which will be a perfect case to apply this technique. Magnetic and resistivity method was implemented at the study area where the anomalies coverage area for magnetic and resistivity is 531.5 m2 and 636 m2 respectively which total area of both anomalies was 764 m2. By applying combine technique, the anomalies area reduce to 403.7 m2 which reduce the suspected anomalies by 47.16 %. The unsuspected clay brick monument area was increase from 15.86% to 55.54% which improve the cost and labor work for excavation.

CO-CO coupling on Cu facets: Coverage, strain and field effects

DOE PAGES

Sandberg, Robert B.; Montoya, Joseph H.; Chan, Karen; ...

2016-08-21

We present a DFT study on the effect of coverage, strain, and electric field on CO-CO coupling energetics on Cu (100), (111), and (211). Our calculations indicate that CO-CO coupling is facile on all three facets in the presence of a cation-induced electric field in the Helmholtz plane, with the lowest barrier on Cu(100). The CO dimerization pathway is therefore expected to play a role in C 2 formation at potentials negative of the Cu potential of zero charge, corresponding to CO 2/CO reduction conditions at high pH. Both increased *CO coverage and tensile strain further improve C-C coupling energeticsmore » on Cu (111) and (211). Since CO dimerization is facile on all 3 Cu facets, subsequent surface hydrogenation steps may also play an important role in determining the overall activity towards C 2 products. Adsorption of *CO, *H, and *OH on the 3 facets were investigated with a Pourbaix analysis. Here, the (211) facet has the largest propensity to co-adsorb *CO and *H, which would favor surface hydrogenation following CO dimerization.« less

Psychiatry's future: facing reality.

PubMed

Staton, D

1991-01-01

U.S. public and private health care costs, including mental health treatment costs, continue to rise at unacceptably high annual rates of increase. "Basic" health insurance plans presently being developed by both public and private payers, in response to this crisis, will include: (1) severely limited coverage for psychiatric care; and (2) coverage for specific categories of serious mental illness. Psychiatrists must develop cost-effective goals and treatment standards that achieve satisfactory outcomes for these high-priority conditions. Treatment standards must be compatible with economic reality. Psychiatry as a profession (i.e., all psychiatrists) must accept cost-effective treatment responsibility for society's most seriously mentally ill individuals. We need to train psychiatrists who are biologically-, crisis-, and rehabilitation-oriented and who can practice effectively and comfortably within society's treatment expectations and funding constraints.

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

Datacube Interoperability, Encoding Independence, and Analytics

NASA Astrophysics Data System (ADS)

Baumann, Peter; Hirschorn, Eric; Maso, Joan

2017-04-01

Datacubes are commonly accepted as an enabling paradigm which provides a handy abstraction for accessing and analyzing the zillions of image files delivered by the manifold satellite instruments and climate simulations, among others. Additionally, datacubes are the classic model for statistical and OLAP datacubes, so a further information category can be integrated. From a standards perspective, spatio-temporal datacubes naturally are included in the concept of coverages which encompass regular and irregular grids, point clouds, and general meshes - or, more abstractly, digital representations of spatio-temporally varying phenomena. ISO 19123, which is identical to OGC Abstract Topic 6, gives a high-level abstract definition which is complemented by the OGC Coverage Implementation Schema (CIS) which is an interoperable, yet format independent concretization of the abstract model. Currently, ISO is working on adopting OGC CIS as ISO 19123-2; the existing ISO 19123 standard is under revision by one of the abstract authors and will become ISO 19123-1. The roadmap agreed by ISO further foresees adoption of the OGC Web Coverage Service (WCS) as an ISO standard so that a complete data and service model will exist. In 2016, INSPIRE has adopted WCS as Coverage Download Service, including the datacube analytics language Web Coverage Processing Service (WCPS). The rasdaman technology (www.rasdaman.org) is both OGC and INSPIRE Reference Implementation. In the global EarthServer initiative rasdaman database sizes are exceeding 250 TB today, heading for the Petabyte frontier well in 2017. Technically, CIS defines a compact, efficient model for representing multi-dimensional datacubes in several ways. The classical coverage cube defines a domain set (where are values?), a range set (what are these values?), and range type (what do the values mean?), as well as a "bag" for arbitrary metadata. With CIS 1.1, coordinate/value pair sequences have been added, as well as tiled representations. Further, CIS 1.1 offers a unified model for any kind of regular and irregular grids, also allowing sensor models as per SensorML. Encodings include ASCII formats like GML, JSON, RDF as well as binary formats like GeoTIFF, NetCDF, JPEG2000, and GRIB2; further, a container concept allows mixed representations within one coverage file utilizing zip or other convenient package formats. Through the tight integration with the Sensor Web Enablement (SWE), a lossless "transport" from sensor into coverage world is ensured. The corresponding service model of WCS supports datacube operations ranging from simple data extraction to complex ad-hoc analytics with WPCS. Notably, W3C is working has set out on a coverage model as well; it has been designed relatively independently from the abovementioned standards, but there is informal agreement to link it into the CIS universe (which allows for different, yet interchangeable representations). Particularly interesting in the W3C proposal is the detailed semantic modeling of metadata; as CIS 1.1 supports RDF, a tight coupling seems feasible.

Vegetation Coverage and Impervious Surface Area Estimated Based on the Estarfm Model and Remote Sensing Monitoring

NASA Astrophysics Data System (ADS)

Hu, Rongming; Wang, Shu; Guo, Jiao; Guo, Liankun

2018-04-01

Impervious surface area and vegetation coverage are important biophysical indicators of urban surface features which can be derived from medium-resolution images. However, remote sensing data obtained by a single sensor are easily affected by many factors such as weather conditions, and the spatial and temporal resolution can not meet the needs for soil erosion estimation. Therefore, the integrated multi-source remote sensing data are needed to carry out high spatio-temporal resolution vegetation coverage estimation. Two spatial and temporal vegetation coverage data and impervious data were obtained from MODIS and Landsat 8 remote sensing images. Based on the Enhanced Spatial and Temporal Adaptive Reflectance Fusion Model (ESTARFM), the vegetation coverage data of two scales were fused and the data of vegetation coverage fusion (ESTARFM FVC) and impervious layer with high spatiotemporal resolution (30 m, 8 day) were obtained. On this basis, the spatial variability of the seepage-free surface and the vegetation cover landscape in the study area was measured by means of statistics and spatial autocorrelation analysis. The results showed that: 1) ESTARFM FVC and impermeable surface have higher accuracy and can characterize the characteristics of the biophysical components covered by the earth's surface; 2) The average impervious surface proportion and the spatial configuration of each area are different, which are affected by natural conditions and urbanization. In the urban area of Xi'an, which has typical characteristics of spontaneous urbanization, landscapes are fragmented and have less spatial dependence.

Making Better Re/Insurance Underwriting and Capital Management Decisions with Public-Private-Academic Partnerships

NASA Astrophysics Data System (ADS)

Michel, G.; Gunasekera, R.; Werner, A.; Galy, H.

2012-04-01

Similar to 2001, 2004, and 2005, 2011 was another year of unexpected international catastrophe events, in which insured losses were more than twice the expected long-term annual average catastrophe losses of USD 30 to 40bn. Key catastrophe events that significantly contributed these losses included the Mw 9.0 Great Tohoku earthquake and tsunami, the Jan. 2011 floods in Queensland, the October 2011 floods in Thailand, the Mw 6.1 Christchurch earthquake and Convective system (Tornado) in United States. However, despite considerable progress in catastrophe modelling, the advent of global catastrophe models, increasing risk model coverage and skill in the detailed modelling, the above mentioned events were not satisfactorily modelled by the current mainstream Re/Insurance catastrophe models. This presentation therefore address problems in models and incomplete understanding identified from recent catastrophic events by considering: i) the current modelling environment, and ii) how the current processes could be improved via: a) the understanding of risk within science networks such as the Willis Research Network, and b) the integration of risk model results from available insurance catastrophe models and tools. This presentation aims to highlight the needed improvements in decision making and market practices, thereby advancing the current management of risk in the Re/Insurance industry. This also increases the need for better integration of Public-Private-Academic partnerships and tools to provide better estimates of not only financial loss but also humanitarian and infrastructural losses as well.

Limits on same-day billing in Medicaid hinders integration of behavioral health into the medical home model.

PubMed

Roby, Dylan H; Jones, Erynne E

2016-02-01

The potential expansion of insurance coverage through the Patient Protection and Affordable Care Act of 2010 can facilitate the reduction of access barriers and improved quality for behavioral health care. More than 5 million of the newly insured are expected to have mental health and substance use disorders. In addition, state and federal efforts to integrate behavioral and medical health needs through patient-centered medical home models and innovations in payment strategies provide an unprecedented opportunity to use federal financial support to improve not only access to care, but also improve quality through active care coordination, use of interdisciplinary teams, colocating services, and engaging in warm hand-offs between providers in the same setting. These potential advances are hindered in 24 different states because of Medicaid payment policy, with 7 explicitly limiting the ability to reimburse for physical health and behavioral health services on the same day for all providers. Without the ability for providers to be reimbursed for different services on the same day to improve behavioral and medical health care coordination, these states could be limited in their ability to improve care via patient-centered approaches and interdisciplinary team-based care that would involve physicians, clinical psychologists, psychiatrists, and other mental health professionals. Limits on same-day billing in Medicaid programs could impact up to 36.7 million people in 24 states, which is approximately 52.6% of all Medicaid enrollees. (c) 2016 APA, all rights reserved).

Leveraging paraprofessionals and family strengths to improve coverage and penetration of nutrition and early child development services.

PubMed

Tomlinson, Mark; Rahman, Atif; Sanders, David; Maselko, Joanna; Rotheram-Borus, Mary Jane

2014-01-01

Children need to be protected in intergenerational networks, with parents who have positive mood, resources to feed their children, and skills to promote early childhood development (ECD). Globally, more than 200 million children are raised annually without these resources. This article reviews the potential contributions of increasing coverage and penetration of services for these children, challenges to achieving penetration of services in high-risk families, opportunities created by bundling multiple services within one provider, potential leveraging of paraprofessionals to deliver care, and mobilizing communities to support children in households at high risk for negative outcomes. We end with a number of suggestions for how to ensure the equitable scale-up of integrated ECD and nutrition services that take into account current global priorities, as well as coverage and penetration of services. © 2013 New York Academy of Sciences.

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

PubMed

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

2015-07-01

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

The cigarette advertising broadcast ban and magazine coverage of smoking and health.

PubMed

Warner, K E; Goldenhar, L M

1989-01-01

At the time of the cigarette broadcast advertising ban, which took effect in 1971, cigarette manufacturers rapidly shifted advertising expenditures from the broadcast media to the print media. In the last year of broadcast advertising and the first year of the ban, cigarette ad expenditures in a sample of major national magazines increased by 49 and then 131 percent in constant dollars. From an 11-year period preceding the ban to an 11-year period following it, these magazines decreased their coverage of smoking and health by 65 percent, an amount that is statistically significantly greater than decreases found in magazines that did not carry cigarette ads and in two major newspapers. This finding adds to evidence that media dependent on cigarette advertising have restricted their coverage of smoking and health. This may have significant implications for public health, as well as raising obvious concerns about the integrity of the profession of journalism.

Experimental and Numerical Analysis of Microstructures and Stress States of Shot-Peened GH4169 Superalloys

NASA Astrophysics Data System (ADS)

Hu, Dianyin; Gao, Ye; Meng, Fanchao; Song, Jun; Wang, Rongqiao

2018-04-01

Combining experiments and finite element analysis (FEA), a systematic study was performed to analyze the microstructural evolution and stress states of shot-peened GH4169 superalloy over a variety of peening intensities and coverages. A dislocation density evolution model was integrated into the representative volume FEA model to quantitatively predict microstructural evolution in the surface layers and compared with experimental results. It was found that surface roughness and through-depth residual stress profile are more sensitive to shot-peening intensity compared to coverage due to the high kinetic energy involved. Moreover, a surface nanocrystallization layer was discovered in the top surface region of GH4169 for all shot-peening conditions. However, the grain refinement was more intensified under high shot-peening coverage, under which enough time was permitted for grain refinement. The grain size gradient predicted by the numerical framework showed good agreement with experimental observations.

How Health-Care Policies Affect Children's Health and Development. Social Policy Report Brief. Volume 29, Issue 4

ERIC Educational Resources Information Center

Bridgman, Anne

2016-01-01

Most U.S. children (94%) have some form of health insurance coverage. While this is the highest rate in U.S. history, poor children still lag behind middle-income children. Serious infectious diseases (e.g., measles, diphtheria, meningitis) and severe malnutrition have declined or disappeared, and new treatments have improved life expectancy among…

Changing stand structure and regional growth reductions in Georgia's natural pine stands: discussion paper response

Treesearch

W.A. Bechtold; G.A. Ruark; F.T. Lloyd

1991-01-01

This paper was submitted for discussion in the expectation that the discussion format would allow maximum coverage of the many issues associated with the valuation of temporal growth patterns over extensive geographic areas. To this end, the input from the discussants and numerous other reviewers has been extremely valuable, and we are sincerely grateful for their many...

Assessment of Malawi's success in child mortality reduction through the lens of the Catalytic Initiative Integrated Health Systems Strengthening programme: Retrospective evaluation.

PubMed

Doherty, Tanya; Zembe, Wanga; Ngandu, Nobubelo; Kinney, Mary; Manda, Samuel; Besada, Donela; Jackson, Debra; Daniels, Karen; Rohde, Sarah; van Damme, Wim; Kerber, Kate; Daviaud, Emmanuelle; Rudan, Igor; Muniz, Maria; Oliphant, Nicholas P; Zamasiya, Texas; Rohde, Jon; Sanders, David

2015-12-01

Malawi is estimated to have achieved its Millennium Development Goal (MDG) 4 target. This paper explores factors influencing progress in child survival in Malawi including coverage of interventions and the role of key national policies. We performed a retrospective evaluation of the Catalytic Initiative (CI) programme of support (2007-2013). We developed estimates of child mortality using four population household surveys undertaken between 2000 and 2010. We recalculated coverage indicators for high impact child health interventions and documented child health programmes and policies. The Lives Saved Tool (LiST) was used to estimate child lives saved in 2013. The mortality rate in children under 5 years decreased rapidly in the 10 CI districts from 219 deaths per 1000 live births (95% confidence interval (CI) 189 to 249) in the period 1991-1995 to 119 deaths (95% CI 105 to 132) in the period 2006-2010. Coverage for all indicators except vitamin A supplementation increased in the 10 CI districts across the time period 2000 to 2013. The LiST analysis estimates that there were 10 800 child deaths averted in the 10 CI districts in 2013, primarily attributable to the introduction of the pneumococcal vaccine (24%) and increased household coverage of insecticide-treated bednets (19%). These improvements have taken place within a context of investment in child health policies and scale up of integrated community case management of childhood illnesses. Malawi provides a strong example for countries in sub-Saharan Africa of how high impact child health interventions implemented within a decentralised health system with an established community-based delivery platform, can lead to significant reductions in child mortality.

Assessment of Malawi’s success in child mortality reduction through the lens of the Catalytic Initiative Integrated Health Systems Strengthening programme: Retrospective evaluation

PubMed Central

Doherty, Tanya; Zembe, Wanga; Ngandu, Nobubelo; Kinney, Mary; Manda, Samuel; Besada, Donela; Jackson, Debra; Daniels, Karen; Rohde, Sarah; van Damme, Wim; Kerber, Kate; Daviaud, Emmanuelle; Rudan, Igor; Muniz, Maria; Oliphant, Nicholas P; Zamasiya, Texas; Rohde, Jon; Sanders, David

2015-01-01

Background Malawi is estimated to have achieved its Millennium Development Goal (MDG) 4 target. This paper explores factors influencing progress in child survival in Malawi including coverage of interventions and the role of key national policies. Methods We performed a retrospective evaluation of the Catalytic Initiative (CI) programme of support (2007–2013). We developed estimates of child mortality using four population household surveys undertaken between 2000 and 2010. We recalculated coverage indicators for high impact child health interventions and documented child health programmes and policies. The Lives Saved Tool (LiST) was used to estimate child lives saved in 2013. Results The mortality rate in children under 5 years decreased rapidly in the 10 CI districts from 219 deaths per 1000 live births (95% confidence interval (CI) 189 to 249) in the period 1991–1995 to 119 deaths (95% CI 105 to 132) in the period 2006–2010. Coverage for all indicators except vitamin A supplementation increased in the 10 CI districts across the time period 2000 to 2013. The LiST analysis estimates that there were 10 800 child deaths averted in the 10 CI districts in 2013, primarily attributable to the introduction of the pneumococcal vaccine (24%) and increased household coverage of insecticide–treated bednets (19%). These improvements have taken place within a context of investment in child health policies and scale up of integrated community case management of childhood illnesses. Conclusions Malawi provides a strong example for countries in sub–Saharan Africa of how high impact child health interventions implemented within a decentralised health system with an established community–based delivery platform, can lead to significant reductions in child mortality. PMID:26649176

The Effects of an Integrated Community Case Management Strategy on the Appropriate Treatment of Children and Child Mortality in Kono District, Sierra Leone: A Program Evaluation.

PubMed

Ratnayake, Ruwan; Ratto, Jeffrey; Hardy, Colleen; Blanton, Curtis; Miller, Laura; Choi, Mary; Kpaleyea, John; Momoh, Pheabean; Barbera, Yolanda

2017-09-01

Integrated community case management (iCCM) aims to reduce child mortality in areas with poor access to health care. iCCM was implemented in 2009 in Kono district, Sierra Leone, a postconflict area with high under-five mortality rates (U5MRs). We evaluated iCCM's impact and effects on child health using cluster surveys in 2010 (midterm) and 2013 (endline) to compare indicators on child mortality, coverage of appropriate treatment, timely access to care, quality of care, and recognition of community health workers (CHWs). The sample size was powered to detect a 28% decline in U5MR. Clusters were selected proportional to population size. All households were sampled to measure mortality and systematic random sampling was used to measure coverage in a subset of households. We used program data to evaluate utilization and access; 5,257 (2010) and 3,649 (2013) households were surveyed. U5MR did not change significantly (4.54 [95% confidence interval [CI]: 3.47-5.60] to 3.95 [95% CI: 3.06-4.83] deaths per 1,000 per month ( P = 0.4)) though a relative change smaller than 28% could not be detected. CHWs were the first source of care for 52% (2010) and 50.9% (2013) of children. Coverage of appropriate treatment of fever by CHWs or peripheral health units increased from 45.5% [95% CI: 39.2-52.0] to 58.2% [95% CI: 50.5-65.5] ( P = 0.01); changes for diarrhea and pneumonia were not significant. The continued reliance on the CHW as the first source of care and improved coverage for the appropriate treatment of fever support iCCM's role in Kono district.

Necessity and approach to integrated nanomaterial legislation and governance.

PubMed

Wang, Jiafan; Gerlach, John D; Savage, Nora; Cobb, George P

2013-01-01

Nanotechnology is one of the most promising technologies to emerge in recent decades. Materials that are specially engineered to have at least one dimension that is no larger than 100 nm are now continuously manufactured and incorporated as critical components of different products that people use daily. While we are taking advantage of nanomaterials (NMs) and nano-products, they may pose a risk to humans and the broader environment. Some types of fibrous NMs such as carbon nanotubes and nano-fibers may present a risk similar to that of asbestos. Some carbon or metal based NMs may threaten the environment due to their bioaccumulative nature within food webs. In order to prevent future adverse effects from products or byproducts of nanotechnology, we suggest an integrated multi-faceted approach which includes an integrated regulation that is based upon life cycle assessment, empirically derived risk assessment. Advanced research that fills the knowledge gap regarding the understanding of NMs in scientific and social norms will be helpful in a full life cycle assessment of NMs. Emphasizing nanotechnology education to the public for an increased understanding and participation associated with media coverage will finally draw governments' attention with an integrated legislation to be instituted. Developing the optimal mix of these tools, including research, public education, media coverage, integrated legislation, will be significant to proactively manage the complexity of nanotechnology and prevent any undesirable effect due to the NMs exposure. Copyright © 2012 Elsevier B.V. All rights reserved.

Motivational beliefs, values, and goals.

PubMed

Eccles, Jacquelynne S; Wigfield, Allan

2002-01-01

This chapter reviews the recent research on motivation, beliefs, values, and goals, focusing on developmental and educational psychology. The authors divide the chapter into four major sections: theories focused on expectancies for success (self-efficacy theory and control theory), theories focused on task value (theories focused on intrinsic motivation, self-determination, flow, interest, and goals), theories that integrate expectancies and values (attribution theory, the expectancy-value models of Eccles et al., Feather, and Heckhausen, and self-worth theory), and theories integrating motivation and cognition (social cognitive theories of self-regulation and motivation, the work by Winne & Marx, Borkowski et al., Pintrich et al., and theories of motivation and volition). The authors end the chapter with a discussion of how to integrate theories of self-regulation and expectancy-value models of motivation and suggest new directions for future research.

Executive Function in Education: From Theory to Practice

ERIC Educational Resources Information Center

Meltzer, Lynn, Ed.

2007-01-01

This uniquely integrative book brings together leading researchers and practitioners from education, neuroscience, and psychology. It presents a theoretical framework for understanding executive function difficulties together with a range of effective approaches to assessment and instruction. Coverage includes executive function processes in…

Women and Private Pensions.

ERIC Educational Resources Information Center

Benson, Helene A.

This speech focuses on women and private pension plans, such as private pension coverage and smaller benefit amounts. Pension issues affecting women as employees include participation in plans, vesting, break-in service, benefit accruals, integration with Social Security, sex-based actuarial tables, portability, inflation, and individual…

Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India

PubMed Central

Diaz, M; Kim, J J; Albero, G; de Sanjosé, S; Clifford, G; Bosch, F X; Goldie, S J

2008-01-01

Cervical cancer is a leading cause of cancer death among women in low-income countries, with ∼25% of cases worldwide occurring in India. We estimated the potential health and economic impact of different cervical cancer prevention strategies. After empirically calibrating a cervical cancer model to country-specific epidemiologic data, we projected cancer incidence, life expectancy, and lifetime costs (I$2005), and calculated incremental cost-effectiveness ratios (I$/YLS) for the following strategies: pre-adolescent vaccination of girls before age 12, screening of women over age 30, and combined vaccination and screening. Screening differed by test (cytology, visual inspection, HPV DNA testing), number of clinical visits (1, 2 or 3), frequency (1 × , 2 × , 3 × per lifetime), and age range (35–45). Vaccine efficacy, coverage, and costs were varied in sensitivity analyses. Assuming 70% coverage, mean reduction in lifetime cancer risk was 44% (range, 28–57%) with HPV 16,18 vaccination alone, and 21–33% with screening three times per lifetime. Combining vaccination and screening three times per lifetime provided a mean reduction of 56% (vaccination plus 3-visit conventional cytology) to 63% (vaccination plus 2-visit HPV DNA testing). At a cost per vaccinated girl of I$10 (per dose cost of $2), pre-adolescent vaccination followed by screening three times per lifetime using either VIA or HPV DNA testing, would be considered cost-effective using the country's per capita gross domestic product (I$3452) as a threshold. In India, if high coverage of pre-adolescent girls with a low-cost HPV vaccine that provides long-term protection is achievable, vaccination followed by screening three times per lifetime is expected to reduce cancer deaths by half, and be cost-effective. PMID:18612311

Lessons learned from the initial sequencing of the pig genome: comparative analysis of an 8 Mb region of pig chromosome 17

PubMed Central

Hart, Elizabeth A; Caccamo, Mario; Harrow, Jennifer L; Humphray, Sean J; Gilbert, James GR; Trevanion, Steve; Hubbard, Tim; Rogers, Jane; Rothschild, Max F

2007-01-01

Background We describe here the sequencing, annotation and comparative analysis of an 8 Mb region of pig chromosome 17, which provides a useful test region to assess coverage and quality for the pig genome sequencing project. We report our findings comparing the annotation of draft sequence assembled at different depths of coverage. Results Within this region we annotated 71 loci, of which 53 are orthologous to human known coding genes. When compared to the syntenic regions in human (20q13.13-q13.33) and mouse (chromosome 2, 167.5 Mb-178.3 Mb), this region was found to be highly conserved with respect to gene order. The most notable difference between the three species is the presence of a large expansion of zinc finger coding genes and pseudogenes on mouse chromosome 2 between Edn3 and Phactr3 that is absent from pig and human. All of our annotation has been made publicly available in the Vertebrate Genome Annotation browser, VEGA. We assessed the impact of coverage on sequence assembly across this region and found, as expected, that increased sequence depth resulted in fewer, longer contigs. One-third of our annotated loci could not be fully re-aligned back to the low coverage version of the sequence, principally because the transcripts are fragmented over several contigs. Conclusion We have demonstrated the considerable advantages of sequencing at increased read depths and discuss the implications that lower coverage sequence may have on subsequent comparative and functional studies, particularly those involving complex loci such as GNAS. PMID:17705864

State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments - United States, 2015-2017.

PubMed

DiGiulio, Anne; Jump, Zach; Yu, Annie; Babb, Stephen; Schecter, Anna; Williams, Kisha-Ann S; Yembra, Debbie; Armour, Brian S

2018-04-06

Cigarette smoking prevalence among Medicaid enrollees (25.3%) is approximately twice that of privately insured Americans (11.8%), placing Medicaid enrollees at increased risk for smoking-related disease and death (1). Medicaid spends approximately $39 billion annually on treating smoking-related diseases (2). Individual, group, and telephone counseling and seven Food and Drug Administration (FDA)-approved medications* are effective in helping tobacco users quit (3). Although state Medicaid coverage of tobacco cessation treatments improved during 2014-2015, coverage was still limited in most states (4). To monitor recent changes in state Medicaid cessation coverage for traditional (i.e., nonexpansion) Medicaid enrollees, the American Lung Association collected data on coverage of a total of nine cessation treatments: individual counseling, group counseling, and seven FDA-approved cessation medications † in state Medicaid programs during July 1, 2015-June 30, 2017. The American Lung Association also collected data on seven barriers to accessing covered treatments, such as copayments and prior authorization. As of June 30, 2017, 10 states covered all nine of these treatments for all enrollees, up from nine states as of June 30, 2015; of these 10 states, Missouri was the only state to have removed all seven barriers to accessing these cessation treatments. State Medicaid programs that cover all evidence-based cessation treatments, remove barriers to accessing these treatments, and promote covered treatments to Medicaid enrollees and health care providers would be expected to reduce smoking, smoking-related disease, and smoking-attributable federal and state health care expenditures (5-7).

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.

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

Boehling, Nicholas S.; Grosshans, David R., E-mail: dgrossha@mdanderson.org; Bluett, Jaques B.

Purpose: Cranial irradiation in pediatric patients is associated with serious long-term adverse effects. We sought to determine whether both three-dimensional conformal proton radiotherapy (3D-PRT) and intensity-modulated proton therapy (IMPT) compared with intensity-modulated radiotherapy (IMRT) decrease integral dose to brain areas known to harbor neuronal stem cells, major blood vessels, and other normal brain structures for pediatric patients with craniopharyngiomas. Methods and Materials: IMRT, forward planned, passive scattering proton, and IMPT plans were generated and optimized for 10 pediatric patients. The dose was 50.4 Gy (or cobalt Gy equivalent) delivered in 28 fractions with the requirement for planning target volume (PTV)more » coverage of 95% or better. Integral dose data were calculated from differential dose-volume histograms. Results: The PTV target coverage was adequate for all modalities. IMRT and IMPT yielded the most conformal plans in comparison to 3D-PRT. Compared with IMRT, 3D-PRT and IMPT plans had a relative reduction of integral dose to the hippocampus (3D-PRT, 20.4; IMPT, 51.3%{sup Asterisk-Operator }), dentate gyrus (27.3, 75.0%{sup Asterisk-Operator }), and subventricular zone (4.5, 57.8%{sup Asterisk-Operator }). Vascular organs at risk also had reduced integral dose with the use of proton therapy (anterior cerebral arteries, 33.3{sup Asterisk-Operator }, 100.0%{sup Asterisk-Operator }; middle cerebral arteries, 25.9%{sup Asterisk-Operator }, 100%{sup Asterisk-Operator }; anterior communicating arteries, 30.8{sup Asterisk-Operator }, 41.7%{sup Asterisk-Operator }; and carotid arteries, 51.5{sup Asterisk-Operator }, 77.6{sup Asterisk-Operator }). Relative reduction of integral dose to the infratentorial brain (190.7{sup Asterisk-Operator }, 109.7%{sup Asterisk-Operator }), supratentorial brain without PTV (9.6, 26.8%{sup Asterisk-Operator }), brainstem (45.6, 22.4%{sup Asterisk-Operator }), and whole brain without PTV (19.4{sup Asterisk-Operator }, 34.4%{sup Asterisk-Operator }) were recorded with the use of proton therapy. ({sup Asterisk-Operator }Differences were significant based on Friedman's test with Bonferroni-Dunn correction, {alpha} = 0.05) Conclusions: The current study found that proton therapy was able to avoid excess integral radiation dose to a variety of normal structures at all dose levels while maintaining equal target coverage. Future studies will examine the clinical benefits of these dosimetric advantages.« less

The Economic Value of Long-Lasting Insecticidal Nets and Indoor Residual Spraying Implementation in Mozambique

PubMed Central

Lee, Bruce Y.; Bartsch, Sarah M.; Stone, Nathan T. B.; Zhang, Shufang; Brown, Shawn T.; Chatterjee, Chandrani; DePasse, Jay V.; Zenkov, Eli; Briët, Olivier J. T.; Mendis, Chandana; Viisainen, Kirsi; Candrinho, Baltazar; Colborn, James

2017-01-01

Malaria-endemic countries have to decide how much of their limited resources for vector control to allocate toward implementing long-lasting insecticidal nets (LLINs) versus indoor residual spraying (IRS). To help the Mozambique Ministry of Health use an evidence-based approach to determine funding allocation toward various malaria control strategies, the Global Fund convened the Mozambique Modeling Working Group which then used JANUS, a software platform that includes integrated computational economic, operational, and clinical outcome models that can link with different transmission models (in this case, OpenMalaria) to determine the economic value of vector control strategies. Any increase in LLINs (from 80% baseline coverage) or IRS (from 80% baseline coverage) would be cost-effective (incremental cost-effectiveness ratios ≤ $114/disability-adjusted life year averted). However, LLIN coverage increases tend to be more cost-effective than similar IRS coverage increases, except where both pyrethroid resistance is high and LLIN usage is low. In high-transmission northern regions, increasing LLIN coverage would be more cost-effective than increasing IRS coverage. In medium-transmission central regions, changing from LLINs to IRS would be more costly and less effective. In low-transmission southern regions, LLINs were more costly and less effective than IRS, due to low LLIN usage. In regions where LLINs are more cost-effective than IRS, it is worth considering prioritizing LLIN coverage and use. However, IRS may have an important role in insecticide resistance management and epidemic control. Malaria intervention campaigns are not a one-size-fits-all solution, and tailored approaches are necessary to account for the heterogeneity of malaria epidemiology. PMID:28719286

An empiric estimate of the value of life: updating the renal dialysis cost-effectiveness standard.

PubMed

Lee, Chris P; Chertow, Glenn M; Zenios, Stefanos A

2009-01-01

Proposals to make decisions about coverage of new technology by comparing the technology's incremental cost-effectiveness with the traditional benchmark of dialysis imply that the incremental cost-effectiveness ratio of dialysis is seen a proxy for the value of a statistical year of life. The frequently used ratio for dialysis has, however, not been updated to reflect more recently available data on dialysis. We developed a computer simulation model for the end-stage renal disease population and compared cost, life expectancy, and quality adjusted life expectancy of current dialysis practice relative to three less costly alternatives and to no dialysis. We estimated incremental cost-effectiveness ratios for these alternatives relative to the next least costly alternative and no dialysis and analyzed the population distribution of the ratios. Model parameters and costs were estimated using data from the Medicare population and a large integrated health-care delivery system between 1996 and 2003. The sensitivity of results to model assumptions was tested using 38 scenarios of one-way sensitivity analysis, where parameters informing the cost, utility, mortality and morbidity, etc. components of the model were by perturbed +/-50%. The incremental cost-effectiveness ratio of dialysis of current practice relative to the next least costly alternative is on average $129,090 per quality-adjusted life-year (QALY) ($61,294 per year), but its distribution within the population is wide; the interquartile range is $71,890 per QALY, while the 1st and 99th percentiles are $65,496 and $488,360 per QALY, respectively. Higher incremental cost-effectiveness ratios were associated with older age and more comorbid conditions. Sensitivity to model parameters was comparatively small, with most of the scenarios leading to a change of less than 10% in the ratio. The value of a statistical year of life implied by dialysis practice currently averages $129,090 per QALY ($61,294 per year), but is distributed widely within the dialysis population. The spread suggests that coverage decisions using dialysis as the benchmark may need to incorporate percentile values (which are higher than the average) to be consistent with the Rawlsian principles of justice of preserving the rights and interests of society's most vulnerable patient groups.

Projecting the epidemiological effect, cost-effectiveness and transmission of HIV drug resistance in Vietnam associated with viral load monitoring strategies.

PubMed

Pham, Quang Duy; Wilson, David P; Nguyen, Thuong Vu; Do, Nhan Thi; Truong, Lien Xuan; Nguyen, Long Thanh; Zhang, Lei

2016-05-01

The objective of this study was to investigate the potential epidemiological impact of viral load (VL) monitoring and its cost-effectiveness in Vietnam, where transmitted HIV drug resistance (TDR) prevalence has increased from <5% to 5%-15% in the past decade. Using a population-based mathematical model driven by data from Vietnam, we simulated scenarios of various combinations of VL testing coverage, VL thresholds for second-line ART initiation and availability of HIV drug-resistance tests. We assessed the cost per disability-adjusted life year (DALY) averted for each scenario. Projecting expected ART scale-up levels, to approximately double the number of people on ART by 2030, will lead to an estimated 18 510 cases (95% CI: 9120-34 600 cases) of TDR and 55 180 cases (95% CI: 40 540-65 900 cases) of acquired drug resistance (ADR) in the absence of VL monitoring. This projection corresponds to a TDR prevalence of 16% (95% CI: 11%-24%) and ADR of 18% (95% CI: 15%-20%). Annual or biennial VL monitoring with 30% coverage is expected to relieve 12%-31% of TDR (2260-5860 cases), 25%-59% of ADR (9620-22 650 cases), 2%-6% of HIV-related deaths (360-880 cases) and 19 270-51 400 DALYs during 2015-30. The 30% coverage of VL monitoring is estimated to cost US$4848-5154 per DALY averted. The projected additional cost for implementing this strategy is US$105-268 million over 2015-30. Our study suggests that a programmatically achievable 30% coverage of VL monitoring can have considerable benefits for individuals and leads to population health benefits by reducing the overall national burden of HIV drug resistance. It is marginally cost-effective according to common willingness-to-pay thresholds. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Cost-effectiveness of HPV vaccination in the prevention of cervical cancer in Malaysia.

PubMed

Ezat, Wan Puteh Sharifa; Aljunid, Syed

2010-01-01

Cervical cancers (CC) demonstrate the second highest incidence of female cancers in Malaysia. The costs of chronic management have a high impact on nation's health cost and patient's quality of life that can be avoided by better screening and HPV vaccination. Respondents were interviewed from six public Gynecology-Oncology hospitals. Methods include experts' panel discussions to estimate treatment costs by severity and direct interviews with respondents using costing and SF-36 quality of life (QOL) questionnaires. Three options were compared i.e. screening via Pap smear; quadrivalent HPV Vaccination and combined strategy (screening plus vaccination). Scenario based sensitivity analysis using screening population coverage (40-80%) and costs of vaccine (RM 300-400/dose) were calculated. 502 cervical pre invasive and invasive cervical cancer (ICC) patients participated in the study. Mean age was 53.3 +/- 11.2 years, educated till secondary level (39.4%), Malays (44.2%) and married for 27.73 +/- 12.1 years. Life expectancy gained from vaccination is 13.04 years and average Quality Adjusted Life Years saved (QALYs) is 24.4 in vaccinated vs 6.29 in unvaccinated. Cost/QALYs for Pap smear at base case is RM 1,214.96/QALYs and RM 1,100.01 at increased screening coverage; for HPV Vaccination base case is at RM 35,346.79 and RM 46,530.08 when vaccination price is higher. In combined strategy, base case is RM 11,289.58; RM 7,712.74 at best case and RM 14,590.37 at worst case scenario. Incremental cost-effectiveness ratio (ICER) showed that screening at 70% coverage or higher is highly cost effective at RM 946.74 per QALYs saved and this is followed by combined strategy at RM 35,346.67 per QALYs saved. Vaccination increase life expectancy with better QOL of women when cancer can be avoided. Cost effective strategies will include increasing the Pap smear coverage to 70% or higher. Since feasibility and long term screening adherence is doubtful among Malaysian women, vaccination of young women is a more cost effective strategy against cervical cancers.

Integration, Validation, and Application of a PV Snow Coverage Model in SAM

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

Freeman, Janine M.; Ryberg, David Severin

2017-08-01

Due to the increasing deployment of PV systems in snowy climates, there is significant interest in a method capable of estimating PV losses resulting from snow coverage that has been verified for a variety of system designs and locations. Many independent snow coverage models have been developed over the last 15 years; however, there has been very little effort verifying these models beyond the system designs and locations on which they were based. Moreover, major PV modeling software products have not yet incorporated any of these models into their workflows. In response to this deficiency, we have integrated the methodologymore » of the snow model developed in the paper by Marion et al. (2013) into the National Renewable Energy Laboratory's (NREL) System Advisor Model (SAM). In this work, we describe how the snow model is implemented in SAM and we discuss our demonstration of the model's effectiveness at reducing error in annual estimations for three PV arrays. Next, we use this new functionality in conjunction with a long term historical data set to estimate average snow losses across the United States for two typical PV system designs. The open availability of the snow loss estimation capability in SAM to the PV modeling community, coupled with our results of the nationwide study, will better equip the industry to accurately estimate PV energy production in areas affected by snowfall.« less

Quasi-continuous frequency tunable terahertz quantum cascade lasers with coupled cavity and integrated photonic lattice.

PubMed

Kundu, Iman; Dean, Paul; Valavanis, Alexander; Chen, Li; Li, Lianhe; Cunningham, John E; Linfield, Edmund H; Davies, A Giles

2017-01-09

We demonstrate quasi-continuous tuning of the emission frequency from coupled cavity terahertz frequency quantum cascade lasers. Such coupled cavity lasers comprise a lasing cavity and a tuning cavity which are optically coupled through a narrow air slit and are operated above and below the lasing threshold current, respectively. The emission frequency of these devices is determined by the Vernier resonance of longitudinal modes in the lasing and the tuning cavities, and can be tuned by applying an index perturbation in the tuning cavity. The spectral coverage of the coupled cavity devices have been increased by reducing the repetition frequency of the Vernier resonance and increasing the ratio of the free spectral ranges of the two cavities. A continuous tuning of the coupled cavity modes has been realized through an index perturbation of the lasing cavity itself by using wide electrical heating pulses at the tuning cavity and exploiting thermal conduction through the monolithic substrate. Single mode emission and discrete frequency tuning over a bandwidth of 100 GHz and a quasi-continuous frequency coverage of 7 GHz at 2.25 THz is demonstrated. An improvement in the side mode suppression and a continuous spectral coverage of 3 GHz is achieved without any degradation of output power by integrating a π-phase shifted photonic lattice in the laser cavity.

Automatic Testcase Generation for Flight Software

NASA Technical Reports Server (NTRS)

Bushnell, David Henry; Pasareanu, Corina; Mackey, Ryan M.

2008-01-01

The TacSat3 project is applying Integrated Systems Health Management (ISHM) technologies to an Air Force spacecraft for operational evaluation in space. The experiment will demonstrate the effectiveness and cost of ISHM and vehicle systems management (VSM) technologies through onboard operation for extended periods. We present two approaches to automatic testcase generation for ISHM: 1) A blackbox approach that views the system as a blackbox, and uses a grammar-based specification of the system's inputs to automatically generate *all* inputs that satisfy the specifications (up to prespecified limits); these inputs are then used to exercise the system. 2) A whitebox approach that performs analysis and testcase generation directly on a representation of the internal behaviour of the system under test. The enabling technologies for both these approaches are model checking and symbolic execution, as implemented in the Ames' Java PathFinder (JPF) tool suite. Model checking is an automated technique for software verification. Unlike simulation and testing which check only some of the system executions and therefore may miss errors, model checking exhaustively explores all possible executions. Symbolic execution evaluates programs with symbolic rather than concrete values and represents variable values as symbolic expressions. We are applying the blackbox approach to generating input scripts for the Spacecraft Command Language (SCL) from Interface and Control Systems. SCL is an embedded interpreter for controlling spacecraft systems. TacSat3 will be using SCL as the controller for its ISHM systems. We translated the SCL grammar into a program that outputs scripts conforming to the grammars. Running JPF on this program generates all legal input scripts up to a prespecified size. Script generation can also be targeted to specific parts of the grammar of interest to the developers. These scripts are then fed to the SCL Executive. ICS's in-house coverage tools will be run to measure code coverage. Because the scripts exercise all parts of the grammar, we expect them to provide high code coverage. This blackbox approach is suitable for systems for which we do not have access to the source code. We are applying whitebox test generation to the Spacecraft Health INference Engine (SHINE) that is part of the ISHM system. In TacSat3, SHINE will execute an on-board knowledge base for fault detection and diagnosis. SHINE converts its knowledge base into optimized C code which runs onboard TacSat3. SHINE can translate its rules into an intermediate representation (Java) suitable for analysis with JPF. JPF will analyze SHINE's Java output using symbolic execution, producing testcases that can provide either complete or directed coverage of the code. Automatically generated test suites can provide full code coverage and be quickly regenerated when code changes. Because our tools analyze executable code, they fully cover the delivered code, not just models of the code. This approach also provides a way to generate tests that exercise specific sections of code under specific preconditions. This capability gives us more focused testing of specific sections of code.

Financial hardship on the path to Universal Health Coverage in the Gulf States.

PubMed

Alshamsan, Riyadh; Leslie, Hannah; Majeed, Azeem; Kruk, Margaret

2017-03-01

Countries globally are pursuing universal health coverage to ensure better healthcare for their populations and prevent households from catastrophic expenditure. The countries of the Gulf Cooperation Council (GCC) have and continue to implement reforms to strengthen their health systems. A common theme between the countries is their pursuit of universal health coverage to provide access to necessary health care without exposing people to financial hardship. Using nationally representative data from the Global Findex study, we sought to analyze the hardship faced by individuals from four high-income countries in the GCC. We estimated the weighted proportion of individuals borrowing for medical reasons and those who are not able to obtain emergency funds. We further examined variations in these outcomes by key socioeconomic factors. We found up to 11% of respondents borrowed money for medical purposes, double of that reported in other high-income countries. In contrast to affluent respondents, we found that respondents from deprived background were more likely to borrow money for medical purposes (adjusted odds ratio: 1.81, P<0.001) and expected to fail in obtaining emergency funds (adjusted odds ratio: 4.03, P<0.001). In moving forward with their reforms, GCC countries should adopt a financing strategy that addresses the health needs of poorer groups in their pursuit of universal health coverage. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparative evaluation of management of gingival recession using subepithelial connective tissue graft and collagen membrane by periodontal microsurgical technique: A clinical study of 40 cases

PubMed Central

Thankkappan, Prasanth; Roy, Subrata; Mandlik, Vivek Bapurao

2016-01-01

Background: New technologies, instruments, and surgical techniques are necessary to help the clinician ensure the best result and satisfy the patient's expectations, and surgical microscope has been thoroughly demonstrated as a useful tool. A clinical study was carried out to compare 2 different types of root coverage procedures using periodontal microsurgical procedure. Materials and Methods: Forty patients were selected and divided into Group A and Group B. Group A subjects were treated with subepithelial connective tissue graft (CTG) whereas Group B subjects were treated using a resorbable collagen membrane. The procedures were performed with the help of an operating microscope using 250 mm objective lens and ×6 magnification. Results: A comparison between baseline, 1, 3, and 12 months have been done between groups among all parameters. It has been noticed that the root coverage was better in Group A subjects at all time. At 12 months, Group A showed 81.42% coverage where in Group B it was 70.08%. Similarly, increase in the width of keratinized gingiva and attached gingiva were more in Group A. Conclusions: The present study showed that use of microsurgical instrument helped to deliver precise incision, better visual acuity, and improved illumination which facilitate to gain a better final outcome. Root coverage was better in the patients using CTG. PMID:27143833

Perceptions of the usefulness of external support to immunization coverage in Guinea-Bissau: a Delphi analysis of the GAVI-Alliance cash-based support.

PubMed

Ferrinho, Paulo; Dramé, Mohamed; Biai, Sidu; Lopes, Orlando; Sousa, Fernando de; Van Lerberghe, Wim

2013-01-01

Although many countries have improved vaccination coverage in recent years, some, including Guinea-Bissau, failed to meet expected targets. This paper tries to understand the main barriers to better vaccination coverage in the context of the GAVI-Alliance (The Global Alliance for Vaccines and Immunisation) cash-based support provided to Guinea-Bissau. The analysis is based on a document analysis and a three round Delphi study with a final consensus meeting. Consensus attributed about 25% of the failure to perform better to implementation problems; and about 10% to governance and also 10% to scarce resources. The qualitative analysis validates the importance of implementation issues and upgraded the relevance of the human resources crisis as an important drawback. The recommendations were balanced in their upstream-downstream focus but were blind to health information issues and logistical difficulties. It is commendable that such a fragile state, with all sorts of barriers, manages to sustain a slow steady growth of its vaccination coverage. Not reaching the targets set reflects the inappropriateness of those targets rather than a lack of commitment of the health workforce. In the unstable context of countries such as Guinea-Bissau, the predictability of the funds from global health initiatives like the GAVI-Alliance seem to make all the difference in achieving small consistent health gains even in the presence of other major bottlenecks.

The importance of values in shaping how health systems governance and management can support universal health coverage.

PubMed

Fattore, Giovanni; Tediosi, Fabrizio

2013-01-01

In this article, we use cultural theory to investigate the nature of health systems governance and management, showing that it may be helpful in identifying key aspects of the debate about how to promote universal health coverage. Cultural theory argues that "how" we govern and manage health services depends on what we think about the nature of government organizations and the legitimacy of their scope of action. The values that are implied by universal health coverage underlie choices about "how" health systems are governed and their organizations are managed. We draw two main conclusions. First, the translation of principles and goals into practice requires exceptional efforts to design adequate decision-making arrangements (the essence of governance) and management practices. Management and governance, or "how" policies are decided and conducted, are not secondary to the selection of the best policy solutions (the "what"). Second, governance and management solutions are not independent of the values that they are expected to serve. Instead, they should be designed to be consonant with these values. Cultural theory suggests-and experience supports-the idea that "group identity" is favorable for shaping different forms of social life and public administrations. This approach should thus be a starting point for those who strive to obtain universal health coverage. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2015-01-01

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

Markets for individual health insurance: can we make them work with incentives to purchase insurance?

PubMed

Swartz, K

2001-01-01

Simple income-based incentives to purchase health insurance (tax credits or deductions, or subsidies) are unlikely to succeed in significantly reducing the number of uninsured because income is not a good predictor of the extent to which individuals use medical service. Proposals to provide incentives to low-income people so they will purchase individual health insurance need to address the inherent tension between the interests of low-risk and high-risk people who rely on individual coverage. If carriers are forced to cover all applicants and to community rate premiums, low-risk people will drop coverage or not apply for it because premiums will exceed their expected need for insurance. Concern for people who currently have access to individual coverage calls for careful examination of options to permit incentive programs to succeed with the individual insurance markets. In particular, attention should focus on using alternatives to simple income-based subsidies to spread the burden of high-risk people's costs broadly, rather than impose the costs on low-risk people who purchase individual coverage. This paper describes three such alternatives. One uses risk adjustments and two rely on reinsurance so that carriers are compensated for the higher costs of covering high-risk people who use incentives to buy insurance. One alternative also permits risk selection by insurance carriers.

Mapping the literature of home health nursing

PubMed Central

Friedman, Yelena

2006-01-01

Objectives: The purpose of this study was to identify core journals in home health nursing and to determine how well these journals were covered by indexing and abstracting services. The study was part of the project for mapping the nursing literature of the Medical Library Association's Nursing and Allied Health Resource Section. Methods: A citation analysis of two core journals was done to determine distribution of references by format types and age of citations and dispersion of the literature, according to Bradford's Law of Scattering. The analysis of indexing coverage for Zone 1 and 2 was also provided. Results: The study showed that 64.2% of citations came from journals, versus 22.9% from books and 12.9% from other publications. PubMed/ MEDLINE rated highest in average indexing coverage of Zone 1 and 2 journals, followed by CINAHL. PsycINFO, SocioAbstracts, and EBSCO Health Business FullTEXT showed practically no coverage for the home health nursing literature. Conclusion: As expected, journal articles were found to be the primary source for referencing and books, the secondary source. In regard to bibliographic control, no databases provided full coverage of the journals in the field of home health nursing. PubMed/MEDLINE and CINAHL gave better results in combination, because CINAHL tended to cover more nursing journals, while PubMed/MEDLINE did better with medical titles. PMID:16710463

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

PubMed Central

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

2016-01-01

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

Child Psychopathology, Second Edition.

ERIC Educational Resources Information Center

Mash, Eric J.; Barkley, Russell A.

This text integrates state-of-the-art theory and empirical research on a wide range of child and adolescent disorders. Featuring contributions from leading scholars and clinicians, the volume provides comprehensive coverage of the biological, psychological, and social-contextual determinants of childhood problems. Each chapter focuses on a…

Forecasting Lightning Threat Using WRF Proxy Fields

NASA Technical Reports Server (NTRS)

McCaul, E. W., Jr.

2010-01-01

Objectives: Given that high-resolution WRF forecasts can capture the character of convective outbreaks, we seek to: 1. Create WRF forecasts of LTG threat (1-24 h), based on 2 proxy fields from explicitly simulated convection: - graupel flux near -15 C (captures LTG time variability) - vertically integrated ice (captures LTG threat area). 2. Calibrate each threat to yield accurate quantitative peak flash rate densities. 3. Also evaluate threats for areal coverage, time variability. 4. Blend threats to optimize results. 5. Examine sensitivity to model mesh, microphysics. Methods: 1. Use high-resolution 2-km WRF simulations to prognose convection for a diverse series of selected case studies. 2. Evaluate graupel fluxes; vertically integrated ice (VII). 3. Calibrate WRF LTG proxies using peak total LTG flash rate densities from NALMA; relationships look linear, with regression line passing through origin. 4. Truncate low threat values to make threat areal coverage match NALMA flash extent density obs. 5. Blend proxies to achieve optimal performance 6. Study CAPS 4-km ensembles to evaluate sensitivities.

Comparison of sequencing-based methods to profile DNA methylation and identification of monoallelic epigenetic modifications

PubMed Central

Harris, R. Alan; Wang, Ting; Coarfa, Cristian; Nagarajan, Raman P.; Hong, Chibo; Downey, Sara L.; Johnson, Brett E.; Fouse, Shaun D.; Delaney, Allen; Zhao, Yongjun; Olshen, Adam; Ballinger, Tracy; Zhou, Xin; Forsberg, Kevin J.; Gu, Junchen; Echipare, Lorigail; O’Geen, Henriette; Lister, Ryan; Pelizzola, Mattia; Xi, Yuanxin; Epstein, Charles B.; Bernstein, Bradley E.; Hawkins, R. David; Ren, Bing; Chung, Wen-Yu; Gu, Hongcang; Bock, Christoph; Gnirke, Andreas; Zhang, Michael Q.; Haussler, David; Ecker, Joseph; Li, Wei; Farnham, Peggy J.; Waterland, Robert A.; Meissner, Alexander; Marra, Marco A.; Hirst, Martin; Milosavljevic, Aleksandar; Costello, Joseph F.

2010-01-01

Sequencing-based DNA methylation profiling methods are comprehensive and, as accuracy and affordability improve, will increasingly supplant microarrays for genome-scale analyses. Here, four sequencing-based methodologies were applied to biological replicates of human embryonic stem cells to compare their CpG coverage genome-wide and in transposons, resolution, cost, concordance and its relationship with CpG density and genomic context. The two bisulfite methods reached concordance of 82% for CpG methylation levels and 99% for non-CpG cytosine methylation levels. Using binary methylation calls, two enrichment methods were 99% concordant, while regions assessed by all four methods were 97% concordant. To achieve comprehensive methylome coverage while reducing cost, an approach integrating two complementary methods was examined. The integrative methylome profile along with histone methylation, RNA, and SNP profiles derived from the sequence reads allowed genome-wide assessment of allele-specific epigenetic states, identifying most known imprinted regions and new loci with monoallelic epigenetic marks and monoallelic expression. PMID:20852635

Contemporary Network Proteomics and Its Requirements

PubMed Central

Goh, Wilson Wen Bin; Wong, Limsoon; Sng, Judy Chia Ghee

2013-01-01

The integration of networks with genomics (network genomics) is a familiar field. Conventional network analysis takes advantage of the larger coverage and relative stability of gene expression measurements. Network proteomics on the other hand has to develop further on two critical factors: (1) expanded data coverage and consistency, and (2) suitable reference network libraries, and data mining from them. Concerning (1) we discuss several contemporary themes that can improve data quality, which in turn will boost the outcome of downstream network analysis. For (2), we focus on network analysis developments, specifically, the need for context-specific networks and essential considerations for localized network analysis. PMID:24833333

Evidence for Chemical and Electronic Nonuniformities in the Formation of the Interface of RbF-Treated Cu(In,Ga)Se2 with CdS.

PubMed

Nicoara, Nicoleta; Kunze, Thomas; Jackson, Philip; Hariskos, Dimitrios; Duarte, Roberto Félix; Wilks, Regan G; Witte, Wolfram; Bär, Marcus; Sadewasser, Sascha

2017-12-20

We report on the initial stages of CdS buffer layer formation on Cu(In,Ga)Se 2 (CIGSe) thin-film solar cell absorbers subjected to rubidium fluoride (RbF) postdeposition treatment (PDT). A detailed characterization of the CIGSe/CdS interface for different chemical bath deposition (CBD) times of the CdS layer is obtained from spatially resolved atomic and Kelvin probe force microscopy and laterally integrating X-ray spectroscopies. The observed spatial inhomogeneity in the interface's structural, chemical, and electronic properties of samples undergoing up to 3 min of CBD treatments is indicative of a complex interface formation including an incomplete coverage and/or nonuniform composition of the buffer layer. It is expected that this result impacts solar cell performance, in particular when reducing the CdS layer thickness (e.g., in an attempt to increase the collection in the ultraviolet wavelength region). Our work provides important findings on the absorber/buffer interface formation and reveals the underlying mechanism for limitations in the reduction of the CdS thickness, even when an alkali PDT is applied to the CIGSe absorber.

Opening the CHOCBOX: clumpy stellar winds in Cyg X-1

NASA Astrophysics Data System (ADS)

Grinberg, V.; Uttley, P.; Wilms, J.; Miller-Jones, J.; Pottschmidt, K.; Niu, S.; Hirsch, M.; Chocbox Collaboration

2017-10-01

Winds of O/B-stars are key drivers of enrichment and star formation and evolution. Yet, our understanding of their clumpy structure is limited. Luckily, high mass X-ray binaries, where the compact object accretes from the stellar wind of the companion, are perfect laboratories to study such winds: the X-ray radiation from the vicinity of the compact object is quasi-pointlike and effectively X-rays the clumps crossing the line of sight. We observed the high mass X-ray binary Cyg X-1 with XMM for 7 consecutive days with simultaneous coverage with NuSTAR, INTEGRAL and VLBA. One of our main aims was to probe the wind of the O-type companion in an unprecedented uninterrupted campaign, spanning more than an orbital period and including two superior conjunctions where we expect the densest wind. Here, we present first results from the CHOCBOX (Cyg X-1 Hard state Observations of a Complete Binary Orbit in X-rays) campaign and compare them to previous work, in particular multi-year studies of absorption variability and high resolution snapshots with Chandra-HETG. We argue that the clumps have a complex structure with hotter outer and colder inner layers and are not symmetrical.

Quantitative multi-modal NDT data analysis

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

Heideklang, René; Shokouhi, Parisa

2014-02-18

A single NDT technique is often not adequate to provide assessments about the integrity of test objects with the required coverage or accuracy. In such situations, it is often resorted to multi-modal testing, where complementary and overlapping information from different NDT techniques are combined for a more comprehensive evaluation. Multi-modal material and defect characterization is an interesting task which involves several diverse fields of research, including signal and image processing, statistics and data mining. The fusion of different modalities may improve quantitative nondestructive evaluation by effectively exploiting the augmented set of multi-sensor information about the material. It is the redundantmore » information in particular, whose quantification is expected to lead to increased reliability and robustness of the inspection results. There are different systematic approaches to data fusion, each with its specific advantages and drawbacks. In our contribution, these will be discussed in the context of nondestructive materials testing. A practical study adopting a high-level scheme for the fusion of Eddy Current, GMR and Thermography measurements on a reference metallic specimen with built-in grooves will be presented. Results show that fusion is able to outperform the best single sensor regarding detection specificity, while retaining the same level of sensitivity.« less

Biocompatibility and Systemic Safety of a Novel Implantable Annuloplasty Ring for the Treatment of Mitral Regurgitation in a Minipig Model.

PubMed

Ramot, Yuval; Rousselle, Serge D; Yellin, Nadav; Willenz, Udi; Sabag, Itai; Avner, Avi; Nyska, Abraham

2016-07-01

Prosthetic annuloplasty rings are a common treatment modality for mitral regurgitation, and recently, percutaneous implantation techniques have gained popularity due to their favorable safety profile. Although in common use, biocompatibility of annuloplasty rings has been reported only sparsely in the literature, and none of these reports used the percutaneous technique of implantation. We report on the biocompatibility and the systemic safety of a novel transcatheter mitral valve annuloplasty ring (AMEND™) in 6 minipigs. This device is composed of a nitinol tube surrounded by a braided polyethylene terephthalate fabric tube. The device produced no adverse inflammatory response, showing gradual integration between the metal ring and the fabric by normal host fibrocellular response, leading to complete neoendocardium coverage. There was no evidence for adverse reactions, rejection, or intolerance in the valvular structure. In 2 animals, hemopericardium resulted from the implantation procedure, leading to right-sided cardiac insufficiency with pulmonary edema and liver congestion. The findings reported herein can serve as a case study for the expected healing pathology reactions after implantation of transcatheter mitral valve annuloplasty rings. © The Author(s) 2016.

SynopSIS: integrating physician sign-out with the electronic medical record.

PubMed

Sarkar, Urmimala; Carter, Jonathan T; Omachi, Theodore A; Vidyarthi, Arpana R; Cucina, Russell; Bokser, Seth; van Eaton, Erik; Blum, Michael

2007-09-01

Safe delivery of care depends on effective communication among all health care providers, especially during transfers of care. The traditional medical chart does not adequately support such communication. We designed a patient-tracking tool that enhances provider communication and supports clinical decision making. To develop a problem-based patient-tracking tool, called Sign-out, Information Retrieval, and Summary (SynopSIS), in order to support patient tracking, transfers of care (ie, sign-outs), and daily rounds. Tertiary-care, university-based teaching hospital. SynopSIS compiles and organizes information from the electronic medical record to support hospital discharge and disposition decisions, daily provider decisions, and overnight or cross-coverage decisions. It reflects the provider's patient-care and daily work-flow needs. We plan to use Web-based surveys, audits of daily use, and interdisciplinary focus groups to evaluate SynopSIS's impact on communication between providers, quality of sign-out, patient continuity of care, and rounding efficiency. We expect SynopSIS to improve care by facilitating communication between care teams, standardizing sign-out, and automating daily review of clinical and laboratory trends. SynopSIS redesigns the clinical chart to better serve provider and patient needs. (c) 2007 Society of Hospital Medicine.

Technology Insight: Combined external-beam radiation therapy and brachytherapy in the management of prostate cancer.

PubMed

Hurwitz, Mark D

2008-11-01

External-beam radiation therapy (EBRT) combined with brachytherapy is an attractive treatment option for selected patients with clinically localized prostate cancer. This therapeutic strategy offers dosimetric coverage if local-regional microscopic disease is present and provides a highly conformal boost of radiation to the prostate and immediate surrounding tissues. Either low-dose-rate (LDR) permanent brachytherapy or high-dose-rate (HDR) temporary brachytherapy can be combined with EBRT; such combined-modality therapy (CMT) is typically used to treat patients with intermediate-risk to high-risk, clinically localized disease. Controversy persists with regard to indications for CMT, choice of LDR or HDR boost, isotope selection for LDR, and integration of EBRT and brachytherapy. Initial findings from prospective, multicenter trials of CMT support the feasibility of this strategy. Updated results from these trials as well as those of ongoing and new phase III trials should help to define the role of CMT in the management of prostate cancer. In the meantime, long-term expectations for outcomes of CMT are based largely on the experience of single institutions, which demonstrate that CMT with EBRT and either LDR or HDR brachytherapy can provide freedom from disease recurrence with acceptable toxicity.

Determinants of Health Insurance Coverage among People Aged 45 and over in China: Who Buys Public, Private and Multiple Insurance

PubMed Central

Jin, Yinzi; Hou, Zhiyuan; Zhang, Donglan

2016-01-01

Background China is reforming and restructuring its health insurance system to achieve the goal of universal coverage. This study aims to understand the determinants of public, private and multiple insurance coverage among people of retirement-age in China. Methods We used data from the China Health and Retirement Longitudinal Survey 2011 and 2013, a nationally representative survey of Chinese people aged 45 and over. Multinomial logit regression was performed to identify the determinants of public, private and multiple health insurance coverage. We also conducted logit regression to examine the association between public insurance coverage and demand for private insurance. Results In 2013, 94.5% of this population had at least one type of public insurance, and 12.2% purchased private insurance. In general, we found that rural residents were less likely to be uninsured (Relative Risk Ratio (RRR) = 0.40, 95% Confidence Interval (CI): 0.34–0.47) and were less likely to buy private insurance (RRR = 0.22, 95% CI: 0.16–0.31). But rural-to-urban migrants were more likely to be uninsured (RRR = 1.39, 95% CI: 1.24–1.57). Public health insurance coverage may crowd out private insurance market (Odds Ratio = 0.55, 95% CI: 0.48–0.63), particularly among enrollees of Urban Resident Basic Medical Insurance. There exists a huge socioeconomic disparity in both public and private insurance coverage. Conclusion The migrants, the poor and the vulnerable remained in the edge of the system. The growing private insurance market did not provide sufficient financial protection and did not cover the people with the greatest need. To achieve universal coverage and reduce socioeconomic disparity, China should integrate the urban and rural public insurance schemes across regions and remove the barriers for the middle-income and low-income to access private insurance. PMID:27564320

Integrating normal and abnormal personality structure: a proposal for DSM-V.

PubMed

Widiger, Thomas A

2011-06-01

The personality disorders section of the American Psychiatric Association's fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is currently being developed. The purpose of the current paper is to encourage the authors of DSM-V to integrate normal and abnormal personality structure within a common, integrative model, and to suggest that the optimal choice for such an integration would be the five-factor model (FFM) of general personality structure. A proposal for the classification of personality disorder from the perspective of the FFM is provided. Discussed as well are implications and issues associated with an FFM of personality disorder, including validity, coverage, feasibility, clinical utility, and treatment implications.

Integrating technology readiness into the expectation-confirmation model: an empirical study of mobile services.

PubMed

Chen, Shih-Chih; Liu, Ming-Ling; Lin, Chieh-Peng

2013-08-01

The aim of this study was to integrate technology readiness into the expectation-confirmation model (ECM) for explaining individuals' continuance of mobile data service usage. After reviewing the ECM and technology readiness, an integrated model was demonstrated via empirical data. Compared with the original ECM, the findings of this study show that the integrated model may offer an ameliorated way to clarify what factors and how they influence the continuous intention toward mobile services. Finally, the major findings are summarized, and future research directions are suggested.

Advancing the expectancy concept via the interplay between theory and research.

PubMed

Del Boca, Frances K; Darkes, Jack; Goldman, Mark S; Smith, Gregory T

2002-06-01

Four papers from a 2001 Research Society on Alcoholism symposium on expectancy theory and research are summarized. The symposium contributors describe recent advances in expectancy theory and discuss their implications for assessment and for understanding the processes of development and change in the behavioral domain of alcohol use. First, findings are integrated across the diverse domains in which the expectancy concept has been applied. Second, the implications of expectancy theory for the measurement of expectancy structure and process are examined. Third, research and theory regarding alcohol expectancy development and change are presented, with an emphasis on the role of expectancies as mediators of known antecedents of drinking. Finally, an experimental procedure for investigating the causal role of expectancies is described, together with its implications for theory testing and prevention or intervention programming. Collectively, the symposium contributions demonstrate the utility of an integrated expectancy theory for the generation of innovative research operations and new insights regarding behavior development and change. Consistent with the notion of consilience, expectancy theory has demonstrated a convergence of findings across different levels of analysis, as well as across different operations, methods, and research designs.

eRegistries: Electronic registries for maternal and child health.

PubMed

Frøen, J Frederik; Myhre, Sonja L; Frost, Michael J; Chou, Doris; Mehl, Garrett; Say, Lale; Cheng, Socheat; Fjeldheim, Ingvild; Friberg, Ingrid K; French, Steve; Jani, Jagrati V; Kaye, Jane; Lewis, John; Lunde, Ane; Mørkrid, Kjersti; Nankabirwa, Victoria; Nyanchoka, Linda; Stone, Hollie; Venkateswaran, Mahima; Wojcieszek, Aleena M; Temmerman, Marleen; Flenady, Vicki J

2016-01-19

The Global Roadmap for Health Measurement and Accountability sees integrated systems for health information as key to obtaining seamless, sustainable, and secure information exchanges at all levels of health systems. The Global Strategy for Women's, Children's and Adolescent's Health aims to achieve a continuum of quality of care with effective coverage of interventions. The WHO and World Bank recommend that countries focus on intervention coverage to monitor programs and progress for universal health coverage. Electronic health registries - eRegistries - represent integrated systems that secure a triple return on investments: First, effective single data collection for health workers to seamlessly follow individuals along the continuum of care and across disconnected cadres of care providers. Second, real-time public health surveillance and monitoring of intervention coverage, and third, feedback of information to individuals, care providers and the public for transparent accountability. This series on eRegistries presents frameworks and tools to facilitate the development and secure operation of eRegistries for maternal and child health. In this first paper of the eRegistries Series we have used WHO frameworks and taxonomy to map how eRegistries can support commonly used electronic and mobile applications to alleviate health systems constraints in maternal and child health. A web-based survey of public health officials in 64 low- and middle-income countries, and a systematic search of literature from 2005-2015, aimed to assess country capacities by the current status, quality and use of data in reproductive health registries. eRegistries can offer support for the 12 most commonly used electronic and mobile applications for health. Countries are implementing health registries in various forms, the majority in transition from paper-based data collection to electronic systems, but very few have eRegistries that can act as an integrating backbone for health information. More mature country capacity reflected by published health registry based research is emerging in settings reaching regional or national scale, increasingly with electronic solutions. 66 scientific publications were identified based on 32 registry systems in 23 countries over a period of 10 years; this reflects a challenging experience and capacity gap for delivering sustainable high quality registries. Registries are being developed and used in many high burden countries, but their potential benefits are far from realized as few countries have fully transitioned from paper-based health information to integrated electronic backbone systems. Free tools and frameworks exist to facilitate progress in health information for women and children.

Implications of the 2017 Tax Cuts and Jobs Act for Public Health.

PubMed

Glied, Sherry

2018-06-01

The recently passed Tax Cuts and Jobs Act will reduce total federal revenues by about 4% between 2018 and 2027. The law makes multiple changes to the taxation of individuals and corporations. It also repeals the Affordable Care Act's (ACA's) individual mandate penalties, which will erase some of the gains in insurance coverage achieved since implementation of the ACA's coverage expansions. The resulting increases in rates of uninsurance will likely lead to increased uncompensated care and deflect hospitals and health departments from addressing other prevention and public health needs. In addition, the law is expected to lead to substantial increases in the federal debt and, consequently, to calls for reductions in spending on entitlement programs, particularly Medicare, and on discretionary programs, including public health. Many other provisions of the law could also have second-order effects on public health.

Combined search for electroweak production of charginos and neutralinos in proton-proton collisions at $$\\sqrt{s} =$$ 13 TeV

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

Sirunyan, Albert M; et al.

A statistical combination of several searches for the electroweak production of charginos and neutralinos is presented. All searches use proton-proton collision data atmore » $$\\sqrt{s}=$$ 13 TeV, recorded with the CMS detector at the LHC in 2016 and corresponding to an integrated luminosity of 35.9 fb$$^{-1}$$. In addition to the combination of previous searches, a targeted analysis requiring three or more charged leptons (electrons or muons) is presented, focusing on the challenging scenario in which the difference in mass between the two least massive neutralinos is approximately equal to the mass of the Z boson. The results are interpreted in simplified models of chargino-neutralino or neutralino pair production. For chargino-neutralino production, in the case when the lightest neutralino is massless, the combination yields an observed (expected) limit at the 95% confidence level on the chargino mass of up to 650 (570) GeV, improving upon the individual analysis limits by up to 40 GeV. If the mass difference between the two least massive neutralinos is approximately equal to the mass of the Z boson in the chargino-neutralino model, the targeted search requiring three or more leptons obtains observed and expected exclusion limits of around 225 GeV on the second neutralino mass and 125 GeV on the lightest neutralino mass, improving the observed limit by about 60 GeV in both masses compared to the previous CMS result. In the neutralino pair production model, the combined observed (expected) exclusion limit on the neutralino mass extends up to 650-750 (550-750) GeV, depending on the branching fraction assumed. This extends the observed exclusion achieved in the individual analyses by up to 200 GeV. The combined result additionally excludes some intermediate gaps in the mass coverage of the individual analyses.« less

Balancing investments in Federally Qualified Health Centers and Medicaid for improved access and coverage in Pennsylvania.

PubMed

Griffin, Paul M; Lee, Hyunji; Scherrer, Christina; Swann, Julie L

2014-12-01

Two common health disparities in the US include a lack of access to care and a lack of insurance coverage. To help address these disparities, healthcare reform will provide $11B to expand Federally Qualified Health Centers (FQHCs) over the next 5 years. In 2014, Medicaid rules will be modified so that more people will become eligible. There are, however, important tradeoffs in the investment in these two programs. We find a balanced investment between FQHC expansion and relaxing Medicaid eligibility to improve both access (by increasing the number of FQHCs) and coverage (by FQHC and Medicaid expansion) for the state of Pennsylvania. The comparison is achieved by integrating multi-objective mathematical models with several public data sets that allow for specific estimations of healthcare need. Demand is estimated based on current access and coverage status in order to target groups to be considered preferentially. Results show that for Pennsylvania, FQHCs are more cost effective than Medicaid if we invest all of the resources in just one policy. However, we find a better investment point balancing those two policies. This point is approximately where the additional expenses incurred from relaxing Medicaid eligibility equals the investment in FQHC expansion.

The Impact of Imitation on Vaccination Behavior in Social Contact Networks

PubMed Central

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

2012-01-01

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

Universal Health Coverage and Primary Healthcare: Lessons From Japan Comment on "Achieving Universal Health Coverage by Focusing on Primary Care in Japan: Lessons for Low- and Middle-Income Countries".

PubMed

Bloom, Gerald

2016-08-28

A recent editorial by Naoki Ikegami has proposed three key lessons from Japan's experience of achieving virtually universal coverage with primary healthcare services: the need to integrate the existing providers of primary healthcare services into the organised health system; the need to limit government commitments to finance hospital services and the need to empower providers of primary healthcare to influence decisions that influence their livelihoods. Although the context of low- and middle-income countries (LMICs) differs in many ways from Japan in the late 19th and early 20th centuries, the lesson that short-term initiatives to achieve universal coverage need to be complemented by an understanding of the factors influencing long-term change management remains highly relevant. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Medicare essential: an option to promote better care and curb spending growth.

PubMed

Davis, Karen; Schoen, Cathy; Guterman, Stuart

2013-05-01

Medicare's core benefit design reflects private insurance as of 1965, with separate coverage for hospital and physician services (and now prescription drugs) and no protection against catastrophic costs. Modernizing Medicare's benefit design to offer comprehensive benefits, financial protection, and incentives to choose high-value care could improve coverage and lower beneficiary costs. We describe a new option we call Medicare Essential, which would combine Medicare's hospital, physician, and prescription drug coverage into an integrated benefit with an annual limit on out-of-pocket expenses for covered benefits. Cost sharing would be reduced for enrollees who seek care from high-quality low-cost providers. Out-of-pocket savings from lower premiums and health care costs for a Medicare Essential enrollee could be $173 per month, compared to what an enrollee would pay with traditional Medicare, prescription drug and private supplemental coverage. Financed by a budget-neutral premium, we estimate that this new plan choice could reduce total health spending relative to current projections by $180 billion and reduce employer retiree spending by $90 billion during 2014-23. Given its potential, such an alternative should be a part of the debate over the future of Medicare.

Health financing for universal coverage and health system performance: concepts and implications for policy.

PubMed

Kutzin, Joseph

2013-08-01

Unless the concept is clearly understood, "universal coverage" (or universal health coverage, UHC) can be used to justify practically any health financing reform or scheme. This paper unpacks the definition of health financing for universal coverage as used in the World Health Organization's World health report 2010 to show how UHC embodies specific health system goals and intermediate objectives and, broadly, how health financing reforms can influence these. All countries seek to improve equity in the use of health services, service quality and financial protection for their populations. Hence, the pursuit of UHC is relevant to every country. Health financing policy is an integral part of efforts to move towards UHC, but for health financing policy to be aligned with the pursuit of UHC, health system reforms need to be aimed explicitly at improving coverage and the intermediate objectives linked to it, namely, efficiency, equity in health resource distribution and transparency and accountability. The unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Concern only with specific schemes is incompatible with a universal coverage approach and may even undermine UHC, particularly in terms of equity. Conversely, if a scheme is fully oriented towards system-level goals and objectives, it can further progress towards UHC. Policy and policy analysis need to shift from the scheme to the system level.

Genotator: a disease-agnostic tool for genetic annotation of disease.

PubMed

Wall, Dennis P; Pivovarov, Rimma; Tong, Mark; Jung, Jae-Yoon; Fusaro, Vincent A; DeLuca, Todd F; Tonellato, Peter J

2010-10-29

Disease-specific genetic information has been increasing at rapid rates as a consequence of recent improvements and massive cost reductions in sequencing technologies. Numerous systems designed to capture and organize this mounting sea of genetic data have emerged, but these resources differ dramatically in their disease coverage and genetic depth. With few exceptions, researchers must manually search a variety of sites to assemble a complete set of genetic evidence for a particular disease of interest, a process that is both time-consuming and error-prone. We designed a real-time aggregation tool that provides both comprehensive coverage and reliable gene-to-disease rankings for any disease. Our tool, called Genotator, automatically integrates data from 11 externally accessible clinical genetics resources and uses these data in a straightforward formula to rank genes in order of disease relevance. We tested the accuracy of coverage of Genotator in three separate diseases for which there exist specialty curated databases, Autism Spectrum Disorder, Parkinson's Disease, and Alzheimer Disease. Genotator is freely available at http://genotator.hms.harvard.edu. Genotator demonstrated that most of the 11 selected databases contain unique information about the genetic composition of disease, with 2514 genes found in only one of the 11 databases. These findings confirm that the integration of these databases provides a more complete picture than would be possible from any one database alone. Genotator successfully identified at least 75% of the top ranked genes for all three of our use cases, including a 90% concordance with the top 40 ranked candidates for Alzheimer Disease. As a meta-query engine, Genotator provides high coverage of both historical genetic research as well as recent advances in the genetic understanding of specific diseases. As such, Genotator provides a real-time aggregation of ranked data that remains current with the pace of research in the disease fields. Genotator's algorithm appropriately transforms query terms to match the input requirements of each targeted databases and accurately resolves named synonyms to ensure full coverage of the genetic results with official nomenclature. Genotator generates an excel-style output that is consistent across disease queries and readily importable to other applications.

Integrated NDVI images for Niger 1986-1987. [Normalized Difference Vegetation Index

NASA Technical Reports Server (NTRS)

Harrington, John A., Jr.; Wylie, Bruce K.; Tucker, Compton J.

1988-01-01

Two NOAA AVHRR images are presented which provide a comparison of the geographic distribution of an integration of the normalized difference vegetation index (NDVI) for the Sahel zone in Niger for the growing seasons of 1986 and 1987. The production of the images and the application of the images for resource management are discussed. Daily large area coverage with a spatial resolution of 1.1 km at nadir were transformed to the NDVI and geographically registered to produce the images.

AccessMod 3.0: computing geographic coverage and accessibility to health care services using anisotropic movement of patients

PubMed Central

Ray, Nicolas; Ebener, Steeve

2008-01-01

Background Access to health care can be described along four dimensions: geographic accessibility, availability, financial accessibility and acceptability. Geographic accessibility measures how physically accessible resources are for the population, while availability reflects what resources are available and in what amount. Combining these two types of measure into a single index provides a measure of geographic (or spatial) coverage, which is an important measure for assessing the degree of accessibility of a health care network. Results This paper describes the latest version of AccessMod, an extension to the Geographical Information System ArcView 3.×, and provides an example of application of this tool. AccessMod 3 allows one to compute geographic coverage to health care using terrain information and population distribution. Four major types of analysis are available in AccessMod: (1) modeling the coverage of catchment areas linked to an existing health facility network based on travel time, to provide a measure of physical accessibility to health care; (2) modeling geographic coverage according to the availability of services; (3) projecting the coverage of a scaling-up of an existing network; (4) providing information for cost effectiveness analysis when little information about the existing network is available. In addition to integrating travelling time, population distribution and the population coverage capacity specific to each health facility in the network, AccessMod can incorporate the influence of landscape components (e.g. topography, river and road networks, vegetation) that impact travelling time to and from facilities. Topographical constraints can be taken into account through an anisotropic analysis that considers the direction of movement. We provide an example of the application of AccessMod in the southern part of Malawi that shows the influences of the landscape constraints and of the modes of transportation on geographic coverage. Conclusion By incorporating the demand (population) and the supply (capacities of heath care centers), AccessMod provides a unifying tool to efficiently assess the geographic coverage of a network of health care facilities. This tool should be of particular interest to developing countries that have a relatively good geographic information on population distribution, terrain, and health facility locations. PMID:19087277

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

PubMed Central

2012-01-01

Background In November 2009, Sierra Leone conducted a preventive yellow fever (YF) vaccination campaign targeting individuals aged nine months and older in six health districts. The campaign was integrated with a measles follow-up campaign throughout the country targeting children aged 9–59 months. For both campaigns, the operational objective was to reach 95% of the target population. During the campaign, we used clustered lot quality assurance sampling (C-LQAS) to identify areas of low coverage to recommend timely mop-up actions. Methods We divided the country in 20 non-overlapping lots. Twelve lots were targeted by both vaccinations, while eight only by measles. In each lot, five clusters of ten eligible individuals were selected for each vaccine. The upper threshold (UT) was set at 90% and the lower threshold (LT) at 75%. A lot was rejected for low vaccination coverage if more than 7 unvaccinated individuals (not presenting vaccination card) were found. After the campaign, we plotted the C-LQAS results against the post-campaign coverage estimations to assess if early interventions were successful enough to increase coverage in the lots that were at the level of rejection before the end of the campaign. Results During the last two days of campaign, based on card-confirmed vaccination status, five lots out of 20 (25.0%) failed for having low measles vaccination coverage and three lots out of 12 (25.0%) for low YF coverage. In one district, estimated post-campaign vaccination coverage for both vaccines was still not significantly above the minimum acceptable level (LT = 75%) even after vaccination mop-up activities. Conclusion C-LQAS during the vaccination campaign was informative to identify areas requiring mop-up activities to reach the coverage target prior to leaving the region. The only district where mop-up activities seemed to be unsuccessful might have had logistical difficulties that should be further investigated and resolved. PMID:22676225

Prioritizing research for integrated implementation of early childhood development and maternal, newborn, child and adolescent health and nutrition platforms.

PubMed

Sharma, Renee; Gaffey, Michelle F; Alderman, Harold; Bassani, Diego G; Bogard, Kimber; Darmstadt, Gary L; Das, Jai K; de Graft-Johnson, Joseph E; Hamadani, Jena D; Horton, Susan; Huicho, Luis; Hussein, Julia; Lye, Stephen; Pérez-Escamilla, Rafael; Proulx, Kerrie; Marfo, Kofi; Mathews-Hanna, Vanessa; Mclean, Mireille S; Rahman, Atif; Silver, Karlee L; Singla, Daisy R; Webb, Patrick; Bhutta, Zulfiqar A

2017-06-01

Existing health and nutrition services present potential platforms for scaling up delivery of early childhood development (ECD) interventions within sensitive windows across the life course, especially in the first 1000 days from conception to age 2 years. However, there is insufficient knowledge on how to optimize implementation for such strategies in an integrated manner. In light of this knowledge gap, we aimed to systematically identify a set of integrated implementation research priorities for health, nutrition and early child development within the 2015 to 2030 timeframe of the Sustainable Development Goals (SDGs). We applied the Child Health and Nutrition Research Initiative method, and consulted a diverse group of global health experts to develop and score 57 research questions against five criteria: answerability, effectiveness, deliverability, impact, and effect on equity. These questions were ranked using a research priority score, and the average expert agreement score was calculated for each question. The research priority scores ranged from 61.01 to 93.52, with a median of 82.87. The average expert agreement scores ranged from 0.50 to 0.90, with a median of 0.75. The top-ranked research question were: i) "How can interventions and packages to reduce neonatal mortality be expanded to include ECD and stimulation interventions?"; ii) "How does the integration of ECD and MNCAH&N interventions affect human resource requirements and capacity development in resource-poor settings?"; and iii) "How can integrated interventions be tailored to vulnerable refugee and migrant populations to protect against poor ECD and MNCAH&N outcomes?". Most highly-ranked research priorities varied across the life course and highlighted key aspects of scaling up coverage of integrated interventions in resource-limited settings, including: workforce and capacity development, cost-effectiveness and strategies to reduce financial barriers, and quality assessment of programs. Investing in ECD is critical to achieving several of the SDGs, including SDG 2 on ending all forms of malnutrition, SDG 3 on ensuring health and well-being for all, and SDG 4 on ensuring inclusive and equitable quality education and promotion of life-long learning opportunities for all. The generated research agenda is expected to drive action and investment on priority approaches to integrating ECD interventions within existing health and nutrition services.

Prioritizing research for integrated implementation of early childhood development and maternal, newborn, child and adolescent health and nutrition platforms

PubMed Central

Sharma, Renee; Gaffey, Michelle F; Alderman, Harold; Bassani, Diego G; Bogard, Kimber; Darmstadt, Gary L; Das, Jai K; de Graft–Johnson, Joseph E; Hamadani, Jena D; Horton, Susan; Huicho, Luis; Hussein, Julia; Lye, Stephen; Pérez–Escamilla, Rafael; Proulx, Kerrie; Marfo, Kofi; Mathews–Hanna, Vanessa; Mclean, Mireille S; Rahman, Atif; Silver, Karlee L; Singla, Daisy R; Webb, Patrick; Bhutta, Zulfiqar A

2017-01-01

Background Existing health and nutrition services present potential platforms for scaling up delivery of early childhood development (ECD) interventions within sensitive windows across the life course, especially in the first 1000 days from conception to age 2 years. However, there is insufficient knowledge on how to optimize implementation for such strategies in an integrated manner. In light of this knowledge gap, we aimed to systematically identify a set of integrated implementation research priorities for health, nutrition and early child development within the 2015 to 2030 timeframe of the Sustainable Development Goals (SDGs). Methods We applied the Child Health and Nutrition Research Initiative method, and consulted a diverse group of global health experts to develop and score 57 research questions against five criteria: answerability, effectiveness, deliverability, impact, and effect on equity. These questions were ranked using a research priority score, and the average expert agreement score was calculated for each question. Findings The research priority scores ranged from 61.01 to 93.52, with a median of 82.87. The average expert agreement scores ranged from 0.50 to 0.90, with a median of 0.75. The top–ranked research question were: i) “How can interventions and packages to reduce neonatal mortality be expanded to include ECD and stimulation interventions?”; ii) “How does the integration of ECD and MNCAH&N interventions affect human resource requirements and capacity development in resource–poor settings?”; and iii) “How can integrated interventions be tailored to vulnerable refugee and migrant populations to protect against poor ECD and MNCAH&N outcomes?”. Most highly–ranked research priorities varied across the life course and highlighted key aspects of scaling up coverage of integrated interventions in resource–limited settings, including: workforce and capacity development, cost–effectiveness and strategies to reduce financial barriers, and quality assessment of programs. Conclusions Investing in ECD is critical to achieving several of the SDGs, including SDG 2 on ending all forms of malnutrition, SDG 3 on ensuring health and well–being for all, and SDG 4 on ensuring inclusive and equitable quality education and promotion of life–long learning opportunities for all. The generated research agenda is expected to drive action and investment on priority approaches to integrating ECD interventions within existing health and nutrition services. PMID:28685048

[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.

Modeling the Impact on HIV Incidence of Combination Prevention Strategies among Men Who Have Sex with Men in Beijing, China

PubMed Central

Lou, Jie; Blevins, Meridith; Ruan, Yuhua; Vermund, Sten H.; Tang, Sanyi; Webb, Glenn F.; Shepherd, Bryan E.; He, Xiong; Lu, Hongyan; Shao, Yiming; Qian, Han-Zhu

2014-01-01

Objective To project the HIV/AIDS epidemics among men who have sex with men (MSM) under different combinations of HIV testing and linkage to care (TLC) interventions including antiretroviral therapy (ART) in Beijing, China. Design Mathematical modeling. Methods Using a mathematical model to fit prevalence estimates from 2000–2010, we projected trends in HIV prevalence and incidence during 2011–2020 under five scenarios: (S1) current intervention levels by averaging 2000–2010 coverage; (S2) increased ART coverage with current TLC; (S3) increased TLC/ART coverage; (S4) increased condom use; and (S5) increased TLC/ART plus increased condom use. Results The basic reproduction number based upon the current level of interventions is significantly higher than 1 ( confidence interval (CI), 1.83–2.35), suggesting that the HIV epidemic will continue to increase to 2020. Compared to the 2010 prevalence of 7.8%, the projected HIV prevalence in 2020 for the five prevention scenarios will be: (S1) Current coverage: 21.4% (95% CI, 9.9–31.7%); (S2) Increased ART: 19.9% (95% CI, 9.9–28.4%); (S3) Increased TLC/ART: 14.5% (95% CI, 7.0–23.8%); (S4) Increased condom use: 13.0% (95% CI, 9.8–28.4%); and (S5) Increased TLC/ART and condom use: 8.7% (95% CI, 5.4–11.5%). HIV epidemic will continue to rise () for S1–S4 even with hyperbolic coverage in the sensitivity analysis, and is expected to decline () for S5. Conclusion Our transmission model suggests that Beijing MSM will have a rapidly rising HIV epidemic. Even enhanced levels of TLC/ART will not interrupt epidemic expansion, despite optimistic assumptions for coverage. Promoting condom use is a crucial component of combination interventions. PMID:24626165

Free-Roaming Dog Population Estimation and Status of the Dog Population Management and Rabies Control Program in Dhaka City, Bangladesh

PubMed Central

Tenzin, Tenzin; Ahmed, Rubaiya; Debnath, Nitish C.; Ahmed, Garba; Yamage, Mat

2015-01-01

Beginning January 2012, a humane method of dog population management using a Catch-Neuter-Vaccinate-Release (CNVR) program was implemented in Dhaka City, Bangladesh as part of the national rabies control program. To enable this program, the size and distribution of the free-roaming dog population needed to be estimated. We present the results of a dog population survey and a pilot assessment of the CNVR program coverage in Dhaka City. Free-roaming dog population surveys were undertaken in 18 wards of Dhaka City on consecutive days using mark-resight methods. Data was analyzed using Lincoln-Petersen index-Chapman correction methods. The CNVR program was assessed over the two years (2012–2013) whilst the coverage of the CNVR program was assessed by estimating the proportion of dogs that were ear-notched (processed dogs) via dog population surveys. The free-roaming dog population was estimated to be 1,242 (95 % CI: 1205–1278) in the 18 sampled wards and 18,585 dogs in Dhaka City (52 dogs/km2) with an estimated human-to-free-roaming dog ratio of 828:1. During the two year CNVR program, a total of 6,665 dogs (3,357 male and 3,308 female) were neutered and vaccinated against rabies in 29 of the 92 city wards. A pilot population survey indicated a mean CNVR coverage of 60.6% (range 19.2–79.3%) with only eight wards achieving > 70% coverage. Given that the coverage in many neighborhoods was below the WHO-recommended threshold level of 70% for rabies eradications and since the CNVR program takes considerable time to implement throughout the entire Dhaka City area, a mass dog vaccination program in the non-CNVR coverage area is recommended to create herd immunity. The findings from this study are expected to guide dog population management and the rabies control program in Dhaka City and elsewhere in Bangladesh. PMID:25978406

Free-roaming dog population estimation and status of the dog population management and rabies control program in Dhaka City, Bangladesh.

PubMed

Tenzin, Tenzin; Ahmed, Rubaiya; Debnath, Nitish C; Ahmed, Garba; Yamage, Mat

2015-05-01

Beginning January 2012, a humane method of dog population management using a Catch-Neuter-Vaccinate-Release (CNVR) program was implemented in Dhaka City, Bangladesh as part of the national rabies control program. To enable this program, the size and distribution of the free-roaming dog population needed to be estimated. We present the results of a dog population survey and a pilot assessment of the CNVR program coverage in Dhaka City. Free-roaming dog population surveys were undertaken in 18 wards of Dhaka City on consecutive days using mark-resight methods. Data was analyzed using Lincoln-Petersen index-Chapman correction methods. The CNVR program was assessed over the two years (2012-2013) whilst the coverage of the CNVR program was assessed by estimating the proportion of dogs that were ear-notched (processed dogs) via dog population surveys. The free-roaming dog population was estimated to be 1,242 (95 % CI: 1205-1278) in the 18 sampled wards and 18,585 dogs in Dhaka City (52 dogs/km2) with an estimated human-to-free-roaming dog ratio of 828:1. During the two year CNVR program, a total of 6,665 dogs (3,357 male and 3,308 female) were neutered and vaccinated against rabies in 29 of the 92 city wards. A pilot population survey indicated a mean CNVR coverage of 60.6% (range 19.2-79.3%) with only eight wards achieving > 70% coverage. Given that the coverage in many neighborhoods was below the WHO-recommended threshold level of 70% for rabies eradications and since the CNVR program takes considerable time to implement throughout the entire Dhaka City area, a mass dog vaccination program in the non-CNVR coverage area is recommended to create herd immunity. The findings from this study are expected to guide dog population management and the rabies control program in Dhaka City and elsewhere in Bangladesh.

Locus of Control and Academic Achievement: Integrating Social Learning Theory and Expectancy-Value Theory

ERIC Educational Resources Information Center

Youse, Keith Edward

2012-01-01

The current study examines predictors of math achievement and college graduation by integrating social learning theory and expectancy-value theory. Data came from a nationally-representative longitudinal database tracking 12,144 students over twelve years from 8th grade forward. Models for math achievement and college graduation were tested…

Teaching for Justice in a Contradictory World

ERIC Educational Resources Information Center

Reilly, George

2017-01-01

School today is caught in the dilemma of being expected to educate young people so that they can be integrated into modern industrial society. Because of structural injustices in society, not all students have equal chances in this integration process. Education in school is also expected to impart proficiency in skills which go beyond the…

An Introduction to Flight Software Development: FSW Today, FSW 2010

NASA Technical Reports Server (NTRS)

Gouvela, John

2004-01-01

Experience and knowledge gained from ongoing maintenance of Space Shuttle Flight Software and new development projects including Cockpit Avionics Upgrade are applied to projected needs of the National Space Exploration Vision through Spiral 2. Lessons learned from these current activities are applied to create a sustainable, reliable model for development of critical software to support Project Constellation. This presentation introduces the technologies, methodologies, and infrastructure needed to produce and sustain high quality software. It will propose what is needed to support a Vision for Space Exploration that places demands on the innovation and productivity needed to support future space exploration. The technologies in use today within FSW development include tools that provide requirements tracking, integrated change management, modeling and simulation software. Specific challenges that have been met include the introduction and integration of Commercial Off the Shelf (COTS) Real Time Operating System for critical functions. Though technology prediction has proved to be imprecise, Project Constellation requirements will need continued integration of new technology with evolving methodologies and changing project infrastructure. Targets for continued technology investment are integrated health monitoring and management, self healing software, standard payload interfaces, autonomous operation, and improvements in training. Emulation of the target hardware will also allow significant streamlining of development and testing. The methodologies in use today for FSW development are object oriented UML design, iterative development using independent components, as well as rapid prototyping . In addition, Lean Six Sigma and CMMI play a critical role in the quality and efficiency of the workforce processes. Over the next six years, we expect these methodologies to merge with other improvements into a consolidated office culture with all processes being guided by automated office assistants. The infrastructure in use today includes strict software development and configuration management procedures, including strong control of resource management and critical skills coverage. This will evolve to a fully integrated staff organization with efficient and effective communication throughout all levels guided by a Mission-Systems Architecture framework with focus on risk management and attention toward inevitable product obsolescence. This infrastructure of computing equipment, software and processes will itself be subject to technological change and need for management of change and improvement,

Reducing diarrhoea deaths in South Africa: costs and effects of scaling up essential interventions to prevent and treat diarrhoea in under-five children.

PubMed

Chola, Lumbwe; Michalow, Julia; Tugendhaft, Aviva; Hofman, Karen

2015-04-17

Diarrhoea is one of the leading causes of morbidity and mortality in South African children, accounting for approximately 20% of under-five deaths. Though progress has been made in scaling up multiple interventions to reduce diarrhoea in the last decade, challenges still remain. In this paper, we model the cost and impact of scaling up 13 interventions to prevent and treat childhood diarrhoea in South Africa. Modelling was done using the Lives Saved Tool (LiST). Using 2014 as the baseline, intervention coverage was increased from 2015 until 2030. Three scale up scenarios were compared: by 2030, 1) coverage of all interventions increased by ten percentage points; 2) intervention coverage increased by 20 percentage points; 3) and intervention coverage increased to 99%. The model estimates 13 million diarrhoea cases at baseline. Scaling up intervention coverage averted between 3 million and 5.3 million diarrhoea cases. In 2030, diarrhoeal deaths are expected to reduce from an estimated 5,500 in 2014 to 2,800 in scenario one, 1,400 in scenario two and 100 in scenario three. The additional cost of implementing all 13 interventions will range from US$510 million (US$9 per capita) to US$960 million (US$18 per capita), of which the health system costs range between US$40 million (less than US$1 per capita) and US$170 million (US$3 per capita). Scaling up 13 essential interventions could have a substantial impact on reducing diarrhoeal deaths in South African children, which would contribute toward reducing child mortality in the post-MDG era. Preventive measures are key and the government should focus on improving water, sanitation and hygiene. The investments required to achieve these results seem feasible considering current health expenditure.

Multicriteria decision analysis for including health interventions in the universal health coverage benefit package in Thailand.

PubMed

Youngkong, Sitaporn; Baltussen, Rob; Tantivess, Sripen; Mohara, Adun; Teerawattananon, Yot

2012-01-01

Considering rising health expenditure on the one hand and increasing public expectations on the other hand, there is a need for explicit health care rationing to secure public acceptance of coverage decisions of health interventions. The National Health Security Office, the institute managing the Universal Coverage Scheme in Thailand, recently called for more rational, transparent, and fair decisions on the public reimbursement of health interventions. This article describes the application of multicriteria decision analysis (MCDA) to guide the coverage decisions on including health interventions in the Universal Coverage Scheme health benefit package in the period 2009-2010. We described the MCDA priority-setting process through participatory observation and evaluated the rational, transparency, and fairness of the priority-setting process against the accountability for reasonableness framework. The MCDA was applied in four steps: 1) 17 interventions were nominated for assessment; 2) nine interventions were selected for further quantitative assessment on the basis of the following criteria: size of population affected by disease, severity of disease, effectiveness of health intervention, variation in practice, economic impact on household expenditure, and equity and social implications; 3) these interventions were then assessed in terms of cost-effectiveness and budget impact; and 4) decision makers qualitatively appraised, deliberated, and reached consensus on which interventions should be adopted in the package. This project was carried out in a real-world context and has considerably contributed to the rational, transparent, and fair priority-setting process through the application of MCDA. Although the present project has applied MCDA in the Thai context, MCDA is adaptable to other settings. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Nutrition, dieting, and fitness messages in a magazine for adolescent women, 1970-1990.

PubMed

Guillen, E O; Barr, S I

1994-09-01

This study was designed to characterize nutrition and fitness messages presented between 1970-1990 in a magazine for adolescent women; to evaluate whether these messages changed over time; and to assess the body shape portrayed as desirable, and whether this changed over time. A data collection form was developed to code nutrition and fitness-related written items, advertisements and recipes, and the page coverage allocated to these items. Body shape was assessed by measuring bust:waist and hip:waist ratios of photographs of models wearing bathing suits or underwear. Magazines from even years between 1970-1990 (n = 132) were coded. Both nutrition-related and fitness-related coverage emphasized weight loss and physical appearance. Half the major nutrition-related articles presented a weight-loss plan, and weight loss was frequently addressed in other nutrition articles. The primary reasons presented for following a nutrition of fitness plan were to lose weight and become more attractive. Statements that the product or service would promote weight loss were found in 47% of nutrition-related advertisements. Nutrition coverage did not exhibit a net change over time, whereas fitness coverage increased (F = 6.6, p < .005), and the ratio of nutrition: fitness coverage changed from 10:1 in 1970 to 0.75:1 in 1990. Models' body shapes were less curvaceous than those in magazines for adult women, and the hip:waist ratio decreased over time (F = 7.3, p < .01). The nutrition and fitness messages in this magazine for adolescent women emphasize body shape and appearance, similar to findings from adult women's magazines, and contribute to the cultural milieu in which thinness is an expectation for women. Between 1970-1990, the emphasis on fitness increased, and the body shape of models tended to become more linear.

International Development Education in the English Classroom.

ERIC Educational Resources Information Center

Chamberlin, John; Harder, John

International development education in the English classroom might consist of the critical analysis of print-media coverage of events in the Third World and the reading of fiction written by Third World authors. An integration of both activities requires a theoretical framework that would affirm the usefulness of the discipline's pursuits in…

Engineering Design Skills Coverage in K-12 Engineering Program Curriculum Materials in the USA

ERIC Educational Resources Information Center

Chabalengula, Vivien M.; Mumba, Frackson

2017-01-01

The current "K-12 Science Education framework" and "Next Generation Science Standards" (NGSS) in the United States emphasise the integration of engineering design in science instruction to promote scientific literacy and engineering design skills among students. As such, many engineering education programmes have developed…

Influenza vaccination coverage rates among adults before and after the 2009 influenza pandemic and the reasons for non-vaccination in Beijing, China: a cross-sectional study.

PubMed

Wu, Shuangsheng; Yang, Peng; Li, Haiyue; Ma, Chunna; Zhang, Yi; Wang, Quanyi

2013-07-08

To optimize the vaccination coverage rates in the general population, the status of coverage rates and the reasons for non-vaccination need to be understood. Therefore, the objective of this study was to assess the changes in influenza vaccination coverage rates in the general population before and after the 2009 influenza pandemic (2008/2009, 2009/2010, and 2010/2011 seasons), and to determine the reasons for non-vaccination. In January 2011 we conducted a multi-stage sampling, retrospective, cross-sectional survey of individuals in Beijing who were ≥ 18 years of age using self-administered, anonymous questionnaires. The questionnaire consisted of three sections: demographics (gender, age, educational level, and residential district name); history of influenza vaccination in the 2008/2009, 2009/2010, and 2010/2011 seasons; and reasons for non-vaccination in all three seasons. The main outcome was the vaccination coverage rate and vaccination frequency. Differences among the subgroups were tested using a Pearson's chi-square test. Multivariate logistic regression was used to determine possible determinants of influenza vaccination uptake. A total of 13002 respondents completed the questionnaires. The vaccination coverage rates were 16.9% in 2008/2009, 21.8% in 2009/2010, and 16.7% in 2010/2011. Compared to 2008/2009 and 2010/2011, the higher rate in 2009/2010 was statistically significant (χ2=138.96, p<0.001), and no significant difference existed between 2008/2009 and 2010/2011 (χ2=1.296, p=0.255). Overall, 9.4% of the respondents received vaccinations in all three seasons, whereas 70% of the respondents did not get a vaccination during the same period. Based on multivariate analysis, older age and higher level of education were independently associated with increased odds of reporting vaccination in 2009/2010 and 2010/2011. Among participants who reported no influenza vaccinations over the previous three seasons, the most commonly reported reason for non-vaccination was 'I don't think I am very likely to catch the flu' (49.3%). Within the general population of Beijing the vaccination coverage rates were relatively low and did not change significantly after the influenza pandemic. The perception of not expecting to contract influenza was the predominant barrier to influenza vaccination. Further measures are needed to improve influenza vaccination coverage.

The distributional consequences of a Medicare premium support proposal.

PubMed

Rice, Thomas; Desmond, Katherine A

2004-12-01

This article analyzes the distributional consequences of enacting a particular premium support proposal known as Breaux-Frist I. Under the proposal, the federal government would contribute a certain amount toward the purchase of Medicare coverage, based on the premiums charged by different health plans. Beneficiaries could choose something akin to the traditional fee-for-service option or a privately sponsored ealth plan such as a health maintenance organization. The article simulates the expected distributional impacts in three areas: among beneficiaries who choose to retain fee-for-service coverage, between different geographic areas, and according to various beneficiary characteristics. We find that the legislation would result in increased premiums for beneficiaries remaining in the Medicare fee-for-service program as a result of unfavorable selection; lead to a geographic redistribution in premium payments, with those living in areas with high levels of Medicare expenditures paying more; and a much lower financial burden than is the case now for near-poor beneficiaries who do not have full Medicaid coverage. Finally, the article discusses how these results compare to those that may occur under the premium support demonstration project, beginning in 2010, established under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

Surface hydrogenation regulated wrinkling and torque capability of hydrogenated graphene annulus under circular shearing.

PubMed

Li, Yinfeng; Liu, Silin; Datta, Dibakar; Li, Zhonghua

2015-11-12

Wrinkles as intrinsic topological feature have been expected to affect the electrical and mechanical properties of atomically thin graphene. Molecular dynamics simulations are adopted to investigate the wrinkling characteristics in hydrogenated graphene annulus under circular shearing at the inner edge. The amplitude of wrinkles induced by in-plane rotation around the inner edge is sensitive to hydrogenation, and increases quadratically with hydrogen coverage. The effect of hydrogenation on mechanical properties is investigated by calculating the torque capability of annular graphene with varying hydrogen coverage and inner radius. Hydrogenation-enhanced wrinkles cause the aggregation of carbon atoms towards the inner edge and contribute to the critical torque strength of annulus. Based on detailed stress distribution contours, a shear-to-tension conversion mechanism is proposed for the contribution of wrinkles on torque capacity. As a result, the graphane annulus anomalously has similar torque capacity to pristine graphene annulus. The competition between hydrogenation caused bond strength deterioration and wrinkling induced local stress state conversion leads to a U-shaped evolution of torque strength relative to the increase of hydrogen coverage from 0 to 100%. Such hydrogenation tailored topological and mechanical characteristics provides an innovative mean to develop novel graphene-based devices.

What should health insurance cover? A comparison of Israeli and US approaches to benefit design under national health reform.

PubMed

Nissanholtz Gannot, Rachel; Chinitz, David P; Rosenbaum, Sara

2018-04-01

What health insurance should cover and pay for represents one of the most complex questions in national health policy. Israel shares with the US reliance on a regulated insurance market and we compare the approaches of the two countries regarding determining health benefits. Based on review and analysis of literature, laws and policy in the United States and Israel. The Israeli experience consists of selection of a starting point for defining coverage; calculating the expected cost of covered benefits; and creating a mechanism for updating covered benefits within a defined budget. In implementing the Affordable Care Act, the US rejected a comprehensive and detailed approach to essential health benefits. Instead, federal regulators established broadly worded minimum standards that can be supplemented through more stringent state laws and insurer discretion. Notwithstanding differences between the two systems, the elements of the Israeli approach to coverage, which has stood the test of time, may provide a basis for the United States as it renews its health reform debate and considers delegating decisions about coverage to the states. Israel can learn to emulate the more forceful regulation of supplemental and private insurance that characterizes health policy in the United States.

Soil biogeochemistry in the age of big data

NASA Astrophysics Data System (ADS)

Cécillon, Lauric; Barré, Pierre; Coissac, Eric; Plante, Alain; Rasse, Daniel

2015-04-01

Data is becoming one of the key resource of the XXIst century. Soil biogeochemistry is not spared by this new movement. The conservation of soils and their services recently came into the political agenda. However, clear knowledge on the links between soil characteristics and the various processes ensuring the provision of soil services is rare at the molecular or the plot scale, and does not exist at the landscape scale. This split between society's expectations on its natural capital, and scientific knowledge on the most complex material on earth has lead to an increasing number of studies on soils, using an increasing number of techniques of increasing complexity, with an increasing spatial and temporal coverage. From data scarcity with a basic data management system, soil biogeochemistry is now facing a proliferation of data, with few quality controls from data collection to publication and few skills to deal with them. Based on this observation, here we (1) address how big data could help in making sense of all these soil biogeochemical data, (2) point out several shortcomings of big data that most biogeochemists will experience in their future career. Massive storage of data is now common and recent opportunities for cloud storage enables data sharing among researchers all over the world. The need for integrative and collaborative computational databases in soil biogeochemistry is emerging through pioneering initiatives in this direction (molTERdb; earthcube), following soil microbiologists (GenBank). We expect that a series of data storage and management systems will rapidly revolutionize the way of accessing raw biogeochemical data, published or not. Data mining techniques combined with cluster or cloud computing hold significant promises for facilitating the use of complex analytical methods, and for revealing new insights previously hidden in complex data on soil mineralogy, organic matter and biodiversity. Indeed, important scientific advances have already been made thanks to meta-analysis, chemometrics, machine-learning systems and bioinformatics. Some techniques like structural equation modeling eventually propose to explore causalities opening a way towards the mechanistic understanding of soil big data rather than simple correlations. We claim that data science should be fully integrated into soil biogeochemists basic education schemes. We expect the blooming of a new generation of soil biogeochemists highly skilled in manipulating big data. Will big data represent a net gain for soil biogeochemistry? Increasing the amount of data will increase associated biases that may further be exacerbated by the increasing distance between data manipulators, soil sampling and data acquisition. Integrating data science into soil biogeochemistry should thus not be done at the expenses of pedology and metrology. We further expect that the more data, the more spurious correlations will appear leading to possible misinterpretation of data. Finally, big data on soils characteristics and processes will always need to be confronted to biogeochemical theories and socio-economic knowledge to be useful. Big data could revolutionize soil biogeochemistry, fostering new scientific and business models around the conservation of the soil natural capital, but our community should go into this new era with clear-sightedness and discernment.

Experimental demonstration of multi-dimensional resources integration for service provisioning in cloud radio over fiber network

NASA Astrophysics Data System (ADS)

Yang, Hui; Zhang, Jie; Ji, Yuefeng; He, Yongqi; Lee, Young

2016-07-01

Cloud radio access network (C-RAN) becomes a promising scenario to accommodate high-performance services with ubiquitous user coverage and real-time cloud computing in 5G area. However, the radio network, optical network and processing unit cloud have been decoupled from each other, so that their resources are controlled independently. Traditional architecture cannot implement the resource optimization and scheduling for the high-level service guarantee due to the communication obstacle among them with the growing number of mobile internet users. In this paper, we report a study on multi-dimensional resources integration (MDRI) for service provisioning in cloud radio over fiber network (C-RoFN). A resources integrated provisioning (RIP) scheme using an auxiliary graph is introduced based on the proposed architecture. The MDRI can enhance the responsiveness to dynamic end-to-end user demands and globally optimize radio frequency, optical network and processing resources effectively to maximize radio coverage. The feasibility of the proposed architecture is experimentally verified on OpenFlow-based enhanced SDN testbed. The performance of RIP scheme under heavy traffic load scenario is also quantitatively evaluated to demonstrate the efficiency of the proposal based on MDRI architecture in terms of resource utilization, path blocking probability, network cost and path provisioning latency, compared with other provisioning schemes.

Experimental demonstration of multi-dimensional resources integration for service provisioning in cloud radio over fiber network.

PubMed

Yang, Hui; Zhang, Jie; Ji, Yuefeng; He, Yongqi; Lee, Young

2016-07-28

Cloud radio access network (C-RAN) becomes a promising scenario to accommodate high-performance services with ubiquitous user coverage and real-time cloud computing in 5G area. However, the radio network, optical network and processing unit cloud have been decoupled from each other, so that their resources are controlled independently. Traditional architecture cannot implement the resource optimization and scheduling for the high-level service guarantee due to the communication obstacle among them with the growing number of mobile internet users. In this paper, we report a study on multi-dimensional resources integration (MDRI) for service provisioning in cloud radio over fiber network (C-RoFN). A resources integrated provisioning (RIP) scheme using an auxiliary graph is introduced based on the proposed architecture. The MDRI can enhance the responsiveness to dynamic end-to-end user demands and globally optimize radio frequency, optical network and processing resources effectively to maximize radio coverage. The feasibility of the proposed architecture is experimentally verified on OpenFlow-based enhanced SDN testbed. The performance of RIP scheme under heavy traffic load scenario is also quantitatively evaluated to demonstrate the efficiency of the proposal based on MDRI architecture in terms of resource utilization, path blocking probability, network cost and path provisioning latency, compared with other provisioning schemes.

Experimental demonstration of multi-dimensional resources integration for service provisioning in cloud radio over fiber network

PubMed Central

Yang, Hui; Zhang, Jie; Ji, Yuefeng; He, Yongqi; Lee, Young

2016-01-01

Cloud radio access network (C-RAN) becomes a promising scenario to accommodate high-performance services with ubiquitous user coverage and real-time cloud computing in 5G area. However, the radio network, optical network and processing unit cloud have been decoupled from each other, so that their resources are controlled independently. Traditional architecture cannot implement the resource optimization and scheduling for the high-level service guarantee due to the communication obstacle among them with the growing number of mobile internet users. In this paper, we report a study on multi-dimensional resources integration (MDRI) for service provisioning in cloud radio over fiber network (C-RoFN). A resources integrated provisioning (RIP) scheme using an auxiliary graph is introduced based on the proposed architecture. The MDRI can enhance the responsiveness to dynamic end-to-end user demands and globally optimize radio frequency, optical network and processing resources effectively to maximize radio coverage. The feasibility of the proposed architecture is experimentally verified on OpenFlow-based enhanced SDN testbed. The performance of RIP scheme under heavy traffic load scenario is also quantitatively evaluated to demonstrate the efficiency of the proposal based on MDRI architecture in terms of resource utilization, path blocking probability, network cost and path provisioning latency, compared with other provisioning schemes. PMID:27465296

Community coverage in a rural, church-based, hypertension screening program in Edgecombe County, North Carolina.

PubMed Central

Strogatz, D S; James, S A; Elliott, D; Ramsey, D; Cutchin, L M; Ibrahim, M A

1985-01-01

In a rural, church-based hypertension program in Edgecombe County, North Carolina, screening of the congregations was complemented by a community outreach component targeted at 18-60 year old males, a group at higher risk for untreated hypertension. Compared with its estimated frequency in the community, untreated hypertension was as common in the church congregations and somewhat less prevalent than expected among outreach screenees. PMID:3976968

Unmanned spacecraft for surveying earth's resources

NASA Technical Reports Server (NTRS)

George, T. A.

1970-01-01

The technical objectives and payloads for ERTS A and B are discussed. The primary emphasis is on coverage of the United States and the ocean areas immediately adjacent, using 3-camera return beam vidicon TV system, 4-channel multispectral point scanner, data collection system, and wideband video tape recorder. The expected performance and system characteristics of the RBV system and the 4-band multispectral object plane point scanner are outlined. Ground station considerations are also given.

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

PubMed

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

2010-11-01

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

Moving Toward Universal Health Coverage (UHC) to Achieve Inclusive and Sustainable Health Development: Three Essential Strategies Drawn From Asian Experience

PubMed Central

Xu, Ye; Huang, Cheng; Colón-Ramos, Uriyoán

2015-01-01

Binagwaho and colleagues’ perspective piece provided a timely reflection on the experience of Rwanda in achieving the Millennium Development Goals (MDGs) and a proposal of 5 principles to carry forward in post-2015 health development. This commentary echoes their viewpoints and offers three lessons for health policy reforms consistent with these principles beyond 2015. Specifically, we argue that universal health coverage (UHC) is an integrated solution to advance the global health development agenda, and the three essential strategies drawn from Asian countries’ health reforms toward UHC are: (1) Public financing support and sequencing health insurance expansion by first extending health insurance to the extremely poor, vulnerable, and marginalized population are critical for achieving UHC; (2) Improved quality of delivered care ensures supply-side readiness and effective coverage; (3) Strategic purchasing and results-based financing creates incentives and accountability for positive changes. These strategies were discussed and illustrated with experience from China and other Asian economies. PMID:26673477

Land status and federal mineral ownership in the Powder River basin, Wyoming and Montana; a digital data set for geographic information systems

USGS Publications Warehouse

Biewick, Laura; Urbanowski, Shayne R.; Cain, Sheila; Neasloney, Larry

1998-01-01

As the Nation's energy resources continue to be examined for development, it is critical that a digital database exist that contains location data for all Federal land and mineral resources. The U.S. Geological Survey (USGS), in cooperation with the Bureau of Land Management (BLM), is collecting these ownership files and compiling them in Environmental Systems Research Institute, Inc. (ESRI) ARC/INFO coverages, to form a standardized data library. A coverage is a digital version of a map in the form of vector data storage. These coverages are combined with models of coal deposits from the USGS National Coal Resource Assessment project, a five-year effort to identify and characterize the coal beds and coal zones that will provide fuel for the Nation’s energy needs during the first quarter of the twenty-first century. Geographic and geologic data layers are integrated in a Geographic Information System (GIS) to answer complex geo-spatial questions concerning coal resource occurrence.

Impacts of Professional Development in Integrated STEM Education on Teacher Self-Efficacy, Outcome Expectancy, and STEM Career Awareness

ERIC Educational Resources Information Center

Knowles, J. Geoff

2017-01-01

This research analyzed the effects of teacher professional development and lesson implementation in integrated Science, Technology, Engineering, and Math (STEM) on: (1.) Teacher self-efficacy and their confidence to teach specific STEM subjects; (2.) Teaching outcome expectancy beliefs concerning the impact of actions by teachers on student…

Pre-Service Physical Education Teachers' Technological Pedagogical Content Knowledge, Technology Integration Self-Efficacy and Instructional Technology Outcome Expectations

ERIC Educational Resources Information Center

Semiz, Kivanc; Ince, Mustafa Levent

2012-01-01

The purposes of this study were to (1) identify the Technological Pedagogical Content Knowledge (TPACK), Technology Integration Self Efficacy (TISE) and Instructional Technology Outcome Expectations (ITOE) of pre-service physical education teachers, (2) examine the relationships among TPACK, TISE and ITOE, and lastly (3) examine the differences…

The Development of TPACK, Technology Integrated Self-Efficacy and Instructional Technology Outcome Expectations of Pre-Service Physical Education Teachers

ERIC Educational Resources Information Center

Cengiz, Cevdet

2015-01-01

The purpose of this intervention has been to improve pre-service physical education teachers' Technological Pedagogical Content Knowledge (TPCK or TPACK), Technology Integrated Self-Efficacy (TISE), and Instructional Technology Outcome Expectations (ITOE). A pre-/post-test design without a control group was used in the study. Participants were…

The Gap between Expectations and Reality: Integrating Computers into Mathematics Classrooms

ERIC Educational Resources Information Center

Guven, Bulent; Cakiroglu, Unal; Akkan, Yasar

2009-01-01

As a result of dramatic changes in mathematics education around the world, in Turkey both elementary and secondary school mathematics curriculums have changed in the light of new demands since 2005. In order to perform the expected change in newly developed curriculum, computer should be integrated into learning and teaching process. Teachers'…

Integration, Validation, and Application of a PV Snow Coverage Model in SAM

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

Ryberg, David; Freeman, Janine

2015-09-01

Due to the increasing deployment of PV systems in snowy climates, there is significant interest in a method capable of estimating PV losses resulting from snow coverage that has been verified for a wide variety of system designs and locations. A scattering of independent snow coverage models have been developed over the last 15 years; however, there has been very little effort spent on verifying these models beyond the system design and location on which they were based. Moreover, none of the major PV modeling software products have incorporated any of these models into their workflow. In response to thismore » deficiency, we have integrated the methodology of the snow model developed in the paper by Marion et al. [1] into the National Renewable Energy Laboratory's (NREL) System Advisor Model (SAM). In this work we describe how the snow model is implemented in SAM and discuss our demonstration of the model's effectiveness at reducing error in annual estimations for two PV arrays. Following this, we use this new functionality in conjunction with a long term historical dataset to estimate average snow losses across the United States for a typical PV system design. The open availability of the snow loss estimation capability in SAM to the PV modeling community, coupled with our results of the nation-wide study, will better equip the industry to accurately estimate PV energy production in areas affected by snowfall.« less

A high-resolution atlas of composite Sloan Digital Sky Survey galaxy spectra

NASA Astrophysics Data System (ADS)

Dobos, László; Csabai, István.; Yip, Ching-Wa; Budavári, Tamás.; Wild, Vivienne; Szalay, Alexander S.

2012-02-01

In this work we present an atlas of composite spectra of galaxies based on the data of the Sloan Digital Sky Survey Data Release 7 (SDSS DR7). Galaxies are classified by colour, nuclear activity and star formation activity to calculate average spectra of high signal-to-noise ratio (S/N) and resolution (? at Δλ= 1 Å), using an algorithm that is robust against outliers. Besides composite spectra, we also compute the first five principal components of the distributions in each galaxy class to characterize the nature of variations of individual spectra around the averages. The continua of the composite spectra are fitted with BC03 stellar population synthesis models to extend the wavelength coverage beyond the coverage of the SDSS spectrographs. Common derived parameters of the composites are also calculated: integrated colours in the most popular filter systems, line-strength measurements and continuum absorption indices (including Lick indices). These derived parameters are compared with the distributions of parameters of individual galaxies, and it is shown on many examples that the composites of the atlas cover much of the parameter space spanned by SDSS galaxies. By co-adding thousands of spectra, a total integration time of several months can be reached, which results in extremely low noise composites. The variations in redshift not only allow for extending the spectral coverage bluewards to the original wavelength limit of the SDSS spectrographs, but also make higher spectral resolution achievable. The composite spectrum atlas is available online at .

Multipath for Agricultural and Rural Information Services in China

NASA Astrophysics Data System (ADS)

Ge, Ningning; Zang, Zhiyuan; Gao, Lingwang; Shi, Qiang; Li, Jie; Xing, Chunlin; Shen, Zuorui

Internet cannot provide perfect information services for farmers in rural regions in China, because farmers in rural regions can hardly access the internet by now. But the wide coverage of mobile signal, telephone line, and television network, etc. gave us a chance to solve the problem. The integrated pest management platform of Northern fruit trees were developed based on the integrated technology, which can integrate the internet, mobile and fixed-line telephone network, and television network, to provide integrated pest management(IPM) information services for farmers in rural regions in E-mail, telephone-voice, short message, voice mail, videoconference or other format, to users' telephone, cell phone, personal computer, personal digital assistant(PDA), television, etc. alternatively. The architecture and the functions of the system were introduced in the paper. The system can manage the field monitoring data of agricultural pests, deal with enquiries to provide the necessary information to farmers accessing the interactive voice response(IVR) in the system with the experts on-line or off-line, and issue the early warnings about the fruit tree pests when it is necessary according to analysis on the monitoring data about the pests of fruit trees in variety of ways including SMS, fax, voice and intersystem e-mail.The system provides a platform and a new pattern for agricultural technology extension with a high coverage rate of agricultural technology in rural regions, and it can solve the problem of agriculture information service 'last kilometer' in China. The effectiveness of the system was certified.

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.

Subnanogram proteomics: Impact of LC column selection, MS instrumentation and data analysis strategy on proteome coverage for trace samples

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

Zhu, Ying; Zhao, Rui; Piehowski, Paul D.

One of the greatest challenges for mass spectrometry (MS)-based proteomics is the limited ability to analyze small samples. Here we investigate the relative contributions of liquid chromatography (LC), MS instrumentation and data analysis methods with the aim of improving proteome coverage for sample sizes ranging from 0.5 ng to 50 ng. We show that the LC separations utilizing 30-µm-i.d. columns increase signal intensity by >3-fold relative to those using 75-µm-i.d. columns, leading to 32% increase in peptide identifications. The Orbitrap Fusion Lumos mass spectrometer significantly boosted both sensitivity and sequencing speed relative to earlier generation Orbitraps (e.g., LTQ-Orbitrap), leading tomore » a ~3× increase in peptide identifications and 1.7× increase in identified protein groups for 2 ng tryptic digests of bacterial lysate. The Match Between Runs algorithm of open-source MaxQuant software further increased proteome coverage by ~ 95% for 0.5 ng samples and by ~42% for 2 ng samples. The present platform is capable of identifying >3000 protein groups from tryptic digestion of cell lysates equivalent to 50 HeLa cells and 100 THP-1 cells (~10 ng total proteins), respectively, and >950 proteins from subnanogram bacterial and archaeal cell lysates. The present ultrasensitive LC-MS platform is expected to enable deep proteome coverage for subnanogram samples, including single mammalian cells.« less

Health Plans' Early Response to Federal Parity Legislation for Mental Health and Addiction Services.

PubMed

Horgan, Constance M; Hodgkin, Dominic; Stewart, Maureen T; Quinn, Amity; Merrick, Elizabeth L; Reif, Sharon; Garnick, Deborah W; Creedon, Timothy B

2016-02-01

In 2008, the federal Mental Health Parity and Addiction Equity Act (MHPAEA) passed, prohibiting U.S. health plans from subjecting mental health and substance use disorder (behavioral health) coverage to more restrictive limitations than those applied to general medical care. This require d some health plans to make changes in coverage and management of services. The aim of this study was to examine private health plans' early responses to MHPAEA (after its 2010 implementation), in terms of both intended and unintended effects. Data were from a nationally representative survey of commercial health plans regarding the 2010 benefit year and the preparity 2009 benefit year (weighted N=8,431 products; 89% response rate). Annual limits specific to behavioral health care were virtually eliminated between 2009 and 2010. Prevalence of behavioral health coverage was unchanged, and copayments for both behavioral and general medical services increased slightly. Prior authorization requirements for specialty medical and behavioral health outpatient services continued to decline, and the proportion of products reporting strict continuing review requirements increased slightly. Contrary to expectations, plans did not make significant changes in contracting arrangements for behavioral health services, and 80% reported an increase in size of their behavioral health provider network. The law had the intended effect of eliminating quantitative limitations that applied only to behavioral health care without unintended consequences such as eliminating behavioral health coverage. Plan decisions may also reflect other factors, including anticipation of the 2010 regulations and a continuation of trends away from requiring prior authorization.

Recommendation system for immunization coverage and monitoring.

PubMed

Bhatti, Uzair Aslam; Huang, Mengxing; Wang, Hao; Zhang, Yu; Mehmood, Anum; Di, Wu

2018-01-02

Immunization averts an expected 2 to 3 million deaths every year from diphtheria, tetanus, pertussis (whooping cough), and measles; however, an additional 1.5 million deaths could be avoided if vaccination coverage was improved worldwide. 1 1 Data source for immunization records of 1.5 M: http://www.who.int/mediacentre/factsheets/fs378/en/ New vaccination technologies provide earlier diagnoses, personalized treatments and a wide range of other benefits for both patients and health care professionals. Childhood diseases that were commonplace less than a generation ago have become rare because of vaccines. However, 100% vaccination coverage is still the target to avoid further mortality. Governments have launched special campaigns to create an awareness of vaccination. In this paper, we have focused on data mining algorithms for big data using a collaborative approach for vaccination datasets to resolve problems with planning vaccinations in children, stocking vaccines, and tracking and monitoring non-vaccinated children appropriately. Geographical mapping of vaccination records helps to tackle red zone areas, where vaccination rates are poor, while green zone areas, where vaccination rates are good, can be monitored to enable health care staff to plan the administration of vaccines. Our recommendation algorithm assists in these processes by using deep data mining and by accessing records of other hospitals to highlight locations with lower rates of vaccination. The overall performance of the model is good. The model has been implemented in hospitals to control vaccination across the coverage area.

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

PubMed

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

2016-02-01

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

Spanish youth is emigrating: A bibliometric approach to the media coverage.

PubMed

Selva, Clara; Recordà, Aniol

2018-01-01

Recent years have witnessed the emigration of young Spanish people searching for labor opportunities. A decade after the beginning of the worldwide economic crisis in 2007, the rapid deterioration of living conditions and lack of opportunities for personal development combined with the breakdown of professional expectations have led thousands of young people to emigrate from Spain, creating the so-called youth exodus. The press has paid recurrent attention to this phenomenon, often using eye-catching headlines such as 'Brain Drain'. Given the regular interest of the media in this phenomenon, the objective of this research is to analyze the media coverage of the drain of Spanish talent capital, or the emigration of young Spanish people seeking a better future, to create a distributive map that defines the characteristics and trends of this coverage. The analyzed corpus comprises 346 articles from eight Spanish and eleven international newspapers. The articles were coded based on descriptive variables (i.e., author, publication year, newspaper and language) and categorical variables (i.e., section, method, approach to the phenomenon, assessment of the phenomenon and overview of the phenomenon). The results indicate a significant increase in press coverage over the past few years and reveal associations between assessment of the phenomenon and year and between assessment of the phenomenon and section. As a result of this research, new investigative lines are unveiled regarding the social construction of the phenomenon in the media and the identity and individual construction of the 'truncated careers' of young Spanish people.

Integrating Prevention of Mother-to-Child HIV Transmission Programs to Improve Uptake: A Systematic Review

PubMed Central

Tudor Car, Lorainne; Van Velthoven, Michelle H. M. M. T.; Brusamento, Serena; Elmoniry, Hoda; Car, Josip; Majeed, Azeem; Tugwell, Peter; Welch, Vivian; Marusic, Ana; Atun, Rifat

2012-01-01

Background We performed a systematic review to assess the effect of integrated perinatal prevention of mother-to-child transmission of HIV interventions compared to non- or partially integrated services on the uptake in low- and middle-income countries. Methods We searched for experimental, quasi-experimental and controlled observational studies in any language from 21 databases and grey literature sources. Results Out of 28 654 citations retrieved, five studies met our inclusion criteria. A cluster randomized controlled trial reported higher probability of nevirapine uptake at the labor wards implementing HIV testing and structured nevirapine adherence assessment (RRR 1.37, bootstrapped 95% CI, 1.04–1.77). A stepped wedge design study showed marked improvement in antiretroviral therapy (ART) enrolment (44.4% versus 25.3%, p<0.001) and initiation (32.9% versus 14.4%, p<0.001) in integrated care, but the median gestational age of ART initiation (27.1 versus 27.7 weeks, p = 0.4), ART duration (10.8 versus 10.0 weeks, p = 0.3) or 90 days ART retention (87.8% versus 91.3%, p = 0.3) did not differ significantly. A cohort study reported no significant difference either in the ART coverage (55% versus 48% versus 47%, p = 0.29) or eight weeks of ART duration before the delivery (50% versus 42% versus 52%; p = 0.96) between integrated, proximal and distal partially integrated care. Two before and after studies assessed the impact of integration on HIV testing uptake in antenatal care. The first study reported that significantly more women received information on PMTCT (92% versus 77%, p<0.001), were tested (76% versus 62%, p<0.001) and learned their HIV status (66% versus 55%, p<0.001) after integration. The second study also reported significant increase in HIV testing uptake after integration (98.8% versus 52.6%, p<0.001). Conclusion Limited, non-generalizable evidence supports the effectiveness of integrated PMTCT programs. More research measuring coverage and other relevant outcomes is urgently needed to inform the design of services delivering PMTCT programs. PMID:22558134

National health expenditure projections, 2014-24: spending growth faster than recent trends.

PubMed

Keehan, Sean P; Cuckler, Gigi A; Sisko, Andrea M; Madison, Andrew J; Smith, Sheila D; Stone, Devin A; Poisal, John A; Wolfe, Christian J; Lizonitz, Joseph M

2015-08-01

Health spending growth in the United States is projected to average 5.8 percent for 2014-24, reflecting the Affordable Care Act's coverage expansions, faster economic growth, and population aging. Recent historically low growth rates in the use of medical goods and services, as well as medical prices, are expected to gradually increase. However, in part because of the impact of continued cost-sharing increases that are anticipated among health plans, the acceleration of these growth rates is expected to be modest. The health share of US gross domestic product is projected to rise from 17.4 percent in 2013 to 19.6 percent in 2024. Project HOPE—The People-to-People Health Foundation, Inc.

Adsorption of natural dissolved organic matter at the oxide/water interface

USGS Publications Warehouse

Davis, James A.

1982-01-01

Natural organic matter is readily adsorbed by alumina and kaolinite in the pH range of natural waters. Adsorption occurs by complex formation between surface hydroxyls and the acidic functional groups of the organic matter. Oxides with relatively acidic surface hydroxyls, e.g. silica, do not react strongly with the organic matter. Under conditions typical for natural waters, almost complete surface coverage by adsorbed organic matter may be expected for alumina, hydrous iron oxides and the edge sites of aluminosilicates. Potentiometric titration and electrophoresis indicate that most of the acidic functional groups of the adsorbed organic matter are neutralized by protons from solution. The organic coating is expected to have a great influence on subsequent adsorption of inorganic cations and anions.

DFT study on bimetallic Pt/Cu(1 1 1) as efficient catalyst for H2 dissociation

NASA Astrophysics Data System (ADS)

Liu, Ji; Fan, Xiaofeng; Sun, Chang Q.; Zhu, Weiguang

2018-05-01

To design a catalyst for the dissociation of H2 with better CO-tolerance performance is very important for proton exchange membrane fuel cells (PEMFCs) towards high efficiency. With slab model, the catalytic properties of overlayer Pt on Cu substrate (Pt/Cu) are analyzed by first-principle calculations. The CO saturation coverage (40%) on Pt2/Cu is found to be lower than that of pure Pt (about 75%). The dissociation barrier from H2 to H is less than 0.4 eV under the saturation coverage of CO. On the basis of kinetics of proton formation, the CO-tolerance ability on double-layer Pt with Cu is found to be greatly improved compared with that on pure Pt. It is expected that Pt overlayer on Cu(1 1 1) is a potential anode material with lower cost for PEMFCs.

Looking above the prairie: localized and upward acute vision in a native grassland bird.

PubMed

Tyrrell, Luke P; Moore, Bret A; Loftis, Christopher; Fernández-Juricic, Esteban

2013-12-02

Visual systems of open habitat vertebrates are predicted to have a band of acute vision across the retina (visual streak) and wide visual coverage to gather information along the horizon. We tested whether the eastern meadowlark (Sturnella magna) had this visual configuration given that it inhabits open grasslands. Contrary to our expectations, the meadowlark retina has a localized spot of acute vision (fovea) and relatively narrow visual coverage. The fovea projects above rather than towards the horizon with the head at rest, and individuals modify their body posture in tall grass to maintain a similar foveal projection. Meadowlarks have relatively large binocular fields and can see their bill tips, which may help with their probe-foraging technique. Overall, meadowlark vision does not fit the profile of vertebrates living in open habitats. The binocular field may control foraging while the fovea may be used for detecting and tracking aerial stimuli (predators, conspecifics).

Implications of the 2017 Tax Cuts and Jobs Act for Public Health

PubMed Central

2018-01-01

The recently passed Tax Cuts and Jobs Act will reduce total federal revenues by about 4% between 2018 and 2027. The law makes multiple changes to the taxation of individuals and corporations. It also repeals the Affordable Care Act’s (ACA’s) individual mandate penalties, which will erase some of the gains in insurance coverage achieved since implementation of the ACA’s coverage expansions. The resulting increases in rates of uninsurance will likely lead to increased uncompensated care and deflect hospitals and health departments from addressing other prevention and public health needs. In addition, the law is expected to lead to substantial increases in the federal debt and, consequently, to calls for reductions in spending on entitlement programs, particularly Medicare, and on discretionary programs, including public health. Many other provisions of the law could also have second-order effects on public health. PMID:29565668

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.

Economic grand rounds: the price is right? Changes in the quantity of services used and prices paid in response to parity.

PubMed

Goldman, Howard H; Barry, Colleen L; Normand, Sharon-Lise T; Azzone, Vanessa; Busch, Alisa B; Huskamp, Haiden A

2012-02-01

The impact of parity coverage on the quantity of behavioral health services used by enrollees and on the prices of these services was examined in a set of Federal Employees Health Benefit (FEHB) Program plans. After parity implementation, the quantity of services used in the FEHB plans declined in five service categories, compared with plans that did not have parity coverage. The decline was significant for all service types except inpatient care. Because a previous study of the FEHB Program found that total spending on behavioral health services did not increase after parity implementation, it can be inferred that average prices must have increased over the period. The finding of a decline in service use and increase in prices provides an empirical window on what might be expected after implementation of the federal parity law and the parity requirement under the health care reform law.

Developing a framework for gathering and using service user experiences to improve integrated health and social care: the SUFFICE framework.

PubMed

Ward, Vicky; Pinkney, Lisa; Fry, Gary

2016-09-08

More people than ever receive care and support from health and social care services. Initiatives to integrate the work of health and social care staff have increased rapidly across the UK but relatively little has been done to chart and improve their impact on service users. Our aim was to develop a framework for gathering and using service user feedback to improve integrated health and social care in one locality in the North of England. We used published literature and interviews with health and social care managers to determine the expected service user experiences of local community-based integrated teams and the ways in which team members were expected to work together. We used the results to devise qualitative data collection and analysis tools for gathering and analyzing service user feedback. We used developmental evaluation and service improvement methodologies to devise a procedure for developing service improvement plans. We identified six expected service user experiences of integrated care and 15 activities that health and social care teams were expected to undertake. We used these to develop logic models and tools for collecting and analysing service user experiences. These include a narrative interview schedule, a plan for analyzing data, and a method for synthesizing the results into a composite 'story'. We devised a structured service improvement procedure which involves teams of health and social care staff listening to a composite service user story, identifying how their actions as a team may have contributed to the story and developing a service improvement plan. This framework aims to put service user experiences at the heart of efforts to improve integration. It has been developed in collaboration with National Health Service (NHS) and Social Care managers. We expect it to be useful for evaluating and improving integrated care initiatives elsewhere.

Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study.

PubMed

Rasella, Davide; Basu, Sanjay; Hone, Thomas; Paes-Sousa, Romulo; Ocké-Reis, Carlos Octávio; Millett, Christopher

2018-05-01

Since 2015, a major economic crisis in Brazil has led to increasing poverty and the implementation of long-term fiscal austerity measures that will substantially reduce expenditure on social welfare programmes as a percentage of the country's GDP over the next 20 years. The Bolsa Família Programme (BFP)-one of the largest conditional cash transfer programmes in the world-and the nationwide primary healthcare strategy (Estratégia Saúde da Família [ESF]) are affected by fiscal austerity, despite being among the policy interventions with the strongest estimated impact on child mortality in the country. We investigated how reduced coverage of the BFP and ESF-compared to an alternative scenario where the level of social protection under these programmes is maintained-may affect the under-five mortality rate (U5MR) and socioeconomic inequalities in child health in the country until 2030, the end date of the Sustainable Development Goals. We developed and validated a microsimulation model, creating a synthetic cohort of all 5,507 Brazilian municipalities for the period 2017-2030. This model was based on the longitudinal dataset and effect estimates from a previously published study that evaluated the effects of poverty, the BFP, and the ESF on child health. We forecast the economic crisis and the effect of reductions in BFP and ESF coverage due to current fiscal austerity on the U5MR, and compared this scenario with a scenario where these programmes maintain the levels of social protection by increasing or decreasing with the size of Brazil's vulnerable populations (policy response scenarios). We used fixed effects multivariate regression models including BFP and ESF coverage and accounting for secular trends, demographic and socioeconomic changes, and programme duration effects. With the maintenance of the levels of social protection provided by the BFP and ESF, in the most likely economic crisis scenario the U5MR is expected to be 8.57% (95% CI: 6.88%-10.24%) lower in 2030 than under fiscal austerity-a cumulative 19,732 (95% CI: 10,207-29,285) averted under-five deaths between 2017 and 2030. U5MRs from diarrhoea, malnutrition, and lower respiratory tract infections are projected to be 39.3% (95% CI: 36.9%-41.8%), 35.8% (95% CI: 31.5%-39.9%), and 8.5% (95% CI: 4.1%-12.0%) lower, respectively, in 2030 under the maintenance of BFP and ESF coverage, with 123,549 fewer under-five hospitalisations from all causes over the study period. Reduced coverage of the BFP and ESF will also disproportionately affect U5MR in the most vulnerable areas, with the U5MR in the poorest quintile of municipalities expected to be 11.0% (95% CI: 8.0%-13.8%) lower in 2030 under the maintenance of BFP and ESF levels of social protection than under fiscal austerity, compared to no difference in the richest quintile. Declines in health inequalities over the last decade will also stop under a fiscal austerity scenario: the U5MR concentration index is expected to remain stable over the period 2017-2030, compared to a 13.3% (95% CI: 5.6%-21.8%) reduction under the maintenance of BFP and ESF levels of protection. Limitations of our analysis are the ecological nature of the study, uncertainty around future macroeconomic scenarios, and potential changes in other factors affecting child health. A wide range of sensitivity analyses were conducted to minimise these limitations. The implementation of fiscal austerity measures in Brazil can be responsible for substantively higher childhood morbidity and mortality than expected under maintenance of social protection-threatening attainment of Sustainable Development Goals for child health and reducing inequality.

Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study

PubMed Central

Paes-Sousa, Romulo; Ocké-Reis, Carlos Octávio; Millett, Christopher

2018-01-01

Background Since 2015, a major economic crisis in Brazil has led to increasing poverty and the implementation of long-term fiscal austerity measures that will substantially reduce expenditure on social welfare programmes as a percentage of the country’s GDP over the next 20 years. The Bolsa Família Programme (BFP)—one of the largest conditional cash transfer programmes in the world—and the nationwide primary healthcare strategy (Estratégia Saúde da Família [ESF]) are affected by fiscal austerity, despite being among the policy interventions with the strongest estimated impact on child mortality in the country. We investigated how reduced coverage of the BFP and ESF—compared to an alternative scenario where the level of social protection under these programmes is maintained—may affect the under-five mortality rate (U5MR) and socioeconomic inequalities in child health in the country until 2030, the end date of the Sustainable Development Goals. Methods and findings We developed and validated a microsimulation model, creating a synthetic cohort of all 5,507 Brazilian municipalities for the period 2017–2030. This model was based on the longitudinal dataset and effect estimates from a previously published study that evaluated the effects of poverty, the BFP, and the ESF on child health. We forecast the economic crisis and the effect of reductions in BFP and ESF coverage due to current fiscal austerity on the U5MR, and compared this scenario with a scenario where these programmes maintain the levels of social protection by increasing or decreasing with the size of Brazil’s vulnerable populations (policy response scenarios). We used fixed effects multivariate regression models including BFP and ESF coverage and accounting for secular trends, demographic and socioeconomic changes, and programme duration effects. With the maintenance of the levels of social protection provided by the BFP and ESF, in the most likely economic crisis scenario the U5MR is expected to be 8.57% (95% CI: 6.88%–10.24%) lower in 2030 than under fiscal austerity—a cumulative 19,732 (95% CI: 10,207–29,285) averted under-five deaths between 2017 and 2030. U5MRs from diarrhoea, malnutrition, and lower respiratory tract infections are projected to be 39.3% (95% CI: 36.9%–41.8%), 35.8% (95% CI: 31.5%–39.9%), and 8.5% (95% CI: 4.1%–12.0%) lower, respectively, in 2030 under the maintenance of BFP and ESF coverage, with 123,549 fewer under-five hospitalisations from all causes over the study period. Reduced coverage of the BFP and ESF will also disproportionately affect U5MR in the most vulnerable areas, with the U5MR in the poorest quintile of municipalities expected to be 11.0% (95% CI: 8.0%–13.8%) lower in 2030 under the maintenance of BFP and ESF levels of social protection than under fiscal austerity, compared to no difference in the richest quintile. Declines in health inequalities over the last decade will also stop under a fiscal austerity scenario: the U5MR concentration index is expected to remain stable over the period 2017–2030, compared to a 13.3% (95% CI: 5.6%–21.8%) reduction under the maintenance of BFP and ESF levels of protection. Limitations of our analysis are the ecological nature of the study, uncertainty around future macroeconomic scenarios, and potential changes in other factors affecting child health. A wide range of sensitivity analyses were conducted to minimise these limitations. Conclusions The implementation of fiscal austerity measures in Brazil can be responsible for substantively higher childhood morbidity and mortality than expected under maintenance of social protection—threatening attainment of Sustainable Development Goals for child health and reducing inequality. PMID:29787574

Tackling the Sustainability Dilemma: A Holistic Approach to Preparing Students for the Professional Organization

ERIC Educational Resources Information Center

Mabry, Sibylle

2011-01-01

Increased knowledge of business sustainability as the basis of a holistic approach to value creation has inspired many managers to integrate ecological and social stewardship into their strategic business innovation plans. However, the coverage of sustainability issues in business courses remains small at many universities. This article…

The State of the Digital Humanities: A Report and a Critique

ERIC Educational Resources Information Center

Liu, Alan

2012-01-01

The scholarly field of the digital humanities has recently expanded and integrated its fundamental concepts, historical coverage, relationship to social experience, scale of projects, and range of interpretive approaches. All this brings the overall field (including the related area of new media studies) to a tipping point where it has the…

Hiroshima: Perspectives on the Atomic Bombing.

ERIC Educational Resources Information Center

Cheng, Amy

In this curriculum module students analyze both U.S. and Japanese perspectives of the atomic bombing of Hiroshima. The activities integrate Howard Gardner's work on multiple intelligences. The module is recommended as a supplement to textbook coverage of the war in the Pacific and of the atomic bombing of Hiroshima. It can be used to support both…

Opinion Integration and Summarization

ERIC Educational Resources Information Center

Lu, Yue

2011-01-01

As Web 2.0 applications become increasingly popular, more and more people express their opinions on the Web in various ways in real time. Such wide coverage of topics and abundance of users make the Web an extremely valuable source for mining people's opinions about all kinds of topics. However, since the opinions are usually expressed as…

Are Two Systemic Fish Assemblage Sampling Programmes on the Upper Mississippi River Telling Us the Same Thing?

EPA Science Inventory

We applied an Index of Biotic Integrity (IBI) used on the Upper Mississippi River (UMR) to compare data from three sampling programs. Ability to use multiple sampling programs could greatly extend spatial and temporal coverage of river assessment and monitoring efforts. We an...

78 FR 41873 - Energy Conservation Program for Consumer Products and Certain Commercial and Industrial Equipment...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-12

... limited to) desktop computers, integrated desktop computers, laptop/notebook/ netbook computers, and... computer, and 65% of U.S. households owning a notebook, laptop, or netbook computer, in 2013.\\4\\ Coverage... recently published studies. In these studies, the average annual energy use for a desktop computer was...

Protecting Investments: Third-Party Warranty Coverage for Tablets

ERIC Educational Resources Information Center

Sands, Austin

2012-01-01

A year ago, only a handful of K-12 schools and universities had integrated tablets into their curricula. Today, not one week passes with out another iPad rollout announcement. The reasons that schools use tablets are as varied as the schools themselves. Hawaii Preparatory Academy uses iPads to encourage budding physicists, linguists, and…

Publication of the maps of Tenke and Manono (Zaire) from LANDSAT data

NASA Technical Reports Server (NTRS)

Yampania, M.

1981-01-01

The collection of cartographic data on Zaire up to the present time was based on aerial reconnaissance. This approach is very expensive if repetitive coverage is required in such a large country. The integration with the LANDSAT program among the data collection systems improves the mapping efforts substantially.

Spatial fuel data products of the LANDFIRE Project

Treesearch

Matt Reeves; Kevin C. Ryan; Matthew G. Rollins; Thomas G. Thompson

2009-01-01

The Landscape Fire and Resource Management Planning Tools (LANDFIRE) Project is mapping wildland fuels, vegetation, and fire regime characteristics across the United States. The LANDFIRE project is unique because of its national scope, creating an integrated product suite at 30-m spatial resolution and complete spatial coverage of all lands within the 50...

Rain Volume Estimation over Areas Using Satellite and Radar Data

NASA Technical Reports Server (NTRS)

Doneaud, A. A.; Miller, J. R., Jr.; Johnson, L. R.; Vonderhaar, T. H.; Laybe, P.

1984-01-01

The application of satellite data to a recently developed radar technique used to estimate convective rain volumes over areas on a dry environment (the northern Great Plains) is discussed. The area time integral technique (ATI) provides a means of estimating total rain volumes over fixed and floating target areas of the order of 1,000 to 100,000 km(2) for clusters lasting 40 min. The basis of the method is the existence of a strong correlation between the area coverage integrated over the lifetime of the storm (ATI) and the rain volume. One key element in this technique is that it does not require the consideration of the structure of the radar intensities inside the area coverage to generate rain volumes, but only considers the rain event per se. This fact might reduce or eliminate some sources of error in applying the technique to satellite data. The second key element is that the ATI once determined can be converted to total rain volume by using a constant factor (average rain rate) for a given locale.

The interruption of Onchocerca volvulus and Wuchereria bancrofti transmission by integrated chemotherapy in the Obongi focus, North Western Uganda

PubMed Central

Gabriel, Matwale; Tukahebwa, Edridah; Onapa, Ambrose Winston; Tinkitina, Benjamin; Tukesiga, Ephraim; Nyaraga, Michael; Auma, Anna Mary; Habomugisha, Peace; Byamukama, Edson; Oguttu, David; Katabarwa, Moses; Unnasch, Thomas Raymond

2017-01-01

Intervention Few studies have documented the interruption of onchocerciasis and Lymphatic Filariasis (LF) by integrated chemotherapy in Uganda. The study describes the interruption of transmission of the two diseases co-endemic in Obongi focus, north western Uganda. Base line data for Onchocerciasis and LF were collected in 1994 and 2006, respectively. Annual mass drug administration for onchocerciasis (Ivermectin) and Lymphatic Filariasis (Ivermectin + albendazole) was conducted for 20 and 6 years, respectively. Thereafter, assessments by skin snip, larval searches in rivers and human landing catches were performed. Children <10 years were screened for IgG4 antibodies using Ov16 ELISA technique in 2013. LF Pre-TAS and TAS1 were conducted in sentinel sites. ITN coverage and utilization for the implementation unit was also reported. Intervention coverage Onchocerciasis treatment coverage was <80% but improved with the introduction of CDTI in 1999. While for LF, effective coverage of >65% was achieved in the six treatment rounds. Household ownership of ITN’s and utilization was 96% and 72.4%., respectively. Impact Parasitological examinations conducted for onchocerciasis among 807 adults and children, revealed a reduction in mf prevalence from 58% in 1994 to 0% in 2012. Entomological monitoring conducted at the two sites had no single Simulium damnosum fly caught. Serological analysis using Ov16 ELISA for onchocerciasis revealed that out of the 3,308 children <10 years old screened in 2013, only 3/3308 (0.091%) positive cases were detected. All Ov16 positive children were negative when tested for patent infection by skin snip PCR. A reduction in LF microfilaria prevalence from 2.5% (n = 13/522) in 2006 to 0.0% (n = 602) in 2014 was observed. LF TAS1 conducted in 2015 among 1,532 children 6–7 years, all were negative for antigens of W. bancrofti. Conclusion The results concluded that interruption of onchocerciasis and LF has been achieved. PMID:29253862

How prior expectations shape multisensory perception.

PubMed

Gau, Remi; Noppeney, Uta

2016-01-01

The brain generates a representation of our environment by integrating signals from a common source, but segregating signals from different sources. This fMRI study investigated how the brain arbitrates between perceptual integration and segregation based on top-down congruency expectations and bottom-up stimulus-bound congruency cues. Participants were presented audiovisual movies of phonologically congruent, incongruent or McGurk syllables that can be integrated into an illusory percept (e.g. "ti" percept for visual «ki» with auditory /pi/). They reported the syllable they perceived. Critically, we manipulated participants' top-down congruency expectations by presenting McGurk stimuli embedded in blocks of congruent or incongruent syllables. Behaviorally, participants were more likely to fuse audiovisual signals into an illusory McGurk percept in congruent than incongruent contexts. At the neural level, the left inferior frontal sulcus (lIFS) showed increased activations for bottom-up incongruent relative to congruent inputs. Moreover, lIFS activations were increased for physically identical McGurk stimuli, when participants segregated the audiovisual signals and reported their auditory percept. Critically, this activation increase for perceptual segregation was amplified when participants expected audiovisually incongruent signals based on prior sensory experience. Collectively, our results demonstrate that the lIFS combines top-down prior (in)congruency expectations with bottom-up (in)congruency cues to arbitrate between multisensory integration and segregation. Copyright © 2015 Elsevier Inc. All rights reserved.

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.

US Health Care Reform and Transplantation, Part II: impact on the public sector and novel health care delivery systems.

PubMed

Axelrod, D A; Millman, D; Abecassis, M M

2010-10-01

The Patient Protection and Affordable Care Act passed in 2010 will result in dramatic expansion of publically funded health insurance coverage for low-income individuals. It is estimated that of the 32 million newly insured, 16 million will obtain coverage through expansion of the Medicaid Program, and the remaining 16 million will purchase coverage through their employer or newly legislated insurance exchanges. While the Act contains numerous provisions to improve access to private insurance as discussed in Part I of this analysis, public sector coverage will significantly be affected. The cost of health care reform will be borne disproportionately by Medicare, which faces nearly $500 billion in cuts to be identified by a new independent board. Transplant centers should be concerned about the impact of the reform on the financial aspects of transplantation. In addition, this legislation also utilizes the Medicare Program to drive reform of the health care delivery system, by encouraging the development of integrated Accountable Care Organizations, experimentation with new 'models' of healthcare delivery, and expanded support for Comparative Effectiveness Research. Transplant providers, including transplant centers and physicians/surgeons need to lead this movement, drawing on our experience providing comprehensive multidisciplinary care under global budgets with publically reported outcomes.

Comparison of the endothelial coverage in everolimus and zotarolimus-eluting stents in normal, atherosclerotic, and bifurcation rabbit iliac arteries.

PubMed

Torii, Sho; Nakazawa, Gaku; Ijichi, Takeshi; Yoshikawa, Ayako; Ohno, Yohei; Ikari, Yuji

2018-01-01

The aim of this study is to evaluate differences in stent endothelial coverage among the second generation of drug-eluting stents. Incomplete stent coverage is one of the major causes of late stent thrombosis. Rabbits fed a normal diet received an everolimus (Xience Prime; EES) and a zotarolimus-eluting stent (Resolute Integrity; R-ZES) in each iliac artery, followed by sacrifice at 14 and 28 days after stent implantation. In addition, a group of atherosclerotic rabbits similarly received EES and R-ZES, and were sacrificed at 28 days. The extent of stent endothelial coverage was assessed by scanning electron microscopy. To evaluate endothelial coverage after bifurcation stenting, rabbits received EES and R-ZES placed with culotte stenting at the iliac bifurcation, followed by sacrifice at 14 and 28 days. In rabbits fed a normal diet, the percent uncovered strut area 14 days after stent implantation was significantly higher in R-ZES than in EES (10.1% (IQR 9.8-15.5) vs. 3.0% (IQR 1.5-9.7), p = 0.03), whereas it was not significantly different at 28-days (3.9% (IQR 0.8-10.3) vs. 1.0% (IQR 0.0-2.8), p = 0.2). In rabbits with induced atheroma, R-ZES also showed less endothelial coverage 28 days after stent implantation (5.3% (IQR 2.2-9.9) vs. 1.1% (IQR 0-6.2), p = 0.03). In the culotte stenting model, the percent uncovered strut area of the proximal overlapped segment was significantly higher in R-ZES at 14 days (15.8% (IQR 14.3-17.7) vs. 8.8% (IQR 8.3-9.8), p = 0.03) and 28 days (9.9% (IQR 4.1-13.9) vs. 2.5% (IQR 1.6-6.7), p = 0.04) after stent implantation. The carina area also showed a better coverage in EES compared with R-ZES. EES showed a better stent endothelial coverage compared with R-ZES after stent implantation in the early phase in normals, in arteries with lipid rich plaque, and in bifurcation stented sites.

Securing insurance protection against fraud and abuse liability.

PubMed

Callison, S

1999-07-01

Healthcare organizations concerned about corporate compliance need to review securing appropriate insurance coverage as part of their corporate compliance program. Provider organizations often mistakenly expect that their directors and officers liability (D&O), malpractice, or standard errors and omissions (E&O) insurance policies will cover the cost of Medicare fraud and abuse fines. The insurance industry has developed a specific billing E&O insurance product to cover providers that run afoul of government fraud and abuse statutes.

Insurance companies' point of view toward moral hazard incentives.

PubMed

Khorasani, Elahe; Keyvanara, Mahmoud; Etemadi, Manal; Asadi, Somayeh; Mohammadi, Mahan; Barati, Maryam

2016-01-01

Moral hazards are the result of an expansive range of factors mostly originating in the patients' roles. The objective of the present study was to investigate patient incentives for moral hazards using the experiences of experts of basic Iranian insurance organizations. This was a qualitative research. Data were collected through semi-structured interviews. The study population included all experts of basic healthcare insurance agencies in the City of Isfahan, Iran, who were familiar with the topic of moral hazards. A total of 18 individuals were selected through purposive sampling and interviewed and some criteria such as data reliability and stability were considered. The anonymity of the interviewees was preserved. The data were transcribed, categorized, and then, analyzed through thematic analysis method. Through thematic analysis, 2 main themes and 11 subthemes were extracted. The main themes included economic causes and moral-cultural causes affecting the phenomenon of moral hazards resulted from patients' roles. Each of these themes has some sub-themes. False expectations from insurance companies are rooted in the moral and cultural values of individuals. People with the insurance coverage make no sense if using another person insurance identification or requesting physicians for prescribing the medicines. These expectations will lead them to moral hazards. Individuals with any insurance coverage should consider the rights of insurance agencies as third party payers and supportive organizations which disburden them from economical loads in the time of sickness.

EVA: Evryscopes for the Arctic and Antarctic

NASA Astrophysics Data System (ADS)

Richichi, A.; Law, N.; Tasuya, O.; Fors, O.; Dennihy, E.; Carlberg, R.; Tuthill, P.; Ashley, M.; Soonthornthum, B.

2017-06-01

We are planning to build Evryscopes for the Arctic and Antarctic (EVA), which will enable the first ultra-wide-field, high-cadence sky survey to be conducted from both Poles. The system is based on the successful Evryscope concept, already installed and operating since 2015 at Cerro Tololo in Chile with the following characteristics: robotic operation, 8,000 square degrees simultaneous sky coverage, 2-minute cadence, milli-mag level photometric accuracy, pipelined data processing for real-time analysis and full data storage for off-line analysis. The initial location proposed for EVA is the PEARL station on Ellesmere island; later also an antarctic location shall be selected. The science goals enabled by this unique combination of almost full-sky coverage and high temporal cadence are numerous, and include among others ground-breaking forays in the fields of exoplanets, stellar variability, asteroseismology, supernovae and other transient events. The EVA polar locations will enable uninterrupted observations lasting in principle over weeks and months. EVA will be fully robotic. We discuss the EVA science drivers and expected results, and present the logistics and the outline of the project which is expected to have first light in the winter of 2018. The cost envelope can be kept very competitive thanks to R&D already employed for the CTIO Evryscope, to our experience with both Arctic and Antarctic locations, and to the use of off-the-shelf components.

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.

Integration of population census and water point mapping data-A case study of Cambodia, Liberia and Tanzania.

PubMed

Yu, Weiyu; Wardrop, Nicola A; Bain, Robert; Wright, Jim A

2017-07-01

Sustainable Development Goal (SDG) 6 has expanded the Millennium Development Goals' focus from improved drinking-water to safely managed water services. This expanded focus to include issues such as water quality requires richer monitoring data and potentially integration of datasets from different sources. Relevant data sets include water point mapping (WPM), the survey of boreholes, wells and other water points, census and household survey data. This study examined inconsistencies between population census and WPM datasets for Cambodia, Liberia and Tanzania, and identified potential barriers to integrating the two datasets to meet monitoring needs. Literatures on numbers of people served per water point were used to convert WPM data to population served by water source type per area and compared with census reports. For Cambodia and Tanzania, discrepancies with census data suggested incomplete WPM coverage. In Liberia, where the data sets were consistent, WPM-derived data on functionality, quantity and quality of drinking water were further combined with census area statistics to generate an enhanced drinking-water access measure for protected wells and springs. The process revealed barriers to integrating census and WPM data, including exclusion of water points not used for drinking by households, matching of census and WPM source types; temporal mismatches between data sources; data quality issues such as missing or implausible data values, and underlying assumptions about population served by different water point technologies. However, integration of these two data sets could be used to identify and rectify gaps in WPM coverage. If WPM databases become more complete and the above barriers are addressed, it could also be used to develop more realistic measures of household drinking-water access for monitoring. Copyright © 2017 Elsevier GmbH. All rights reserved.

Design of integrated ship monitoring system using SAR, RADAR, and AIS

NASA Astrophysics Data System (ADS)

Yang, Chan-Su; Kim, Tae-Ho; Hong, Danbee; Ahn, Hyung-Wook

2013-06-01

When we talk about for the ship detection, identification and its classification, we need to go for the wide area of monitoring and it may be possible only through satellite based monitoring approach which monitors and covers coastal as well as the oceanic zone. Synthetic aperture radar (SAR) has been widely used to detect targets of interest with the advantage of the operating capability in all weather and luminance free condition (Margarit and Tabasco, 2011). In EU waters, EMSA(European Maritime Safety Agency) is operating the SafeSeaNet and CleanSeaNet systems which provide the current positions of all ships and oil spill monitoring information in and around EU waters in a single picture to Member States using AIS, LRIT and SAR images. In many countries, a similar system has been developed and the key of the matter is to integrate all available data. This abstract describes the preliminary design concept for an integration system of RADAR, AIS and SAR data for vessel traffic monitoring. SAR sensors are used to acquire image data over large coverage area either through the space borne or airborne platforms in UTC. AIS reports should be also obtained on the same date as of the SAR acquisition for the purpose to perform integration test. Land-based RADAR can provide ships positions detected and tracked in near real time. In general, SAR are used to acquire image data over large coverage area, AIS reports are obtained from ship based transmitter, and RADAR can monitor continuously ships for a limited area. In this study, we developed individual ship monitoring algorithms using RADAR(FMCW and Pulse X-band), AIS and SAR(RADARSAT-2 Full-pol Mode). We conducted field experiments two times for displaying the RADAR, AIS and SAR integration over the Pyeongtaek Port, South Korea.

High-throughput optical inter-board interconnects for next-generation on-board digital transparent processors

NASA Astrophysics Data System (ADS)

Venet, N.; Sotom, M.; Gachon, H.; Foucal, V.; Pez, M.; Heikkinen, V.; Tuominen, T.; Pantoja, S.

2017-11-01

The satellite telecommunication sector is continuously facing new challenges. Operators turn towards increasing capacity payloads with higher number of beams and broader bandwidth, in order to cope with exhausting orbital positions and to lower the cost of in-orbit delivery of bit. Only satellites able to provide high data rate connections to numerous users are expected to achieve affordable communication prices. On the other hand, as the telecom market grows and the range of offered services (HDTV, Video On Demand, Triple Play), operators call for more versatile solutions to quickly grasp new markets and to adapt to these evolutions over the average 15 years of a satellite lifetime. Flexible payloads have found an increasing interest for a number of years. Flexibility is considered as a means for a better commercial exploitation of a satellite fleet and a better allocation of resource in response to traffic evolution and/or changing business plans, with potential advantages such as a wider range of applications, less customization for specific missions, increased production runs of equipment, enhancement of reliability, reduction of equipment cost, reduction of program schedules [1]. Flexibility is expected to be offered in spectrum management and frequency plan, in coverage, or in the repeater power allocation. The industry is taking up the challenge both by improving current telecom satellites and offering new payload technology, more flexible and able to address the new markets. From a system integrator perspective, flexibility is as an opportunity to design more generic payloads, that can be customized during or after fabrication only, thus shortening the design-to-manufacturing cycle, and improving the industry competitiveness.

Generalizable Class Solutions for Treatment Planning of Spinal Stereotactic Body Radiation Therapy

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

Weksberg, David C.; Palmer, Matthew B.; Vu, Khoi N.

2012-11-01

Purpose: Spinal stereotactic body radiation therapy (SBRT) continues to emerge as an effective therapeutic approach to spinal metastases; however, treatment planning and delivery remain resource intensive at many centers, which may hamper efficient implementation in clinical practice. We sought to develop a generalizable class solution approach for spinal SBRT treatment planning that would allow confidence that a given plan provides optimal target coverage, reduce integral dose, and maximize planning efficiency. Methods and Materials: We examined 91 patients treated with spinal SBRT at our institution. Treatment plans were categorized by lesion location, clinical target volume (CTV) configuration, and dose fractionation scheme,more » and then analyzed to determine the technically achievable dose gradient. A radial cord expansion was subtracted from the CTV to yield a planning CTV (pCTV) construct for plan evaluation. We reviewed the treatment plans with respect to target coverage, dose gradient, integral dose, conformality, and maximum cord dose to select the best plans and develop a set of class solutions. Results: The class solution technique generated plans that maintained target coverage and improved conformality (1.2-fold increase in the 95% van't Riet Conformation Number describing the conformality of a reference dose to the target) while reducing normal tissue integral dose (1.3-fold decrease in the volume receiving 4 Gy (V{sub 4Gy}) and machine output (19% monitor unit (MU) reduction). In trials of planning efficiency, the class solution technique reduced treatment planning time by 30% to 60% and MUs required by {approx}20%: an effect independent of prior planning experience. Conclusions: We have developed a set of class solutions for spinal SBRT that incorporate a pCTV metric for plan evaluation while yielding dosimetrically superior treatment plans with increased planning efficiency. Our technique thus allows for efficient, reproducible, and high-quality spinal SBRT treatment planning.« less

Keeping All the PIECES: Phylogenetically Informed Ex Situ Conservation of Endangered Species.

PubMed

Larkin, Daniel J; Jacobi, Sarah K; Hipp, Andrew L; Kramer, Andrea T

2016-01-01

Ex situ conservation in germplasm and living collections is a major focus of global plant conservation strategies. Prioritizing species for ex situ collection is a necessary component of this effort for which sound strategies are needed. Phylogenetic considerations can play an important role in prioritization. Collections that are more phylogenetically diverse are likely to encompass more ecological and trait variation, and thus provide stronger conservation insurance and richer resources for future restoration efforts. However, phylogenetic criteria need to be weighed against other, potentially competing objectives. We used ex situ collection and threat rank data for North American angiosperms to investigate gaps in ex situ coverage and phylogenetic diversity of collections and to develop a flexible framework for prioritizing species across multiple objectives. We found that ex situ coverage of 18,766 North American angiosperm taxa was low with respect to the most vulnerable taxa: just 43% of vulnerable to critically imperiled taxa were in ex situ collections, far short of a year-2020 goal of 75%. In addition, species held in ex situ collections were phylogenetically clustered (P < 0.001), i.e., collections comprised less phylogenetic diversity than would be expected had species been drawn at random. These patterns support incorporating phylogenetic considerations into ex situ prioritization in a manner balanced with other criteria, such as vulnerability. To meet this need, we present the 'PIECES' index (Phylogenetically Informed Ex situ Conservation of Endangered Species). PIECES integrates phylogenetic considerations into a flexible framework for prioritizing species across competing objectives using multi-criteria decision analysis. Applying PIECES to prioritizing ex situ conservation of North American angiosperms, we show strong return on investment across multiple objectives, some of which are negatively correlated with each other. A spreadsheet-based decision support tool for North American angiosperms is provided; this tool can be customized to align with different conservation objectives.

Toward universal coverage in Afghanistan: A multi-stakeholder assessment of capacity investments in the community health worker system.

PubMed

Edward, Anbrasi; Branchini, Casey; Aitken, Iain; Roach, Melissa; Osei-Bonsu, Kojo; Arwal, Said Habib

2015-11-01

Global efforts to scale-up the community health workforce have accelerated as a result of the growing evidence of their effectiveness to enhance coverage and health outcomes. Reconstruction efforts in Afghanistan integrated capacity investments for community based service delivery, including the deployment of over 28,000 community health workers (CHWs) to ensure access to basic preventive and curative services. The study aimed to conduct capacity assessments of the CHW system and determine stakeholder perspectives of CHW performance. Structured interviews were conducted on a national sample from 33 provinces and included supervisors, facility providers, patients, and CHWs. Formative assessments were also conducted with national policymakers, community members and health councils in two provinces. Results indicate that more than 70% of the NGO's provide comprehensive training for CHWs, 95% CHWs reported regular supervision, and more than 60% of the health posts had adequate infrastructure and essential commodities. Innovative strategies of paired male and female CHWs, institution of a special cadre of community health supervisors, and community health councils were introduced as systems strengthening mechanisms. Reported barriers included unrealistic and expanding task expectations (14%), unsatisfactory compensation mechanisms (75%), inadequate transport (69%), and lack of commodities (40%). Formative assessments evidenced that CHWs were highly valued as they provided equitable, accessible and affordable 24-h care. Their loyalty, dedication and the ability for women to access care without male family escorts was appreciated by communities. With rising concerns of workforce deficits, insecurity and budget constraints, the health system must enhance the capacity of these frontline workers to improve the continuum of care. The study provides critical insight into the strengths and constraints of Afghanistan's CHW system, warranting further efforts to contextualize service delivery and mechanisms for their support and motivation. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Single Junction InGaP/GaAs Solar Cells Grown on Si Substrates using SiGe Buffer Layers

NASA Technical Reports Server (NTRS)

Ringel, S. A.; Carlin, J. A.; Andre, C. L.; Hudait, M. K.; Gonzalez, M.; Wilt, D. M.; Clark, E. B.; Jenkins, P.; Scheiman, D.; Allerman, A.

2002-01-01

Single junction InGaP/GaAs solar cells displaying high efficiency and record high open circuit voltage values have been grown by metalorganic chemical vapor deposition on Ge/graded SiGe/Si substrates. Open circuit voltages as high as 980 mV under AM0 conditions have been verified to result from a single GaAs junction, with no evidence of Ge-related sub-cell photoresponse. Current AM0 efficiencies of close to 16% have been measured for a large number of small area cells, whose performance is limited by non-fundamental current losses due to significant surface reflection resulting from greater than 10% front surface metal coverage and wafer handling during the growth sequence for these prototype cells. It is shown that at the material quality currently achieved for GaAs grown on Ge/SiGe/Si substrates, namely a 10 nanosecond minority carrier lifetime that results from complete elimination of anti-phase domains and maintaining a threading dislocation density of approximately 8 x 10(exp 5) per square centimeter, 19-20% AM0 single junction GaAs cells are imminent. Experiments show that the high performance is not degraded for larger area cells, with identical open circuit voltages and higher short circuit current (due to reduced front metal coverage) values being demonstrated, indicating that large area scaling is possible in the near term. Comparison to a simple model indicates that the voltage output of these GaAs on Si cells follows ideal behavior expected for lattice mismatched devices, demonstrating that unaccounted for defects and issues that have plagued other methods to epitaxially integrate III-V cells with Si are resolved using SiGe buffers and proper GaAs nucleation methods. These early results already show the enormous and realistic potential of the virtual SiGe substrate approach for generating high efficiency, lightweight and strong III-V solar cells.

Keeping All the PIECES: Phylogenetically Informed Ex Situ Conservation of Endangered Species

PubMed Central

Larkin, Daniel J.; Jacobi, Sarah K.; Hipp, Andrew L.; Kramer, Andrea T.

2016-01-01

Ex situ conservation in germplasm and living collections is a major focus of global plant conservation strategies. Prioritizing species for ex situ collection is a necessary component of this effort for which sound strategies are needed. Phylogenetic considerations can play an important role in prioritization. Collections that are more phylogenetically diverse are likely to encompass more ecological and trait variation, and thus provide stronger conservation insurance and richer resources for future restoration efforts. However, phylogenetic criteria need to be weighed against other, potentially competing objectives. We used ex situ collection and threat rank data for North American angiosperms to investigate gaps in ex situ coverage and phylogenetic diversity of collections and to develop a flexible framework for prioritizing species across multiple objectives. We found that ex situ coverage of 18,766 North American angiosperm taxa was low with respect to the most vulnerable taxa: just 43% of vulnerable to critically imperiled taxa were in ex situ collections, far short of a year-2020 goal of 75%. In addition, species held in ex situ collections were phylogenetically clustered (P < 0.001), i.e., collections comprised less phylogenetic diversity than would be expected had species been drawn at random. These patterns support incorporating phylogenetic considerations into ex situ prioritization in a manner balanced with other criteria, such as vulnerability. To meet this need, we present the ‘PIECES’ index (Phylogenetically Informed Ex situ Conservation of Endangered Species). PIECES integrates phylogenetic considerations into a flexible framework for prioritizing species across competing objectives using multi-criteria decision analysis. Applying PIECES to prioritizing ex situ conservation of North American angiosperms, we show strong return on investment across multiple objectives, some of which are negatively correlated with each other. A spreadsheet-based decision support tool for North American angiosperms is provided; this tool can be customized to align with different conservation objectives. PMID:27257671

Poor drug distribution as a possible explanation for the results of the PRECISE trial.

PubMed

Sampson, John H; Archer, Gary; Pedain, Christoph; Wembacher-Schröder, Eva; Westphal, Manfred; Kunwar, Sandeep; Vogelbaum, Michael A; Coan, April; Herndon, James E; Raghavan, Raghu; Brady, Martin L; Reardon, David A; Friedman, Allan H; Friedman, Henry S; Rodríguez-Ponce, M Inmaculada; Chang, Susan M; Mittermeyer, Stephan; Croteau, David; Puri, Raj K

2010-08-01

Convection-enhanced delivery (CED) is a novel intracerebral drug delivery technique with considerable promise for delivering therapeutic agents throughout the CNS. Despite this promise, Phase III clinical trials employing CED have failed to meet clinical end points. Although this may be due to inactive agents or a failure to rigorously validate drug targets, the authors have previously demonstrated that catheter positioning plays a major role in drug distribution using this technique. The purpose of the present work was to retrospectively analyze the expected drug distribution based on catheter positioning data available from the CED arm of the PRECISE trial. Data on catheter positioning from all patients randomized to the CED arm of the PRECISE trial were available for analyses. BrainLAB iPlan Flow software was used to estimate the expected drug distribution. Only 49.8% of catheters met all positioning criteria. Still, catheter positioning score (hazard ratio 0.93, p = 0.043) and the number of optimally positioned catheters (hazard ratio 0.72, p = 0.038) had a significant effect on progression-free survival. Estimated coverage of relevant target volumes was low, however, with only 20.1% of the 2-cm penumbra surrounding the resection cavity covered on average. Although tumor location and resection cavity volume had no effect on coverage volume, estimations of drug delivery to relevant target volumes did correlate well with catheter score (p < 0.003), and optimally positioned catheters had larger coverage volumes (p < 0.002). Only overall survival (p = 0.006) was higher for investigators considered experienced after adjusting for patient age and Karnofsky Performance Scale score. The potential efficacy of drugs delivered by CED may be severely constrained by ineffective delivery in many patients. Routine use of software algorithms and alternative catheter designs and infusion parameters may improve the efficacy of drugs delivered by CED.

A Dynamic Bayesian Observer Model Reveals Origins of Bias in Visual Path Integration.

PubMed

Lakshminarasimhan, Kaushik J; Petsalis, Marina; Park, Hyeshin; DeAngelis, Gregory C; Pitkow, Xaq; Angelaki, Dora E

2018-06-20

Path integration is a strategy by which animals track their position by integrating their self-motion velocity. To identify the computational origins of bias in visual path integration, we asked human subjects to navigate in a virtual environment using optic flow and found that they generally traveled beyond the goal location. Such a behavior could stem from leaky integration of unbiased self-motion velocity estimates or from a prior expectation favoring slower speeds that causes velocity underestimation. Testing both alternatives using a probabilistic framework that maximizes expected reward, we found that subjects' biases were better explained by a slow-speed prior than imperfect integration. When subjects integrate paths over long periods, this framework intriguingly predicts a distance-dependent bias reversal due to buildup of uncertainty, which we also confirmed experimentally. These results suggest that visual path integration in noisy environments is limited largely by biases in processing optic flow rather than by leaky integration. Copyright © 2018 Elsevier Inc. All rights reserved.

Bibliography on aerodynamics of airframe/engine integration of high-speed turbine-powered aircraft, volume 1

NASA Technical Reports Server (NTRS)

Nichols, M. R.

1980-01-01

This bibliography was developed as a first step in the preparation of a monograph on the subject of the aerodynamics of airframe/engine integration of high speed turbine powered aircraft. It lists 1535 unclassified documents published mainly in the period from 1955 to 1980. Primary emphasis was devoted to aerodynamic problems and interferences encountered in the integration process; however, extensive coverage also was given to the characteristics and problems of the isolated propulsion system elements. A detailed topic breakdown structure is used. The primary contents of the individual documents are indicated by the combination of the document's title and its location within the framework of the bibliography.

Integration of mental health into primary care and community health working in Kenya: context, rationale, coverage and sustainability.

PubMed

Jenkins, Rachel; Kiima, David; Okonji, Marx; Njenga, Frank; Kingora, James; Lock, Sarah

2010-03-01

Integration of mental health into primary care is essential to meet population needs yet faces many challenges if such projects are to achieve impact and be sustainable in low income countries alongside other competing priorities. This paper describes the rationale and progress of a collaborative project in Kenya to train primary care and community health workers about mental health and integrate mental health into their routine work, Within a health systems strengthening approach. So far 1877 health workers have been trained. The paper describes the multiple challenges faced by the project, and reviews the mechanisms deployed which have strengthened its impact and sustainability to date.

Analysis for predicting adiabatic wall temperatures with single hole coolant injection into a low speed crossflow

NASA Astrophysics Data System (ADS)

Wang, C. R.; Papell, S. S.; Graham, R. W.

Assuming the local adiabatic wall temperature equals the local total temperature in a low speed coolant mixing layer, integral conservation equations with and without the boundary layer effects are formulated for the mixing layer downstream of a single coolant injection hole oriented at a 30 degree angle to the crossflow. These equations are solved numerically to determine the center line local adiabatic wall temperature and the effective coolant coverage area. Comparison of the numerical results with an existing film cooling experiment indicates that the present analysis permits a simplified but reasonably accurate prediction of the centerline effectiveness and coolant coverage area downstream of a single hole crossflow streamwise injection at 30 degree inclination angle.

Analysis for predicting adiabatic wall temperatures with single hole coolant injection into a low speed crossflow

NASA Technical Reports Server (NTRS)

Wang, C. R.; Papell, S. S.; Graham, R. W.

1981-01-01

Assuming the local adiabatic wall temperature equals the local total temperature in a low speed coolant mixing layer, integral conservation equations with and without the boundary layer effects are formulated for the mixing layer downstream of a single coolant injection hole oriented at a 30 degree angle to the crossflow. These equations are solved numerically to determine the center line local adiabatic wall temperature and the effective coolant coverage area. Comparison of the numerical results with an existing film cooling experiment indicates that the present analysis permits a simplified but reasonably accurate prediction of the centerline effectiveness and coolant coverage area downstream of a single hole crossflow streamwise injection at 30 degree inclination angle.

Analysis for predicting adiabatic wall temperatures with single hole coolant injection into a low speed crossflow

NASA Astrophysics Data System (ADS)

Wang, C. R.; Papell, S. S.; Graham, R. W.

1981-03-01

Assuming the local adiabatic wall temperature equals the local total temperature in a low speed coolant mixing layer, integral conservation equations with and without the boundary layer effects are formulated for the mixing layer downstream of a single coolant injection hole oriented at a 30 degree angle to the crossflow. These equations are solved numerically to determine the center-line local adiabatic wall temperature and the effective coolant coverage area. Comparison of the numerical results with an existing film cooling experiment indicates that the present analysis permits a simplified but reasonably accurate prediction of the centerline effectiveness and coolant coverage area downstream of a single hole crossflow streamwise injection at 30-deg inclination angle.

Analysis for predicting adiabatic wall temperatures with single hole coolant injection into a low speed crossflow

NASA Technical Reports Server (NTRS)

Wang, C. R.; Papell, S. S.; Graham, R. W.

1981-01-01

Assuming the local adiabatic wall temperature equals the local total temperature in a low speed coolant mixing layer, integral conservation equations with and without the boundary layer effects are formulated for the mixing layer downstream of a single coolant injection hole oriented at a 30 degree angle to the crossflow. These equations are solved numerically to determine the center-line local adiabatic wall temperature and the effective coolant coverage area. Comparison of the numerical results with an existing film cooling experiment indicates that the present analysis permits a simplified but reasonably accurate prediction of the centerline effectiveness and coolant coverage area downstream of a single hole crossflow streamwise injection at 30-deg inclination angle.

The XMM Large Scale Structure Survey

NASA Astrophysics Data System (ADS)

Pierre, Marguerite

2005-10-01

We propose to complete, by an additional 5 deg2, the XMM-LSS Survey region overlying the Spitzer/SWIRE field. This field already has CFHTLS and Integral coverage, and will encompass about 10 deg2. The resulting multi-wavelength medium-depth survey, which complements XMM and Chandra deep surveys, will provide a unique view of large-scale structure over a wide range of redshift, and will show active galaxies in the full range of environments. The complete coverage by optical and IR surveys provides high-quality photometric redshifts, so that cosmological results can quickly be extracted. In the spirit of a Legacy survey, we will make the raw X-ray data immediately public. Multi-band catalogues and images will also be made available on short time scales.

[The health system of Colombia].

PubMed

Guerrero, Ramiro; Gallego, Ana Isabel; Becerril-Montekio, Victor; Vásquez, Johanna

2011-01-01

This document briefly describes the health conditions of the Colombian population and, in more detail, the characteristics of the Colombian health system. The description of the system includes its structure and coverage; financing sources; expenditure in health; physical material and human resources available; monitoring and evaluation procedures; and mechanisms through which the population participates in the evaluation of the system. Salient among the most recent innovations implemented in the Colombian health system are the modification of the Compulsory Health Plan and the capitation payment unit, the vertical integration of the health promotion enterprises and the institutions in charge of the provision of services and the mobilization of additional resources to meet the objectives of universal coverage and the homologation of health benefits among health regimes.

Polar Environmental Monitoring

NASA Technical Reports Server (NTRS)

Nagler, R. G.; Schulteis, A. C.

1979-01-01

The present and projected benefits of the polar regions were reviewed and then translated into information needs in order to support the array of polar activities anticipated. These needs included measurement sensitivities for polar environmental data (ice/snow, atmosphere, and ocean data for integrated support) and the processing and delivery requirements which determine the effectiveness of environmental services. An assessment was made of how well electromagnetic signals can be converted into polar environmental information. The array of sensor developments in process or proposed were also evaluated as to the spectral diversity, aperture sizes, and swathing capabilities available to provide these measurements from spacecraft, aircraft, or in situ platforms. Global coverage and local coverage densification options were studied in terms of alternative spacecraft trajectories and aircraft flight paths.

Typical and atypical brain development: a review of neuroimaging studies

PubMed Central

Dennis, Emily L.; Thompson, Paul M.

2013-01-01

In the course of development, the brain undergoes a remarkable process of restructuring as it adapts to the environment and becomes more efficient in processing information. A variety of brain imaging methods can be used to probe how anatomy, connectivity, and function change in the developing brain. Here we review recent discoveries regarding these brain changes in both typically developing individuals and individuals with neurodevelopmental disorders. We begin with typical development, summarizing research on changes in regional brain volume and tissue density, cortical thickness, white matter integrity, and functional connectivity. Space limits preclude the coverage of all neurodevelopmental disorders; instead, we cover a representative selection of studies examining neural correlates of autism, attention deficit/hyperactivity disorder, Fragile X, 22q11.2 deletion syndrome, Williams syndrome, Down syndrome, and Turner syndrome. Where possible, we focus on studies that identify an age by diagnosis interaction, suggesting an altered developmental trajectory. The studies we review generally cover the developmental period from infancy to early adulthood. Great progress has been made over the last 20 years in mapping how the brain matures with MR technology. With ever-improving technology, we expect this progress to accelerate, offering a deeper understanding of brain development, and more effective interventions for neurodevelopmental disorders. PMID:24174907

Development of a Short Form of the Abridged Big Five-Dimensional Circumplex Model to Aid with the Organization of Personality Traits.

PubMed

Bucher, Meredith A; Samuel, Douglas B

2018-02-01

Although there has been widespread consensus on the use of the Five-Factor Model (FFM) of general personality functioning in personality research, there are various, diverse models of the lower order traits of the FFM domains. Given the usefulness of these finer grained traits, it is imperative to integrate facets proposed across a variety of models and eventually reach consensus on the lower level traits of the FFM. Due to its depth and coverage, the Abridged Big Five-Dimensional Circumplex (AB5C) model potentially provides a useful framework for organizing various faceted models due to its conceptual organization and inclusiveness. The only measure of this model-the IPIP-AB5C-has shown promise, but is limited by its length (i.e., 485 items). This study developed an abbreviated version of the IPIP-AB5C using an iterative process including item response theory methods. The shorter version maintained key features of the long form including a factor structure that matched the full form as well as facets that correlated in expected ways with other FFM measures. Building on this support, the short form was used to contextualize and organize the facets from 2 commonly used measures.

Typical and atypical brain development: a review of neuroimaging studies.

PubMed

Dennis, Emily L; Thompson, Paul M

2013-09-01

In the course of development, the brain undergoes a remarkable process of restructuring as it adapts to the environment and becomes more efficient in processing information. A variety of brain imaging methods can be used to probe how anatomy, connectivity, and function change in the developing brain. Here we review recent discoveries regarding these brain changes in both typically developing individuals and individuals with neurodevelopmental disorders. We begin with typical development, summarizing research on changes in regional brain volume and tissue density, cortical thickness, white matter integrity, and functional connectivity. Space limits preclude the coverage of all neurodevelopmental disorders; instead, we cover a representative selection of studies examining neural correlates of autism, attention deficit/hyperactivity disorder, Fragile X, 22q11.2 deletion syndrome, Williams syndrome, Down syndrome, and Turner syndrome. Where possible, we focus on studies that identify an age by diagnosis interaction, suggesting an altered developmental trajectory. The studies we review generally cover the developmental period from infancy to early adulthood. Great progress has been made over the last 20 years in mapping how the brain matures with MR technology. With ever-improving technology, we expect this progress to accelerate, offering a deeper understanding of brain development, and more effective interventions for neurodevelopmental disorders.

SLEPR: A Sample-Level Enrichment-Based Pathway Ranking Method — Seeking Biological Themes through Pathway-Level Consistency

PubMed Central

Yi, Ming; Stephens, Robert M.

2008-01-01

Analysis of microarray and other high throughput data often involves identification of genes consistently up or down-regulated across samples as the first step in extraction of biological meaning. This gene-level paradigm can be limited as a result of valid sample fluctuations and biological complexities. In this report, we describe a novel method, SLEPR, which eliminates this limitation by relying on pathway-level consistencies. Our method first selects the sample-level differentiated genes from each individual sample, capturing genes missed by other analysis methods, ascertains the enrichment levels of associated pathways from each of those lists, and then ranks annotated pathways based on the consistency of enrichment levels of individual samples from both sample classes. As a proof of concept, we have used this method to analyze three public microarray datasets with a direct comparison with the GSEA method, one of the most popular pathway-level analysis methods in the field. We found that our method was able to reproduce the earlier observations with significant improvements in depth of coverage for validated or expected biological themes, but also produced additional insights that make biological sense. This new method extends existing analyses approaches and facilitates integration of different types of HTP data. PMID:18818771

Acoustic window planning for ultrasound acquisition.

PubMed

Göbl, Rüdiger; Virga, Salvatore; Rackerseder, Julia; Frisch, Benjamin; Navab, Nassir; Hennersperger, Christoph

2017-06-01

Autonomous robotic ultrasound has recently gained considerable interest, especially for collaborative applications. Existing methods for acquisition trajectory planning are solely based on geometrical considerations, such as the pose of the transducer with respect to the patient surface. This work aims at establishing acoustic window planning to enable autonomous ultrasound acquisitions of anatomies with restricted acoustic windows, such as the liver or the heart. We propose a fully automatic approach for the planning of acquisition trajectories, which only requires information about the target region as well as existing tomographic imaging data, such as X-ray computed tomography. The framework integrates both geometrical and physics-based constraints to estimate the best ultrasound acquisition trajectories with respect to the available acoustic windows. We evaluate the developed method using virtual planning scenarios based on real patient data as well as for real robotic ultrasound acquisitions on a tissue-mimicking phantom. The proposed method yields superior image quality in comparison with a naive planning approach, while maintaining the necessary coverage of the target. We demonstrate that by taking image formation properties into account acquisition planning methods can outperform naive plannings. Furthermore, we show the need for such planning techniques, since naive approaches are not sufficient as they do not take the expected image quality into account.

Examination of the "CSI Effect" on Perceptions of Scientific and Testimonial Evidence in a Hong Kong Chinese Sample.

PubMed

Hui, Cora Y T; Lo, T Wing

2017-05-01

Television is a powerful medium through which to convey information and messages to the public. The recent proliferation of forensic science and criminal justice information throughout all forms of media, coupled with raised expectations toward forensic evidence, has led some to suspect that a "CSI effect" ( Crime Scene Investigation effect) is taking place. The present study contributes to the literature addressing the CSI effect in two ways. First, it examines whether the CSI effect exists in the Chinese population of Hong Kong. Second, using a mock-jury paradigm, it empirically examines a more integrative perspective of the CSI effect. It was found that, although the amount of media coverage involving forensic evidence does influence participants' perception of legal evidence to some degree, such a perception does not affect participants' legal decision making. Viewers of forensic dramas were not more likely to convict the defendant when forensic evidence was presented and not less likely to convict when only testimonial evidence was presented. The only significant predictor of the defendant's culpability when scientific evidence was presented was participants' ratings of the reliability of scientific evidence. Results from the present study lend no support to the existence of the CSI effect in Hong Kong.

The search for Pleiades in trait constellations: functional integration and phenotypic selection in the complex flowers of Morrenia brachystephana (Apocynaceae).

PubMed

Baranzelli, M C; Sérsic, A N; Cocucci, A A

2014-04-01

Pollinator-mediated natural selection on single traits, such as corolla tube or spur length, has been well documented. However, flower phenotypes are usually complex, and selection is expected to act on several traits that functionally interact rather than on a single isolated trait. Despite the fact that selection on complex phenotypes is expectedly widespread, multivariate selection modelling on such phenotypes still remains under-explored in plants. Species of the subfamily Asclepiadoideae (Apocynaceae) provide an opportunity to study such complex flower contrivances integrated by fine-scaled organs from disparate developmental origin. We studied the correlation structure among linear floral traits (i) by testing a priori morphological, functional or developmental hypotheses among traits and (ii) by exploring the organization of flower covariation, considering alternative expectations of modular organization or whole flower integration through conditional dependence analysis (CDA) and integration matrices. The phenotypic selection approach was applied to determine whether floral traits involved in the functioning of the pollination mechanism were affected by natural selection. Floral integration was low, suggesting that flowers are organized in more than just one correlation pleiad; our hypothetical functional correlation matrix was significantly correlated with the empirical matrix, and the CDA revealed three putative modules. Analyses of phenotypic selection showed significant linear and correlational gradients, lending support to expectations of functional interactions between floral traits. Significant correlational selection gradients found involved traits of different floral whorls, providing evidence for the existence of functional integration across developmental domains. © 2014 The Authors. Journal of Evolutionary Biology © 2014 European Society For Evolutionary Biology.

Influenza vaccination coverage rates among adults before and after the 2009 influenza pandemic and the reasons for non-vaccination in Beijing, China: A cross-sectional study

PubMed Central

2013-01-01

Background To optimize the vaccination coverage rates in the general population, the status of coverage rates and the reasons for non-vaccination need to be understood. Therefore, the objective of this study was to assess the changes in influenza vaccination coverage rates in the general population before and after the 2009 influenza pandemic (2008/2009, 2009/2010, and 2010/2011 seasons), and to determine the reasons for non-vaccination. Methods In January 2011 we conducted a multi-stage sampling, retrospective, cross-sectional survey of individuals in Beijing who were ≥ 18 years of age using self-administered, anonymous questionnaires. The questionnaire consisted of three sections: demographics (gender, age, educational level, and residential district name); history of influenza vaccination in the 2008/2009, 2009/2010, and 2010/2011 seasons; and reasons for non-vaccination in all three seasons. The main outcome was the vaccination coverage rate and vaccination frequency. Differences among the subgroups were tested using a Pearson’s chi-square test. Multivariate logistic regression was used to determine possible determinants of influenza vaccination uptake. Results A total of 13002 respondents completed the questionnaires. The vaccination coverage rates were 16.9% in 2008/2009, 21.8% in 2009/2010, and 16.7% in 2010/2011. Compared to 2008/2009 and 2010/2011, the higher rate in 2009/2010 was statistically significant (χ2=138.96, p<0.001), and no significant difference existed between 2008/2009 and 2010/2011 (χ2=1.296, p=0.255). Overall, 9.4% of the respondents received vaccinations in all three seasons, whereas 70% of the respondents did not get a vaccination during the same period. Based on multivariate analysis, older age and higher level of education were independently associated with increased odds of reporting vaccination in 2009/2010 and 2010/2011. Among participants who reported no influenza vaccinations over the previous three seasons, the most commonly reported reason for non-vaccination was ‘I don’t think I am very likely to catch the flu’ (49.3%). Conclusions Within the general population of Beijing the vaccination coverage rates were relatively low and did not change significantly after the influenza pandemic. The perception of not expecting to contract influenza was the predominant barrier to influenza vaccination. Further measures are needed to improve influenza vaccination coverage. PMID:23835253

Low-temperature-grown continuous graphene films from benzene by chemical vapor deposition at ambient pressure

NASA Astrophysics Data System (ADS)

Jang, Jisu; Son, Myungwoo; Chung, Sunki; Kim, Kihyeun; Cho, Chunhum; Lee, Byoung Hun; Ham, Moon-Ho

2015-12-01

There is significant interest in synthesizing large-area graphene films at low temperatures by chemical vapor deposition (CVD) for nanoelectronic and flexible device applications. However, to date, low-temperature CVD methods have suffered from lower surface coverage because micro-sized graphene flakes are produced. Here, we demonstrate a modified CVD technique for the production of large-area, continuous monolayer graphene films from benzene on Cu at 100-300 °C at ambient pressure. In this method, we extended the graphene growth step in the absence of residual oxidizing species by introducing pumping and purging cycles prior to growth. This led to continuous monolayer graphene films with full surface coverage and excellent quality, which were comparable to those achieved with high-temperature CVD; for example, the surface coverage, transmittance, and carrier mobilities of the graphene grown at 300 °C were 100%, 97.6%, and 1,900-2,500 cm2 V-1 s-1, respectively. In addition, the growth temperature was substantially reduced to as low as 100 °C, which is the lowest temperature reported to date for pristine graphene produced by CVD. Our modified CVD method is expected to allow the direct growth of graphene in device manufacturing processes for practical applications while keeping underlying devices intact.

First Year Open Enrollment Findings: Health Insurance Coverage for Asian Americans and the Role of Navigators.

PubMed

Chandrasekar, Edwin; Kim, Karen E; Song, Sharon; Paintal, Ranjana; Quinn, Michael T; Vallina, Helen

2016-09-01

The health insurance coverage established by the Patient Protection and Affordable Care Act has created an opportunity to reduce racial/ethnic disparities in healthcare. It is expected that of the 24 million individuals projected to join, nearly one-half will be non-white and one-fourth will speak a language other than English at home. Asian Americans are one of the fastest growing racial/ethnic groups in the USA. The majority are foreign born and experience limited English proficiency. The role of navigators has been shown to increase enrollment rates of public insurance programs. They are trusted for their shared traditions and sense of community. By conducting culturally-targeted outreach, Cambodian, Chinese, Vietnamese, Korean, and Laotian community-based organizations were able to reach individuals for whom the percentage of uninsured is disproportionately high. They enrolled eligible Asians immigrants in coverage despite language barriers and limited health knowledge. Through a collaborative network, a community-level intervention was implemented that was associated with increases in first year marketplace enrollment and greater likelihood of obtaining a primary care physician. Preventable illnesses, lost productivity, and inadequate healthcare are major hardships in immigrant communities that bear similar burdens to society. Bringing primary care to the underserved helps to contain these costs.

Commercial Health Plan Coverage of Selected Treatments for Opioid Use Disorders from 2003 to 2014.

PubMed

Reif, Sharon; Creedon, Timothy B; Horgan, Constance M; Stewart, Maureen T; Garnick, Deborah W

2017-01-01

Opioid use disorders (OUDs) are receiving significant attention in the U.S. as a public health crisis. Access to treatment for OUDs is essential and was expected to improve following implementation of the federal parity law and the Affordable Care Act. This study examines changes in coverage and management of treatments for OUDs (opioid treatment programs (OTPs) as a covered service benefit, buprenorphine as a pharmacy benefit) before, during, and after parity and ACA implementation. Data are from three rounds of a nationally representative survey conducted with commercial health plans regarding behavioral health services in benefit years 2003, 2010, and 2014. Data were weighted to be representative of health plans' commercial products in the continental United States (2003 weighted N = 7,469, 83% response rate; 2010 N = 8,431, 89% response rate; and 2014 N = 6,974, 80% response rate). Results showed treatment for OUDs was covered by nearly all health plan products in each year of the survey, but the types and patterns varied by year. Prior authorization requirements for OTPs have decreased over time. Despite the promise of expanded access to OUD treatment suggested by parity and the ACA, improved health plan coverage for treatment of OUDs, while essential, is not sufficient to address the opioid crisis.

Commercial Health Plan Coverage of Selected Treatments for Opioid Use Disorders from 2003 to 2014

PubMed Central

Reif, Sharon; Creedon, Timothy B.; Horgan, Constance M.; Stewart, Maureen T.; Garnick, Deborah W.

2018-01-01

Opioid use disorders (OUDs) are receiving significant attention as a public health crisis. Access to treatment for OUDs is essential and was expected to improve following implementation of the federal parity law and the Affordable Care Act. This study examines changes in coverage and management of treatments for OUDs (opioid treatment programs (OTPs) as a covered service benefit, buprenorphine as a pharmacy benefit) before, during and after parity and ACA implementation. Data are from three rounds of a nationally representative survey conducted with commercial health plans regarding behavioral health services in benefit years 2003, 2010, and 2014. Data were weighted to be representative of health plans’ commercial products in the continental United States (2003 weighted N= 7,469, 83% response rate; 2010 N=8,431, 89% response rate; and 2014 N=6,974, 80% response rate). Results showed treatment for OUDs was covered by nearly all health plan products in each year of the survey, but the types and patterns varied by year. Prior authorization requirements for OTPs have decreased over time. Despite the promise of expanded access to OUD treatment suggested by parity and the ACA, improved health plan coverage for treatment of OUDs, while essential, is not sufficient to address the opioid crisis. PMID:28350229

A Spoken Dialogue System for Command and Control

DTIC Science & Technology

2012-10-01

Previous work in this domain focused on the formal representation of linguistic concepts in ontologies for data integration. His doctoral...20 2.8 Ongoing and Future Work .................................................................................... 20 2.8.1 Dynamic... work , we developed grammars with broader coverage for the domain of Livespace room-control. The goal was to provide commands and queries to be

Environmental Accounting Coverage in the Accounting Curriculum: A Survey of U.S. Universities and Colleges.

ERIC Educational Resources Information Center

Yakhou, Mehenna; Dorweiler, Vernon P.

2002-01-01

In a survey of accounting department chairs (122 of 660 responded), only 11% thought that environmental issues should be a standalone course; only four schools had such a course. Environmental topics rated highest were managerial and cost accounting and external reporting and auditing. Respondents believed that integrating topics into courses…

2005 8th Annual Systems Engineering Conference. Volume 4, Thursday

DTIC Science & Technology

2005-10-27

requirements, allocation , and utilization statistics Operations Decisions Acquisition Decisions Resource Management — Integrated Requirements/ Allocation ...Quality Improvement Consultants, Inc. “Automated Software Testing Increases Test Quality and Coverage Resulting in Improved Software Reliability.”, Mr...Steven Ligon, SAIC The Return of Discipline, Ms. Jacqueline Townsend, Air Force Materiel Command Track 4 - Net Centric Operations: Testing Net-Centric

Integrating Cross-Cultural Marketing Research Training in International Business Education Programs: It's Time, and Here's Why and How

ERIC Educational Resources Information Center

Taylor, Ruth Lesher; Brodowsky, Glen H.

2012-01-01

International business necessitates that its international business educators prepare today's workforce with skills necessary to take on cross-cultural research tasks and challenges. Yet, global business finds these skills in short supply. Perhaps this is the case because empirical evidence shows U.S. academic coverage of cross-cultural research…

A Rotating Space Interferometer with Variable Baselines and Low Power Consumption

NASA Technical Reports Server (NTRS)

Gezari, Daniel Y.

1999-01-01

A new concept is presented here for a large, rotating space interferometer which would achieve full u, v plane coverage with reasonably uniform integration times, yet once set in motion no additional energy would be required to change collector separations, maintain constant baseline rotation rates, or to counteract centrifugal forces on the collectors.

Integrating real-time and manual monitored data to predict hillslope soil moisture dynamics with high spatio-temporal resolution using linear and non-linear models

USDA-ARS?s Scientific Manuscript database

Spatio-temporal variability of soil moisture (') is a challenge that remains to be better understood. A trade-off exists between spatial coverage and temporal resolution when using the manual and real-time ' monitoring methods. This restricted the comprehensive and intensive examination of ' dynamic...

INTEGRATION OF SATELLITE, MODELED, AND GROUND BASED AEROSOL DATA FOR USE IN AIR QUALITY AND PUBLIC HEALTH APPLICATIONS ( AGU-BALTIMORE )

EPA Science Inventory

Within the next several years NOAA and EPA will begin to issue PM_2.5 air quality forecasts over the entire domain of the eastern United States, eventually extending to national coverage. These forecasts will provide continuous estimated values of particulate matter on ...

Evaluating fire-damaged components of historic covered bridges

Treesearch

Brian Kukay; Charles Todd; Tyler Jahn; Jenson Sannon; Logan Dunlap; Robert White; Mark Dietenberger

2016-01-01

Arson continues to claim many historic covered bridges. Site-specific, post-fire evaluations of the structural integrity of a bridge are often necessary in a fire’s aftermath. Decisions on whether individual wood components can be rehabilitated, reconstructed, or replaced must be made. This report includes coverage of existing approaches and exploratory approaches that...

An integrated genetic linkage map of watermelon and genetic diversity based on single nucleotide polymorphism (SNP) and simple sequence repeat (SSR) markers

USDA-ARS?s Scientific Manuscript database

Watermelon (Citrullus lanatus var. lanatus) is an important vegetable fruit throughout the world. A high number of single nucleotide polymorphism (SNP) and simple sequence repeat (SSR) markers should provide large coverage of the watermelon genome and high phylogenetic resolution of germplasm acces...

Evidence for high-energy extraterrestrial neutrinos at the IceCube detector.

PubMed

Aartsen, M G; Abbasi, R; Abdou, Y; Ackermann, M; Adams, J; Aguilar, J A; Ahlers, M; Altmann, D; Auffenberg, J; Bai, X; Baker, M; Barwick, S W; Baum, V; Bay, R; Beatty, J J; Bechet, S; Becker Tjus, J; Becker, K-H; Benabderrahmane, M L; BenZvi, S; Berghaus, P; Berley, D; Bernardini, E; Bernhard, A; Bertrand, D; Besson, D Z; Binder, G; Bindig, D; Bissok, M; Blaufuss, E; Blumenthal, J; Boersma, D J; Bohaichuk, S; Bohm, C; Bose, D; Böser, S; Botner, O; Brayeur, L; Bretz, H-P; Brown, A M; Bruijn, R; Brunner, J; Carson, M; Casey, J; Casier, M; Chirkin, D; Christov, A; Christy, B; Clark, K; Clevermann, F; Coenders, S; Cohen, S; Cowen, D F; Cruz Silva, A H; Danninger, M; Daughhetee, J; Davis, J C; Day, M; De Clercq, C; De Ridder, S; Desiati, P; de Vries, K D; de With, M; DeYoung, T; Díaz-Vélez, J C; Dunkman, M; Eagan, R; Eberhardt, B; Eichmann, B; Eisch, J; Ellsworth, R W; Euler, S; Evenson, P A; Fadiran, O; Fazely, A R; Fedynitch, A; Feintzeig, J; Feusels, T; Filimonov, K; Finley, C; Fischer-Wasels, T; Flis, S; Franckowiak, A; Frantzen, K; Fuchs, T; Gaisser, T K; Gallagher, J; Gerhardt, L; Gladstone, L; Glüsenkamp, T; Goldschmidt, A; Golup, G; Gonzalez, J G; Goodman, J A; Góra, D; Grandmont, D T; Grant, D; Groß, A; Ha, C; Haj Ismail, A; Hallen, P; Hallgren, A; Halzen, F; Hanson, K; Heereman, D; Heinen, D; Helbing, K; Hellauer, R; Hickford, S; Hill, G C; Hoffman, K D; Hoffmann, R; Homeier, A; Hoshina, K; Huelsnitz, W; Hulth, P O; Hultqvist, K; Hussain, S; Ishihara, A; Jacobi, E; Jacobsen, J; Jagielski, K; Japaridze, G S; Jero, K; Jlelati, O; Kaminsky, B; Kappes, A; Karg, T; Karle, A; Kelley, J L; Kiryluk, J; Kläs, J; Klein, S R; Köhne, J-H; Kohnen, G; Kolanoski, H; Köpke, L; Kopper, C; Kopper, S; Koskinen, D J; Kowalski, M; Krasberg, M; Krings, K; Kroll, G; Kunnen, J; Kurahashi, N; Kuwabara, T; Labare, M; Landsman, H; Larson, M J; Lesiak-Bzdak, M; Leuermann, M; Leute, J; Lünemann, J; Madsen, J; Maggi, G; Maruyama, R; Mase, K; Matis, H S; McNally, F; Meagher, K; Merck, M; Meures, T; Miarecki, S; Middell, E; Milke, N; Miller, J; Mohrmann, L; Montaruli, T; Morse, R; Nahnhauer, R; Naumann, U; Niederhausen, H; Nowicki, S C; Nygren, D R; Obertacke, A; Odrowski, S; Olivas, A; O'Murchadha, A; Paul, L; Pepper, J A; Pérez de los Heros, C; Pfendner, C; Pieloth, D; Pinat, E; Posselt, J; Price, P B; Przybylski, G T; Rädel, L; Rameez, M; Rawlins, K; Redl, P; Reimann, R; Resconi, E; Rhode, W; Ribordy, M; Richman, M; Riedel, B; Rodrigues, J P; Rott, C; Ruhe, T; Ruzybayev, B; Ryckbosch, D; Saba, S M; Salameh, T; Sander, H-G; Santander, M; Sarkar, S; Schatto, K; Scheriau, F; Schmidt, T; Schmitz, M; Schoenen, S; Schöneberg, S; Schönwald, A; Schukraft, A; Schulte, L; Schulz, O; Seckel, D; Sestayo, Y; Seunarine, S; Shanidze, R; Sheremata, C; Smith, M W E; Soldin, D; Spiczak, G M; Spiering, C; Stamatikos, M; Stanev, T; Stasik, A; Stezelberger, T; Stokstad, R G; Stößl, A; Strahler, E A; Ström, R; Sullivan, G W; Taavola, H; Taboada, I; Tamburro, A; Tepe, A; Ter-Antonyan, S; Tešić, G; Tilav, S; Toale, P A; Toscano, S; Unger, E; Usner, M; van Eijndhoven, N; Van Overloop, A; van Santen, J; Vehring, M; Voge, M; Vraeghe, M; Walck, C; Waldenmaier, T; Wallraff, M; Weaver, Ch; Wellons, M; Wendt, C; Westerhoff, S; Whitehorn, N; Wiebe, K; Wiebusch, C H; Williams, D R; Wissing, H; Wolf, M; Wood, T R; Woschnagg, K; Xu, D L; Xu, X W; Yanez, J P; Yodh, G; Yoshida, S; Zarzhitsky, P; Ziemann, J; Zierke, S; Zoll, M

2013-11-22

We report on results of an all-sky search for high-energy neutrino events interacting within the IceCube neutrino detector conducted between May 2010 and May 2012. The search follows up on the previous detection of two PeV neutrino events, with improved sensitivity and extended energy coverage down to about 30 TeV. Twenty-six additional events were observed, substantially more than expected from atmospheric backgrounds. Combined, both searches reject a purely atmospheric origin for the 28 events at the 4σ level. These 28 events, which include the highest energy neutrinos ever observed, have flavors, directions, and energies inconsistent with those expected from the atmospheric muon and neutrino backgrounds. These properties are, however, consistent with generic predictions for an additional component of extraterrestrial origin.

An Integrated Model of Application, Admission, Enrollment, and Financial Aid

ERIC Educational Resources Information Center

DesJardins, Stephen L.; Ahlburg, Dennis A.; McCall, Brian Patrick

2006-01-01

We jointly model the application, admission, financial aid determination, and enrollment decision process. We find that expectations of admission affect application probabilities, financial aid expectations affect enrollment and application behavior, and deviations from aid expectations are strongly related to enrollment. We also conduct…

An integrated theoretical approach to substance use and risky sexual behavior among men who have sex with men.

PubMed

Wells, Brooke E; Golub, Sarit A; Parsons, Jeffrey T

2011-04-01

Research demonstrates a consistent association between substance use and sexual risk, particularly among men who have sex with men (MSM). The present study builds upon two existing theories (Cognitive Escape Theory and Expectancy Theory) to examine the synergistic role of sexual conflict (surrounding unsafe sex) and expectancies in sexual behavior among 135 MSM. Two conflicts were examined: (1) The conflict between motivation to practice safer sex and temptation for unprotected sex; and (2) The conflict between motivation to practice safer sex and perceived benefits of unprotected sex. Factorial ANOVAs (2 × 2; high versus low expectancies and conflict versus no conflict) revealed a significant interaction between conflict and expectancies-individuals who reported high levels of conflict were more sensitive to the effect of expectancies than were those experiencing low levels of sexual conflict. Results demonstrate the synergistic effects of conflict and expectancies and highlight the importance of integrating existing theories to more fully consider the intrapsychic operation and experience of sexual conflicts.

An assessment of Lot Quality Assurance Sampling to evaluate malaria outcome indicators: extending malaria indicator surveys.

PubMed

Biedron, Caitlin; Pagano, Marcello; Hedt, Bethany L; Kilian, Albert; Ratcliffe, Amy; Mabunda, Samuel; Valadez, Joseph J

2010-02-01

Large investments and increased global prioritization of malaria prevention and treatment have resulted in greater emphasis on programme monitoring and evaluation (M&E) in many countries. Many countries currently use large multistage cluster sample surveys to monitor malaria outcome indicators on a regional and national level. However, these surveys often mask local-level variability important to programme management. Lot Quality Assurance Sampling (LQAS) has played a valuable role for local-level programme M&E. If incorporated into these larger surveys, it would provide a comprehensive M&E plan at little, if any, extra cost. The Mozambique Ministry of Health conducted a Malaria Indicator Survey (MIS) in June and July 2007. We applied LQAS classification rules to the 345 sampled enumeration areas to demonstrate identifying high- and low-performing areas with respect to two malaria program indicators-'household possession of any bednet' and 'household possession of any insecticide-treated bednet (ITN)'. As shown by the MIS, no province in Mozambique achieved the 70% coverage target for household possession of bednets or ITNs. By applying LQAS classification rules to the data, we identify 266 of the 345 enumeration areas as having bednet coverage severely below the 70% target. An additional 73 were identified with low ITN coverage. This article demonstrates the feasibility of integrating LQAS into multistage cluster sampling surveys and using these results to support a comprehensive national, regional and local programme M&E system. Furthermore, in the recommendations we outlined how to integrate the Large Country-LQAS design into macro-surveys while still obtaining results available through current sampling practices.

Demographic history and rare allele sharing among human populations.

PubMed

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

2011-07-19

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

Obamacare: what the Affordable Care Act means for patients and physicians.

PubMed

Hall, Mark A; Lord, Richard

2014-10-22

The Affordable Care Act's core achievement is to make all Americans insurable, by requiring insurers to accept all applicants at rates based on population averages regardless of health status. The act also increases coverage by allowing states to expand Medicaid (the social healthcare program for families and people with low income and resources) to cover everyone near the poverty line, and by subsidizing private insurance for people who are not poor but who do not have workplace coverage. The act allows most people to keep the same kind of insurance that they currently have, and it does not change how private insurance pays physicians and hospitals. Although the act falls short of achieving truly universal coverage, nine million uninsured people have received coverage so far. Market reforms have not hurt the insurance industry's profitability, prices for individual insurance have been lower than expected, and government costs so far have been less than initially projected. The act expands several ongoing pilot programs in Medicare that reform how doctors and hospitals are paid, but it does not directly change how private insurers pay healthcare providers. Nevertheless, it has set into motion market dynamics that are affecting medical practice, such as limiting insurance networks to fewer providers and requiring patients to pay for more treatment costs out of pocket. In response, many hospitals and physicians are forming closer and larger affiliations. Further time and study are needed to learn whether these evolutionary changes will achieve their goals without harming the doctor-patient relationship. © BMJ Publishing Group Ltd 2014.

Effect of the 80-hour work week on resident case coverage.

PubMed

Shin, Susanna; Britt, Rebecca; Britt, L D

2008-05-01

On July 1, 2003, residency training programs were required to institute restricted duty hours as mandated by the Accreditation Council for Graduate Medical Education. A major concern, voiced by both surgical residents and faculty, was an expectation that this would result in a decrease in operative experience. We hypothesized that implementing restricted duty hours would decrease case coverage by resident trainees. A retrospective study was performed of operative and endoscopic cases scheduled for a single general surgery practice for a year before and after July 1, 2003. Data collected included operation performed, number of attending surgeons present, whether a resident was present, and level of resident. From July 2002 to June 2003, there were 1,278 cases scheduled; 890 records were available. From July 2004 to June 2005, there were 1,182 cases scheduled; 960 records were available. Before institution of the restricted duty hours, 24.6% of junior-level (PGY1 and 2) cases, 21.7% of intermediate-level (PGY3) cases, and 6.2% of senior-level (PGY4 and 5) cases were not covered by residents. After restricted duty hours were implemented, 27.3% of junior-level cases, 15.9% of intermediate-level cases, and 8.1% of senior-level cases were not covered by residents. Overall 20.8% (185 of 890) and 20.4% (196 of 960) of cases were not covered by residents before and after instituting restricted duty hours, respectively. No difference in case coverage was statistically significant in each category or overall. Restricted duty hours have not affected resident case coverage.

Effect of the 80-hour work week on resident case coverage: corrected article.

PubMed

Shin, Susanna; Britt, Rebecca; Britt, L D

2008-07-01

On July 1, 2003, residency training programs were required to institute restricted duty hours as mandated by the Accreditation Council for Graduate Medical Education. A major concern,voiced by both surgical residents and faculty, was an expectation that this would result in a decrease in operative experience. We hypothesized that implementing restricted duty hours would decrease case coverage by resident trainees. A retrospective study was per formed of operative and endoscopic cases scheduled for a single general surgery practice for a year before and after July 1, 2003. Data collected included operation per formed, number of attending surgeons present, whether a resident was present,and level of resident. From July 2002 to June 2003, there were 1,278 cases scheduled; 890 records were available. From July 2004 to June 2005, there were 1,182 cases scheduled; 960 records were available. Before institution of the restricted duty hours, 24.6% of junior-level (PGY1 and 2) cases, 21.7%of intermediate-level (PGY3) cases, and 6.2% of senior-level (PGY4 and 5) cases were not covered by residents. After restricted duty hours were implemented, 27.3% of junior-level cases,15.9% of intermediate-level cases, and 8.1% of senior-level cases were not covered by residents. Overall 20.8% (185 of 890) and 20.4% (196 of 960) of cases were not covered by residents before and after instituting restricted duty hours, respectively. No difference in case coverage was statistically significant in each category or overall. Restricted duty hours have not affected resident case coverage.

Demographic history and rare allele sharing among human populations

PubMed Central

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

2011-01-01

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

Subnanogram proteomics: impact of LC column selection, MS instrumentation and data analysis strategy on proteome coverage for trace samples

DOE PAGES

Zhu, Ying; Zhao, Rui; Piehowski, Paul D.; ...

2017-09-01

One of the greatest challenges for mass spectrometry (MS)-based proteomics is the limited ability to analyze small samples. Here in this study, we investigate the relative contributions of liquid chromatography (LC), MS instrumentation and data analysis methods with the aim of improving proteome coverage for sample sizes ranging from 0.5 ng to 50 ng. We show that the LC separations utilizing 30-μm-i.d. columns increase signal intensity by >3-fold relative to those using 75-μm-i.d. columns, leading to 32% increase in peptide identifications. The Orbitrap Fusion Lumos MS significantly boosted both sensitivity and sequencing speed relative to earlier generation Orbitraps (e.g., LTQ-Orbitrap),more » leading to a ~3-fold increase in peptide identifications and 1.7-fold increase in identified protein groups for 2 ng tryptic digests of the bacterium S. oneidensis. The Match Between Runs algorithm of open-source MaxQuant software further increased proteome coverage by ~95% for 0.5 ng samples and by ~42% for 2 ng samples. Using the best combination of the above variables, we were able to identify >3,000 proteins from 10 ng tryptic digests from both HeLa and THP-1 mammalian cell lines. We also identified >950 proteins from subnanogram archaeal/bacterial cocultures. Finally, the present ultrasensitive LC-MS platform achieves a level of proteome coverage not previously realized for ultra-small sample loadings, and is expected to facilitate the analysis of subnanogram samples, including single mammalian cells.« less

Vaccination against meningococcus C. vaccinal coverage in the French target population.

PubMed

Stahl, J-P; Cohen, R; Denis, F; Gaudelus, J; Lery, T; Lepetit, H; Martinot, A

2013-02-01

Immunization against meningococcus C has been recommended in France since 2009 (infants from 12 to 24 months of age, and catch up vaccination up to 25 years of age). It has been reimbursed since January 2010. We had for aim to assess the vaccine coverage in 2011. The study population included mothers of children targeted by the recommendation. They were recruited using Internet data (quotas based on the French National Institute of Statistics (INSEE) data based on a census made in 2007) based on the Institut des Mamans panel and its partners. The mothers had completed a standardized questionnaire and reported all vaccinations mentioned in their child's health-record. We included 3000 mothers of children, 0 to 35 months of age, (1000 for each of the following age range: 0-11 months, 12-23 months, 24-35 months), and 2250 mothers of teenagers, 14 to 16 years of age. Vaccination was deemed "essential/useful" for respectively 90.2% (CI 95%: 89.2-91.3) and 87.8% (CI 95%: 86.4-89.2) of mothers. Vaccine coverage levels were 32.3% (12-23 months), 57.3% (24-35 months), and 21.3% (14-16 years). Two years after the Ministry of Health's decision to reimburse this vaccine, vaccine coverage levels were much lower than they should have been, to expect effectiveness of the vaccination policy. Only 21.3% of teenagers had been vaccinated, and 32.3% of infants during the second year of life. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Impact of the Centers for Disease Control's HIV Preexposure Prophylaxis Guidelines for Men Who Have Sex With Men in the United States.

PubMed

Jenness, Samuel M; Goodreau, Steven M; Rosenberg, Eli; Beylerian, Emily N; Hoover, Karen W; Smith, Dawn K; Sullivan, Patrick

2016-12-15

 Preexposure prophylaxis (PrEP) is effective for preventing human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) within trial settings. Population impact will depend on clinical indications for PrEP initiation, coverage levels, and drug adherence. No modeling studies have estimated the impact of clinical practice guidelines for PrEP issued by the Centers for Disease Control and Prevention (CDC).  Mathematical models of HIV transmission among MSM were used to estimate the percentage of infections averted (PIA) and the number needed to treat (NNT) under behavioral indications of the CDC's PrEP guidelines. We modeled the contribution of these indications while varying treatment coverage and adherence.  At 40% coverage of indicated MSM over the next decade, application of CDC guidelines would avert 1162 infections per 100 000 person-years, 33.0% of expected infections. The predicted NNT for the guidelines would be 25. Increasing coverage and adherence jointly raise the PIA, but reductions to the NNT were associated with better adherence only.  Implementation of CDC PrEP guidelines would result in strong and sustained reductions in HIV incidence among MSM in the United States. The guidelines strike a good balance between epidemiological impact (PIA) and efficiency (NNT) at plausible scale-up levels. Adherence counseling could maximize public health investment in PrEP by decreasing the NNT. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Health Plans’ Early Response to Federal Parity Legislation for Mental Health and Addiction Services

PubMed Central

Horgan, Constance M.; Hodgkin, Dominic; Stewart, Maureen T.; Merrick, Elizabeth L.; Reif, Sharon; Garnick, Deborah W.; Quinn, Amity E.; Creedon, Timothy B.

2015-01-01

Objective In 2008 the federal Mental Health Parity and Addiction Equity Act (MHPAEA) passed, prohibiting U.S. health plans from subjecting mental health and substance use disorder (behavioral health) coverage to more restrictive limitations than those applied to general medical care. This require d some health plans to make changes in coverage and management of services. The aim of this study was to examine private health plans’ early responses to MHPAEA (after its 2010 implementation), in terms of both the intended and unintended effects. Methods Data were from a nationally representative survey of commercial health plans regarding the 2010 benefit year and the preparity 2009 benefit year (weighted N=8,431 products; 89% response rate). Results Annual limits specific to behavioral health care were virtually eliminated between 2009 and 2010. Prevalence of behavioral health coverage was unchanged, and copayments for both behavioral and general medical services increased slightly. Prior authorization requirements for specialty medical and behavioral health outpatient services continued to decline, and the proportion of products reporting strict continuing review requirements increased slightly. Contrary to expectations, plans did not make significant changes in contracting arrangements for behavioral health services, and 80% reported an increase in size of their behavioral health provider network. Conclusions The law had the intended effect of eliminating quantitative limitations that applied only to behavioral health care without unintended consequences such as eliminating behavioral health coverage. Plan decisions may also reflect other factors, including anticipation of the 2010 regulations and a continuation of trends away from requiring prior authorization. PMID:26369886

Root-coverage procedures for the treatment of localized recession-type defects: a Cochrane systematic review.

PubMed

Chambrone, Leandro; Sukekava, Flávia; Araújo, Maurício G; Pustiglioni, Francisco E; Chambrone, Luiz Armando; Lima, Luiz A

2010-04-01

The purpose of this review is to evaluate the effectiveness of different root-coverage procedures in the treatment of recession-type defects. The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched for entries up to October 2008. There were no restrictions regarding publication status or the language of publication. Only clinical randomized controlled trials (RCTs) with a duration > or = 6 months that evaluated recession areas (Miller Class I or II > or = 3 mm) that were treated by means of periodontal plastic surgery procedures were included. Twenty-four RCTs provided data. Only one trial was considered to be at low risk of bias. The remaining trials were considered to be at high risk of bias. The results indicated a significantly greater reduction in gingival recession and gain in keratinized tissue for subepithelial connective tissue grafts (SCTGs) compared to guided tissue regeneration (GTR) with bioabsorbable membranes (GTR bms). A significantly greater gain in keratinized tissue was found for enamel matrix protein compared to a coronally advanced flap (0.40 mm) and for SCTGs compared to GTR bms plus bone substitutes. Limited data exist on the changes of esthetic conditions as related to the opinions and preferences of patients for specific procedures. SCTGs, coronally advanced flaps alone or associated with other biomaterial, and GTR may be used as root-coverage procedures for the treatment of localized recession-type defects. In cases where root coverage and gain in keratinized tissue are expected, the use of SCTGs seems to be more adequate.

Advance distribution of misoprostol for prevention of postpartum hemorrhage (PPH) at home births in two districts of Liberia

PubMed Central

2014-01-01

Background A postpartum hemorrhage prevention program to increase uterotonic coverage for home and facility births was introduced in two districts of Liberia. Advance distribution of misoprostol was offered during antenatal care (ANC) and home visits. Feasibility, acceptability, effectiveness of distribution mechanisms and uterotonic coverage were evaluated. Methods Eight facilities were strengthened to provide PPH prevention with oxytocin, PPH management and advance distribution of misoprostol during ANC. Trained traditional midwives (TTMs) as volunteer community health workers (CHWs) provided education to pregnant women, and district reproductive health supervisors (DRHSs) distributed misoprostol during home visits. Data were collected through facility and DRHS registers. Postpartum interviews were conducted with a sample of 550 women who received advance distribution of misoprostol on place of delivery, knowledge, misoprostol use, and satisfaction. Results There were 1826 estimated deliveries during the seven-month implementation period. A total of 980 women (53.7%) were enrolled and provided misoprostol, primarily through ANC (78.2%). Uterotonic coverage rate of all deliveries was 53.5%, based on 97.7% oxytocin use at recorded facility vaginal births and 24.9% misoprostol use at home births. Among 550 women interviewed postpartum, 87.7% of those who received misoprostol and had a home birth took the drug. Sixty-three percent (63.0%) took it at the correct time, and 54.0% experienced at least one minor side effect. No serious adverse events reported among enrolled women. Facility-based deliveries appeared to increase during the program. Conclusions The program was moderately effective at achieving high uterotonic coverage of all births. Coverage of home births was low despite the use of two channels of advance distribution of misoprostol. Although ANC reached a greater proportion of women in late pregnancy than home visits, 46.3% of expected deliveries did not receive education or advance distribution of misoprostol. A revised community-based strategy is needed to increase advance distribution rates and misoprostol coverage rates for home births. Misoprostol for PPH prevention appears acceptable to women in Liberia. Correct timing of misoprostol self-administration needs improved emphasis during counseling and education. PMID:24894566

State of inequality in malaria intervention coverage in sub-Saharan African countries.

PubMed

Galactionova, Katya; Smith, Thomas A; de Savigny, Don; Penny, Melissa A

2017-10-18

Scale-up of malaria interventions over the last decade have yielded a significant reduction in malaria transmission and disease burden in sub-Saharan Africa. We estimated economic gradients in the distribution of these efforts and of their impacts within and across endemic countries. Using Demographic and Health Surveys we computed equity metrics to characterize the distribution of malaria interventions in 30 endemic countries proxying economic position with an asset-wealth index. Gradients were summarized in a concentration index, tabulated against level of coverage, and compared among interventions, across countries, and against respective trends over the period 2005-2015. There remain broad differences in coverage of malaria interventions and their distribution by wealth within and across countries. In most, economic gradients are lacking or favor the poorest for vector control; malaria services delivered through the formal healthcare sector are much less equitable. Scale-up of interventions in many countries improved access across the wealth continuum; in some, these efforts consistently prioritized the poorest. Expansions in control programs generally narrowed coverage gaps between economic strata; gradients persist in countries where growth was slower in the poorest quintile or where baseline inequality was large. Despite progress, malaria is consistently concentrated in the poorest, with the degree of inequality in burden far surpassing that expected given gradients in the distribution of interventions. Economic gradients in the distribution of interventions persist over time, limiting progress toward equity in malaria control. We found that, in countries with large baseline inequality in the distribution of interventions, even a small bias in expansion favoring the least poor yielded large gradients in intervention coverage while pro-poor growth failed to close the gap between the poorest and least poor. We demonstrated that dimensions of disadvantage compound for the poor; a lack of economic gradients in the distribution of malaria services does not translate to equity in coverage nor can it be interpreted to imply equity in distribution of risk or disease burden. Our analysis testifies to the progress made by countries in narrowing economic gradients in malaria interventions and highlights the scope for continued monitoring of programs with respect to equity.

Assessing Requirements Quality through Requirements Coverage

NASA Technical Reports Server (NTRS)

Rajan, Ajitha; Heimdahl, Mats; Woodham, Kurt

2008-01-01

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

Advance distribution of misoprostol for prevention of postpartum hemorrhage (PPH) at home births in two districts of Liberia.

PubMed

Smith, Jeffrey Michael; Baawo, Saye Dahn; Subah, Marion; Sirtor-Gbassie, Varwo; Howe, Cuallau Jabbeh; Ishola, Gbenga; Tehoungue, Bentoe Z; Dwivedi, Vikas

2014-06-04

A postpartum hemorrhage prevention program to increase uterotonic coverage for home and facility births was introduced in two districts of Liberia. Advance distribution of misoprostol was offered during antenatal care (ANC) and home visits. Feasibility, acceptability, effectiveness of distribution mechanisms and uterotonic coverage were evaluated. Eight facilities were strengthened to provide PPH prevention with oxytocin, PPH management and advance distribution of misoprostol during ANC. Trained traditional midwives (TTMs) as volunteer community health workers (CHWs) provided education to pregnant women, and district reproductive health supervisors (DRHSs) distributed misoprostol during home visits. Data were collected through facility and DRHS registers. Postpartum interviews were conducted with a sample of 550 women who received advance distribution of misoprostol on place of delivery, knowledge, misoprostol use, and satisfaction. There were 1826 estimated deliveries during the seven-month implementation period. A total of 980 women (53.7%) were enrolled and provided misoprostol, primarily through ANC (78.2%). Uterotonic coverage rate of all deliveries was 53.5%, based on 97.7% oxytocin use at recorded facility vaginal births and 24.9% misoprostol use at home births. Among 550 women interviewed postpartum, 87.7% of those who received misoprostol and had a home birth took the drug. Sixty-three percent (63.0%) took it at the correct time, and 54.0% experienced at least one minor side effect. No serious adverse events reported among enrolled women. Facility-based deliveries appeared to increase during the program. The program was moderately effective at achieving high uterotonic coverage of all births. Coverage of home births was low despite the use of two channels of advance distribution of misoprostol. Although ANC reached a greater proportion of women in late pregnancy than home visits, 46.3% of expected deliveries did not receive education or advance distribution of misoprostol. A revised community-based strategy is needed to increase advance distribution rates and misoprostol coverage rates for home births. Misoprostol for PPH prevention appears acceptable to women in Liberia. Correct timing of misoprostol self-administration needs improved emphasis during counseling and education.

Risk factors for low vaccination coverage among Roma children in disadvantaged settlements in Belgrade, Serbia.

PubMed

Stojanovski, Kristefer; McWeeney, Gerry; Emiroglu, Nedret; Ostlin, Piroska; Koller, Theadora; Licari, Lucianne; Kaluski, Dorit Nitzan

2012-08-10

Full vaccination coverage for children under 59 months of age in Serbia is over 90%. This study assesses vaccination coverage and examines its association with birth registration among Roma children who resided in disadvantaged settlements in Belgrade, Serbia. The First Roma Health and Nutrition Survey in Belgrade settlements, 2009, was conducted among households of 468 Roma children between the ages of 6-59 months. The 2005 WHO Immunization Coverage Cluster Survey sampling methodology was employed. Vaccinations were recorded using children's vaccination cards and through verification steps carried out in the Primary Health Care Centers. For those who had health records the information on vaccination was recorded. About 88% of children had vaccination cards. The mean rate of age appropriate full immunization was 16% for OPV and DTP and 14.3% for MMR. Multivariate analyses indicated that children whose births were registered with the civil authorities were more likely to have their vaccination cards [OR=6.1, CI (2.5, 15.0)] and to have their full, age appropriate, series vaccinations for DTP, OPV, MMR and HepB [OR=3.8, CI (1.5, 10.0), OR=3.2, CI (1.5, 6.6), OR=4.8, CI (1.1, 21.0), OR=5.4, CI (1.4, 21.6), respectively]. The immunization coverage among Roma children in settlements is far below the WHO/UNICEF MDG4 target in achieving prevention and control of vaccine preventable diseases. It demonstrates the need to include "invisible" populations into the health systems in continuous, integrated, comprehensive, accessible and sensitive modes. Copyright © 2012 Elsevier Ltd. All rights reserved.

Health financing for universal coverage and health system performance: concepts and implications for policy

PubMed Central

2013-01-01

Abstract Unless the concept is clearly understood, “universal coverage” (or universal health coverage, UHC) can be used to justify practically any health financing reform or scheme. This paper unpacks the definition of health financing for universal coverage as used in the World Health Organization’s World health report 2010 to show how UHC embodies specific health system goals and intermediate objectives and, broadly, how health financing reforms can influence these. All countries seek to improve equity in the use of health services, service quality and financial protection for their populations. Hence, the pursuit of UHC is relevant to every country. Health financing policy is an integral part of efforts to move towards UHC, but for health financing policy to be aligned with the pursuit of UHC, health system reforms need to be aimed explicitly at improving coverage and the intermediate objectives linked to it, namely, efficiency, equity in health resource distribution and transparency and accountability. The unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Concern only with specific schemes is incompatible with a universal coverage approach and may even undermine UHC, particularly in terms of equity. Conversely, if a scheme is fully oriented towards system-level goals and objectives, it can further progress towards UHC. Policy and policy analysis need to shift from the scheme to the system level. PMID:23940408

State budget transfers to Health Insurance Funds for universal health coverage: institutional design patterns and challenges of covering those outside the formal sector in Eastern European high-income countries.

PubMed

Vilcu, Ileana; Mathauer, Inke

2016-01-15

Many countries from the European region, which moved from a government financed and provided health system to social health insurance, would have had the risk of moving away from universal health coverage if they had followed a "traditional" approach. The Eastern European high-income countries studied in this paper managed to avoid this potential pitfall by using state budget revenues to explicitly pay health insurance contributions on behalf of certain (vulnerable) population groups who have difficulties to pay these contributions themselves. The institutional design aspects of their government revenue transfer arrangements are analysed, as well as their impact on universal health coverage progress. This regional study is based on literature review and review of databases for the performance assessment. The analytical framework focuses on the following institutional design features: rules on eligibility for contribution exemption, financing and pooling arrangements, and purchasing arrangements and benefit package design. More commonalities than differences can be identified across countries: a broad range of groups eligible for exemption from payment of health insurance contributions, full state contributions on behalf of the exempted groups, mostly mandatory participation, integrated pools for both the exempted and contributors, and relatively comprehensive benefit packages. In terms of performance, all countries have high total population coverage rates, but there are still challenges regarding financial protection and access to and utilization of health care services, especially for low income people. Overall, government revenue transfer arrangements to exempt vulnerable groups from contributions are one option to progress towards universal health coverage.

Integration of SAR and AIS for ship detection and identification

NASA Astrophysics Data System (ADS)

Yang, Chan-Su; Kim, Tae-Ho

2012-06-01

This abstract describes the preliminary design concept for an integration system of SAR and AIS data. SAR sensors are used to acquire image data over large coverage area either through the space borne or airborne platforms in UTC. AIS reports should also obtained on the same date as of the SAR acquisition for the purpose to perform integration test. Once both data reports are obtained, one need to match the timings of AIS data acquisition over the SAR image acquisition time with consideration of local time & boundary to extract the closest time signal from AIS report in order to know the AIS based ship positions, but still one cannot be able to distinguish which ships have the AIS transponder after projection of AIS based position onto the SAR image acquisition boundary. As far as integration is concerned, the ship dead-reckoning concept is most important forecasted position which provides the AIS based ship position at the time of SAR image acquisition and also provides the hints for azimuth shift which occurred in SAR image for the case of moving ships which moves in the direction perpendicular to the direction of flight path. Unknown ship's DR estimation is to be carried out based on the initial positions, speed and course over ground, which has already been shorted out from AIS reports, during the step of time matching. This DR based ship's position will be the candidate element for searching the SAR based ship targets for the purpose of identification & matching within the certain boundary around DR. The searching method is performed by means of estimation of minimum distance from ship's DR to SAR based ship position, and once it determines, so the candidate element will look for matching like ship size match of DR based ship's dimension wrt SAR based ship's edge, there may be some error during the matching with SAR based ship edges with actual ship's hull design as per the longitudinal and transverse axis size information obtained from the AIS reports due to blurring effect in SAR based ship signatures, once the conditions are satisfied, candidate element will move & shift over the SAR based ship signature target with the minimum displacement and it is known to be the azimuth shift compensation and this overall methodology are known to be integration of AIS report data over the SAR image acquisition boundary with assessment of time matching. The expected result may provide the good accuracy of the SAR and AIS contact position along with dimension and classification of ships over SAR image. There may be possibilities of matching speed and course from candidate element with SAR based ship signature, but still the challenges are presents in front of us that to estimation of speed and course by means of SAR data, if it may be possible so the expected final result may be more accurate as due to extra matching effects and the results may be used for the near real time performance for ship identification with help of integrated system design based on SAR and AIS data reports.