Estimating resource needs for HIV/AIDS health care services in low-income and middle-income countries.

As funding mechanisms like the Global Fund for HIV/AIDS, Tuberculosis and Malaria increasingly make funding decisions on the basis of burden of disease estimates and financial need calculations, the importance of reliable and comparable estimating methods is growing. This paper presents a model for estimating HIV/AIDS health care resource needs in low- and middle-income countries. The model presented was the basis for the United Nations' call for US dollars 9.2 billion to address HIV/AIDS in developing countries by 2005 with US dollars 4.4 billion to address HIV/AIDS health care and the rest to deal with HIV/AIDS prevention. The model has since been updated and extended to produce estimates for 2007. This paper details the methods and assumptions used to estimate HIV/AIDS health care financial needs and it discusses the limitations and data needs for this model

The Lives Saved Tool (LiST) as a model for diarrhea mortality reduction

BACKGROUND: Diarrhea is a leading cause of morbidity and mortality among children under five years of age. The Lives Saved Tool (LiST) is a model used to calculate deaths averted or lives saved by past interventions and for the purposes of program planning when costly and time consuming impact studies are not possible. DISCUSSION: LiST models the relationship between coverage of interventions and outputs, such as stunting, diarrhea incidence and diarrhea mortality. Each intervention directly prevents a proportion of diarrhea deaths such that the effect size of the intervention is multiplied by coverage to calculate lives saved. That is, the maximum effect size could be achieved at 100% coverage, but at 50% coverage only 50% of possible deaths are prevented. Diarrhea mortality is one of the most complex causes of death to be modeled. The complexity is driven by the combination of direct prevention and treatment interventions as well as interventions that operate indirectly via the reduction in risk factors, such as stunting and wasting. Published evidence is used to quantify the effect sizes for each direct and indirect relationship. Several studies have compared measured changes in mortality to LiST estimates of mortality change looking at different sets of interventions in different countries. While comparison work has generally found good agreement between the LiST estimates and measured mortality reduction, where data availability is weak, the model is less likely to produce accurate results. LiST can be used as a component of program evaluation, but should be coupled with more complete information on inputs, processes and outputs, not just outcomes and impact. SUMMARY: LiST is an effective tool for modeling diarrhea mortality and can be a useful alternative to large and expensive mortality impact studies. Predicting the impact of interventions or comparing the impact of more than one intervention without having to wait for the results of large and expensive mortality studies is critical to keep programs focused and results oriented for continued reductions in diarrhea and all-cause mortality among children under five years of age

Standards for CHERG reviews of intervention effects on child survival

Background The Lives Saved Tool (LiST) uses estimates of the effects of interventions on cause-specific child mortality as a basis for generating projections of child lives that could be saved by increasing coverage of effective interventions. Estimates of intervention effects are an essential element of LiST, and need to reflect the best available scientific evidence. This article describes the guidelines developed by the Child Health Epidemiology Reference Group (CHERG) that are applied by scientists conducting reviews of intervention effects for use in LiST. Methods The guidelines build on and extend those developed by the Cochrane Collaboration and the Working Group for Grading of Recommendations Assessment, Development and Evaluation (GRADE). They reflect the experience gained by the CHERG intervention review groups in conducting the reviews published in this volume, and will continue to be refined through future reviews. Presentation of the guidelines Expected products and guidelines are described for six steps in the CHERG intervention review process: (i) defining the scope of the review; (ii) conducting the literature search; (iii) extracting information from individual studies; (iv) assessing and summarizing the evidence; (v) translating the evidence into estimates of intervention effects and (vi) presenting the results. Conclusions The CHERG intervention reviews represent an ambitious effort to summarize existing evidence and use it as the basis for supporting sound public health decision making through LiST. These efforts will continue, and a similar process is now under way to assess intervention effects for reducing maternal mortalit

A survey of automatic teller machine usage across the adult lifespan.

The purpose of this study was to analyze automatic teller machine (ATM) usage across the adult life span. We conducted an extensive survey of 9000 people in the Memphis and Atlanta metropolitan areas. Approximately 17% of those people responded. The survey assessed detailed demographic information, experience with technology in general, experience specifically related to ATMs, problems and dislikes with ATMs, and reasons that people do not use ATMs. The survey provided a valuable set of data. First, we have detailed information about the demographics and individual characteristics of ATM users and nonusers; importantly, these data are stratified across the adult life span. In addition, we know the likes and dislikes of ATM users and the types of problems they typically have using ATMs. Moreover, we have a detailed analysis of why adults of all ages may choose not to use ATMs. Training and design implications of these data are discussed

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

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

Training older adults to use automatic teller machines.

The present study assessed the success of several instructional programs in teaching the use of automatic teller machines (ATMs). Fifty-six older adults (aged 61 to 81) participated in the study, randomly assigned to each of four, 14-member groups. The description group received only a general overview of an ATM; the text guide group received written instructions for performing various transactions on an ATM; the pictorial guide group received written instructions accompanied by pictures of corresponding ATM screens; and the online tutorial group completed a step-by-step tutorial on a simulated ATM. Participants practiced on an ATM simulator. They were tested after a 24-h interval on their ability to perform familiar transactions on an unfamiliar ATM simulator and to perform completely novel transactions. Accuracy was best for the online tutorial group, intermediate for the text and pictorial guide groups, and worst for the description group. These data demonstrate both the importance of providing older adults with ATM training and the fact that the type of training influences the level of performance. The online tutorial, which provided specific practice on the task components, best facilitated acquisition and transfer performance

Comparative susceptibility of mosquito populations in North Queensland, Australia to oral infection with dengue virus.

Dengue is the most prevalent arthropod-borne virus, with at least 40% of the world's population at risk of infection each year. In Australia, dengue is not endemic, but viremic travelers trigger outbreaks involving hundreds of cases. We compared the susceptibility of Aedes aegypti mosquitoes from two geographically isolated populations to two strains of dengue virus serotype 2. We found, interestingly, that mosquitoes from a city with no history of dengue were more susceptible to virus than mosquitoes from an outbreak-prone region, particularly with respect to one dengue strain. These findings suggest recent evolution of population-based differences in vector competence or different historical origins. Future genomic comparisons of these populations could reveal the genetic basis of vector competence and the relative role of selection and stochastic processes in shaping their differences. Lastly, we show the novel finding of a correlation between midgut dengue titer and titer in tissues colonized after dissemination

Analysis of the MOST light curve of the heavily spotted K2IV component of the single-line spectroscopic binary II Pegasi

Continuous photometric observations of the visible component of the single-line, K2IV spectroscopic binary II Peg carried out by the MOST satellite during 31 consecutive days in 2008 have been analyzed. On top of spot-induced brightness modulation, eleven flares were detected of three distinct types characterized by different values of rise, decay and duration times. The flares showed a preference for occurrence at rotation phases when the most spotted hemisphere is directed to the observer, confirming previous similar reports. An attempt to detect a grazing primary minimum caused by the secondary component transiting in front of the visible star gave a negative result. The brightness variability caused by spots has been interpreted within a cold spot model. An assumption of differential rotation of the primary component gave a better fit to the light curve than a solid-body rotation model.Comment: Accepteed to MNRA