Assessing Surveillance Elements of the Zanzibar Malaria Elimination Program to Support Malaria Elimination in Zanzibar

Though significant progress has been made through control efforts in recent years, malaria remains a leading cause of morbidity and mortality throughout the world, with 3.2 billion people at risk of developing the disease. Zanzibar is currently pursuing malaria elimination through the Zanzibar Malaria Elimination Program (ZAMEP), and is working toward a goal of no locally acquired malaria cases by 2018. A comprehensive and well functioning malaria surveillance program is central to achieving this goal. Under ZAMEP’s current surveillance strategy, District Malaria Surveillance Officers (DMSOs) respond to malaria case notifications through the reactive case detection (RACD) system. Three malaria screening and treatment strategies are undertaken in response to this system, including household-level (HSaT), focal-level (FSaT), and mass-level (MSaT). Each strategy is triggered by a different case threshold and tests different-sized populations. The aims of this study were to (1) assess the cost effectiveness of three malaria screening and treatment strategies; (2) assess the timeliness and completeness of ZAMEP’s RACD system; (3) and qualitatively explore the roles of DMSOs.

Screening disposition and budget information for 2014 screening and treatment strategies was analyzed to determine prevalence rates in screened populations and the cost effectiveness of each strategy. Prevalence rates within the screened population varied by strategy: 6.1 percent in HSaT, 1.2 percent in FSaT, and 0.9 percent in MSaT. Of the various costing scenarios considering cost per person screened, MSaT was the most cost-effective, with costs ranging from $9.57 to $12.57 per person screened. Of the various costing scenarios considering cost per case detected, HSaT was the most cost-effective, at $385.51 per case detected.

Case data from 2013 through mid-2015 was used to assess the timeliness and completeness of the RACD system. The average number of RACD activities occurring within 48 hours of notification improved slightly between 2013 and the first half of 2015, from 90.7 percent to 93.1 percent. The average percentage of household members screened during RACD also increased over the same time period, from 84 percent in 2013 to 89.9 percent in the first half of 2015.

Interviews with twenty DMSOs were conducted to gain insights into the challenges to malaria elimination both from the health system and the community perspectives. Major themes discussed in the interviews include the need for additional training, inadequate information capture at health facility, resistance to household testing, transportation difficulties, inadequate personnel during the high transmission season, and community misinformation.

Zanzibar is now considered a low transmission setting, making elimination feasible, but also posing new challenges to achieving this goal. The findings of this study provide insight into how surveillance activities can be improved to support the goal of malaria elimination in Zanzibar. Key changes include reevaluating the use of MSaT activities, improving information capture at health facilities, hiring additional DMSOs during the high transmission season, and improving community communication.

Operating cost based cruise speed reduction for ground delay programs: Effect of scope length

Ground delay programs typically involve the delaying of aircraft that are departing from origin airports within some set distance of a capacity constrained destination airport. Long haul flights are not delayed in this way. A trade-off exists when fixing the distance parameter: increasing the ‘scope’ distributes delay among more aircraft and may reduce airborne holding delay but could also result in unnecessary delay in the (frequently observed) case of early program cancellation. In order to overcome part of this drawback, a fuel based cruise speed reduction strategy aimed at realizing airborne delay, was suggested by the authors in previous publications. By flying slower, at a specific speed, aircraft that are airborne can recover part of their initially assigned delay without incurring extra fuel consumption if the ground delay program is canceled before planned. In this paper, the effect of the scope of the program is assessed when applying this strategy. A case study is presented by analyzing all the ground delay programs that took place at San Francisco, Newark Liberty and Chicago O’Hare International airports during one year. Results show that by the introduction of this technique it is possible to define larger scopes, partially reducing the amount of unrecovered delay.

Systematic Review Protocol to Evaluate the Effectiveness and Cost Effectiveness of Personalised Surveillance after Colorectal Adenomatous Polypectomy

Lifetime risk of developing colorectal cancer (CRC) is 5% and five-year survival at early-stage is 92%. CRC risk following index colonoscopy should establish post-screening surveillance benefit, which may be greater in high-risk patients. This review evaluated published cost-effectiveness estimates of post-polypectomy surveillance to assess the potential for personalised recommendations by risk sub-group. Current data suggested colonoscopy identifies those at low-risk of CRC, who may not benefit from intensive surveillance, which risks unnecessary harms and inefficient use of colonoscopy resources. Meta-analyses of incidence of advanced-neoplasia post-polypectomy for low-risk was comparable to those without adenoma; both rates were under the lifetime risk of 5%. Therefore, greater personalisation through de-intensified strategies for low-risk individuals could be beneficial and could employ non-invasive testing such as faecal immunochemical tests (FIT) combined with primary prevention or chemoprevention, thereby reserving colonoscopy for targeted use in personalised risk-stratified surveillance.
This systematic review aims to:
1. Assess if there is evidence supporting a program of personalised surveillance in patients with colorectal adenoma according to risk sub-group.
2. Compare the effectiveness of surveillance colonoscopy with alternative prevention strategies.
3. Assess trade-off between costs, benefits and adverse effects which must be considered in a decision to adopt or reject personalised surveillance.

Iowa Motor Vehicle Fuel Reduction Program, 1989

This report documents the results of a three million dollar traffic signal improvement demonstration program, known as the Iowa Motor Vehicle Fuel Reduction Program (the program). The program was funded with the use of oil overcharge funds and administered by the Iowa Departments of Natural Resources and Transportation. The objective of the program was to provide restitution to overcharged motorists by improving the efficiency of traffic signals. More efficient traffic signals reduce fuel consumption, delay, travel time, and automobile pollution while improving traffic safety. The program demonstrated the effectiveness of improving traffic signals and resulted in a 14.20-to-1 benefit-to-cost ratio.

BUILDING EFFICIENT AND COST-EFFECTIVE CLOUD-BASED BIG DATA MANAGEMENT SYSTEMS

In today’s big data world, data is being produced in massive volumes, at great velocity and from a variety of different sources such as mobile devices, sensors, a plethora of small devices hooked to the internet (Internet of Things), social networks, communication networks and many others. Interactive querying and large-scale analytics are being increasingly used to derive value out of this big data. A large portion of this data is being stored and processed in the Cloud due the several advantages provided by the Cloud such as scalability, elasticity, availability, low cost of ownership and the overall economies of scale. There is thus, a growing need for large-scale cloud-based data management systems that can support real-time ingest, storage and processing of large volumes of heterogeneous data. However, in the pay-as-you-go Cloud environment, the cost of analytics can grow linearly with the time and resources required. Reducing the cost of data analytics in the Cloud thus remains a primary challenge. In my dissertation research, I have focused on building efficient and cost-effective cloud-based data management systems for different application domains that are predominant in cloud computing environments. In the first part of my dissertation, I address the problem of reducing the cost of transactional workloads on relational databases to support database-as-a-service in the Cloud. The primary challenges in supporting such workloads include choosing how to partition the data across a large number of machines, minimizing the number of distributed transactions, providing high data availability, and tolerating failures gracefully. I have designed, built and evaluated SWORD, an end-to-end scalable online transaction processing system, that utilizes workload-aware data placement and replication to minimize the number of distributed transactions that incorporates a suite of novel techniques to significantly reduce the overheads incurred both during the initial placement of data, and during query execution at runtime. In the second part of my dissertation, I focus on sampling-based progressive analytics as a means to reduce the cost of data analytics in the relational domain. Sampling has been traditionally used by data scientists to get progressive answers to complex analytical tasks over large volumes of data. Typically, this involves manually extracting samples of increasing data size (progressive samples) for exploratory querying. This provides the data scientists with user control, repeatable semantics, and result provenance. However, such solutions result in tedious workflows that preclude the reuse of work across samples. On the other hand, existing approximate query processing systems report early results, but do not offer the above benefits for complex ad-hoc queries. I propose a new progressive data-parallel computation framework, NOW!, that provides support for progressive analytics over big data. In particular, NOW! enables progressive relational (SQL) query support in the Cloud using unique progress semantics that allow efficient and deterministic query processing over samples providing meaningful early results and provenance to data scientists. NOW! enables the provision of early results using significantly fewer resources thereby enabling a substantial reduction in the cost incurred during such analytics. Finally, I propose NSCALE, a system for efficient and cost-effective complex analytics on large-scale graph-structured data in the Cloud. The system is based on the key observation that a wide range of complex analysis tasks over graph data require processing and reasoning about a large number of multi-hop neighborhoods or subgraphs in the graph; examples include ego network analysis, motif counting in biological networks, finding social circles in social networks, personalized recommendations, link prediction, etc. These tasks are not well served by existing vertex-centric graph processing frameworks whose computation and execution models limit the user program to directly access the state of a single vertex, resulting in high execution overheads. Further, the lack of support for extracting the relevant portions of the graph that are of interest to an analysis task and loading it onto distributed memory leads to poor scalability. NSCALE allows users to write programs at the level of neighborhoods or subgraphs rather than at the level of vertices, and to declaratively specify the subgraphs of interest. It enables the efficient distributed execution of these neighborhood-centric complex analysis tasks over largescale graphs, while minimizing resource consumption and communication cost, thereby substantially reducing the overall cost of graph data analytics in the Cloud. The results of our extensive experimental evaluation of these prototypes with several real-world data sets and applications validate the effectiveness of our techniques which provide orders-of-magnitude reductions in the overheads of distributed data querying and analysis in the Cloud.

Phobos: The design and implementation of embedded software for a low cost radar warning receiver

This portfolio thesis describes work undertaken by the author under the Engineering Doctorate program of the Institute for System Level Integration. It was carried out in conjunction with the sponsor company Teledyne Defence Limited. A radar warning receiver is a device used to detect and identify the emissions of radars. They were originally developed during the Second World War and are found today on a variety of military platforms as part of the platform’s defensive systems. Teledyne Defence has designed and built components and electronic subsystems for the defence industry since the 1970s. This thesis documents part of the work carried out to create Phobos, Teledyne Defence’s first complete radar warning receiver. Phobos was designed to be the first low cost radar warning receiver. This was made possible by the reuse of existing Teledyne Defence products, commercial off the shelf hardware and advanced UK government algorithms. The challenges of this integration are described and discussed, with detail given of the software architecture and the development of the embedded application. Performance of the embedded system as a whole is described and qualified within the context of a low cost system.

Cost-Effectiveness of Rotavirus Vaccination for Under-Five Children in Iran

Background: Rotavirus diarrhea is one of the most important causes of death among under-five children. Anti-rotavirus vaccination of these children may have a reducing effect on the disease. Objectives: this study is intended to contribute to health policy-makers of the country about the optimal decision and policy development in this area, by performing cost-effectiveness and cost-utility analysis on anti-rotavirus vaccination for under-5 children. Patients and Methods: A cost-effectiveness analysis was performed using a decision tree model to analyze rotavirus vaccination, which was compared with no vaccination with Iran’s ministry of health perspective in a 5-year time horizon. Epidemiological data were collected from published and unpublished sources. Four different assumptions were considered to the extent of the disease episode. To analyze costs, the costs of implementing the vaccination program were calculated with 98% coverage and the cost of USD 7 per dose. Medical and social costs of the disease were evaluated by sampling patients with rotavirus diarrhea, and sensitivity analysis was also performed for different episode rates and vaccine price per dose. Results: For the most optimistic assumption for the episode of illness (10.2 per year), the cost per DALY averted is 12,760 and 7,404 for RotaTeq and Rotarix vaccines, respectively, while assuming the episode of illness is 300%, they will be equal to 2,395 and 354, respectively, which will be highly cost-effective. Number of life-years gained is equal to 3,533 years. Conclusions: Assuming that the illness episodes are 100% and 300% for Rotarix and 300% for Rota Teq, the ratio of cost per DALY averted is highly cost-effective, based on the threshold of the world health organization (< 1 GDP per capita = 4526 USD). The implementation of a national rotavirus vaccination program is suggested.

Effect of the Supplemental Nutrition Assistance Program (SNAP) and Nutrition Education on Nutrition and Health Outcomes of HIV+ Individuals

Factors associated with and barriers to participation in Supplemental Nutrition Assistance Program (SNAP) and the effect participation has on food security, nutrition status, disease status and quality of life was investigated in a cross-sectional study including 175 HIV infected individuals. In addition, the effect of a targeted nutrition education on nutrition knowledge, readiness to dietary behavior change, nutrition status, disease status and quality of life was also investigated among a subset of the population (N = 45) in a randomized clinical control trial. SNAP participation rate was 70.3%, similar to the State of Florida and national participation rates. SNAP participation was positively and independently associated with being born in the US (P < 0.001), having monthly income less than $1000 (P = 0.006), and receiving antiretroviral treatment (P < 0.001). Participation barriers include denial of participation by program, recent incarceration, living in a shelter where participation is not allowed and unawareness of eligibility status. In regression analyses, SNAP participation was not significantly associated with improved food security, nutrition status, disease status and health related quality of life (HRQOL). Over half (56%) of the population experienced food insecurity and had inadequate intakes of half of the nutrients assessed. Illicit drug, alcohol and cigarette use were high in this population (31%, 55% and 63% respectively), and affected food security, nutrients intake, disease status and HRQOL. The nutrition education intervention resulted in a trend towards improvements nutrition knowledge, self-efficacy, and readiness to change without impacting nutrition status, disease state and quality of life. Food insecurity and other nutrition related issues, with implications for treatment, management and cost of HIV disease, continue to plague infected individuals living in poverty. More resources, including food and nutrition programs, specifically targeted towards this population are needed to address these issues.

Design of maintenance structures for rural electrification with solar home systems. The case of the Moroccan program.

n decentralised rural electrification through solar home systems, private companies and promoting institutions are faced with the problem of deploying maintenance structures to operate and guarantee the service of the solar systems for long periods (ten years or more). The problems linked to decentralisation, such as the dispersion of dwellings, difficult access and maintenance needs, makes it an arduous task. This paper proposes an innovative design tool created ad hoc for photovoltaic rural electrification based on a real photovoltaic rural electrification program in Morocco as a special case study. The tool is developed from a mathematical model comprising a set of decision variables (location, transport, etc.) that must meet certain constraints and whose optimisation criterion is the minimum cost of the operation and maintenance activity assuming an established quality of service. The main output of the model is the overall cost of the maintenance structure. The best location for the local maintenance headquarters and warehouses in a given region is established, as are the number of maintenance technicians and vehicles required.

Review of Preventative Controls for Fraud, Waste, and Abuse in the Supplemental Nutrition Assistance Program (SNAP), Department of Social Services

This review of preventative controls for fraud, waste, and abuse in the Supplemental Nutrition Assistance Program (SNAP), administered by the Department of Social Services, was self-initiated by the State Inspector General as part of a broader statewide review of preventative fraud, waste, and abuse management controls of major benefit programs in State agencies. This review’s scope and objectives were: Assess SNAP’s preventative management controls for fraud, waste, and abuse; Identify SNAP preventative management control best practices; and Identify opportunities to improve SNAP management controls to cost/effectively mitigate risks of fraud, waste, and abuse.

Review of Program Integrity Operations At Six Managed Care Organizations Delivering Medicaid Services under a Contract with the South Carolina Department of Health & Human Services

The State contracted with six managed care organizations to deliver Medicaid managed care at an annual cost of $2.7 billion, representing 10% of the State’s annual budget, to 750,000 Medicaid beneficiaries in South Carolina. This review’s scope and objectives were: Test the six MCOs’ compliance and effective execution of the SCDHHS’s managed care contract “Section 11 - Program Integrity” focusing on the operational components of pre-payment review and post-payment review. Identify opportunities to improve SCDHHS’s biennial managed care contract, contract monitoring, and MCO compliance and effective execution of the contract.

Impact on hip fracture mortality after the establishment of an orthogeriatric care program in a colombian hospital

El objetivo del estudio es evaluar la mortalidad a un año en pacientes con fractura de cadera, mayores de 65 años tratados en un programa establecido de orto-geriatría. 298 se trataron de acuerdo al protocolo de orto-geriatría, se calculo la mortalidad a un año, se establecieron los predictores de mortalidad orto-geriátrico. La sobrevida anual se incremento de 80% a 89% (p = .039) durante los cuatro años de seguimiento del programa y disminuyo el riesgo de mortalidad anual postoperatorio (Hazard Ratio = 0.54, p = .049). La enfermedad cardiaca y la edad maor a 85 años fueron predictores positivos para mortalidad.

Undulatory Physical Resistance Training Program Increases Maximal Strength In Elderly Type 2 Diabetics.

To investigate the effects of a specific protocol of undulatory physical resistance training on maximal strength gains in elderly type 2 diabetics. The study included 48 subjects, aged between 60 and 85 years, of both genders. They were divided into two groups: Untrained Diabetic Elderly (n=19) with those who were not subjected to physical training and Trained Diabetic Elderly (n=29), with those who were subjected to undulatory physical resistance training. The participants were evaluated with several types of resistance training's equipment before and after training protocol, by test of one maximal repetition. The subjects were trained on undulatory resistance three times per week for a period of 16 weeks. The overload used in undulatory resistance training was equivalent to 50% of one maximal repetition and 70% of one maximal repetition, alternating weekly. Statistical analysis revealed significant differences (p<0.05) between pre-test and post-test over a period of 16 weeks. The average gains in strength were 43.20% (knee extension), 65.00% (knee flexion), 27.80% (supine sitting machine), 31.00% (rowing sitting), 43.90% (biceps pulley), and 21.10% (triceps pulley). Undulatory resistance training used with weekly different overloads was effective to provide significant gains in maximum strength in elderly type 2 diabetic individuals.

Is Misión Milagro an effective program to prevent blindness in Latin America?

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Programa preventivo da cárie dentária baseado no controle mecânico da placa bacteriana em crianças, por meio da profilaxia profissional periódica: Resultados após 25 anos de acompanhamento

OBJETIVOS: o objetivo deste trabalho foi verificar a incidência de cárie dentária em um programa de prevenção aplicado durante 25 anos em clínica particular. METODOLOGIA: participaram desse programa 640 crianças de ambos os gêneros, na faixa etária de 3 a 15 anos de idade. O programa foi baseado no controle mecânico da placa bacteriana dentária por meio da profilaxia profissional com jato de bicarbonato de sódio com uma periodicidade mensal. A incidência de cárie foi verificada por meio de exames clínicos durante as sessões de atendimento e radiográficos anualmente. A média de idade das crianças ao ingressarem no programa foi de 7,8 anos. RESULTADOS: antes de ingressar no programa, as crianças apresentaram, em média, 5,3 faces cariadas, enquanto após o programa a média foi de 0,18. A incidência de cáries por ano antes do programa foi de 0,9 faces cariadas e durante o programa de 0,03. O tempo de permanência das crianças no programa foi, em média, de 52,6 meses, e a média de faltas foi de 0,5 falta por ano. Esses resultados demonstram o sucesso do programa, principalmente por ter uma filosofia que procura o equilíbrio da biodiversidade da cavidade bucal, sem o risco de produzir efeitos colaterais indesejáveis. CONCLUSÕES: conclui-se, assim, que esse parece ser o caminho mais curto para resolver o problema da cárie dentária, ou seja, o controle mecânico da placa bacteriana dentária através da profilaxia profissional mensal, pois é um método de prevenção possível de ser aplicado em qualquer criança, independentemente de suas condições psicomotoras e sociais, e que proporciona a melhor relação custo-benefício, além de estar de acordo com os conceitos mais atuais de cárie e de seus fatores etiológicos. Em função da faixa etária das crianças, o programa é de suma importância para clínicas de Odontopediatria e Ortodontia.