Do Increasing Rates of Loss to Follow-up in Antiretroviral Treatment Programs Imply Deteriorating Patient Retention?

In several studies of antiretroviral treatment (ART) programs for persons with human immunodeficiency virus infection, investigators have reported that there has been a higher rate of loss to follow-up (LTFU) among patients initiating ART in recent years than among patients who initiated ART during earlier time periods. This finding is frequently interpreted as reflecting deterioration of patient retention in the face of increasing patient loads. However, in this paper we demonstrate by simulation that transient gaps in follow-up could lead to bias when standard survival analysis techniques are applied. We created a simulated cohort of patients with different dates of ART initiation. Rates of ART interruption, ART resumption, and mortality were assumed to remain constant over time, but when we applied a standard definition of LTFU, the simulated probability of being classified LTFU at a particular ART duration was substantially higher in recently enrolled cohorts. This suggests that much of the apparent trend towards increased LTFU may be attributed to bias caused by transient interruptions in care. Alternative statistical techniques need to be used when analyzing predictors of LTFU-for example, using "prospective" definitions of LTFU in place of "retrospective" definitions. Similar considerations may apply when analyzing predictors of LTFU from treatment programs for other chronic diseases.

A regional climate palaeosimulation for Europe in the period 1500–1990 – Part 2: Shortcomings and strengths of models and reconstructions

This study compares gridded European seasonal series of surface air temperature (SAT) and precipitation (PRE) reconstructions with a regional climate simulation over the period 1500–1990. The area is analysed separately for nine subareas that represent the majority of the climate diversity in the European sector. In their spatial structure, an overall good agreement is found between the reconstructed and simulated climate features across Europe, supporting consistency in both products. Systematic biases between both data sets can be explained by a priori known deficiencies in the simulation. Simulations and reconstructions, however, largely differ in the temporal evolution of past climate for European subregions. In particular, the simulated anomalies during the Maunder and Dalton minima show stronger response to changes in the external forcings than recorded in the reconstructions. Although this disagreement is to some extent expected given the prominent role of internal variability in the evolution of regional temperature and precipitation, a certain degree of agreement is a priori expected in variables directly affected by external forcings. In this sense, the inability of the model to reproduce a warm period similar to that recorded for the winters during the first decades of the 18th century in the reconstructions is indicative of fundamental limitations in the simulation that preclude reproducing exceptionally anomalous conditions. Despite these limitations, the simulated climate is a physically consistent data set, which can be used as a benchmark to analyse the consistency and limitations of gridded reconstructions of different variables. A comparison of the leading modes of SAT and PRE variability indicates that reconstructions are too simplistic, especially for precipitation, which is associated with the linear statistical techniques used to generate the reconstructions. The analysis of the co-variability between sea level pressure (SLP) and SAT and PRE in the simulation yields a result which resembles the canonical co-variability recorded in the observations for the 20th century. However, the same analysis for reconstructions exhibits anomalously low correlations, which points towards a lack of dynamical consistency between independent reconstructions.

Recent Advances in Adaptive Sampling and Reconstruction for Monte Carlo Rendering

Monte Carlo integration is firmly established as the basis for most practical realistic image synthesis algorithms because of its flexibility and generality. However, the visual quality of rendered images often suffers from estimator variance, which appears as visually distracting noise. Adaptive sampling and reconstruction algorithms reduce variance by controlling the sampling density and aggregating samples in a reconstruction step, possibly over large image regions. In this paper we survey recent advances in this area. We distinguish between “a priori” methods that analyze the light transport equations and derive sampling rates and reconstruction filters from this analysis, and “a posteriori” methods that apply statistical techniques to sets of samples to drive the adaptive sampling and reconstruction process. They typically estimate the errors of several reconstruction filters, and select the best filter locally to minimize error. We discuss advantages and disadvantages of recent state-of-the-art techniques, and provide visual and quantitative comparisons. Some of these techniques are proving useful in real-world applications, and we aim to provide an overview for practitioners and researchers to assess these approaches. In addition, we discuss directions for potential further improvements.

STUDY OF THE EFFECTS OF TOTAL MODULATION TRANSFER FUNCTION CHANGES ON OBSERVER PERFORMANCE USING CLINICAL MAMMOGRAMS

The main goal of this study was to relate physical changes in image quality measured by Modulation Transfer Function (MTF) to diagnostic accuracy.^ One Hundred and Fifty Kodak Min-R screen/film combination conventional craniocaudal mammograms obtained with the Pfizer Microfocus Mammographic system were selected from the files of the Department of Radiology, at M.D. Anderson Hospital and Tumor Institute.^ The mammograms included 88 cases with a variety of benign diagnosis and 62 cases with a variety of malignant biopsy diagnosis. The average age of the patient population was 55 years old. 70 cases presented calcifications with 30 cases having calcifications smaller than 0.5mm. 46 cases presented irregular bordered masses larger than 1 cm. 30 cases presented smooth bordered masses with 20 larger than 1 cm.^ Four separated copies of the original images were made each having a different change in the MTF using a defocusing technique whereby copies of the original were obtained by light exposure through different thicknesses (spacing) of transparent film base.^ The mammograms were randomized, and evaluated by three experienced mammographers for the degree of visibility of various anatomical breast structures and pathological lesions (masses and calicifications), subjective image quality, and mammographic interpretation.^ 3,000 separate evaluations were anayzed by several statistical techniques including Receiver Operating Characteristic curve analysis, McNemar test for differences between proportions and the Landis et al. method of agreement weighted kappa for ordinal categorical data.^ Results from the statistical analysis show: (1) There were no statistical significant differences in the diagnostic accuracy of the observers when diagnosing from mammograms with the same MTF. (2) There were no statistically significant differences in diagnostic accuracy for each observer when diagnosing from mammograms with the different MTF's used in the study. (3) There statistical significant differences in detail visibility between the copies and the originals. Detail visibility was better in the originals. (4) Feature interpretations were not significantly different between the originals and the copies. (5) Perception of image quality did not affect image interpretation.^ Continuation and improvement of this research ca be accomplished by: using a case population more sensitive to MTF changes, i.e., asymptomatic women with minimum breast cancer, more observers (including less experienced radiologists and experienced technologists) must collaborate in the study, and using a minimum of 200 benign and 200 malignant cases.^

Comparison of a traditional and a multilevel Cox Proportional Hazards model

Hierarchically clustered populations are often encountered in public health research, but the traditional methods used in analyzing this type of data are not always adequate. In the case of survival time data, more appropriate methods have only begun to surface in the last couple of decades. Such methods include multilevel statistical techniques which, although more complicated to implement than traditional methods, are more appropriate. ^ One population that is known to exhibit a hierarchical structure is that of patients who utilize the health care system of the Department of Veterans Affairs where patients are grouped not only by hospital, but also by geographic network (VISN). This project analyzes survival time data sets housed at the Houston Veterans Affairs Medical Center Research Department using two different Cox Proportional Hazards regression models, a traditional model and a multilevel model. VISNs that exhibit significantly higher or lower survival rates than the rest are identified separately for each model. ^ In this particular case, although there are differences in the results of the two models, it is not enough to warrant using the more complex multilevel technique. This is shown by the small estimates of variance associated with levels two and three in the multilevel Cox analysis. Much of the differences that are exhibited in identification of VISNs with high or low survival rates is attributable to computer hardware difficulties rather than to any significant improvements in the model. ^

Measuring Potential Output and Output Gap and Macroeconomic Policy: The Case of Kenya

Measuring the level of an economy.s potential output and output gap are essential in identifying a sustainable non-inflationary growth and assessing appropriate macroeconomic policies. The estimation of potential output helps to determine the pace of sustainable growth while output gap estimates provide a key benchmark against which to assess inflationary or disinflationary pressures suggesting when to tighten or ease monetary policies. These measures also help to provide a gauge in the determining the structural fiscal position of the government. This paper attempts to measure Kenya.s potential output and output gap using alternative statistical techniques and structural methods. Estimation of potential output and output gap using these techniques shows varied results. The estimated potential output growth using different methods gave a range of .2.9 to 2.4 percent for 2000 and a range of .0.8 to 4.6 for 2001. Although various methods produce varied results, they however provided a broad consensus on the over-all trend and performance of the Kenyan economy. This study found that firstly, potential output growth is declining over the recent time and secondly, the Kenyan economy is contracting in the recent years.

Variation in hospital inpatient charges by payer in Houston, Texas

An analysis of variation in hospital inpatient charges in the greater Houston area is conducted to determine if there are consistent differences among payers. Differences in charges are examined for 59 Composite Diagnosis Related Groups (CDRGs) and two regression equations estimating charges are specified. Simple comparison of mean charges by diagnostic categories are significantly different for 42 (71 percent) of the 59 categories examined. In 41 of the 42 significant categories, charges to Medicaid were less than charges to private insurers. Meta-analytic statistical techniques yielded a weighted average effect size of $-$0.7198 for the 59 diagnostic categories, indicating an overall effect that Medicaid charges were less than private insurance charges. Results of a multiple regression estimating charges showed that private insurance was a significant independent variable, along with age, length of stay, and hospital variables. Results indicated consistent differential charges in the present analysis. ^

AMERICAN TRYPANOSOMIASIS (CHAGAS') DISEASE - A STUDY OF FETO-MATERNAL MORBIDITY AND MORTALITY

The possibility of a relationship between American Trypanosomiasis (Chagas') disease and pregnancy outcome was analyzed measuring feto-maternal morbidity and mortality in a sample of 604 pregnant women and their offspring seen at the Hospital Universitario de Maternidad y Neonatologia in Cordoba, Argentina during 1979.^ A cross-sectional, "case-comparison" investigation was employed to determine the degree of risk between having a reactive chagasic serologic test and a negative pregnancy outcome as determined by abortion, stillbirth, and infant death prior to one week of age. Patients were selected using a dichotomous, 0-1 scale with either the presence or the absence of a reactive Machado-Guerreiro complement fixation serologic blood test result.^ The data obtained were analyzed using appropriate statistical techniques for measuring the comparisons between the case and control groups under various demographic and socioeconomic variables such as, age, marital status, educational attainment, and residence. Similarly, additional biological variables of birth order, maternal and fetal complications, and prematurity were examined.^ From the analysis of the data obtained in this investigation, no definite conclusions can be reached regarding the risk of having an unsuccessful pregnancy outcome in the presence of a reactive serologic finding because the study design was a cross-sectional one and the number of events were too few for an adequate analysis. Notwithstanding these limitations, the results obtained, after statistical adjustments were employed, demonstrated that women with a reactive test result were older, were of a higher parity, and were less educated. Marital status and residence were not significant variables. The risk of pregnancy wastage, however, was almost twice as frequent in the reactive group as in the non-reactive group of women. Statistically significant differences in maternal morbidity involved two complications, polyhydramnios and varicosities of the lower extremities and vulva; while in the newborn, infection was higher in infants whose mothers exhibited a reactive serologic test result.^ In summary, what this research study has shown is the need for engaging in a larger, longitudinal study for an in-depth exploration of feto-maternal morbidity and mortality--an investigation that would corraborate or refute the findings of this study.^

Características palinológicas de mieles de eucalipto (Eucalyptus sp.) y tréboles (Trifolium sp.) provenientes de la Provincia Fitogeográfica Pampeana Argentina

El objetivo de este trabajo fue estudiar el perfil polínico de mieles de tréboles y de eucalipto de la Provincia Fitogeográfica Pampeana Argentina, con el fin de contribuir a su caracterización palinológica. Se realizó un análisis polínico cualitativo y se aplicaron técnicas estadísticas descriptivas y multivariadas, para conocer la distribución de frecuencia de los pólenes y caracterizar cada origen floral, según los pólenes acompañantes y los años de cosecha. Se analizaron 81 muestras de miel, de cuatro cosechas diferentes. Se encontraron 41 tipos morfológicos de polen, cuya variación por muestra osciló entre dos y ocho. El taxón presente en más del 80% de las mieles fue Eucalyptus sp. Los principales pólenes acompañantes encontrados pertenecieron a los tipos Helianthus annuus y Carduus sp., para ambos orígenes florales estudiados, y a la familia de las Brassicaceae, para las mieles de tréboles. Los años de cosecha estudiados mostraron diferentes espectros polínicos.

Turismo y trabajo : Una aproximación desde el mercado hotelero

El presente trabajo tiene por objetivo profundizar en el comportamiento del mercado de trabajo en regiones donde la principal actividad económica es el turismo mediante el análisis de la información que desde el año 2004 se obtiene a través de la Encuesta de Ocupación Hotelera (EOH) que releva el INDEC. La posibilidad de contar con la EOH, especialmente en aquellas localidades que, por su dimensión no poseen información proveniente de las Encuestas Permanente de Hogares (EPH), abre la posibilidad de que, a través del comportamiento hotelero y para-hotelero, se acceda a una aproximación de la situación ocupacional en esas localidades, donde se presentan serias dificultades durante algunos períodos del año. Aunque la serie de que se dispone es aún breve 'en el mejor de los casos de hasta cinco años', se la analiza mediante técnicas estadísticas para determinación de estacionalidad, como punto de partida para un posterior seguimiento y puesta en discusión de otras alternativas de abordaje. Se trabaja con localidades de manera desagregada, pudiendo advertirse nítidamente las especificidades según la modalidad turística de cada una de ellas y concentrando el comportamiento de las mismas en dos grupos diferentes: a) Localidades con economías de perfiles más diversificadas; b) Localidades con base económica preponderantemente turística. Mediante este análisis se pretende alcanzar algunos resultados que, eventualmente complementados con información de carácter primaria tanto cuantitativa como de carácter más cualitativo, aporten al conocimiento de un mercado de trabajo cuyas especificidades lo tornan complejo y cuyas consecuencias preocupan tanto al sector público como al privado

Turismo y trabajo : Una aproximación desde el mercado hotelero

El presente trabajo tiene por objetivo profundizar en el comportamiento del mercado de trabajo en regiones donde la principal actividad económica es el turismo mediante el análisis de la información que desde el año 2004 se obtiene a través de la Encuesta de Ocupación Hotelera (EOH) que releva el INDEC. La posibilidad de contar con la EOH, especialmente en aquellas localidades que, por su dimensión no poseen información proveniente de las Encuestas Permanente de Hogares (EPH), abre la posibilidad de que, a través del comportamiento hotelero y para-hotelero, se acceda a una aproximación de la situación ocupacional en esas localidades, donde se presentan serias dificultades durante algunos períodos del año. Aunque la serie de que se dispone es aún breve 'en el mejor de los casos de hasta cinco años', se la analiza mediante técnicas estadísticas para determinación de estacionalidad, como punto de partida para un posterior seguimiento y puesta en discusión de otras alternativas de abordaje. Se trabaja con localidades de manera desagregada, pudiendo advertirse nítidamente las especificidades según la modalidad turística de cada una de ellas y concentrando el comportamiento de las mismas en dos grupos diferentes: a) Localidades con economías de perfiles más diversificadas; b) Localidades con base económica preponderantemente turística. Mediante este análisis se pretende alcanzar algunos resultados que, eventualmente complementados con información de carácter primaria tanto cuantitativa como de carácter más cualitativo, aporten al conocimiento de un mercado de trabajo cuyas especificidades lo tornan complejo y cuyas consecuencias preocupan tanto al sector público como al privado

Turismo y trabajo : Una aproximación desde el mercado hotelero

El presente trabajo tiene por objetivo profundizar en el comportamiento del mercado de trabajo en regiones donde la principal actividad económica es el turismo mediante el análisis de la información que desde el año 2004 se obtiene a través de la Encuesta de Ocupación Hotelera (EOH) que releva el INDEC. La posibilidad de contar con la EOH, especialmente en aquellas localidades que, por su dimensión no poseen información proveniente de las Encuestas Permanente de Hogares (EPH), abre la posibilidad de que, a través del comportamiento hotelero y para-hotelero, se acceda a una aproximación de la situación ocupacional en esas localidades, donde se presentan serias dificultades durante algunos períodos del año. Aunque la serie de que se dispone es aún breve 'en el mejor de los casos de hasta cinco años', se la analiza mediante técnicas estadísticas para determinación de estacionalidad, como punto de partida para un posterior seguimiento y puesta en discusión de otras alternativas de abordaje. Se trabaja con localidades de manera desagregada, pudiendo advertirse nítidamente las especificidades según la modalidad turística de cada una de ellas y concentrando el comportamiento de las mismas en dos grupos diferentes: a) Localidades con economías de perfiles más diversificadas; b) Localidades con base económica preponderantemente turística. Mediante este análisis se pretende alcanzar algunos resultados que, eventualmente complementados con información de carácter primaria tanto cuantitativa como de carácter más cualitativo, aporten al conocimiento de un mercado de trabajo cuyas especificidades lo tornan complejo y cuyas consecuencias preocupan tanto al sector público como al privado

Operator and replicability bias in comparative taphonomic studies

The operator effect is a well-known methodological bias already quantified in some taphonomic studies. However, the replicability effect, i.e., the use of taphonomic attributes as a replicable scientific method, has not been taken into account to the present. Here, we quantified for the first time this replicability bias using different multivariate statistical techniques, testing if the operator effect is related to the replicability effect. We analyzed the results reported by 15 operators working on the same dataset. Each operator analyzed 30 biological remains (bivalve shells) from five different sites, considering the attributes fragmentation, edge rounding, corrasion, bioerosion and secondary color. The operator effect followed the same pattern reported in previous studies, characterized by a worse correspondence for those attributes having more than two levels of damage categories. However, the effect did not appear to have relation with the replicability effect, because nearly all operators found differences among sites. Despite the binary attribute bioerosion exhibited 83% of correspondence among operators it was the taphonomic attributes that showed the highest dispersion among operators (28%). Therefore, we conclude that binary attributes (despite showing a reduction of the operator effect) diminish replicability, resulting in different interpretations of concordant data. We found that a variance value of nearly 8% among operators, was enough to generate a different taphonomic interpretation, in a Q-mode cluster analysis. The results reported here showed that the statistical method employed influences the level of replicability and comparability of a study and that the availability of results may be a valid alternative to reduce bias.

Geochemistry of terrigenous material in deep-sea sediments of the equatorial Pacific

Biological productivity in the modern equatorial Pacific Ocean, a region with high nutrients and low chlorophyll, is currently limited by the micronutrient Fe. In order to test whether Fe was limiting in the past and to identify potential pathways of Fe delivery that could drive Fe fertilization (i.e., dust delivery from eolian inputs vs. Fe supplied by the Equatorial Undercurrent), we chemically isolated the terrigenous material from sediment along a cross-equatorial transect in the central equatorial Pacific at 140°W and at Ocean Drilling Program Site 850 in the eastern equatorial Pacific. We quantified the contribution from each potential Fe-bearing terrigenous source using a suite of chemical- and isotopic discrimination strategies as well as multivariate statistical techniques. We find that the distribution of the terrigenous sources (i.e., Asian loess, South American ash, Papua New Guinea, and ocean island basalt) varies through time, latitude, and climate. Regardless of which method is used to determine accumulation rate, there also is no relationship between flux of any particular Fe source and climate. Moreover, there is no connection between a particular Fe source or pathway (eolian vs. Undercurrent) to total productivity during the Last Glacial Maximum, Pleistocene glacial episodes, and the Miocene "Biogenic Bloom". This would suggest an alternative process, such as an interoceanic reorganization of nutrient inventories, may be responsible for past changes in total export in the open ocean, rather than simply Fe supply from dust and/or Equatorial Undercurrent processes. Additionally, perhaps a change in Fe source or flux is related to a change in a particular component of the total productivity (e.g., the production of organic matter, calcium carbonate, or biogenic opal).

Chemical composition of surficial bottom sediments from the Chukchi Sea and adjacent part of the Arctic Ocean

This paper presents data on chemical composition of bottom sediments from the Chukchi Sea and the adjacent Arctic Ocean. Multivariate statistical techniques were used for analysis of the data set and revealed that grain size fractionation of the original terrigenous component during sedimentation was the major factor of clustering of the samples in study. Secondary factors include accumulation of biogenic siliceous and carbonate material and chemogenic or biochemical accumulation of iron, manganese, and some trace elements. The latter factor was significant in areas of tectonic activity within the graben-rift system of the Chukchi Sea.