11 research outputs found
Measuring coverage in MNCH: population HIV-free survival among children under two years of age in four African countries
BACKGROUND: Population-based evaluations of programs for prevention of mother-to-child HIV transmission (PMTCT) are scarce. We measured PMTCT service coverage, regimen use, and HIV-free survival among children â€24 mo of age in Cameroon, CĂŽte D'Ivoire, South Africa, and Zambia. Methods and FINDINGS: We randomly sampled households in 26 communities and offered participation if a child had been born to a woman living there during the prior 24 mo. We tested consenting mothers with rapid HIV antibody tests and tested the children of seropositive mothers with HIV DNA PCR or rapid antibody tests. Our primary outcome was 24-mo HIV-free survival, estimated with survival analysis. In an individual-level analysis, we evaluated the effectiveness of various PMTCT regimens. In a community-level analysis, we evaluated the relationship between HIV-free survival and community PMTCT coverage (the proportion of HIV-exposed infants in each community that received any PMTCT intervention during gestation or breastfeeding). We also compared our community coverage results to those of a contemporaneous study conducted in the facilities serving each sampled community. Of 7,985 surveyed children under 2 y of age, 1,014 (12.7%) were HIV-exposed. Of these, 110 (10.9%) were HIV-infected, 851 (83.9%) were HIV-uninfected, and 53 (5.2%) were dead. HIV-free survival at 24 mo of age among all HIV-exposed children was 79.7% (95% CI: 76.4, 82.6) overall, with the following country-level estimates: Cameroon (72.6%; 95% CI: 62.3, 80.5), South Africa (77.7%; 95% CI: 72.5, 82.1), Zambia (83.1%; 95% CI: 78.4, 86.8), and CĂŽte D'Ivoire (84.4%; 95% CI: 70.0, 92.2). In adjusted analyses, the risk of death or HIV infection was non-significantly lower in children whose mothers received a more complex regimen of either two or three antiretroviral drugs compared to those receiving no prophylaxis (adjusted hazard ratio: 0.60; 95% CI: 0.34, 1.06). Risk of death was not different for children whose mothers received a more complex regimen compared to those given single-dose nevirapine (adjusted hazard ratio: 0.88; 95% CI: 0.45, 1.72). Community PMTCT coverage was highest in Cameroon, where 75 of 114 HIV-exposed infants met criteria for coverage (66%; 95% CI: 56, 74), followed by Zambia (219 of 444, 49%; 95% CI: 45, 54), then South Africa (152 of 365, 42%; 95% CI: 37, 47), and then CĂŽte D'Ivoire (3 of 53, 5.7%; 95% CI: 1.2, 16). In a cluster-level analysis, community PMTCT coverage was highly correlated with facility PMTCT coverage (Pearson's r â=â0.85), and moderately correlated with 24-mo HIV-free survival (Pearson's r â=â0.29). In 14 of 16 instances where both the facility and community samples were large enough for comparison, the facility-based coverage measure exceeded that observed in the community. CONCLUSIONS: HIV-free survival can be estimated with community surveys and should be incorporated into ongoing country monitoring. Facility-based coverage measures correlate with those derived from community sampling, but may overestimate population coverage. The more complex regimens recommended by the World Health Organization seem to have measurable public health benefit at the population level, but power was limited and additional field validation is needed. Please see later in the article for the Editors' Summar
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Fuzzy Set Theory Applied to Measurement Data for Exposure Control in Beryllium Part Manufacturing.
Fuzzy set theory has been applied to some exposure control problems encountered in the machining and the manufacturing of beryllium parts at Los Alamos National Laboratory. A portion of that work is presented here. The major driving force for using fuzzy techniques in this case rather than classical statistical process control is that beryllium exposure is very task dependent and this manufacturing plant is quite atypical. It is feared that standard techniques produce too many false alarms. Our beryllium plant produces parts on a daily basis, but every day is different. Some days many parts are produced and some days only a few. Some times the parts are large and sometimes the parts are small. Some machining cuts are rough and some are fine. These factors and others make it hard to define a typical day. The problem of concern, for this study, is the worker beryllium exposure. Even though the plant is new and very modern and the exposure levels are expected to be well below the required levels, the Department of Energy (DOE), who is our major customer, has demanded that the levels for this plant be well below required levels. The control charts used to monitor this process are expected to answer two questions: (1) Is the process out of Control? Do we need to instigate special controls such as requiring workers to use respirators? (2) Are new, previously untested, controls making a difference? The standard Schewart type control charts, based on consistent plant operating conditions do not adequately answer this question. The approach described here is based upon a fuzzy modification to the Schewart Xbar-R chart. This approach is expected to yield better results than work based upon the classical probabilistic control chart
HIV-free survival by country and by PMTCT regimen in the PEARL Study.
<p>(A) HIV-free survival by country among exposes children; (B) HIV-free survival by PMTCT regimen among exposed children. AZT, zidovudine.</p
Characteristics of antenatal and postnatal care for children under 2 y of age in the PEARL Study.
<p>Data are number (percent) unless otherwise indicated.</p>a<p>Restricted to those who consulted ANC.</p>b<p>Restricted to those who consulted ANC and had an HIV test.</p><p>ANC, antenatal care.</p
Description of the cohort of children born in the previous 2 y (<i>n</i>â=â10,236) from all eligible households (<i>n</i>â=â9,348) visited from May 2008 to May 2009.
<p>Description of the cohort of children born in the previous 2 y (<i>n</i>â=â10,236) from all eligible households (<i>n</i>â=â9,348) visited from May 2008 to May 2009.</p
Relationship among service coverage at the facility level, service coverage at the community level, and HIV-free survival in children under 2 y of age in the PEARL Study.
<p>(A) Facility-based coverage versus community-based coverage; (B) community-based coverage versus HIV-free survival; (C) facility-based coverage versus HIV-free survival.</p
Comparison of PMTCT service coverage in the community survey compared to results of a simultaneous survey in corresponding facilities [15].
<p>Coverage defined as the proportion of children born to HIV-positive mothers in whom any ARV drug is reported to have been used during pregnancy.</p>a<p>Not adjusted to account for clustering within communities or countries.</p
Characteristics of mothers surveyed with a child under 2 y of age in the PEARL Study.
<p>Data are number (percent) unless otherwise indicated.</p
ZmÄna zĂĄkladnĂho tĂłnu ĆeÄi a transformace hlasu pomocĂ PSOLA
In the paper a voice transformation approach based on the application of the Pitch Synchronous OverLap and Add /PSOLA/ principle and resampling is proposed. This algorithm has lower computational demands than frequency domain methods