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

Evaluation of the CyberGlove(TM) as a Whole Hand Input Device

We present a careful evaluation of the sensor characteristics of the CyberGlove(TM) model CG1801 whole hand input device. In particular, we conducted an experimental study that investigated level of sensitivity of the sensors, their performance in recognized angles, and factors that affect accuracy of recognition of flexion measurements. Among our results, we show that hand size differences between the subjects of the study did not have a statisical affect on the accuracy of the device. We also analyzed the effect of differect software calibration approaches on accuracy of the sensors

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