1,061 research outputs found
Information for decision making from imperfect national data: tracking major changes in health care use in Kenya using geostatistics
No full textBackground: most Ministries of Health across Africa invest substantial resources in some form of health management information system (HMIS) to coordinate the routine acquisition and compilation of monthly treatment and attendance records from health facilities nationwide. Despite the expense of these systems, poor data coverage means they are rarely, if ever, used to generate reliable evidence for decision makers. One critical weakness across Africa is the current lack of capacity to effectively monitor patterns of service use through time so that the impacts ofchanges in policy or service delivery can be evaluated. Here, we present a new approach that, for the first time, allows national changes in health service use during a time of major health policy change to be tracked reliably using imperfect data from a national HMIS.Methods: monthly attendance records were obtained from the Kenyan HMIS for 1 271 government-run and 402 faith-based outpatient facilities nationwide between 1996 and 2004. Aspace-time geostatistical model was used to compensate for the large proportion of missing records caused by non-reporting health facilities, allowing robust estimation of monthly and annualuse of services by outpatients during this period.Results: we were able to reconstruct robust time series of mean levels of outpatient utilisation of health facilities at the national level and for all six major provinces in Kenya. These plots revealed reliably for the first time a period of steady nationwide decline in the use of health facilities in Kenyabetween 1996 and 2002, followed by a dramatic increase from 2003. This pattern was consistent across different causes of attendance and was observed independently in each province.Conclusion: the methodological approach presented can compensate for missing records in health information systems to provide robust estimates of national patterns of outpatient service use. This represents the first such use of HMIS data and contributes to the resurrection of these hugely expensive but underused systems as national monitoring tools. Applying this approach to Kenya has yielded output with immediate potential to enhance the capacity of decision makers in monitoring nationwide patterns of service use and assessing the impact of changes in health policy and service deliver
The limits and intensity of Plasmodium falciparum transmission: implications for malaria control and elimination worldwide
No full textBACKGROUND: The efficient allocation of financial resources for malaria control using appropriate combinations of interventions requires accurate information on the geographic distribution of malaria risk. An evidence-based description of the global range of Plasmodium falciparum malaria and its endemicity has not been assembled in almost 40 y. This paper aims to define the global geographic distribution of P. falciparum malaria in 2007 and to provide a preliminary description of its transmission intensity within this range. METHODS AND FINDINGS: The global spatial distribution of P. falciparum malaria was generated using nationally reported case-incidence data, medical intelligence, and biological rules of transmission exclusion, using temperature and aridity limits informed by the bionomics of dominant Anopheles vector species. A total of 4,278 spatially unique cross-sectional survey estimates of P. falciparum parasite rates were assembled. Extractions from a population surface showed that 2.37 billion people lived in areas at any risk of P. falciparum transmission in 2007. Globally, almost 1 billion people lived under unstable, or extremely low, malaria risk. Almost all P. falciparum parasite rates above 50% were reported in Africa in a latitude band consistent with the distribution of Anopheles gambiae s.s. Conditions of low parasite prevalence were also common in Africa, however. Outside of Africa, P. falciparum malaria prevalence is largely hypoendemic (less than 10%), with the median below 5% in the areas surveyed. CONCLUSIONS: This new map is a plausible representation of the current extent of P. falciparum risk and the most contemporary summary of the population at risk of P. falciparum malaria within these limits. For 1 billion people at risk of unstable malaria transmission, elimination is epidemiologically feasible, and large areas of Africa are more amenable to control than appreciated previously. The release of this information in the public domain will help focus future resources for P. falciparum malaria control and elimination
Development Of A Preliminary Lifing Analysis Tool For The F135-PW-100 Engine
No full textIn the near future the Royal Netherlands Air Force will replace their fleet of F-16’s with the F-35. In the past the NLR has aided the Air Force with life cycle and deterioration analysis work on the F100-PW-220 engine, which powers the F-16. Understanding the physical system of the engine allows for on-condition maintenance. The same is preferred for the F135-PW-100 engine powering the F-35. Therefore, a preliminary lifing analysis tool has been developed for the F135-PW-100 engine rotor blades, based on open source literature. Aerospace Engineerin
0.85 PW laser operation at 3.3 Hz and high-contrast ultrahigh-intensity λ = 400 nm second-harmonic beamline
No full textWe demonstrate the generation of 0.85 PW, 30 fs laser pulses at a repetition rate of 3.3 Hz with a record average power of 85 W from a Ti:sapphire laser. The system is pumped by high-energy Nd:glass slab amplifiers frequency doubled in LiB3O5 (LBO). Ultrahigh-contrast λ = 400 nm femtosecond pulses were generated in KH2PO4 (KDP) with>40% efficiency. An intensity of 6.5 × 1021 W∕cm2 was obtained by frequency doubling 80% of the available Ti:sapphire energy and focusing the doubled light with an f∕2 parabola. This laser will enable highly relativistic plasma experiments to be conducted at high repetition rate
A local space–time kriging approach applied to a national outpatient malaria data set
No full textIncreases in the availability of reliable health data are widely recognised as essential for efforts to strengthen health-care
systems in resource-poor settings worldwide. Effective health-system planning requires comprehensive and up-to-date
information on a range of health metrics and this requirement is generally addressed by a Health Management
Information System (HMIS) that coordinates the routine collection of data at individual health facilities and their
compilation into national databases. In many resource-poor settings, these systems are inadequate and national databases
often contain only a small proportion of the expected records. In this paper, we take an important health metric in Kenya
(the proportion of outpatient treatments for malaria (MP)) from the national HMIS database and predict the values of MP
at facilities where monthly records are missing. The available MP data were densely distributed across a spatiotemporal
domain and displayed second-order heterogeneity. We used three different kriging methodologies to make cross-validation
predictions of MP in order to test the effect on prediction accuracy of (a) the extension of a spatial-only to a space–time
prediction approach, and (b) the replacement of a globally stationary with a locally varying random function model.
Space–time kriging was found to produce predictions with 98.4% less mean bias and 14.8% smaller mean imprecision than
conventional spatial-only kriging. A modification of space–time kriging that allowed space–time variograms to be
recalculated for every prediction location within a spatially local neighbourhood resulted in a larger decrease in mean
imprecision over ordinary kriging (18.3%) although the mean bias was reduced less (87.5%)
Shifting attention in viewer- and object-based reference frames after unilateral brain injury
No full textThe aims of the present study were to investigate the respective roles that object- and viewer-based reference frames play in reorienting visual attention, and to assess their influence after unilateral brain injury. To do so, we studied 16 right hemisphere injured (RHI) and 13 left hemisphere injured (LHI) patients. We used a cueing design that manipulates the location of cues and targets relative to a display comprised of two rectangles (i.e., objects). Unlike previous studies with patients, we presented all cues at midline rather than in the left or right visual fields. Thus, in the critical conditions in which targets were presented laterally, reorienting of attention was always from a midline cue. Performance was measured for lateralized target detection as a function of viewer-based (contra- and ipsilesional sides) and object-based (requiring reorienting within or between objects) reference frames. As expected, contralesional detection was slower than ipsilesional detection for the patients. More importantly, objects influenced target detection differently in the contralesional and ipsilesional fields. Contralesionally, reorienting to a target within the cued object took longer than reorienting to a target in the same location but in the uncued object. This finding is consistent with object-based neglect. Ipsilesionally, the means were in the opposite direction. Furthermore, no significant difference was found in object-based influences between the patient groups (RHI vs. LHI). These findings are discussed in the context of reference frames used in reorienting attention for target detection
Developing geostatistical space–time models to predict outpatient treatment burdens from incomplete national data
No full textBasic health system data such as the number of patients utilizing different health facilities and the types of illness for which they are being treated are critical for managing service provision. These data requirements are generally addressed with some form of national Health Management Information System (HMIS), which coordinates the routine collection and compilation of data from national health facilities. HMIS in most developing countries are characterized by widespread underreporting. Here we present a method to adjust incomplete data to allow prediction of national outpatient treatment burdens. We demonstrate this method with the example of outpatient treatments for malaria within the Kenyan HMIS. Three alternative modeling frameworks were developed and tested in which space–time geostatistical prediction algorithms were used to predict the monthly tally of treatments for presumed malaria cases (MC) at facilities where such records were missing. Models were compared by a crossvalidation exercise and the model found to most accurately predict MC incorporated available data on the total number of patients visiting each facility each month. A space–time stochastic simulation framework to accompany this model was developed and tested in order to provide estimates of both local and regional prediction uncertainty. The level of accuracy provided by the predictive model, and the accompanying estimates of uncertainty around the predictions, demonstrate how this tool can mitigate the uncertainties caused by missing data, substantially enhancing the utility of existing HMIS data to health-service decision makers
Supplementary Data: Spectral Control via Multi-Species Effects in PW-Class Laser-Ion Acceleration
No full textSupplementary materials for our paper "Spectral Control via Multi-Species Effects in PW-Class Laser-Ion Acceleration".
Additional high-resolution, raw HDF5 files using the openPMD standard (DOI:10.5281/zenodo.1167843) increase simulation output data to 4.7 TByte and are available from the corresponding author upon reasonable request.This project received funding within the MEPHISTO project (BMBF-Förderkennzeichen 01IH16006C)
Wall-pressure-velocity transfer kernel in high Reynolds number turbulent channel flows
No full textSince wall-pressure fluctuations would form a practically-robust input to a real-time active controller of wall-bounded turbulence, it is of high practical interest to study the scaling behavior of the wall-pressure-velocity coupling. This work investigates the coupling of the wall-pressure fluctuations with the streamwise and wall-normal velocity fluctuations. Both the gain (or coherence) and phase spectra of the wall-pressure-velocity transfer kernel are assessed using a comprehensive database, available from direct numerical simulations of turbulent channel flow. With data spanning a decade in friction Reynolds number Reτ ∼ 550-5200, a 1D analysis (in terms of the streamwise wavelength, λx) reveals that the streamwise velocity and wall-pressure are most strongly coupled at a self-similar wall-scaling of λx/y ≈ 14. For the wall-normal velocity component, the strongest coupling appears at approximately half this ratio (λx/y ≈ 8.5). An analysis of the kernel's phase demonstrates that both the coherent fluctuations of streamwise and wall-normal velocity obey a forward-leaning inclination angle of α ≈ 30◦. When extending the analysis to 2D (as a function of λx and λz), the peak-coherence for pw and u still resides close to λx/y ≈ 14 and is reasonably symmetric around λx/λz = 2.3. The 2D coherence for pw and v peaks around λx/λz = 1.0. Both the 2D coherence for pw and u, and pw and v, adhere to a wall-scaling with y. Scaling behaviours identified in this work will aid the efficacy of real-time controllers, by for instance the implementation of data-derived FIR filters to only control velocity structures that are captured through wall-pressure measurements.Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Aerodynamic
Kościół katedralny pw. Wniebowzięcia Najświętszej Maryi Panny i Polonia w Charkowie: krótki szkic historyczny (XIX wiek)
No full textCathedral church of Assumptoin of the Blessed Virgin Marry a short historical draft (19th century). The author of the article presents a short outline of the cathedral church of Assumption of the Blessed Virgin Marry in Kharkiv since the moment it was built to its ceremonial cosercation in June 26, 1892 by the bishop of Molyhowska Diocese Albin Simon. Building of the church has been shown on the background of functioning of Polish community in Kharkiv in the 19th century which from a small group of believers managed transform into an important part of the citizens of the city. The cathedral church of Assumption of the Blessed Virgin Marry was a rock for Poles’ activities leaving in Kharkiv. The church survived till today and it adrous the city centre as an architectural jewel.Kościół katedralny pw. Wniebowzięcia Najświętszej Maryi Panny i Polonia w Charkowie: krótki szkic historyczny (XIX wiek). Autorka w przedstawionym artykule przybliża krótki zarys historii kościoła katedralnego pw. Wniebowzięcia Najświętszej Maryi Panny w Charkowie od czasu jego wzniesienia do chwili jego uroczystego poświęcenia 26 lipca 1892 roku przez biskupa pomocniczego diecezji mohylowskiej Franciszka Albina Simona. Budowa świątyni została ukazana na tle funkcjonowania w Charkowie w XIX wieku społeczności polskiej, która z niewielkiej garstki wiernych zdołała przekształcić się w niezwykle istotną część składową mieszkańców miasta. Ostoją dla działalności Polaków mieszkających w Charkowie był kościół katedralny pw. Wniebowzięcia Najświętszej Maryi Panny, który przetrwał do czasów obecnych, i dziś, jako perła architektury sakralnej, zdobi centrum miasta
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