bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance Study of Soft Local Binary Pattern over Local Binary Pattern under Noisy Images
Authors: Yasmin Sabina , Masud Rana Md.
Published: June 2016

In this paper, the performance of soft local binary pattern (SLBP) method has been investigated with edge detection techniques for face recognition in case of noisy condition. Various edge detection techniques such as Canny, Robert and Log methods have been used with SLBP for recognizing faces. The results obtained using SLBP with various edge detection for noisy condition based on image quality measurement shows better recognition rate compared to the results obtained using local binary pattern (LBP). Simplified edge detection methods simplify the images as a result SLBP with edge detection requires less computation time compared with edge detection of LBP.
Review of Software Fault-Tolerance Methods for Reliability Enhancement of Real-Time Software Systems
Authors: Verma Anjushi , Ghartaan Ankur , Gayen Tirthankar
Published: June 2016

Real time systems are those systems which must guarantee to response correctly within strict time constraint or within deadline. Failures can arise from both functional errors as well as timing bugs. Hence, it is necessary to provide temporal correctness of programs used in real time applications in addition to providing functional correctness. Although, there are several researches concerned with achieving fault tolerance in the presence of various functional and operational errors but many of them did not address the problem concerned with the timing bugs which is an important issue in real time systems. As for real time systems, many times it becomes a necessity for a given service to be delivered within the specified time deadline. Therefore, this paper reviews the existing approaches from the perspective of  real time systems to analyse the shortcomings of these approaches to  present a versatile and cost effective approach in the presence of timing bugs for providing fault tolerance to enhance the reliability of the real time software applications.
Machine Learning Techniques on Multidimensional Curve Fitting Data Based on R- Square and Chi-Square Methods
Authors: P Vidyullatha , Rao D. Rajeswara
Published: June 2016

Curve fitting is one of the procedures in data analysis and is helpful for prediction analysis showing graphically how the data points are related to one another whether it is in linear or non-linear model. Usually, the curve fit will find the concentrates along the curve or it will just use to smooth the data and upgrade the presence of the plot. Curve fitting checks the relationship between independent variables and dependent variables with the objective of characterizing a good fit model. Curve fitting finds mathematical equation that best fits given information. In this paper, 150 unorganized data points of environmental variables are used to develop Linear and non-linear data modelling which are evaluated by utilizing 3 dimensional ‘Sftool’ and ‘Labfit’ machine learning techniques. In Linear model, the best estimations of the coefficients are realized by the estimation of R- square turns in to one and in Non-Linear models with least Chi-square are the criteria. 
Breakdowns' Diagnosis of A New Character Three-Phase High Voltage Power Supply for Industrial Microwave Generators with N=2 Magnetrons per Phase
Authors: Batit R. , Chraygane M. , Ferfra M. , Fadel M. , Dsoul A. , Bahani B.
Published: June 2016

This paper treats the modelisation of a new three phase character high voltage supply (HV) for industrial microwave generators with N=2 magnetrons per phase. This alimentation is based on the presentation of an equivalent p circuit model of a newly dimensioned high voltage transformer. Each phase of the three phase system supplies two parallel cell voltage doublers and current stabilizer. Each of these cells in turn supplies one magnetron 800Watts / 2.45GHz. This power supply is a star connection of three identical models of the single-phase power for N=2 magnetrons. The simulation under EMTP (Electro Magnetic Transients Program) in nominal conditions allows concluding that theoretical results are adjacent to the experimental measurements. Furthermore, a failure study of six magnetron of the microwave generator is also processed. The results permit to observe that the interaction between magnetrons dosn’t influence the nominal operation of the system.
Secure Digital Signature Scheme Based on Elliptic Curves for Internet of Things
Authors: Koppula Sumanth , Muthukuru Jayabhaskar
Published: June 2016

Advances in the info and communication knowledge have led to the emergence of Internet of things (IoT). Internet of things (loT) is worthwhile to members, trade, and society seeing that it generates a broad range of services by interconnecting numerous devices and information objects. Throughout the interactions among the many ubiquitous things, security problems emerge as noteworthy, and it is signiﬁcant to set up more suitable solution for security protection. Nonetheless, as loT devices have limited resource constraints to appoint strong protection mechanisms, they are vulnerable to sophisticated security attacks. For this reason, a sensible authentication mechanism that considers each useful resource constraints and safety is required. Our proposed scheme uses the standards of Elliptic Curve digital signature scheme and evaluates systematically the efficiency of our scheme and observes that our scheme with a smaller key size and lesser infrastructure performs on par with the prevailing schemes without compromising the security level.
The Effects of Spread-Spectrum Techniques in Mitigating Conducted EMI to LED Luminance
Authors: Hariyawan Mohammad Yanuar , Hidayat Risanuri , Firmansyah Eka
Published: June 2016

Rapid voltage and current changes in recently ubiquitous LED driver have a potency to interfere other devices. Solutions with special converter design, component design, EMI filter, and spread-spectrum techniques have been proposed. Due to cost-size-weight constraints, spread-spectrum technique seems a potential candidate in alleviating EMI problem in LED application. In this paper, the effectiveness of conducted EMI suppression performance of the spread-spectrum technique is evaluated. Spread-spectrum techniques applied by giving disturbance to the system LED driver with 3 profile signals, filtered square, triangular, and sine disturbance signal to the switching pattern of a buck LED driver. From the test results, 472.5 kHz triangular and 525 kHz sine signal can reduce EMI about 42 dBuV while
the filtered square signal can reduce EMI 40.70 dBuV compare with fundamental constantfrequency reference 669 kHz. The average reduction in the power level of the third signal in
the frequency range of 199 kHz to 925 kHz for 5.154281 dBuV and the filtered square signal can reduce the average power level better than other signal disturbance of 5.852618 dBuV.
LED luminance decrease when the spread-spectrum technique is applied to the system about 2814 lux.
AC Interference on Gas Pipeline due to Phase to Ground Faults in Overhead Transmission Line
Authors: I. El Gayar Ali , Abdul-Malek Zulkurnain
Published: June 2016

The purpose of this research is to investigate the severity of voltages induced on gas pipeline installed in parallel to a 115 kV overhead transmission line. The overhead transmission line (OHTL) is configured as a single-circuit. One of the phases exposed to single phase to ground fault. Transmission of high voltage along the same right of way (ROW) with metallic conductor may possibly introduce interference on metallic conductors such as gas pipeline (GPL) due to power frequency voltage as well as due to phase faults and switching phenomena. Two main approaches were used to compute the induced voltages, namely the method of moment (MOM), which is based on electromagnetic field theory, and circuit based method. The simulation considers the length of OHTL and GPL are 30 km and 10km respectively. The pipeline buried at 1 m underground in homogenous earth structure with various soil resistivites ranged from 10 to 1000 Ω-m. The transmission line consists of 150 towers and 200 m span length. The separation distance between the GPL and OHTL is varied from 5 to 100 m. The phase to ground fault current changed from 0.5 to 10 kA. Several observation points are made throughout the corridor, to examinant the induced voltages at different locations. The result show that, the soil resistivity, separation distance, and fault current had significant effect on pipeline induced voltage. In case of the observation points lying on the soil or on the outer surface of the pipeline coating, the induced voltage increased, when the soil resistivity increase, as expected. In case of the observation points placed inside the pipeline metal, and the pipeline is well coated, the induced voltage will decreased, when the soil resistivity increase.
Survey: Models and Prototypes of Schema Matching
Authors: Sutanta Edhy , Wardoyo Retantyo , Mustofa Khabib , Winarko Edi
Published: June 2016

Schema matching is critical problem within many applications to integration of data/information, to achieve interoperability, and other cases caused by schematic heterogeneity. Schema matching evolved from manual way on a specific domain, leading to a new models and methods that are semi-automatic and more general, so it is able to effectively direct the user within generate a mapping among elements of two the schema or ontologies better. This paper is a summary of literature review on models and prototypes on schema matching within the last 25 years to describe the progress of and research chalenge and opportunities on a new models, methods, and/or prototypes.
Referenced Approximation Technique for a Rom-Less Sweep Frequency Synthesizer
Authors: Jbari Atman , Bellarbi Larbi , Errachid Abdelhamid
Published: June 2016

The main goal of this paper is to present a novel ROM-less direct digital frequency synthesizer for sweep instrumentation systems. It provides a main sweep channel for frequency analysis and a reference channel for phase and amplitude measurement block operating at constant frequency. For phase to amplitude converter, we propose a new trigonometric approximation technique based on a set of reference angles. In addition, we present the design of the proposed synthesizer and its evaluation in Matlab-Simulink environment. The simulation results illustrate the performances and demonstrate the effectiveness of our proposed circuit.
Mortalidade atribuível ao consumo de bebidas alcoólicas
Authors: Bohland Anna Klara , Gonçalves Arquimedes Ribeiro
Published: June 2016

O consumo abusivo de álcool se traduz em grave problema de saúde pública em todo o mundo. Neste trabalho objetivou-se descrever os óbitos atribuíveis ao álcool em Sergipe, entre 1998 e 2010. Foram coletados dados contidos no Sistema de Informações sobre Mortalidade e analisados pelo programa TabWin. Observou-se aumento do número e dos coeficientes em todas regionais de saúde, entre os homens, na idade entre 45 e 54 anos, em ambiente hospitalar e cuja causa básica estivesse relacionada aos transtornos mentais e comportamentais. Dessa forma, ao ampliar a abordagem da mortalidade, este estudo poderá subsídiar futuras investigações, bem como contribuir para os gestores de saúde, em especial da saúde mental.
Percepção da equipe de enfermagem sobre os fatores de risco para o consumo de drogas pelas gestantes
Authors: Rodrigues Priscila De Meireles , Zerbetto Sonia Regina , Ciccilini Mariane Fabiani
Published: June 2016

O consumo de substâncias psicoativas pela gestante é preocupante devido aos danos causados ao binômio mãe/filho(a). O objetivo deste estudo consistiu em identificar a percepção de profissionais de enfermagem de Unidades de Saúde da Família de uma cidade do interior paulista sobre os fatores de risco para o uso de substâncias psicoativas em gestantes. Trata-se de pesquisa de abordagem qualitativa, realizada com cinco enfermeiros e nove auxiliares de enfermagem, no período de outubro de 2013 a março de 2014, através de entrevistas semiestruturadas, utilizando a análise de conteúdo de Bardin. Os resultados apontaram que os fatores de risco estão relacionados a questões familiares, socioeconômicas, culturais e biopsicológicas. Concluiu-se que os profissionais devem atentar ao pré-natal, condições de vida e dinâmica familiar das gestantes.
Randomized, Controlled Trial of an Advance Care Planning Video Decision Support Tool for Patients With Advanced Heart Failure
Authors: El-Jawahri Areej , Paasche-Orlow Michael K. , Matlock Dan , Stevenson Lynne Warner , Lewis Eldrin F. , Stewart Garrick , Semigran Marc , Chang Yuchiao , Parks Kimberly , Walker-Corkery Elizabeth S. , Temel Jennifer S. , Bohossian Hacho , Ooi Henry , Mann Eileen , Volandes Angelo E.
Published: June 2016

Background:

Conversations about goals of care and cardiopulmonary resuscitation (CPR)/intubation for patients with advanced heart failure can be difficult. This study examined the impact of a video decision support tool and patient checklist on advance care planning for patients with heart failure.

Methods:

This was a multisite, randomized, controlled trial of a video-assisted intervention and advance care planning checklist versus a verbal description in 246 patients ≥64 years of age with heart failure and an estimated likelihood of death of >50% within 2 years. Intervention participants received a verbal description for goals of care (life-prolonging care, limited care, and comfort care) and CPR/intubation plus a 6-minute video depicting the 3 levels of care, CPR/intubation, and an advance care planning checklist. Control subjects received only the verbal description. The primary analysis compared the proportion of patients preferring comfort care between study arms immediately after the intervention. Secondary outcomes were CPR/intubation preferences and knowledge (6-item test; range, 0–6) after intervention.

Results:

In the intervention group, 27 (22%) chose life-prolonging care, 31 (25%) chose limited care, 63 (51%) selected comfort care, and 2 (2%) were uncertain. In the control group, 50 (41%) chose life-prolonging care, 27 (22%) selected limited care, 37 (30%) chose comfort care, and 8 (7%) were uncertain (
P
<0.001). Intervention participants (compared with control subjects) were more likely to forgo CPR (68% versus 35%;
P
<0.001) and intubation (77% versus 48%;
P
<0.001) and had higher mean knowledge scores (4.1 versus 3.0;
P
<0.001).

Conclusions:

Patients with heart failure who viewed a video were more informed, more likely to select a focus on comfort, and less likely to desire CPR/intubation compared with patients receiving verbal information only.

Clinical Trial Registration:

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01589120.
Long-Term Risk of Atherosclerotic Cardiovascular Disease in US Adults With the Familial Hypercholesterolemia Phenotype
Authors: Perak Amanda M. , Ning Hongyan , de Ferranti Sarah D. , Gooding Holly C. , Wilkins John T. , Lloyd-Jones Donald M.
Published: June 2016

Background:

Heterozygous familial hypercholesterolemia (FH) affects up to 1 in 200 individuals in the United States, but atherosclerotic cardiovascular disease (ASCVD) outcomes of FH in the general US population have not been described. We therefore sought to evaluate long-term coronary heart disease (CHD) and total ASCVD risks in US adults with an FH phenotype.

Methods:

Using individual pooled data from 6 large US epidemiological cohorts, we stratified participants by low-density lipoprotein cholesterol level at index ages from 20 to 79 years. For the primary analysis, low-density lipoprotein cholesterol levels ≥190 and <130 mg/dL defined the FH phenotype and referent, respectively. Sensitivity analyses evaluated the effects of varying the FH phenotype definition. We used Cox regression models to assess covariate-adjusted associations of the FH phenotype with 30-year hazards for CHD (CHD death or nonfatal myocardial infarction) and total ASCVD (CHD or stroke).

Results:

We included 68 565 baseline person-examinations; 3850 (5.6%) had the FH phenotype by the primary definition. Follow-up across index ages ranged from 78 985 to 308 378 person-years. After covariate adjustment, the FH phenotype was associated with substantially elevated 30-year CHD risk, with hazard ratios up to 5.0 (95% confidence interval, 1.1–21.7). Across index ages, CHD risk was accelerated in those with the FH phenotype by 10 to 20 years in men and 20 to 30 years in women. Similar patterns of results were found for total ASCVD risk, with hazard ratios up to 4.1 (95% confidence interval, 1.2–13.4). Alternative FH phenotype definitions incorporating family history, more stringent age-based low-density lipoprotein cholesterol thresholds, or alternative lipid fractions decreased the FH phenotype prevalence to as low as 0.2% to 0.4% without materially affecting CHD risk estimates (hazard ratios up to 8.0; 95% confidence interval, 1.0–61.6).

Conclusions:

In the general US population, the long-term ASCVD burden related to phenotypic FH, defined by low-density lipoprotein cholesterol ≥190 mg/dL, is likely substantial. Our finding of CHD risk acceleration may aid efforts in risk communication.
Impact of Renal Function on Outcomes With Edoxaban in the ENGAGE AF-TIMI 48 Trial
Authors: Bohula Erin A. , Giugliano Robert P. , Ruff Christian T. , Kuder Julia F. , Murphy Sabina A. , Antman Elliott M. , Braunwald Eugene
Published: June 2016

Background:

Edoxaban, an oral factor Xa inhibitor with 50% renal clearance, was noninferior to well-managed warfarin for stroke or systemic embolism (S/SE) prevention and reduced bleeding in patients with atrial fibrillation. We evaluated the efficacy and safety of edoxaban versus warfarin across the range of baseline creatinine clearance (CrCl) in the ENGAGE AF-TIMI 48 trial (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation–Thrombolysis in Myocardial Infarction Study 48) with a focus on the higher-dose edoxaban regimen (HDER) and the upper range of CrCl.

Methods:

A total of 14 071 patients with atrial fibrillation at moderate to high risk for stroke were randomized to warfarin or HDER (60 mg daily or a 50% dose reduction to 30 mg daily for CrCl 30–50 mL/min, body weight of ≤60 kg, or use of a potent phosphorylated glycoprotein inhibitor). CrCl <30 mL/min was exclusionary. End points of S/SE, International Society on Thrombosis and Haemostasis major bleeding, and the net clinical outcome of S/SE/major bleeding or death were evaluated by intention-to-treat analysis using the prespecified CrCl cut point of 50 mL/min and additional exploratory cut points with the Cockcroft-Gault formula. A sensitivity analysis was performed with the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula for estimating renal function.

Results:

The relative risk of S/SE with HDER versus warfarin in patients with CrCl >50 mL/min (hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.72–1.04) was similar to that in patients with CrCl ≤50 mL/min (HR, 0.87; 95% CI, 0.65–1.18;
P
for interaction=0.94). Several exploratory analyses suggested lower relative efficacy for the prevention of S/SE with HDER compared with warfarin at higher levels of CrCl (CrCl ≤50 mL/min: HR, 0.87; 95% CI, 0.65–1.18; CrCl >50–95 mL/min: HR, 0.78; 95% CI, 0.64–0.96; CrCl >95 mL/min: HR, 1.36; 95% CI, 0.88–2.10;
P
for interaction=0.08). Bleeding rates were lower at all levels of CrCl with HDER (
P
for interaction=0.11). Because of the preserved effect on bleeding, the net clinical outcome was more favorable with HDER across the range of CrCl (
P
for interaction=0.73). Similar findings were observed in the sensitivity analysis using the CKD-EPI formula.

Conclusions:

Although there was an apparent decrease in relative efficacy to prevent arterial thromboembolism in the upper range of CrCl, the safety and net clinical benefit of HDER compared with warfarin are consistent across the range of renal function.

Clinical Trial Registration:

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00781391.
Thomas Willis Lecture
Authors: Dirnagl Ulrich
Published: June 2016

Based on research, mainly in rodents, tremendous progress has been made in our basic understanding of the pathophysiology of stroke. After many failures, however, few scientists today deny that bench-to-bedside translation in stroke has a disappointing track record. I here summarize many measures to improve the predictiveness of preclinical stroke research, some of which are currently in various stages of implementation: We must reduce preventable (detrimental) attrition. Key measures for this revolve around improving preclinical study design. Internal validity must be improved by reducing bias; external validity will improve by including aged, comorbid rodents of both sexes in our modeling. False-positives and inflated effect sizes can be reduced by increasing statistical power, which necessitates increasing group sizes. Compliance to reporting guidelines and checklists needs to be enforced by journals and funders. Customizing study designs to exploratory and confirmatory studies will leverage the complementary strengths of both modes of investigation. All studies should publish their full data sets. On the other hand, we should embrace inevitable NULL results. This entails planning experiments in such a way that they produce high-quality evidence when NULL results are obtained and making these available to the community. A collaborative effort is needed to implement some of these recommendations. Just as in clinical medicine, multicenter approaches help to obtain sufficient group sizes and robust results. Translational stroke research is not broken, but its engine needs an overhauling to render more predictive results.
Partial Superficial Parotidectomy With Retrograde Dissection of the Facial Nerve for Clinically “Benign” Parotid Tumors
Authors: Patel Depak K. , Ahmad Zahoor , Morton Randall P.
Published: June 2016

Background:

To review experience with partial superficial parotidectomy (PSP) and retrograde dissection of the facial nerve as a treatment for benign parotid tumors.

Methods:

Retrospective cohort study of all patients presenting with a suspected benign primary parotid tumor undergoing parotid surgery.

Results:

There were 214 cases retrieved. Postoperative facial nerve weakness occurred in 33% of patients; all were temporary. Increased extent of surgical resection ( P < .001), deeper tumors ( P = .05), and close tumor proximity to the facial nerve ( P = .007) significantly correlated with postoperative facial weakness. The surgical margin was clear in 54%; 31% had capsule exposed in at least 1 point, and 13.5% had tumor at the margin. Cases with close proximity of tumor to facial nerve were more likely to have tumor at the margin ( P = .034).

Conclusion:

Partial superficial parotidectomy with retrograde dissection is a suitable method for benign appearing parotid tumors.
Quantitative Evaluation of Adult Subglottic Stenosis Using Intraoperative Long-range Optical Coherence Tomography
Authors: Sharma Giriraj K. , Chin Loy Anthony , Su Erica , Jing Joe , Chen Zhongping , Wong Brian J-F. , Verma Sunil
Published: June 2016

Objectives:

To determine the feasibility of long-range optical coherence tomography (LR-OCT) as a tool to intraoperatively image and measure the subglottis and trachea during suspension microlaryngoscopy before and after endoscopic treatment of subglottic stenosis (SGS).

Methods:

Long-range optical coherence tomography of the adult subglottis and trachea was performed during suspension microlaryngoscopy before and after endoscopic treatment for SGS. The anteroposterior and transverse diameters, cross-sectional area (CSA), distance from the vocal cords, and length of the SGS were measured using a MATLAB software. Pre-intervention and postintervention airway dimensions were compared. Three-dimensional volumetric airway reconstructions were generated using medical image processing software (MIMICS).

Results:

Intraoperative LR-OCT imaging was performed in 3 patients undergoing endoscopic management of SGS. Statistically significant differences in mean anteroposterior diameter ( P < .01), transverse diameter ( P < .001), and CSA ( P < .001) were noted between pre-intervention and postintervention data. Three-dimensional airway models were viewed in cross-sectional format and via virtual “fly through” bronchoscopy.

Conclusions:

This is the first report of intraoperative LR-OCT of the subglottic and tracheal airway before and after surgical management of SGS in humans. Long-range optical coherence tomography offers a practical means to measure the dimensions of SGS and acquire objective data on the response to endoscopic treatment of SGS.
Spectroscopic Investigation Leading to the Documentation of Three Post-Byzantine Wall Paintings
Authors: Lampakis Dimitrios , Karapanagiotis Ioannis , Katsibiri Olga
Published: June 2016

The main churches of three monasteries in Thessalia, Central Greece, were decorated with wall paintings in the post-Byzantine period. The main goal of the present study is to characterize the inorganic and organic materials present in the paint layers of areas that have been gilded. Optical microscopic examination was carried out on samples taken from the gilded decoration of the paintings to view their layer build-up. The combined use of micro Fourier transform infrared (FT-IR) and micro-Raman spectroscopy led to the detection of the pigments and the binding media used. The results from specimens taken from different wall paintings were compared with each other to observe their differences and similarities. The three investigated churches are believed to have been painted by the same iconographer, Tzortzis, who however has only been identified in only one of them. The comparison led to the conclusion that there are many similarities in the painting materials used and the general methodology adopted and, therefore, this study offers support to the belief that the mural paintings of the three monasteries could have been painted by the same iconographer. While not authenticating the two painting as being by Tzortzis, the results provide further critical material that is consistent with this attribution. However, this statement must be carefully considered because the pigments identified have been commonly and diffusely used in historic mural paintings.
Hidden in Plain Sight
Authors: Ng Susan J. , Hill Mary F. , Rawlinson Catherine
Published: June 2016

Twice-exceptional students are characterized by the almost paradoxical combination of giftedness accompanied by learning difficulties that hinder their ability to reach their potential in a traditional academic setting. This qualitative study examined the experiences of three twice-exceptional students during transfer to a New Zealand high school. Successful transfer has been shown to be dependent on factors such as the timely handover of accurate and complete student records. Barriers to successful transfer result in disruption in curriculum continuity, which can be especially detrimental for learners with special needs. Using student voice data from interviews and journal entries, the participants’ lived experiences of the transfer process were revealed. Findings suggest that the way in which the twice-exceptional students experienced transfer influenced the development of their personal capabilities as learners in the education setting.
Squeaky Wheels and Troop Loyalty
Authors: Johnson Jaclyn , Thyne Clayton L.
Published: June 2016

This article considers how domestic protests influence coups. Protests signal regime illegitimacy, which incentivizes coups and provides a favorable climate for postcoup reforms. Protests also ease coordination obstacles among coup plotters and make international actors less likely to punish coup leaders. We expect these signaling processes to be strongest when protests take place near the capital or are nonviolent. Our empirical analyses introduce event-level protest data from the Social, Political, and Economic Event Database project into the coup literature. Examining a global sample of coup attempts from 1951 to 2005, we find strong support for our theoretical expectations. Our discussion provides implications for scholars studying coups and nonviolent movements more generally. It also speaks to the influence of external actors on social uprisings and highlights the importance of geographical disaggregation in the study of dissident behavior.
Evaluation Framework for HIV Prevention and Care Activities in the Enhanced Comprehensive HIV Prevention Planning Project, 2010–2013
Authors: Fisher Holly H. , Hoyte Tamika , Flores Stephen A. , Purcell David W. , Dunbar Erica , Stratford Dale
Published: June 2016

Objective.

The Enhanced Comprehensive HIV Prevention Planning (ECHPP) project was a demonstration project implemented by 12 U.S. health departments (2010–2013) to enhance HIV program planning in cities with high AIDS prevalence, in support of National HIV/AIDS Strategy goals. Grantees were required to improve their planning and implementation of HIV prevention and care programs to increase their impact on local HIV epidemics. A multilevel evaluation using multiple data sources, spanning multiple years (2008–2015), will be conducted to assess the effect of ECHPP on client outcomes (e.g., HIV risk behaviors) and impact indicators (e.g., new HIV diagnoses).

Methods.

We designed an evaluation approach that includes a broad assessment of program planning and implementation, a detailed examination of HIV prevention and care activities across funding sources, and an analysis of environmental and contextual factors that may affect services. A data triangulation approach was incorporated to integrate findings across all indicators and data sources to determine the extent to which ECHPP contributed to trends in indicators.

Results.

To date, data have been collected for 2008–2009 (pre-ECHPP implementation) and 2010–2013 (ECHPP period). Initial analysis of process data indicate the ECHPP grantees increased their provision of HIV testing, condom distribution, and partner services programs and expanded their delivery of prevention programs for people diagnosed with HIV.

Conclusion.

The ECHPP evaluation (2008–2015) will assess whether ECHPP programmatic activities in 12 areas with high AIDS prevalence contributed to changes in client outcomes, and whether these changes were associated with changes in longer-term, community-level impact.
Needs Assessment for Patients with Sickle Cell Disease in South Carolina, 2012
Authors: Schlenz Alyssa M. , Boan Andrea D. , Lackland Daniel T. , Adams Robert J. , Kanter Julie
Published: June 2016

Objective.

We conducted a needs assessment for patients with sickle cell disease (SCD) in South Carolina using statewide administrative data to examine acute care utilization during a defined 12-month period. The data were collected to provide information for state and regional service providers, managed care companies, and policy makers to identify demographic gaps in care and inform policy and educational efforts to improve care.

Methods.

We obtained records on emergency department visits and hospitalizations through patient-based uniform billing data. We stratified analyses of acute care utilization and 30-day readmission rates by patient age, region, and expected payer.

Results.

Young adults, those with public insurance, and those who resided in a region with the largest number of patients had the highest rates of acute care utilization and 30-day readmissions. Patients who resided in a largely rural area without access to comprehensive care also had high rates of acute care utilization and readmissions. The pattern of readmissions data suggested that data on 7- or 14-day readmission rates, in addition to data on 30-day readmission rates, could be used as benchmarks of quality of care for adult patients with SCD.

Conclusion.

Administrative datasets can provide important information on demographic gaps in care for patients with SCD. The results highlight both national and regional issues in the provision of health-care services for patients with SCD.
Evaluating Early Case Capture of Pediatric Cancers in Seven Central Cancer Registries in the United States, 2013
Authors: Puckett Mary , Neri Antonio , Rohan Elizabeth , Clerkin Castine , Underwood J. Michael , Ryerson A. Blythe , Stewart Sherri L.
Published: June 2016

Objective.

Cancer is the second-leading cause of death in children, but incidence data are not available until two years after diagnosis, thereby delaying data dissemination and research. An early case capture (ECC) surveillance program was piloted in seven state cancer registries to register pediatric cancer cases within 30 days of diagnosis. We sought to determine the quality of ECC data and understand pilot implementation.

Methods.

We used quantitative and qualitative methods to evaluate ECC. We assessed data quality by comparing demographic and clinical characteristics from the initial ECC submission to a resubmission of ECC pilot data and to the most recent year of routinely collected cancer data for each state individually and in aggregate. We conducted telephone focus groups with registry staff to determine ECC practices and difficulties in August and September 2013. Interviews were recorded, transcribed, and coded to identify themes.

Results.

Comparing ECC initial submissions with submissions for all states, ECC data were nationally representative for age (9.7 vs. 9.9 years) and sex (673 of 1,324 [50.9%] vs. 42,609 of 80,547 [52.9%] male cases), but not for primary site (472 of 1,324 [35.7%] vs. 27,547 of 80,547 [34.2%] leukemia/lymphoma cases), behavior (1,219 of 1,324 [92.1%] vs. 71,525 of 80,547 [88.8%] malignant cases), race/ethnicity (781 of 1,324 [59.0%] vs. 64,518 of 80,547 [80.1%] white cases), or diagnostic confirmation (1,233 of 1,324 [93.2%] vs. 73,217 of 80,547 [90.9%] microscopically confirmed cases). When comparing initial ECC data with resubmission data, differences were seen in race/ethnicity (808 of 1,324 [61.1%] vs. 1,425 of 1,921 [74.2%] white cases), primary site (475 of 1,324 [35.9%] vs. 670 of 1,921 [34.9%] leukemia/lymphoma cases), and behavior (1,215 of 1,324 [91.8%] vs. 1,717 of 1,921 [89.4%] malignant cases). Common themes from focus group analysis included implementation challenges and facilitators, benefits of ECC, and utility of ECC data.

Conclusions.

ECC provided data rapidly and reflected national data overall with differences in several data elements. ECC also expanded cancer reporting infrastructure and increased data completeness and timeliness. Although challenges related to timeliness and increased work burden remain, indications suggest that researchers may reliably use these data for pediatric cancer studies.
Social Media's Initial Reaction to Information and Misinformation on Ebola, August 2014: Facts and Rumors
Authors: Fung Isaac Chun-Hai , Fu King-Wa , Chan Chung-Hong , Chan Benedict Shing Bun , Cheung Chi-Ngai , Abraham Thomas , Tse Zion Tsz Ho
Published: June 2016

Objective.

We analyzed misinformation about Ebola circulating on Twitter and Sina Weibo, the leading Chinese microblog platform, at the outset of the global response to the 2014–2015 Ebola epidemic to help public health agencies develop their social media communication strategies.

Methods.

We retrieved Twitter and Sina Weibo data created within 24 hours of the World Health Organization announcement of a Public Health Emergency of International Concern (Batch 1 from August 8, 2014, 06:50:00 Greenwich Mean Time [GMT] to August 9, 2014, 06:49:59 GMT) and seven days later (Batch 2 from August 15, 2014, 06:50:00 GMT to August 16, 2014, 06:49:59 GMT). We obtained and analyzed a 1% random sample of tweets containing the keyword Ebola. We retrieved all Sina Weibo posts with Chinese keywords for Ebola for analysis. We analyzed changes in frequencies of keywords, hashtags, and Web links using relative risk (RR) and c2 feature selection algorithm. We identified misinformation by manual coding and categorizing randomly selected sub-datasets.

Results.

We identified two speculative treatments (i.e., bathing in or drinking saltwater and ingestion of Nano Silver, an experimental drug) in our analysis of changes in frequencies of keywords and hashtags. Saltwater was speculated to be protective against Ebola in Batch 1 tweets but their mentions decreased in Batch 2 (RR=0.11 for “salt” and RR=0.14 for “water”). Nano Silver mentions were higher in Batch 2 than in Batch 1 (RR=10.5). In our manually coded samples, Ebola-related misinformation constituted about 2% of Twitter and Sina Weibo content. A range of 36%–58% of the posts were news about the Ebola outbreak and 19%–24% of the posts were health information and responses to misinformation in both batches. In Batch 2, 43% of Chinese microblogs focused on the Chinese government sending medical assistance to Guinea.

Conclusion.

Misinformation about Ebola was circulated at a very low level globally in social media in either batch. Qualitative and quantitative analyses of social media posts can provide relevant information to public health agencies during emergency responses.
Integrating Routine HIV Screening in the New York City Community Health Center Collaborative
Authors: Rodriguez Vanessa , Lester Deborah , Connelly-Flores Alison , Barsanti Franco A. , Hernandez Paloma
Published: June 2016

Objective.

One in seven of the 1.1 million people living in the United States infected with HIV are not aware of their HIV status. At the same time, many clinical settings have not adopted routine HIV screening, which promotes linkage to specialist medical care. We sought to improve HIV screening in a large community health center network by using a data-driven, collaborative learning approach and system-wide modifications, where counselor-based HIV screening and testing were replaced by health-care providers and medical assistants.

Methods.

Urban Health Plan, Inc., a network of federally qualified health centers in the boroughs of the Bronx and Queens in New York City, provided HIV screening training for its health-care providers. In January 2011, it modified its electronic medical record system to incorporate HIV test offering. This study compared the 2010 baseline year with the three-year implementation follow-up period (January 2011 through December 2013) to determine the number of eligible individuals for HIV testing, HIV tests offered and performed, HIV-positive individuals, and HIV cases linked to specialty care.

Results.

A total of 26,853 individuals at baseline and 100,369 individuals in the implementation period were eligible for HIV testing. HIV testing was performed on 2,079 (8%) of 26,853 eligible individuals in 2010 and 49,646 (50%) of 100,369 eligible individuals from 2011 through 2013. HIV-positive status was determined in 19 (0.9%) of 2,079 tested individuals in 2010 and 166 (0.3%) of 49,646 tested individuals from 2011 through 2013. Linkage to care was observed in all 19 eligible individuals and 127 (77%) of 166 eligible individuals who tested HIV positive in 2010 and 2011–2013, respectively.

Conclusion.

This study enabled routine HIV implementation testing at a community health center network, which resulted in enhanced HIV testing, an increased number of HIV-positive cases identified, and a rise in the number of patients linked to HIV specialist care.
Experiences Implementing a Routine HIV Screening Program in Two Federally Qualified Health Centers in the Southern United States
Authors: Crumby Natasha S. , Arrezola Erica , Brown Emily H. , Brazzeal Angela , Sanchez Travis H.
Published: June 2016

Objective.

The southern United States is highly affected by HIV, and community health centers play a key role in addressing the health-care needs of residents of southern cities. In 2012, Southside Medical Care Services (“Southside”) in Atlanta, Georgia, and Central Care Community Health Center (“Central Care”) in Houston, Texas, began comprehensive programs for routine HIV screening and linkage to HIV care.

Methods.

We examined patient-level testing outcomes using medical record-derived data. We also compared the total number of HIV tests and HIV-positive tests in the most recent 12 months of the program with the number of HIV tests and HIV-positive tests during the 12 months prior to the program start.

Results.

Southside saw 52,437 eligible patients from June 2012 through April 2014; 41,720 (80%) were offered an HIV test, 11,092 (27% of those offered a test) were tested, 75 (0.7% of those tested) had a positive result, and 74 (99% of those with a positive result) were linked to HIV care. Compared with the 12 months prior to the start of routine HIV screening implementation, Southside's routine HIV screening program conducted 5,955 more HIV tests (733% increase) and had 31 more patients who tested positive (238% increase). Central Care saw 22,658 eligible patients from July 2012 to April 2014; 10,904 (48%) were offered an HIV test, 9,909 (91% of those offered a test) were tested, 52 (0.5% of those tested) had a positive result, and 41 (79% of those with a positive result) were linked to HIV care. Compared with the 12 months before routine HIV screening was implemented, Central Care's routine HIV screening program conducted 4,559 more HIV tests (618% increase) and had 36 more patients who tested positive (600% increase).

Conclusion.

Southside and Central Care effectively implemented routine HIV screening programs that dramatically increased their testing volume while also linking the majority of HIV-positive patients to care. Other community health centers should consider similar programs.
Improving Screening Methods for Hepatitis C Among People Who Inject Drugs: Findings from the HepTLC Initiative, 2012–2014
Authors: Blackburn Natalie A. , Patel Rajiv C. , Zibbell Jon E.
Published: June 2016

Objective.

People who inject drugs (PWID) are at increased risk for hepatitis C virus (HCV) infection. We examined HCV testing outcomes among PWID through CDC's Hepatitis Testing and Linkage to Care initiative, which promoted viral hepatitis B and hepatitis C screening, posttest counseling, and linkage to care at 34 U.S. sites during 2012–2014. Ten grantees in nine geographically diverse cities conducted HCV testing among PWID.

Methods.

Among those testing positive for HCV antibody (anti-HCV), we calculated the proportion who were offered a confirmatory HCV ribonucleic acid (RNA) test, positively diagnosed, and referred to a specialist for care. We stratified anti-HCV-positive people who completed each step by same-day testing (i.e., an HCV RNA test administered on the same date as an anti-HCV test) vs. person not receiving same-day testing to evaluate whether the need for follow-up testing affected diagnosis of chronic infection and linkage to care.

Results.

A total of 15,274 people received an anti-HCV test at 84 testing sites targeting PWID. Of those, 11,159 (73%) reported having injected drugs in their lifetime, 7,789 (51%) reported injecting drugs in the past 12 months, and 3,495 (23%) tested anti-HCV positive. A total of 1,630 people received testing for HCV RNA, of whom 1,244 (76%) were HCV RNA positive. When not receiving both tests on the same day, 601 of 2,465 (24%) anti-HCV-positive people received an HCV RNA test.

Conclusion.

Strategies to diagnose PWID for HCV infection are needed to reduce associated morbidity and mortality. Agencies can substantially increase the number of PWID who are diagnosed and informed of their HCV infection by administering both anti-HCV and HCV RNA tests during a single testing event.
Hepatitis C Virus Testing and Linkage to Care in North Carolina and South Carolina Jails, 2012–2014
Authors: Schoenbachler Ben T. , Smith Bryce D. , Seña Arlene C. , Hilton Alison , Bachman Sallie , Lunda Mulamba , Spaulding Anne C.
Published: June 2016

Objective.

We evaluated a hepatitis C virus (HCV) testing and linkage-to-care post-release program among detainees of small- to medium-sized jails in North Carolina and South Carolina as part of the Hepatitis Testing and Linkage to Care initiative.

Methods.

An HCV testing and linkage-to-care program was implemented in selected jails in North Carolina and South Carolina from December 2012 to March 2014. Health-care workers not affiliated with the jails conducted HCV antibody (anti-HCV) and HCV ribonucleic acid (RNA) testing and linkage-to-care activities. The North Carolina jail provided universal opt-out testing for HCV; South Carolina jails initially targeted high-risk individuals before expanding to routine testing.

Results.

Of 669 detainees tested for HCV in North Carolina, 88 (13.2%) tested anti-HCV positive, of whom 81 (92.0%) received an HCV RNA test, 66 (81.5%) of whom tested HCV RNA positive (i.e., currently infected). Of the 66 detainees with current HCV infection, 18 were referred to HCV medical care post-release and 10 attended their first appointment. Of 224 detainees tested for HCV in South Carolina, 18 (8.0%) tested anti-HCV positive, of whom 13 received an HCV RNA test. Nine of 13 detainees tested HCV RNA positive, seven detainees were referred to post-release medical care, and two detainees attended their first appointment. Overall, 106 of 893 (11.9%) detainees were anti-HCV positive.

Conclusion.

This study demonstrated that HCV testing, identification of infection, and linkage to care are feasible among jail populations. The rate of anti-HCV positivity was lower than that found in national studies of incarcerated populations, suggesting that HCV infection prevalence in jails may vary across U.S. states or regions.
Impact of the Hepatitis Testing and Linkage to Care (HepTLC) Initiative on Linkage to Care for Minnesota Refugees with Hepatitis B, 2012–2014
Authors: Linde Ann C. , Sweet Kristin A. , Nelson Kailey , Mamo Blain , Chute Sara M.
Published: June 2016

Objective.

The Hepatitis Testing and Linkage to Care (HepTLC) initiative promoted viral hepatitis B and hepatitis C screening, posttest counseling, and linkage to care at 34 U.S. sites from 2012 to 2014. Through the HepTLC initiative, the Minnesota Department of Health (MDH) and clinic partners began conducting linkage-to-care activities with hepatitis B-positive refugees in October 2012. This intervention provided culturally appropriate support to link refugees to follow-up care for hepatitis B.

Methods.

MDH refugee health and viral hepatitis surveillance programs, along with clinics that screened newly arrived refugees in Hennepin and Ramsey counties in Minnesota, collaborated on the project, which took place from October 1, 2012, through September 30, 2014. Bilingual care navigators contacted refugees to provide education, make appointments, and arrange transportation. We compared the linkage-to-care rate for participants with the rates for refugees screened the year before project launch using a two-sample test of proportions.

Results.

In the year preceding the project (October 2011 through September 2012), 87 newly arrived refugees had a positive hepatitis B surface antigen (HBsAg) test. Fifty-six (64%) refugees received follow-up care, 12 (14%) refugees did not receive follow-up care, and 19 (22%) refugees could not be located and had no record of follow-up care. During the project, 174 HBsAg-positive, newly arrived refugees were screened. Of those 174 refugees, 162 (93%) received follow-up care, seven (4%) did not receive follow-up care, and five (3%) could not be located and had no record of follow-up care. The one-year linkage-to-care rate for project participants (93%) was significantly higher than the rate for refugees screened the previous year (64%) ( p<0.001).

Conclusion.

In the context of a strong screening and surveillance infrastructure, a simple intervention improved the linkage-to-care rate for HBsAg-positive refugees.