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Trans R Soc Trop Med Hyg ; 114(1): 7-15, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31943116


BACKGROUND: The objective of this study was to develop multiple prediction tools that calculate the risk of developing dengue haemorrhagic fever. METHODS: Training data consisted of 1771 individuals from 2006-2008 admitted with dengue fever whereby 304 developed dengue haemorrhagic fever during hospitalisation. Least absolute shrinkage and selection operator regression was used to construct three types of calculators, static admission calculators and dynamic calculators that predict the risk of developing dengue haemorrhagic fever for a subsequent day (DAily Risk Tomorrow [DART]) or for any future point after a specific day since fever onset (DAily Risk Ever [DARE]). RESULTS: From 119 admission covariates, 35 were in at least one of the calculators, which reported area under the curve (AUC) values of at least 0.72. Addition of person-time data for DART improved AUC to 0.76. DARE calculators displayed a large increase in AUC to 0.79 past day 7 with the inclusion of a strong predictor, maximum temperature on day 6 since onset, indicative of a saddleback fever. CONCLUSIONS: All calculators performed well when validated with 2005 data. Addition of daily variables further improved the accuracy. These calculators can be used in tandem to assess the risk of dengue haemorrhagic fever upon admission and updated daily to obtain more precise risk estimates.

Value Health ; 22(12): 1345-1354, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31806190


BACKGROUND: The lack of seasonality in influenza epidemics in the tropics makes the application of well-established temperate zone national vaccination plans challenging. OBJECTIVES: We developed an individual-based simulation model to study optimal vaccination scheduling and assess cost-effectiveness of these vaccination schedules in scenarios of no influenza seasonality and the seasonality regimes of Singapore, Taipei, and Tokyo. METHODS: The simulation models heterogeneities in human contact networks, levels of protective antibodies following infection, the effectiveness of the influenza vaccine, and seasonality. Using a no intervention baseline, we consider 3 alternative vaccination strategies: (1) annual vaccination for a percentage of the elderly, (2) biannual vaccination for a percentage of the elderly, and (3) annual vaccination for all elderly and a fraction of the remaining population. We considered 5 vaccination uptake rates for each strategy and modeled the estimated costs, quality-adjusted life years, and incremental cost-effectiveness ratios (ICERs), indicating the cost-effectiveness of each scenario. RESULTS: In Singapore, annual vaccination for a proportion of elderly is largely cost-effective. However, with fixed uptake rates, partial biannual vaccination for the elderly yields a higher ICER than partial annual vaccination for the elderly, resulting in a cost-ineffective ICER. The most optimal strategy is the total vaccination of all the elderly and a proportion of individuals from other age groups, which results in a cost-saving ICER. This finding is consistent across different seasonality regimes. CONCLUSIONS: Tropical countries like Singapore can have comparably cost-effective vaccination strategies as found in countries with winter epidemics. The vaccination of all the elderly and a proportion of other age groups is the most cost-effective strategy, supporting the need for an extensive national influenza vaccination program.

Sci Rep ; 8(1): 16558, 2018 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-30409993


Effective conservation planning needs to consider the threats of cropland expansion to biodiversity. We used Myanmar as a case study to devise a modeling framework to identify which Key Biodiversity Areas (KBAs) are most vulnerable to cropland expansion in a context of increasingly resolved armed conflict. We studied 13 major crops with the potential to expand into KBAs. We used mixed-effects models and an agricultural versus forest rent framework to model current land use and conversion of forests to cropland for each crop. We found that the current cropland distribution is explained by higher agricultural value, lower transportation costs and lower elevation. We also found that protected areas and socio-political instability are effective in slowing down deforestation with conflicts in Myanmar damaging farmland and displacing farmers elsewhere. Under plausible economic development and socio-political stability scenarios, the models forecast 48.5% of land to be converted. We identified export crops such as maize, and pigeon pea as key deforestation drivers. This cropland expansion would pose a major threat to Myanmar's freshwater KBAs. We highlight the importance of considering rapid land-use transitions in the tropics to devise robust conservation plans.

Agricultura/legislação & jurisprudência , Conservação dos Recursos Naturais , Produtos Agrícolas/crescimento & desenvolvimento , Biodiversidade , Produtos Agrícolas/classificação , Desenvolvimento Econômico , Florestas , Modelos Teóricos , Mianmar
Open Forum Infect Dis ; 3(2): ofw103, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27419175


RIDL (release of insects with dominant lethality) and Wolbachia are 2 potentially powerful tools in the fight against Zika, but their technological advancement is being hampered by policy barriers. In this study, we discuss what could be done to overcome these regulatory deadlocks.

Parasit Vectors ; 7: 65, 2014 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-24520937


BACKGROUND: Tracking the movement of mosquitoes and understanding dispersal dynamics is essential for the control and prevention of vector-borne diseases. A variety of marking techniques have been used, including dusts and dyes. METHODS: In this study, Aedes aegypti were marked using fluorescent dusts ('DayGlo': A-19 Horizon Blue & A-13-N Rocket Red; 'Brian Clegg': pink, blue & red), fluorescent paints ('Brian Clegg': blue, red & yellow) and metallic gold dust ('Brian Clegg'). Dusting methods were those previously used in mark-release-recapture experiments, including application with a bulb duster, creation of a dust storm or shaking in a bag. RESULTS: Results showed marking mosquitoes using a dust storm allowed relatively high survival, compared to unmarked controls (Males: χ² = 3.24, df = 4, p = 0.07; Females: χ² = 3.24, df = 4, p = 0.04), and high marking efficiency. Using a bulb duster showed high survival in male mosquitoes (χ² = 12.59, df = 4, p < 0.000), but low survival in female mosquitoes during the first 15 days of the study (χ² = 5.17, df = 4, p < 0.05). The bulb duster also had the lowest marking efficiency compared to other dry marking techniques. The bag method showed low survival in males during the first 15 days of the study (χ² = 5.77, df = 4, p < 0.05). Applying paints had an overall negative impact on survival for males (χ² = 5.03, df = 3, p < 0.05), but not for females (χ² = 0.19, df = 3, p = 0.661). Males dusted with DayGlo Horizon Blue dust, and females dusted with DayGlo Rocket Red dust, had the most significant reduction in survivorship in comparison to the control (Males: χ² = 15.70, df = 6, p < 0.000; Females: χ² = 24.47, df = 6, p < 0.000). Mosquitoes marked with Brian Clegg gold dust showed mortality rates similar to controls within male mosquitoes (χ² = 0.18, df = 6, p = 0.674), but significantly lower in females (χ² = 16.59, df = 6, p < 0.000). CONCLUSIONS: This study showed that marking technique and colour can have a significant impact on the survival and marking coverage of a mosquito.

Aedes/efeitos dos fármacos , Corantes Fluorescentes/toxicidade , Insetos Vetores/efeitos dos fármacos , Aedes/fisiologia , Animais , Feminino , Insetos Vetores/fisiologia , Masculino , Compostos Orgânicos/toxicidade , Densidade Demográfica , Dinâmica Populacional