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Search Results: 1 - 10 of 192851 matches for " Troy D Moon "
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Lessons Learned while Implementing an HIV/AIDs Care and Treatment Program in Rural Mozambique
Troy D. Moon,Janeen R. Burlison,Mohsin Sidat,Paulo Pires
Retrovirology: Research and Treatment , 2010,
Abstract: Mozambique has severe resource constraints, yet with international partnerships, the nation has placed over 145,000 HIV- infected persons on antiretroviral therapies (ART) through May 2009. HIV clinical services are provided at .215 clinical venues in all 11 of Mozambique’s provinces. Friends in Global Health (FGH), affiliated with Vanderbilt University in the United States (US), is a locally licensed non-governmental organization (NGO) working exclusively in small city and rural venues in Zambézia Province whose population reaches approximately 4 million persons. Our approach to clinical capacity building is based on: 1) technical assistance to national health system facilities to implement ART clinical services at the district level, 2) human capacity development, and 3) health system strengthening. Challenges in this setting are daunting, including: 1) human resource constraints, 2) infrastructure limitations, 3) centralized care for large populations spread out over large distances, 4) continued high social stigma related to HIV, 5) limited livelihood options in rural areas and 6) limited educational opportunities in rural areas. Sustainability in rural Mozambique will depend on transitioning services from emergency foreign partners to local authorities and continued funding. It will also require “wrap-around” programs that help build economic capacity with agricultural, educational, and commercial initiatives. Sustainability is undermined by serious health manpower and infrastructure limitations. Recent U.S. government pronouncements suggest that the U.S. President’s Emergency Plan for AIDS Relief will support concurrent community and business development. FGH, with its Mozambican government counterparts, see the evolution of an emergency response to a sustainable chronic disease management program as an essential and logical step. We have presented six key challenges that are essential to address in rural Mozambique
Sociocultural and epidemiological aspects of HIV/AIDS in Mozambique
Carolyn M Audet, Janeen Burlison, Troy D Moon, Mohsin Sidat, Alfredo E Vergara, Sten H Vermund
BMC International Health and Human Rights , 2010, DOI: 10.1186/1472-698x-10-15
Abstract: To review the unique challenges faced by Mozambique as they have attempted to stem the HIV epidemic, we undertook a systematic literature review through multiple search engines (PubMed, Google Scholar?, SSRN, AnthropologyPlus, AnthroSource) using Mozambique as a required keyword. We searched for any articles that included the required keyword as well as the terms 'HIV' and/or 'AIDS', 'prevalence', 'behaviors', 'knowledge', 'attitudes', 'perceptions', 'prevention', 'gender', drugs, alcohol, and/or 'health care infrastructure'.UNAIDS 2008 prevalence estimates ranked Mozambique as the 8th most HIV-afflicted nation globally. In 2007, measured HIV prevalence in 36 antenatal clinic sites ranged from 3% to 35%; the national estimate of was 16%. Evidence suggests that the Mozambican HIV epidemic is characterized by a preponderance of heterosexual infections, among the world's most severe health worker shortages, relatively poor knowledge of HIV/AIDS in the general population, and lagging access to HIV preventive and therapeutic services compared to counterpart nations in southern Africa. Poor education systems, high levels of poverty and gender inequality further exacerbate HIV incidence.Recommendations to reduce HIV incidence and AIDS mortality rates in Mozambique include: health system strengthening, rural outreach to increase testing and linkage to care, education about risk reduction and drug adherence, and partnerships with traditional healers and midwives to effect a lessening of stigma.Mozambique, a southeast African nation of ≈21 million people, suffers one of the world's highest burdens of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) (Figure 1). In 2007, HIV prevalence in the 36 antenatal clinic (ANC) sentinel surveillance sites ranged from 3% to 35% with a national estimate of 16% (plausibility bounds from 14-17%) in women ages 15-49 years [1]. Provincial HIV prevalence estimates ranged from 8% to 27% and were highest in the cen
Implementation of cervical cancer screening using visual inspection with acetic acid in rural Mozambique: successes and challenges using HIV care and treatment programme investments in Zambézia Province
Troy D Moon,Carla Silva-Matos,Aventina Cordoso,Alberto J Baptista
Journal of the International AIDS Society , 2012, DOI: 10.7448/ias.15.2.17406
Abstract: Background: In order to maximize the benefits of HIV care and treatment investments in sub-Saharan Africa, programs can broaden to target other diseases amenable to screening and efficient management. We nested cervical cancer screening into family planning clinics at select sites also receiving PEPFAR support for antiretroviral therapy (ART) rollout. This was done using visual inspection with acetic acid (VIA) by maternal child health nurses. We report on achievements and obstacles in the first year of the program in rural Mozambique. Methods: VIA was taught to clinic nurses and hospital physicians, with a regular clinical feedback loop for quality evaluation and retraining. Cryotherapy using carbon dioxide as the refrigerant was provided at clinics; loop electrosurgical excision procedure (LEEP) and surgery were provided at the provincial hospital for serious cases. No pathology services were available. Results: Nurses screened 4651 women using VIA in Zambézia Province in year one of the program, more than double the Ministry of Health service target. VIA was judged positive for squamous intraepithelial lesions in 8% (n=380) of the women (9% if age ≥30 years (n=3154) and 7% if age <30 years (n=1497); p=0.02). Of the 380 VIA-positive women, 4% (n=16) had lesions (0.3% of 4651 total screened) requiring referral to Quelimane Provincial Hospital. Fourteen (88%) of these 16 women were seen at the hospital, but records were inadequate to judge outcomes. Of women screened, 2714 (58%) either had knowledge of their HIV status prior to VIA or were subsequently sent for HIV testing, of which 583 (21%) were HIV positive. Conclusions: Screening and clinical services were successfully provided on a large scale for the first time ever in these rural clinics. However, health manpower shortages, equipment problems, poor paper record systems and a limited ability to follow-up patients inhibited the quality of the cervical cancer screening services. Using prior HIV investments, chronic disease screening and management for cervical cancer is feasible even in severely resource-constrained rural Africa.
Barriers to antiretroviral therapy adherence in rural Mozambique
Kate Groh, Carolyn M Audet, Alberto Baptista, Mohsin Sidat, Alfredo Vergara, Sten H Vermund, Troy D Moon
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-650
Abstract: To better understand barriers to adherence, we conducted 18 community and clinic focus groups in six rural districts. We interviewed 76 women and 88 men, of whom 124 were community participants (CP; 60 women, 64 men) and 40 were health care workers (HCW; 16 women, 24 men) who provide care for those living with HIV.While there was some consensus, both CP and HCW provided complementary insights. CP focus groups noted a lack of confidentiality and poor treatment by hospital staff (42% CP vs. 0% HCW), doubt as to the benefits of antiretroviral therapy (75% CP vs. 0% HCW), and sharing medications with family members (66% CP vs. 0%HCW). Men expressed a greater concern about poor treatment by HCW than women (83% men vs. 0% women). Health care workers blamed patient preference for traditional medicine (42% CP vs. 100% HCW) and the side effects of medication for poor adherence (8% CP vs. 83% CHW).Perspectives of CP and HCW likely reflect differing sociocultural and educational backgrounds. Health care workers must understand community perspectives on causes of suboptimal adherence as a first step toward effective intervention.Mozambique has one of the highest HIV infection rates in sub-Saharan Africa, with a national prevalence estimated between 11.5% and 16% [1-4]. Funding from international donors has allowed the Ministry of Health (MISAU) to expand HIV care and treatment services to rural communities [3-7], but only 24% of eligible patients in 2009 were accessing combination antiretroviral therapy (cART) [8]. Access to care and treatment is poorer in rural areas than in urban areas where, historically, educational and health care services were better established [1,9-12]. With funding from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), Friends in Global Health (FGH), which is affiliated with the Vanderbilt Institute for Global Health (VIGH), has partnered with MISAU to provide support for HIV care and treatment in clinics throughout Zambézia Province (Figur
Bacteremia as a Cause of Fever in Ambulatory, HIV-Infected Mozambican Adults: Results and Policy Implications from a Prospective Observational Study
Troy D. Moon, Wilson P. Silva, Manuel Buene, Luís Morais, Emilio Valverde, Sten H. Vermund, Paula E. Brentlinger
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0083591
Abstract: Fever is typically treated empirically in rural Mozambique. We examined the distribution and antimicrobial susceptibility patterns of bacterial pathogens isolated from blood-culture specimens, and clinical characteristics of ambulatory HIV-infected febrile patients with and without bacteremia. This analysis was nested within a larger prospective observational study to evaluate the performance of new Mozambican guidelines for fever and anemia in HIV-infected adults (clinical trial registration NCT01681914, www.clinicaltrials.gov); the guidelines were designed to be used by non-physician clinicians who attended ambulatory HIV-infected patients in very resource-constrained peripheral health units. In 2012 (April-September), we recruited 258 HIV-infected adults with documented fever or history of recent fever in three sites within Zambézia Province, Mozambique. Although febrile patients were routinely tested for malaria, blood culture capacity was unavailable in Zambézia prior to study initiation. We confirmed bacteremia in 39 (15.1%) of 258 patients. The predominant organisms were non-typhoid Salmonella, nearly all resistant to multiple first-line antibiotics (ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole). Features most associated with bacteremia included higher temperature, lower CD4+ T-lymphocyte count, lower hemoglobin, and headache. Introduction of blood cultures allowed us to: 1) confirm bacteremia in a substantial proportion of patients; 2) tailor specific antimicrobial therapy for confirmed bacteremia based on known susceptibilities; 3) make informed choices of presumptive antibiotics for patients with suspected bacteremia; and 4) construct a preliminary clinical profile to help clinicians determine who would most likely benefit from presumptive bacteremia treatment. Our findings demonstrate that in resource-limited settings, there is urgent need to expand local microbiologic capacity to better identify and treat cases of bacteremia in HIV-infected and other patients, and to support surveillance. Data on the prevalence and susceptibility patterns of important pathogens can guide national formulary and prescribing practices.
Formation of Mercury(II)-Glutathione Conjugates Examined Using High Mass Accuracy Mass Spectrometry  [PDF]
Zachary Fine, Troy D. Wood
International Journal of Analytical Mass Spectrometry and Chromatography (IJAMSC) , 2013, DOI: 10.4236/ijamsc.2013.12011
Abstract:

Maternal exposure to Hg(II) during pregnancy has been identified as a potential causal factor in the development of severe neurobehavioral disorders. Children with autism have been identified with lower reduced glutathione (GSH)/oxidized glutathione (GSSG) ratios, and GSH is known to strongly bind Hg(II). In order to gain insight into the mechanism by which GSH binds Hg(II), high resolution mass spectrometry coupled with tandem mass spectrometry was utilized to examine the conjugation process. While the 1:1 Hg(II):GSH conjugate is not formed immediately upon mixing aqueous solutions of Hg(II) and GSH, two species containing Hg(II) are observed:the 1:2 Hg(II):GSH conjugate, [(GS)2 Hg + H+], and a second Hg(II)-containing species around m/z 544. Interestingly, this species at m/z 544 decreases in time while the presence of the 1:1 Hg(II):GSH conjugate increases, suggesting that m/z 544 is an intermediate in the formation of the 1:1 conjugate. Experiments using the high mass accuracy capability of Fourier transform ion cyclotron resonance (FT-ICR) mass spectrometry coupled to an electrospray ionization source indicate that the intermediate species is [GSH + HgCl]+, andnotthe 1:1 conjugate [Hg(GSH) – H + 2H2O]+postulated in previous literature. Further confirmation of [GSH + HgCl]+ is supported by collisionofinduced dissociation experiments, which show neutral loss of HCl from the intermediate and loss of the N- and C-terminal amino acids, indicating binding of Hg(II) at the Cys residue.

Lessons Learned while Implementing an HIV/AIDs Care and Treatment Program in Rural Mozambique
Troy D. Moon, Janeen R. Burlison, Mohsin Sidat, Paulo Pires, Wilson Silva, Manuel Solis, Michele Rocha, Chiqui Arregui, Eric J. Manders, Alfredo E. Vergara and Sten H. Vermund
Retrovirology: Research and Treatment , 2012, DOI: 10.4137/RRT.S4613
Abstract: Mozambique has severe resource constraints, yet with international partnerships, the nation has placed over 145,000 HIV- infected persons on antiretroviral therapies (ART) through May 2009. HIV clinical services are provided at .215 clinical venues in all 11 of Mozambique’s provinces. Friends in Global Health (FGH), affiliated with Vanderbilt University in the United States (US), is a locally licensed non-governmental organization (NGO) working exclusively in small city and rural venues in Zambézia Province whose population reaches approximately 4 million persons. Our approach to clinical capacity building is based on: 1) technical assistance to national health system facilities to implement ART clinical services at the district level, 2) human capacity development, and 3) health system strengthening. Challenges in this setting are daunting, including: 1) human resource constraints, 2) infrastructure limitations, 3) centralized care for large populations spread out over large distances, 4) continued high social stigma related to HIV, 5) limited livelihood options in rural areas and 6) limited educational opportunities in rural areas. Sustainability in rural Mozambique will depend on transitioning services from emergency foreign partners to local authorities and continued funding. It will also require “wrap-around” programs that help build economic capacity with agricultural, educational, and commercial initiatives. Sustainability is undermined by serious health manpower and infrastructure limitations. Recent U.S. government pronouncements suggest that the U.S. President’s Emergency Plan for AIDS Relief will support concurrent community and business development. FGH, with its Mozambican government counterparts, see the evolution of an emergency response to a sustainable chronic disease management program as an essential and logical step. We have presented six key challenges that are essential to address in rural Mozambique
Cost-effectiveness analysis comparing robotic sacrocolpopexy to a vaginal mesh hysteropexy for treatment of uterovaginal prolapse  [PDF]
Patrick J. Culligan, Charbel Salamon, Christa Lewis, Troy D. Abell
Open Journal of Obstetrics and Gynecology (OJOG) , 2013, DOI: 10.4236/ojog.2013.38110
Abstract:

Objective: To compare costs and QoL associated with 2 minimally invasive operations to treat uterovaginal prolapse. Study Design: A decision analytic cost-effectiveness model comparing vaginal mesh hysteropexy to robotic-assisted sacrocolpopexy. Costs were derived from a hospital perspective. QoL estimates focused on: recurrent prolapse; erosion; infection; transfusion; cystotomy; chronic pain; lower urinary tract symptoms; and mortality. Actual procedural costs at our institution were calculated. Costs and quality adjusted life years were examined over 1 year. Results: The costs ($21,853) and QALYs (0.9645) for robotic sacrocolpopexy produced a CE Ratio of $22,657 per QALY. The costs ($14,890) and QALYs (0.9309) for vaginal mesh produced a CE Ratio of $15,995 per QALY. The incremental cost per QALYs for robotic surgery was $207,232. Sensitivity analysis on all utilities, cost estimates, and complication estimates didn’t cross any thresholds. Conclusion: Vaginal mesh was more cost-effective than robotic sacrocolpopexy even when the cost of the robot was not factored.

Planar Rook Algebras and Tensor Representations of gl(1|1)
G. Benkart,D. Moon
Mathematics , 2012,
Abstract: We establish a connection between planar rook algebras and tensor representations $\VV^{\otimes k}$ of the natural two-dimensional representation $\VV$ of the general linear Lie superalgebra $\gl$. In particular, we show that the centralizer algebra $\maths{End}_{\gl}(\VV^{\otimes k})$ is the planar rook algebra $\CC \mathsf{P}_{k-1}$ for all $k \geq 1$, and we exhibit an explicit decomposition of $\VV^{\otimes k}$ into irreducible $\gl$-modules. We obtain similar results for the quantum enveloping algebra $\UU_\qq(\gl)$ and its natural two-dimensional module $\VV_\qq$.
Missing Data using Decision Forest and Computational Intelligence
D. Moon,T. Marwala
Statistics , 2008,
Abstract: Autoencoder neural network is implemented to estimate the missing data. Genetic algorithm is implemented for network optimization and estimating the missing data. Missing data is treated as Missing At Random mechanism by implementing maximum likelihood algorithm. The network performance is determined by calculating the mean square error of the network prediction. The network is further optimized by implementing Decision Forest. The impact of missing data is then investigated and decision forrests are found to improve the results.
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