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A methodological study of a nonlinear stochastic model of the AIDS epidemic in Philadelphia.

机译:费城艾滋病流行的非线性随机模型的方法学研究。

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A nonlinear stochastic model with heterogeneous risk behavior and recruitment is fitted to Philadelphia public health data adjusted for delays in reporting. Nonlinear difference equations embedded in a stochastic population process are used in computer intensive searches through the parameter space of time homogeneous factor and level combinations to fit projections for cumulative new AIDS cases to data for whites and blacks. Time inhomogeneous factors are applied in efforts to improve the fits and compute confidence bounds for the projections by Monte Carlo simulation, which measures central tendency for the random functions of the process. The model partitions the population into the risk categories of homosexual, bisexual, or heterosexual male, and prostitute or nonprostitute female. Each is further partitioned by intravenous or non-intravenous drug use, a low or high level of needle sharing and sexual contact, and state of HIV disease. The epidemics are seeded by high risk homosexual and bisexual males with recruitment of susceptibles based on census and behavioral data. The Philadelphia public health data covers 1981 to 1992 with a sharp upturn in AIDS cases in 1987 corresponding to a change in the definition of AIDS. The various combinations of factors providing good fits to the data for individual risk categories suggest that several different epidemics exist. Further, for white and black male homosexual/bisexual non-intravenous drug users, the largest data risk categories, the better fitting confidence bounds are achieved with the probabilities of infection per sexual contact decreasing over time. This could suggest an increased awareness of HIV transmission and the use of condoms to prevent infection. For white male homosexual/bisexual non-intravenous drug users, the fit suggests that recruits may be decreasing over time as well.
机译:费城公共卫生数据拟合了具有异质风险行为和募集的非线性随机模型,并针对报告延迟进行了调整。嵌入在随机人口过程中的非线性差分方程用于计算机密集搜索中,通过时间均质因子和水平组合的参数空间,以将累积的新艾滋病病例的预测拟合为白人和黑人的数据。时间非均匀性因素被用于通过蒙特卡洛模拟来改进投影的拟合度和计算其置信范围的方法,该方法测量过程随机函数的集中趋势。该模型将人口分为男性,男性和女性为pro妓,双性恋或异性恋的风险类别。通过静脉内或非静脉内药物使用,低水平或高水平的针头共享和性接触以及HIV疾病状态进一步划分每种药物。流行病是由高风险的同性恋和双性恋男性引发的,并根据人口普查和行为数据招募了易感人群。费城的公共卫生数据涵盖1981年至1992年,1987年的AIDS病例急剧增加,这与AIDS定义的改变相对应。各种因素组合非常适合单个风险类别的数据,表明存在几种不同的流行病。此外,对于白人和黑人男性同性恋/双性恋非静脉吸毒者,最大的数据风险类别,随着每次性接触的感染概率随时间降低,获得了更好的拟合置信范围。这可能表明人们对艾滋病传播和使用避孕套预防感染的认识有所提高。对于白人男性同性恋/双性恋非静脉吸毒者,拟合度表明,新兵人数也可能随着时间而减少。

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