measuring the cost of a pediatric vaccine administration in the uk

Abstract The administration of a vaccine dose involves a series of activities prior to and on the day of vaccine delivery. Total vaccination cost should include the cost of each activity, which is often not done or poorly reported. To calculate those costs a field study was performed in 6 United Kingdom (UK) sites (General Practitioner (GP) practices) during a 4-month period (April–June 2015). First, a workflow map of all the relevant vaccine-related activities per site was obtained through interviews. Second, time estimates for activities happening prior to the vaccination day were obtained through interviews and associated costs were calculated. A prospective, non-interventional study using Time & Motion (T&M) methodology was used to measure time for activities happening on the day of vaccination. Consumables, wastage, and guardian time were also collected. Third, the time for each task and for all tasks combined during the T&M study was analyzed using a random intercept model to account for site effect. Hundred and twenty-three T&M observations with approximately 20 per site were collected and were equally stratified by vaccination visit during the first year of a baby's life. Total cost per visit was £11.9 (site range: £8.6–£17.0) when supply cost and time for activities prior to the vaccination day were included. Time per dose administrated was 7.1 min (site range: 5.7–9.2) and the associated cost was £4.3 (site range: £3.1–£6.2). The study demonstrates an accurate reflection of the time and cost involved in a vaccine dose administration in a pediatric setting in the UK. The amount measured is consistent with the current National Health Services fee schedule

Achtergrondstudie bij de subsidies voor de biologische land- en tuinbouw in Vlaanderen

In opdracht van de Vlaamse overheid heeft het Louis Bolk Instituut, samen met het Instituut voor landbouw- en visserijonderzoek (ILVO), een studie uitgevoerd naar de bedrijfseconomische gevolgen van de omschakeling van gangbare naar biologische landbouw. Aanleiding voor de studie waren een mogelijke herziening van de hoogte van de overheidssubsidie die biologische landbouwers in Vlaanderen hiervoor ontvangen en het geringe aantal omschakelende agrariërs. Conclusie van de studie is dat voor veel bedrijven omschakeling naar biologische landbouw een rendabel alternatief kan vormen. De studie bevestigt tevens een aantal fundamentele kwetsbaarheden en obstakels. Transitiekosten (het vergaren van nieuwe kennis en marktcontacten, de afzet van de producten en voor sommige bedrijven desinvesteringen tijdens de overgangsperiode) kunnen een groot obstakel vormen voor omschakeling omdat deze transitiekosten pas na vele jaren worden terugverdiend. Daarnaast kan het risico op marktfalen goed bedrijfsresultaat in de weg staan. Deze kwetsbaarheden en obstakels manifesteren zich vooral op bedrijfsniveau waardoor ze moeilijker toewijsbaar worden naar teeltniveau. Een van de aanbevelingen is daarom om (ook) instrumenten te ontwikkelen die de overgangskosten en het risico op marktfalen verminderen. Doordat omschakeling voor veel bedrijven een aantrekkelijke optie lijkt en belangrijke kostencomponenten zich vooral op bedrijfsniveau manifesteren is een blijvende en op hectarebasis teruggebrachte ondersteuningspremie voor biologische landbouw nog slechts beperkt te verantwoorden. Aangezien prijzen continue wisselen en de beschikbaarheid van betrouwbare gegevens beperkt is, is ook een ‘beslissingsondersteunend rekenmodel’ opgeleverd waarmee berekeningen gemakkelijk later opnieuw gedaan kunnen worden

Financial phantasmagoria: corporate image-work in times of crisis

Our purpose in this article is to relate the real movements in the economy during 2008 to the ?image-work? of financial institutions. Over the period January?December 2008 we collected 241 separate advertisements from 61 financial institutions published in the Financial Times. Reading across the ensemble of advertisements for themes and evocative images provides an impression of the financial imaginaries created by these organizations as the global financial crisis unfolded. In using the term ?phantasmagoria? we move beyond its colloquial sense of a set of strange images designed to dazzle towards the more technical connotation used by Ranci�re (2004) who suggested that words and images can offer a trace of an overall determining set-up if they are torn from their obviousness so they become phantasmagoric figures. The key phantasmagoric figure we identify here is that of the financial institution as timeless, immortal and unchanging; a coherent and autonomous entity amongst other actors. This notion of uniqueness belies the commonality of thinking which precipitated the global financial crisis as well as the limited capacity for control of financial institutions in relation to market events. It also functions as a powerful naturalizing force, making it hard to question certain aspects of the recent period of ?capitalism in crisis?

Using a gamified monitoring app to change adolescents' snack intake : the development of the REWARD app and evaluation design

Background: As the snacking pattern of European adolescents is of great concern, effective interventions are necessary. Till now health promotion efforts in children and adolescents have had only limited success in changing adolescents' eating patterns and anthropometrics. Therefore, the present study proposes an innovative approach to influence dietary behaviors in youth based on new insights on effective behavior change strategies and attractive intervention channels to engage adolescents. This article describes the rationale, the development, and evaluation design of the 'Snack Track School' app. The aim of the app is to improve the snacking patterns of Flemish 14- to 16-year olds. Methods: The development of the app was informed by the systematic, stepwise, iterative, and collaborative principles of the Intervention Mapping protocol. A four week mHealth intervention was developed based on the dual-system model with behavioral change strategies targeting both the reflective (i.e., active learning, advance organizers, mere exposure, goal-setting, monitoring, and feedback) and automatic processes (i.e., rewards and positive reinforcement). This intervention will be evaluated via a controlled pre-post design in Flemish schools among 1400 adolescents. Discussion: When this intervention including strategies focused on both the reflective and automatic pathway proves to be effective, it will offer a new scientifically-based vision, guidelines and practical tools for public health and health promotion (i.e., incorporation of learning theories in intervention programs)

Biopython: freely available Python tools for computational molecular biology and bioinformatics

Summary: The Biopython project is a mature open source international collaboration of volunteer developers, providing Python libraries for a wide range of bioinformatics problems. Biopython includes modules for reading and writing different sequence file formats and multiple sequence alignments, dealing with 3D macro molecular structures, interacting with common tools such as BLAST, ClustalW and EMBOSS, accessing key online databases, as well as providing numerical methods for statistical learning. Availability: Biopython is freely available, with documentation and source code at www.biopython.org under the Biopython license. Contact: All queries should be directed to the Biopython mailing lists, see www.biopython.org/wiki/[email protected]

Correlations of health status indicators with perceived neuropsychological impairment and cognitive processing speed in multiple sclerosis

Background: Comorbidity and health behaviours may explain heterogeneity regarding cognitive performance in multiple sclerosis. Patient-reported cognitive difficulties have impact but do not consistently correlate with objective cognitive performance. Our study aims to investigate whether health status indicators including comorbidities, body mass index, physical activity, smoking, sleeping behaviour and consumption patterns for fish, alcohol and caffeinated drinks are associated with measures of subjective and objective cognitive performance. Methods: Survey data on self-reported cognitive performance, assessed with the MS Neuropsychological Screening Questionnaire (MSNQ), were related to the presence of arterial hypertension, diabetes mellitus, cardiovascular and chronic renal diseases, hypercholesterolemia, depression based on 2-question screening tool, health and consumption behaviors. We included the Symbol Digit Modalities Test when available within 6 months as an objective, performance-based metric of cognitive processing speed. We investigated the interrelation between all variables with a Spearman correlation matrix and corrected for multiple testing. Regression models were built and controlled for age, sex and phenotype. Results: We used available data from 751 patients with definite MS, including 290 SDMT scores within a time window of 6 months, to study relations between variables. MSNQ and SDMT scores were not significantly correlated. Correlation patterns for subjective and objective performance differed. Age, disease duration and physical disability correlated with SDMT scores only. Regression analyses could be performed for MSNQ scores in 595/751 (79.2%) and for SDMT scores in 234/751 (31.2%) participants. After restricting variables to avoid collinearity and adjusting for the number of variables, regression models explained 15% of the variance for subjective and 14% of the variance for objective cognitive performance. A higher number of physical comorbidities, reporting depressive symptoms, sleeping 9 h or more and daily use of sleeping medication were associated with lower subjective cognitive performance, whereas increasing age was associated with reduced processing speed. These associations persisted after correction for multiple testing. Conclusion: Increasing age is associated with reduced cognitive processing speed whereas comorbidities and sleep behaviors contribute to subjective cognitive performance

Regression shrinkage methods for clinical prediction models do not guarantee improved performance: simulation study

When developing risk prediction models on datasets with limited sample size, shrinkage methods are recommended. Earlier studies showed that shrinkage results in better predictive performance on average. This simulation study aimed to investigate the variability of regression shrinkage on predictive performance for a binary outcome. We compared standard maximum likelihood with the following shrinkage methods: uniform shrinkage (likelihood-based and bootstrap-based), penalized maximum likelihood (ridge) methods, LASSO logistic regression, adaptive LASSO, and Firth's correction. In the simulation study, we varied the number of predictors and their strength, the correlation between predictors, the event rate of the outcome, and the events per variable. In terms of results, we focused on the calibration slope. The slope indicates whether risk predictions are too extreme (slope 1). The results can be summarized into three main findings. First, shrinkage improved calibration slopes on average. Second, the between-sample variability of calibration slopes was often increased relative to maximum likelihood. In contrast to other shrinkage approaches, Firth's correction had a small shrinkage effect but showed low variability. Third, the correlation between the estimated shrinkage and the optimal shrinkage to remove overfitting was typically negative, with Firth's correction as the exception. We conclude that, despite improved performance on average, shrinkage often worked poorly in individual datasets, in particular when it was most needed. The results imply that shrinkage methods do not solve problems associated with small sample size or low number of events per variable.Development and application of statistical models for medical scientific researc