The monetary benefit of early flood warnings in Europe

Effective disaster risk management relies on science-based solutions to close the gap between prevention and preparedness measures. The consultation on the United Nations post-2015 framework for disaster risk reduction highlights the need for cross-border early warning systems to strengthen the preparedness phases of disaster risk management, in order to save lives and property and reduce the overall impact of severe events. Continental and global scale flood forecasting systems provide vital early flood warning information to national and international civil protection authorities, who can use this information to make decisions on how to prepare for upcoming floods. Here the potential monetary benefits of early flood warnings are estimated based on the forecasts of the continental-scale European Flood Awareness System (EFAS) using existing flood damage cost information and calculations of potential avoided flood damages. The benefits are of the order of 400 Euro for every 1 Euro invested. A sensitivity analysis is performed in order to test the uncertainty in the method and develop an envelope of potential monetary benefits of EFAS warnings. The results provide clear evidence that there is likely a substantial monetary benefit in this cross-border continental-scale flood early warning system. This supports the wider drive to implement early warning systems at the continental or global scale to improve our resilience to natural hazards

Forecast convergence score: a forecaster's approach to analysing hydro-meteorological forecast systems.

In this paper the properties of a hydro-meteorological forecasting system for forecasting river flows have been analysed using a probabilistic forecast convergence score (FCS). The focus on fixed event forecasts provides a forecaster's approach to system behaviour and adds an important perspective to the suite of forecast verification tools commonly used in this field. A low FCS indicates a more consistent forecast. It can be demonstrated that the FCS annual maximum decreases over the last 10 years. With lead time, the FCS of the ensemble forecast decreases whereas the control and high resolution forecast increase. The FCS is influenced by the lead time, threshold and catchment size and location. It indicates that one should use seasonality based decision rules to issue flood warnings

Applying a cost-based pricing model for innovative cancer treatments subject to indication expansion:A case study for pembrolizumab and daratumumab

BACKGROUND: Expanding the indication of already approved immuno-oncology drugs presents treatment opportunities for patients but also strains healthcare systems. Cost-based pricing models are discussed as a possibility for cost containment. This study focuses on two drugs, pembrolizumab (Keytruda) and daratumumab (Darzalex), to explore the potential effect of indication broadening on the estimated price when using the cost-based pricing (CBP) model proposed by Uyl-de Groot and Löwenberg (2018). METHODS: The model was used to calculate cumulative yearly prices, cumulative prices per indication, and non-cumulative indication-based prices using inputs such as research and development (R&amp;D) costs, manufacturing costs, eligible patient population, and a profit margin. A deterministic stepwise analysis and scenario analysis were conducted to examine how sensitive the estimated price is to the different input assumptions. RESULTS: The yearly cumulative cost-based prices (CBPs) ranged from €52 to €885 for pembrolizumab per vial and €823 to €31,941 for daratumumab per vial. Prices were higher in initial years or indications due to smaller patient populations, decreased over time or after additional indications. Sensitivity analysis showed that the number of eligible patients had the most significant impact on the estimated price. In the scenario analysis the profit margin contributed most to a higher CBPs for both drugs. Lower estimates resulted from assumed lower R&amp;D costs. DISCUSSION: The estimated CBPs are consistently lower than Dutch list prices for pembrolizumab (€2,861), mainly resulting from larger patient populations in registered indications. However, daratumumab's list prices fall within the range of modeled CBPs depending on the year or indication (€4,766). Both CBPs decrease over time or with additional indications. The number of eligible patients and initial R&amp;D costs have the most significant influence on the CBPs. These findings contribute to the ongoing discussions on pharmaceutical pricing, especially concerning cancer drugs with expanding indications.</p

Multilevel use of image repository in the field of veterinary imaging and dissemination of training tools

[Extract] Until now the veterinary teaching environment is limited to static two dimensional materials. In order to improve the teaching experience we decided to adapt our educational PACS to build 2D and 3D viewing veterinary datasets. As entry level of education we setup a knowledge base consisting out of normal anatomy [1, 2]. The second step is the construction of an imaging atlas compared with the normal anatomy of every animal. The third step is the construction of a database containing a wide variety of radiopathology cases. The final level is the integration in an e-learning platform namely WikiVet [3] which is a collaborative initiative involving UK veterinary schools. The project is creating a comprehensive online knowledge base and will provide a reliable reference source to supersede Wikipedia for veterinary students, paramedics and graduates anywhere in the world, improving diagnostic skills using diagnostic imaging

Second-line treatment for acute graft-versus-host disease with mesenchymal stromal cells. a decision model

Objective: No standard second-line treatment exists for acute graft-versus-host disease steroid-refractory (SR-aGvHD), and long-term outcomes remain poor. Mesenchymal stromal cells (MSCs) have been evaluated as treatment, but no disease model (DM) exists that integrates and extrapolates currently available evidence. The aim of this study was to develop such a DM to describe the natural history of SR-aGvHD and to predict long-term outcomes. Method: The DM was developed in collaboration with experts in haematology-oncology. Subsequently, a model simulation was run. Input parameters for transition and survival estimates were informed by published data of clinical trials on MSC treatment for SR-aGvHD. Parametric distributions were used to estimate long-term survival rates after MSCs. Results: The newly developed DM is a cohort model that consists of eight health states. For the model simulation, we obtained data on 327 patients from 14 published phase II trials. Due to limited evidence, DM structure was simplified and several assumptions had to be made. Median overall survival was 3.2 years for complete response and 0.5 years for no complete response. Conclusion: The DM provides a comprehensive overview on the second-line treatment pathway for aGvHD and enables long-term predictions that can be used to perform a cost-effectiveness analysis comparing any treatment for SR-aGvHD

Policy evaluation and behavioral economics

Empirical policy evaluation is necessary to answer the question: what is a good policy? To answer this question, this chapter will review the management of policy evaluation and cover key performance indicators for evaluation, such as efficiency and fidelity. On the basis of these indicators, common frameworks for policy evaluation are explained. Some of the challenges in conducting policy evaluation, though, are the complex and variable aspects of all policies, as well as their context-specific antecedents and outcomes. This makes comparison between policies very challenging, if not impossible; hence, we close with an example of strategies for standardizing the evaluation of policies across domains and approaches. Ultimately, the purpose of this chapter is to identify not only what comprises a strong policy but also how to produce effective policies that maximize the number of people reached and impacted.</p

How do I know if my forecasts are better? Using benchmarks in Hydrological ensemble prediction

The skill of a forecast can be assessed by comparing the relative proximity of both the forecast and a benchmark to the observations. Example benchmarks include climatology or a naïve forecast. Hydrological ensemble prediction systems (HEPS) are currently transforming the hydrological forecasting environment but in this new field there is little information to guide researchers and operational forecasters on how benchmarks can be best used to evaluate their probabilistic forecasts. In this study, it is identified that the forecast skill calculated can vary depending on the benchmark selected and that the selection of a benchmark for determining forecasting system skill is sensitive to a number of hydrological and system factors. A benchmark intercomparison experiment is then undertaken using the continuous ranked probability score (CRPS), a reference forecasting system and a suite of 23 different methods to derive benchmarks. The benchmarks are assessed within the operational set-up of the European Flood Awareness System (EFAS) to determine those that are ‘toughest to beat’ and so give the most robust discrimination of forecast skill, particularly for the spatial average fields that EFAS relies upon. Evaluating against an observed discharge proxy the benchmark that has most utility for EFAS and avoids the most naïve skill across different hydrological situations is found to be meteorological persistency. This benchmark uses the latest meteorological observations of precipitation and temperature to drive the hydrological model. Hydrological long term average benchmarks, which are currently used in EFAS, are very easily beaten by the forecasting system and the use of these produces much naïve skill. When decomposed into seasons, the advanced meteorological benchmarks, which make use of meteorological observations from the past 20 years at the same calendar date, have the most skill discrimination. They are also good at discriminating skill in low flows and for all catchment sizes. Simpler meteorological benchmarks are particularly useful for high flows. Recommendations for EFAS are to move to routine use of meteorological persistency, an advanced meteorological benchmark and a simple meteorological benchmark in order to provide a robust evaluation of forecast skill. This work provides the first comprehensive evidence on how benchmarks can be used in evaluation of skill in probabilistic hydrological forecasts and which benchmarks are most useful for skill discrimination and avoidance of naïve skill in a large scale HEPS. It is recommended that all HEPS use the evidence and methodology provided here to evaluate which benchmarks to employ; so forecasters can have trust in their skill evaluation and will have confidence that their forecasts are indeed better

Captive breeding of Margaritifera auricularia (Spengler, 1793) and its conservation importance

Margaritifera auricularia is one of the most endangered freshwater mussels (Bivalvia, Unionida) in the world. Since 2013, the abundance of this species in the Ebro River basin (Spain) has sharply declined, driving the species to the verge of regional extinction. Therefore, any management measures that might facilitate the recovery of this species would be essential for its conservation. During 2014–2016, captive breeding of M. auricularia allowed the production of >106 juveniles, out of which 95% were released into the natural environment, and 5% were grown in the laboratory under controlled conditions. The aim of this experimental work was to establish the best culture conditions for the survival and growth of M. auricularia juveniles in the laboratory. The experiment was divided into two phases: phase I, in which juveniles recently detached from fish gills were cultured in detritus boxes until they reached a shell length of 1 mm; and phase II, in which these specimens were transferred to larger aquaria to grow up to 3–4 mm. The best experimental conditions for juvenile survival and growth corresponded to treatments in glass containers at a density of 0.2 ind. L−1, using river water, with added substrate and detritus, enriched with phytoplankton, and avoiding extra aeration. The highest survival and growth rates attained, respectively, values of c. 60% at 100 days and 2.56 mm in shell length at 30–32 weeks. This is the first study to report on the long‐term survival and growth of juvenile M. auricularia in the laboratory, providing essential information in order to implement future conservation measures addressed at reinforcing the natural populations of this highly threatened species in European water bodies.This project was funded by the Government of Aragón, Department of Rural Development and Sustainability and carried out by the Environmental Service Department of SARGA. Special thanks go to Manuel Alcántara, Miguel Ángel Muñoz, Ester Ginés, Carlos Catalá, and Juan Pablo de la Roche, who were involved in the project. The authors appreciate the work of the reviewer and editor who improved the quality of the manuscript. The Aragón's forest rangers are thanked for their assistance during fieldwork

Trait-based analysis of the human skin microbiome

The past decade of microbiome research has concentrated on cataloging the diversity of taxa in different environments. The next decade is poised to focus on microbial traits and function. Most existing methods for doing this perform pathway analysis using reference databases. This has both benefits and drawbacks. Function can go undetected if reference databases are coarse-grained or incomplete. Likewise, detection of a pathway does not guarantee expression of the associated function. Finally, function cannot be connected to specific microbial constituents, making it difficult to ascertain the types of organisms exhibiting particular traits—something that is important for understanding microbial success in specific environments. A complementary approach to pathway analysis is to use the wealth of microbial trait information collected over years of lab-based, culture experiments.https://doi.org/10.1186/s40168-019-0698-