Health and economic outcomes of 20-valent pneumococcal conjugate vaccine compared to 15-valent pneumococcal conjugate vaccine strategies for adults in Greece

ObjectiveHigher valency pneumococcal conjugate vaccines (PCVs) are expected to improve protection against pneumococcal disease through coverage of additional serotypes. The aim of the present study was to evaluate the cost-effectiveness of 20-valent pneumococcal conjugate vaccine (PCV20) compared to 15-valent pneumococcal conjugate vaccine (PCV15) alone or followed by 23-valent polysaccharide vaccine (PPV23) for adults in Greece.MethodsA published Markov model was adapted to simulate lifetime risk of clinical and economic outcomes from the public payer’s perspective. The model population was stratified based on age and risk profile (i.e., low, moderate, or high-risk of developing pneumococcal disease). Epidemiologic parameters, serotype coverage and vaccines’ effectiveness were based on published literature, while direct medical costs (prices €, 2022) were obtained from official sources. Main model outcomes were projected number of invasive pneumococcal disease (IPD) and all-cause non-bacteremic pneumonia (NBP) cases and attributable deaths, costs and quality-adjusted life-years (QALY) for each vaccination strategy. Sensitivity analyses were performed to ascertain the robustness of model results.ResultsOver the modeled time horizon, vaccination with PCV20 compared to PCV15 alone or PCV15 followed by PPV23 prevents an additional 747 and 646 cases of IPD, 10,334 and 10,342 cases of NBP and 468 and 455 deaths respectively, resulting in incremental gain of 1,594 and 1,536 QALYs and cost savings of €11,183 and €48,858, respectively. PSA revealed that the probability of PCV20 being cost-effective at the predetermined threshold of €34,000 per QALY gained was 100% compared to either PCV15 alone or the combination of PCV15 followed by PPV23.ConclusionPCV20 is estimated to improve public health by averting additional pneumococcal disease cases and deaths relative to PCV15 alone or followed by PPV23, and therefore translates to cost-savings for the public payer. Overall results showed that vaccination with PCV20 was estimated to be a dominant vaccination strategy (improved health outcomes with reduced costs) over PCV15 alone or followed by PPV23 for prevention of pneumococcal disease in adults in Greece

Medical Physics: forming and testing solutions to clinical problems

According to the European Federation of Organizations for Medical Physics (EFOMP) policy statement No. 13, “The rapid advance in the use of highly sophisticated equipment and procedures in the medical field increasingly depends on information and communication technology. In spite of the fact that the safety and quality of such technology is vigorously tested before it is placed on the market, it often turns out that the safety and quality is not sufficient when used under hospital working conditions. To improve safety and quality for patient and users, additional safeguards and related monitoring, as well as measures to enhance quality, are required. Furthermore a large number of accidents and incidents happen every year in hospitals and as a consequence a number of patients die or are injured. Medical Physicists are well positioned to contribute towards preventing these kinds of events”. The newest developments related to this increasingly important medical speciality were presented during the 8th European Conference of Medical Physics 2014 which was held in Athens, 11–13 September 2014 and hosted by the Hellenic Association of Medical Physicists (HAMP) in collaboration with the EFOMP and are summarized in this issue

“Trait EI in the relationship between needs fulfilment and symptoms and attitudes associated with EDs”

Eating disorders (EDs) are a set of pathologies, which have been increasing in prevalence in the recent years, suggesting the importance of studying symptoms and attitudes associated with EDs in depth. Several studies have showed that both psychological basic needs and trait emotion intelligence (trait EI) are relevant aspects of EDs, however these two aspects were never tested concurrently. Previous studies have shown that self-determined motivation could be a plausible antecedent that may account for individual variation in trait EI, and for this reason, it seems to be extremely relevant to integrate trait EI in a Self-Determination Theory (SDT) framework. The aim of this study is to test a mediation model of trait EI in the relationship between need fulfilment and eating disorders. In a sample of 159 females aged between 16 and 22 years old (M = 18.71; SD = 1.98) instruments were administered to measure the basic psychological needs, trait EI, and eating disorders. Results of this study showed that need fulfilment was negatively related to eating disorders and positively related to trait EI, whereas trait EI was negatively related to eating disorders. Furthermore, trait EI has shown a mediation role in the relation between basic psychological needs and eating disorders

“Trait EI in the relationship between needs fulfilment and symptoms and attitudes associated with EDs”

Eating disorders (EDs) are a set of pathologies, which have been increasing in prevalence in the recent years, suggesting the importance of studying symptoms and attitudes associated with EDs in depth. Several studies have showed that both psychological basic needs and trait emotion intelligence (trait EI) are relevant aspects of EDs, however these two aspects were never tested concurrently. Previous studies have shown that self-determined motivation could be a plausible antecedent that may account for individual variation in trait EI, and for this reason, it seems to be extremely relevant to integrate trait EI in a Self-Determination Theory (SDT) framework. The aim of this study is to test a mediation model of trait EI in the relationship between need fulfilment and eating disorders. In a sample of 159 females aged between 16 and 22 years old (M = 18.71; SD = 1.98) instruments were administered to measure the basic psychological needs, trait EI, and eating disorders. Results of this study showed that need fulfilment was negatively related to eating disorders and positively related to trait EI, whereas trait EI was negatively related to eating disorders. Furthermore, trait EI has shown a mediation role in the relation between basic psychological needs and eating disorders

Numerical methods for first and second order fully nonlinear partial differential equations

This thesis focuses on the numerical analysis of partial differential equations (PDEs) with an emphasis on first and second-order fully nonlinear PDEs. The main goal is the design of numerical methods to solve a variety of equations such as orthogonal maps, the prescribed Jacobian equation and inequality, the elliptic and parabolic Monge-Ampère equations. For orthogonal map we develop an \emph{operator-splitting/finite element} approach for the numerical solution of the Dirichlet problem. This approach is built on the variational principle, the introduction of an associated flow problem, and a time-stepping splitting algorithm. Moreover, we propose an extension of this method with an \emph{anisotropic mesh adaptation algorithm}. This extension allows us to track singularities of the solution's gradient more accurately. Various numerical experiments demonstrate the accuracy and the robustness of the proposed method for both constant and adaptive mesh. For the prescribed Jacobian equation and the three-dimensional Monge-Ampère equation, we consider a \emph{least-squares/relaxation finite element method} for the numerical solution of the Dirichlet problems. We then introduce a relaxation algorithm that splits the least-square problem, which stems from a reformulation of the original equations, into local nonlinear and variational problems. We develop dedicated solvers for the algebraic problems based on Newton method and we solve the differential problems using mixed low-order finite element method. Overall the least squares approach exhibits appropriate convergence orders in L2(Ω) and H1(Ω) error norms for various numerical tests. We also design a \emph{second-order time integration method} for the approximation of a parabolic two-dimensional Monge-Ampère equation. The space discretization of this method is based on low-order finite elements, and the time discretization is achieved by the implicit Crank-Nicolson type scheme. We verify the efficiency of the proposed method on time-dependent and stationary problems. The results of numerical experiments show that the method achieves nearly optimal orders for the L2(Ω) and H1(Ω) error norms when smooth solutions are approximated. Finally, we present an adaptive mesh refinement algorithm for the elliptic Monge-Ampere equation based on the residual error estimate. The robustness of the proposed algorithm is verified using various test cases and two different solvers which are inspired by the two previous proposed numerical methods

Numerical approximation of rigid maps in origami theory

In origami theory, the problem of rigid maps consists in finding a paper folding from the two-dimensional space onto the three-dimensional space. This problem is an example of a first-order fully nonlinear equation. In this article, we present a general variational framework to solve the problem of rigid maps with Dirichlet boundary conditions. The numerical framework relies on the introduction of a regularized objective function and the penalization of the constraints. A splitting algorithm is advocated for the corresponding flow problem. The iterations sequence consists of local nonlinear problems and a global linear variational problem at each step. Numerical experiments validate the efficiency of the method for piecewise smooth exact solutions

Evaluation of the occupational exposure to electromagnetic fields: specialization for the magnetic resonance imaging systems

The occupational exposure to electromagnetic fields (EMF), an Occupational Health and Safety (OHS) issue of great scientific, social and economic significance, was under intense European negations for the last twenty years; the new relevant Directive 2013/35/EU is the legislative integration.A research program concerning occupational EMF exposure was launched by the University of Thessaly, the Ministry of Labor (which was in charge for the timely implementation of the European Directive into national legislation) and the Office of Non-Ionizing Radiation of the Greek Atomic Energy Commission (EEAE). The appropriate measurements and exposure assessments were conducted at selected workplaces including power production and distribution, railway, broadcasting, hospital MRI systems, port bridge cranes, industrial and research installation and ordinary workplace offices.For the vast majority of the workplaces, the measured EMF values were not only below the occupational limits of the Directive, but also below the general public exposure limits. The few locally detected high EMF values and the possible overexposures are manageable through appropriate technical and organizational OHS measures.The case of maintenance of EMF emitting equipment is an exception that needs proper attention, as the maintenance procedures are, in general, risky and can lead to overexposures.The widespread, usually social, concern about the EMF exposure, most of the times involve very low and/or undefined exposures. This thorough occupational EMF survey, in general, did not justify the concern and through the knowledge added, hopes to contribute to the occupational EMF exposure assessment both nationally and internationally.Η έκθεση των εργαζομένων σε ηλεκτρομαγνητικά πεδία (ΗΜΠ), ζήτημα Υγείας και Ασφάλειας της Εργασίας (ΥΑΕ) με έντονο επιστημονικό, κοινωνικό και οικονομικό ενδιαφέρον, αποτέλεσε αντικείμενο έντονων εξελίξεων σε Ευρωπαϊκό επίπεδο τα τελευταία σχεδόν είκοσι χρόνια. Η νέα σχετική Οδηγία 2013/35/ΕΕ και το σχετικό εναρμονισμένο Ελληνικό π.δ. 120/2016, είναι η νομοθετική ολοκλήρωση του κρίσιμου αυτού θέματος.Ο υπογράφων, στα πλαίσια της ενασχόλησης του με τις μη-ιοντίζουσες ακτινοβολίες ως ερευνητής του Πανεπιστημίου Θεσσαλίας, σε συνεργασία με το Υπουργείο Εργασίας (αρμόδιο για την έγκαιρη και ουσιαστική εφαρμογή της Οδηγίας), εκπόνησε πιλοτικό ερευνητικό πρόγραμμα διερεύνησης της επαγγελματικής έκθεσης σε ΗΜΠ σε συνεργασία με το Γραφείο Μη-Ιοντιζουσών Ακτινοβολιών της Ελληνικής Επιτροπής Ατομικής Ενέργειας. Πραγματοποιήθηκαν μετρήσεις και αξιολόγηση της έκθεσης σε κατάλληλα επιλεγμένες θέσεις σε εγκαταστάσεις της ΔΕΗ, του ΟΣΕ, της ΕΡΤ, σε νοσοκομεία με συστήματα Απεικόνισης Μαγνητικού Συντονισμού, στον ΟΛΠ, σε βιομηχανικές και ερευνητικές εγκαταστάσεις, αλλά και σε χώρους γραφείων.Η συντριπτική πλειοψηφία των μετρήσεων δεν παρουσίασε υπερβάσεις των οριακών τιμών έκθεσης της Οδηγίας, ενώ στις περισσότερες περιπτώσεις δεν υπερβαίνονται ούτε τα εθνικά όρια για τον γενικό πληθυσμό. Οι λίγες περιπτώσεις υπερβάσεων είναι εξαιρετικά τοπικά εντοπισμένες και διαχειρίσιμες με τεχνικά και οργανωτικά μέτρα στην βάση των αρχών της ΥΑΕ. Ανοικτό θέμα παραμένει η συντήρηση του εξοπλισμού που εκπέμπει ΗΜΠ, διότι σε περίπτωση που είναι ενεργός ενδέχεται να υπάρχουν σημαντικές υπερβάσεις.Ο διάχυτος, περισσότερο κοινωνικός, προβληματισμός γύρω από τα ΗΜΠ υπάρχει συνήθως για πολύ χαμηλές ή/και απροσδιόριστες εκθέσεις. Με την παρούσα εργασία δημιουργήθηκε επιπλέον γνώση για την συνολική κατάσταση στην Ελλάδα, η οποία αποτελεί πυλώνα για την διαχείριση των ΗΜΠ σε χώρους εργασίας στην χώρα μας αλλά και διεθνώς