A visual approach to the economic evaluation of vaccines : opening the health economic black box

Objectives: The economic evaluation of vaccines has attracted a great deal of controversy. In the academic literature, several vaccination advocates argue that the evaluation frame for vaccines should be expanded to give a more complete picture of their benefits. We seek to contribute to the debate and facilitate informed dialogue about vaccine assessment using visualization, as able to support both deliberation by technical committees about the substance of evaluation and communication of the underlying rationale to non-experts. Methods: We present two visualizations, an Individual Risk Plot (IRP), and a Population Impact Plot (PIP), both showing the beneficiary population on one axis and the degree of individual benefit and cost of an individual dose on the second axis. We sketch out such graphs for 10 vaccines belonging to the UK routine childhood immunization schedule and present our own analysis for the rotavirus and meningitis B vaccines. Results: While the IRPs help classify diseases by morbidity and mortality, the PIPs display the health and economic loss averted after introducing a vaccine, allowing further comparisons. Conclusion: The visualizations presented, albeit open to provide an increasingly complete accounting of the value of vaccination, ensure consistency of approach where comparative judgments are most needed

Machine learning for real-time aggregated prediction of hospital admission for emergency patients

Machine learning for hospital operations is under-studied. We present a prediction pipeline that uses live electronic health-records for patients in a UK teaching hospital's emergency department (ED) to generate short-term, probabilistic forecasts of emergency admissions. A set of XGBoost classifiers applied to 109,465 ED visits yielded AUROCs from 0.82 to 0.90 depending on elapsed visit-time at the point of prediction. Patient-level probabilities of admission were aggregated to forecast the number of admissions among current ED patients and, incorporating patients yet to arrive, total emergency admissions within specified time-windows. The pipeline gave a mean absolute error (MAE) of 4.0 admissions (mean percentage error of 17%) versus 6.5 (32%) for a benchmark metric. Models developed with 104,504 later visits during the Covid-19 pandemic gave AUROCs of 0.68-0.90 and MAE of 4.2 (30%) versus a 4.9 (33%) benchmark. We discuss how we surmounted challenges of designing and implementing models for real-time use, including temporal framing, data preparation, and changing operational conditions

IB Middle years programme : global issues . Project organizer 1

Libro para alumnos del primer curso del Programa de los Años Intermedios (PAI) del Bachillerato Internacional (IB) centrado en el aprendizaje interdisciplinar. Sus contenidos reflejan aspectos clave de la filosofía y el enfoque del programa del BI como la mentalidad internacional y la honestidad académica. Está estructurado en seis lecciones cada una sobre un tema extraído de los Objetivos de Desarrollo del Milenio acordados por Naciones Unidas: erradicación de la pobreza, refugiados e inmigrantes, educación universal, salud y enfermedad, comercio mundial y desarrollo, sostenibilidad del medio ambiente. El acercamiento a cada tema se hace desde distintas materias para estructurar y facilitar el estudio interdisciplinario.SCBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5 - 3 planta; 28014 Madrid; Tel. +34917748000; [email protected]

The Performance and Limitations of ϵ- Stealthy Attacks on Higher Order Systems

In a cyber-physical system, security problems are of vital importance as the failure of such system can have catastrophic effects. Detection methods can be employed to sense the existence of an attack. In a previous study of an attack on the controller while avoiding detection in scalar systems under a certain control assumption, the notion of e-stealthiness was introduced and the strength of e-stealthy attacks was fully characterized. We generalize to the vector system and prove the cases in which we show that the limitations of e-stealthy attack do not extend, in the sense that e-stealthy can inflict damage of arbitrary magnitude to a vector system

Using a genetic algorithm to solve a non-linear location allocation problem for specialised children's ambulances in England and Wales

Since 1997, special paediatric intensive care retrieval teams (PICRTs) based in 11 locations across England and Wales have been used to transport sick children from district general hospitals (DGHs)to one of 24 paediatric intensive care units (PICUs). The national quality standard says that a PICRT should arrive at a patient’s bedside within 3 hours from accepting the referral. In this paper we develop a location allocation optimisation framework to help inform decisions on the optimal number of locations for each PICRT, where those locations should be, which local hospital each location serves and how many teams should station each location. Our framework allows for stochastic journey times, differential weights for each journey leg and incorporates queuing theory by considering the time spent waiting for a PICRT to become available (if all teams are away fromthe base when a referral comes in). A two-stage genetic algorithm is used to solve the resultingnonlinear optimisation problem and the optimal locations of PICRT stations and the allocation ofDGHs are obtained based on available data. An additional problem with this optimisation is how to distribute a given number of teams, with which we applied a greedy algorithm. We examine the average waiting time and the average time to bedside under different number of operational PICRT stations, different number of teams per station and different levels of demand. We show that consolidating the teams into fewer stations for higher availability leads to better performance and only with a level of guaranteed availability will the geographic advantage of more stations further improve performance