The study aim was to help the Girl Scouts of Central Maryland evaluate, quantify, and potentially modify the Girl Scouts Fierce & Fit program. Methods: From 2018 to 2019, our Public Health Informatics, Computational, and Operations Research team developed a computational simulation model representing the 250 adolescent girls participating in the Fierce & Fit program and how their diets and physical activity affected their BMI and subsequent outcomes, including costs. Results: Changing the Fierce & Fit program from a 6-week program meeting twice a week, with 5 minutes of physical activity each session, to a 12-week program meeting twice a week with 30 minutes of physical activity
Background: Although current human papillomavirus (HPV) genotype screening tests identify genotypes 16 and 18 and do not specifically identify other high-risk types, a new extended genotyping test identifies additional individual (31, 45, 51, and 52) and groups (33/58, 35/39/68, and 56/59/66) of high-risk genotypes.
Methods:We developed a Markov model of the HPV disease course and evaluated the clinical and economic value of HPV primary screening with Onclarity (BD Diagnostics, Franklin Lakes, NJ) capable of extended genotyping in a cohort of women 30 years or older. Women with certain genotypes were later rescreened instead of undergoing immediate colposcopy and varied which genotypes were rescreened, disease progression rate, and test cost.
Objective:
Due to shortages of N95 respirators during the COVID-19 pandemic, it is necessary to estimate the number of N95s required for healthcare workers (HCW) to inform manufacturing targets and resource allocation.
Methods:
We developed a model to determine the number of N95 respirators needed for HCWs both in a single acute care hospital and the United States.
Results:
For an acute care hospital with 400 all-cause monthly admissions, the number of N95 respirators needed to manage COVID-19 patients admitted during a month ranges from 113 (95% IPR: 50-229) if 0.5% of admissions are COVID-19 patients to 22,101 (95% IPR: 5,904-25,881) if 100% of admissions are COVID-19 patients (assuming single use per respirator, and 10 encounters between HCWs and each COVID-19 patient per day). The number of N95s needed decreases (22 [95% IPR: 10-43]-4,445 [95% IPR: 1,975-8,684]) if each N95 is used for five patient encounters. Varying monthly all-cause admissions to 2,000 requires 6,645-13,404 respirators with a 60% COVID-19 admission prevalence, 10 HCW-patient encounters, and reusing N95s 5-10 times. Nationally, the number of N95 respirators needed over the course of the pandemic ranges from 86 million (95% IPR: 37.1-200.6 million) to 1.6 billion (95% IPR: 0.7-3.6 billion) as 5-90% of the population is exposed (single-use), and 17.4 million (95% IPR: 7.3-41 million) to 312.3 million (95% IPR: 131.5-737.3 million) using each respirator for five encounters.
Conclusions:
Our study quantifies the number of N95 respirators needed for a given acute care hospital and nationally during the COVID-19 pandemic under varying conditions.
Background
While the 2015–2016 Zika epidemics prompted accelerated vaccine development, decision makers need to know the potential economic value of vaccination strategies.
Methods
We developed models of Honduras, Brazil, and Puerto Rico, simulated targeting different populations for Zika vaccination (women of childbearing age, school-aged children, young adults, and everyone) and then introduced various Zika outbreaks. Sensitivity analyses varied vaccine characteristics.
Results
With a 2% attack rate ($5 vaccination), compared to no vaccination, vaccinating women of childbearing age cost $314–$1664 per case averted ($790–$4221/disability-adjusted life-year [DALY] averted) in Honduras, and saved $847–$1644/case averted in Brazil, and $3648–$4177/case averted in Puerto Rico, varying with vaccination coverage and efficacy (societal perspective). Vaccinating school-aged children cost $718–$1849/case averted (≤$5002/DALY averted) in Honduras, saved $819–$1609/case averted in Brazil, and saved $3823–$4360/case averted in Puerto Rico. Vaccinating young adults cost $310–$1666/case averted ($731–$4017/DALY averted) in Honduras, saved $953–$1703/case averted in Brazil, and saved $3857–$4372/case averted in Puerto Rico. Vaccinating everyone averted more cases but cost more, decreasing cost savings per case averted. Vaccination resulted in more cost savings and better outcomes at higher attack rates.
Conclusions
When considering transmission, while vaccinating everyone naturally averted the most cases, specifically targeting women of childbearing age or young adults was the most cost-effective.
Background
Studies show that by three months, over half of US infants receive formula and guidelines play a key role in formula feeding. The question then is, what might happen if caregivers follow guidelines and, more specifically, are there situations where following guidelines can result in infants who are overweight/have obesity?
Methods
We used our “Virtual Infant” agent-based model representing infant-caregiver pairs that allowed caregivers to feed infants each day according to guidelines put forth by Johns Hopkins Medicine(JHM), Children’s Hospital of Philadelphia(CHOP), Children’s Hospital of the King’s Daughters(CHKD), and WIC. The model simulated the resulting development of the infants from birth to six months. The two sets of guidelines vary in their recommendations, and do not provide studies that support amounts at given ages.
Results
Simulations identified several scenarios where caregivers followed JHM/CHOP/CHKD and WIC guidelines but infants still became overweight/with obesity by six months. For JHM/CHOP/CHKD guidelines, this occurred even when caregivers adjusted feeding based on infant’s weight. For WIC guidelines, when caregivers adjusted formula amounts, infants maintained healthy weight.
Conclusions
WIC guidelines may be a good starting point for caregivers who adjust as their infant grows, but the minimum amounts for JHM/CHKD/CHOP recommendations may be too high.
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