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Search Results: 1 - 10 of 3079 matches for " Carol Levin "
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Economic analyses to support decisions about HPV vaccination in low- and middle-income countries: a consensus report and guide for analysts
Jit Mark,Levin Carol,Brisson Marc,Levin Ann
BMC Medicine , 2013, DOI: 10.1186/1741-7015-11-23
Abstract: Low- and middle-income countries need to consider economic issues such as cost-effectiveness, affordability and sustainability before introducing a program for human papillomavirus (HPV) vaccination. However, many such countries lack the technical capacity and data to conduct their own analyses. Analysts informing policy decisions should address the following questions: 1) Is an economic analysis needed? 2) Should analyses address costs, epidemiological outcomes, or both? 3) If costs are considered, what sort of analysis is needed? 4) If outcomes are considered, what sort of model should be used? 5) How complex should the analysis be? 6) How should uncertainty be captured? 7) How should model results be communicated? Selecting the appropriate analysis is essential to ensure that all the important features of the decision problem are correctly represented, but that the analyses are not more complex than necessary. This report describes the consensus of an expert group convened by the World Health Organization, prioritizing key issues to be addressed when considering economic analyses to support HPV vaccine introduction in these countries.
Unit Cost of Medical Services at Different Hospitals in India
Susmita Chatterjee, Carol Levin, Ramanan Laxminarayan
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0069728
Abstract: Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates under government-sponsored insurance schemes.
Costs of Introducing and Delivering HPV Vaccines in Low and Lower Middle Income Countries: Inputs for GAVI Policy on Introduction Grant Support to Countries
Ann Levin, Susan A. Wang, Carol Levin, Vivien Tsu, Raymond Hutubessy
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0101114
Abstract: Background In November 2011, the GAVI Alliance made the decision to add HPV vaccine as one of the new vaccines for which countries eligible for its funding (less than $1520 per capita income) could apply to receive support for national HPV vaccination, provided they could demonstrate the ability to deliver HPV vaccines. This paper describes the data and analysis shared with GAVI policymakers for this decision regarding GAVI HPV vaccine support. The paper reviews why strategies and costs for HPV vaccine delivery are different from other vaccines and what is known about the cost components from available data that originated primarily from HPV vaccine delivery costing studies in low and middle income-countries. Methods Financial costs of HPV vaccine delivery were compared across three sources of data: 1) vaccine delivery costing of pilot projects in five low and lower-middle income countries; 2) cost estimates of national HPV vaccination in two low income countries; and 3) actual expenditure data from national HPV vaccine introduction in a low income country. Both costs of resources required to introduce the vaccine (or initial one-time investment, such as cold chain equipment purchases) and recurrent (ongoing costs that repeat every year) costs, such as transport and health personnel time, were analyzed. The cost per dose, cost per fully immunized girl (FIG) and cost per eligible girl were compared across studies. Results Costs varied among pilot projects and estimates of national programs due to differences in scale and service delivery strategy. The average introduction costs per fully immunized girl ranged from $1.49 to $18.94 while recurrent costs per girl ranged from $1.00 to $15.69, with both types of costs varying by delivery strategy and country. Evaluating delivery costs along programme characteristics as well as country characteristics (population density, income/cost level, existing service delivery infrastructure) are likely the most informative and useful for anticipating costs for HPV vaccine delivery. Conclusions This paper demonstrates the importance of country level cost data to inform global donor policies for vaccine introduction support. Such data are also valuable for informing national decisions on HPV vaccine introduction.
The costs of home delivery of a birth dose of hepatitis B vaccine in a prefilled syringe in Indonesia
Levin,Carol E.; Nelson,Carib M.; Widjaya,Anton; Moniaga,Vanda; Anwar,Chairiyah;
Bulletin of the World Health Organization , 2005, DOI: 10.1590/S0042-96862005000600014
Abstract: objective: to provide global policy-makers with decision-making information for developing strategies for immunization of infants with a birth dose of hepatitis b vaccine, this paper presents a retrospective cost analysis, conducted in indonesia, of delivering this vaccine at birth using the uniject prefill injection device. methods: incremental costs or cost savings associated with changes in the hepatitis b immunization programme were calculated using sensitivity analysis to vary the estimates of vaccine wastage rates and prices for vaccines and injection devices, for the birth dose of hepatitis b vaccine. findings: the introduction of hepatitis b vaccine prefilled in uniject? (hb-uniject) single-dose injection devices for use by midwives for delivering the birth dose is cost-saving when the wastage rate for multidose vials is greater than 33% (uniject is a trademark of bd, franklin lakes, nj, usa). conclusion: the introduction of hb-uniject for birth-dose delivery is economically worthwhile and can increase coverage of the critical birth dose, improve resource utilization, reduce transmission of hepatitis b and promote injection safety.
Discourse Processing of Dialogues with Multiple Threads
Carolyn Penstein Rose',Barbara Di Eugenio,Lori S. Levin,Carol Van Ess-Dykema
Computer Science , 1995,
Abstract: In this paper we will present our ongoing work on a plan-based discourse processor developed in the context of the Enthusiast Spanish to English translation system as part of the JANUS multi-lingual speech-to-speech translation system. We will demonstrate that theories of discourse which postulate a strict tree structure of discourse on either the intentional or attentional level are not totally adequate for handling spontaneous dialogues. We will present our extension to this approach along with its implementation in our plan-based discourse processor. We will demonstrate that the implementation of our approach outperforms an implementation based on the strict tree structure approach.
Why Study Problematizations? Making Politics Visible  [PDF]
Carol Bacchi
Open Journal of Political Science (OJPS) , 2012, DOI: 10.4236/ojps.2012.21001
Abstract: This paper introduces the theoretical concept, problematization, as it is developed in Foucauldian-inspired poststructural analysis. The objective is two-fold: first, to show how a study of problematizations politicizes taken-for-granted “truths”; and second, to illustrate how this analytic approach opens up novel ways of approaching the study of public policy, politics and comparative politics. The study of problematizations, it suggests, directs attention to the heterogenous strategic relations – the politics – that shape lives. It simultaneously alerts researchers to their unavoidable participation in these relations, opening up a much-needed conversation about the role of theory in politics.
Sexually Risky Behavior in College-Aged Students  [PDF]
Carol Caico
Open Journal of Preventive Medicine (OJPM) , 2014, DOI: 10.4236/ojpm.2014.45043
Abstract:

Objective: To examine college-aged students’ sexual risk taking behavior and their knowledge level. Design: descriptive design participants. Setting: A convenience sample of college-aged students between the ages of 17 - 25. Results: Seven hundred and seventy students responded to the survey. Findings revealed that 33% had sexual intercourse with two to five individuals, and 15.5% between eleven and twenty sexual partners. 50.9% had unprotected vaginal intercourse not using condoms and of those 45.8% either do not insist on condom use or only use them occasionally. 22.1% do not insist on using condoms for sexual intercourse and 24.7% responded that they sometimes insist on condom use. 47.2% are not worried about getting AIDS. 41.3% are not concerned with genital lesions. 42.4% would rate themselves as not being very knowledgeable about sexually transmitted infections. 12.4% of the females had unintended pregnancies and overall 74.9% would not feel comfortable discussing their sexual activity with their mothers. 58.1% use alcohol prior to or during sexual intercourse.

The Turn to Problematization: Political Implications of Contrasting Interpretive and Poststructural Adaptations  [PDF]
Carol Bacchi
Open Journal of Political Science (OJPS) , 2015, DOI: 10.4236/ojps.2015.51001
Abstract: The purpose of this paper is to introduce and elaborate the varied meanings of problematization in contemporary policy theory. The primary focus is on the different meanings and uses of the term in interpretivism and in Foucault-influenced poststructuralism. The paper argues that interpretive/argumentative adaptations direct attention primarily to how policy makers/workers develop problematizations (ways of understanding a problem) while Foucault-influenced poststructuralists critically scrutinize problematizations (the ways in which “problems” are produced and represented) in governmental policies and practices. It concludes that Foucault-influenced adaptations provide a more substantive critique of extant social arrangements than interpretive approaches, which tend to be reformist in design and inclination.
Measuring decision quality: psychometric evaluation of a new instrument for breast cancer surgery
Karen R Sepucha, Jeffrey K Belkora, Yuchiao Chang, Carol Cosenza, Carrie A Levin, Beverly Moy, Ann Partridge, Clara N Lee
BMC Medical Informatics and Decision Making , 2012, DOI: 10.1186/1472-6947-12-51
Abstract: Cross-sectional mail survey of recent breast cancer survivors, providers and healthy controls and a retest survey of survivors. The decision quality instrument includes knowledge questions and a set of goals, and results in two scores: a breast cancer surgery knowledge score and a concordance score, which reflects the percentage of patients who received treatments that match their goals. Hypotheses related to acceptability, feasibility, discriminant validity, content validity, predictive validity and retest reliability of the survey instrument were examined.We had responses from 440 eligible patients, 88 providers and 35 healthy controls. The decision quality instrument was feasible to implement in this study, with low missing data. The knowledge score had good retest reliability (intraclass correlation coefficient?=?0.70) and discriminated between providers and patients (mean difference 35%, p?<?0.001). The majority of providers felt that the knowledge items covered content that was essential for the decision. Five of the 6 treatment goals met targets for content validity. The five goals had moderate to strong retest reliability (0.64 to 0.87). The concordance score was 89%, indicating that a majority had treatments concordant with that predicted by their goals. Patients who had concordant treatment had similar levels of confidence and regret as those who did not.The decision quality instrument met the criteria of feasibility, reliability, discriminant and content validity in this sample. Additional research to examine performance of the instrument in prospective studies and more diverse populations is needed.
Safety and Tolerability of Antiretrovirals during Pregnancy
Adriana Weinberg,Jeri Forster-Harwood,Jill Davies,Elizabeth J. McFarland,Jennifer Pappas,Kay Kinzie,Emily Barr,Suzanne Paul,Carol Salbenblatt,Elizabeth Soda,Anna Vazquez,Myron J. Levin
Infectious Diseases in Obstetrics and Gynecology , 2011, DOI: 10.1155/2011/867674
Abstract: Combination antiretroviral therapy (CART) dramatically decreases mother-to-child HIV-1 transmission (MTCT), but maternal adverse events are not infrequent. A review of 117 locally followed pregnancies revealed 7 grade ≥3 AEs possibly related to antiretrovirals, including 2 hematologic, 3 hepatic, and 2 obstetric cholestasis cases. A fetal demise was attributed to obstetric cholestasis, but no maternal deaths occurred. The drugs possibly associated with these AE were zidovudine, nelfinavir, lopinavir/ritonavir, and indinavir. AE or intolerability required discontinuation/substitution of nevirapine in 16% of the users, zidovudine in 10%, nelfinavir in 9%, lopinavir/ritonavir in 1%, but epivir and stavudine in none. In conclusion, nevirapine, zidovudine, and nelfinavir had the highest frequency of AE and/or the lowest tolerability during pregnancy. Although nevirapine and nelfinavir are infrequently used in pregnancy at present, zidovudine is included in most MTCT preventative regimens. Our data emphasize the need to revise the treatment recommendations for pregnant women to include safer and better-tolerated drugs. 1. Introduction Combination antiretroviral therapy (CART) has decreased HIV mother-to-child-transmission (MTCT) to <2% in the USA and other countries where ART is readily available [1–5]. To reliably achieve suppression of maternal HIV replication, which is essential for prevention of MTCT, information on the safety and tolerability of drug regimens for HIV-infected pregnant women is critically important. Antiretroviral regimens recommended by the WHO for PMTCT (http://www.who.int/hiv/pub/mtct/antiretroviral2010/en/index.html) include zidovudine (AZT) and lamivudine (3TC) with a single dose of nevirapine (NVP) at delivery or AZT/3TC with lopinavir/ritonavir (LPV/RTV), with efavirenz (EFV; only in the 2nd trimester or later) or with abacavir (ABC) for the entire duration of treatment in pregnancy. Overall, the most commonly used nucleoside reverse transcriptase inhibitors (NRTIs) during pregnancy are AZT and 3TC [6]. Some NRTIs are avoided during pregnancy due to their toxicity, such as didanosine (DDI) with stavudine (D4T) [7]. NVP was associated in some studies with a high level of hepatotoxicity in women with CD4 > 200?cells/μL [8, 9]. Although this observation was not confirmed in other studies [10, 11], NVP is currently recommended only as a single dose at delivery or in women with CD4?< 250?cells/μL. Tenofovir (TNV) has not been extensively studied in pregnancy. Its use is limited because of its effect on bone mineralization [12, 13].
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