| 1. |
- D’Aeth, Josh C., et al.
(författare)
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Optimal national prioritization policies for hospital care during the SARS-CoV-2 pandemic
- 2021
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Ingår i: Nature Computational Science. - : Springer Nature. - 2662-8457. ; 1:8, s. 521-531
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Tidskriftsartikel (refereegranskat)abstract
- In response to unprecedented surges in the demand for hospital care during the SARS-CoV-2 pandemic, health systems have prioritized patients with COVID-19 to life-saving hospital care to the detriment of other patients. In contrast to these ad hoc policies, we develop a linear programming framework to optimally schedule elective procedures and allocate hospital beds among all planned and emergency patients to minimize years of life lost. Leveraging a large dataset of administrative patient medical records, we apply our framework to the National Health Service in England and show that an extra 50,750–5,891,608 years of life can be gained compared with prioritization policies that reflect those implemented during the pandemic. Notable health gains are observed for neoplasms, diseases of the digestive system, and injuries and poisoning. Our open-source framework provides a computationally efficient approximation of a large-scale discrete optimization problem that can be applied globally to support national-level care prioritization policies.
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| 2. |
- D’Aeth, Josh, et al.
(författare)
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Report 40 : Optimal scheduling rules for elective care to minimize years of life lost during the SARS-CoV-2 pandemic: an application to England
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Countries have deployed a wide range of policies to prioritize patients to hospital care to address unprecedent surges in demand during the course of the pandemic. Those policies included postponing planned hospital care for non-emergency cases and rationing critical care.We developed a model to optimally schedule elective hospitalizations and allocate hospital general and critical care beds to planned and emergency patients in England during the pandemic. We apply the model to NHS England data and show that optimized scheduling leads to lower years of life lost and costs than policies that reflect those implemented in England during the pandemic. Overall across all disease areas the model enables an extra 50,750-5,891,608 years of life gained when compared to standard policies, depending on the scenarios. Especially large gains in years of life are seen for neoplasms, diseases of the digestive system, and injuries &poisoning.
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| 3. |
- Forchini, Giovanni, et al.
(författare)
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Report 28 : Excess non-COVID-19 deaths in England and Wales between 29th February and 5th June 2020
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- There were 189,403 deaths from any cause reported in England from 29th February to 5th June 2020 inclusive, and 11,278 all-cause deaths in Wales over the same period. Of those deaths, 44,736 (23.6%) registered COVID-19 on the death certificate in England, and 2,294 (20.3%) in Wales, while 144,667 (76.4%) were not recorded as having been due to COVID-19 in England, and 8,984 (79.7%) in Wales. However, it could be that some of the ‘non-COVID-19’ deaths have in fact also been caused by COVID-19, either as the direct cause of death, or indirectly through provisions for the pandemic impeding access to care for other conditions. There is uncertainty in how many of the non-COVID-19 deaths were directly or indirectly caused by the pandemic. We estimated the excess deaths that were not recorded as associated with COVID-19 in the death certificate (excess non-COVID-19 deaths) as the deaths for which COVID-19 was not reported as the cause, compared to those we would have expected to occur had the pandemic not happened. Expected deaths were forecast with an analysis of historic trends in deaths between 2010 and April 2020 using data by the Office of National Statistics and a statistical time series model.According to the model, we expected 136,294 (95% CI 133,882 - 138,696) deaths in England, and 8,983 (CI 8,051 - 9,904) in Wales over this period, significantly fewer than the number of deaths reported. This means that there were 8,983 (95% CI 5,971 - 10,785) total excess non-COVID-19 deaths in England. For every 100 COVID-19 deaths during the period from 29th February to 5th June 2020 there were 19 (95% CI 13 – 24) cumulative excess non-COVID-19 deaths. The proportion of cumulative excess non-COVID-19 deaths of all reported deaths during this period was 4.4% (95% CI 3.2% - 5.7%) in England, with small regional variations. Excess deaths were highest in the South East at 2,213 (95% CI 327 - 4,047) and in London at 1,937 (95% CI 896 - 3,010), respectively. There is no evidence of non-COVID-19 excess deaths in Wales. Excess non-COVID-19 deaths are occurring in individuals aged 85+ and 75-84, and those aged 45-64. For those aged 85+, excess non-COVID-19 deaths are driven by females, with 6,115 (95% CI 206 – 11,795) deaths in total but no significant findings for males of those ages. For ages 75-84, excess non-COVID-19 deaths are nearly double for females at 2,070 (95% CI 393 – 3,887) than for males at 1,336 (95% CI 938 – 1,710), while for ages 45-64, excess non-COVID-19 deaths for females are at 347 (95% CI 90 – 603), almost half those of males at 681 (95% CI 282 – 1,091). There is no evidence of excess non-COVID-19 deaths for ages 65-74, and those below 45.Excess non-COVID-19 deaths could be due to non-reporting of COVID-19 on the death certificate or an increase in mortality for non-COVID-19 conditions. Severely ill patients may have been unable to access life-saving emergency treatment because of constraints in healthcare provision, or because they avoided seeking care due to concern over hospital-acquired infection, or to avoid burdening healthcare providers. Further research into reasons for excess non-COVID-19 deaths is warranted.This report accompanies the weekly update of excess death estimates on the Github website of the Abdul Latif Jameel Institute of Disease and Emergency Analytics (J-IDEA) (https://j-idea.github.io/ONSdeaths/) which has been set up to be regularly updated until June 2022.
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| 4. |
- Forchini, Giovanni, et al.
(författare)
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Seasonal and Regional Fluctuations in the Demand for Accident and Emergency Carein English Hospitals
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- There is a profusion of evidence on the population and supply side factors explaining demand for emergency care, but surprisingly very little evidence about how seasonal patterns of demand vary across regions. Such information is crucial to help hospitals manage fluctuations in demand and ease capacity constraints. The objective of this study is to analyse the patterns of weekly attendances to Accident and Emergency departments in England, controlling for a wide range of determinants. The study uses both panel and common trend methods on data for 135 English hospitals and their catchment areas merged from a variety of sources over 156 weeks from 2012 to 2015. Modelling of unobservable factors with common trend models shows systematic patterns in the data related to season and the location of providers. Coastal areas experience more attendances in summer than urban areas, and this trend is reversed in winter, possibly due to temporary population movements. Internal reorganizations between major A&E departments and minor injury units within hospitals lead to structural breaks in attendances. In the panel models, only the share of the working population, weather and socioeconomic deprivation are statistically significant predictors of attendances in the panel models. The forecasting ability of both panel and common trends methods is similar. Fine-tuning funding allocations across trusts and seasons according to temporary population movements could be a promising avenue to help alleviate existing capacity constraints emergency departments.
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| 5. |
- Gerckens, Michael, et al.
(författare)
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Phenotypic drug screening in a human fibrosis model identified a novel class of antifibrotic therapeutics
- 2021
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Ingår i: Science Advances. - : American Association for the Advancement of Science (AAAS). - 2375-2548. ; 7:52, s. 1-19
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Tidskriftsartikel (refereegranskat)abstract
- Fibrogenic processes instigate fatal chronic diseases leading to organ failure and death. Underlying biological processes involve induced massive deposition of extracellular matrix (ECM) by aberrant fibroblasts. We subjected diseased primary human lung fibroblasts to an advanced three-dimensional phenotypic high-content assay and screened a repurposing drug library of small molecules for inhibiting ECM deposition. Fibrotic Pattern Detection by Artificial Intelligence identified tranilast as an effective inhibitor. Structure-activity relationship studies confirmed N-(2-butoxyphenyl)-3-(phenyl)acrylamides (N23Ps) as a novel and highly potent compound class. N23Ps suppressed myofibroblast transdifferentiation, ECM deposition, cellular contractility, and altered cell shapes, thus advocating a unique mode of action. Mechanistically, transcriptomics identified SMURF2 as a potential therapeutic target network. Antifibrotic activity of N23Ps was verified by proteomics in a human ex vivo tissue fibrosis disease model, suppressing profibrotic markers SERPINE1 and CXCL8. Conclusively, N23Ps are a novel class of highly potent compounds inhibiting organ fibrosis in patients.
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| 6. |
- Haw, David J., et al.
(författare)
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Data needs for integrated economic-epidemiological models of pandemic mitigation policies
- 2022
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Ingår i: Epidemics. - : Elsevier. - 1755-4365 .- 1878-0067. ; 41
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Tidskriftsartikel (refereegranskat)abstract
- The COVID-19 pandemic and the mitigation policies implemented in response to it have resulted in economic losses worldwide. Attempts to understand the relationship between economics and epidemiology has led to a new generation of integrated mathematical models. The data needs for these models transcend those of the individual fields, especially where human interaction patterns are closely linked with economic activity. In this article, we reflect upon modelling efforts to date, discussing the data needs that they have identified, both for understanding the consequences of the pandemic and policy responses to it through analysis of historic data and for the further development of this new and exciting interdisciplinary field.
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| 7. |
- Haw, David J., et al.
(författare)
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Optimizing social and economic activity while containing SARS-CoV-2 transmission using DAEDALUS
- 2022
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Ingår i: Nature Computational Science. - : Springer Science and Business Media LLC. - 2662-8457. ; 2:4, s. 223-233
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Tidskriftsartikel (refereegranskat)abstract
- To study the trade-off between economic, social and health outcomes in the management of a pandemic, DAEDALUS integrates a dynamic epidemiological model of SARS-CoV-2 transmission with a multi-sector economic model, reflecting sectoral heterogeneity in transmission and complex supply chains. The model identifies mitigation strategies that optimize economic production while constraining infections so that hospital capacity is not exceeded but allowing essential services, including much of the education sector, to remain active. The model differentiates closures by economic sector, keeping those sectors open that contribute little to transmission but much to economic output and those that produce essential services as intermediate or final consumption products. In an illustrative application to 63 sectors in the United Kingdom, the model achieves an economic gain of between £161 billion (24%) and £193 billion (29%) compared to a blanket lockdown of non-essential activities over six months. Although it has been designed for SARS-CoV-2, DAEDALUS is sufficiently flexible to be applicable to pandemics with different epidemiological characteristics.
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| 8. |
- Haw, David, et al.
(författare)
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Report 35 : How can we keep schools and universities open? Differentiating closures by economic sector to optimize social and economic activity while containing SARS-CoV-2 transmission
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- There is a trade-off between the education sector and other economic sectors in the control of SARS-CoV-2 transmission. Here we integrate a dynamic model of SARS-CoV-2 transmission with a 63-sector economic model reflecting sectoral heterogeneity in transmission and economic interdependence between sectors. We identify control strategies which optimize economic production while keeping schools and universities operational and constraining infections such that emergency hospital capacity is not exceeded. The model estimates an economic gain of between £163bn and £205bn for the United Kingdom compared to a blanket lockdown of non-essential activity over six months, depending on hospital capacity. Sectors identified as potential priorities for closure are contact-intensive and/or less economically productive.
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| 9. |
- Johnson, Rob, et al.
(författare)
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Promoting healthy populations as a pandemic preparedness strategy : a simulation study from Mexico
- 2024
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Ingår i: Lancet Regional Health - Americas. - : Elsevier. - 2667-193X. ; 30
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Tidskriftsartikel (refereegranskat)abstract
- Background: The underlying health status of populations was a major determinant of the impact of the COVID-19 pandemic, particularly obesity prevalence. Mexico was one of the most severely affected countries during the COVID-19 pandemic and its obesity prevalence is among the highest in the world. It is unknown by how much the COVID-19 burden could have been reduced if systemic actions had been implemented to reduce excess weight in Mexico before the onset of the pandemic.Methods: Using a dynamic epidemic model based on nationwide data, we compare actual deaths with those under hypothetical scenarios assuming a lower body mass index in the Mexican population, as observed historically. We also model the number of deaths that would have been averted due to earlier implementation of front-of-pack warning labels or due to increases in taxes on sugar-sweetened beverages and non-essential high-energy foods in Mexico.Findings: We estimate that 52.5% (95% prediction interval (PI) 43.2, 61.6%) of COVID-19 deaths were attributable to obesity for adults aged 20–64 and 23.8% (95% PI 18.7, 29.1%) for those aged 65 and over. Had the population BMI distribution remained as it was in 2000, 2006, or 2012, COVID-19 deaths would have been reduced by an expected 20.6% (95% PI 16.9, 24.6%), 9.9% (95% PI 7.3, 12.9%), or 6.9% (95% PI 4.5, 9.5%), respectively. If the food-labelling intervention introduced in 2020 had been introduced in 2018, an expected 6.2% (95% PI 5.2, 7.3%) of COVID-19 deaths would have been averted. If taxes on sugar-sweetened beverages and high-energy foods had been doubled, trebled, or quadrupled in 2018, COVID-19 deaths would have been reduced by an expected 4.1% (95% PI 2.5, 5.7%), 7.9% (95% PI 4.9, 11.0%), or 11.6% (95% PI 7.3, 15.8%), respectively.Interpretation: Public health interventions targeting underlying population health, including non-communicable chronic diseases, is a promising line of action for pandemic preparedness that should be included in all pandemic plans.
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| 10. |
- Johnson, Rob, et al.
(författare)
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The societal value of SARS-CoV-2 booster vaccination in Indonesia
- 2023
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Ingår i: Vaccine. - : Elsevier. - 0264-410X .- 1873-2518. ; 41:11, s. 1885-1891
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To estimate the expected socio-economic value of booster vaccination in terms of averted deaths and averted closures of businesses and schools using simulation modelling.Methods: The value of booster vaccination in Indonesia is estimated by comparing simulated societal costs under a twelve-month, 187-million–dose Moderna booster vaccination campaign to costs without boosters. The costs of an epidemic and its mitigation consist of lost lives, economic closures and lost education; cost-minimising non-pharmaceutical mitigation is chosen for each scenario.Results: The cost-minimising non-pharmaceutical mitigation depends on the availability of vaccines: the differences between the two scenarios are 14 to 19 million years of in-person education and $153 to $204 billion in economic activity. The value of the booster campaign ranges from $2,500 ($1,400-$4,100) to $2,800 ($1,700-$4,600) per dose in the first year, depending on life-year valuations.Conclusions: The societal benefits of booster vaccination are substantial. Much of the value of vaccination resides in the reduced need for costly non-pharmaceutical mitigation. We propose cost minimisation as a tool for policy decision-making and valuation of vaccination, taking into account all socio-economic costs, and not averted deaths alone.
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