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A private–academic partnership built the Vaccine Equity Planner (VEP) to help decision-makers improve geographic access to COVID-19 vaccinations across the United States by identifying vaccine deserts and facilities that could fill those deserts. The VEP presented complex, updated data in an intuitive form during a rapidly changing pandemic situation. The persistence of vaccine deserts in every state as COVID-19 booster recommendations develop suggests that vaccine delivery can be improved. Underresourced public health systems benefit from tools providing real-time, accurate, actionable data. (Am J Public Health. 2023;113(4):363–367. https://doi.org/10.2105/AJPH.2022.307198) [ABSTRACT FROM AUTHOR]

Background The purpose of this study was to estimate prevalence of asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among patients admitted to obstetric inpatient units throughout the United States as detected by universal screening. We sought to describe the relationship between obstetric inpatient asymptomatic infection rates and publicly available surrounding community infection rates. Methods A cross-sectional study in which medical centers reported rates of positive SARS-CoV-2 testing in asymptomatic pregnant and immediate postpartum patients over a 1–3-month time span in 2020. Publicly reported SARS-CoV-2 case rates from the relevant county and state for each center were collected from the COVID Act Now dashboard and the COVID Tracking Project for correlation analysis. Results Data were collected from 9 health centers, encompassing 18 hospitals. Participating health centers were located in Alabama, California, Illinois, Louisiana, New Jersey, North Carolina, Pennsylvania, Rhode Island, Utah, and Washington State. Each hospital had an active policy for universal SARS-CoV-2 testing on obstetric inpatient units. A total of 10 147 SARS-CoV-2 tests were administered, of which 124 were positive (1.2%). Positivity rates varied by site, ranging from 0–3.2%. While SARS-CoV-2 infection rates were lower in asymptomatic obstetric inpatient groups than the surrounding communities, there was a positive correlation between positivity rates in obstetric inpatient units and their surrounding county (P =.003, r =.782) and state (P =.007, r =.708). Conclusions Given the correlation between community and obstetric inpatient rates, the necessity of SARS-CoV-2–related healthcare resource utilization in obstetric inpatient units may be best informed by surrounding community infection rates. [ABSTRACT FROM AUTHOR]

Background: Multi-cancer early detection (MCED) next-generation-sequencing blood tests represent a potential paradigm shift in screening.Methods: We estimated the impact of screening in the US and UK. We used country-specific parameters for uptake, and test-specific sensitivity and false-positive rates for current screening: breast, colorectal, cervical and lung (US only) cancers. For the MCED test, we used cancer-specific sensitivities by stage. Outcomes included the true-positive:false-positive (TP:FP) ratio; and the cost of diagnostic investigations among screen positives, per cancer detected (Diagcost). Outcomes were estimated for recommended screening only, and then when giving the MCED test to anyone without cancer detected by current screening plus similarly aged adults ineligible for recommended screening.Results: In the US, current screening detects an estimated 189,498 breast, cervical, colorectal and lung cancers. An MCED test with 25-100% uptake detects an additional 105,526-422,105 cancers (multiple types). The estimated TP:FP (Diagcost) was 1.43 ($89,042) with current screening but only 1:1.8 ($7060) using an MCED test. For the UK the corresponding estimates were 1:18 (£10,452) for current screening, and 1:1.6 (£2175) using an MCED test.Conclusions: Adding an MCED blood test to recommended screening can potentially be an efficient strategy. Ongoing randomised studies are required for full efficacy and cost-effectiveness evaluations. [ABSTRACT FROM AUTHOR]

In this article, we interrogate the entanglement of technology with the moral dilemmas of capital punishment in the United States. Although death is obviously front and center of capital punishment, it is often backgrounded analytically speaking, serving as a looming backdrop that rarely makes it to the center of analysis. For the purposes of this article, however, death is an important focal point precisely because it is the direct target of execution technology and also the most crucial element implicated when something goes wrong with executions. Using the introduction of new execution technology (the electric chair, the gas chamber, and lethal injection) in every state as our empirical case, we enhance our understanding of the promises and perils of new execution technology by showing how the boundaries between acceptable and unacceptable executions get redrawn with each new technology, thus undermining the prospects of a technological solution to the dilemmas with capital punishment. We argue that technology cannot fix capital punishment and that is because the problem, at its root, is not about how efficiently and painlessly we kill but instead the fact that we kill at all. And this, we conclude, is a moral, not technological, problem. [ABSTRACT FROM AUTHOR]

Aim: To estimate the cost‐effectiveness of sequential addition of empagliflozin versus sitagliptin after metformin in patients with type 2 diabetes (T2D) with or without cardiovascular disease (CVD) from the perspective of the US healthcare payer. Methods: An individual simulation model predicted lifetime diabetes‐related complications, using UKPDS‐OM2 equations in patients without CVD, and EMPA‐REG OUTCOME equations in patients with CVD. Additional US‐based sources informed inputs for population characteristics, adverse events, non‐CV death, treatment escalation, quality of life and costs. Costs and quality‐adjusted life‐years (QALYs) were discounted 3.0% annually. Results: The incremental cost‐effectiveness ratio (ICER) for second‐line empagliflozin versus sitagliptin in the overall T2D population was $6967/QALY. Empagliflozin led to longer CVD‐free survival (0.07 years) and an 11% reduction in CV death in patients with CVD compared with sitagliptin. Empagliflozin resulted in greater benefits with greater costs in patients with versus without baseline CVD, yielding ICERs of $3589/QALY versus $12 577/QALY, respectively. Results were consistent across a range of deterministic and probabilistic sensitivity analyses and scenarios. Conclusion: Compared with sitagliptin, empagliflozin was cost‐effective (at $50 000/QALY US threshold) as a second‐line treatment to metformin for T2D patients with or without CVD in the United States. Our findings lend additional support for more widespread adoption of guidelines by healthcare decision‐makers for T2D treatment. [ABSTRACT FROM AUTHOR]

The article discusses a study on the link between ovarian stimulation and risk of low birth weight in neonates born after in vitro fertilization (IVF). The study used the Society for Assisted Reproductive Technologies database to determine IVF-conceived neonates in the U.S. Neonates born after fresh embryo transfer had higher rates of low birth weight than those born after frozen embryo transfer. Neonates born after oocyte donation showed no difference in low birth weight for both IVF methods.

The United States Environmental Protection Agency/Environmental Response Team (US EPA/ERT), in conjunction with St. John's College, Dr B R Ambedkar University, Agra, India, is conducting a study to determine mercury vapor emission rates resulting from broken compact fluorescent lamps (CFLs) in a residential setting. The overall objectives of the study are to obtain a mercury emission model and provide a homeowner with cleanup procedures and disposal options for broken CFLs. An important component in achieving these objectives is the determination of the total mercury content in CFLs for the selection of bulbs to be used in the emission study. Most of the currently available CFLs in the United States (U.S.) market are manufactured in China for U.S. companies. Several different types of CFLs were purchased from local stores and the cap and electronic parts were removed without breaking the bulb. The bulb was then placed into a 2-L polypropylene bottle containing glass stoppers or glass marbles in a mixture of nitric acid and bromine monochloride solution (BrCl). The mixture was shaken to break the lamp and allow the mercury to be completely absorbed by the BrCl. The digested samples were analyzed for mercury using standard cold vapor atomic absorption (CVAA) methods. This CFL preparation method provides excellent results for laboratory control samples (typically, 90%-110% recovery) and good repeatability for CFL bulb analyses. The sampling and analysis phases of this study are discussed in this paper. [ABSTRACT FROM AUTHOR]

Objective: Diabetes is a common comorbid condition in patients with heart failure (HF) and was reported to be associated with worse outcomes. In patients with type 2 diabetes (T2D) and established cardiovascular (CV) disease, treatment with empagliflozin reduced heart failure hospitalizations and CV death compared to standard of care (SoC), with a consistent benefit in patients with and without HF at baseline. Given the poor outcomes and the high economic burden of these comorbidities, we investigated the cost-effectiveness of empagliflozin on top of SoC vs SoC in patients with T2D and HF at baseline over a lifelong time horizon from the US payer perspective. Methods: Discrete event simulation economic model was developed to project CV events including hospitalization for heart failure (HHF), CV death, and renal outcomes for the EMPA-REG OUTCOME trial subgroup of patients with T2D and HF at baseline. Respective risk equations were derived using event-free survival curves with time-dependent covariates. Model validity was assessed by comparing predicted and observed outcomes at three years. Costs in the United States (US) and health utilities were obtained from published literature. Outcomes included event rates per 100 patient-years (PYs), life years (LYs), costs, and quality-adjusted life years (QALYs). Results: Patients in the empagliflozin arm were projected to experience fewer events of 1st HHF (3.64 vs 4.61 per 100 PY) and recurrent HHF (2.78 vs 4.92 per 100 PY), CV deaths (6.07 vs 7.37 per 100 PY), and non-fatal MI (2.67 vs 3.31 per 100 PY), but higher event rate for non-fatal stroke (2.57 vs 1.54 per 100 PY), compared to SoC. Treatment with empagliflozin projected 1.2 LYs and 0.67 QALYs gained. Incremental Cost-Effectiveness Ratio (ICER) for empagliflozin compared with SoC was $22,644/QALY. Probabilistic sensitivity analyses suggested that the probability of empagliflozin being cost-effective in patients with T2D and HF at a threshold of $100,000/QALY was 87%. Conclusions: Based on results of EMPA-REG OUTCOME, this cost effectiveness analysis suggests that empagliflozin on top of SoC is a cost-effective treatment option for patients with T2D and chronic HF from the US payer perspective. [ABSTRACT FROM AUTHOR]

This study aims to estimate the cost-effectiveness of dabigatran 150 mg twice daily versus warfarin for stroke and systemic embolism risk reduction in patients with nonvalvular atrial fibrillation initiating treatment before age 75 (<75), at or after age 75 (≥ 75), and the overall population (All) from a US Medicare payer perspective. Clinical event rates by age cohort with dabigatran or warfarin for safety-on-treatment and intent-to-treat populations were estimated from Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY). An economic model was adapted using these data to evaluate the impact of starting age on clinical and economic outcomes. Costs were obtained from Medicare payment schedules and utilities from publications. Model outputs included event rates, costs, quality-adjusted life-years, and incremental cost-effectiveness ratios. The RE-LY analysis shows that the <75 cohort has lower rates of all events than the ≥ 75 cohort; versus warfarin, dabigatran performed better in main efficacy and safety in all age cohorts with the exception of extracranial hemorrhage in the ≥ 75 cohort. The clinical event costs avoided per patient for dabigatran were $1,100, $135, and $713 for cohorts <75, ≥ 75, and All, respectively. Extrapolating over a lifetime horizon, the model found that dabigatran resulted in lower rates of stroke and intracranial hemorrhage and higher rates for extracranial hemorrhage versus warfarin for all age cohorts. Lifetime quality-adjusted life-years and costs were higher for dabigatran than warfarin, resulting in incremental cost-effectiveness ratios of $52,773, $65,946, and $56,131 for cohorts <75, ≥ 75, and All, respectively. In conclusion, dabigatran was cost-effective versus warfarin in US patients with atrial fibrillation regardless of age of treatment initiation., (Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.)