scholarly journals Epidemiology and Control of Meningococcal Disease in Canada: A Long, Complex, and Unfinished Story

2019 ◽  
Vol 2019 ◽  
pp. 1-11
Author(s):  
Philippe De Wals
Keyword(s):  
Meningococcal Disease ◽  
Epidemiological Surveillance ◽  
Immunization Programs ◽  
Political Factors ◽  
Conjugate Vaccines ◽  
Complex Decision Making ◽  
Advocacy Campaigns ◽  
Complex Decision ◽  
Recent Occurrence ◽  
And Control

The epidemiology of meningococcal disease in Canada has been punctuated by outbreaks caused by serogroup A strains in the 1940s, virulent serogroup C clones from 1985 to 2001, a serogroup B clone in Quebec from 2003 to 2014, and more recently a W clone in British Columbia. Region- and province-wide immunization campaigns have been implemented to control these outbreaks using meningococcal C polysaccharide and conjugate vaccines, a quadrivalent ACWY conjugate vaccine, and a serogroup B protein-based vaccine. Meningococcal C conjugate vaccines have been included in routine immunization programs for children, and ACWY conjugate vaccines have been included in school-based programs for adolescents in most jurisdictions. In contrast, serogroup B protein-based vaccines were only recommended and used for high-risk individuals and to control outbreaks. Currently, the immunization schedules adopted in provinces and territories are not uniform. This is not explained by notable epidemiologic differences. Publicly funded immunization programs are the result of a complex decision-making process. Political factors including public opinion, media attention, interest groups’ advocacy campaigns, decision-makers’ priorities and budgetary constraints have played important roles in shaping meningococcal programs in Canada, and this should be recognized. As the recent occurrence of outbreaks caused by virulent W clones shows, continued investments in epidemiological surveillance at both the provincial and national levels are necessary, so there can be early warning and informed decisions can be made.

scholarly journals Impact and effectiveness of meningococcal vaccines: a review

2017 ◽  
Vol 41 ◽  
pp. 1
Author(s):  
Lucia Helena De Oliveira ◽  
Barbara Jauregui ◽  
Ana Flavia Carvalho ◽  
Norberto Giglio
Keyword(s):  
Conjugate Vaccine ◽  
Meningococcal Disease ◽  
Age Groups ◽  
Epidemiological Surveillance ◽  
Surveillance Systems ◽  
Protein Subunit ◽  
Conjugate Vaccines ◽  
Vaccination Programs ◽  
Meta Analyses ◽  
The Impact

Objectives.To summarize and critically evaluate the evidence on the impact and effectiveness of meningococcal vaccination programs around the world in order to inform decisionmaking in Latin America and the Caribbean.Methods.A review of the literature was conducted following several components of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed Central® was searched for papers published in any language from January 1999 – March 2017.Results.In all, 32 studies were included, most of which evaluated the meningococcal C conjugate vaccine. Fourteen studies measured effectiveness and 30 measured impact. The effectiveness of polysaccharide vaccines was 65% – 83.7% (different age groups), while the effectiveness of the conjugate vaccines was 66% – 100%. Incidence decline of laboratory-confirmed meningococcal disease for the conjugate vaccine ranged from 77% – 100% among different ages groups. The only study that evaluated the protein subunit vaccine reported a vaccine effectiveness of 82.9%.Conclusions.The studies reviewed show impact and effectiveness of both polysaccharide vaccines and conjugate vaccines on vaccine-serogroup meningococcal disease. The conjugate vaccines, however, show higher impact and effectiveness with longer-lasting protection over the polysaccharide vaccines. Given the variance in potential use of a meningococcal vaccine, epidemiological surveillance systems should be strengthened to inform national decisions.

63 Moons-NSEL Merger: A Boon or a Bane for the Stakeholders

2019 ◽  
Vol 23 (02) ◽  
pp. 369-398
Author(s):  
Shernaz Bodhanwala
Keyword(s):  
Decision Making ◽  
Organizational Structure ◽  
Real World ◽  
Decision Making Process ◽  
Monitoring And Control ◽  
The Real ◽  
Major Fault ◽  
Complex Decision Making ◽  
Complex Decision ◽  
And Control

The Ministry of Corporate Affairs, Government of India, had ordered the mandatory merger of 63 Moons Technologies Limited (63 Moons) with its crisis struck subsidiary company, National Spot Exchange Limited (NSEL), the electronic commodity spot exchange of India. However, 63 Moons’ board and promoters did not agree with the forced merger order as they believed that they were not at major fault behind the NSEL payment crisis. The case provides an opportunity to participate in the real-world complex decision-making process which involves the forced merger of two entities that may affect the interest of various stakeholders. The case allows examination of the issues such as related party transactions, internal monitoring and control processes, organizational structure and the regulatory framework which led to the payment crisis.

scholarly journals Profile of Serogroup Y Meningococcal Infections in Canada: Implications for Vaccine Selection

2009 ◽  
Vol 20 (4) ◽  
pp. e130-e134 ◽  
Author(s):  
Nicole Le Saux ◽  
Julie A Bettinger ◽  
Susan Wootton ◽  
Scott A Halperin ◽  
Wendy Vaudry ◽  
...  
Keyword(s):  
New Brunswick ◽  
Conjugate Vaccine ◽  
Meningococcal Disease ◽  
Prince Edward Island ◽  
Value Added ◽  
Invasive Meningococcal Disease ◽  
Immunization Programs ◽  
Meningococcal Infections ◽  
Conjugate Vaccines ◽  
Routine Infant

Canada is a leader in establishing routine infant immunization programs against meningococcal C disease. Currently, all provinces have routine programs to provide meningococcal C conjugate vaccines to infants and children. The result of the existing programs has been a decrease in serogroup C incidence. The second most common vaccine-preventable serogroup in Canada is serogroup Y, the incidence of which has been stable. The availability of a quadrivalent conjugate vaccine against serogroups A, C, Y and W135 focuses attention on serogroup Y disease as it becomes relatively more prominent as a cause of vaccine-preventable invasive meningococcal disease. This vaccine was licensed in November 2006 but is not routinely used except in Nunavut, New Brunswick and Prince Edward Island. To allow a better understanding of the ‘value added’ by a serogroup Y-containing vaccine, it is necessary to have a contemporary profile of Y disease in Canada. In the present paper, recent surveillance data on invasive meningococcal disease across Canada are summarized.

scholarly journals A Delphi Study Investigating Clinicians’ Views on Access to, Delivery of, and Adaptations of MBCT in the UK Clinical Settings

Mindfulness ◽  
2021 ◽  
Author(s):  
Kate Williams ◽  
Samantha Hartley ◽  
Peter Taylor
Keyword(s):  
Delphi Study ◽  
Good Practice ◽  
Evidence Base ◽  
Clinical Settings ◽  
Training Support ◽  
Decision Making Processes ◽  
Complex Decision Making ◽  
Complex Decision ◽  
The Uk ◽  
Clinical Populations

Abstract Objectives Mindfulness-based cognitive therapy (MBCT) is a well-evidenced relapse-prevention intervention for depression with a growing evidence-base for use in other clinical populations. The UK initiatives have outlined plans for increasing access to MBCT in clinical settings, although evidence suggests that access remains limited. Given the increased popularity and access to MBCT, there may be deviations from the evidence-base and potential risks of harm. We aimed to understand what clinicians believe should be best clinical practice regarding access to, delivery of, and adaptations to MBCT. Methods We employed a two-stage Delphi methodology. First, to develop statements around best practices, we consulted five mindfulness-based experts and reviewed the literature. Second, a total of 59 statements were taken forward into three survey rating rounds. Results Twenty-nine clinicians completed round one, with 25 subsequently completing both rounds two and three. Forty-four statements reached consensus; 15 statements did not. Clinicians agreed with statements regarding sufficient preparation for accessing MBCT, adherence to the evidence-base and good practice guidelines, consideration of risks, sufficient access to training, support, and resources within services, and carefully considered adaptations. The consensus was not reached on statements which reflected a lack of evidence-base for specific clinical populations or the complex decision-making processes involved in delivering and making adaptations to MBCT. Conclusions Our findings highlight the delicate balance of maintaining a client-centred and transparent approach whilst adhering to the evidence-base in clinical decisions around access to, delivery of, and adaptations in MBCT and have important wide-reaching implications.

scholarly journals Goal-driven active learning

2021 ◽  
Vol 35 (2) ◽  
Author(s):  
Nicolas Bougie ◽  
Ryutaro Ichise
Keyword(s):  
Decision Making ◽  
Reinforcement Learning ◽  
Learning Process ◽  
Real World ◽  
Imitation Learning ◽  
Learning Approaches ◽  
Wide Range ◽  
Fixed Set ◽  
Complex Decision Making ◽  
Complex Decision

AbstractDeep reinforcement learning methods have achieved significant successes in complex decision-making problems. In fact, they traditionally rely on well-designed extrinsic rewards, which limits their applicability to many real-world tasks where rewards are naturally sparse. While cloning behaviors provided by an expert is a promising approach to the exploration problem, learning from a fixed set of demonstrations may be impracticable due to lack of state coverage or distribution mismatch—when the learner’s goal deviates from the demonstrated behaviors. Besides, we are interested in learning how to reach a wide range of goals from the same set of demonstrations. In this work we propose a novel goal-conditioned method that leverages very small sets of goal-driven demonstrations to massively accelerate the learning process. Crucially, we introduce the concept of active goal-driven demonstrations to query the demonstrator only in hard-to-learn and uncertain regions of the state space. We further present a strategy for prioritizing sampling of goals where the disagreement between the expert and the policy is maximized. We evaluate our method on a variety of benchmark environments from the Mujoco domain. Experimental results show that our method outperforms prior imitation learning approaches in most of the tasks in terms of exploration efficiency and average scores.

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