Reducing Unintended Pregnancies as a Strategy to Avert Zika-Related Microcephaly Births in the United States: A Simulation Study

Abstract Clinical trials are the gold standard for generating reliable medical evidence. The biggest bottleneck in clinical trials is recruitment. To facilitate recruitment, tools for patient search of relevant clinical trials have been developed, but users often suffer from information overload. With nearly 700 coronavirus disease 2019 (COVID-19) trials conducted in the United States as of August 2020, it is imperative to enable rapid recruitment to these studies. The COVID-19 Trial Finder was designed to facilitate patient-centered search of COVID-19 trials, first by location and radius distance from trial sites, and then by brief, dynamically generated medical questions to allow users to prescreen their eligibility for nearby COVID-19 trials with minimum human computer interaction. A simulation study using 20 publicly available patient case reports demonstrates its precision and effectiveness.

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Comparison of Driver Navigation at Turbo Roundabouts and Modern Two-Lane Roundabouts: Simulation Study

Transportation Research Record Journal of the Transportation Research Board ◽

10.3141/2637-11 ◽

2017 ◽

Vol 2637 (1) ◽

pp. 89-98

Author(s):

Elisha Jackson Wankogere ◽

Valerian Kwigizile ◽

Jun-Seok Oh ◽

Pavel Ikonomov

Keyword(s):

United States ◽

Simulation Study ◽

Virtual World ◽

Driving Simulator ◽

Speed Control ◽

The United States ◽

Safety Concerns ◽

Pavement Markings ◽

New Type ◽

Lane Keeping

Roundabouts can be a solution to safety concerns common to conventional intersections. Recently in the United States, there has been an increase in the conversion of problematic intersections to roundabouts to improve their safety. However, there are some important considerations and challenges to make roundabouts safe for all users, especially multilane roundabouts. There may also be challenges for drivers to navigate a newly built or a new type of roundabout. Roundabout features such as pavement markings and signage play an important role in driver navigational performance. This research was an effort to evaluate new roundabout design and existing roundabout safety and operational features such as signs and pavement markings. The focus was on how such features influenced the performance of drivers, specifically at multilane roundabouts. Two-lane roundabouts and rotor turbo roundabouts were evaluated. A driving simulator was employed to test various simulation scenarios in a virtual world. The results indicate that lane keeping and higher navigation speeds are still problems at multilane roundabouts. The rotor turbo roundabout outperforms the two-lane roundabout in enabling correct lane choice and navigation speed control by drivers. Furthermore, it was found that roundabout signs and pavement markings used in the United States can be adopted for turbo roundabouts.

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Quantifying the economic burden of unintended pregnancies due to drug–drug interactions with hormonal contraceptives from the United States payer perspective

Gates Open Research ◽

10.12688/gatesopenres.13430.1 ◽

2021 ◽

Vol 5 ◽

pp. 171

Author(s):

Meenakshi Srinivasan ◽

Annesha White ◽

Jason Lott ◽

Todd Williamson ◽

Sheldon X Kong ◽

...

Keyword(s):

United States ◽

Drug Interactions ◽

Unintended Pregnancy ◽

Oral Contraceptives ◽

Pregnancy Outcomes ◽

The United States ◽

Reproductive Age ◽

Contraceptive Failure ◽

Unintended Pregnancies ◽

Payer Perspective

Background: In the United States of America (USA), nearly 10 million women use oral contraceptives (OCs). Concomitant administration of certain medications can result in contraceptive failure, and consequently unintended pregnancies due to drug–drug interactions (DDIs). The objective of this analysis was to estimate the economic impact of unintended pregnancies due to DDIs among women of reproductive age using an OC alone or in combination with an enzyme inducer co-medication in the USA from a payer perspective. Methods: A Markov model using a cohort of 1,000 reproductive-age women was developed to estimate costs due to contraceptive failure for OC alone versus OC with concomitant enzyme inducer drugs. All women were assumed to begin an initial state, continuing until experiencing an unintended pregnancy. Unintended pregnancies could result in birth, induced abortion, spontaneous abortion, or ectopic pregnancy. The cohort was analyzed over a time horizon of 1 year with a cycle length of 1 month. Estimates of costs and probabilities of unintended pregnancy outcomes were obtained from the literature. Probabilities from the Markov cohort trace was used to estimate number of pregnancy outcomes. Results: On average, enzyme inducers resulted in 20 additional unintended pregnancies with additional unadjusted and adjusted costs median (range) of USD136,304 (USD57,436–USD320,093) and USD65,146 (USD28,491–USD162,635), respectively. The major component of the direct cost is attributed to the cost of births. Considering the full range of events, DDIs with enzyme inducers could result in 16–25 additional unintended pregnancies and total unadjusted and adjusted costs ranging between USD46,041 to USD399,121 and USD22,839 to USD202,788 respectively. Conclusion: The direct costs associated with unintended pregnancies due to DDIs may be substantial and are potentially avoidable. Greater awareness of DDI risk with oral contraceptives among payers, physicians, pharmacists and patients may reduce unintended pregnancies in at-risk populations.

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