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Lintonen T, Karjalainen K, Rönkä S, Kotovirta E, Niemelä S. Delphi method applicability in drug foresight. Subst Abuse Treat Prev Policy 2024; 19:35. [PMID: 39068443 PMCID: PMC11282797 DOI: 10.1186/s13011-024-00617-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 07/01/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND The aim of the current study was to assess the accuracy of expert predictions, which were derived using a Delphi panel foresight study between 2009 and 2011, on a variety of drug-related topics in Finland in 2020. METHODS The material used to evaluate the accuracy of the predictions consists of published reports on statistics, survey results, official register data, wastewater analyses and official documents. Whenever possible, we used multiple information sources to ascertain possible changes related to the predictions. RESULTS Between 2009 and 2011, the majority - but not all - of the experts accurately predicted an increase in drug use. Indeed, more people experimented with or used drugs, and more drug residues were found in wastewater monitoring. The experts also correctly predicted an increase in population-level approval of drug use, but this development has been rather slow. Contrary to predictions, there was no marked increase in the use of new synthetic drugs. However, the misuse of buprenorphine increased during the 2010s. In the drug market, unit prices were surprisingly stable over the ten-year period. There were no changes in legislation related to the legal status of drugs, as was foreseen by the experts. However, enforcement moved in the direction foreseen by the experts: more lenient measures have been taken against users. Drug care system reforms favored a combination of mental health and addiction care units between 2009 and 2011, and 2020, as foreseen by the experts. CONCLUSIONS It seems to have been easier for the experts to foresee the continuation of existing trends, e.g., increasing use of drugs or widening approval of drugs, than to predict possible changes in the popularity of distinct groups of drugs such as new psychoactive substances (NPS). Even armed with the prediction that drug imports and wholesale would increasingly fall into the domain of organized crime, this undesirable development could not be stopped. Expert disagreement can also be seen as a valuable indication of uncertainty regarding the future. Foresight related to drug-related issues can produce relatively accurate and realistic views of the future at least up to ten years ahead.
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Affiliation(s)
- Tomi Lintonen
- Finnish Foundation for Alcohol Studies, PO Box 30, Helsinki, FI-00271, Finland.
| | | | - Sanna Rönkä
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | | | - Solja Niemelä
- Department of Psychiatry, University of Turku, Turku, Finland
- Department of Psychiatry, Addiction Psychiatry Unit, Turku University Hospital, The Wellbeing Services County of Southwest Finland, Turku, Finland
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Milkman KL, Ellis SF, Gromet DM, Jung Y, Luscher AS, Mobarak RS, Paxson MK, Silvera Zumaran RA, Kuan R, Berman R, Lewis NA, List JA, Patel MS, Van den Bulte C, Volpp KG, Beauvais MV, Bellows JK, Marandola CA, Duckworth AL. Megastudy shows that reminders boost vaccination but adding free rides does not. Nature 2024; 631:179-188. [PMID: 38926578 PMCID: PMC11222156 DOI: 10.1038/s41586-024-07591-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/20/2024] [Indexed: 06/28/2024]
Abstract
Encouraging routine COVID-19 vaccinations is likely to be a crucial policy challenge for decades to come. To avert hundreds of thousands of unnecessary hospitalizations and deaths, adoption will need to be higher than it was in the autumn of 2022 or 2023, when less than one-fifth of Americans received booster vaccines1,2. One approach to encouraging vaccination is to eliminate the friction of transportation hurdles. Previous research has shown that friction can hinder follow-through3 and that individuals who live farther from COVID-19 vaccination sites are less likely to get vaccinated4. However, the value of providing free round-trip transportation to vaccination sites is unknown. Here we show that offering people free round-trip Lyft rides to pharmacies has no benefit over and above sending them behaviourally informed text messages reminding them to get vaccinated. We determined this by running a megastudy with millions of CVS Pharmacy patients in the United States testing the effects of (1) free round-trip Lyft rides to CVS Pharmacies for vaccination appointments and (2) seven different sets of behaviourally informed vaccine reminder messages. Our results suggest that offering previously vaccinated individuals free rides to vaccination sites is not a good investment in the United States, contrary to the high expectations of both expert and lay forecasters. Instead, people in the United States should be sent behaviourally informed COVID-19 vaccination reminders, which increased the 30-day COVID-19 booster uptake by 21% (1.05 percentage points) and spilled over to increase 30-day influenza vaccinations by 8% (0.34 percentage points) in our megastudy. More rigorous testing of interventions to promote vaccination is needed to ensure that evidence-based solutions are deployed widely and that ineffective but intuitively appealing tools are discontinued.
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Affiliation(s)
- Katherine L Milkman
- Department of Operations, Information and Decisions, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
| | - Sean F Ellis
- Behavior Change for Good Initiative, The Wharton School and the School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Dena M Gromet
- Behavior Change for Good Initiative, The Wharton School and the School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Youngwoo Jung
- Behavior Change for Good Initiative, The Wharton School and the School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Alex S Luscher
- Behavior Change for Good Initiative, The Wharton School and the School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Rayyan S Mobarak
- Department of Agricultural and Resource Economics, University of Maryland, College Park, MD, USA
| | - Madeline K Paxson
- Behavior Change for Good Initiative, The Wharton School and the School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Ramon A Silvera Zumaran
- Behavior Change for Good Initiative, The Wharton School and the School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Kuan
- Department of Operations, Information and Decisions, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Ron Berman
- Department of Marketing, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Neil A Lewis
- Department of Communication, Cornell University, Ithaca, NY, USA
| | - John A List
- Department of Economics, University of Chicago, Chicago, IL, USA
| | - Mitesh S Patel
- Clinical Transformation and Behavioral Insights, Ascension Health, St Louis, MO, USA
| | | | - Kevin G Volpp
- Penn Center for Health Incentives and Behavioral Economics, Departments of Medical Ethics and Health Policy and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Angela L Duckworth
- Department of Operations, Information and Decisions, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
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3
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McAndrew T, Gibson GC, Braun D, Srivastava A, Brown K. Chimeric Forecasting: An experiment to leverage human judgment to improve forecasts of infectious disease using simulated surveillance data. Epidemics 2024; 47:100756. [PMID: 38452456 DOI: 10.1016/j.epidem.2024.100756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 12/06/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
Forecasts of infectious agents provide public health officials advanced warning about the intensity and timing of the spread of disease. Past work has found that accuracy and calibration of forecasts is weakest when attempting to predict an epidemic peak. Forecasts from a mechanistic model would be improved if there existed accurate information about the timing and intensity of an epidemic. We presented 3000 humans with simulated surveillance data about the number of incident hospitalizations from a current and two past seasons, and asked that they predict the peak time and intensity of the underlying epidemic. We found that in comparison to two control models, a model including human judgment produced more accurate forecasts of peak time and intensity of hospitalizations during an epidemic. Chimeric models have the potential to improve our ability to predict targets of public health interest which may in turn reduce infectious disease burden.
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Affiliation(s)
- Thomas McAndrew
- Department of Community and Population Health, College of Health, Lehigh University, Bethlehem PA, United States of America.
| | - Graham C Gibson
- Statistical Sciences, Los Alamos National Laboratory, Los Alamos, NM, United States of America
| | - David Braun
- Department of Psychology College of Arts and Science, Lehigh University, Bethlehem PA, United States of America
| | - Abhishek Srivastava
- P.C. Rossin College of Engineering & Applied Science, Lehigh University, Bethlehem PA, United States of America
| | - Kate Brown
- Department of Community and Population Health, College of Health, Lehigh University, Bethlehem PA, United States of America
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4
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Dedhe AM, Chowkase AA, Gogate NV, Kshirsagar MM, Naphade R, Naphade A, Kulkarni P, Naik M, Dharm A, Raste S, Patankar S, Jogdeo CM, Sathe A, Kulkarni S, Bapat V, Joshi R, Deshmukh K, Lele S, Manke-Miller KJ, Cantlon JF, Pandit PS. Conventional and frugal methods of estimating COVID-19-related excess deaths and undercount factors. Sci Rep 2024; 14:10378. [PMID: 38710715 DOI: 10.1038/s41598-024-57634-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/20/2024] [Indexed: 05/08/2024] Open
Abstract
Across the world, the officially reported number of COVID-19 deaths is likely an undercount. Establishing true mortality is key to improving data transparency and strengthening public health systems to tackle future disease outbreaks. In this study, we estimated excess deaths during the COVID-19 pandemic in the Pune region of India. Excess deaths are defined as the number of additional deaths relative to those expected from pre-COVID-19-pandemic trends. We integrated data from: (a) epidemiological modeling using pre-pandemic all-cause mortality data, (b) discrepancies between media-reported death compensation claims and official reported mortality, and (c) the "wisdom of crowds" public surveying. Our results point to an estimated 14,770 excess deaths [95% CI 9820-22,790] in Pune from March 2020 to December 2021, of which 9093 were officially counted as COVID-19 deaths. We further calculated the undercount factor-the ratio of excess deaths to officially reported COVID-19 deaths. Our results point to an estimated undercount factor of 1.6 [95% CI 1.1-2.5]. Besides providing similar conclusions about excess deaths estimates across different methods, our study demonstrates the utility of frugal methods such as the analysis of death compensation claims and the wisdom of crowds in estimating excess mortality.
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Affiliation(s)
- Abhishek M Dedhe
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA.
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA.
- Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, USA.
| | - Aakash A Chowkase
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Niramay V Gogate
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA
- Department of Physics and Astronomy, Texas Tech University, Lubbock, TX, USA
| | - Manas M Kshirsagar
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA
- Institute of Clinical Neurobiology, University Hospital Würzburg, Würzburg, Germany
| | - Rohan Naphade
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA
| | - Atharv Naphade
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA
| | - Pranav Kulkarni
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA
- Department of Electrical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Mrunmayi Naik
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA
| | - Aarya Dharm
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA
- School of Computer Science and Engineering, University of Washington, Seattle, WA, USA
| | - Soham Raste
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA
| | - Shravan Patankar
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA
- Department of Mathematics, University of Illinois, Chicago, IL, USA
| | - Chinmay M Jogdeo
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Aalok Sathe
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Soham Kulkarni
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA
- Troy High School, Fullerton, CA, USA
| | - Vibha Bapat
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA
- Department of Biology, Indian Institute of Science Education and Research, Pune, Maharashtra, India
| | - Rohinee Joshi
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA
- Department of Mathematics, Indian Institute of Technology Bombay, Mumbai, Maharashtra, India
| | - Kshitij Deshmukh
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA
- Division of Molecular and Cellular Function, School of Biological Sciences, University of Manchester, Manchester, Greater Manchester, UK
- Department of Molecular Physiology and Biophysics, Pappajohn Biomedical Discovery Building (PBDB), University of Iowa, Iowa City, IA, USA
| | - Subhash Lele
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada
| | | | - Jessica F Cantlon
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Pranav S Pandit
- JPF Analytics, Jnana Prabodhini Foundation, Murrieta, CA, USA.
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA.
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5
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Bosse NI, Abbott S, Bracher J, van Leeuwen E, Cori A, Funk S. Human judgement forecasting of COVID-19 in the UK. Wellcome Open Res 2024; 8:416. [PMID: 38618198 PMCID: PMC11009611 DOI: 10.12688/wellcomeopenres.19380.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/16/2024] Open
Abstract
Background In the past, two studies found ensembles of human judgement forecasts of COVID-19 to show predictive performance comparable to ensembles of computational models, at least when predicting case incidences. We present a follow-up to a study conducted in Germany and Poland and investigate a novel joint approach to combine human judgement and epidemiological modelling. Methods From May 24th to August 16th 2021, we elicited weekly one to four week ahead forecasts of cases and deaths from COVID-19 in the UK from a crowd of human forecasters. A median ensemble of all forecasts was submitted to the European Forecast Hub. Participants could use two distinct interfaces: in one, forecasters submitted a predictive distribution directly, in the other forecasters instead submitted a forecast of the effective reproduction number R t. This was then used to forecast cases and deaths using simulation methods from the EpiNow2 R package. Forecasts were scored using the weighted interval score on the original forecasts, as well as after applying the natural logarithm to both forecasts and observations. Results The ensemble of human forecasters overall performed comparably to the official European Forecast Hub ensemble on both cases and deaths, although results were sensitive to changes in details of the evaluation. R t forecasts performed comparably to direct forecasts on cases, but worse on deaths. Self-identified "experts" tended to be better calibrated than "non-experts" for cases, but not for deaths. Conclusions Human judgement forecasts and computational models can produce forecasts of similar quality for infectious disease such as COVID-19. The results of forecast evaluations can change depending on what metrics are chosen and judgement on what does or doesn't constitute a "good" forecast is dependent on the forecast consumer. Combinations of human and computational forecasts hold potential but present real-world challenges that need to be solved.
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Affiliation(s)
- Nikos I. Bosse
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- NIHR Health Protection Research Unit in Modelling & Health Economics, London, UK
| | - Sam Abbott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Johannes Bracher
- Computational Statistics Group, Heidelberg Institute for Theoretical Studies, Heidelberg, Germany
- Chair of Statistical Methods and Econometrics, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Edwin van Leeuwen
- NIHR Health Protection Research Unit in Modelling & Health Economics, London, UK
- Modelling Economics Unit, UK Health Security Agency, London, UK
| | - Anne Cori
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, England, UK
| | - Sebastian Funk
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- NIHR Health Protection Research Unit in Modelling & Health Economics, London, UK
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6
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Grossmann I, Varnum MEW, Hutcherson CA, Mandel DR. When expert predictions fail. Trends Cogn Sci 2024; 28:113-123. [PMID: 37949791 DOI: 10.1016/j.tics.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
We examine the opportunities and challenges of expert judgment in the social sciences, scrutinizing the way social scientists make predictions. While social scientists show above-chance accuracy in predicting laboratory-based phenomena, they often struggle to predict real-world societal changes. We argue that most causal models used in social sciences are oversimplified, confuse levels of analysis to which a model applies, misalign the nature of the model with the nature of the phenomena, and fail to consider factors beyond the scientist's pet theory. Taking cues from physical sciences and meteorology, we advocate an approach that integrates broad foundational models with context-specific time series data. We call for a shift in the social sciences towards more precise, daring predictions and greater intellectual humility.
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Affiliation(s)
- Igor Grossmann
- Department of Psychology, University of Waterloo, Waterloo, N2L 3G1, ON, Canada.
| | - Michael E W Varnum
- Department of Psychology, Arizona State University, Tempe, AZ 85287, USA
| | - Cendri A Hutcherson
- Department of Psychology, University of Toronto Scarborough, Toronto, M1C 1A4, ON, Canada
| | - David R Mandel
- Defence Research and Development Canada, Toronto, M3K 2C9, ON, Canada
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7
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Aleta A, Blas-Laína JL, Tirado Anglés G, Moreno Y. Unraveling the COVID-19 hospitalization dynamics in Spain using Bayesian inference. BMC Med Res Methodol 2023; 23:24. [PMID: 36698070 PMCID: PMC9875773 DOI: 10.1186/s12874-023-01842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/13/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND One of the main challenges of the COVID-19 pandemic is to make sense of available, but often heterogeneous and noisy data. This contribution presents a data-driven methodology that allows exploring the hospitalization dynamics of COVID-19, exemplified with a study of 17 autonomous regions in Spain from summer 2020 to summer 2021. METHODS We use data on new daily cases and hospitalizations reported by the Spanish Ministry of Health to implement a Bayesian inference method that allows making short-term predictions of bed occupancy of COVID-19 patients in each of the autonomous regions of the country. RESULTS We show how to use the temporal series for the number of daily admissions and discharges from hospital to reproduce the hospitalization dynamics of COVID-19 patients. For the case-study of the region of Aragon, we estimate that the probability of being admitted to hospital care upon infection is 0.090 [0.086-0.094], (95% C.I.), with the distribution governing hospital admission yielding a median interval of 3.5 days and an IQR of 7 days. Likewise, the distribution on the length of stay produces estimates of 12 days for the median and 10 days for the IQR. A comparison between model parameters for the regions analyzed allows to detect differences and changes in policies of the health authorities. CONCLUSIONS We observe important regional differences, signaling that to properly compare very different populations, it is paramount to acknowledge all the diversity in terms of culture, socio-economic status, and resource availability. To better understand the impact of this pandemic, much more data, disaggregated and properly annotated, should be made available.
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Affiliation(s)
- Alberto Aleta
- grid.418750.f0000 0004 1759 3658ISI Foundation, Via Chisola 5, 10126 Torino, Italy ,grid.11205.370000 0001 2152 8769Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, 50018 Zaragoza, Spain
| | - Juan Luis Blas-Laína
- grid.413293.e0000 0004 1764 9746Servicio de Cirugía General y Aparato Digestivo (Jefe de Servicio), Hospital Royo Villanova, Av San Gregorio s/n, 50015 Zaragoza, Spain
| | - Gabriel Tirado Anglés
- grid.413293.e0000 0004 1764 9746Unidad de Cuidados Intensivos (Jefe de Servicio), Hospital Royo Villanova, Av San Gregorio s/n, 50015 Zaragoza, Spain
| | - Yamir Moreno
- grid.11205.370000 0001 2152 8769Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, 50018 Zaragoza, Spain ,grid.11205.370000 0001 2152 8769Department of Theoretical Physics, University of Zaragoza, 50018 Zaragoza, Spain ,Centai Institute, 10138 Torino, Italy ,grid.484678.1Complexity Science Hub, 1080 Vienna, Austria
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Abstract
Two years ago, in the early stages of the COVID-19 pandemic, there were widespread and grim predictions of an ensuing suicide epidemic. Not only has this not happened but also by the end of 2021 in the majority of countries and regions with available data, the suicide rates had, if anything, declined. We discuss four reasons why the predictions of suicide models were exaggerated: (1) government intervention reduced the economic and mental costs of lockdowns, (2) the pandemic itself and lockdowns had less of an effect on mental health than assumed, (3) the evidence for a link between economic downturns, distress and suicide is weaker and less consistent than the models assumed and (4) predicting suicide is generally hard. Predictive models have an important place, but their strong modelling assumptions need to acknowledge the inherent high degree of uncertainty which has been further augmented by behavioural responses of pandemic management.
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Affiliation(s)
- Nick Glozier
- Central Clinical School, Faculty of
Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- ARC Centre of Excellence for Children
and Families over the Life Course, Indooroopilly, QLD, Australia
| | - Richard Morris
- Central Clinical School, Faculty of
Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- ARC Centre of Excellence for Children
and Families over the Life Course, Indooroopilly, QLD, Australia
- School of Psychology, Faculty of
Science, The University of Sydney, Sydney, NSW, Australia
| | - Stefanie Schurer
- ARC Centre of Excellence for Children
and Families over the Life Course, Indooroopilly, QLD, Australia
- School of Economics, The University of
Sydney, Sydney, NSW, Australia
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Braun D, Ingram D, Ingram D, Khan B, Marsh J, McAndrew T. Crowdsourced Perceptions of Human Behavior to Improve Computational Forecasts of US National Incident Cases of COVID-19: Survey Study. JMIR Public Health Surveill 2022; 8:e39336. [PMID: 36219845 PMCID: PMC9822568 DOI: 10.2196/39336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/08/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Past research has shown that various signals associated with human behavior (eg, social media engagement) can benefit computational forecasts of COVID-19. One behavior that has been shown to reduce the spread of infectious agents is compliance with nonpharmaceutical interventions (NPIs). However, the extent to which the public adheres to NPIs is difficult to measure and consequently difficult to incorporate into computational forecasts of infectious diseases. Soliciting judgments from many individuals (ie, crowdsourcing) can lead to surprisingly accurate estimates of both current and future targets of interest. Therefore, asking a crowd to estimate community-level compliance with NPIs may prove to be an accurate and predictive signal of an infectious disease such as COVID-19. OBJECTIVE We aimed to show that crowdsourced perceptions of compliance with NPIs can be a fast and reliable signal that can predict the spread of an infectious agent. We showed this by measuring the correlation between crowdsourced perceptions of NPIs and US incident cases of COVID-19 1-4 weeks ahead, and evaluating whether incorporating crowdsourced perceptions improves the predictive performance of a computational forecast of incident cases. METHODS For 36 weeks from September 2020 to April 2021, we asked 2 crowds 21 questions about their perceptions of community adherence to NPIs and public health guidelines, and collected 10,120 responses. Self-reported state residency was compared to estimates from the US census to determine the representativeness of the crowds. Crowdsourced NPI signals were mapped to 21 mean perceived adherence (MEPA) signals and analyzed descriptively to investigate features, such as how MEPA signals changed over time and whether MEPA time series could be clustered into groups based on response patterns. We investigated whether MEPA signals were associated with incident cases of COVID-19 1-4 weeks ahead by (1) estimating correlations between MEPA and incident cases, and (2) including MEPA into computational forecasts. RESULTS The crowds were mostly geographically representative of the US population with slight overrepresentation in the Northeast. MEPA signals tended to converge toward moderate levels of compliance throughout the survey period, and an unsupervised analysis revealed signals clustered into 4 groups roughly based on the type of question being asked. Several MEPA signals linearly correlated with incident cases of COVID-19 1-4 weeks ahead at the US national level. Including questions related to social distancing, testing, and limiting large gatherings increased out-of-sample predictive performance for probabilistic forecasts of incident cases of COVID-19 1-3 weeks ahead when compared to a model that was trained on only past incident cases. CONCLUSIONS Crowdsourced perceptions of nonpharmaceutical adherence may be an important signal to improve forecasts of the trajectory of an infectious agent and increase public health situational awareness.
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Affiliation(s)
- David Braun
- Department of Psychology, Lehigh University, Bethlehem, PA, United States
| | - Daniel Ingram
- Actuarial Risk Management, Austin, TX, United States
| | - David Ingram
- Actuarial Risk Management, Austin, TX, United States
| | - Bilal Khan
- Computer Science and Engineering, Lehigh University, Bethlehem, PA, United States
| | - Jessecae Marsh
- Department of Psychology, Lehigh University, Bethlehem, PA, United States
| | - Thomas McAndrew
- College of Health, Lehigh University, Bethlehem, PA, United States
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10
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McAndrew T, Codi A, Cambeiro J, Besiroglu T, Braun D, Chen E, De Cèsaris LEU, Luk D. Chimeric forecasting: combining probabilistic predictions from computational models and human judgment. BMC Infect Dis 2022; 22:833. [PMID: 36357829 PMCID: PMC9648897 DOI: 10.1186/s12879-022-07794-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/12/2022] [Indexed: 11/12/2022] Open
Abstract
Forecasts of the trajectory of an infectious agent can help guide public health decision making. A traditional approach to forecasting fits a computational model to structured data and generates a predictive distribution. However, human judgment has access to the same data as computational models plus experience, intuition, and subjective data. We propose a chimeric ensemble-a combination of computational and human judgment forecasts-as a novel approach to predicting the trajectory of an infectious agent. Each month from January, 2021 to June, 2021 we asked two generalist crowds, using the same criteria as the COVID-19 Forecast Hub, to submit a predictive distribution over incident cases and deaths at the US national level either two or three weeks into the future and combined these human judgment forecasts with forecasts from computational models submitted to the COVID-19 Forecasthub into a chimeric ensemble. We find a chimeric ensemble compared to an ensemble including only computational models improves predictions of incident cases and shows similar performance for predictions of incident deaths. A chimeric ensemble is a flexible, supportive public health tool and shows promising results for predictions of the spread of an infectious agent.
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Affiliation(s)
| | - Allison Codi
- College of Health, Lehigh University, Bethlehem, PA, USA
| | - Juan Cambeiro
- Metaculus, Santa Cruz, CA, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Tamay Besiroglu
- Metaculus, Santa Cruz, CA, USA
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - David Braun
- Department of Psychology, Lehigh University, Bethlehem, PA, USA
| | - Eva Chen
- Good Judgment Inc., New York, NY, USA
| | | | - Damon Luk
- College of Health, Lehigh University, Bethlehem, PA, USA
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11
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Bosse NI, Abbott S, Bracher J, Hain H, Quilty BJ, Jit M, van Leeuwen E, Cori A, Funk S. Comparing human and model-based forecasts of COVID-19 in Germany and Poland. PLoS Comput Biol 2022; 18:e1010405. [PMID: 36121848 PMCID: PMC9534421 DOI: 10.1371/journal.pcbi.1010405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 10/05/2022] [Accepted: 07/18/2022] [Indexed: 11/19/2022] Open
Abstract
Forecasts based on epidemiological modelling have played an important role in shaping public policy throughout the COVID-19 pandemic. This modelling combines knowledge about infectious disease dynamics with the subjective opinion of the researcher who develops and refines the model and often also adjusts model outputs. Developing a forecast model is difficult, resource- and time-consuming. It is therefore worth asking what modelling is able to add beyond the subjective opinion of the researcher alone. To investigate this, we analysed different real-time forecasts of cases of and deaths from COVID-19 in Germany and Poland over a 1-4 week horizon submitted to the German and Polish Forecast Hub. We compared crowd forecasts elicited from researchers and volunteers, against a) forecasts from two semi-mechanistic models based on common epidemiological assumptions and b) the ensemble of all other models submitted to the Forecast Hub. We found crowd forecasts, despite being overconfident, to outperform all other methods across all forecast horizons when forecasting cases (weighted interval score relative to the Hub ensemble 2 weeks ahead: 0.89). Forecasts based on computational models performed comparably better when predicting deaths (rel. WIS 1.26), suggesting that epidemiological modelling and human judgement can complement each other in important ways.
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Affiliation(s)
- Nikos I. Bosse
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for the Mathematical Modelling of Infectious Diseases (members of the CMMID COVID-19 working group are listed in S1 Acknowledgements), London, United Kingdom
| | - Sam Abbott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for the Mathematical Modelling of Infectious Diseases (members of the CMMID COVID-19 working group are listed in S1 Acknowledgements), London, United Kingdom
| | - Johannes Bracher
- Institute of Economic Theory and Statistics, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Habakuk Hain
- Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Billy J. Quilty
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for the Mathematical Modelling of Infectious Diseases (members of the CMMID COVID-19 working group are listed in S1 Acknowledgements), London, United Kingdom
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for the Mathematical Modelling of Infectious Diseases (members of the CMMID COVID-19 working group are listed in S1 Acknowledgements), London, United Kingdom
| | | | - Edwin van Leeuwen
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- UK Health Security Agency, London, United Kingdom
| | - Anne Cori
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Sebastian Funk
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for the Mathematical Modelling of Infectious Diseases (members of the CMMID COVID-19 working group are listed in S1 Acknowledgements), London, United Kingdom
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12
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McAndrew T, Reich NG. An expert judgment model to predict early stages of the COVID-19 pandemic in the United States. PLoS Comput Biol 2022; 18:e1010485. [PMID: 36149916 PMCID: PMC9534428 DOI: 10.1371/journal.pcbi.1010485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 10/05/2022] [Accepted: 08/11/2022] [Indexed: 01/05/2023] Open
Abstract
From February to May 2020, experts in the modeling of infectious disease provided quantitative predictions and estimates of trends in the emerging COVID-19 pandemic in a series of 13 surveys. Data on existing transmission patterns were sparse when the pandemic began, but experts synthesized information available to them to provide quantitative, judgment-based assessments of the current and future state of the pandemic. We aggregated expert predictions into a single "linear pool" by taking an equally weighted average of their probabilistic statements. At a time when few computational models made public estimates or predictions about the pandemic, expert judgment provided (a) falsifiable predictions of short- and long-term pandemic outcomes related to reported COVID-19 cases, hospitalizations, and deaths, (b) estimates of latent viral transmission, and (c) counterfactual assessments of pandemic trajectories under different scenarios. The linear pool approach of aggregating expert predictions provided more consistently accurate predictions than any individual expert, although the predictive accuracy of a linear pool rarely provided the most accurate prediction. This work highlights the importance that an expert linear pool could play in flexibly assessing a wide array of risks early in future emerging outbreaks, especially in settings where available data cannot yet support data-driven computational modeling.
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Affiliation(s)
- Thomas McAndrew
- Department of Community and Population Health, College of Health, Lehigh University, Bethlehem, Pennsylvania, United States of America
| | - Nicholas G. Reich
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts, United States of America
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13
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Cascante-Vega J, Cordovez JM, Santos-Vega M. Estimating and forecasting the burden and spread of Colombia's SARS-CoV2 first wave. Sci Rep 2022; 12:13568. [PMID: 35945249 PMCID: PMC9427755 DOI: 10.1038/s41598-022-15514-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/24/2022] [Indexed: 12/03/2022] Open
Abstract
Following the rapid dissemination of COVID-19 cases in Colombia in 2020, large-scale non-pharmaceutical interventions (NPIs) were implemented as national emergencies in most of the country's municipalities, starting with a lockdown on March 20th, 2020. Recently, approaches that combine movement data (measured as the number of commuters between units), metapopulation models to describe disease dynamics subdividing the population into Susceptible-Exposed-Asymptomatic-Infected-Recovered-Diseased and statistical inference algorithms have been pointed as a practical approach to both nowcast and forecast the number of cases and deaths. We used an iterated filtering (IF) framework to estimate the model transmission parameters using the reported data across 281 municipalities from March to late October in locations with more than 50 reported deaths and cases in Colombia. Since the model is high dimensional (6 state variables in every municipality), inference on those parameters is highly non-trivial, so we used an Ensemble-Adjustment-Kalman-Filter (EAKF) to estimate time variable system states and parameters. Our results show the model's ability to capture the characteristics of the outbreak in the country and provide estimates of the epidemiological parameters in time at the national level. Importantly, these estimates could become the base for planning future interventions as well as evaluating the impact of NPIs on the effective reproduction number ([Formula: see text]) and the critical epidemiological parameters, such as the contact rate or the reporting rate. However, our forecast presents some inconsistency as it overestimates the deaths for some locations as Medellín. Nevertheless, our approach demonstrates that real-time, publicly available ensemble forecasts can provide short-term predictions of reported COVID-19 deaths in Colombia. Therefore, this model can be used as a forecasting tool to evaluate disease dynamics and aid policymakers in infectious outbreak management and control.
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Affiliation(s)
- Jaime Cascante-Vega
- Universidad de los Andes, Grupo de Biología y Matemática Computacional (BIOMAC), Bogotá D.C., 111711, Colombia
- Facultad de Medicina, Universidad de los Andes, Bogotá D.C., Colombia
| | - Juan Manuel Cordovez
- Universidad de los Andes, Grupo de Biología y Matemática Computacional (BIOMAC), Bogotá D.C., 111711, Colombia
| | - Mauricio Santos-Vega
- Universidad de los Andes, Grupo de Biología y Matemática Computacional (BIOMAC), Bogotá D.C., 111711, Colombia.
- Facultad de Medicina, Universidad de los Andes, Bogotá D.C., Colombia.
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14
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Bitterly TB, VanEpps EM, Schweitzer ME. The predictive power of exponential numeracy. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2022. [DOI: 10.1016/j.jesp.2022.104347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Teaching Two-Eyed Seeing in Education for Sustainable Development: Inspirations from the Science|Environment|Health Pedagogy in Pandemic Times. SUSTAINABILITY 2022. [DOI: 10.3390/su14106343] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This conceptual paper starts by outlining six important concerns of Science|Environment|Health (S|E|H), a new pedagogy of science that has been developed during the last decade by a Special Interest Group of the ESERA community. The paper points out that the importance of these six concerns even increased during the SARS-CoV-2 pandemic. They play an essential role in preparing future citizens not only for coping with the pandemic but in general with other great challenges that lie ahead of our world. In this way S|E|H is naturally connected to the UN Sustainable Development Goals, and the paper discusses how S|E|H work in recent years may inspire education for sustainable development. The six concerns are: (1) the question of curricular change, (2) the role of knowledge in S|E|H contexts, (3) the danger of scientism and the tension between individual and political responsibility, (4) decision-making in S|E|H contexts, (5) the challenge of coping with uncertainty, and (6) the question of scientific holism. Structured by these concerns, the paper reviews recent research of the S|E|H community. These findings are reframed by the Two-Eyed Seeing approach that has recently found growing interest in the S|E|H community. This new approach distinguishes between the scientific image and the life-world image on an ontological basis, which helps to disentangle the six concerns and to provide a framework for tackling them in teacher education and educational research—in S|E|H contexts and also in education for sustainable development.
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16
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Lutz CB, Giabbanelli PJ. When Do We Need Massive Computations to Perform Detailed COVID-19 Simulations? ADVANCED THEORY AND SIMULATIONS 2022; 5:2100343. [PMID: 35441122 PMCID: PMC9011599 DOI: 10.1002/adts.202100343] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/01/2021] [Indexed: 12/25/2022]
Abstract
The COVID-19 pandemic has infected over 250 million people worldwide and killed more than 5 million as of November 2021. Many intervention strategies are utilized (e.g., masks, social distancing, vaccinations), but officials making decisions have a limited time to act. Computer simulations can aid them by predicting future disease outcomes, but they also require significant processing power or time. It is examined whether a machine learning model can be trained on a small subset of simulation runs to inexpensively predict future disease trajectories resembling the original simulation results. Using four previously published agent-based models (ABMs) for COVID-19, a decision tree regression for each ABM is built and its predictions are compared to the corresponding ABM. Accurate machine learning meta-models are generated from ABMs without strong interventions (e.g., vaccines, lockdowns) using small amounts of simulation data: the root-mean-square error (RMSE) with 25% of the data is close to the RMSE for the full dataset (0.15 vs 0.14 in one model; 0.07 vs 0.06 in another). However, meta-models for ABMs employing strong interventions require much more training data (at least 60%) to achieve a similar accuracy. In conclusion, machine learning meta-models can be used in some scenarios to assist in faster decision-making.
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Affiliation(s)
- Christopher B. Lutz
- Department of Computer Science & Software EngineeringMiami University205 Benton HallOxfordOH45056USA
| | - Philippe J. Giabbanelli
- Department of Computer Science & Software EngineeringMiami University205 Benton HallOxfordOH45056USA
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17
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McAndrew T, Cambeiro J, Besiroglu T. Aggregating human judgment probabilistic predictions of the safety, efficacy, and timing of a COVID-19 vaccine. Vaccine 2022; 40:2331-2341. [PMID: 35292162 PMCID: PMC8882426 DOI: 10.1016/j.vaccine.2022.02.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/15/2022]
Abstract
Safe, efficacious vaccines were developed to reduce the transmission of SARS-CoV-2 during the COVID-19 pandemic. But in the middle of 2020, vaccine effectiveness, safety, and the timeline for when a vaccine would be approved and distributed to the public was uncertain. To support public health decision making, we solicited trained forecasters and experts in vaccinology and infectious disease to provide monthly probabilistic predictions from July to September of 2020 of the efficacy, safety, timing, and delivery of a COVID-19 vaccine. We found, that despite sparse historical data, a linear pool—a combination of human judgment probabilistic predictions—can quantify the uncertainty in clinical significance and timing of a potential vaccine. The linear pool underestimated how fast a therapy would show a survival benefit and the high efficacy of approved COVID-19 vaccines. However, the linear pool did make an accurate prediction for when a vaccine would be approved by the FDA. Compared to individual forecasters, the linear pool was consistently above the median of the most accurate forecasts. A linear pool is a fast and versatile method to build probabilistic predictions of a developing vaccine that is robust to poor individual predictions. Though experts and trained forecasters did underestimate the speed of development and the high efficacy of a SARS-CoV-2 vaccine, linear pool predictions can improve situational awareness for public health officials and for the public make clearer the risks, rewards, and timing of a vaccine.
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18
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Ioannidis JP, Tezel A, Jagsi R. Overall and COVID-19-specific citation impact of highly visible COVID-19 media experts: bibliometric analysis. BMJ Open 2021; 11:e052856. [PMID: 34706959 PMCID: PMC8551747 DOI: 10.1136/bmjopen-2021-052856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/13/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To evaluate whether the COVID-19 experts who appear most frequently in media have high citation impact for their research overall, and for their COVID-19 peer-reviewed publications in particular and to examine the representation of women among such experts. DESIGN Cross-linking of data sets of most highly visible COVID-19 media experts with citation data on the impact of their published work (career-long publication record and COVID-19-specific work). SETTING Cable news appearance in prime-time programming or overall media appearances. PARTICIPANTS Most highly visible COVID-19 media experts in the USA, Switzerland, Greece and Denmark. INTERVENTIONS None. OUTCOME MEASURES Citation data from Scopus along with discipline-specific ranks of overall career-long and COVID-19-specific impact based on a previously validated composite citation indicator. RESULTS We assessed 76 COVID-19 experts who were highly visible in US prime-time cable news, and 50, 12 and 2 highly visible experts in media in Denmark, Greece and Switzerland, respectively. Of those, 23/76, 10/50, 2/12 and 0/2 were among the top 2% of overall citation impact among scientists in the same discipline worldwide. Moreover, 37/76, 15/50, 7/12 and 2/2 had published anything on COVID-19 that was indexed in Scopus as of 30 August 2021. Only 18/76, 6/50, 2/12 and 0/2 of the highly visible COVID-19 media experts were women. 55 scientists in the USA, 5 in Denmark, 64 in Greece and 56 in Switzerland had a higher citation impact for their COVID-19 work than any of the evaluated highly visible media COVID-19 experts in the respective country; 10/55, 2/5, 22/64 and 14/56 of them were women. CONCLUSIONS Despite notable exceptions, there is a worrisome disconnect between COVID-19 claimed media expertise and scholarship. Highly cited women COVID-19 experts are rarely included among highly visible media experts.
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Affiliation(s)
- John P Ioannidis
- Meta-Resarch Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
- Departments of Medicine, of Epidemiology and Population Health, and of Statistics, Stanford University, Stanford, California, USA
| | | | - Reshma Jagsi
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
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19
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Shultz JM, Berg RC, Bernal Acevedo OA, Ocampo Cañas JA, Escobar VAP, Muñoz O, Espinel Z, Uribe-Restrepo JM. Complex correlates of Colombia's COVID-19 surge. ACTA ACUST UNITED AC 2021; 3:100072. [PMID: 34541569 PMCID: PMC8432891 DOI: 10.1016/j.lana.2021.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/10/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022]
Affiliation(s)
- James M Shultz
- Associate Professor, Educator Track, Director and Senior Fellow, Comprehensive Drug Research Center (CDRC) ,Director, Center for Disaster & Extreme Event Preparedness (DEEP Center), Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14 Street Room 1507, Miami FL USA 33136
| | - Ryan C Berg
- Senior Fellow, Americas Program, Center for Strategic and International Studies (CSIS), Washington, DC
| | | | | | - Victoria A Pinilla Escobar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida 33136
| | - Omar Muñoz
- Jackson Memorial Medical Center, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL USA 33136
| | - Zelde Espinel
- Sylvester Comprehensive Cancer Center, Assistant Professor, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL USA 33136
| | - José Miguel Uribe-Restrepo
- Associate Professor, Department of Psychiatry and Mental Health, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
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