Publications by authors named "Bryan A Norman"

Childhood obesity is a public health concern in the United States. Consequences of childhood obesity include metabolic disease and heart, lung, kidney, and other health-related comorbidities. Therefore, the early determination of obesity risk is needed and predicting the trend of a child's body mass index (BMI) at an early age is crucial.

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Pharmacy robots and automated dispensing cabinets are commonly used to distribute medications to inpatient units efficiently and safely. Decisions regarding the use of these technologies are often made without full knowledge regarding system effects. This paper determines a cost effective and safe way to distribute medications to patients across a hospital system by minimizing the distribution cost and missing dose rate.

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Introduction: Nurse scheduling within an emergency department can be a very time-consuming process as nursing leadership works to reach sufficient nurse-staffing levels across every day of the schedule while also working to satisfy nurse preferences.

Methods: A mathematical model is formulated to determine nursing shifts to minimize the number of shifts across a day while accounting for staffing level requirements, nurse preferences, and meal breaks.

Results: A daily schedule based on nursing shifts was created and used within the self-scheduling process.

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Background: The use of Long-Acting Injectable (LAI) antipsychotic medications has increased for patients with Serious Mental Illness (SMI). Care coordination for this population is complex, and pharmacist involvement may improve and support long-term medication adherence and patient outcomes.

Objectives: (1) Examine pharmacists' role in addressing care coordination and adherence challenges for patients taking Long-Acting Injectable (LAI) antipsychotics; and (2) explore patients' medication use experiences with LAI antipsychotics and educational needs.

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The Expanded Programme on Immunization (EPI) was established in 1974 to ensure that children all around the world benefit from life-saving vaccines. However, in many low and middle income countries, it is extremely difficult to vaccinate the entire population with the standard regimen of vaccines. One important reason for this is geographically dispersed or nomadic populations.

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Objective: To evaluate the potential impact and value of applications (e.g. adjusting ordering levels, storage capacity, transportation capacity, distribution frequency) of data from demand forecasting systems implemented in a lower-income country's vaccine supply chain with different levels of population change to urban areas.

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Article Synopsis
  • - The study evaluates the structure of vaccine supply chains in 57 GAVI-eligible countries, examining if these chains are effectively tailored to the specific needs of each country and whether a redesign is necessary.
  • - Researchers categorized these supply chains into three clusters based on their characteristics, finding that 34 out of 57 chains follow a four-level model, which doesn't significantly correlate with various national factors.
  • - The results indicated that simplified supply chain models, with fewer steps between central distribution points and immunization locations, could lead to lower costs, suggesting a need for less complex and more customized designs in vaccine distribution.
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Background: Within a typical vaccine supply chain, vaccines are packaged into individual cylindrical vials (each containing one or more doses) that are bundled together in rectangular "inner packs" for transport via even larger groupings such as cold boxes and vaccine carriers. The variability of vaccine inner pack and vial size may hinder efficient vaccine distribution because it constrains packing of cold boxes and vaccine carriers to quantities that are often inappropriate or suboptimal in the context of country-specific vaccination guidelines.

Methods: We developed in Microsoft Excel (Microsoft Corp.

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While new mechanisms such as advance market commitments and co-financing policies of the GAVI Alliance are allowing low- and middle-income countries to gain access to vaccines faster than ever, understanding the full scope of vaccine program costs is essential to ensure adequate resource mobilization. This costing analysis examines the vaccine costs, supply chain costs, and service delivery costs of immunization programs for routine immunization and for supplemental immunization activities (SIAs) for vaccines related to 18 antigens in 94 countries across the decade, 2011-2020. Vaccine costs were calculated using GAVI price forecasts for GAVI-eligible countries, and assumptions from the PAHO Revolving Fund and UNICEF for middle-income countries not supported by the GAVI Alliance.

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Article Synopsis
  • New vaccine introductions have strained global vaccine supply chains, prompting the Republic of Benin's Ministry of Health to seek improvements in their system due to suboptimal coverage.
  • A computational model, HERMES, was used to evaluate three options for enhancing the vaccine supply chain, focusing on consolidating or removing the Commune level and analyzing shipping loops.
  • The most effective solution combined redesigning the supply chain to a Health Zone level with the addition of shipping loops, resulting in significant cost savings and increased vaccine availability.
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  • Many countries need better storage and transport for vaccines, but international donors primarily provide storage rather than transport equipment.
  • A study using a simulation model in Niger found that increasing stationary storage increases the transport capacity required, with significant increases for different types of vehicles.
  • This means adding storage alone can lead to new transport challenges, potentially preventing vaccines from reaching their intended populations; dynamic modeling can help identify these issues.
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Background: The challenge of keeping vaccines cold at health posts given the unreliability of power sources in many low- and middle-income countries and the expense and maintenance requirements of solar refrigerators has motivated the development of passive cold storage devices (PCDs), containers that keep vaccines cold without using an active energy source. With different PCDs under development, manufacturers, policymakers and funders need guidance on how varying different PCD characteristics may affect the devices' cost and utility.

Methods: We developed an economic spreadsheet model representing the lowest two levels of a typical Expanded Program on Immunization (EPI) vaccine supply chain: a district store, the immunization locations that the district store serves, and the transport vehicles that operate between the district store and the immunization locations.

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Article Synopsis
  • The study focuses on improving vaccine supply chains, particularly the balance between stationary storage solutions and transport capacities for new vaccines like pneumococcal and rotavirus in Niger.
  • Results indicated that enhancing transport frequency significantly boosted vaccine availability (by up to 30%) compared to merely expanding stationary storage, which only increased availability by 11%.
  • The findings suggest that prioritizing transport improvements can alleviate storage bottlenecks and reduce the need for extensive stationary storage in vaccine supply chains.
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Objective: Since many of the world's vaccine supply chains contain multiple levels, the question remains of whether removing a level could bring efficiencies.

Methods: We utilized HERMES to generate a detailed discrete-event simulation model of Niger's vaccine supply chain and compared the current four-tier (central, regional, district, and integrated health center levels) with a modified three-tier structure (removing the regional level). Different scenarios explored various accompanying shipping policies and frequencies.

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Article Synopsis
  • Policymakers often overlook how their choices about target populations and timing for influenza vaccination impact vaccine supply chains and availability.
  • A simulation model of Thailand's National Immunization Program revealed that introducing influenza vaccines creates bottlenecks affecting both influenza and other vaccines, primarily due to limited transportation capacity.
  • The study found that even vaccinating a quarter of the recommended population over six months limits access to vaccines, highlighting the need for policymakers to integrate supply chain considerations into vaccination strategy decisions.
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Article Synopsis
  • The study examined the potential impact of introducing rotavirus and pneumococcal vaccines in Niger and how it could strain the existing vaccine supply chain.
  • Researchers created a computational model to analyze how these new vaccines would fit into the current immunization framework funded by the Bill and Melinda Gates Foundation.
  • Findings revealed that adding these vaccines could severely limit storage and transport capacity, reducing overall vaccine availability significantly unless additional resources were allocated.
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Article Synopsis
  • The significant health burdens from rotavirus and pneumococcal diseases have prompted countries, including Thailand, to consider adding new vaccines (RV and PCV-7) to their National Immunization Programs.
  • Research conducted on the vaccine supply chain in Trang Province revealed that the introduction of these vaccines could strain existing storage and transport capacities, exceeding available refrigerator space at district and sub-district levels.
  • Except for the smallest RV presentation, all other vaccine options would require substantial increases in both storage (20-1151 L/month) and transport (1-187 L) capacities to ensure effective distribution and availability to patients.
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Background: Many countries, such as Niger, are considering changing their vaccine vial size presentation and may want to evaluate the subsequent impact on their supply chains, the series of steps required to get vaccines from their manufacturers to patients. The measles vaccine is particularly important in Niger, a country prone to measles outbreaks.

Methods: We developed a detailed discrete event simulation model of the vaccine supply chain representing every vaccine, storage location, refrigerator, freezer, and transport device (e.

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In a low or middle income country, determining the correct number of routine vaccines to order at a health clinic can be difficult, especially given the variability in the number of patients arriving, minimal vaccination days and resource (e.g., information technology and refrigerator space) constraints.

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Objective: To estimate the economic value of dispensing preoperative home-based chlorhexidine bathing cloth kits to orthopedic patients to prevent surgical site infection (SSI).

Methods: A stochastic decision-analytic computer simulation model was developed from the hospital's perspective depicting the decision of whether to dispense the kits preoperatively to orthopedic patients. We varied patient age, cloth cost, SSI-attributable excess length of stay, cost per bed-day, patient compliance with the regimen, and cloth antimicrobial efficacy to determine which variables were the most significant drivers of the model's outcomes.

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Introduced to minimize open vial wastage, single-dose vaccine vials require more storage space and therefore may affect vaccine supply chains (i.e., the series of steps and processes involved in distributing vaccines from manufacturers to patients).

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Single-dose vaccine formats can prevent clinic-level vaccine wastage but may incur higher production, medical waste disposal, and storage costs than multi-dose formats. To help guide vaccine developers, manufacturers, distributors, and purchasers, we developed a computational model to predict the potential economic impact of various single-dose versus multi-dose measles (MEA), hemophilus influenzae type B (Hib), Bacille Calmette-Guérin (BCG), yellow fever (YF), and pentavalent (DTP-HepB-Hib) vaccine formats. Lower patient demand favors fewer dose formats.

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This research developed worker schedules by using administrative controls and a computer programming model to reduce the likelihood of worker hearing loss. By rotating the workers through different jobs during the day it was possible to reduce their exposure to hazardous noise levels. Computer simulations were made based on data collected in a real setting.

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