Improving Predictive Accuracy in Elections.

The problem of accurately predicting vote counts in elections is considered in this article. Typically, small-sample polls are used to estimate or predict election outcomes. In this study, a machine-learning hybrid approach is proposed. This approach utilizes multiple sets of static data sources, such as voter registration data, and dynamic data sources, such as polls and donor data, to develop individualized voter scores for each member of the population. These voter scores are used to estimate expected vote counts under different turnout scenarios. The proposed technique has been tested with data collected during U.S. Senate and Louisiana gubernatorial elections. The predicted results (expected vote counts, predicted several days before the actual election) were accurate within 1%.

Safety and tolerability of a high-potency zoster vaccine in adults >/= 50 or years of age.

BACKGROUND: Herpes zoster (HZ) incidence rises with age, especially after 50 years of age, probably due to waning varicella-zoster virus (VZV)-specific immunity. The Shingles Prevention Study [Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults, N Engl J Med 2005;352:2271-84], enrolled people >/= 60 or years of age and showed that zoster vaccine prevents HZ and postherpetic neuralgia (PHN), presumably through boosting VZV-specific immunity. This study of people >/= 50 or years of age compared the safety and tolerability of two zoster vaccine potencies. METHODS: Adults >/= 50 or years old enrolled in a randomized, double-blind, multicenter study to compare the safety and tolerability of one dose of two zoster vaccine potencies, approximately 58,000 and approximately 207,000 plaque-forming units/dose. Adverse experiences (AEs) were recorded on a standardized Vaccination Report Card for 42 days postvaccination. For assessment of injection-site AEs, clinically acceptable tolerability was predefined based on experience with PNEUMOVAX 23, a licensed vaccine recommended for use in older people. RESULTS: Six hundred and ninety-eight subjects (age 50-90 years, median 64 years) were enrolled. No serious vaccine-related AEs were reported. Similar AE rates were observed in the higher and lower potency groups (overall systemic AEs: 37.5 and 39.3%, vaccine-related systemic AEs: 10.9 and 13.2%, injection-site AEs: 63.0 and 59.8%). Rates for a combined endpoint of moderate or severe injection-site pain/tenderness/soreness and swelling were 17.2% (95% CI 13.9, 21.0) and 9.0% (95% CI 5.6, 13.4), respectively. Most combined endpoint events were reported as moderate in intensity. CONCLUSIONS: Both vaccine potencies were generally well tolerated in this study of people > or years of age. Although rates of some moderate or severe injection-site AEs were greater in the higher potency group, all rates met the prespecified criteria for clinically acceptable tolerability.

A comprehensive patient assessment and physician reminder tool for adult immunization: effect on vaccine administration.

We determined if a patient-self assessment/provider reminder tool (A/R) would increase administration of the eight vaccines that may be indicated for adults. In three family practice clinics, the A/R was completed by intervention patients and given to their provider. Control patients received an exercise reminder. On the day of the intervention, influenza, pneumococcal polysaccharide, and tetanus-diphtheria (Td) vaccines vaccine were administered significantly (P<0.01) more commonly to intervention patients in one clinic, Td in the second, and none in the third. There were no additional significant differences during one year of follow-up. A number of barriers to comprehensive vaccination were encountered.

Determining indications for adult vaccination: patient self-assessment, medical record, or both?

CONTEXT: Eight or more vaccines may be indicated for adults in the United States. Determining if any vaccines are needed requires integrating information on the patient's demographic and behavioral risk factors and health status, the health status of the patient's close contacts, and the patient's immunization history. This process can be time consuming for providers and their staff. We used patient self-assessment as a method of determining which vaccines are indicated for a patient and whether indicated vaccines had been received. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional convenience sample of 300 adults in three family practice settings. Participants completed a self-assessment tool to determine if influenza, pneumococcal, measles, mumps, and rubella (MMR), tetanus, hepatitis A and hepatitis B vaccines were indicated and previously received. A chart audit was then performed to obtain similar information. MAIN OUTCOME MEASURES: Agreement (kappa statistic [< 0.00: poor agreement; 0.00-0.20: slight; 0.21-0.40: fair; 0.41-0.60: moderate; 0.61-0.80: substantial; 0.81-1.00: almost perfect]) between the self-assessment tool and the audit for (1) indicated vaccines and (2) previous receipt of indicated vaccines indicated according to both the assessment form and the audit. RESULTS: Agreement between the self-assessment tool and chart review was substantial or better only for pneumococcal and MMR vaccines (kappa=0.65 and 0.85, respectively). For influenza vaccine, agreement improved (from kappa = 0.56 to kappa = 0.74) when indications attributable to health conditions of family members were excluded. Agreement regarding receipt of vaccines was highest for influenza vaccine (kappa = 0.70). Only 57% of patients correctly recalled tetanus vaccination that were documented in the medical record (kappa = -0.04). Kappa statistics were unreliable for hepatitis A and B vaccines because so few vaccinations had been received. CONCLUSIONS: Discrepancies in agreement regarding indications for vaccines appeared to result from absence of information in the medical record regarding high risk behaviors and family contacts. Lack of agreement regarding vaccines that had been previously been received appeared due to both poor recall and lack of documentation. Combining medical record audit with self-assessment may be the most complete assessment of vaccination status of adults, but requires reconciling disagreements. Electronic medical records and registries that contain information about risk factors and previously administered vaccines may be necessary to overcome some these problems.

Safety and immunogenicity of concomitant versus nonconcomitant administration of hepatitis B, tetanus-diphtheria, and measles-mumps-rubella vaccines in healthy eleven- to twelve-year-olds.

PURPOSE: To study safety and immunogenicity of concomitant administration of hepatitis B (HB), Tetanus-diphtheria (Td), and Measles-mumps-rubella (MMR) vaccines in healthy 11-12-year-olds. METHOD: One hundred ninety-seven healthy 11-12-year-olds from the general community were randomized in an unblinded study to concomitant vaccination with Recombivax HB brand of HB vaccine and Td and MMR vaccines or to HB given at a separate time from Td and MMR vaccination. Primary analyses were for induction of protective immunity and safety. Secondary endpoints were mean geometric antibody titers for HB and a boosting effect for Td and MMR. Differences in immunogenicity were analyzed using the one-sided Pearson's Chi-square test. RESULTS: Concomitant vaccination for HB, Td, and MMR had a significantly increased incidence of headache, red eyes, and rash compared with nonconcomitant vaccination. There was no significant difference in incidence of serious adverse events, rates of protective immunity, or in secondary endpoints. CONCLUSIONS: Concomitant HB, Td, and MMR vaccination in 11-12-year-olds is as safe and immunogenic as nonconcomitant vaccination.