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Two general types of studies are used to determine how well influenza vaccines work: randomized controlled trials and observational studies. Vaccine efficacy refers to vaccine protection measured in RCTs usually under optimal conditions where vaccine storage and delivery are monitored and participants are usually healthy. Once an influenza vaccine has been licensed by FDA, recommendations are typically made by CDC's Advisory Committee for Immunization Practices (ACIP) for its routine use. What factors can affect the results of influenza vaccine efficacy and effectiveness studies?
The measurement of influenza vaccine efficacy and effectiveness can be affected by virus and host factors as well as the study methodology used. The protective benefits of influenza vaccination are generally lower during flu seasons where the majority of circulating influenza viruses differ from the influenza viruses used to make the vaccines. In addition to virus factors, host factors such as age, underlying medical conditions, history of prior infections and prior vaccinations can affect the benefits received from vaccination.
Experts consider RCTs to be the best study design because they are less susceptible to biases.
For both RCTs and observational studies, the specificity of the outcome measured in the study is important.
Can you describe biases that are important to consider for observational studies measuring vaccine effectiveness? Observational studies are subject to various forms of bias (see above for definition) more so than RCT studies. Information bias occurs if exposures or outcome information are based on different sources of information for people with and without the disease of interest.
How well do influenza vaccines work during seasons in which the flu vaccine is not well matched to circulating influenza viruses? As described above, when the virus components of the flu vaccine are not well matched with circulating influenza viruses, the benefits of influenza vaccination may be reduced.
Among older adults, annual influenza vaccination was recommended based on the high burden of influenza-related disease and demonstrated vaccine efficacy among younger adults.
Several observational studies have reported significant vaccine effectiveness against RT-PCR confirmed influenza-related hospitalization among older adults. In a four-year RCT of inactivated vaccines among children aged 1a€“15 years, vaccine efficacy was estimated at 77% against influenza A (H3N2) and 91% against influenza A (H1N1) virus infection[18]. Several RCTs of live attenuated influenza vaccines among young children have demonstrated vaccine efficacy against laboratory confirmed influenza with estimates ranging from 74%-94%[22,23,24,25]. An RCT conducted among pregnant women in South Africa during 2011 and 2012 reported vaccine efficacy against RT-PCR confirmed influenza of 50% among HIV-negative women and 58% among HIV-positive women vaccinated during the third trimester[27].
A randomized trial in Bangladesh found that babies born to mothers vaccinated during pregnancy with trivalent inactivated influenza vaccines were significantly less likely to be born small for gestational age and weighed an average of 200g more than babies born to unvaccinated mothers[29,30]. How well does the live attenuated influenza vaccine (LAIV) work compared to inactivated influenza vaccine (IIV)?
Three randomized clinical trials comparing live attenuated influenza vaccine to trivalent inactivated influenza vaccine in young children, 2-8 years of age, suggested that live attenuated influenza vaccine had superior efficacy compared to inactivated influenza vaccine[36,37,38]. Clinical trials during 2004-05, 2005-06, and 2007-08 that compared inactivated influenza vaccines and live attenuated influenza vaccines to no vaccine among adults suggested that inactivated influenza vaccines provided better protection against influenza than live attenuated influenza vaccines in adults7,8.
CDC monitors vaccine effectiveness annually through the Influenza Vaccine Effectiveness (VE) Network, a collaboration with participating institutions in five geographic locations. Bridges CB, Thompson WW, Meltzer MI, Reeve GR, Talamonti WJ, Cox NJ, Lilac HA, Hall H, Klimov A, Fukuda K. DiazGranados CA, Dunning AJ, Kimmel M, Kirby D, Treanor J, Collins A, Pollak R, Christoff J, Earl J, Landolfi V, Martin E, Gurunathan S, Nathan R, Greenberg DP, Tornieporth NG, Decker MD, Talbot HK. Madhi SA, Maskew M, Koen A, Kuwanda L, Besselaar TG, Naidoo D, Cohen C, Valette M, Cutland CL, Sanne I. Hoberman A, Greenberg DP, Paradise JL, Rockette HE, Lave JR, Kearney DH, Colborn DK, Kurs-Lasky M, Haralam MA, Byers CJ, Zoffel LM, Fabian IA, Bernard BS, Kerr JD. Ashkenazi S, Vertruyen A, ArA­stegui J, Esposito S, McKeith DD, Klemola T, Biolek J, KA?hr J, Bujnowski T, Desgrandchamps D, Cheng SM, Skinner J, Gruber WC, Forrest BD; CAIV-T Study Group. Fleming DM, Crovari P, Wahn U, Klemola T, Schlesinger Y, Langussis A, A?ymar K, Garcia ML, Krygier A, Costa H, Heininger U, Pregaldien JL, Cheng SM, Skinner J, Razmpour A, Saville M, Gruber WC, Forrest B; CAIV-T Asthma Study Group. Belshe RB, Edwards KM, Vesikari T, Black SV, Walker RE, Hultquist M, Kemble G, Connor EM; CAIV-T Comparative Efficacy Study Group.
Chung JR, Flannery B, Thompson MG, Gaglani M, Jackson ML, MontoAS, NowalkMP, Talbot HK, Treanor JJ, Belongia EA, Murthy K, Jackson LA, G.
Gaglani M , Pruszynski J, Murthy K, Clipper L, Robertson A, Reis M, Chung JR, Piedra PA, Avadhanula V, Nowalk MP Zimmerman RK, Jackson ML, Jackson LA, Petrie JG, Ohmit SE, Monto AS, McLean HQ, Belongia EA, Fry AM, Flannery B. For IT equipment, it is best to collect power data from your rack power distribution units (PDUs) as they can often meter down to the individual outlet level providing insights into the efficiency of individual equipment.
The data you collect can be manually added to a worksheet at predetermined intervals and you can set up functions or macros to perform your calculations for you. For companies focused on growth, one of the biggest opportunities is making sales more productive. Data-savvy digital marketers must still maintain an emotional connection with the people who do the buying. Targeted offerings: Identify and focus on the highest priority customer segments with products and solutions that are bundled and priced for maximum revenue, retention and renewals. Optimized tools and procedures: Develop the right cadence for monitoring the results of customer-facing selling efforts in a timely way, and then reinforce it with effective forecasting, lead generation, back-office technology, support and service.
With this strategy, we have helped companies increase profitability by as much as 25 percent over sustained periods.
Bain helps to drive improvements in productivity and growth beginning with an assessment of a company’s selling system.
If the salesforce and channels don’t know which customers are most profitable today or in the future, then any segmentation strategy is futile.
Technological innovations, maturing markets and more sophisticated buyers have opened a host of routes to the customer. Most sales executives understand that compensation practices affect their companies’ ability to recruit and retain top talent. Mobilizing back-office resources to augment field reps’ efforts is a powerful force multiplier. How customer segmentation and a new account model can help a telecom company provide the specialized service that customers have come to expect in this market. Private equity investors doubled their return after Bain helped stem the tide of employee and customer defections from a portfolio company. The Internet of Things is not a single market but a set of battlegrounds, each with unique opportunities.
As customers seize the balance of power and more aspects of the sales process migrate online, leading B2B sales organizations find they must radically restructure their approach. Why a finely honed sales model is crucial to meeting the sophisticated needs of today's business customer.
Advances in statistical methods and analytics give marketers a far more powerful and sophisticated technique through experimental design. Leading marketers now have a far more powerful and sophisticated technique to test direct marketing campaigns. We have a dedicated team of experts that we deploy around the globe to focus on sales and channel effectiveness opportunities. In addition to the leaders listed above, we have an extensive and diverse team of experts ready to serve the needs of clients worldwide. Following up the introduction post for PPC, we are going to discuss one of the most important factors: Measuring the effectiveness of the PPC campaign.
In this article we will examine briefly the Keyword Quality Score and some ways to Track, Monitor and Control your Campaigns. Either you run a PPC campaign on your own or you hired a PPC agency make sure that you regularly monitor the progress of the campaign and the proper metrics.


According to the above, the keyword “t-shirt stores” had 1000 impressions (displayed 1000 times), the cost per click was $1 and it returned 23 conversions. Keep in mind that you must always select the correct keywords, regularly check the metrics of your PPC and optimize your strategy when needed.
I think it’s important, also, to make incremental adjustments in your spend after you take at least a month’s worth of data. I seek for the most powerful linkbuilding and blog commenting services to get better ranking in Google.
There are several types of observational studies, including cohort and case-control studies. Vaccine effectiveness refers to vaccine protection measured in observational studies that include people with underlying medical conditions who have been administered vaccines by different health care providers under real-world conditions. Influenza viruses are continuously changing through a natural process known as antigenic drift. However, as stated above, these studies cannot be conducted when vaccination is recommended in a population and these studies are very difficult to conduct for more severe outcomes that are less common. Non-specific outcomes, such as pneumonia hospitalizations or influenza-like illness (ILI) can be associated with influenza virus infections as well as infections with other viruses and bacteria. The problem with VE studies that use serology to test for influenza infection, is that vaccination elevates antibody levels, similar to infection. Therefore, it is important that bias be minimized with the study design or adjusted for in the analysis.
In RCTs, confounding factors are expected to be evenly distributed between vaccinated and unvaccinated groups. In observational studies of influenza vaccine effectiveness, people with and without influenza may have different likelihoods of being vaccinated, and this can bias the estimate of vaccine effectiveness. For example, if researchers obtain information on vaccination for children with influenza from immunization records but ask parents of children without influenza if the child was vaccinated, this difference in data collection procedures could bias the results of the study. However, the degree of antigenic drift from vaccine viruses and the proportion of circulating drifted viruses can vary. One RCT of adults aged 60 years and older relied on serology for confirmation of influenza and reported a vaccine efficacy of 58% (95% confidence interval (CI): 26-77)[2]. These studies have reported vaccine efficacy estimates ranging from 16%-75%; VE of 16% was reported during a season with few influenza infections. An RCT of children aged 6a€“24 months reported vaccine efficacy of 66% against laboratory-confirmed influenza in 1999-2000 but no vaccine efficacy during the second year when there was little influenza activity[19]. A study conducted among children aged 12 through 36 months living in Asia during consecutive influenza seasons reported efficacy for live attenuated influenza vaccine of 64%a€“70%[26].
In addition, the trial showed that vaccination reduced the incidence of laboratory-confirmed influenza among infants born to HIV-negative women by 49%; the study was unable to assess vaccine efficacy among infants of HIV infected women. No effect of maternal immunization on infant birth weight was reported in the South African trial described above. Recently, several observational studies suggest that LAIV did not consistently provide better protection against influenza than inactivated vaccine, especially against influenza caused by the 2009 H1N1 pandemic virus[39,40,41].
These institutions enroll patients with respiratory symptoms at ambulatory clinics and test for influenza by RT-PCR. Effectiveness and cost-benefit of influenza vaccination of healthy working adults: A randomized controlled trial. Effectiveness of seasonal influenza vaccine in community-dwelling elderly people: a meta-analysis of test-negative design case-control studies.
Effectiveness of seasonal vaccine in preventing confirmed influenza-associated hospitalization in community dwelling older adults. Influenza vaccine prevents medically attended influenza-associated acute respiratory illness in adults aged a‰?50 years. Prevention of symptomatic seasonal influenza in 2005-2006 by inactivated and live attenuated vaccines. Safety, efficacy, and immunogenicity of an inactivated influenza vaccine in healthy adults: a randomized, placebo-controlled trial over two influenza seasons. Challenge of conducting a placebo-controlled randomized efficacy study for influenza vaccine in a season with low attack rate and a mismatched vaccine B strain: a concrete example. Efficacy of inactivated split-virus influenza vaccine against culture-confirmed influenza in healthy adults: a prospective, randomized, placebo-controlled trial. Trivalent inactivated influenza vaccine in African adults infected with human immunodeficient virus: double blind, randomized clinical trial of efficacy, immunogenicity, and safety.
Clinical efficacy of cell culture-derived and egg-derived inactivated subunit influenza vaccines in healthy adults.
Protective efficacy of a trivalent recombinant hemagglutinin protein vaccine (FluBlok(R)) against influenza in healthy adults: a randomized, placebo-controlled trial. Efficacy, safety, and immunogenicity of a Vero-cell-culture-derived trivalent influenza vaccine: a multicentre, double-blind, randomised, placebo-controlled trial.
Efficacy of inactivated and cold-adapted vaccines against influenza A infection, 1985 to 1990: the pediatric experience.
Effectiveness of inactivated influenza vaccine in preventing acute otitis media in young children: a randomized controlled trial.
Effect of influenza vaccination of children on infection rates in Hutterite communities: a randomized trial. The efficacy of live attenuated, cold-adapted, trivalent, intranasal influenzavirus vaccine in children. Safety, efficacy, and effectiveness of cold-adapted influenza vaccine-trivalent against community-acquired, culture-confirmed influenza in young children attending day care. Efficacy and safety of 1 and 2 doses of live attenuated influenza vaccine in vaccine-naive children.
Efficacy and safety of a live attenuated, cold-adapted influenza vaccine, trivalent against culture-confirmed influenza in young children in Asia. Effectiveness of seasonal trivalent influenza vaccine for preventing influenza virus illness among pregnant women: a population-based case-control study during the 2010-2011 and 2011-2012 influenza seasons. Neonatal outcomes after influenza immunization during pregnancy: a randomized controlled trial.
Maternal influenza immunization and reduced likelihood of prematurity and small for gestational age births: a retrospective cohort study. Vaccination against H1N1 influenza with Pandemrix((R)) during pregnancy and delivery outcome: a Swedish register study. Neonatal outcomes after antenatal influenza immunization during the 2009 H1N1 influenza pandemic: impact on preterm birth, birth weight, and small for gestational age birth. Superior relative efficacy of live attenuated influenza vaccine compared with inactivated influenza vaccine in young children with recurrent respiratory tract infections.
Comparison of the efficacy and safety of live attenuated cold-adapted influenza vaccine, trivalent, with trivalent inactivated influenza virus vaccine in children and adolescents with asthma. Update on effectiveness of live-attenuated versus inactivated influenza vaccines in children and adolescents aged 2-18 years a€“ US Flu VE Network. Influenza Vaccine Effectiveness against the 2009 Pandemic A (H1N1) Virus Differed by Vaccine-type During 2013-14 in the United States. For instance, many data center managers know that their PUE readings should be as close to the number one as possible, but why?
When a company’s sales channels realize their full potential, they not only boost revenue and share but create a high performance organization pulling together for breakthrough financial results. Results begin to accelerate in the first year, while the full boost typically kicks in over two to three years. We then work with a company to develop a pragmatic, actionable implementation schedule that can reliably increase sales without disrupting a company’s current revenue streams.
Effective sales organizations choose deliberately, based on economics, selecting the channel that is most cost effective, yields full revenue potential and ultimately exceeds the expectations of their target customers. Two fast ways to boost both the top and bottom lines are to tighten up pricing discipline and to engage in focused cross-selling to the most promising segments.


The best sales organizations therefore measure customer facing time and use internal support to create more.
We work to understand their reality and deliver true results—focusing on strategic decisions and practical actions.
We work as an integrated part of your team, from frontline to C-suite, to deliver true results and make the changes stick. Quality Score measures how relevant your keyword is to the text ads, to the content of the target page and to the search query. For example if you consider as conversion goal the registration to a newsletter, you need to calculate the cost of 1 registration that comes from the campaign. On the other hand, the second keyword “t-shirts for djs” had also 1000 impressions and the cost per click was $2.
A high Quality Score means that your keyword will trigger ads in a higher position and at a lower cost-per-click (CPC). It may be tempting to throw huge wads of cash at something you perceive to be performing well ROI wise, but if you over-do it, you’ll wind up driving Cost per Conversion up and ROI down in some cases. Vaccine efficacy is measured by comparing the frequency of influenza illness in the vaccinated and the unvaccinated (placebo) groups.
Observational studies assess how influenza vaccines work by comparing the occurrence of influenza among people who have been vaccinated compared to people not vaccinated. There are several observational study designs, but many programs currently use the test-negative, case-control design. New influenza infections could be missed in a vaccinated person since antibodies are already high and a four-fold increase doesna€™t develop.
Observational studies of influenza vaccine effectiveness can be subject to three forms of bias: confounding, selection bias, and information bias.
As a result, even when circulating influenza viruses are mildly or moderately drifted in comparison to the vaccine, it is still possible that people may receive some protective benefit from influenza vaccination.
However, it is unknown if infections were missed by serology among the study participants that were vaccinated (and if the vaccine efficacy estimate is biased upwards a€“ see previous description of how bias can occur in VE studies that test for influenza using serology). An RCT in South Africa among HIV infected adults reported vaccine efficacy of 76% (95 CI 9-96).[13] A meta-analysis that included data from RCTs of licensed inactivated influenza vaccines reported a pooled vaccine effectiveness of 59% (95% CI 51-67) against influenza confirmed by RT-PCR or viral culture[14].
During 2010-11, the vaccine efficacy of a quadrivalent inactivated vaccine among children aged 3-8 years was 59% (95% CI: 45%-70%)[20].
An observational study in the United States during 2010-11 and 2011-12 using a test-negative design reported vaccine effectiveness of 44% (95% CI: 5 to 67) against influenza among pregnant woman[28]. Some observational studies in developed and developing countries have found lower risk of prematurity or low birth weight in babies born to vaccinated mothers, but the effect has not been consistently demonstrated[31,32,33,34,35]. However, a randomized, school-based study in Canada reported lower rates of confirmed influenza among students vaccinated with live-attenuated vaccine compared to students vaccinated with inactivated influenza vaccine, as well as decreased influenza transmission among family members of students vaccinated with live-attenuated influenza vaccines[42].
Vaccine effectiveness is estimated using the test negative design, comparing proportions (odds) of influenza vaccination among patients with and without influenza.
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 2012. Llame al 1-800-CDC-INFO si tiene preguntas sobre la influenza estacional, cuyas respuestas no ha encontrado en este sitio. And we align our incentives with our clients' objectives, so they know we're in it together. Keeping your quality score high helps you to lower your Cost Per Click (CPC) and achieve better placement. For this process you’re going to need conversion trackers that help you find exactly how many of the paid clicks return conversions (purchases, bookings, registrations etc). Additionally we can see that it had a lower number of clicks but much more conversions compared to the cheaper keyword. Vaccine effectiveness is the percent reduction in the frequency of influenza illness among vaccinated people compared to people not vaccinated, usually with adjustment for factors (like presence of chronic medical conditions) that are related to both influenza illness and vaccination. These universal vaccine recommendations make it unethical to perform placebo-controlled RCTs because assigning people to a placebo group could place them at risk for serious complications from influenza. So even when circulating influenza viruses are mildly or moderately drifted in comparison to the vaccine, it is possible that people may still receive some protective benefit from vaccination; and if other circulating influenza viruses are well matched, the vaccine could still provide protective benefits overall. In the test-negative design, people who seek care for an acute respiratory illness are enrolled at ambulatory care settings (such as outpatient clinics, urgent care clinics, and emergency department) and information is collected about the patientsa€™ influenza vaccination status. For example, chronic medical conditions can confound the association between influenza vaccination and hospitalization with influenza in observational studies. In addition, even when some circulating influenza viruses are significantly drifted, it is possible for other influenza viruses in circulation to be well matched to the vaccine.
A meta-analysis of observational studies that used the test-negative design provided VE estimates for adults aged >60 years against RT-PCR confirmed influenza infection. In addition, RCTs of cell-based inactivated influenza vaccines (IIVs) and recombinant trivalent HA protein vaccines have been performed among healthy adults.
Statistical methods are used to account for differences in age, race and underlying medical conditions that might influence vaccine effectiveness.
Bias is an unintended systematic error in the way researchers select study participants, measure outcomes, or analyze data that can lead to inaccurate results. Also, observational studies often are the only option to measure vaccine effectiveness against more severe, less common influenza outcomes, such as hospitalization. All participants are tested for influenza using a highly specific and sensitive test for influenza virus infection, such as reverse transcription polymerase chain reaction (RT-PCR). Chronic medical conditions increase the risk of influenza-related hospitalization and vaccination coverage often is higher among people with chronic medical conditions.
The test-negative study design minimizes selection bias related to health care seeking by enrolling patients who seek care for a respiratory illness. It is not possible to predict how well the vaccine and circulating strains will be matched in advance of the influenza season, nor is it possible to predict how this match may affect vaccine effectiveness.
This meta-analysis reported significant vaccine effectiveness of 52% (95% CI: 41-61) during seasons when the vaccine and circulating viruses were well-matched [3]. In general, efficacy estimates for these types of vaccines are similar to other inactivated influenza vaccines that are egg-based[15,16,17].
Estimates are reported annually, and often, an early estimate is reported during the season. In a RCT, vaccine allocation is usually double-blinded, which means neither the study volunteers nor the researchers know if a given person has received vaccine or placebo.
Therefore, the presence of a chronic medical condition in a study participant is a potential confounding factor that should be considered in analysis. This study design is used by many studies globally, including CDC-funded networks that measure vaccine effectiveness. During seasons when the circulating viruses were antigenically drifted (not well matched), reported VE was 36% (95% CI: 22-48)3. Since the match between circulating and vaccine viruses is not known before the season, annual estimates of vaccine effectiveness give a real-world look at how well the vaccine protects against influenza caused by circulating viruses each season. National regulatory authorities, such as the Food and Drug Administration (FDA) in the United States, require RCTs to be conducted and to demonstrate the protective benefits of a new vaccine before the vaccine is licensed for routine use. However, some vaccines are licensed based on RCTs that use antibody response to the vaccine as measured in the laboratory, rather than decreases in influenza disease among people who were vaccinated. In addition to the test-negative design, there are additional observational study designs that have been used to estimate vaccine effectiveness. Not adjusting for confounders could bias the vaccine effectiveness estimate away from the true estimate.
In the example given, the vaccine effectiveness estimate could be biased lower, or towards lower effectiveness.



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