Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment.
Health Technology Assessment, No. 19.94.
Adams J, Bateman B, Becker F, et al.
Southampton (UK): NIHR Journals Library; 2015 Nov.
A DCE was undertaken to estimate the value parents place on key attributes and associated attribute levels of preschool vaccination programmes. DCEs describe a service or intervention in terms of a number of characteristics, or 'attributes' (e.g. where vaccinations are delivered, who delivers the vaccination and what information is provided). The extent to which an individual values a service or an intervention would be expected to vary as a function of the 'levels' of the attributes (e.g. one attribute could be the location in which vaccinations are administered, with levels being a local surgery or a community clinic).
Discrete choice experiments allow us to explore the relative importance of each attribute of the vaccination service that may influence a parent's decision to vaccinate their child and allow uptake of services configured in different ways to be predicted.98 DCEs are a well-established methodology in health economics to elicit preferences on health-care products, programmes and in the valuation of preference for health states99–101 and offer an additional approach to investigating service acceptability.
Financial attributes/levels can also be incorporated into a DCE. Therefore, it is possible to determine a population's willingness to pay (WTP) for, or accept, an intervention. The marginal willingness to accept (WTA) is defined here as the minimum monetary value that would be required to compensate for a change in the level of a certain attribute,102 that is, when individuals face a reduction in utility derived from moving from one scenario to another.
A DCE was designed for the following: (i) to establish the preferences of parents and carers of preschool-aged children for vaccination programmes with differing attributes and levels; (ii) to provide policy-relevant information on parental preferences on the configuration of vaccination programmes in England; (iii) to establish the likely minimum level of effective parental incentives; and (iv) to predict uptake levels of the different configurations of vaccination programmes.
stage 4 – data analysis and interpretation.
These are described in turn.
The results from published systematic reviews,5–7,16 the systematic review (see Chapter 3), the qualitative study (see Chapter 4) and a focused search of the general literature were used to develop a comprehensive list of potential attributes for inclusion in the DCE. This assessed the literature around immunisation services and programmes available for preschool children in England. Twelve studies identified that preferences for specific health professionals, parental education and perceived effectiveness of vaccinations are important factors influencing parental decision-making. An expert panel (comprising the project team and steering group members) deliberated these attributes and associated levels in a series of discussions. This process generated a provisional list of attributes and associated levels that may influence the uptake of preschool vaccination programmes. In all cases, attributes and levels had to be plausible in both clinical and policy terms.98 Information from all sources available to us informed the identification of maximum and minimum attribute levels, where relevant.
In addition to service configuration attributes, parental incentive attributes were included so that WTA could be indirectly estimated from the DCE.6 Incentive attributes were framed as financial rewards, which would be offered to parents for immunising their child as either a universal (all parents) or a targeted reward (targeted at parents highly unlikely to immunise their children). These attributes were included to arrive at an estimate of the minimum incentive (if any) that the population would be willing to accept in exchange for having a child immunised, and enabled the likely value of effective incentives to be established.
This process resulted in a list of nine attributes and associated levels (Table 8).
The Parent Advisory Group [see Chapter 1, Parent Advisory Group (public involvement)], comprising eight parents and guardians of preschool children, was consulted on the comprehensiveness and acceptability of the provisional list of attributes and levels. This took the form of an interactive workshop, which was facilitated by JA, RM and LT. Participants were presented with a hand-out (see Appendix 4) of the list of attributes and levels in Table 8 and their views on each were elicited. In addition, for attribute 3 (method of conveying information on net benefit from vaccination) participants were presented with examples of natural frequencies, clustered bar graphs and pictographs.
Participants reported mixed preferences for type of health-care professional administering vaccinations. With regard to location of vaccinations services, there was a dominant preference for community settings (e.g. Sure Start Centres). Participants also suggested additional locations for the provision of vaccinations, such as a vaccination bus, to be situated outside schools, and local pharmacies.
Few participants expressed a preference for vaccination services within a GP surgery; this was because of protracted waiting times and a lack of choice of appointment times, with several intimating that they had received a letter stating the date and time when they were required to attend their GP surgery. Extended waiting periods were considered particularly problematic, owing to a lack of child-friendly spaces and activities in GP surgeries. When participants were asked about the maximum time they would wait for an appointment, there was a general consensus that up to 60 minutes would be acceptable. Participants also reported difficulties in attending afternoon appointments, owing to the necessity of collecting other children from school at around 3 p.m.
The attribute of 'method of conveying information on net benefit from vaccination' elicited strong preferences for numerical presentation alone or the use of clustered bar graphs. Contrary to expectations, pictographs attracted largely negative comments and were considered to be unclear. Participants were in general agreement that receipt of information on benefits and risks was desirable to inform their decisions about immunising their children. However, those present in the workshop reported that they had received very little information on the benefits of vaccination. Indeed, the majority of participants would have preferred to have received balanced information on benefits and risks of vaccination presented to them verbally by a health-care professional (e.g. a health visitor) prior to appointments (e.g. 7 days before a scheduled appointment).
With regard to parental incentives, there was initially a strong opposition to any type of incentives being offered for immunising children. However, several participants conceded that £10–20 per visit (assuming seven visits) would be acceptable, with the caveat that this 'reward' should be universal (as opposed to targeted at those parents unlikely to immunise their children).
The workshop also identified very strong preferences for as few visits as possible, and it was unlikely that including this as a variable attribute in the DCE would yield any meaningful data.
The type of health-care professional administering vaccinations was intrinsically linked to location. Therefore, this attribute was amended to capture preferences on a range of health-care professionals administering vaccinations at specific locations.
Mode of information provision about vaccinations (benefits, risks and consequences) prior to appointment. This reflects the provision of 'balanced' information in terms of benefits, risks and consequences of a parent's decisions to vaccinate or not vaccinate his or her child prior to the first appointment. The level was via the post, and, in order to demarcate the different methods of electronic information provision, a further two levels were included (e-mail and multimedia via the internet).
Method of conveying information on consequences of disease, including absolute risk reduction in probability of disease from vaccination. There is good evidence that pictographs can effectively support the communication of balanced probabilistic information to people irrespective of their health literacy level.105 However, the examples of pictographs presented to participants in the workshop were not well received and were not considered clear or valuable. Furthermore, the graphical methods used in the workshop were illustrative examples, and a separate research project is warranted to identify the optimal mode, form and information content of graphical risk presentations in this case context. Therefore, the decision was made to omit illustrative examples of graphical display. To enable elicitation of preferences on generic methods of communicating probabilistic information, the following levels were presented textually: numerical (percentages and frequencies 'out of 100 children'); graphical methods such as bar graphs; and both numerical and graphical methods.
Given the value that workshop participants placed on verbal information provided by trusted health-care professionals, the levels of the attributes related to benefit and risk information, and method of probabilities on consequences and risk reduction from vaccination, were all suffixed with 'plus verbal information at time of appointment'.
The phrase 'normal hours' was replaced with 'working hours during school term times (9 a.m. to 5 p.m.)' in the levels of the attribute 'Availability of appointments'.
References to quasi-mandatory schemes were raised during the expert panel discussion. However, these were not deemed to be prudent for inclusion in the DCE, as exploring mandates and incentives within the same DCE would be counterintuitive and impose too many design constraints; that is, inclusion of a mandate in a choice scenario would prohibit the inclusion of levels related to parental incentives (form, type and value). However, an item to assess preferences for no reward (current practice), targeted versus universal rewards, and mandatory schemes was given in the questionnaire included with the DCE.
The terms 'reward' and 'incentive' were used interchangeably in the descriptions of DCE attributes and the associated levels. Expert panel discussions emphasised the need for consistency (and interpretation, as there are qualitative differences between the two terms); the term 'reward' was deemed to be more accessible to parents and any references to incentive were replaced with 'reward' in the DCE attributes and levels and other survey items. Levels for the parental reward attribute were also amended based on discussions with the Parent Advisory Group.
For the attribute 'waiting time at each appointment', the three levels were amended in accordance with the maximal value identified from the workshop (60 minutes), with a capped value (up to 120 minutes) to facilitate interpretation of the parameter estimates.
The revised list of eight attributes and levels for inclusion in the DCE are shown in Table 9, with number of visits to complete the full vaccination programme designated as a ninth, fixed attribute.
Not all attributes and level combinations were plausible (e.g. if type of reward was 'no reward' then value of reward must be '£0'). Design constraints were utilised to ensure plausibility and reduce hypothetical bias (where the hypothetical nature of the questions result in biased responses). Excluding implausible combinations of attribute levels affected level balance and statistical efficiency (a good choice design is level balanced where all levels of an attribute occur with equal frequency across the total number of choice sets included in all versions of a questionnaire). Levels were unbalanced with regard to type of reward, with 'no reward' appearing less frequently; and incentive amount, with '£0' appearing less frequently. For respondents with strong preferences for those under-represented attribute levels of 'no reward' and '£0' incentive value, the opt-out option was assumed to present a valid alternative choice. Therefore, following guidelines for best practice, level balance (and hence some statistical efficiency) was sacrificed in favour of a practical and plausible design with the aim of increasing in overall response efficiency.
In order to minimise respondents' cognitive burden, each participant was presented with 18 choice questions. The design allowed for four blocks of 18 choice scenarios to maximise variance in the data. Each respondent was assigned to one block randomly.
Study information: what the work is aiming to achieve, what participation would involve, the estimated time to complete the survey and the purpose of the research, including obtaining consent to participate.
Screening questions, based on inclusion criteria.
Respondents' (and, where applicable, their partners') demographics, socioeconomic status (household income, highest level of education, employment status, ethnicity) and self-assessed health status.
Details of the respondents' children (number, age, gender, presence of disability).
Introduction and explanation of the choice task with an illustrative example of pairwise choice scenario (choice set), followed by presentation of choice sets based on the Ngene design in the format shown in Table 10.
Questions to assess how difficult the respondents found the DCE task to complete.
Questions on the influence of financial incentives on decisions to immunise, including for those individuals who stated that they would require an incentive to vaccinate, the minimum value of that incentive (their WTA), and, for those who would not require an incentive, the maximum level at which they believed an incentive should be set (including £0). Questions also included whether cash or vouchers would be preferable and the reasons underpinning the minimum acceptable incentive value they stated (if applicable).
Questions about preferences for organisation of vaccination services (universal, targeted, mandatory or current practice).
Information on vaccinations, including mode information, was received, extent information needs were fulfilled and alternative sources of information were consulted.
Intentions for immunising participants' youngest child, followed by a series of attitudinal questions designed to assess attitudes towards the safety, importance/value and efficacy of vaccinations.
A ranking exercise in which respondents were asked to rank order the eight attributes in the choice sets.
An open-ended question asking for any further information on the topic of vaccination in preschool age children.
Paper piloting was undertaken with five parents or guardians of preschool-aged children (one male and four female) using a 'think-aloud' approach110 to test respondents' understanding of the wording of questionnaire survey items, the DCE choice task, the definitions of attributes and levels; and identification of salient 'missing' attributes and levels. The sample size for this aspect was determined by data saturation – that is, we continued conducting additional interviews until no new issues were raised.
The first two participants took considerable time to read text in both columns of the choice sets (i.e. they were experiencing excessive cognitive burden that prohibited an expeditious and valid comparison of attribute levels between the pairwise scenarios). Therefore, the format of presenting the pairwise choice sets shown in Table 11 was used to reduce cognitive burden in subsequent pilot participants.
Based on responses during the paper piloting, participants expressed a desire to know why information on demographics and socioeconomic status was being sought. In response, we included the following information: 'the following questions ask about the characteristics of the parents responding to the survey (so we can demonstrate that we have collected information from a representative cross section of parents living in England) and to explore how characteristics of parents could help us to design better vaccination services'. An option of 'prefer not to say' was also added to items in this section.
Participants also noted that knowledge of the full vaccination schedule was a prerequisite for responding to the questionnaire items. Consequently, in the introduction section a link to details of the vaccination schedule currently recommended by the NHS was included.
Other comments that resulted in amendments were that participants wanted to know whether or not pharmacists would have received specific training on vaccinations in order to consider this attribute as a valid option. In the section on WTA, one participant queried the locations at which shopping vouchers could be redeemed (this item was subsequently amended to state that shopping vouchers would be accepted in most high-street shops and supermarkets). The paper pilot identified no other salient issues (other than minor typographical errors and clarification of potentially ambiguous definitions in the demographic and socioeconomic status items).
The findings of the paper-pilot, along with additional expert panel discussions, informed the development of a revised list of attributes and levels (Table 12) along with a final paper-based version of the questionnaire survey for electronic piloting.
Please state the minimum amount you would be willing to accept.
What is the minimum amount you would require?
What do you think should be the maximum financial reward offered to parents for immunising their child?
A second 'soft launch' was undertaken with the revised WTA questions (n = 37). In addition to the tests conducted as part of the first soft launch, further data analysis was undertaken at this stage. This included running preliminary regression analyses (n = 77) and analysing data relating to participants' understanding of the DCE questions. The majority (82%) of respondents stated that they fully understood the questions, while 17% partially understood and around 1% reported that they did not understand the DCE questions. This high level of understanding of the DCE was deemed satisfactory and no further changes were made to the DCE design or survey questionnaire.
Ethical approval for all aspects of this study (piloting and main study data collection) was granted from Newcastle University Ethics Committee (reference 00748).
Recruitment and data collection was subcontracted to the market research company (ResearchNow.com), who adhere to the highest standards of market research ethics, as described in the Market Research Society's Code of Conduct.111 ResearchNow use a number of methods to recruit individuals onto their panels, including e-mail, online marketing and website targeting. 'By invitation' methods are also used, where individuals with known characteristics are directly targeted. Small (£1–2) incentives in the form of shopping vouchers were paid to participants, as per their normal procedures. Data were returned to the research team in an anonymised format. The research team did not receive contact details or any personal identifier information from survey participants.
The first soft-launch data collection started in November 2014. Final survey data collection commenced in December 2014, with the final data set available in early January 2015.
Two samples were included in the study: relative to the likelihood of not having their children fully vaccinated, parents were identified as either 'at high risk' or 'not at high risk' of not having their children fully vaccinated. It is particularly important to explore the preferences of parents 'at high risk', as this subgroup would probably be the primary target of any parental incentive scheme. It was also important to explore the preferences of parents who were 'not at high risk' in order to determine the wider impact of population-wide changes in the configuration of vaccination services.
a member of an online research panel held by the subcontracting market research company ResearchNow.com.
a parent or guardian of more than three children (of any age).
Respondents who did not meet any of the above criteria were assigned to the 'not at high risk' sample.
Lancsar and Louviere98 highlight the complexities and problems of performing sample size calculations for DCEs and the need for further research in this area. Previous studies using DCEs for exploring experience factors in health-care settings have included samples ranging from fewer than 50112 to almost 4000,113 and robust choice models have been estimated from sample sizes of between 50 and 100 respondents.114 Optimal sample size requirements for DCEs depend on knowledge of the true choice probabilities, which are not known prior to undertaking the research115 and, therefore, DCE sample size estimates are generally based on rules-of-thumb and budget constraints. Given the number of attributes included in the DCE, it was estimated that a minimum sample size of 400 [i.e. 200 'at high risk' (50 per block) plus 200 'not at high risk' parents (50 per block)] would provide sufficient statistical power based on a rule of thumb of a minimum of 10 observations per parameter estimate plus an additional 50.
Descriptive statistical techniques were used to describe the sociodemographic profile and characteristics of parents and their children of the full sample, and the subgroups 'at high risk' and 'not at high risk' of incompletely vaccinating their children. Appropriate tests of differences (chi-squared tests and t-tests) were used to establish any statistically significant differences between the subsamples as a function of sociodemographic and child variables.
The DCE approach allows an analysis of individual stated preferences in response to hypothetical choices and enables the quantification of the relative importance of each attribute/level during the decision-making process.103,107 When presented with hypothetical options (i.e. choice scenarios) that describe alternative specifications of a vaccination service, respondents are assumed to choose the scenario they prefer. The higher a respondent's preference for certain attribute levels, the more likely they are to choose that scenario over any alternative.
Appendix 6 provides a technical description of the data analytic strategy applied to the choice scenario data. In short, the initial analysis employed a conditional logit model116 which is based on three assumptions: (i) independence of irrelevant alternatives (IIAs) (i.e. the ratio of probabilities for any two alternatives is assumed to be independent of the attribute levels in a third alternative); (ii) error terms are independent and identically distributed across observations; and (iii) no preference heterogeneity (i.e. homogeneous preferences across respondents).
As the number of observations for the opt-out option was too small (around 5% of chosen options) to perform the appropriate Hausman test, we assumed a violation of the IIA assumption, which would result in biased parameter estimates. Therefore, mixed-effects logistic regression models were considered more appropriate to analyse the choice set data. Mixed logit models counteract any violations in the assumptions of conditional logit models and permit the investigation of unobserved preference heterogeneity, that is, varying model estimates across individuals.
Mixed logit models were, therefore, used to establish whether or not the eight attributes presented in the choice scenarios were statistically significant predictors of parents' preferences. Positive coefficients in the models represent a positive preference (utility) associated with a particular level of an attribute, whereas negative coefficients represent a negative preference (disutility) associated with a particular level of an attribute compared with the reference level. p-Values < 0.05 indicate whether positive or negative preferences are statistically significantly different from zero. Mixed logit models were undertaken using choice set data from the full sample and the two subgroups.
For all models the intercepts [alternative specific constants (ASCs)] and time attribute are assumed to be random and normally distributed [means and standard deviations (SDs) reported]; all other parameters in the model remain fixed (mean estimates reported only). For all mixed logit models, positive values for the intercepts (ASCs for options A and B) would indicate a general parental preference for vaccinating their children. Attributes capturing 'time' and 'value' were included in the analysis as linear variables. Effects coding was used for all categorical attributes (using +1, 0 and –1 to represent different attribute levels) to facilitate estimation of main effects across all categorical attributes and levels.117 The level 'no reward' in the attribute 'type of reward' was omitted in these analyses owing to multicollinearity; the no-reward situation was already coded by the according category in the type of reward attribute and additionally included in the choice sets descriptions only for plausibility.
Marginal WTA values for all statistically significant attributes in the mixed logit models were also calculated for the full sample and subgroups in the form of a minimum monetary value that would be required as 'compensation' for any change in the level of an attribute associated with gains or losses in utility.102 This enables an estimate of the trade-offs between attribute levels and the magnitude of the coefficient in the mixed logit models (i.e. the WTA values can be compared to determine the relative strength of preferences). The estimated WTA values, therefore, represent the amount of financial incentive (in £) that parents would need to receive in order to compensate for accepting a level of an attribute of a vaccination service that is associated with a negative preference (disutility).
Responses to the following questions presented after the respondents had completed the choice task (DCE) were analysed using appropriate descriptive statistics for the full sample and two subgroups: parents' preferences for organisation of vaccination services (universal, targeted, mandatory or current practice); influence of financial incentives on decisions to immunise, including for those individuals who stated that they would require an incentive to vaccinate, the minimum value of that incentive (their WTA), and, for those who would not require an incentive, the maximum value they thought an incentive should be (their WTP); preferences for cash or voucher rewards and the reasons underpinning the minimum acceptable incentive value (if applicable); information received on vaccinations, including the way that information was received, the extent their information needs were fulfilled and alternative sources of information consulted; and the rank order assigned to the eight attributes presented in the DCE choice task.
Items used to assess parents' intentions for immunising their youngest child, and attitudes on safety, importance/value and efficacy of vaccinations, were analysed using overall means and SDs for each subscale in accordance with the factor structure reported in Kennedy et al.122 Differences between subgroups were analysed using independent t-tests and chi-squared statistics.
Observed and predictive uptake rates for vaccination services were calculated for the full sample. Observed uptake rates were based on responses to the 18 choice questions. Predictive uptake rates were based on findings of the mixed logit models and used to produce estimated probabilities that control for all levels included in the 72 choice sets in the DCE across all respondents.
Uptake rates were also calculated for vaccination services based on the most and least preferred choice scenarios (as defined by the DCE results) and were compared with predicted uptake rates based on the scenario that represents current practice and an 'opt-out option'. These statistics are expressed as percentages and capture the variation in uptake rates associated with different configurations of vaccination services based on preferences across the sample.
Table 13 presents a summary of the sociodemographic profile and characteristics of the study respondents in the overall sample (n = 521) and subgroups of respondents classified to be 'at high risk' (n = 259, 49.7%) of not fully vaccinating their children and 'not at high risk' (n = 262, 50.3%).
Respondents had a mean age of 34 years. The majority of respondents were white (86%); female (71%); employed or on maternity leave (73%); and in a relationship (76%). The modal annual income was £35,000 to < £50,000 (23%). Almost half had a degree or post-graduate education (48%). The majority of the sample reported 'good' health (53%) over the past 12 months and had an average of two children (4% of whom were reported to have a physical or mental disability).
Many of the differences between subgroups reflect the criteria for allocation to groups. There were significantly more female and single or separated/divorced/widowed respondents, with, on average, more children and children with disabilities in the 'at high risk' group. A significantly smaller proportion of respondents in the 'at high risk' group reported good health over the past 12 months. The 'at high risk' group also had significantly greater and smaller proportions of respondents in the lowest (< £15,000) and highest (> £70,000) annual household income ranges, respectively. Significantly larger proportions of respondents in the 'not at high risk' group had a degree or post-graduate education and were employed or on maternity leave, with significantly greater numbers of unemployed respondents in the 'at high risk' group. Patterns of ethnicity were approximately equivalent across subgroups.
The results of the mixed logit models for the full sample are presented in Table 14. The ASCs for options A and B are both positive and statistically significant, indicating that there is a general preference for vaccinations, compared with not vaccinating (option C). Indeed, only 5% of all respondents chose the opt-out option, 'I would not vaccinate my child'.
The SDs for all random coefficients, namely ASCs and time variables, are statistically significant, indicating the existence of preference heterogeneity among respondents for the characteristics of vaccination services in the DCE choice sets.
Given the use of effects coding, the reported results for each of the attribute levels indicate the distance from average utility (specified as the negative sum of coefficients for all but the reference level) derived from a specific attribute. According to equation (2) (see Appendix 6), positive coefficients indicate a positive preference (utility) and negative coefficients indicate a negative preference (disutility) associated with a specific attribute level compared with the reference category. Non-significant attribute levels indicate respondents' indifference between the specific level and the reference level of each attribute.
There were statistically significant negative preferences (disutility) for pharmacists delivering vaccination in a local pharmacy (WTA = £142.40) and community nurses delivering vaccinations in a community bus stationed at schools (WTA = £67.96); for use of charts or pictures to convey information on risks and benefits (WTA = £55.45); use of targeted rewards (WTA = £194.40); and for longer waiting times at each appointment (WTA = £8 per minute of additional wait after having waited for 30 minutes).
On the other hand, there was a statistically significant positive preference (utility) for cash rewards. Higher-value rewards were associated with a statistically significant increase in utility.
Results of the mixed logit models for the subgroups of respondents classified as 'at high risk' and 'not at high risk' are presented in Table 15. There was a general preference for vaccinations in both subgroups as well as the existence of preference heterogeneity for the characteristics of vaccination services in the DCE choice sets. This result is consistent with the full sample (model 1), in which only 5% of all respondents use the opt-out option 'I would not vaccinate my child'. In the subgroup analyses, 6% of the 'at high risk' group and 4% of the 'not at high risk' group use the opt-out option.
There were statistically significant negative preferences (disutility) for pharmacist-delivered vaccinations in both the 'at high risk' and 'not at high risk' groups; although this disutility was substantially stronger in the former than the latter group (WTA = £356.84 and £88.44, respectively). In the 'not at high risk' group there was a statistically significant disutility for vaccinations provided by community nurses in a school-based vaccination bus (WTA = £104.17) and utility for vaccinations provided by health visitors in the community.
Parents in the 'at high risk' group also had statistically significant disutility for receipt of information on the benefits and risks of vaccinations in the form of charts and pictures (WTA = £186.12). Furthermore, only the 'not at high risk' group had a statistically significant positive preference (utility) for additional flexibility around availability of appointments.
Both subgroups expressed significant disutility for targeted rewards (WTA = £461.65 and £126.28 in the 'at high risk' and 'not at high risk' group, respectively), whereas only respondents at high risk of not fully vaccinating their children had a statistically significant utility for cash rewards. Increased value of rewards was statistically significant only in the 'not at high risk' group.
Finally, increased waiting times were associated with significant disutility in both subgroups (WTA values for each additional minute waiting after 30 minutes was £22.22 and £4.55 in the 'at high risk' and 'not at high risk' group, respectively).
Individual attitudes towards the organisation of vaccination services and attitudes towards financial rewards for preschool vaccinations were captured using the questionnaire which followed the DCE. The questionnaire also included open-ended WTA and WTP questions using the contingent valuation method. Results of these additional questions are presented in Table 16.
One-quarter of respondents stated that they would require a financial incentive to vaccinate their child, with a higher proportion of respondents in the 'at high risk' group than 'not at high risk' groups indicating this (31% vs. 19%). Of those who stated that they would require an incentive, the average 'minimum' WTA was £110 (greater in the 'at high risk' than in the 'not at high risk' group) and the most frequently cited reason was compensation for their time, followed by time off work.
Consistent with the results of the logit models, there was a generic preference for cash as opposed to voucher rewards as well as for universal as opposed to targeted rewards.
Although a large majority of respondents stated that they would not require a financial incentive to vaccinate their child, approximately 80% would accept one if offered. The maximum value of any incentive (for an unspecified vaccination programme) on average was £69.41 and was substantially larger in the 'at high risk' subgroup (£81.34) than in the 'not at high risk' group (£57.41). Again, the most common reason influencing these values was compensation for time to attend appointments.
Worthy of note is that approximately one-fifth of respondents expressed a preference for current organisation of vaccination services and a further one-fifth for mandatory schemes. Preference for the latter was greater in the 'not at high risk' subgroup (31% vs. 24%), but this difference was not statistically significant.
On average, the majority (76%) of respondents in the full sample stated an intention for their youngest child to receive all of the recommended vaccinations. Respondents in the 'at high risk' subgroup were significantly less likely to express an intention for their children to receive all the recommended vaccinations (69%) than those in the 'not at high risk' subgroup (83%).
Attitudes towards importance, value and efficacy of preschool vaccinations were also generally positive, with mean values of ≈4 for all items (Table 17). However, attitudes were significantly more positive in the 'not at high risk' subgroup, compared with the 'at high risk' group for 9 out of the 12 attitudes items (related to value/importance and safety of vaccinations). Significant differences in proportions of responses 'strongly disagree/not at all likely' were found between subgroups, with greater numbers of respondents in the 'at high risk group' stating 'strongly disagree/not at all likely' for items on perceived susceptibility of their child, other children and family members to serious disease if children are not immunised.
The majority of respondents (55%) stated that they had not received any information regarding vaccinations in the past 3 months, with similar proportions in both subgroups (Table 18). Of those who had received information, the majority reported that they had received this by post (67%). Respondents were also asked 'to what extent would you agree the information you received for your youngest child in the last 3 months addressed all your information needs about vaccination?'. Overall, 63% (n = 148) of the full sample responded strongly agreed or agreed with the statement.
Additional information regarding vaccinations was sought by 43% of respondents, including 49% of parents 'at high risk' of incompletely vaccinating their children and 37% of those 'not at high risk'. Information sources consulted by the full sample included the internet (57%), GP (43%) and friends or family (41%). There were no statistically significant differences between subgroups for any of the responses to the questions about vaccination information.
who receives the reward, for example universal or targeted (mean score 6.84, SD 1.32).
Appendix 7 presents the percentages of respondents choosing specific options from the 72 choice sets presented in the DCE as well as the predicted probability of uptake estimated from the mixed logit models.
Predicted uptake rates for a vaccination incentive scheme (i.e. options A or B) ranged from 13% (choice situation 27, option B; observed, 22%) to 85% (choice situation 27, option A; observed, 70%). Conversely, predicted uptake for the no vaccination scheme (i.e. opt-out option C) ranged from 2% (choice situation 4; observed, 3%) to 7% (choice situation 52; observed, 11%).
Predicted uptake rates, based on a hypothetical choice set forcing respondents to choose between the most preferred scenario [health visitor in the community at local clinic or children's centre; vaccination information: electronic (e-mail); risk information: numbers and charts/pictures; during working hours and out of hours; cash reward; value (£280); universal reward; waiting time (up to 30 minutes); ASC] and a current practice alternative [practice nurse; vaccination information: written (post); risk information: numbers; during working hours; type of reward: no reward; value (£0); parents receiving reward: no reward; waiting time (up to 30 minutes); ASC], were 66% for the most preferred scenario in the total sample (60% in the 'at high risk' sample, 55% in the 'not at high risk' sample), 32% for the current practice scenario in the total sample (38%; 44%) and 2% for the opt-out option (2%; 2%).
Similarly, for a choice set including the least preferred scenario [pharmacist; vaccination information: electronic (internet); risk information: charts/pictures; during working hours; shopping voucher; value (£0); targeted reward; waiting time (up to 120 minutes); ASC] current practice scenario and an opt-out option, the predicted uptake rates were estimated as 15% for the least preferred scenario in the total sample (36% in the at high risk sample, 33% in the not at high risk sample), 80% for the current practice scenario in the total sample (61%; 63%) and 5% for the opt-out option (3%; 3%).
This is the first DCE to investigate the differential configuration of vaccination services and their potential impact on parents' decisions to vaccinate their children in accordance with the full programme recommended by the NHS, including the efficacy of incentive-based schemes on service acceptability and uptake rates.
Analysis of choice set data from the DCE (hypothetical vaccination services described in the choice scenarios) revealed that ≈95% of parents had strong preferences for vaccinating their children and we found evidence of statistically significant preference heterogeneity for different characteristics of vaccination services.
In terms of type of health-care professional administering vaccinations and their location, there was a strong negative preference for pharmacists. Statistically significant negative preferences (disutility) were identified for vaccination services with three characteristics. In descending rank order of WTA these were (i) pharmacists with specialist training (compared with practice nurses within GP practices), with stronger disutility for this characteristic in the 'at high risk' group; (ii) targeted rewards to parents who are 'at high risk' of not adhering to the full vaccination programme (as opposed to universal rewards for all parents), which was stronger in the group 'at high risk' of incompletely vaccinating their children; and (iii) longer waiting times for each appointment with greater disutility, as indicated by WTA values in the 'at high risk' group per additional minute after 30 minutes had expired.
We also found evidence of differences in preferences for characteristics of vaccination services as a function of a parent's risk status. In those 'at high risk' of incompletely vaccinating their children, there were significant positive preferences (utility) for cash rewards for completing the full vaccination schedule (as opposed to no reward), and a significant disutility associated with presenting information on the risks and benefits of vaccinations using graphical methods (compared with only numerical presentation).
In those 'not at high risk' of incompletely vaccinating their children, there were significant positive preferences (utility) for provision of vaccinations by health visitors in the community and strong negative preferences for community nurses in a school-based vaccination bus. This group also preferred more flexible appointment times (out of hours). They also assigned greater utility to increasing reward values.
There were no statistically significant positive or negative preferences for mode of information provision about vaccinations (benefits and risks) prior to appointment (written vs. electronic).
Consistent with the results of the logit models, there was a generic preference for cash as opposed to voucher rewards as well as universal as opposed to targeted rewards in the attitudinal questionnaire. We also found evidence of a 'gift horse attitude' being adopted towards the issue of incentives. The majority of parents reported that they did not require a reward (the ≈20% who did reported an average 'minimum' WTA value of £110), but the majority would accept a financial reward for completion of the vaccination programme if it was offered to them (maximum value ranged from £57.41 in the 'not at high risk' group to £81.34 in the 'at high risk' group). Compensation for time to attend appointments was the factor that most influenced the rationale underpinning the minimum and maximum values suggested by parents.
There was minority support (≈20%) for current practice and for mandatory schemes, should they be rolled out, with support for the latter greater in those 'not at high risk' of incomplete vaccination (31%).
Responses to items about the intentions of parents for their youngest child to receive all of the recommended vaccinations were high, but not maximal (i.e. 76% overall), and there was a statistically significant lower rate of expressed intentions in the subgroup 'at high risk' of incomplete vaccination (69% vs. 83% in the 'not at high risk' group). In the full sample, attitudes towards the safety, importance/value and efficacy of immunisations was positive across both subgroups, although statistically significantly greater numbers of respondents in the 'at high risk' group stated 'strongly disagree/not all likely' for items on the perceived susceptibility of their child, other children and family members to serious disease if children are not vaccinated.
Approximately 50% of parents in both subgroups had not received any information about vaccinations in the past 3 months. Although the majority (63%, n = 148) were satisfied that the information they had received fulfilled all of their information needs, substantial numbers of respondents (43%) sought additional information, most frequently via the internet.
Strong opposition to pharmacists delivering vaccinations may be a result of concerns around safety and perceived adequacy of training. This is supported by comments to this effect from the Parent Advisory Group workshop in the development phase of this study. Disutility in parents 'not at high risk' of incompletely vaccinating their children for vaccinations provided by community nurses in vaccination buses located at schools may be attributable to these parents placing a greater value on flexibility. This is reflected in this subgroup having significant utility for health visitor-administered vaccinations in the community, and the availability of out-of-hours appointments.
It is not surprising that cash rewards were preferred by parents in the 'at high risk' group, given the lower-income status of these parents. However, increasing the value of a reward was associated with significant utility only in the subgroup of parents who were 'not at high risk' of incomplete vaccination. Therefore, cash and higher-value non-financial incentives may be more effective depending on the parents' inherent risk status.
Disutility for targeted rewards was found in the DCE logit regression models, the survey responses and in the discussions with the Parent Advisory Group. Reasons provided by Parent Advisory Group members were that some parents may be susceptible to 'game playing' in the form of strategically delaying vaccinations if they thought that a reward might be given. Furthermore, targeted rewards were considered by some parents in the Parent Advisory Group to represent a reward for 'bad behaviour' (i.e. not vaccinating children). The finding that parents 'at high risk' of incompletely vaccinating would be less willing to wait at vaccination appointments than those 'not at high risk' may be related to the former group experiencing greater difficulties with arranging child care or cover at work as well as other practical considerations while they are waiting for appointments (e.g. having more children to manage).
There is robust evidence that graphical displays such as bar graphs and pictographs can effectively support the communication of balanced probabilistic information to people irrespective of their health literacy level.105 However, parents 'at high risk' assigned disutility to this method of information provision. This was reflected in the Parent Advisory Group workshop, where examples of graphical display (pictographs and bar graphs) were not well received. This finding for disutility of graphical methods in the DCE may be an artefact created by presenting these options using textual descriptions as opposed to mocked-up examples.
The high proportion of parents reporting non-receipt of information within the past 3 months may be influenced by recall bias. It will also be influenced by the specific age of their children and whether or not the children were due vaccinations in the previous 3 months. However, this finding provides some further evidence that quality information provision is currently suboptimal, and this was supported by comments made in the Parent Advisory Group.
The use of the internet is common to investigate issues relating to health. However, not all sites are reputable and there is a risk of parents being exposed to inaccessible, unbalanced and unreliable information that may impact on their decisions about vaccinating their children.
Suboptimal intentions to vaccinate their youngest child were more pronounced in those identified as 'at high risk' of incompletely vaccinating their children. This may in part be related to disutility associated with long waiting times for appointments, suboptimal information provision and lower perceived susceptibility of their child, other children and family members to serious disease if children are not vaccinated.
A major strength of our approach to eliciting preferences for different characteristics of vaccination services is the use of a DCE embedded within an online survey. We adhered to best practice guidelines for design and development of DCEs (with a clear audit trail and engagement of an expert Parent Advisory Group) and survey questionnaires to maximise internal validity and external validity.
The strength of the DCE approach is that it permits an examination of multiple factors influencing decision-making and that all choices involve trade-offs between levels of multiple factors, which cannot be readily elucidated, rank ordered or quantified using other methods. The increased internal and external validity of the DCE approach is evidenced by findings of the ranking exercise that does not account for preferences as a function of different levels of attributes or their complex trade-offs with levels of other attributes. Moreover, we incorporated WTA terms into the DCE analyses to facilitate the interpretation of results in terms of the strength of positive or negative preferences.
Discrete choice experiments have been criticised as difficult for participants to understand. To minimise the risk of this we conducted substantial development work. The overwhelming majority of respondents indicated a good understanding of the DCE.
We acknowledge that the sample recruited by the research company is effectively a non-random (convenience) sample that may not be representative of the target population. Furthermore, by using the recruitment method we did, it is not possible to determine response rates to the survey. However, we asked ResearchNow to recruit a national sample of parents that fulfilled our inclusion criteria, which were stratified into groups according to pre-defined criteria in order to maximise representativeness. Previous DCE research suggests that alternative methods of recruitment and data collection in this context, such as random postal or telephone surveys, achieve very low response rates, which also threatens representativeness.123 By using a stratified sampling matrix we were at least able to ensure a degree of representativeness in the sample.
We combined health-care professional delivering immunisations and the place of delivery of immunisations into one attribute. Although these may be seen as separate constructs, they are inextricably linked, and separating them out would have imposed a prohibitive number of design constraints, which would have had negative implications for the model parameters and conclusions that could be drawn from the results.
As with the qualitative study, we were primarily asking participants to reflect on interventions that few, if any, of them would have had any personal experience of. This may have limited their ability to give fully informed opinions.
Furthermore, and as with the qualitative study, we restricted the DCE to consideration of incentives for parents of children who had fully completed the preschool vaccination schedule described in Table 1. This was both to reflect existing practice, as described in the systematic review, and because partially rewarding partial immunisation would have introduced significant complexity into the design of the DCE.
Respondents desired probabilistic information about the benefits and risks of vaccination and expressed strong preferences for numerical presentation of these data. Natural frequencies using consistent denominators (out of 100 children aged under 5 years) are likely to impact positively on parents' understanding and perceptions of the benefits of vaccination. It is also important to ensure that parents receive this information prior to appointments. There is also a pressing need to evaluate the impact of probabilistic information on perceptions of benefit from vaccination and uptake rates. More research is needed to engage parents in an iterative codesign process to design optimally acceptable and usable information that conveys robust and balanced data on the consequences of disease and the benefits and risks of vaccinations.
According to our findings, incentive-based schemes are likely to be optimal in future vaccination service design. However, the cost of rolling out incentive-based schemes may be prohibitive and may prove difficult to justify. Mandatory schemes may, therefore, be the next best alternative for increasing uptake rates for vaccination services, although in this study only a minority of parents preferred these. The factors that may increase acceptance of mandatory schemes warrant further research and additional DCEs could be conducted to explore parental preferences for how a mandate for vaccination might be imposed.
Differences in predicted uptake rates for the most and least preferred scenarios in the DCE show that the specification of a financial incentive scheme is essential when aiming to effectively increase vaccination rates among the population in general or across specific subgroups. According to our findings, any policy that specifically targets specific groups using incentives would meet significant resistance, as there were strong negative preferences for targeted incentives.
Furthermore, taking into account similarities and differences in preferences expressed by parents 'at high risk' and 'not at high risk' of completing the full programme could be valuable for any policy directive at improving uptake rates. This will serve to maintain uptake rates in parents who are likely to complete the full programme and potentially increase uptake rates in the high-risk group.
Findings from the DCE suggest that universal rewards would be acceptable and could be made available as a cash payment or voucher (with the latter at an increased monetary value). A public education campaign may also be warranted, given suboptimal intentions to vaccinate, low perceived susceptibility to serious disease if children are not vaccinated and issues related to information provision. However, such campaigns are expensive and frequently do not impact on the actual behaviour of the public. An alternative would be to review and update the information currently provided to include robust, probabilistic information on the consequences of disease and the net benefit from vaccination.
This is the first use of a DCE to elicit parental preferences for the optimal organisation of vaccination services and the relative importance of different service configurations. We found that universal 'high-value' rewards, in the form of cash payments for parents, are likely to increase uptake rates within populations 'at high risk' of incomplete vaccination without any negative impact on current high uptake rates of those 'not at high risk' of incomplete vaccination. The cost of incentives could be offset to some extent by offering additional flexibility in terms of alternative community settings for vaccinations and out-of-hours appointments. The provision of robust and balanced information on consequences of disease and the benefits and risks of vaccination in numerical format prior to appointments is also likely to increase uptake rates. Further research to optimise the provision and quality of such information is warranted. Mandatory schemes may be more acceptable alternatives to incentives, and further research should investigate parental preferences for the organisation of such schemes.
Copyright © Queen's Printer and Controller of HMSO 2015. This work was produced by Adams et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.
Included under terms of UK Non-commercial Government License.
Adams J, Bateman B, Becker F, et al. Effectiveness and acceptability of parental financial incentives and quasi-mandatory schemes for increasing uptake of vaccinations in preschool children: systematic review, qualitative study and discrete choice experiment. Southampton (UK): NIHR Journals Library; 2015 Nov. (Health Technology Assessment, No. 19.94.) Chapter 5, Discrete choice experiment.


text:
Dieser Artikel listet Erfolge und Fahrer des Radsportteams Eddy Merckx-Indeland in der Saison 2012 auf.

Platzierungen in UCI-Ranglisten

Zugänge – Abgänge

Mannschaft

Weblinks

Radsportteam 2012

redpajama_set_name: RedPajamaWikipedia


text:
Q: Execute a string in C# 4.0 I want to execute dynamically created string in C#. I know VB and JScript.Net can do it, and there is even a way to use its assembly in C# as a workaround. I also found this article describing how to do it.
I read today about C# 4.0 features which bring it closer to the dynamic languages that have this as one of the main features. So, does anybody know does C# 4.0 includes some built in features that allows for string execution, or any other way to do whats described in the article above.

A: At the moment, the CSharpCodeProvider (in the article you cite) is the only way in the MS .NET implementation. The "compiler as a service" is one of the .NET vFuture features, and provides exactly what you ask for. Mono 2.x already has something comparable, IIRC (as discussed here).

A: This is dead easy to do. I built the following convenience wrappers. They are structured so that you can construct an assembly from fragments of source code defining methods or expressions and invoke them by name using the helper methods of DynamicCodeManager.
The code is compiled on demand in response to invocation. Adding more methods will cause automatic recompilation on next invocation.
You provide only a method body. If you don't want to return a value then return null and don't bother to use the object returned by InvokeMethod.
If you use this in commercial code do me a favour and credit my work. The real jewel in this library is the invocation support. Getting the code to compile isn't the problem, it's invocation. It's quite tricky to get reflection to correctly match the method signature when you have a variable length parameter list. This is the reason for the existence of DynamicBase: the compiler resolves method binding to this explicitly declared base class giving us access to the right VMT. From there on in it all comes out in the wash.
I should also point out that this capability makes your desktop application vulnerable to script injection attacks. You should either take great care to vet the origin of script or reduce the trust level under which the generated assembly runs.
DynamicBase.cs
using System.Reflection;

namespace Dynamo
{
  public abstract class DynamicBase
  {
    public bool EvaluateCondition(string methodName, params object[] p)
    {
      methodName = string.Format("__dm_{0}", methodName);
      BindingFlags flags = BindingFlags.InvokeMethod | BindingFlags.Instance | BindingFlags.NonPublic;
      return (bool)GetType().InvokeMember(methodName, flags, null, this, p);
    }
    public object InvokeMethod(string methodName, params object[] p)
    {
      BindingFlags flags = BindingFlags.InvokeMethod | BindingFlags.Instance | BindingFlags.NonPublic;
      return GetType().InvokeMember(methodName, flags, null, this, p);
    }
    public double Transform(string functionName, params object[] p)
    {
      functionName = string.Format("__dm_{0}", functionName);
      BindingFlags flags = BindingFlags.InvokeMethod | BindingFlags.Instance | BindingFlags.NonPublic;
      return (double)GetType().InvokeMember(functionName, flags, null, this, p);
    }
  }
}

DynamicCodeManager.cs
using System;
using System.CodeDom.Compiler;
using System.Collections.Generic;
using System.Diagnostics;
using System.Reflection;
using System.Text;
using Microsoft.CSharp;

namespace Dynamo
{
  public static class DynamicCodeManager
  {
    #region internal statics and constants
    static Dictionary<string, string> _conditionSnippet = new Dictionary<string, string>();
    static Dictionary<string, string> _methodSnippet = new Dictionary<string, string>();
    static string CodeStart = "using System;\r\nusing System.Collections.Generic;\r\n//using System.Linq;\r\nusing System.Text;\r\nusing System.Data;\r\nusing System.Reflection;\r\nusing System.CodeDom.Compiler;\r\nusing Microsoft.CSharp;\r\nnamespace Dynamo\r\n{\r\n  public class Dynamic : DynamicBase\r\n  {\r\n";
    static string DynamicConditionPrefix = "__dm_";
    static string ConditionTemplate = "    bool {0}{1}(params object[] p) {{ return {2}; }}\r\n";
    static string MethodTemplate = "    object {0}(params object[] p) {{\r\n{1}\r\n    }}\r\n";
    static string CodeEnd = "  }\r\n}";
    static List<string> _references = new List<string>("System.dll,System.dll,System.Data.dll,System.Xml.dll,mscorlib.dll,System.Windows.Forms.dll".Split(new char[] { ',' }));
    static Assembly _assembly = null;
    #endregion

    public static Assembly Assembly { get { return DynamicCodeManager._assembly; } }

    #region manage snippets
    public static void Clear()
    {
      _methodSnippet.Clear();
      _conditionSnippet.Clear();
      _assembly = null;
    }
    public static void Clear(string name)
    {
      if (_conditionSnippet.ContainsKey(name))
      {
        _assembly = null;
        _conditionSnippet.Remove(name);
      }
      else if (_methodSnippet.ContainsKey(name))
      {
        _assembly = null;
        _methodSnippet.Remove(name);
      }
    }

    public static void AddCondition(string conditionName, string booleanExpression)
    {
      if (_conditionSnippet.ContainsKey(conditionName))
        throw new InvalidOperationException(string.Format("There is already a condition called '{0}'", conditionName));
      StringBuilder src = new StringBuilder(CodeStart);
      src.AppendFormat(ConditionTemplate, DynamicConditionPrefix, conditionName, booleanExpression);
      src.Append(CodeEnd);
      Compile(src.ToString()); //if the condition is invalid an exception will occur here
      _conditionSnippet[conditionName] = booleanExpression;
      _assembly = null;
    }

    public static void AddMethod(string methodName, string methodSource)
    {
      if (_methodSnippet.ContainsKey(methodName))
        throw new InvalidOperationException(string.Format("There is already a method called '{0}'", methodName));
      if (methodName.StartsWith(DynamicConditionPrefix))
        throw new InvalidOperationException(string.Format("'{0}' is not a valid method name because the '{1}' prefix is reserved for internal use with conditions", methodName, DynamicConditionPrefix));
      StringBuilder src = new StringBuilder(CodeStart);
      src.AppendFormat(MethodTemplate, methodName, methodSource);
      src.Append(CodeEnd);
      Trace.TraceError("SOURCE\r\n{0}", src);
      Compile(src.ToString()); //if the condition is invalid an exception will occur here
      _methodSnippet[methodName] = methodSource;
      _assembly = null;
    }
    #endregion

    #region use snippets
    public static object InvokeMethod(string methodName, params object[] p)
    {
      DynamicBase _dynamicMethod = null;
      if (_assembly == null)
      {
        Compile();
        _dynamicMethod = _assembly.CreateInstance("Dynamo.Dynamic") as DynamicBase;
      }
      return _dynamicMethod.InvokeMethod(methodName, p);
    }

    public static bool Evaluate(string conditionName, params object[] p)
    {
      DynamicBase _dynamicCondition = null;
      if (_assembly == null)
      {
        Compile();
        _dynamicCondition = _assembly.CreateInstance("Dynamo.Dynamic") as DynamicBase;
      }
      return _dynamicCondition.EvaluateCondition(conditionName, p);
    }

    public static double Transform(string functionName, params object[] p)
    {
      DynamicBase _dynamicCondition = null;
      if (_assembly == null)
      {
        Compile();
        _dynamicCondition = _assembly.CreateInstance("Dynamo.Dynamic") as DynamicBase;
      }
      return _dynamicCondition.Transform(functionName, p);
    }
    #endregion

    #region support routines
    public static string ProduceConditionName(Guid conditionId)
    {
      StringBuilder cn = new StringBuilder();
      foreach (char c in conditionId.ToString().ToCharArray()) if (char.IsLetterOrDigit(c)) cn.Append(c);
      string conditionName = cn.ToString();
      return string.Format("_dm_{0}",cn);
    }
    private static void Compile()
    {
      if (_assembly == null)
      {
        StringBuilder src = new StringBuilder(CodeStart);
        foreach (KeyValuePair<string, string> kvp in _conditionSnippet)
          src.AppendFormat(ConditionTemplate, DynamicConditionPrefix, kvp.Key, kvp.Value);
        foreach (KeyValuePair<string, string> kvp in _methodSnippet)
          src.AppendFormat(MethodTemplate, kvp.Key, kvp.Value);
        src.Append(CodeEnd);
        Trace.TraceError("SOURCE\r\n{0}", src);
        _assembly = Compile(src.ToString());
      }
    }
    private static Assembly Compile(string sourceCode)
    {
      CompilerParameters cp = new CompilerParameters();
      cp.ReferencedAssemblies.AddRange(_references.ToArray());
      cp.ReferencedAssemblies.Add(Assembly.GetExecutingAssembly().ManifestModule.FullyQualifiedName);
      cp.CompilerOptions = "/target:library /optimize";
      cp.GenerateExecutable = false;
      cp.GenerateInMemory = true;
      CompilerResults cr = (new CSharpCodeProvider()).CompileAssemblyFromSource(cp, sourceCode);
      if (cr.Errors.Count > 0) throw new CompilerException(cr.Errors);
      return cr.CompiledAssembly;
    }
    #endregion

    public static bool HasItem(string methodName)
    {
      return _conditionSnippet.ContainsKey(methodName) || _methodSnippet.ContainsKey(methodName);
    }
  }
}

A: There's no other way of executing arbitrary C# source code other than compiling it into assembly and then executing it. Anders Hejlsberg (architect of C#) announced plans to expose the C# compiler as a service (basically a set of CLR classes), so this might be of some help when this happens.
"Compiler as a Service" basically means that you can compile an arbitrary piece of code into Expression or, better yet, into an AST and generally get hold of internal compiler workings.

A: This has not much to do with dynamic features of C# 4.0. Rather, the enhancements of the managed compiler and exposing its data structures to managed code makes it so easy.

A: Is it essential that the language in the string be C#?
I know that Java can execute Python and Ruby dynamically if you include the relevant Jars, and I can't see why someone wouldn't have thought to port these systems to C# and .NET.

A: You could dynamically create a XSLT document in memory that includes a c# extension method.
The actual transformation could be little more then passing parms to the extension method and return results.
But the cited article is probably easier to use....
Whats the problem with using that code?

redpajama_set_name: RedPajamaStackExchange


text:
Identification of novel compounds that inhibit S100P and RAGE binding as a new therapy for Pancreatic Cancer
Louise MacKenzie
Pancreatic adenocarcinoma (PDAC) is one of the most lethal human cancers with a 5-year survival of less than 5% due mostly to the lack of effective therapy and difficulty of detection at an early stage of development. Recent studies have shown a high prevalence of S100 proteins in PDAC, in particular the calcium-binding protein S100P. It has been proposed that the metastasis-promoting calcium-binding protein S100P which possesses both intracellular and extracellular functions activates key cell signaling pathways, including MAP kinase and nuclear factor NFκB pathways through its extracellular interaction with the receptor for advanced glycation end products (RAGE). The interaction between RAGE-S100P stimulates pancreatic tumor proliferation, survival, invasion and metastasis progression in vitro and tumor metastasis in vivo. Using computational chemistry methods, our laboratory have identified 87 novel compounds that prevent S100P binding to RAGE. Here in this talk we will outline the key challenges and methodology used to validate an ELISA to measure S100P and RAGE interaction. Our initial results highlight 22 new lead compounds that inhibit S100P-RAGE interaction, some of which have shown an ability to decrease pancreatic cell line growth. This work is supported by the Association for International cancer research and the University of Hertfordshire.
Published - 24 Aug 2015
Molecular Medicine - London, United Kingdom
Duration: 24 Aug 2015 → …
Molecular August 2015 Mackenzie RCAccepted author manuscript, 94.4 KB
Dive into the research topics of 'Identification of novel compounds that inhibit S100P and RAGE binding as a new therapy for Pancreatic Cancer'. Together they form a unique fingerprint.
Receptor for Advanced Glycation End Products Medicine & Life Sciences 100%
Calcium-Binding Proteins Medicine & Life Sciences 38%
Neoplasm Metastasis Medicine & Life Sciences 28%
Computational Chemistry Medicine & Life Sciences 26%
S100 Proteins Medicine & Life Sciences 18%
L.Mackenzie2brighton.acuk
School of Applied Sciences - Principal Lecturer
Centre for Stress and Age-Related Disease
MacKenzie, L. (2015). Identification of novel compounds that inhibit S100P and RAGE binding as a new therapy for Pancreatic Cancer. Abstract from Molecular Medicine, London, United Kingdom.
MacKenzie, Louise. / Identification of novel compounds that inhibit S100P and RAGE binding as a new therapy for Pancreatic Cancer. Abstract from Molecular Medicine, London, United Kingdom.
@conference{70fe69b3fdf1444f87d52476186dd482,
title = "Identification of novel compounds that inhibit S100P and RAGE binding as a new therapy for Pancreatic Cancer",
abstract = "Pancreatic adenocarcinoma (PDAC) is one of the most lethal human cancers with a 5-year survival of less than 5% due mostly to the lack of effective therapy and difficulty of detection at an early stage of development. Recent studies have shown a high prevalence of S100 proteins in PDAC, in particular the calcium-binding protein S100P. It has been proposed that the metastasis-promoting calcium-binding protein S100P which possesses both intracellular and extracellular functions activates key cell signaling pathways, including MAP kinase and nuclear factor NFκB pathways through its extracellular interaction with the receptor for advanced glycation end products (RAGE). The interaction between RAGE-S100P stimulates pancreatic tumor proliferation, survival, invasion and metastasis progression in vitro and tumor metastasis in vivo. Using computational chemistry methods, our laboratory have identified 87 novel compounds that prevent S100P binding to RAGE. Here in this talk we will outline the key challenges and methodology used to validate an ELISA to measure S100P and RAGE interaction. Our initial results highlight 22 new lead compounds that inhibit S100P-RAGE interaction, some of which have shown an ability to decrease pancreatic cell line growth. This work is supported by the Association for International cancer research and the University of Hertfordshire.",
author = "Louise MacKenzie",
note = "Molecular Medicine ; Conference date: 24-08-2015",
MacKenzie, L 2015, 'Identification of novel compounds that inhibit S100P and RAGE binding as a new therapy for Pancreatic Cancer', Molecular Medicine, London, United Kingdom, 24/08/15.
Identification of novel compounds that inhibit S100P and RAGE binding as a new therapy for Pancreatic Cancer. / MacKenzie, Louise.
2015. Abstract from Molecular Medicine, London, United Kingdom.
T1 - Identification of novel compounds that inhibit S100P and RAGE binding as a new therapy for Pancreatic Cancer
AU - MacKenzie, Louise
N2 - Pancreatic adenocarcinoma (PDAC) is one of the most lethal human cancers with a 5-year survival of less than 5% due mostly to the lack of effective therapy and difficulty of detection at an early stage of development. Recent studies have shown a high prevalence of S100 proteins in PDAC, in particular the calcium-binding protein S100P. It has been proposed that the metastasis-promoting calcium-binding protein S100P which possesses both intracellular and extracellular functions activates key cell signaling pathways, including MAP kinase and nuclear factor NFκB pathways through its extracellular interaction with the receptor for advanced glycation end products (RAGE). The interaction between RAGE-S100P stimulates pancreatic tumor proliferation, survival, invasion and metastasis progression in vitro and tumor metastasis in vivo. Using computational chemistry methods, our laboratory have identified 87 novel compounds that prevent S100P binding to RAGE. Here in this talk we will outline the key challenges and methodology used to validate an ELISA to measure S100P and RAGE interaction. Our initial results highlight 22 new lead compounds that inhibit S100P-RAGE interaction, some of which have shown an ability to decrease pancreatic cell line growth. This work is supported by the Association for International cancer research and the University of Hertfordshire.
AB - Pancreatic adenocarcinoma (PDAC) is one of the most lethal human cancers with a 5-year survival of less than 5% due mostly to the lack of effective therapy and difficulty of detection at an early stage of development. Recent studies have shown a high prevalence of S100 proteins in PDAC, in particular the calcium-binding protein S100P. It has been proposed that the metastasis-promoting calcium-binding protein S100P which possesses both intracellular and extracellular functions activates key cell signaling pathways, including MAP kinase and nuclear factor NFκB pathways through its extracellular interaction with the receptor for advanced glycation end products (RAGE). The interaction between RAGE-S100P stimulates pancreatic tumor proliferation, survival, invasion and metastasis progression in vitro and tumor metastasis in vivo. Using computational chemistry methods, our laboratory have identified 87 novel compounds that prevent S100P binding to RAGE. Here in this talk we will outline the key challenges and methodology used to validate an ELISA to measure S100P and RAGE interaction. Our initial results highlight 22 new lead compounds that inhibit S100P-RAGE interaction, some of which have shown an ability to decrease pancreatic cell line growth. This work is supported by the Association for International cancer research and the University of Hertfordshire.
M3 - Abstract
T2 - Molecular Medicine
Y2 - 24 August 2015
MacKenzie L. Identification of novel compounds that inhibit S100P and RAGE binding as a new therapy for Pancreatic Cancer. 2015. Abstract from Molecular Medicine, London, United Kingdom.

redpajama_set_name: RedPajamaCommonCrawl


Fix issue where PvP stats was not always registered for all players of the game.
Sparta ranked match reward now more Empire Points.
Sparta ranked match reward now more Sparta Points.
Day/Night effect has been add to Skirmish and PvP maps.
Allie AI Skirmish have been updated to be more able to defend them selves.


text:
Nyceryx furtadoi is a moth of the  family Sphingidae. It is known from Brazil, Bolivia and Paraguay. It is possibly also found in Argentina.

The wingspan is about 60 mm. It can be distinguished from all other Nyceryx species by the relatively uniform pale brown ground colour of the forewing upperside, on which the transverse lines form a conspicuous striped pattern, and the oversized discal spots.

Adults are probably on wing year round and have been recorded from September to October in Brazil and in August in Paraguay.

References

Nyceryx
Moths described in 1996


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Silicon Valley slang for a company that was developed in somebody's garage (or on someone's kitchen table) but has now moved into its first real office and is considered professional. The term arose from the fact that approximately 12 percent of Internet start-ups are actually started "out of garages" or in residential areas.
Historical perspective: Hewlett-Packard is a well-known example of a company founded by two men, William Hewlett and Bill Packard, who started by working out-of-the-garage. Same with Apple, Steve Jobs and Steve Wozniak started Apple out-of-the-garage too.


This handwoven scarf is made of mulberry silk and handspun khadi cotton. The base is alternating a pink and a soft orange silk with various soft orange cotton stripes woven in. One end is pink silk, the other is orange silk.


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ANALYSIS: Lee Zeldin's House Floor Speech On Election Was Deficient In Facts
Brendan J. O'Reilly - January 8, 2021
UPDATE: Zeldin Defends Objections In Wake Of Rioting; Predecessor Calls Stance 'Perpetuation Of A Lie'
Zeldin Still Not Acknowledging Biden Victory, Defends Trump Attacks On Election
Election 2020 Saw Record-Setting Turnout In Suffolk; Even Split Of Support For Trump, Biden
Democrats Hope To Land Blows In A Virtual Congressional Campaign
Elections & Politics Stephen J. Kotz - April 22, 2020
Suffolk County Legislator Bridget Fleming, East Hampton businessman Perry Gershon, and Stony Brook University chemistry professor Nancy Goroff, the three Democratic challengers, have been forced to abandon live campaign rallies, candidate forums, fundraising events, and even door-to-door canvassing during the shutdown caused by the coronavirus pandemic.
Schneiderman, Bouvier Endorse Fleming In Bid For Democratic Nomination For 1st District Seat
Elections & Politics Bill Sutton - April 17, 2020
On Monday, Southampton Town Supervisor Jay Schneiderman and Town Councilman John Bouvier announced their support for Ms. Fleming in the 1st Congressional District race.
And Dave Driscoll Makes It Seven, In Growing East Hampton Village Election Scrum
Elections & Politics Michael Wright - April 2, 2020
On Saturday, Village Trustee and mayoral candidate Arthur Graham announced that he will now be running in tandem with a new candidate, David Driscoll, who will join a now four-way race for one of two trustee seats that will be on the ballot.
Former Schivaoni Campaign Staffer Claims She Was Victim Of Sexual Harassment
Elections & Politics Bill Sutton - March 11, 2020
The former director of interns for Tommy John Schiavoni's State Senate campaign claimed in a Facebook post this week that she was the victim of sexual harassment by Brookhaven Town Democratic Committee members — and was fired from her paid position because she reported the harassment.
Tommy John Schiavoni Endorsed By East End Supervisors For State Senate Bid
Elections & Politics Bill Sutton - February 20, 2020
Southampton Town Board member and State Senate hopeful Tommy John Schiavoni announced this week that he has received three key endorsements in his bid to seek the Democratic nomination for the 1st District Senate seat.
Assemblyman Anthony Palumbo Announces Bid For LaValle's Seat
Elections & Politics Greg Wehner - February 5, 2020
Just weeks after State Senator Kenneth P. LaValle announced he was not seeking reelection to his post, after serving the 1st District of New York for 44 years, Assemblyman Anthony Palumbo, a Republican like Mr. LaValle, has thrown his name into the mix as a candidate for the seat.
Thiele Throws His Support Behind Fleming In 1st District Congressional Race
Elections & Politics Editorial Board - January 29, 2020
Suffolk County Legislator Bridget Fleming, who is seeking the Democratic nomination to challenge Republican U.S. Representative Lee Zeldin, this week announced that State Assemblyman Fred W. Thiele Jr. had endorsed her candidacy.
Schaivoni Retracted LaValle Statement
Elections & Politics Kathryn G. Menu - January 17, 2020
Tommy John Schiavoni, the Southampton Town Councilman from Sag Harbor running for New York State Senate, retracted a statement critical of Senator Kenneth P. LaValle shortly after it was released following the announcement of Mr. LaValle's retirement late last week.
Fleming Picks Up Two Endorsements In Congressional Bid
Elections & Politics Stephen J. Kotz - January 15, 2020
Suffolk County Legislator Bridget Fleming, who is seeking the Democratic nomination to challenge incumbent Republican Lee Zeldin for his 1st District seat in the U.S. House of Representatives in November, has picked up two key East End endorsements.
Friends, Colleagues, Family Honor State Senator Kenneth P. LaValle At Retirement Announcement On Friday
Elections & Politics Bill Sutton - January 15, 2020
The mood was bittersweet at the Village Center in Port Jefferson on Friday morning as New York State Senator Kenneth P. LaValle's friends, family and colleagues — from both sides of the aisle — honored him as he made an official announcement that he will not seek reelection to another term in the State Senate in Albany next year.
Q&A: State Senator Kenneth P. LaValle Reflects On 44 Years In Albany
Elections & Politics Joseph P. Shaw - January 15, 2020
Just prior to the official announcement on Friday, Mr. LaValle agreed to a conversation covering his time in office, his most important friendship and what's next in his professional life.
Candidates Weigh In On LaValle Retirement
Zeldin Votes Against Impeachment, Blasts Democrats For 'Schiff Show'
Elections & Politics Michael Wright - December 23, 2019
The South Fork's congressman, U.S. Representative Lee Zeldin, cast an emphatic "nay" vote on Wednesday evening, December 18, in the historic action by the House of Representatives to impeach President Donald J. Trump.
Fleming To Seek Democratic Party Nomination to Unseat Zeldin
Elections & Politics Kathryn G. Menu - November 27, 2019
Just three weeks after securing reelection to her seat on the Suffolk County Legislature, Democratic Legislator Bridget Fleming on Tuesday morning announced plans to...
Tommy John Schiavoni Announces State Senate Run
Elections & Politics Greg Wehner - November 18, 2019
Southampton Town Board member and Sag Harbor resident Tommy John Schiavoni announced his candidacy for State Senate on Friday
27Speaks: Anxiety About The Rush To Get Vaccinated Against COVID-19
News Editorial Board - January 16, 2021
In this week's edition of 27Speaks, the editors are joined by senior reporter Michael Wright for a discussion about the ongoing rollout of the COVID-19 vaccine, and the questions, confusion and anxiety about getting vaccinated.
Amy Kirwin is Guild Hall's Inaugural Chief Creative Officer
Arts & Leisure Annette Hinkle - January 13, 2021
It was early 2011 when Amy Kirwin and Andrea Grover first met at the Parrish Art Museum in Southampton, and it wasn't long before the two artistic souls realized they were kindred spirits. "We're like twins. I came out of the womb first," said Kirwin, who arrived on the East End in the fall of 2010, just three months ahead of Grover.
Sag Harbor Publisher Dr. Martin Shepard Dies
Arts & Leisure Karl Grossman - January 13, 2021
Dr. Martin Shepard, a psychiatrist, author, and with his wife, Judith, a trailblazing publisher, has died. Dr. Shepard passed away at his home in Sag Harbor surrounded by family on December 17, 2020, after a brief illness. He was 86.
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Jerusalem: First photographs from Israel's TecSAR satellite, launched into space two weeks ago by Indian space agency ISRO, was received by Israeli ground stations for the first time Wednesday.
TecSAR manufacturer, Israel Aerospace Industries (IAI), reported that the satellite, which is Israel's most advanced, was working perfectly. The IAI added that satellite's first photos, including a topographical picture of the Latrun memorial monument, were transmitted with a very high quality.
The Latrun monument serves as a memorial site of the Israeli Armoured Corps.
Yitzhak Nitzan, head of IAI, said the satellite's capabilities were a huge technological achievement. According to Nitzan, the IAI had begun the TecSAR project with little knowledge and considerable financial constraints, but had managed to achieve perfect results.
Israeli Defence establishment officials have stated earlier that the TecSAR is Israel's best satellite to date. It was sent into orbit from the Sriharikota Launching Range in India on the back of an Indian rocket, the Polar Satellite Launch Vehicle (PSLV).
The TecSAR uses radar to identify targets under all weather conditions, including dense clouds. The radar sets it apart from other Israeli reconnaissance satellites, such as those from the Ofek series, which rely on cameras. It's sophisticated systems can spot an object the size of a license plate or "even smaller," according to Israeli security officials.


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Prodigal Son comes Home: Patrice Bernier joins the Montreal Impact
By Sofiane Benzaza@sofianebenzaza Mar 6, 2012, 2:58pm EST
Share All sharing options for: Prodigal Son comes Home: Patrice Bernier joins the Montreal Impact
via www.impactmontreal.com
Now that I have your attention with the "prodigal son" title, it is great news to see that the Montreal Impact have signed home boy, Patrice Bernier, to an MLS contract adding depth,experience,talent, professionalism and more to the 19th MLS franchise.
Before talking about the signing, what will it bring to the team and more, I would like to congratulate the Impact for a classy, informative press conference in which everything was pretty much clear and to the point. including:
The recruiting process and the back and forth between Jesse Marsch and Patrice Bernier
The expectations that the Montreal Impact have for Patrice Bernier
Patrice Bernier's expectations towards the Montreal Impact and himself as per his role on and off the field
Kudos to Jesse Marsch for making the regular effort of starting his official press conferences with a few French sentences, showing respect to the culture without going overboard. From A to Z, the Montreal Impact are giving the Montreal Canadiens a lesson in PR with clear and concise messages, no smokes and mirrors.
Prodigal Son?
Being Canadian, hence filling one of the 3 mandatory Canadian spots (as per MLS roster Rules) , Quebecer and Montrealer, Patrice Bernier would be the perfect candidate for being a hero and son of this city in the realm of soccer.But Patrice Bernier is neither a hero nor a prodigal son. He is a soccer player with his qualities and faults who will bring his experience, poise, intensity and professionalism, qualities that an expansion team will look for to build its foundations with.
You know that a team and coach are interested in a player when the coach takes the time to travel to Denmark to watch the player play and talk to him. Jesse Marsch has indicated to have an eye on Patrice Bernier since taking the job in Montreal and did not shy away from complimenting him for what he can bring on the pitch. Keywords like ''saavy, intelligence, tactical awareness'' were words used by Marsch, words that were not chosen randomly and carefully weighted.
Bernier's leadership quality was a big factor in the signing of Patrice Bernier as Jesse Marsch and the whole Impact organization expect him to take on a leadership role within the team. The newly acquired midfielder appreciated Jesse Marsch's trip to Denmark as both men were able the team's plans for him and where/how would he fit in those plans.
Local content but not by default
With a resume that includes playing in Germany, Norway and Denmark, and 40+ International cap with the Canadian National Team, Patrice Bernier is bringing more than the home boy feel to the team. Actually, Jesse Marsch, Nick De Santis (Sporting Director) and Patrice Bernier himself quickly stated that as much as being a local player is important, it is the soccer component that is important. Soccer wise is where the importance lies and the Montreal Impact will make Patrice Bernier an important piece of their team. Once again the Montreal Impact have quickly stated the rules of the game, unlike the Montreal Canadiens, about their recruitement process.
As much as the Montreal Impact is a Montreal and Quebec organisation, it also recognizes excellence, added value and performance. Patrice Bernier says it himself when he states that as much as he appreciates coming back home, he is back for the pitch and the rest is more of a bonus (that he will gladly take). He understands that he has a role to play as local player playing for his hometown in the MLS without ever forgetting that it's all about what happens on the field.
Taking us to the next point, like we say in French ''La verite est sur le terrain'' : the truth is in the field.
The Truth is on the Field
As a 32 year-old, Patrice Bernier understands where he stands in his career, what he can bring to the team and what he can learn. Coming from Europe where the game is more tactical and strategy oriented, he realizes that the MLS is a whole new game and is humble enough to realize that and wanting the challenge. Usually, a defensive midfielder, Patrice Bernier could prove to bring some offense knowing that the MLS has a more open style of play than Europe.
Nick De Santis re-inforced the importance of having the right player for the right team tagging the signing to ''make sense'' for both parties. The Montreal Impact will get 10 years of overseas experience and soccer mileage from Patrice Bernier but also realizes that an adjustement period will be needed ''but all the other stuff is bonus, from him to be a local player'', well said by Nick De Santis.
I cannot stress that enough in a city like Montreal that jumps at every language violation , that forsters an umbilical relationship for having the local player at all cost, with no regard to soccer skills beyond a superficial analysis that does not look at the real fit of the player in the team, in the organization.
As a central midfielder, in a more defensive role, Patrice Bernier will be playing an important position as per defensive awareness, ball distribution, offensive support for the attacking players and defensive support for the defensive players. Jesse Marsch has an interesting connection to Patrice Bernier as he played the same position in his MLS days as a player. He recognizes that Bernier ''is already equipped with so many of the tools in that spot'' to be successfull in that position but leaves room for improvement and showed confidence in being able to ''make him better'' as a player.
Congratulations to the Montreal Impact for a good signing that many Montrealers hoped. The signing makes total sense soccer wise, the only factor that should count for an expansion team that needs to built correctly and not please via a PR game that will make them sign a local player for the wrong reasons.
Birth date: September 23, 1979, Brossard, Québec
Place of residence: Brossard, QC
Former club: Lyngby BK (Denmark)
Acquired: December 19, 2011


SAINT AUGUSTINE, Fla. – The Barton women's golf team stands in 12th place after round one Monday of Lincoln Memorial University Spring Kickoff Intercollegiate at The Golf Club at South Hampton. The tournament is the first for the Bulldogs for the 2019 spring campaign.
The Bulldogs shot a 336 (+48) on the par-72, 5,958-yard course while Lynn, ranked No. 13 in NCAA Division II after the fall season, leads at the halfway point with a 10-over 298.
Barton is led by junior Clare McMahon (Red Deer, Alberta, CANADA), who is tied for 45th overall with an 83 (+11) while both senior Kelsey Woodall (Chester, Md.) and junior Nikki Norlin (Insifill, Ontario, CANADA) carded a 12-over 84 and are tied for 47th.
Meanwhile, Wingate's Warissa Puangcharoen, Carson-Newman's Rachel Watts and North Greenville's Savannah Hallman are tied at the top of the leaderboard with a two-under 70 after 18 holes of play.
The tournament concludes with the second round on Tuesday.