bluuebunny/crossref_metadata_2025 huggingface dataset:
Nickel‐mediated cross‐coupling via C–O activation assisted by organoaluminum
Authors: Liu Cheng‐Yuan , Wititsuwannakul Taveechai , Hsieh Chu‐Han , Tsai Chung‐Yu , Wang Ting‐Hsuan , Ambre Ram , Chen Wen‐Ching , Surawatanawong Panida , Ong Tiow‐Gan
Published: December 2019

We report the alkylation and arylation cross‐coupling of aryl ethers based on C–O bond activation using a nickel catalyst and organoaluminum reagents. Ni(cod)2 in combination with 1,2‐bis(dicyclohexylphosphino)ethane ligand in toluene solution at 130°C are the best conditions. The naphthyl ether or methoxy pyridine derivatives are suitable substrates for alkylation and arylation reaction with a wider scope of aluminum reagents in good yields. Computational analysis on the pyridine substrate is provided to help delineate the mechanistic pathway and demonstrate the important aspects of the cooperative interaction bimetallic catalysis. First, the coordination of AlMe3 to the O atom of pyridine is essential for C–O activation. Second, the β‐H transfer from methoxy to pyridine could be discouraged through the use of bidentate phosphine as a ligand. Finally, excess AlMe3 reagent is critical for facilitating a reductive elimination process.
Study on steroidal saponins in crude and stir‐fried Fructus Tribuli by ultra‐high‐performance liquid chromatography‐mass spectrometry coupled with multivariate statistical analysis
Authors: Zhang Chao , Yuan Rui , Guo Fei , Shi Lei , Zhang Longfei , Sun Linlin , Wang Yingzi , Zhang Xuelan , Ma Baiping
Published: December 2019

Fructus Tribuli is a traditional Chinese medicine used clinically for many years. Crude Fructus Tribuli and stir‐fried Fructus Tribuli are recorded in the Pharmacopoeia of the People′s Republic of China. However, the differences between steroidal saponins in crude Fructus Tribuli and stir‐fried Fructus Tribuli have not been compared. In this study, ultra‐high‐performance liquid chromatography quadrupole time‐of‐flight mass spectrometry along with multivariate statistical analysis was developed to discriminate the chemical profiles and identify the steroidal saponins of crude Fructus Tribuli and stir‐fried Fructus Tribuli. Additionally, an ultra‐high‐performance liquid chromatography triple‐quadrupole mass spectrometer was used for the simultaneous quantification of nine major steroidal saponins to analyze the variations between crude Fructus Tribuli and stir‐fried Fructus Tribuli. Finally, a total of 30 steroidal saponins whose structures or contents changed significantly after processing were found and identified. The mechanism of structural transformations deduced indicated that during the stir‐frying of Fructus Tribuli, C‐22 hydroxy furostanol saponins were converted to the corresponding furostanol saponins containing C‐20‐C‐22 double bonds by dehydroxylation and deglycosylation reactions that occurred in the spirostanol saponins causing the generation of steroidal sapogenins. This study was successfully applied to the global analysis of crude Fructus Tribuli and stir‐fried Fructus Tribuli. The results of this research will be beneficial to explore the processing mechanism of Fructus Tribuli.
Ultrasound Diagnosis of Breast Lymphoma and the Identification of Breast Infiltrating Ductal Carcinoma
Authors: Chen Yang , Zhou Jie‐hong , Fan Hong‐xia , Luo Yan , Peng Yu‐lan , Ma Bu‐yun
Published: December 2019

Objectives

By analyzing the B‐mode ultrasound and color Doppler flow imaging characteristics of breast lymphoma (BL) and breast infiltrating ductal carcinoma (BIDC), we expected to discriminate these diseases.

Methods

Thirty‐two patients with BL and 30 with BIDC confirmed pathologically were selected. The BL group was divided into nodular and diffuse groups. We analyzed and compared the general and imaging characteristics of the BL subgroups and the BIDC group.

Results

The mean maximum diameter of BL was 54.93 ± 43.74 cm, and that of BIDC was 23.90 ± 6.79 cm (P < .05). The differences between the nodular BL and BIDC groups in a circumscribed margin (60.00% versus 20.00%), calcification (20.00% versus 53.33%), aggregation characteristics (0.00% versus 53.33%), and density (73.33% versus 10.00%) were statistically significant (P < .05). The differences between the diffuse BL and BIDC groups in calcification (6.67% versus 53.33%), aggregation characteristics (6.67% versus 53.33%) and density (40.00% versus 10.00%) were statistically significant (P < .05). The difference in a circumscribed margin (60% versus 13.33%) between the BL subgroups was statistically significant (P < .05). The blood flow signal in BL lesions was richer than that in BIDC lesions (P < .05).

Conclusions

Extrasuperior‐quadrant single lesions in the BL group were larger than those in the BIDC group. The edges of the lesions in the nodular BL group were circumscribed and dense. Lesions in the diffuse BL group did not have a circumscribed margin, calcification, aggregation characteristics, or density. The blood flow signal in BL lesions was richer than that in BIDC lesions.
Evaluating the performance drivers of French ski resorts: A hierarchical approach
Authors: Corne Aurélie , Goncalves Olga , Peypoch Nicolas
Published: December 2019

This paper aims to analyse the operational performance of French ski resorts by using data envelopment analysis models. The findings show that the hierarchical category data envelopment analysis is more appropriate than the standard one as it takes into account heterogeneity. The impact of the business environment (size, ownership, elevation, and location) on performance level is assessed with efficiency scores that are significantly higher for smaller ski resorts, those that are public managed, and those located at medium elevations. In addition, the results highlight a statistical relation between ski resort location and performance. Finally, the implications of the results and future research perspectives are discussed.
Near‐shore geophysical and geotechnical investigations in support of the Trieste Marine Terminal extension
Authors: Masoli Carlo Alberto , Petronio Lorenzo , Gordini Emiliano , Deponte Michele , Boehm Gualtiero , Cotterle Diego , Romeo Roberto , Barbagallo Alfio , Belletti Rinaldo , Maffione Stefano , Meneghini Fabio , Baradello Luca
Published: December 2019

The Port of Trieste is an international hub for land and sea trade with the dynamic markets of central and eastern Europe. Thanks to its deep natural draft (about 18 m), the modern high‐capacity vessels can moor to the piers. In view of the foreseen increase in maritime traffic, this harbour is undergoing modernization in order to improve the commercial traffic capability. In this expansion plan, the container Trieste Marine Terminal, Pier VII, is seeking an extension by about 200 m. In support of this feasibility study, multidisciplinary data acquisition was conducted in order to characterize the seabed, the sub‐bottom sediments and the bedrock (flysch formation) in front of the Trieste Marine Terminal. The acquisition of high‐resolution swath bathymetry, side‐scan sonar and magnetometer data allowed a detailed analysis of the seabed conditions from an environmental and safety perspective. High‐resolution seismic reflection data enabled us to characterize the Plio‐Quaternary soft sediments and the underlying bedrock. A static underwater refraction survey was performed using hydrophone array deployed on the sea bottom to obtain seismic velocities and to achieve a reliable time‐to‐depth conversion of reflection seismic data by first‐arrival tomographic inversion. In addition to geophysical investigations, 11 offshore boreholes were drilled for detailed logging. In situ standard penetration tests were performed on core samples with the use of a pocket penetrometer and pocket vane in order to obtain uniaxial compressive strength, undrained shear strength and undrained cohesion values, and assess the cohesive soils. During drilling, 17 undisturbed samples and 12 semi‐disturbed samples were extracted to perform laboratory tests for the identification of the principal geotechnical parameters. The goal was to obtain a reliable geological/geotechnical model in front of the Trieste Marine Terminal – from the seabed to the bedrock. Below the seafloor, a sequence of about 20–30 m thickness, containing Plio‐Quaternary soft sediments, overlies the flysch, which locally presents alteration with rocks of reduced quality. The geophysical–geotechnical integrated approach allowed us to identify and map the top of the bedrock and provided valuable information for planning the pier extension project.
Hepatic focal nodular hyperplasia after pediatric hematopoietic stem cell transplantation: The impact of hormonal replacement therapy and iron overload
Authors: Cattoni Alessandro , Rovelli Attilio , Prunotto Giulia , Bonanomi Sonia , Invernizzi Pietro , Perego Rosangela , Mariani Anna Maria , Balduzzi Adriana
Published: December 2019

Background

The advent of techniques for the assessment of iron overload (liver T2*‐MRI) has led to the awareness that focal nodular hyperplasia (FNH) represents a possible incidental finding after hematopoietic stem cell transplantation (HSCT), though its pathogenesis is still unclear.

Methods

We performed a retrospective analysis of the liver T2*‐MRI scans performed between 2013 and 2018 in a single pediatric HSCT Unit and recorded the number of patients with FNH (group A). Patients incidentally diagnosed with FNH at imaging performed for different clinical indications were included in group B.

Results

Nine of 105 (8.6%) patients from group A were diagnosed with FNH. Group B included three patients. Overall, 12 patients were diagnosed 4.4 ± 3.1 years after HSCT. At univariate analysis, female gender (odds ratio [OR] 3.77, P = .03), moderate‐to‐severe iron overload (OR 6.97, P = .01), and hormone replacement therapy (HRT) administered for at least 6 months (OR 18.20, P = .0002) exposed patients to a higher risk of developing FNH. The detrimental effect of HRT was significant also at multivariate analysis (OR 7.93, P = .024). MRI‐T2* values in affected patients were statistically lower than healthy controls (P < .001).

Conclusions

We confirm the high incidence of FNH among transplanted pediatric patients and demonstrate the potential pathogenic role of HRT and iron overload.
Neurofibromatosis‐associated malignant peripheral nerve sheath tumors in children have a worse prognosis: A nationwide cohort study
Authors: Martin Enrico , Coert J. Henk , Flucke Uta E. , Slooff Willem‐Bart M. , van de Sande Michiel A.J. , van Noesel Max M. , Grünhagen Dirk J. , Wijnen Marc H.W.A. , Verhoef Cornelis
Published: December 2019

Background

Malignant peripheral nerve sheath tumors (MPNST) are rare and aggressive non‐rhabdomyoblastic soft‐tissue sarcomas (NRSTS) in children. This study set out to investigate clinical presentation, treatment modalities, and factors associated with survival in pediatric MPNST using Dutch nationwide databases.

Methods

Data were obtained from the Netherlands Cancer Registry (NCR) and the Dutch Pathology Database (PALGA) from 1989 to 2017. All primary MPNSTs were collected. Demographic differences were analyzed between adult and pediatric (age ≤18 years) MPNST. In children, demographic and treatment differences between neurofibromatosis type 1 (NF1) and non‐NF1 were analyzed. A Cox proportional hazard model was constructed for localized pediatric MPNSTs.

Results

A total of 70/784 MPNST patients were children (37.1% NF1). Children did not present differently from adults. In NF1 children, tumor size was more commonly large (> 5 cm, 92.3% vs 59.1%). Localized disease was primarily resected in 90.6%, and radiotherapy was administered in 37.5%. Non‐NF1 children tended to receive chemotherapy more commonly (39.5% vs 26.9%). Overall, estimated five‐year survival rates of localized NF1‐MPNST was 52.4% (SE: 10.1%) compared with 75.8% (SE: 7.1%) in non‐NF1 patients. The multivariate model showed worse survival in NF1 patients (HR: 2.98; 95% CI, 1.17‐7.60, P = 0.02) and increased survival in patients diagnosed after 2005 (HR: 0.20; 95% CI, 0.06‐0.69, P = 0.01). No treatment factors were independently associated with survival.

Conclusion

Pediatric MPNSTs have presentations similar to adult MPNSTs. In children, NF1 patients present with larger tumors, but are treated similarly to non‐NF1 MPNSTs. In localized pediatric MPNST, NF1 is associated with worse survival. Promisingly, survival has increased for pediatric MPNSTs after 2005.
Ballistic behavior of multiwalled carbon nanotube‐reinforced toughened polycarbonate nanocomposites
Authors: Bagotia Nisha , Sharma Durlubh Kumar
Published: December 2019

The overall goal of this research is to develop a material that is able to absorb mechanical shocks. Polycarbonate/ethylene methyl acrylate‐multiwalled carbon nanotube (PC/EMA‐MWCNTs) nanocomposites have been prepared using the melt‐blending method using a micro compounder, and their dynamic impact behavior has been studied. A Split Hopkinson pressure bar instrument has been used for dynamic impact testing of the nanocomposite samples. The impact tests were performed under varying strain rates ranging from 100 to 10 000 seconds−1. The present study reports the stress‐strain properties of PC/EMA‐MWCNTs nanocomposites under a high strain rate. Stress tolerance of these nanocomposites was studied to analyze the effectiveness of small amounts of carbon nanotubes for impact/stress absorption in comparison to pure polycarbonate (PC) and polycarbonate/ethylene methyl acrylate [PC/EMA (95/5 wt/wt)] blend samples. It is found that, at concentration levels of 5 phr of MWCNTs, the impact absorption of composites sample increased by 130% and 76% compared to pure PC and PC/EMA (95/5 wt/wt) blend, respectively.
Hexameric structure of the ATPase motor subunit of magnesium chelatase in chlorophyll biosynthesis
Authors: Gao Yong‐Shan , Wang Yan‐Li , Wang Xiao , Liu Lin
Published: December 2019

Magnesium chelatase (MgCh) is a heterotrimeric enzyme complex, composed of two AAA+ family subunits that can assembly into a double ring structure and a large catalytic subunit. The small AAA+ subunit has ATPase activity and can self‐oligomerize into a ring structure, while the other AAA+ subunit lacks independent ATPase activity. Previous structural studies of the ATPase motor subunit of MgCh from a bacteriochlorophyll‐synthesizing bacterium have identified a unique ATPase clade, but the model of oligomeric assembly is unclear. Here we present the hexameric structure of the MgCh ATPase motor subunit from the chlorophyll‐synthesizing cyanobacterium Synechocystis sp. PCC 6803. This structure reveals details of how the hexameric ring is assembled, and thus provides a basis for further studying the heterotrimeric complex.
Can we characterize river corridor evolution at a continental scale from historical topographic maps? A first assessment from the comparison of four countries
Authors: García J. Horacio , Dunesme Samuel , Piégay Hervé
Published: December 2019

National historical map resources are assessed in four European countries to characterize river corridor features and associated channel changes, as well as identify issues limiting or promoting geomorphic assessment procedures at a continental scale. A geomorphic audit that launches potential data for diagnosis from reach to continental scales could offer a good resource for biology and ecology managers of river authorities or government agencies and engineers. The assessment compares the resources available by country in terms of period covered, spatial scale, history and chronology, and representation of the fluvial corridor features. We then applied the Historical Maps Vectorization Toolbox, initially developed for vectorizing river corridors from French maps, to detect and extract flow channels, unvegetated bars and riparian vegetation patches from historical topographical maps. We found that (a) it is difficult to apply an audit of channel changes to the whole continental scale because map legends differ between countries due to geographic and political specificity; (b) there exists an opportunity to get assessment information in all countries at reach or national scale where map resources are available; (c) the highest potential is observed in Switzerland and Belgium where there is high quality national map coverage from the 19th century; and (d) the algorithm Historical Maps Vectorization Toolbox applied to map resources works well with any of the countries, and its widespread application is encouraging.
Case notion discovery and recommendation: automated event log building on databases
Authors: de Murillas E. González López , Reijers H. A. , van der Aalst W. M. P.
Published: December 2019

Process mining techniques use event logs as input. When analyzing complex databases, these event logs can be built in many ways. Events need to be grouped into traces corresponding to a case. Different groupings provide different views on the data. Building event logs is usually a time-consuming, manual task. This paper provides a precise view on the case notion on databases, which enables the automatic computation of event logs. Also, it provides a way to assess event log quality, used to rank event logs with respect to their interestingness. The computational cost of building an event log can be avoided by predicting the interestingness of a case notion, before the corresponding event log is computed. This makes it possible to give recommendations to users, so they can focus on the analysis of the most promising process views. Finally, the accuracy of the predictions and the quality of the rankings generated by our unsupervised technique are evaluated in comparison to the existing regression techniques as well as to state-of-the-art learning to rank algorithms from the information retrieval field. The results show that our prediction technique succeeds at discovering interesting event logs and provides valuable recommendations to users about the perspectives on which to focus the efforts during the analysis.
Putting a federal capacities assessment to work: blueprint for a national program for the early detection of and rapid response to invasive species (EDRR)
Authors: Reaser Jamie K.
Published: December 2019

This paper responds to national policy directives intended to improve the US government’s capacity to protect national security from the adverse impacts of invasive species. It is the final, synthesizing contribution to a Special Issue of Biological Invasions comprising 12 papers that collectively inform the development and implementation of a national program for the early detection of and rapid response to invasive species (EDRR). The blueprint sets forth policies, goals, and actions to be taken by relevant Executive Branch agencies and components of the Executive Office of the President to develop a national EDRR program, appropriations permitting. It is designed to function as guidance for advancing federal policy through Presidential, Secretarial, and/or Congressional directives. Those committed to protecting national security, the economy, and the well-being of American people are forewarned that our ability to establish a national EDRR program is undermined by the diminishment of the federal workforce; institutional structures, policies, and programs; and directly applicable leadership mechanisms, including the National Invasive Species Council, Invasive Species Advisory Committee, and their managerial Secretariat.
Costs and long-term outcomes following pulmonary vein isolation for atrial fibrillation in elderly patients using second-generation cryoballoon vs. open-irrigated radiofrequency in China
Authors: Chen Chao-feng , Liu Mei-jun , Jin Chao-lun , Gao Xiao-fei , Liu Xiao-hua , Xu Yi-zhou
Published: December 2019

Purpose

Limited comparative data are available regarding catheter ablation (CA) of atrial fibrillation (AF) using second-generation cryoballoon (CB-2) vs. radiofrequency (RF) ablation in elderly patients (> 75 years old). The present study aimed to compare the costs and clinical outcomes in elderly patients using these two strategies.

Methods

Elderly patients with symptomatic drug-refractory paroxysmal/short-lasting persistent AF were included in the study. Pulmonary vein isolation (PVI) was performed in all patients.

Results

A total of 324 elderly patients were included (RF,176; CB-2,148) from September 2016 to April 2019. The CB-2 was associated with shorter procedure time and left atrial dwell time (112.9 ± 11.1 vs. 135.1 ± 9.9 min, P < 0.001; 53.7 ± 8.9 vs. 65.1.9 ± 9.0 min, P < 0.001) but marked fluoroscopy utilization (22.1 ± 3.3 vs. 18.5 ± 3.6 min, P < 0.001). Complications occurred in 3.3% (CB-2) and 6.2% (RF) of patients with no significant different (p = 0.307). The length of stay after ablation was shorter, but the costs were higher in the CB-2 group (1.94 vs. 2.53 days, P < 0.001 and 91,132.6 ± 3723.5 vs. 81,149.4 ± 6824.1 CNY, P < 0.001) compared to the RF group. Additionally, the rate of early recurrence of atrial arrhythmia (ERAA) was lower in the CB-2 group (14.2 vs. 23.3%, P = 0.047), but the long-term success rate was similar between two groups.

Conclusions

CB-2 is associated with shorter procedure time, left atrial dwell time, and length of stay after ablation, as well as lower ERAA, but its costs and fluoroscopy time are greater than the RF group. Moreover, the rate of complications and long-term success is similar between the two groups.
Associations between Adolescents’ Interpersonal Relationships, School Well-being, and Academic Achievement during Educational Transitions
Authors: Kiuru Noona , Wang Ming-Te , Salmela-Aro Katariina , Kannas Lasse , Ahonen Timo , Hirvonen Riikka
Published: December 2019

A youth’s ability to adapt during educational transitions has long-term, positive impacts on their academic achievement and mental health. Although supportive relationships with parents, peers, and teachers are protective factors associated with successful educational transitions, little is known about the reciprocal link between the quality of these interpersonal relationships and school well-being, with even less known about how these two constructs affect academic achievement. This longitudinal study examined how the quality of interpersonal relationships and school well-being worked together to affect academic achievement during the transition from primary school to lower secondary school. Data were collected from 848 Finnish adolescents (54% girls, mean age at the outset 12.3 years) over the course of sixth and seventh grade. The results support a transactional model illustrating the reciprocal associations between the quality of interpersonal relationships and school well-being during the transition to lower secondary school. As such, the presence of high quality interpersonal relationships promoted higher academic achievement through increased school well-being, whereas high school well-being promoted higher subsequent academic achievement through increased quality of interpersonal relationships. Overall, the results suggest that promoting learning outcomes and helping adolescents with challenges during educational transitions is a critical part of supporting school well-being and the formation of high-quality interpersonal relationships.
Screening of halogenated phenolic compounds in plasma and serum from marine wildlife
Authors: Lindqvist D.
Published: December 2019

The growing knowledge of the impact of halogenated phenolic compounds on hormonal and metabolic systems has led to an increased interest in the exposure and potential effects of these compounds in wildlife. In the present study, a screening procedure was developed to detect and quantify halogenated phenolic compounds in serum and plasma from marine wildlife. A mass spectral library containing selective ion monitoring data was created using gas chromatography electron capture negative ionization mass spectrometry. The selective ion monitoring data in the library were accompanied with retention indices to increase the specificity of each entry in the library. The library together with the developed extraction procedure and optimized instrumental settings can be used for the detection of 52 different halogenated phenolic compounds of environmental concern, including 23 hydroxylated polychlorinated biphenyls and 24 hydroxylated polybrominated diphenyl ethers. The instrument limit of detection for the compounds included in the library ranged from 30 to 320 fg/injection, with a median detection limit of 90 fg/injection. The average recovery of 11 different halogenated phenolic compounds, from four species of marine wildlife, was 66 ± 14%. A full-scan mass spectral library was also created containing an additional seven compounds. Gray seals, long-tailed ducks, and two species of fish from the Baltic Sea were screened for halogenated phenolic compounds using the developed procedure. A total of 33 compounds included in the library were detected and quantified.
Dynamic Characteristics of Deep Dolomite Under One-Dimensional Static and Dynamic Loads
Authors: Wang Jianguo , Liu Yang , Li Kegang
Published: December 2019

The failure characteristics of rock subjected to impact disturbance under one-dimensional static axial compression are helpful for studying the problems of pillar instability and rock burst in deep, high geostress surrounding rock under blasting disturbances. Improved split Hopkinson pressure bar equipment was used for one-dimensional dynamic–static combined impact tests of deep-seated dolomite specimens under axial compression levels of 0, 12, 24, and 36 MPa. The experimental results demonstrate that the dolomite specimens exhibit strong brittleness. The dynamic strength always maintains a strong positive correlation with the strain rate when the axial compression is fixed; when the strain rate is close, the dynamic elasticity modulus and peak strength of the specimens first increase and then decrease with the increase in axial compression, and the peak value appears at 24 MPa. The impact resistance of specimens can be enhanced when the axial compression is 12 or 24 MPa, but when it increases to 36 MPa, the damage inside the specimen begins to cause damage to the dynamic rock strength. Prior to the rock macroscopic failure, the axial static load changes the rock structure state, and it can store strain energy or cause irreversible damage.
Association of sleep, screen time and physical activity with overweight and obesity in Mexico
Authors: Kolovos Spyros , Jimenez-Moreno Aura Cecilia , Pinedo-Villanueva Rafael , Cassidy Sophie , Zavala Gerardo A.
Published: December 2019

Purpose

Approximately 70% of adults in Mexico are overweight or obese. Unhealthy lifestyle behaviors are also prevalent. We examined the association of three lifestyle behaviors with body mass index (BMI) categories in adults from Mexico.

Methods

We used publicly available data from the ENSANUT 2016 survey (n = 6419). BMI was used to categorize participants. Differences in sleep duration, suffering from symptoms of insomnia, TV watching time, time in front of any screen, vigorous physical activity (yes vs no), moderate physical activity (> 30 min/day—yes vs. no) and walking (> 60 min/day—yes vs. no) were compared across BMI groups using adjusted linear and logistic regression analyses.

Results

Thirty-nine percent of participants were overweight and 37% obese. Time in front of TV, in front of any screen, sleep duration and physical activity were significantly associated with overweight and obesity. Compared to normal weight participants, participants in the obese II category spend on average 0.60 h/day (95% CI 0.36–0.84, p = 0.001) and participants in the obese III category 0.54 h/day (95% CI 0.19–0.89, p < 0.001) more in front of any screen; participants in the obese II category reported 0.55 h/day less sleep (95% CI − 0.67 to − 0.43, p < 0.001); participants in the obese III category were less likely to engage in vigorous activity (OR = 0.60, 95% CI 0.43–0.84, p ≤ 0.003), or walking (OR = 0.65, 95% CI 0.49–0.88, p = 0.005).

Conclusion

Screen time, sleeping hours, and physical activity were associated with overweight and obesity. However, these associations were not consistent across all BMI categories. Assuming established causal connections, overweight individuals and individuals with obesity would benefit from reduced screen time and engaging in moderate/vigorous physical activity.

Level of evidence

Level III: observational case-control analytic study.
Dependence of fluid flow on cleat aperture distribution and aperture–length scaling: a case study from Gondwana coal seams of Raniganj Formation, Eastern India
Authors: Bandyopadhyay Krishanu , Mallik Jyotirmoy , Ghosh Trishit
Published: December 2019

Dimensions and mutual relationships amongst fracture (cleat) parameters such as maximum aperture width, average aperture width, length, spacing etc. control the connectivity within a fracture network and the fluid flow in a coal seam as the matrix permeability, here, is negligible. In this paper, we document cleat size distributions and investigate length–aperture relationships from coals of Raniganj coalfield in Eastern India. This coalfield has a proven extractable reserve of six billion tons of coal and holds immense potential to be one of the largest coal bed methane fields serving India’s growing energy needs. Here, cleat length (L) correlates with corresponding maximum aperture width (Dmax) in a power-law function with an exponent of 0.84 (DmaxαL0.84) instead of the commonly observed exponents of 1 or 0.5 applicable for other natural ‘opening-mode’ fractures. The conventional wisdom pertains that laminar fluid flow (Q) through an isolated, smooth-walled, parallel-plate fracture, embedded in an impermeable matrix, is directly proportional to the cube of its aperture width (b, equivalent toDavg; cubic law:Qαb3). This assumes a linear relationship between length and fracture aperture. However, the modified relationship between cleat length and average aperture width changes the cubic law applicable for Raniganj coal seam and now fluid flow correlates with aperture width in a power-law function with an exponent of 4.25 (Qαb4.25) instead of 3 (cube). Such simplifications will come handy for the modeling and estimation of fluid flow as it will reduce the effort of cleat length measurement which is anyway difficult and can be misleading due to the risk of undersampling.
Introductory Remarks by Adrien K. Wing
Authors: Wing Adrien K.
Published: December 2019

My name is Adrien Wing. I am Associate Dean of International and Comparative Law Programs at the University of Iowa College of Law where I have been teaching for thirty-two years. I am also pleased to be with you today because I have been a member of ASIL for thirty-seven years. When I joined, we did not have any topics like today's subject. We certainly did not have the demographic diversity that is represented in this room. We have come a long way in some respects, and so at least for programming, it is wonderful that we have this topic “Diverse Perspectives on the Impact of Colonialism on International Law.” Three of the speakers will emphasize Africa. One person will focus on Latin America. The MILIG Interest Group, the minority interest group, is sponsoring this session. We are fortunate to have the co-chairs of the Interest Group here: Rafael Porrata-Doria and Christina Beharry.
Taiwan and the United States Free and Open Indo-Pacific Strategy
Authors: Ku Julian
Published: December 2019

I want to begin by spending a little time articulating how I understand the U.S. government's new “free and open Indo-Pacific” (FOIP) policy, which encompasses more than the trade agreements Inu discussed in her remarks. Then, I want to take a look at how this new U.S. strategy and approach would apply to one important key player in the region: Taiwan.
Small State Representative
Authors: Pasipanodya Tafadzwa
Published: December 2019

I am honored to be here, in San Francisco, representing a small developing country.

Right from the conception of my state, Small Developing Country X, following decolonization in the 1960s, we have engaged with this whole global project on the premise that there is an ever-increasing economic pie. We have acted on the assumption of the nation-state leading a process of expanding economic and social well-being of its citizens through international cooperation and solidarity. But as we all know, this assumption is under threat today. World economic expansion is under threat. The real wealth of the world, not just the economic wealth, may be shrinking. And, the well-being of our vulnerable populations is becoming further impaired.
OP10 Approaches To Gain Reimbursement For Medical Devices In Germany
Authors: Neeser Kurt , Müller Elvira , Oelze Ilse-Barbara
Published: December 2019

Introduction

Medical devices (MDs) differ regarding their risk class (I to III), operational area (in-, outpatient), intended use (diagnostic, monitoring, intervention), and with regard to available clinical evidence. Therefore, the market access processes as well as the approach of gaining reimbursement differ significantly. From a variety of potential approaches the underlying analysis illustrates five MD-specific processes.

Methods

Based on a systematic search of publicly available regulations the main pathways of potential reimbursement for MDs were evaluated.

Results

MDs to be used in the in-patient setting can be divided into three categories: an innovative MD (a) is exceeding a current reimbursement framework (German Operations and Procedures Key (OPS) / diagnosis related groups (DRG)), (b) falls within an existing reimbursement rate, or (c) the MD is based on a known mode of action (MoA) for which already adequate reimbursement exists. Due to less empirical data from MDs for a) and b), a health technology assessment (HTA) is required before inclusion in a DRG, whereas a MD with known concept (c) will be grouped into existing price structures. Initiators of these processes are hospitals through a so-called NUB application. MDs entering the outpatient sector are covered by another reimbursement catalogue (EBM/GOÄ) and have to pass an assessment by the G-BA (rapid HTA) if based on new MoA (d). Such an assessment can only be initiated by respective umbrella organizations of service providers (e.g. KBV (National Association of Statutory Health Insurance Physicians)). MDs not being positively recommended by the G-BA are not reimbursable. For MDs (e) with known MoA no HTA is required.

Conclusions

For a successful market launch including sufficient reimbursement not only the market potential, but also the specific regulatory pathways have to be considered carefully. New and innovative MDs in the outpatient sector may have a longer application process to gain a positive reimbursement decision than MDs used in inpatient setting.
OP33 Treatment Of Mitral Insufficiency And Multicriteria Decision-Making
Authors: Désy François , Goetghebeur Mireille , Nicolae Maria Vutcovici , Lambert Laurie , de Guise Michèle
Published: December 2019

Introduction

Controversy regarding the efficacy of transcatheter mitral valve repair with a clip (TMVRc) in reducing the mitral regurgitation is related to the lack of solid scientific evidence. Worldwide, refusal or conditional acceptance for implementation of TMVRc, reflect ongoing uncertainty. We sought to apply a systematic multicriteria framework to ensure a fair and reasonable decision regarding the use of TMVRc in Quebec.

Methods

The framework included the following domains: context, quality of evidence concerning safety, efficacy and effectiveness, unmet patient needs, expected volume of patients, and impact on the health system including costs. Each domain within the framework was examined by a review of the literature and through consultations with a scientific advisory committee, a TMVRc clinical expert committee, TMVRc clinical teams, industry representatives and the Institut national d'excellence en santé et en services sociaux (INESSS) clinical excellence committee.

Results

The literature review indicated that uncertainty about the efficacy and effectiveness of TMVRc persists, particularly in the real world context, and this view was supported by scientific experts. The TMVRc clinical teams provided insight into the burden of mitral insufficiency on patients and the health system and their belief in the promise of TMVRc. They also highlighted the challenges of patient selection and organizational issues related to the introduction of TMVRc within their institutions. The advisory committee stressed the need for further evaluation prior to wide diffusion.

Conclusions

Using a multicriteria framework facilitated a more standardized and transparent approach to our literature review and consultations as well as to the development of the proposed recommendations. This was especially important in the context of an evaluation of a promising new approach to treat mitral valve disease with many important uncertainties. This multi-criteria approach will facilitate a more standardized process for deliberation on how new health technologies should be implemented into the Quebec health system.
OP41 Intercultural Medical Decision Support System Using Natural Language Processing (NLP)
Authors: Gökgöl Merve , Orhan Zeynep
Published: December 2019

Introduction

This study aimed to reach patients using different languages while providing an opportunity to enter symptoms in their everyday language text besides medical expressions of symptoms.

Methodology

Named entity recognition (NER) techniques, based on natural language processing (NLP), were applied to develop a language independent predictive model. The research was based on extracting symptoms entered to the system by patient using NER method of NLP. In order to implement the system, python was used while pre-processing the data and string similarity function was used to estimate similarity with disease symptoms. Two sets were used for classification, one including only symptoms, and the other the matching diseases. Four thousand two hundred and eighty different symptoms were processed for the corresponding 880 diseases.

Results

Each user symptom had a similarity score for each symptom in all diseases. Top N results with highest similarities were chosen from this list. The final N results are matched with diseases. According to these results, matched diseases were ordered in terms of the percentage of matched symptoms in the disease's symptoms. Extracted terms were implied as an input of the model and analysed for a matching diagnosis where an accuracy of 83 percent was accomplished when it is tested and compared using Mayo Clinic data for specific foreign languages other than English.

Conclusion

This language independent online diagnostic tool is a solution for both personal and clinical use and provides maintainable, updatable and more reliable diagnostics. This tool is particularly relevant today, with global mobility growing at a rate faster than the world`s population. We aim to upgrade the system by adding speech recognition and engaging it with the background (if available, electronic health records) of the patient.
OP112 Project Management for EUnetHTA Non-Pharmaceutical Technologies
Authors: De Villiers Cecilia , Ettinger Sabine , Erdos Judit
Published: December 2019

Introduction

The European Network for Health Technology Assessment (EUnetHTA) facilitates and produces Health Technology Assessments (HTA) across Europe. Project Management (PM) provides the coordination and strategic overview of assessment production and enables the flow of scientific knowledge and assessment publications through collaboration and standardized processes, procedures and documentation.

Methods

EUnetHTA established a central PM function at the Ludwig Boltzmann Institute for HTA (LBI-HTA) for central coordination and assessment production of non-pharmaceutical technologies. LBI-HTA subsequently pursued capability and capacity through a decentralized hub-and-spoke-PM model with six activity centers (AC) providing decentralized coordination and PM of assessments. LBI-HTA provided central oversight and supervision with training days, e-meetings and ad hoc e-mail and telephone support as required. This was complemented by standardized operating procedures (SOPs) in the online Companion Guide (CG). A qualitative data collection via electronic questionnaires collected feedback from AC-PM, LBI-HTA-PM and assessment authors. Specific questions with free-text responses assessed current experiences, challenges, recommendations, communication and task distributions of the centralized and decentralized PM processes from these different perspectives.

Results

The feedback concluded that PM is a separate, well-defined and important role for assessment coordination and production. The AC-PM received adequate training from the central PM and authors experienced no difference between projects managed centrally or decentrally. The CG and SOPs are important for guiding standard practice and allowing AC-PM to operate independently. Challenges were around extended timelines due to complex topics, external stakeholder involvement, insufficient team communication and not yet published SOPs resulting in additional central support.

Conclusions

Decentralized coordination of assessments, knowledge management and governance achieve scale, capacity and capability through a designated pool of agencies with established roles and growing experience in sustainable collaboration of HTA production. Valuable insight into the PM model's operational efficiency, avoidance of duplication and resource savings potentially provides a sustainable post 2020 European network policy and efficiency model for high quality HTA assessment production.
OP147 Educational Costs And Benefits Of Mental Health Interventions
Authors: Pokhilenko Irina , Janssen Luca , Paulus Aggie , Drost Ruben , Evers Silvia
Published: December 2019

Introduction

The burden of mental health disorders has a wide societal impact affecting primarily individuals and their significant others. Mental health interventions produce costs and benefits in the health care sector but can also lead to costs and benefits in non-healthcare sectors, also known as inter-sectoral costs and benefits (ICBs). The aim of this study was to develop an internationally applicable list of ICBs in the educational sector resulting from mental health interventions and to facilitate the inclusion of ICBs in economic evaluations across the European Union (EU) by prioritizing important ICBs.

Methods

Some ICBs of mental health interventions were identified in earlier research, which were used as a basis for this study. Additional data was collected via a systematic literature search of PubMed and a grey literature search carried out in six EU countries. In order to validate the international applicability of the list and prioritize the ICBs, a survey was conducted with the international group of experts from the educational sector. The outcomes of the expert survey were used to create the condensed list containing the most important ICBs.

Results

The literature search allowed identifying additional ICBs and creating a comprehensive list of items. In order to improve its usability, a multi-dimensional list was constructed distinguishing between tangible (i.e. special education) and intangible items (i.e. cognitive deficits). Based on the expert survey, the international applicability of the list was validated and the most important ICBs from the economic perspective were determined.

Conclusions

Mental health interventions can affect a large number of educational facilities. The list of ICBs developed in this study could be used to select relevant educational facilities for economic evaluations of specific mental health disorders. Further research is needed to define, measure, and valuate the identified ICBs in order to facilitate the practical application of the list in economic evaluations.
OP165 Health Technology Assessment And Public Health Priority Setting In China
Authors: Xiao Yue , Qiu Yingpeng , Shi Liwei , Zhao Kun
Published: December 2019

Introduction

Since 2009, China has initiated a national program on free provision of essential public health services. The national program has expanded both in terms of service categories and funding, showing China's great commitment to universal health coverage. However, with slowdown of public input in the health sector, the government decided to prioritize interventions and optimize reimbursement packages. Researchers in the China National Health Development Research Center (CNHDRC)—the Chinese national health technology assessment (HTA) agency were asked to design the tools to facilitate the decision process.

Methods

With multi-criteria decision analysis (MCDA) method, the researchers analyzed value dimensions in public health issues, and built an evidence matrix for the priority-setting decisions. Supported by HTA tools, they appraised interventions and services through literature review and field studies, and projected budget impact of potential adjustment decisions based on cost analysis results. A deliberative process of key stakeholder groups was taken, and their views were counted in making the final recommendations.

Results

Based on evidence review and scores of stakeholders’ judgment, two public health service interventions were recommended for removal, and another two for adjustment (one for merger, one for optimizing care pathway). Cost estimation and potential budgetary impact were also analyzed to support financial decisions.

Conclusions

HTA and MCDA are key tools for defining the value criteria, evidence framework, and deliberative process for the essential public health program. However, lack of cost-effectiveness evidence hinders fine-tuned decisions on resource allocation. Continual health economic evaluation needs to be conducted in the near future.
OP168 The EUnetHTA Quality Management System: Development And Evaluation
Authors: Fathollah-Nejad Reza , Luhnen Miriam , Rehrmann Maike , Nocon Maya , Hutner Heike
Published: December 2019

Introduction

One objective of the European Network for Health Technology Assessment (EUnetHTA) Joint Action 3 (JA3) is to set up a quality management system (QMS) for joint work that serves as a standalone infrastructure for a sustainable European HTA-collaboration. Structures of the QMS (quality policy, processes and procedures, and organizational structures) combined with the measures of QM (quality planning, assurance, control and improvement) both ensure achieving the objective of producing high-quality HTAs.

Methods

Based on a thorough concept with involvement of a spectrum of EUnetHTA partners, re-evaluation, internal workshops and national expertise, the existing inventory consisting of procedures, templates, methodological guidelines and tools is being refined, complemented and revised. Procedures are gradually being transferred into Standard Operating Procedures (SOPs), seamlessly and chronologically covering all assessment phases. Supplemented by quality-control-checklists and templates these SOPs are linked to relevant guidelines and tools. The so-established QMS is subject to continuous improvement by recurrently applying the Plan-Do-Check-Act (PDCA)-cycle. Members of the assessment teams are surveyed after the publication of each EUnetHTA-report (check-phase). Processed results lead to modification, maintenance and improvement of the inventory (act-phase).

Results

The majority of content has already been developed or revised and was already made available to the assessment teams to put to practical test. The survey results are systematically collected, processed and compiled. Derived from these results, a comprehensive report and a thorough list of improvement measures have been developed and will serve as a basis for further adaptions.

Conclusions

The establishment of structures of QMS and measures of QM both are supposed to assure high-quality HTA-reports for EUnetHTA and a possible permanent European collaboration on HTA after JA3 as proposed by the EU-commission's regulation proposal 2018/0018 (COD). The installed systematic data collection, processing and compilation mechanisms are a solid basis for the identification of future needs for developments.