bluuebunny/crossref_metadata_2025 huggingface dataset:
OP380 A Review Of The Methodology Used To Synthesize Continuous And Time-To-Event Outcomes For Clinical And Cost-Effectiveness
Authors: Freeman Suzanne , Sutton Alex , Cooper Nicola
Published: December 2020

Introduction

Synthesis of continuous and time-to-event outcomes is often complicated by the use of multiple outcome scales and heterogeneous reporting of outcomes across trials. Simple methods of evidence synthesis for clinical effectiveness can fail to account for these issues and result in a reduction of the evidence base, which can be further reduced at the cost-effectiveness stage as common outcome measures, such as standardized mean differences, cannot easily be incorporated into the economic decision model. Recent methodological advances for synthesizing continuous and time-to-event outcomes aim to include a greater proportion of the available evidence base within a single coherent analysis.

Methods

To assess the statistical methods commonly used in health technology assessment (HTA) and establish whether recent advances in synthesis methods have been adopted in practice, we conducted a review of HTA reports and guidelines published in the United Kingdom (UK) between 1 April 2018 and 31 March 2019 reporting a quantitative meta-analysis (MA), network meta-analysis (NMA) or indirect treatment comparison (ITC) of at least one continuous or time-to-event outcome.

Results

Forty-seven articles were considered eligible for this review. Fifty-one percent of eligible articles reported at least one continuous outcome and 55 percent at least one time-to-event outcome. Twenty-nine articles reported NMA or ITC and twenty-seven reported MA of a continuous or time-to-event outcome. Forty articles included a decision model, of which twenty-seven incorporated evidence from a synthesis of a continuous or time-to-event outcome with eleven informed by a single trial (despite synthesis being conducted).

Conclusions

Uptake of methods to include a greater proportion of the available evidence base within a single coherent analysis in UK HTA reports has been slow. Evaluating health technologies using an evidence-based approach often results in better outcomes for patients. Therefore, HTA analysts and decision modelers must be aware of the expanding literature for synthesis of continuous and time-to-event outcomes and appreciate the limitations of simpler approaches.
OP407 Network Meta-Analysis Of Prolonged Release Calcifediol And Paricalcitol
Authors: Gunnarsson Joel , Lauppe Rosa , Csomor Philipp , Intorcia Michele , Soro Marco
Published: December 2020

Introduction

Secondary hyperparathyroidism (SHPT) is a consequence of non-dialysis chronic kidney disease (ND-CKD), causing disturbances in metabolic parameters including increased phosphate and parathyroid hormone (PTH) and reduced calcium serum level, which can cause bone disease, extra-skeletal calcification and increased cardiac disease risk through vascular and visceral calcification. According to Kidney Disease Improving Global Outcomes (KDIGO) guidelines in 2017, treatment with paricalcitol is no longer recommended in early stage CKD due to increased risk of hypercalcemia. Prolonged release calcifediol (PRC) has been developed as a novel treatment for SHPT in ND-CKD. The objective of this study was to compare the efficacy and safety of PRC versus paricalcitol by assessing biomarkers such as PTH, calcium and phosphate.

Methods

To identify relevant randomized control trials (RCTs) to be included in the network meta-analysis (NMA), a systematic literature search was performed in PubMed. All analyses were performed with a frequentist random-effects NMA. Comparisons were made between the overall treatment effects of the two drugs (including all studies, with fixed and titrated dosage regimens), and between low fixed doses (PRC: 30 μg/day, paricalcitol: 1 μg/day) and high fixed doses (PRC: 60 μg/day, paricalcitol: 2 μg/day).

Results

Nine RCTs, comprising a total of 1,426 patients, were included in the analyses. No statistically significant differences in PTH reduction were found. Paricalcitol showed significantly larger increases in calcium when overall effects and high doses were analyzed. No differences in effects on phosphate were observed. Although effect sizes and statistical significance levels vary somewhat across analyses, the general pattern of similar PTH reductions and larger increases in calcium from paricalcitol are observed in all analyses.

Conclusions

The non-inferiority shown by PRC in lowering PTH and the tendency to increase calcium serum levels observed with paricalcitol treatment indicates that PRC might be used as an equally effective but potentially safer alternative to paricalcitol in treating patients with SHPT.
OP414 The Influence Of Cost-Effectiveness Evidence And Other Factors On China's National Reimbursement Drug Listing Decisions
Authors: Butt Thomas , Ollendorf Daniel , Zhao Renxing , Liu Gordon G.
Published: December 2020

Introduction

China's National Reimbursement Drug List (NRDL) covers medicines that are included in national health insurance schemes. NRDL updates take into account evidence and recommendations of experts from the fields of medicine, health economics, pharmacy and health policy. A negotiation mechanism between the government and manufacturers was introduced in 2017 to include a more detailed evaluation and negotiation for high cost drugs. However, the values that are considered in NRDL decision making are not well-understood. This study aims to investigate the influence of available evidence and other factors on coverage decisions.

Methods

Outcomes of the 2017 and 2018 NRDL negotiations were analyzed. Logistic regression was used to investigate factors associated with listing decisions. Ordinary least squares and Tobit regression were used to investigate factors associated with negotiated price discounts. Independent variables were published cost-effectiveness analysis (CEA), incremental cost-effectiveness ratio (ICER), disease area, burden of disease (disability-adjusted life years), company ownership (domestic or foreign) and regulatory approval year.

Results

Twenty-eight out of sixty-two negotiated drugs had one or more published CEA studies in the English or Chinese language, although neither the presence of a study nor the central ICER estimates were predictive of price discount or listing. A longer time since regulatory approval was a significant predictor of listing (p < 0.05). Disease area (oncology) and ownership (foreign) were significant predictors of a higher price discount (p < 0.01).

Conclusions

The NRDL plays a key role in providing access to healthcare for the 95 percent of China's population that is covered by public insurance. We found several factors that were associated with reimbursement decisions. Many of the medicines in the NRDL negotiation have CEA evidence, although the role of CEA in reimbursement decision making in China remains inconclusive.
OP605 Artificial Intelligence Assisted Diagnosis Technology For Benign-Malignant Lung Nodule Classification On Computerized Tomography Images: A Meta-Analysis
Authors: Huang Guo , Zhang Yizhong , Xue Di
Published: December 2020

Introduction

Artificial Intelligence (AI) is an important product of the rapid development of computer technology today. It has a far-reaching impact on the development of medical diagnostic technology especially in combination with medical imaging. The aim of this study was to analyze the diagnostic accuracy of AI-assisted diagnosis technology for classification of benign and malignant lung nodules on Computerized Tomography (CT) images.

Methods

A meta-analysis was conducted of published research articles on diagnostic accuracy of AI-assisted diagnosis technology for lung nodules classification between 2010 and 2019 in the databases of PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform and China Bio-medicine Database. Statistical analysis was performed with the software SAS 9.4 and Stata 12.0, and the summary receiver operating characteristic (SROC) curve was drawn to evaluate accuracy of the method.

Results

A total of 27 studies with 5,701 lung nodules were considered. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and the area under the curve of SROC for AI-assisted diagnosis technology for lung nodules classification respectively were 0.892 (95% confidence interval [CI]: 0.854–0.920), 0.876 (95% CI: 0.833–0.909), 7.190 (95% CI: 5.194–9.955), 0.124 (95% CI: 0.089–0.171), 58.102 (95% CI: 32.391–104.219) and 0.95 (95%CI: 0.92–0.96).

Conclusions

Of note, several limitations should be considered when interpreting the findings of this meta-analysis. Data acquisition is not comprehensive enough because the language of the literature search was limited to Chinese and English. Furthermore,heterogeneity caused due to the difference of lung nodule size affected the study results. Despite these limitations, our study suggests that AI-assisted diagnosis technology for benign-malignant lung nodule classification on CT images obtains high diagnostic accuracy, and it can be used as a novel method to differentiate benign and malignant pulmonary nodules.
PP298 Comparison Of Quality Of Life Between Colposcopy And Human Papillomavirus Testing In Thai Women With Atypical Squamous Cells Of Undetermined Significance
Authors: Thaweethamcharoen Tanita , Ruengkhachorn Irene , Noparatayaporn Prapaporn
Published: December 2020

Introduction

Cervical cancer is the second most common cancer for Thai females. After screening, women diagnosed with atypical squamous cells of undetermined significance (ASC-US) are referred for colposcopy or human papillomavirus (HPV) testing for further diagnostics. The impact of colposcopy and HPV testing on quality of life (QOL) is not well documented. The objective of this study was to evaluate the impact of both diagnostic procedures, to fill the knowledge gap and inform healthcare professionals and decision makers.

Methods

This was a cross-sectional study conducted between August 2017 and January 2019 at a university hospital. One hundred and twenty-four and forty-two women were referred for colposcopy and HPV testing, respectively. QOL was assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and the 5-level EuroQol questionnaire (EQ-5D-5L). Socio-demographic details were collected. The WHOQOL-BREF and EQ-5D-5L scores were compared between colposcopy and HPV testing using independent t-test or Mann-Whitney test, depending on data distribution.

Results

The EQ-5D-5L score and four domains (mobility, self-care, usual activity, anxiety/depression) of EQ-5D-5L responses of the colposcopy and HPV testing groups were not significantly different (p > 0.05). However, the pain/discomfort domain of EQ-5D-5L in the colposcopy group was significantly higher than the HPV testing group (p = 0.032). The overall QOL and four domains (physical, psychological, social relationships, and environmental) of WHOQOL-BREF were not significantly different (p > 0.05).

Conclusions

The QOL scores between the colposcopy and HPV testing groups were similar. HPV testing is more expensive and is not included in all health benefit packages, thus most ASC-US patients are referred to colposcopy according to reimbursement. Some women in the colposcopy group judged their social and working impact worse from the pain. Nevertheless, HPV testing would be alternative option in terms of less pain. The findings from this study may assist in promoting QOL in this group of women.
PP326 Health Economic Value Of The Midline Catheter Versus Peripherally Inserted Central Catheter In Korean Inpatient Setting
Authors: Gala Smeet , Shim Hana , Jeon Sook-Young , Euh YoonJe , Lee KwonSun , Kwon KyungWoo
Published: December 2020

Introduction

It is estimated that over 90 percent of hospitalized patients will receive some form of vascular access device (VAD) for their treatment. Currently, patients requiring medium-term catheterization often have peripherally inserted central catheters (PICCs) placed, which are expensive, time consuming and usually for long-term catheterization. Midline catheters (MCs) are VADs placed in deep peripheral veins, with a dwell time of up to 29 days. The study aimed to evaluate if using MCs over PICCs has any clinical and economic benefits.

Methods

A cost-calculator was developed in Microsoft Excel 2013 to demonstrate the clinical and economic differences of using MCs over PICCs in an inpatient setting in Korea. A literature review was conducted and included eighteen studies that showed MCs have positive clinical, patient, economic, and institutional outcomes. The model captured clinical outcomes such as usage duration, complications, and costs. The time horizon was one year, and various model inputs were derived from the literature review.

Results

For an annual catheter utilization of MCs over PICCs, the total cost-saving was USD 3,764,994. Total treatment costs for MCs were USD 7,230,825 and for PICCs were USD 8,987,922. The total treatment costs included device cost, complication cost and labor cost related to using both MCs and PICCs. For MCs versus PICCs, device costs were USD 6,554,317 versus USD 6,563,356, complication costs were USD 106,749 versus USD 982,417, and labor costs were USD 569,759 versus USD 1,442,149.

Conclusions

In both the base and sensitivity analyses, results showed that MCs can be an impressive cost-saving option among patients with unnecessary PICC use in Korea. Among patients who require medium-term catheterization and use PICCs even when not targeted for central line insertion, MCs are a more cost-effective option, and MCs will benefit these patients with lesser complication rates. MCs are a suitable alternative with clinical and economic benefits that could lead to lower burden on patients and healthcare systems.
PP349 Use Of Applications For Mobile Devices In Asthma Control: A Systematic Review Of Literature
Authors: Lacerda Caroline Pavin , Kny Katiuce Tomazi , Ferreira Maria Angélica Pires
Published: December 2020

Introduction

Cell phones and information technology can be allies in the care of chronic diseases. Despite the wide availability of mobile device applications (apps), many offered by industry and providers, questions remain about the real efficacy of these technologies. The objective of this study was to evaluate the efficacy of mobile device apps designed for use by outpatients in treatment for asthma and describe its main characteristics and functionalities.

Methods

A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was conducted. MEDLINE and EMBASE were searched for randomized clinical trials (RCTs) evaluating the adoption of mobile apps on Android or iOS systems compared to the usual care, published in the last five years. Asthma control rate was defined as the primary outcome, and visits to emergency departments, hospitalizations and adherence to pharmacological treatment were secondary outcomes.

Results

Four RCTs (n = 415) met the inclusion criteria, two involving children and adults, and two only adults. Methodological quality was low to moderate. Common functionalities were asthma action plans, registration of the usual treatment, symptom diaries and educational alerts. Results were heterogeneous with respect to all outcomes evaluated. Study dropouts and lack of follow-up were frequent.

Conclusions

The clinical utility of mobile apps for asthma was evaluated in a few randomized studies; more data are necessary to establish the value of these technologies for asthma control.
PP369 Development Of A Dysmenorrhea Quality Of Life Scale Based On Traditional Chinese Medicine Theory: A Mixed-Methods Study
Authors: Bai Gengliang , Hu Minghui , Liu Yue , Wu Yingxiong , Tian Kan
Published: December 2020

Introduction

It is difficult to generalize health technology assessment in the field of traditional Chinese medicine (TCM). The lack of an outcomes evaluation system based on TCM theory is one of the important reasons. Studies conducted in menstruating women have shown that the prevalence of primary dysmenorrhea varies from 45 to 95 percent. As a debilitating condition for many women, dysmenorrhea is one of the leading causes of absenteeism from school or work, which has a negative effect on quality of life (QoL). TCM has obvious advantages in treating dysmenorrhea. This study aimed to develop a dysmenorrhea QoL scale based on TCM theory.

Methods

We conducted focus group discussions and in-depth interviews with TCM gynecologists and patients, and adapted items from previously published scales. We generated an initial pool of forty-one items with eight domains. The Delphi method was used for preliminary item selection. Then, we administered the items to a sample of adolescent girls (n = 200). The distribution of survey items, discrete trend, factor analysis, correlation coefficient, and Cronbach's α coefficient were used to select items.

Results

After two rounds of expert consultation, a total of thirty items were included in the dysmenorrhea QoL scale. And after sample analysis, four items' frequency distribution was skewed, five items' standard deviation (SD) was <0.8, four items' factor loading was <0.4, five items' score correlation coefficient with a related domain was <0.4, and three items’ deletion would cause their domain's Cronbach's α coefficient increased. The items were deleted when they met more than two above standards.

Conclusions

A total of twenty items with eight domains were included in the dysmenorrhea QoL scale. The methods to select the dysmenorrhea QoL scale items based on TCM theory were preferable. Given the paucity of research in this area, this new dysmenorrhea QoL scale may provide opportunities for patient-reported outcome evaluation in the field of TCM.
PP391 Economic Analysis Of Treatment For Spinal Muscular Atrophy: A Scoping Review
Authors: Duan Chengaxin , Sui Binyan , Zhao Kun , Ai Dandan , Xu Qian
Published: December 2020

Introduction

Spinal muscular atrophy (SMA) is a rare, life-threatening, and seriously debilitating neuromuscular disorder, which has a heavy burden on patients, caregivers and the health system. Technological advances have improved clinical effect, but have also increased the financial burden. There is limited information in the literature on the resource utilization and economic burden of SMA. Our research aims to summarize the current literature on resource use, cost and economic evaluations of treatments for SMA, to inform further research and policy decision making.

Methods

Databases, including PubMed, Embase, Cochrane Library and CRD Database, were searched from inception. Two reviewers undertook title and abstract screening followed by full-text screening, and any disagreement was resolved in consensus. Data extraction was conducted using a customized form. Included studies were summarized using narrative synthesis structured around general and economic characteristics. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered to where applicable.

Results

We reviewed 552 abstracts and included twenty-six from 2015 to 2019. Four-fifths were published in the United States and Europe. Five full economic evaluations and one budget impact analysis compared nusinersen with AVXS-101 or best supportive care, and the remaining evaluated the economic burden of SMA. The most common outcomes were healthcare resource utilization and direct medical costs, only a few studies evaluated direct non-medical costs or indirect cost.

Conclusions

SMA patients have significant medical expenditures and high utilization of healthcare services, including nusinersen-treated patients. The results highlight the substantial burden of treatment for SMA, not only for patients but also for their caregivers. SMA represents a significant hidden cost that society should be made aware of, and that should be considered in the design, implementation and evaluation of support programs for people who suffer from this disease and their families, as well as in the economic evaluation of new treatments.
PP399 Analysis Of Referral Patterns To Specialized Centers In Idiopathic Pulmonary Fibrosis To Define A New Regional Care Pathway
Authors: Di Bidino Rossella , Richeldi Luca , Rogliani Paola , Sebastiani Alfredo , Ricci Alberto , Varone Francesco , Cicchetti Americo
Published: December 2020

Introduction

Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease. Due to insufficient awareness of the disease, and the lack of specificity of clinical and physiological signs, the diagnosis of IPF is often delayed. In the Lazio Region (Italy) four reference centers manage patients with IPF. The objective of this analysis is to support the definition of a new regional care and therapeutic pathway (Percorso Diagnostico Terapeutico Assistenziale [PDTA]) for IPF to anticipate the moment of diagnosis by reference centers. The delayed referral to specialized centers has clinical consequences both in terms of survival and access to treatments.

Methods

A survey collected aggregated evidence on factors associated with referral patterns to specialized centers for IPF. Its content was defined on the basis of a literature search, the experience of involved clinicians, and hospital data sources. The survey considered patients diagnosed with IPF by the network of reference centers from 2014 to 2018. Aggregated data on the pre-diagnosis pathway and evidence on organizational features of each reference center were collected.

Results

Patients with a confirmed diagnosis of IPF increased from 2014 (n = 81) to 2018 (n = 344). A similar trend emerged considering only older patients. Incidence rates reached 11.33 cases per 100,000 residents in 2018. The majority of patients had a diagnosis in time to access to available treatments (87% in 2018). The number of specialists in multidisciplinary teams didn't change in a significant way. GPs, pneumologists, and IPF centers emerged as the pillar of the de-facto PDTA.

Conclusions

A new regional care and therapeutic pathway has been proposed to improve treatment of IPF. The first goal is to improve interaction among GPs, pneumologists, and IPF centers along the natural course of the disease. Criteria for referral to IPF centers has been defined (i.e. high-resolution computed tomography) as well as for adoption of a hub-and-spoke approach based on telemedicine.
PP498 Decision Support Tool For Investments In Health Technology Replacement: Experience Of A Public Teaching Hospital In Brazil
Authors: Schlatter Rosane Paixão , Coutinho Ana Paula , Rodrigues João Antonio Paim , Sanches Paulo Roberto Stefani , Ribeiro Luciano , Casella Mauricio Leser , Mahmud Simone Dalla Pozza , Muller André Frota , Tondin Bruno Rodriguez
Published: December 2020

Introduction

Based on the needs assessment of the medical and non-medical departments, the Investment Committee of the Hospital de Clínicas de Porto Alegre (HCPA), a teaching hospital in Brazil, recommends on which technologies the limited financial resources should be invested. Technology inclusion requests are evaluated by the hospital's technology assessment unit. For technology replacement, we have found models to assess the criticality of medical equipment, but they were insufficient to support the decision, which involves all departments of our hospital. This study aimed to develop an automated tool to support decision making regarding investments in equipment replacement in the hospital.

Methods

A working group was set up with professionals from healthcare administration, clinical engineering and research departments. From the hospital's inventory database, we developed the tool using Google SheetsR. We have defined three departments for pilot testing of the tool: hemodynamics, laundry, and basic research. These departments represent the areas of healthcare, support services, and teaching and research in the hospital.

Results

The criticality of medical equipment is assessed based on the criteria of function, physical risk, impact, remaining equipment life cycle, intensity of use and number of corrective maintenance actions performed. For the equipment in the administrative, support and research areas, the function and physical risk criteria were replaced by the safety and by the risks to the quality of service criteria. The evaluation is carried out by a multidisciplinary team. The tool categorizes the equipment into low, medium and high criticality.

Conclusions

The tool prioritized the equipment based on objective criteria evaluated by the departments’ multidisciplinary team comprising experts who use the equipment in their activities, the department administrator and clinical engineers, and provided transparency regarding the decision-making of the hospital's Investment Committee. In 2019, the limited financial resources were invested only in the replacement of highly critical equipment. We believe the tool can be reproduced in hospitals in low and middle-income countries.
PP502 AQuAS Learnings From Implementing GRADE Approach, Especially The Evidence To Decision Framework And Multidisciplinary Final Consensus
Authors: Giménez Emmanuel , Estrada Maria-Dolors , Garcia Xavier , Castillo Maria Auxiliadora , Varela Leonor , Espallargues Mireia
Published: December 2020

Introduction

In recent years, the GRADE system has been adopted internationally to make judgments about evidence and/or recommendations. Recently, the Spanish Network of HTA (RedETS) has promoted among its members the use of the GRADE system, especially the “Evidence to Decision” tool (EtD) where a multidisciplinary panel is involved. The objective is to describe the methodological approach with the first AQuAS experience using this methodology in HTA, focused on inclusion/exclusion of these technologies in the Spanish National Health Service (NHS) portfolio.

Methods

The standard EtD tool was used for clinical and financial decisions. Four multidisciplinary panels were constituted by relevant professionals in clinical practice and, where possible, patients. The four panels discussed on the following four interventions: in two cases, AQuAS prepared preliminary recommendations and participants provided feedback, while in the other two cases, experts received the evidence review and were asked to formulate recommendations. These recommendations were voted on and, in the case of disagreement, adapted and then voted on for a second time. Finally, any discrepancies were noted in the report. Evaluated interventions were: maxillofacial 3D-reconstruction, cataract surgery equipment, non-invasive surgery in obesity and pharmacological treatment in secondary fracture prevention.

Results

Especially when more than one evaluative question was addressed in the HTA report the EtD and the consensus results required discussion. Consensus was fast but not immediate. Meeting length depended on the number of HTA questions and the amount of original disagreement in the recommendations. The nuances on how to write recommendations also affected the panel duration. All panels were successful in formulating the final recommendations.

Conclusions

Standardizing methodologies increased the homogeneity across HTA reports. The GRADE system is a feasible and useful tool because it favors transparency and rigor in drawing up recommendations on the inclusion/exclusion of technologies in the NHS portfolio. The EtD framework complements GRADE tables, which display the relevant evidence in a way that can be used by multidisciplinary groups to reach a consensual recommendation.

Although all participants received a short training video, more experience in the use of these methodologies might shorten the duration of the process and facilitate reaching consensus. Some considerations on how to overcome the difficulties and complexity of this methodological approach are discussed.
A cost-effective beam forming structure for global navigation satellite system multipath mitigation and its assessment
Authors: Jia Qiongqiong , Hsu Li-Ta , Xu Bing , Wu Renbiao
Published: December 2020

Array antenna beam forming has high potential to improve the performance of the global navigation satellite system (GNSS) in urban areas. However, the widespread application of array antennas for GNSS multipath mitigation is restricted by many factors, such as the complexity of the system, the computation load and conflicts between required performance, cost budget and limited room for the antenna placement. The scope of this work is triplicate. (1) The pre-correlation beam forming structure is first suggested for multipath mitigation to decrease the system complexity. (2) With the pre-correlation structure, the equivalence of adaptive beam forming to quiescent beam forming is revealed. Therefore, the computational load for beam forming is greatly decreased. (3) A theoretical model is established to link the benefits of beam forming with GNSS performance improvement in terms of pseudorange quality. The model can be used by industry to balance the aforementioned restrictions. Numerical results with different array settings are given, and a 2 × 2 rectangle array with $0.4\lambda $ element spacing is suggested as a cost-effective choice in GNSS positioning applications in urban canyon areas.
Temperature and humidity associated with increases in tuberculosis notifications: a time-series study in Hong Kong
Authors: Xu M. , Li Y. , Liu B. , Chen R. , Sheng L. , Yan S. , Chen H. , Hou J. , Yuan L. , Ke L. , Fan M. , Hu P.
Published: December 2020

Previous studies have revealed associations of meteorological factors with tuberculosis (TB) cases. However, few studies have examined their lag effects on TB cases. This study was aimed to analyse nonlinear lag effects of meteorological factors on the number of TB notifications in Hong Kong. Using a 22-year consecutive surveillance data in Hong Kong, we examined the association of monthly average temperature and relative humidity with temporal dynamics of the monthly number of TB notifications using a distributed lag nonlinear models combined with a Poisson regression. The relative risks (RRs) of TB notifications were >1.15 as monthly average temperatures were between 16.3 and 17.3 °C at lagged 13–15 months, reaching the peak risk of 1.18 (95% confidence interval (CI) 1.02–1.35) when it was 16.8 °C at lagged 14 months. The RRs of TB notifications were >1.05 as relative humidities of 60.0–63.6% at lagged 9–11 months expanded to 68.0–71.0% at lagged 12–17 months, reaching the highest risk of 1.06 (95% CI 1.01–1.11) when it was 69.0% at lagged 13 months. The nonlinear and delayed effects of average temperature and relative humidity on TB epidemic were identified, which may provide a practical reference for improving the TB warning system.
Correlation of population mortality of COVID-19 and testing coverage: a comparison among 36 OECD countries
Authors: Wei C. , Lee C. C. , Hsu T. C. , Hsu W. T. , Chan C. C. , Chen S. C. , Chen C. J.
Published: December 2020

Although testing is widely regarded as critical to fighting the COVID-19 pandemic, what measure and level of testing best reflects successful infection control remains unresolved. Our aim was to compare the sensitivity of two testing metrics – population testing number and testing coverage – to population mortality outcomes and identify a benchmark for testing adequacy. We aggregated publicly available data through 12 April on testing and outcomes related to COVID-19 across 36 OECD (Organization for Economic Development) countries and Taiwan. Spearman correlation coefficients were calculated between the aforementioned metrics and following outcome measures: deaths per 1 million people, case fatality rate and case proportion of critical illness. Fractional polynomials were used to generate scatter plots to model the relationship between the testing metrics and outcomes. We found that testing coverage, but not population testing number, was highly correlated with population mortality (rs = −0.79, P = 5.975 × 10−9vs. rs = −0.3, P = 0.05) and case fatality rate (rs = −0.67, P = 9.067 × 10−6vs. rs = −0.21, P = 0.20). A testing coverage threshold of 15–45 signified adequate testing: below 15, testing coverage was associated with exponentially increasing population mortality; above 45, increased testing did not yield significant incremental mortality benefit. Taken together, testing coverage was better than population testing number in explaining country performance and can serve as an early and sensitive indicator of testing adequacy and disease burden.
Species identification and antimicrobial susceptibility testing of non-tuberculous mycobacteria isolated in Chongqing, Southwest China
Authors: Zhang Huizheng , Luo Ming , Zhang Ke , Yang Xin , Hu Kui , Fu Zongqiang , Zhang Liwen , Wu Ping , Wan Dongyong , Han Mei , Wang Xiaoying
Published: December 2020

With the rapid rise in the prevalence of non-tuberculous mycobacteria (NTM) diseases across the world, the microbiological diagnosis of NTM isolates is becoming increasingly important for the diagnosis and treatment of NTM disease. In this study, the clinical presentation, species distribution and drug susceptibility of patients with NTM disease visiting the Chongqing Public Health Medical Centre during March 2016–April 2019 were retrospectively analysed. Among the 146 patients with NTM disease, eight NTM species (complex) were identified. The predominant NTM species in these patients were identified to be Mycobacterium abscessus complex (53, 36.3%), M. intracellulare (38, 26%) and M. fortuitum (17, 11.7%). In addition, two or more species were isolated from 7.5% of the patients. Pulmonary NTM disease (142, 97.3%) showed the highest prevalence among the patients. It was observed that 40.1% of the patients with pulmonary NTM disease had chronic pulmonary obstructive disease and bronchiectasis, while 22.5% had prior tuberculosis. Male patients showed more association with the conditions of cough and haemoptysis than the female patients. In an in vitro antimicrobial susceptibility testing, most of the species showed susceptibility to linezolid, amikacin and clarithromycin, while M. fortuitum exhibited low susceptibility to tobramycin. In conclusion, the prevalence of NTM disease, especially that of the pulmonary NTM disease, is common in Southwest China. Species identification and drug susceptibility testing are thus extremely important to ensure appropriate treatment regimens for patient care and management.
High prevalence of food insecurity, the adverse impact of COVID-19 in Brazilian favela
Authors: Manfrinato Catarina V , Marino Aluízio , Condé Vitória F , Franco Maria do Carmo P , Stedefeldt Elke , Tomita Luciana Y
Published: December 2020

Objective:

To investigate food insecurity (FI) prevalence in two favelas in Brazil in the early weeks of the social distancing policy, from 27 March 2020 to 1 June 2020.

Design:

A cross-sectional study using an online questionnaire to elicit information on socio-economic and demographic characteristics, the types of stores visited to buy food, and FI screening. The FI experience was evaluated according to the Brazilian Food Insecurity Scale. Factors associated with moderate or severe FI were investigated using the logistic regression model.

Setting:

São Paulo city, Brazil.

Participants:

Totally, 909 householders.

Results:

Eighty-eight per cent of the households included young women working as cleaners or kitchen assistants and in sales services. One-fifth of the participants were involved in the federal cash transfer programme, called Bolsa Família. There were 92 % households with children. The most frequent experience reported was uncertainty about food acquisition or receiving more (89 %), eating less than one should (64 %), not being able to eat healthy and nutritious food (46 %), and skipping a meal (39 %). Forty-seven per cent of the participants experienced moderate or severe FI. Factors associated with moderate and severe FI were low income, being a Bolsa Família recipient, having a low level of education and living in a household without children.

Conclusions:

Half of the participants experienced moderate or severe FI, and almost 10 % experienced hunger. Our data suggest that families with children were at a lower risk of moderate to severe FI. It is possible that nationally established social programmes such as Bolsa Família were protecting those families.
Clientelism from the Client’s Perspective: A Meta-Analysis of Ethnographic Literature
Authors: Pellicer Miquel , Wegner Eva , Bayer Markus , Tischmeyer Christian
Published: December 2020

Mainstream political science literature on clientelism tends to focus on its supply side and on vote-buying, whereas ethnographic work often emphasizes client agency and incentives and paints a more diverse image of clientelism. We bridge the gap between these literatures by conducting a meta-analysis of ethnographic literature on clientelism from the client perspective. We code characteristics of clientelistic exchanges described in this work. We use cluster analysis and principal component analysis to systematize these data. Cluster analysis groups exchanges into three core subtypes of clientelism (“vote-buying”, “relational”, and “collective”); principal component analysis delivers two fundamental dimensions of clientelism: equal-unequal and individual-universal. We show that the two dimensions are associated with different aspects of client welfare and trade-offs from the client perspective. Our results reaffirm and reconcile existing deductive typologies of clientelism and can serve as a basis for a structured study of the demand side of clientelism.
Symposium: Authority, legitimacy, and contestation in global governance
Authors: Fioretos Orfeo , Tallberg Jonas
Published: December 2020

As global governance institutions appear increasingly contested by state and non-state actors alike, understanding their origin, operation, and impact is becoming ever more urgent. This symposium uses Michael Zürn's A Theory of Global Governance: Authority, Legitimacy, and Contestation (OUP, 2018) as a springboard to explore the state of global governance theory. A Theory opens new terrain and advances bold and original arguments, including the contention that global governance is itself best understood as a political system. It analyzes a cycle from rising authority beyond the state through the 20th century, to ensuing legitimation problems toward the century's end, to the politicization and contestation triggered by such problems. A book of such ambition inevitably elicits queries within diverse international relations research communities. This symposium features seven articles from diverse traditions in engagement with A Theory's understanding of global contestation, authority, and legitimacy. These are followed by a response from Zürn. An introduction situates A Theory within extant research on global governance, highlights its endogenous theory of global politics, and identifies the stakes of deepening research on the sources of global authority, contestation, and political legitimation.
Sense and sensibility or: remarks on the ‘bounds of (non)sense’
Authors: Peltonen Hannes
Published: December 2020

Kratochwil's diagnostic approach identifies specific failures in particular, historical contexts in order to prescribe practically realisable remedies under non-ideal conditions. The diagnostic approach compares actual alternatives against each other rather than against some ideal. Yet, the basis for such an identification is unclear. By reinterpreting Kratochwil's approach with the help of Buddha's Four Noble Truths, one can understand Kratochwil's existential worldview and his aims, but the medium Kratochwil uses hinders the attainment of those goals. He tries to communicate in writing something (phronesis) that belongs in the world of experience.
Hope behind the critique of grand narratives of collective salvation: remarks on ‘The power of metaphors and narratives’
Authors: Vasconcelos Vilaça Guilherme
Published: December 2020

Kratochwil criticizes two important teleological global narratives of universal progress – Luhmannian systems theory andjus cogens– and defends the need for a non-ideal and situated approach to law and politics. Despite the cogency of Kratochwil's analysis, why should we place our hope in his pragmatic program given the complexity of actual decision-making? This paper shows that more needs to be said about the role of hope grounding Kratochwil's account. Which hopes are hopeless, and which warranted? Why should we care and ‘go on’, choosing to be prudential and political rather than focusing on one's inner development or pleasure?
On engagement and distance in social analysis: a reply to my critics
Authors: Kratochwil Friedrich
Published: December 2020

The problem of ‘distance and engagement’ highlights the Weberian paradox that objectivity in the social sciences cannot be based on demonstrative proof; it has to take into account values as the constituents of our ‘interests’. Values should be explicit even if this ‘perspectivity’ cannot satisfy the criteria of necessity and universality. Allegedly, my skeptical approach to ‘social theory’ leaves researchers with insufficient ‘hope’, but one also learns from understanding that something is impossible or conceptually flawed. Moreover, deeper issues of analyzing social action, with existential and moral dimensions, should be considered. These involve our cognitive capacities, experiences, and emotions.
A field day with Fritz: introduction to the Symposium
Authors: Wiener Antje
Published: December 2020

The Status of Law begins with the suspicion ‘that “law” might have become the problem rather than the solution, and this problem requires further analysis’. Given that law is a social construct, Kratochwil invites us to turn to the sites where this construction takes place. To bring the many constitutions and contestations of law to the fore, he conjures theoretical sparring partners to engage in nine meditations. The genius of this Symposium consists of inviting nine colleagues, each engaging with a different meditation, and inviting a tenth colleague to add this introduction as a way to engage the engagement. By doing practice on practice the Symposium does full justice Kratochwil's move towards looking at the practice ‘in the middle of things’. The resulting field day with Fritz is a piece of intellectual mastery compiled by ‘spirited members of the republic of letters’ that carries the reader along on a journey that reveals and addresses Kratochwil's suspicions about the problem with law. In the end, we know more through sharing the problem and partaking in the joy of addressing it.
Bewitching the world: remarks on ‘Inter-disciplinarity, the epistemological ideal of incontrovertible foundations, and the problem of praxis’
Authors: Onuf Nicholas
Published: December 2020

Kratochwil's magnificent The Status of Law in World Society's first meditation, a philosophical discursus masquerading as a meditation about meditation, addresses how International Law and International Relations deal so differently with their common concerns. Kratochwil treats these concerns with his usual cogency. Yet, critical links are missing. How do we get from speaking as a normative practice to the status of law in today's world? How does language (even more than law) go from an ‘agency-related notion’ to ‘a pervasive force penetrating all social relations’? The bewitchment of the world through language is ontology's greatest mystery, worthy of endless meditation.
Observations of Mirror Mode Structures in the Dawn‐Side Magnetosphere
Authors: Chandler M. O. , Schwartz S. J. , Avanov L. A. , Coffey V. N. , Giles B. L. , Moore T. E. , Pollock C. J. , Burch J. L. , Russell C. T. , Torbert R. B.
Published: December 2020

We present observations of mirror mode structures in the dawn‐side magnetosphere from the Magnetospheric Multiscale Mission. The observations were made during a period of relatively stable northward interplanetary magnetic field conditions. We observed magnetic troughs only with reductions of up to 90% in the magnitude of the local magnetic field. The structures were closely aligned with the local magnetic field and had sizes perpendicular to the magnetic field of the order of 1Re and ion densities up to twice that of the surrounding regions. We used ion, magnetic field, and electric field data to examine the plasma conditions inside and outside of these structures to investigate the stability and evolution of the structures and estimate the magnitude of changes in the ion distributions. Comparing the ion bulk properties to theoretical predictions, we concluded that variations in the parameters with trough depth were due to the spacecraft traversing them at different locations along their length. Our calculations of heating and cooling of the ions at different pitch angles is consistent with theory. We conclude that these troughs were likely long‐lived, bistable structures that originated in the magnetosheath near the nose of the magnetopause and were captured into the magnetosphere by dual‐lobe reconnection.
Centrifugal Equator in Jupiter’s Plasma Sheet
Authors: Phipps Phillip , Bagenal Fran
Published: December 2020

In Jupiter’s magnetosphere, the structure of the plasma sheet depends on the magnetic field geometry and the centrifugal forces on the plasma. We present a simple formulation for the centrifugal equator, the farthest point along a magnetic flux tube from the planetary spin axis, for Jupiter’s torus to plasma sheet region (5–30 jovian radii). The formulation is based on a dipole magnetic field and azimuthally symmetric current sheet, both tilted by 9.5° toward System III west longitude of 201°. We find a good fit to such a model with a hyperbolic tangent function varying sinusoidally with longitude. The latitudinal angle of the derived centrifugal equator relative to the jovigraphic equator changes from the dipolar value (2/3 of the dipole tilt) around 5 jovian radii to close to the full dipole tilt at 25 jovian radii.
Methyl Chloroform Continues to Constrain the Hydroxyl (OH) Variability in the Troposphere
Authors: Patra P. K. , Krol M. C. , Prinn R. G. , Takigawa M. , Mühle J. , Montzka S. A. , Lal S. , Yamashita Y. , Naus S. , Chandra N. , Weiss R. F. , Krummel P. B. , Fraser P. J. , O'Doherty S. , Elkins J. W.
Published: December 2020

Trends and variability in tropospheric hydroxyl (OH) radicals influence budgets of many greenhouse gases, air pollutant species, and ozone depleting substances. Estimations of tropospheric OH trends and variability based on budget analysis of methyl chloroform (CH3CCl3) and process‐based chemistry transport models often produce conflicting results. Here we use a previously tested transport model to simulate atmospheric CH3CCl3 for the period 1985–2018. Based on mismatches between model output and observations, we derive consistent anomalies in the inverse lifetime of CH3CCl3 (KG) using measurements from two independent observational networks (National Oceanic and Atmospheric Administration and Advanced Global Atmospheric Gases Experiment). Our method allows a separation between “physical” (transport, temperature) and “chemical” (i.e., abundance) influences on OH + CH3CCl3 reaction rate in the atmosphere. Small increases in KG due to “physical” influences are mostly driven by increases in the temperature‐dependent reaction between OH and CH3CCl3 and resulted in a smoothly varying increase of 0.80% decade−1. Chemical effects on KG, linked to global changes in OH sources and sinks, show larger year‐to‐year variations (∼2%–3%), and have a negative correlation with the El Niño Southern Oscillation. A significant positive trend in KG can be derived after 2001, but it persists only through 2015 and only if we assume that CH3CCl3 emissions decayed more slowly over time than our best estimate suggests. If global CH3CCl3 emissions dropped below 3 Gg year−1 after 2015, recent CH3CCl3 measurements indicate that the 2015–2018 loss rate of CH3CCl3 due to reaction with OH is comparable to its value 2 decades ago.