bluuebunny/crossref_metadata_2025 huggingface dataset:
PP350 Study On The Awareness, Willingness To Pay And Satisfaction With Non-Invasive Prenatal Testing Among Pregnant Women
Authors: Fan Changjia , Shang Wenru , Huang Jiayan , Wan Yang
Published: December 2020

Introduction

Birth defects seriously affect children's survival and quality of life and bring great suffering and financial burden to children and their families. Down's syndrome is one of the most common birth defects. Compared with traditional serological screening methods, non-invasive prenatal testing (NIPT) has higher sensitivity and specificity in the screening of Down's syndrome. In April 2017, the People's Government of Fuyang City, Anhui Province launched a NIPT free screening program. From the perspective of the beneficiary, this research investigated the awareness, willingness to pay and satisfaction of pregnant women in Fuyang City, Anhui Province, to better improve the use of NIPT.

Methods

A questionnaire survey was conducted on 1,221 pregnant women who experienced this program in Fuyang City, Anhui Province. Multivariate ordered logistic regression models were established to analyze the factors affecting the satisfaction of NIPT.

Results

A total of 1,217 valid questionnaires were collected. Research indicated 82.5 percent knew about NIPT and 81.9 percent were willing to pay personally when its price was CNY 800 (USD 113.88) per test among pregnant women. The satisfaction of pregnant women with NIPT showed that the waiting time for test results was relatively low (4.5 out of 5 points) compared with other aspects of satisfaction. The higher the education level of the pregnant women, the lower their satisfaction with NIPT.

Conclusions

It is necessary to pay attention to the characteristics of education and to improve the awareness and satisfaction of NIPT among pregnant women. Meanwhile, if it is affordable enough for NIPT services to be provided by the government, this mode should be promoted. In conjunction with the willingness to pay of pregnant women, NIPT payment methods should be developed appropriately.
PP355 Evolution Of Health Technology Assessment For Rare Diseases In Asia
Authors: Jandoo Tarveen , Deniz Baris , Yang Shuo
Published: December 2020

Introduction

We reviewed the health technology assessment (HTA) guidelines for therapies targeting orphan conditions in four countries/regions in Asia.

Methods

A pragmatic literature search was conducted to identify and review key documents outlining reimbursement, pricing, and coverage policies in China, Taiwan, Korea, and Japan.

Results

Therapies for rare diseases in Japan and those for ultra-rare diseases in Korea are exempt from cost-effectiveness evaluations. Taiwan provides full financial coverage for rare disease therapies. China has no special considerations for rare diseases. Drugs included in the medical insurance list are reimbursed at varying levels depending on the “class” of the listing. Unlike prior variations at provincial levels for coverage of off-the-list drugs, new national policy has introduced consistency in coverage.

Conclusions

Access and reimbursement processes vary between markets in Asia. New HTA guidelines in Japan allow for easier access to therapies targeting rare diseases by eliminating cost-effectiveness analysis for price determination. On the other hand, a value dossier including an economic evaluation is necessary for rare diseases in Korea. However, manufacturers can provide risk-sharing schemes for rare diseases. China has not yet introduced any specific evaluations or reimbursement criteria for therapies targeting rare diseases. Policies for rare diseases are evolving rapidly to improve access and affordability.
PP382 Research On The Second-Line Anti-Tuberculosis Drugs Supply Based On Stakeholder Theory Of China
Authors: Liu Zhao , Shen Lijun , Zhang Fan , Du Tiantian , Liu Yuehua
Published: December 2020

Introduction

China is one of the twenty-seven countries with a high burden of Multidrug-resistant tuberculosis (MDR-TB) in the world. Of the new TB patients in China in 2017, about 63,000 are MDR-TB patients, accounting for one-third of the number of new MDR-TB patients worldwide.

In the latest “China's 13th Five-Year Plan” national TB prevention and control plan promulgated in 2017, it is clearly emphasized that all regions should gradually incorporate TB into the payment catalogue of special outpatient medical insurance, according to local conditions. However, for this special group of MDR-TB patients, there is no specialized prevention and control policy at the national level, and there are also blind spots in the medical security policy.

Responding to the drug needs of MDR-TB patients, it is necessary to provide patients with stable and affordable second-line anti-TB drugs. It is also necessary to understand the overall drug demand for second-line drugs nationwide to guide further policy formulation and budget research.

Methods

Through semi-structured group interviews and key informant interviews, five provinces and cities were investigated. Qualitative analysis was conducted based on stakeholder theory selected doctors and staff from Centers for Disease Control.

Results

Through investigations in this study, problems like low purchasing price, insufficient purchasing volume, low drug supply efficiency, and monopoly producers were found. Through the analysis of roles and relationships among the major stakeholders in the second-line drug supply system, together with the motivation and resistance factors, it was found that all stakeholders have the motivation to solve the problem and face their dilemmas and obstacles at the same time.

Conclusions

Patients with MDR-TB still have difficulties in obtaining medicines. The interests of various stakeholders need to be balanced to improve drug accessibility and affordability. It is recommended to take advantage of the country's centralized procurement, encourage the development and listing of new anti-tuberculosis drugs and generic drugs, and improve the supervision system to ensure the supply of drugs to benefit more patients with tuberculosis.
PP383 Assessment Of The Implementation Effect Of Health Poverty Alleviation Policy: A Case Study Of Hebei Province, China.
Authors: Liu Yuehua , Chen Chen , Liu Zhao , Zhang Fan , Du Tiantian , Zhao Kun
Published: December 2020

Introduction

Since the 18th National Congress of the Communist Party of China (CPC), remarkable achievements have been made in poverty alleviation. Over the past five years, the population of people living in poverty had decreased by 68.53million, fallen from 98.99 million in 2012 to 30.46 million at the end of 2017. As an impoverished province, Hebei province has been implementing the CPC Central Committee's guidance in the battle against poverty. In 2016, the government released the Implementation Scheme Plan for Improving the Level of Medical Security and Assistance. The plan introduces multi-layer medical security and assistance mechanisms which covers basic medical insurance, major disease insurance and medical assistance. In 2017, the government formulated the Implementation Plan for the Three-Batch Action Plan on the Health Care Program for Poverty Alleviation in Hebei Province, for people with major disease. Hebei Province has carried out many explorations on the health care program for poverty alleviation, and its effectiveness is a problem worthy of attention.

Methods

Based on data including basic medical insurance, major illness insurance, medical assistance, and other related information, we used descriptive statistics and quantitative methods to evaluate the overall expenditure of the poverty alleviation for Hebei province and the areas under its jurisdiction. Additionally, the expenditure of different levels of medical security system, the medical burden for people facing poverty and the distribution of disease in the population with assistance were evaluated.

Results

The out-of-pocket payment per capita has decreased year by year, and it has dropped to 3% of catastrophic medical expenditure and 20% below the poverty line by June 2018. An imbalanced situation occurred with the implementation, with the more impoverished areas having greater the pressure on medical care and poverty alleviation. For people with medical assistance, diseases with higher population and overall expenditure are cerebrovascular disease, malignant tumor, diabetes and some other chronic diseases.

Conclusions

The health policies for poverty alleviation in Hebei province has achieved a remarkable success, and the medical burden of the poor has been significantly reduced. However, the implementation of the policies in various cities has shown an imbalanced situation, and the poverty alleviation policies need to be further improved.
PP387 Budget Impact Analysis Of Adalimumab In The Treatment Of Ankylosing Spondylitis In China
Authors: Duan Chengaxin , Sui Binyan , Zhao Kun , Ai Dandan , Xu Qian
Published: December 2020

Introduction

Ankylosing spondylitis (AS) is a common disease that causes pain and affects productivity. Tumor necrosis factor-α (TNF-α) like adalimumab can bring better clinical efficacy and improve quality of life. Adalimumab is likely to be covered by health insurance. It is necessary to assess the impact of adalimumab for patients with AS on the medical insurance budget in China. Our research aims to give support evidence for policy-making.

Methods

From the perspective of medical insurance payers, a budget impact model was established to evaluate the impact of adalimumab for the treatment of adults with severe active AS that has responded inadequately to conventional therapy. The time horizon was 5 years (2020–2024). The cost of measurement included drug and treatment costs for adverse events. Scenario analysis was conducted to evaluate the results under different drug price reimbursement ratios and treatment ratios.

Results

Based on the current price of adalimumab (CNY 3,160 [USD 446]/unit), under the reimbursement ratio of 70 percent, adalimumab will increase medical insurance expenditure by CNY 162 [USD 22] million, CNY 152 [USD 21] million, CNY 114 [USD 16] million, CNY 100 [USD 14] million and CNY 88.11 [USD 12] million in the next 1–5 years, respectively. The increased medical insurance expenditure accounts for 0.091, 0.085, 0.064, 0.056, and 0.049 percent of the annual medical insurance expenditure in the next 1–5 years, respectively, which is assumed to be equivalent to the expenditure in 2018 of CNY 1782.2 [USD 251] billion.

Conclusions

The budget impact of adalimumab for AS on medical insurance expenditure is limited, and including adalimumab in the medical insurance catalogue can reduce the burden on individuals, enrich treatment options, and satisfy clinical needs better.
PP404 Effect Evaluation Of Two Family Doctor Contracting Service Models On Diabetic Patients: A Real-World Study In Chengdu, China
Authors: Zhou Li , Zhu Xingyue , Liu Hongyuan , Huang Yanli , Hu Ming
Published: December 2020

Introduction

To strengthen the care capacity of primary facilities, China has vigorously promoted the construction of a hierarchical medical system and a family doctor care system. In July 2017, a family doctor care plan was launched in an urban district of Chengdu, Sichuan Province, and two family doctor contracting service models were adopted, one provided a basic-service package and the other a paid-service package. In order to evaluate the effect of different models on diabetic patients, this study conducted a real world study based on the district healthcare database.

Methods

Diabetic patients who contracted family doctor services January 2018 to January 2019 as reported in the database were enrolled in the paid- or basic-service group. Propensity score matching (PSM) was conducted to balance the distribution of covariances between the groups. The results of the first and last examination of glycosylated hemoglobin, low-density lipoprotein cholesterol (LDL-C), systolic and diastolic blood pressure in the groups were compared by independent sample t-test and chi-square test.

Results

Included were 4,871 patients in basic-service and 394 patients in paid-service. In both groups the total control rates of blood pressure, glycosylated hemoglobin and LDL-C at the last physical examination were 43.67, 79.28 and 51.11 percent, respectively, a significant increase from pre-test. The combined control rates of HbAlc, LDL-C and blood pressure in the basic- and paid-service group were 20.76% and 22.37%, respectively. After PSM, there was no significant difference between the groups.

Conclusions

Up to now, there is no significant difference between basic-service and paid-service family doctor contracting service models in improving the comprehensive control rate of diabetic patients. The possible reasons may be that the quality and content of paid-service is not as good as expected, the period of implementation is not long enough and the sample size of paid-service patients is limited.
PP443 Effectiveness And Safety Of Transcatheter Therapy Interventions Devices For Treatment Of Tricuspid Regurgitation
Authors: Garcia_Carpintero Esther Elena , Freixa Jordi Gol , Gómez Luis María Sánchez
Published: December 2020

Introduction

Tricuspid regurgitation (TR) is defined as incompetence of the tricuspid valve (TV), which produces the movement of blood flow from the right ventricle (RV) to the right atrium during systole. Pathological TR is functional in nearly 80–90 percent of cases, secondary to volume and/or pressure overload in the RV. Surgical intervention of TR is associated with mortality rates of 10 percent. Transcatheter therapy interventions (TTI) can be an alternative for severe TR. The aim of this study is to assess effectiveness and safety of TTI.

Methods

A systematic review was carried out. The scientific literature search was performed in major medical databases. Studies analyzing the efficacy and safety of the devices were included. Outcomes related with mortality rates, TR volume reduction, echocardiographic findings and adverse events were analyzed. The methodological quality of the studies was analyzed with the Canadian Institute of Health Economics Quality Appraisal Checklist.

Results

Nine studies comprising 557 patients were included (two first-in-human studies, one retrospective, five single arm prospective studies and one international registry). The studies were small with short follow up. The outcome of procedural success ranged from 80 to 100 percent. Mortality rates at 30 days were lower than 5 percent. Improvements in reduction of TR, European System for Cardiac Operative Risk Evaluation (EuroSCORE), heart failure symptoms or quality of life scores were observed in all studies.

Conclusions

TTI for moderate-severe TR show significant reduction of annulus dimension, improvements in heart failure symptoms and quality of life, which are maintained in mid-term follow up. TTI present lower rates of major serious adverse events. No differences were observed between different TTI devices in terms of procedural success, mortality or safety. Randomized studies comparing TTI with optimal medical therapy are needed to confirm the preliminary clinical impact in patients with severe TR, and define aspects such as patient selection, risk factors associated with procedural success or mortality rates.
PP495 Addressing The Interactions Between Health Regulation And Health Technology Assessment In Brazil
Authors: Ramos Maíra Catharina , de Oliveira Margarete Martins , da Silva Erica Tatiane , Pereira Daniella Cristina Rodrigues , Elias Flávia Tavares da Silva
Published: December 2020

Introduction

The interaction of health technology assessment (HTA) and health regulatory agencies has been widespread, especially for decision-making in health system coverage. The objective of this paper is to report the HTA-regulatory interaction in Brazil.

Methods

This is a case study on the interaction between HTA and regulation in Brazil. Technical documents and Brazilian legislation on health regulation and HTA were analyzed. The study was conducted in July 2019.

Results

HTA-Regulatory Interaction in Brazil is still incipient. There is no responsible agency for interaction between agencies, as there is in Europe and Canada, for example. In the last 4 years, cooperation has started between the Brazilian Health Surveillance Agency (Anvisa) and the Oswaldo Cruz Foundation (Fiocruz) for post-registration monitoring of medicines. During this partnership, 170 post-marketing drug opinions were prepared, assisting the regulatory agency in decision-making.

Conclusions

Brazil legislation guarantees essential medicines at low cost or free. The interaction between HTA and regulation has the potential to reduce the time taken to incorporate technology to the patient, in addition to ensuring greater safety for users of the Unified Health System. In this sense, it was observed that the interaction between health regulation and science and technology institutions has innovative potential in this approach.
PP501 Inclusion Of Key Stakeholders’ Views When Developing A mHealth Assessment Tool: Focus Groups And Health Consensus Results
Authors: Puigdomènech Elisa , Poses Elisa , Velasco César , Garcia Xavier , Espallargues Mireia
Published: December 2020

Introduction

The Agency for Health Quality and Assessment of Catalonia (AQuAS) is developing an evaluation tool for mobile health (mHealth) solutions to be used by health technology assessment (HTA) agencies and evaluation experts. In order to have a practical and comprehensive tool taking into account the particularities and challenges of mobile interventions, we considered the views and opinions of key stakeholders. The objective was to present the final selection of general aspects (dimensions) to be assessed in the evaluation, as well as the specific items (criteria) to be included in each of these topics, as a result of different co-design approaches with health professionals, developers, hospital managers, HTA agencies and patients.

Methods

A list of criteria used for health apps evaluation were drawn from a literature review. The initial list included eighty-nine criteria items grouped in nine domains. Those criteria and domains were discussed during four focus groups (FG). The importance of the criteria that were not considered as mandatory were later rated through a Delphi online sub-study, in a scale from one to six points, taking as consensus value when median value (median 6, Interquartile range, 0–1) was reached.

Results

FG reduced domains and criteria from nine to seven and from eighty-nine to thirty-three, respectively. Most mandatory criteria were related with security, user experience, and clinical effectiveness. Fifty-seven individuals (53.7% of 106 invited to participate) were registered in the online platform (50.1% women, 68.4% 35–64years old and 42.1% from HTA agencies). From fifty non-mandatory criteria under consensus, ten criteria reached consensus (most from solution's content and health problem covered domains) concluding with a 43/7 criteria/domain tool.

Conclusions

Insights from main stakeholders on the content of the tool for mHealth assessment were considered through the FG and Delphi technique. The dimensions of security and privacy, clinical effectiveness, solutions’ content, technological aspects, users’ experience and costs were considered mandatory. The dimension related to the impact on the organization was appraised as a secondary domain for evaluation. A workshop with AQuAS research team and HTA external researchers will help to define: the assessment methods (type of instrument, dichotomous responses and/or Likert scales) for the evaluation and the format and dimension's weights of the final design of the tool.
PP574 Cost-Effectiveness Of Newborn Screening Of Primary Immunodeficiency Diseases: A Systematic Review And Economic Evaluation
Authors: Yang Junting , Zhang Fan , Liu Zhao , Yue Ning , Liu Yuehua
Published: December 2020

Introduction

Primary immunodeficiency diseases (PIDs) are a heterogeneous group of over 200 disorders with defects in the function and/or development of the immune system. Although early screening is imperative for improving therapeutic efficiency and preventing disease-associated morbidity, its widespread use has been limited, owing to the low incidence of PIDs. It is particularly important to evaluate the cost-effectiveness of PIDs screening for newborns. The aim of this study was to provide an overview of the existing cost-effectiveness evidence on newborn screening of PIDs and to provide reference for decision-makers in China and other developing countries.

Methods

We conducted a systematic review using three electronic databases (PubMed, CNKI, and CSPD) of cost and cost-effectiveness studies of PIDs screening published during 2000–2019. Two reviewers independently searched databases and screened titles, abstracts and full texts; a third reviewer resolved disputes when necessary. The initial search returned 124 references, of which 10 full articles were included in the review. Five of the studies conducted analyses using model-based techniques.

Results

Severe combined immunodeficiency (SCID) was the predominantly studied condition (80%). Most studies (70%) examined the T-cell receptor excision circle (TREC) assay. A healthcare system's perspective was commonly used (50%) for cost calculations, and most studies (50%) were US-based. The majority (67%) of the studies found the TREC assay an effective screening tool for SCID, but the incremental cost-effectiveness ratio (ICER) varied across screening test specificity and disease incidence.

Conclusions

Evidence from the published literature demonstrated that newborn screening for PIDs generally appeared to be cost-effective, and most importantly, it is lifesaving and allows children with PIDs an opportunity to live a healthier life. However, the type of PIDs included in this study were limited and most studies were done in developed countries whose health systems are different from low-/middle-income countries (LMIC). Further research is required to identify the cost-effectiveness of PIDs screening both in developed and developing countries.
PP581 Catastrophic Costs Of Multidrug-Resistant Tuberculosis: Estimation Based On The Cost Of Treatment In China
Authors: Shen Lijun , Gu Shangshang , Zhang Fan , Liu Zhao , Liu Yuehua
Published: December 2020

Introduction

China bears a considerably high burden of multidrug-resistant tuberculosis (MDR-TB). Second-line anti-TB drugs are urgently needed yet domestic MDR-TB drugs are expensive and lack policy support. Patients’ living conditions are closely related to the drug affordability. The national TB prevention programs should play a critical role. The purpose of this study is to measure the cost of treating MDR-TB patients under different treatment schemes and price sources. The results of this study are expected to inform the relevant drug protection policies and provide inputs for further cost-effectiveness analyses.

Methods

Based on the treatment plan of China's Multidrug-Resistant Pulmonary Tuberculosis Clinical Path (2012 edition) and the World Health Organization (WHO) Drug-Resistant Tuberculosis Treatment Guide (2018 edition), the treatment costs of MDR-TB were measured under different scenarios. Catastrophic health expenditure was then calculated if the treatment cost exceeds 40 percent of the household's non-subsistence income. National, rural and disposable income per capita in 2018, were used to represent Chinese patients’ affordability.

Results

Under varied treatment schemes and market price sources in China, the total costs for MDR-TB patients range from 19,401 to 126,703 CNY [2,853 to 18,633 USD] per person. Under current prices, all treatment schemes recommended by the WHO will incur catastrophic costs for Chinese MDR-TB patients. Significant differences were found between rural and urban areas as 52.8 percent of the treatment listed in the 2012 China Guideline would lead to catastrophic cost for rural patients but not urban ones.

Conclusions

Our study concludes that the domestic drugs are more expensive than the international purchase price and the treatment of MDR-TB imposes substantial economic burden on patients, especially in the rural areas. The results of the study also indicate that it is urgent for the state to emphasize government responsibility and initiate centralized procurement for price negotiations to reduce the market price of MDR-TB drugs. The urban-rural gap should also be addressed in the design of future policies to ensure the drug affordability for all patients in need.
Modelling pool testing for SARS-CoV-2: addressing heterogeneity in populations
Authors: Fernández-Salinas Javier , Aragón-Caqueo Diego , Valdés Gonzalo , Laroze David
Published: December 2020

Amplifying the testing capacity and making better use of testing resources is a crucial measure when fighting any pandemic. A pooled testing strategy for SARS-CoV-2 has theoretically been shown to increase the testing capacity of a country, especially when applied in low prevalence settings. Experimental studies have shown that the sensitivity of reverse transcription-polymerase chain reaction is not affected when implemented in small groups. Previous models estimated the optimum group size as a function of the historical prevalence; however, this implies a homogeneous distribution of the disease within the population. This study aimed to explore whether separating individuals by age groups when pooling samples results in any further savings on test kits or affects the optimum group size estimation compared to Dorfman's pooling, based on historical prevalence. For this evaluation, age groups of interest were defined as 0–19 years, 20–59 years and over 60 years old. Generalisation of Dorfman's pooling was performed by adding statistical weight to the age groups based on the number of confirmed cases and tests performed in the segment. The findings showed that when the pooling samples are based on age groups, there is a decrease in the number of tests per subject needed to diagnose one subject. Although this decrease is minuscule, it might account for considerable savings when applied on a large scale. In addition, the savings are considerably higher in settings where there is a high standard deviation among the positivity rate of the age segments of the general population.
Engagement with smartphone-delivered behavioural activation interventions: a study of the MoodMission smartphone application
Authors: Aizenstros Abby , Bakker David , Hofmann Stefan G. , Curtiss Joshua , Kazantzis Nikolaos
Published: December 2020

Background:

Despite increased research interest in smartphone mental health applications (MHapps), few studies have examined user engagement and its determinants. MoodMission is a MHapp that targets low mood and anxiety via evidence-based techniques including behavioural activation (BA).

Aims:

The present study aimed to investigate (i) whether BA interventions delivered with visual psychoeducation had greater engagement than BA interventions delivered with solely written psychoeducation, (ii) whether BA interventions targeting mastery would have greater engagement than those targeting pleasure, and (iii) the relationship between level of engagement and MHapp benefit.

Method:

Participants downloaded MoodMission and completed activities and within-app evaluations over a 30-day period. Data from 238 MoodMission users were analysed via multi-level modelling and linear regression.

Results:

The average number of app-based activities completed was 5.46 and the average self-reported engagement level was in the low to moderate range. As hypothesized, higher levels of engagement significantly predicted more positive activity appraisal.

Conclusions:

The results suggest that BA technique beliefs are involved in MHapp engagement and future research examining user appraisals of techniques is warranted.
High sugar content and body mass index: modelling pathways around the first 1000 d of life, BRISA cohort
Authors: Pinto Dâmaris Alves Silva , Nascimento Joelma Ximenes Prado Teixeira , Padilha Luana Lopes , da Conceição Sueli Ismael Oliveira , França Ana Karina Teixeira da Cunha , Simões Vanda Maria Ferreira , Batista Rosângela Fernandes Lucena , Barbieri Marco Antônio , Ribeiro Cecilia Claudia Costa
Published: December 2020

Objective:

Few studies are focused on sugar consumption around the first 1000 d of life. Thus, this work modelled the pathways linking the consumption of sugary drinks in pregnancy and maternal pre-gestational BMI to early child’s exposure to products with high sugar content and to BMI z-score in the second year of life.

Design:

BRISA cohort, São Luís, Brazil was used from the baseline to the follow-up at the second year of life.

Setting:

A theoretical model was constructed to analyse associations between variables from prenatal period (socio-economic status, age, frequency of sugary drinks consumption during pregnancy and pre-gestational BMI), birth weight, exclusive breast-feeding and two outcomes: higher calories from products with added sugar as a percentage of the total daily energy intake and BMI z-score at follow-up at the first 2 years of life, using structural equation modelling.

Participants:

Data of pregnant women (n 1136) and their offspring.

Results:

Higher pre-gestational BMI (standardised coefficient (SC) = 0·100; P = 0·008) and higher frequency of sugary drinks consumption during pregnancy (SC = 0·134; P < 0·001) resulted in high percentage of daily calories from products with added sugar in the second year of child, although no yet effect was observed on offspring weight at that time.

Conclusions:

Maternal obesity and sugary drinks consumption in pregnancy increased the risk of early exposure (before to 2 years) and high exposure of child to added sugar, showing perpetuation of the unhealthy dietary behaviours in the first 1000 d of life.
Evaluation of dietary supplement, functional food and herbal medicine use by dietitians during the COVID-19 pandemic
Authors: Kamarli Altun Hulya , Karacil Ermumcu Merve Seyda , Seremet Kurklu Nilgun
Published: December 2020

Objective:

The current study was conducted to evaluate the dietary habits of the dietitians who had a leading role in this regard during the pandemic and their use of dietary supplements, functional food and herbal medicines.

Design:

A cross-sectional study. An online questionnaire was used as a data collection tool to identify the participants’ socio-demographic characteristics, health statuses and dietary habits and their use of dietary supplements, functional foods and herbal medicines.

Setting:

Turkey.

Participants:

The study population was 550 dietitians.

Results:

In the current study, the participants’ average age was 30·6 ± 9·1 years, and most of them (88·2 %) were women. More than half of the participants (88·9 %) thought that adequate and balanced nutrition would positively affect the course of COVID-19. To avoid COVID-19, 94·5 % of the dietitians used dietary supplements, 46·1 % herbal medicines and 34·9 % functional foods during the pandemic. The most commonly used dietary supplement was fish oil (81·9 %), functional food was vegetables and fruits (80·5 %) and the herbal medicine was cinnamon (63·5 %). Women’s consumption of functional foods was approximately twice higher compared with men (95 % Cl: 1·048, 4·165; P < 0·05). The findings showed that the longer the dietitians were in their careers, the more functional foods and herbal medicines they used.

Conclusion:

During the pandemic, dietitians’ use of foods with protective effects against diseases increased depending on their academic knowledge and experience in nutrition. The findings obtained in the current study suggest that an expert’s opinion should be obtained before using dietary supplements and herbal medicines.
Change in or of global governance?
Authors: Barnett Michael
Published: December 2020

Michael Zürn'sTheory of Global Governanceis an original, bold, and compelling argument regarding the causes of change in global governance. A core argument is that legitimation problems trigger changes in global governance. This contribution addresses two core features of the argument. Although I am persuaded that legitimacy matters, there are times when: legitimacy appears to be given too much credit to the relative neglect of other factors; other times when the lack of legitimacy has little discernible impact on the working of global governance; and unanswered questions about how the legitimacy of global governance relates to the legitimacy of the international order of which it is a part. The second feature is what counts as change in global governance. Zürn reduces change to either deepening or decline, overlooking the possible how of global governance. In contrast to Zürn's map of global governance that is dominated by hierarchies in the form of international organizations, an alternative map locates multiple modes of governance: hierarchies, markets, and networks. The kinds of legitimation problems that Zürn identifies, I argue, can help explain some of the movement from hierarchical to other modes of global governance.
Politics and theory of global governance
Authors: Fioretos Orfeo , Tallberg Jonas
Published: December 2020

At a point when global governance appears to be at a crossroad, caught between globalizing and national populist forces, International Relations theorists are deeply immersed in debating what brought the world to this point. This contribution enlists Michael Zürn'sA Theory of Global Governance(2018) to explore the state of global governance theory through a focus on three substantive themes: authority, legitimacy, and contestation in global governance. It identifies the current state of theorizing on each theme, situates Zürn's claims within these literatures, and previews counterpoints from a variety of theoretical perspectives.
Beyond institutionalism: toward a transformed global governance theory
Authors: Scholte Jan Aart
Published: December 2020

Prompted by both promises and pitfalls in Michael's Zürn'sA Theory of Global Governance, this paper reflects on challenges going forward beyond liberal institutionalism in the study of world politics. Six suggestions are particularly highlighted for future theorizing of global governance: (a) further distance from state-centrism; (b) greater attention to transscalar qualities of global governing; (c) more incorporation of social-structural aspects of global regulation; (d) trilateral integration of individual, institutional, and structural sources of legitimacy in global governance; (e) more synthesis of positive and normative analysis; and (f) transcendence of Euro-centrism. Together these six shifts would generate a transformed global governance theory – and possibly practice as well.
Politics asRealitätsprinzipin the debate on constitutions and fragmented orders: remarks ‘On constitutions and fragmented orders’
Authors: Kurowska Xymena
Published: December 2020

The promise of constitutionalisation is, according to Kratochwil, the existential comfort that comes from having a coherent framework for judgement and action. This apparent epistemological confidence comes at the price of parting with a realistic assessment of the concrete situation, and it conceals that politics operate across all levels all the time. This paper critiques this vision and points beyond the idea of exhaustive frameworks. Figuring out contextually appropriate configurations of constitutionalisation and fragmentation allows for greater agency and pluralism. A more fundamental tension in Kratochwil's work remains, however, his falling back on the abstract to articulate the experiential.
Subsurface Reflectors Detected by SHARAD Reveal Stratigraphy and Buried Channels Over Central Elysium Planitia, Mars
Authors: Xiong Siting , Tao Yu , Persaud Divya M. , Campbell Jacqueline D. , Putri Alfiah Rizky Diana , Muller Jan‐Peter
Published: December 2020

The Central Elysium Planitia (CEP) is one of the youngest geological units on Mars and displays evidence of volcanic and fluvial activities on the surface. The origin of the CEP material has long been debated with a range of hypotheses from purely fluvial to solely volcanic origins. This study presents a comprehensive investigation of SHAllow RADar (SHARAD) data to reveal subsurface radar reflectors over the CEP region. Distribution of the detected radar reflectors show possible connections between the CEP and outflow channels, such as Athabasca Valles and Marte Vallis. Analysis of the radar reflectors in the CEP region show six subsurface layers implying multiple depositional and erosional episodes. One detected subsurface layer is found to correspond to the upper exposed layers of one terraced crater. By measuring the depth accurately of these exposed layers in the derived HiRISE (High Resolution Imaging Scientific Experiment) and CTX (Context Camera) DTMs (Digital Terrain Models) and inverting the dielectric constant combining the layers in radargrams, an interpretation that the filling material contains water ice is favored.
Probabilistic Characterization of Extreme Storm Surges Induced by Tropical Cyclones
Authors: Zhang B. , Wang S.
Published: December 2020

The overtopping of flood defenses by extreme storm surges during tropical cyclones poses a significant threat to life and property in coastal and estuarine regions. Since little effort has been devoted to investigating the complex interaction of multiple mechanisms causing extreme storm surges, for the first time, we propose a robust data‐driven framework to explicitly uncover the complex interaction and thus to improve the characterization of extreme storm surges induced by tropical cyclones. The framework constructs a probabilistic ensemble of dependence structures of multiple climatological forcing factors that potentially cause extreme storm surges based on a multi‐structure regular vine copula approach. The uncertainty in the vine‐based model structure is explicitly addressed in a Bayesian framework. The climatological forcing factors sensitive to extreme storm surge levels are selected using partial correlations, including 10‐m wind, 850‐mb temperature, 700‐mb geopotential height, precipitation, sea level pressure, and its spatial gradient extracted from the ERA5 reanalysis data. We demonstrate the framework by an in‐depth analysis of the extreme storm surge levels observed over two tidal gauging stations in Hong Kong during 1979–2018. Our findings show that the proposed framework substantially improves the characterization of extreme storm surges by taking into account the joint evolution of multiple mechanisms causing extreme storm surges and underlying uncertainties. Furthermore, the framework not only demonstrates higher skill than previous single‐structure vine‐based models but also can outperform the principal components regression and the random forest regression in terms of characterizing extreme storm surges.
CT fatty muscle fraction as a new parameter for muscle quality assessment predicts outcome in venovenous extracorporeal membrane oxygenation
Authors: Faron Anton , Kreyer Stefan , Sprinkart Alois M. , Muders Thomas , Ehrentraut Stefan F. , Isaak Alexander , Fimmers Rolf , Pieper Claus C. , Kuetting Daniel , Schewe Jens-Christian , Attenberger Ulrike , Putensen Christian , Luetkens Julian A.
Published: December 2020

Impaired skeletal muscle quality is a major risk factor for adverse outcomes in acute respiratory failure. However, conventional methods for skeletal muscle assessment are inapplicable in the critical care setting. This study aimed to determine the prognostic value of computed tomography (CT) fatty muscle fraction (FMF) as a biomarker of muscle quality in patients undergoing extracorporeal membrane oxygenation (ECMO). To calculate FMF, paraspinal skeletal muscle area was obtained from clinical CT and separated into areas of fatty and lean muscle based on densitometric thresholds. The cohort was binarized according to median FMF. Patients with high FMF displayed significantly increased 1-year mortality (72.7% versus 55.8%, P = 0.036) on Kaplan–Meier analysis. A multivariable logistic regression model was built to test the impact of FMF on outcome. FMF was identified as a significant predictor of 1-year mortality (hazard ratio per percent FMF, 1.017 [95% confidence interval, 1.002–1.033]; P = 0.031), independent of anthropometric characteristics, Charlson Comorbidity Index, Simplified Acute Physiology Score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction Score, and duration of ECMO support. To conclude, FMF predicted 1-year mortality independently of established clinical prognosticators in ECMO patients and may have the potential to become a new muscle quality imaging biomarker, which is available from clinical CT.
Pillared cobalt metal–organic frameworks act as chromatic polarizers
Authors: Gonzalez-Nelson Adrian , Joglekar Chaitanya , van der Veen Monique A.
Published: December 2020

The anisotropic alignment of chromophores in a cobalt-based metal–organic framework produces a dichromatic dichroic effect, showing a range of colors from blue to yellow depending on the orientation of polarized light relative to the crystal.
Structural diversity of four lanthanide metal–organic frameworks based on 2,6-naphthalenedicarboxylate: synthesis, structures and photoluminescent properties
Authors: Chatenever Ana R. K. , Ehlke Beatriz , Le Maguerès Pierre , Reinheimer Eric W. , Song Xueling , Fei Honghan , Oliver Scott R. J.
Published: December 2020

We report four lanthanide metal–organic frameworks based on 2,6-naphthalenedicarboxylate which displays multiple bonding modes, implying more structures await discovery.
Comparative hydrothermal synthesis of CeO2 crystals for use in light-scattering layers of dye-sensitized solar cells
Authors: Shoji Takahito , Hagiwara Manabu , Fujihara Shinobu
Published: December 2020

Light-scattering octahedral CeO2 particles could be used to increase the short-circuit photocurrent density of ZnO-based dye-sensitized solar cells.
HCl-mediated cascade cyclocondensation of oxygenated arylacetic acids with arylaldehydes: one-pot synthesis of 1-arylisoquinolines
Authors: Hsueh Nai-Chen , Chen Shin-Mei , Lin Chun-Yi , Chang Meng-Yang
Published: December 2020

In this paper, a concise, open-vessel synthesis of 1-arylisoquinolines is described via HCl-mediated intermolecular cyclocondensation of oxygenated arylacetic acids with arylaldehydes in the presence of NH2OH and alcoholic solvents under mild and one-pot reaction conditions.
High-crystallinity and high-rate Prussian Blue analogues synthesized at the oil–water interface
Authors: Duan Ceheng , Meng Yan , Wang Yujue , Zhang Zhaokun , Ge Yunchen , Li Xiaopeng , Guo Yong , Xiao Dan
Published: December 2020

A two-phase method was first used for preparing Prussian blue analogues (PBAs), and PBAs synthesized at the oil–water interface showed a highly crystalline structure and superior high-rate performance.
Combining simulations and experiments for the molecular engineering of multifunctional collagen mimetic peptide-based materials
Authors: Hilderbrand Amber M. , Taylor Phillip A. , Stanzione Francesca , LaRue Mark , Guo Chen , Jayaraman Arthi , Kloxin April M.
Published: December 2020

Synergistic approach of experiments and simulations to design multifunctional collagen mimetic peptides relevant for the creation of nanostructured soft materials.
Brain medical image fusion scheme based on shuffled frog‐leaping algorithm and adaptive pulse‐coupled neural network
Authors: Miao Yu , Chunyu Ning , Yazhuo Xue
Published: December 2020

Aiming at the problems of low contrast and blurred edge textures in medical image fusion, a new fusion scheme in non‐subsampled contourlet transform (NSCT) domain is proposed to improve the quality of fused brain images which is based on pulse‐coupled neural network (PCNN) and shuffled frog‐leaping algorithm (SFLA). First, the source images are decomposed into low‐frequency (LF) and high‐frequency (HF) subbands using NSCT; if one of the source images is multicolour, then hue, saturation and brightness (HSI) transform is needed first. Second, different PCNN fusion rules are designed for LF and HF subbands according to their features, respectively. Parameters including decay time constants and amplification factors are optimised by SFLA. Finally, the fused image is reconstructed by inverse NSCT; and if necessary, an inverse HSI transform is needed. Visual and quantitative analysis of experimental results show that the fused image preserves more information of the source images, and the ability of edge retention is strong. The scheme has prominent advantages in mutual information and QAB/F for multimodal brain images, including MRI‐PET, MRI‐SPECT, and CT‐MRI, which proves that it can obtain better visual effect and have strong robustness as well as wide applications.
Was können „intelligente“ Matratzen und Betten – und was nicht?
Authors: Ackermann Christine , Skiba Thomas , Zilezinski Max , Bergjan Manuela
Published: December 2020

Um einem Dekubitus bei Patienten vorzubeugen, wird unter anderem ein häufiger Positionswechsel empfohlen. Dabei können auch sogenannte „intelligente“ Betten oder Matratzen helfen, die etwa Vitalparameter aufzeichnen und sogar eigenständig Interventionen durchführen können.
Copper and N-Heterocyclic Carbene-Catalyzed Oxidative Amidation of Aldehydes with Amines
Authors: Narula Anudeep Kumar , Singh Ashmita
Published: December 2020

A one-pot two-step oxidative process has been developed for the tert-butyl hydroperoxide mediated transformation of aldehydes and amines into amides catalyzed by copper(I) iodide and an N-heterocyclic carbene. The process is additive-free and does not require the amine to be transformed into its hydrochloride salts. The method is simple and practicable, has a broad substrate scope, and uses economical, feasible, and abundant reagents.
CMV Disease of Upper GI Tract in Immunocompetent Host: Two Case Reports and Brief Review of Literature
Authors: Mahajan Nikhil , Sharma Aproo , Nasa Mukesh , Lipi Lipika , Sharma Rini , Arora Navleen , Singh Balwinder
Published: December 2020

Gastrointestinal cytomegalovirus (GI-CMV) infection is well-reported in immunocompromised individuals and those on chemotherapy or other immunosuppressive medications. Rarely, CMV infection of gastrointestinal tract (GIT) occurs in immunocompetent individuals. Colon is the most common site of GI involvement with CMV. However, in immunocompetent individuals, upper GIT involvement is more common. Clinical spectrum of GI-CMV disease is variable and depends on the location and severity of the disease. Prompt diagnosis and treatment aids in reducing morbidity and mortality related to CMV involvement in GI tract. We present two interesting cases of CMV-induced GI ulcers in immunocompetent individuals with brief review of diagnostic and treatment challenges associated with CMV disease in immunocompetent individuals.
Optimized InAlAs graded buffer and tensile-strained dislocation filter layer for high quality InAs photodetector grown on Si
Authors: Ryu Geunhwan , Woo Seungwan , Kang Soo Seok , Chu Rafael Jumar , Han Jae-Hoon , Lee In-Hwan , Jung Daehwan , Choi Won Jun
Published: December 2020

We demonstrate a low threading dislocation density (TDD) and smooth surface InAs layer epitaxially grown on Si by suppressing phase separation of InxAl1−xAs (x = 0 to 1) graded buffer and by inserting a tensile-strained In0.95Al0.05As dislocation filter layer. While keeping the total III–V layer below 2.7 μm to avoid thermal cracks, we have achieved a sixfold reduction of TDD in InAs on Si compared to the unoptimized structure. We found a strong correlation between the metamorphic InAs surface roughness and TDD as a function of InxAl1−xAs buffer thickness. An optimal thickness of 175 nm was obtained where both phase separation and 3D islanding growth were suppressed. Moreover, a tensile-strained In0.95Al0.05As dislocation filter layer and high growth temperature of the InAs cap layer further assisted the dislocation reduction process, which led to a TDD to 1.37 × 108 cm−2. Finally, an InAs p-i-n photodetector grown on the optimized InAs/Si template confirmed its high quality by showing an improved responsivity from 0.16 to 0.32 A/W at a 2 μm wavelength.