bluuebunny/crossref_metadata_2025 huggingface dataset:
Topological properties of CPN − 1 models in the large-N limit
Authors: Bonanno Claudio , Bonati Claudio , D’Elia Massimo
Published: January 2019

Abstract

We investigate, by numerical simulations on a lattice, the θ-dependence of 2d CP

N − 1 models for a range of N going from 9 to 31, combining imaginary θ and simulated tempering techniques to improve the signal-to-noise ratio and alleviate the critical slowing down of the topological modes. We provide continuum extrapolations for the second and fourth order coefficients in the Taylor expansion in θ of the vacuum energy of the theory, parameterized in terms of the topological susceptibility χ and of the so-called b
2 coefficient. Those are then compared with available analytic predictions obtained within the 1/N expansion, pointing out that higher order corrections might be relevant in the explored range of N, and that this fact might be related to the non-analytic behavior expected for N = 2. We also consider sixth-order corrections in the θ expansion, parameterized in terms of the so-called b
4 coefficient: in this case our present statistical accuracy permits to have reliable non-zero continuum estimations only for N ≤ 11, while for larger values we can only set upper bounds. The sign and values obtained for b
4 are compared to large-N predictions, as well as to results obtained for SU(N

c
) Yang-Mills theories, for which a first numerical determination is provided in this study for the case N

c
= 2.
A functional RG approach for the BFKL Pomeron
Authors: Bartels Jochen , Contreras Carlos , Vacca Gian Paolo
Published: January 2019

Abstract

In this paper we encode the perturbative BFKL leading logarithmic resummation, relevant for the Regge limit behavior of QCD scattering amplitudes, in the IR-regulated effective action which satisfies exact functional renormalization group equations. This is obtained using a truncation with a specific infinite set of non local vertices describing the multi-Regge kinematics (MRK). The goal is to use this framework to study, in the high energy limit and at larger transverse distances the transition to a much simpler effective local reggeon field theory, whose critical properties were recently investigated in the same framework. We perform a numerical analysis of the spectrum of the BFKL Pomeron deformed by the introduction of a Wilsonian infrared regulator to understand the properties of the leading poles (states) contributing to the high energy scattering.
Confronting SUSY SO(10) with updated Lattice and Neutrino data
Authors: Deppisch Thomas , Schacht Stefan , Spinrath Martin
Published: January 2019

Abstract

We present an updated fit of supersymmetric SO(10) models to quark and lepton masses and mixing parameters. Including latest results from lattice QCD determinations of quark masses and neutrino oscillation data, we show that fits neglecting supersymmetric threshold corrections are strongly disfavoured in our setup. Only when we include these corrections we find good fit points. We present χ
2-profiles for the threshold parameters, which show that in our setup the thresholds related to the third generation of fermions exhibit two rather narrow minima.
Planck 2018 and brane inflation revisited
Authors: Kallosh Renata , Linde Andrei , Yamada Yusuke
Published: January 2019

Abstract

We revisit phenomenological as well as string-theoretical aspects of D-brane inflation cosmological models. Phenomenologically these models stand out on par with α-attractors, as models with Planck-compatible values of n

s
, moving down to the sweet spot in the data with decreasing value of r. On the formal side we present a new supersymmetric version of these models in the context of de Sitter supergravity with a nilpotent multiplet and volume modulus stabilization. The geometry of the nilpotent multiplet is evaluated in the framework of string theory.
’t Hooft anomaly matching condition and chiral symmetry breaking without bilinear condensate
Authors: Yamaguchi Satoshi
Published: January 2019

Abstract

We explore 4-dimensional SU(N) gauge theory with a Weyl fermion in an irreducible self-conjugate representation. This theory, in general, has a discrete chiral symmetry. We use ’t Hooft anomaly matching condition of the center symmetry and the chiral symmetry, and find constraints on the spontaneous chiral symmetry breaking in the confining phase. The domain-walls connecting different vacua are discussed from the point of view of the ’t Hooft anomaly. We consider the SU(6) gauge theory with a Weyl fermion in the rank 3 anti-symmetric representation as an example. It is argued that this theory is likely to be in the confining phase. The chiral symmetry ℤ
6 should be spontaneously broken to ℤ
2 under the assumption of the confinement, although there cannot be any fermion bilinear condensate in this theory.
Unbalanced Stückelberg holographic superconductors with backreaction
Authors: Hafshejani Ahmad Jamali , Mansoori Seyed Ali Hosseini
Published: January 2019

Abstract

We numerically investigate some properties of unbalanced Stückelberg holographic superconductors, by considering backreaction effects of fields on the background geometry. More precisely, we study the impacts of the chemical potential mismatch and Stückelberg mechanism on the condensation and conductivity types (electrical, spin, mixed, thermo-electric, thermo-spin and thermal conductivity). Our results show that the Stückelberg’s model parameters C

α
and α not only have significant impacts on the phase transition, but also affect the conductivity pseudo-gap and the strength of conductivity fluctuations. Moreover, the effects of these parameters on a system will be gradually reduced as the imbalance grows. We also find that the influence of α on the amplitude of conductivity fluctuations depends on the magnitude of the both C

α
and δμ/μ in the electric and thermal conductivity cases. This results in that increasing α can damp the conductivity fluctuations of an unbalanced system in contrast to balanced ones.
Infrastructure Expansion for Children’s Surgery: Models That are Working
Authors: Ameh Emmanuel A. , Butler Marilyn W.
Published: January 2019

Children’s surgical care is cost‐effective and can avert mortality and long‐term disability in children, with ramifications throughout life not only for the patient, but for the extended family and community as well. Considering the current gaps and limited capacity for children’s surgery in low‐ and middle‐income countries (LMICs), it is clear that without expanding and scaling up the infrastructure, World Health Assembly (WHA) resolution 68/15 targets and child‐related targets of Sustainable Development Goals and Universal Health Care are unlikely to be met by 2030. The most promising models to expand infrastructure are those that include ongoing partnerships and capacity building by educating and training local surgeons and healthcare professionals who will not only provide care for children, but who will train future generations of surgical providers as well. Efforts to improve infrastructure necessarily include raising the standard of children’s surgical care at all levels of the healthcare system, which will hopefully be guided by National Surgical, Obstetrics, and Anesthesia Plans and by the Optimal Resources for Children’s Surgery document. The private sector can be effectively engaged to fill infrastructure and service gaps that cannot be met by government budgets. Ultimately, success of any infrastructure expansion initiative depends on strong advocacy to allocate ample funding for children’s surgical care.
Urban Places as Aesthetic Phenomena: Framework for a Place-Based Ontology of Urban Lifeworld
Authors: Vihanninjoki Vesa
Published: January 2019

Urban places are of central significance for cities both as built structures and as centers of everyday life. Due to the emergence of various design-led place-making policies and practices, “urban place” has largely become a marketed and branded product. Aesthetics plays a major role in this project of place-making, and the related interpretation of “commodified aesthetics of place” emphasizes certain experiential and qualitative place-attributes—such as authenticity—despite apparent conceptual confusions and controversies. A thorough reconsideration of central place-concepts is required to shed light on this problematic sphere. This article provides an alternative reading of urban places and the related aesthetic dimensions, based primarily on a Heideggerian account of human existence as placed being in the world. Such an approach emphasizes the decisive difference between an object-based and a contextual interpretation of place, providing also a framework for understanding the aesthetics of place and its fundamental lifeworld-constituting role anew.
Average Effects Based on Regressions with a Logarithmic Link Function: A New Approach with Stochastic Covariates
Authors: Kiefer Christoph , Mayer Axel
Published: January 2019

Researchers often use regressions with a logarithmic link function to evaluate the effects of a treatment on a count variable. In order to judge the average effectiveness of the treatment on the original count scale, they compute average treatment effects, which are defined as the average difference between the expected outcomes under treatment and under control. Current practice is to evaluate the expected differences at every observation and use the sample mean of these differences as a point estimate of the average effect. The standard error for this average effect estimate is based on the implicit assumption that covariate values are fixed, i.e., do not vary across different samples. In this paper, we present a new way of analytically computing average effects based on regressions with log link using stochastic covariates and develop new formulas to obtain standard errors for the average effect. In a simulation study, we evaluate the statistical performance of our new estimator and compare it with the traditional approach. Our findings suggest that the new approach gives unbiased effect estimates and standard errors and outperforms the traditional approach when strong interaction and/or a skewed covariate is present.
A rare missense variant of CASP7 is associated with familial late‐onset Alzheimer's disease
Authors: Zhang Xiaoling , Zhu Congcong , Beecham Gary , Vardarajan Badri N. , Ma Yiyi , Lancour Daniel , Farrell John J. , Chung Jaeyoon ,   Alzheimer's Disease Sequencing Project, Mayeux Richard , Haines Jonathan , Schellenberg Gerard , Pericak‐Vance Margaret , Lunetta Kathy , Farrer Lindsay
Published: January 2019

Introduction

The genetic architecture of Alzheimer's disease (AD) is only partially understood.

Methods

We conducted an association study for AD using whole sequence data from 507 genetically enriched AD cases (i.e., cases having close relatives affected by AD) and 4917 cognitively healthy controls of European ancestry (EA) and 172 enriched cases and 179 controls of Caribbean Hispanic ancestry. Confirmation of top findings from stage 1 was sought in two family‐based genome‐wide association study data sets and in a whole genome–sequencing data set comprising members from 42 EA and 115 Caribbean Hispanic families.

Results

We identified associations in EAs with variants in 12 novel loci. The most robust finding is a rare CASP7 missense variant (rs116437863; P = 2.44 × 10−10) which improved when combined with results from stage 2 data sets (P = 1.92 × 10−10).

Discussion

Our study demonstrated that an enriched case design can strengthen genetic signals, thus allowing detection of associations that would otherwise be missed in a traditional case‐control study.
Growing democratic citizenship competencies: Fostering social studies understandings through inquiry learning in the preschool garden
Authors: Casey Erin M. , DiCarlo Cynthia F. , Sheldon Kerry L.
Published: January 2019

Essential skills and attitudes necessary for active citizenship need to be cultivated as early as prekindergarten. This exploratory study investigated if three and four-year olds could be actively engaged in social studies practices through inquiry learning in a school garden. Eleven children openly interacted and conducted personally-driven investigations on a daily basis in the school garden located on their playground over nine-months. Three interviews with children, teacher observation notes, and lesson plans were analyzed to discover whether NCSS preK-12 learning themes (2010) for the social studies curriculum could be correlated with garden inquiries. Three prevalent NCSS themes surfaced from data analysis with Civic Ideals and Practices, People, Places, and Environments, and Time, Continuity, and Change being most prevalent. Results imply that working in a school garden through inquiry learning can foster the development of democratic competencies and thus, could be used to design C3 lessons for preschoolers in the garden.
Determining the utility of standard hospital microbiology testing: Comparing standard microbiology cultures with DNA sequence analysis in patients with chronic sinusitis
Authors: Rapoport Sarah K. , Smith Alyssa J. , Bergman Maxwell , Scriven Kelly A. , Brook Itzhak , Mikula Suzette K.
Published: January 2019

Objective

To demonstrate DNA sequencing analysis (DNAsa) of sinus cultures in patients with CRS is a reliable method of detecting pathogens in polymicrobial CRS infections.

Methods

After obtaining Institutional Review Board approval for this prospective cohort study, we selected a random sample of 50 patients with CRS at Medstar Georgetown University Hospital between September 2016 and March 2017. We defined CRS as a history of rhinosinusitis refractory to maximal medical therapy and prior endoscopic sinus surgery. Patients demonstrating active purulence in a sinus cavity were prospectively selected to undergo standard hospital cultures (SHC) and DNAsa cultures. Organisms identified in both methods were compared for each patient.

Results

Specimens were obtained from 29 female and 16 male patients with a mean age of 50 years. A total of 45 cultures were included in our final analysis; five cultures were excluded after inappropriate laboratory processing. Results from these patients were compared and analyzed. Cohen's weighted kappa analysis showed agreement between the two testing methods in identifying predominant microorganisms. DNAsa detected 31.9% more microorganisms compared to SHC (P < 0.05). When multiple microorganisms were detected, DNAsa yielded more positive results compared to SHC (P < 0.05).

Conclusions

DNAsa detects all microorganisms identified by SHC as well as predominant microorganisms not detected by SHC. Thus molecular pathogen identification may be more reliable for identifying multiple microorganisms as compared to standard culture techniques that identify only one or two microorganisms. In recalcitrant cases of CRS, DNAsa may provide better guidance in selection of appropriate antimicrobial treatment.
Transforming State Visions: Ideology and Ideas in Armed Groups Turned Political Parties – Introduction to Special Issue
Authors: Curtis Devon E.A. , Sindre Gyda M.
Published: January 2019

How do the visions of the state articulated by armed movements during conflict change when they become political parties after war? We show that ideas about the state are often central to the strategies and direction of these new parties, but there is variation in the extent to which these ideas have changed. The first part of this article shows why a focus on former rebel parties provides valuable insights into the role of ideas in post-war politics. The second part draws on the literatures on civil wars and political parties to highlight their relevance for former rebel parties. The third part provides a framework for understanding the variation in the role of ideology in former rebel parties, by focusing on ideological content and explanations of post-war ideological continuity and change. This part also introduces the other articles in the special issue and wider collection. Finally, we discuss the effects of these ideologies when they encounter other logics of post-war politics.
Bem Study of 3D Heat Conduction in Multiply Adjoined Anisotropic Media with Quadratic Domain Heat Generation
Authors: Tuan N. A. , Shiah Y. C.
Published: January 2019

In engineering, it is quite often to have applications of the heat transfer of conduction having domain heat generation present inside. The paper aims to present boundary element formulations for analyzing the three-dimensional heat-conduction in dissimilarly bonded anisotropic media involving quadratic volume heat sources. In this paper, the additional volume integral present in the boundary integral equation is analytically transformed to the boundary surface for the volume heat sources modeled by quadratic functions. The technique of domain-mapping is employed to treat the three-dimensional anisotropic heat conduction in multiply adjoined media with proper interfacial conditions provided. For showing our successful implementation, a few example cases are analyzed with verification of independent analyses by the finite element method.
Refining the Paleo-Aleut to Neo-Aleut transition using a new ΔR for the eastern Aleutian Islands, Alaska
Authors: West Dixie , Khasanov Bulat , Krylovich Olga , Hatfield Virginia , Khasanov Timur , Vasyukov Dmitry , Savinetsky Arkady
Published: January 2019

Using six paired terrestrial and marine organics collected in the Islands of Four Mountains, Alaska, we present a new regional correction factor, ΔR (495±20 yr), for the eastern Aleutians. We compare our ΔR with previous North Pacific marine corrections. Using the ΔR for the eastern Aleutians, we calibrated the radiocarbon dates of 80 human skeletons recovered from village site Chaluka and cave burials at Ship Rock and Kagamil Islands. These burial places contain two morphologically and genetically distinct humans—an early form called Paleo-Aleut and a later form called Neo-Aleut. Researchers have contested (1) the timing of Neo-Aleut movements into the Aleutians, and (2) Neo-Aleut interactions with Paleo-Aleuts. Our recalibrations indicate that the oldest Paleo-Aleut burial (1135 BC) occurred at Chaluka and the youngest Paleo-Aleut cave burial occurred at Kagamil during the fourteenth century (AD 1305). Neo-Aleuts buried their dead at Chaluka by AD 1375. The oldest definitive Neo-Aleut cave burial occurred during the fifteenth century (AD 1420) at Ship Rock. Eastern Aleuts buried their dead in caves for centuries, with the youngest Neo-Aleut buried at Kagamil circa AD 1865.
Democracy's Deficit: The Role of Institutional Contact in Shaping non-White Political Behavior
Authors: García-Castañon Marcela , Huckle Kiku , Walker Hannah L. , Chong Chinbo
Published: January 2019

This paper examines the effect of institutional contact on political participation among non-White communities. While both formal and informal institutions help shape community citizen participation, their effects vary on the historical inclusion (or exclusion) of certain racial groups. Formal institutions, like political parties, have historically excluded or neglected non-White and immigrant voters. We argue that for the excluded or neglected, non-traditional political institutions, like community based organizations, serve as supplements to facilitate political incorporation and engagement. These informal institutions help develop skills and resources among their constituents, and offer routine opportunities to participate. We use the 2008 Collaborative Multi-racial Post-Election Survey (CMPS) to test the differential effects of self-reported voter mobilization through nonpartisan and partisan institutional contact to explain variations among racial groups by the intensity of contact, occurrence of co-ethnic outreach, and type of institutional mobilization. We find that while contact by a partisan/political institution, like a political party or campaign, has an overall positive effect on political participation for all voters, contact by a nonpartisan/civic or community group is substantively more important for Latino and Asian American voter mobilization. Our analysis therefore offers cohesive evidence of how voters interact with and are affected by mobilization efforts that attends to differences across racial and ethnic boundaries, and variations in institutional contact.
Philosophie pour le monde et sagesse hors du monde : les limites de la revendication éclectique chez Christian Thomasius
Authors: PELLETIER ARNAUD
Published: January 2019

Christian Thomasius a revendiqué pour lui-même l’expression de «philosophe éclectique». Cette revendication est d’abord celle d’une raison émancipée de toute autre autorité, permettant de faire émerger de nouveaux droits sur le plan juridique, mais aussi de déterminer la philosophie comme sagessepour le monde. Cette revendication a toutefois ses limites : en limitant le savoir scolastique et en dénonçant ses synthèses hâtives, Thomasius entend faire de la place pour la croyance purifiée de toutes les confusions philosophico-théologiques, pour une sagessehors du monde. Antidogmatique et anti-syncrétique, la revendication éclectique ne fut ainsi ni antisystématique ni antireligieuse.
The Running Stitch
Authors: LENNARD KATHERINE
Published: January 2019

This essay uses a quilt made from used Ku Klux Klan regalia to examine the complicated interpersonal relationships and internal ambivalence that have emerged in the process of the author's study of Klan material culture. Concerns about the relationship between preserving objects and preserving ideology emerge through the process of untangling the story of this enigmatic object.
Lessons from the English auxiliary system
Authors: SAG IVAN A. , CHAVES RUI P. , ABEILLÉ ANNE , ESTIGARRIBIA BRUNO , FLICKINGER DAN , KAY PAUL , MICHAELIS LAURA A. , MÜLLER STEFAN , PULLUM GEOFFREY K. , VAN EYNDE FRANK , WASOW THOMAS
Published: January 2019

The English auxiliary system exhibits many lexical exceptions and subregularities, and considerable dialectal variation, all of which are frequently omitted from generative analyses and discussions. This paper presents a detailed, movement-free account of the English Auxiliary System within Sign-Based Construction Grammar (Sag 2010, Michaelis 2011, Boas & Sag 2012) that utilizes techniques of lexicalist and construction-based analysis. The resulting conception of linguistic knowledge involves constraints that license hierarchical structures directly (as in context-free grammar), rather than by appeal to mappings over such structures. This allows English auxiliaries to be modeled as a class of verbs whose behavior is governed by general and class-specific constraints. Central to this account is a novel use of the featureaux, which is set both constructionally and lexically, allowing for a complex interplay between various grammatical constraints that captures a wide range of exceptional patterns, most notably the vexing distribution of unstresseddo, and the fact that Ellipsis can interact with other aspects of the analysis to produce the feeding and blocking relations that are needed to generate the complex facts of EAS. The present approach, superior both descriptively and theoretically to existing transformational approaches, also serves to undermine views of the biology of language and acquisition such as Berwick et al. (2011), which are centered on mappings that manipulate hierarchical phrase structures in a structure-dependent fashion.
Dirty, soothing, secret magic: individualism and spirituality in New Age and extreme metal music cultures
Authors: Coggins Owen
Published: January 2019

Taking inspiration from a press article comparing doom metal and New Age music, I explore individualism and magic in these musical cultures, reflecting on the ‘dirty, soothing secret’ suggested in that article's title. I trace the loosely defined characteristics of New Age music in the limited academic research on the topic, before situating the music in the wider New Age milieu which centres around the epistemological authority of the seeking self among diverse spiritual resources. Then, I examine the claims made about metal in the news article, drawing out themes which also relate to individualism and magic. Finally, I return to the concepts of the dirty, the soothing and the secret, arguing that these are not merely incidental aspects of the mainstream reception of New Age and metal music, but in fact can be understood as contributing to the magical potential of such music for listeners.
‘More powerful than politics’: Affective magic in the DIY musical activism after Egypt's 2011 Revolution
Authors: Sprengel Darci
Published: January 2019

With a return to authoritarian rule only a few years after the initially successful 2011 revolution, some Egyptian DIY musicians have made it a point to avoid the political. These musicians consider the ordinary politics of discursive critique and public protest to be ineffective and have opted to continue the revolution by appealing to the ineffable properties of listening as a less ideologically driven way to produce social change. This article explores how and why the sonic ineffable is believed to be a more utopian form of politics. It argues that mobilizing ‘magic’ is a particularly positioned solution to political failure that obscures the relations of power it perpetuates. Building from 30 months of ethnographic research conducted in Egypt among DIY musicians between 2010 and 2017, it avoids a romanticisation of the ineffable, showing instead how utilising the ambiguity between the conscious and subconscious aspects of sonic experience is a political tool not removed from power.
Sound, music and magic in football stadiums
Authors: Marra Pedro Silva , Trotta Felipe
Published: January 2019

This article discusses the role of music performance in football matches, highlighting the importance of the belief in its sonic powers as a trigger for causal relations between events. Music functions as a communicational axis linking the physical realm to mystical or intangible dimensions. By performing music and sounds on terraces, fans believe that they can change the course of the match, interfering in the mood, the bodies and, eventually, the result. Magic is a shared belief among fans, players and journalists, one that is activated through sounds and rituals. In football, the idea of magic is often perceived and referred to as a causal explanation for achievements and defeats that could hardly be understood or explained through rational and scientific knowledge. Music is a key feature in this process.
‘Conjuring some magic’: paganism and the musical and visual aesthetics of Florence + the Machine and Bat for Lashes
Authors: Smith Erin Sweeney
Published: January 2019

Magic and mystery shroud Florence + the Machine's and Bat for Lashes's performances and interviews, which frequently frame the two groups’ frontwomen, Florence Welch and Natasha Khan, as ‘witchy’ or magical, or spur comparisons to Pagan aesthetics. This article investigates the unique ways the two bands use Pagan influences to speak to mainstream and Pagan audiences. Ultimately, the two groups set themselves apart from other bands through marketing that fuses commercialism with an esoteric religion. Florence + the Machine and Bat for Lashes create a ‘Pagan chic’ that draws in listeners through videos, instrumentation often featuring harp and tom-tom drums, fantasy-oriented lyrics, and stage props which use a Pagan lens to respond to current political events reminiscent of the counterculture of the 1960s and 1970s.
OP04 Cardiac Implant Registries: Systematic Review Of Global Practices
Authors: Kolominsky-Rabas Peter , Zhang Shixuan , Gaiser Sebastian
Published: January 2019

Introduction:

The importance of Cardiac Implant Registry (CIR) for ensuring a long-term follow-up in post-marked surveillance has been recognized and approved, but there is a lack of consensus standards on how to establish a CIR. The aim of this study is to investigate the structure and key elements of CIRs in the past decade (2006–2016) and to provide recommendations on “best practice” approaches.

Methods:

A systematic search on CIR was employed in line with the PRISMA guidelines. The following databases were searched: the PubMed (Medline), ScienceDirect, EMBASE and the Scopus database. After identifying the existing CIR, an inductive approach was used to explore key elements emerging in the identified registries.

Results:

The following eighty-two registries were identified: eighteen ICD registries, seven CRT registries, five pacemaker registries, and six Cardiovascular Implantable Electronic Device (CIED) registries which combined ICD, pacemaker and CRT implantation data; as well as twenty-two coronary stent registries and twenty-four TAVI registries. While seventy-one national or local registries are from a single country, forty-four are from European countries, and nine are located in USA. The following criteria have been summarized from the identified registries, including: registry working group, ethic issues, transparency, research objective, inclusion criteria, compulsory participation, endpoint, sample size, data collection basement, data collection methods, data entry, data validation and statistical analysis.

Conclusions:

For HTA as well as regulatory decision making, medical device registries provide a “real-world” picture for patients, physicians, manufacturers, payers, decision-makers and other stakeholders. CIRs are important for regulatory decisions concerning the safety and approval issues of medical devices; for payers CIRs provide evidence on the medical device benefits and drive the decision as to whether the product should be reimbursed or not; for hospitals data from CIRs are important for sound procurement decisions, and CIRs also help patients and their physicians to reach a joint decision on which of the products is the most appropriate. However, many current CIRs are still lacking standards to inform on patient safety and ensure transparency.
OP13 2017 Health Technology Assessment International Asia Policy Forum: The Perspective Of Not-For-Profit Members
Authors: Pwu Raoh-Fang , Trowman Rebecca
Published: January 2019

Introduction:

The fifth Health Technology Assessment International (HTAi) Asia Policy Forum (APF) was held in Beijing, November 2017. The topic of the meeting was ‘Universal Health Care in the Asia Region: Overcoming the Barriers using HTA and Real World Data’. This presentation will focus on the use of real world data (RWD) as a mechanism of informing HTA in the Asia region – from the perspective of the not-for-profit HTA agencies that were represented at the APF.

Methods:

The 2017 HTAi APF had senior representatives from government and HTA agencies from 11 countries in the Asia region. This included first-time attendees from Iran, Indonesia and the Philippines. A keynote presentation on the lessons learnt from Taiwan on the use of RWD was delivered, and there were guided breakout group discussions.

Results:

There are a number of registries and sources of RWD available to the HTA agencies across the Asia region. However it was noted that the databases are resource intensive to maintain, and there are noted time lags in the data collection and release. There are examples where the data from these sources have been used to evaluate local utilization of treatments and post-market surveillance, but it has not yet been used in pricing/reimbursement decisions.

Conclusions:

Although RWD could be a good tool for healthcare decision-making in the Asia region, it is still unclear how to do so properly. Infrastructure and human capacity, as well as law, are key factors to the successful use of RWD. Standardized methodologies, increased transparency, quality control and capacity building are essential elements to better implementing RWD in HTA.
OP15 Actions Arising From The 2017 Health Technology Assessment International Asia Policy Forum
Authors: Kearney Brendon , Trowman Rebecca
Published: January 2019

Introduction:

Universal health care (UHC) leads to better health, educational outcomes and productivity. However, Asian healthcare systems are experiencing huge pressures and are striving to achieve UHC. With this in mind, the Health Technology Assessment International (HTAi) Asia Policy Forum (APF) tackled, ‘Universal Health Care in the Asia Region: Overcoming the Barriers using HTA and Real World Data (RWD)’.

Methods:

The HTAi APF convened forty-four senior representatives from HTA agencies and industry from Asia. Through a mixture of keynote presentations and guided group discussions, APF members spent two days grappling with the topic.

Results:

There were a number of key messages from the APF, plus actions that were identified by APF members. The actions included: (i) A standardized HTA methodology for the prioritization of technologies in the Asia region should be developed to support health care systems; (ii) HTAi need to define what real-world data means in the HTA glossary; (iii) Members of the APF should develop a catalogue of what public and private data is available across countries in the region; (iv) A policy statement that agencies can use with a common approach to the release of data needs to be developed.

Conclusions:

HTA and access to RWD were identified as essential tools to be used in achieving the goal of UHC; this goal should indeed be pursued in the Asia region. However, issues such as transparency and accountability of HTA, and trust and collaboration between the public and private sectors are important concerns which need to be addressed in order to progress this goal. The recommendations for actions resulting from this successful APF update on progress towards these identified actions will be presented.
OP16 Decision Criteria That Influence Managed Entry Agreements
Authors: Freeman-Robinson Maxine , Mihalopoulos Cathrine , Merlin Tracy , Roughead Elizabeth
Published: January 2019

Introduction:

Managed Entry Agreements (MEAs) enable payers to subsidize access to new medicines while addressing uncertainties. Uncertainties may relate to the criteria for decision-making articulated in decision-making frameworks. The study's aim was to determine if there was any association between the type of MEA and criteria considered during decision-making.

Methods:

All medicines with MEAs listed on the Australian national subsidy scheme between 2012-2016 were identified. Data were extracted on the types of MEA and information related to the criteria considered in decision-making for each medicine and its associated indication (i.e. a medicine-indication pair [MIP]). The criteria considered in decision-making included the comparator (therapy to which it was compared), type of economic analysis, accepted value, budget impact, financial cost of supply, cost of therapy per patient, access control (such as restrictions or prior authorization), and clinical need. Associations between types of MEA and the criteria were assessed using Chi Squared test.

Results:

There were 87 MIPs, of which 56 had only financial MEAs and 31 had performance-based MEAs. Coverage with evidence development MEAs had very high incremental cost-effectiveness ratio (ICER)/quality adjusted life year (QALY) (74 percent > AUD 50,000 [USD 37,822]). Financial MEAs where performance measures were linked to reimbursement had lower ICER/QALY (13 percent > AUD 50,000 [USD 37,822]) but greater budget impact (33% > AUD 80million [USD 60.5million]) compared to simple financial MEAs. A statistically significant association (Cramer's V = 0.5, p < 0.001) was only found between performance-based MEAs and the cost of unsubsidized therapy per patient.

Conclusions:

The main influence on the choice of performance based MEA was the provision of access to clinically important medicines with a high treatment cost for patients.
OP23 Setting The Value Of New Technologies - A Survey
Authors: Tal Orna , Connelly Yaron
Published: January 2019

Introduction:

Technology assessment in hospital traditionally involves parameters of safety, effectiveness and costs. The prosperity of medical innovations in an era of scarce resources requires more precisely refined methodologies to measure ‘added value’. Our aim was to reveal the added values of technologies by asking professionals to prioritize their adoption into hospitals.

Methods:

Twelve innovative technologies that were discussed for adoption over three years were controversial regarding their actual “added value”. Fifty-two managerial health professionals ranked these technologies on two scales: hierarchic importance (league scale) and comparative score rating (CSR), reflecting willingness-to-pay (WTP). The distribution of ranking indicates the internal agreement (IA) among the participants.

Results:

There was only partial correlation between the two scales. For example, glucose-monitoring was ranked ‘highly important’ on the hierarchic (league) scale with high CSR/WTP, but with low IA. This can be interpreted as “a valuable technology but with disagreement on comprehensive adoption in the entire hospital”. The surgical robot was ranked ‘highly important’ on the hierarchic scale with low CSR/WTP, but with high IA, meaning “a valuable technology but with consensus to delay adoption in the hospital”. Overall, the participants raised thirty-two “values” that can be assorted into five clusters of significance: clinical effect (6 values), social/public dimension (8 values), patient-physician interaction (9 values), technological aspect (5 values) and policy-regulatory perception (4 values).

Conclusions:

We identified different ‘;patterns’ for defining the ‘value’ of various technologies. Revealing these aspects can create a “set of values” of relative weights that may explain the added value considerations in prioritization of decision making. Interestingly, there were technologies that were ranked low, but achieved a high rating. This can be explained by individual personal-oriented added value perspectives. Using this innovative tool to incorporate social value-based scores can assist in understanding the determinants, beyond the current traditional rationing mechanism, that guide professionals while prioritizing medical technologies.
OP49 An Alternative Cost-Effectiveness Model For Health Technology Delivery
Authors: Yan Charles , Armijo-Olivo Susan , Guo Bing , Zheng Yufei , Hill Michael , Mann Balraj , Jeerakathil Thomas , Kamal Noreen , Amlani Shy , Chuck Andy W.
Published: January 2019

Introduction:

The cost-effectiveness of endovascular therapy (EVT) compared to tissue plasminogen activator (tPA) alone for acute ischemic stroke (AIS) has been established in the literature. However, decision-makers still face challenges of how to best deliver EVT in a timely manner to maximize patient outcomes while minimizing the burden to the healthcare system, given that AIS has time-dependent treatment outcomes. The objective of this presentation is to report an optimization approach for improving health system value and outcomes for patients with AIS who are eligible for EVT in Alberta.

Methods:

An economic model was developed to compare combinations of “mothership” (transport directly to a comprehensive stroke center [CSC] to receive tPA and EVT) and “drip-and-ship” (transport to a primary stroke centre to receive tPA, followed by transport to a CSC to receive EVT) methods across Alberta. The model considered geographical variation and searched for the best delivery methods through a pairwise comparison of all possible strategies. The controlled variables including in the model were population densities, disease epidemiology, time/distance to hospitals, available medical services, treatment eligibility and efficacy, and costs. Patient outcomes were measured by functional independence. The model defined optimal strategies by identifying the transport methods that produced the highest probability of improved health outcomes at the lowest cost.

Results:

The analysis produced an optimization map showing optimal strategies for EVT delivery. The lifetime cost (standard deviation [SD]) per patient and likelihood (SD) of good outcomes was CAD 291,769 (CAD 11,576) [USD 226,207 (USD 8,975)] and 41.82 percent (0.013) when considering optimal clinical outcomes, and CAD 287,725 (CAD 4,141) [USD 223,097 (USD 3,211)] and 41.67 percent (0.016) when considering optimal economic efficiency.

Conclusions:

Our model reduces the gap that exists between health technology implementation and cost-effectiveness analysis; namely, neither fully addresses relative efficiency driven by geographical variation, which may misrepresent system value in local settings. Implementation strategies generated in our model capture full values in terms of patient outcomes and costs.
OP53 Comparing Approaches To Univariate Sensitivity Analysis
Authors: Teljeur Conor , Harrington Patricia , Ryan Máirín
Published: January 2019

Introduction:

Fully probabilistic analyses are now standard for economic models, with all parameters varied according to probability distributions. Using univariate sensitivity analyses to explore the influence of different parameters on the model results are also standard. Although there are several approaches available, there has been little discussion of the merits of each or justification for the method used in any given analysis. The aim of this study was to compare three approaches to univariate sensitivity analysis using a case study.

Methods:

We considered three univariate sensitivity analysis approaches: (i) set one parameter at its upper and lower bounds while all others are set at their mean value; (ii) analysis of variance; and (iii) set one parameter at its mean and vary all others. We compared these approaches using an economic model of mechanical thrombectomy for the treatment of acute ischemic stroke, considering outcomes of incremental costs, incremental quality-adjusted life-years (QALYs), and net monetary benefit (NMB).

Results:

For incremental costs and QALYs the correlation between the approaches was moderate to high, with correlation coefficients between 0.46 and 0.94. For NMB the correlation between approaches was also high (range 0.89 to 0.98), but some of the most influential parameters were ranked differently. Setting one parameter at its upper and lower bounds was the only method that facilitated an analysis of direction of influence.

Conclusions:

The three approaches addressed different but relevant questions. Setting individual parameters at their bounds is effectively a systematic scenario analysis and may be misleading to decision makers. Analysis of variance may be more easily interpreted, but it has disadvantages. Setting a parameter at its mean, while varying other parameters, is similar to value of information analysis. As with any sensitivity analysis, it is imperative that the uncertainty associated with each parameter is adequately captured in the model.
OP64 Review Of Economic Evaluations Of Next-Generation Precision Oncology
Authors: Weymann Deirdre , Pataky Reka , Regier Dean A.
Published: January 2019

Introduction:

Proponents of precision oncology report that genomic testing has the potential to reduce health system costs and improve patient health. Yet, testing also involves significant expenditures that challenge the sustainability of adopting technologies into routine practice. Our study explores the availability and scope of economic evaluations of precision oncology informed by next-generation sequencing (NGS).

Methods:

We searched Medline (PubMed), Embase (Ovid), and Web of Science databases for English-language full-text peer reviewed articles published between 2000 and 2016. We focused our search on articles that estimated the benefit of precision oncology in relation to its costs. We excluded studies that did not undertake full economic evaluations or did not focus on NGS. We reviewed all included studies and summarized key methodological and empirical study characteristics.

Results:

Fifty-five economic evaluations met our inclusion criteria. The first study was published in 2005 and the number of published studies increased steadily, from three studies between 2005 and 2007 to twenty-six between 2014 and 2016. Most studies evaluated multiplex panels (86 percent). Testing was frequently used to diagnose patients (24 percent) or predict prognosis (67 percent), rather than identify targeted therapies (7 percent). Methods varied considerably and cost-effectiveness differed according to test type, test strategy, and cancer type. Deterministic and probabilistic analyses were typically used to characterize uncertainty (91% percent and 75% percent).

Conclusions:

While the availability of economic evidence examining precision oncology increased over time, methods used often did not align with current guidelines. Future evaluations should undertake extensive sensitivity analysis to address all sources of uncertainty associated with rapidly changing NGS technologies. Further, additional research is needed evaluating the cost-effectiveness of more comprehensive next-generation technologies prior to implementing these on a wider scale.
OP77 Conducting Rapid Assessments: Lessons From 25 Years Of Good Practice
Authors: Corabian Paula , Guo Bing , Armijo-Olivo Susan , Moga Carmen , Scott Ann
Published: January 2019

Introduction:

The Health Technology Assessment (HTA) Program at the Institute of Health Economics (IHE) has conducted rapid assessments (RAs) for 25 years. The presentation draws on this experience to chart the evolution of RAs over a 25-year relationship between a policy maker and an arms-length HTA agency to quantify the effects of this partnership on the RAs produced.

Methods:

The number, types, and methodological attributes of RAs produced over a 25-year partnership with a single requestor were reviewed. The reasons for developmental changes in RA products over time were charted to document the push-pull tension between requestor needs and HTA best practice. The elements contributing to the relevance and impact, or not, of the RAs were also identified.

Results:

Results demonstrated the dynamic relationship required for HTA researchers to meet best practice and requestor needs. As literature search spans lengthened and data analyses became more complex, limitations were imposed on RAs to fulfill the requirements of timeliness, utility, and best practice. Adaptations were driven by requestor, researcher, and the external policy environment. Facilitators of RA utility for HTA requestors include: asking focused, well-articulated questions; specifying the request's purpose; providing detailed information about local context and other relevant issues; and understanding the risk of bias associated with RAs. Considerations for HTA doers include: assembling a team using a triage process; involving requestors throughout RA development; negotiating deliverables and timelines using a HTA product matrix; transparently reporting methods; narratively describing methodological issues; and internally reviewing the draft RAs.

Conclusions:

RAs are a useful component of HTA programs. To keep these products relevant and useful, HTA agencies must allow RAs to evolve according to need, but with grounding in good practice. Negotiating the line between rigor and relevance is a key skill for HTA agencies. Having the right team is helpful.