bluuebunny/crossref_metadata_2025 huggingface dataset:
تقديرات الهوامش التسويقية لأهم محاصيل الخضار والفواكه في الجمهورية اليمنية للمدة (1990-2004)
Authors: الأكوع د. أحمد علي
Published: July 2023

تعتبر دراسة الهوامش التسويقية من الأهمية بمكان، لدورها الأساسي في فهم طبيعة المشاكل التسويقية من ناحية، ومعرفة مستوى التطور والأداء الذي بلغته أي دولة في نظامها التسويقي من ناحية أخرى. من هذا المنطق، أجريت هذه الدراسة، بهدف تقدير الهوامش التسويقية لأهم محاصيل الخضار والفاكهة في الجمهورية اليمنية خلال المدة (1990-2004) والكشف من خلالها عن واقع التسويق في اليمن بما في ذلك معرفة الخدمات التسويقية المقدمة للسلع المبحوثة وانعكاسات ذلك على أسعارها الزراعية بين سوقي

الجملة والتجزئة. خلصت الدراسة إلى أن متوسط الهامش التسويقي للخضار بلغ 25 % والفاكهة 10 % من متوسط أسعارهما في أسواق التجزئة على مستوى الجمهورية.  وبقدر ما تعكس هذه النتيجة مستوى منخفضًا للتكاليف التسويقية للمحاصيل المدروسة بين أسواق الجملة والتجزئة، إلا أنها تشير من ناحية أخرى إلى ضعف الأجهزة التسويقية ومحدودية الخدمات والوظائف التسويقية المؤداة على تسويق هذه السلع في اليمن، مما يستدعي تقوية وتطوير هذه الأجهزة التسويقية.
Teaching Practice at Yemeni Universities as Perceived by Educators: A Call for Change
Authors: Sharyan Dr.  Ayid
Published: July 2023

This paper aims at identifying the obstacles of implementing effective Teaching Practice (TP) at the Yemeni Universities to find suitable solutions for placement of student teachers in the TP, weighing individual and multi-supervision, training supervisors, funding of TP, etc. The informants (47) of the study are policymakers and experts in Education in Yemen. Through a questionnaire, consisting of 11 core close-responses type questions pertinent to measure major dimensions of TP, participants were asked to indicate to the extent to which they agreed with. Then the participants were asked to brainstorm the difficulties that face TP. After sticking the difficulties on the wall, the participants were asked to vote on the top five only. The study ends with identifying the problems: limited funding (74%), insufficiency of supervisors (73%), increase in the number of student teachers (71%), short period of TP (69%), absence of coordination between the Ministry of Education (MoE), and the universities (65%), there is no manual and by-law to regulate TP (53%), some departments use only microteaching (53%). The participants suggested solutions. The length of the training should be about a term. The STs need to spend a major period of their training at schools supervised by the faculty supervisor and cooperative teacher/s as well as school administration. The placement of STs has to be arranged between the Faculty, MoE offices and schools. There should be some training for the supervisor who should be given some incentives for their supervision. Funding has to be managed by the university and the ministry of finance. Assessment of TP is to be shared between the different supervisors.
The most important factor behind students ' weakness in English language from the point view of English Language teachers
Authors: Al-Kahtani Dr. Hamud A.
Published: July 2023

This study aimed at finding out the most important factor behind students ' weakness

in English language from the view of English Language teachers identifying . The study used the analytic descriptive research design as well as questionnaire. The questionnaire was given to the sample of the study at the university of Thamar and Sana'a University. The study reached the following results: 1. Students' background in English language is weak thus it affects their learning. 2. Lack of listening evaluation was found to be one of the most important factors behind students' weakness in English language. 3. Society's negative attitudes towards learning English language affects students' learning of English language.

Lack of listening lab was found to be one of the most important factors behind students' weakness in English language.
قضايا التلوث الهوائي بأمانة العاصمة صنعاء كما يتصورها عينة من معلمي التعليم العام
Authors: الدهمشي د. عبدالولي حسين , النهاري د. عبدالباقي
Published: July 2023

هدفت الدراسة إلى استقصاء آراء معلمي التعليم العام بأمانة العاصمة، من مختلف التخصصات الأكاديمية، حول بعض القضايا ذات العلاقة بالتلوث، وعلى وجه الخصوص التلوث الهوائي بأمانة العاصمة، ومن أجل إنجاز هذا الهدف فقد تم اختيار عينة عشوائية من المدارس الواقعة ضمن نطاق الأمانة موزعة إلى مدارس للذكور ومدارس للإناث، وتم تطبيق الأداة على عينة من مدرسي المقررات العلمية وعينة من مدرسي المقررات الأدبية، علما أن الأداة المستخدمة في هذه الدراسة عبارة عن مقياس يحتوي على فقرات تتعلق بالتعرف على تصورات وآراء بعض شرائح المجتمع حول بعض قضايا التلوث الهوائي، وخاصة تلك التي نتجت عن عوادم ومخلفات السيارات والمركبات، وقد أعدها الباحثان وفق القواعد والإجراءات العلمية المطلوبة.
Calibration of Watershed Conceptual Models Using Local and Global ptimization
Authors: A.Jazim Abdulnoor
Published: July 2023

Many issues related to water resources require the solution of optimization problems. Optimization problems can be quite difficult such as the calibration of many conceptual watershed models. Conceptual watershed models are formulated using empirical relationships between hydrological variables observed in nature or field experiments .The success of automatic calibration depends mainly on the choice of optimization method. Most early attempts to calibrate watershed models have been based on local-search optimization methods. Local optimization methods are not designed to handle the presence of multiple regions of attraction, multi-local optima, insensitivities and parameter interdependencies, and other problems encountered in the calibration of watersheds models. It is therefore imperative that global optimization procedures that are capable of dealing with these various difficulties be employed. In this study, one local search optimization method and one global search method are used to calibrate the parameters a simple tenparameter rainfall-runoff model. The local search method is the well-known Rosenbrock's direct search method; the global search method is the newly developed Shuffled Complex Evolution (SCE) method . The results revealed that Shuffle Complex Evolution optimization method is more superior to Rosenbrok’s direct search method. The results confirmed the finding of many watershed modellers about the dependency of Rosenbrock’s method on the choice of initial search points. It further adds that Rosenbrock’s method is only effective when the initial search points are taken within 5 % or less from the true optimum parameter set. The results indicate that a proper choice of optimization methods can enhance the possibility of obtaining unique and conceptually realistic parameter estimate.
تحليل النمط الاستهلاكي الغذائي في الجمهورية اليمنية
Authors: القباطي د. عامر عبدالحافظ
Published: July 2023

تتناول هذه الدراسة تحليل نمط الاستهلاك الغذائي في الجمهورية اليمنية، وتستهدف وصف هذا النمط وتقدير مرونات الطلب الإنفاقية للسلع الغذائية من خلال الاستهلاك- الدخل، وقد قدرت معادلات الإنفاق بطريقة المربعات الصغرى الاعتيادية (O.L.S) من بيانات مسح ميزانية الأسرة لعام 1998، وقد أظهرت النتائج أن نمط الاستهلاك الغذائي في اليمن يتميز بارتفاع نسبة الإنفاق على الحبوب مع انخفاض متوسط نصيب الفرد اليمني من السلع الغذائية الأخرى مقارنة بالمتوسط العالمي، كما أظهرت النتائج أن مرونات الطلب الإنفاقية لكل مجموعات السلع الغذائية كانت موجبة، وقد وجد أن كل من الحبوب، الخضروات، الأسماك، الألبان، الزيوت، السكر، التوابل والشاي والبن تتميز بمرونة منخفضة أقل من الواحد الصحيح، وفي المقابل وجد أن مجموعات اللحوم والمياه المعدنية والمشروبات، البقول والفاكهة تتميز بمرونة إنفاقية مرتفعة. وقد وجدت الدراسة أن الإنفاق على القات والتبغ يتميز كذلك بكون المرونة الإنفاقية أكبر من الواحد الصحيح أي أن المستهلك اليمني يزيد من إنفاقه على القات بنسبة أكبر من نسبة الزيادة في الداخل.
صورة اليهودي في عقلية معلمي التعليم الثانوي
Authors: جحاف د. أمة السلام محمد علي
Published: July 2023

تهدف الدراسة إلى إبراز مدة اهتمام الصحافة اليمنية الرسمية وغير الرسمية بالشئون اليهودية/ الإسرائيلية التي تعزز من ارتباط أبناء اليمن بقضيتهم (فلسطين). وقد اقتصرت الدراسة على متابعة أربع صحف صادرة في الجمهورية اليمنية، صحيفتان رسميتان: الثورة و14 أكتوبر، وصحيفتان غير رسميتين: الثوري، والصحوة، وقد تقرر تتبع هذه الصحف خلال عشر سنوات، في المدة (من 1991-2000م)، وتم اختيار هذه المدة لخلوها من التوتر الشديد أو المواجهة المسلحة بين العرب وإسرائيل. واتبع البحث منهج تحليل المضمون، وتم تصميم قائمة تحليل محتوى صحف عينة الدراسة، أداة للدراسة، وتضمنت هذه القائمة خمسة عناصر، وتوصل البحث إلى أن الاستمرارية والمداومة على تناول القضايا والموضوعات هي المحك الحقيقي للحكم، وبناء على ذلك فإن الصحف اليمنية الرسمية وغير الرسمية تتساوى في عدم الجدية في تناول القضايا والموضوعات المتعلقة بالشئون اليهودية/ الإسرائيلية، كما أن غياب الاستمرارية والظهور الموسمي للاهتمام هو ما أدى إلى إصدار الحكم بعدم جدية الصحافة اليمنية.
الكفايات التعليمية اللازمة لبرنامج إعداد المعلمين في كلية التربية ذمار - جامعة ذمار
Authors: الكولي د. جبر محمد عبدالله
Published: July 2023

يتناول البحث قضية تربوية على درجة كبيرة من الأهمية؛ لأن الإعداد الجيد للمعلم يقوم على عدد من المبادئ مثل الارتباط بين التعليم التربوي النظري والإعداد العملي، ويحاول أن يجيب عن ما الكفايات التعلمية اللازمة لبرنامج إعداد المعلمين في كلية التربية جامعة ذمار؟ وتقتصر حدود البحث على أعضاء الهيئة التدريسية والهيئة الإدارية في كلية التربية ذمار - جامعة ذمار للعام الجامعي 2008م/2009 الفصل الدراسي الأول، ويتكون مجتمع البحث من جميع أعضاء الهيئة التدريسية والإدارية في كلية التربية في العام الجامعي 2008م/2009م، الفصل الدراسي الأول وقد بلغ عددهم 45 فردا، منهم 35 فردا يمثلون أعضاء هيئة التدريس الذين يقومون بتدريس متطلبات البرنامج: الثقافية، والتربوية، والتخصصية، والعدد المتبقي منهم 10 يمثلون الهيئة الإدارية. أما عينة البحث فقد تكونت من 25 فردا من أعضاء الهيئة التدريسية ومن 5 أفراد من أعضاء الإدارة. وتوصل البحث إلى أن جميع الكفايات التعليمية من مقررات علم نفس التربوي قد زاد وسيطها الحسابي عن الوسط الحسابي المعتمد (2.5)، وبذلك يمكن القول إن تلك الكفايات يجب التركيز عليها أثناء إعداد الطالب في برنامج كلية التربية.
مدى فاعلية المنحى المنظومي لتدريس الكيمياء في تنمية التفكير العلمي والاتجاهات العلمية لدى طلبة المرحلة الثانوية في الأردن
Authors: صباريني د. محمد سعيد , ملاك د. حسن علي
Published: July 2023

هدفت الدراسة إلى الكشف عن مدى فاعلية استخدام المنحى المنظومي في تنمية التفكير العلمي في الكيمياء، لدى طلبة الصف الأول الثانوي العلمي، وأثره في الاتجاهات العلمية لديهم وفقا لجنسهم. وتكونت عينة الدراسة من 106 طالبا وطالبة من طلبة الصف الأول ثانوي العلمي في المدارس التابعة لمديرية تربية الرمثاء للعام الدراسي 2007/2008م، وتوزعت عينة الدراسة على أربع شعب في مدرستين تم اختيارهما عشوائيا، وتكونت المجموعة التجريبية من 54 طالبا وطالبة والمجموعة الضابطة من 52 طالبا وطالبة، ولجمع بيانات الدراسة تم تطبيق أداتين هما: اختبار تفكير علمي، ومقياس اتجاهات علمية. وقد تم تطبقي هاتين الأداتين قبل المعالجة وبعدها، وتم تدريب المعلمين على استخدام المنحى المنظومي في التدريس، وتزويدهم بدليل المعلم المتضمن خطط الدروس والإجراءات المتبعة لتنفيذها. ودرست المجموعة التجريبية باستخدام المنحى المنظومي والمجموعة الضابطة بالطريقة الاعتيادية، إذ تم اختيار وحدة الروابط الكيميائية ووحدة القوى بين جزئيات المادة. وقد أزهرت نتائج الدراسة وجود فرق دال إحصائيا في التفكير العلمي لدى الطلبة يعزى إلى طريقة التدريس ولصالح طلبة المجموعة التجريبية إضافة إلى وجود فرق دال إحصائيا في التفكير العلمي يعزى إلى الجنس ولصالح الإناث. وعدم وجود فرق دال إحصائيا في اتجاهات الطلبة العلمية يعزى إلى طريقة التدريس وقد فسرت هذه النتيجة بأن المدة الزمنية غير كافية لتغيير أو تعديل اتجاهات الطلبة.
تأثير دور الشركات المتعددة الجنسيات على حركة الاقتصاد العالي
Authors: Alobaidi Dr. Faiq Gomah Hamza
Published: July 2023

يهدف البحث إلى دراسة تأثير دور الشركات المتعددة الجنسيات على حركة الاقتصاد العالي، وقد استعرض الباحث بعض الملامح السياسية والاقتصادية التي يمكن من خلالها رسم صورة حقيقية وواضحة عن طبيعة وعمل الشركات وارتباطاتها العميقة والمؤثرة في مجمل حركة الاقتصاد العالمي. كما اتضح من خلال البحث حجم الضرر الواقع على مختلف الدول لاسيما الصناعية المتقدمة الكبرة بما فيها اقتصاد الولايات المتحدة الأمريكية بسبب تعاظم دور هذه الشركات في سيطرتها على مفاصل الاقتصاد العالمي، وما حالة الكساد الاقتصادي العالمي اليوم والأزمة المالية المتفاقمة التي بدأت تدب في جوانب مهمة في الاقتصاد الأمريكي التي انعكست تأثيراتها السلبية على مختلف اقتصاديات بلدان العالم، ومنها أيضا اقتصاديات الدول النامية إلا دليل واضح على ما تسببت فيهه هذه الشركات بفعل تدخلها اللامحدود في إدارة دفة الاقتصاد العالمي وسيطرتها على متخذي القرار والتحكم بحجم الاستكثارات والتدفقات المالية والنقدية وخروجها عن دائرة السيطرة والرقابة لحكومات الدول التي أسهمت في إنشاء تكوين مثل هذه الشركات العملاقة، كذلك أوضح البحث مدى الترابط الوثيق بين العلاقات الاقتصادية والعلاقات السياسية بما يؤدي إلى خدمة أهداف مصالح مثل هذه الشركات.
Effect of khat leaves extract (Catha edulis) on the excitability of frog gastrocnemius.
Authors: Thabet Dr. Amin A. Thabet
Published: July 2023

This study was held on the isolated excitable tissue of frog's gastrocnemius muscle. Experiments were down by determining the dose dependent of leaves of khat extract. Work down in accordance with personal presupposition since reported that khat have psycho stimulant effects accordingly we thought khat might have effects on systemically biology that mediated by chticol amines. Results showed the effect of khat leaves extract on excitability of muscle contraction that was easily attested when the electrical stimuli were applied either through the nerve or directly to the muscle. Whereas khat treatment showed a significant increase in the contraction period of the gastrocnemius muscle and both of the relaxation periods and half relaxation time were shortened. Also it was found that pretreatment by khat leaves extract caused changes in the tension output, increased the height of effect intensity with prolonged the contraction period, while the latent period was decreased and reduced slightly the half relaxation period of the twitch comparison with the normal control muscle. These experimental results indicated that khat had highly stimulant effects on muscle, whereas caused liberation of thermoenzymatic and chemical energy during contraction which converted into mechanical energy, which manifested its self as work.
أسباب الرسوب في مادة التفاضل والتكامل (1) من وجهة نظر الطلاب في كلية التربية - المحويت
Authors: الزهيري عماد متعب
Published: July 2023

هدف البحث إلى التعرف على أسباب الرسوب في مادة التفاضل والتكامل (1) من وجهة نظر الطلاب في كلية التربية المحويت، وذلك لارتفاع نسبة الرسوب في هذه المادة، وقد صيغت مشكلة الدراسة من خلال السؤال الآتي: ما هي أسباب الرسوب في مادة التفاضل والتكامل (1) من وجهة نظر الطلاب في كلية التربية في المحويت؟ وتفرع عنه سؤلان: أولهما يؤشر الأسباب الرئيسية، والثاني يؤشر الأسباب الفرعية للرسوب. وتكونت عينة الدراسة من (90) طالب وطالبة من الراسبين في مادة التفاضل والتكامل (1) للعام الجامعي 2007-2008م. واستخدم الباحث الاستبانة أداة للبحث، لجمع المعلومات والبيانات التي شملت أسبابا تعود إلى (الطالب، الأستاذ، المنهج)، بعد التأكد من صدقها وثباتها، وقد بلغ عدد من الفقرات النهائية للاستبانة (48) فقرة. واستخدم الباحث في تحليل النتائج النسبة المئوية، والوسط المرجح والوسط الفرضي والوزن المئوي ومعادلة ألفا كرونباخ لحساب معامل الثبات. وتوصل البحث إلى وجود أسباب رئيسية حقيقية تقف وراء الرسوب في مادة التفاضل والتكامل (1).
Ampullary Adenocarcinoma, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology
Authors: Chiorean E. Gabriela , Chiaro Marco Del , Tempero Margaret A. , Malafa Mokenge P. , Benson Al B. , Cardin Dana B. , Christensen Jared A. , Chung Vincent , Czito Brian , Dillhoff Mary , Donahue Timothy R. , Dotan Efrat , Fountzilas Christos , Glazer Evan S. , Hardacre Jeffrey , Hawkins William G. , Klute Kelsey , Ko Andrew H. , Kunstman John W. , LoConte Noelle , Lowy Andrew M. , Masood Ashiq , Moravek Cassadie , Nakakura Eric K. , Narang Amol K. , Nardo Lorenzo , Obando Jorge , Polanco Patricio M. , Reddy Sushanth , Reyngold Marsha , Scaife Courtney , Shen Jeanne , Truty Mark J. , Vollmer Charles , Wolff Robert A. , Wolpin Brian M. , RN Beth McCullough , Lubin Senem , Darlow Susan D.
Published: July 2023

Ampullary cancers refer to tumors originating from the ampulla of Vater (the ampulla, the intraduodenal portion of the bile duct, and the intraduodenal portion of the pancreatic duct), while periampullary cancers may arise from locations encompassing the head of the pancreas, distal bile duct, duodenum, or ampulla of Vater. Ampullary cancers are rare gastrointestinal malignancies, and prognosis varies greatly based on factors such as patient age, TNM classification, differentiation grade, and treatment modality received. Systemic therapy is used in all stages of ampullary cancer, including neoadjuvant therapy, adjuvant therapy, and first-line or subsequent-line therapy for locally advanced, metastatic, and recurrent disease. Radiation therapy may be used in localized ampullary cancer, sometimes in combination with chemotherapy, but there is no high-level evidence to support its utility. Select tumors may be treated surgically. This article describes NCCN recommendations regarding management of ampullary adenocarcinoma.
3rd High-Performance Computing Security Workshop :
Authors: Guo Yang , Licata Jeremy , Pillitteri Victoria , Rekhi Sanjay , Beverly Robert , Yuan Xin , Key Gary , Gregg Rickey , Bowman Stephen , Hinton Catherine , Reuther Albert , Adamson Ryan , Warren Aron , Bangalore Purushotham , Deumens Erik , Farkas Csilla
Published: July 2023

High-performance computing (HPC) is a vital computational
infrastructure for processing large data volumes, performing complex simulations,
and conducting advanced machine learning model training. As such, HPC is a critical
component of scientific discovery, innovation, and economic competitiveness.
Cybersecurity thus plays an important role in HPC by safeguarding against abuse and
misuse and ensuring data and research integrity. However, HPC systems often have
unique hardware, software, and user environments that pose distinct cybersecurity
challenges. This collaborative workshop gathered stakeholders from government,
academia, and industry to discuss community needs, ongoing activities, and future
directions in HPC security. This public workshop report provides detailed summaries
of technical sessions, key takeaways from breakout sessions, and a summary of the
keynote presentations.
PHOTODIELECTRIC CHARACTERIZATION OF LIGHT-DRIVEN Au/TiO2 NANOMOTORS IN LIQUID MEDIUM
Authors: Danilović Danijela , Trpkov Đordje , Dojčilović Radovan , Tošić Dragana , Pajović Jelena , Škipina Blanka , Dudić Duško
Published: July 2023

This article reports on photodielectric properties of hydrocolloids of TiO2 particles and Au/TiO2 hybrid particles of lateral dimension of ∼200 nm. Illumination of the colloids with visible light did not cause measurable changes in their electrical conductivity, while the application of UV (365 nm) light led to photoinduced increase in conductivity of up to 2%. The photogeneration of ions in water, regardless of the presence of the particles, makes a dominant contribution to the photoinduced increase in conductivity of the colloids.
INFLUENCE OF GEOLOGICAL PARAMETERS ON THE INDOOR RADON CONCENTRATION IN THE CITY OF TREBINJE
Authors: Ćurguz Zoran , Đurić Neđo
Published: July 2023

The paper deals with the analysis of the indoor radon concentration results measured in four schools of Trebinje city and taking into consideration their geological background and its characteristics. There have been 13 measurements and the results showed the range of 75 Bq/m3 to 4244 Bq/m3. Some of the indoor radon concentrations were very high, up to 15 times higher than recommended ones reaching the level of 300 Bq/m3. In each of the four schools there are spots with the high geogenic potential and, 38 % results show a concentration higher than 1100 Bq/m3, which further characterize this area as Radon Priority Area. From the geological point of view, the geological sheet Trebinje represents a part of Mesozoic and Paleogenic complex which build the outdoor Dinarides part. There are also different varieties of calcium carbonate and dolomite areas with sporadic occurrence of sandstones (pescari) and marlstones (laporci) accumulated at the end of the Paleogene period so that lithological content is pretty simple. The main part of the terrain is represented by sediments originated from Mesozoic and Paleogenic structures which appear along with greater dislocation in narrow strings.
Asthma - is there an association between the quality of life and the levels of alexithymia?
Authors: Grabowska-Krawiec Patrycja , Jahnz-Różyk Karina
Published: July 2023

In psychological theories, difficulties of affect regulation, defined as alexithymia, are correlated with asthma but the association between alexithymia, asthma and quality of life has not been explained yet. The aim of the study was to: 1) determine the prevalence of alexithymia in patients with asthma, 2) evaluate the associations between the quality of life and the levels of alexithymia. Methods: Alexithymia was assessed with the TAS- 20 (Toronto Alexithymia Scale). The prevalence of this disorder in patients with asthma was compared to that in healthy subjects. Quality of life was evaluated with: AQLQ by Juniper for asthmatics. The associations among alexithymia, and the quality of life were estimated by data analysis. The data were analyzed using Pearson correlations, t-Student test. A p value ≤ 0.05 was required for statistical significance. Results: Fifty healthy people and fifty one asthmatic outpatients of Military Institute of Medicine in Warsaw, Poland participated in the study. Twenty percent of asthmatics and only four percent of healthy people reported high alexithymia scores. A higher alexithymia score was associated with worse quality of life. Conclusions: The prevalence of alexithymia is higher in patients with asthma. The coexistence of asthma and alexithymia is associated with deterioration of patient's quality of life.
A cost-effectiveness analysis of programmable baclofen pump therapy in children with spastic cerebral palsy
Authors: Dardziński Wiktor , Jóźwiak Marek , Jasińska Anna , Garbacka Magdalena , Obrzut Grzegorz
Published: July 2023

Background: The purpose of this survey is to estimate profitability of using baclofen solution administered by an implanted programmable pump in treatment of spastic cerebral palsy in comparison to standard therapy of spasticity in Poland. Methods: The cost-utility analysis of intrathecal baclofen treatment was performed from the perspective of public payer in 6 years' time horizon, using Markov model, constructed in the frame of computer program TreeAge® Pro Suite 2008. The target population are children with severe spasticity in cerebral palsy which is refractory to current treatment options. Annual discount rate was set equal to 5% both for costs and the health effects. Assumptions of the analysis were tested in one- and multiway sensitivity analysis. Results: A gain of one quality adjusted life year (QALY) in child with spasticity costs 60 224 PLN (17 126 €) when standard treatment is replaced with baclofen pump therapy. Conclusion. Intrathecal baclofen pump therapy in children with spastic cerebral palsy is a cost-effective strategy in Poland.
The organization of the health care system in the Russian Federation
Authors: Holownia-Voloskova Malwina , Vorobiev Pavel
Published: July 2023

This article is a part of the "Road Map ISPOR" and comprehensively describes health care system in the Russian Federation - including its funding, sources of financing, free medical care, and also the rules of mandatory medical insurance. It presents the organization of the health system at both local and national levels including the division of funding for programs and health care provided to specific groups of citizens. Functioning of the departmental health care financed from public funds is also described. Apart from the mandatory insurance, the article also outlines voluntary medical insurance. Finally it describes the decision-making structure and procedures in the health care system as well as organizations carrying out health technology assessment in Russia.
Clinical Effectiveness and cost-utility analysis of sunitinib for the treatment of pancreatic neuroendocrine tumors
Authors: Kroc Jacek , Garbacka Magdalena , Jarosz Joanna , Lipińska Marzena , Zawieja Justyna , Prząda-Machno Patrycja
Published: July 2023

Background: The objective of this review is to assess the clinical effectiveness and cost–utility of sunitinib and best supportive care (BSC) versus placebo and best supportive care in the treatment of patients with unresectable or metastatic well-differentiated pancreatic neuroendocrine tumors with disease progression. Methods: Assessment of the clinical effectiveness of the interventions was conducted in accordance with the principles of systematic review, based on the Cochrane Collaboration guidelines (Cochrane Reviewer’s Handbook) and the guidelines of the Polish Agency for Health Technology Assessment (AOTM). The Markov model constructed in TreeAge Pro 2009 was used in the cost-utility analysis. The time horizon covered the period from the beginning of the treatment until the patient’s death (lifetime horizon). Quality adjusted years (QALY) were used as the measure of effectiveness and the results were presented as incremental cost-utility. CUA was conducted from the perspective of the public payer for health services (Polish National Health Fund, PNHF) and from the patient’s and PNHF’s perspective. Results: As the result of the systematic search, one primary randomized clinical trial satisfying the inclusion criteria was found (Raymond 2011). The results of the present analysis clearly prove that sunitinib administered in a 37.5 mg dose is an effective and safe therapy in the treatment of patients with unresectable or metastatic well-differentiated pancreatic neuroendocrine tumors with disease progression. The cost of gaining an additional QALY by replacing placebo+BSC with sunitinib+BSC is PLN 84,214 /PLN 84,296 (€20,441/€20,461) from PNHF/PNHF+patient perspective. Conclusion: Sunitinib is a more costly and a more effective therapy than BSC.
Opioids, history still present. Policy issues in implementing the drug treatment of pain
Authors: Giermaziak Wojciech
Published: July 2023

In the history of medicine and pharmacy issues of treatment or prevention of pain disorders have been discussed since ancient times to the present. Opioids are a class of drugs controlled in the manufacturing, distribution, their use is specified by a certain health policy, medicine, pharmaceutical economics and rationalization of treatment within the competence of the ministries of health. The treatment of chronic pain management in both origin cancer and non-malignant forms provides solutions to ensure the relative balance in all aspects of the policy of balance, or balancing the risk factors associated with the use of opioids as controlled drugs in health care. In the analysis of a variety of sources, including the evaluation of the Polish pharmaceutical market, particularly during the legislative process of the Reimbursement Act, it seems an important challenge for state drug policy makers to balance the controlled drugs market (including opioids).
Opimatization of effects and medical costs in the system of medical care for the heavy users patient group
Authors: Ameljańczyk Tomasz
Published: July 2023

The paper concerns the optimization of effects and medical costs in the process of providing medical services with the Health Care System. The idea of optimization relies on the use of the opportunity to steer the demand for medical services by different segments of potential patients. For this purpose the most important patient groups were identified from the perspective of effects and medical costs. A special attention was paid to the groups of patients of the HEAVY USERS (HU) and the LIGHTHEARTED USERS (LU) types – the so called „carefree” patients. The paper contains the concept of the method identifying HU type and LU types patients. Patients of these groups generate relatively high medical costs. The costs are usually unjustified (the losses of the HCS) additionally leading to the decrease of medical and social effects of medical care. Identification and classification of the groups of patients further enables the use of the application of adequately selected clinical paths and the medical intervention system.
Early medical technology assessments of medical devices and tests
Authors: Mikudina Boglárka
Published: July 2023

Background: Classic medical technology assessment (MTA) is typically conducted at the end of the development process to assess the overall value of a drug, medical device or diagnostic test. Recently, researchers and manufacturers have recognized that MTA in the early phases could help to make better decisions about further development, the regulatory and reimbursement strategy, and allocating public support for new technologies. The aim of this study is to introduce the most commonly used methods in early MTAs of emerging technologies and examine which methods have been used in the early MTAs of medical devices and tests. Methods: An explorative literature review. Results: Classic MTA supports particularly regulators and payers in market and reimbursement decisions, while early MTA primarily supports decisions of manufacturers about investments and strategies regarding further development as well as decisions by policymakers about public support. Important methods that can be used in early MTAs of medical devices include early health economic modelling, the headroom method, the Bayesian analytical framework, clinical trial simulation, multi-criteria decision analysis and value of information analysis. Only a few articles have been described early HTAs of devices and tests and most of these have used economic modelling, sometimes in combination with other methods. Conclusions: Various methods can be applied in performing early MTA. While early MTA follows the same steps as classic MTA, repeated assessments and sensitivity analysis play a more significant role.
Experience of the Latvian medicines reimbursement system
Authors: Araja Diana
Published: July 2023

In Latvia, the drug reimbursement system for outpatient treatment develops under limited resources. The reimbursement is performed against the degree of severity of certain diseases. The largest part of the health care budget recourses for the reimbursement system is allocated for groups of diagnoses ‘Diseases of the circulatory system’ (21.48% of total expenditures in 2012), ‘Endocrine, nutritional und metabolic diseases’ (20.44% of total expenditures in 2012) and ‘Neoplasms’ (14.60% of total expenditures in 2012). Taking into account the rapid growth of the reimbursement expenditures in 2011 as well as the patients’ co-payment for non-reference medicinal products certain measures have been implemented such as refund, depending on the exceeded market share, which was implemented for the period of 2011-2012 and amounted to LVL 3.7million in 2011 and LVL 2million in 2012. The two-level tender system has been implemented since September 2011 for interchangeable medicinal products and for newly diagnosed patients only reference medicine is reimbursed by the NHS at the time of the first treatment. As the result of these activities with the increased number of patients an average price per prescription was reduced from LVL 15.30 in 2011 to LVL 14.43 in 2012 the expenditures per patient were reduced from LVL 157.38 in 2011 to LVL 145.63 in 2012. With the strictly limited state budget, a necessity to use additional possibilities to optimise the resource allocation for the health care program and prevention activities remain topical.
The German AMNOG and its current potential implications on the Spanish and Belgian pricing and reimbursement decisions
Authors: Walzer Stefan , Parow Detlef , Zoellner York , Shekarriz Sarah , Antonanzas Fernando
Published: July 2023

Background: EU policymakers have implemented mechanisms to slow down the rate of increase in health care costs. The most recent reform that came into effect in Germany was the Act to Reorganise the Pharmaceutical Market (AMNOG - Das Arzneimittelmarktneuordnungsgesetz (). Methods: Exemplarily for countries, which used Germany as a price reference country, Spain and Belgium were chosen for pilot evaluation if AMNOG might have any further impact on reimbursement and pricing decisions in these countries. The general market access and potential impacts on clinical development programs will be discussed and evaluated. Results: In Spain, GBA assessments may influence the central decisions in pricing and reimbursement in the sense that lower prices will be expected for new drugs in the benchmarking process. In Belgium, AMNOG will also have an impact: the Price Commission will possibly observe lower prices than before, what may lead to other decisions for approved Belgian prices. More importantly, the decisions in Germany, related to added benefits of new drugs, might influence the Commission members. Finally, clinical developments of new compounds may also be influenced by AMNOG, regarding the requests of reimbursement decision makers for special clinical trial designs. Conclusions: The potential impact on additional clinical benefits and price decisions with the Spitzenverband der Krankenkassen may be observed in some other countries as well. Furthermore, the impact on future clinical development programs of new compounds might as well be significant. Further research and experience in Germany and other countries is needed and awaited.
Biosimilar drugs - reimbursement regulations. Polish ISPOR chapter’s Therapeutic Programs and Pharmaceutical Care (TPPC) task force report
Authors: Drozd Mariola
Published: July 2023

Objectives: Due to the increased number in biosimilar drugs getting marketing authorization, there is a question to be answered which reimbursement procedure should be followed. Methods: The TPPC task force has checked the approach to biosimilar drugs by WHO, at the EMA level and in a few countries worldwide. Among other aspects discussed, we concentrated on the production process of the reference (original) drugs and biosimilars and looked for differences. An internet search was performed checking the definitions as well as regulatory and reimbursement processes worldwide, with focus on the countries having HTA procedure in place. Findings: It was found that due to specifics of biosimilars, detailed and comprehensive regulatory processes have been established centrally for EU states. No reimbursement guidelines have been identified. Due to lack of specific reimbursement guidelines TPPC agreed on a need to define a biosimilar drugs reimbursement process in Poland. TPPC task force also agreed that due to central European registration process the definitions for biosimilar drug in Poland should be in line with the EMA guidelines. The reimbursement process is different in each EU member state and it should be defined for these products on a country level. Probably, it also requires specific guidelines to be developed, especially in countries such as Polandwith “HTA dependent reimbursement process”. Conclusions: TPPC task force has only identified regulatory guidelines and its opinion is that in Poland, a detailed reimbursement process should be developed in the way it also includes the biosimilar drugs.
Schizophrenia and negative symptoms – burden of disease in seven Central and Eastern European (CEE) countries. Literature review and retrospective data collection – project design and rationale
Authors: Szkultecka-Dębek Monika , Augustyńska Joanna , Pieniążek Izabela , Dębowska Grażyna , Miernik Katarzyna
Published: July 2023

Objective: Schizophrenia is a serious public health problem: it affects approximately 1% of world’s population and is a leading cause of disability. The main objective was to develop a report concerning burden of schizophrenia with special attention to negative symptoms in seven Central and Eastern European countries. Methods: The project consisted of two phases: literature review and retrospective data collection. The literature review involved a search for published literature in international databases and country-specific data from local sources in relation to: epidemiology, clinical guidelines, standards of care, cost of illness, resource utilisation, health related quality of life and caregiver burden. The second phase involved retrospective data collection on the basis of patients’ medical cards and gathering the medical experts’ opinions. In each country 3–6 medical centers participated in the project. Psychiatrists completed questionnaires with data from randomly selected medical cards. Statistical analysis was used to test differences between included centers and countries with regards to the treatment of schizophrenia. Results: The results of literature review served as the framework for retrospective data collection. For the second phase of the project, the sample size included about 1,000 patients’ cards from participating countries showing the daily clinical practice of schizophrenia treatment. Results from the project were presented and discussed with medical experts and key opinion leaders during local workshops. Conclusion: The project addresses relevant issues related to the burden of schizophrenia and complements data presented in the literature with additional data gathered in clinical practice, especially in the area of schizophrenia negative symptoms.
Cost-effectiveness of injectable atypical long-acting antipsychotics for chronic schizophrenia in Poland
Authors: Hemels Michiel E. H. , Zilbershtein Roman , Schubert Agata , Skrzekowska-Baran Iwona , Van Impe Kristel
Published: July 2023

Objective: In order to determine the cost-effectiveness of paliperidone palmitate (PP-LAI), a long-acting injectable formulation, indicated for once-monthly injections as antipsychotic therapy, it was compared with risperidone, a long-acting, injectable (RLAI) and biweekly agent, administered for treatment of chronic schizophrenia in Poland, as perceived from the perspective of the National Health Fund (NHF). Methods: We adapted a 1-year decision tree model to the Polish healthcare system with literature-derived and clinical expert inputs. The compared drugs included PP-LAI, a new treatment option of antipsychotic therapy, and RLAI, the established treatment for Polish patients. Clinical rates were derived from published trials. Model outputs included expected cost per patient, as well as the rates of hospitalization, emergency room visits, days free of symptoms and quality-adjusted life-years (QALYs). One-way sensitivity analyses were applied to major inputs. All the inputs were also simultaneously varied in probabilistic sensitivity analyses. Results: Despite its higher acquisition cost, PP-LAI demonstrated a lower expected cost per treated patient. PP-LAI was associated with 0.824 QALYS, 323 days with stable disease and 44.6% hospitalization. RIS-LAI had 0.817 QALY, 317 stable days and 51.3% hospitalization. PP-LAI dominated RIS-LAI in the base case and in 55.0% of 10,000 simulations, and was cost-effective in 76.6%. However, the cost-effectiveness was sensitive, being lost with modest increases for PP-LAI or decreases for compared drugs with respect to their prices, relapse and adherence rates. Because it is injected monthly as opposed to biweekly, PP-LAI saves caregiver time as it is administered monthly, as opposed to the biweekly regimen. Conclusions: From the viewpoint of the National Health Fund of Poland, when compared with RLAI, PP-LAI is a cost-effective drug with potential to reduce healthcare expenses.
How to optimize public spending on antihypertensive treatment in Poland - an example of rationalization analysis
Authors: Hermanowski Tomasz , Faluta Tomasz
Published: July 2023

Background: Approximately 13% of global deaths are assigned to high blood pressure. ACE-Is and ARBs belong to most frequently prescribed classess of antihypertensive treatment. Recent meta-analyses have confirmed lack of evidence for predominance of ARBs over ACE-Is. Nevertheless, in Poland ARBs remain premium priced and better reimbursed compared to ACE-Is. Objective: To assess economic impact of combining existing separate limit groups of the RAAS inhibitors into one group. Presented analysis is an example of rationalization analysis – a new type of analysis introduced by the reimbursement law 2011. Methods: Reimbursement spending in one year horizon was assessed in two scenarios, assuming separate and common limit groups for ACE-Is and ARBs. List of products analysed and their unit prices are based on MoH listing of reimbursed drugs for 1 July 2013. Yearly volume of reimbursed packs was based on the most recent available data ie. NHF reports May 2012 to April 2013. Results: Yearly savings from the public payer perspective is estimated at 155 mln PLN, a significant fraction (2.3%) of the actual spending on drug reimbursement. Average cost of reimbursement of a monthly therapy using ACE-Is and ARBs is estimated at 2.22 and 3.85 PLN respectively, as compared to 2.35 and 10.85 PLN prior to the change. Conclusion: Combining ACE-Is and ARBs into a common limit group could ensure significant savings for the payer without compromising public health. Existing clinical evidence suggests that current practice of financial preference of ARBs over ACE-Is may lead to suboptimal allocation of the public resources.
Polish Experience in Financial Management of Medicines Market by Public Payer
Authors: Fałek Artur , Śliwczyński Andrzej , Michalak Jacek , Iltchev Petre , Czeleko Tomasz , Jahnz-Różyk Karina , Marczak Michał
Published: July 2023

The most important features of medicines market in Poland are presented with the special reference to the terms and conditions of medicines reimbursement. A number of data on value and development of the pharmaceutical market, the value of reimbursement of medicines, changes in the numbers of open pharmacies, are presented also. The processes of decision making on reimbursing medicines in Poland before and after the Reimbursement Act are described in details. The implementation of the Act resulted in the increase of transparency of ways and methods for pricing of medicines, including them into the national health insurance system; the improved financial stability of public payer - gained by the precisely defined part of payer’s budget, spent on medicines; patient-oriented approach in introducing new molecules into reimbursement system. The positive impact of the Reimbursement Act on the pharmaceutical market can be noted.
Hepatitis C – the implications and the need for change in the health care system in Poland
Authors: Władysiuk Magdalena , Hałdaś Mateusz
Published: July 2023

Hepatitis C is a disease spreading across the world. It is estimated that more than 185 million people are potentially infected with HCV. Each year approximately 350 thousand people die of diseases resulting from HCV. In Poland about 231 thousand people are believed to be infected, with up to 85% of them unaware of their progressive illness. Hepatitis C leads to serious complications in the liver and, consequently, can lead to death. The disease generates appreciable costs associated with the treatment of the complications of HCV in the advanced stages of the disease as well as lost productivity. As there is no vaccine against HCV, hepatitis C treatment is the only way to eradicate the virus. This is now possible with new therapies. This article presents the burden of hepatitis C and its changing dynamics in the context of hepatitis B and HIV in Poland. The natural history, the costs generated by the disease, available current therapies and suggested ways forward are also discussed in the article.
Current treatment options with immunoglobulin G for adult patients with primary immunodeficiency disease in Poland
Authors: Więsik-Szewczyk Ewa , Kucharczyk Aleksandra , Jahnz-Różyk Karina
Published: July 2023

Polyclonal immunoglobulin G life-long replacement is a corner stone therapy in patients with primary antibodies deficiency. The evidence of safety and effectiveness of IgG in PAD are strongly documented for reduction and protection for serious infections. There are still limited data for deletion from long term complications as progression of chronic lung diseases, bronchiectasis and damage. Nowadays accelerated progress in IgG products modulation and ways of administration allows for adjustment of this chronic treatment for patients needs and preferences, improving the patients’ compliances and quality of life. Intra venous immunoglobulin therapy has been used for many years. There are worldwide accumulating experiences with subcutaneous therapy. The latter can be given by infusion delivery pump, via rapid push or facilitated by preinfusion of recombinant human hyaluronidase (rHuPH20). The immunoglobulin G life-long replacement is an expensive procedure. In the past in Poland replacement immunoglobulin therapy was provided mainly by pediatricians resulting in a gap with high quality care for adult patients. Awareness of problem of primary immunodeficiency in adult patients provokes the rise of centers which take care of adult patients. To improve the access for immunoglobulin therapy in Poland, a drug program has been introduced for adult patients with primary immunodeficiency. This review paper presents aspects of current immunoglobulin therapy in primary immunodeficiency complying resolutions proposed in Polish health care system.
XYZ-analysis to determine doctors' influence on the pharmacy assortment of OHD in the Podolsky region of Ukraine
Authors: Ivko Tanya
Published: July 2023

XYZ-analysis of oral hypoglycemic drugs (OHD) was conducted to determine the effect of individual parameters of the doctors on the formation of pharmacy assortment. It was found that the OHD of the groups X and Y were formed by practitioners under the age of 30 years (47%), with work experience up to 5 years (40%), mostly – endocrinologists (73%), with the second qualifying category (33%), with high qualifying category (27%), and without qualifying category (26%). 14% of these doctors have scientific degree as PhD and associate professor. The group Z was formed by the doctors aged 51-60 years (60%), in 100% of cases there were endocrinologists with 11-20 years of experience on specialty (66%), with the second qualification category (67%), and with the high qualifying category without academic degrees and titles (33%). It has been established that the doctors of Podolsky region of Ukraine who formed groups X and Y were largely committed to the German and French manufacturers, and the doctors who formed group Z were largely committed to the manufacturer of Poland and Ukraine. This indicates a more stable position of manufacturers of Germany and France at the pharmaceutical market of OHD in Podolsky region of Ukraine. It has been established that the cause of these doctor’s commitment was the high efficiency of OHD of manufacturers from Germany and France.
Current issues of therapy with monoclonal antibodies
Authors: Jahnz-Różyk Karina
Published: July 2023

The paper presents the most important aspects of treatment with monoclonal antibodies (MABs). Clinical and economic consequences of MABs biosimilars were shown. Access to MABs treatment in drug programs in Poland has been also presented.