bluuebunny/crossref_metadata_2025 huggingface dataset:
VP28 The Use Of Ethnographic Fieldwork In Health Technology Assessment
Authors: Hansen Helle , Thomsen Tine
Published: January 2018

INTRODUCTION:

The aim of the study was to introduce ethnographic fieldwork (1), including participant-observation and ethnographic interviews. Ethnographic fieldwork is a robust research methodology to study patients experiences and perspectives and, therefore, particularly valuable for Health Technology Assessment (HTA). Conducting ethnographic fieldwork requires that the researcher joins the people under study where they live or work for a period of time to observe and experience their everyday life and grasp their point of view in relation to the assessment of a health technology.

METHODS:

The presentation focuses on ethnographic fieldwork with participant-observation and ethnographic interviews. In relation to HTA, fieldwork can be highly relevant in order to understand the social world of the patients, for instance how they perceive and act in relation to a health technology. Furthermore fieldnotes, considerations on the analytic process and the production of knowledge will be a focus in the presentation.

RESULTS:

We argue, that a small fieldwork study based on participant-observation can do much more than just act as supplements to differents forms of interviews. We demonstrate that in the production of an HTA, patient knowledge should not depend on or prioritize one method like interviews or recorded talks. We show the importance of good fieldnotes in the process of analysis together with a discussion of the production of knowledge.

CONCLUSIONS:

To explore patients perspectives is thus not to identify one ’true’ perspective through an individual interview. Patients perspectives and experiences are emerging, relational and shifting. Therefore, there is a need for enhancing methodological and epistemological reflections and discussions about future development of ethnographic fieldwork in relation to HTA and patient involvement. The potential use of ethnographic fieldwork including participant-observation and ethnographic interviews will be highly relevant in relation to the assessment of new screening procedures, tele-health solutions, and collaboration between different sectors such as hospitals, municipalities and general practice. Furthermore, ethnographic fieldwork would be of importance for exploring how technology is working in local settings.
VP34 Economic Impact Of Influenza-Like-Illness In Vietnam
Authors: Vo Trung
Published: January 2018

INTRODUCTION:

Influenza is a disease related to the human respiratory system, with economic and social burden a common cause of Influenza-Like-Illness (ILI) among children and the elderly. This study was conducted to estimate cost of illness based on social perspectives of ILI cases.

METHODS:

A prospective study was conducted between February and March 2016 in pharmacies and private clinics at Khanh Hoa, Lam Dong, Tay Ninh, Dong Nai province, Ho Chi Minh City and Hospital of Tropical Diseases. Demographic and clinical information was collected by face-to-face interview. Treatment costs included direct costs (for example, diagnosis, therapeutics) and indirect cost (cost of days lost).

RESULTS:

Average costs associated with the ILI were USD88.09 per case among all age groups, direct non-medical costs were more dominant than direct medical costs accounting for 39.5 percent in pharmacies, 71.1 percent in clinics and 64.2 percent in hospitals. Total average cost was estimated to be EUR105 in children, and EUR514 in adults in Germany (1); and in South China, direct medical cost of ILI would be USD22.69 (2).

CONCLUSIONS:

The cost of ILI was the reason for the economic burden of patients and their families. This study provides the data for the future research, programs and policies which can be applied for influenza or ILI in Vietnam.
VP55 Health Technology Assessment Of Orphan Drugs: The Case Of Hereditary Angioedema In Italy
Authors: Federici Carlo , Cicardi Marco , Perego Francesca , Tarricone Rosanna
Published: January 2018

INTRODUCTION:

The evaluation of orphan drugs raises both positive and normative issues. Due to the rarity of the disease, higher drug costs and greater uncertainty on effectiveness often result in incremental cost-effectiveness ratios (ICER) far beyond the usually accepted thresholds for reimbursement. However, decision makers may need to consider other criteria to assess the social value of orphan drugs such as equity, the rule of rescue, and the perceived need in the community. Hereditary Angioedema (HAE) is a rare congenital deficiency resulting in recurrent attacks of angioedema in affected patients. These episodes cause extreme pain and distress, and may even be fatal when air pathways are involved. In Italy, icantibant or C1-Esterase-Inhibitors (C1-INH) are the indicated treatments for acute attacks. Although more expensive, icantibant may reduce time to symptom-relief and the need for further treatments. Nonetheless, evidence on its social value is missing. The present study aims at evaluating the cost-effectiveness of icantibant and providing new insights on other potentially relevant criteria for decision making on HAE treatments.

METHODS:

A cost-effectiveness model of icantibant versus C1-INH (Berinert) was developed. Using a two-part bayesian model, costs were estimated from real-world data of an unpublished national registry. Efficacy data were synthesized from both the registry and an indirect comparison of existing trials, whereas utilities were derived from the literature.

RESULTS:

In our Italian registry, respectively 98 percent and 60 percent of patients self-administered icatibant or Berinert at home in absence of medical personnel. On average, per treatment costs were 60 percent higher and attack duration 25 percent shorter with icantibant compared to Berinert. The resulting ICER greatly exceeded the considered threshold of EUR30,000.

CONCLUSIONS:

On cost-effectiveness grounds icantibant did not demonstrate good value for money compared to Berinert. However, further considerations are needed on whether standard health-related quality of life measures are able to truly reflect societal preferences for HAE treatments.The use of real-world data for the economic evaluation of orphan drugs can support decision making when evidence from clinical studies is too sparse.
VP60 The Importance Of Patient Organizations Involvement In Health Technology Assessment
Authors: Apostolidis Kathi , Makaroff Lydia , De Lorenzo Francesco , Florindi Francesco
Published: January 2018

INTRODUCTION:

In Europe, the work done by the European Commission and the European Network for Health Technology Assessment (EUnetHTA) has consolidated the role of Health Technology Assessment (HTA), and promises to better harmonize its impact across European Union (EU) countries. However, more work is needed to improve patient involvement in assessing new health technology, and in developing research priorities.

METHODS:

The European Cancer Patient Coalition (ECPC) developed a model for engagement of patients in HTA based on the experience from:

•

ECPC's ‘Value of Innovation in Oncology’ White Paper, which includes input from ECPC's membership

•

ECPC's leading role in the Patient Preferences in Benefit-Risk Assessments during the Drug Life Cycle (PREFER) study, funded by the Innovative Medicines Initiative, to develop guidelines on how patient-preference studies should be performed throughout the development of new medical treatments.

RESULTS:

The ECPC ‘Value of Innovation in Oncology’ White Paper was launched in 2017. The paper provides ECPC's policy position on key obstacles to equitable access to meaningful innovation. The paper recommends the establishment of an EU-wide HTA body to reduce delays and variations in access and to avoid duplication of effort by individual Member States. The paper also recommends that patients should be formally and routinely included in HTA policy and operations at EU and at national levels. These recommendations were also submitted to the European Commission's public consultation on strengthening EU cooperation on HTA.

Through its work in PREFER, ECPC is helping to improve how patient preferences are measured and valued to capture the impact of health technology on patients daily life. Patient preferences are concerned with measuring how patients value components such as treatment end points, route of administration, treatment duration, treatment frequency, frequency of side-effects, price, and quality of life.

CONCLUSIONS:

Patient organization involvement in HTA is vital. Patient organizations offer unique insights, experiences, identify unmet needs, and can help to produce practical recommendations
VP95 The Monetary Value Of A Statistical Life Year: A Systematic Review
Authors: Schlander Michael , Schwarz Oliver , Schaefer Ramon
Published: January 2018

INTRODUCTION:

Among economists, there is widespread agreement that the monetary valuation of health gains should reflect the preferences of those who will be affected by resource allocation decisions. In the context of Health Technology Assessments (HTAs), this view implies a need for reliable empirical estimates of the value of statistical life year (VSLY), which should provide a useful point of reference for cost benefit analyses.

METHODS:

We conducted a systematic review of the literature on the economic value of a statistical life (VSL). We searched in the EconBiz and EconLit databases for studies, which reported VSL estimates based on original research and were published between 1995 and 2015. We classified studies by methodology, that is, revealed preference (RP) or stated preference (SP; that is, CV, contingent valuation, or DCE (discrete choice experiment) approach, and by regional origin of data. We transformed VSL estimates into VSLY expressed in year 2014 Euros, using life expectancy tables for the populations studied, a real discount rate of 3 percent, national Consumer Price Indices for inflating, and purchasing power parities for currency conversion. In addition, we calculated ratios of VSLY to gross domestic product (GDP) per capita.

RESULTS:

Our search yielded 120 studies appropriate for inclusion. From these, we extracted a total of 132 VSL estimates (RP, n = 60; SP, n = 72). The median VSLY was 6.4 times GDP/capita. Transformed into Euro (2014), the median VSLY was EUR165,000 (mean, EUR217,000). We found significant differences by regional source of data (North American, median EUR272,000; European, EUR158,000) and by method (RP, EUR241,000; SP: CV, EUR117,000; DCE, EUR187,000). VSLY estimates were sensitive to discount rate.

CONCLUSIONS:

Our data indicate that VSLY estimates based on empirical data exceed benchmarks commonly used in the context of HTAs. However, inter-study variability, methodological limitations, and normative considerations, all suggest to exercise caution before translating this observation into actual policy.
VP99 Economic Impact Of rpFVIII In The Management Of Acquired Hemophilia A
Authors: Lorenzoni Valentina , Triulzi Isotta , Turchetti Giuseppe
Published: January 2018

INTRODUCTION:

Acquired hemophilia A (AHA) is a rare coagulation disease characterized by frequent bleeding episodes treated with plasma-derived products and bypassing agents as rFVIIa and aPCC. Similar to the previous plasma-derived porcine FVIII and without its side effects, pFVIII (Obizur®) is a porcine recombinant factor VIII produced with the recombinant DNA technique. The study analyzes the economic impact of pFVIII compared to the other available therapies in order to manage the bleeding episodes in AHA patients.

METHODS:

To assess the impact of the introduction of pFVIII in the market-mix of products for the management of AHA a budget impact analysis was conducted from the perspective of the Italian National Health System (INHS) and considering a three-year time horizon. Consumption of products, products’ wastage, needs for additional treatment in case of failure of first line therapy, laboratory tests, hospitalization and drug wastage were considered for cost estimation. Model inputs were derived from literature, preliminary experience with the use of pFVIII for compassionate use, and from the updating of previous evidence by data collected among a panel of clinical experts. Univariate sensitivity analysis was performed to explore overall uncertainties in input parameters.

RESULTS:

The management of a bleeding episode considering conventional treatment is EUR8,229,621 per year, with an overall cost over three years equal to EUR24,688,864. The introduction of pFVIII leads to an overall costs saving ranging from EUR2,253,938 and EUR1,196,985 when the treatment duration is varied between 5 and 6.5 days, according to data from compassionate use or literature, respectively.

CONCLUSIONS:

The model outlined a significant reduction of all the components of direct costs for the INHS when Obizur® is introduced into the market with an ex-factory unit price equal to EUR2.32/IU.
VP129 Social Cost Benefit Analysis (SCBA) Of Three Alcohol Policy Measures
Authors: de Wit Ardine , van Gils Paul , Over Eelco , Lokkerbol Joran , Smit Filip , Mosca Ilaria , Spit Wim , de Kinderen Reina , Evers Silvia
Published: January 2018

INTRODUCTION:

Alcohol abuse and addiction lead to a high disease burden for the persons concerned. Moreover, it has economic consequences for society, including costs of health care, costs due to reduced productivity, criminal activities, traffic accidents, and violence, both in private and public domains. The aim of this study was to perform a social cost-benefit analysis (SCBA) of three policy measures (tax increase, reducing number of sales venues, and advertising ban) over a period of 50 years, along with the distribution of costs and benefits among stakeholders (1).

METHODS:

The analysis follows Dutch guidelines for performing SCBAs. Costs and benefits in eight different domains were comprehensively identified. Model simulations were used to estimate future social costs and benefits of three policy measures, compared to not intervening.

RESULTS:

Over a period of 50 years, the greatest social benefits were expected from a tax increase. The cumulative discounted net monetary benefit over a period of 50 years is EUR12 billion (95 percent Confidence Interval, CI EUR11-EUR13billion) in the 50 percent tax increase scenario. The net benefits of the other two measures are smaller. The cumulative discounted value to society of a 10 percent decrease in outlet density over a 50-year period amounts to EUR4 billion (range: EUR3 - EUR5 billion). A total media ban with an estimated reduction of 4 percent in alcohol consumption leads to an expected cumulative discounted value to society over a 50-year period of EUR7 billion.

CONCLUSIONS:

All policy scenarios lead more or less to positive effects for society. The greatest benefits are associated with measures aimed at raising the excise tax on alcohol. Estimations as made in this study may serve to inform alcohol policy in the Netherlands.
VP142 Assessing Human Enhancements: Exposing And Elucidating Ethical Issues
Authors: Hofmann Bjørn
Published: January 2018

INTRODUCTION:

Human enhancement technologies need assessments, but they differ from other health technologies. Therefore we may need other methods for their assessment, also with regard to addressing its ethical issues. The objective of this paper is to describe the elaboration of a method for exposing and elucidating ethical issues with human cognitive enhancement. The approach is elaborated in order to support and facilitate open and transparent deliberation and decision making with an emerging type of technology with great potential and formative implications for individuals and society.

METHODS:

The literature search identified relevant approaches. Conventional content analysis of the identified papers and methods revealed their suitability for assessing human cognitive enhancement. Four selection criteria were applied and followed by method development. Pilot testing on smart-glasses (1) resulted in amendments.

RESULTS:

A method for exposing and elucidating ethical issues in the assessment of human cognitive enhancement technologies was developed based on three existing approaches in Health Technology Assessment (HTA) (2). The method consists of six steps and a guiding list of forty-three questions. An overview of the approach will be presented.

CONCLUSIONS:

A method for exposing and elucidating ethical issues in the assessment of human cognitive enhancement has been developed. The method paves the way for context specific ethical assessment and analysis of a new and emerging type of technology.
VP147 Implementing Electronic Health Record In A Children's Hospital
Authors: Andellini Martina , Faggiano Francesco , Sabusco Francesca , Derrico Pietro , Ritrovato Matteo
Published: January 2018

INTRODUCTION:

Since the adoption of electronic health record (EHR) systems, which contain large volumes of aggregated longitudinal clinical data, promises a number of substantial benefits including better care, improved safety issues and decreased healthcare costs (1). It is also associated with significant costs and large technical and organizational impacts, therefore it is important to conduct comprehensive evaluations of healthcare delivery outcomes. The purpose of the study is to gather evidence on safety and overall effectiveness of EHR implementation in Bambino Gesù Children's Hospital (OPBG).

METHODS:

Decision-oriented HTA (DoHTA) method (2) was applied to assess the technology on clinical, technical, organizational, economic, legal, ethical and safety domains. It's a new implementation of the European Network for Health Technology Assessment (EUnetHTA) CoreModel integrated with the Analytic Hierarchy Process. It allows defining an evaluation structure represented by a hierarchical decision tree filled by indicators of technology's performances, each of which was given a weight proportional to the impact that this criterion provides to achieve the purpose of the decision problem; finally, the alternatives’ ranking was defined.

RESULTS:

The multidisciplinary assessment took into consideration all of the aspects and recommendations about the benefits and disadvantages of EHR (3). The synthesis of scientific evidence integrated with results of the specific context analysis, resulted in the definition of components of the decisional hierarchy structure. In particular, EHR seems to offer many benefits in terms of safety and clinical effectiveness such as improved continuity and quality of care, and increased accessibility of the data. The implementation of EHR resulted in important organizational outcome such as EHR configuration, learning curve and training. For these reasons, the usability was the main technical characteristics of the technology taken into account. Finally, legal aspects on privacy and security of data, covered a key role in the assessment.

CONCLUSIONS:

A thorough evaluation of the EHR before its implementation has permitted hospital's decision makers to choose knowingly.
VP151 Endovenous Iron Deficiency Anemia Treatment In Inflammatory Bowel Disease: Hospital-based Health Technology Assessment
Authors: Stojanovic Jovana , Kheiraoui Flavia , Proli Enrica Maria , Scaldaferri Franco , Volpe Massimo , Di Pietro Maria Luisa , Zace Drieda , Gasbarrini Antonio , Fabrizio Laura , Boccia Stefania , Favaretti Carlo , Poscia Andrea
Published: January 2018

INTRODUCTION:

Iron Deficiency Anemia (IDA), a common cause of anemia in the world, is a frequently neglected disease that represents the main extraintestinal manifestation affecting patients with inflammatory bowel disease (IBD) (1). The release of new intravenous (IV) iron compounds represents a great opportunity for both physicians and patients, but the higher costs might hold back their optimal diffusion. A Health Technology Assessment (HTA) approach was used to provide insights on the sustainability of the IV iron formulations in a hospital setting, with a special focus on ferric carboxymaltose.

METHODS:

Epidemiology of IBD, as well as IDA associated with these conditions, was assessed with a systematic appraisal of the published literature. Data on efficacy and safety of IV iron formulations currently used in Italy were retrieved from the available medical electronic databases. A hospital based cost-analysis of the outpatient delivery of IV iron treatments was performed. Organizational and ethical implications were discussed.

RESULTS:

The reported prevalence of anemia in patients with IBD varies markedly from 10 to 73 percent for Crohn's Disease and from 9 to 67 percent for Ulcerative Colitis. Although there are no studies on direct comparison of different IV iron preparations, the literature indicates good efficacy and safety profiles of these formulations. However, ferric carboxymaltose seemed to provide a better and faster correction of hemoglobin and serum ferritin levels in iron-deficient patients (2,3). Our analyses indicated that ferric carboxymaltose, in spite of a greater price, would have positive benefits for the hospital, in terms of reduced costs related to individual patient management, and for the patients themselves, by reducing the number of infusions and accesses to health facilities.

CONCLUSIONS:

This hospital-based HTA reports an overall positive organizational, economic and ethical evaluation for the sustainable introduction of ferric carboxymaltose in the Italian outpatient setting.
VP165 Landscape Assessment: Patient Engagement In Health Technology Assessment
Authors: Oehrlein Elisabeth , Harris Jason , Labkoff Nicole , Perfetto Eleanor , Ziadeh Manal , El-Gendi Sarah , Ghorashi Bahareh , Boutin Marc
Published: January 2018

INTRODUCTION:

Understanding the current landscape of patient engagement across value decision-making bodies internationally is a critical first step toward improving the patient centricity of Health Technology Assessment (HTA). This study assessed: (i) Terms and definitions used; (ii) Patient engagement opportunities; (iii) Evidence of patient engagement.

METHODS:

A sample of country-specific HTA's (HTA; n = 6), professional organizations (PO; n = 4), and collaborations/independent organizations (CO; n = 3) was selected for representativeness. Information was gathered through: (i) targeted web search and (ii) emailing organizations directly. Definitions, HTA methods documents, and the three most recent evaluations were identified, abstracted, and compared. Data were collected between September-October 2016.

RESULTS:

Numerous terms are used to describe patient engagement: patient input (HTA = 1, PO = 1), patient-group submitted information (HTA = 1), cooperation with patients/users (HTA = 1), public consultation (HTA = 1), patient perspectives (HTA = 1, PO = 1), involvement of people affected (HTA = 1), patient involvement (HTA = 2), patient and public involvement (HTA = 1), lay involvement (HTA = 1), inclusion of patient representative (PO = 3), patient reports (PO = 1), patient preference (PO = 2), public consultation (CO = 1), stakeholder consultation (CO = 1), open input (CO = 1), stakeholder engagement (CO = 1), and patient participation (CO = 1). Opportunities for patient engagement were described as: patient questionnaire (HTA = 2); comment period (HTA = 1; CO = 1); committee participation (HTA = 3; PO = 3); propose topics (HTA = 1); draft guidance (HTA = 1); general stakeholder forum (CO = 1). While organizations outline opportunities for patient engagement, not all organizations have clear evidence the practices are used or have impact. Recent evaluations demonstrate clear evidence of engagement (HTA = 2); Unclear or mixed evidence (HTA = 1; PO = 1; CO = 2); No evidence (HTA = 3; PO = 3; CO = 1).

CONCLUSIONS:

There is substantial heterogeneity in the terms used to describe patient engagement activities across organizations. While a variety of opportunities for patient engagement are described, lack of clear evidence to how patient engagement practices are consistently used may contribute to the perception that engagement by HTAs.
VP172 Clinical Effectiveness Of A Predictive Risk Model In Primary Care
Authors: Snooks Helen , Porter Alison , Kingston Mark , Watkins Alan , Hutchings Hayley , Whitman Shirley , Davies Jan , Evans Bridie , Bailey-Jones Kerry , Burge-Jones Deborah , Dale Jeremy , Fitzsimmons Deborah , Heaven Martin , Howson Helen , John Gareth , Lewis Leo , Philips Ceri , Sewell Bernadette , Williams Victoria , Russell Ian
Published: January 2018

INTRODUCTION:

New approaches are needed to safely reduce emergency admissions to hospital by targeting interventions effectively in primary care. A predictive risk stratification tool (PRISM) identifies each registered patient's risk of an emergency admission in the following year, allowing practitioners to identify and manage those at higher risk. We evaluated the introduction of PRISM in primary care in one area of the United Kingdom, assessing its impact on emergency admissions and other service use.

METHODS:

We conducted a randomized stepped wedge trial with cluster-defined control and intervention phases, and participant-level anonymized linked outcomes. PRISM was implemented in eleven primary care practice clusters (total thirty-two practices) over a year from March 2013. We analyzed routine linked data outcomes for 18 months.

RESULTS:

We included outcomes for 230,099 registered patients, assigned to ranked risk groups.

Overall, the rate of emergency admissions was higher in the intervention phase than in the control phase: adjusted difference in number of emergency admissions per participant per year at risk, delta = .011 (95 percent Confidence Interval, CI .010, .013). Patients in the intervention phase spent more days in hospital per year: adjusted delta = .029 (95 percent CI .026, .031). Both effects were consistent across risk groups.

Primary care activity increased in the intervention phase overall delta = .011 (95 percent CI .007, .014), except for the two highest risk groups which showed a decrease in the number of days with recorded activity.

CONCLUSIONS:

Introduction of a predictive risk model in primary care was associated with increased emergency episodes across the general practice population and at each risk level, in contrast to the intended purpose of the model. Future evaluation work could assess the impact of targeting of different services to patients across different levels of risk, rather than the current policy focus on those at highest risk.
VP173 Determinants Of Behavioral Health System Efficiency In Organisation For Economic Co-operation And Development (OECD) Countries
Authors: Cinaroglu Songul , Baser Onur
Published: January 2018

INTRODUCTION:

This study examined the technical efficiency determinants of each Organisation for Economic Co-operation and Development (OECD) country's behavioral health system (BHS).

METHODS:

The technical efficiency of each OECD country's BHS was analyzed through data envelopment analysis with model combinations ranging from 1–11 models, with each model constructed with different BHS input and output variable combinations. A decision tree was generated from the efficiency scores of the model with the highest mean technical efficiency score as a predictor variable. Data was obtained from 2013 OECD and Eurostat statistics.

RESULTS:

Different model combinations indicated that the model with the highest mean technical efficiency score (.9214) for OECD countries included (i) input variables for smoking, alcohol consumption, daily fruit consumption, the number of psychiatrists, the percentage of live births of young mothers first children, and the time devoted to leisure and personal care and (ii) output variables for death rate by mental and behavioral disorders, diabetes hospital admissions in adults, and suicide rates. Among all model combinations, >45 percent of OECD countries have an efficient BHS. The decision tree graph shows that daily fruit consumption, smoking, and suicide rates are predictor variables of the technical efficiency of an OECD country's BHS.

CONCLUSIONS:

The study results offer important insights regarding the development of BHS in OECD countries. Health policymakers must develop collaborative activities and implement comprehensive policies promoting internationally-oriented BHS in order to improve the health status of people worldwide and reduce health inequality.
VP184 A Cost Analysis Of Flash Glucose Monitoring Systems In Veneto Region
Authors: Curto Alessandro , Torbol Marika , Cavazzana Anna , Andretta Margherita , Scroccaro Giovanna
Published: January 2018

INTRODUCTION:

A novel, sensor-based, factory-calibrated Flash Monitoring System (FMS) has recently proved to be an effective alternative to conventional self-monitoring of blood glucose (SMBG) in patients affected by type 1 and type 2 diabetes. The 14-days adhesive sensor, that continuously measures glucose levels in the interstitial fluid, can transfer glucose levels data to a handheld reader or a smartphone equipped with a specific medical app. The uptake of the new technology has been limited so far, because of its high costs. A cost analysis has been conducted to identify the optimal target population of introducing FSM in Veneto.

METHODS:

The model was designed with a 1-year time horizon for patients with diabetes using intensive insulin in Veneto region. The costs of the new technology was estimated using inputs from the two main randomized controlled trials (the IMPACT study and the REPLACE study) published in the international literature, Regional evidence-based guidelines and administrative database. Resource utilization included strips, lancets, needles, sensors, distribution and patients training. Regional unit costs were adopted.

RESULTS:

FSM has not shown so far relevant and statically significant benefits in terms of severe adverse events’ reduction. Estimated yearly costs for a FSM user included glucose monitoring, technology training and distribution costs, for a total of EUR1277 per patient. The new technology has been shown to be affordable in diabetic patients with i) 4years<age<18years, ii) continuous subcutaneous insulin infusion and iii) ≥5 blood glucose monitoring per day.

CONCLUSIONS:

The Veneto Region should carefully consider prescribing extension to other diabetic patients categories, since the high cost of the new technology. A strict prescribing monitoring is strongly recommended with the aim of ensuring appropriateness and avoiding overspending.
VP189 Hemolysis Induced By Modern Infusion Pumps During Blood Transfusion
Authors: Poder Thomas , Boileau Jean-Christian , Lafrenière Renée , Thibault Louis , Carrier Nathalie , De Grandmont Marie-Joëlle , Beauregard Patrice
Published: January 2018

INTRODUCTION:

Following a first field evaluation conducted in 2013, we found that hemolysis can be induced by infusion pumps during blood transfusion. Actually, limited data is available on the risk of hemolysis associated with the most used infusion pumps in Quebec hospitals: InfusomatSpace (peristaltic), Plum A+TM (piston) and ColleagueCXE (shuttle).

METHODS:

Staff from the blood bank and the Health Technology Assessment (HTA) unit in our hospital collaborated in 2016 to assess the hemolysis and potassium level (that is, a blood test sensitive to hemolysis) induced by the use of the three infusion pumps mentioned above. Measurements were taken for each pump at five flow rates, from 30 to 450 ml/hour, and were compared with measurements taken before using the pumps. Tests were conducted with 135 red blood cell (RBC) units. RBC units were aged from 10 to 28 days.

RESULTS:

The shuttle- and piston-type pumps resulted in low hemolysis levels. The peristaltic-type pump produced significantly more hemolysis. However, the absolute value of hemolysis remained within the range recommended by the regulatory agencies in North America and Europe. Potassium levels did not increase with the use of the pumps.

CONCLUSIONS:

The collaboration between the blood bank and the HTA unit led to the conclusion that modern infusion pumps widely used in Quebec hospitals produce non-threatening levels of hemolysis during blood transfusion. This finding is important to ensure safe practices.
Recurrent hypoglycaemia in a toddler on β-blocker therapy
Authors: Pépin Véronique , Gagné Nancy , Rottembourg Diane
Published: January 2018

Hypoglycaemia is a well-known side effect of Propranolol. We described the case of a child presenting severe and recurrent Propranolol-induced hypoglycaemia. Those episodes were not related to prolonged fasting and were associated with only mild ketosis. Thus, therapy with β blockers may not only aggravate classical ketotic hypoglycaemia but also interfere with glucose metabolism.
Assessing an Undergraduate Curriculum: The Evolving Roles of Subfields, Methods, Ethics, and Writing for Government Majors
Authors: Szarejko Andrew A. , Carnes Matthew E.
Published: January 2018

To determine whether our undergraduate curriculum fulfills the pedagogical goals of our department, the authors conducted a semester-long curriculum assessment. This article discusses five main lessons and three lingering questions to demonstrate potential benefits of curriculum assessment and to prompt further disciplinary conversation about how undergraduate teaching should be structured. The overarching lesson, however, is that although student needs may be quite diverse, an emphasis on core aspects of the program can yield better training for all undergraduates.
An Honest Conversation: An In-Class Tool to Help Pre-Law Students Determine Their Compatibility with Law School and a Legal Career
Authors: Gollob Justin
Published: January 2018

At a time when a single semester of law school can be a significant financial investment, the decision to attend law school should not be made casually. Instead, decisions should be influenced by data, reflection, and an understanding of real-world outcomes. In this article, I present The Legal Career Compatibility Project; a tool to help students make an informed decision about pursuing a career in law. Using Bolles (2003), Phases 1 and 2 help prospective law students determine whether they should pursue a legal career. Phase 3 helps students determine where and how to apply to law school. Considering that the odds of gaining admission to law school are high, conversations about whether one should attend law school are equally, if not more, important than conversations about how to gain admission. The purpose of the project is to influence how decisions to attend law school are made, not to encourage or discourage students from a career in law.
Assessing the information and support needs of radical prostate cancer patients and acceptability of a group-based treatment review: a questionnaire and qualitative interview study
Authors: Chauhan Munisha , Holch Patricia , Holborn Catherine
Published: January 2018

Aims

Current literature suggests the information and support needs of oncology patients undergoing radical radiotherapy to the prostate often remain unmet and can impact quality of life. We aimed to explore the effectiveness of delivery and opportunities for service improvement, including a group-based treatment review.

Methods

A total of 60 prostate patients completing radical radiotherapy (mean age 70, range 47–79) in a UK cancer-centre completed a self-designed questionnaire assessing information and support. To explore views on a group-based treatment review, 11% took part in a semi-structured interview. Descriptive data were computed and interviews transcribed and analysed thematically.

Results

In all, 87% were satisfied with information and support when delivered by radiographers. However, 26% were only ‘sometimes’ able to complete bladder-filling, suggesting information regarding treatment delays would improve this. In total, 49% preferred both Doctor and Urology nurse reviews whereas 26% preferred nurse only; 70% stated their ‘concerns were always addressed’ by a nurse and 49% by a Doctor. Interviews revealed that a group review was generally acceptable with peer support an influencing factor.

Findings

Overall patients felt their needs were being met. Suggestions for improvement (more information on preparation, side effects and delays) will be implemented locally. Future work will explore the feasibility of group reviews in patients undergoing radical radiotherapy to the prostate.
Adults’ Sex Difference in a Dynamic Mental Rotation Task
Authors: Heil Martin , Krüger Markus , Krist Horst , Johnson Scott P. , Moore David S.
Published: January 2018

Abstract. With the Mental Rotation Test (MRT), large and reliable sex differences are found. Used with children younger than about 9 or 10 years, MRT performance is at chance level. Simpler tasks used with younger children have revealed inconclusive results. Moore and Johnson (2008 , 2011 ) observed sex differences in infants using a habituation task with 3D cube figures rotating back and forth in depth through a 240° angle. Thereafter, female infants treated similarly the original figure and a mirror-image cube figure presented revolving through the previously unseen 120° angle, whereas male infants behaved as if they recognized the familiar object. In the present study, 256 adults participated in the MRT as well as in a modified two-alternative forced-choice dynamic version of the infants’ task. Sex differences were present for both tasks. More importantly, there was a positive correlation in performance across both tasks for both women and men. Since the new task turned out to be simpler, it might be suitable also for children. We present the first, although indirect, evidence that the sex effects reported by Moore and Johnson might indeed reflect early sex differences in mental rotation.
Publisher Correction: Acoustic allometry revisited: morphological determinants of fundamental frequency in primate vocal production
Authors: Garcia Maxime , Herbst Christian T. , Bowling Daniel L. , Dunn Jacob C. , Fitch W. Tecumseh
Published: January 2018

A correction to this article has been published and is linked from the HTML version of this paper. The error has not been fixed in the paper.
Preoperative anemia in colorectal cancer: relationships with tumor characteristics, systemic inflammation, and survival
Authors: Väyrynen Juha P. , Tuomisto Anne , Väyrynen Sara A. , Klintrup Kai , Karhu Toni , Mäkelä Jyrki , Herzig Karl-Heinz , Karttunen Tuomo J. , Mäkinen Markus J.
Published: January 2018

Anemia is common in colorectal cancer (CRC) but its relationships with tumor characteristics, systemic inflammation, and survival have not been well characterized. In this study, blood hemoglobin levels and erythrocyte mean corpuscular volume (MCV) levels were measured in two independent cohorts of 148 CRC patients and 208 CRC patients, and their correlation with patient and tumor characteristics, systemic inflammatory markers (modified Glasgow Prognostic Score: mGPS; serum levels of thirteen cytokines, C-reactive protein, albumin), and survival were analyzed. We found that anemia, most frequently normocytic, followed by microcytic, was present in 43% of the patients. Microcytic anemia was most commonly associated with proximal colon tumor location. Average MCV and blood hemoglobin levels were lower in tumors with high T-class. Low blood hemoglobin associated with systemic inflammation, including high mGPS and high serum levels of C-reactive protein and IL-8. Particularly, normocytic anemia associated with higher mGPS. Normocytic anemia associated with a tendency towards worse overall survival (multivariate hazard ratio 1.61, 95% confidence interval 1.07–2.42, p = 0.023; borderline statistical significance considering multiple hypothesis testing). In conclusion, anemia in CRC patients is most frequently normocytic. Proximal tumor location is associated with predominantly microcytic anemia and systemic inflammation is associated with normocytic anemia.
Publisher Correction: Trapping and manipulation of nanoparticles using multifocal optical vortex metalens
Authors: Ma Yanbao , Rui Guanghao , Gu Bing , Cui Yiping
Published: January 2018

A correction to this article has been published and is linked from the HTML version of this paper. The error has been fixed in the paper.
3D printed high density, reversible, chip-to-chip microfluidic interconnects
Authors: Gong Hua , Woolley Adam T. , Nordin Gregory P.
Published: January 2018

We develop a new high-density, reversible, chip-to-chip interconnection method for hundreds of interconnects that is 3D printed as part of the connecting chips.
DNA methylation assay using droplet-based DNA melting curve analysis
Authors: Liu F.-W. , Liao H.-F. , Lin S.-P. , Lu Y.-W.
Published: January 2018

A novel platform, combining droplet microfluidics and melting curve analysis, was developed to detect and to quantify the methylation status in a specific genomic region.
Self-assembly of bis-salphen compounds: from semiflexible chains to webs of nanorings
Authors: Pyrlin Sergey V. , Hine Nicholas D. M. , Kleij Arjan W. , Ramos Marta M. D.
Published: January 2018

A mechanism is proposed explaining self-assembly of webs of interconnected microrings of bis-salphen compounds based on molecular level simulations of their structure and aggregation in solvent.
Massive MIMO antenna selection algorithms based on iterative swapping
Authors: Tang Hua , Nie Zaiping
Published: January 2018

Based on capacity maximisation metric, an iterative swapping antenna selection method is proposed for massive multiple‐input multiple‐output (MIMO). Then a ‘local’ swapping algorithm is proposed for massive MIMO antenna selection, which swaps the target antennas ‘locally’. A ‘global’ swapping algorithm is also proposed to reduce the computational complexity, which exchanges the target antennas ‘globally’. Both of the proposed algorithms are near optimal, due to the consideration of the influences of the unselected antennas and the selected ones on the antenna to be selected. Last, numerical simulations are provided to validate the proposed algorithms.
Calibration and validation of cellular automaton traffic flow model with empirical and experimental data
Authors: Jin Cheng‐Jie , Knoop Victor L. , Jiang Rui , Wang Wei , Wang Hao
Published: January 2018

For traffic flow models, calibration and validation are essential. Cellular automaton (CA) models are a special class of models, describing the movement of vehicles in discretised space and time. However, the previous work on calibration and validation does not discuss CA models systematically. This study calibrates and validates a stochastic CA model. The authors use a simple CA model, which only has two important parameters to be calibrated. The methodology for optimisation is to minimise the relative root mean square error between two properties: the averaged velocity and the variation of velocities in a platoon at a given density. Three different sites are used as cases to show the methodology, for which different types of data (video trajectories or GPS data) are available. The authors find that the best model parameters vary for the different locations. This may result from various driving strategies and potential tendencies. Thus, it is concluded that for CA models, various traffic flow phenomena need to be simulated by various parameters.
On the codimension of the abnormal set in step two Carnot groups
Authors: Ottazzi Alessandro , Vittone Davide
Published: January 2018

In this article we prove that the codimension of the abnormal set of the endpoint map for certain classes of Carnot groups of step 2 is at least three. Our result applies to all step 2 Carnot groups of dimension up to 7 and is a generalisation of a previous analogous result for step 2 free nilpotent groups.
Duality results and regularization schemes for Prandtl–Reuss perfect plasticity
Authors: Hintermüller M. , Rösel S.
Published: January 2018

We consider the time-discretized problem of the quasi-static evolution problem in perfect plasticity posed in a non-reflexive Banach space. Based on a novel equivalent reformulation in a reflexive Banach space, the primal problem is characterized as a Fenchel dual problem of the classical incremental stress problem. This allows to obtain necessary and sufficient optimality conditions for the time-discrete problems of perfect plasticity. Furthermore, the consistency of a primal-dual stabilization scheme is proven. As a consequence, not only stresses, but also displacements and strains are shown to converge to a solution of the original problem in a suitable topology. The corresponding dual problem has a simpler structure and turns out to be well-suited for numerical purposes. For the resulting subproblems an efficient algorithmic approach in the infinite-dimensional setting based on the semismooth Newton method is proposed.
Avaliação prognóstica dos aneurismas intracranianos por estudo do grau clínico, tomografia computadorizada e angiografia cerebral
Authors: Gallo Pasquale , Bonatelli Antonio de Pádua
Published: January 2018

Embora sejam inúmeras as publicações sobre o prognóstico dos aneurismas intracranianos utilizando uma metodologia cada vez mais sofisticada, este trabalho tende a demonstrar que os parâmetros mais elementares são os mais confiáveis para o prognóstico.

Com a finalidade de compreender e quantificar esse prognóstico, foram estudados prospectivamente 100 pacientes com hemorragia subaracnóidea provocada por aneurismas intracranianos, confirmado por diversos métodos diagnósticos no Serviço de Neurocirurgia do Hospital Cristo Redentor, em Porto Alegre, entre outubro de 1992 e outubro de 1995. Todos os pacientes foram classificados pelo grau clínico à internação, pela presença ou pela ausência de sangue na tomografia computadorizada e pela presença ou pela ausência de vasoespasmo angiográfico. Os exames foram realizados tão precocemente quanto possível, de acordo com o estado clínico do paciente. A cirurgia foi realizada assim que as condições clínicas permitiram. Os pacientes foram seguidos pelo período de seis meses e os resultados correlacionados aos diversos fatores que foram analisados.

Foi possível constatar que a correta observação do grau clínico, da tomografia computadorizada e da angiografia cerebral, tanto isoladamente quanto em conjunto, nos forneceu uma quantidade expressiva de informações, capaz de nos indicar o prognóstico do resultado pós-operatório de forma bastante confiável.
Meningioma papilar: Relato de caso
Authors: Picarelli Helder , Lopes Lisandro Ferreira , Bacchi Carlos E.
Published: January 2018

Relatamos o caso de um homem de 49 anos, com episódio convulsivo único, portador de um tumor na convexidade parietal direita, implantado na dura-máter, que foi submetido a tratamento cirúrgico com remoção radical da lesão. O exame anatomopatológico foi compatível com meningioma papilar e o tratamento foi complementado com radioterapia externa. Após cinco anos, o paciente apresenta-se assintomático, sem sinais de recidiva local ou a distância.

Na tomografia computadorizada do crânio, a lesão levemente hiperdensa, sem calcificações e com pequeno edema vasogênico, apresentava realce heterogêneo após injeção do contraste iodado. Como na maioria dos meningiomas, na ressonância magnética do encéfalo, o tumor isointenso em T1 aumentava a intensidade do sinal em T2 e após a injeção do contraste paramagnético. No caso descrito, esses achados permitiram diagnóstico da extensão e localização da lesão, entretanto não foram úteis para prever o possível comportamento biológico e subtipo do tumor, embora alguns trabalhos sugiram essa possibilidade.

A identificação no exame anatomopatológico de hipercelularidade, arranjo papilar ao redor dos vasos (pseudo-rosetas perivasculares), perda da arquitetura celular, aumento do número de mitoses e pleomorfismo nuclear com nucléolo proeminente permitiu o diagnóstico de meningioma papilar e orientou o tratamento definitivo. O caso descrito ilustra aspectos clínicos, radiológicos e histopatológicos desse tipo raro de meningioma maligno.