bluuebunny/crossref_metadata_2025 huggingface dataset:
PD188 Step-By-Step Introduction Of Hospital-Based Health Technology Assessment In Ukraine
Authors: Filiniuk Olena , Siromaha Serhii , Dorohina Anna , Leskiv Bohdan , Yarynych Kostiantyn , Kosyachenko Kostiantyn , Babenko Mykhailo , Sucu Rabia
Published: January 2025

Introduction

Health technology assessment (HTA) became mandatory in Ukraine in 2020 for public coverage of new medicines. This review outlines the steps Ukraine took to introduce HTA at the hospital level through hospital-based HTA (HB-HTA). HB-HTA is a globally recognized, science-based tool that helps hospital stakeholders answer questions on the safety, efficacy, and cost effectiveness of health technologies they are planning to introduce.

Methods

The authors examined the steps taken to introduce and implement HB-HTA in Ukraine, the impacts reached thus far, and the implications for further national scale-up. Key steps associated with the intervention included the following: awareness raising activities in HB-HTA; structured stakeholder engagement; review of global HB-HTA tools and their adaptation to the local context; training for key hospital staff; piloting tools in a select hospital; and review of the pilot experience to inform future application.

Results

Starting from 2021, HB-HTA was introduced through awareness raising activities. The regulatory framework for introducing health technologies into hospitals was analyzed, outlining the need for updated regulations. Review of global HB-HTA tools revealed that tools developed by the Adopting Hospital Based Health Technology Assessment in European Union project were the most applicable for Ukraine and were subsequently adapted to the country’s context by an expert panel of 13 hospital stakeholders. Following this, Safe, Affordable, and Effective Medicines for Ukrainians (SAFEMed) organized HB-HTA training for key hospital stakeholders. The Amosov National Institute of Cardiovascular Surgery was chosen for the pilot due to its high level of operational activity. The results of the pilot are expected soon.

Conclusions

Introducing globally recognized HB-HTA tools and piloting them in a real-world setting provides basic concepts to the HTA experts who will be involved in scaling up HB-HTA in Ukraine. Initial recommendations point to the need to scale-up HB-HTA slowly, first working with one hospital to gain HB-HTA experience that will inform further application across the country.
PD190 The Brazilian Health Technology Assessment Network Strategy: Capacity Building And Its Importance For The Sustainability Of The Public Health System
Authors: Ottavio Barbara Pozzi , Freitas Marcela , Barbosa Lais , D’agostini Maria Stella , Nóbrega Rafaella , Vidal Ávila , Bonan Luciene
Published: January 2025

Introduction

The Brazilian Health Technology Assessment (HTA) Network (REBRATS) dates to 2008, when the Ministry of Health (MoH) launched a call to register Brazil’s first HTA groups to promote and disseminate HTA in the country. To understand whether this strategy is succeeding, this paper evaluated the actions of REBRATS and the degree of advancement of the HTA field in Brazil.

Methods

The following data on the composition of REBRATS were collected and analyzed: the number of HTA groups and professionals registered in the network, the number of professionals that have benefited from qualifying courses, and the evolution of the Brazilian National Committee for Health Technology Incorporation (CONITEC).

Results

REBRATS expanded from 24 HTA groups to 112 groups in 2023, which includes over 800 professionals. From 2019 to 2023, the MoH financed over 90 courses, which have benefited more than 1,000 professionals. More HTA groups (from five to 23) have been hired to support CONITEC, enabling it to respond to a higher demand and more complex topics. These groups have been contributing to the development of HTA by assisting the MoH in defining a cost-effectiveness threshold; evolving the assessment of medical devices and new technologies (i.e., gene and targeted therapies); and creating methodological guideline–there will be 21 by 2024.

Conclusions

Although the composition and technical capability of its member groups vary greatly, REBRATS has consolidated itself as a key strategy to support decision-making regarding technologies.
PD196 The Importance Of Promoting The Culture Of Health Technology Assessment Among Healthcare Professionals
Authors: Llinàs-Mallol Laura , Mestre-Lleixà Berta , Vivanco-Hidalgo Rosa Maria
Published: January 2025

Introduction

Last year we developed a survey focused on decision-making in health innovation within the health system of Catalonia. Evaluation of the survey results, coupled with the relationships we established with various members of the Catalan health ecosystem, has highlighted the need for informative activities on health technology assessment (HTA) that aim to bring HTA closer to healthcare professionals.

Methods

We designed a two-hour training workshop divided into three thematic blocks and a group dynamic. The first block addressed HTA and the lifecycle of a health technology. The second and third blocks delved into the development of an HTA report, the role of healthcare professionals, and the formulation of a research question. During the workshops, we showcased a video and an infographic and distributed promotional bags to the attendees. A satisfaction survey was distributed at the conclusion of the workshop. We have conducted three editions of the workshop in a face-to-face format and one in a virtual format.

Results

Of the 56 people who participated in the workshops, 48 responded to the satisfaction survey. The most frequent participants were directors, care coordinators, and health managers. The attendees rated the workshops with 4.6 out of five points. About 66.7 percent of attendees indicated that the workshop had met their training needs. Most attendees (79.2%) considered that the workshop had provided knowledge that they could apply to their daily tasks. Finally, when asked about topics of interest for future workshops, the participants voted for advanced HTA methodology, the development of HTA in healthcare centers, and the evaluation of digital health.

Conclusions

The feedback from participants across all the workshops was very positive. The degree of satisfaction among attendees was high, with the main area for improvement being the need to develop new workshops to delve deeper into HTA. In 2024, we aim to design a training program consisting of HTA workshops that fulfil the requests of the attendees.
PD207 Modelling Co-Financing Scenarios To Address The Financial Challenges Of Implementing A Colorectal Cancer Screening Program For Private Insurance Beneficiaries
Authors: Muñoz-Montecinos Carlos , Quirland Camila , Maza Felipe , Barrientos Carlos , González-Browne Catalina
Published: January 2025

Introduction

The World Health Organization (WHO) recommends population-based cancer screening programs for colorectal cancer (CRC). However, CRC screening is not available in Chile´s public health system. The Arturo Lopez Perez Foundation (FALP) is interested in implementing a CRC screening program for their insurance beneficiaries, despite some uncertainties regarding cost effectiveness and budget impact. Exploring co-financing scenarios could reveal feasible choices for program implementation.

Methods

A Markov model was developed to assess the cost effectiveness of a biennial fecal immunochemical test (FIT) strategy for individuals aged 50 to 69 years from a private insurer perspective. Survival probabilities and average costs for each cancer stage at diagnosis were derived from our CRC patients. Benefits were measured as life-years gained. The budget impact was calculated using the expected population of beneficiaries for 20 years. Cost-effectiveness results were reported using the incremental cost-effectiveness ratio (ICER), with a referential threshold of one to three times the gross domestic product per capita (USD16,000 to USD48,000). Shared funding scenarios with national public insurers and out-of-pocket payments were simulated.

Results

CRC screening was cost effective in the base case and shared funding scenarios. Indeed, it showed some benefits and savings in the latter scenario. On the other hand, budget impact values were unaffordable for the base case scenario, revealing that implementing the program would be difficult even with the promising ICER. However, in shared funding scenarios, the budget impact decreased and even showed savings after five years due to the decrease in cancer treatment costs.

Conclusions

CRC screening with a biennial FIT is a cost-effective strategy for FALP beneficiaries, but the budget impact is substantial and poses challenges for its implementation. The use of shared funding strategies could help alleviate the budget impact, making the implementation of a screening program more feasible.
PD213 An Unmet Health-Related Needs Evidence Database For Informing Policy And Innovation Decisions In Health Care
Authors: Cleemput Irina , Levy Muriel , Schönborn Claudia , De Jaeger Mats , Kohn Laurence , Claerman Rani , De Pauw Robby , de Noordhout Charline Maertens
Published: January 2025

Introduction

As there is no standard definition of unmet patient or societal needs, the Needs Examination, Evaluation, Dissemination (NEED) project defined criteria for assessing these needs. This study describes the creation of an exploitable evidence database on unmet health-related patient and societal needs for various health conditions, and how this can be used in decision-making.

Methods

The NEED framework defines explicit dimensions (patient, societal, and future needs), domains (health, healthcare, and social needs), and criteria, along with specific measurable indicators, to identify unmet health-related patient and societal needs for various health conditions. For each indicator, information sources were sought, including both quantitative and qualitative evidence. For some indicators, guidance on evidence generation was developed. Possible uses of the NEED database were discussed with national and international panels of experts, stakeholders, and decision-makers.

Results

Data sources were identified for some but not all patient and societal needs criteria. They included existing databases (e.g., the Global Burden of Disease database and administrative databases), literature, and primary data collection. A standardized methodology was defined for primary data collection (quantitative and qualitative). The NEED evidence database can be used by researchers, research funders, regulators, health technology assessment agencies, policymakers, patients, healthcare providers, etcetera for prioritizing areas of research as well as—thanks to the level of detail provided in the database—to assess the extent to which proposed “solutions” meet the most pressing unmet needs of patients or society.

Conclusions

Once operational, an unmet patient and societal needs evidence database, anchored to an explicit framework, can serve different stakeholders and decision-makers for various purposes. It collects evidence on unmet health-related patient and societal needs for various health conditions, given the current standard of care, independent of any new product or service, and therefore supports a needs-driven healthcare innovation and policy system.
PD214 Appraisal Of Reimbursement Thresholds For Medicines In Brazil’s Private Health System
Authors: Borin Marcus Carvalho , Martins Carina Rejane , dos Reis Daniel Pitchon , Coelho Ribeiro Geraldo Jose , Tupinambas Julia Teixeira , de Castro Zocrato Karina , de Almeida Carvalho Lelia Maria , de Freitas Marcela Pinto , da Gloria Cruvinel Horta Maria , Barbosa Mariana Michel , Torres Talim Mariza Cristina , Loureiro Bersan Sergio Adriano , Bruschi Kelles Silvana Marcia
Published: January 2025

Introduction

Brazil’s public health system serves most of the population, but 25 percent of citizens rely on private health insurance. The National Regulatory Agency for Private Health Insurance and Plans (ANS) regulates private medicine reimbursements, which diverge from the public sector threshold. In 2022, the National Committee for Health Technology Incorporation (CONITEC) set a willingness-to-pay benchmark of BRL40,000 (USD8,215) per quality-adjusted life-year. The ANS has no such benchmark, highlighting a pivotal gap in economic evaluations for private health care.

Methods

This quantitative study investigated the Incremental cost-effectiveness ratios (ICER) for reimbursed medicines in Brazil’s private health sector, comparing them with CONITEC’s benchmarks and international thresholds. Data were extracted from industry reimbursement submissions to the ANS and analyzed for statistical disparity and policy implications.

Results

Preliminary findings found an ICER peak of BRL619,900 (USD127,220) per quality-adjusted life-year for talazoparib, which is used to treat certain advanced breast cancers. This contrasted sharply with CONITEC’s established threshold, indicating a critical need to evaluate ANS policies.

Conclusions

Early results indicate that the ICERs for some medicines surpass CONITEC’s willingness-to-pay limit, suggesting that the ANS should consider establishing a defined cost-effectiveness threshold. This is imperative to harmonize with global standards and maintain sustainable health financing.
PD220 Clinical Expert Opinion To Inform Health Technology Assessment In Ireland
Authors: O’Callaghan Joan , Tilson Lesley , Fogarty Emer , McCullagh Laura
Published: January 2025

Introduction

The National Centre for Pharmacoeconomics (NCPE) in Ireland conducts health technology assessments (HTAs) of drugs under consideration by the decision-maker for reimbursement. We analyzed how clinical expert opinion obtained by applicant pharmaceutical companies is used to inform HTA submissions made to the NCPE. We also describe how clinical opinion obtained by the NCPE is used to inform NCPE assessments.

Methods

We conducted a retrospective review of HTA submissions made to the NCPE from July 2019 to June 2020 inclusive. Data were extracted using a bespoke data collection instrument created in Microsoft Excel. To describe how clinical opinion informed the NCPE assessments, we extracted data from NCPE HTA Technical Summary Reports available on the NCPE website.

Results

A total of 18 HTA submissions were reviewed. Clinical expert opinion was used by applicants to support all submissions. The median number of clinical experts who informed each individual HTA submission was seven (range 1 to 33); the majority were hospital physicians. Clinical opinion was used to inform HTA domains, including patient and population estimates (n=14; 78%), use of drugs in clinical practice (n=13; 78%), treatment effectiveness (n=6; 33%), healthcare resource use (n=14; 78%), and health-related quality of life (n=5; 28%). We present examples where clinical opinion, obtained by the NCPE, was used to inform NCPE assessments.

Conclusions

Clinical expert opinion informed all 18 applicant HTA submissions made to the NCPE during the study period. The NCPE also seeks clinical expert opinion to inform their assessments. Healthcare professionals make an important contribution to HTA and, thus, inform the decision-making processes on drug reimbursement in Ireland.
PD221 Health Regulation And Health Technology Assessment: Brazilian Experience In Developing Actions For Health Regulation
Authors: Silva Elias Flávia Tavares , Camargo Erika Barcosa , de Oliveira Margarete Martins , Ramos Maíra Catharina , da Silva Erica Tatiane
Published: January 2025

Introduction

In 2017, the Brazilian Health Regulatory Agency (Anvisa) and the Oswaldo Cruz Foundation (Fiocruz) in Brazil entered into a collaboration that enabled the production of evidence and dissemination of technical scientific information in the regulatory field, with aim of supporting the decision-making process on regulatory issues.

Methods

This qualitative and descriptive study was designed to report on the technical cooperation between Anvisa and Fiocruz in Brazil during from 2017 to 2020.

Results

The studies developed by the Decentralized Execution Term assisted in the formulation of health policies at the macro, meso, and micro political levels, supporting the strengthening of institutional regulatory policy. The medicines agenda was the most recurrent in cooperation outputs, followed by the food and smoking agendas. The postmarket surveillance agenda played a leading role in actions carried out with the updating of the Technovigilance Manual and the creation of pharmacovigilance bulletins, both of which were available to health professionals and citizens. Finally, 27 courses were offered, and 1,276 certificates were issued (606 to workers linked to health regulation).

Conclusions

The Brazilian experience enabled to capacity building and critical analysis of evidence in regulatory scope. It has facilitated the preparation of productions that align with the regulatory agenda. Health technology assessment and health regulation need to converge in monitoring processes to reduce uncertainties and increase user safety.
PD227 Qualitative Assessment Of The Value Of The Magnetic Resonance Linear Accelerator To Guide Decisions On Its Optimal Use
Authors: Ulehake Marike , Brunenberg Ellen , Tummers Marcia , Verheij Marcel , Grutters Janneke
Published: January 2025

Introduction

The added value of medical technology is typically assessed in specific patient groups, which is less useful to guide decisions on optimal use. The magnetic resonance linear accelerator (MR-Linac) is a costly innovation that can enhance radiotherapy precision through daily imaging and plan adaptation. This study aimed to better understand its potential value and inform users on its optimal application.

Methods

Semi-structured interviews (n=24) were conducted with stakeholders, ranging from end users (radiation oncologist, clinical physicists, radiotherapy technologists, managers) to patient representatives and policy officers (e.g., procurement, health insurance, health technology assessment agency, and regulatory body). Themes explored with end users focused on the decision-making process of acquisition, current use, potential future deployment, optimal use, and the added value of MR-Linac. Themes explored with policymakers and patient representatives included their roles concerning costly medical technologies and their perspectives on the added value of the MR-Linac. Interview data were analyzed using thematic analysis.

Results

Preliminary results showed stakeholders’ optimism for improved patient outcomes, including reduced toxicity and increased treatment efficacy. Patient representatives highlighted not only the clinical value, but also the importance of ensuring patients’ access to innovative care. End users perceived the MR-Linac as a gradual improvement, placing trust in its theoretical benefits. Additionally, they found value in its contribution to providing innovative treatment, potentially benefiting hospitals by attracting new patients. They also experienced improved job satisfaction. Policy officers emphasized the need for evidence to support potential clinical advantages as well as the significant costs associated with the MR-Linac within the broader healthcare context.

Conclusions

This qualitative, technology focused study deepens our understanding of the potential added value of the MR-Linac, beyond a specific context or patient group. The results not only highlight potential patient benefits, but also show a broader significance of the MR-Linac at other levels (e.g., clinician, hospital, and society). It is important to consider these different levels when guiding decisions on use of the MR-Linac.
PD238 Evolution Of The Consumer Evidence And Engagement Unit And Contribution To Consumer Input In Australian Health Technology Assessment Processes
Authors: Watson Jo , Trowman Rebecca
Published: January 2025

Introduction

Various committees provide health technology assessment (HTA) recommendations to the Australian government on health technology subsidization. All committees include consumer members, but operations vary across committees. To support the committee’s consumer members and facilitate consumer input, the Consumer Evidence and Engagement Unit (CEEU) was launched in 2019. The CEEU aims to enhance inclusion of consumer input in Commonwealth HTA processes.

Methods

The CEEU operates within the Australian Government Department of Health and Aged Care in a hybrid format. The core functions of the CEEU include secretariat support for the HTA Consumer Consultative Committee (CCC), which comprises consumer members from all HTA committees. The CEEU also summarizes consumer input for the HTA committees. In 2022, the CEEU launched the Conversations for Change series, which was developed through a range of different consultation activities. As a result, an ongoing “Changing Conversations” mandate is in place, to build and sustain relational, non-transactional partnerships in a true collaborative style.

Results

The HTA committees and subcommittees operate across cycles with overlapping timelines, requiring consumer input to be gathered at different timepoints for different purposes. The CEEU has launched materials, including the Consultation Hub and HTA Engage, and is developing a Consultation Toolkit to raise awareness and facilitate these processes. The role of the HTA CCC is evolving as a forum to enable consumer committee members to share experiences and receive CEEU support. Improvements in consultation processes have enabled the CEEU to provide consumer comments to consumer committee members to facilitate genuine representation of consumer and other external stakeholder views.

Conclusions

Managing consumer input can be resource intensive, however there is increasing recognition of the importance of consumer engagement in Australian HTA. The CEEU expects continued growth and a wider remit from 2024, as new processes and changes occur. Additional materials are planned to support consumer committee members and to build capacity among consumers and consumer organizations.
Embarrassment in English language classrooms
Authors: Khajavy Gholam Hassan , Smid Dávid , Mercer Sarah , Murillo-Miranda Carlos
Published: January 2025

This study is designed to understand embarrassment in the second/foreign language (L2) context. Following a mixed-method design, in Phase 1, a sample of 141 tertiary-level Austrian English language learners were asked to write a narrative about their experiences of embarrassment in their language learning histories. Analyzing the narratives showed that L2 embarrassment is a multidimensional construct that is frequently experienced by a range of language learners. In Phase 2, we developed and validated an L2 classroom speaking embarrassment (L2CSE) scale among a sample of 402 international English language learners drawing on the literature and analysis of the narratives. Data showed that L2 embarrassment is best represented by a bifactor exploratory structural equation model, capturing both general and specific aspects of L2 embarrassment. We found that a supportive classroom environment and fostering a growth mindset can decrease the risk of L2 embarrassment. As expected, L2 embarrassment was a negative predictor of willingness to communicate and self-perceived language proficiency. These initial findings suggest that L2 embarrassment could be an important and influential emotion in the language learning classroom context which requires further research.
The 2023 fatal dengue outbreak in Bangladesh highlights a paradigm shift of geographical distribution of cases
Authors: Hasan Mohammad Nayeem , Rahman Mahbubur , Uddin Meraj , Ashrafi Shah Ali Akbar , Rahman Kazi Mizanur , Paul Kishor Kumar , Sarker Mohammad Ferdous Rahman , Haque Farhana , Sharma Avinash , Papakonstantinou Danai , Paudyal Priyamvada , Asaduzzaman Md , Zumla Alimuddin , Haider Najmul
Published: January 2025

In 2023, Bangladesh experienced its largest and deadliest outbreak of the Dengue virus (DENV), reporting the highest-ever recorded annual cases and deaths. Historically, most of the cases were recorded in the capital city, Dhaka. We aimed to characterize the geographical transmission of DENV in Bangladesh. From 1 January–31 December 2023, we extracted and analyzed daily data on dengue cases and deaths from the Management Information System of the Ministry of Health and Family Welfare. We performed a generalized linear mixed model to identify the associations between division-wise daily dengue counts and various geographical and meteorological covariates. The number of dengue cases reported in 2023 was 1.3 times higher than the total number recorded in the past 23 years (321,179 vs. 244,246), with twice as many deaths than the total fatalities recorded over the past 23 years (1705 vs. 849). Of the 1,705 deaths in 2023, 67.4% (n = 1,015) died within one day after hospital admission. The divisions southern to Dhaka had a higher dengue incidence/1000 population (2.30 vs. 0.50, p <0.01) than the northern divisions. Festival-related travel along with meteorological factors and urbanization are likely to have contributed to the shift of dengue from Dhaka to different districts in Bangladesh.
Unique duck rearing practice in irrigated rice paddy fields driving recurrent H5N1 avian influenza outbreaks in two districts of Kerala, India
Authors: Chanda Mohammed Mudassar , Shivachandra Sathish Bhadravati , Mishra Adhiraj , Punnoose Previn , Panikkassery Shaji , Potti Sanjay Devarajan , Mohan Vysakh , Prajapati Awadhesh , Yogisharadhya Revanaiah , Hemadri Divakar , Gulati Baldev Raj , Tosh Chakradhar
Published: January 2025

Highly pathogenic avian influenza (HPAI) outbreaks have repeatedly occurred in two districts of Kerala state, India, over the last few years. The outbreaks in the wetland areas coincided with the arrival of migratory birds. At the time, the factors responsible for local transmission in ducks were not known. This study aimed to identify the socio-economic factors responsible for spatial variation in the occurrence of HPAI outbreaks in the two districts using Bayesian network modelling (BNM) and Stochastic Partial Differential Equation (SPDE) model. Further, information was collected on the duck rearing practices in rice paddy fields to identify the risk factors for local – spread of the outbreaks. We found that the SPDE model without covariates explained variation in occurrence of outbreaks. The number of rice paddy fields used by the duck farmers was identified as risk factor. We concluded based on BNM and SPDE that the infected migratory birds were the source of infection for the first few duck farms in the wetland areas and subsequent transmission was driven by shifting of ducks from one rice paddy field to other fields. There is a probability of persistent and recurrent infections in the ducks and possible spill over to humans. Hence, it is important to have surveillance in ducks to prevent recurrent outbreaks in the region.
The healthfulness of major food brands according to Health Canada’s nutrient profile model for proposed restrictions on food marketing to children
Authors: Vergeer Laura , Mulligan Christine , Jeong Hayun , Khan Ayesha , L’Abbé Mary R
Published: January 2025

Objective:

To examine the proportion of products offered by leading food brands in Canada that are ‘unhealthy’ according to Health Canada’s (HC) nutrient profile model for proposed restrictions on food marketing to children (M2K-NPM).

Design:

Nutritional information for products offered by top brands was sourced from the University of Toronto FLIP and Menu-FLIP 2020 databases, respectively. HC’s M2K-NPM, which includes thresholds for Na, total sugars and saturated fat, was applied to products.

Setting:

Canada.

Participants:

Overall, 1385 products from top breakfast cereal (n 15 brands, n 222 products), beverage (n 21 brands, n 769 products) and yogurt (n 10 brands, n 394 products) brands, and 3153 menu items from seventeen chain restaurants in Canada were assessed (n 60 unique brands overall).

Results:

For 42 % of brands (n 21), 100 % of their products exceeded ≥1 nutrient threshold(s), with ≥50 % of the products offered by twenty-three brands (46 %) exceeding two thresholds. Specifically, one or more nutrient thresholds were exceeded by ≥50 % of the products offered by 14/15 breakfast cereal brands, 18/21 beverage brands, all ten yogurt brands and all seventeen restaurant brands. Notably, 100·0 % of the products offered by ten breakfast cereal, six beverage, two yogurt and three restaurant brands exceeded ≥1 threshold(s).

Conclusions:

Most products offered by top food brands in Canada exceeded HC’s M2K-NPM thresholds. Nonetheless, these brands could still be marketed under the proposed regulations, which exclude brand marketing (i.e. promotions without an identifiable product) despite its contribution to marketing power. These findings reinforce the need for Canada and other countries to include brand marketing in M2K policies.
Receipt of humanitarian cash transfers, household food insecurity and the subjective wellbeing of Syrian refugee youth in Jordan
Authors: Sieverding Maia , Jamaluddine Zeina
Published: January 2025

Objective:

Humanitarian aid, including food aid, has increasingly shifted towards the provision of cash assistance over in-kind benefits. This paper examines whether food security mediates the relationship between receipt of humanitarian cash transfers and subjective wellbeing among Syrian refugee youth in Jordan.

Design:

Secondary analysis of the 2020–21 Survey of Young People in Jordan, which is nationally representative of Syrian youth aged 16–30. We employ stepwise model building and structural equation models.

Setting:

Jordan.

Participants:

Syrian refugee youth aged 16–30 (n 1572).

Results:

While 92 % of Syrian households with youth received cash transfers from a UN agency, 78 % of households were food insecure using the Food Insecurity Experience Scale. Fifty-one percent of youth suffered from poor wellbeing using the WHO-5 subjective wellbeing scale. Household food insecurity was associated with poorer youth wellbeing. Receiving larger cash transfer amounts was associated with better wellbeing among Syrian youth in unadjusted models. The relationship between receipt of cash transfers and youth wellbeing was not mediated by food security.

Conclusion:

We do not find support for the hypothesis that food security is a mediator of the association between cash transfers and subjective wellbeing for this population.
Labor Union Membership and Women’s Political Ambition: Evidence from the United States
Authors: Macdonald David
Published: January 2025

Women have long been underrepresented in American politics. This is evidenced by women being less likely to run for and hold elected office. Existing scholarship largely focuses on explaining why women are less politically ambitious than their male counterparts but pays less attention to why some women do run for office. To this end, I focus on the potential role of labor union membership. I argue that labor unions can foster political ambition and increase ordinary people’s likelihood of running for office. I test this among women in the American mass public, primarily with survey data from the 2010–22 Cooperative Election Study (CES). Overall, I find that labor union membership is significantly associated with women’s likelihood of running for office. I also find that this robust relationship is unlikely to be driven by self-selection or omitted variable biases. Overall, these findings help us to better understand the sources of political ambition, illustrate a viable potential pathway to boost women’s likelihood of seeking elected office, and underscore the political consequences of organized labor.
Just informal patient payments are not enough, ‘personal connections’ and knowledge of the ‘rules’ are also required: a logistic regression analysis of informal practices in health care in Ukraine
Authors: Levenets Olena , Stepurko Tetiana , Polese Abel , Pavlova Milena , Groot Wim
Published: January 2025

In Ukraine, patients and their family members face numerous barriers to health care services. In response, they use coping strategies, that are manifold and complex activities aimed at overcoming these barriers, the financial burden of the treatment, and the poor quality of health care services. These activities include formal and informal practices. Based on representative survey data from 2015 (N = 2,022), we identify patterns in the use of coping strategies, specific coping strategies used to secure good quality consultation and treatment, and analyse opinions and actions towards coping practices. We further analyse the factors associated with the last experience of coping and look at patterns of connection building. We find that the chances of using both money and connection as a coping strategy are higher for people with incomplete higher and highest levels of education. The size of this effect increases with the level of education. Older people, people with better health, and people with a higher opinion of the state use informal practices less, while women are more active in developing connections. The closer the relationship is with a medical doctor, the higher is the chance that such connection will be used in case of health service consumption.
Reimbursement prices of new, innovative medicines in Germany: a comparison of negotiation and cost-effectiveness analysis
Authors: Gandjour Afschin
Published: January 2025

This study aimed to compare reimbursement prices for new, innovative non-orphan drugs in Germany based on price negotiation and cost-effectiveness analysis, using the efficiency frontier (EF) approach and cost-utility analysis (CUA). For the EF, the next effective intervention and no intervention were used as comparators. Three pairwise comparisons were conducted: negotiation vs EF, CUA vs EF and negotiation vs CUA. For the comparison between negotiation and EF, relative risk reductions for a given added health benefit were assigned, and resulting price premiums were determined using an empirical estimate from the literature and a conceptual model. The difference between CUA vs EF was determined based on an aggregation rule and thresholds for CUA based on the average and marginal cost-effectiveness of the health care system. The difference between negotiation and CUA was determined through an indirect comparison. Price premiums based on negotiation are approximately 10–40 per cent higher than those based on EF using no intervention as a comparator. Furthermore, price premiums based on CUA (threshold at system-average cost-effectiveness) are approximately 25–50 per cent higher than those based on EF using no intervention as a comparator. The indirect comparison predicts that price premiums based on CUA (threshold at system-average cost-effectiveness) are approximately 10–15 per cent higher than those based on negotiation. For a threshold set at system-marginal cost-effectiveness, price premiums based on CUA are more than threefold higher than those based on negotiation. In the German health care system, CUA with a threshold set at system-average or system-marginal cost-effectiveness is predicted to yield higher reimbursement prices than price negotiations or the EF approach based on no intervention as a comparator.
Ten Years of Earth and Space Science: Introduction to the Special Collection
Authors: Caprarelli Graziella , Baratoux David , Bulusu Subrahmanyam , Cervato Cinzia , Diviacco Paolo , Donea Alina , Fletcher Steven J. , Glaves Helen M. , Jones Cathleen E. , Lu Gaopeng , Maute Astrid , Mills Franklin P. , Pryor Sara C. , Tiampo Kristy , Xie Zunyi
Published: January 2025

The journal Earth and Space Science (ESS) was founded in 2014 to offer the scientific community a new platform for the dissemination of key new data, observations, methods, instruments, and models, presented within the context of their application. Thus, the aim of the journal was (and is) to highlight the complexity and importance of experimental design, methodology, data acquisition and processing, intertwined with data interpretation. Such approach is consistent with the mission of most AGU journals, but the distinctive element for ESS is its focus on the concept of the useful impact of publication, progressively replacing that on conventional publication metrics. In this context, the journal has been, since its inception, the preferred home for studies stemming from both global and local geoscience research. This special collection contains 16 papers published in ESS, selected by the Editorial Board to highlight the aims, scope and path of evolution and growth of the journal since it inaugural issue, in 2014.
Spectral Structures of Jovian Broadband Kilometric Radiation Revealed by Cassini and Juno
Authors: Fischer G. , Taubenschuss U. , Píša D. , Imai M. , Kurth W. S.
Published: January 2025

Cassini flew past Jupiter in 2000/2001, and Juno has been orbiting the gas giant since mid‐2016. Here we focus on the spectral properties of Jovian broadband kilometric radiation (bKOM), and we classified them according to their slope in the time–frequency spectrum and distinguish four categories with negative, positive, mixed, or no slope in frequency. These bKOM structures had mostly negative slopes during the inbound portion of the Cassini Jupiter flyby, whereas they were mostly positive for the outbound. The reason for this could be higher intensities of bKOM emissions from midnight to dawn local times. We interpret the semi‐circles of the Jovian radio emission nicknamed “bullseyes” as negatively sloped bKOM connected with positively sloped bKOM, and we detected 40 bullseyes in Juno Waves data until the end of 2017. Cassini and Juno show similar distributions of bKOM with respect to the Jovian Central Meridian Longitude like the Voyagers and Ulysses. This means that bKOM has not changed over several decades and “rotates” with the system III period. Several features of the bKOM structures suggest emission cones with thick mantles and moderate beaming angles around . We found an enhancement of the occurrence probability of southern bKOM for certain phases of Ganymede and Callisto.
The Hawaii Dust Regime: Patterns and Variability in Aerosol Mineral Dust From MERRA‐2 at Station ALOHA and the Hawaii Aerosol Time‐Series
Authors: Ohnemus Daniel C. , Kollman Charlotte , Marsay Christopher M. , Ricci Mariah , Buck Clifton S.
Published: January 2025

The transport and delivery of low‐abundance, bioactive trace elements to the surface ocean by aerosol mineral dust is a major planetary control over marine primary production and hence the global carbon cycle. Variations in the concentration of atmospheric dust have established links to global climate over geologic timescales and to regional biogeographic shifts over seasonal timescales. Constraining atmospheric dust variability is thus of high value to understanding oceanographic systems, especially vast, constitutively low‐nutrient subtropical gyre ecosystems and high‐nutrient/low‐chlorophyll ecosystems where availability of the trace element iron is a dominant ecological control. Here we leverage the MERRA‐2 reanalysis product to examine over four decades of surface‐level atmospheric mineral dust concentrations in a domain of the subtropical North Pacific centered at Ocean Station ALOHA. This study region has been sampled regularly since the mid‐1980s and was the site of the Hawaii Aerosol Time‐Series (HATS) project in 2022–2023. Two unequal semi‐annual periods of elevated dust evident in the long‐term results are described and constrained. We look for evidence of shifts in total and seasonal atmospheric dust abundances or in the timing of the onset of the dominant spring/summer dusty period, finding year‐to‐year variations but little evidence for long‐term trends. We observe significant but complex relationships between the Pacific Decadal Oscillation (PDO) index and both dust and precipitation. The 2022 calendar year was among the dustiest years for the study domain in the preceding two decades and, by contrast, 2023 exhibited a significant early spring lull in dust.
Study of an Extremely Strong Quasi‐20‐Sol Wave During a Global Dust Storm in Mars Year 34
Authors: Xiao Qiao , Ma Zheng , Gong Yun , Zhang Shaodong , Huang Chunming
Published: January 2025

Based on the temperature and dust opacity data from the Mars Reconnaissance Orbiter/Mars Climate Sounder and the OpenMars reanalysis, we report an extremely strong quasi‐20‐sol wave (Q20SW) during the global dust storm (GDS) in Mars Year (MY) 34. After the onset of the GDS in MY34, the amplitude of the Q20SW reaches approximately 12 K in temperature, which is the strongest from MY29 to MY35. By analyzing the Eliassen‐Palm fluxes of the Q20SW and their divergences, we conclude that the Q20SW is enhanced due to the unseasonal temperature increase caused by the GDS. Moreover, we find a strong eastward propagating oscillation with a period of 12–16 sols and a wavenumber of 1 exists in the dust opacity after the commencement of the GDS. This indicates that the strong Q20SW could also modulate the dust variation in the middle latitudes during the GDS.
Meteorological Conditions Influence the Migration of a Marine Dune Field in the Southern North Sea
Authors: Durand Noémie , Tassi Pablo , Blanpain Olivier , Lefebvre Alice
Published: January 2025

A field of marine dunes has been studied in the Southern Bight of the North Sea. These large dunes, 1–5 m in height and several hundred meters in length, are highly mobile: migration rates of up to 30 m/year have been observed in places. The area is dominated by tides and is characterized by strong currents. Winds are predominantly from the southwest and, to a lesser extent, from the north. A large‐scale 3D numerical model was used to simulate the migration of this dune field over time. It is based on the process‐based opentelemac system. The model has been calibrated and validated against in situ bathymetric data and is therefore suited to our objective: to explore the contribution of weather (wind and atmospheric pressure) to the propagation of large marine dunes, in relation to that of tidal currents. To do this, a 4‐month period was simulated, with and without meteorological effects being taken into account in the numerical model. The results highlight the fundamental role of wind conditions in an accurate representation of seabed changes over time. They also show how meteorological events that are different from the prevailing conditions influence the short‐term evolution of the dune field.
Sociobiology meets oncology: unraveling altruistic cooperation in cancer cells and its implications
Authors: bin Masroni Muhammad Sufyan , Koay Evelyn Siew-Chuan , Lee Victor Kwan Min , Ng Siok Bian , Tan Soo Yong , Tan Karen Meiling , Archetti Marco , Leong Sai Mun
Published: January 2025

Altruism, an act of benefiting others at a cost to the self, challenges our understanding of evolution. This Perspective delves into the importance of altruism in cancer cells and its implications for therapy. Against the backdrop of existing knowledge on various social organisms found in nature, we explore the mechanisms underlying the manifestation of altruism within breast tumors, revealing a complex interplay of seemingly counteracting cancer signaling pathways and processes that orchestrate the delicate balance between cost and benefit underlying altruistic cooperation. We also discuss how evolutionary game theory, coupled with contemporary molecular tools, may shed light on understudied mechanisms governing the dynamics of altruistic cooperation in cancer cells. Finally, we discuss how molecular insights gleaned from these mechanistic dissections may fuel advancements in our comprehension of altruism among cancer cells, with implications across multiple disciplines, offering innovative prospects for therapeutic strategies, molecular discoveries, and evolutionary investigations.
A systematic assessment of the stability of SLA® vs. SLActive® implant surfaces over 12 weeks
Authors: Patel Rohit , Patel Serena , Girgis Wail , Ahmed Waqar , Barrak Fadi
Published: January 2025

Objective

This study aims to assess the impact of two implant surfaces, SLA and SLActive, on implant stability, measured by ISQ levels over a 12-week period.

Methods

A comprehensive search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Dentistry and Oral Sciences databases for randomized controlled trials (RCTs) up to February 2023 was conducted. The inclusion criteria were studies involving adult patients treated with SLA and SLActive implants, with assessment of implant stability through ISQ levels up to 12 weeks post-placement.

Results

From the initial 180 potentially eligible publications identified, six RCTs were included in our analysis, comprising 326 implants (50.6% SLA and 49.4% SLActive). Three studies were classified as low risk, while three had an unclear risk of bias. Overall, SLActive implants demonstrated comparable stability levels, as measured by ISQ, to SLA implants within the 12-week interval for implants placed in the maxillary or mandibular region. However, findings from the RCTs suggest that the SLActive surface led to an earlier transition point, a faster return to stability levels, and higher ISQ values at the end of 12 weeks compared to the SLA surface for implants placed in the palatal region.

Conclusion

SLActive surfaces exhibited stability levels similar to SLA surfaces for maxillary and mandibular implants. Notably, for palatal implants, SLActive resulted in a quicker transition point and higher stability levels at the 12-week mark. Due to the limited number of trials and potential study heterogeneity, further research is needed to validate these findings.
NPC1 controls TGFBR1 stability in a cholesterol transport-independent manner and promotes hepatocellular carcinoma progression
Authors: Li Shuangyan , Yan Lishan , Li Chaoying , Lou Lijuan , Cui Fengjiao , Yang Xiao , He Fuchu , Jiang Ying
Published: January 2025

Niemann-Pick disease type C protein 1 (NPC1), classically associated with cholesterol transport and viral entry, has an emerging role in cancer biology. Here, we demonstrate that knockout of Npc1 in hepatocytes attenuates hepatocellular carcinoma (HCC) progression in both DEN (diethylnitrosamine)-CCl4 induced and MYC-driven HCC mouse models. Mechanistically, NPC1 significantly promotes HCC progression by modulating the TGF-β pathway, independent of its traditional role in cholesterol transport. We identify that the 692-854 amino acid region of NPC1’s transmembrane domain is critical for its interaction with TGF-β receptor type-1 (TGFBR1). This interaction prevents the binding of SMAD7 and SMAD ubiquitylation regulatory factors (SMURFs) to TGFBR1, reducing TGFBR1 ubiquitylation and degradation, thus enhancing its stability. Notably, the NPC1 (P691S) mutant, which is defective in cholesterol transport, still binds TGFBR1, underscoring a cholesterol-independent mechanism. These findings highlight a cholesterol transport-independent mechanism by which NPC1 contributes to the stability of TGFBR1 in HCC and suggest potential therapeutic strategies targeting NPC1 for HCC treatment.