bluuebunny/crossref_metadata_2025 huggingface dataset:
Electrochemical removal of diazinon insecticide in aqueous solution by Pb/β‐PbO2 anode. Effect of parameters and optimization using response surface methodology
Authors: Mahmoudpoor Moteshaker Parisa , Saadi Sommayeh , Rokni Seyed Ehsan
Published: December 2019

Diazinon is one of the most extensively used organophosphorus pesticides that is used against a variety of agricultural pests and disease vectors and is resistant to biodegradation; its release into the environment is a severe environmental concern due to their widespread use. The aim of this study was to investigate the electrochemical removal of diazinon insecticides from aqueous solutions and to optimize the process by response surface methodology (RSM). This is an experimental study that was performed on a laboratory scale and in a batch mood. scanning electron microscopy, energy dispersive X‐ray, and X‐ray diffraction analyses were performed to accurately evaluate and characterize the coated electrode. The central composite design (CCD) was used to investigate the influence of pH, electrolysis time, diazinon concentration, and current density, as well as the effect of their interaction on the removal of diazinon during the electrochemical process. The results showed that by increasing electrolysis time and current density and decreasing diazinon pH and concentration, diazinon removal efficiency increased. According to the results, Na2SO4 was selected as the supporting electrolyte with the highest degradation efficiency (97.88%) compared to the other two compounds (NaCl and NaNO3). The linear regression coefficient (R2) between experiments and different response values ​​in the model was .99. The results showed that the amount of AOS in the effluent of the three‐dimensional electrochemical process was increased from 0.06 to 1.22 and the COD/TOC ratio decreased from 2.62 to 1.85, respectively; this indicates the biodegradability of the diazinon insecticide through the electrochemical system. The removal efficiency of COD and TOC in optimum condition was 85.78% and 79.86%, respectively. In general, the electrochemical process using Pb/β‐PbO2 electrode compared to other methods can be used as a suitable and reliable method for the treatment of effluents containing chemical toxins such as diazinon.

Practitioner Points

Electrochemical degradation of diazinon insecticide using Pb/β‐PbO2 anode.

Effect of operating parameters on electrodegradation diazinon insecticide in electrochemical processes using Pb/β‐PbO2 anode.

Biodegradability study of diazinon insecticide electrodegradation using Pb/β‐PbO2 anode.

Optimization operating parameters using central composite design (CCD).
From parts lists to functional significance—RNA–protein interactions in gene regulation
Authors: Kilchert Cornelia , Sträßer Katja , Kunetsky Vladislav , Änkö Minna‐Liisa
Published: December 2019

Hundreds of canonical RNA binding proteins facilitate diverse and essential RNA processing steps in cells forming a central regulatory point in gene expression. However, recent discoveries including the identification of a large number of noncanonical proteins bound to RNA have changed our view on RNA–protein interactions merely as necessary steps in RNA biogenesis. As the list of proteins interacting with RNA has expanded, so has the scope of regulation through RNA–protein interactions. In addition to facilitating RNA metabolism, RNA binding proteins help to form subcellular structures and membraneless organelles, and provide means to recruit components of macromolecular complexes to their sites of action. Moreover, RNA–protein interactions are not static in cells but the ribonucleoprotein (RNP) complexes are highly dynamic in response to cellular cues. The identification of novel proteins in complex with RNA and ways cells use these interactions to control cellular functions continues to broaden the scope of RNA regulation in cells and the current challenge is to move from cataloguing the components of RNPs into assigning them functions. This will not only facilitate our understanding of cellular homeostasis but may bring in key insights into human disease conditions where RNP components play a central role. This review brings together the classical view of regulation accomplished through RNA–protein interactions with the novel insights gained from the identification of RNA binding interactomes. We discuss the challenges in combining molecular mechanism with cellular functions on the journey towards a comprehensive understanding of the regulatory functions of RNA–protein interactions in cells.

This article is categorized under:

RNA Interactions with Proteins and Other Molecules > Protein–RNA Interactions: Functional Implications

aRNA Interactions with Proteins and Other Molecules > RNA–Protein Complexes

RNA Interactions with Proteins and Other Molecules > Protein–RNA Recognition
Molecular crosstalk between cancer and neurodegenerative diseases
Authors: Seo Jiyeon , Park Mikyoung
Published: December 2019

The progression of cancers and neurodegenerative disorders is largely defined by a set of molecular determinants that are either complementarily deregulated, or share remarkably overlapping functional pathways. A large number of such molecules have been demonstrated to be involved in the progression of both diseases. In this review, we particularly discuss our current knowledge on p53, cyclin D, cyclin E, cyclin F, Pin1 and protein phosphatase 2A, and their implications in the shared or distinct pathways that lead to cancers or neurodegenerative diseases. In addition, we focus on the inter-dependent regulation of brain cancers and neurodegeneration, mediated by intercellular communication between tumor and neuronal cells in the brain through the extracellular microenvironment. Finally, we shed light on the therapeutic perspectives for the treatment of both cancer and neurodegenerative disorders.
Review of defects in lattice structures manufactured by powder bed fusion
Authors: Echeta Ifeanyichukwu , Feng Xiaobing , Dutton Ben , Leach Richard , Piano Samanta
Published: December 2019

Additively manufactured lattice structures are popular due to their desirable properties, such as high specific stiffness and high surface area, and are being explored for several applications including aerospace components, heat exchangers and biomedical implants. The complexity of lattices challenges the fabrication limits of additive manufacturing processes and thus, lattices are particularly prone to manufacturing defects. This paper presents a review of defects in lattice structures produced by powder bed fusion processes. The review focuses on the effects of lattice design on dimensional inaccuracies, surface texture and porosity. The design constraints on lattice structures are also reviewed, as these can help to discourage defect formation. Appropriate process parameters, post-processing techniques and measurement methods are also discussed. The information presented in this paper contributes towards a deeper understanding of defects in lattice structures, aiming to improve the quality and performance of future designs.
Social Capital and Risk of Concurrent Sexual Partners Among African Americans in Jackson, Mississippi
Authors: Ransome Yusuf , Cunningham Karlene , Paredes Miguel , Mena Leandro , Sutten-Coats Cassandra , Chan Philip , Simmons Dantrell , Willie Tiara C. , Nunn Amy
Published: December 2019

Concurrent sexual partnerships (i.e., relationships that overlap in time) contribute to higher HIV acquisition risk. Social capital, defined as resources and connections available to individuals is hypothesized to reduce sexual HIV risk behavior, including sexual concurrency. Additionally, we do not know whether any association between social capital and sexual concurrency is moderated by gender. Multivariable logistic regression tested the association between social capital and sexual concurrency and effect modification by gender. Among 1445 African Americans presenting for care at an urban STI clinic in Jackson, Mississippi, mean social capital was 2.85 (range 1–5), mean age was 25 (SD = 6), and 62% were women. Sexual concurrency in the current year was lower for women compared to men (45% vs. 55%, χ2(df = 1) = 11.07, p = .001). Higher social capital was associated with lower adjusted odds of sexual concurrency for women compared to men (adjusted Odds Ratio [aOR] = 0.62 (95% CI 0.39–0.97), p = 0.034), controlling for sociodemographic and psychosocial covariates. Interventions that add social capital components may be important for lowering sexual risk among African Americans in Mississippi.
Influence of Structure Sensitivity on Apparent Activation Energy of Parallel Heterogeneous Catalytic Reactions
Authors: Murzin Dmitry Yu.
Published: December 2019

Analysis of apparent activation energy is presented for different heterogeneous catalytic reactions with parallel reaction routes. In the case of kinetic coupling between catalytic cycles the activation energy in a particular route depends not only on the activation energies of the elementary steps comprising this route, but also on the frequency of the steps in a parallel route. Expressions were derived for coupling between routes through irreversible adsorption of the substrate, quasi-equilibrated binding as well as different substrate adsorption modes. Theoretical analysis of the apparent activation energy was extended for the reaction network with two routes possessing mechanistically different rate determining steps (i.e. monomolecular vs bimolecular). For structure sensitive reactions an expression for the apparent activation energy for parallel reactions was developed for cases with a continuous distribution of active centers and a cubo-octahedral representation of the metal clusters. A comparison between the theoretical analysis and experimental data on transformations of furfural to furfuryl alcohol and furan on ruthenium clusters shows applicability of the developed theoretical framework.

Graphic Abstract
A Study of the Automated Eddy Current Detection of Cracks in Steel Plates
Authors: Mohseni Ehsan , Habibzadeh Boukani Hamid , Ramos França Demartonne , Viens Martin
Published: December 2019

Applying life estimation approaches to determine in-service life of structures and plan the inspection schedules accordingly are becoming acceptable safety design procedures in aerospace. However, these design systems shall be fed with reliable parameters related to material properties, loading conditions and defect characteristics. In this context, the role of non-destructive (NDT) testing reliability is of high importance in detecting and sizing defects. Eddy current test (ECT) is an electromagnetic NDT method frequently used to inspect tiny surface fatigue cracks in sensitive industries. Owing to the new advances in robotic technologies, there is a trend to integrate the ECT into automated systems to perform NDT inspections more efficiently. In fact, ECT can be effectively automated as to increase the coverage, repeatability and scanning speed. The reliability of ECT scanning, however, should be thoroughly investigated and compared to conventional modes of applications to obtain a better understanding of the advantages and shortcomings related to this technique. In this contribution, a series of manual and automated ECT tests are carried out on a set of samples using a split-D reflection differential surface probe. The study investigates the level of noise recorded in each technique and discuss its dependency on different parameters, such as surface roughness and frequency. Afterwards, a description of the effect of crack orientation on ECT signal amplitude is provided through experimental tests and finite element simulations. Finally, the reliability of each ECT technique is investigated by means of probability of detection (POD) curves. POD parameters are then extracted and compared to examine the effect of scanning index, frequency and automation on detection reliability.
Tuning Crystal Field Potential by Orbital Dilution in Strongly Correlated d4 Oxides
Authors: Brzezicki Wojciech , Forte Filomena , Noce Canio , Cuoco Mario , Oleś Andrzej M.
Published: December 2019

We investigate the interplay between Coulomb-driven orbital order and octahedral distortions in strongly correlated Mott insulators due to orbital dilution, i.e., doping by metal ions without an orbital degree of freedom. In particular, we focus on layered transition metal oxides and study the effective spin–orbital exchange due to d3 substitution at d4 sites. The structure of the d3 − d4 spin–orbital coupling between the impurity and the host in the presence of octahedral rotations favors a distinct type of orbital polarization pointing towards the impurity and outside the impurity–host plane. This yields an effective lattice potential that generally competes with that associated with flat octahedra and, in turn, can drive an inversion of the crystal field interaction.
Design catalogue for eco-engineering of coastal artificial structures: a multifunctional approach for stakeholders and end-users
Authors: O’Shaughnessy Kathryn A. , Hawkins Stephen J. , Evans Ally J. , Hanley Mick E. , Lunt Paul , Thompson Richard C. , Francis Robert A. , Hoggart Simon P. G. , Moore Pippa J. , Iglesias Gregorio , Simmonds David , Ducker James , Firth Louise B.
Published: December 2019

Coastal urbanisation, energy extraction, food production, shipping and transportation have led to the global proliferation of artificial structures within the coastal and marine environments (sensu “ocean sprawl”), with subsequent loss of natural habitats and biodiversity. To mitigate and compensate impacts of ocean sprawl, the practice of eco-engineering of artificial structures has been developed over the past decade. Eco-engineering aims to create sustainable ecosystems that integrate human society with the natural environment for the benefit of both. The science of eco-engineering has grown markedly, yet synthesis of research into a user-friendly and practitioner-focused format is lacking. Feedback from stakeholders has repeatedly stated that a “photo user guide” or “manual” covering the range of eco-engineering options available for artificial structures would be beneficial. However, a detailed and structured “user guide” for eco-engineering in coastal and marine environments is not yet possible; therefore we present an accessible review and catalogue of trialled eco-engineering options and a summary of guidance for a range of different structures tailored for stakeholders and end-users as the first step towards a structured manual. This work can thus serve as a potential template for future eco-engineering guides. Here we provide suggestions for potential eco-engineering designs to enhance biodiversity and ecosystem functioning and services of coastal artificial structures with the following structures covered: (1) rock revetment, breakwaters and groynes composed of armour stones or concrete units; (2) vertical and sloping seawalls; (3) over-water structures (i.e., piers) and associated support structures; and (4) tidal river walls.
Elevated Free Thyroxine Levels Are Associated with Poorer Overall Survival in Patients with Gastroesophageal Cancer: A Retrospective Single Center Analysis
Authors: Puhr H. C. , Wolf P. , Berghoff A. S. , Schoppmann S. F. , Preusser M. , Ilhan-Mutlu Aysegul
Published: December 2019

As endocrinological parameters such as thyroid hormones modulate proliferative, metabolic, and angiogenic pathways, it is surmised that their levels can be associated with cancer development and progression. Most patients with gastroesophageal cancer are diagnosed very late and have a poor prognosis, yet the association with endocrinological parameters has not been addressed so far. The aim of this study was to correlate hormones with the outcome, so new prognostic and potentially therapeutic markers can be defined. We analyzed clinical and endocrinological parameters including history of thyroid disorders and laboratory analyses of thyroid hormones and correlated these with the overall survival in a large European cohort of patients with inoperable locally advanced or metastatic gastroesophageal cancer treated between 2002 and 2018 at the Vienna General Hospital, Austria. In total, the survival outcome of 258 patients was evaluated. Higher levels of fT4 (p = 0.041, HR = 2.202) and lower levels of T3 (p = 0,003, HR = 0,141) were associated with significantly shorter survival. However, the overall survival of patients with known thyroid disorders did not differ significantly from euthyroid patients (euthyroid, 283 days; hyperthyroid, 354 days; hypothyroid, 284 days; p = 0.472). Elevated fT4 levels are associated with poorer overall survival of patients with gastroesophageal cancer in advanced stages. Since data on the correlation of endocrinological parameters and gastroesophageal cancer are scarce, this analysis is an important impulse for further studies concerning the impact of thyroxine on patients with cancer of the upper GI tract.
Transport behaviors of humic acid, kaolin and kaolin–humic acid compound colloids on naphthalene in floating islands with biofilmed fillers
Authors: Yu Sheng , Li Bang-yu , Chen Yi-hu
Published: December 2019

As one of the persistent organic pollutants, the investigations of naphthalene transports with humic acid, kaolin and kaolin–humic acid compound colloids by passing through the floating islands with biofilmed filler matrix pores were checked out. Naphthalene was easily captured onto the biofilmed fillers while it was passing through the floating islands with the filling percentages of 0.0 to 60.0 by absorbing bigger contaminated colloids, reflecting that the naphthalene concentrations in influents were, respectively, decreased from 200 to 57 μg L−1 for the humic acid colloids, to 32 μg L−1 for the kaolin colloids and to 13 μg L−1 for the kaolin–humic acid compound colloids. With the filling percentages of 60.0 to 80.0, the naphthalene concentrations in effluents were maintained at 57 ± 2 μg L−1 for the humic acid colloids, at 32 ± 3 μg L−1 for the kaolin colloids and at 13 ± 3 μg L−1 for the kaolin–humic acid compound colloids, respectively. The naphthalene distribution amounts on the biofilmed fillers were, respectively, from 213 to 96 ng m−1 for the humic acid colloids, from 274 to 96 ng m−1 for the kaolin colloids and from 340 to 83 ng m−1 for the kaolin–humic acid compound colloids. Thus, the biofilmed fillers in the floating islands could decrease the naphthalene concentrations by the captures of the humic acid, kaolin and kaolin–humic acid compound colloids to make the contaminated colloid concentrations reduced and promote the water qualities.
A blood‐based nutritional risk index explains cognitive enhancement and decline in the multidomain Alzheimer prevention trial
Authors: Bowman Gene L. , Dodge Hiroko H. , Guyonnet Sophie , Zhou Nina , Donohue Juliana , Bichsel Aline , Schmitt Jeroen , Hooper Claudie , Bartfai Tamas , Andrieu Sandrine , Vellas Bruno ,   MAPT/DSA Study Group, Vellas Bruno , Guyonnet Sophie , Carrié Isabelle , Brigitte Lauréane , Faisant Catherine , Lala Françoise , Delrieu Julien , Villars Hélène , Combrouze Emeline , Badufle Carole , Zueras Audrey , Andrieu Sandrine , Cantet Christelle , Morin Christophe , Van Kan Gabor Abellan , Dupuy Charlotte , Rolland Yves , Caillaud Céline , Ousset Pierre‐Jean , Lala Françoise
Published: December 2019

Introduction

Multinutrient approaches may produce more robust effects on brain health through interactive qualities. We hypothesized that a blood‐based nutritional risk index (NRI) including three biomarkers of diet quality can explain cognitive trajectories in the multidomain Alzheimer prevention trial (MAPT) over 3‐years.

Methods

The NRI included erythrocyte n‐3 polyunsaturated fatty acids (n‐3 PUFA 22:6n‐3 and 20:5n‐3), serum 25‐hydroxyvitamin D, and plasma homocysteine. The NRI scores reflect the number of nutritional risk factors (0–3). The primary outcome in MAPT was a cognitive composite Z score within each participant that was fit with linear mixed‐effects models.

Results

Eighty percent had at lease one nutritional risk factor for cognitive decline (NRI ≥1: 573 of 712). Participants presenting without nutritional risk factors (NRI=0) exhibited cognitive enhancement (β = 0.03 standard units [SU]/y), whereas each NRI point increase corresponded to an incremental acceleration in rates of cognitive decline (NRI‐1: β = −0.04 SU/y, P = .03; NRI‐2: β = −0.08 SU/y, P < .0001; and NRI‐3: β = −0.11 SU/y, P = .0008).

Discussion

Identifying and addressing these well‐established nutritional risk factors may reduce age‐related cognitive decline in older adults; an observation that warrants further study.
A roadmap to develop dementia research capacity and capability in Pakistan: A model for low‐ and middle‐income countries
Authors: Leroi Iracema , Chaudhry Nasim , Daniel Anna , Dunne Ross , Eman Saima , Farina Nicolas , Haidry Sana‐e‐Zehra , Husain Nusrat , Jafri Hussain , Karim Salman , Kiran Tayyeba , Khan Murad , Khan Quratulain , Malik Shakil Jehangir , Memon Rakhshi , Rana Mowadat Hussain , Sathish Ambily , Sheikh Saima , Tamizudin Asad , Tofique Sehrish , Zadeh Zainab ,   Pakistan Dementia Research Stakeholder Group (PDRSG), Abbasi Yasser , Eitesam Sadaf , Jafri Mohammed , Khaliq Aysha , Karim Raheel , Nafis Saima , Wasay Mohammad
Published: December 2019

Objective

To produce a strategic roadmap for supporting the development of dementia research in Pakistan.

Background

While global research strategies for dementia research already exist, none is tailored to the specific needs and challenges of low‐ and middle‐income countries (LMIC) like Pakistan.

Methods

We undertook an iterative consensus process with lay and professional experts to develop a Theory of Change‐based strategy for dementia research in Pakistan. This included Expert Reference Groups (ERGs), strategic planning techniques, a “research question” priority survey, and consultations with Key Opinion Leaders.

Results

We agreed on ten principles to guide dementia research in Pakistan, emphasizing pragmatic, resource sparing, real‐world approaches to support people with dementia, both locally and internationally. Goals included capacity/capability building. Priority research topics included raising awareness and understanding of dementia, and improving quality of life.

Conclusion

This roadmap may be a model for other LMIC health ecosystems with emerging dementia research cultures.
Remarks by Michael J. Glennon
Authors: Glennon Michael J.
Published: December 2019

I am going to say a few brief words this afternoon about one of the great myths in American constitutional law. That is the myth that the federal government has exclusive power over foreign affairs, the myth that the United States is always required to speak internationally with one voice. That myth is flat wrong. It is belied by the constitutional text, by subsequent practice, and by the functional purposes of federalism. Consider each in turn.
Remarks by Alice Farmer (as Summarized by the Moderator)
Authors: Farmer Alice
Published: December 2019

Alice Farmer discussed the UN High Commissioner for Refugees’ (UNHCR) long-standing and strengthening work to address forced migration from Central America within the context of the current international legal regime. In keeping with the panel's theme, she noted that international refugee law was written in the wake of World War II, in a time when the nature of persecution looks very different than it does today. With 68.5 million forcibly displaced people in the world—an all-time high—many of the solutions that the UNHCR has used in the past are not viable anymore. The numbers we are seeing now will be dwarfed in a few decades as climate change displacement rises. Fixing our stressed legal regime is urgent.
International Law as an Instrument: Dialogue, Tensions, Accomplishments
Authors: Pinto Mónica
Published: December 2019

It is my great pleasure to be with you today in this Annual Meeting of the American Society of International Law under the theme “International Law as an Instrument.”
Opening Remarks by Sean D. Murphy
Authors: Murphy Sean D.
Published: December 2019

I welcome you all to this closing panel for the 113th Annual Meeting of the American Society of International Law.
A Common Code of Conduct for Investment Arbitrators?
Authors: Giorgetti Chiara
Published: December 2019

Investor-State Dispute Settlement (ISDS) is in the midst of an important reform process, and the call for reform includes ethics. Amongst others, criticisms related to ethics in ISDS include concerns related to the lack of diversity among arbitrators, the ensuing increasing possibility of personal, professional, and issue conflicts, the concern that actors can simultaneously wear multiple hats (so-called “double hatting”) as they can serve as counsel in one arbitration and as arbitrator or expert in another that deals with similar or connected issues, as well as, more generally, the lack of common ethical standards applicable to all participants in arbitral proceedings irrespective of their diverse legal cultures.
Introductory Remarks by Kathleen Claussen
Authors: Claussen Kathleen
Published: December 2019

Again, we are delighted to have you here. I am Kathleen Claussen. I teach at the University of Miami Law School, and I am delighted to moderate this session that will address current U.S. trade policy, and this particular moment in time in U.S. trade policy, which some have called, as you know well, a trade war.
OP29 Building A Global, Public Repository Of Patient Experience Data
Authors: Holliday Catherine
Published: December 2019

Introduction

The Patient Experience, Expectations and Knowledge (PEEK) protocol was developed so that a holistic, comprehensive, independent, proactive and systematic approach could be taken to inform decisions made in the context of health technology assessment and other parts of the health sector. Each PEEK study is made publicly available which over time will result in a global repository of patient experience data.

Methods

The PEEK protocol is a single protocol that can be implemented across disease areas and includes a quantitative and qualitative component. The quantitative component is based on a series of validated tools that provide baseline health and demographic data for the study population. The qualitative component is the result of two years of protocol testing to develop a structured interview that solicits comprehensive and holistic patient experience data, and provides participants with the opportunity to provide advice on their future expectations.

Results

PEEK studies in breast cancer, bladder cancer, lung cancer, spinal muscular atrophy, atopic dermatitis, chronic kidney disease, chronic heart failure and mitochondrial disease have been completed in the Australian context (www.cc-dr.org/peek). Holistic patient experience themes are presented commencing with symptoms and diagnosis experience, through to communication, information, treatments experienced and quality of life. Information is also available in relation to participant's expectations of future treatment, care, information and communication. The result is a freely available repository of patient experience data that anyone in the sector can access to complement clinical and economic evidence.

Conclusions

The process of providing patient feedback and real-world evidence in the context of health technology assessment is often ad-hoc. The lack of consistency means that it has been difficult to assess the impact of patient engagement and feedback in the context of health technology assessment. The PEEK protocol and program is an example of a systematic, independent and holistic approach to patient experience and real-world evidence data collection that provides the sector with an opportunity to proactively engage the community in decisions that are made about treatment, care and support.
OP62 Let's Co-design A Tool To Assess Overweight And Obesity Health Apps
Authors: Puig Elisa Puigdomenech , Robles Noemí , Gomez Corpus , Saigí-Rubió Francesc , Zamora Alberto , Moharra Montse , Paluzié Guillem , Balfegó Mariona , Cuatrecasas Guillem , Carrion i Ribas Carme
Published: December 2019

Introduction

There are more than 320,000 accessible health apps, with the most downloaded of those related to physical exercise and weight control. However the initiatives for their validation address only partial aspects of the evaluation. The EVALAPPS project aims to develop an assessment tool for overweight and obesity management apps, based on the evaluation of efficacy, effectiveness and safety. In the present phase of the project, the team is co-creating the assessment tool considering both the evidence and the expertise of professionals (co-creation process).

Methods

Proposed co-creation methodology includes: 1) a modified Delphi process for selecting the assessment criteria. Criteria were identified through a) an exhaustive review of the criteria used by several mHealth assessment tools and b) a systematic review of efficacy, safety and effectiveness criteria used in mHealth interventions that assess overweight and obesity management. 2) a co-creation session using “Design Thinking” techniques for defining the final content and appearance of the tool (November 2018).

Results

Ten dimensions and 133 criteria were identified, both in relation to the outputs (Usability, Clinical Effectiveness, Security, Development, etc.) and the outcomes (such as weight loss, number of steps). Of those, 114 were included in the modified Delphi, in which 31 professionals participated. A set of 63 criteria were selected as candidates for being part of the tool. Criteria mainly belonged to Security (22%) and Usability dimensions (14%), followed by Quality (11%), and outcomes related to Activity (11%) and Physical status (11%). Once the co-creation session has been performed, the final tool will be developed.

Conclusions

Relevant criteria to evaluate the efficacy and safety of mHealth interventions in the management of overweight and obesity have been identified. Once the tool is developed it will be user tested and piloted on users of overweight and obesity management apps.
OP78 Picturing ELSI+: Mapping Ethical, Legal, Social And Value Issues
Authors: Krahn Murray , Bremner Karen , de Oliveira Claire , Almeida Nisha , Clement Fiona , Lorenzetti Diane , O'Campo Patricia , Pechlivanoglou Petros , Tricco Andrea
Published: December 2019

Introduction

Health technology assessment (HTA) is value-laden. Consideration of ethical, legal, and social issues (ELSI), and patient values (ELSI+), is challenged by lack of conceptual clarity and the multi-disciplinary nature of ELSI + . This study used concept mapping to identify key concepts in the ELSI+ domain and their interrelationships.

Methods

We conducted a scoping review using Medline and EMBASE (2000-2016, English language) with search terms related to ethics, legal/law, social/society/patient, “ELSI”, and HTA/technology/assessment. Items from the review and additional items from an expert brainstorming session were consolidated into 80 ELSI+-related statements which were entered into Concept Systems® Global MAX software. Participants (N = 38; 36 percent researchers, 21 percent academics; 42 percent self-identified as HTA experts) sorted the statements into thematic groups that made sense to them, and rated the statements on their importance in decision-making about adoption of technologies in Canada: 1 (not at all important), 5 (extremely important), 2, 3, and 4 (unlabeled). We used Concept Systems® Global MAX software to create and analyze concept maps with four to 16 clusters, which were reviewed by the study team.

Results

We selected the map with five clusters because its clusters represented different concepts and the statements within each cluster represented the same concept. Based on the concepts, we named these clusters: patient preferences and experiences, patient quality of life and function, patient burden/harm, fairness, and organizational. The highest mean importance ratings were for the statements in the patient burden/harm (3.82) and organizational (3.92) clusters.

Conclusions

This study suggests an alternative approach to conceptualize the domains originally described as “ELSI+”. We identified clusters of relevant concepts that focus on patient perspectives (preferences, experiences, quality of life, function), burden and harm, fairness (individual and societal), and organizational issues. Basing ELSI+ on conceptual consonance, rather than academic disciplines or traditions, provides a framework for coherent consideration of ELSI+ in HTA.
PP36 Inflammatory Bowel Disease: The Disability Costs Among Italian Workers
Authors: Nardone Claudia , Russo Simone , Gazzillo Simone , Migliorini Raffaele , Aurilio Marco Trabucco , Mennini Francesco Saverio
Published: December 2019

Introduction

The aim of the study is to estimate the disability insurance costs (social security system in Italy is financed by public expenditure) induced by patients with Inflammatory Bowel Disease (IBD) and specifically for Crohn's disease (CD) and Ulcerative Colitis (UC) between 2009 and 2015.

Methods

We analyzed the database about the disability insurance awards and the mean cost per benefit of the National Institute of Social Security (INPS) for two types of social security benefits: incapacity pensions (IP - for people without workability) and disability benefits (DB - for people with reduced work ability). From this data, we have estimated the total benefit provided and the total costs for each disease. A probabilistic model with a Monte Carlo simulation was developed in order to estimate the total benefits provided and costs.

Results

For CD, an average of 820 beneficiaries of social security benefits were detected per year (2009-2015): the total expenditure was EUR 50 million, EUR 7 million per year (about EUR 7,900 per patient); for UC, about 1,550 beneficiaries per year were detected and the total expenditure was EUR 93 million, EUR 13 million per year (about EUR 8,600 per patient).

Conclusions

The disability insurance costs related with the management of CD and UC showed a significant impact on the expenditure for the Italian system: the most important costs for disability for CD and UC in Italy in the analyzed period were DB (92 percent for CD and 95 percent for UC). Rapid access to innovative treatments could reduce the costs incurred by the social security system.
PP44 Optimal Use Of Warfarin: Self-Monitoring From A Quebec Perspective
Authors: Bouchard Sylvie , St-Pierre Frederic , Levesque Ann , Turgeon Melanie , Guay Helene , Freitas Adriana , Plante Eric , Carpentier Gabriel , Tardif Mélanie
Published: December 2019

Introduction

Frequent standard International Normalized Ratio (INR) monitoring by health professionals is one of the major inconveniences reported by warfarin users. However, portable coagulometers are now available to reduce this burden by allowing patients to self-monitor their INR in the comfort of their home, thereby reducing their visiting frequency to a medical clinic. The aim of this work was thus to elaborate recommendations on the use of self-monitoring in the management of warfarin-treated patients in the province of Quebec.

Methods

Systematic literature reviews were conducted to retrieve the most up-to-date scientific data from primary studies and pharmacoeconomic evaluations as well as recommendations from published clinical practice guidelines. This information was then triangulated with the experiential knowledge of Quebec experts and clinicians collaborating on the project.

Results

The scientific, contextual and experiential evidence gathered during this work provided convincing support for the use of self-monitoring for long-term warfarin-treated patients, leading to a more effective treatment than standard monitoring while being safe, cost-effective and potentially improving patients’ quality of life. However, physical and mental limitations can hinder the use of portable coagulometers, outlining the need for caution in the selection and support of self-monitoring patients.

Conclusions

This work led to the development of specific recommendations on the use of self-monitoring along with a clinical tool to help discussion between patients and health professionals leading to a shared decision-making. This work will be part of two optimal usage guides on oral anticoagulant therapy to be published by the Institut national d'excellence en santé et en services sociaux.
PP68 Indicators From The Real World Data To Improve Opioid Use
Authors: Tremblay Eric , Daigle Jean-Marc , Breton Marie-Claude , Bouchard Sylvie
Published: December 2019

Introduction

Opioids are being used increasingly to treat chronic noncancer pain despite the uncertainty regarding its long-term benefits. This study served to determine if problems are associated with opioid use in Québec for new users from 2006 to 2013 without history of cancer.

Methods

A retrospective longitudinal cohort study was conducted using administrative databases stored at the Régie de l'assurance maladie du Québec (RAMQ) to describe the annual proportion of new users to whom at least one of the five indicators of potentially inappropriate opioid use applied was estimated. These indicators are (i) overlapping opioid prescriptions, (ii) overlapping opioid and benzodiazepine prescriptions, (iii) the use of long-acting opioids at the start of treatment, (iv) a high mean daily dose, and (v) a rapid increase in the opioid dose.

Results

The annual proportion of new users to whom at least one of the five indicators of potentially inappropriate opioid use applied decreased from 15.4 percent in 2006 to 12.3 percent in 2013. It was mainly the following three indicators that contributed the most to these proportions in 2013: (i) overlapping opioid prescriptions (5.8 percent), (ii) overlapping opioid and benzodiazepine prescriptions (8.2 percent), and (iii) the use of long-acting opioids at the start of treatment (1.8 percent).

Conclusions

The vast majority of new users with no history of diagnosed cancer used opioids adequately according to the five indicators of potentially inappropriate opioid use applied. Improvement could still be made to decrease mainly overlapping opioid prescriptions and overlapping opioid and benzodiazepine prescriptions.
PP79 Impact Of Hidradenitis Suppurativa On Healthcare Resource Utilization
Authors: Andrade Larissa de Araujo Costa , Moreira Ricardo , Vitale Vinicius
Published: December 2019

Introduction

Hidradenitis suppurativa (HS) is a debilitating, chronic inflammatory skin disease characterized by painful nodules and abscesses. HS has a strong impact on patient quality of life. In Brazil, the prevalence of HS is estimated at 0.4 percent. Medical and surgical treatments have low effectiveness and disease recurrence is common, which affects health system costs. This study aimed to assess how HS patients utilize medical care (emergency and inpatient care) in Brazil and to describe the all-cause costs.

Methods

Data were retrieved from a public healthcare claims database (DATASUS), which provides access to information regarding health services and costs. Data from DATASUS were used to perform a cost-identification analysis on patients with HS who used health services over a two-year period. A retrospective bottom-up approach was used to estimate direct costs, multiplying the amount of each medical resource consumed by its unit cost.

Results

Over the two-year period, 90 patients (16%) with HS received inpatient care (151 procedures) at a total cost of BRL 83,520 (USD 21,715). Surgeries were the most frequently performed (73% of total) and expensive procedures, costing BRL 73,122 (USD 19,011; 88% of total costs), followed by clinical treatments (BRL 8,354 [USD 2,172]; 10%), and physician consulting (BRL 1,659 [USD 431]; 2%). For the 500 patients treated in the emergency department (total cost BRL 3,027 [USD 787]), the most frequently received services were physician consulting (34%), nursing care (12%), and minor surgeries (11%). Each patient received, on average, three procedures over the two-year period.

Conclusions

HS is a high-burden disease, as demonstrated by the high healthcare resource utilization among patients. Since DATASUS is a public database, the costs presented reflect a government reference price and do not consider local costs, which is a limitation of this study. Health managers should be aware of this finding, although further research is needed to investigate the effect of healthcare utilization on patient outcomes.
PP123 Management of Patients’ Conflicts Of Interest And Of Commitment In Health Technology Assessment
Authors: Roy Marie-Christine , Ganache Isabelle , Pomey Marie-Pascale , Demers-Payette Olivier , Roy Denis
Published: December 2019

Introduction

Health technology assessment (HTA) and the development of clinical practice guidelines (CPGs) support important health policy and clinical decisions. Conflicts of interest (COI) and conflicts of commitment (COC) can undermine the credibility and integrity of these processes, that of the actors involved, and, more alarmingly, the health of the population. Thus, management of COI and COC is critical. Although COI among experts participating in HTA and CPG development are increasingly discussed and managed, little is said about COCs and the possible COI and COC associated with patient participation. The aim of our study, which is part of the Institut national d'excellence en santé et services sociaux (INESSS) continuing improvement process for COI and COC management, was to identify best practices in this matter.

Methods

We examined the COI and COC management policies of ten HTA and CPG organizations and performed a review of the relevant academic literature.

Results

Three HTA and CPG organizations had norms regarding the management of patients’ COI and COC, whether they were representatives of patient associations or not. These norms addressed situations such as: when a patient represents a patients’ association; when a patients’ association or an individual patient has important (financial) ties with the pharmaceutical industry; or when an expert or one of his/her family members suffers from the disease related to the HTA or CPG. The declaration of a COI or COC should not necessarily lead to the individual's exclusion from the entire HTA or CPG development process, but it must lead to some evaluation and management. Patients appointed to share their perspectives are not considered to have COI or COC if their mandate is explicit.

Conclusions

The COI and COC of all participants in HTA and CPG development should be managed fairly and transparently. Therefore, the management of COI and COC among patients participating in HTA or CPG development should be based on the same principles as those applied to clinical experts.
PP132 Telemedicine Enhances Community Hospital Response Capacity
Authors: Galvan Pedro , Velazquez Miguel , Rivas Ronald , Portillo Juan , Mazzoleni Julio , Hilario Enrique
Published: December 2019

Introduction

Telediagnostic apps based on information and communication technology tools can be used to enhance community hospital response capacity. Evidence on how this innovative technology can improve health services is limited, but will likely expand in the new decade. The ability of different telediagnostic methods to enhance the response capacity of community hospitals in rural areas of Paraguay was investigated.

Methods

This descriptive study was carried out by the Telemedicine Unit of the Ministry of Public Health and Social Welfare, in collaboration with the Department of Biomedical Engineering and Imaging of the Health Science Research Institute and the University of the Basque Country, to evaluate the utility of telediagnostic apps for different disciplines in public health. The results from implementing telediagnosis apps in 60 public community hospitals across the country were analyzed and evaluated.

Results

A total of 410,840 diagnoses were performed remotely between January 2014 and August 2018 across 60 rural community hospitals. The diagnoses involved computed tomography (147,627 or 36%), electrocardiography (256,422 or 62%), electroencephalography (6,772 or 2%), and ultrasound (19 or 0.01%). There were no significant differences between the remote and face-to-face diagnoses; remote diagnoses were correct in 93 percent of cases. Utilizing telediagnostic apps reduced costs, which is an important benefit for the 60 communities.

Conclusions

The results showed that telemedicine can significantly enhance the community hospital response capacity of diagnostic services and health programs, making optimal use of professional time and productivity, increasing access and equity, and reducing costs. However, before carrying out the systematic implementation of this technology, contextualization with the regional epidemiological profile must be performed.
PP210 Identification Of Frailty to Healthy Ageing In European Population
Authors: Paz-Valiñas Lucinda , Vallés Maria José Faraldo , Bugarín-González Rosendo
Published: December 2019

Introduction

The European population is aging rapidly. The number of Europeans aged over sixty-five will double in the next fifty years. Active and healthy aging is a societal challenge shared by all European countries, but also an opportunity. The World Health Organization indicated that frailty has become an indicator of lack of successful aging. Therefore, identification of frail elderly is becoming important. However, there are many different screening tools that are currently used to identify frailty. The optimal test should have the capacity to easily identify from the community-dwelling population, those older people at risk of adverse outcomes. During the past years, gait speed has been repeatedly reported as an appealing instrument as a screening tool to detect frailty.

Methods

Systematic review of literature on gait speed as predictor of frailty was performed.

Results

A total of 992 articles were retrieved from the literature search and only eleven studies met the inclusion criteria. Frailty is a common geriatric syndrome, characterized by decreased reserve and increased vulnerability to adverse outcomes, including falls, hospitalization, institutionalization and death. Despite frailty is being increasingly recognized in the literature, there is a paucity of direct evidence to guide interventions to reduce frailty. Many single and composite tools to detect the frailty have been proposed but none is consensual, most are time-consuming while evaluating different domains of impairments, and many are not validated. Gait speed seems to be a single, reliable, valid, sensitive, cheap, quick and simple tool that identifies frailty people. However, the way to perform the test parameters vary widely, influencing interpretations of physical performance.

Conclusions

The evidence recommends to detect frailty in people in order to achieve an active and healthy ageing. Gait speed could be a suitable predictor to identify frailty although this systematic review found many differences between the gait speed protocols used in clinical practice. It is necessary to establish a standard protocol of gait speed agreed by experts in the area on frailty to be implemented with success in clinical practice.