bluuebunny/crossref_metadata_2025 huggingface dataset:
PD174 The Emerging Role Of National Health Service England In The UK – An Access Enabler Or Barrier For Innovations?
Authors: Gassanova Aigun , Leong Katherine , Macaulay Richard
Published: January 2025

Introduction

Since April 2017, National Health Service England (NHSE) has been granted new powers to negotiate directly with pharmaceutical companies offering innovative, high value medicines. This research systematically evaluated all innovative therapies that have undergone commercial discussions with NHSE.

Methods

NHSE press releases for the period from 1 April 2017 to 10 November 2023 were screened for drug reimbursement decisions and the corresponding National Institute for Health and Care Excellence (NICE) assessments were identified. Key information was extracted, including reimbursement decision, date of decision, and type of commercial deal.

Results

NHSE announced the conclusion of commercial discussions for 36 therapies (four in 2017, three in 2018, nine in 2019, two in 2020, nine in 2021, seven in 2022, and two in 2023). Of these, 27 NHSE commercial discussions were associated with positive NICE guidance; 12 of the 27 preceded the NICE final appraisal determination. In addition, three of the 36 therapies were associated with negative NICE appraisals (not recommended or non-submissions), one had an ongoing NICE assessment, and five did not go through NICE (subject to clinical commissioning policies). The specific type of agreement was not typically stated, but two were outcomes-based agreements, three were budget neutral, one was a portfolio-wide agreement, and one was a population health agreement.

Conclusions

NHSE is becoming an increasingly active and important stakeholder in medicines access. The UK may become an increasingly important early launch market for certain therapies, as evidence by the Medicines and Healthcare products Regulatory Agency joining Project Orbis and the Access Consortium and Casgevy (the first CRISPR-based gene therapy) receiving its first global marketing authorization in the UK.
PD178 Impacts Of COVID-19 On Mental Health Services: Telepsychiatry Efficacy And Substance Use Disorder Challenges In The USA
Authors: Kockaya Guvenc , Okcun Selin , Ozdemir Ekin Begum , Erkut Yaren , Kurnaz Mustafa , Tibet Birol
Published: January 2025

Introduction

The COVID-19 pandemic significantly affected mental health, particularly among individuals with existing issues, and altered mental health services. While the direct psychiatric effects of SARS‑CoV‑2 are unclear, there is potential for the virus to cross the blood-brain barrier, raising concerns about neural invasion and inflammation. This study explored these impacts and the implications for future psychiatric disorder epidemiology.

Methods

This study used a mixed-methods approach, combining a literature review on pandemic-related mental health impacts with an analysis of health databases and emergency room records from the USA. It compared pre-pandemic and pandemic data on telepsychiatry, in-person services, emergency visits, and opioid incidents, employing statistical analyses to identify key trends in healthcare utilization during the COVID-19 pandemic.

Results

During the COVID-19 pandemic, rates of telepsychiatry visit completion in the USA reached 74.2 percent, which was 6.68 times higher than in-person visits and indicated that telepsychiatry was an effective alternative. The use of in-person mental health services declined by 57 percent, while telehealth services increased by 1,925 percent, with a notable rise in telehealth for people with anxiety disorders. Concurrently, general emergency room visits dropped by 52 percent. In contrast, there was a 34 percent increase in opioid overdose deaths, reaching a record of 96,779 deaths in 12 months, which highlighted ongoing healthcare challenges in treating substance use disorders. The number of emergency room visits for opioid use disorder surpassed the 2019 value by May 2020.

Conclusions

The pandemic significantly shifted mental health services toward telepsychiatry, proving its effectiveness, especially for anxiety disorders. Despite reduced in-person service usage, telehealth played a vital role. However, the period saw heightened challenges in substance use disorders, marked by a significant increase in opioid overdoses and emergency visits for opioid use disorder, which underscored the need for adapted healthcare strategies.
PD185 Is The Incorporation Of Medications For Ultrarare Diseases In Brazil Predominantly Driven By Costs? A Shift In Paradigm
Authors: da Silva Pereira Curado Daniel , Machado-Rugolo Juliana , Komoda Denis Satoshi , de Paula de Sordi Monica Aparecida , Coneglian de Almeida Juliana Tereza , Fonseca Alan , Lima Silvana Molina , Theresa Weber Silke Anna , Modelli de Andrade Luis Gustavo , Tarride Jean-Eric , Thabane Lehana , de Almeida Cardoso Marilia Mastrocolla , Santos Marisa
Published: January 2025

Introduction

Incorporating technologies for ultrarare diseases (URD) poses challenges for global health technology assessment (HTA) agencies. Difficulties include defining an analytical framework and establishing differentiated cost-effectiveness thresholds. The rise of technological innovations intensifies demands from healthcare professionals, media, and the general population, placing pressure on healthcare systems in developing countries.

Methods

To analyze ultrarare medicine costs in submissions to the Brazilian National Committee for Health Technology Incorporation (CONITEC), data from HTA reports on URD (from 2012 to 2022) were extracted. Diseases were classified as URD based on an epidemiological criterion or Orphanet consultation (prevalence ≤1 per 50,000 inhabitants). Extracted variables included initial and final prices, annual patient cost, incremental cost-effectiveness ratio (ICER), and initial and final CONITEC recommendations. Price differences were calculated by the Brazilian Medicines Market Regulation Chamber.

Results

Among 53 reports, 30 featured economic evaluations, with only 13.3 percent initially receiving positive recommendations. However, eight gained favor, including post-consultation, price-conditioned, and risk sharing-based approvals. Annual medication costs ranged from USD17,439.20 to USD1,108,237.00 per patient, with discounts of between 25 and 64 percent. Despite some technologies having ICERs that were significantly higher than the national threshold, no statistical relationship was found between ICERs and recommendations. Monthly and annual costs varied, with higher costs for heterogeneous diseases and lower costs for metabolic conditions. Sensitivity analyses, using both deterministic and probabilistic analyses, were conducted in 58 percent of the reports.

Conclusions

Incorporation of technologies for URD does not correlate with lower annual costs or increased discounts because costs are not considered in isolation by CONITEC’s decision-making process. Recognizing URD as a subgroup with distinct criteria may enhance the implementation of HTA processes tailored to the unique challenges of these conditions.
PD200 Implications Of The European Artificial Intelligence Act For Health Technology Assessment
Authors: Di Bidino Rossella , Arbia Giuseppe , Sacchini Dario , Cicchetti Americo
Published: January 2025

Introduction

The European parliament is working on a proposal for an Artificial Intelligence (AI) Act. The goal is to guarantee that AI systems used in the European Union are “safe, transparent, traceable, non-discriminatory and environmentally friendly.” The Act is not directly linked to health technology assessment (HTA), but implications for HTA are expected.

Methods

The final aim of the AI Act is the adoption of harmonized rules for AI foundation models. Foundation models are designed to produce a wide variety of outputs that are being adopted across various sectors. Therefore, their adaptation to specific (clinical) needs plays a key role and has implications on the required training data. The goal of our analysis was to critically investigate the potential implications of the Act’s requirements for HTA. The analysis moves from the technology (foundation models in health care) to the requirements and adopted terminology.

Results

The definition of methods to assess the adaptation of foundation models has become a priority for HTA. The Act focuses on data quality, transparency, human oversight, and accountability. Available frameworks, such as the one developed by the AI MIND project, include them, but experience is required. HTA must define how to adapt its methods and frameworks as well as the risk levels addressed by the Act. In addition, the reference to energy efficiency standards confirms the need for HTA to clarify the role of and methods for environmental impact assessment. Finally, the patient perspective has great relevance in relation to the risk of discrimination.

Conclusions

The AI Act confirms the importance of topics already debated in HTA that still need resolution and testing. Harmonization of rules for AI and approaches for HTA is the main challenge. The AI Act, the HTA regulation, and ongoing European Union projects (i.e., AI-MIND and European Digital Health Technology Assessment) are showing the route to follow in the coming years.
PD204 Comparison Of Reimbursement Systems In France Denmark, Norway, And The United Kingdom - Possibilities Of Implementation In Poland
Authors: Rdzanek Magdalena , Chmielewska Magdalena , Dawicki Marcin , Zawada Aleksandra
Published: January 2025

Introduction

Reimbursement schemes should be regularly updated to maintain a trade-off between costs for the system and access to medicines. The aim of this study was to review reimbursement systems in several European countries in terms of solutions that could have a positive impact on the health technology assessment (HTA) and reimbursement processes in Poland (e.g., increasing patient access to medicines while maintaining payers’ spending).

Methods

Secondary publications and the websites of key institutions responsible for drug policy (the Ministry of Health, HTA agencies, and payers) in selected European countries were searched to find unique solutions that could have a positive impact on drug policies in Poland. The keywords used were “drug reimbursement” and “HTA”. A more specific search was conducted as needed.

Results

The following solutions considered worthy of further consideration:

•

central organization of tenders for hospital drugs and conducting price negotiations with regional financial responsibility;

•

determining the maximum annual copayment per patient for reimbursed drugs;

•

complementary private health insurance that reduces patient copayments;

•

creating a separate path for hybrid drugs in the HTA and pricing processes;

•

increasing the number of consultations with the market authorization holder, clinical experts, and the public during drug evaluation; and

•

not accounting for the costs of lost productivity during HTA due to the discrimination of seniors and children.

Conclusions

Minor changes in the HTA process, such as increasing the role of consultations, as well as major systemic changes (e.g., introducing complementary private insurance, creating a separate path for hybrid drugs, and introducing a maximum annual copayment for reimbursed drugs) could improve patients’ access to drugs. Implementing these solutions requires significant adaptation of the local legal framework.
PD205 “Medical Fund” – A Novel Approach To Granting Individuals Access To Cutting-Edge Therapies
Authors: Jachimowicz Michał , Pruszko Cezary , Dziadek Karolina
Published: January 2025

Introduction

Access to innovative and expensive medicines is a significant challenge for Poland’s healthcare system. These therapies often do not meet the reimbursement criterion that is currently set at three times the gross domestic product per capita. Nevertheless, there are ongoing efforts to identify funds that can cover the cost of innovative and expensive medicines.

Methods

A new legal act established the Medical Fund, which is an addition to the regular National Health Fund. The Medical Fund finances medical technologies recognized by the Polish healthcare system as highly innovative or of high clinical value. Lists of such therapies are prepared by the health technology assessment agency, in consultation with clinical experts, and then approved by the Ministry of Health. Simplified marketing authorization applications based on a budget impact analysis, a more straightforward assessment process, and a separate budget may allow patients to access these therapies faster.

Results

Since January 2022, ten highly innovative therapies have been funded for patients with conditions such as spinal muscular atrophy, acute hepatic porphyria, and primary hyperoxaluria. The reimbursement decisions were issued for a two-year period, during which data on treatment efficacy were collected. If the data collected after two years is insufficient to assess the treatment’s efficacy, the decision can be extended without an additional procedure for another two years. After two or four years, the marketing authorization holder must submit a reimbursement application based on a full health technology assessment report. Risk-sharing schemes based on clinical outcomes are mandatory.

Conclusions

The Medical Fund has granted early access to modern therapies. The decision to continue funding for a particular drug depends on whether registry results confirm data from experimental studies.
PD209 Social Burden Of Inflammatory Bowel Diseases In Poland: Impact Of Changes In Drug Programs On Social Security Expenditures
Authors: Binowski Grzegorz , Strządała Dominik , Dziadek Karolina , Nadzieja-Kozioł Agnieszka , Jakubowska Monika , Pruszko Cezary
Published: January 2025

Introduction

Crohn’s disease and ulcerative colitis are chronic conditions that primarily affect young individuals of working age and can lead to severe and irreversible complications, which may result in the temporary or permanent inability to work. The objective of this report was to determine whether including broader reimbursement of innovative drugs would result in tangible benefits from a public expenditure perspective.

Methods

Social security and social insurance fund benefits paid to incapacitated patients between 2012 and 2021 were used to measure the effectiveness of the innovative drug reimbursement policy. The analysis included expenditures per patient and the full population. Disability and sickness benefits were classified as public transfers and were not included in the costs for the pharmacoeconomic analyses. However, they are crucial in evaluating the efficacy of treatment for a specific disease because they broaden the perspective of public spending. An increase in social benefit expenses per patient suggests a decline in the patient’s health status, whereas a decrease indicates an improvement.

Results

The cost of disability benefits for patients diagnosed with Crohn’s disease and ulcerative colitis was approximately EUR5,814 annually. However, the cost of reimbursing drugs used in drug programs per patient was notably lower. The analysis results indicated positive changes in the amount and structure of social benefits for this patient population (e.g., fewer patients receiving disability benefits). This conclusion was further strengthened by an analysis of the data for each province separately.

Conclusions

The expansion of reimbursement for innovative drugs in the treatment of inflammatory bowel disease provides benefits for public spending.
PD215 Assessing Drug Pricing Disparities In Brazil’s Public And Private Healthcare Sectors
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

In Brazil, equitable access to medications is critical. There are significant pricing disparities between the National Health System and private health care, which are influenced by the National Committee for Health Technology Incorporation (CONITEC) and Law 14.307. This study investigated these disparities, with aim of proposing strategies for equitable access and sustainability in health care.

Methods

This analysis compared prices between the public and private sectors for trastuzumab and adalimumab. Public sector prices were obtained from the Health Prices Database (HPD) and private sector prices were obtained from the Unimed National Table of Materials and Medications (TNUMM), as of May 2023. The study evaluated the extent of pricing discrepancies, considering Drug Market Regulation Chamber ceiling prices and industry discounts.

Results

The cost of the trastuzumab biosimilar, KANJINTI® (Amgen Inc.), was BRL15.79 (USD3.24) per mg in the private sector, compared with BRL4.50 (USD0.92) per mg in the public sector (a 250% difference). The original version of adalimumab, HUMIRA® (AbbVie), was priced at BRL5,450.38 (USD1,120.53) in the TNUMM versus BRL2,445.46 (USD502.33) in the HPD (a 123% difference). The adalimumab biosimilar, HYRIMOZ® (Sandoz Inc.), was priced at BRL7,723.99 (USD1,586.87) in the TNUMM compared with BRL2,449.19 (USD503.05) in the HPD (a 215% price discrepancy).

Conclusions

The study highlights significant disparities in drug pricing between Brazil’s public and private healthcare sectors. These disparities affect the financial sustainability of private health entities and elevate costs for consumers, potentially increasing reliance on the National Health System. Policy revisions, price parity strategies, and further studies are vital for a sustainable healthcare system.
PD216 Efficiency Frontier Analysis: Supporting Sustainable Non-Small Cell Lung Cancer Healthcare Policies In Brazil
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

Informed healthcare policies in Brazil rely on robust health technology assessment (HTA), especially for conditions like non-small cell lung cancer (NSCLC). We present an efficiency frontier analysis to evaluate NSCLC treatments that correlates annual treatment costs with clinical outcomes, offering a systematic approach to enhance decision-making in the Brazilian healthcare context.

Methods

This quantitative study analyzed NSCLC drug costs within the Brazilian healthcare system and the clinical efficacy data of pivotal studies. The data were analyzed using Python and R software. The dataset comprised drug costs and hazard ratios for overall survival. After data preparation, which involved normalization and outlier management, we constructed an efficiency frontier by ranking drugs based on cost and effectiveness. A linear regression model was then developed to extrapolate this frontier, deriving a formula that predicts treatment costs for specified improvements in overall survival.

Results

The analysis delineated an efficiency frontier and revealed cost-effective NSCLC treatments in Brazil. The following linear regression equation was derived: overall survival = (1.033551 − 0.000003) × treatment cost (USD). This allows for the estimation of appropriate treatment costs for new therapies based on their expected clinical outcomes. This initial model provides a foundation for estimating the economic impact of new treatments.

Conclusions

This preliminary efficiency frontier analysis offers a novel perspective for evaluating NSCLC treatment strategies in Brazil to support sustainable healthcare policy decisions. The model is subject to limitations due to the absence of a systematic literature review. However, it represents an initial step towards a more comprehensive HTA framework. Further research should refine the model by including systematic data collection and analysis.
PD218 Quantitative Analysis Of The Policy Text For Free Training Of Rural Order-Oriented Medical Students In China
Authors: Li Xiaona , Gao Min , Shao Jiaxian , Yu Yuncong , Yin Wenqiang , Chen Zhongming
Published: January 2025

Introduction

To speed up the construction of grassroots medical and health teams in China, free training of rural order-oriented medical students was launched in June 2010. Based on the theory of policy tools, a quantitative analysis of policy texts at the national level was conducted to explore the use of policy tools and to put forward corresponding suggestions for adjustments.

Methods

From January to February 2023, the research team searched the Peking University Treasure Database and the official websites of the State Council, the National Health Commission, the Ministry of Education, and other ministries for national policy documents related to free training of order-oriented medical students published from June 2010 to May 2023. A policy tool and policy target analysis framework were used to quantitatively analyze the policy documents.

Results

A total of 16 policy documents were included and 213 policy provisions were extracted. From the perspective of policy tools, the proportion of policy provisions using imperative policy tools was the highest (63.4%), followed by advisory policy tools (18.8%). and reward-based policy tools (13.6%). Functional expansion tools (2.8%) and authoritative restructuring tools (1.4%) accounted for a relatively low proportion. The institutional education stage is the main policy target, with provisions accounting for 75 percent (162 articles), followed by the continuing education stage (17.6%; 38 articles), and the postgraduate education stage (7.4%; 16 articles).

Conclusions

The distribution of policy tools for the free training policy of rural order-oriented medical students in China needs to be balanced, and the internal combination of the same policy tools needs to be optimized. The policy targets were mainly concentrated in the education stage of universities.
PD222 Balancing Patient Preferences With Feasible Healthcare Delivery: Using Discrete Choice Experiments Alongside Knowledge Exchange To Inform Care Pathways
Authors: Holmes Emily , Morris Beth , Dixon Pete , Mathieson Amy , Ridsdale Leone , Morgan Myfanwy , McKinlay Alison , Dickson John , Goodacre Steve , Jackson Mike , Hughes Dyfrig , Marson Tony , Noble Adam
Published: January 2025

Introduction

Emergency department (ED) visits for epilepsy are common, costly, and often clinically unnecessary. Configuration of care pathways (CPs) that could divert people away from ED offer an alternative. The aim was to measure patient and carer preferences for alternative CPs and to explore the feasibility of implementing the preferred CPs in the National Health Service (NHS) England with a wider group of stakeholders.

Methods

Formative work (provider survey, service-user interviews, knowledge exchange, and think-aloud piloting) informed a discrete choice experiment (DCE) with six attributes: access to care plan, conveyance, time, epilepsy specialist today, general practitioner (GP) notification, and epilepsy specialist follow-up. This was hosted online with random assignment to two of three scenarios (home, public, or atypical). Logistic regression generated preference weights that were used to calculate the utility of CPs. The highest ranked CPs plus a status quo were discussed at three online knowledge exchange workshops. The nominal group technique was used to ascertain stakeholder views on preference evidence and to seek group consensus on optimal feasible alternatives.

Results

A sample of 427 people with epilepsy and 167 friends or family completed the survey. People with epilepsy preferred paramedics to have access to care plan, non-conveyance, one to three hours, epilepsy specialists today, GP notification, and specialist follow-up within two to three weeks. Family and friends differed when considering atypical seizures, favoring conveyance to urgent treatment centers and shorter time. Optimal configuration of services from service users’ perspectives outranked current practice. Knowledge exchange (n=27 participants) identified the optimal CP as feasible but identified two scenarios for resource reallocation: care plan substitutes specialist advice today and times of strain on NHS resources.

Conclusions

Preferences differed to current practice but had minimal variation by seizure type or stakeholder. This study clearly identified optimal and feasible alternative CPs. The mixed-methods approach allowed for robust measurement of preferences, whilst knowledge exchange examined feasibility to enhance implementation of optimal alternative CPs in the future.
PD224 Evaluating Participant Satisfaction In Health Technology Assessment Reports: A Survey Study In Catalonia, Spain
Authors: Llinàs-Mallol Laura , Moltó-Puigmartí Carolina , Segur-Ferrer oan , Ruiz-Baena Jessica , Gallastegui Edurne , Pla Anna Godo , Estrada Sabadell Maria Dolors , Vivanco-Hidalgo Rosa Maria
Published: January 2025

Introduction

Developing a health technology assessment (HTA) report requires the involvement of relevant stakeholders, specifically healthcare professionals, patients, and industry representatives. Evaluating the satisfaction of participants in HTA reports is crucial to improving internal procedures and increasing the participation of stakeholders, who play a crucial role in adding knowledge and experience to the reports.

Methods

We developed a nine-question survey to assess the satisfaction of healthcare professionals and patients involved in HTA reports. The questions evaluated global satisfaction with participating in the HTA report (scored 0 to 10), as well as with the information received to develop tasks within the report and the time given to perform them. Healthcare professionals (n=86), patients (n=3), and contributors to outcome prioritization (n=4) involved in 12 HTA reports developed in Catalonia, Spain were invited to participate.

Results

Thirty-two contributors (34.4%) responded. Twenty-nine were healthcare professionals (33.7% response rate) and three were patients (100% response rate); 59.4 percent of respondents had only participated in one HTA report. Contributors rated their participation with 8.53 points, with external reviewers and patients being the most satisfied collaborators (9.33 and 9.00 points, respectively). Twenty-eight participants (87.5%) felt they had received enough information to develop their tasks in the report, while the other four (12.5%) would have preferred more specific information about the aims of the evaluation. All but one contributor was satisfied with the amount of time given to perform the required tasks.

Conclusions

Collaborators in HTA reports were satisfied with their participation. Both the information provided about the tasks and the time provided to perform them were adequate. Nevertheless, the assessment team must always ensure that the aims of the evaluation are clear to everyone. We plan to evaluate the satisfaction of industry collaborators in the near future.
PD229 “It’s All About Layers”: Painting The Picture Of Health Inequalities For Health Technology Assessment
Authors: Malcolm Robert , Woods Sam , Holmes Hayden
Published: January 2025

Introduction

Health inequalities can be described as avoidable, systematic, and unjust differences in health between different groups within society. This research described and evaluated potential methods to measure the effects of health inequalities that could be used in health technology assessment (HTA) in the UK. The research included recommendations for current and future policy objectives relating to incorporating health inequalities.

Methods

A targeted literature review was conducted to identify methodological approaches used to incorporate health inequalities in HTA. Stakeholder interviews and a workshop were conducted with a range of stakeholders in the UK. This engagement aimed to discuss any gaps in the literature and to assess whether attitudes, methods, and policies were evolving at the same rate as the literature. Other aims of the engagement included obtaining stakeholder views on health inequalities and a better understanding of the perspectives of decision-makers.

Results

Five potential methods were identified to account for health inequalities, with equity-based weighting and distributional cost-effectiveness analysis considered to be the most feasible quantification methods. Stakeholders reiterated that a deliberative process should remain the center of HTA. Stakeholders also raised issues such as the burden on committees, trade-offs between complexity and accessibility, and the importance of measuring the size and direction of inequality impacts. Recommendations were then produced based on these findings to better account for inequalities in HTA, highlighting the importance of combining a range of approaches.

Conclusions

Both companies and HTA agencies should be more proactive in accounting for health inequalities. Companies should be encouraged to provide quantitative analysis on health inequalities, while decision-makers should be trained in new methods. Despite the recent rise in quantitative methods, qualitative methods remain extremely important for a layered approach to considering health inequalities.
PD237 Perspectives On Involvement In Health Technology Assessment: Insights From Representatives Of Persons With Mental Health Conditions
Authors: López Jorge Alonso , Faraldo Vallés María José , Gómez-Salgado Patricia
Published: January 2025

Introduction

The participation of people with mental health conditions or patient representatives is of relevance in the health technology assessment (HTA) field, although there are some challenges that need to be considered. This study was designed to gain the perspectives of patient representatives with experience participating in HTA projects, with the aim of delving into the main issues and proposing ideas for the future.

Methods

A structured interview, based on five open-ended questions, was formulated and distributed via email. Five patient representatives from the Saúde Mental FEAFES Galicia (the Federation of Associations of Family Members and Persons with Mental Illness of Galicia, Spain) who had actively engaged in HTA projects over the past five years participated in the study. The collected data were analyzed using thematic analysis.

Results

Participants underscored the pivotal role of involving persons with mental health conditions and their representatives in HTA and emphasized the importance of knowing their perspectives, preferences, and values. Challenges included the complexity of HTA reports and processes, in terms of length and the technical language used, and socioeconomic barriers. Proposed solutions included material adaptation, streamlined processes, and institutional and professional support. Future recommendations emphasized improving awareness, disseminating the HTA field, fostering active participation, and emphasizing the relevance of participating in the HTA process. Of particular significance was the encouragement of training and capacity building among patients with mental health conditions.

Conclusions

This study reveals the need to strengthen and facilitate the participation of individuals with mental health conditions in HTA processes, and emphasizes the importance of knowing their perspectives, preferences, and values. Recommendations include training and capacity building, simplifying materials and processes, and providing adequate support.
The Old Republic: Clientelism in American Political Development
Authors: Broxmeyer Jeffrey D.
Published: January 2025

The American state was a republic of patrons and clients throughout the Long Nineteenth Century. Unequal ties of hierarchy and reciprocity went far beyond the partisan administration and electioneering that we associate with the spoils system. As a form of “belated feudalism,” clientelism proved resilient because it was a familial property relation embedded within a diverse and changing society. Officeholding politics subsumed a host of racialized and gendered dependents—White men of lower status, women, children, and the enslaved—into the penumbra of the state, which itself was governed via the extended party household. What elements of patron–client relations endured or changed from the colonial inheritance until the New Deal? This article reinterprets the republic’s classical age, first, by exploring the origins of party patrimonialism, and then, by examining the dynamics of officeholding political economy and the rise of markets for patronage. Political rule before the New Deal had a different orientation. Clientelism fused older lineages of dependence with the kind of profit-seeking exchanges typical of the burgeoning capitalist economy. It was this mixed state, at once patrimonial and capitalist, that proved so difficult to reform at the turn of the twentieth century.
Access to healthcare for children with CHDs in middle and low-income countries: a systematic literature review
Authors: Lopez-Barreda Rodrigo , Salas Wilbaldo , Pavlova Milena , Groot Wim , Ibla Juan C.
Published: January 2025

CHD includes a wide range of cardiac disorders present at birth. If appropriate care is delivered in time, the prognosis is relatively good. However, in many parts of the world, access to healthcare continues to be a problem for these patients, particularly in low- and middle-income countries. The aim of this study was to synthesise and analyse the available evidence to provide a deeper understanding of this problem. The literature search identified 1578 articles, and the final selection included 57 articles. Using the patient-centred healthcare access framework for identifying facilitators and barriers, issues were found at all levels of the health provision pathway, of which diagnosis, referral systems, lack of qualified institutions/health professionals, financing, inappropriate health insurance, and quality of care stand out. More evidence is needed to analyse the effect of potential barriers linked to acceptability. Given the nature of the barriers that this population faces, solutions depend on the health system and the local context.
The prevalence and consequences of support for off-label Ozempic prescriptions
Authors: Callaghan Timothy , Motta Matthew , Stein Michael , Goidel Kirby
Published: January 2025

Ozempic and related semaglutide drugs represent a popular new strategy to address obesity in the United States, yet uptake of these medications has sparked opposition highlighting concerns about off-label drug use policies, drug safety, supply shortages and cost. Public attitudes towards off-label prescribing by physicians broadly, and towards Ozempic in particular, in light of this opposition are unclear. To better understand public sentiment on this topic, we analysed data from a representative survey of 3,420 US adults conducted from 13 to 22 June 2023. Public attitudes towards off-label prescribing were split, with 46.3 percent supporting physician discretion to prescribe off-label. Importantly though, 58 percent of respondents were at least somewhat concerned about Ozempic supply shortages caused by off-label use and 63 percent were concerned about Ozempic safety in the context of off-label use. Further analysis from an embedded survey experiment shows that rhetoric highlighting safety (but not supply) concerns surrounding off-label Ozempic prescribing is associated with a significant drop in support for off-label use. These results suggest that the introduction of obesity drugs like Ozempic present a pharmaceutical industry-led path for combatting obesity, but rhetoric opposing these drugs could blunt public support and uptake.
Exploring the Use of Adaptive Teaching Methods to Improve Class Engagement with a Year 9 Latin Class in Chapter 13 of Suburani
Authors: Shirley Izzy
Published: January 2025

After beginning to teach a year 9 Latin class I noticed a distinct lack of engagement from the majority of the pupils. I decided to use four different adaptive teaching strategies to try to improve engagement from the class. After choosing the four strategies (grouping, questioning, input, and choice) I planned four consecutive lessons around the strategies and modern literature. The study showed that adaptive teaching strategies work best when teachers have good prior knowledge of individual pupils. Without this prior knowledge, I feel the two most successful strategies, grouping and input, would have been significantly less effective. The less effective of the four strategies, questioning and choice, could have been successful with more time and if they were used consistently throughout the teaching year. They both need time in order to develop the way in which they are used by teachers (specifically questioning) and by pupils (both choice and questioning), which is something I will be considering when starting my teaching career.
Interannual Variability of the Indonesian Throughflow in the Makassar Strait Associated With the 2015/2016 Super El Niño
Authors: Xu Wending , Yuan Dongliang , Li Mingting
Published: January 2025

The interannual variability of the Indonesian Throughflow (ITF) in the Makassar Strait in 2015–2017 is analyzed using observations and ORAS5 reanalysis data. Strong northward and ensuing strong southward current anomalies in the sub‐thermocline Makassar Strait are identified during and after the 2015/2016 El Niño, respectively. However, the upper layer current anomalies are weakly southward in September–October 2015 and strongly northward in April 2016 through April 2017. These anomalies of the Makassar Strait throughflow in the upper layer are found to be induced mainly by Indian Ocean Kelvin waves forcing sea surface height anomalies off the south Java coasts. The sub‐thermocline current anomalies are found to be generated by the westward and downward propagation of interannual Rossby waves from the central equatorial Pacific during and after the 2015/2016 El Niño. The results underline the importance of the planetary wave propagation into the Indonesian seas in forcing the ITF anomalies.
Increasing Tephra Deposition in Northeastern North America Points to Atmospheric Circulation Changes at the Early Mid Holocene Transition
Authors: Monteath A. J. , Jensen B. J. L. , Davies L. J. , Bolton M. S. M. , Hughes P. D. M. , Mackay H. , Edwards M. E. , Finkenbinder M. , Booth R. K. , Cwynar L. C. , Harvey J. , Pyne‐O’Donnell S. , Papp C. N. , Froese D. G. , Mallon G. , Amesbury M. J. , Mayfield R. J.
Published: January 2025

The number of cryptotephra (non‐visible volcanic ash) records from northeastern North America is unique in the continent. The resulting tephrostratigraphic framework includes ash deposits sourced from volcanic arcs across the Northern Hemisphere and is an exceptional resource for correlating and dating paleoenvironmental records. It also provides an opportunity to explore more novel questions regarding the controls on ultra‐distal tephra (volcanic ash >3,000 km from source) dispersal and deposition. Here, we examine temporal patterns in the tephrostratigraphy of northeastern North America to test the legitimacy of a previously noted change in ash deposition frequency at the Early Mid Holocene transition. We integrate five new cryptotephra records into the existing framework to improve its temporal and spatial extent and report further occurrences of widespread cryptotephra deposits including Mt. St. Helens We, Jala pumice, White River Ash east, Ruppert tephra, Mt. St. Helens Yn and Mazama Ash. Reexamination of the combined tephrostratigraphy using breakpoint analysis shows a significant increase in the frequency of ashfall after ca. 9,000 (7,860–9,650) cal yr BP (calendar years before C.E. 1950). We discuss this change in relation to volcanic and environmental controls of fine ash dispersal and preservation. We reject hypotheses relating to eruption frequency or depositional processes in favor of changing atmospheric transport patterns and tephra dispersal—possibly caused by the retreat of the Laurentide Ice Sheet. Our study is a novel example of how tephrostratigraphy can be used beyond traditional correlative and dating studies, in this case indicating large‐scale changes in atmospheric circulation through time.
Silyloxy-substituted anthraquinones as Type I photoinitiators for visible light-induced radical polymerization
Authors: Lee Eunseok , Sekizawa Takuya , Kobayashi-Miyajima Yuki , Hirose Takaya , Himori Shunichi , Yamada Akihiko , Gotoh Hiroaki
Published: January 2025

Among the photoinitiators that can be activated using ultraviolet-visible light-emitting diodes, Type I photoinitiators often contain sulfur, nitrogen, and phosphorus and may affect human health and the environment, whereas Type II photoinitiators typically contain only carbon, hydrogen, and oxygen, as exemplified by anthraquinone derivatives, but require coinitiators. Hence, sulfur-, nitrogen-, and phosphorus-free Type I photoinitiators are highly desirable. In our pursuit of such photoinitiators, we examined the ability of different silyloxyanthraquinones to initiate radical photopolymerization upon irradiation at 405 nm and found that some achieved high conversion in the absence of a coinitiator. The initiation mechanism was probed by analyzing the photolysis products, electron spin resonance spectroscopy, and isotope labeling experiments. The 1-substituted silyloxy compounds acted as Type I photoinitiators, generating isopropyl radicals as the initiating species. These compounds are among the very few known Type I photoinitiators with an anthraquinone skeleton that are sensitive to 405 nm visible light. The findings of this study facilitate the design of clean initiators free of the sulfur, nitrogen, and phosphorus commonly present in other Type I initiators.
Canine Best disease as a translational model
Authors: Aguirre Gustavo D. , Beltran William A.
Published: January 2025

In this review, we summarize the findings of several pre-clinical studies in the canine BEST1 disease model. To this end, client-owned and purpose bred dogs that were compound heterozygotes or homozygotes, respectively, for two or one of 3 different mutations in BEST1 were evaluated by ophthalmic examination, cSLO/sdOCT imaging, and retinal immunohistochemistry to characterize the clinical and microanatomic features of the disease. Subsequently AAV-mediated gene therapy was done to transfer the BEST1 transgene to the RPE under control of a hVMD2 promoter. We demonstrated that canine bestrophinopathies are an RPE-photoreceptor interface disease with underdeveloped RPE apical microvilli that invest rod and cone outer segments. This leads to microdetachments which later progress to clinically evident RPE-retinal separation and a spectrum of disease stages, ranging from vitelliform to vitelliruptive/atrophic lesions, similar to Best Vitelliform Macular Dystrophy (BVMD). Gene therapy corrects the microdetachments and reverses large lesions when delivered at the pseudohypopyon stage of disease. Because of the similar clinical and microstructural abnormalities between the canine model and BVMD, and positive response to gene therapy, the canine model is a valuable translational model for developing gene and other therapies for BVMD.
Exposing the obscured influence of state-controlled media via causal inference of quotation propagation
Authors: Schlessinger Joseph , Bennet Richard , Coakwell Jacob , Smith Steven , Kao Edward
Published: January 2025

Reporting by major media outlets influences news coverage by other outlets, resulting in an outsized impact on public opinion. Understanding this inter-outlet influence, known as intermedia agenda setting, is important for assessing the impact of state media and strategic communications. We demonstrate a novel method to quantify inter-outlet influence using causal inference on “quote following,” where one outlet uses the same quote as another outlet at a later date. By applying our methodology to a dataset of quotes from over 100,000 articles published in European media between May 2018 and October 2019, we reveal obscured influence by Russian state-affiliated media over other outlets and the general dynamics of European media. We find that Russian state-controlled media have a strong influence on the coverage of other Russian outlets, including independent outlets. Moreover, this influence extends to media ecosystems of other countries. Finally, we demonstrate quantifying inter-outlet influence on the specific topic of nuclear forces treaty, as an example of precision study of intermedia agenda setting on specific issues. Overall, our methodology quantifies sources and channels of influence between news outlets with important implications for strategic communication, influence operations, and media independence.
Examination of the requirements for powered air-purifying respirator (PAPR) utilization as an alternative to lockdown
Authors: Fujii Yusaku
Published: January 2025

With the emergence of COVID-19 variants and new viruses, it remains uncertain when the next pandemic will occur. A lockdown is considered the last resort to halt the spread of infection; however, it causes significant economic and social damage. Therefore, exploring less harmful alternatives during such scenarios is crucial. This study explores the feasibility of using a powered air-purifying respirator (PAPR) as an alternative to lockdowns and as a strategy for infection control. Specifically, the study examines the potential impact of the PAPR wearing rate and PAPR aerosol shielding performance on the controllability of the spread of infections. The study investigated the necessary PAPR wearing rate and aerosol shielding performance to control infections as an alternative to the lockdown, using a simple simulation under limited conditions. When using a PAPR with 100% aerosol shielding capability in air supply, only 55% of the population needs to consistently wear the PAPR to reduce the effective reproduction number from a critical level (Rt = 2) to a target level (Rt = 0.9). Furthermore, if everyone consistently wears PAPR, only 55% the reduction ratio in the probability of becoming infected by PAPR supplying air Ir_in is enough for reducing the effective reproduction number from a critical level (Rt = 2) to a target level (Rt = 0.9). This study demonstrates the potential for utilizing PAPR as an alternative to lockdowns.