bluuebunny/crossref_metadata_2025 huggingface dataset:
OP316 Patients’ Testimonials In The National Committee For Health Technology Incorporation In Brazilian Public Health System (Conitec) Meetings
Authors: Portugal Clarice , Prates Adriana , Losco Luiza , Floriano Fabiana , da Silva Odete , de Souza Andrea , Viana Bruna , Prado Corah , Canuto Vania
Published: December 2021

Introduction

The Department of Management and Incorporation of Technologies and Innovation in Health (DGITIS) acts as Conitec's Executive Secretariat. Among its attributions, it promotes the public/patient involvement in the health technology assessment (HTA) process. Recently, Conitec has been working on the inclusion of patient's testimonials about their illness experience in the plenary sessions, that is, the monthly meeting where technologies are assessed.

Methods

To support the action of including patient reporting in Conitec's HTA process, DGITIS developed research on HTA agencies websites worldwide. The main criteria was the inclusion of patients’ reports in their Committee meetings. DGITIS contacted some of these agencies and requested a listserv question to the International Network of Agencies for Health Technology Assessment (INAHTA) members. These findings supported the DGITIS for the inclusion of patient participation in Conitec's meetings, from the selection process to the actual participation.

Results

For the Conitec's HTA process, the patients’ participation should occur in the prior session to the public consultation, guaranteeing the inclusion of their perspective since the recommendation process beginning. Hence, every demand for incorporation to be discussed at Conitec's meeting should be preceded by a public call for patients with the clinical condition. The DGITIS will also hold preparatory meetings, which will serve as moments for shared construction of knowledge and literacy.

Conclusions

The nomination process, so far, has been grounded as a consensus among the patients. Thus, Conitec acts as a mediator, connecting the involved stakeholders, in a way that they can autonomously organize themselves and indicate the main representative and an alternate one. With the inclusion of the patient's perspective in the Conitec's meeting, another form of patient participation was opened in the HTA process. Therefore, the consolidation of this participation space is feasible and contributes to enrich the Brazilian HTA process.
OP321 The Scale And Variation Of The Impact Of COVID-19 On Prescribing Of Medicines In Primary Care In Wales
Authors: Hardy Will , McManus Dan , Murphy Susan , Hughes Dyfrig
Published: December 2021

Introduction

Prescribing of medicines in primary care in Wales has been exceptional in 2020 due to COVID-19 and the associated changes to the delivery of health services. The changes are likely to have harmful, albeit unintended, consequences, including disruption of pharmacy stock management; unpredictable changes in prescribing; and interruption to patients’ supply of medicines and reduced medication adherence. Changes in prescribing are unlikely to be distributed evenly across the country or population. Therefore, this study aimed to identify changes in GP prescribing compared with previous years, the variation of these changes, and factors related to the variation in changes, to identify patient subgroups for whom the impact is disproportionate.

Methods

We identified medicines of interest where concerns around prescribing have been raised and, for each of these medicines, retrieved monthly prescribing data for each GP practice in Wales (N = 492). We then linked these data with other publicly available data (for example, practice size, indices of multiple deprivation, disease prevalence).

We developed a novel approach to measure the impact of COVID-19 on GP prescribing. We compared observed with expected prescribing volume projected via time series modelling and differences were related to patient and practice characteristics using general estimating equations.

Results

There was evidence of stockpiling of medicines during March 2020 (for example, oral-contraceptives and oral-anticoagulants with 11.6 and 18.5 percent increases from March 2019), followed by a short-term reduction in prescribing for oral-contraceptives (a reduction of 12.9 percent), but not oral-anticoagulants (an increase of 6.5 percent). However, GP level data show considerable deviation from the national trend for several GPs, which may be due to health and socio-demographic factors.

Conclusions

COVID-19 has had a major impact on primary care prescribing in Wales. The distribution of changes in prescribing will not be even across the country or the population. Identification of systematic variation in impacts on prescribing could identify geographical areas or patients in need of additional support to ensure uninterrupted and appropriate access to medicines.
OP440 Comparison Of Evidence Supporting Cancer Drug Approvals And Prices In The US And Brazil
Authors: Brummell Adriana Ivama , Naci Huseyin
Published: December 2021

Introduction

Cancer drug prices are high on the policy agenda worldwide. Previous research found no association between cancer drug benefits and prices at the time of regulatory approval. Drugs approved in the US with uncertain benefits may have spill-over effects in other settings. Our objective was to compare the evidence supporting cancer drug approvals in the US and Brazil, and to examine the association between cancer drug prices and availability of added therapeutic benefit.

Methods

We matched all novel cancer drugs approved in the US from 2010–2019 to approvals in Brazil. We extracted data on pivotal study design characteristics and outcomes in the US and Brazil, and evidence supporting price approval in Brazil, including availability of added therapeutic benefit.

Results

From 2010–2019, fifty-six cancer drugs with matching indications were approved in US and Brazil and had their prices authorized in Brazil by December 2020. Drug were available in Brazil following a median 522 days after US approval (IQR: 351–932). In the US, thirty-four (60.7 percent) of the drugs had pivotal randomized controlled trials (RCTs) and Twelve (21.4 percent) had overall survival benefit. By the time of Brazilian approval, forty-one (73.2 percent) drugs had pivotal RCTs and twenty-two (39.3 percent) had overall survival benefit. A total of twenty-eight (50 percent) drugs did not demonstrate added therapeutic benefit over other authorized drugs for the same indication and had a median reduction from requested to approved price of 6.1 percent (IQR: 0–27.8 percent) in Brazil. The twenty-seven (48.2 percent) drugs with added therapeutic benefit had a median price reduction of 2.0 percent (IQR: 0–9.2 percent).

Conclusions

Half of new cancer drugs approved in Brazil failed to demonstrate added therapeutic benefit. The Brazilian pricing system secured considerable price reductions, ensuring that prices for medicines with no added therapeutic benefit were not higher than existing treatments for the same approved indication. Although evidence was more mature by the time of Brazilian review, pivotal studies often lacked randomization and overall survival endpoints.
OP456 Encouraging Shared Decision-Making Of Goals Of Care Discussions In Lung Cancer Patients Using A Smartphone Application
Authors: Lovato Amanda , Almeida Nisha
Published: December 2021

Introduction

An important reason for receiving non-beneficial treatment at end-of life is the lack of timely discussions on goals of care and end-of-life preferences. A recent randomized clinical trial demonstrated that patients primed with a questionnaire on their end-of-life preferences were more likely to initiate such conversations with their doctors. Our objective is to integrate the questionnaire into a smartphone application to facilitate early goals of care discussions. To achieve this goal, we first plan to undertake a feasibility study to understand stakeholder preferences.

Methods

As part of a quality improvement initiative at our Canadian quaternary-care hospital, we conducted focus groups with oncology and palliative care physicians and patients to understand barriers to early conversations on end-of-life preferences, and to assess feasibility of using smartphone technology in facilitating these conversations. The app would integrate a questionnaire to patients and send prompts to physicians on patient readiness and timing of conversations.

Results

We conducted separate focus groups with lung cancer patients (n = 6) and clinicians in oncology (n = 6) and palliative care (n = 6). Clinical teams expressed enthusiasm about early conversations but raised several barriers including system (lack of electronic documentation and access to data; multiple physicians), clinician (lack of time) and patient (stigma associated with end-of-life) barriers. Clinicians agreed that an app could overcome some of these barriers such as access to patient and electronic data by making patients the repository of all their data and empowering them to initiate discussions. However, they raised concerns about universal accessibility of such technology, especially among the elderly. Patient focus groups will take place in March 2021 and inform us on feasibility in this population.

Conclusions

There is a consensus among physicians at our hospital that early end-of-life conversations have the potential to mitigate adverse events and that use of a smart phone app could facilitate such conversations.
PP152 Epigenetic In Vitro Diagnostic Test For Early Diagnosis In Lung Cancer: An Early Assessment
Authors: Hijas-Gómez Ana Isabel , Polo-de-Santos Mar , Luengo-Matos Setefilla , Sánchez-Gómez Luis Maria
Published: December 2021

Introduction

Lung cancer is a leading cause of morbidity and mortality, and early diagnosis is essential for patient survival. Epigenetics is an innovative discipline that provides biomarkers to aid in early diagnosis, patient risk classification, or outcome prediction. Each type of tumor may present specific patterns of gene methylation, the analysis of which may be useful as a diagnostic tool. The aim of this study was to conduct an early assessment of novel in vitro diagnostic (IVD) tests based on the identification of DNA hypermethylation epigenetic signatures developed for the early detection of lung cancer.

Methods

We identified this technology through the Early Awareness and Alert System “SINTESIS-new technologies” of the Agencia de Evaluación de Tecnologías Sanitarias - Instituto de Salud Carlos III. A literature search of PubMed, the Trip Medical Database, the International Clinical Trials Registry Platform, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials was conducted. Studies published up to November 2019 were reviewed.

Results

Three tests were identified. Epi proLung® analyzes the hypermethylation status of SHOX2/PTGER4 genes in blood samples using polymerase chain reaction (PCR) and showed good discrimination capacity with respect to healthy controls (area under the curve [AUC] = 0.91) and patients with non-malignant lung diseases (AUC = 0.86). The Epi proLung BL Reflex Assay® for determining the hypermethylation state of the SHOX2 gene in bronchoalveolar lavage samples by PCR had modest sensitivity (69%, 95% confidence interval [CI]: 64–75) and high specificity (96%, 95% CI: 97–100). A test in development for determining the hypermethylation state of BCAT1/CDO1/TRIM58/ZNF177 genes in aspirated or bronchoalveolar lavage samples by pyrosequencing yielded a sensitivity of 85 percent and a specificity of 81 percent, with an AUC of 0.91 at the optimal cutoff point.

Conclusions

The evidence for the three tests showed promising results in terms of diagnostic validity. However, although personalized medicine is becoming increasingly widespread in the field of cancer diagnosis, more studies are needed to evaluate the clinical utility of these diagnostic tests, either as a complementary or a screening test, and the economic impact of their use.
PP180 Optimal Treatment Sequence For Targeted Immune Modulators For The Treatment Of Moderate To Severe Ulcerative Colitis
Authors: Bloudek Lisa , Ollendorf Dan , Pandey Rajshree , Fazioli Katherine , Carlson Josh
Published: December 2021

Introduction

Several targeted immune modulators (TIMs) have demonstrated effectiveness in moderate-to-severe ulcerative colitis, including adalimumab, golimumab, infliximab, infliximab biosimilars, tofacitinib, ustekinumab, and vedolizumab. In addition to assessing individual TIMs, evaluating TIM sequences can inform clinical care as well as coverage and reimbursement policies. Our objective was to identify optimal treatment sequences based on maximum net health benefit (NHB), lowest total cost (cost minimizing), quality-adjusted life-year (QALY) maximization, or convenience (avoidance of intravenous treatments), and to evaluate their cost effectiveness compared with conventional treatment from the health sector perspective.

Methods

We developed a Markov model with eight-week cycles and a lifetime time horizon. The health states were active, clinical response without remission, remission, and death. TIM efficacy was informed by a network meta-analysis conducted by the Institute for Clinical and Economic Review. Sequences were generated by ranking TIMs and then conventional treatment according to NHB, cost minimization, QALY maximization, or convenience and combining top ranked TIMs in the biologic naïve and biologic experienced populations. NHB was calculated at USD 150,000 per QALY. Probabilistic sensitivity analysis (PSA) was undertaken to estimate the probability of each sequence having the highest NHB rank, QALY maximizing rank, and cost-minimizing rank.

Results

Twenty-one sequences were evaluated. The sequence with the highest NHB was infliximab followed by tofacitinib (-0.12 QALYs), which also had the lowest incremental costs (USD37,266). For orally and subcutaneously administered TIMs, the sequence of golimumab-tofacitinib had the highest NHB (-0.34 QALYs). Ustekinumab-vedolizumab was not only the top ranked sequence as measured by QALY maximization (0.172 incremental QALYs), but it also had the highest total incremental cost (USD166,094). Results of the PSA were consistent with deterministic rankings for the top-ranking sequences and showed that the top two or three regimens were close in magnitude.

Conclusions

The optimal sequence with regard to NHB and cost minimization was infliximab or biosimilars, followed by tofacitinib, adalimumab, or vedolizumab. Sequences that generated the most QALYs began with ustekinumab, followed by vedolizumab, tofacitinib, and adalimumab.
PP206 Health Technology Assessment Guidance In The United Kingdom: Addressing Issues Specific To Medical Devices
Authors: Gibson Scott , Saunders Sita , Hedblom Amanda Hansson , Blüher Maximilian , Torres Rafael Torrejon , Saunders Rhodri
Published: December 2021

Introduction

The United Kingdom spends approximately GBP4.2 billion (USD5.6 billion; EUR4.7 billion) each year on medical devices, but healthcare providers receive little health technology assessment (HTA) guidance on cost-effective device procurement. Our objective was to assess the availability of HTA guidance for medical technologies and to identify key challenges related to the economic assessment of these technologies.

Methods

National Institute for Health and Care Excellence technology appraisal (TA) and Medical Technologies Evaluation Programme (MTEP) appraisals published online between November 2009 and October 2020 were identified. The “case for adoption” recommendation, type of devices, and critiques of economic analyses for each MTEP appraisal were extracted and categorized.

Results

In comparison to 415 publicly available TAs for pharmaceuticals, only 45 medical technologies have been appraised through the MTEP. MTEP-submitted technologies can be categorized into diagnostic (7), monitoring (3), prophylaxis (5), therapeutic (28), and other (2). Furthermore, 11 were implants, seven were used by patients, and 27 had provider interaction. Major points of MTEP criticism were a failure to model cost consequences, training costs, and organizational impact. There was also the barrier of transferring costs across budgeting divisions.

Conclusions

In comparison to HTA guidance for pharmaceuticals, there is a dearth of medical device guidance. Therapeutic and implantable devices appear to be disproportionately overrepresented in the MTEP process. This may be because their appraisal is most akin to pharmaceuticals, for which HTA processes are well established. To encourage more HTAs of medical devices, HTA guidance should elaborate on issues specifically related to medical devices.
PP283 Living Systematic Reviews In Time Of COVID-19: An Innovative Approach To Decision-making In An Environment Of Changing Evidence
Authors: Paz-Valiñas Lucinda , Mejuto-Martí Teresa , Casal-Acción Beatriz , Triñanes-Pego Yolanda , Maceira-Rozas María del Carmen , Cantero-Muñoz Paula Gaudalupe , Puñal-Rioboó Janet , Rodríguez-González del Blanco Paula Sabela , Faraldo-Vallés María José
Published: December 2021

Introduction

The management of the COVID-19 pandemic is a challenge for Health Technology Assessment (HTA) methodology due to the need to formulate evidence-based recommendations in times of uncertainty in minimal time - for a large number of publications and with changing or even contradictory information. Living systematic reviews (LSRs) are systematic reviews that are continually updated, incorporating relevant new evidence as it becomes available. Since the COVID-19 pandemic fits all criteria to perform LSRs: (i) the Review question is a particular priority for decision-making, (ii) there is an high level of uncertainty about the existing evidence, and (iii) there is likely to be emerging evidence that will impact on the conclusions of the LSR, the aim of which is to analyze the role of LSRs as an innovative approach to HTA in recent years, and its impact on the management of the pandemic.

Methods

A systematic search of LSRs (published or protocols) was run on the main biomedical databases (Medline, Embase and Cochrane Library) in November 2020 and it was rerun in June 2021 without time limit. The results will be analyzed and classified by year and category (epidemiology, treatment, prognosis, symptoms, diagnosis and vaccines).

Results

The literature research has returned a total of 187 publications. The LSR concept emerged in 2014, from which some LSRs began to be published, but an exponential increase has been observed in 2020 with 76 references of which 66 percent were focused on the SARS-CoV-2. By category, 81.8 percent were focused on treatment, 41.8 percent on epidemiology, 20.9 percent on rehabilitation, 15.1 percent on diagnosis, 10.2 percent on prognosis and 2.2 percent on symptoms until June 2021. There wasn't any LSR for vaccines and 28 percent was focused on other fields.

Conclusions

LSRs are particularly important during the COVID-19 pandemic, with research evidence emerging rapidly, current evidence being uncertain, and new research changing policy or decisions on health. The majority of LSRs published up to June 2021 were focused on the treatment of COVID-19.
PP293 Tiered Rapid Response Products In The Evidence Directorate Of Healthcare Improvement Scotland
Authors: Anand Neil , Campbell Evan , Macgann Tracey , Macpherson Karen , Muniz Tomas
Published: December 2021

Introduction

The Evidence Directorate produced eighteen rapid responses during the early stages of the COVID-19 pandemic. To address this need while retaining methodological integrity a three-tiered system for rapid responses was developed.

Methods

All rapid responses answer specific research questions rather than broad health system issues. The appropriate level varies depending on the time and resource available, and the requester's need:

•

Level 1 – Reference List (turnaround 4–8hrs, delivered by an information scientist): a quick search for best available evidence, and results presented as a reference list.

•

Level 2 – Summary of evidence (turnaround 1–2 days, delivered by an information scientist): a quick search and brief summary of the best available evidence.

•

Level 3 – Synthesis of evidence (turnaround 3–7 days, delivered by a Health Services Researcher or Health Economist): a quick search and then a narrative summary and synthesis of the best available evidence, with a brief appraisal of validity, reliability and generalizability.

Results

Since the launch of the three-tiered model in September 2020 there have been five rapid responses. Two were Level 2 products and three were Level 3 products.

Conclusions

The Evidence Directorate of Healthcare Improvement Scotland now has an agile rapid response product which can be applied to a variety of settings and needs. This was borne out of a need for a rapid turnaround and evidence synthesis during the COVID-19 pandemic.
PP297 Management Of Sudden Onset Severe Headache Presenting To The Emergency Department: A Systematic Review
Authors: Wade Ros , Walton Matthew , Harden Melissa , Hodgson Robert , Eastwood Alison , Storey James , Hassan Taj , Randall Marc , Hassan Abu , Williams John
Published: December 2021

Introduction

Sudden onset severe headache is usually caused by a primary headache disorder but occasionally is secondary to a more serious problem, such as subarachnoid hemorrhage (SAH). Guidelines recommend non-contrast brain computed tomography (CT) followed by lumbar puncture (LP) to exclude SAH. However, guidelines pre-date the introduction of more sensitive modern CT scanners. A systematic review was undertaken to assess the clinical effectiveness of different care pathways for the management of headache in the Emergency Department.

Methods

Eighteen databases (including MEDLINE and Embase) were searched to February 2020. Studies were quality assessed using criteria relevant to the study design; most studies were assessed using the QUADAS-2 tool for diagnostic accuracy studies. Where sufficient information was reported, diagnostic accuracy data were extracted into 2 × 2 tables to calculate sensitivity, specificity, false-positive and false-negative rates. Where possible, hierarchical bivariate meta-analysis was used to synthesize results, otherwise studies were synthesized narratively.

Results

Fifty-one studies were included in the review. Eight studies assessing the accuracy of the Ottawa SAH clinical decision rule were pooled; sensitivity was 99.5 percent, specificity was 23.7 percent. The high false positive rate suggests that 76.3 percent SAH-negative patients would undergo further investigation unnecessarily. Four studies assessing the accuracy of CT within six hours of headache onset were pooled; sensitivity was 98.7 percent, specificity was 100 percent. CT sensitivity beyond six hours was considerably lower (≤90%; 2 studies). Three studies assessing LP following negative CT were pooled; sensitivity was 100 percent, specificity was 95.2 percent. LP-related adverse events were reported in 5.3–9.5 percent of patients.

Conclusions

The evidence suggests that the Ottawa SAH Rule is not sufficiently accurate for ruling out SAH and does little to aid clinical decision making. Modern CT within six hours of headache onset (with images assessed by a neuroradiologist) is highly accurate, but sensitivity reduces considerably over time. The CT-LP pathway is highly sensitive for detecting SAH, although LP resulted in some false-positives and adverse events.
PP353 Patient-Reported Outcomes: What Matters For Brazilian Breast Cancer Patients?
Authors: Silva Aline Silveira , França Ana , Padilla Matheus Piccin , Macedo Luana Schroeder , Magliano Carlos , Santos Marisa
Published: December 2021

Introduction

Patient-Reported Outcomes (PRO) are directly reported by the patient without interpretation of the patient's response by a clinician or anyone else and pertains to the patient's health, quality of life, or functional status associated with health care or treatment. It can provide patients’ perspectives regarding treatment benefit and harm, directly measure treatment benefit and harm beyond survival, and are often the outcomes of most importance to patients. This study aims to analyze outcomes reported by Brazilian women diagnosed with breast cancer and rank the most important attributes for these patients.

Methods

Observational study composed of interviews and questionnaires applied to a convenience sample of women diagnosed with breast cancer. The instruments were developed taking into account the literature on the topic and the expertise of specialists. The questionnaire was built with close-ended questions using multiple-choice and a Likert scale, in order to rank the attributes and outcomes found in the interviews.

Results

The total sample was composed of 65 women diagnosed with breast cancer. Twelve women were interviewed, in September 2020, to explore the main outcomes and preferences about their treatments, such as the most common side effects and the most impacted aspects of life after diagnosis and breast cancer treatment. Psychological, emotional, and sexual impacts were frequently described as aspects of life affected by the disease and its treatment. Fifty-three women, from all the five Brazilian regions, answered the survey applied in October and November 2020. Following an order of importance ranking, the following outcomes were chosen, respectively: overall survival, progression-free survival; and quality of life. The treatment effects that were considered less important, among this sample, were pain and adverse events.

Conclusions

Thinking about expanding the therapeutic quality of users, it is essential to take into account the experiences of patients. PRO is a trend in current research to achieve this goal, in order to influence the decisions of HTA agencies about the importance of valuing outcomes that affect patients' lives.
Closest conjunct agreement with attributive adjectives
Authors: An Aixiu , Abeillé Anne
Published: December 2021

Contrary to most French grammars claiming that French only allows masculine agreement when mixed-gender nouns are conjoined, we show that closest conjunct agreement (CCA) does exist in contemporary French, as in other Romance languages, and is the preferred strategy for prenominal adjectives. Using data from a large corpus (FrWac) and an acceptability rating experiment, we show that (feminine) CCA is well accepted in contemporary French, and should be distinguished from attraction errors, despite the norm prescribing masculine agreement. We also show the role of the adjective position, i.e. prenominal or post-nominal, and humanness. CCA is the preferred strategy for prenominal adjectives, and non-human nouns favour CCA for post-nominal adjectives. Assuming a hierarchical structure for coordination, the closest noun is the highest in A-N order, whereas it is the lowest in N-A order. Thus CCA in prenominal position may be favoured by a shorter structural distance. One can also see CCA with a prenominal adjective as ‘early’ agreement. Regarding humanness, grammatical gender is interpreted as social gender with human nouns, and a masculine plural can refer to a mixed group. This ‘gender neutral’ plural may favour masculine agreement for human nouns, or the prescriptive norm is more influential for human nouns.
Aleutian Tern Onychoprion aleuticus abundance estimates at four globally significant colonies
Authors: RENNER HEATHER , RENNER MARTIN , LYONS DON , ZYKOV VLADIMIR , REVYAKINA ZOYA , OEHLERS SUSAN
Published: December 2021

Aleutian Tern Onychoprion aleuticus numbers have been in steep decline at known Alaskan breeding colonies in recent decades (IUCN recently uplisted to ‘Vulnerable’). Available data suggest that most of the species may currently breed in Russia. Efforts to document global abundance and trends have been hampered by remoteness of colonies, lack of a formal monitoring programme, and the absence of reproducible population estimates with quantifiable errors, especially for large colonies. We surveyed four historically large colonies in Russia (2018) and Alaska (2019), which together may comprise 30–50% of the global breeding population. At each colony we obtained high resolution aerial photographs using a small Unmanned Aircraft System (sUAS). The large size of the colonies and the minimum altitude required to identify terns made it impractical to collect imagery of the entire colony. Instead, we employed a sampling approach, with sample locations selected based on spatially balanced acceptance sampling. Statistically sampled, low altitude sUAS images provided a fast, reproducible, and rigorous count of abundance for geographically large colonies, with low disturbance, and were generally consistent with concurrent ground-based observations. Concurrence among observers in photo counts indicated high precision in counts of attending birds and unattended nests, although species attribution in mixed tern colonies remains a source of significant uncertainty. Our results indicate that the four colonies surveyed here together supported <2,500 pairs of Aleutian Terns in the survey years. None of the colonies approached their peak size reported previously, likely due to recent predation, long-term decline, cold early season weather, or other factors. If these reduced colony sizes are representative of the current conditions, the implications for the global population would be dire.
Proposed multidimensional pain outcome methodology to demonstrate analgesic drug efficacy and facilitate future drug approval for piglet castration
Authors: Baysinger Angela , Webb Sherrie R. , Brown Jennifer , Coetzee Johann F. , Crawford Sara , DeDecker Ashley , Karriker Locke A. , Pairis-Garcia Monique , Sutherland Mhairi A. , Viscardi Abbie V.
Published: December 2021

Castration of male piglets in the United States is conducted without analgesics because no Food and Drug Administration (FDA) approved products are labeled for pain control in swine. The absence of approved products is primarily due to a wide variation in how pain is measured in suckling piglets and the lack of validated pain-specific outcomes individually indistinct from other biological responses, such as general stress or inflammation responses with cortisol. Simply put, to measure pain mitigation, measurement of pain must be specific, quantifiable, and defined. Therefore, given the need for mitigating castration pain, a consortium of researchers, veterinarians, industry, and regulatory agencies was formed to identify potential animal-based outcomes and develop a methodology, based on the known scientific research, to measure pain and the efficacy of mitigation strategies. The outcome-based measures included physiological, neuroendocrine, behavioral, and production parameters. Ultimately, this consortium aims to provide a validated multimodal methodology to demonstrate analgesic drug efficacy for piglet castration.

Measurable outcomes were selected based on published studies suggesting their validity, reliability, and sensitivity for the direct or indirect measurement of pain associated with surgical castration in piglets. Outcomes to be considered are observation of pain behaviors (i.e. ethogram defined behaviors and piglet grimace scale), gait parameters measured with a pressure mat, infrared thermography of skin temperature of the cranium and periphery of the eye, and blood biomarkers. Other measures include body weight and mortality rate.

This standardized measurement of the outcome variable's primary goal is to facilitate consistency and rigor by developing a research methodology utilizing endpoints that are well-defined and reliably measure pain in piglets. The resulting methodology will facilitate and guide the evaluation of the effectiveness of comprehensive analgesic interventions for 3- to 5-day-old piglets following surgical castration.
Progressing Towards a Freer Market in Australian Residential Aged Care
Authors: Cochrane Susan F , Holmes Alice L , Ibrahim Joseph E
Published: December 2021

The Royal Commission into Aged Care Quality and Safety has again focussed attention on the failings of the Australian aged care system. Residential aged care in Australia has become increasingly market-driven since the major reforms of 1997. The aims of increased marketisation include providing residents with greater choice, higher quality services, and increasing providers’ efficiency and innovation. However, marketisation is not meeting these aims, predominantly due to asymmetries of knowledge and power between residents and aged care providers. These asymmetries arise from inadequate provision of information, geographic disparities, urgency for care as needs arise acutely, and issues surrounding safety, including cultural safety. We propose a human rights framework, supported by responsive regulation, to overcome the failings of the current system and deliver an improved aged care system which is fit for purpose.
Different, Yet the Same: Three Decades of Family Policy Change in Hungary, Lithuania and Romania
Authors: Kovacs Borbala
Published: December 2021

The article analyses over-time changes in family transfers in Hungary, Lithuania and Romania from 1990-2018 to seek evidence of similarity in the ethos of policy adaptation. Informed by recent scholarship signalling growing disparities in social entitlements along socio-economic lines in Hungary and Romania, the analysis assesses whether three decades of change in family transfers in three different policy contexts might exhibit the selective, pro-wealthy ethos of social policy transformation described. Using data from an original dataset drawing on exhaustive social legislation pertaining to family allowances, family tax breaks and paid parental leave-related transfers, the article shows that, for most of the last three decades, institutional dualisms in the protection of families with dependent children have grown. Policy drift undercuts the rights of the neediest and policy layering leads to programme expansion targeting dual-earner, high-income families especially. This trend has intensified over the last fifteen years and is most evident in paid leave schemes.
Maternal high-fat diet consumption programs male offspring to mitigate complications in liver regeneration
Authors: Fante T. , Simino L. A. P. , Fontana Marina Figueiredo , Reginato Andressa , Ramalheira Thomaz Guadagnini , Rodrigues Hosana Gomes , Lisboa Patricia Cristina , de Moura Egberto Gaspar , Ignácio-Souza Leticia Martins , Milanski Marciane , Torsoni Marcio Alberto , Torsoni Adriana Souza
Published: December 2021

In the last decades, obesity and nonalcoholic fatty liver disease (NAFLD) have become increasingly prevalent in wide world. Fatty liver can be detrimental to liver regeneration (LR) and offspring of obese dams (HFD-O) are susceptible to NAFLD development. Here we evaluated LR capacity in HFD-O after partial hepatectomy (PHx). HFD-O re-exposed or not to HFD in later life were evaluated for metabolic parameters, inflammation, proliferation, tissue repair markers and survival rate after PHx. Increasing adiposity and fatty liver were observed in HFD-O. Despite lower IL-6 levels, Ki67 labeling, cells in S phase and Ciclin D1/PCNA protein content, a lower impact on survival rate was found after PHx, even when re-exposed to HFD. However, no difference was observed between offspring of control dams (SC-O) and HFD-O after surgery. Although LR impairment is dependent of steatosis development, offspring of obese dams are programmed to be protected from the damage promoted by HFD.
Rayleigh‐Love Discrepancy Highlights Temporal Changes in Near‐Surface Radial Anisotropy After the 2004 Great Sumatra Earthquake
Authors: Yu W. , Song T.‐R. A. , Su J. , Lin J.‐T.
Published: December 2021

Strong ground motions from large earthquakes are capable of damaging near‐surface sediments and promoting notable reductions in their seismic velocity structures. These velocity reductions can be monitored using either body waves or surface waves from repeatable seismic sources, such as repeating earthquakes (REs) or ambient seismic noise. Here, we compile a decade‐long catalog of REs since the 2004 Mw 9.2 Sumatra Earthquake, and monitor the temporal velocity changes from Rayleigh waves (δVLR) and Love waves (δVLQ). We observe a δVLR of −0.16% and δVLR/δVLQ ratio of ∼6, inconsistent with velocity reductions in isotropic media. To reconcile the observations, we carry out analyses of sensitivity kernels of surface waves in isotropic and vertical transversely isotropic (VTI) media and forward waveform modeling. The modeling reveals that the observed large δVLR/δVLQ ratio can be explained by strong dβV (−4%) and weak dβH (−0.615%) reductions and an increase in radial anisotropy in the near surface. These changes are best explained by a 2% increase in crack density of aligned horizontal cracks in overpressured sediments near the compressive subduction zone forearc. Temporal variations of δVLR/δVLQ ratios and radial anisotropy after consecutive great earthquakes are consistent with laboratory experiments under cyclic loading and unloading.
Climate Response to Latitudinal and Altitudinal Distribution of Stratospheric Sulfate Aerosols
Authors: Zhao Mengying , Cao Long , Bala Govindasamy , Duan Lei
Published: December 2021

Stratospheric aerosol injection is one of the most widely studied solar radiation modification methods to reduce some effects of anthropogenic warming. We perform idealized simulations to analyze climate response to different latitudinal and altitudinal distributions of additional stratospheric sulphate aerosols. We analyze climate response to both large volcanic‐size aerosols that are representative of sulphate aerosols which form when SO2 is injected into the stratosphere by major volcanic eruptions or by proposed stratospheric sulphate aerosol geoengineering option, and small background‐size aerosols which are present in the stratosphere during quiescent periods with no major volcanic eruptions. Our simulations show that under the climate state with doubled atmospheric CO2, for the same total mass, independent of size‐distributions, aerosols concentrated at higher latitudes produce less negative effective radiative forcing but larger surface cooling as a result of larger forcing efficacy. For the same latitudinal distribution, small background‐size aerosols added at lower altitudes cause larger surface cooling as a result of hygroscopic growth that increases scattering of sunlight. In contrast, large volcanic‐size aerosols added at lower altitudes cause smaller surface cooling than at higher altitudes as a result of enhanced stratospheric heating and associated water vapor feedback that enhance absorption of solar and terrestrial radiation. For both background‐size and volcanic‐size aerosols, asymmetric distributions about the equator induce substantial cross‐equatorial energy transport, causing the Intertropical Convergence Zone to move to the warmer hemisphere with less aerosol loading. Our study helps to understand the climate consequences of different spatial patterns and size distributions of stratospheric aerosol perturbation.
Influence of Spatial Rainfall Gradients on River Longitudinal Profiles and the Topographic Expression of Spatially and Temporally Variable Climates in Mountain Landscapes
Authors: Leonard Joel S. , Whipple Kelin X.
Published: December 2021

Mountain landscapes have dynamic climates that, together with tectonic processes, influence their topographic evolution. Spatial and temporal variations in rainfall are ubiquitous in these settings as orographic precipitation patterns evolve with climate change and topography. Despite important implications such changes have for river incision, their influence is understudied. Here, we investigate how changes in rainfall pattern should affect both the steady state form and transient evolution of river profiles at the catchment scale using the stream power model. We find that spatially varied rainfall patterns can complicate steady state relationships between mean rainfall, channel steepness and fluvial relief, depending on where rainfall is concentrated in catchments, and lead to unexpected transient behavior if they are neglected. Specifically, changes in rainfall pattern cause multi‐stage transient responses that differ from responses to uniform changes in rainfall. Disparate responses by rivers that experience different rainfall conditions, particularly trunk and tributary rivers, are also an important factor in understanding catchment‐wide responses to climate change. Accounting for such disparities in sampling strategies and topographic analyses may, therefore, be vital for detecting and quantifying climate's role in landscape evolution. Lastly, we show how explicitly accounting for rainfall patterns in channel steepness indices, and thus spatial variations in erosional efficiency, may advance understanding of landscape sensitivity to climate. These results have important implications for detecting transient responses to changes in rainfall pattern (and more broadly climate), interpretation of morphometrics in steady state and transient landscapes, and quantifying the sensitivity of landscapes and erosion rates to climate.
The Prediction of Day‐to‐Day Occurrence of Low Latitude Ionospheric Strong Scintillation Using Gradient Boosting Algorithm
Authors: Zhao Xiukuan , Li Guozhu , Xie Haiyong , Hu Lianhuan , Sun Wenjie , Yang Sipeng , Li Yi , Ning Baiqi , Takahashi Hisao
Published: December 2021

Ionospheric scintillations caused by equatorial plasma bubbles (EPBs) can seriously affect various high technology systems based on Global Navigation Satellite System (GNSS) signals at equatorial and low latitudes. A reliable prediction of ionospheric scintillation occurrence is critical to relieve the effect. Using the long‐term ground‐based GNSS receiver and ionosonde data collected in the Brazilian longitude sector during 2012–2020, an ionospheric strong scintillation prediction model based on the gradient boosting algorithms extreme gradient boosting (XGBoost), light gradient boosting machine (LightGBM), and CatBoost is created and tested. It is for the first time that the XGBoost, LightGBM, and CatBoost are utilized to predict the day‐to‐day occurrence of regional ionospheric scintillation during post‐sunset hours. The relative importance of different parameters affecting EPB/scintillation occurrence for building the prediction model is examined. A comparison of daily scintillation occurrence from the modeled and observed results during 2014 (solar maximum) and 2020 (solar minimum) shows that the gradient boosting algorithms are effective for predicting strong scintillations over low latitude, with a prediction accuracy of ∼85%. The results suggest that the trained model with input of total electron content, equatorial F layer peak height and critical frequency before sunset could be well employed to predict the occurrence/nonoccurrence of intense scintillations over low latitude after sunset on a daily basis.
Quantifying Hydraulic Roughness From Field Data: Can Dune Morphology Tell the Whole Story?
Authors: de Lange S. I. , Naqshband S. , Hoitink A. J. F.
Published: December 2021

Hydraulic roughness is a fundamental property in river research, as it directly affects water levels, flow strength and the associated sediment transport rates. However, quantification of roughness is challenging, as it is not directly measurable in the field. In lowland rivers, bedforms are a major source of hydraulic roughness. Decades of research have focused on dunes to allow parameterization of roughness, with relatively little focus on field verification. This study aims to establish the predictive capacity of current roughness predictors, and to identify reasons for the unexplained part of the variance in roughness. We quantified hydraulic roughness based on the Darcy‐Weisbach friction factor (f) calculated from hydraulic field data of a 78 km‐long trajectory of the river Rhine and river Waal in the Netherlands. This is compared to predicted roughness values based on dune geometry, and to the spatial trends in the local topographic leeside angle, both inferred from bathymetric field data. Results from both approaches show the same general trend and magnitude of roughness values (0.019 < f < 0.069). Roughness inferred from dune geometry explains at best 31% of the variance. Efforts to explain the remaining variance from statistics of the local topographic leeside angles, which supposedly control flow separation, were unsuccessful. Unexpectedly, multi‐kilometer depth oscillations explain 34% of the total roughness variations. We suggest that flow divergence associated with depth increase causes energy loss, which is reflected in an elevated hydraulic roughness. Multi‐kilometer depth variations occur in many rivers worldwide, which implies a cause of flow resistance that needs further study.
Stochastic Decadal Projections of Colorado River Streamflow and Reservoir Pool Elevations Conditioned on Temperature Projections
Authors: Woodson David , Rajagopalan Balaji , Baker Sarah , Smith Rebecca , Prairie James , Towler Erin , Ge Ming , Zagona Edith
Published: December 2021

Decadal (∼10‐year)‐scale flow projections in the Colorado River Basin (CRB) are increasingly important for water resources management and planning of its reservoir system. Physical models, ensemble streamflow prediction (ESP), do not have skill beyond interannual time scales. However, Global Climate Models have good skill in projecting decadal temperatures. This, combined with the sensitivity of CRB flows to temperature from recent studies, motivate the research question, can skill in decadal temperature projections be translated to operationally skillful flow projections and consequently, water resources management? To explore this, we used temperature projections from the Community Earth System Model‐Decadal Prediction Large Ensemble (CESM‐DPLE) along with past basin runoff efficiency as covariates in a Random Forest (RF) method to project ensembles of multiyear mean flow at the key aggregate gauge of Lees Ferry, Arizona. RF streamflow projections outperformed both ESP and climatology in a 1982–2017 hindcast, as measured by ranked probability skill score. The projections were disaggregated to monthly and subbasin scales to drive the Colorado River Mid‐term Modeling System (CRMMS) to generate ensembles of water management variables. The projections of pool elevations in Lakes Powell and Mead, the two largest U.S. reservoirs that are critical for water resources management in the basin, were found to reduce the hindcast median root mean square error by up to −20% and −30% at lead times of 48 and 60 months, respectively, relative to projections generated from ESP. This suggests opportunities for enhancing water resources management in the CRB and potentially elsewhere.
Curved display based on programming origami tessellations
Authors: Deng Yang , Liu Weixuan , Cheung Yik Kin , Li Yongkai , Hong Wei , Yu Hongyu
Published: December 2021

Curved displays have recently become very popular, with wide applications for both industry and consumers. However, built upon initially flat films, most flexible displays are often incompatible with general nondevelopable surfaces. In this paper, we report a method for producing curved displays of nondevelopable shapes by using a structure-mechanics-inspired functional optimization method to design tessellation patterns that fold into the desired shapes. Representative displays in spherical and saddle shapes are demonstrated. The microfabrication process is employed for manufacturing 2D flexible foldable circuit boards, pick-and-place technology is used for placing illuminant elements onto the boards, and mold guidance is used for folding 2-D sheets into curved 3D display prototypes. The proposed technology is feasible for mass production and advances the application of next-generation curved displays.