bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of improved TMD and CGC frameworks in forward quark dijet production
Authors: Fujii Hirotsugu , Marquet Cyrille , Watanabe Kazuhiro
Published: December 2020

Abstract

For studying small-x gluon saturation in forward dijet production in high-energy dilute-dense collisions, the improved TMD (ITMD) factorization formula was recently proposed. In the Color Glass Condensate (CGC) framework, it represents the leading term of an expansion in inverse powers of the hard scale. It contains the leading-twist TMD factorization formula relevant for small gluon’s transverse momentum kt, but also incorporates an all-order resummation of kinematical twists, resulting in a proper matching to high-energy factorization at large kt. In this paper, we evaluate the accuracy of the ITMD formula quantitatively, for the case of quark dijet production in high-energy proton-proton(p+p) and proton-nucleus (p+A) collisions at LHC energies. We do so by comparing the quark-antiquark azimuthal angle ∆ϕ distribution to that obtained with the CGC formula. For a dijet with each quark momentum pt much larger than the target saturation scale, Qs, the ITMD formula is a good approximation to the CGC formula in a wide range of azimuthal angle. It becomes less accurate as the jet pt’s are lowered, as expected, due to the presence of genuine higher-twists contributions in the CGC framework, which represent multi-body scattering effects absent in the ITMD formula. We find that, as the hard jet momenta are lowered, the accuracy of ITMD start by deteriorating at small angles, in the high-energy-factorization regime, while in the TMD regime near ∆ϕ = π, very low values of pt are needed to see differences between the CGC and the ITMD formula. In addition, the genuine twists corrections to ITMD become visible for higher values of pt in p + A collisions, compared to p+p collisions, signaling that they are enhanced by the target saturation scale.
Surface defects on E-string from 5-brane webs
Authors: Kim Sung-Soo , Sugimoto Yuji , Yagi Futoshi
Published: December 2020

Abstract

We study 6d E-string theory with defects on a circle. Our basic strategy is to apply the geometric transition to the supersymmetric gauge theories. First, we calculate the partition functions of the 5d SU(3)0 gauge theory with 10 flavors, which is UV-dual to the 5d Sp(2) gauge theory with 10 flavors, based on two different 5-brane web diagrams, and check that two partition functions agree with each other. Then, by utilizing the geometric transition, we find the surface defect partition function for E-string on ℝ4 × T2. We also discuss that our result is consistent with the elliptic genus. Based on the result, we show how the global symmetry is broken by the defects, and discuss that the breaking pattern depends on where/how we insert the defects.
Becoming clinical supervisors: identity learnings from a registrar faculty development program
Authors: Noble Christy , Young Jessica , Hourn Ellen , Sheehan Dale
Published: December 2020

This article shares our experiences and surprises as we developed, implemented and evaluated a 12-week faculty development program for registrars as clinical supervisors over three cohorts. The program has consistently been rated highly by participants. Yet, following a comprehensive curriculum review, we were surprised that our goal of encouraging identity development in clinical supervisors seemed to be unmet. Whilst our evaluation suggests that the program made important contributions to the registrars’ knowledge, application and readiness as clinical supervisors, challenges linked to developing a supervisor identity and managing the dual identity of supervisor and clinician remain. In this article we describe our program and argue for the importance of designing faculty development programs to support professional identity formation. We present the findings from our program evaluation and discuss the surprising outcomes and ongoing challenges of developing a cohesive clinical educator identity. Informed by recent evidence and workplace learning theory we critically appraise our program, explain the mechanisms for the unintended outcomes and offer suggestions for improving curricular and pedagogic practices of embedded faculty development programs. A key recommendation is to not only consider identity formation of clinical supervisors from an individualist perspective but also from a social perspective.
Anticancer Agent Gefitinib and Congenital Anomalies
Authors: Joshi Madhura , Gopinath P. M. , Kalaichelvi K.
Published: December 2020

Congenital abnormalities caused by human teratogenic drugs account for less than 1% of total congenital abnormalities. We report the first case of multiple anomalies associated with antenatal exposure to the anticancer agent Gefitinib. The patient conceived while she was on tablet Gefitinib 250 mg once a day for stage IV adenocarcinoma of lungs. The first scan done at 29 weeks 2 days showed liquor amnii on the upper limit of normal, single umbilical artery, left sided congenital diaphragmatic hernia, ventriculoseptal defect and left radial ray defect. The patient had a preterm delivery after one week and she refused autopsy. It is important to advise patients regarding contraception while undergoing chemotherapy as there is an increased risk of drug induced fetal malformations.
Prenatal Diagnosis of Bardet-Biedl Syndrome: A Case Study and Review of Literature
Authors: Sablok Aanchal , Thakur Seema , Sharma Akshatha , Kaul Anita
Published: December 2020

Bardet-Biedl syndrome (BBS) is a rare autosomal recessive disease with a prevalence rate of 1 in 125,000–170,000. BBS can occur as a result of mutation in one of the 19 known genes of the BBS gene complex. The syndrome is mostly diagnosed post-natally based on the structural and functional manifestations of the disease in childhood like short stature, obesity, polydactyly or syndactyly, retinal dystrophy, structural renal abnormalities, neurodevelopment delays, mental retardation, diabetes mellitus. We present a case of Bardet-Biedl syndrome diagnosed prenatally at 18 weeks gestation based on prenatal ultrasound findings of post axial polydactyly with bilateral hyperechogenic kidneys. Clinical suspicion based on ultrasound findings was supplemented amniocentesis and clinical exome sequencing. This showed a pathogenic variant in homozygous state in the MKKS gene, consistent with Bardet-Biedl syndrome type 6. Unless BBS has been suspected antenatally, diagnosis of BBS is usually made in late childhood or early adulthood adding to the psychological, emotional and financial burden on the family. With advances in prenatal ultrasound techniques and tremendous improvement in genetic diagnosis of suspicious findings on ultrasonography, diagnosis of rare genetic disorders like BBS is now possible as early as the 18–20 weeks scan. This can aid in appropriate counseling of the family and timely intervention in children born with this condition.
Crisis and Intergovernmental Retrenchment in the European Union? Framing the EU’s Answer to the COVID-19 Pandemic
Authors: Salvati Eugenio
Published: December 2020

The outbreak of the COVID-19 pandemic has placed severe pressure on the EU’s capacity to provide a timely and coordinated response capable of curbing the pandemic’s disastrous economic and social effects on EU member states. In this situation, the supranational institutions and their models of action are evidently under pressure, seeming incapable of leading the EU out of the stormy waters of the present crisis. The article frames the first months of management of the COVID-19 crisis at EU level as characterised by the limited increase in the level of steering capacity by supranational institutions, due to the reaffirmed centrality of the intergovernmental option. To explain this situation, the article considers the absence of the institutional capacity/legitimacy to extract resources from society(ies), and the subsequent impossibility of guaranteeing an effective and autonomous process of political (re)distribution, the key factors accounting for the weakness of vertical political integration in the response to the COVID-19 challenge. This explains why during the COVID-19 crisis as well, the pattern followed by the EU is rather similar to past patterns, thus confirming that this has fed retrenchment aimed at the enforcement of the intergovernmental model and the defence of the most sensitive core state powers against inference from supranational EU institutions.
Mixing operators with prescribed unimodular eigenvalues
Authors: BEISE H.-P. , FRERICK L. , MÜLLER J.
Published: December 2020

For arbitrary closed countable subsetsZof the unit circle examples of topologically mixing operators on Hilbert spaces are given which have a densely spanning set of eigenvectors with unimodular eigenvalues restricted toZ. In particular, these operators cannot be ergodic in the Gaussian sense.
Ofrendas y rituales postclásicos dedicados a Chaahk en el sitio maya de Chilonché (Petén, Guatemala)
Authors: Vidal Lorenzo Cristina , Muñoz Cosme Gaspar , Horcajada Campos Patricia
Published: December 2020

La adaptación de los mayas postclásicos a las nuevas condiciones de vida surgidas a raíz de la crisis generalizada del final del período Clásico mediante respuestas resilientes se ha convertido en un tema de creciente interés por parte de los investigadores mayistas en las últimas décadas. El estudio de vestigios arqueológicos adscritos al Postclásico puede ayudar a entender por qué ciertas tradiciones fueron abandonadas, mientras que otras han perdurado a lo largo del tiempo, como es el caso de las ceremonias del culto a la lluvia. Ejemplo de ello son los hallazgos de ofrendas y otros vestigios arquitectónicos realizados en Chilonché, un antiguo asentamiento urbano maya fundado en la cuenca del río Mopán (Petén), cuya arquitectura y manifestaciones artísticas son un fiel exponente de la importancia política que tuvo el sitio en su dilatado período de ocupación. Los resultados de esta investigación, que combina los estudios arqueológicos y arquitectónicos con los análisis arqueométricos e iconográficos de las piezas cerámicas exhumadas, permiten afirmar que las ofrendas postclásicas halladas en un palacio de la acrópolis de Chilonché están íntimamente ligadas al acto de verter agua y a la imagen de Chaahk, y por lo tanto a rituales vinculados a la lluvia.
Historical Perspectives on Exceptional Climatic Years at the Labrador/Nunatsiavut Coast 1780 to 1950
Authors: Ouellet-Bernier Marie-Michèle , de Vernal Anne , Chartier Daniel , Boucher Étienne
Published: December 2020

This interdisciplinary study presents a human perspective on climatic variations by combining documentary, discursive, instrumental, and proxy data. Historical sources were used to characterize climate variations along the coast of Labrador/Nunatsiavut during the 19th century and the first half of the 20th century. Written and early instrumental archives provided original information on the state and perception of climate before the establishment of meteorological stations, which permitted an intra-annual perspective on climatic variations. Written sources depicted the sensitivity of humans to climatic variations. Exceptional seasonal climatic events were extracted from documentary and discursive sources, which were complemented by tree-ring and early instrumental data. From 1780 to 1900, data indicated a succession of relatively warm and cold episodes. Most warm periods were described as stormy and variable. The final part of the studied records showed cold conditions from 1900 to 1925 and warm conditions from 1925 to 1950. Historical sources helped to discriminate a seasonal signal. Mild autumn-winter conditions were recorded since 1910 in relation with positive anomalies of the North Atlantic Oscillation in winter. Relatively warm spring-summer conditions were recorded after 1920, which corresponds to a phase of positive anomaly of the Atlantic Multidecadal Oscillation.
Distribution and abundance of turritelline gastropods (Cerithioidea: Turritellidae) in Hong Kong and the English Channel: implications for a characteristic fossil assemblage
Authors: Shin Caren P. , Allmon Warren D. , Anderson Brendan M. , Kelly Bridget T. , Hiscock Keith , Shin Paul K.S.
Published: December 2020

Abundant species are typically also viewed as ecologically dominant, and are frequently used to characterize the communities in which they live. Such characteristic assemblages may also be used as indicators of environmental conditions, such as relative stability. Fossil and modern turritelline gastropods are often the most abundant species in the marine assemblages and communities in which they occur, forming ‘turritelline-dominated assemblages’ (TDAs). We use data on modernTurritella bacillumfrom waters around Hong Kong as a case study to analyse fluctuations in abundance over 25 years. While turritellines were not always dominant in the area surveyed (~1650 km2), populations were notably persistent, and rebound after decline of abundances occurred within ~5 years at some sites. δ18O sclerochronology suggests that individuals were ~1–2 years old. It is also notable thatT. bacillumwas found to be abundant at salinities as low as 10–15 psu, despite the general characterization of turritellines as fully marine. Comparison with data on modernT. communisin the western English Channel corroborates this pattern, as localized sites of high abundance also appear transient. These results have implications for the interpretation of TDAs in the fossil record: they may signify the cumulative result of short-lived, spatially restricted populations, possibly resulting from essentially stochastic larval settlement. This suggests that the palaeoenvironmental setting of fossil TDAs does not always control their occurrence on short temporal scales.
OP270 Why The Haute Autorité de Santé Rejects the Widespread Use Of “Mini-Bypass”/One Anastomosis Gastric Bypass For Obesity In France
Authors: Lafarge Jean-Charles , David Denis-Jean , Carbonneil Cédric
Published: December 2020

Introduction

One anastomosis gastric bypass (OAGB) has become a widespread technique over the last few years in France, without any prior assessment and despite existing controversies among bariatric surgeons. An older bypass technique for treating obesity, the Roux-en-Y gastric bypass (RYGB), is available and reimbursed, having been assessed and approved for use in 2005. In 2019, the French Haute Autorité de Santé (HAS) assessed OAGB for the treatment of severe and massive obesity. This assessment, the first in the world, was undertaken for OAGBs carried out with a 200- or 150-centimeter biliopancreatic-limb (BP-limb) length.

Methods

A systematic review (SR) of the literature and consultation of a working group consisting of both healthcare professionals (clinician and surgeons) and patients were carried out. The primary aim of our assessment was to determine whether the OAGB technique can replace RYGB. The efficacy and safety profile of OAGB was compared with RYGB in adult patients with massive, severe obesity. Complications and postoperative follow up specific to OAGB were identified.

Results

The three selected randomized controlled trials (RCTs) could not confirm the superiority or the non-inferiority of OAGB, compared with RYGB, on the selected efficacy endpoints of weight loss, resolution of comorbidities, and quality of life. Adverse events reported for OAGB included severe nutritional complications and bile reflux that could potentially lead to lower esophageal cancer. In one RCT, the frequency of serious adverse events in the OAGB group was almost two times higher than in the RYGB group.

Conclusions

HAS considered that OAGB carried out with a longer (200 centimeter) BP-limb is not a validated technique for the surgical treatment of massive, severe obesity. Thus, it cannot be considered an alternative to RYGB. There were insufficient data available on OAGB performed with a 150-centimeter BP-limb. Thus, HAS recommended undertaking a multicenter RCT to assess the efficacy and safety of OAGB. Patients who have already undergone OAGB should receive the same follow up as patients who have received RYGB, including close monitoring for nutritional complications and lower esophageal cancer and an endoscopic examination five years after surgery.
OP279 Monitoring The Effectiveness Of Implementing And Using New Health Technologies In Hospital Practice
Authors: Avdeyev Andrey , Benberin Valeriy , Shanazarov Nasrulla , Kudaibergenova Maigul , Kaptagayeva Aigul , Makalkina Larissa , Hailey David , Akhmedullin Ruslan , Ismailova Leilya , Nurmasheva Arailym
Published: December 2020

Introduction

According to international experience in the field of hospital-based health technology assessment (HB-HTA), most of the implemented new health technologies must undergo a clinical and economic assessment (CEA) of their viability by creating a mini-health technology assessment report. However, HB-HTA should not be limited only to the initial CEA; further monitoring of the effectiveness of implemented new health technologies is necessary.

Methods

We developed a special reporting form for creating a CEA of implemented new health technologies and integrated it into the hospital information system. Indicators of clinical effectiveness are determined individually for each implemented technology. The main indicators of economic effectiveness are financial results (or net profit) and profitability—high-cost and high-tech health technologies have priority for monitoring.

Results

In order to ensure a more detailed and complete CEA of implemented health technologies, the following measures were proposed: (i) before implementing the technology, determine the key clinical effectiveness criteria for further monitoring for each implemented health technology; (ii) if possible, determine comparative technologies (alternatives or analogs) for conducting comparative CEA of the implemented health technologies; and (iii) carry out a prospective CEA of the implemented health technologies with a view to publishing the results.

Conclusions

The organization of a continuous monitoring process that analyzes the effectiveness and usage of new health technologies in hospital practice will allow assessment of the following: the clinical effectiveness and safety of the implemented technologies in comparison with world data; the economic effectiveness of the technology, including an accurate calculation of the payback period for investments; and the “real” data on the effectiveness of implemented health technologies in comparison with the initial request for implementation.
OP315 An Artificial Intelligence Approach To Improve Medical Diagnosis Of Ischemic Cardiopathy In Patients With Non-Traumatic Chest Pain
Authors: Arri Eunate Arana , de Vicuña-Meléndez Aitor García , Santorcuato Ana , Revuelta-Antizar Ivan , González-Barcina Imanol , Rodríguez-Tejedor Santiago , López-Moreno Borja , Hernándo Carlos Saiz
Published: December 2020

Introduction

Current clinical practice is based on guidelines and local protocols that are informed by clinical evidence. This means that clinical variability is reduced, but can lead to inefficient clinical decision-making and can increase medical errors, decreasing patient's safety. The aim of the EXCON project is to investigate the innovative concept of Intelligent Clinical History (ICH), and to develop functional prototypes of high added-value in healthcare services.

Methods

The innovative EXCON project will take advantage of recent advances in technologies for coding, structuring and semantizing medical information. Thanks to this new structuring, the EXCON platform will be developed. The final users will be health professionals and other decision-makers. Doctors, nurses, epidemiologists and information specialists will be involved in the development and subsequent validation of the platform.

Results

The EXCON platform identifies profiles of patients with a high probability of ischemic heart disease. In the sample analyzed (n = 4,700), 17 percent of patients were admitted to a cardiology unit with suspected coronary heart disease. Of the patients admitted, 53.7 percent did not have ischemic heart disease at discharge. If we apply the algorithm developed by the EXCON project, 24.8 percent of patients would not have been admitted and did not have ischemic heart disease.

Conclusions

In coming decades, patient management will be impacted by the application of new advanced data analytics tools. This will allow for safer and more efficient clinical management, decrease variability in clinical practice, and improve equity. That is why the development and assessment of these technologies is necessary.
OP447 Feasibility And Validity Of Real-World Data As Evidence Of Effectiveness - Experience From Breast Cancer Care In Scotland
Authors: Gray Ewan , Marti Joachim , Brewster David H , Wyatt Jeremy C , Hall Peter S
Published: December 2020

Introduction

Data from randomized controlled trials (RCTs) are the primary source for health technology assessment (HTA) however these are limited by strict patient inclusion criteria, leading to concerns about whether treatment benefit estimates are accurate for all patients (generalizability). Real-World Data (RWD) have been proposed as a solution however as these are observational data there is additional potential for bias when estimating treatment effectiveness. To maximize the utility of RWD it is useful to consider the whole process of evidence generation and robustly address issues of feasibility and validity.

Methods

A series of complementary studies investigated whether population-based routinely collected health data from Scotland are suitable for estimating the effectiveness of chemotherapy for early breast cancer. Firstly, a prognostic score was validated in this population. Secondly, a comparison of RWD and randomized trial effectiveness estimates was made to investigate feasibility and validity of several methods – Propensity Score Matching (PSM), Instrumental variables (IV) and Regression Discontinuity. Finally, effectiveness estimates in trial underrepresented groups were produced.

Results

PSM and IV were feasible and produced results in relatively close agreement with randomized data. Effectiveness estimates in trial underrepresented groups (women over 70 years and women with high comorbidity) were consistent with an approximate one-third reduction in the risk of death from breast cancer. This is equivalent to approximately a 3–4 percentage point difference in all cause mortality over 10 years in these groups.

Conclusions

RWD are a feasible for generating estimates of effectiveness of adjuvant chemotherapy in early stage breast cancer. The process of using RWD for this purpose should include careful assessment of data quality and comparison of alternative strategies for causal identification in the context of available randomized data.
OP522 Years Of Potential Productive Life Lost Due To Cancer Premature Mortality In Brazil: 2000 to 2016
Authors: Martins Luís Felipe Leite , De Camargo Cancela Marianna , de Souza Leonardo Borges , Bezerra de Souza Dyego Leandro , Barchuk Anton , Schilithz Arthur Correa , Hanly Paul , Sharp Linda , Pearce Alison , Soerjomataram Isabelle
Published: December 2020

Introduction

Early death from cancer is potentially preventable. In developing countries, it is not only a human tragedy but also an economic tragedy. In Latin America and the Caribbean, the estimated number of deaths for people 15–64 years in 2018 was 262,141, with Brazil being the country with the largest number of cases in the region (38.2%). The mortality rate for cancer in Brazil was 68.7/100,000. The analysis of causes impacting premature mortality is an essential function of public health surveillance. This study aims to estimate Potential Productive Life Years of Lost (YPPLL) due to cancer from 2000 to 2016, according to the region, sex and cancer site.

Methods

Official data from the Brazilian government were used for the period 2000–2016 for the 15–64 age group (economically active population). For each cancer death in working-age people, potential years of productive life lost (YPPLL) were calculated as the difference between pensionable age and age at death from cancer (based on the age group mid-point). The limit considered as pensionable age was 65 years for men and 60 years for women.

Results

The total of cancer deaths among working-age people was 61,547 in 2000 and increased to 93,551 in 2016. The correspondent YPPLL was 717,883 and 944,565, respectively (increase of 31.6%), mostly coming from males (56.8%). Highest individual YPPLL were observed in the North and Northeast and Midwest, for both sexes. The most substantial changes observed from 2000 to 2016 in total YPPLL were for colorectal cancer, which moved from sixth to the second position nationally.

Conclusions

The YPPLL due to cancer is increasing in Brazil and present different patterns by sex and geographic regions. While in the South and Southeast lung cancer has the highest impact among males, in the North and Northeast most YPPLL come from stomach cancer. Among females, a clear pattern is observed with breast cancer being responsible for most YPPLL excepting in the North, where cervical cancer still having a major impact compared to other tumors.
OP611 Breast Cancer Classification In Histopathological Images Using Artificial Intelligence Assisted Diagnosis Technology: A Meta-Analysis
Authors: Huang Guo , Xue Di
Published: December 2020

Introduction

Artificial Intelligence (AI) is an important product of the rapid development of computer technology today. It has a far-reaching impact on the development of medical diagnostic technology especially in combination with medical imaging. The aim of this study was to analyze the diagnostic accuracy of AI-assisted diagnosis technology for classification of breast cancer in histopathological images.

Methods

A meta-analysis was conducted of published research articles on diagnostic accuracy of AI-assisted diagnosis technology for breast cancer classification between January 2010 and September 2019 in the databases of PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform and China Bio-medicine Database. Statistical analysis was performed with software Meta-Disc 1.4 and Stata 12.0, and the summary receiver operating characteristic (SROC) curve was drawn to evaluate accuracy of the method.

Results

A total of 18 studies with 13,573 breast histopathological images were considered for the analysis. The pooled sensitivity, specificity, diagnostic odds ratio and the area under the curve of the SROC for AI-assisted diagnosis technology for classification of breast cancer respectively, were 0.94 (95% confidence interval [CI]: 0.93–0.85), 0.84 (95% CI: 0.93–0.94), 255.47 (95% CI: 168.33–387.73) and 0.98 (95%CI: 0.96–0.99).

Conclusions

Several limitations should be considered when interpreting the findings of this meta-analysis. First, despite the extensive literature search, the number of included studies was small; however, the number of images enrolled was satisfactory, thereby decreasing type II error. Second, data acquisition is not comprehensive enough because the language of literature search was limited to Chinese and English. Furthermore, the heterogeneity caused due to different sources of data affected the study results. Despite these limitations, our study suggests AI-assisted diagnosis technology for breast cancer classification in histopathological images is a highly accurate and reliable diagnostic method for clinical application.
PP143 TeCHO+ Program In Gujarat, India: A Protocol For Health Technology Assessment
Authors: Saha Somen , Kotwani Priya , Pandya Apurvakumar , Saxena Deepak , Puwar Tapasvi , Desai Shrey , Dahiya Gaurav , Vaghela Prakash , Patel DM , Patel Chintan , Rawal Devang , Ravi Jayanti
Published: December 2020

Introduction

The Health and Family Welfare Department of the Government of Gujarat is implementing a program called Technology for Community Health Operation (TeCHO+) to address the state's priority health issues. This paper details the protocol for using health technology assessment to assess the impact of the TeCHO+ program on data quality, service delivery coverage, rates of morbidity and mortality, and cost effectiveness.

Methods

This mixed-method study will be conducted in five districts. Data will be validated in a phased manner over a three-year period, along with an assessment of key outcome indicators. Additionally, key informant interviews will be conducted and cost data will be gathered.

Results

Early implementation of TeCHO+ has highlighted mixed impact at an operational level, with gaps in implementation. Despite some gaps in the available evidence, TeCHO+ solutions can significantly improve health service delivery through increased accuracy of data management, high-risk identification, and quality and accessibility of care. However, implementation challenges require even greater efforts to establish comprehensive systems for troubleshooting and corrective measures for improving data quality. Positive experiences encourage grassroots teams for continuing the use of TeCHO+.

Conclusions

TeCHO+ is expected to improve service coverage and reduce rates of morbidity and mortality by improving the population's nutritional status, the timeliness of care for high-risk cases, and the non-communicable disease profile of the community.
PP189 Operational Evaluations Of Laminar Flow Cabinets
Authors: Vallejos Benicio Grossling , Rivas Ronald , Galván Pedro
Published: December 2020

Introduction

Laminar flow cabinets (LFC) are designed to maintain an area free of particles and contaminants that could damage the environment during the preparation of sensitive materials. Several regulations detail the types and frequency of tests that must be performed to ensure the proper functioning of LFCs. The objective of this work was to evaluate the operational and functional status of LFCs.

Methods

A descriptive study was carried out in which three tests were selected for evaluating LFCs: the high-efficiency particulate air (HEPA) filter integrity test; the air speed and uniformity test; and the general physical verification test. In selecting these tests, we relied on recommendations established in international standards and the manufacturers’ technical manuals.

Results

During testing it was possible to verify the existence of leaks in the periphery of the HEPA filters due to a mismatch in their assembly, as well as a poor seal in the side panels of the cabinet through which particles were entering the work area. It was also discovered that the equipment lighting system (fluorescent tubes) was inadequate.

Conclusions

The use of these tests was very important for detecting certain faults in the equipment, which allowed us to introduce corrective actions to maintain sterile conditions in the cabinet. It is recommended to include these tests in the maintenance regimen of LFCs to pre-empt future failures.
PP277 Analysis Of The Current Situation Of Using Hospital-Based Health Technology Assessment In Kazakhstan
Authors: Avdeyev Andrey , Kaptagayeva Aigul , Benberin Valeriy , Shanazarov Nasrulla , Makalkina Larissa , Hailey David
Published: December 2020

Introduction

Hospital-based health technology assessment (HB-HTA) in Kazakhstan is currently at the initial stage of development. The Medical Center Hospital of the President's Affairs Administration, Nur-Sultan is one of the first examples of implementing and using an HB-HTA system in practice, having included in its structure an HB-HTA unit in 2015.

Methods

In order to evaluate the current situation of using the principles of HB-HTA in Kazakhstan hospitals, a special questionnaire was developed. The questionnaire was sent in the form of an official request on behalf of the Ministry of Health Care. An official response was received from twenty-nine hospitals, of which nine were at the federal level, thirteen at the regional level, and seven at the city level.

Results

Of the twenty-nine hospitals that participated in the survey, only half (52%) indicated that they were aware of the principles of using the HB-HTA system and of the structure and functions of mini-health technology assessment reports (55%). Nonetheless, most hospitals (90%) noted that the results of HB-HTA may affect the final decision on implementing new technologies in practice, and that using the systematic approach of technology assessment is necessary.

Conclusions

In assessing the clinical and economic effectiveness of new health technologies in hospitals, and the viability of implementing them, there is a lack of standardized processes in managerial decision making. The assessment of clinical effectiveness and safety when implementing technologies is carried out mainly by technology applicants or by the main specialists who are responsible for the profile of evaluating technology. This can be regarded as a conflict of interest, since the applicant's wish to introduce the new technology may bias the evaluation process.
PP289 Impact Of Regional Human Immunodeficiency Virus Therapeutic Pathway On Prescriptions: The Experience Of The Lazio Region In Italy
Authors: Bidino Rossella Di , Roberto Cauda , Massimo Andreoni , Andrea Antinori , Claudio Mastroianni , Vincenzo Vullo , Americo Cicchetti
Published: December 2020

Introduction

In 2017, the Lazio Region (Italy) published a care and therapeutic pathway (Percorso Diagnostico Terapeutico Assistenziale [PDTA]) to guide the choice of treatments for human immunodeficiency virus (HIV) patients. Recommendations were based on clinical and economic criteria to guarantee the most appropriate care and sustainability of the regional National Health Service. Our pilot study was conducted to assess how the PDTA impacts clinical decisions and expenditure. Organizational and economic analyses were based on four HIV treatment centers at the regional level.

Methods

An ad hoc data collection was conducted. Each center provided data on the volume of prescriptions for each treatment option for the first semester of 2017 and 2018. The period January-June 2017 (H1-2017) represents the scenario pre-PDTA, while January-June 2018 (H1-2018) provides evidence on the first impact of the PDTA. Expenditure was estimated considering prices reported in the PDTA document. For each center, a semi-structured survey collected evidence on which factors influence treatment decisions.

Results

Between H1-2017 and H1-2018 the number of experienced patients increased 10.1 percent (6,580 versus 7,249, respectively), while that of naive patients decreased 3 percent (227 versus 220). More than 80 percent of naive patients were treated with regimes recommended by the PDTA versus 36 percent in H1-2017 and 62 percent in H1-2018 of experienced patients. Regimes with a monthly cost > EUR 700 were preferred. The survey showed that the PDTA is a useful tool for supporting clinical decisions.

Conclusions

Our pilot study provides a snapshot on the impact of a regional HIV PDTA and identifies key aspects for its future update. Personalization of HIV therapies for an aging (5–29% of patients were >65 years in the four centers) and complex (>65% of patients had at least one comorbidity) population should be discussed for a PDTA update. Posology and treatment adherence should be further investigated.
PP309 Accuracy Of Automated Wrist Blood Pressure Monitors: Systematic Review
Authors: Albuquerque Nila , Araujo Thelma , Borges Samantha , Silva Liana Queren , da Silva Lais Vitoria , Rabelo Talita , Lino Maria Kecia , da Rocha Fabian Elery , de Freitas Luzia Sibele
Published: December 2020

Introduction

The use of automated blood pressure monitors is recommended by current guidelines; however, the accuracy of the device must be validated according to standardized protocols. Wrist blood pressure monitors have been undergoing technical improvements; nonetheless, their reliability is not unanimously recognized. No systematic review to date has analyzed the accuracy of wrist blood pressure monitors according to standardized protocols. This study aims to summarize the evidence on the accuracy of wrist blood pressure monitors in adults.

Methods

Three databases (PubMed, Scopus and SciELO) were searched on 9 September 2019. The PICO (Patient, Intervention, Comparison and Outcome) strategy was used to outline the research question: Do automated wrist blood pressure monitors have accuracy equivalent to mercury sphygmomanometers in adults? Validation studies of wrist blood pressure monitors were included. Two reviewers independently screened abstracts and full texts. Summary data was extracted for each device, including mean difference of systolic blood pressure (SBP) and diastolic blood pressure (DBP) between the monitor and the mercury sphygmomanometer.

Results

The review identified twenty-nine validation studies. Most of them were developed in China (44.82%), followed by Italy (20.68%). The most commonly used validation protocol was from the British Society of Hypertension. The mean difference between the devices and the mercury sphygmomanometers was 0.47 (±5.75) mmHg for SBP and 0.17 (±4.75) mmHg for DBP. The percentage of wrist blood pressure monitors that passed validation protocols was 93.1.

Conclusions

Most automated wrist blood pressure monitors showed accuracy equivalent to the reference standard for blood pressure measurement, with mean differences less than 0.5 mmHg for SBP and 0.2 for DBP. This evidence supports the recommendation to adopt this technology for the measurement of blood pressure in adults. However, wrist blood pressure monitors have patient positioning specificities, which, if not followed, may lead to measurement errors. Therefore, the adoption of these monitors should consider not only their accuracy, but also aspects of patient use and preferences.
PP385 Using Common Data Models And Data Networks For Evidence Generation In Health Technology Assessment
Authors: Kent Seamus , Bouvy Jacoline
Published: December 2020

Introduction

Differences between healthcare datasets in structure, content, and coding systems are widely recognized as significant barriers to generating robust evidence for regulatory and medical decision making. As a result, there is a growing interest in using common data models embedded within large data networks. By standardizing the structure, contents, and semantics of disparate healthcare databases, common data models like the Observational and Medical Outcomes Partnerships common data model (OMOP-CDM) enable multidatabase studies to be undertaken at speed and in a transparent way. To date, little attention has been given to their potential role in health technology assessment (HTA).

Methods

We identify the uses of observational data in generating evidence in HTA, some common analytical challenges faced in their estimation, and the infrastructural, technical, and data reusability constraints that limit its wider use. We discuss where and how the OMOP-CDM could overcome these barriers in relation to different types of evidence requirements.

Results

The OMOP-CDM increases the interoperability of otherwise disparate datasets, allowing reliable evidence to be generated from multidatabase studies at speed and transparently. The current analytical tools are best suited for clinical characterization and population-level effect estimation. Further developments to these tools are required to support analyses common in HTA like parametric survival modeling. Differences in costing methods as well as the structure of healthcare delivery between countries may limit the feasibility and value of standardization.

Conclusions

The OMOP-CDM has the potential to support reliable and timely evidence generation in HTA. The analytical tools should be further developed to support common HTA use cases.
PP469 From Theory To Practice: Which Value Framework Is Applied For Onco-Hematology Therapies In Italy? A 5-year Retrospective Analysis
Authors: Cicchetti Americo , Di Bidino Rossella , Xoxi Entela , Luccarini Irene , Brigido Alessia
Published: December 2020

Introduction

Different value frameworks (VFs) have been proposed in order to translate available evidence on risk-benefit profiles of new treatments into Pricing & Reimbursement (P&R) decisions. However limited evidence is available on the impact of their implementation. It's relevant to distinguish among VFs proposed by scientific societies and providers, which usually are applicable to all treatments, and VFs elaborated by regulatory agencies and health technology assessment (HTA), which focused on specific therapeutic areas. Such heterogeneity in VFs has significant implications in terms of value dimension considered and criteria adopted to define or support a price decision.

Methods

A literature research was conducted to identify already proposed or adopted VF for onco-hematology treatments. Both scientific and grey literature were investigated. Then, an ad hoc data collection was conducted for multiple myeloma; breast, prostate and urothelial cancer; and Non Small Cell Lung Cancer (NSCLC) therapies. Pharmaceutical products authorized by European Medicines Agency from January 2014 till December 2019 were identified. Primary sources of data were European Public Assessment Reports and P&R decision taken by the Italian Medicines Agency (AIFA) till September 2019.

Results

The analysis allowed to define a taxonomy to distinguish categories of VF relevant to onco-hematological treatments. We identified the “real-world” VF that emerged given past P&R decisions taken at the Italian level. Data was collected both for clinical and economical outcomes/indicators, as well as decisions taken on innovativeness of therapies. Relevant differences emerge between the real world value framework and the one that should be applied given the normative framework of the Italian Health System.

Conclusions

The value framework that emerged from the analysis addressed issues of specific aspects of onco-hematological treatments which emerged during an ad hoc analysis conducted on treatment authorized in the last 5 years. The perspective adopted to elaborate the VF was the one of an HTA agency responsible for P&R decisions at a national level. Furthermore, comparing a real-world value framework with the one based on the general criteria defined by the national legislation, our analysis allowed identification of the most critical point of the current national P&R process in terms ofsustainability of current and future therapies as advance therapies and agnostic-tumor therapies.
PP553 Study On The Utilization Of Medical Resources In Patients With Malignant Tumors in China
Authors: Liu Yuehua , Du Tiantian , Zhang Fan , Zhao Kun
Published: December 2020

Introduction

Malignant tumors have become a major public health problem and their treatment cost is increasing rapidly in China, but treatment aimed at healing diseases or extending patients’ life. There is little empirical research on utilization of healthcare resources of terminally ill cancer patients. In order to explore the optimal treatment decision for patients and provide information for relevant decision makers, this study analyzed the consumption status of medical resources in patients with cancer during the whole treatment period, and the current medical resource utilization efficiency in different levels of hospital for end-stage cancer patients.

Methods

This study was based on the clinical treatment and payment data of 2,536 cases of patients with lung cancer from the medical insurance database during the period of 2007 to 2014 in Hubei province. We retrospectively analyzed patients’ medical expenditure and utilization of different medical resources during their whole treatment period as well as at the end stage.

Results

The per capita inpatient expenditures of patients under 50 years old was 193,000 CNY (27,451 USD), while that of the patients over 70 years were 80,000–90,000 CNY (11,379–12,802 USD). Secondly, the medical expenditures spent during the last 6 months of life accounted for 66.1 percent of the total expenditures. Lastly, the medical expenditure spent in tertiary hospitals accounted for 95.3 percent of the total expenditure, and the expenditure was 14,200 ± 17,030 CNY (2,019.82 ± 2,422.36 USD) per visit.

Conclusions

Population aging is not the only factor causing the rise of medical expenditure. The unclear objectives of treatment and the reverse of medical resource allocation are also important factors to boost the growth of medical expenditure. It is necessary to improve the healthcare insurance payment system, strengthen the capacity of primary medical institutions, and develop the palliative care system in China.
PP554 Quality Assessment Of Clinical Practice Guidelines On Chronic Obstructive Pulmonary Disease Based On The Appraisal Of Guidelines For Research And Evaluation II (AGREE II) Instrument
Authors: Xu Qian , Zhao Kun , Xin Duan Cheng A , Ai Dandan , Sui Binyan
Published: December 2020

Introduction

The scientific application of clinical evidence-based guidelines can reduce the variability of clinical practice, and standardize clinical diagnosis and treatment pathways. At present, many evidence-based guidelines on Chronic Obstructive Pulmonary Disease (COPD) prevention have been issued in countries around the world, but the procedures and evaluation strategies developed by different guidelines are not the same. This study aimed to evaluate the quality of published clinical practice guidelines (CPGs) relating to COPD using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument.

Methods

Databases were systematically searched PubMed, EMBASE, Wan Fang, and CNKI as well as guidelines websites on COPD prevention and treatment. The search period was from inception of the database up to May 2019. The inclusion criteria for this study are as follows: (i) published and in accordance with the definition of the practice guidelines; (ii)the main target population is COPD patients with the diagnostic criteria of the 2019 edition of the global initiative for COPD (GOLD), and the content of the guideline is related to the prevention and treatment practice of COPD; (ii) the same guide is included in the latest updated version; (iv) the published language is English or Chinese. Guidelines that met these inclusion criteria were evaluated for the quality of the AGREE II guidelines. Then, a descriptive analysis was made of the consensus that exists in the guidelines.

Results

A total of fifteen guidelines/Consensuses Statements were included in the study. Two guidelines were assessed as recommended, eleven guidelines were assessed as recommended with modifications and two guidelines were not recommended. The mean scores of the included guidelines in the six domains (scope and purpose, personnel involved in guideline development, rigor of development, clarity, applicability, independence) were 90 percent, 72 percent, 49 percent, 96 percent, 60 percent, 69 percent, respectively. Thus, the study identified a consensus that disease risk factors and recommended interventions were mentioned in the guidelines, and that they comprehensively evaluated the quality of guideline reporting to provide reference for standardizing the development of practice guidelines for COPD in China.

Conclusions

The overall methodological quality of COPD CPGs should be improved. The key recommended areas for improvement include standardization of guideline report writing and synthesis of the latest and best evidence, to develop CPGs for COPD to improve the quality of clinical diagnosis and treatment for COPD.