bluuebunny/crossref_metadata_2025 huggingface dataset:
Implications of freeboard policy for homeowners in different income-groups: A case study of Jefferson parish
Authors: Deria Anisha , Mostafiz Rubayet Bin , Lee Yong-Cheol , Friedland Carol J.
Published: January 2025

The National Flood Insurance Program (NFIP) encourages the adoption of at least a 1ft. freeboard against flooding. Though freeboard is an effective flood mitigation method, the strategy involves additional investment that may cause economic liabilities. Moreover, such strategies are often generalized and do not consider optimal requirements at the micro-level. To this end, this study identifies the factors of economic vulnerability and proposes a framework for investigating the implications of such policy on different income groups. The discriminant analysis method was used to empirically quantify vulnerability and identify factors that are significant contributors to vulnerability. In addition, a vulnerability-benefit analysis was conducted by quantifying the benefits in terms of savings. The framework has been elucidated with a case study conducted for a group of cities in Jefferson parish with a poverty rate of 20% or more. It was found that though economic vulnerability increased with a decrease in income level, the benefits associated with the use of freeboard were almost equally distributed across all levels of vulnerability. The framework developed in this study is expected to provide helpful insight regarding the impact of different policies formulated for mitigating and managing flood disasters on various population groups at the micro-level.
Make it or leave it?– An exploration of post-foundation dynamics among female entrepreneurs
Authors: Uebbing Lina , Wehner Marius Claus , Aránega Alba Yela , Guaita Martínez José Manuel
Published: January 2025

Female entrepreneurs encounter several barriers before starting a business. The prevalent association of entrepreneurship with masculine stereotypes in many countries is a contributing factor as to why fewer women pursue entrepreneurial ventures. Yet our understanding of whether these barriers vanish once females have founded a new business remains limited. To shed more light on women’s experiences, we conducted 32 semi-structured interviews to investigate German female entrepreneurs’ perceptions of challenges post-foundation. Our findings show that female entrepreneurs are still affected by stereotypes of their private and professional surroundings after their business has launched. The main reasons for exiting their businesses are experienced role conflicts that may result in mental health issues. Based on these findings, we developed a framework illustrating how women navigate through the entrepreneurial lifecycle, encountering increased role incongruity as they become more deeply immersed in the entrepreneurial environment. Understanding the factors through which women decide about their future paths is important for researchers and practitioners to support female entrepreneurs after new business startup. We conclude that sustained private and professional as well as instrumental and non-instrumental support during the early stages after starting a new venture may help sustain the share of female entrepreneurs and reduce the share of females resigning and going into other labor.
An example of fractional ODE loss of maximum principle and Hopf’s lemma
Authors: Li Yulong , Raihen Md Nurul , Çelik Emine , Telyakovskiy Aleksey S.
Published: January 2025

It has been known that the fractional ODEs involving Riemann–Liouville fractional derivatives maintain many “analogies” of the classic elliptic-type properties, including maximum principles, Hopf’s Lemma, the existence of real eigenvalues, etc. However, in this short work, we construct a counterexample demonstrating that Caputo-type fractional operators (and their compositions) fail to uphold the maximum principle and Hopf’s lemma. This finding is somewhat unexpected and serves as a benchmark problem or counterexample, reminding us to remain cautious when developing parallel theories for fractional differential equations and applying them in modeling. Since the maximum principle and Hopf’s lemma are often used to construct convex cones in Banach spaces and guarantee the existence of a principal eigenvalue in classical elliptic theory, this result leads us to conjecture that fractional Sturm–Liouville problems involving the Caputo fractional derivative may lack a conventional principal eigenvalue. This conjecture is partially proved in a following-up work.
Framing Effects in Object Perception
Authors: Ivy Spencer , Mroczko-Wąsowicz Aleksandra
Published: January 2025

In this paper we argue that object perception may be affected by what we call “perceptual frames.” Perceptual frames are adaptations of the perceptual system that guide how perceptual objects are singled out from a sensory environment. These adaptations are caused by perceptual learning and realized through bottom-up functional processes such that sensory information is organized in a subject-dependent way leading to idiosyncratic perceptual object representations. Through domain-specific training, perceptual learning, and the acquisition of object-knowledge, it is possible to modulate the adaptive perceptual system such that its ability to represent becomes bespoke. Different perceivers with different perceptual frames may, therefore, receive the same sensory information and perceive different perceptual objects due to the effects of framing. Consequently, we demonstrate the plausibility of this account by surveying empirical data concerning the functions of (1) multisensory integration, (2) amodal completion, and (3) predictive anticipation. Regarding (1), we argue that the perceptual system’s optimization processes employ perceptual frames to facilitate multisensory feature binding. Regarding (2), we argue that amodal completion can occur with or without the help of mental imagery, yet either instance of amodal completion requires perceptual frames. Regarding (3), we demonstrate that perceptually anticipating an object’s motion involves the implementation of perceptual frames. We conclude that framing effects are a matter of perceptual diversity and highlight the need to accommodate unique perspectives in the philosophy and science of perception.
Improving the Cardiovascular Outcomes of Obstructive Sleep Apnea: Towards More Precise Hypoxia-Based Models of Disease Severity
Authors: Qayyum Nida T. , Cole Andrew T. , Khayat Rami N. , Grosberg Anna
Published: January 2025

Purpose of Review

Obstructive sleep apnea (OSA) affects at least 1 billion people worldwide, and its increasing prevalence is alarming considering an association to comorbidities such as cardiovascular disease (CVD) and to demonstrated health disparities. This raises concerns regarding the current diagnostic standards, which are also impacted by disparities. The current review was aimed at identifying limitations in the apnea-hypopnea index (AHI), the primary clinical indicator of OSA severity, and analyzing recent alternatives. In addition, the association between OSA and CVD was discussed, and, considering the role of intermittent hypoxia, solutions were proposed for improving OSA diagnosis.

Recent Findings

Based on a review of current literature, alternative metrics to the AHI such as the hypoxia burden, sleep apnea-specific pulse rate, and oxygen desaturation rate were shown to be correlated with indicators of CVD in OSA patients. A recent mathematical study also presents the possibility of a model-based metric to eliminate existing bias in diagnostics and to provide a more accurate quantification of tissue hypoxia.

The analyzed studies give incentive to look beyond current clinical standards in OSA. Through this review, we motivate the use of mathematical modeling as a future avenue to improve OSA diagnosis with a hypoxia-based approach.
Analysis of Traumatic Electric Scooter Injuries and Prevention
Authors: Nemeh Christopher , Schmoke Nicholas , Sheikh Fariha
Published: January 2025

Purpose of Review

Electric scooter falls and collisions are becoming more prominent mechanisms of injury in trauma. With the continued use of electric scooters, hospitals are anticipated to more frequently encounter patients presenting with a wide array of injuries. We sought to analyze the pattern of injuries associated with electric scooters in adults and pediatrics and ascertain ways to prevent or limit the degree of injuries to patients who use electric scooters.

Recent Findings

The injuries associated with electric scooters have the potential to be severe and can include intra-abdominal hemorrhage, intra-thoracic hemorrhage, intracranial hemorrhage, and fractures of the skull, facial bones, ribs, and long bones. There is some support for laws regarding electric scooter use which can be helpful to reduce the injury burden for this particular mechanism.

Traumas involving electric scooters are becoming increasingly prevalent. Injuries can be just as severe if not more severe than other trauma mechanisms. The focus of this chapter is to enhance the understanding of trauma from electric scooter injuries by summarizing injury patterns and evaluating the epidemiology to guide clinicians and highlight areas of future research.
An adjoint feature-selection-based evolutionary algorithm for sparse large-scale multiobjective optimization
Authors: Zhang Panpan , Yin Hang , Tian Ye , Zhang Xingyi
Published: January 2025

Sparse large-scale multiobjective optimization problems (sparse LSMOPs) are characterized by an enormous number of decision variables, and their Pareto optimal solutions consist of a majority of decision variables with zero values. This property of sparse LSMOPs presents a great challenge in terms of how to rapidly and precisely search for Pareto optimal solutions. To deal with this issue, this paper proposes an adjoint feature-selection-based evolutionary algorithm tailored for tackling sparse LSMOPs. The proposed optimization strategy combines two distinct feature selection approaches. Specifically, the paper introduces the sequential forward selection approach to investigate independent sparse distribution, denoting it as the best sequence of decision variables for generating a high-quality initial population. Furthermore, it introduces the Relief approach to determine the relative sparse distribution, identifying crucial decisive variables with dynamic updates to guide the population in a promising evolutionary direction. Experiments are conducted on eight benchmark problems and two real-world problems, and experimental results verify that the proposed algorithm outperforms the existing state-of-the-art evolutionary algorithms for solving sparse LSMOPs.
Detection of dynamic communities in temporal networks with sparse data
Authors: Djurdjevac Conrad Nataša , Tonello Elisa , Zonker Johannes , Siebert Heike
Published: January 2025

Temporal networks are a powerful tool for studying the dynamic nature of a wide range of real-world complex systems, including social, biological and physical systems. In particular, detection of dynamic communities within these networks can help identify important cohesive structures and fundamental mechanisms driving systems behaviour. However, when working with real-world systems, available data is often limited and sparse, due to missing data on systems entities, their evolution and interactions, as well as uncertainty regarding temporal resolution. This can hinder accurate representation of the system over time and result in incomplete or biased community dynamics. In this paper, we consider established methods for community detection and, using synthetic data experiments and real-world case studies, we evaluate the impact of data sparsity on the quality of identified dynamic communities. Our results give valuable insights on the evolution of systems with sparse data, which are less studied in existing literature, but are frequently encountered in real-world applications.
Microwave activation of ground tyre rubber and its application in off-road tyre tread formulation
Authors: Hrdlička Zdeněk , Brejcha Jiří , Otruba Ján , Skočilas Jan , Štancl Jaromír , Kadeřábková Alena , Čadek Drahomír , Krmela Jan , Krmelová Vladimíra
Published: January 2025

Finding a way to increase the amount of recycled waste tyres is a current global challenge. Among others, the production of ground tyre rubber (GTR) and its application in a new rubber compound looks as a perspective way. However, the compatibility of GTR and rubber matrix is limited, leading to insufficient properties of the new material. To improve them, it is suitable to activate the GTR prior to mixing. In this paper, GTR obtained by water jet process was activated with microwave irradiation (i) in a household oven at 400 W and 800 W for 1 and 3 min, and (ii) in an industrial device at 500 W, 1000 W, 1500 W and 1750 W for 1, 3 and 5 min. A total of 7% (w/w) of the irradiated GTR was incorporated into a carbon black-filled rubber compound based on styrene-butadiene rubber (SBR), natural rubber (NR) and butadiene rubber (BR), with a formulation for off-road tyre treads. Most compounds containing microwave-treated GTR showed comparable or better properties than the reference with untreated GTR (tensile strength, 14.9 MPa; elongation at break, 437%; modulus at 300% elongation, 8.97 MPa; hardness, 65.6 Shore A). The industrial microwave device offered better results and the possibility of use of higher variation in conditions than the home microwave oven.
Efficacy of plant extracts and bio-fertilizers for the control of bacterial wilt and soft rot agents in potato
Authors: Elhalag Kamel M. , Al-Anany Mohamed S. , Megahed Allam A.
Published: January 2025

This study aims to assess the suppressive effect of plant crude extracts, bio-, and mineral fertilizers, plant-animal origin compost, and vermicompost for controlling potato bacterial wilt and soft diseases in in-vitro and in-vivo pots experiments. Nine plant crude extracts were screened in-vitro for their antibacterial effectiveness against Ralstonia solanacearum, Pectobacterium carotovorum, and Pectobacterium atrosepticum. Ethanolic and water crude extracts from peels and leaves of Punicum granatum L. and Eucalyptus camaldulensis Dehnh respectively, showed the most growth inhibition against the three tested bacteria. In-vivo assessment, the peels ethanolic and water crude extract for P. granatum L. were the most effective treatments that exhibited a 91% and 89% decrease in the disease severity, area under disease progress curve of R. solanacearum wilt disease, population count, and enhanced the potato growth parameters, triterpenoids, and higher potato yield compared to other assessed mineral and organic fertilizers. In another in-planta experiment, treating potato tubers with these plant extracts significantly suppressed the maceration symptoms on the tubers, pre-inoculated by either P. carotovorum or P. atrosepticum with a treatment efficiency (TE) of 100% for each, except for the water extract of E. camaldulensis Dehnh that showed 22% of efficiency as compared to untreated potato tubers. Phytochemical characterization and Gas Chromatography-Mass Spectrometry (GC-MS) revealed the presence of phenols, tannins, and flavonoids that have antimicrobial activity in both extracts. These treatments are recommended to be applied individually or as an effective component of integrated pest management program to enhance potato tolerance against bacterial pathogens during the growing season and storage.
Ritonavir loaded solid lipid nanoparticles for oral drug delivery and bioavailability enhancement
Authors: Chettupalli Ananda Kumar , Bukke Sarad Pawar Naik , Rahaman Shaik Abdul , Unnisa Aziz , Adepu Madhumitha , Kavitha Marati , Babu Molakpogu Ravindra , Narapureddy Bayapa Reddy , Onohuean Hope
Published: January 2025

Background

Ritonavir is an anti-retroviral protease inhibitor to treat HIV, AIDS infections.

Methods

The RN-SLNs were prepared by using hot homogenization followed ultrasonication method and optimized by using a two-factor, three-level central composte design (CCD). The independent variables were selected as phospholipids (X1) and type of surfactants (X2), whereas the dependent variables were chosen as percent entrapment efficiency (%EE) (Y1), size of the particle (Y2), and percent cumulative drug release (Y3). Further, the formulated R-SLNs were characterized and in vitro drug release studies were performed. The optimized R-SLNs were subjected to in vivo pharmacokinetic studies.

Results

The solid lipid soya leccithin showed the maximum solubility of RN (103.34 mg/g) compared to stearic acid (81.44 mg/g), glyceryl monostearate (67.21 mg/g), Gelucire 39/1 (44.22 mg/g), and Compritol 888 ATO (31.23 mg/g). Further, the surfactant blend (Tween 80: Poloxamer 188 (8:2)) showed the maximum entrapment efficiency and was the most suitable surfactant. The optimized RN-SLN formulation showed a particle size of 265.06 ± 5.12 nm, % EE of 86.2 ± 3.16 and cumulative drug release of 94.8 ± 0.16%. In addition, in-vitro drug release studies confirmed a biphasic release pattern, and followed Higuchi’s model. The in vivo pharmacokinetic studies showed an increase in bioavailability by 4.3 folds as compared to marketed formulation.

Conclusions

The optimized RN-SLNs significantly enhanced the solubility and bioavailability of RN. The results of the present study can become a promising platform for the enhancement of oral bioavailability by novel nano carriers.

Graphical abstract
Legal and ethical implications of AI-based crowd analysis: the AI Act and beyond
Authors: Veltmeijer Emmeke , Gerritsen Charlotte
Published: January 2025

The increasing global population and the consequent rise in crowded environments have amplified the risks of accidents and tragedies. This underscores the need for effective crowd management strategies, with Artificial Intelligence (AI) holding potential to complement traditional methods. While AI offers promise in analysing crowd dynamics and predicting escalations, its deployment raises significant ethical concerns, regarding privacy, bias, accuracy, and accountability. This paper investigates the legal and ethical implications of AI in automated crowd analysis, with a focus on the European perspective. We examine the effect of the GDPR and the recently accepted AI Act on the field. The study then delves into remaining concerns post-legislation and proposes recommendations for ethical deployment. Key findings highlight challenges in notifying individuals of data usage, protecting vulnerable groups, balancing privacy with safety, and mitigating biased outcomes. Recommendations advocate for non-invasive data collection methods, refraining from predicting and decision-making AI systems, contextual considerations, and individual responsibility. The recommendations offer a foundational framework for ethical AI deployment, with universal applicability to benefit citizens globally.
Dead or dormant? German Ostpolitik after Ukraine
Authors: Klinke Ian
Published: January 2025

Germany’s 2022 Zeitenwende (watershed) has been widely interpreted as a break with Berlin’s decades-long attempts to offer security ‘with rather than against Russia’. In the 1970s, West Germany’s social democrat-led government had embarked on Ostpolitik (Eastern policy) as a way of normalising relations with the German Democratic Republic (GDR) and other Soviet satellites by fostering closer economic ties with Moscow. This policy was extended by subsequent governments and even endured, though in new form, after the fall of the Berlin wall. Ostpolitik is now commonly seen to have culminated in a Kremlin-friendly political landscape and an economy dependent on Russian gas. More than two years after Zeitenwende, the jury is still out as to whether Ostpolitik has been dismantled or simply remains on hold. This article shows that although German politics has experienced a seismic shift since the invasion, forces of continuity remain in operation. Ostpolitik was always in part the symptom of a desire to do realpolitik in Europe. This urge is unlikely to disappear.
An evaluation of reduced hack and squirt (RHS) treatment with aminocyclopyrachlor and aminopyralid for invasive tree control in Florida
Authors: Enloe Stephen F , Leary James K , Lastinger Cody , Lauer Dwight K
Published: January 2025

Reduced hack and squirt (RHS) is an herbicide injection technique that controls woody species with a limited number of hacks. When used with aminopyralid or aminocyclopyrachlor, the technique controls multi-stem shrubs such as Schinus terebinthifolia Raddi and Eugenia uniflora L. However, additional data is needed to compare its effectiveness on other woody invasive species against standard individual plant treatment techniques. We compared RHS with aminocyclopyrachlor or aminopyralid administered with 0.5 ml of undiluted concentrate (240 g L-1) against traditional basal bark and cut stump techniques using triclopyr at 96 and 120 g L-1 respectively, on six invasive trees in Florida, USA. For all species tested, the RHS technique with aminocyclopyrachlor was not different or was more effective than basal bark or cut stump treatment with triclopyr. The RHS technique with aminopyralid was effective on certain species but did not control as many species as RHS with aminocyclopyrachlor or cut stump treatment with triclopyr. The RHS technique required significantly less time than cut stump treatment but was not different than basal bark treatment. Across all species, when compared to basal bark and cut stump treatment with triclopyr, the RHS approach resulted in reductions of average total herbicide mix applied by 98 and 89%, respectively. For herbicide active ingredient, when compared to basal bark and cut stump treatment with triclopyr, RHS resulted in reductions of 95 and 86%, respectively. These results indicate that when compared to conventional individual plant treatment (IPT) approaches with triclopyr, the RHS approach yielded a high level of target efficacy on a broad spectrum of species, comparable or shorter application times, and substantial reductions in herbicide mix and active ingredient applied. Future research should seek a continued refinement of this technique for woody plant control on other troublesome invaders.
Materiality of Traumatic Experience and the Limits of Representation in Hassan Bani Ameri's Gonjeshkha Behesht ra Mifahmand (Sparrows Understand Heaven)
Authors: Ghodrati Maryam
Published: January 2025

This paper examines the materialization of trauma as both a narrative and embodied phenomenon in Hassan Bani Ameri's 2006 novel, Gonjeshkha Behesht ra Mifahmand, using contemporary narrative and trauma theory. The postmodernist narrative, told from the perspective of a photojournalist, reconstructs events surrounding the death of a celebrated Iran-Iraq War commander. I argue that traumatic truths resist full integration into conventional frameworks of understanding, evident in the novel's non-linear, fragmented narrative and its shift from visual realism to confessional surrealism in an ending that challenges traditional storytelling and historical documentation. By vividly simulating the sensory processing of traumatic memories, the novel emphasizes the material reality of trauma that demands to be seen, heard, and physically felt, thus negating celebratory institutional narratives around the culture of war and martyrdom.
Framing the Judiciary: Effects of Partisan, Procedural, and Populist Frames on Apex Court Perceptions in Czechia
Authors: Juzgenbayev Alisher
Published: January 2025

Students of comparative law have long argued that undermining judicial independence is electorally costly, and that the norms against interference uphold institutional checks and balances essential to constitutionalism. However, evidence from countries with robust judiciaries suggests that exposing voters to deficiencies in the legal process or the courts’ partisan leanings can reduce perceptions of judicial legitimacy, making such interference on part of would-be authoritarians more likely. The rise of populist politicians poses additional risks: by emphasizing judges’ unelected status and counter-majoritarian tendencies, populists may erode legitimacy, framing judges as part of a “corrupt elite” opposing “the people.” This rhetoric challenges liberal-democratic norms that limit state interference with individual rights. To test whether one observes the effects of partisanship and procedural fairness on voters’ perceptions of the courts outside the US context, and whether populist messages produce comparable effects, a pre-registered survey experiment is conducted in the context of Czechia, a country that, until recently, has had both a populist executive and a strong and independent Constitutional Court. The study presented respondents with vignettes describing an important electoral ruling of the Czech Constitutional Court, embedding messages that highlighted judges’ unelected status, the ruling’s procedural irregularities, or its partisan implications. Contrary to expectations, findings show no significant effects of any message type on perceptions of judicial legitimacy. The results of the study suggest that the marginalization of robust judiciaries in backsliding democracies may be a largely elite-driven institutional process, with uncertain electoral payoffs.
Gone with the Rebels: Reshaping Local Orders in Post-Peace Agreement Colombia
Authors: Gutiérrez José A. , Voyvodic Clara
Published: January 2025

The 2016 peace agreement between the Colombian government and the FARC-EP, and the demobilization of the latter, dismantled the governance structures in regions formerly under rebel control. Drawing from a relational security framework, this article explores how, across three case-studies, communities use their former experience of rebel governance as a framework through which they could express expectations and dissatisfaction with new types of order. This blueprint is also used to make specific demands to new or reconstituted armed groups and to take direct action to address governance gaps, reproducing and co-constructing order post-demobilization. However, we observe that both the organization of the community and the capacity and ideology of armed groups could also be limiting factors to the community’s reproduction of order post-demobilization. From a peacebuilding perspective, this means that there can be pressure from below in favor of remobilization, as a predictable insurgent order may be preferable to uncertainty.
Child marriage, educational attainment, and comprehensive knowledge of HIV/AIDS: a multi-country analysis
Authors: Onagoruwa Adenike , Wodon Quentin
Published: January 2025

Understanding the link between HIV/AIDS knowledge and child marriage is important for designing and planning effective intervention programmes. Despite significant advances in HIV/AIDS prevention and treatment, it remains important to study the impact of child marriage on HIV/AIDS knowledge because HIV/AIDS continues to affect millions globally. This study investigated the association of child marriage with scores on an index measuring comprehensive knowledge about HIV/AIDS transmission and prevention. Analysis was conducted on a sample of women aged 18–24 years, using nationally representative DHS household surveys from 18 countries. Findings indicate that there is no direct statistically significant effect of child marriage on women’s comprehensive knowledge about HIV/AIDS once controls for other factors affecting knowledge are included in the regression. However, the coefficients for educational attainment are statistically significant in most countries, at least when secondary or higher education is considered. This suggests that child marriage may affect knowledge about HIV/AIDS indirectly through its impact on educational attainment for girls who marry early.
Linear stability analysis of a pair plasma with arbitrary non-neutrality in the magnetic field of an infinite, straight wire
Authors: Steinbrunner P. , O'Neil T.M.
Published: January 2025

We investigate the global stability properties of an electron–positron pair plasma in the linear regime. The plasma is confined by the magnetic field of an infinitely long wire. This configuration is the large-aspect-ratio limit of the levitated dipole experiment of the APEX collaboration. The stability is governed by the diocotron mode and the interchange mode. The diocotron mode dominates in the case of a cold, non-neutral plasma. For specific density profiles we find analytic solutions. We derive a necessary condition for instability and find unstable solutions if the plasma forms a thin shell around the wire. Solutions for arbitrary density profiles with finite temperature are obtained numerically. We find that finite-temperature effects stabilise the diocotron mode. The interchange mode, on the other hand, dominates if the plasma is neutral and has a finite temperature. This mode becomes unstable for a steep-enough density gradient, that is aligned with the gradient of the magnetic field strength and is stabilised by the equilibrium

$E\times B$

drift of a non-neutral plasma.
Morphological traits and spatial distribution of azooxanthellate corals of Rhizangiidae in the Laccadive Sea
Authors: Viswambharan Divya , K. R. Sreenath
Published: January 2025

Azooxanthellate corals of Rhizangiidae, with their distinctive morphological and ecological features, are widely distributed across global oceans but remain under-studied due to identification challenges. Comprehensive underwater surveys across diverse marine habitats such as rocky reefs and submerged shipwrecks were undertaken, and findings highlighted the exclusive presence of Culicia stellata in natural rocks, off the coast of Kaup for the first time in Indian EEZ. The study also records the presence of Cladangia exusta, nearly six decades after the first record from off Cochin, Laccadive Sea. This research presents a detailed study of the taxonomic description, distribution, and ecological preferences of Cladangia exusta and Culicia stellata in the Laccadive Sea. This study underscores the importance of accurate species identification for effective conservation strategies and enriching biodiversity records.
Rethinking rebel victory in civil war
Authors: Wedgwood Young Enrique , Florea Adrian
Published: January 2025

Research on civil war termination typically classifies conflict outcomes into homogeneous categories. Civil wars are conventionally described as ending in ‘victory’ for one side, ‘negotiated settlement’, or ‘stalemate’. However, each of these common categories conceals a significant degree of unexplored variation. Not all peace processes are the same, nor should we assume equivalence between all ‘victory’ outcomes. Ignoring the variability in outcomes obscures our understanding of how civil wars actually end and can undermine efforts to examine how this may influence the sustainability of the ensuing peace. This article focuses on the concept of rebel victory and argues that it has been used to describe a wide range of civil war outcomes that share some features but that also differ along three dimensions: (i) the residual threat posed by the defeated regime; (ii) the role of external actors in enabling victory; and (iii) rebel fragmentation. The article describes these dimensions and the influence that they can exert on the likelihood of continued political instability in the aftermath of rebel victories. The examples of rebel victories in the Central African Republic (2003 and 2012) are used to demonstrate the analytical utility of this novel conceptualisation of rebel victory.
OP10 Affordability Decision Rules: Systematic Review And Categorization Of Budget Impact Thresholds For 174 Countries Based On International Practices
Authors: Pichon-Riviere Andres , Cairoli Federico , Marti Sebastian Garcia , Augustovski Federico
Published: January 2025

Introduction

Effective health intervention coverage decision-making hinges on understanding budget impact (BI). Despite progress in estimating cost-effectiveness thresholds, a standardized approach for defining BI, particularly high BI, remains elusive. Addressing this gap, our systematic review aims to identify existing BI thresholds and establish universally applicable BI categories, providing a much-needed framework for global health policy.

Methods

In our systematic review, we adhered to Cochrane methods and PRISMA reporting guidelines (PROSPERO protocol CRD42020221652). We included articles that detailed current BI or affordability thresholds used by national or regional healthcare systems, sourcing from PubMed, Embase, and International Network of Agencies for Health Technology Assessment (INAHTA) communications. To address variability across jurisdictions, we normalized BI/affordability thresholds to a fraction of each country’s total healthcare expenditure. This approach enabled us to categorize BI thresholds into four distinct levels (low, moderate, high, and very high) and apply these categories universally across countries.

Results

We retrieved 1,592 records, identifying affordability thresholds and their underlying rationales in 12 countries: Argentina, Australia, England, Canada, Germany, France, Netherlands, USA, Taiwan, Ukraine, Scotland, and Singapore. Utilizing this data, we established four BI threshold levels relative to the total health budget: low (below 0.00005), moderate (0.00005 to <0.0001), high (0.0001 to <0.0002), and very high (>=0.0002). We then extrapolated these thresholds, along with their uncertainty ranges, to 174 countries, using 2022 World Bank data.

Conclusions

Our study provides a comprehensive overview of current global affordability thresholds and their implications for healthcare coverage and reimbursement. We found that explicit BI thresholds are predominantly established in high-income countries. Our findings offer critical, evidence-based guidance on affordability decision rules, applicable to health systems in 174 countries, thereby contributing significantly to the standardization and informed policymaking in global healthcare.
OP11 Assessing Patient And Societal Unmet Needs: The Needs Examination, Evaluation And Dissemination (NEED) Assessment Framework
Authors: de Noordhout Charline Maertens , Levy Muriel , Schönborn Claudia , De Jaeger Mats , Kohn Laurence , Claerman Rani , De Pauw Robby , Cleemput Irina
Published: January 2025

Introduction

The healthcare ecosystem is predominantly supply-driven, leading to a lack of innovation in financially less-attractive health areas, inefficient use of public resources for healthcare, and unmet patient and societal needs. This study proposes a framework to identify unmet health-related patient and societal needs for different health conditions, to inform and support the development of needs-driven healthcare policy and innovations.

Methods

Two systematic literature reviews were conducted: one to update an already published literature review that identified tools for measuring patient needs; another to identify criteria for measuring health-related societal needs. Ovid MEDLINE and Embase were searched for English, French, and Dutch publications. In April 2023, 22 Belgian stakeholders and experts reviewed selected societal needs criteria. The NEED (Needs Examination, Evaluation and Dissemination) assessment framework, incorporating literature-derived patient and societal needs criteria, underwent discussions with the Health Minister’s Cabinet and federal health agencies from May to July 2023. The framework was challenged in November 2023 during international and national advisory committee meetings.

Results

The literature reviews covered 52 studies. The NEED framework addresses patient, societal, and future needs across health, healthcare, and social domains. Patient-level criteria (13) include health (e.g., impact on quality of life), healthcare (e.g., burden of treatment), and social (e.g., social support). Societal needs criteria (6) encompass health (e.g., transmissibility), healthcare (e.g., value for money), and social (e.g., productivity losses). Future needs criteria (2) consider future burden of disease and economic burden. Each criterion (total: 40) has measurable indicators with calculation methods and data sources. Equity is recognized as a transversal dimension, requiring unmet needs data disaggregated by population group.

Conclusions

For the first time, a transparent scientific framework containing criteria and indicators for assessing the unmet needs of patients and society has been developed. This lays the foundations for a major shift towards a more needs-driven healthcare policy and innovation.
OP12 Identification Of Patient And Societal Needs In Melanoma: Application Of The Needs Examination, Evaluation And Dissemination (NEED) Assessment Framework
Authors: Schönborn Claudia , De Jaeger Mats , Levy Muriel , Kohn Laurence , Claerman Rani , De Pauw Robby , Cleemput Irina , de Noordhout Charline Maertens
Published: January 2025

Introduction

The NEED (Needs Examination, Evaluation and Dissemination) assessment framework aims to identify patient and societal unmet needs in various diseases, highlighting gaps for intervention. This approach is exemplified through a malignant melanoma case study, ranking sixth in European cancers. Therapeutic progress has been made over the last decade, prompting an assessment of remaining unmet needs.

Methods

The applicability of the NEED framework has been evaluated through a case study of melanoma in Belgium. The methodology had four components: (i) an overall description of the disease based on the scientific (published and grey) literature and clinical expert input; (ii) an online survey on the unmet needs of patients (n=37); (iii) semistructured interviews with individuals affected by melanoma (n=9); and (iv) secondary data collection for each NEED framework criterion, including scientific literature and public databases. The survey results were analyzed with descriptive statistics, and the interview transcripts were analyzed using a thematic analysis.

Results

Unmet needs in melanoma were categorized as patient-level health, healthcare, and social needs, alongside wider societal needs. Patients experienced a substantial burden from mortality in advanced stages, burdensome symptoms such as fatigue, and notable side effects of systemic treatment. Inadequate psychological support contributed to high levels of fear and anxiety. A scarcity of dermatologists posed a barrier to timely care access, and low awareness of melanoma risk led many patients to delay seeking medical attention, with significant societal implications for melanoma prevention efforts. The case study also identified research gaps concerning social and ethnic inequalities in melanoma care in Europe.

Conclusions

Using the NEED framework highlighted melanoma patients’ most crucial unmet needs. This evidence can be used to assess whether new interventions address the highest unmet patient or societal needs. Challenges in ensuring adequate sample size limit the generalizability of results. Capturing melanoma’s complexity in a snapshot masks some needs heterogeneity.
OP32 Identification Of Factors Alongside Costs And Effectiveness For The Technology Assessment Of Comprehensive Genomic Profiling: A Systematic Review
Authors: Schaik Lucas van , Engelhardt Ellen , Wilthagen Erica , Steeghs Neeltje , Coves Andrea Fernandez , Joore Manuela , Harten Wim van , Retèl Valesca
Published: January 2025

Introduction

Comprehensive genomic profiling (CGP) identifies many targets at once. However, it is challenging for reimbursement decision-makers to incorporate all potential effects in their assessment. The aim of this study is twofold: first, to identify which factors, besides effectiveness and costs, might influence the choice for CGP in advanced cancer patients, and second, to identify the available evidence for these factors.

Methods

We performed a systematic literature review in MEDLINE, Embase, and Scopus with a two-step design. First, a scoping search was performed to identify relevant factors. Extracted factors were grouped with domains of the EUnetHTA core model and ISPOR (Professional Society for Health Economics and Outcomes Research) “value flower.” Two expert sessions were held to validate factors and construct definitions. Second, a systematic search was conducted to identify the available empirical evidence for these factors. Eligibility criteria for the systematic search were the use of CGP (≥200 genes), advanced cancer patients, and the presentation of empirical evidence on one of the factors.

Results

Five factors were identified in the scoping search: “feasibility” (adopting tests in the health care system), “test journey” (pathway from requesting tests until reporting of results), “wider implications of diagnostic results” (impact of test beyond identifying on-label treatments), “organization of laboratories” (organization of tests and access to tests), and “scientific spillover” (learnings of testing). Eighty-three articles were included following the systematic search, and empirical evidence was identified for the factors “test journey” and “wider implications of diagnostic results”. Few studies had adequate comparative study designs. Heterogeneity was observed among studies in the definitions of outcomes and the reported evidence.

Conclusions

Comprehensive reimbursement decision-making for CGP can be supported by including the five identified factors. However, quantifiable evidence was only identified for the “patient test journey” and “wider implications of diagnostic results”. Current literature provides limited high-quality evidence to establish the added benefit of CGP, as adequately designed comparisons are lacking. For evidence-based decision-making, uniform outcome measurements are recommended.
OP35 Early Access To Medicinal Products In France: A Positive Evaluation Two Years Into The New Framework
Authors: Crespel Virginie , Roux Guillaume , Desbiolles Alice , Beaufils Alexandre , Diatta Thierno , Pelon Floriane , Thomassin Camille
Published: January 2025

Introduction

Introduced in July 2021, early access to pharmaceuticals allows French patients to have rapid and reimbursed access to presumed innovative medicines prior to marketing authorization or regular reimbursement registration. The French National Authority for Health (Haute Autorité de Santé [HAS]) is responsible for granting early access authorizations and for health technology assessment upstream of regular reimbursement. This analysis evaluates the outcomes of the 2021 reform.

Methods

In collaboration with the national regulatory body (ANSM) and the Ministry of Health, a descriptive and retrospective analysis has been conducted to assess the impact of this reform. The data were extracted from published HAS decisions and from the HAS internal information system (EVAMED). The period considered is the first two years of the reform, from 1 July 2021 to 30 June 2023. Different information has been analyzed, such as conclusions of decisions returned, therapeutic areas concerned, and decision processing time. An additional analysis focused on HAS opinions on regular reimbursement for the medicines for which early access was granted.

Results

In two years, over 250 applications (including first applications, modifications, and renewals) have been submitted, increasing over time, and 180 decisions were issued by HAS within this period. Eighty percent of HAS decisions were positive for early access. Among the medicines for which early access was granted, 86 were also assessed for regular reimbursement, of which 78 percent obtained a positive clinical added value score (at least ASMR IV). Overall, the early access program is estimated to have facilitated coverage approximately nine months before regular reimbursement and benefited over 100,000 patients.

Conclusions

Manufacturers make extensive use of early access applications. A positive assessment of the reform outcomes emerges from this analysis, emphasizing the role of HAS in accelerating patient access to presumed innovative treatments. In light of US experience and of the uncertainties surrounding fast-track authorization procedures, monitoring of the French early access system will continue.
OP38 Perinatal And Infant Mental Health Care: International Guideline Recommendations And Situation In Austria
Authors: Zechmeister-koss Ingrid , Reinsperger Inanna , Kern Julia , Edlinger Michael , Paul Jean
Published: January 2025

Introduction

Mental illnesses during pregnancy and after birth (perinatal period) affect one in five mothers and one in ten fathers. They can have adverse implications for child health and development and come with substantial economic costs. Many countries have developed integrated care models. We aim to summarize the international care model recommendations and contrast them with the current situation in Austria.

Methods

We conducted a scoping review of guidelines and recommendations for perinatal and infant mental health care (PIMHC) models and synthesized them into a best-practice model. The model overview targets prevention, early identification, and care of perinatal mental illness (PMI), as well as professional groups involved. We identified available Austrian PIMHC services via online search and expert consultation, clustered them according to our international model structure, and visualized availability on a geographical map. Additionally, we analyzed the use of five core mental health benefits from health insurance data. We narratively contrasted international recommendations with the Austrian availability and use of services.

Results

International recommendations suggest integrating primary prevention, systematic screening, and stepped care. After identifying a PMI, a care pathway needs to be defined, including diagnostic and coordinated needs-based care. For severe PMI, specialized services should be available and provided by trained psychiatrists and specialists, such as perinatal mental health midwives. In Austria, various services for different severity levels of PMI are available. However, large geographical variations and gaps exist regarding specialist services, such as mother–baby units. Specially trained health professionals are lacking. Still, almost one in five mothers claimed one of the defined mental health benefits during the perinatal period.

Conclusions

PIMHC in Austria currently does not follow best-practice recommendations. The main gaps are in providing guideline-based specialized care by trained professionals. Insurance-funded mental health service use during the perinatal period corresponds with international prevalence figures, although only a part of available services is included in the analysis. To ensure women receive high-quality care, PIMHC needs to be more prioritized.