bluuebunny/crossref_metadata_2025 huggingface dataset:
A Basic Time Series Forecasting Course with Python
Authors: Zemkoho Alain
Published: December 2022

The aim of this paper is to present a set of Python-based tools to develop forecasts using time series data sets. The material is based on a 4-week course that the author has taught for 7 years to students on operations research, management science, analytics, and statistics 1-year MSc programmes. However, it can easily be adapted to various other audiences, including executive management or some undergraduate programmes. No particular knowledge of Python is required to use this material. Nevertheless, we assume a good level of familiarity with standard statistical forecasting methods such as exponential smoothing, autoregressive integrated moving average (ARIMA), and regression-based techniques, which is required to deliver such a course. Access to relevant data, codes, and lecture notes, which serve as based for this material, is made available (see https://github.com/abzemkoho/forecasting) for anyone interested in teaching such a course or developing some familiarity with the mathematical background of relevant methods and tools.
Classification of Hamiltonian Non-Abelian Painlevé Type Systems
Authors: Bobrova Irina , Sokolov Vladimir
Published: December 2022

All Hamiltonian non-abelian Painlevé systems of $${{\,\mathrm{P_{1}}\,}}-{{\,\mathrm{P_{6}}\,}}$$

P
1

-

P
6

type with constant coefficients are found. For $${{\,\mathrm{P_{1}}\,}}-{{\,\mathrm{P_{5}}\,}}$$

P
1

-

P
5

systems, we replace an appropriate inessential constant parameter with a non-abelian constant. To prove the integrability of new $${{\,\mathrm{P_{3}^{\prime }}\,}}$$

P

3

′

and $${{\,\mathrm{P_{5}}\,}}$$

P
5

systems thus obtained, we find isomonodromic Lax pairs for them.
A Philosopher Looks at the Religious Life
Authors: Hitz Zena
Published: December 2022

What is happiness? Does life have a meaning? If so, is that meaning available in an ordinary life? The philosopher Zena Hitz confronted these questions head-on when she spent several years living in a Christian religious community. Religious life -- the communal life chosen by monks, nuns, friars, and hermits -- has been a part of global Christianity since earliest times, but many of us struggle to understand what could drive a person to renounce wealth, sex, children, and ambition to live a life of prayer and sacrifice. Hitz's lively and accessible book explores questions about faith, sacrifice, asceticism and happiness through philosophy, stories, and examples from religious life. Drawing on personal experience as well as film, literature, history, biography, and theology, it demystifies an important element of contemporary culture, and provides a picture of human flourishing and happiness which challenges and enriches modern-day life.
Evaluating the feasibility and acceptability of the Mood Assessment Post-Stroke (MAPS) mood screening training
Authors: El-Helou Rebecca , Rogers Jeffrey M. , Ryan Brooke , Marsden Dianne L. , Winkler Ann , Baillie Andrew , Kneebone Ian
Published: December 2022

Mood problems are common after stroke, and screening is recommended. Training may support staff knowledge and implementation of screening, but the feasibility of training programmes in the Australian healthcare system has not been formally established. This study aimed to assess the feasibility of a mood screening training for a multidisciplinary team (MDT) of stroke clinicians working in a post-acute inpatient rehabilitation service.

Twelve staff from a rehabilitation service at a major hospital in Sydney, Australia participated in a 3-h interactive training session. The feasibility of running the course, assessment of knowledge gained via a consolidation exercise and quiz and acceptability of the training were assessed via focus groups.

The in-person modality of the training hindered recruitment and assessment of participants’ knowledge, though the actual measures themselves appeared appropriate. Nine participants provided feedback in two focus groups. Thematic analysis identified positive reactions to the training. However, low self-efficacy persisted and organisational/socio-cultural barriers to implementation emerged. Following training, the medical officers of the MDT had successfully implemented routine screening.

Overall, the training appeared acceptable and to foster knowledge in staff. However, limitations to recruitment and administering evaluations were identified. The development of flexible online training may improve future evaluations of screening training programmes/pathways.
Introducing Cambridge Prisms: Coastal Futures
Authors: Spencer Tom , Adams Janine , Le Tissier Martin , Murray Brad , Splinter Kristen
Published: December 2022

Whilst there is little argument that coasts are on the frontline when it comes to the impacts of near-future global environmental change, is there a need for yet another coastal journal? Emphatically ‘yes’. There is an unfilled niche here for a forum that promotes and presents cross-disciplinary research, from fundamental science to impact-orientated approaches. We wish to see a journal that informs pathways away from unsustainable practices towards more socially just and equitable futures for the world’s coastlines and their communities. We set out below some of the questions that arise when articulating this pathway, using the high-level categories in the journal’s topic map as some of the stepping stones that will be encountered along the way.
Toward data assimilation of ship-induced aerosol–cloud interactions
Authors: Patel Lekha , Shand Lyndsay
Published: December 2022

Satellite imagery can detect temporary cloud trails or ship tracks formed from aerosols emitted from large ships traversing our oceans, a phenomenon that global climate models cannot directly reproduce. Ship tracks are observable examples of marine cloud brightening, a potential solar climate intervention that shows promise in helping combat climate change. In this paper, we demonstrate a simulation-based approach in learning the behavior of ship tracks based upon a novel stochastic emulation mechanism. Our method uses wind fields to determine the movement of aerosol–cloud tracks and uses a stochastic partial differential equation (SPDE) to model their persistence behavior. This SPDE incorporates both a drift and diffusion term which describes the movement of aerosol particles via wind and their diffusivity through the atmosphere, respectively. We first present our proposed approach with examples using simulated wind fields and ship paths. We then successfully demonstrate our tool by applying the approximate Bayesian computation method-sequential Monte Carlo for data assimilation.
Hospital-acquired bacterial infections in coronavirus disease 2019 (COVID-19) patients in Israel
Authors: Schwaber Mitchell J. , Temkin Elizabeth , Lobl Rona , Schechner Vered , Nutman Amir , Carmeli Yehuda
Published: December 2022

Background:

We sought to determine incidence of common hospital-acquired bacteria among coronavirus disease 2019 (COVID-19) patients in Israeli general hospitals during the first year of the pandemic.

Methods:

We analyzed routinely collected incidence data to determine hospital acquisition of the following sentinel bacteria: Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, Pseudomonas aeruginosa, Acinetobacter baumannii, and Clostridioides difficile. We examined 3 acquisition measures: (1) sentinel bacteria, (2) sentinel bacteremia, and (3) antimicrobial-resistant sentinel bacteremia. The study period was March 1, 2020, through January 31, 2021.

Results:

Analysis of pooled data from the 26 hospitals surveyed revealed that rates were higher for all 3 acquisition measures among COVID-19 patients than they were among patients on general medical wards in 2019, but lower than those among patients in intensive care units in 2019. The incidence rate was highest during the first COVID-19 wave, despite a lower proportion of severe COVID-19 cases among total hospitalized during this wave. Wide variation in incidence was evident between hospitals.

Conclusions:

Hospitalized COVID-19 patients experienced nosocomial bacterial infection at rates higher than those of patients on pre-pandemic general medical wards, adding to the complexity of their care. Lower rates of nosocomial infection after the first wave, despite higher proportions of severely ill patients, suggest that healthcare worker practices, rather than patient-related factors, were responsible for most of these infections.
The challenge of writing histories of ‘women’: the case of women and the law in late medieval Ireland
Authors: Booker Sparky
Published: December 2022

Critiques of women's history based on intersectional analysis have demonstrated the importance of recognising differences between women and the perils of assuming commonality of experience based on gender. The idea that we can treat women as a group in some meaningful way is further complicated in medieval legal history by the fact that women's legal entitlements differed depending on their marital status. This paper examines women's experiences of the law in the English colony in late medieval Ireland. It argues that, despite the importance of ethnicity, social status and marital status in shaping different women's experiences of the law, gender played a significant role in their legal arguments and the ways in which juries and justices perceived them. Women's experiences at law were influenced in myriad ways by shared societal assumptions about their vulnerability and subordination to men. These assumptions influenced women regardless of the many social divisions and circumstances that made each woman unique. This study finds, therefore, that ‘women’ is a legitimate and productive category for historical research in the late medieval legal context but urges historians to interrogate more robustly why ‘women’ is an appropriate analytical category for their specific historical questions.
Developing an agenda for the history of women religious in Ireland: historiography and potentiality
Authors: Raftery Deirdre
Published: December 2022

In ‘An Agenda for women's history in Ireland, 1500–1900’ (1992), Margaret MacCurtain, Mary O'Dowd and Maria Luddy noted that research on convents and women religious (nuns/sisters) in Ireland was beginning to open up in the 1980s. They also suggested areas that merited the attention of scholars, including the experience of vowed religious life by women, issues of class and power within Irish convents, and the role of nuns in Irish society. This article examines historiographical developments, with a view to seeing whether or not scholars rose to the challenges posed in 1992. Additionally, it considers areas that still demand attention.
Exploring the ordinary: migration, sexuality and crime, and the progression of the ‘Agenda’ in Irish women's history, 1850s–1950s
Authors: Farrell Elaine , McCormick Leanne , Redmond Jennifer
Published: December 2022

This article reflects on some developments in women's history based on the 1992 ‘An agenda for women's history in Ireland, 1500–1900’, particularly responding to the section authored by Maria Luddy, incorporating work grounded in the nineteenth century up to the first half of the twentieth. Specifically, it considers developments in Irish women's social history over the past thirty years on the period from the 1850s to 1950s. The focus is on themes of poverty and migration, crime, and sexuality, which were touched on in the ‘Agenda’ and identified as areas for future research. Analysis on these subjects allows for an insight into lived realities for ‘ordinary’ women. These are areas which reveal the growth and development of historical research and its impact on public narratives and policy. Taking its cue from the ‘Agenda’, this article also identifies other fruitful research topics that could be further explored in future scholarship.
The textual terrain: developments and directions in women's writing, 1500–1700
Authors: Coolahan Marie-Louise
Published: December 2022

This article assesses our much-expanded view of the texts produced by early modern women in Ireland, surveying what is available to present-day researchers and considering emerging methodologies for the analysis of early modern female voices. The range of genres with which we now know early modern women engaged owes much to feminist literary historians’ capacious approach to defining literature, expanding beyond traditionally elite genres (drama, poetry, fiction) to encompass writing in all its forms. Thus, the present corpus includes letters and petitions, life writing, devotional prose, legal depositions, as well as all kinds of verse and song, in multiple languages. Moreover, where the primary evidence in Ireland sometimes seems sparse, international perspectives have illuminated the currents of women's writing. Interpretative paradigms from other fields — book history and the history of reading, culinary and medical history, network analysis — are being applied to yield fresh insights about this material. The question of how early modern Ireland was experienced by women has been explored in studies that address such texts as articulations of subjectivity, in the light of the history of emotions. The wide range of situations and genres of women's writing in early modern Ireland is now firmly evident, inspiring a host of new approaches.
Margaret MacCurtain (1929–2020): an appreciation
Authors: O'Dowd Mary
Published: December 2022

‘Wisdom it was I loved and searched for her from my youth. I resolved to have her as my companion. I fell in love with her beauty ….’

At the funeral mass for Margaret MacCurtain, her grandnephew, Michael, read the first reading from the Book of Wisdom, a moving and appropriate text with which to begin a celebration of Margaret's life. The words carried an added significance as Michael's reading emphasised that wisdom was represented in the biblical verse as female.
The effects of proposal power on incumbents' vote share: updated results from a naturally occurring experiment
Authors: Green Donald P. , Sevi Semra
Published: December 2022

A pioneering study by Loewen et al. made use of the Canadian legislature's newly instituted lottery, which enabled non-cabinet Members of Parliament (MPs) to propose a bill or motion. Their study used this lottery in order to identify the causal effect of proposal power on incumbents' vote share in the next election. Analyzing the first two parliaments to use the lottery, Loewen et al. found that proposal power benefits incumbents, but only incumbents who belong to the governing party. Our study builds on these initial results by adding data from four subsequent parliaments. The pooled results no longer support the hypothesis that MPs—even those who belong to the governing party—benefit appreciably from proposal power. These updated findings resolve a theoretical puzzle noted by Loewen et al., as proposal power would not ordinarily be expected to confer electoral benefits in strong party systems, such as Canada's.
Correlated mechanochemical maps of Arabidopsis thaliana primary cell walls using atomic force microscope infrared spectroscopy
Authors: Bilkey Natasha , Li Huiyong , Borodinov Nikolay , Ievlev Anton V. , Ovchinnikova Olga S. , Dixit Ram , Foston Marcus
Published: December 2022

Spatial heterogeneity in composition and organisation of the primary cell wall affects the mechanics of cellular morphogenesis. However, directly correlating cell wall composition, organisation and mechanics has been challenging. To overcome this barrier, we applied atomic force microscopy coupled with infrared (AFM-IR) spectroscopy to generate spatially correlated maps of chemical and mechanical properties for paraformaldehyde-fixed, intact Arabidopsis thaliana epidermal cell walls. AFM-IR spectra were deconvoluted by non-negative matrix factorisation (NMF) into a linear combination of IR spectral factors representing sets of chemical groups comprising different cell wall components. This approach enables quantification of chemical composition from IR spectral signatures and visualisation of chemical heterogeneity at nanometer resolution. Cross-correlation analysis of the spatial distribution of NMFs and mechanical properties suggests that the carbohydrate composition of cell wall junctions correlates with increased local stiffness. Together, our work establishes new methodology to use AFM-IR for the mechanochemical analysis of intact plant primary cell walls.
The Muslim Students’ Society of Nigeria (MSSN) since 1954: education, Muslim–Christian encounters and regional variation
Authors: Balogun Adeyemi
Published: December 2022

The Muslim Students’ Society of Nigeria (MSSN) is a movement that promotes the Islamic identity of Muslims in Nigeria’s educational institutions. Despite promoting the same objectives around the country, a comparison of the MSSN’s activities between the northern and southern regions of Nigeria suggests that the success of the movement varies in many aspects. This is because there are two main types of regional variation relating to the MSSN: the success of Christian opposition to the MSSN’s objectives; and the attitude of many Muslims and the government to those objectives. For example, in the Muslim-dominated northern states, the call by the MSSN to let Muslim girls wear the hijab in schools and the MSSN’s support for the reintroduction of sharia were welcomed by the state governors. However, in the south-west region, where the populations of Muslims and Christians are roughly equal, the MSSN struggled to get the state governors to accept the hijab and the call for sharia was rejected. This article thus argues that, despite envisioning the same notion of Islam for all Muslim students in Nigeria, the MSSN’s activities do not produce a monolithic Islam, and that this reflects differences in the practice of the religion across the country.
OP03 Patient Characteristics Affect Their Treatment Choice: A Discrete Choice Experiment With Breast Cancer Patients In Six European Countries
Authors: Stamuli Eugena , Corry Sorcha , Foss Petter
Published: December 2022

Introduction

The evolution of breast cancer treatments over the last decade has resulted in tailored therapies for the different types and stages of breast cancer. Each treatment has a profile of benefits and adverse effects which are taken into consideration when planning a treatment pathway. The objective of this study is to examine whether patients’ preferences are in line with what is considered important from policy-makers viewpoint.

Methods

An online discrete choice experiment (DCE) was conducted in six European countries (France, Germany, Ireland, Poland, Spain, UK) with breast cancer (BC) patients. The DCE comprised of six attributes: overall survival (OS), hyperglycaemia, rash, pain, functional well-being (FWB) and out-of-pocket payment (OOP). Sixteen choice sets with two hypothetical treatments and a “no treatment” option were presented. Sociodemographic and disease related data were collected. Heteroscedastic conditional and mixed logistic models accounted for scale and preference heterogeneity between countries and patients respectively. Latent class analysis categorized patients in classes. Marginal rates of substitution (MRS) were estimated for OOP versus the rest of attributes to establish the ranking of preferences for each attribute.

Results

Two hundred and forty-seven patients with advanced or metastatic BC and 314 with early-stage BC responded. Forty-nine percent of patients were less than 44 years old and 65 percent had completed university education. The MRS of the analysis demonstrated that “severe pain” is the highest dis-preferred attribute level, followed by “severe impairment in FWB” and OS. Four classes of patients as “decision-makers” were identified. Additionally, there is sensitivity in preferences for both levels of pain and FWB depending on the stage of the disease.

Conclusions

This study suggests that there is heterogeneity in treatment preferences of breast cancer patients depending on their sociodemographic and disease related characteristics. In combination with clinical guidelines, patient preferences can support the selection and tailoring of treatment options.
OP08 Early Access To New Direct-Acting Antiviral: A Journey On Introduction Of Ravidasvir For Hepatitis C Treatment In Malaysia
Authors: Idrus Nazatul Syima , Yusof Faridah Aryani Md , Lajis Rosliza
Published: December 2022

Introduction

Access to affordable direct-acting antiviral (DAA) remains limited in developing countries, often due to high treatment cost. This study aimed to elaborate the initiatives taken by the Ministry of Health Malaysia (MoHM) to provide early access to ravidasvir, a new DAA for hepatitis C treatment, in Malaysia.

Methods

MoHM collaborated with Drugs for Neglected Diseases initiative (DNDi) to develop ravidasvir, a new chemical entity of oral non-structural protein 5A (NS5A) inhibitor. MoHM co-sponsored and participated the DNDi-led Phase II/III study (STORM-C-1 trial) to assess the efficacy and safety of ravidasvir-sofosbuvir combination therapy. Agreement was signed between Pharmaniaga, Pharco Pharmaceuticals and DNDi to register and supply affordable hepatitis C treatment in Malaysia and South-East Asia. MoHM and Pharmaniaga mutually worked on the registration of ravidasvir in Malaysia. Series of pre-submission meetings took place, rolling submission was allowed and conditional registration pathway was used. As a separate initiative, MoHM partnered with the Foundation for Innovative New Diagnostics (FIND) to implement decentralization and test-and-treat strategies for screening of hepatitis C virus (HCV).

Results

First stage of the STORM-C-1 trial reported that the combination of ravidasvir-sofosbuvir was highly effective across all genotypes and safe. The Drug Control Authority (DCA) Malaysia has granted a conditional registration for ravidasvir hydrochloride 200mg tablet (Ravida®) in June 2021, making Malaysia as the first country in the world to approve ravidasvir. Registration process expedited and took place within 15 months. The supply of Ravida® in Malaysia is expected in near future. Meanwhile, MoHM also implemented nationwide HCV screening using rapid diagnostic test kit in private hospitals, community clinics, prisons and rehabilitation centers which previously was done only in hospitals for outreach to the targeted group.

Conclusions

Ravidasvir-sofosbuvir has potential as a tool to eliminate hepatitis C in Malaysia by 2030, the WHO’s global elimination targets. This alternative new drug development model was successful due to strong leadership, public-private partnership and collaborative strategies. This could also be exercised in other disease area.
OP10 Outcomes Of Expanded Access To Transcatheter Aortic Valve Implantation In Ontario: A Model-Based Analysis
Authors: Miranda Rafael N , Peel John , Naimark David , Wijeysundera Harindra
Published: December 2022

Introduction

Transcatheter aortic valve implantation (TAVI) is a minimally invasive therapy for patients with severe aortic stenosis. In Ontario, increases in capacity have not matched the rapidly growing demand for TAVI. As a result, wait-times for TAVI in Ontario exceed guideline targets, and waitlist morbidity is consequently considerable. The objective of this study was to evaluate the clinical implications of expanded TAVI capacity.

Methods

We performed a decision analysis using an open, parallel, resource-constrained microsimulation from the Ontario Ministry of Health perspective. Simulated patients entered the model during a five-year period, and stayed in the model until death or end of time horizon. Referral numbers increased annually according to historical trends. The additional capacity required to meet wait-time benchmarks in five years was identified by a sensitivity analysis. Clinical outcomes were estimated for three strategies: (i) current practice with annual capacity increases; (ii) accelerated capacity increases achieving benchmarks after five years; and (iii) no increase in capacity. Outcomes included pre-procedural mortality and hospitalization, and the proportion of TAVIs performed urgently.

Results

Over the five years, we estimated that TAVI referrals would increase from 1,980/year to 3,268/year. To achieve wait-time benchmarks during this period, TAVI rates must be increased by approximately 6.3 percent annually, for a total of 12,220 procedures performed over the 5 years. Compared to current TAVI capacity increase, an accelerated increase in capacity achieving wait-time benchmarks led to a reduction of 29.36 percent in pre-procedural deaths, as well as 26.38 percent in pre-procedural hospitalizations and 30.31 percent in nonelective TAVIs.

Conclusions

Increases in TAVI capacity in Ontario must be accelerated to meet wait-time benchmarks in five years. Expansion of TAVI care in Ontario would be associated with considerable reductions in mortality and hospitalizations. Without intervention, both wait-times and adverse outcomes on the waitlist are expected to continue increasing. Prioritization strategies to mitigate the adverse effects of long wait-times must be used until wait-time targets are achieved.
OP11 Differences And Similarities In Past Health Technology Assessments In Beneluxa Initiative Countries
Authors: Vreman Rick , van Hoof Daan , Adams Roisin , van de Casteele Marc , Nachtnebel Anna , Timmers Lonneke
Published: December 2022

Introduction

Conducting joint health technology assessments (HTA) is one of the main goals of the Beneluxa Initiative. To strengthen this collaboration, this study aimed to assess similarities and differences between past assessments of Beneluxa Initiative member countries (Austria, Belgium, Ireland and the Netherlands).

Methods

A retrospective comparative analysis was performed that investigated the similarities and differences in drug assessments in the period 2016 to 2020 in (i) the number and type of assessed indications; (ii) the conclusions within assessments performed by at least two member countries; and (iii) the main arguments leading to the conclusions through a qualitative analysis of selected cases, looking into the patient population, the intervention, comparator, outcome, timing, and included evidence.

Results

The scope of HTA differs between the countries, with Belgium and Ireland assessing most, the Netherlands focusing on drugs above a budget impact threshold and Austria on outpatient drugs. Furthermore, indications might slightly differ between countries. Therefore, only 44 (10%) of the 444 included drug-indication combinations were assessed through a full HTA by all four countries. Between any pair of countries, the overlap was higher, from 63 (Austria-the Netherlands) to 188 (Belgium-Ireland). Added benefit conclusions matched exactly in 62 to 76 percent of the indications, depending on the compared countries. In the remaining cases, often a difference of one added benefit level was observed (e.g., higher versus equal relative effect). Contradictory outcomes were very rare. Differences were observed with regards to whether a cost-effectiveness analysis was performed. When assessing the underlying arguments within the reports for nine cases with different outcomes, it became clear that organizations agree on almost all aspects, and that differences are mostly attributable to slight differences in weighing of some aspects and uncertainties.

Conclusions

Overall, which indications are assessed differs, but for those indications that are assessed by multiple member countries, considerations and assessment outcomes are similar.
OP16 Learning From Engagement With Human Immunodeficiency Virus Community Organizations In The Health Technology Assessment Lifecycle
Authors: Marsden Laura , Livingstone Heidi , Tonkinson Mandy
Published: December 2022

Introduction

Involving patients and community organizations in the health technology assessment (HTA) lifecycle is a core principle at the National Institute for Health and Care Excellence (NICE) and helps build public confidence in the healthcare decision-making. From 2019 to2021 NICE assessed a HIV-1 medicine for the first time. This presented new opportunities and challenges for engaging with Human Immunodeficiency Virus (HIV) community organizations who hadn’t participated in a NICE HTA before. To understand their experience, we collected feedback on the impact and experience of community involvement throughout the assessment.

Methods

We used a mixed-method approach using a survey and qualitative feedback from the committee lay member, community experts, and the community organizations. An impact survey was sent to key committee members, the NICE technical team and Associate Director. It included Likert scale questions and open text boxes to capture both quantitative and qualitative data. Additionally, qualitative feedback was gathered throughout the assessment’s lifecycle from the NICE team and the community stakeholders.

Results

Results from the impact survey showed that the community input: had significant impact on the evaluation (100% (n=5)); helped interpret the other evidence and information (80% (n=4)); provided new evidence (60% (n=3)); and, was consistent with the other evidence (40% (n=2)). Examples of impact included highlighting the population heterogeneity, stigma, side effects and the effects of frequent clinic attendance. The key feedback from the qualitative data from the community organizations and experts in terms of their experience were: early support and support throughout from the NICE team; NICE’s flexibility in involving them; and, meaningful inclusion of their evidence in the committee slides.

Conclusions

Both the NICE committee and the community stakeholders recognized that the community input was valued and had an impact on the decision-making. To ensure meaningful community engagement, support and flexibility from NICE were required throughout the assessment. This level of engagement will be adopted in future for community organizations new to medicines HTAs at NICE.
OP19 Comparative Effectiveness Of Common Treatment Options For Benign Prostatic Hyperplasia: A Systematic Review And Network Meta-Analysis
Authors: Rojanasarot Sirikan , Neeser Kurt , Fu Shuai , Bhattacharyya Samir , McVary Kevin
Published: December 2022

Introduction

Treatment options for men with moderate-to-severe lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) include medical therapy, minimally invasive surgical therapies (MISTs), and invasive surgical procedures. While these treatments are recommended by American Urological Association Guidelines, they have different clinical profiles impacting both efficacy and durability outcomes. Using an indirect comparison approach, this study assessed the clinical effects of combination therapy (CT) using alpha-blockers and 5-alpha reductase inhibitors, two emerging MISTs (prostatic urethral lift [PUL] and water vapor thermal therapy [WVTT]), and two invasive surgical procedures (photoselective vaporization of the prostate [PVP] and transurethral resection of the prostate [TURP]).

Methods

A systematic search of Medline, Embase, Cochrane Library, and relevant health technology assessment (HTA) databases was conducted to identify randomized and non-randomized clinical trials of the five treatments published prior to December 2020. Trials were included if they reported changes in International Prostate Symptom Score (IPSS) and retreatment rates, without any country or language restrictions. A random-effects network meta-analysis (NMA) with an aggregate regression model was performed to account for the baseline BPH severity and characteristic differences among men from the different trials.

Results

A total of 237 of 3,104 retrieved abstracts were included for full-text review. Of these, 16 randomized and four non-randomized clinical trials were included in the NMA. The random-effects NMA showed among medical and minimally invasive therapies, WVTT had the greatest one-year IPSS improvement (-∆11.7), followed by PUL (-∆10.4) and CT (-∆10.3). The one-year IPSS improvement for TURP and PVP was comparable (-∆14.1 vs. -∆13.8, respectively; p-value=0.675). The one-year retreatment rates were lowest for WVTT (3.0%), followed by CT (3.6%), TURP (6.3%), PVP (7.8%), and PUL (8.0%).

Conclusions

WVTT provided greater clinical and durability benefits compared to other less invasive treatment options for men with BPH. Given NMA is increasingly used in HTA processes, this study provided systematically synthesized evidence that could facilitate decision-makers in determining new technology coverage decisions globally.
OP22 Using Threshold Analysis To Guide Searches For Additional Sources Of Evidence
Authors: Anwer Sumayya , Dias Sofia , Simmonds Mark , South Emily , Wade Ros , Eastwood Alison
Published: December 2022

Introduction

Threshold analysis is a novel statistical approach which can be used to investigate which direct comparisons in a network meta-analysis (NMA) have estimated relative effects that may not be robust to changes in the evidence, either due to possible bias, sampling variation, or relevance.

Methods

In a health technology assessment of the clinical effectiveness of ablative and non-invasive therapies for patients with early hepatocellular carcinoma (HCC), we conducted a threshold analysis to identify treatment comparisons that would be sensitive to changes in the randomized controlled trial (RCT) evidence used in the NMAs, potentially leading to a change in the recommended treatment. The results of the threshold analysis were used to guide a targeted systematic review of high-quality, non-randomized, prospective comparative studies that could strengthen the evidence for those comparisons identified as sensitive to change.

Results

We conducted NMAs of RCT evidence for four outcomes: overall survival (16 RCTs), progression-free survival (6 RCTs), overall recurrence (7 RCTs), and local recurrence (10 RCTs). The results of the NMAs displayed a high level of uncertainty, attributable to the sparse nature of the network, characterised by interventions being mainly compared in small trials. A targeted systematic review was conducted on relevant interventions that were identified as being sensitive to changes in evidence by the threshold analysis. The studies identified in this review were incorporated into a second NMA to support the RCT evidence.

Conclusions

Threshold analysis has been typically used as a tool to assess how robust comparisons in an NMA are to additional sources of evidence, but it can also be used to guide the search for additional non-randomized evidence when the available RCT evidence is sparse.
OP28 Health Technology Assessment: A Situation Analysis Of Zimbabwe
Authors: Dzingirai Blessing , Matyanga Celia , Manyau Pinky , Postma Maarten Jacubos , van Hulst Marinus , Mafirakureva Nyashadzaishe
Published: December 2022

Introduction

With ever increasing burden of disease and limited resources, health technology assessment (HTA) is required for efficient resources allocation and priority setting in healthcare. The objective of this study was to establish the baseline HTA evidence generation and use in Zimbabwe.

Methods

In 2019, we convened a stakeholder workshop on HTA at the University of Zimbabwe. Presentations on HTA processes, current healthcare reimbursement model, priority setting in the Ministry of Health and selection of medicines into the treatment guidelines, were done by the experts. We adapted the Health Intervention and Technology Assessment Program questionnaire for situational analysis of HTA introduction at national level and administered it among the workshop participants. We report the baseline information on HTA situation, the need, demand and supply of HTA in Zimbabwe obtained from the presentations and responses from workshop participants.

Results

A total of 33 participants attended the workshop. Participants indicated that there is no formal HTA agency or process in Zimbabwe. The selection of medicines into treatment guideline is determined by disease burden, safety, efficacy and cost data, and it is done by a group of experts. The Association of Healthcare Funders of Zimbabwe (AFHOZ) reported that private healthcare funders use resource-based relative value scale system to determine tariffs and reimbursement levels. The regulator requires safety, efficacy and product quality data for the registration of medicines. Transparency in decision-making, registration of heath technology and formulation of essential medicines and treatment guidelines were reported as the major needs of HTA. The major users of HTA outputs were reported as medicines regulator, AFHOZ and Ministry of Health. Key suppliers of HTA evidence are academic and clinical research institutions and healthcare workers. Lack of training in health economics was cited as the major challenge to supply of HTA evidence.

Conclusions

There is a need to institute a formal, systematic and transparent processes of determining value of health technologies.
OP29 Lifecycle Assessment Of Machine Learning-Derived Early Warning System. An Early Economic Evaluation Of An Intraoperative Hypotension Prediction Index
Authors: Piaggio Davide , Federici Carlo , Di Bidino Rossella , Bracale Umberto , Pecchia Leandro
Published: December 2022

Introduction

An iterative, life-cycle approach to the evaluation of healthcare technologies requires that clinical and economic evidence is collected since the initial stages of diffusion. Nevertheless, early cost-effectiveness models are challenging mainly due to the difficulties in estimating model parameters and faithfully characterizing parameter uncertainty. This is especially true with AI-based diagnostics, where attribution of effects on costs and patient-relevant outcomes is more challenging. Empirical applications of early-models are useful to identify the main challenges of iterative modelling and provide recommendations on best-practices. Here, we reported on a case study on a machine learning-derived hypotension predictive index (HPI), that predicts the onset of intraoperative hypotension and trigger corrective measures.

Methods

A hybrid decision-tree/Markov model was developed comparing an HPI-based intervention protocol to standard-of-care intervention protocol during gynecological procedures. A short-term component of the model was populated using data from individual patients collected at one hospital in Italy. An historical control group was also defined using propensity score matching. Long-term costs and consequences of HPI were modelled using secondary data. A probabilistic version of the headroom approach was used to determine the maximum achievable price of HPI based on available evidence. Value of Information analysis was also conducted to identify the parameters that contribute the most to the overall uncertainty, and to identify optimal future study designs. Extensive deterministic and probabilistic sensitivity analyses were conducted to characterize the uncertainty over the cost-effectiveness of HPI.

Results

The preliminary results of the analysis suggest that HPI has potential to improve patients’ outcomes and generate efficiency gains by reducing hypotension events and permanent complications, such as acute kidney injury. The link between reduction in hypotension and the rate of complications, or the long-term effects on healthcare costs and patients’ quality of life are the parameters that contribute the most to model uncertainty.

Conclusions

Early cost-effectiveness models are a valuable tool to inform further product development and evidence requirements, but characterization of uncertainty and transparency in modelling assumptions are key.
OP32 A Multistep Multistakeholder Priority Setting Exercise For Fecal Incontinence
Authors: O’connor Nicole , Thomson Katie , Dangova Kim , Gill Sean , Wallace Sheila , Jackson Sara , Pearson Fiona
Published: December 2022

Introduction

Fecal incontinence (FI) is the involuntary loss of feces and can affect up to 17 percent of community dwelling individuals, rising to 40 percent of older people in residential care homes. There is limited up-to-date evidence which formally set research priorities addressing FI. This project aimed to identify research topics of highest importance to key FI stakeholders.

Methods

An evidence gap map was produced incorporating three streams of evidence coded against predefined topic domains. The evidence streams included: emerging evidence identified through horizon scanning; existing evidence identified through systematic searches of bibliographic databases; and key FI stakeholder insights collected through an international survey. Findings were presented as a visual map to facilitate knowledge exchange during an online workshop with a purposeful sample of multidisciplinary stakeholders. The identified gaps in research were explored to see whether they were deemed representative of unmet needs, and as such, areas of priority to key FI stakeholders. Ideation techniques and group discussions were used to refine and rank priority areas.

Results

Overall, there was a mismatch between the existing and emerging evidence, and the priorities of key FI stakeholders. New pharmaceutical and medical technology innovations were limited. Eight percent of early-stage trials identified were concerned with the use of repurposed drugs. Within the existing evidence base, individual bowel management strategies and treatments were examined, however, key FI stakeholders desired interventions to improve patient education and the psychological aspects of living with FI. The five priority topics identified in order of importance are as follows: psychological support; lifestyle interventions; long-term effects; education; and constipation.

Conclusions

The robust methodology used to identify priority topics were successful in identifying broad and wide-ranging areas of importance to key stakeholders. The evidence gap map was a useful visual tool to facilitate knowledge exchange and highlight where research efforts have been focused historically, identifying a mismatch between the existing evidence base and what stakeholders consider important.
OP33 Expectations, Needs And Challenges Of Setting Up An International Collaboration On Horizon Scanning For Medical Devices
Authors: Michels Renee Else , de Graaff Bert , Abrishami Payam , Delnoij Diana Maria Johanna
Published: December 2022

Introduction

International collaboration on horizon scanning for medical devices is seen as desirable, because the development of medical devices is not limited to the national level, and horizon scanning for medical devices on a country-level can be challenging due to scarcity and diversity of information. The International Horizon Scanning Initiative Medical Devices Working Group (IHSI MDWG) was set up in June 2021. The objective of this study was to research the expectations and experiences of the participants of this initiative, in order to reflect on the possibilities and challenges of governing innovative medical technologies.

Methods

A questionnaire was sent out to 10 purposively selected representatives of the IHSI MDWG participating counties: Austria, Belgium, Canada, Denmark, Italy, Luxembourg, Netherlands, Norway, Portugal, and Sweden. The survey covered individual countries’ respective purposes for an international horizon scanning system as well as questions related to the desired scope and perceived challenges of such a system. The questionnaire was supplemented with online, semi-structured, in-depth interviews with the same representatives from each participating country. These interviews provided for diving deeper into the survey topics as well as discussing the relation between horizon scanning and health technology assessment, the relation to other international horizon scanning collaborations, and the relation between an international versus a national horizon scanning system. In addition, participant observations were conducted at the Dutch National Health Care Institute and during IHSI MDWG working group meetings.

Results

Preliminary results are discussed first with participants after which we will draw our final conclusions and recommendations for practice. Our analysis focuses on exploring participants’ expectations and experiences with international horizon scanning through triangulating the three sources of data in our analysis.

Conclusions

The study will report on the expectations, needs and challenges of setting up an international collaboration for horizon scanning of medical devices and reflect on the regulation and governance of innovative medical technologies across several countries in Europe and Canada.
OP35 Suitability Of Preference Methods Across The Medical Product Lifecycle: A Multicriteria Decision Analysis
Authors: Veldwijk Jorien , de Bekker-Grob Esther , Juhaeri  , van Overbeeke Eline , Tcherny-Lessenot Stephanie , Pinto Cathy Anne , DiSantostefano Rachael L. , Groothuis-Oudshoorn Catharina G.M.
Published: December 2022

Introduction

To understand the importance of the preference methods criteria to stakeholders at each decision point in the Medical Product Lifecycle (MPLC) and to determine the suitability of commonly applied preference methods (Discrete Choice Experiment [DCE], swing weighting [SW], probabilistic threshold technique [PTT], Best-Worst Scaling case 1 [BWS1], Best-Worst Scaling case 2 [BWS2]) for a given decision-point.

Methods

Nineteen preference methods criteria of an existing performance matrix were incorporated in an online survey of industry, regulatory, and health technology assessment (HTA) stakeholders. All methods criteria were given a relative weight based on the SW ranking and point allocation task in the survey. Based on this relative weight and the performance matrix values, an overall suitability score was calculated for each method per critical decision point along the MPLC. Several sensitivity analyses were conducted for which the performance matrix was adapted.

Results

In total 59 industry, 29 regulatory, and 5 HTA representatives completed the survey. In general, ‘estimating trade-offs between characteristics’, and ‘estimating weights for treatment characteristics’ were important preference method criteria throughout all MPLC decision points, while other preference method criteria were most important only for specific MPLC stages. Both BWS1 and BWS2 seem equally suitable across decision points, DCEs seem most suitable during clinical development and regulatory launch, and SW and PTT seem most suitable throughout industry decision points. Sensitivity analysis showed substantial impact of slight changes in the performance matrix.

Conclusions

With rapid changes in preference research, performance matrices of preference methods should continue to be re-evaluated as more and more evidence accumulates. While DCE is the most applied preference elicitation method, other methods should also be considered to address the needs of MPLC stakeholders. Development of evidence-based guidance documents for designing, conducting, and analyzing such methods could enhance their use.