bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP132 Telemedicine Enhances Community Hospital Response Capacity
Authors: Galvan Pedro , Velazquez Miguel , Rivas Ronald , Portillo Juan , Mazzoleni Julio , Hilario Enrique 
Published: December 2019

IntroductionTelediagnostic apps based on information and communication technology tools can be used to enhance community hospital response capacity. Evidence on how this innovative technology can improve health services is limited, but will likely expand in the new decade. The ability of different telediagnostic methods to enhance the response capacity of community hospitals in rural areas of Paraguay was investigated.MethodsThis descriptive study was carried out by the Telemedicine Unit of the Ministry of Public Health and Social Welfare, in collaboration with the Department of Biomedical Engineering and Imaging of the Health Science Research Institute and the University of the Basque Country, to evaluate the utility of telediagnostic apps for different disciplines in public health. The results from implementing telediagnosis apps in 60 public community hospitals across the country were analyzed and evaluated.ResultsA total of 410,840 diagnoses were performed remotely between January 2014 and August 2018 across 60 rural community hospitals. The diagnoses involved computed tomography (147,627 or 36%), electrocardiography (256,422 or 62%), electroencephalography (6,772 or 2%), and ultrasound (19 or 0.01%). There were no significant differences between the remote and face-to-face diagnoses; remote diagnoses were correct in 93 percent of cases. Utilizing telediagnostic apps reduced costs, which is an important benefit for the 60 communities.ConclusionsThe results showed that telemedicine can significantly enhance the community hospital response capacity of diagnostic services and health programs, making optimal use of professional time and productivity, increasing access and equity, and reducing costs. However, before carrying out the systematic implementation of this technology, contextualization with the regional epidemiological profile must be performed.
PP210 Identification Of Frailty to Healthy Ageing In European Population
Authors: Paz-Valiñas Lucinda , Vallés Maria José Faraldo , Bugarín-González Rosendo 
Published: December 2019

IntroductionThe European population is aging rapidly. The number of Europeans aged over sixty-five will double in the next fifty years. Active and healthy aging is a societal challenge shared by all European countries, but also an opportunity. The World Health Organization indicated that frailty has become an indicator of lack of successful aging. Therefore, identification of frail elderly is becoming important. However, there are many different screening tools that are currently used to identify frailty. The optimal test should have the capacity to easily identify from the community-dwelling population, those older people at risk of adverse outcomes. During the past years, gait speed has been repeatedly reported as an appealing instrument as a screening tool to detect frailty.MethodsSystematic review of literature on gait speed as predictor of frailty was performed.ResultsA total of 992 articles were retrieved from the literature search and only eleven studies met the inclusion criteria. Frailty is a common geriatric syndrome, characterized by decreased reserve and increased vulnerability to adverse outcomes, including falls, hospitalization, institutionalization and death. Despite frailty is being increasingly recognized in the literature, there is a paucity of direct evidence to guide interventions to reduce frailty. Many single and composite tools to detect the frailty have been proposed but none is consensual, most are time-consuming while evaluating different domains of impairments, and many are not validated. Gait speed seems to be a single, reliable, valid, sensitive, cheap, quick and simple tool that identifies frailty people. However, the way to perform the test parameters vary widely, influencing interpretations of physical performance.ConclusionsThe evidence recommends to detect frailty in people in order to achieve an active and healthy ageing. Gait speed could be a suitable predictor to identify frailty although this systematic review found many differences between the gait speed protocols used in clinical practice. It is necessary to establish a standard protocol of gait speed agreed by experts in the area on frailty to be implemented with success in clinical practice.
VP16 A NICE Way To Manage Managed Access: Case Study In Muscular Dystrophy
Authors: Kent Emma , Paling Thomas 
Published: December 2019

IntroductionManaged access arrangements (MAAs) represent a way of enabling patient access to promising treatments while collecting real world data to inform future health technology evaluations (HTE) and commissioning decisions. In July 2016, the National Institute for Health and Care Excellence (NICE) recommended Ataluren for treating Duchenne Muscular Dystrophy within a MAA. NICE is uniquely placed to oversee the implementation and monitoring of this MAA in collaboration with multiple stakeholders to ensure the final outputs meet the needs of a future HTE.MethodsNICE assembled an Ataluren Managed Access Oversight Committee (MAOC) consisting of representatives from the manufacturer, patient organisations, commissioning body and treatment centres. This group were to meet every six months under the chairmanship of NICE with the primary function of reviewing the progress of data collection and identifying operational challenges in implementing the terms of the arrangement.ResultsThe Ataluren MAOC has convened four times since the MAA commenced and these discussions identified a number of important actions. Data completeness was a concern and prompted stakeholders to collaborate on implementing measures to circumvent this, to ensure data quality for future HTE. Lack of awareness and understanding of the MAA in the patient community was highlighted and resulted in the production of lay information. A review of the statistical analysis plan resulted in the need for an agreement amendment. To ensure an audit trail and appropriate critique, NICE produced an amendment process to define and justify amendments made during the agreement term.ConclusionsMAOC meetings play an important role in monitoring the progress of MAAs and have ensured that implementation issues are identified promptly and resolved with input from key stakeholders. This process allows NICE to coordinate the work of stakeholders to facilitate the success of the MAA, and will be adopted in future NICE MAAs in ultra-rare diseases.
VP23 Assessing The Effectiveness Of A Medical Device With Limited Evidence
Authors: Macmillan Thomas , Chalkidou Anastasia , Goddard Kate 
Published: December 2019

IntroductionSecurAcath (Interrad Medical), a catheter securement device designed for central venous catheters, was assessed by the National Institute for Health and Care Excellence (NICE) in 2017 resulting in Medical Technology Guidance 34 (MTG34). Due to the limited number and quality of published evidence, novel methods were used to deliver a report that allowed a recommendation on adoption to be made.MethodsKiTEC, an external assessment centre for NICE, independently evaluated the manufacturers submission of clinical and economic evidence. The submission was characterised by a lack of strong clinical evidence, comprising just one randomized clinical trial (RCT) and a small number of non-comparative observational studies, some of which were available as conference abstracts or poster presentations. KiTEC ran a meta-analysis of these studies along with data on the comparators, securement with sutures and securement with StatLock (Bard Access Systems). Due to the lack of comparative studies, KiTEC pooled data on five outcomes (migration, dislodgement, catheter-related infection, CRBSI, unplanned removals/reinsertions) and calculated relative risks for each. KiTEC revised the manufacturer's cost model, changing a number of parameters and assumptions. The decision to recommend SecurAcath for use in the National Health Service (NHS) was also supported by qualitative evidence from expert clinicians who had used the SecurAcath in practice.ResultsKiTEC's meta-analysis showed non-inferiority for SecurAcath over the comparators. The limited information in the studies made it impossible to ascertain study heterogeneity in the meta-analysis. KiTEC's economic analyses showed that SecurAcath could be cost saving in some scenarios, but not for short indwell times (≤5 days). However, clinical expert opinion was overwhelmingly positive and this qualitative evidence was viewed alongside the less conclusive clinical and cost-effectiveness evidence. SecurAcath was recommended to be used in the NHS, with annual savings estimated to be a minimum of GBP 4.2m.ConclusionsIn cases where there is a lack of published evidence, unpublished material and expert clinical opinion can be used to bolster the case for the adoption of medical devices.
VP34 Impact Of Adverse Events On Reimbursement Recommendations
Authors: Inumerable Riza Veronica , Farinella Michelle , Rubinstein Judith , Sharma Kriti 
Published: December 2019

IntroductionEuropean agencies evaluate the adverse events (AEs) of asthma drugs in studies. The impact of these evaluations on reimbursement decisions remains unclear.MethodsAdult asthma evaluations were accessed from initial regulatory decision by the European Medicines Agency (EMA) through reimbursement evaluations. Omalizumab and reslizumab were chosen for the comparison of an older with a newer asthma drug. A timeline was then constructed to evaluate the effect of AEs on reimbursement recommendations. Evaluations from the United Kingdom (NICE) were not used because their documents are not as complete or in depth, including those from Sweden (TLV) and Germany (IQWIG).ResultsOmalizumab was first approved as add-on therapy to improve asthma control in October 2005. Of the 6 decisions made between 2006 and 2012, safety information was found in 4 of them, all from 2006 and evaluated by either Scotland (SMC) or France (HAS). These desicions all received either a ‘Do not recommend’ or a ‘Recommend with restrictions’ decision. Reslizumab was first approved as add-on therapy for patients with severe eosinophilic asthma in August 2016. Of the 9 decisions made in 2017, safety information was found in 5 decisions evaluated by IQWiG, Germany (G-BA), HAS, or SMC, which gave them a Do not recommend, Recommend with restrictions, or Recommend decision. Of the Do not recommend decisions, both the omalizumab and reslizumab safety evaluations mentioned common AEs (worsening asthma) and less common AEs (malignant tumors). Of the Recommend with restrictions decisions, the same AEs were seen. Only reslizumab had Recommended decisions. In the safety evaluation, there were no specific AEs named.ConclusionsThe impact of AEs on reimbursement decisions could not be detected when comparing omalizumab and reslizumab reviews, as other factors may contribute to the decisions. Further research should be conducted to explore this issue.
VP61 Rapid HTA Of The CarbonCool Full Body Suit For Exertional Heat Injuries
Authors: Pwee Keng Ho 
Published: December 2019

IntroductionThe CarbonCool full body suit is a portable, non-invasive core body cooling system for use by first responders and clinicians for targeted temperature management and heat stroke treatment. It uses pads made of a highly thermal conductive carbon-based cooling medium to absorb heat from the body. Our department was requested to review the effectiveness of the suit and whether it might be used in place of a Body Cooling Unit (BCU).MethodsA rapid review was carried out on the technology. The PICO elements were: Population- Emergency department patients with exertional heat injury; Intervention- CarbonCool full body suit; Comparator- Body Cooling Unit; Outcomes- Adverse effects, clinical outcomes (survival, neurological status), physical measures (rate of cooling). The NHS Centre for Reviews & Dissemination databases, Cochrane Database of Systematic Reviews, PubMed (MEDLINE) and the US National Guidelines Clearinghouse were searched for systematic reviews, HTA reports and clinical practice guidelines. The importer was contacted to provide supporting studies for their product.ResultsNo publications were found on CarbonCool products. The importer provided the unpublished abstract of a retrospective cohort study of 124 post-cardiac arrest patients requiring targeted temperature management. The importer advised that a trial on pre-hospital heat stroke was pending. The full body suit is not intended as a replacement for body cooling units. Three clinical practice guidelines on management of heat injuries did not mention such cooling systems, but did recommend ice packs as a treatment option.ConclusionsThe CarbonCool Full Body Suit is not intended as a replacement for a Body Cooling Unit. No published studies were found showing effectiveness for managing exertional heat injuries. A trial on pre-hospital heat stroke was pending. Guidelines on managing heat injuries do not mention the use of the technology. It was recommended to await results of pending trials, or to use it only under research.
VP77 Extrapolating ICERs At Different Discount Rates
Authors: Teljeur Conor , Ryan Máirín 
Published: December 2019

IntroductionApplicability of incremental cost-effectiveness ratios from another jurisdiction is often affected by a different local discount rate, creating uncertainty about the ICER using the local discount rate. The ICER is sometimes reported at additional discount rates in the sensitivity analysis. We aimed to investigate the extent to which an ICER can be predicted at a given non-differential discount rate if estimates are available for at least two discount rates.MethodsWe used six previously published economic models representing analyses with a range of time horizons and ICERs calculated at discount rates from 1% to 8%. A simulation exercise was applied whereby the ICER at a discount rate selected from the range 2% to 5% was calculated based on ICERs provided at two or three randomly selected discount rates. With two discount rates a linear model was used to predict the ICER at the selected rate. For three discount rates an exponential model was used. Error between the predicted and actual ICER was calculated as the absolute difference divided by the actual ICER.ResultsFor four of the models, ICERs could be well predicted by a linear model (i.e., with two points), with average errors of less than 5%. For the final two models the error was substantial with a linear model but substantially improved to under 15% with an exponential model (i.e., with three data points). The two models with a poor fit to a linear model assessed childhood vaccination programmes over a lifetime horizon.ConclusionsFor studies with a relatively short time-horizon, or where the majority of costs and benefits accrue in the short-term, a simple linear extrapolation can facilitate calculation of the ICER at a discount rate other than those reported. With longer time horizons, a third data point facilitates more reliably extrapolation of ICERs at desired discount rates.
High-mass X-ray binaries: Evolutionary population synthesis modeling
Authors: Zuo Zhao-yu 
Published: December 2019

AbstractUsing an evolutionary population synthesis code, we modeled the universal, featureless X-ray luminosity function of high-mass X-ray binaries (HMXBs) in star-forming galaxies. We put constraints on the natal kicks, super-Eddington accretion factor, as well as common envelope prescriptions usually adopted (i.e., the αCE formalism and the γ algorithm), and presented the detailed properties of HMXBs under different models, which may be investigated further by future high-resolution X-ray and optical observations.
The black hole spin in coalescing binary black holes and high-mass X-ray binaries
Authors: Qin Y. , Fragos T. , Meynet G. , Marchant P. , Kalogera V. , Andrews J. , Sørensen M. , Song H. F. 
Published: December 2019

AbstractThe six LIGO detections of merging black holes (BHs) allowed to infer slow spin values for the two pre-merging BHs. The three cases where the spins of the BHs can be determined in high-mass X-ray binaries (HMXBs) show that those BHs have high spin values. We discuss here scenarios explaining these differences in spin properties in these two classes of object.
Massive star winds and HMXB donors
Authors: Sander Andreas A. C. 
Published: December 2019

AbstractUnderstanding the complex behavior of High Mass X-ray binaries (HMXBs) is not possible without detailed information about their donor stars. While crucial, this turns out to be a challenge on multiple fronts. First, multi-wavelength spectroscopy is vital. As such systems can be highly absorbed, this is often already hard to accomplish. Secondly, even if the spectroscopic data is available, the determination of reliable stellar parameters requires sophisticated model atmospheres that accurately describe the outermost layers and the wind of the donor star.For early-type donors, the stellar wind is radiatively driven and there is a smooth transition between the outermost layers of the star and the wind. The intricate non-LTE conditions in the winds of hot stars complicate the situation even further, as proper model atmospheres need to account for a multitude of physics to accurately provide stellar and wind parameters. The latter are especially crucial for the so-called “wind-fed” HXMBs, where the captured wind of the supergiant donor is the only source for the material accreted by the compact object.In this review I will briefly address the different approaches for treating stellar winds in the analysis of HMXBs. The fundamentals of stellar atmosphere modeling will be discussed, also addressing the limitations of modern models. Examples from recent analysis results for particular HMXBs will be outlined. Furthermore, the path for the next generation of stellar atmosphere models will be outlined, where models can be used not only for measurement purposes, but also to make predictions and provide a laboratory for theoretical conclusions. Stellar atmospheres are a key tool in understanding HMXBs, e.g. by providing insights about the accretion of stellar winds onto the compact object, or by placing the studied systems in the correct evolutionary context in order to identify potential gravitational wave (GW) progenitors.
Investigating High Mass X-ray Binaries at hard X-rays with INTEGRAL
Authors: Sidoli Lara , Paizis Adamantia 
Published: December 2019

AbstractThe INTEGRAL archive developed at INAF-IASF Milano with the available public observations from late 2002 to 2016 is investigated to extract the X-ray properties of 58 High Mass X-ray Binaries (HMXBs). This sample consists of sources hosting either a Be star (Be/XRBs) or an early-type supergiant companion (SgHMXBs), including the Supergiant Fast X-ray Transients (SFXTs). INTEGRAL light curves (sampled at 2 ks) are used to build their hard X-ray luminosity distributions, returning the source duty cycles, the range of variability of the X-ray luminosity and the time spent in each luminosity state. The phenomenology observed with INTEGRAL, together with the source variability at soft X-rays taken from the literature, allows us to obtain a quantitative overview of the main sub-classes of massive binaries in accretion (Be/XRBs, SgHMXBs and SFXTs). Although some criteria can be derived to distinguish them, some SgHMXBs exist with intermediate properties, bridging together persistent SgHMXBs and SFXTs.
Rapid evolution of the relativistic jet system SS 433
Authors: Goranskij V. P. , Barsukova E. A. , Burenkov A. N. , Valeev A. F. , Trushkin S. A. , Volkov I. M. , Esipov V. F. , Irsmambetova T. R. , Zharova A. V. 
Published: December 2019

Abstract. We analyzed a 40-year set of multicolor photometry and a 15-year set of synoptic monitoring of SS 433 along with fragmentary spectral and radio data. This system contains a neutron star and an A3–A7 I giant. The system is found to be either close, in contact, or it has a common envelope from time to time. The A-type giant is now in transition to the dynamical mass transfer.
X-ray binaries with neutron stars at different accretion stages
Authors: Postnov Konstantin A. , Kuranov Alexander G. , Yungelson Lev R. 
Published: December 2019

Abstract. Different accretion regimes onto magnetized NSs in HMXBs are considered: wind-fed supersonic (Bondi) regime at high accretion rates <math/> g s-1, subsonic settling regime at lower <math/> and supercritical disc accretion during Roche lobe overflow. In wind-fed stage, NSs in HMXBs reach equilibrium spin periods P* proportional to binary orbital period Pb. At supercritical accretion stage, the system may appear as a pulsating ULX. Population synthesis of Galactic HMXBs using standard assumptions on the binary evolution and NS formation is presented. Comparison of the model P* – Pb (the Corbet diagram), P* – Lx and Pb – Lx distributions with those for the observed HMXBs (including Be X-ray binaries) and pulsating ULXs suggests the importance of the reduction of P* in non-circular orbits, explaining the location of Be X-ray binaries in the model Corbet diagram, and the universal parameters of pulsating ULXs depending only on the NS magnetic fields.
Numerical models of VHE emission by magnetic reconnection in X-ray binaries: GRMHD simulations and Monte Carlo cosmic-ray emission
Authors: Rodríguez-Ramírez J. C. , de Gouveia Dal Pino E. M. , Alves Batista R. 
Published: December 2019

AbstractGalactic microquasars have been detected at very-high-energies (VHE) (> 100 GeV) and the particle acceleration mechanisms that produce this emission are not yet well-understood. Here we investigate a hadronic emission scenario where cosmic-rays (CRs) are accelerated in magnetic reconnection events by the turbulent, advected-dominated accretion flow (ADAF) believed to be present in the hard state of black hole binaries. We present Monte Carlo simulations of CR emission plus γ-γ and inverse Compton cascades, injecting CRs with a total energy consistent with the magnetic energy of the plasma. The background gas density, magnetic, and photon fields where CRs propagate and interact are modelled with general relativistic (GR), magneto-hydrodynamical simulations together with GR radiative transfer calculations. Our approach is applied to the microquasar Cygnus X-1, where we show a model configuration consistent with the VHE upper limits provided by MAGIC collaboration.
Firm detection of 7-year X-ray periodicity from X Persei
Authors: Nakajima Motoki , Negoro Hitoshi , Mihara Tatehiro , Sugizaki Mutsumi , Yatabe Fumiaki , Makishima Kazuo 
Published: December 2019

AbstractWe report on the detection of long-term X-ray periodicity from the Be/X-ray binary pulsar X Persei. Based on over 23 years of X-ray data observed using RXTE/ASM, Swift/BAT and MAXI/GSC, we confirmed that X Persei exhibits quasi-periodic X-ray flares with a period of ∼7 years. The recurrence timescale corresponds to approximately 10 times its binary orbital period of 250 days. Spectral and hardness ratio changes were not detected along with long-term periodic activity. If we interpret the observed 7 year periodicity of X-ray band flux as a superorbital modulation, then this would be the first observation among the Be/X-ray binaries.