bluuebunny/crossref_metadata_2025_split huggingface dataset:
VP01 A Disinvestment Toolkit: The Prioritization Of Technologies Of No Or Low Added Value
Authors: Polisena Julie , Varela-Lema Leonor , Gutiérrez-Ibarluzea Iñaki , Godman Brian 
Published: January 2019

Introduction:Candidate health technologies identified for disinvestment will require prioritization depending on the system's capacity for dealing with the assessments or for further considerations. Compilations of low value lists, such as the National Institutes for Health and Clinical Excellence's, “Do not do recommendations”, can serve as databases for prioritization topics. Prioritization processes can also be triggered by experience or event-based regional requests and decisions; new evidence on safety, effectiveness and cost-effectiveness, variations in clinical practice, patient or consumer voicing, discrepancies between practice and guidelines; and or time-based mechanisms, such as approval of new health technologies and reassessment five years after introduction.Methods:A search of the published and grey literature was conducted to identify the current methods or tools used to prioritize potential health technologies and services for disinvestment. The description of the methods and tools identified, the prioritization criteria, and the stakeholders involved in the process were reviewed and summarized.Results:The methods and tools used for prioritization that were identified in the literature include the PriTec Prioritization tool, nominal group technique, Program Budgeting and Marginal Analysis, consensus building, and online surveys. Further, common criteria for prioritization centered on the disease burden, possible risks and benefits, costs and cost-effectiveness, utilization, and time-based criteria. Prioritization can be conducted by health care professionals, decision makers, patients or patient groups and representative community members.Conclusions:The prioritization process for disinvestment candidates should be transparent and guided largely by evidence. It is highly recommended that the list of predefined criteria be developed with input from all relevant stakeholders to meet the objectives of the specific health care setting. The commonly cited basic requirements include clinical parameters, economic measures, and social, ethical or legal considerations.
VP09 Trastuzumab For Metastatic Breast Cancer Access Assessment In Brazil
Authors: do Valle Paula , Vianna Cid , Mosegui Gabriela , de Oliveira Fabiano , de Lima Idoaldo 
Published: January 2019

Introduction:Trastuzumab is the most recent biological therapy incorporated by the Brazilian Health Ministry for HER-2 overexpressed metastatic breast cancer treatment (2012). The aim of this study was to investigate if access to this technology is appropriate.Methods:We performed a web-based questionnaire, which received answers from October 2016 to April 2017. Oncologists that work in the care of patients with overexpressed HER-2 metastatic breast cancer were the focus of the survey. Forty-three professionals informed work location, sector (public, private or both) and trastuzumab access. This research was approved by Brazilian Ethics Committee (CAE 59076316300005260).Results:Among 43 valid answers, nine informed they work in the public sector, 10 in the private sector and 24 in both sectors. In total, 33 reported to work in public and 34 in private sector. We observed that 17 (51.5 percent) participants who work in the public sector do not have access to trastuzumab, while in private sector only one participant (2.9 percent) reported the lack of access to this technology for HER-2 overexpressed metastatic breast cancer treatment. Regarding the respondents who informed the lack of access, six (33.3 percent) work in Northeast Brazilian region, six (33.3 percent) in Southeast, two (11.1 percent) in South, one (5.6 percent) in Central-West and three (16.7 percent) did not give this information. Eleven respondents reported they do not have another treatment option for these patients, while seven informed access only to chemotherapy without biological therapy.Conclusions:Trastuzumab is a biological therapy that can increase HER-2 overexpressed metastatic breast cancer patients overall survival by nine months on average. The questionnaire results indicate that its access in Brazil is still irregular, mainly in public sector, even five years after its incorporation by the Brazilian Health Ministry. Although universal access is one of Brazilian Public Health System main directives, there is evidence of a serious issue regarding its services equity.
VP10 Impact Of Health Technology Assessment On Policy And Clinical Decision Making In Korea
Authors: Lee Min Ji , Park Jeong-eun , Kim Miseong , Park Eunkyo , Park Jooyeon 
Published: January 2019

Introduction:Since established in 2009, the National Evidence-based healthcare Collaborating Agency (NECA) has been the sole government-funded Health Technology Assessment (HTA) institution in Korea, yet little effort has been made to systematically evaluate the influence of its products. In this study, we aimed to measure the impact of the HTA products of NECA on clinical and policy decisions by introducing a systematic framework.Methods:We included HTA reports published from 2009 to 2015. Among the 141 research reports published during this period, there were 67 HTA reports. We gathered data on the influence by literature and news article search, review of administrative documents and directly listening to the decision makers. The influence was categorized into three decision types: changes in clinical guidelines, administrative decision on investment/disinvestment and healthcare policy making. Whether a research report was used directly in decision making, or followed by subsequent researches or round-table conference, was recorded to examine the knowledge transfer process.Results:In total, 67.2 percent of the included HTA reports were used to support clinical and policy decisions. Twenty-seven reports had influenced administrative decisions on investment/disinvestment. Ten provided evidence for new health policies or legislation. Eight were reflected in clinical guidelines. The impact of HTA reports published by NECA was more evident when the research was directly requested by decision-making bodies such as government institutions. Although most HTA reports were conducted in collaboration with clinicians, the use of results by clinicians was limited. Definitive results were more likely to be used, but reports with competing interests had fewer impacts.Conclusions:HTA by NECA had impacts on the rational use of healthcare resources in Korea, and NECA has established its role as an intermediary between governmental decision-making bodies and clinicians. However, more continuous approaches rather than one-time HTA research are needed for HTA on controversial topics to have impacts on decision making.
VP34 Incorporation Of Medical Equipment In Northeastern Brazil
Authors: Marques Paulo Leonardo Ponte , Junior Antonio Ferreira Rodrigues , de Souza Vieira Luiza Jane Eyre 
Published: January 2019

Introduction:Improving universal health coverage is a big challenge in many nations. Nevertheless, in countries like Brazil, the Constitution provides for universal access to meet population needs. Medical equipment is indispensable for the diagnosis and treatment of diseases in public and private health services. This study aims to analyze medical diagnostic equipment incorporation in a Brazilian state.Methods:This evaluative research was carried out using data from Brazil's Unified Health System (SUS) and Private Health Services. The research took place in Ceará, Northeastern Brazil. It is the eighth most populous Brazilian state, with 8.8 million inhabitants. Data on the types and quantity of medical devices in the public and private services were collected from August 2005 to August 2017. The results were analyzed by comparing population and normative parameters with technology incorporation in Brazil.Results:A mean of 17.6 +/− 10.6 (SD) devices were incorporated each year in SUS versus 31.7 +/− 15.7 (SD) in the private services. Over a twelve year period, the incorporation of equipment increased 59.7 percent in the public system and 152.6 percent in the private services. The production from these technologies increased to 18.1 percent. Considering both public and private services, tomography equipment coverage exceeds (147.4 percent) the parameter established by the Ministry of Health while magnetic resonance imaging equipment coverage is 90.5 percent.Conclusions:An expressive number of medical devices were incorporated in public and private health services, with higher rates in the latter. Both services presented a downward trend, suggesting that the incorporation of equipment is no longer needed. Such an extra coverage reveals an uncritical incorporation of these devices, that was not based on real needs; therefore, it is necessary to develop an action plan aimed at a better distribution of these devices to allow effective universal coverage.
Participation in structured programming may prevent unhealthy weight gain during the summer in school-aged children from low-income neighbourhoods: feasibility, fidelity and preliminary efficacy findings from the Camp NERF study
Authors: Hopkins Laura C , Holloman Christopher , Melnyk Bernadette , Fristad Mary , Goodway Jacqueline D , Kennel Julie A , Eneli Ihuoma , Gunther Carolyn 
Published: January 2019

AbstractObjectiveEvaluate the feasibility, fidelity and preliminary efficacy of Camp NERF to prevent unhealthy weight gain and promote healthy behaviours in children during the summer.DesignCamp NERF was an 8-week, multicomponent, theory-based programme coupled with the US Department of Agriculture’s Summer Food Service Program. Twelve eligible elementary-school sites were randomized to one of three treatment groups: (i) Active Control (non-nutrition, -physical activity (PA), -mental health); (ii) Standard Care (nutrition and PA); or (iii) Enhanced Care (nutrition and PA, plus cognitive behavioural techniques) programming. Efficacy was determined by assessing mean change by group in child outcomes using hierarchical linear regression models.SettingLow-income, urban neighbourhoods in Columbus, OH, USA.ParticipantsEconomically disadvantaged, racial minority children of elementary school age (kindergarten–5th grade).ResultsEighty-seven child–caregiver dyads consented; eighty-one completed pre- and post-intervention assessments resulting in a 93·10 % retention rate. Delivery of the intended lesson occurred 79–90 % of the time. Of the children, 56·98 % (n 49) were female; 89·53 % (n 77) were Black. Overall mean change in BMI Z-score from baseline to post-intervention was −0·03 (se 0·05); change in BMI Z-score did not differ significantly between treatment group. Change in nutrition, PA, mental health or psychosocial outcomes did not differ between groups.ConclusionsResults from the current study demonstrate feasibility and fidelity, yet no intervention effect of Camp NERF. Instead, findings suggest that participation in structured programming of any type (health behaviour-related or not) may prevent unhealthy summer weight gain. Additional studies are needed to confirm findings. Results have implications for child nutrition policy addressing the issue of summer health.
Gender Climate in Authoritarian Politics: A Comparative Study of Russia and Turkey
Authors: Doğangün Gokten 
Published: January 2019

AbstractIn Russia and Turkey, the pro-authoritarian regimes have largely relied on nationalistic narratives appealing to cultural authenticity, tradition, and religion for legitimacy and cultural resonance at the mass level. Within this narrative, as it is argued, traditional notions of family and femininity are endorsed so as to represent national power against the West and to invigorate social unity and morality in Russian and Turkish societies. The revival of traditional gender norms and patterns that characterize the prevailing gender climates in Russia and Turkey is visible in the restructuring of gender equality mechanisms, the organization of reproduction in accordance with pronatalist policies, women's employment patterns, and state policy on combating domestic violence. This analysis relies on empirical data obtained through in-depth interviews with academics, representatives of international organizations and nongovernmental organizations, feminist activists, experts from women's shelters, and public officials based in Russia and Turkey. It is supplemented with a review of relevant examples from political discourse employed by political leaders, legal regulations, and public policies on these four areas. The article concludes that the revival of traditional gender categories and stereotypes aggravates the inferior position of women and unleashes discriminatory attitudes toward them at home, in society, and in the labor market.
Interannual Coral Δ14C Records of Surface Water Exchange Across the Luzon Strait
Authors: Ramos R. D. , Goodkin N. F. , Druffel E. R. M. , Fan T. Y. , Siringan F. P. 
Published: January 2019

AbstractThe Luzon Strait (LS) hosts the largest transport of water between the Western Pacific Ocean (WPO) and the South China Sea (SCS). The transport through the strait, dominated by the westward propagation of the Kuroshio Intrusion, influences the climate and circulation of the SCS. While numerical models have investigated the interannual variability of the transport and subsequent water exchange across the LS, a lack of long‐term on‐site records prevents a general consensus on the transport rates, variability, and drivers. Corals offer high‐resolution, continuous histories of radiocarbon (Δ14C) content of the seawater dissolved inorganic carbon, allowing us to track changes in ocean transport and circulation through time. Seasonal and annual Δ14C samples from Houbihu, Taiwan, and Palaui, Philippines, located on either side of the strait, are compared to the Western Pacific Ocean and SCS Δ14C records to examine the spatial and temporal Δ14C variability in the region. We calculated the mean transport across the strait using a five‐box mixing model and identified its potential drivers. The mean amount of water exchanged across the strait from 1970 to 1999 was 2.2 Sv, ranging from −13.4 to 16 Sv, where a positive (negative) value indicates net flow into (out of) the SCS. A weaker East Asian Winter Monsoon increases the contribution of the SCS outflow on the Kuroshio Intrusion‐dominated LS, while the El Niño–Southern Oscillation primarily drives the intrusion into the SCS. These results provide support to the dominant control of El Niño–Southern Oscillation on the long‐term ocean circulation variability in this region.
Cloud‐Resolving Model Intercomparison of an MC3E Squall Line Case: Part II. Stratiform Precipitation Properties
Authors: Han Bin , Fan Jiwen , Varble Adam , Morrison Hugh , Williams Christopher R. , Chen Baojun , Dong Xiquan , Giangrande Scott E. , Khain Alexander , Mansell Edward , Milbrandt Jason A. , Shpund Jacob , Thompson Gregory 
Published: January 2019

AbstractIn this second part of a cloud microphysics scheme intercomparison study, we focus on biases and variabilities of stratiform precipitation properties for a midlatitude squall line event simulated with a cloud‐resolving model implemented with eight cloud microphysics schemes. Most of the microphysics schemes underestimate total stratiform precipitation, mainly due to underestimation of stratiform precipitation area. All schemes underestimate the frequency of moderate stratiform rain rates (2–6 mm/hr), which may result from low‐biased ice number and mass concentrations for 0.2–2‐mm diameter particles in the stratiform ice region. Most simulations overestimate ice water content (IWC) at altitudes above 7 km for temperatures colder than −20 °C but produce a decrease of IWC approaching the melting level, which is opposite to the trend shown by in situ observations. This leads to general underestimations of stratiform IWC below 5‐km altitude and rainwater content above 1‐km altitude for a given rain rate. Stratiform precipitation area positively correlates with the convective condensate detrainment flux but is modulated by hydrometeor type, size, and fall speed. Stratiform precipitation area also changes by up to 17%–25% through alterations of the lateral boundary condition forcing frequency. Stratiform precipitation, rain rate, and area across the simulations vary by a factor of 1.5. This large variability is primarily a result of variability in the stratiform downward ice mass flux, which is highly correlated with convective condensate horizontal detrainment strength. The variability of simulated local microphysical processes in the stratiform region plays a secondary role in explaining variability in simulated stratiform rainfall properties.
Estuarine Sediments Exhibit Dynamic and Variable Biogeochemical Responses to Hypoxia
Authors: Foster S. Q. , Fulweiler R. W. 
Published: January 2019

AbstractEstuarine ecosystems are considered among the most valuable regions worldwide because of the wealth of ecosystem services they provide. Given their proximity to the land, they are also vulnerable to excessive nutrient inputs, which can lead to eutrophication and hypoxia. Water column hypoxia can dramatically alter sediment biogeochemistry, yet the response of specific processes varies widely. Predicting whether sediments are sources or sinks of ecologically and climatologically relevant nutrients and gases remains elusive, particularly for shallow coastal regions. In this study, we conducted experiments with sediments collected from Waquoit Bay (Massachusetts, United States) and measured dissolved nutrient and gas fluxes across the sediment‐water interface to investigate the impact of water column hypoxia (defined here as dissolved oxygen ≤3 mg/L) on three important ecosystem functions: nutrient regeneration, removal of reactive nitrogen, and the regulation of greenhouse gases. Under hypoxia we observed variable responses in sediment biogeochemical cycling, including little to no change in important nitrogen cycling processes such as ammonium efflux and nitrogen removal through denitrification. As expected, low oxygen conditions stimulated sediment phosphate efflux. This caused nutrient ratios for both nitrogen to phosphorus and silica to phosphorus in the overlying water to decrease by 50%. Such changes can alter both the composition of water column primary producers as well as the rate of primary production. Hypoxia led to an almost 60% decrease in sediment nitrous oxide consumption but had little impact on sediment methane emissions. Taken together, these experimental results suggest sediment biogeochemical cycling has variable and dynamic responses to hypoxia.
The Salinity Structure of the Amazon River Plume Drives Spatiotemporal Variation of Oceanic Primary Productivity
Authors: Gouveia N. A. , Gherardi D. F. M. , Wagner F. H. , Paes E. T. , Coles V. J. , Aragão L. E. O. C. 
Published: January 2019

AbstractThe Amazon river is a major source of terrestrially derived organic carbon to the tropical Atlantic Ocean. Field, satellite and a vertically generalized production model data were used to estimate empirical surface salinity and fit an inverse logit function to investigate the limiting effect of salinity on the productivity in the Amazon river plume. Satellite data included Moderate Resolution Imaging Spectroradiometer, Soil Moisture and Ocean Salinity, and Aquarius missions. Previous empirical surface salinity models have relied on a very narrow range of salinity values and satellite data to estimate the spatial extent of the river plume. The empirical surface salinity model presented here extended the range of salinity values and captures all the main surface mesoscale features, particularly those related to the main path of the low‐salinity water. We also show that it is possible to gain new insights on the spatiotemporal variability of the Amazon river plume by improving the empirical surface salinity and expanding its sampling period with the aid of remote sensing data. The variability of primary productivity is dominated by the subannual (6 month) and annual (12 month) frequency bands. Low‐salinity river water influences surface primary productivity continuously during the year through mechanisms associated with the western tropical Atlantic circulation and vertical mixing.
Differential Response of Greenhouse Gas Evasion to Storms in Forested and Wetland Streams
Authors: Aho K. S. , Raymond P. A. 
Published: January 2019

AbstractGreenhouse gas evasion from inland waters is a globally significant yet highly uncertain flux, especially in regard to effects of wetlands and hydrologic variability. We sampled five first‐order and two second‐order streams with variable wetland influence during storm events for dissolved CO2, CH4, and N2O. We also calculated gas evasion rates. In first‐order streams, pCO2 and pN2O were significantly higher in the stream with the most wetland influence (mean ± 1 std: 3,965 ± 1,504 and 1.18 ± 0.37 μatm, respectively) than the forested stream (2,927 ± 439 and 0.47 ± 0.08 μatm, respectively). In second‐order streams, pCO2, pCH4, and pN2O were higher in the 14% wetland stream (3,274 ± 825, 501 ± 207, and 1.37 ± 0.43 μatm, respectively) than in the 2% wetland stream (1,858 ± 423, 137 ± 53, and 0.37 ± 0.08 μatm, respectively). In first‐order streams, pCO2 in streams with wetland influence increased during rain events, while pCO2 in streams with little to no wetland influence decreased or remained constant. Generally, pCH4 and pN2O followed the same trend, except in one stream with intermediate wetland influence. Gas transfer velocity increased in all streams during storm events. However, the forested streams had higher gas transfer velocities than the wetland streams due to steeper topography. CO2, CH4, and N2O evasion peaked in one of the intermediate wetland streams at high flow (maximum: 66 g C·m−2·day−1, 177 mg C·m−2·day−1, and 9.7 mg N·m−2·day−1, respectively). These findings suggest that gases are shunted downstream in flatter, wetland streams, while gases are evaded closer to their source in steeper, forested streams.
Definition of Seismic Input From Fault‐Based PSHA: Remarks After the 2016 Central Italy Earthquake Sequence
Authors: Valentini A. , Pace B. , Boncio P. , Visini F. , Pagliaroli A. , Pergalani F. 
Published: January 2019

AbstractThis work focuses on how the progress in earthquake science that follows a large, deeply studied earthquake might be promptly combined with updated approaches of seismic hazard analysis to guide applicative choices for seismic risk reduction, such as postevent seismic microzoning and building design. Both seismic microzoning and seismic design of structures require strong motion records to perform numerical site response analyses. These records have to be related to the seismotectonic context and historical seismicity of the investigation area. We first performed a fault‐based probabilistic seismic hazard analysis in the area struck by the 2016 central Italy seismic sequence to individuate reference uniform hazard spectra at rock conditions. We used two different seismic hazard models, one considering 27 individual seismogenic sources (ISSs), and the second one involving grid point seismicity, using a fixed‐radius smoothing approach. The geological and seismotectonic data of the 2016 seismic sequence were used to update the model of ISSs. We performed a deaggregation analysis to evaluate the contribution of the ISS in the hazard of four representative sites and to select the magnitude‐distance pairs useful in the selection of the real accelerograms. The deaggregation analysis has been performed to identify which source and magnitude most contribute to the hazard for each site, and for different periods of spectral accelerations. Finally, we select, for each site, a set of natural accelerograms, from both nonimpulsive and pulse‐like records, based on the magnitude‐distance pairs that are compatible on average with target uniform hazard spectra.