bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Split Hopkinson Pressure Bar Investigation of Impact-Induced Reaction of HMX, RDX and PETN
Authors: Williamson D. M. , Morley O. J. 
Published: December 2023

AbstractWe have used a split Hopkinson pressure bar arrangement to investigate impact-induced reaction of the secondary explosives HMX, RDX and PETN in granular form. Sentencing of the experiments was performed by detecting reaction light emission, the spectral analysis of which can also provide information about the temperature of reaction. We measure the fraction of the mechanical energy that passes through the specimens that is absorbed in the run up to reaction, which we refer to as the efficiency factor, and for these experiments is of order 5–10%. We postulate that the efficiency factor is a function of the microstructure. The measured amounts of energy that were absorbed are comparable to those amounts required to bulk heat the samples to their melt points. A critical absorbed energy for reaction implies a minimum duration of loading for a given mechanical power and efficiency factor, and this idea is supported by the observation that the more intense the loading, the shorter the time to reaction. Additionally, we postulate a critical minimum mechanical power below which heat is redistributed faster than it can be accumulated. A minimum mechanical power threshold in turn dictates a minimum pressure threshold; but the idea of a stand-alone critical pressure is not experimentally supported.
Thermal damage evolution of granite under different thermal conditions based on two-scale tessellation via discrete element method
Authors: Ma Qianchi , Liu Xiaoli , Song Danqing , Wang Enzhi , Zhang Jianmin , Yao Wenli , Wang Mingyang 
Published: December 2023

AbstractThis paper presents a numerical modeling method that integrates a grain-growth model and Voronoi polygon configuration to investigate the thermal damage characteristics and fracture mechanism of granite under three distinct thermal conditions: rapid heating, slow heating, and cycle heating. The proposed method accurately simulates the intra-grain damage modes of mineral particles and the mechanical responses of granite. Through the simulation, it was observed that slow heating induces more significant deterioration compared to rapid heating, while cycle heating leads to wider crack openings and apparent brittle damage during the cooling phase. Furthermore, the peak strength and elastic modulus of granite demonstrate a significant decrease with increasing temperature under all three heating conditions. Notably, slow heating exhibits ductility characteristics in its post-peak residual strength. This study also analyzes the effects of different thermal conditions on the damage evolution pattern and cracking mechanism of rocks. It is found that slow heating generates a higher number of cracks with a broader distribution and intra-grain damage, whereas cycle heating results in severe cracks and fractures. The findings of this study have practical implications for preventing and controlling thermal disasters in deep rock engineering.
Impact of intensified prevention measures on the rate of hospital-acquired bloodstream infections among mechanically ventilated COVID-19 patients
Authors: Lampl Shimrit , Cohen Yael , Maor Yasmin , Ben-David Debby 
Published: December 2023

Abstract

Background:
The COVID-19 pandemic was associated with increased rates of hospital-acquired infections. During the early months of the pandemic, we observed high rates of hospital-acquired bloodstream infections (HA-BSIs) among COVID-19 patients, prompting the implementation of intensified prevention measures.

Objectives:
To assess the prevalence of HA-BSI among mechanically ventilated COVID-19 patients, identify risk factors, and evaluate the effect of prevention measures.

Methods:
We conducted a retrospective matched case-control study in adult medical step-up units between March 1, 2020, and March 31, 2021. We matched mechanically ventilated COVID-19 patients with ventilated non-COVID-19 patients based on age group and length of stay before ventilation. In response to the high rates of HA-BSI among COVID-19 patients, a comprehensive infection control intervention was implemented.

Results:
A total of 136 COVID-19 patients were matched with 136 non-COVID-19 patients. No significant differences were observed in pre-hospitalization characteristics. The central venous catheter utilization ratio was higher in COVID-19 patients (83.6%) versus 35.6% in the control group (p < 0.001). During pre-intervention, 35.2% (32/91) of COVID-19 patients developed HA-BSI, compared to 17.8% (13/73) in the control group (p < 0.001). Following the intervention, no significant difference was observed between the groups (17.8% (8/45) versus 15.9% (10 /63), p = 0.79). In a multivariate analysis, HA-BSI was associated with low body mass index (OR 0.9 (95% CI 0.9–1.0), p = 0.015)) and presence of temporary dialysis catheter (OR 2.7 (95% CI 1.0–7.3), p = 0.05)).

Conclusions:
Mechanically ventilated COVID-19 patients were at higher risk for developing HA-BSI compared to non-COVID-19 patients. Intensified prevention measures were associated with decreased rates of HA-BSI.
Prehospital Mass Casualty Incident Response to a Fire in a Nursing Home in Milan, Italy: Actions Taken and Shortcomings
Authors: Ripoll-Gallardo Alba , D’Ambrosio Annapaola , Manzoni Paola , Grifone Vincenzo , Pedrazzi Catia , De Luca Giovanni , Arghetti Davide , Stellini Armando , Zambelan Alessandro , Ruggiero Ilaria , Cusmà-Piccione Riccardo , Bacullo Gianluca , Lorito Franco , Perbellini Paolo , Giacovelli Matteo , De Donno Massimo , Pelà Simone , Colzani Giacomo , Brioschi Elena , Chiodini Gianliuca , Sechi Giuseppe , Zoli Alberto , Fumagalli Roberto , Stucchi Riccardo 
Published: December 2023

Abstract
On July 7, 2023, at 1:21 am, a fire was declared in a retirement home in Milan, Italy. The number of casualties (n = 87) according to the Simple Triage and Rapid Treatment (START) triage system was categorized as 65 green, 14 yellow, 2 red, and 6 black; 75% were women, and the mean age was 85.1 years (± 9). Most patients were unable to walk. A total of 30 basic life support (BLS) ambulances, 3 advanced cardiac life support (ACLS) teams on fast cars, 2 buses, and 1 coordination team were deployed. A scoop and run approach was adopted with patients being transported to 15 health care facilities. The event was terminated at 5:43 am. Though the local mass casualty incident (MCI) response plan was correctly applied, the evacuation of the building was difficult due to the age and comorbidities of the patients. START failed to correctly identify patients categorized as minor. Communication problems arose on site that led to the late evacuation of critical patients.
On Cognitive Modeling and Other Minds
Authors: Gamboa J. P. 
Published: December 2023

AbstractScientists and philosophers alike debate whether various systems such as plants and bacteria exercise cognition. One strategy for resolving such debates is to ground claims about nonhuman cognition in evidence from mathematical models of cognitive capacities. In this article, I show that proponents of this strategy face two major challenges: demarcating phenomenological models from process models and overcoming underdetermination by model fit. I argue that even if the demarcation problem is resolved, fitting a process model to behavioral data is, on its own, not strong evidence for any cognitive process, let alone processes shared with humans.
Ordovician sedimentation and basin development in the North Armorican Massif, NW France: Field evidence from the northern Cotentin Peninsula
Authors: Went David J. 
Published: December 2023

AbstractField evidence from the northern Cotentin Peninsula and regional data are used to construct a tectono-stratigraphic model for the Ordovician which characterizes basin development in the North Armorican Massif. In La Hague, 15 m of transgressive marine sandstone belongs to the Dapingian age Grès Armoricain Formation which onlaps lower Cambrian, rift-fill deposits via an unconformity. Approximately 450 m of overlying Darriwilian strata are dominated by shallow marine sandstone showing hummocky cross-stratification with subordinate shales containing trace and body fossils. Together, these facies support an interpretation of offshore shallow marine strata overlying a break-up unconformity. Regional analysis indicates the time gap at the unconformity is 20–40 Ma and formed from crustal upwarping, which was greatest in the north of the Armorican Massif. Dapingian strata (Grès Armoricain) thins irregularly to the north (0–94 m), interpreted to reflect passive onlap onto residual relief associated with the uplift and the initiation of thermal subsidence on the margin. The succeeding Darriwilian strata (Schistes de Beaumont to Grès de May) conversely display a steady thickening (161–623 m) to the north, the stratal patterns suggesting that from the Darriwilian onwards, the ocean basin to the north was firmly established as the main locus of subsidence on the continental margin.
OP01 Causal Association Between Type 2 Diabetes Mellitus And Risk Of Cancer
Authors: Lemus Fabiola , Hawkins Neil , Boyd Kathleen A. 
Published: December 2023

IntroductionType 2 diabetes mellitus (T2DM) is a major public health problem. Evidence suggests an association between diabetes and cancer, but this may be distorted by confounding. This research aimed to identify and assess the evidence suggesting a causal association between T2DM and cancer.MethodsA systematic review was conducted in Pubmed, Embase, CINAHL, Web of Science, and the Cochrane Library for literature on the association between T2DM and cancer, from inception to 7 May 2021. Case-control and cohort studies published in any language were considered. Based on a targeted literature review, a directed acyclic graph for each type of cancer was developed to test whether the causal effects were adequately controlled for potential confounding.ResultsA total of 131 studies with a low risk of bias were selected that reported 415 effect estimates of the association of T2DM with 57 types of cancer. Breast, colorectal, pancreas, prostate, and lung were the cancer sites with the highest number of studies. Causality was claimed in 57 studies, but only 34 percent of the outcomes were adequately controlled for confounders. Of the studies assessing a causal relationship for prostate and pancreatic cancer, 87 and 70 percent adequately controlled for confounding. In contrast, only 29 percent of lung cancer, 27 percent of colorectal cancer, and 17 percent of breast cancer results considered the minimal sufficient adjustment set. Lifestyle variables were identified as key potential confounders in more than 20 types of cancer, but they were not included in the analyses.ConclusionsMany studies simply reported an association between diabetes and cancer. The policy implications of such studies are unclear. Of the studies claiming a causal link between diabetes and cancer, a large proportion did not adequately control for confounding. It is critical that studies take a systematic approach to identifying potential confounding factors, such as targeted reviews and the development of directed acyclic graph approaches, to estimate causal effects that may be useful in informing health policy.
OP07 Eleven Years Of Conitec: Advances And Challenges Of Patient And Public Involvement In The Brazilian Health Technology Assessment Process
Authors: Souza Andrea Brigida , Prates Adriana , Almeida Andrija , Portugal Clarice , Losco Luiza , Fonseca Mariana , Barros Melina , Canuto Vania 
Published: December 2023

IntroductionPatient and public involvement (PPI) is a core element of the health technology assessment (HTA) process. Since its creation in 2011, the National Committee for Health Technology Incorporation (Conitec) has promoted initiatives to include stakeholders in HTA for the Brazilian Public Health System (SUS). This work aimed to present a report on the advances and challenges related to PPI in 11 years of Conitec.MethodsA retrospective analysis of PPI actions carried out at Conitec was conducted, based on an analysis of minutes and records of meetings and discussions held internally and documents published on Conitec´s website.ResultsEvents and meetings were held over the years with different actors interested in the HTA process. Since 2015, a plain-language version of the technical report has been made available to the public during public consultations for each HTA topic. Recently, a register of patients, specialists, and SUS managers was created to form a database and establish a network with the stakeholders. Since 2020, SUS users have been allocated time to speak at Conitec´s meetings. Qualitative analysis of public consultation documents started in 2021 and a pilot qualitative evidence synthesis was carried out in 2022. These initiatives, although not directly focused on PPI, increase the consideration of the perspectives of patients, family members, and caregivers in the HTA process.ConclusionsPPI actions implemented at Conitec have significantly promoted inclusiveness and exchanges among stakeholders, contributing to a greater transparency regarding Conitec’s actions. Nonetheless, we have important challenges on our horizon, such as strengthening connections with primary healthcare managers and professionals and social movements. It is also strategic to expand the technical and scientific discussion on PPI and qualitative approaches with HTA researchers and the voting members of Conitec. Finally, another aim is to improve knowledge of HTA and public health policy among law professionals and the pharmaceutical industry in Brazil.
OP08 International Benchmarking Of Health Technology Assessment Training Tools And Materials For Patients And Consumers
Authors: Low Eunice , André-Vert Joëlle , Guerrier Marc , Fanelli Gaëlle , Galbraith Margaret 
Published: December 2023

IntroductionThe objective was to conduct a benchmarking study of available online health technology assessment (HTA) training tools for patients, specifically those used by HTA agencies and major European and international patient and consumer groups (PCGs). We compared existing online training tools on this topic in order to develop in-house HTA training tools for French patients and consumers.MethodsA literature search and a scoping review of websites was conducted by including the websites of HTA agencies, European and international PCGs, and other bodies. This was supplemented with videoconference interviews with selected HTA agencies and patient groups. The inclusion criterion was the existence of content describing HTA and patient and public involvement (PPI) in HTA that PCGs could use (regardless of its format).ResultsEighty-two online training tools were selected according to the specified inclusion criterion. Sixteen international HTA bodies, nine European and international PCGs, and 13 other bodies provided online HTA training tools available for patients and consumers. No journal articles matching the inclusion criterion were found. Two broad categories of content were identified: the first relating to HTA and the second relating to PPI in HTA. Moreover, the formats of these tools ranged from interactive to non-interactive, with varying accessibility (freely available or with a paywall) and assessment methods.ConclusionsThese results should be considered together with budget requirements, project time constraints, human resources, and the preferences of HAS and patients when developing HTA training tools to improve the participation of patients and consumers in the HTA process at HAS.
OP14 Cost-Utility Analysis Of Regorafenib For Patients With Hepatocellular Carcinoma Who Progressed On Sorafenib Treatment
Authors: Singh Ambrish , Hussain Salman 
Published: December 2023

IntroductionIn the RESORCE trial, regorafenib was shown to provide overall survival (OS) benefit for patients with hepatocellular carcinoma (HCC) that has progressed on sorafenib treatment. Subsequently, it was approved by the Therapeutic Goods Administration for the treatment of patients with HCC who were previously treated with sorafenib; however, regorafenib is still not recommended by the Pharmaceutical Benefits Advisory Committee in Australia. We aimed to assess the cost effectiveness of regorafenib as a second-line therapy for patients with HCC who progressed on sorafenib from an Australian healthcare perspective.MethodsWe developed a Markov model to compare the cost effectiveness of regorafenib with best supportive care (BSC) as a second-line therapy for HCC after treatment with sorafenib. The health outcomes of life-years and quality-adjusted life-years (QALYs) were derived from the RESORCE trial. Survival benefits sourced from the RESORCE trial were fitted with the parametric model to estimate survival beyond the follow-up period. Drug costs and costs associated with adverse events (AEs) were sourced from published literature and the Independent Health and Aged Care Pricing Authority cost report. Model validity was verified using probabilistic sensitivity analyses.ResultsThe incremental monthly cost of treatment with regorafenib was AUD19,273 (USD13,374), with an incremental life-year gain of 0.38, compared with BSC. The incremental QALYs gained with regorafenib were 0.24, resulting in a base-case incremental cost-effectiveness ratio (ICER) of AUD80,511 (USD55,872) per QALY. In the probabilistic sensitivity analyses across scenarios, the ICER remained above the conventional threshold of AUD50,000 (USD34,698) per QALY, with a zero probability of being cost effective at this willingness-to-pay threshold.ConclusionsAt the current price, second-line treatment with regorafenib in patients with HCC that has progressed on sorafenib was not cost effective at the conventional willingness-to-pay threshold from an Australian health-system perspective.
OP19 Exploring The Environment/Capacity Of South African Citizen Actors To Contribute To Health Technology Assessment Processes, Policy Development And Institutionalization
Authors: Pretorius Lauren , Muller Debjani 
Published: December 2023

IntroductionSeveral overarching health policy reform processes are currently underway in South Africa (SA), providing an opportunity to establish health technology assessment (HTA) and value-based assessment (VBA) frameworks that foster patient and citizen involvement (PCI). A mapping of the capacity, knowledge, and skill of SA PCI advocacy actors and understanding of the ‘middle-ground’ and influencing relationships that influence advocacy strategies for PCI in HTA, will allow us to determine the needs of PCI actors to entrench PCI principles in the emerging institutionalization of HTA in SA.MethodsAn analysis of national and international legislative and policy frameworks indicates current gaps and opportunities for PCI institutionalization in HTA in SA. A survey was conducted to determine SA patient and citizen advocacy actors’ capacity, knowledge, and skill across multiple disease areas. An analysis of decision maker’s opinions and positions about PCI in HTA and VBA policy, and their potential influence on the PCI process was undertaken.ResultsThe legislation and policy review indicate that engagement initiatives are positioned at the ‘involvement’ or ‘consultation’ stages of the engagement continuum, rather than higher-level engagement. Five percent of patient advocacy groups (PAGs) interviewed have formalized PCI HTA advocacy strategies. Few PAGs indicated employing processes to actively monitor the HTA and PCI-related activities of decision-makers.The majority of PAGs stated that collaborative efforts within larger networks would generate more success, if they engaged in PCI in HTA advocacy. Over eighty percent of civil society stakeholders face capacity constraints, such as lack of knowledge of the legislative framework and theory of HTA, funding and manpower to engage in PCI. The majority of HTA processes undertaken by funders in SA do not actively include PAGs or formalized PCI.ConclusionsExisting legislative and policy frameworks do not include PCI capacity-building strategies. This is impacted by the lack of coordination amongst patient and consumer groups, the willingness of existing HTA structures to formalize PCI, and the resources of the country’s PCI advocate actors to influence existing HTA processes.
OP52 Treating Osteoporosis In Postmenopausal Women With Denosumab (Prolia®): A Systematic Review And Network Meta-Analysis
Authors: Moshi Magdalena Ruth , Nicolopoulos Konstance , Stringer Danielle , Ma Ning , Jenal Mathias , Vreugdenburg Thomas 
Published: December 2023

IntroductionIt is estimated that osteoporosis affects over 200 million people globally. Postmenopausal women (PMW) have an increased risk of developing osteoporosis due to low estrogen levels. This study assessed the safety and effectiveness of denosumab (Prolia®) relative to placebo, selective estrogen receptor modulators (SERMs) (bazedoxifene and raloxifene), and bisphosphonates (alendronate, ibandronate, risedronate, and zoledronate) for the treatment of osteoporosis in PMW.MethodsSystematic searches were conducted in three biomedical databases (PubMed, the Cochrane Library, and Embase) to identify randomized controlled trials (RCTs) of PMW with osteoporosis allocated to denosumab, placebo, bisphosphonates, or SERMs. The Cochrane Risk of Bias 2.0 tool was used to critically appraise included RCTs. Pairwise and Bayesian network meta-analyses were performed on the following predetermined outcomes: fractures (vertebral and nonvertebral); adverse events (AEs); mortality; serious AEs (SAEs); withdrawals due to AEs; bone mineral density (BMD); and AEs caused by denosumab discontinuation.ResultsThe analyses included 12 RCTs (22 publications, 25,879 participants). Denosumab, ibandronate, alendronate, zoledronate, and risedronate produced a statistically significant improvement in total hip (TH) and lumbar-spine (LS) BMD, compared with placebo. Similarly, ibandronate, risedronate, and alendronate showed a statistically significant improvement in femoral neck (FN) BMD. Risedronate produced a statistically significant decrease in nonvertebral fractures (risk ratio 0.20, 95% confidence interval: 0.00, 0.97) relative to placebo. However, there were no significant differences between any of the interventions for rates of vertebral fractures, AEs, SAEs, withdrawals due to AEs, or mortality, compared with placebo.None of the included trials reported evidence on AEs caused by denosumab discontinuation.ConclusionsDenosumab was associated with significant improvements in both LS and TH BMD relative to placebo. Similarly, compared with placebo, denosumab was not associated with significant changes in nonvertebral or vertebral fractures. Denosumab was not associated with significant changes in safety outcomes relative to placebo. Given that some of the analyses suffered from statistical imprecision, these findings should be interpreted with caution. Regarding policy, continued funding of denosumab needs to be reviewed.