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The aim of this study was to describe the development and activities of the Hospital-Based Health Technology Assessment (HB-HTA) Unit in the Hospital of the President's Affairs Administration, one of the first examples of the implementation of HB-HTA into the practice of Kazakhstani hospitals.
Details of the development of the Unit were obtained from the hospital's administrative records. The Unit's own records were used to describe the reports prepared and the clinical areas that were covered. Responses to recommendations in the Unit's reports were obtained from hospital administration and individual departments. Estimates of savings and payback periods were based on data from the hospital information system, and data submitted by manufacturers and distributors of medical equipment.
Fifty-one rapid- and mini-HTA reports were prepared by the Unit from 2015 to 2017. Seventeen health technologies (33 percent) were not recommended for implementation in hospital practice. Refusal to implement sixteen of these technologies saved approximately 1,053,500 USD. Of the thirty-four recommended health technologies, twenty-four were implemented to treat or diagnose 1,376 patients, and eight others were included in plans for 2018–20. Of the twenty-four implemented health technologies, twelve did not require additional investments. The payback period of investments for the other twelve implemented technologies is not more than 3 years for six, less than 5 years for four, and more than 10 years for two technologies.
Establishment of the HB-HTA Unit in the hospital created the basis for making informed managerial decisions; identifying key directions for strategic development; and improving hospital management.
Radio frequency identification (RFID) technology offers a real-time solution to monitor behavioral responses of individual animals to various stimuli, which provides crucial implications on farm management and animal well-being. The objectives of this study were to (1) develop and describe an ultra-high frequency radio frequency identification (UHF-RFID) system for continuously monitoring feeding and drinking behaviors of individual broilers in group settings; and (2) validate the performance of the UHF-RFID system against video analysis in determining the instantaneous bird number (IBN) and time spent (TS) at feeder and drinker. The UHF-RFID system consisted of cable-tie tags, antennas, a reader and a data acquisition (DAQ) system. The antennas generated electromagnetic fields where tags were detected and registered by the DAQ system. Electromagnetic fields of the antennas were modified to cover areas of concern (i.e. tube feeders and nipple drinkers) through a series of system evaluations and customizations including tag sensitivity test, power adjustment, radio wave shielding, and assessment of interference by add-ons (e.g. plastic wraps for protecting antennas and an empty carton box for zoning out broilers) and feed/feeder. System validation was performed in two experimental rooms, each with 60 tagged broilers. The results showed that the max reading distances of tags with an identical manufacturer’s specification were markedly different, indicating large variations in sensitivity among the tags. Desired electromagnetic fields could be achieved by adjusting the power supplied to antennas and by partially shielding antennas with customized stainless steel sheets. The protection materials and fully loaded feeder had little effect on electromagnetic fields of the antennas. The accuracies of the UHF-RFID system for determining IBN and TS were, respectively, 92.5±4.2% and 99.0±1.2% by the feeder antennas and 94.7±4.2% and 93.7±6.9% by the drinker antennas. It is concluded that the UHF-RIFD system can accurately detect and record feeding and drinking behaviors of individual broilers in group settings and thus is a useful tool for investigating impacts of resource allocations and management practices on these behaviors.
Cochlear implantation (CI) is a standard technology for the management of children with sensorineural hearing loss. In the Republic of Kazakhstan (RK), CI was introduced in 2007. In 2012, a report for the Ministry of Health (MoH) of the RK considered the effectiveness of CI, age of implantation, use of clinical protocols, and availability of audiological screening and rehabilitation services. We assessed the influence of the report findings on the provision of medical care in the RK for children with sensorineural hearing loss.
Information was collected in a survey of all RK health regions on issues related to CI, audiological screening and rehabilitation. Administrative data relevant to the provision of CI in the RK were obtained from the MoH. Data obtained were compared with those available for preparation of the 2012 report.
The proportion of medical organizations with equipment to provide audiological screening had improved, from 29 percent in 2012 to 90 percent in 2018. The proportion of children under two receiving CI increased from 12 percent to 36 percent, while that for children over five years decreased from 48 percent to 17 percent. A clinical protocol for CI in children was developed by a center in the MoH. Progress with post-CI rehabilitation of children was limited by a lack of specialists in the health regions. The proportion of school-age children with implants who have attended general schools remains low.
The findings of the HTA report had a positive influence on availability of screening services and a protocol for CI. The average age of children receiving an implant has decreased, though it is still higher than in other countries. The need for improvements in post-CI rehabilitation and placement of children with implants in general schools is recognized but these await further resources.
One of the main tools for Hospital-Based Health Technology Assessment (HB HTA) is the preparation of a mini-health technology assessment (HTA) report. Despite the high value of the results of mini-HTA reports for hospital decision-makers, the classical mini-HTA report does not allow a direct comparison of several health technologies among themselves.
Based on the analysis of international experience of using the principles of multiple-criteria decision analysis (MCDA) in the field of HB HTA, we created and approved our own managerial decision-making model which includes five standardized multiple criteria. The value (weight) of each criterion was defined as the arithmetic mean obtained as a result of interviewing hospital decision-makers and an HTA expert group.
Five standardized multiple criteria were included in the structure of our mini-HTA report. These criteria presented the main results of assessment of the viability of implementing new health technologies (HTs) in hospital practice and contain the following: i) Novelty/innovation; ii) Comparative clinical effectiveness and safety; iii) Relevance (demand); iv) Economic effectiveness; and, v) Payback period. We conducted the modeling of various options of HTA results by using multiple criteria, which allowed us to determine the threshold values of the evaluated HTs corresponding to their priority for implementation: i) High priority - HTs are recommended for implementation; ii) Medium priority - HTs can be recommended only if there are sufficient financial resources in hospital; and, iii) Low priority - HTs may be recommended only if there are strong reasons for their need.
Integration of the principles of MCDA in the structure of mini-HTA reports gives the opportunity to i) make comparative assessments of implementing new health technologies based on standardized criteria; ii) determine the priority for implementation of newly evaluated health technologies; iii) avoid the influence of subjective factors on the managerial decision-making in hospitals.
Health technology assessment (HTA) agencies wish to ensure the impact of their HTAs. HTA impact assessment measures the influence of a HTA on decision-making and downstream to patient outcomes. Despite their potential to provide insights, the use of impact assessment frameworks by HTA agencies is limited. Understanding the underlying mechanisms of adopting HTA impact assessment frameworks is therefore important. Using a social cognitions lens, this study aims to provide insights into the enabling and hindering factors associated with the assessment of HTA impact by INAHTA members.
Using an interpretive description design, this cross-sectional study used semi-structured interviews of INAHTA members to gain insight into attitudes, social support, self-efficacy, barriers, and intentions towards HTA impact assessment. Transcriptions were analyzed using a social cognitions lens by two researchers using a constant comparative method to identify themes.
Twenty-six of forty-seven INAHTA members participated. Preliminary results showed that interviewees most often perceived support for assessing impact from their ministry of health or from agency staff. Most interviewees noted challenges to measuring impact at the right time and a lack of human resources, methods, and tools as internal barriers. A lack of transparency and a limited impact assessment culture were perceived as the main external barriers. Interviewees reported feeling fairly confident in overcoming internal barriers, but were less confident in overcoming external barriers. Providing feedback for improvement to HTA processes and making achievements visible were the most frequently reported advantages of assessing impact, whereas its time consuming nature was the biggest disadvantage.
This is the first study to use a social cognitions model to understand HTA impact assessment. Although the results of this convenience sample need to be interpreted with caution, they contribute knowledge on factors that facilitate and hinder agencies in the assessment of impact and illuminate opportunities for developing effective strategies to support HTA agencies in this area.
Objectives: The aim of this study was to obtain information on methods used to measure health technology assessment (HTA) influence, decisions that were influenced, and outcomes linked to HTA.
Methods: Electronic databases were used to locate studies in which HTA influence had been demonstrated. Inclusion criteria were studies that reliably reported consideration by decision makers of HTA findings; comparative studies of technology use before and after HTA; and details of changes in policy, health outcomes, or research that could be credibly linked to an HTA.
Results: Fifty-one studies were selected for review. Settings were national (24), regional (12), both national and regional (3) hospitals (9), and multinational (3). The most common approach to appraisal of influence was review of policy or administrative decisions following HTA recommendations (51 percent). Eighteen studies (35 percent) reported interview or survey findings, thirteen (26 percent) reviewed administrative data, and six considered the influence of primary studies. Of 142 decisions informed by HTA, the most common types were on routine clinical practice (67 percent of studies), coverage (63 percent), and program operation (37 percent). The most frequent indications of HTA influence were on decisions related to resource allocation (59 percent), change in practice pattern (31 percent), and incorporation of HTA details in reference material (18 percent). Few publications assessed the contribution of HTA to changing patient outcomes.
Conclusions: The literature on HTA influence remains limited, with little on longer term effects on practice and outcomes. The reviewed publications indicated how HTA is being used in different settings and approaches to measuring its influence that might be more widely applied, such as surveys and monitoring administrative data.
Objectives: The aim of this study was to develop criteria for the prioritization of topics for health technology assessment (HTA) in the healthcare system of Kazakhstan.
Methods: Initial proposals for criteria were suggested through consultation with Ministry of Health (MoH) policy areas. These were refined through a workshop attended by HTA department staff, persons from medical universities and research institutes, and MoH policy makers. The workshop included discussion on methods used in international HTA practice. Opinions of participants on selection of criteria from those specified in a review of prioritization processes were used to define a list for inclusion in an instrument for routine use. A scoring system was established in later discussion.
Results: Selected criteria for HTA prioritization were burden of disease, availability of alternative technology, clinical effectiveness, economic efficiency, budget impact, and ethical, legal, and/or psychosocial aspects. For each criterion, a health technology under consideration is given a score from 3 (High) to 1 (Low). The total score determines whether the technology is of high to medium priority or of low priority. Determination of priorities for assessment, using the instrument, should be carried out by an expert group appointed by the MoH. The process was applied in 2014 to a selection of topics, and three health technologies were chosen for full assessments.
Conclusions: Criteria for prioritization have evolved with development of the HTA program in Kazakhstan. A method for HTA prioritization has been developed that is easy to apply, requires comparatively few resources, and is compatible with processes required by the MoH.
Accurate wavelengths for highly-ionized L-shell spectra were measured in the 10–16Å region. The purpose being to determine lines in coincidence with L-shell transitions from the elements oxygen, fluorine, and neon. L-shell transitions have been proposed for resonant photopumping of K-shell electrons in these elements to, generate lasing between upper levels in the 40–150 eV region. The current effort improves on and expands the earlier spectroscopic work performed at KMS Fusion, Inc., where possible line coincidences were identified for photoionizing in the 1–3 and 1–4 levels in fluorine. New experimental techniques have led to a wavelength accuracy now believed to be ± 2 mÅ for cases in which adequate calibration lines are available. Exact spectral line matches were found for Mn with the F H,-line at 12.643Å and for both Mn and Cr with the F He line at 14.458Å. The Mn line at 12.643Å has been identified, using ab initio atomic structure calculations, as the 1D2 − 1F3 transition in Be-like Mn XXII. The Mn line emissivity was determined to be 30 MW into 2 steradians for a conversion efficiency of 0.04%. Photopumping with Mn coated gasfilled targets is presently being tried in gain measurement experiments at LLNL.
Objectives: The aim of this study was to implement health technology assessment (HA) in the First General City Hospital in Astana, Kazakhstan.
Methods: We organized trainings to familiarize hospital staff with the purpose and details of HTA. An HTA committee was established, with representation from hospital physicians and managers, and criteria for prioritization of health technologies determined. Clinical departments of the hospital were asked to prepare applications for new technologies for their services.
Results: The HTA committee reviewed five applications and selected a technology from one of these, on single incision laparoscopic surgery (SILS), for assessment. A short HTA report on SILS was prepared, covering its safety, clinical effectiveness, and cost effectiveness. The report was used to support a request to the Department of Health for additional funding to implement this technology within the hospital. This funding was approved and SILS was established in several hospital departments.
Conclusions: This successful initial experience with HTA has paved the way for its routine use by the hospital for informing decisions on the procurement and use of new health technologies.
Traveling homeless youth (i.e., youth who migrate from city to city, after a short period of time) exhibit elevated levels of risky substance use behaviors compared to non-traveling youth. Using sociometric data, we examined the characteristics of homeless youth who are connected to at least one traveler and how at least one connection to travelers was associated with substance use of travelers and non-travelers. Data were collected from 386 homeless youth at two drop-in centers in Los Angeles, CA. Results indicated that, comparing to what would be expected by chance, youth who reported at least one connection to travelers were more likely to use substances, more travelers reported at least one tie to another traveler, and more substance-using travelers reported at least one tie to other substance-using travelers. Multivariate analyses revealed that binge drinking and marijuana use were associated with homeless youth reporting connections to at least one substance-using traveler. Injection drug use was associated with reporting at least one connection to an injection drug user, regardless of traveler status, once we controlled for demographic characteristics and traveler status. We suggest the need for substance-using traveler-specific services using brief one-on-one interventions to prevent further engagement in risky substance use.
In this response to Guzzo, Fink, King, Tonidandel, and Landis (2015), we suggest industrial–organizational (I-O) psychologists join business analysts, data scientists, statisticians, mathematicians, and economists in creating the vanguard of expertise as we acclimate to the reality of analytics in the world of big data. We enthusiastically accept their invitation to share our perspective that extends the discussion in three key areas of the focal article—that is, big data sources, logistic and analytic challenges, and data privacy and informed consent on a global scale. In the subsequent sections, we share our thoughts on these critical elements for advancing I-O psychology's role in leveraging and adding value from big data.
The search for life on other planets is an active area of research. Many of the likeliest planetary bodies, such as Europa, Enceladus, and Mars are characterized by cold surface environments and ice-rich terrains. Both Raman and ultraviolet-induced fluorescence (UIF) spectroscopies have been proposed as promising tools for the detection of various kinds of bioindicators in these environments. We examined whether macro-scale Raman and UIF spectroscopy could be applied to the analysis of unprocessed terrestrial frozen peat and clear ground ice samples for detection of bioindicators. It was found that this approach did not provide unambiguous detection of bioindicators, likely for a number of reasons, particularly due to strong broadband induced fluorescence. Other contributing factors may include degradation of organic matter in frozen peat to the point that compound-specific emitted fluorescence or Raman peaks were not resolvable. Our study does not downgrade the utility of either UIF or Raman spectroscopy for astrobiological investigations (which has been demonstrated in previous studies), but does suggest that the choice of instrumentation, operational conditions and sample preparation are important factors in ensuring the success of these techniques.
Once students have been introduced to the history and practice of papermaking, they may become interested in ways scholars have used paper to solve bibliographic problems. A fine introduction to the subject is John Bidwell's ‘The Study of Paper as Evidence, Artefact, and Commodity’ where he observes that ‘By examining paper, scholars have detected literary forgeries, discovered misleading dates in early imprints, and reassembled manuscripts in their proper order after the original sequence had been disturbed’. My purpose here is to introduce a technique for the description and analysis of hand-made antique laid paper that is simple and effective enough to be widely accessible even to nascent filigranologists.
One of the earliest studies to show the importance of paper as bibliographical evidence is W. W. Greg's two-part essay ‘On Certain False Dates in Shakespearian Quartos’ (The Library, 1908). The Pavier quartos, so called for their publisher, are a group of ten plays attributed to Shakespeare which are occasionally found bound together and are variously dated 1600, 1608, and 1619. Having distinguished twenty-six different watermarks as well as some unmarked stock used to print these quartos, Greg found that in a number of instances paper bearing the same watermarks appeared in quartos with different title page dates. Understanding that hand-made printing paper was an industrial commodity produced on moulds whose lifespan was probably something on the order of a year to eighteen months, that paper was typically bought ad hoc by publishers and/or printers, and that stocks of paper were quickly consumed, Greg recognized that the earlier dates must be false.
Objectives: The aim of this study was to evaluate the effectiveness of bilateral cochlear implantation (CI) compared with unilateral CI for deaf children in the context of the Republic of Kazakhstan health system.
Methods. A literature search was conducted, using the PubMed, Cochrane, and Embase data bases for studies that compared the effectiveness of bilateral and unilateral CI in children. The search included English language, publications from 2002–2012. Two reviewers independently evaluated all relevant studies. Administrative data relevant to CI in Kazakhstan were obtained from the Ministry of Health.
Results: Three relevant systematic reviews and an health technology assessment report were found. There was evidence of incremental benefits from bilateral CI but the quality of the available studies was poor and there was little information on longer term outcomes. No conclusions could be drawn regarding later incremental improvements to speech perception, learning, and quality of life. To date, in the Republic of Kazakhstan there is not full coverage of audiological screening due to the lack of medical equipment. This leads to late detection of hearing-impaired children and a long rehabilitation period, requiring more resources. Age of implantation in children is late and only a small minority attend general schools.
Conclusions: The clinical effectiveness of bilateral CI, an expensive health technology, requires further study. Given the current situation in Kazakhstan with audiological screening and access to unilateral CI, there appeared to be other priorities for improving services for children with profound hearing impairment.
Objectives: The aim of this study was to assist in the development of a health technology assessment (HTA) program for the Ministry of Health (MOH) of the Republic of Kazakhstan
Methods: Mentoring of an initial HTA program in Kazakhstan was provided by the Canadian Society for International Health (CSIH) by means of a partnership with the Kazakhstan MOH. HTA materials, courses, and one-on-one support for the preparation of a series of initial HTA reports by MOH HTA staff were provided by a seven-member CSIH team over a 2.5-year project.
Results: Guidance documents on HTA and institutional strengthening were prepared in response to an extensive set of deliverables developed by the MOH and the World Bank. Introductory and train-the-trainer workshops in HTA and economic evaluation were provided for MOH staff members, experts from Kazakhstan research institutes and physicians. Five short HTA reports were successfully developed by staff in the Ministry's HTA Unit with assistance from the CSIH team. Challenges that may be relevant to other emerging HTA programs included lack of familiarity with some essential underlying concepts, organization culture, and limited time for MOH staff to do HTA work.
Conclusions: The project helped to define the need for HTA and mentored MOH staff in taking the first steps to establish a program to support health policy decision making in Kazakhstan. This experience offers practical lessons for other emerging HTA programs, although these should be tailored to the specific context.
One of the major science objectives of the Nuclear Spectroscopic Telescope Array (NuSTAR) observatory is to perform the first sub-arcminute, hard X-ray survey of several square degrees of the Galactic plane, centered on a region near the Galactic center. As a prelude to the full survey, which began in July 2013, NuSTAR conducted a ∼500 ks, 0.3 × 0.4° “mini-survey” focused on Sgr A* and its environs. We present analysis of several candidate pulsar wind nebulae and filaments, which are revealed to be intense sources of X-ray emission at >10 keV.
Objectives: To obtain further information from members of the International Network of Agencies for Health Technology Assessment (INAHTA) on the involvement of consumers in their programs.
Methods: A questionnaire for a survey was developed and sent to member agencies in November 2010. Survey responses were compared with those from an earlier survey conducted in 2005.
Results: Of the thirty-three agencies that provided responses, 67 percent involve consumers in some aspects of their health technology assessment (HTA) programs, compared with 57 percent in 2005. As in the earlier survey, most agencies reporting involvement have contact with consumer or patient organizations and a large minority also involve individual consumers. Summaries of HTA reports that are intended to be easily understood by consumers are prepared by 84 percent of the agencies, and 42 percent involve consumers in dissemination of HTA material. In both areas, there was some increase from the levels previously reported.
Conclusions: The survey results suggest that there is a trend to increased involvement of consumers by the INAHTA agencies in their programs but that the level of involvement remains relatively limited. The manner of consumer participation varies between agencies.
The Herschel Key Project SHINING performs a study of the ISM in star forming and active
infrared bright galaxies (starbursts, AGN, (U)LIRGs, interacting and low metallicity
galaxies) at local and intermediate redshifts. Here we present some surprising and
promising first results from parts of this programme, including spatially resolved PDR
diagnostics, line deficit diagnostics, and large scale molecular outflows traced by the OH
Iron-based amorphous alloy Fe49.7Cr17.7Mn1.9Mo7.4W1.6B15.2C3.8Si2.4 was compared to borated stainless steel and Ni-Cr-Mo-Gd alloy on their corrosion resistance in various high-[Cl-] solutions. The melt-spun ribbon of this iron-based amorphous alloy have demonstrated a better corrosion resistance than the bulk borated stainless steel and the bulk Ni-Cr-Mo-Gd alloy, in high-[Cl-] brines at temperatures 90ºC or higher.