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Very few practical frameworks exist to guide the formulation of recommendations at hospital-based health technology assessment (HTA) units. The objectives of our study were: (i) to identify decision criteria specific to the context of hospital-based health technologies and interventions, (ii) to estimate the extent to which the expert community agrees on the importance of the identified criteria, (iii) to incorporate the identified criteria into a decision-aid tool, and (iv) to illustrate the application of a prototype decision-aid tool.
Relevant decision criteria were identified using existing frameworks for HTA recommendations, our past experience, a literature search, and feedback from a survey of diverse stakeholders.
Based on the survey results, twenty-three decision criteria were incorporated into the final framework. We defined an approach that eschewed a scoring system, but instead relied on a visual means for arriving at a final recommendation, by juxtaposing the importance rating for each criterion against the results of the health technology assessment. For a technology to be approved, a majority of criteria considered important should also have received favorable findings.
We created a simple and practical decision-aid tool that incorporates all decision criteria relevant to a hospital-based HTA unit. With its ease of use and accessibility, our tool renders the subjective decision-making process more structured and transparent.
Marinobacter sp. W1-16 from Antarctic surface seawater was analysed for the production of extracellular polymeric substances (EPSs). Enhancement of the EPS biosynthesis was carried out by evaluating the influences of the carbon source (type and concentration), temperature, pH and salinity. EPS yields varied strongly depending on sugar substrate and temperature, while pH and salinity did not strongly affect levels of EPS production. Marinobacter sp. W1-16 produced the highest quantity of EPSs when growing at 15°C and pH 8, in the presence of 2% glucose and 3% NaCl. The EPS chemical characterization revealed a molecular weight of about 260 kDa. Colorimetric assays determined a higher quantity of carbohydrate than of proteins and uronic acids, as well as the presence of sulphate, in the extracted EPSs. The monosaccharidic composition resulted in Glc:Man:Gal:GalN:GalA:GlcA in relative molar proportions of 1:0.9:0.2:0.1:0.1:0.01. Some biotechnological potentialities (i.e. emulsifying and cryoprotective actions, and heavy metal binding properties) of the EPSs were proved, suggesting possible industrial and bioremediation applications.
Systematic mixed studies reviews are a type of systematic review that combine qualitative, quantitative and mixed methods studies. They are gaining in popularity due to their potential for providing in-depth answers to complex clinical problems and practical concerns. However, several challenges are encountered in systematic mixed studies reviews because of the heterogeneity of included study designs. One of these challenges is related to the quality appraisal of included studies. To address this challenge, a critical appraisal tool for assessing the quality of quantitative, qualitative and mixed methods studies was developed in 2007: the Mixed Methods Appraisal Tool (MMAT). The aim of this project was to strengthen the content validity of the MMAT.
A new version of the MMAT was developed using the results from a literature review on critical appraisal tools and a modified e-Delphi study with methodological experts (n = 73) to identify the core relevant criteria to include in the MMAT.
The results of this project and the new version of the MMAT will be presented. The MMAT has three main characteristics. First, it can be used for different study designs since it includes criteria for qualitative, quantitative and mixed methods studies. Second, the MMAT focuses on the core relevant methodological criteria and has five criteria per category of study. Third, it includes specific criteria for assessing mixed methods studies.
Currently, there exists over 500 critical appraisal tools, making the task of selecting the proper tools for use in systematic mixed studies reviews more difficult. The MMAT offers an alternative solution by proposing a unique tool that can appraise the quality of different study designs. Also, by limiting to core criteria, the MMAT can provide a more time efficient assessment.
According to European Guidelines for Legionnaires’ Disease prevention and control, travel-associated Legionnaires’ disease (TALD) cases are managed differently if classified as sporadic or as part of a cluster and more stringent control measures are deployed after clusters are identified. In this study, we propose to modify the current cluster definition: ‘two or more cases of Legionnaires’ disease (LD) who stayed at, or visited, the same commercial accommodation site 2–10 days before onset of illness and whose onset is within the same 2-year period’ with a new cluster definition, i.e. accommodation sites associated with multiple cases regardless of the time elapsed between them. TALD cases occurred in Italy and in the Balearic Islands between 2005 and 2015 were analysed applying the current European Legionnaires’ Disease Surveillance Network (ELDSNet) cluster definition. In a sample of selected accommodation sites with multiple cases, a microbiological study was also conducted. Using the new definition, 63 additional sites (16.4% increase) and 225 additional linked cases (19.5% increase) were identified. Legionella pneumophila sg1 was isolated from 90.7% of the selected accommodation sites. The use of the here proposed TALD cluster definition would warrant a full investigation for each new identified case. This approach should therefore increase the number of sites that will require a risk assessment and, in the presence of an increased risk, the adoption of LD control measures to hopefully prevent additional cases.
In June 2012, the Botswana Ministry of Health and Wellness (MOHW; Gaborone, Botswana) initiated a national Emergency Medical Services (EMS) system in response to significant morbidity and mortality associated with prehospital emergencies. The MOHW requested external expertise to train its developing workforce. Simulation-based training was planned to equip these health care providers with clinical knowledge, procedural skills, and communication techniques.
The objective of this study was to assess the educational needs of the pioneer Botswana MOHW EMS providers based on retrospective EMS logbook review and EMS provider feedback to guide development of a novel educational curriculum.
Data were abstracted from a representative sample of the Gaborone, Botswana MOHW EMS response log from 2013-2014 and were quantified into the five most common call types for both adults and children. Informal focus groups with health professionals and EMS staff, as well as surveys, were used to rank common response call types and self-perceived educational needs.
Based on 1,506 calls, the most common adult response calls were for obstetric emergencies, altered mental status, gastrointestinal/abdominal pain, trauma, gynecological emergencies, and cardiovascular and respiratory distress-related emergencies. The most common pediatric response calls were for respiratory distress, gastrointestinal complaints/dehydration, trauma and musculoskeletal injuries, newborn delivery, seizures, and toxic ingestion/exposure. The EMS providers identified these same chief complaints as priorities for training using the qualitative approach. A locally relevant, simulation-based curriculum for the Botswana MOHW EMS system was developed and implemented based on these data.
: Trauma, respiratory distress, gastrointestinal complaints, and puerperal/perinatal emergencies were common conditions for all age groups. Other age-specific conditions were also identified as educational needs based on epidemiologic data and provider feedback. This needs assessment may be useful when designing locally relevant EMS curricula in other low-income and middle-income countries.GlombNW, KosokoAA, DoughtyCB, RusMC, ShahMI, CoxM, GalapiC, ParkesPS, KumarS, LabaB.Needs Assessment for Simulation Training for Prehospital Providers in Botswana. Prehosp Disaster Med. 2018;33(6):621–626.
Boar taint is a major meat quality defect, which affects about 10% of entire male pigs. It is due to an excessive accumulation of skatole and androstenone in adipose tissue. One of the reasons for accumulation of these compounds is a low rate of their metabolism. Androstenone is metabolised in liver via the enzyme 3-beta-hydroxysteroid dehydrogenase (HSD). This enzyme is well characterised in the testis, where it participates in the synthesis of steroids, while its properties in liver are unknown. The aim of the present study was to characterise and compare properties of HSD from pig liver versus pig testis when metabolising androstenone.
The one-dimensional snow model SNTHERM is validated using field measurements of snow and superimposed ice thickness and surface energy fluxes. These were performed during the spring-to-summer transition in Svalbard and in the Weddell Sea, Antarctica. Both the seasonal snow-thickness decrease and the formation of superimposed ice are well reproduced by the model. During the three observation periods, observed and modeled snow thickness differ only by 13.1–27.1mm on average. In regional studies, the model is forced with atmospheric re-analysis data (European Centre for Medium-Range Weather Forecasts) and applied to several meridional transects across the Arctic and Southern Ocean. These show fundamental regional differences in the onset, duration and magnitude of snow thinning in summer. In the central Arctic, snowmelt onset occurs within a narrow time range of ±11 days and without significant regional differences. In contrast, the snow cover on Antarctic sea ice begins to melt about 25 days earlier and the length of the Antarctic snow-thinning season increases with increasing latitude. The importance of melting and evaporation for the modeled snow-thickness decrease is very different in the two hemispheres. The ratio of evaporated snow mass to melted snow mass per unit area is derived from the model, and amounts to approximately 4.2 in the Antarctic and only 0.75 in the Arctic. This agrees with observations and model results of the surface energy balance, and illustrates the dominance of surface cooling by upward turbulent fluxes in the Antarctic.
Over the perennial Sea ice in the western and central Weddell Sea, Antarctica, the onset of Summer is accompanied by a Significant decrease of Sea-ice brightness temperatures (Tb) as observed by passive-microwave radiometers Such as the Special Sensor Microwave/Imager (SSM/I). The Summer-specific Tb drop is the dominant feature in the seasonal cycle of Tb data and represents a conspicuous difference to most Arctic Sea-ice regions, where the onset of Summer is mostly marked by a rise in Tb. Data from a 5 week drift Station through the western Weddell Sea in the 2004/05 austral Summer, Ice Station POLarstern (IsPOL), helped with identifying the characteristic processes for Antarctic Sea ice. In Situ glaciological and meteorological data, in combination with SSM/I Swath Satellite data, indicate that the cycle of repeated diurnal thawing and refreezing of Snow (‘freeze–thaw cycles’) is the dominant process in the Summer Season, with the absence of complete Snow wetting. The resulting metamorphous Snow with increased grain Size, as well as the formation of ice layers, leads to decreasing emissivity, enhanced volume Scattering and increased backscatter. This causes the Summer Tb drop.
The cryosphere is an essential component of the global climate system, equally affecting climate processes significantly and being subject, and particularly sensitive, to changes in climate conditions. Numerical models are an important tool for assessing climate-change impacts on the Antarctic ice–sheet–ice–shelf–ocean system. They not only complement field and satellite remotesensing investigations but are often the only feasible alternative for addressing some of the important parameters and processes. Over the last few years, our group has made significant progress in developing and applying innovative numerical methods. In this paper, we provide a brief overview of some of the methods employed and the major results obtained for a number of case studies in the Atlantic sector of Antarctica.
Advanced Microwave Scanning Radiometer (AMSR-E) snow-depth data for Antarctic sea ice are compared with ship-based visual observations of snow depth, ice type and ridged-ice fraction, and with satellite C-band and Ku-band radar backscatter observations for two ship cruises into the Weddell Sea (ISPOL 2004–05,WWOS 2006) and one cruise into the Bellingshausen Sea (SIMBA 2007) during late winter/spring. Most (>75%) AMSR-E and ship-based snow-depth observations agree within 0.2 m during WWOS and SIMBA. Remaining observations indicate substantial underestimations of snow depths by AMSR-E data. These underestimations tend to increase with the ridged-ice fraction for WWOS and SIMBA. In areas with large snow depths, a combination of relatively stable low C-band radar backscatter and variable Ku-band radar backscatter is associated with undeformed first-year ice and may indicate snow metamorphism at this time of year during SIMBA. In areas with small snow depths, a combination of relatively stable low Ku-band radar backscatter, high C-band radar backscatter and low C-band radar backscatter standard deviations is associated with rough first-year ice during SIMBA. This information can help to better understand causes of the observed AMSR-E snow-depth bias during late-winter/spring conditions with decreasing average snow depth and to delineate areas where this bias occurs.
This paper assesses the capabilities of a new one-dimensional snow scheme developed for the thermodynamic component of the Louvain-la-Neuve sea-Ice Model (LIM). the model is validated at Point Barrow, Alaska, and at Ice Station Polarstern (ISPOL) in the western Weddell Sea, Southern Ocean. the new snow thermodynamic scheme leads to better snow internal temperature profiles, with a set-up-dependent increase in the correlation between simulated and observed temperature profiles. on average over all runs, these correlations are 27% better with the six-layer configuration. the model’s ability to reproduce observed temperatures improves with the number of snow layers, but stabilizes after a threshold layer number is reached. the lowest and highest values for this threshold are 3 (at Point Barrow) and 6 (at ISPOL), respectively. Overall, the improvement of the model’s ability to simulate sea-ice thickness is not as significant as for snow temperature, probably because of the rather crude representation of the snow stratigraphy in the model.
Basal melt of ice shelves may lead to an accumulation of disc-shaped ice platelets underneath nearby sea ice, to form a sub-ice platelet layer. Here we present the seasonal cycle of sea ice attached to the Ekström Ice Shelf, Antarctica, and the underlying platelet layer in 2012. Ice platelets emerged from the cavity and interacted with the fast-ice cover of Atka Bay as early as June. Episodic accumulations throughout winter and spring led to an average platelet-layer thickness of 4 m by December 2012, with local maxima of up to 10 m. The additional buoyancy partly prevented surface flooding and snow-ice formation, despite a thick snow cover. Subsequent thinning of the platelet layer from December onwards was associated with an inflow of warm surface water. The combination of model studies with observed fast-ice thickness revealed an average ice-volume fraction in the platelet layer of 0.25 ± 0.1. We found that nearly half of the combined solid sea-ice and ice-platelet volume in this area is generated by heat transfer to the ocean rather than to the atmosphere. The total ice-platelet volume underlying Atka Bay fast ice was equivalent to more than one-fifth of the annual basal melt volume under the Ekström Ice Shelf.
Up to now, snow cover on Antarctic sea ice and its impact on radar backscatter, particularly after the onset of freeze/thaw processes, are not well understood. Here we present a combined analysis of in situ observations of snow properties from the landfast sea ice in Atka Bay, Antarctica, and high-resolution TerraSAR-X backscatter data, for the transition from austral spring (November 2012) to summer (January 2013). The physical changes in the seasonal snow cover during that time are reflected in the evolution of TerraSAR-X backscatter. We are able to explain 76-93% of the spatio-temporal variability of the TerraSAR-X backscatter signal with up to four snowpack parameters with a root-mean-squared error of 0.87-1.62 dB, using a simple multiple linear model. Over the complete study, and especially after the onset of early-melt processes and freeze/thaw cycles, the majority of variability in the backscatter is influenced by changes in snow/ice interface temperature, snow depth and top-layer grain size. This suggests it may be possible to retrieve snow physical properties over Antarctic sea ice from X-band SAR backscatter.
In order to investigate social structure, 11 years of individual photo-identification data of bottlenose dolphin were analysed. We examined the type of association indices between pairs of identified individuals; the patterns of affiliation between individual dolphins and the probabilities of association between individuals over time. Between 2001 and 2012, there were 272 encounters which resulted in the identification of 501 individuals. The discovery curve resulting from the photo-identification analysis indicated an open population with regular recruitment of new individuals. All individuals were found to be associated at an association index of <0.05. A total of 291 individuals recorded from 2004 to 2012 were used to assess the temporal pattern of the social structure. The model fit to the Standardized Lagged Association Rate (SLAR) that best described the studied bottlenose dolphin population was ‘casual acquaintances’, and the analysis of associations over time showed a decreasing SLAR curve that falls until reaching the null rate, confirming random associations. The decline of the SLAR curve after ~500 days (1.4 years) suggests disassociation over that time period which can be explained by demographic events such as mortality or emigration. In an open ocean habitat like Madeira this is not unexpected, as there are neither geographic boundaries nor enclosed environments. This population presented a dynamic and fluctuating social structure, where groups change in size and composition. In future conservation efforts this population should be considered as one large community, where individuals associate, disassociate and reassociate with each other over time.