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To establish how real-world evidence (RWE) has been used to inform single technology appraisals (STAs) of cancer drugs conducted by the National Institute for Health and Care Excellence (NICE).
STAs published by NICE from April 2011 to October 2018 that evaluated cancer treatments were reviewed. Information regarding the use of RWE to directly inform the company-submitted cost-effectiveness analysis was extracted and categorized by topic. Summary statistics were used to describe emergent themes, and a narrative summary was provided for key case studies.
Materials for a total of 113 relevant STAs were identified and analyzed, of which nearly all (96 percent) included some form of RWE within the company-submitted cost-effectiveness analysis. The most common categories of RWE use concerned the health-related quality of life of patients (71 percent), costs (46 percent), and medical resource utilization (40 percent). While sources of RWE were routinely criticized as part of the appraisal process, we identified only two cases where the use of RWE was overtly rejected; hence, in the majority of cases, RWE was accepted in cancer drug submissions to NICE.
RWE has been used extensively in cancer submissions to NICE. Key criticisms of RWE in submissions to NICE are seldom regarding the use of RWE in general; instead, these are typically concerned with specific data sources and the applicability of these to the decision problem. Within an appropriate context, RWE constitutes an extremely valuable source of information to inform decision making; yet the development of best practice guidelines may improve current reporting standards.
In a four year study of bottlenose dolphins along the southern shore of the outer Moray Firth we show that whilst dolphins were encountered along the majority of the survey area, there was a significant preference to the western section, which is the area directly adjacent to the current Special Area of Conservation (SAC). We also show that 80% of all groups encountered (N = 62) included calves, and that neonates were seen throughout the months of July, August, September and October. The mark–recapture abundance estimates for the southern outer Moray Firth were variable, with a highest annual estimate of 108 (95% CI = 79–129), which is similar to previous estimates for the number of animals using the entire Moray Firth. In contrast, the lowest annual estimate of 61 (95% CI = 48–74) suggests that not all individuals regularly use the entire geographical range of the population and that individual ranging patterns may vary across years. The findings of this study indicate that the southern outer Moray Firth is an important area for this population and that it should not simply be considered as a corridor to other areas of more importance. For this reason, we believe that further consideration of the current management of this population in areas outside the existing SAC is necessary.
Various temperature dependent optoelectronic properties were measured for GaAs-based p-type / intrinsic / n-type (pin) solar cell devices containing 5-layers of InAs quantum dots (QDs) grown with strain-compensation layers. Curve fitting of the dark diode characteristics allowed for the temperature dependence of the saturation current and the ideality parameter to be determined. The resulting parameter values indicate high material quality. Air mass zero illuminated current density vs. voltage measurements were used to determine the temperature coefficients of the open circuit voltage, short circuit current, maximum power, and fill factor. A strong correlation between the temperature dependent quantum dot electroluminescence peak emission wavelength and the sub-GaAs bandgap spectral response was observed.
The growth of InAs quantum dots (QDs) by organometallic vapor phase epitaxy (OMVPE) for use in GaAs based photovoltaics devices was investigated. Growth of InAs quantum dots was optimized according to their morphology and photoluminescence using growth temperature and V/III ratio. The optimized InAs QDs had sizes near 7×40 nm with a dot density of 5(±0.5)×1010 cm-2. These optimized QDs were incorporated into GaAs based p-i-n solar cell structures. Cells with single and multiple (5x) layers of QDs were embedded in the i-region of the GaAs p-i-n cell structure. An array of 1 cm2 solar cells was fabricated on these wafers, IV curves collected under 1 sun AM0 conditions, and the spectral response measured from 300-1100 nm. The quantum efficiency for each QD cell clearly shows sub-bandgap conversion, indicating a contribution due to the QDs. Unfortunately, the overarching result of the addition of quantum dots to the baseline p-i-n GaAs cells was a decrease in efficiency. However, the addition of thin GaP strain compensating layers between the QD layers, was found to reduce this efficiency degradation and significantly enhance the subgap conversion in comparison to the un-compensated quantum dot cells.
Indium tin oxide (ITO) films coated on float glass slides were exposed to 5 eV hyperthermal atomic oxygen at room temperature with increasing fluences: 2×1019, 6×1019 and 2×1020 O-atoms/cm2. We characterized the structure of the ITO films after room temperature atomic oxygen exposure with scanning electron microscope (SEM) and atomic force microscope (AFM), synchrotron X-ray diffraction (XRD), and cross-sectional transmission electron microscope (X-TEM). The unexposed ITO films were found to possess a nano-crystalline surface, and clean and abrupt ITO/SiO2 interfaces without interfacial phase. Surface roughness of the exposed ITO films increased with the increasing AO influences. The interface- sensitive peaks in XRD measurements with grazing incidence revealed that the crystallinity of the ITO was modified near the interface. Cross-sectional TEM confirmed that many ITO particles with diameters ranging from 2-10 nm formed in the SiO2 substrate near the interface after AO exposure. These findings suggest that O atoms can travel through the ITO films, where the boundaries of columnar-grown grains may supply the pathway.
Historical and reconstructed snow-cover data show evidence of a gradual increase in snow cover over the continental interior of North America (NA) during much of the 20th century, primarily in response to increasing snowfall. A rapid decrease in Canadian-prairies snow cover after 1970 is not observed over the Great Plains. Analysis of snow-cover-climate relationships revealed systematic increases in the sensitivity of snow cover to Northern Hemisphere (NH) temperatures over the 1940-65 period. This change is mainly due to an increase in snowfall-temperature sensitivity during this period. Seasonal analysis revealed that the observed increase in snow-cover and snowfall temperature sensitivity is primarily a spring phenomenon. A marked increase in the importance of the spring period is observed around 1960, which coincides with a well-documented change in atmospheric circulation over NA. The post-1960 period is characterized by a significant inverse relationship between snow cover and hemispheric air temperature over the Canadian prairies and northern Great Plains regions.
We apply Carol Gilligaris distinction between a “male” mode of moral reasoning, focussed on justice, and a “female” mode, focussed on caring, to the reading of literature. Martha Nussbaum suggests that certain novels are works of moral philosophy. We argue that what Nussbaum sees as the special ethical contribution of such novels is in fact training in the stereotypically female mode of moral concern. We show this kind of training is appropriate to all readers of these novels, not just to women. Finally, we explore what else is involved in distinctively feminist readings of traditional novels.
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