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Introduction: Discrete choice experiments (DCE) are commonly used to elicit patient preferences and to determine the relative importance of attributes but can be complex and costly to administer. Simpler methods that measure relative importance exist, such as swing weighting with direct rating (SW-DR), but there is little empirical evidence comparing the two. This study aimed to directly compare attribute relative importance rankings and weights elicited using a DCE and SW-DR. Methods: A total of 307 patients with non–small-cell lung cancer in Italy and Belgium completed an online survey assessing preferences for cancer treatment using DCE and SW-DR. The relative importance of the attributes was determined using a random parameter logit model for the DCE and rank order centroid method (ROC) for SW-DR. Differences in relative importance ranking and weights between the methods were assessed using Cohen’s weighted kappa and Dirichlet regression. Feedback on ease of understanding and answering the 2 tasks was also collected. Results: Most respondents (>65%) found both tasks (very) easy to understand and answer. The same attribute, survival, was ranked most important irrespective of the methods applied. The overall ranking of the attributes on an aggregate level differed significantly between DCE and SW-ROC (P < 0.01). Greater differences in attribute weights between attributes were reported in DCE compared with SW-DR (P < 0.01). Agreement between the individual-level attribute ranking across methods was moderate (weighted Kappa 0.53–0.55). Conclusion: Significant differences in attribute importance between DCE and SW-DR were found. Respondents reported both methods being relatively easy to understand and answer. Further studies confirming these findings are warranted. Such studies will help to provide accurate guidance for methods selection when studying relative attribute importanc

Two complementary real-photon scattering experiments were conducted on the proton-magic nucleus 64Ni to study the dipole response up to its neutron-separation threshold of Sn = 9.7 MeV. By combining both measurements, 87 E1 and 23 M1 transitions were identified above 4.3 MeV. The results of the observed M1 transitions were compared to shell-model calculations using two different model spaces. It was found that the inclusion of excitations across the Z = 28 shell gap in the calculations has a large impact. Furthermore, average cross sections for decays to the ground state (elastic transitions) as well as to lower-lying excited states (inelastic decays) were determined. The corresponding E1 channel was compared to calculations within the relativistic equation of motion (REOM) framework. Whereas the calculation of highest possible complexity reproduces the fragmentation and overall behavior of the E1 average elastic cross section well, the predicted absolute cross sections are approximately twice as high as the experimental upper limits for the E1 cross section. The latter also include an estimation of the inelastic-decay channel.

Contains fulltext : 294548.pdf (Publisher’s version ) (Open Access), OBJECTIVES: Uncertainty is a fundamental component of decision making regarding access to and pricing and reimbursement of drugs. The context-specific interpretation and mitigation of uncertainty remain major challenges for decision makers. Following the 2021 HTAi Global Policy Forum, a cross-sectoral, interdisciplinary HTAi-DIA Working Group (WG) was initiated to develop guidance to support stakeholder deliberation on the systematic identification and mitigation of uncertainties in the regulatory-HTA interface. METHODS: Six online discussions among WG members (Dec 2021-Sep 2022) who examined the output of a scoping review, two literature-based case studies and a survey; application of the initial guidance to a real-world case study; and two international conference panel discussions. RESULTS: The WG identified key concepts, clustered into twelve building blocks that were collectively perceived to define uncertainty: "unavailable," "inaccurate," "conflicting," "not understandable," "random variation," "information," "prediction," "impact," "risk," "relevance," "context," and "judgment." These were converted into a checklist to explain and define whether any issue constitutes a decision-relevant uncertainty. A taxonomy of domains in which uncertainty may exist within the regulatory-HTA interface was developed to facilitate categorization. The real-world case study was used to demonstrate how the guidance may facilitate deliberation between stakeholders and where additional guidance development may be needed. CONCLUSIONS: The systematic approach taken for the identification of uncertainties in this guidance has the potential to facilitate understanding of uncertainty and its management across different stakeholders involved in drug development and evaluation. This can improve consistency and transparency throughout decision processes. To further support uncertainty management, linkage to suitable mitigation strategies is necessary.

Contains fulltext : 282598.pdf (Publisher’s version ) (Open Access), PURPOSE: Primary congenital glaucoma (PCG) is a form of childhood glaucoma caused by maldevelopment of the anterior chamber. Disease severity differs greatly amongst patients. Ultrasound biomicroscopy (UBM) is a non-invasive technique that can visualize the anterior segment in infants in vivo. The purpose of this narrative review is to make an overview of the UBM data in PCG and study the applicability of UBM in characterizing the disease. METHODS: An online search was performed on PubMed in December 2020. After a critical appraisal of the included articles, study and patient characteristics were summarized. The UBM measurements of the anterior segment in PCG of the different studies were analysed. RESULTS: Six studies were included in this review. All were cross-sectional prospective studies. A total of 221 PCG eyes were examined. PCG eyes showed a larger trabecular iris angle, decreased iris thickness, narrower or absent Schlemm's canal and an increased zonular length compared to controls. Abnormal tissue membrane covering the trabecular meshwork and abnormal insertion of the iris and ciliary process were frequently found. The success rate of glaucoma surgery depended on the severity of anterior segment malformations found with UBM. CONCLUSION: Malformations of the anterior segment in PCG can be demonstrated by UBM in vivo. This imaging can help to characterize disease severity and might support surgical treatment decisions.

Contains fulltext : 282598.pdf (Publisher’s version ) (Open Access), PURPOSE: Primary congenital glaucoma (PCG) is a form of childhood glaucoma caused by maldevelopment of the anterior chamber. Disease severity differs greatly amongst patients. Ultrasound biomicroscopy (UBM) is a non-invasive technique that can visualize the anterior segment in infants in vivo. The purpose of this narrative review is to make an overview of the UBM data in PCG and study the applicability of UBM in characterizing the disease. METHODS: An online search was performed on PubMed in December 2020. After a critical appraisal of the included articles, study and patient characteristics were summarized. The UBM measurements of the anterior segment in PCG of the different studies were analysed. RESULTS: Six studies were included in this review. All were cross-sectional prospective studies. A total of 221 PCG eyes were examined. PCG eyes showed a larger trabecular iris angle, decreased iris thickness, narrower or absent Schlemm's canal and an increased zonular length compared to controls. Abnormal tissue membrane covering the trabecular meshwork and abnormal insertion of the iris and ciliary process were frequently found. The success rate of glaucoma surgery depended on the severity of anterior segment malformations found with UBM. CONCLUSION: Malformations of the anterior segment in PCG can be demonstrated by UBM in vivo. This imaging can help to characterize disease severity and might support surgical treatment decisions.

A workshop on The Next Generation Gamma-Ray Sources, sponsored by the Office of Nuclear Physics at the Department of Energy, was held November 17–19, 2016 in Bethesda, Maryland. The goals of the workshop were to identify basic and applied research opportunities at the frontiers of nuclear physics that would be made possible by the beam capabilities of an advanced laser Compton beam facility. To anchor the scientific vision to realistically achievable beam specifications using proven technologies, the workshop brought together experts in the fields of electron accelerators, lasers, and optics to examine the technical options for achieving the beam specifications required by the most compelling parts of the proposed research programs. An international assembly of participants included current and prospective gamma-ray beam users, accelerator and light-source physicists, and federal agency program managers. Sessions were organized to foster interactions between the beam users and facility developers, allowing for information sharing and mutual feedback between the two groups. The workshop findings and recommendations are summarized.

Photon strength functions are an important ingredient in calculations relevant for the nuclear synthesis of heavy elements. The relation to the photo-absorption cross section allows to experimentally constrain photon strength functions by investigating the photo-response of atomic nuclei. We determine the photoresponse of 66Zn in the energy region of 5.6 MeV to 9.9 MeV and analyze the contribution of the decay channel back to the ground state. In addition, for the elastic channel electric and magnetic dipole transitions can be separated. Nuclear resonance fluorescence experiments were performed using a linearly-polarized quasimonoenergetic photon beam at the High Intensity Gamma-ray Source. Photon beam energies in the energy range from 5.6 MeV to 9.9 MeV with an energy spread of about 3 % were selected in steps of 200 - 300 keV. Two High-Purity Germanium detectors were used for the subsequent gamma-ray spectroscopy. Full photo absorption cross sections are extracted from the data making use of the mono-energetic character of the photon beam. For the ground-state decay channel the average contribution of electric and magnetic dipole strength is disentangled. The average branching ratio back to the ground state is determined as well. The new results show lower cross sections compared to the values extracted from experiments using bremsstrahlung. In the latter the average branching ratio to the ground state needs to be estimated from statistical model calculations in order to analyze the data. The calculations underestimate this branching ratio compared to the values extracted within the present analysis, which would partly explain the high cross sections determined from the bremsstrahlung data.

A workshop on The Next Generation Gamma-Ray Source sponsored by the Office of Nuclear Physics at the Department of Energy, was held November 17-19, 2016 in Bethesda, Maryland. The goals of the workshop were to identify basic and applied research opportunities at the frontiers of nuclear physics that would be made possible by the beam capabilities of an advanced laser Compton beam facility. To anchor the scientific vision to realistically achievable beam specifications using proven technologies, the workshop brought together experts in the fields of electron accelerators, lasers, and optics to examine the technical options for achieving the beam specifications required by the most compelling parts of the proposed research programs. An international assembly of participants included current and prospective gamma-ray beam users, accelerator and light-source physicists, and federal agency program managers. Sessions were organized to foster interactions between the beam users and facility developers, allowing for information sharing and mutual feedback between the two groups. The workshop findings and recommendations are summarized in this whitepaper.

Background: Photon strength functions are an important ingredient in calculations relevant for the nucleosynthesis of heavy elements. The relation to the photoabsorption cross section allows to experimentally constrain photon strength functions by investigating the photoresponse of atomic nuclei. Purpose: We determine the photoresponse of 66Zn in the energy region of 5.6 MeV to 9.9 MeV and analyze the contribution of the 'elastic' decay channel back to the ground state. In addition, for the elastic channel electric and magnetic dipole transitions were separated. Methods: Nuclear resonance fluorescence experiments were performed using a linearly polarized quasi-monoenergetic photon beam at the High Intensity gamma -ray Source. Photon beam energies from 5.6 to 9.9 MeV with an energy spread of about 3% were selected in steps of 200-300 keV. Two high purity germanium detectors were used for the subsequent gamma -ray spectroscopy. Results: Full photoabsorption cross sections are extracted from the data making use of the monoenergetic character of the photon beam. For the ground-state decay channel, the average contribution of electric and magnetic dipole strengths is disentangled. The average Conclusions: The new results indicate lower cross sections when compared to the values extracted from a former experiment using bremsstrahlung on 66Zn. In the latter, the average branching ratio to the ground state is estimated from statistical-model calculations in order to analyze the data. Corresponding estimates from statistical-model calculations underestimate this branching ratio compared to the values extracted from the present analysis, which would partly explain the high cross sections determined from the bremsstrahlung data.

info:eu-repo/semantics/published

Objectives: Patient preference information (PPI) is gaining recognition among the pharmaceutical industry, regulatory authorities, and health technology assessment (HTA) bodies/payers for use in assessments and decision-making along the medical product lifecycle (MPLC). This study aimed to identify factors and situations that influence the value of patient preference studies (PPS) in decision-making along the MPLC according to different stakeholders. Methods: Semi-structured interviews (n = 143) were conducted with six different stakeholder groups (physicians, academics, industry representatives, regulators, HTA/payer representatives, and a combined group of patients, caregivers, and patient representatives) from seven European countries (the United Kingdom, Sweden, Italy, Romania, Germany, France, and the Netherlands) and the United States. Framework analysis was performed using NVivo 11 software. Results: Fifteen factors affecting the value of PPS in the MPLC were identified. These are related to: study organization (expertise, financial resources, study duration, ethics and good practices, patient centeredness), study design (examining patient and/or other preferences, ensuring representativeness, matching method to research question, matching method to MPLC stage, validity and reliability, cognitive burden, patient education, attribute development), and study conduct (patients' ability/willingness to participate and preference heterogeneity). Three types of situations affecting the use of PPS results were identified (stakeholder acceptance, market situations, and clinical situations). Conclusion: The factors and situation types affecting the value of PPS, as identified in this study, need to be considered when designing and conducting PPS in order to promote the integration of PPI into decision-making along the MPLC.

Background: Research has been mainly focused on how to elicit patient preferences, with less attention on why patients form certain preferences. Objectives: To assess which psychological instruments are currently used and which psychological constructs are known to have an impact on patients' preferences and health-related decisions including the formation of preferences and preference heterogeneity. Methods: A systematic database search was undertaken to identify relevant studies. From the selected studies, the following information was extracted: study objectives, study population, design, psychological dimensions investigated, and instruments used to measure psychological variables. Results: Thirty-three studies were identified that described the association between a psychological construct, measured using a validated instrument, and patients' preferences or health-related decisions. We identified 33 psychological instruments and 18 constructs, and categorized the instruments into 5 groups, namely, motivational factors, cognitive factors, individual differences, emotion and mood, and health beliefs. Conclusions: This review provides an overview of the psychological factors and related instruments in the context of patients' preferences and decisions in healthcare settings. Our results indicate that measures of health literacy, numeracy, and locus of control have an impact on health-related preferences and decisions. Within the category of constructs that could explain preference and decision heterogeneity, health locus of control is a strong predictor of decisions in several healthcare contexts and is useful to consider when designing a patient preference study. Future research should continue to explore the association of psychological constructs with preference formation and heterogeneity to build on these initial recommendations.

Background: Patient preferences (PP), which are investigated in PP studies using qualitative or quantitative methods, are a growing area of interest to the following stakeholders involved in the medical product lifecycle: academics, health technology assessment bodies, payers, industry, patients, physicians, and regulators. However, the use of PP in decisions along the medical product lifecycle remains limited. As the adoption of PP heavily relies on these stakeholders, knowledge of their perceptions of PP is critical. Objective: This study aimed to characterize stakeholders’ attitudes, needs, and concerns with respect to PP in decision making along the medical product lifecycle. Methods: Semi-structured interviews (n = 143) were conducted with academics (n = 24), health technology assessment/payer representatives (n = 24), industry representatives (n = 24), patients, caregivers and patient representatives (n = 24), physicians (n = 24), and regulators (n = 23) from seven European countries and the USA. Interviews were conducted between April and August 2017. The framework method was used to organize the data and identify themes and key findings in each interviewed stakeholder group. Results: Interviewees reported being unfamiliar (43%), moderately familiar (42%), or very familiar (15%) with preference methods and studies. Interviewees across stakeholder groups generally supported the idea of using PP in the medical product lifecycle but expressed mixed opinions about the feasibility and impact of using PP in decision making. Interviewees from all stakeholder groups stressed the importance of increasing stakeholders’ understanding of the concept of PP and preference methods and ensuring patients’ understanding of the questions asked in PP studies. Key concerns and needs in each interviewed stakeholder group were as follows: (1) academics: investigating the validity, reliability, reproducibility, and generalizability of preference methods; (2) health technology assess

Background: Research has been mainly focused on how to elicit patient preferences, with less attention on why patients form certain preferences. Objectives: To assess which psychological instruments are currently used and which psychological constructs are known to have an impact on patients' preferences and health-related decisions including the formation of preferences and preference heterogeneity. Methods: A systematic database search was undertaken to identify relevant studies. From the selected studies, the following information was extracted: study objectives, study population, design, psychological dimensions investigated, and instruments used to measure psychological variables. Results: Thirty-three studies were identified that described the association between a psychological construct, measured using a validated instrument, and patients' preferences or health-related decisions. We identified 33 psychological instruments and 18 constructs, and categorized the instruments into 5 groups, namely, motivational factors, cognitive factors, individual differences, emotion and mood, and health beliefs. Conclusions: This review provides an overview of the psychological factors and related instruments in the context of patients' preferences and decisions in healthcare settings. Our results indicate that measures of health literacy, numeracy, and locus of control have an impact on health-related preferences and decisions. Within the category of constructs that could explain preference and decision heterogeneity, health locus of control is a strong predictor of decisions in several healthcare contexts and is useful to consider when designing a patient preference study. Future research should continue to explore the association of psychological constructs with preference formation and heterogeneity to build on these initial recommendations.

Objectives: Patient preference information (PPI) is gaining recognition among the pharmaceutical industry, regulatory authorities, and health technology assessment (HTA) bodies/payers for use in assessments and decision-making along the medical product lifecycle (MPLC). This study aimed to identify factors and situations that influence the value of patient preference studies (PPS) in decision-making along the MPLC according to different stakeholders. Methods: Semi-structured interviews (n = 143) were conducted with six different stakeholder groups (physicians, academics, industry representatives, regulators, HTA/payer representatives, and a combined group of patients, caregivers, and patient representatives) from seven European countries (the United Kingdom, Sweden, Italy, Romania, Germany, France, and the Netherlands) and the United States. Framework analysis was performed using NVivo 11 software. Results: Fifteen factors affecting the value of PPS in the MPLC were identified. These are related to: study organization (expertise, financial resources, study duration, ethics and good practices, patient centeredness), study design (examining patient and/or other preferences, ensuring representativeness, matching method to research question, matching method to MPLC stage, validity and reliability, cognitive burden, patient education, attribute development), and study conduct (patients' ability/willingness to participate and preference heterogeneity). Three types of situations affecting the use of PPS results were identified (stakeholder acceptance, market situations, and clinical situations). Conclusion: The factors and situation types affecting the value of PPS, as identified in this study, need to be considered when designing and conducting PPS in order to promote the integration of PPI into decision-making along the MPLC.

Background: Patient preferences (PP), which are investigated in PP studies using qualitative or quantitative methods, are a growing area of interest to the following stakeholders involved in the medical product lifecycle: academics, health technology assessment bodies, payers, industry, patients, physicians, and regulators. However, the use of PP in decisions along the medical product lifecycle remains limited. As the adoption of PP heavily relies on these stakeholders, knowledge of their perceptions of PP is critical. Objective: This study aimed to characterize stakeholders’ attitudes, needs, and concerns with respect to PP in decision making along the medical product lifecycle. Methods: Semi-structured interviews (n = 143) were conducted with academics (n = 24), health technology assessment/payer representatives (n = 24), industry representatives (n = 24), patients, caregivers and patient representatives (n = 24), physicians (n = 24), and regulators (n = 23) from seven European countries and the USA. Interviews were conducted between April and August 2017. The framework method was used to organize the data and identify themes and key findings in each interviewed stakeholder group. Results: Interviewees reported being unfamiliar (43%), moderately familiar (42%), or very familiar (15%) with preference methods and studies. Interviewees across stakeholder groups generally supported the idea of using PP in the medical product lifecycle but expressed mixed opinions about the feasibility and impact of using PP in decision making. Interviewees from all stakeholder groups stressed the importance of increasing stakeholders’ understanding of the concept of PP and preference methods and ensuring patients’ understanding of the questions asked in PP studies. Key concerns and needs in each interviewed stakeholder group were as follows: (1) academics: investigating the validity, reliability, reproducibility, and generalizability of preference methods; (2) health technology assess

The dipole strength of the nuclide Zn-66 was studied in photon-scattering experiments using bremsstrahlung produced with electron beams of energies of 7.5 and 13.4 MeV at the gamma ELBE facility as well as using quasimonoenergetic and linearly polarized photon beams of 30 energies within the range of 4.3 to 9.9 MeV at the HI gamma S facility. A total of 128 J = 1 states were identified, among them 9 with 1(+) and 86 with 1(-) assignments. The quasicontinuum of unresolved transitions was included in the analysis of the spectra and the intensities of branching transitions were estimated on the basis of simulations of statistical gamma-ray cascades. As a result, the photoabsorption cross section up to the neutron-separation energy was determined and compared with predictions of the statistical reaction model. The experimental M1 strengths from resolved 1(+) states are compared with results of large-scale shell-model calculations.

The dipole strength of the nuclide Zn-66 was studied in photon-scattering experiments using bremsstrahlung produced with electron beams of energies of 7.5 and 13.4 MeV at the gamma ELBE facility as well as using quasimonoenergetic and linearly polarized photon beams of 30 energies within the range of 4.3 to 9.9 MeV at the HI gamma S facility. A total of 128 J = 1 states were identified, among them 9 with 1(+) and 86 with 1(-) assignments. The quasicontinuum of unresolved transitions was included in the analysis of the spectra and the intensities of branching transitions were estimated on the basis of simulations of statistical gamma-ray cascades. As a result, the photoabsorption cross section up to the neutron-separation energy was determined and compared with predictions of the statistical reaction model. The experimental M1 strengths from resolved 1(+) states are compared with results of large-scale shell-model calculations.

High-spin states in Xe-123 were populated in the Se-80(Ca-48, 5n) Xe-123 reaction at a beam energy of 207 MeV. gamma-ray coincidence events were recorded with the Gammasphere spectrometer. Four new high-spin bands have been discovered in this nucleus. The bands are compared with those calculated within the framework of cranked Nilsson-Strutinsky and cranked Nilsson-Strutinsky-Bogoliubov models. It is concluded that the configurations of the bands involve two-proton excitations across the Z = 50 as well as excitation of neutrons across the N = 82 shell gaps resulting in a large deformation, epsilon(2) approximate to 0.30 and gamma approximate to 5 degrees.

High-spin states in Xe-123 were populated in the Se-80(Ca-48, 5n) Xe-123 reaction at a beam energy of 207 MeV. gamma-ray coincidence events were recorded with the Gammasphere spectrometer. Four new high-spin bands have been discovered in this nucleus. The bands are compared with those calculated within the framework of cranked Nilsson-Strutinsky and cranked Nilsson-Strutinsky-Bogoliubov models. It is concluded that the configurations of the bands involve two-proton excitations across the Z = 50 as well as excitation of neutrons across the N = 82 shell gaps resulting in a large deformation, epsilon(2) approximate to 0.30 and gamma approximate to 5 degrees.

The fusion-evaporation reaction Si-28 + Ca-40 at 122 MeV beam energy was used to populate high-spin states in the odd-odd N = Z nucleus Ga-62. With the combination of the Gammasphere spectrometer and the Microball CsI(Tl) charged-particle detector array the decay scheme of Ga-62 was extended beyond 10 MeV excitation energy. The onset of band structures was observed. These high-spin rotational states are interpreted and classified by means of cranked Nilsson-Strutinsky calculations.

The fusion-evaporation reaction Si-28 + Ca-40 at 122 MeV beam energy was used to populate high-spin states in the odd-odd N = Z nucleus Ga-62. With the combination of the Gammasphere spectrometer and the Microball CsI(Tl) charged-particle detector array the decay scheme of Ga-62 was extended beyond 10 MeV excitation energy. The onset of band structures was observed. These high-spin rotational states are interpreted and classified by means of cranked Nilsson-Strutinsky calculations.

A natural silicon target was investigated in a natSi photon-scattering experiment with fully linearlypolarised, quasi-monochromatic. rays in the entrance channel. The mean photon energies used were E = 9.33, 9.77, 10.17, 10.55, 10.93, and 11.37 MeV, and the relative energy spread (full width at half maximum) of the incident beam was.E. 3.5-4 %. The observed angular distributions for the ground-state decay allow firm spin and parity assignments for several levels of the stable even-even silicon isotopes.

The fusion-evaporation reaction Si-28 + Ca-40 at 122 MeV beam energy was used to populate high-spin states in the odd-odd N = Z nucleus Ga-62. With the combination of the Gammasphere spectrometer and the Microball CsI(Tl) charged-particle detector array the decay scheme of Ga-62 was extended beyond 10 MeV excitation energy. The onset of band structures was observed. These high-spin rotational states are interpreted and classified by means of cranked Nilsson-Strutinsky calculations.

A natural silicon target was investigated in a natSi(gamma,gamma' ) photon-scattering experiment using fully polarised, quasi-monochromatic gamma rays in the entrance channel. The mean photon energies used were = 9.33, 9.77, 10.17, 10.55, 10.93, and 11.37 MeV, while the relative energy spread (Full Width Half Maximum) of the incident beam amounts to dE / E ~ 3.5 - 4 %. The observed angular distribution in the ground-state decay channel allows to propose a firm spin and parity assignment for several levels of the stable even-even silicon isotopes.

A natural silicon target was investigated in a natSi photon-scattering experiment with fully linearlypolarised, quasi-monochromatic. rays in the entrance channel. The mean photon energies used were E = 9.33, 9.77, 10.17, 10.55, 10.93, and 11.37 MeV, and the relative energy spread (full width at half maximum) of the incident beam was.E. 3.5-4 %. The observed angular distributions for the ground-state decay allow firm spin and parity assignments for several levels of the stable even-even silicon isotopes.

info:eu-repo/semantics/published

The fusion-evaporation reaction 28Si + 40Ca at 122 MeV beam energy was used to populate high-spin states in the odd-odd N = Z nucleus 62Ga. With the combination of the Gammasphere spectrometer and the Microball CsI(Tl) charged-particle detector array the decay scheme of 62Ga was extended beyond 10 MeV excitation energy. The onset of band structures was observed. These high-spin rotational states are interpreted and classified by means of cranked Nilsson-Strutinsky calculations.

Objectives: Patient preference information (PPI) is gaining recognition among the pharmaceutical industry, regulatory authorities, and health technology assessment (HTA) bodies/payers for use in assessments and decision-making along the medical product lifecycle (MPLC). This study aimed to identify factors and situations that influence the value of patient preference studies (PPS) in decision-making along the MPLC according to diffe

Background Patient preferences (PP), which are investigated in PP studies using qualitative or quantitative methods, are a growing area of interest to the following stakeholders involved in the medical product lifecycle: academics, health technology assessment bodies, p

Objectives: Patient preference information (PPI) is gaining recognition among the pharmaceutical industry, regulatory authorities, and health technology assessment (HTA) bodies/payers for use in assessments and decision-making along the medical product lifecycle (MPLC). This study aimed to identify factors and situations that influence the value of patient preference studies (PPS) in decision-making along the MPLC according to different stakeholders. Methods: Semi-structured interviews (n = 143) were conducted with six different stakeholder groups (physicians, academics, industry representat

Objectives: To investigate stakeholder perspectives on how patient preference studies (PPS) should be designed and conducted to allow for inclusion of patient preferences in decision-making along the medical product life cycle (MPLC), and how patient preferences can be used in such decision-making. Methods: Two literature reviews and semi-structured interviews (n = 143) with healthcare stakeholders in Europe and the US were conducted; results of these informed the design of focus group guides. Eight focus groups were conducted with European patients, industry representatives and regulators, and with US regulators and European/Canadian health technology assessment (HTA) representatives. Focus groups were analyzed thematically using NVivo. Results: Stakeholder perspectives on how PPS should be designed and conducted were as follows: 1) study design should be informed by the research questions and patient population; 2) preferred treatment attributes and levels, as well as trade-offs among attributes and levels should be investigated; 3) the patient sample and method should match the MPLC phase; 4) different stakeholders should collaborate; and 5) results from PPS should be shared with relevant stakeholders. The value of patient preferences in decision-making was found to increase with the level of patient preference sensitivity of decisions on medical products. Stakeholders mentioned that patient preferences are hardly used in current decision-making. Potential applications for patient preferences across industry, regulatory and HTA processes were identified. Four applications seemed most promising for systematic integration of patient preferences: 1) benefit-risk assessment by industry and regulators at the marketing-authorization phase; 2) assessment of major contribution to patient care by European regulators; 3) cost-effectiveness analysis; and 4) multi criteria decision analysis in HTA. Conclusions: The value of patient preferences for decision-making depends on

Accumulation of DNA lesions causing transcription stress is associated with natural and accelerated aging and culminates with profound metabolic alterations. Our understanding of the mechanisms governing metabolic redesign upon genomic instability, however, is highly rudimentary. Using Ercc1-defective mice and Xpg knock-out mice, we demonstrate that combined defects in transcription-coupled DNA repair (TCR) and in nucleotide excision repair (NER) directly affect bioenergetics due to declined transcription, leading to increased ATP levels. This in turn inhibits glycolysis allosterically and favors glucose rerouting through the pentose phosphate shunt, eventually enhancing production of NADPH-reducing equivalents. In NER/TCR-defective mutants, augmented NADPH is not counterbalanced by increased production of pro-oxidants and thus pentose phosphate potentiation culminates in an over-reduced redox state. Skin fibroblasts from the TCR disease Cockayne syndrome confirm results in animal models. Overall, these findings unravel a mechanism connecting DNA damage and transcriptional stress to metabolic redesign and protective antioxidant defenses.

Background: The inclusion of patient preferences (PP) in the medical product life cycle is a topic of growing interest to stakeholders such as academics, Health Technology Assessment (HTA) bodies, reimbursement agencies, industry, patients, physicians and regulators. This review aimed to understand the potential roles, reasons for using PP and the expectations, concerns and requirements associated with PP in industry processes, regulatory benefitrisk assessment (BRA) and marketing authorization (MA), and HTA and reimbursement decision-making. Methods: A systematic review of peer-reviewed and grey literature published between January 2011 and March 2018 was performed. Consulted databases were EconLit, Embase, Guidelines International Network, PsycINFO and PubMed. A two-step strategy was used to select literature. Literature was analyzed using NVivo (QSR international). Results: From 1015 initially identified documents, 72 were included. Most were written from an academic perspective (61%) and focused on PP in BRA/MA and/or HTA/reimbursement (73%). Using PP to improve understanding of patients’ valuations of treatment outcomes, patients’ benefit-risk trade-offs and preference heterogeneity were roles identified in all three decision-making contexts. Reasons for using PP relate to the unique insights and position of patients and the positive effect of including PP on the quality of the decision-making process. Concerns shared across decision-making contexts included methodological questions concerning the validity, reliability and cognitive burden of preference methods. In order to use PP, general, operational and quality requirements were identified, including recognition of the importance of PP and ensuring patient understanding in PP studies. Conclusions: Despite the array of opportunities and added value of using PP throughout the different steps of the MPLC identified in this review, their inclusion in decision-making is hampered by methodological challenges and l

Background Patient preferences (PP), which are investigated in PP studies using qualitative or quantitative methods, are a growing area of interest to the following stakeholders involved in the medical product lifecycle: academics, health technology assessment bodies, payers, industry, patients, physicians, and regulators. However, the use of PP in decisions along the medical product lifecycle remains limited. As the adoption of PP heavily relies on these stakeholders, knowledge of their perceptions of PP is critical. Objective This study aimed to characterize stakeholders’ attitudes, needs, and concerns with respect to PP in decision making along the medical product lifecycle. Methods Semi-structured interviews (n=143) were conducted with academics (n=24), health technology assessment/ payer representatives (n=24), industry representatives (n=24), patients, caregivers and patient representatives (n=24), physicians (n=24), and regulators (n=23) from seven European countries and the USA. Interviews were conducted between April and August 2017. The framework method was used to organize the data and identify themes and key fndings in each interviewed stakeholder group. Results Interviewees reported being unfamiliar (43%), moderately familiar (42%), or very familiar (15%) with preference methods and studies. Interviewees across stakeholder groups generally supported the idea of using PP in the medical product lifecycle but expressed mixed opinions about the feasibility and impact of using PP in decision making. Interviewees from all stakeholder groups stressed the importance of increasing stakeholders’ understanding of the concept of PP and preference methods and ensuring patients’ understanding of the questions asked in PP studies. Key concerns and needs in each interviewed stakeholder group were as follows: (1) academics: investigating the validity, reliability, reproducibility, and generalizability of preference methods; (2) health technology assessment/payer represe

Objectives: Patient preference information (PPI) is gaining recognition among the pharmaceutical industry, regulatory authorities, and health techn

Anticancer drugs are currently widely used for the treatment of cancer and have been detected in hospital effluents, wastewater treatment plant effluents and river water samples in concentrations up to the µg.L-1 range. Within the next two decades, the annual number of cancer cases is expected to rise, which will lead to an increase in the consumption of anticancer drugs. These drugs are extremely important due to their highly potent mechanism of action and their potential risk for humans and the environment. Therefore, the development of effective treatment options is crucial to avoid the release of these emerging contaminants in the aquatic environment. The aim of this study was to assess the viability of nanofiltration for remediation, using as benchmark two representative membranes (Desal 5DK and NF270) to remove four widely consumed anticancer drugs (paclitaxel, etoposide, cyclophosphamide and ifosfamide) from different matrices (laboratory grade water, synthetic urine and real secondary effluent). Experimental results showed that the Desal 5DK membrane is more effective than the NF270 membrane for the rejection of these compounds. It presented average rejections higher than 89% for all the target anticancer drugs spiked in synthetic urine and real secondary effluent, showing no significant matrix influence on the rejection results. Daphnia magna toxicity tests showed that the immobilization effect observed in the permeate samples was lower than the feed samples. The target compounds have very different structures and physico-chemical properties and thus the high effectiveness reported for the Desal 5DK membrane is a good indication of what can be expected to a multitude of compounds.

Objectives: Patient preference information (PPI) is gaining recognition among the pharmaceutical industry, regulatory authorities, and health technology assessment (HTA) bodies/payers for use in assessments and decision-making along the medical product lifecycle (MPLC). This study aimed to identify factors and situations that influence the value of patient preference studies (PPS) in decision-making along the MPLC according to different stakeholders. Methods: Semi-structured interviews (n = 143) were conducted with six different stakeholder groups (physicians, academics, industry representatives, regulators, HTA/payer representatives, and a combined group of patients, caregivers, and patient representatives) from seven European countries (the United Kingdom, Sweden, Italy, Romania, Germany, France, and the Netherlands) and the United States. Framework analysis was performed using NVivo 11 software. Results: Fifteen factors affecting the value of PPS in the MPLC were identified. These are related to: study organization (expertise, financial resources, study duration, ethics and good practices, patient centeredness), study design (examining patient and/or other preferences, ensuring representativeness, matching method to research question, matching method to MPLC stage, validity and reliability, cognitive burden, patient education, attribute development), and study conduct (patients' ability/willingness to participate and preference heterogeneity). Three types of situations affecting the use of PPS results were identified (stakeholder acceptance, market situations, and clinical situations). Conclusion: The factors and situation types affecting the value of PPS, as identified in this study, need to be considered when designing and conducting PPS in order to promote the integration of PPI into decision-making along the MPLC.

BACKGROUND: The inclusion of patient preferences (PP) in the medical product life cycle is a topic of growing interest to stakeholders such as academics, Health Technology Assessment (HTA) bodies, reimbursement agencies, industry, patients, physicians and regulators. This review aimed to understand the potential roles, reasons for using PP and the expectations, concerns and requirements associated with PP in industry processes, regulatory benefit-risk assessment (BRA) and marketing authorization (MA), and HTA and reimbursement decision-making. METHODS: A systematic review of peer-reviewed and grey literature published between January 2011 and March 2018 was performed. Consulted databases were EconLit, Embase, Guidelines International Network, PsycINFO and PubMed. A two-step strategy was used to select literature. Literature was analyzed using NVivo (QSR international). RESULTS: From 1015 initially identified documents, 72 were included. Most were written from an academic perspective (61%) and focused on PP in BRA/MA and/or HTA/reimbursement (73%). Using PP to improve understanding of patients' valuations of treatment outcomes, patients' benefit-risk trade-offs and preference heterogeneity were roles identified in all three decision-making contexts. Reasons for using PP relate to the unique insights and position of patients and the positive effect of including PP on the quality of the decision-making process. Concerns shared across decision-making contexts included methodological questions concerning the validity, reliability and cognitive burden of preference methods. In order to use PP, general, operational and quality requirements were identified, including recognition of the importance of PP and ensuring patient understanding in PP studies. CONCLUSIONS: Despite the array of opportunities and added value of using PP throughout the different steps of the MPLC identified in this review, their inclusion in decision-making is hampered by methodological challenges and