Entry Schemes Research Articles

The Relationship between Entry Grades of Students Admitted to Public Universities in Uganda under Direct Entry Schemes and Their Academic Performance: Implications for Admission Policies

Although studies on relationships between entry qualification and academic performance show that students who excelled academically in entry qualification often perform better than those with low entry qualification in subsequent examinations, this argument has been questioned. This study explored the relationship between entry grades of undergraduate students and academic performance in public universities in Uganda in the first and final years of their studies. A retrospective cohort analysis of data for undergraduate students of Gulu and Makerere Universities using a sample of 2825 academic records from 2013-2016 was conducted. Descriptive statistics and Pearson correlation analysis were used for analysis. Results revealed a significant relationship between entry scores and students’ academic performance for those admitted on national merit, district quota, affirmative action schemes and private sponsorship schemes in four university programs. However, there was no significant correlation between entry scores and students’ academic performance in the Bachelor of Medicine and Bachelor of Surgery programs. Although male students joined with lower grades than females, their performance in the final year was better than their female counterparts. Therefore, this study confirms that the entry qualification score predicts academic outcomes in the early and exit stages of the university. These findings support the current Government entry criteria for public universities, provide important information for the admission committee decisions, and may have implications for admission policies. However, the lack of a significant correlation between entry qualification scores and students’ academic performance in Bachelor of Medicine and Bachelor of Surgery could indicate the need to revisit admissions criteria for this program. Future studies should go beyond the commonly used GPA to measure academic performance by including non-cognitive factors such as practical skills, clinical skills, and professionalism. Furthermore, the role of background and sociodemographic factors in influencing academic performance at public universities should be considered alongside the pre-entry qualification score

Implications of Current Procedural Terminology code accuracy on surgical workflow and financial reimbursement

Objective: Inaccuracies in Current Procedural Terminology (CPT) coding entries for surgical procedures have a profound impact on hospital systems and surgeon compensation for services. We sought to characterize the variations of surgical CPT entry at a multi-site academic medical center and estimate the financial burden implicated by improper code entry.Methods: A mixed methods study was conducted to evaluate variations in CPT entry across an academic center. Semi-structured interviews with 8 surgical schedulers were conducted and analyzed to understand the current scheduling process. Coding data for surgical procedures performed within a 31-day period during September and October 2020 within the large healthcare system were assessed for appropriate CPT code entry. Reimbursement for the 2020 fiscal year was then analyzed to determine the impact of pre-operative CPT code accuracy on reimbursements and denials.Results: Interviews revealed a lack of standardization in the surgical scheduling process across the hospital system. Lack of standardized onboarding and variations in workflow contributed to difficult cross coverage for schedulers and errors in CPT entry. On quantitative analysis, the accuracy of pre-operative CPT code entry was poor with only 59.3% of pre-operative CPT code entries being correct. In the 2020 fiscal year, $5.4 million was lost due to problems related to CPT code entry.Conclusions: Variations and lack of standardization in CPT code entry can greatly contribute to financial losses and disrupt surgical scheduling. Standardization of workflow and CPT entry schemes can help minimize scheduling complications and enhance the quality of care provided to patients.

Spotlight commentary: Navigating between financial risks and improved treatment outcomes with immune checkpoint inhibitors in cancer patients: The need for biomarker identification and dose optimization.

Spotlight commentary: Navigating between financial risks and improved treatment outcomes with immune checkpoint inhibitors in cancer patients: The need for biomarker identification and dose optimization.

Current Issues in Health Technology Assessment of Cancer Therapies: A Survey of Stakeholders and Opinion Leaders in Australia.

The aim of this study was to find ways of bridging the gap in opinions concerning health technology assessment (HTA) in reimbursement submission between manufacturers and payers to avoid access delays for patients of vital medicines such as oncology drugs. This was done by investigating differences and similarities of opinion among key stakeholders in Australia. The survey comprised of nine sections: background demographics, general statements on HTA, clinical claim, extrapolations, quality of life, costs and health resource utilization, agreements, decision making, and capability/capacity. Responses to each question were summarized using descriptive statistics and comparisons were made using chi-square statistics. There were ninety-seven respondents in total, thirty-seven from the public sector (academia/government) and sixty from the private sector (industry/consultancies). Private and public sector respondents had similar views on clinical claims. They were divided when it came to extrapolation of survival data and costs and health resource utilization. However, they generally agreed that rebates are useful, outcomes-based agreements are difficult to implement, managed entry schemes are required when data are limited, and willingness to pay is higher in cancer compared to other therapeutic areas. They also agreed that training mostly takes place through on the job training and that guideline updates were a least favored opportunity for continued training. Private sector respondents favor methods that reduce the incremental cost-effectiveness ratio when compared to the public sector respondents. There still exist a number of challenges for HTA in oncology and many research opportunities as a result of this study.

Designing Leakage-Resilient Password Entry on Head-Mounted Smart Wearable Glass Devices

With the boom of Augmented Reality (AR) and Virtual Reality (VR) applications, head-mounted smart wearable glass devices are becoming popular to help users access various services like E-mail freely. However, most existing password entry schemes on smart glasses rely on additional computers or mobile devices connected to smart glasses, which require users to switch between different systems and devices. This may greatly lower the practicability and usability of smart glasses. In this paper, we focus on this challenge and design three practical anti-eavesdropping password entry schemes on stand-alone smart glasses, named gTapper, gRotator and gTalker. The main idea is to break the correlation between the underlying password and the interaction observable to adversaries. In our IRB-approved user study, these schemes are found to be easy-to-use without additional hardware under various test conditions, where the participants can enter their passwords within moderate time, at high accuracy, and in various situations.

Deriving an Objective Criterion Contextualizing the Meaning of Lateral Entry Schemes

Lateral entry schemes are intended to admit meritorious Diploma holders to the second year/third semester of various Bachelor degrees in a given discipline. Lateral entry has been accepted as a mode of admission in principle by the Sri Lankan qualification framework. Lateral entry schemes have been basically introduced at medical faculties and agriculture faculties in a couple of universities in Sri Lanka. However, there was no proper review so far undertaken to assess the criterion adopted in admitting students. Thus, this study is to contextualize the meaning of lateral entry at the outset and reveal the level of emphasis given to lateral entry schemes in both local and international arena. A literature survey, desk review and an expert interview were conducted to expose a normative criterion of admission with a future direction.

Cost-effectiveness and financial risks associated with immune checkpoint inhibitor therapy.

The reimbursement of immune checkpoint inhibitors is challenging. Funding these technologies involves the careful balance between awarding innovation and ensuring affordability as increases in drug spending compete directly with other health care and social expenditure. This narrative review examines the recommendations of 2 health technology assessment agencies-the Australian Pharmaceutical Benefits Advisory Committee and the British National Institute of Clinical Excellence-to determine the factors that contribute to the approval and rejection of immune checkpoint inhibitors as well as the use of manage entry schemes and risk management strategies to control expenditure. Reimbursement decisions from 6 immune checkpoint inhibitor drugs (ipilimumab, pembrolizumab, nivolumab, durvalumab, atezolizumab, avelumab) covering 10 different cancers were examined. The extrapolation of survival beyond the clinical trial and lack of head-to-head evidence are some of the main issues relating to cost effectiveness. Payers managed financial risks using different mechanisms such as risk share agreements and financial caps. This review of the reimbursement decisions and subsequent financial impact in Australia and the UK suggests budgets for immune checkpoint inhibitor therapy have been well managed so far. Through risk agreements and managed entry programmes, the example of immune checkpoint inhibitor therapies illustrates that industry and payers can effectively collaborate to ensure that innovative, but expensive, drugs can be made readily available to patients.

PNS38 PROPOSING AND EVALUATING A DESIGN FOR GDPR-COMPLIANT, SCALABLE TECHNOLOGY FOR AUTOMATIC ADJUDICATION OF RISK-SHARING AGREEMENTS

Risk-sharing agreements (RSAs) between biopharma manufacturers and payers are increasingly being adopted in European markets, either as managed entry schemes or for marketed products. Such agreements may, according to the literature, control expenditures on higher cost medicines while linking payment to a clinical, economics, or administrative outcome. Documented hurdles to RSA implementation include the costs associated with data collection and adjudication. GDPR and European country-specific privacy laws in some cases restrict the ability of health care data to be entered into a system that could facilitate more scalable, lower-cost adjudication of RSAs; RSA implementation in some jurisdictions has necessitated employing clinical professionals as data managers in hospitals and clinics for a specific contract. Payers and manufacturers have reported in the literature that these cost and logistic hurdles may negate the potential savings of specific RSAs or limit their growth and scale. We previously built and tested a technology approach using blockchain databases to automatically adjudicate a theoretical RSA for a high cost cancer product. Building on the results of this initial testing, we designed a model that used encrypted data signatures across a private, distributed architecture to demonstrate how this technology could be implemented across multiple participating hospital sites at the local level to calculate whether terms of an RSA have been met based on locally held data, and how an encrypted output signal could be sent to a remote node with the ability to interpret whether RSA contract terms had been met or not met in any particular instance. We theorize that building and implementing such a system would significantly reduce the administrative costs associated with RSA adjudication and would provide a method for easier audit and management of RSAs.

Impact of health technology assessment and managed entry schemes on reimbursement decisions of centrally authorised medicinal products in Belgium.

Centrally authorised medicinal products (CAMPs) in the European Union may offer added therapeutic value (ATV) but may be linked to high prices and limited efficiency. Health technology assessment (HTA) and managed entry schemes (MES) may facilitate the reimbursement decision by providing reliable estimates of the medicinal product's value and costs and by controlling the remaining uncertainty, respectively. We investigated the impact of HTA criteria and the initiation of a MES on the reimbursement decision of CAMPs in Belgium. We selected all reimbursement submissions for new centrally authorised medicinal products in the 2010-2015 period. We retrieved data relating to the reimbursement decision, the HTA outcome and the use of a managed entry scheme. The decision of the Minister was available for 115 dossiers, covering 36 (31.3%) orphan medicinal products (OMPs) and 79 ATV products. A MES was used in 41 submissions. A positive reimbursement decision was obtained in 65% of cases. The significant factors affecting the reimbursement decision were the approval of ATV, the medical need if it was considered 'important or major' and the use of a managed entry scheme. Price, budget impact and efficiency had no significant impact. Added therapeutic value and high medical need increase the odds for a positive reimbursement decision. No impact could be demonstrated of the cost-related HTA criteria. Cost elements may be biased by the use of a confidential MES. Without a MES, only 53% of the centrally authorised medicinal products, including OMPs, are reimbursed in Belgium.

Improving Access to High-Cost Technologies in the Asia Region.

Discussions at the Health Technology Assessment International (HTAi) Asia Policy Forum (HAPF) aimed to understand the meaning of "high-cost technologies," and to explore mechanisms to increase access to these technologies in publicly funded health systems in the Asia region. Discussions and presentations at the 2018 HAPF, informed by a literature review and a premeeting survey of HTA agencies and industry, form the basis of this paper. Challenges payers in the public health system face when investing in high-cost technologies include a lack of data, especially real-world data, affordability, and the budgetary impact of high-cost technologies. Managed entry schemes (MES) are one means to enable earlier access to high-cost technologies, or at reduced cost to the system. Most countries surveyed had used an MES to introduce a new health technology and most industry representatives had experience with financial-based MES, such as discounts or rebates, with most put in place to increase access to pharmaceuticals. Little experience of outcome-based or evidence-generation MES was reported. Although it is early days in the implementation of MES in Asia, they have the potential to play an important role enabling access to new, mainly pharmaceutical, health technologies. The development of a "road map" of MES in the region should outline the intent and need for a MES, articulating the "rules of engagement" for all stakeholders-patients, providers, payers, and industry-which will assist countries to clearly identify the problem trying to be solved, and how an MES can be part of the solution.

PHP364 - HOW TO USE RWE TO OPTIMIZE P&R OF NEW HEALTH TECHNOLOGIES

Utilizing real world evidence (RWE) of disease burden and performance of technologies in clinical practice settings is increasingly a focus of the healthcare industry. However, the willingness and ability to use RWE in reimbursement decision-making varies significantly. This research aims to classify major national payers into archetypes based on their use of RWE in decision-making. Publically-available information on payer processes were screened from the relevant websites for UK (NICE), Germany (G-BA), France (HAS), Sweden (TLV), Australia (PBAC), Canada (CADTH) and Italy (AIFA) alongside a targeted search of appraisal outcomes for how RWE has been used. RWE has been used by payers to quantify the unmet need (all), support economic modelling (NICE, TLV, PBAC, CADTH) and/or validate the clinical benefit of a new technology. Some markets have regular HTA re-assessments (HAS) or produce time-limited outcomes (G-BA and NICE[CDF]) where local RWE on clinical benefits can be submitted. Reimbursement can also be linked to patient outcomes using RWE (AIFA [Onco registry], NICE [complex PASs] and PBAC [Managed Entry Schemes]). Few specific examples were identified where RWE directly supported favourable P&R outcomes. No RWE had been used in G-BA assessments, no HAS re-assessments using RWE had increased its ASMR, no drugs have completed the CDF [NICE] and MES [PBAC] processes, and a recent report of AIFA performance-based reimbursement concluded it only produced drug budget savings of 3%. Evidence of RWE directly supporting favorable reimbursement is limited to date. However, payer systems are evolving to better facilitate this. Utilizing RWE to support optimal reimbursement will necessitate a global evidence generation strategy as well as specific local implementation tactics to navigate local requirements. However, archetyping payers by RWE demands can enable a better-focused evidence generation strategy to optimize commercial success.

Are Accelerated Approval Mechanisms A Predictor To Early Access And Coverage? A Global Study Of Cancer Drugs

To explore the interrelationship between accelerated approval schemes for cancer drugs and national HTA processes across thirteen jurisdictions globally, by investigating the impact HTA and value assessment has on drugs approved through accelerated pathways. 15 drug-indication pairs with cancer indications (melanoma, lung and haematology) were selected based on whether they received accelerated approval in the US or Europe via an early access mechanism (one of the FDA Accelerated Approval pathways or the EMA Conditional Marketing Authorisation [CMA], or both) until December 2015. In-depth analysis was conducted to assess the impact HTA and value assessment had on coverage and funding pathways in 13 countries (Australia, Brazil, England, Canada, France, Germany, Italy, Japan, the Netherlands, Scotland, Sweden, Spain and USA). The analysis relied on an analytical framework investigating in-depth: (a) Similarities and differences in clinical and economic evidence submitted; (b) Evidence interpretation; (c) Uncertainties; (d) Other considerations, drug or therapeutic-area related; and (e) Time difference between MA and HTA recommendation. Preliminary analysis indicates that market access for drugs authorised under an early access mechanism continues to rely heavily on HTA requirements. Additionally, HTA for these drugs does not necessarily lead to positive recommendations and may result in longer HTA review processes than drugs approved under standard MA. Moreover, some countries often resort to special funding arrangements to enable access to cancer drugs. Accelerated approval pathways do not guarantee coverage or early market access at population level and may result in delays in access. Alternative data sources and evidence to meet HTA requirements are important, including real world data generation or managed entry schemes, in order to enable access to new cancer therapies.

Educational Disadvantages and Indigenous Law Students: Barriers and Potential Solutions

Indigenous students are under-represented in Australian universities, including in law school, and have lower educational outcomes relative to non-Indigenous students. First, this article identifies systemic barriers that prevent Indigenous students from enrolling in law school, including entrenched educational disadvantage that prevents many Indigenous students from achieving the grades necessary for university entry. Indigenous students who overcome this disadvantage and enrol in law schools then face higher attrition rates relative to non-Indigenous law students. Indigenous students find law schools to be intimidating, unfamiliar and alienating environments. Law schools privilege a narrow Western model of legal education that continues to deny Indigenous understandings of the law. Second, this article identifies potential solutions that may assist in addressing these barriers. These include alternative entry schemes, building pathways between vocational training and universities and engaged outreach programmes for assisting Indigenous students into higher education. Academic, social and financial support is required to address attrition rates; however, solutions need to go deeper than the provision of additional assistance. This article argues for the need to Indigenize legal education, and for the curriculum to consider law as pluralistic and embedded in power relations, and to provide the focus on social justice which motivates many Indigenous students to study law in the first place.

Determining the value of medical technologies to treat ultra-rare disorders: a consensus statement

BackgroundIn most jurisdictions, policies have been adopted to encourage the development of treatments for rare or orphan diseases. While successful as assessed against their primary objective, these policies have prompted concerns among payers about the economic burden that might be caused by an annual cost per patient in some cases exceeding 100,000 Euro. At the same time, many drugs for rare disorders do not meet conventional standards for cost-effectiveness or ‘value for money’. Owing to the fixed (volume-independent) cost of research and development, this issue is becoming increasingly serious with decreasing prevalence of a given disorder.MethodsIn order to critically appraise the problems posed by the systematic valuation of interventions for ultra-rare disorders (URDs), an international group of clinical and health economic experts was convened in conjunction with the Annual European ISPOR Congress in Berlin, Germany, in November 2012. Following this meeting and during subsequent deliberations, the group achieved a consensus on the specific challenges and potential ways forward.ResultsThe group concluded that the complexities of research and development for new treatments for URDs may require conditional approval and reimbursement policies, such as managed entry schemes and coverage with evidence development agreements, but should not use as justification surrogate end point improvement only. As a prerequisite for value assessment, the demonstration of a minimum significant clinical benefit should be expected within a reasonable time frame. As to the health economic evaluation of interventions for URDs, the currently prevailing logic of cost-effectiveness (using benchmarks for the maximum allowable incremental cost per quality-adjusted life year gained) was considered deficient as it does not capture well-established social preferences regarding health care resource allocation.ConclusionModified approaches or alternative paradigms to establish the ‘value for money’ conferred by interventions for URDs should be developed with high priority.

Leakage-resilient password entry: Challenges, design, and evaluation

Password leakage is one of the most serious threats for password-based user authentication. Although this problem has been extensively investigated over the last two decades, there is still no widely adopted solution. In this paper, we attempt to systematically understand the challenges behind this problem and investigate the feasibility of solving it. Since password leakage usually happens when a password is input during authentication, we focus on designing leakage-resilient password entry (LRPE) schemes in this study. We develop a broad set of design criteria and use them to construct a practical LRPE scheme named CoverPad, which not only improves leakage resilience but also retains most usability benefits of legacy passwords. Its practicability is further verified by an extended user study.

Police Direct Entry and the Search for Talent — A Historical Perspective

The ‘Direct Entry’ schemes proposed by Tom Winsor have generated widespread and passionate debate, with most contributors being totally opposed to the concept. This article analyses the Direct Entry (Inspector and Superintendent) Schemes but additionally highlights the little-known but significant experience of the Royal Ulster Constabulary's Cadet Officer programme. That programme was designed to attract well educated young men, with clear command potential, to a career in policing. However, its eventual demise was the result of a failure to adapt it to the changing needs of society. The article supports the case for the Direct Entry (Inspector) Scheme but rejects the need for the Direct Entry (Superintendent) Scheme. It also argues for the police service to adopt a clear theoretical model, based on the British Army's concept of ‘officership’, to address current problems and to underpin any new recruitment schemes.

MIRAGE 1.0: A Key Entry Scheme Resilient to Shoulder Surfing

level authentication systems are widely being used in many ATMs (automatic teller machine).To be more illustrative they are now crust of the security systems in many military agencies. It is very often noticed that, a combination of biometric and key login or a combination of token and a key are widely accepted authentication systems. Besides the problem of high faulty recognition, biometric suffers from a backdrop of high cost and slow authentication process. Like many of our valuable possessions tokens like magnetic cards are highly prone to theft and duplication. Traditional key entry schemes are very much vulnerable to peeping and shoulder surfing attacks. Furthermore, with the advancement of technology many other fake login schemes like dictionary attacks or key logging have become a major security concern. In this paper we propose pattern based key entry scheme, Mirage 1.0, which would not only withstand peeping and shoulder-surfing attacks but also would be resilient towards dictionary attacks and key logging schemes.

Success of an Affiliated College: Benchmarking the Autonomous College

Abstract India among other things has witnessed a phenomenal growth in the number of B-Schools since 2001. While most of the successful B- Schools are autonomous ones, all the new institutions that have come up during the period of 2001-2006 are the affiliated ones. It is only wishful thinking that an affiliated college will be as successful as an autonomous one given the natural limitations- affiliated colleges can’t upgrade the quality of the programme beyond a certain level as they are not allowed to design their curriculum, student assessment and student entry schemes; can’t charge the fee commensurate with the quality of the programme. However there is much competition among the affiliated colleges themselves and being better among the lot, they can in a limited way though, get better students, charge slightly higher fee for the management quota seats and make brand that can be leveraged with the other programmes, the same institute offers. One way to be successful is to bench mark an appropriate autonomous college Course ware, Programme Delivery, Student Assessment Schemes, Student Entry Schemes, Placements and Industry-Institute-Interaction are considered to be the most important factors that make an autonomous college successful.

A child of change: The establishment of the Open Foundation Programme in 1974

In 1974 the University of Newcastle, Australia, established a mature age access programme called the Open Foundation. Since that time, thousands of adults have entered university through the Open Foundation portal. This article explores the layers of context for the establishment of the Open Foundation in the early 1970s. It seeks to understand the reasons why the University of Newcastle, which already provided the means for direct entry for some adults, sought to widen participation for adults at that time by creating a year long pre‐tertiary programme. Pascoe’s explanation that matureage entry schemes in Australian universities were prompted by ‘pragmatic considerations’ such as the disruption to intakes due to the lengthening of secondary schooling in New South Wales in 1969 and the falling demand for university places in the late 1970s and 1980s, does not satisfactorily account for the establishment of the Open Foundation Programme. Rather this article argues that the Open Foundation was set up in response to a variety of international, national and local influences, and as a reflection of educational ideas that were flowing from overseas at the time, especially around the establishment of the Open University in the United Kingdom, and in which not only pragmatism, but also idealism figured.

Postgraduate versus undergraduate entry schemes into medicine: the Irish proposals

Postgraduate versus undergraduate entry schemes into medicine: the Irish proposals