Fellowship Scheme Research Articles

Operational research in seven decades

This paper is an account and reflection on the author’s engagement with operational research (OR) starting in the 1960s with work in the glass industry coinciding with a PhD at Lancaster and a first encounter with the professional membership debate. The 1970s included a brief encounter with stochastic programming, soft OR which recurred throughout the decades, and the start of research into strategy support. The latter continued in the 80s and beyond and work on data envelopment analysis (DEA) began. In the 1990s, a strong DEA team was built at Warwick, and the author led the development of the OR Society’s fellowship scheme. In the 2000s a group met regularly at Warwick focussing on strategic development and leading to a book on strategy support and editing of the European Journal of Operational Research (EJOR) began. In the 2010s editing continued and work began on the contribution of the founders of OR to soft OR and practice. Editing wound down in the 2020s and the founders paper was published in the journal Operations Research.

Towards higher standardization of funding acknowledgements in scientific publications: Current status in the case of a national and a European research fellowship scheme

Abstract Acknowledgement of funding sources in scientific publications is becoming mandatory in science. As funders' instructions are often vague, there is great variability in the way authors acknowledge funding, this hindering the linking of grants to their subsequent publications. The aim of this study is to analyse how funding is acknowledged in scientific publications in two important research fellowship schemes: the Spanish Ramón y Cajal programme (RyC) and the European Marie Skłodowska-Curie Research Actions (MSCA). WoS publications in 2017 by Spain-based researchers that include funding acknowledgements from either of the two programmes are identified. Firstly, compliance with funders’ recommendations in terms of the elements included in acknowledgements is analysed. Secondly, the degree of comprehensiveness in the authors’ description of the grants is studied by focusing on how often different items are reported (funding agency, programme, grant number, grantee, year of the call, etc). Thirdly, the use of normalized structured notations in acknowledgements is examined. Around 78% of RyC vs. 84% of MSCA grants comply with funders’ recommendations regarding the elements to be included in the acknowledgements. A comprehensive description of grants is unusual in both programmes. Structured notations are included in two-thirds of RyC vs. one-third of MSCA grants. Advantages of using structured notations are highlighted, since they provide unique identification of grants, improve the comprehensiveness and normalization of funding data, facilitate automatic data processing and could be compatible with global grant identifiers. Further standardization of funding data in acknowledgements is needed to optimize their use in science policy studies.

Evaluating Parliamentary Academic Fellows

Abstract Parliamentary Academic Fellowship (PAF) schemes have been introduced to boost knowledge exchange between legislatures and the academy. Evaluations of these schemes are rare. This article evaluates the UK Parliament’s PAF scheme based on interviews with former PAFs, Parliamentary hosts, and the Knowledge Exchange Unit. I find that PAFs and hosts want different things from the scheme. This is part of a wider issue of the differing incentives that academics and Parliamentary staff face in conducting knowledge exchange. Bringing academics and Parliamentary staff closer together means adapting the PAF scheme and exploring other forms of engagement beyond a formal fellowship scheme.

Cultivating student researchers: Reflections on a summer undergraduate student fellowship scheme

Cultivating student researchers: Reflections on a summer undergraduate student fellowship scheme

Economic evaluations of assisted reproductive technologies in high-income countries: a systematic review.

Which assited reproductive technology (ART) interventions in high-income countries are cost-effective and which are not? Among all ART interventions assessed in economic evaluations, most high-cost interventions, including preimplantation genetic testing for aneuploidy (PGT-A) for a general population and ICSI for unexplained infertility, are unlikely to be cost-effective owing to minimal or no increase in effectiveness. Approaches to reduce costs in order to increase access have been identified as a research priority for future infertility research. There has been an increasing number of ART interventions implemented in routine clinical practice globally, before robust assessments of evidence on economic evaluations. The extent of clinical effectiveness of some studied comparisons has been evaluated in high-quality research, allowing more informative decision making around cost-effectiveness. We performed a systematic review and searched seven databases (MEDLINE, PUBMED, EMBASE, COCHRANE, ECONLIT, SCOPUS, and CINAHL) for studies examining ART interventions for infertility together with an economic evaluation component (cost-effectiveness, cost-benefit, cost-utility, or cost-minimization assessment), in high-income countries, published since January 2011. The last search was 22 June 2022. Two independent reviewers assessed publications and included those fulfilling the eligibility criteria. Studies were examined to assess the cost-effectiveness of the studied intervention, as well as the reporting quality of the study. The chosen outcome measure and payer perspective were also noted. Completeness of reporting was assessed against the Consolidated Health Economic Evaluation Reporting Standard. Results are presented and summarized based on the intervention studied. The review included 40 studies which were conducted in 11 high-income countries. Most studies (n = 34) included a cost-effectiveness analysis. ART interventions included medication or strategies for controlled ovarian stimulation (n = 15), IVF (n = 9), PGT-A (n = 7), single embryo transfer (n = 5), ICSI (n = 3), and freeze-all embryo transfer (n = 1). Live birth was the mostly commonly reported primary outcome (n = 27), and quality-adjusted life years was reported in three studies. The health funder perspective was used in 85% (n = 34) of studies. None of the included studies measured patient preference for treatment. It remains uncertain whether PGT-A improves pregnancy rates compared to IVF cycles managed without PGT-A, and therefore cost-effectiveness could not be demonstrated for this intervention. Similarly, ICSI in non-male factor infertility appears not to be clinically effective compared to standard fertilization in an IVF cycle and is therefore not cost-effective. Interventions such as use of biosimilars or HMG for ovarian stimulation are cheaper but compromise clinical effectiveness. Lack of both preference-based and standardized outcomes limits the comparability of results across studies. The selection of efficacy evidence offered for some interventions for economic evaluations is not always based on high-quality randomized trials and systematic reviews. In addition, there is insufficient knowledge of the willingness to pay thresholds of individuals and state funders for treatment of infertility. There is variable quality of reporting scores, which might increase uncertainty around the cost-effectiveness results. Investment in strategies to help infertile people who utilize ART is justifiable at both personal and population levels. This systematic review may assist ART funders decide how to best invest to maximize the likelihood of delivery of a healthy child. There was no funding for this study. E.C. and R.W. receive salary support from the National Health and Medical Research Council (NHMRC) through their fellowship scheme (EC GNT1159536, RW 2021/GNT2009767). M.D.-T. reports consulting fees from King Fahad Medical School. All other authors have no competing interests to declare. Prospero CRD42021261537.

Development of a High-Performance Ammonium Formate Fuel Cell

Direct liquid fuel cells fueled by molecules such as methanol, ethanol and formate have received many attentions as proton exchange membrane fuel cells, primarily because of its high energy density, simple structure, small fuel cartridge, and ease storage and transport of fuels. Among them, formate, mainly referring to sodium formate or potassium formate, has drawn increasing interest due to the following advantageous characteristics: a high theoretical voltage of 1.45 V, facile and complete formate oxidation in alkaline media, and easy handle in storage and transportation. However, the cation ion (Na+ or K+) in the fuel solution does not contribute to electricity generation but only increase the extra weight load of the fuel cell system, thus lowering the energy density of formate to 2.1 kWh L-1. In this work, ammonium formate is adopted as the fuel, which not only retains the advantages of formate, but also substitutes the Na+/K+ with ammonium (NH4 +) that can be simultaneously oxidized to release electrons, i.e., electricity generation. Hence, the energy density ammonium formate is upgraded to 3.2 kWh L-1. Although promising, the development of ammonium formate fuel cell has been hindered by technical challenges related to the oxidation of ammonium formate, such as sluggish kinetics and electrode degradation. To tackle these issues, a bimetallic Pt-Pd/C electrocatalyst is synthesized by a facial chemical reduction method using sodium borohydride as agent. The Pt-Pd/C electrocatalyst exhibits better electrocatalytic activity for ammonium formate oxidation than pure Pt/C and Pd/C. Then, an ammonium formate fuel cell is developed and tested, which is composed of a Pt-Pd/C anode, a single-atom Fe/C cathode, and an anion exchange membrane (Figure 1). This fuel cell yields an open-circuit voltage (OCV) of 0.88 V and a peak power density (PPD) of 60.7 mW cm-2 at 60oC. When the hydrogen peroxide is used as oxidant, the OCV and PPD are boosted to 1.31 V and 99.6 mW cm-2, respectively. Further increasing the operating temperature to 90oC leads to a PPD of as high as 187.6 mW cm-2. In addition, a mathematical model incorporating mass/charge transport and electrochemical reactions is developed to shed light on the voltage losses and provide guidance for optimizing structural design and operating parameters.AcknowledgementThis work was supported by a grant the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No. N_PolyU559/21) and The Hong Kong Polytechnic University Centrally Funded Postdoctoral Fellowship Scheme (Project No. 1-YXAZ).Figure 1 Schematic of an ammonium formate fuel cell. Figure 1

Trusts are accused of using foreign doctors as “cheap labour” in fellowship schemes

Trusts are accused of using foreign doctors as “cheap labour” in fellowship schemes

Community, Fellowship, Openness: Supporting Early Career Researchers through Open Educational Practices

Open communities are an increasingly common feature of educational spaces. This article summarises the experience of a fellowship scheme for early career researchers in open education supported by The Global OER Graduate Network (GO-GN), an international network to support doctoral candidates. Nine fellows over a three-year period were supported to conduct six-month personal projects to facilitate their academic career development post-doctoral studies. The fellowship scheme was structured into three, annual cohorts between 2020 and 2022.
 Results from qualitative surveys and interviews indicate a positive and meaningful impact of the scheme. A key aspect of this type of initiative is the support given by more experienced academics and peer fellows. The fellowship scheme enabled the sharing of research among other PhD students and early career researchers through regular webinars and to broader audiences at internationally recognised conferences.
 The results of this paper are of potential interest to those supporting doctoral researchers and organisations interested in running similar fellowships or other support schemes for doctoral researchers or other stakeholder groups.

Building connectivity at the research-policy interface in Aotearoa through a public sector postdoctoral fellowship scheme

Improving connectivity at the research-policy interface and supporting career development for early career researchers are twin goals of government-funded research systems in Aotearoa New Zealand and globally. The Aotearoa Ministry for Business, Innovation, and Employment (MBIE) began the process of overhauling the research system to achieve these, and other, goals through Te Ara Paerangi Future Pathways programme in 2021. Here, I propose a public sector postdoctoral fellowship scheme to place PhD graduates into roles within central government agencies, which MBIE could implement during the first phase of Te Ara Paerangi Future Pathways reforms. The Fellowship would strengthen collaboration at the research-policy interface and provide a low investment, high impact, opportunity to retain talent in Aotearoa by developing flexible career pathways for PhD graduates.

Iterative Backpropagation Method for Efficient Gradient Estimation in Bilevel Network Equilibrium Optimization Problems

Network optimization or network design with an embedded traffic assignment (TA) to model user equilibrium principle, sometimes expressed as bilevel problems or mathematical programs with equilibrium constraints (MPEC), is at the heart of transportation planning and operations. For applications to large-scale multimodal networks with high dimensional decision variables, the problem is nontrivial, to say the least. General-purpose algorithms and problem-specific bilevel formulations have been proposed in the past to solve small problems for demonstration purposes. Research gap, however, exists in developing efficient solution methods for large-scale problems in both static and dynamic contexts. This paper proposes an efficient gradient estimation method called Iterative Backpropagation (IB) for network optimization problems with an embedded static TA model. IB exploits the iterative structure of the TA solution procedure and simultaneously calculates the gradients while the TA process converges. IB does not require any additional function evaluation and consequently scales very well with higher dimensions. We apply the proposed approach to origin-destination (OD) estimation, an MPEC problem, of the Hong Kong multimodal network with 49,806 decision variables, 8,797 nodes, 18,207 links, 2,684 transit routes, and 165,509 OD pairs. The calibrated model performs well in matching the link counts. Specifically, the IB-gradient based optimization technique reduces the link volume squared error by 98%, mean absolute percentage error (MAPE) from 95.29% to 21.23%, and the average GEH statistics from 24.18 to 6.09 compared with the noncalibrated case. The framework, even though applied to OD estimation in this paper, is applicable to a wide variety of optimization problems with an embedded TA model, opening up an efficient way to solve large-scale MPEC or bilevel problems. Funding: The study is supported by IVADO Postdoctoral Fellowship scheme 2021, HSBC 150th Anniversary Charity Programme HKBF17RG01, National Science Foundation of China (71890970, 71890974), General Research Fund (16212819, 16207920) of the HKSAR Government, and the Hong Kong PhD Fellowship.

RCPsych Leadership and Management Fellowship Scheme (Lmfs): An Lypft Project on Equity, Transcultural Intelligence and Inclusion

AimsThe Royal College of Psychiatrists (RCPsych) Leadership and Management Fellowship Scheme (LMFS) is aimed at accelerating a fellows’ leadership and management development using a combination of structured leadership development programmes and a local apprenticeship model. It is open to all higher trainees, utilising special interest time over 12 months.In most establishments, certain groups are more prone to prejudice; whether due to age, gender, ethnic origin, sexual orientation, religion, career progression or disability. Leeds and York Partnership Foundation Trust (LYPFT) values diversity and strives to foster growth within a multicultural workforce and patient group. Equity accepts the difference between persons and ensures everyone reaches full potential, using individualised support. The aim was to create a culturally aware, inclusive and dynamic workforce. This project set out to achieve its objectives through four pillars.MethodsPillar 1-Initiating the local Medical Workforce Race Equality Standards (MWRES) LYPFT action plan: Appointment of the MWRES lead through advertisement and interviews. Pillar 2-Raising awareness on patient, carer and community involvement through a transcultural workshop: A virtual workshop anchored by four professionals and three patients, with lived experience was held, after which survey results were analysed. Pillar 3-Supporting International Medical Graduates (IMGs): Supporting IMGs through raising awareness on challenges and completing the regional handbook. Pillar 4-Interdisciplinary Undergraduate Education: Raising awareness on diversity and inclusion through undergraduate interdisciplinary education.ResultsPillar 1: An MWRES lead was appointed after interviews and is now in office. Pillar 2: Results of survey questions from the workshop around awareness of barriers minority groups experience, available transcultural resources, transcultural issues, local protocols and resources, and likelihood to intervene against discrimination; showed an improvement of 41.2%; with average pre-workshop scores of 55% and average post-workshop scores of 96.2%. Pillar 3: The Health Education England, Yorkshire & Humber IMG handbook has been completed and results from the survey included. Pillar 4: Students reported an improvement in their learning following the session. The weighted improvement on equity and transcultural issues for the pre and post teaching intervention improved from 5.391 to 7.126.ConclusionOverall, the aims of the four pillars of the project were successful achieved, with positive feedback received. LMFS encourages trainees to develop their leadership and management skills through local mentoring structures and should be encouraged. This is a clarion call to all professionals to adopt a culturally informed approach in all aspects of their practice; related to the workforce and patient care.

Using a Volunteer Friends Support Scheme in a Temporary Relocation Programme

Abstract This article describes a voluntary Friends Scheme that sits alongside a temporary relocation scheme for Human Rights Defenders at the University of York, UK. Members of the Scheme, including the scheme’s co-ordinators, are all volunteers drawn from the local community with a remit to befriend the Defenders, help orient them to the city and UK lifestyles and offer the opportunity to experience day-to-day life outside of the university. With the erosion globally of the operational space for Human Rights Defenders’ work, many are in situations of serious risk to their health, well-being and even life, jeopardizing their long-term ability to conduct their work. This has in turn increased their protection needs with temporary relocation providing one mechanism for meeting these. The Protective Fellowship Scheme for Human Rights Defenders at Risk (PFS) at York offers an institutionalized programme and the Friends Scheme arose from the identified need for additional informal well-being support. In describing key aspects of its operation, their evolution over time, and its challenges and rewards, the article draws on feedback from both Defenders and Friends. It is brought up to date, outlining the impact of Covid-19. Experience to date suggests the use of a Friends Scheme can be a valuable part of temporary relocation programmes for Defenders, staff running such schemes, the volunteer Friends and the local community. The use of a systemic approach to its organization through having clear processes, regular communication from and between the co-ordinators and PFS, and providing individual and group support appears valuable.

Formulating Written Feedback For Staff Mentees – An Aristotelian Approach

This article reflects on the intricacy of providing written feedback from a mentor to a mentee in the Study Group Fellowship Scheme, an international education provider in partnership with more than 50 universities and colleges across the world. Using Aristotle’s rhetoric principle of ethos, logos and pathos, it argues that appropriate use of open-ended questions in combination with the situatedness of being ethos-centric, logos-centric, and pathos-centric can be a useful approach centralising the mentee in their learning and developing process.

Tumor cell-macrophage crosstalk promotes immunotherapy resistance via lipid metabolism

Abstract Immune-checkpoint blockade (ICB) therapies have transformed the treatment landscapes of hepatocellular carcinoma (HCC). However, the immunosuppressive tumor microenvironment (TME) constructed by tumor cells restricts the responsiveness of ICB therapies to a minority of patients. Triggering receptor expressed on myeloid cells-2 (TREM2) counteracts inflammation and maintains metabolic fitness in myeloid cells. Single-cell RNA-sequencing analysis of our pembrolizumab study (NCT03419481) identified a subset of tumor-associated macrophages over-expressing TREM2 in non-responders. Consistently, our syngeneic ICB-resistant HCC mouse models verified a group of Trem2+ myeloid cells, which were accumulated in the lipid-rich TME of ICB-resistant tumors. Compared to the parental ICB-sensitive tumor cells, the conditional medium (CM) of ICB-resistant tumor cells significantly increased Trem2 expression in macrophages, which was abolished when lipids in the CM were depleted. Notably, lentivirus-mediated Trem2 ablation reduced lipid accumulation in TME and overcame anti-PD-1 resistance with increased cytotoxic CD8+ T cell infiltration. In conclusion, our study highlights TREM2 as an immuno-metabolic target to enhance HCC immunotherapy. This study is supported by Collaborative Research Fund (C4045-18W) and Li Ka Shing Foundation. Z.L. is supported by Hong Kong PhD Fellowship Scheme.

P165 The incidence of cancer in SLE patients receiving biologic therapy: Results from the British Isles Lupus Assessment Group Biologics Registry (BILAG-BR)

Abstract Background/Aims Patients with systemic lupus erythematosus (SLE) are known to have an increased risk of certain cancers, such as lymphoma, compared to the general population. We aimed to characterise the incidence of cancers in patients with moderate-severe SLE receiving biologic and standard of care (SoC) therapies. Methods The BILAG Biologics Registry (BILAG-BR) is a large prospective observational register of patients with SLE. Participants receiving rituximab, belimumab and SoC therapies from 2010-2021 were included. Data relating to malignancy were collected from study centres and the UK national cancer register. Overall cancer risk was assessed using a Cox proportional hazards model in Stata V14. Results There were 114 previous cancer diagnoses in 108 patients recorded. The most common cancer sites were cervical (43/114), non-melanoma skin cancer (20), breast (15) and lymphoma (13). All cervical neoplasms were carcinoma in situ. Five patients had more than one cancer diagnosis recorded; three had >1 non-melanoma skin cancer and two individuals had unrelated malignancies. During follow-up, (1437 patients with 5,738 person years [pys]), 33 incident cancers occurred in 32 individuals at a median of 477 (IQR 218-1265) days after registration. Incidence rates were 5.9 (95% CI 3.9-8.8) in rituximab, 7.8 (2.5-24.2) in belimumab and 4.16 (1.7-10.0) per 1,000 pys in the SoC group. Using rituximab as the comparator, the age and gender adjusted hazard ratio (HR) was 1.62 (0.48-5.52) for belimumab and 0.63 (0.24-1.65) for the SoC group. Patients who developed an incident cancer were older at registration (HR 1.07 [1.04-1.09] per year) and more likely to be of male sex (HR 2.95 [1.31-6.57]). Caucasian ethnicity was associated with increased risk in univariate analysis (HR 4.25 [1.46-12.32]), but not after adjusting for age and sex (HR 2.60 [0.86-7.83]). There were 6 cancer-related deaths which all occurred in the rituximab group a median of 2.3 (IQR 1.4-3.2) years from registration. Conclusion Although overall cancer numbers are low, the findings of this study are reassuring. The incidence of cancer in this cohort of SLE patients with moderate-to-severe disease appears to be broadly similar between those on biologic and standard of care therapies. Disclosure M. Rodziewicz: Grants/research support; North West England MRC Fellowship Scheme in Clinical Pharmacology and Therapeutics. Award Ref. MR/N025989/1, UCB. S. Dyball: Grants/research support; North West England Medical Research Council Fellowship Scheme in Clinical Pharmacology and Therapeutics. Award Ref. MR/N025989/1, UCB, Eli Lilly. E. Sutton: None. B. Parker: Honoraria; Fresenius-Kabi, AbbVie. Member of speakers’ bureau; Eli Lilly, Roche. Grants/research support; Genzyme/Sanofi, GSK. I.N. Bruce: Consultancies; AstraZeneca, Eli Lilly, ILTOO, GSK, Aurinia. Member of speakers’ bureau; GSK, UCB, AstraZeneca. Grants/research support; GSK, Roche, Janssen.

Vehicle Rebalancing in a Shared Micromobility System with Rider Crowdsourcing

Problem definition: Shared micromobility vehicles provide an eco-friendly form of short-distance travel within an urban area. Because customers pick up and drop off vehicles in any service region at any time, such convenience often leads to a severe imbalance between vehicle supply and demand in different service regions. To overcome this, a micromobility operator can crowdsource individual riders with reward incentives in addition to engaging a third-party logistics provider (3PL) to relocate the vehicles. Methodology/results: We construct a time-space network with multiple service regions and formulate a two-stage stochastic mixed-integer program considering uncertain customer demands. In the first stage, the operator decides the initial vehicle allocation for the regions, whereas in the second stage, the operator determines subsequent vehicle relocation across the regions over an operational horizon. We develop an efficient solution approach that incorporates scenario-based and time-based decomposition techniques. Our approach outperforms a commercial solver in solution quality and computational time for solving large-scale problem instances based on real data. Managerial implications: The budgets for acquiring vehicles and for rider crowdsourcing significantly impact the vehicle initial allocation and subsequent relocation. Introducing rider crowdsourcing in addition to the 3PL can significantly increase profit, reduce demand loss, and improve the vehicle utilization rate of the system without affecting any existing commitment with the 3PL. The 3PL is more efficient for mass relocation than rider crowdsourcing, whereas the latter is more efficient in handling sporadic relocation needs. To serve a region, the 3PL often relocates vehicles in batches from faraway, low-demand regions around peak hours of a day, whereas rider crowdsourcing relocates a few vehicles each time from neighboring regions throughout the day. Furthermore, rider crowdsourcing relocates more vehicles under a unimodal customer arrival pattern than a bimodal pattern, whereas the reverse holds for the 3PL. Funding: This work was supported by the Research Grants Council of Hong Kong [Grants 15501319 and 15505318] and the National Natural Science Foundation of China [Grant 71931009]. Z. Jin was supported by the Hong Kong PhD Fellowship Scheme. Y. F. Lim was supported by the Lee Kong Chian School of Business, Singapore Management University [Maritime and Port Authority Research Fellowship]. Supplemental Material: The online appendices are available at https://doi.org/10.1287/msom.2023.1199 .

Asymmetric Information of Product Authenticity on C2C E-Commerce Platforms: How Can Inspection Services Help?

Problem definition: We consider a customer-to-customer (C2C) platform that provides an inspection service. Uncertain about product authenticity, a seller sells a product through the platform. Before purchasing, a buyer obtains a signal of the product authenticity from the product’s price set by the seller. The platform’s inspection service can detect a counterfeit with a probability. If the product passes the inspection, the platform sends it to the buyer and charges the seller a commission fee. Otherwise, the platform returns it to the seller and charges the seller a penalty fee. Methodology/results: We develop a two-stage game-theoretical model. In the first stage, the platform designs a contract specifying the commission and penalty fees. In the second stage, the seller signals the product authenticity by setting a price and the buyer decides whether to purchase it. This results in a contract design problem that governs a signaling game. We find that the effect of inspection is beyond merely detecting counterfeits. The inspection, even an imperfect one, changes the signaling game’s structure and incentivizes the seller whose product is likely authentic to sell through the platform. This can only be achieved by carefully choosing the commission and penalty fees. Moreover, a larger platform’s expected profit does not imply a larger commission fee or price in equilibrium. Under some mild conditions, the optimal commission increases but the optimal penalty decreases as the platform’s inspection capability improves. Managerial implications: The inspection service is not widely available among leading C2C platforms as it is considered imperfect and costly. Our study suggests that its benefit may be underestimated in practice. Moreover, the inspection can eliminate the seller’s information rent and generate more revenue for the platform. This paper provides guidance on how to set commission and penalty fees when the inspection service is provided. Funding: L. Li is supported by the National Natural Science Foundation of China [Grant 72071198] and the Hong Kong Polytechnic University Distinguished Postdoctoral Fellowship Scheme [Grant 1-YWC7]. X. Fang and Y. F. Lim are grateful for the support from the Lee Kong Chian School of Business, Singapore Management University [Maritime and Port Authority Research Fellowship and Retail Centre of Excellence Research Grant]. Y. F. Lim is supported by the Association of South-East Asian Nations Business Research Initiative Grant [Grant G17C20421], the Research Grants Council of Hong Kong [Grants 15501920 and 15501221], and the Key Program of National Natural Science Foundation of China [Grant 71931009]. Supplemental Material: The online appendices are available at https://doi.org/10.1287/msom.2023.1186 .

Effects of medical therapy, transcatheter intervention, and surgery on outcomes of patients with functional mitral regurgitation: a systematic review and network meta-analysis

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Ching-Hui Sia was supported by the National University of Singapore Yong Loo Lin School of Medicine's Junior Academic Fellowship Scheme. Background Functional mitral regurgitation (FMR) is the most common valvular heart disease worldwide. Despite recent major trials, the relative efficacy between medical therapy, transcatheter intervention, and surgery for the treatment of FMR remains poorly understood. Purpose We performed a systematic review and network meta-analysis of all published randomised controlled trials (RCTs) and observational studies to compare the efficacy between medical therapy, transcatheter intervention, and surgery on the clinical outcomes of patients with FMR. Methods Four electronic databases (PubMed, EMBASE, SCOPUS, and the Cochrane Library) were searched from inception to March 13, 2022, for studies reporting clinical outcomes in patients with FMR and comparing the efficacy between either medical therapy, transcatheter intervention, or surgery. Frequentist network meta-analysis models were utilised to summarise the studies. This study was registered in the International Prospective Register of Systematic Reviews. Results 10 articles were included in the analysis, comprising a combined cohort of 1,981 patients. Network meta-analysis demonstrated that compared to medical therapy, transcatheter intervention achieved a lower relative risk in the composites of all-cause mortality (risk ratio [RR]: 0.43; 95% confidence interval [CI] 0.22-0.82) and mitral regurgitation (MR) severity grade ≥3+ (RR: 0.06; 95% CI 0.01-0.42). Compared to surgery, transcatheter intervention achieved a lower relative risk in the composites of cardiovascular death (RR: 0.36; 95% CI 0.17-0.75) and MR severity grade ≥3+ (RR: 0.25; 95% CI 0.09-0.70) and higher relative risk in the composite of heart failure hospitalisation (RR: 2.94; 95% CI 1.26-6.82). Compared to medical therapy, surgery achieved a higher relative risk in the composite of cardiovascular death (RR: 2.54; 95% CI 1.18-5.47) and lower relative risks in the composites of all-cause mortality (RR: 0.56; 95% CI 0.34-0.91) and heart failure hospitalisation (RR: 0.28; 95% CI 0.13-0.61). Conclusion Medical therapy, transcatheter intervention, and surgery in patients with FMR displayed differing effects on the various clinical outcomes. Further head-to-head trials are required to better understand the optimal treatment modality in this population.

Natural history of functional mitral regurgitation: a systematic review and individual patient data meta-analysis

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Ching-Hui Sia was supported by the National University of Singapore Yong Loo Lin School of Medicine's Junior Academic Fellowship Scheme. Background Functional mitral regurgitation (FMR) precipitates a vicious cycle of left ventricular volume overload and remodelling, leading to perpetual worsening of FMR and left ventricular dysfunction, with a resultant poor prognosis. However, there is a lack of conclusive data on the natural progression of FMR in patients who do not undergo valvular intervention. Purpose We performed a one-stage meta-analysis on reconstructed individual patient data (IPD) to elucidate the natural history of FMR. Methods Four databases (PubMed, Embase, Scopus, Cochrane) were searched for randomised controlled trials or cohorts, published from inception to March 13, 2022, reporting clinical outcomes in patients with FMR not receiving valvular intervention. IPD meta-analysis, as the gold standard approach for evidence synthesis, was performed with reconstructed IPD obtained from the survival curves reported in the included studies. Pooled survival estimates were derived. Quality assessment of included studies was conducted using the Cochrane risk-of-bias tool and Newcastle Ottawa Scale. This study was registered on the International Prospective Register of Systematic Reviews. Results A total of five studies were included, comprising a total cohort of 691 patients with FMR who did not undergo valvular intervention. The mean age of the cohort was 72.4 years (95% CI 67.6 to 77.1) and the proportion of males was 61.1% (95% CI 43.8 to 76.0). All-cause mortality was analysed over a follow-up duration of five years, while hospitalisation for heart failure, cardiovascular death, and the composite of all-cause mortality and hospitalisation for heart failure were analysed over a follow-up duration of three years. The probability of survival of patients with FMR without intervention was 79.4% (95% CI 76.2 to 82.3), 50.9% (95% CI 46.6 to 55.1), and 39.6% (95% CI 33.1 to 46.0) at one, three, and five years respectively. The probability of survival free from the composite of all-cause mortality and hospitalisation for heart failure was 51.3% (95% CI 46.8 to 55.6) and 12.0% (95% CI 8.9 to 15.7) at one year and three years respectively. The probability of survival free from hospitalisation for heart failure was 58.3% (95% CI 54.0 to 62.3) and 19.7% (95% CI 16.0 to 23.7) at one and three years respectively. The probability of survival free from cardiovascular death was 75.4% (95% CI 68.9 to 80.8) and 45.6% (95% CI 29.1 to 60.7) at one and three years respectively. All included studies were of low to moderate risk of bias. Conclusion FMR in the absence of valvular intervention is associated with poor survival and cardiovascular outcomes. Further research should focus on the role of interventions to mitigate its poor prognosis.

How we are igniting change through the chief pharmaceutical officer's Fellowship scheme

How we are igniting change through the chief pharmaceutical officer's Fellowship scheme