One-year Cycles Research Articles

Classification scale for road surface noise based on the CPX method in the Czech Republic

The intention of the research project of the Technology Agency of the Czech Republic is to propose a classification scale for the evaluation of the noise level of pavement layers based on long-term repeated measurements using the Close Proximity Method (CPX). With regard to the other variable parameters (skid resistance, surface unevenness, bearing capacity and defects) that are monitored in the Czech Republic, a five-point scale was also proposed. The scale was tested on the busiest motorway section in the Czech Republic between Prague and Brno, which has been modernized in recent years. The first sections were put into operation in 2014 and the last in 2021. The evaluation of the results of the CPX measurements carried out in regular one-year cycles from 2013 to the present allowed to test the proposed classification scale. This paper will present the results obtained from the modernization of the highway and the proposed classification scale.

Cost–Utility Analysis of Prophylactic Laser Peripheral Iridotomy for Primary Angle Closure Suspects

To assess the cost-utility of prophylactic laser peripheral iridotomy (LPI) for primary angle closure (PAC) suspects (PACS). Economic evaluation. Our Markov model randomized PACS eyes to LPI or observation for 40 one-year cycles (100,000 iterations per strategy). Each cycle, an eye remained in its current health state, advanced linearly through PAC, mild, moderate, severe, and end-stage PAC glaucoma (PACG), or died. Transition rates were derived from the literature including the Zhongshan Angle Closure Prevention (ZAP) trial and the Singapore Asymptomatic Narrow Angles Laser Iridotomy Study (ANA-LIS). Eyes with acute-angle closure advanced to either PAC or directly to various PACG severities. A tracker monitored accumulated perimetric decibel reduction to progress PACG through increasing severities, with an annual probability of either stable or severity-dependent perimetry loss. We set a willingness to pay of an incremental cost-effectiveness ratio (ICER) <$50,000/quality-adjusted life-years. At age 50 years, LPI was cost-saving using ZAP data and cost-effective using ANA-LIS data. The ZAP iterations became cost-effective from the societal perspective when the model started at age 55 years and third-party perspective at age 70 years. LPI was no longer cost-effective from the societal perspective using ANA-LIS data at age 80 years or from the societal perspective using ZAP data or third-party perspective with ANA-LIS data at age 85. Probabilistic sensitivity analyses favored LPI until starting age 85. Prophylactic LPI for PACS is cost-effective across a spectrum of ages and should be considered from a public health perspective.

Artificial Intelligence in Community-Based Diabetic Retinopathy Telemedicine Screening in Urban China: Cost-effectiveness and Cost-Utility Analyses With Real-world Data.

Community-based telemedicine screening for diabetic retinopathy (DR) has been highly recommended worldwide. However, evidence from low- and middle-income countries (LMICs) on the choice between artificial intelligence (AI)-based and manual grading-based telemedicine screening is inadequate for policy making. The aim of this study was to test whether the AI model is more worthwhile than manual grading in community-based telemedicine screening for DR in the context of labor costs in urban China. We conducted cost-effectiveness and cost-utility analyses by using decision-analytic Markov models with 30 one-year cycles from a societal perspective to compare the cost, effectiveness, and utility of 2 scenarios in telemedicine screening for DR: manual grading and an AI model. Sensitivity analyses were performed. Real-world data were obtained mainly from the Shanghai Digital Eye Disease Screening Program. The main outcomes were the incremental cost-effectiveness ratio (ICER) and the incremental cost-utility ratio (ICUR). The ICUR thresholds were set as 1 and 3 times the local gross domestic product per capita. The total expected costs for a 65-year-old resident were US $3182.50 and US $3265.40, while the total expected years without blindness were 9.80 years and 9.83 years, and the utilities were 6.748 quality-adjusted life years (QALYs) and 6.753 QALYs in the AI model and manual grading, respectively. The ICER for the AI-assisted model was US $2553.39 per year without blindness, and the ICUR was US $15,216.96 per QALY, which indicated that AI-assisted model was not cost-effective. The sensitivity analysis suggested that if there is an increase in compliance with referrals after the adoption of AI by 7.5%, an increase in on-site screening costs in manual grading by 50%, or a decrease in on-site screening costs in the AI model by 50%, then the AI model could be the dominant strategy. Our study may provide a reference for policy making in planning community-based telemedicine screening for DR in LMICs. Our findings indicate that unless the referral compliance of patients with suspected DR increases, the adoption of the AI model may not improve the value of telemedicine screening compared to that of manual grading in LMICs. The main reason is that in the context of the low labor costs in LMICs, the direct health care costs saved by replacing manual grading with AI are less, and the screening effectiveness (QALYs and years without blindness) decreases. Our study suggests that the magnitude of the value generated by this technology replacement depends primarily on 2 aspects. The first is the extent of direct health care costs reduced by AI, and the second is the change in health care service utilization caused by AI. Therefore, our research can also provide analytical ideas for other health care sectors in their decision to use AI.

Methods of creating substituted lines for hybrid selection of sugar beet: plants of the species Beta vulgaris L. with new sterile cytoplasm of Beta patula L.

Purpose. Due to changing climatic conditions and the spread of new viral diseases, an important issue in beet growing is the expansion of plasma ulture using new sterile cytoplasm from wild species of the genus Beta L.&#x0D; as an alternative to Owen’s S-cytoplasm. The goal of this work was to obtain new breeding genotypes based on new cytoplasm. Methods. Cytological, biotechnological. field and laboratory. Results. Availability of recombination in the locus of grafted genes of one-year and two-year development cycles B+b- and hypocotyl colour R+r- was determined using the method of analytical crosses. Earlier we have proved the positive effect of sterility maintainer Beta vulgaris Nxxzz in replacement of the sterility maintainer genome based on our results on the selection of hypocotyl of green color r-rand two-year development cycle b-b- in the interspecific hybrids F2 obtained under the hybridization scheme Beta maritima L: ♀B1C maritima / ♂ Beta vulgaris Nxxzz (Роїк М. В., 2013). In the case of interspecific hybrids, in the conditions of sterile cytoplasm Beta patula L., only backcross offspring of the third cycle of saturating crosses were identified by one- and two-year developmental cycles. Seed bearing plants of BC3S patula of a two-year development cycle were characterized by spreading stems, multi-seeded fruits (3, 4 seeds) and sterile anthers. At the same time, monogermity and a two-year development cycle were restored against the background of sterile cytoplasm of Beta patula L. only among the seed bearing plants of the fourth cycle of saturating crosses. Recombinant genotypes with a red hypocotyl colour and a two-year development cycle BC4S patula R+r- were characterized by multigermity, chimericalness by sterility of CMS‑1 and CMS‑0 type and single- and multi-stem morphological types of anthers. The expression of CMS nuclear genes in the newly replaced BC5S patula lines was marked by high sterility rates of the CMS‑0 type; however, the fertility rates required additional rejection of multigerm seed plants. This is an indicator of the complex structure of the fertility locus in wild Beta patula L. and the special response of the nuclear genome of the sterility maintainers to the new cytoplasmic background. Experimental triploid hybrids with the new introductory sterile cytoplasm Beta patula L. were determined by high sugar content and dry matter content up to 29%. Conclusions. Alloplasmic lines based on the cytoplasm of the wild species Beta patula L are created. Their sugar content at the level of experimental triploid hybrids was 19.5% and 20.5% with a dry matter content of 25% —29%. Alloplasmic lines with a new BCC Beta patula L. recommended for use in the selection process of sugar beets.

Harms and benefits of cervical cancer screening among non-attenders in Switzerland: The transition towards HPV-based screening

Human papillomavirus (HPV) testing is replacing cytological screeningfor cervical cancer. Our aim was to assess the expected benefits and harms of different cervical screening strategies. This study is sub-analysis of a previous cost-effectiveness study with a target population of unscreened women without cervical cancer aged ≥ 25 years. A recursive decision-tree with one-year cycles was used to model the life-long natural HPV history. Markov cohort simulations were used to assess the expected outcomes from the model. The outcomes of three strategies were compared with the absence of screening: HPV-testing on self-collected vaginal samples (Self-HPV) followed by colposcopy (Self-HPV/colpo), Self-HPV and triage with cytology (Self-HPV/PAP), cytology and triage with HPV (PAP/HPV). All screening strategies resulted in reductions in cancer cases and deaths. Self-HPV strategies were associated with a lower cancer incidence and mortality life-long, not only when performed every 3 years but also when Self-HPV was performed every 5 years vs cytology every 3 years. The gain in life expectancy obtained was 82 days with Self-HPV/colpo, 81 days with Self-HPV/PAP and 75 days with PAP/HPV compared to no screening. The number of lifetime total visits was greater with PAP/HPV compared with the Self-HPV strategies (13.13 vs < 3). The number of conizations remained relatively stable with the change of screening frequency and strategy. Self-HPV may represent a reasonable balance of harms and benefits when performed every 5 years compared to cytology every 3 years. Self-HPV/PAP yielded the most efficient harm to benefit ratio when using colposcopy as a proxy for harms.

Cost-Effectiveness Analysis of Dapagliflozin Plus Standard Treatment for Patients With Type 2 Diabetes and High Risk of Cardiovascular Disease in China.

PurposeTo evaluate the long-term cost-effectiveness of dapagliflozin, in addition to standard treatment, for the treatment of adult patients with type 2 diabetes (T2DM) at high cardiovascular risk from the Chinese healthcare system perspective.MethodsA decision-analytic Markov model with one-year cycles was developed to evaluate the health and economic outcomes in patients with T2DM and high risk of cardiovascular disease (CVD) treated with standard treatment and dapagliflozin plus standard treatment for 30 years. Clinical data, cost, and utility data were extracted from databases or published literature. Quality-adjusted life-years (QALYs), costs (€/¥ 2021) as well as incremental cost-effectiveness ratios (ICERs) were calculated. Deterministic and probabilistic sensitivity analyses were performed to assess the uncertainty in the results.ResultsCompared with standard treatment, dapagliflozin plus standard treatment was predicted to result in an additional 0.25 QALYs (12.26 QALYs vs. 12.01 QALYs) at an incremental cost of €4,435.81 (¥33,875.83) per patient. The ICER for dapagliflozin plus standard treatment vs. standard treatment was €17,742.07 (¥135,494.41) per QALY gained, which was considered cost-effective in China compared to three times the GDP per capita in 2021 (€31,809.77/¥242,928). The deterministic and probabilistic sensitivity analyses showed the base-case results to be robust.ConclusionsThe study suggests that, from the perspective of the Chinese health system, dapagliflozin plus standard treatment is a cost-effective option for patients with T2DM at high cardiovascular risk. These findings may help clinicians make the best treatment decisions for patients with T2DM at high cardiovascular risk.

Digital health in medicine: Important considerations in evaluating health economic analysis

Digital health in medicine: Important considerations in evaluating health economic analysis

Adopting Learning Analytics to Inform Postgraduate Curriculum Design: Recommendations and Research Agenda

Understanding student sentiment plays a vital role in understanding the changes that could or should be made in curriculum design at university. Learning Analytics (LA) has shown potential for improving student learning experiences and supporting teacher inquiry. Yet, there is limited research that reports on the adoption and actual use of LA to support teacher inquiry. This four-year longitudinal study captures sentiment of postgraduate students at a university in Ireland, by integrating LA with the steps of teacher inquiry. This study makes three important contributions to teaching and learning literature. First, it reports on the use of LA to support teacher inquiry over four one-year cycles of a Master of Science in Business Analytics programme between 2016 and 2020. Second, it provides evidence-based recommendations on how to optimise LA to support teacher inquiry, with specific attention as to how these can improve the assimilation of LA into the curriculum design and delivery. Third, the paper concludes with a research agenda to help improve the adoption and integration of LA in the future.

Economic evaluation of varicella vaccination strategies in Jiangsu province, China: a decision-tree Markov model

ABSTRACT This study evaluated different varicella vaccination strategies in Jiangsu province, China. A decision-tree Markov model was used to evaluate the cost effectiveness of various varicella vaccination strategies for children, including direct and selective vaccination (serotesting pre-vaccination). A cohort of one-year-old children was followed through 60 one-year Markov cycles. The parameter estimation was based on field work, the literature, and statistical yearbooks. We calculated the incremental cost-utility ratio (ICUR) using the saved quality-adjusted life year (QALY). One-way and probability sensitivity analyses were performed to assess uncertainty. Among 100,000 cohort members, one-dose and two-dose direct vaccination averted 8061 and 10,701 varicella cases, respectively, compared with no vaccination. Furthermore, compared with no vaccination, one-dose and two-dose direct vaccination saved one QALY at the ICUR of USD 21,401.33 and USD 35,420.81, respectively, at less than three times the per capita gross domestic product (USD 47,626.86) of Jiangsu. The ICURs of the one-dose and two-dose selective strategies versus no vaccination were USD 42,623.62 and USD 51,406.35 per QALY gained, respectively. The cost effectiveness results were most sensitive to the QALY loss of outpatients and vaccine prices. Thus, in Jiangsu, one-dose and two-dose direct varicella vaccination in children could be cost effective at the willingness to pay threshold of three times provincial GDP per capita from a societal perspective. The findings were sensitive to the vaccine price and health utility of varicella cases.

First-line Treatment with Empagliflozin and Metformin Combination Versus Standard Care for Patients with Type 2 Diabetes Mellitus and Cardiovascular Disease in Qatar. A Cost-Effectiveness Analysis.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have shown to reduce cardiovascular events and mortality in patients with type 2 diabetes mellitus (T2DM), but they are currently not used as first-line therapy in clinical practice. This study sought to evaluate the cost-effectiveness of first-line empagliflozin plus standard care for patients with newly diagnosed T2DM and existing cardiovascular disease (CVD). A decision-analytic Markov model with one-year cycles and a lifetime time horizon was developed from the perspective of the Qatari healthcare system to compare first-line empagliflozin combined with metformin versus metformin monotherapy for patients aged 50 to 79 years with T2DM and existing CVD. Two health states were considered: 'Alive with CVD and T2DM' and 'Dead'. Patients could experience non-fatal myocardial infarction, non-fatal stroke, hospitalization for heart failure, hospitalization for unstable angina, and cardiovascular or non-cardiovascular death. Model inputs were ascertained from published and publicly available sources in Qatar. Costs and outcomes were discounted at 3% per annum. Sensitivity analyses were conducted to evaluate parameter uncertainty. The model predicted that adding empagliflozin to current standard care led to additional 1.9 years of life saved (YoLS) and 1.5 quality-adjusted life year (QALYs) per person, and an incremental cost of QAR 56,869 (USD 15,619), which equated to an incremental cost-effectiveness ratio of QAR 30,675 (USD 8,425) per YoLS and QAR 39,245 (USD 10,779) per QALY. Sensitivity analyses showed the findings to be robust. First-line empagliflozin combined with metformin appears to be a cost-effective therapeutic option for patients with T2DM and CVD.

Estimated productivity of sugarcane through the Agro-Ecological Zone method

The estimate of the potential sugarcane productivity through agroclimatic models aids in the agricultural planning of the crops and the quantification of the yield for a given region. For these estimated values to be considered robust there is a need for validating the performance of such models in different areas and agricultural varieties. Hence, the aim of this study was to validate the Agro-Ecological Zone (AEZ) method with fifteen sugarcane varieties in the region of the Vale do São Patrício, state of Goiás, Brazil. We evaluated the data referring to the cane-plant (one-and-a-half-year sugarcane), as well as the first and second sugarcane ratoons (both with one-year cycles) in an irrigated and dry farming system. The productivities obtained in dry farming were corrected due to the occurrence of a water deficit in the crop. The results indicated that the AEZ method presented productivity estimates more satisfactory for the one-year cultivation cycles (ratoon cycles) for all varieties studied, with the model adjusting best to the CTC15 variety (RMSE = 8.70 t ha-1; MAE = 6.05 t ha-1; d = 0.99).

PRO8 MEDICATIONS FOR ACROMEGALY: COST-UTILITY AND VALUE OF INFORMATION ANALYSIS

To conduct a cost-utility analysis comparing first- and second-line drug strategies involving octreotide, lanreotide, pasireotide, and pegvisomant for the treatment of patients with acromegaly who have failed surgery, from a Brazilian public health system perspective. A probabilistic cohort Markov model was developed. One-year cycles were employed. The patients started at 45 years of age and were followed lifelong. Costs, efficacy, and quality of life parameters were retrieved from the literature. A discount rate (5% per year) was applied to both costs and effects. Incremental cost-effectiveness ratios (ICERs) were calculated when applicable, and reported as cost per quality-adjusted life year (QALY). Scenario analyses considered alternative dosages, discount rates, tax exemption, and continued use of treatment despite lack of response. Value of information (VOI) analysis was conducted to explore uncertainty and to estimate the costs to be spent in future research. One American dollar (U$) equals approximately 4 Brazilian reais (R$) in 2020. Of the 11 strategies compared, four were not dominated. Only lanreotide autogel showed a reasonable ICER for having its use considered in clinical practice (R$ 112,138/QALY compared to “no treatment”). Considering a threshold of 3 times the GDP per capita (R$ 91,645), lanreotide autogel had a 38.19% probability of being cost-effective compared to “no treatment”. Scenario analyses corroborated the base-case result. VOI analysis showed that much uncertainty surrounds the parameters, and future clinical research should cost less than R$ 43,230,000 per year. VOI also showed that almost all uncertainty that precludes an optimal strategy choice involves quality of life. With current information, the only strategy that can be considered cost-effective in Brazil is lanreotide autogel. No second-line treatment is recommended. Significant uncertainty of parameters impairs optimal decision-making, and this conclusion can be generalized to other countries. Future research should focus on acquiring utility data.

Pharmacological Acromegaly Treatment: Cost-Utility and Value of Information Analysis

Objectives: To conduct a cost-utility analysis comparing drug strategies involving octreotide, lanreotide, pasireotide, and pegvisomant for the treatment of patients with acromegaly who have failed surgery, from a Brazilian public payer perspective. Methods: A probabilistic cohort Markov model was developed. One-year cycles were employed. The patients started at 45 years of age and were followed lifelong. Costs, efficacy, and quality of life parameters were retrieved from the literature. A discount rate (5%) was applied to both costs and efficacy. The results were reported as costs per quality-adjusted life year (QALY), and incremental cost-effectiveness ratios (ICERs) were calculated when applicable. Scenario analyses considered alternative dosages, discount rate, tax exemption, and continued use of treatment despite lack of response. Value of information (VOI) analysis was conducted to explore uncertainty and to estimate the costs to be spent in future research. Results: Only lanreotide showed an ICER reasonable for having its use considered in clinical practice (R$ 112,138/US$ 28,389 per QALY compared to no treatment). Scenario analyses corroborated the base-case result. VOI analysis showed that much uncertainty surrounds the parameters, and future clinical research should cost less than R$ 43,230,000/US$ 10,944,304 per year. VOI also showed that almost all uncertainty that precludes an optimal strategy choice involves quality of life. Conclusions: With current information, the only strategy that can be considered cost-effective in Brazil is lanreotide treatment. No second-line treatment is recommended. Significant uncertainty of parameters impairs optimal decision-making, and this conclusion can be generalized to other countries. Future research should focus on acquiring utility data.

Indirect costs of adult pneumococcal disease and the productivity-based rate of return to the 13-valent pneumococcal conjugate vaccine for adults in Turkey

ABSTRACT Productivity benefits of health technologies are ignored in typical economic evaluations from a health payer’s perspective, risking undervaluation. We conduct a productivity-based cost-benefit analysis from a societal perspective and estimate indirect costs of adult pneumococcal disease, vaccination benefits from the adult 13-valent pneumococcal conjugate vaccine (PCV13 Adult), and rates of return to PCV13 Adult for a range of hypothetical vaccination costs. Our context is Turkey’s funding PCV13 for the elderly and for non-elderly adults with select comorbidities within the Ministry of Health’s National Immunization Program. We use a Markov model with one-year cycles. Indirect costs from death or disability equal the expected present discounted value of lifetime losses in the infected individual’s paid and unpaid work and in caregivers’ paid work. Vaccination benefits comprise averted indirect costs. Rates of return equal vaccination benefits divided by vaccination costs, minus one. Input parameters are from public data sources. We model comorbidities’ effects by scalar multiplication of the parameters of the general population. Indirect costs per treatment episode of inpatient community-acquired pneumonia (CAP), bacteremia, and meningitis – but not for outpatient CAP – approach or exceed Turkish per capita gross domestic product. Vaccination benefits equal $207.02 per vaccination in 2017 US dollars. The rate of return is positive for all hypothetical costs below this. Results are sensitive to herd effects from pediatric vaccination and vaccine efficacy rates. For a wide range of hypothetical vaccination costs, the rate of return compares favorably with those of other global development interventions with well-established strong investment cases.

ПРЕЗИДЕНТСЬКІ ТА ПАРЛАМЕНТСЬКІ ВИБОРЧІ КАМПАНІЇ В УМОВАХ ОДНОРІЧНИХ ЕЛЕКТОРАЛЬНИХ ЦИКЛІВ ДОБИ НЕЗАЛЕЖНОСТІ УКРАЇНИ

In this article, three one-year electoral cycles during the Independence of Ukraine have been researched. In 1994, 2014 and 2019 the President of Ukraine and the Verkhovna Rada of Ukraine were elected in one year. The main causes of these elections were political crises that paralyzed the further development of the state and public attitudes that did not match the party composition of the current electoral authorities.It is emphasized that in terms of the sequence of conducting parliamentary and presidential campaigns 1994 is different from 2014 and 2019. In 1994 parliamentary elections were first conducted and then the presidential elections, in 2014 and 2019, on the contrary: presidential and then parliamentary. In terms of the timing of the elections, in 1994 and 2014 the presidential and parliamentary election campaigns were extraordinary and in 2019 the presidential campaign was regular and the parliamentary one was extraordinary.The election systems that have been applied under one-year electoral cycles are analyzed. At the election of the President, the electoral system has remained unchanged during Ukraine’s Independence period – the majoritarian system. At the same time, in relation to the elections to parliament: in 1994 a majoritarian system was used and in 2014 and 2019 – a mixed electoral system (50% majority and 50% proportional with a 5% barrier for political parties).It has been outlined that technologically presidential campaigns of L. Kravchuk and L. Kuchma in 1994 were based on the electoral attitudes of the parliamentary elections, but in 2014 and 2019 elections to the Verkhovna Rada of Ukraine were a logical continuation of the presidential elections while maintaining the basic strategy and main messages of the political parties campaigns.It have been clarified that the request for a radical reformation of authority, a quick reboot of the political system and anti-elite attitudes are the current world trends which are in line with Ukrainian realities through the election of V. Zelensky as President of Ukraine and a high level of electoral confidence in the new party “Servant of the people” in 2019.

Mental performance dynamics: p.i. psychological features of month and oneyear cycles

Mental performance dynamics: p.i. psychological features of month and oneyear cycles

ACCELERATION OF THE BREEDING PROCESS TO CREATE A LINEAR MATERIAL OF RED BEET

The traditional production of linear material and hybrids in the selection of red beet is a time-consuming, long-term process due to the two - year cycle of plant development, self-and cross-incompatibility, inbred depression. Significantly reduce the life cycle of the plant allows the vernalization at different stages of development, including during the "steckling". Cultivation of plants with the use of steckling culture in the selection of red beet has not yet found wide application and has not been studied enough, in this regard, in 2009-2018 on the basis of the Federal State Budgetary Scientific Institution “Federal Scientific Vegetable Center”. The material of the study was inbred offspring I 1-5 , which were studied in several series of independent experiments using different schemes of growing stecklings and roots (one-year and biennial cycles). It is shown that the use of culture of steckling and protected ground for breeding schemes to create lines of red beet is advisable, as it accelerates the process of evaluating the heterogeneity of inbred progenies for earliness, index, root, the manifestation of cytoplasmic sterility, and also allows you to get a wider range of different inbred forms due to the high variability in the offspring. The probability of a valuable fully-sterile ms-forms higher in the group of early maturing plants with a large mass stecklings and promising self-compatibility mf-lines - among small fractions of mid and late inbred offspring. The continuous use of steckling culture should be recommended only for the preliminary evaluation of breeding material on sign of cytoplasmic sterility, followed by the reproduction of selected promising inbred offspring in the open field ("halves method"), and at later stages of the breeding process as a rapid assessment of crossing combinations on sign of cytoplasmic sterility when checking mf-forms on the fixing ability. The alternation of the culture of stecklings with the traditional biennial cycle of culture in conjunction with the techniques of recurrent selection and use of different backgrounds (field, greenhouse), can improve the performance of the selection and get aligned according to the main economic-important signs of promising inbred offspring in a shorter period of time.

Impacts of Climate on Spatiotemporal Variations in Vegetation NDVI from 1982–2015 in Inner Mongolia, China

By using the Global Inventory Modeling and Mapping Studies (GIMMS) third-generation normalized difference vegetation index (NDVI3g) data, this paper explores the spatiotemporal variations in vegetation and their relationship with temperature and precipitation between 1982 and 2015 in the Inner Mongolia region of China. Based on yearly scale data, the vegetation changes in Inner Mongolia have experienced three stages from 1982 to 2015: the vegetation activity kept a continuous improvement from 1982–1999, then downward between 1999–2009, and upward from 2009 to 2015. On the whole, the general trend is increasing. Several areas even witnessed significant vegetation increases: in the east and south of Tongliao and Chifeng, north of Xing’anmeng, north and west of Hulunbir, and in the west of Inner Mongolia. Based on monthly scale data, one-year and half-year cycles exist in normalized difference vegetation index (NDVI) and temperature but only a one-year cycle in precipitation. Finally, based on the one-year cycle, the relationship between NDVI and climatic were studied; NDVI has a significant positive correlation with temperature and precipitation, and temperature has a greater effect in promoting vegetation growth than precipitation. Moreover, based on a half-year changing period, NDVI is only affected by temperature in the study region. Those findings can serve as a critical reference for grassland managers or policy makers to make informed decisions on grassland management.

Cost-effectiveness evaluation of HPV self-testing offered to non-attendees in cervical cancer screening in Switzerland

ObjectiveAbout 30% of women who are eligible for cervical cancer (CC) screening remain un-screened or under-screened in Switzerland. HPV testing on self-collected vaginal samples (Self-HPV) has shown to be more sensitive than cytology while also reaching non-attendees. The objective of this study was to explore the cost-effectiveness of offering Self-HPV to non-attendees in Switzerland. MethodsA recursive decision-tree with one-year cycles was used to model the life-long natural HPV history. Markov cohort simulations were used to assess the expected outcomes from the model. The outcomes of three strategies were compared with the absence of screening: Self-HPV and triage with colposcopy (Self-HPV/colpo), Self-HPV and triage with Pap cytology (Self-HPV/PAP), cytological screening and triage with HPV (PAP/HPV). Sensitivity analyses for the key parameters of the model were conducted to check the robustness of findings. ResultsOffering a Self-HPV screening to non-attendees could prevent 90% of CC and 94% of CC-related deaths in the study population. The current cytology-based program could reduce by 83% the number of CC cases and by 88% the number of CC-related deaths over the population's lifetime. Compared to the absence of screening, incremental cost-effectiveness ratios (ICER) were estimated to be, per saved Quality Adjusted Life Year (QALY), 12413US$ for the strategy Self-HPV/colpo, 11138US$ for the strategy Self-HPV/Pap and 22488US$ for the strategy PAP/HPV. ConclusionsOffering Self-HPV as a CC screening strategy to non-attendees in Switzerland is a cost-effective solution that is associated with a reduction of CC cases and related deaths. Self-HPV is more cost-effective than the currently used cytology-based screening.

How can patient empowerment be integrated into change management while scaling-up an integrated care program?

Introduction: It is a challenge to ensure transferability of successful integrated care services to a new healthcare setting. The ACT@Scale program aims to identify, transfer and scale-up mature integrated care and telehealth practices in different regions in Europe. Patient empowerment PE, representing the process through which greater control over health is gained, is one of the target areas for successful integrated care deployment. In ACT@Scale, five integrated care programs, represented by a local multidisciplinary team, identified the key issues related to PE and required changes to improve the program in order to scale it up. Short description of practice change implemented: During the ACT@Scale project, programs apply collaborative methodologies CM to stimulate rapid process improvement. It encompasses routine data collection and assessment, provision of training material and communication channels. Regions develop and apply changes to improve the level of patient empowerment in their programs. Various surveys that measure PE level are used patient activation PAM[1]; psycho-social profile MAY[2]; program satisfaction NPS[3]; and staff attitude on PE CSPAM[2]. Aim and theory of change: Regions use CM to apply process improvements while learning cycles are managed by Plan-Do-Study-Act PDSA cycles. Evidence from the data is used to start subsequent improvement cycles. We monitor PE during the upscaling process. Targeted population and stakeholders: Implemented changes target patients of five integrated care programs, healthcare providers and program managers. Timeline: Total project duration is three years. Two full one-year PDSA cycles will be completed by participating programs. Highlights: The approach is complemented by an ICT solution for data collection and visualization to support decision-making. ICT data management allows distributed analysis of patient outcomes and resource utilization. This data remains in the regions, while a central engine runs remote analysis and displays aggregated results across regions. Comments on sustainability: The ACT@Scale program has a dedicated work package to address sustainability.Some participating programs are addressing this topic by applying changes in this area. Comments on transferability: Sharing of good practices within the consortium is part of collaborative methodology. During the final phase of ACT@Scale, specific local and international activities on dissemination and knowledge transferability will be organized. Conclusions: By using surveys, we can measure patient empowerment level in the program staff and patients and the regional level of adoption. Tools for monitoring progress of these levels and impact on outcomes during process improvement are essential to support the decision making process. Discussions: The data collection and regional implementation of the ICT technology are in progress. When completed, it will allow a more detailed analysis of patient empowerment levels into integrated care programs. Lessons learned: Distributed analysis can be a solution when data sharing is not allowed.