Local Expert Opinion Research Articles

Development of a new radical cystectomy surveillance protocol and nurse-led cystectomy follow-up clinic in Australia.

This study determined, implemented, and assessed a nurse-led radical cystectomy follow-up protocol. In 2021, an evidence-based risk-stratified protocol (non-urological cancers and benign [N-UC&B], low, or high risk) was developed from current guidelines, local and national expert opinion, and after formal discussion with the Urological Society of Australia and New Zealand (USANZ) Western Australia (WA) and Australia and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group. Retrospective and prospective assessment of cystectomy follow-up occurred between 2015 and 2023. Patients received 'surgeon-led' follow-up March 2015 to August 2021, and 'nurse-led' follow-up August 2021 to April 2023. Adherence to follow-up, cost-analysis, and healthcare efficiency calculations were performed. Of 176 cystectomy patients, 159 (90.3%) were eligible for inclusion. Overall adherence to nurse-led follow-up was 78.6% compared to 43.4% in surgeon-led (P < 0.001). Adherence to nurse-led follow-up was higher in all risk categories (high-risk 79.1% vs. 43%, P < 0.001; low risk 75% vs. 52.3%, P = 0.110; N-UC&B 71% vs. 30%, P = 0.153). Nurse-led consultation saved $59.50 per consultation with overall cost savings of $179.50, $416.50, and $595 for the entire follow-up period for N-UC&B, low, and high-risk groups based on consultation alone. A total of 1072 appointments (536 h, $62 390.40) would have been saved if the surgeon-led cohort of patients were seen in nurse-led clinics. Protocol driven nurse-led cystectomy follow-up demonstrates excellent adherence and may be more cost-effective than surgeon-led follow-up.

Budget Impact Analysis of Olaparib for the Management of Patients with Homologous Recombination Repair (HRR)-Mutated Castration-Resistant Metastatic Prostate Cancer in Argentina.

The aim of this study was to perform a budget impact analysis (BIA) of introducing olaparib treatment for adult patients with metastatic castration-resistant prostate cancer in Argentina. A BIA model was used to estimate the cost difference between the current scenario (without olaparib) and the new scenario (incorporation of olaparib) for a third-party payer over a 5-year time horizon. The budgetary impact is estimated at the national health system level and by healthcare sectors in Argentina. Input parameters were obtained from the literature and validated by local expert opinion. Direct medical costs were obtained from both the Institute for Clinical Effectiveness and Health Policy (IECS) unit cost database and public data in Argentina. The microcosting estimation was used for key variables of the analysis. All costs are reported in US dollars (US$) as for October 2022 (1 US$ = 152.59 Argentine pesos). One-way sensitivity analyses and scenario analyses were conducted to evaluate the model robustness. The incorporation of olaparib, with a wholesale price per pack of US$3176, was associated with a weighted average of the budget impact per member per month (PMPM) of US$0.0191 for the national health system, being slightly higher than the estimated budgeted high impact threshold (US$0.0153). The PMPM budget impact for a 5-year average ranged between US$0.007 (public sector) and US$0.033 (private sector). The duration of treatment with olaparib was the most influential parameter in the budget impact results. The introduction of olaparib for the treatment of metastatic castration-resistant prostate cancer has a high budget impact for Argentina's health system. These findings are informative to support policy decisions aimed to expand the current treatment landscape for prostate cancer.

Paper-based and mobile application-based self-monitoring tool for healthy dietary intake, development and applicability: a non-randomized trial

BackgroundUnhealthy diet is a key risk factor for Non-Communicable Diseases (NCDs) that contribute to increased morbidity and premature mortality. With increased computer literacy and mobile phone penetration, there is a high opportunity for mobile application-based interventions. The current study was conducted to develop a mobile application to monitor dietary intake and to assess its acceptability and effectiveness in diet control compared to a similar paper-based intervention.A mobile application was developed based on research evidence and opinions of local experts. The mobile application was introduced to a selected group of office workers who were in preparation, action, and maintenance stages of the Trans Theoretical Model (TTM) and a paper-based intervention was used as the comparator. Socio-demographic data were collected through a self-administered questionnaire. Participants were followed up for three months for adherence. The effectiveness of interventions was assessed at the end of three months by comparing the progressive change in the stage of change and the change from unhealthy to healthy dietary intake between two groups as primary and secondary outcomes respectively.ResultsAmong 123 office workers who participated in the study, 19.5% preferred the mobile intervention over the paper-based intervention. Younger, unmarried office workers and those who do not have children, had a higher acceptance for the mobile intervention (p < 0.05). There was no difference in adherence (in all three months) or outcomes between the two groups of intervention.Conclusion and recommendationsMobile application-based interventions are better accepted among the young age group and further studies are recommended to explore their applicability.Trial registrationThe study was registered in the Sri Lankan Clinical Trial Registry (Registration No. SLCTR/2020/025; Date 15th December 2020).

Spatio-temporal forecasting for the US Drought Monitor

Abstract The US Drought Monitor is the leading drought monitoring tool in the United States. Updated weekly and freely distributed, it records the drought conditions as geo-referenced polygons showing one of six ordered levels. These levels are determined by a mixture of quantitative environmental measurements and local expert opinion across the entire United States. At present, forecasts of the Drought Monitor only convey the expected direction of drought development (i.e. worsen, persist, subside) and do not communicate any uncertainty. This limits the utility of forecasts. In this paper, we describe a Bayesian spatio-temporal ordinal hierarchical model for use in modelling and projecting drought conditions. The model is flexible, scalable, and interpretable. By viewing drought data as areal rather than point-referenced, we reduce the cost of sampling from the posterior by avoiding dense matrix inversion. Draws from the posterior predictive distribution produce future forecasts of actual drought levels—rather than only the direction of drought development—and all sources of uncertainty are propagated into the posterior. Spatial random effects and an autoregressive model structure capture spatial and temporal dependence, and help ensure smoothness in forecasts over space and time. The result is a framework for modelling and forecasting drought levels and capturing forecast uncertainty.

Development of wastewater quality index as an assessment tool of treated wastewater quality for sea discharge

AbstractThe evaluation of the effluent water quality from wastewater treatment plants is fundamental for human health and aquatic environment considerations. Therefore, this research presents a new and specific water quality index for evaluating the effluent water discharged into the sea by integrating the complex set of wastewater qualities into a single reliable value. Two approaches were utilized for this purpose: experts' opinions and statistical analysis using principal component analysis. In the first approach, the opinions of local experts shortlisted the parameters into six important parameters out of a list of 19 with assigned weights varied from 0.160 to 0.174. In the statistical approach, principal component analysis and correlation analysis reduced the parameters to seven accounting for 75% of the variation in the data. Their weights were calculated based on their eigenvalues and ranged from 0.063 to 0.435. The subindices rating curves were developed based on the Kingdom of Bahrain's legislated standards and the weighted arithmetic mean function was used for the aggregation stage. The established water quality indices were applied to effluents from a local wastewater treatment plant, and the obtained results revealed “Class 1: excellent category” discharge quality maintained throughout the year as per the categories proposed in this work. The developed indices proved their effectiveness and reliability in assessing the treated water. The study provides a comprehensive and reliable assessment of treated water quality, and its approach and outputs could have significant implications globally for ensuring the quality of treated water prior its discharge and promoting sustainable development.

Ethnoprimatology reveals new extended distribution of critically endangered banded langur Presbytis femoralis (Martin, 1838) in Pahang, Malaysia: Insights from indigenous traditional knowledge and molecular analysis.

The banded langur (Presbytis femoralis) is a critically endangered primate, which within Malaysia has not been known to extend significantly outside the state of Johor. Traditionally, distribution studies on this highly threatened primate have relied on conventional methods such as DNA identification, live counting, and camera trapping. However, ethnoprimatology offers an alternative approach to data collection, involving the active participation of indigenous and local communities possessing valuable knowledge and experience with local primate species. This study employed an integrated approach incorporating ethnoprimatology by utilizing pooled local expert opinion, local surveys, interviews, and fecal DNA analysis, resulting in a novel distribution range for the banded langur. The combination of expert opinions revealed this species' most optimistic distribution scenario across Johor and Pahang, inhabiting various ecosystems, including lowland forests, peat swamps, and human-modified landscapes. Further interviews and surveys conducted within the Orang Asli community in Tasik Chini and Tasek Bera have provided additional support for the revised distribution, documenting occurrences of banded langur utilization in indigenous practices, such as food consumption, cultural beliefs, medicinal applications, and craftsmanship. Phylogenetic analysis demonstrated genetic differentiation between populations in Johor and Pahang, with the populations in the southern part of Peninsular Malaysia likely serving as ancestral sources for other populations. Consequently, this study not only elucidated the updated distribution of banded langur through DNA records and direct observations but also established the efficacy of ethnoprimatology as a precursory tool for uncovering the present distribution patterns of other primate species in Malaysia.

Cultural Intermediaries: How Local Experts Shape the Financial Performance of Foreign Cultural Products

Purpose - This study examines the pivotal role of local expert reviewers in the financial success of imported foreign films (Hollywood movies) within the Chinese market. It integrates signaling theory and gatekeeping scholarship to examine how these intermediaries reduce mainstream uncertainty. We hypothesize local expert reviewers to better grasp spaces for resonance between imported films and local preferences compared to foreign critics. Moreover, we examine the moderating roles of films attributes such as production scale, prestigious awards, and local adaptation strategies.&#x0D; Design/Methodology/Approach - We test hypothesized relationships and contingencies via OLS regressions on box office performance spanning 500 top-grossing Hollywood studio imports in China from 2000 2017 with data from multiple sources.&#x0D; Findings - The OLS regressions reveal that local expert reviewers significantly influence cross-border film success, with the impact moderated by production budgets and awards, but potentially diminished by cultural adaptation.&#x0D; Research Implications - Our study unpacks market drivers and product-level contingencies around imported creative products amidst mainstream uncertainty. The findings contribute to international business literature and cultural business by showcasing the nuanced impact of local cultural intermediaries on the financial performance of foreign cultural products. This research underscores the importance of local expert opinions in navigating the complex landscape of global content distribution and consumption, offering valuable insights for content creators and marketers aiming to optimize the global reach of products.

Cultural Intermediaries: How Local Experts Shape the Financial Performance of Foreign Cultural Products

Purpose - This study examines the pivotal role of local expert reviewers in the financial success of imported foreign films (Hollywood movies) within the Chinese market. It integrates signaling theory and gatekeeping scholarship to examine how these intermediaries reduce mainstream uncertainty. We hypothesize local expert reviewers to better grasp spaces for resonance between imported films and local preferences compared to foreign critics. Moreover, we examine the moderating roles of films attributes such as production scale, prestigious awards, and local adaptation strategies. Design/Methodology/Approach - We test hypothesized relationships and contingencies via OLS regressions on box office performance spanning 500 top-grossing Hollywood studio imports in China from 2000 2017 with data from multiple sources. Findings - The OLS regressions reveal that local expert reviewers significantly influence cross-border film success, with the impact moderated by production budgets and awards, but potentially diminished by cultural adaptation. Research Implications - Our study unpacks market drivers and product-level contingencies around imported creative products amidst mainstream uncertainty. The findings contribute to international business literature and cultural business by showcasing the nuanced impact of local cultural intermediaries on the financial performance of foreign cultural products. This research underscores the importance of local expert opinions in navigating the complex landscape of global content distribution and consumption, offering valuable insights for content creators and marketers aiming to optimize the global reach of products.

Achieving cervical cancer elimination: The simulated impacts of HPV vaccination and transitioning from liquid-based cytology to HPV-based screening test.

The Ministry of Health Malaysia aims to fully replace liquid-based cytology (LBC) with Human Papillomavirus (HPV) tests and increase the screening coverage from a baseline of 25% to 40% by 2023, followed by a 10% yearly increment until 70% coverage. This transition requires proper planning, including the number of tests needed and budget allocation. This study aims to simulate different transition strategies involving the shift from LBC to HPV testing with expanded screening coverage to predict their impact on cervical cancer elimination in Malaysia. A system dynamics model was developed to simulate the transition from LBC to HPV testing and HPV vaccination coverage in Malaysia. The dynamic model utilised local epidemiological data, published research, and expert opinion when data was unavailable. The simulation showed that a combination of high HPV vaccination coverage and transitioning fully to five-yearly HPV testing by 2030, coupled with a 70% screening uptake by 2040, would accelerate cancer elimination in Malaysia by 18 years with an estimated screening cost of MYR1.81 billion equivalent to USD 411 millions compared to the baseline of using LBC as the primary screening method (MYR1.39 billion, USD 315 millions). Sustained, it would lead to averting 6,000 new cancer cases by 2070. Alternatively, conducting HPV screenings twice before age 50 would advance cervical cancer elimination by 14 years and prevent approximately 1000 new cases by 2070, with an estimated cost of MYR1.13 billion equivalent to USD 257 millions. A delay in achieving the full transition prolonged the elimination more than a delay in increasing the screening coverage. In all scenarios, yearly vaccination of 90% of girls age 13 is crucial to achieving elimination. In the Malaysian context, where HPV vaccination coverage has reached considerable levels, the evidence advocates for a full transition from LBC to HPV testing, ideally by 2030. While expanding screening coverage remains a critical factor in this endeavour, the findings unequivocally endorse prioritising the transition process. Trial registration: Trial registration number: NMRR ID-22-00187-DJU.

An international Delphi consensus for surgical quality assessment of lymphadenectomy and anastomosis in minimally invasive total gastrectomy for gastric cancer

BackgroundMinimally invasive total gastrectomy (MITG) is a mainstay for curative treatment of patients with gastric cancer. To define and standardize optimal surgical techniques and further improve clinical outcomes through the enhanced MITG surgical quality, there must be consensus on the key technical steps of lymphadenectomy and anastomosis creation, which is currently lacking. This study aimed to determine an expert consensus from an international panel regarding the technical aspects of the performance of MITG for oncological indications using the Delphi method.MethodsA 100-point scoping survey was created based on the deconstruction of MITG into its key technical steps through local and international expert opinion and literature evidence. An international expert panel comprising upper gastrointestinal and general surgeons participated in multiple rounds of a Delphi consensus. The panelists voted on the issues concerning importance, difficulty, or agreement using an online questionnaire. A priori consensus standard was set at > 80% for agreement to a statement. Internal consistency and reliability were evaluated using Cronbach's α.ResultsThirty expert upper gastrointestinal and general surgeons participated in three online Delphi rounds, generating a final consensus of 41 statements regarding MITG for gastric cancer. The consensus was gained from 22, 12, and 7 questions from Delphi rounds 1, 2, and 3, which were rephrased into the 41 statetments respectively. For lymphadenectomy and aspects of anastomosis creation, Cronbach’s α for round 1 was 0.896 and 0.886, and for round 2 was 0.848 and 0.779, regarding difficulty or importance.ConclusionsThe Delphi consensus defined 41 steps as crucial for performing a high-quality MITG for oncological indications based on the standards of an international panel. The results of this consensus provide a platform for creating and validating surgical quality assessment tools designed to improve clinical outcomes and standardize surgical quality in MITG.

Integrating local and scientific ecological knowledge to assess African forest elephant (Loxodonta cyclotis) populations in a data-deficient region, Eastern Democratic Republic of Congo

Given this need to study wildlife populations reliably, quickly and within financial and human resource constraints faced by wildlife managers, we evaluated the pooling local expert opinion (PLEO) as a tool for collecting extensive data on local animal abundance and population trends. We quantified reliability of abundance estimates derived from interviews by comparing them with those obtained from standard field-sampling protocols (distance sampling). We also explored the complementarity of these two approaches in assessing population status and distribution. We estimated there are c. 161 individuals in the selected Itombwe nature reserve and Luama hunting domain landscape covering 1,712 km2. The highly suitable elephant habitat in the Itombwe Reserve was set at 1,045.5 km2 while the largest total of low and unsuitable area was estimated to be 1,529.9 km2. Overall, this study shows that the PLEO methodology provides an effective and complementary tool to estimate forest elephant trend and habitat suitability in tropical rainforests by involving local communities in biodiversity conservation. We suggest that by incorporating the PLEO methodology into regular monitoring activity, conservation bodies can create a platform that allows for participatory wildlife monitoring and create the platform to involve local communities in elephant conservation.

Stochastic model to assess bioeconomic impact of PRRS on pig farms in Costa Rica.

Despite the economic importance of PRRS and its high prevalence in Costa Rica, there are no studies on the bioeconomic impact of the disease in the country or, even, in Central America. Such studies are essential in finding cost-effective preventive measures tailored for different production circumstances. Therefore, the objective of this study was to evaluate economic and production parameters of a PRRSV-infection for a medium-sized farrow-to-finish pig farm system in Costa Rica with a farm-level stochastic Monte Carlo simulation model. The effect of PRRS was assessed by scenario analysis, in which a baseline PRRS-free situation was compared against three alternative scenarios that assumed low, medium and high PRRS effects. The PRRS effects were based on data from local farms, scientific literature and expert opinion. Sensitivity analyses were performed to assess the impact of key input parameters on output variables. Results show that at the animal level, changes between the baseline and the PRRS-high scenario were estimated as: +25 d in age to slaughter, -9.9 pigs to slaughter (per breeding sow/yr), +6% annual replacement rate, -255 d in sow productive lifetime, - 6.9 mo in age at culling of sows, and +24 non- productive days. For a medium size local farm (n=588 sows), a reduction of 5826 fat pigs to slaughter per farm/yr from baseline compared to PRRS-high scenario was observed. PRRS-induced loss per farm per year was estimated at -US $142,542, US $180,109 and -US $524,719 for PRRS-low, medium and high scenarios, respectively. Revenues/costs ratio changed from 1.12 in the baseline to 0.89 in the PRRS-high scenario. The production cost per kg carcass weight increased from US $2.63 for the baseline to US $3.35 in the PRRS-high scenario. PRRS-induced loss was estimated at US $77.1 per slaughtered pig/yr and US $892 per breeding sow/yr for the PRRS-high scenario. Results from the model indicate that pig farms with medium to high prevalence of PRRS will require optimal market conditions in order to have positive economic outcomes. These results can be helpful in the design of better control strategies for PRRS.

The mechanism of knowledge-based behavior of pastoralists for rangeland management: exploitation, restoration and conservation

Pastoralists have managed their lands for a thousand years, but they are ignored in the land management approaches. They have comprehensive information about their rangelands, coming from extensive observations and experiences in continuous herding. This research has focused on revealing the mechanism of knowledge-based behavior of pastoralists for rangeland management. The statistical population is made up of 50 pastoralists, all of whom were included in census. The research instrument was a researcher-made questionnaire that measured the knowledge-based behavior of pastoralists with 58 items in three indicators i.e. exploitation, conservation, and restoration. The validity and reliability of the research instrument were assessed using the opinions of local experts and Cronbach's alpha (α = 0.877). The knowledge-based behavior of pastoralists were from the highest to the lowest related to exploitation, conservation, and restoration with the average of 2.35, 2.07 and 1.58 respectively. Exploitation knowledge, restoration knowledge and conservation knowledge had the strongest and weakest significant relationship with the knowledge-based behavior of pastoralists. “The adequate growth of palatable plants is a sign of the start of grazing” and “the soil should not be wet for the start of grazing” had the highest importance for rangeland exploitation with a values of 0.816 and 0.784 respectively. For rangeland conservation, “holding meetings by elders regarding rangeland conservation is useful” and “reducing the number of pastoralists during droughts is one of the rangeland conservation ways” were the most importance items with the values of 0.852 and 0.848 respectively. For rangeland restoration, “implementation of grazing systems (rotation or rest rotation grazing systems) is one of the rangeland restoration ways” and “the appropriate distribution of watering points is one of the rangeland restoration factors” were the most importance items with the values of 0.840 and 0.812 respectively. There was a positive and significant relationship between the age, history of pastoralism and income with the knowledge-based behavior of pastoralists in rangeland management. Therefore, the presented approach based on indigenous knowledge can be considered as an effective component for rangeland management and can strengthen the positive effects of both management systems and create a transformation in the status of natural resources by a compatible combination of indigenous knowledge and modern knowledge. It is worth noting that by knowing these indicators, we can take an effective step in planning and policy making as well as proper management of rangelands.

Framing Asylum at the Local Level: Experts’ Narratives of Conflictual Dynamics in the Post-Reception Period in Italy

AbstractStudies on the framing of the refugee crisis have focused on media and political discourses, revealing contrasting views and an increasing politicization of immigration. However, the framing-of-asylum discourse in relation to the reception and settlement of asylum seekers in local communities has so far received less attention, especially when conflictual dynamics emerge. This article investigates the ways in which experts at different levels make sense of how the refugee crisis has unfolded in local communities in Italy. Insofar as asylum governance has become a contentious issue, it looks at conflictual situations. The research challenges the binary between humanitarian and fear frames by suggesting the prevalence of a managerialist frame focusing on a problematic implementation of asylum policies. Taking into consideration the opinions of local experts, it also reveals a shift from a fear frame to an inconvenience frame, which denies xenophobic discourses on invasion or social/public disorder in local communities, but finds other reasons to deny acceptance. The article also adds to the study of the horizontal dynamics between public and private actors, which are central, especially at the local level, and introduces refugees as subjects who actively participate in the “battleground” of asylum governance. Therefore, claims about a negotiated order between different tiers of governance within the multilevel governance approach are challenged.

Should artificial intelligence have lower acceptable error rates than humans?

The first patient was misclassified in the diagnostic conclusion according to a local clinical expert opinion in a new clinical implementation of a knee osteoarthritis artificial intelligence (AI) algorithm at Bispebjerg-Frederiksberg University Hospital, Copenhagen, Denmark. In preparation for the evaluation of the AI algorithm, the implementation team collaborated with internal and external partners to plan workflows, and the algorithm was externally validated. After the misclassification, the team was left wondering: what is an acceptable error rate for a low-risk AI diagnostic algorithm? A survey among employees at the Department of Radiology showed significantly lower acceptable error rates for AI (6.8 %) than humans (11.3 %). A general mistrust of AI could cause the discrepancy in acceptable errors. AI may have the disadvantage of limited social capital and likeability compared to human co-workers, and therefore, less potential for forgiveness. Future AI development and implementation require further investigation of the fear of AI's unknown errors to enhance the trustworthiness of perceiving AI as a co-worker. Benchmark tools, transparency, and explainability are also needed to evaluate AI algorithms in clinical implementations to ensure acceptable performance.

Ecosystem services valuation using InVEST modeling: Case from southern Iranian mangrove forests

As one of the most fertile ecosystems on earth, mangrove forests provide many goods and services for humanity. Mangroves are located in the south of Iran on the coasts of Sistan and Baluchistan, Hormozgan and Bushehr provinces, which include two species of Harra (Avicennia marina) and Chandal (Rhizophora mucronata) The purpose of this study was to describe the condition of mangrove forests using the integrated valuation of ecosystem services and tradeoffs (InVEST) between 2010 and 2021 from the southern coasts of Iran. The INVEST model uses land use and land cover maps to estimate habitat quality. With the opinions of local experts, sources of threats, maximum impact distance, state of degradation, and sensitivity to threats were also estimated for each type of land use cover. Urban and rural areas’ development, roads network, piers, oil and non-oil industries, agriculture, and aquaculture activities, were identified as sources that threaten mangroves’ long-term viability. The output maps of the INVEST habitat quality model included degradability and habitat quality maps, which were classified into four categories: poor, low, medium, and high, to better understand quality changes. The results demonstrated that mangrove habitat quality has decreased considerably despite the increase in their area. The area of the target habitats has been increased by 586.45 ha while two first quality categories, including poor and low classes, increased. Based on a habitat quality assessment in 2010, two classes of poor, low habitat quality, were estimated to be around 0.72, and 8.42 ha, which changed to 3.04 ha, and 9.72 ha respectively in 2021. The output maps obtained in this study can help local managers and decision-makers to have an image of what happened to the quality of the target ecosystems and may help them to adopt more effective management strategies for the conservation of these ecosystems.

Lay–Expert Risk Perception Divide: Downscaling Global Problems to National Concerns

In the modern world, risks are complex and systemic, and their effects are interconnected with the transformations in different layers of social systems. Global issues are not necessarily reflected in local contexts, and public perceptions of risks may differ significantly from expert assessments. The aim of the article is to reveal the differences between the opinions of the Lithuanian population and experts on economic, environmental, technological, geopolitical and social risks, and to compare the differences between the opinions of local experts and Lithuanian public and the assessments of experts from the Global Risk Reports. The article presents the results of a representative survey of the Lithuanian population and an online survey of municipal experts. The results of the study show that expert and population perceptions quite often coincide, especially in the case of social and economic threats. The biggest discrepancies, when the experts assessed the risks as higher than the population, were revealed in the cases of COVID-19, floods, forest fires, energy disruptions, and the mines from war legacy. Public identified higher risks than experts in the case of traffic accidents, illegal tracking of persons, illegal use of bank accounts/cards, Astravets NPP, and increase in prices. In the perception of risks of Lithuanian population and municipal experts in 2020–2021 economic and social risks dominated, and global risks with long-term effects, such as ecological or geopolitical, were not reflected in the local perceptions.

Cost-effectiveness of adjuvant chemotherapy for patients with high-risk stage II and stage III colon cancer in South Africa.

6599 Background: Colon cancer (CC) incidence is rising globally, and case fatality rates are greatest in low-income settings, such as South Africa (SA). Adjuvant chemotherapy is standard of care for high-risk stage II and stage III CC in the US. We evaluated the cost-effectiveness of adjuvant chemotherapy for CC in SA public hospitals. Methods: We developed a decision-analytic Markov model comparing lifetime costs and outcomes for 60-year-old high-risk stage II and stage III CC patients treated in a SA public hospital with no adjuvant chemotherapy, versus: capecitabine and oxaliplatin (CAPOX) for 3 or 6 months or capecitabine for 6 months. High-risk stage II was defined as ≥1 of: T4 disease; poorly differentiated tumor; lymphovascular/perineural invasion; &lt;12 lymph nodes dissected, bowel obstruction/perforation. Transition probabilities were derived from clinical trials estimating toxicity, disease recurrence, and survival. Costs from a SA societal perspective and utility estimates were obtained from literature and local expert opinion. The primary outcome was the incremental cost-effectiveness ratio (ICER) in international dollars (I$) per disability-adjusted life year (DALY) averted, with a willingness-to-pay (WTP) threshold equal to 2021 GDP/capita of SA (I$13,764). Results: CAPOX for 3 months was the cost-effective strategy for stage III CC at a lifetime cost of I$5,284 and 5.55 DALYs averted, compared to no adjuvant treatment. All other strategies were absolutely dominated. For high-risk stage II CC, CAPOX for 3 months was the cost-effective strategy (ICER = I$711/DALY averted). No adjuvant chemotherapy was on the efficiency frontier, with a lower lifetime cost, but no DALYs averted. The results of one-way deterministic sensitivity analyses showed that the model is most sensitive to CC recurrence rate. In a probabilistic sensitivity analysis, CAPOX for 3 months was optimal in 88% of iterations for high-risk stage II CC and 79% of iterations for stage III CC. Conclusions: CAPOX for 3 months is the cost-effective adjuvant treatment for high-risk stage II and stage III CC in SA public hospitals. This strategy offers the highest quality of life benefit for the lowest cost and is well within the WTP threshold for SA. The optimal strategy in other settings will vary according to local WTP thresholds. Base case estimates of cost-effectiveness, in order of cost. [Table: see text]

Review of field methods for monitoring Asian bears

Efficient and effective monitoring methods are required to assess population status and gauge efficacy of conservation actions for threatened species. Here we review the spectrum of field methods useful for monitoring distribution, occupancy, abundance, and population trend for the five species of Asian terrestrial bears. Methods reviewed include expert opinion, local knowledge, bear sign, visual observations, camera traps, DNA-based methods (hair and scat derived), and radio telemetry. We examine the application of each method in terms of realizing specific monitoring objectives, their assumptions, challenges, and advantages. Our goal is to assist researchers in matching appropriate field methods with sought-after project objectives and to highlight shortfalls and trade-offs. Methods vary greatly in terms of cost, logistics, required number and expertize of staff, and the reliability of the data they provide. Many Asian bear population assessments have relied on expert opinion, local interviews, and sign surveys to provide estimates of distribution, abundance, and trend, in part because these are inexpensive and relatively easy to employ. However, increasing use of camera traps and DNA-based methods now allow for better monitoring via occupancy or rigorous capture–recapture population estimation, with the caveat that these methods may be restricted by inadequate budgets or logistical constraints. For distribution monitoring, camera traps and DNA yield the most definitive records of presence, but in low density bear populations, sign and local knowledge may be more effective. For occupancy, camera traps and DNA are advantageous in providing definitive detections in known time periods. For abundance/density or population trend monitoring in relatively small areas (<10,000 km 2 ), bears must be individually identified and used in a mark-recapture design. This requires DNA from collections of hair or scat, or a camera-based survey in which natural chest marks are clearly visible and individually distinguishable. DNA-methods or camera traps within individual identification is best for population trend when sufficient funding is available. Alternatively, careful use of local knowledge or expert opinion may be viable options, but come with greater uncertainty. For the foreseeable future, we believe that expert opinion will likely continue to play a large part in monitoring Asian bears, but these opinions should be informed by more rigorous data from the other methods we discuss.

Estimating the Prevalence of Bladder Cancer by Stage in Iran as a Developing Country.

Background: Bladder cancer is among the 10 most common cancers globally and in Iran. The prevalence rate is a crucial metric for both estimating disease burden and policymakers. On the other hand, bladder cancer is a heterogeneous disease with different stages, high recurrence, and progression rate. In planning treatment procedures, it is important to know the prevalence of bladder cancer by stages. In the current study, we aimed to estimate the 5-year prevalence of bladder cancer by stages using the Markov model. Methods: This was a simulation study. To estimate the 5-year prevalence of bladder cancer by stages, we used the Markov model with a time horizon of 5 years following diagnosis. We simulated the natural history of bladder cancer using a literature review. We extracted survival rate, stage-specific recurrence, and progression rate using local and international publications and expert opinion. In addition, we used the Iranian life table and extracted probabilities of mortality due to other causes of death. Results: Five-year prevalence of bladder cancer for the year 2018 was estimated at 21,807 patients. Non- muscle-invasive bladder cancer accounted for around 68% of all cases, with 42% in the Ta low-grade stage. About 32% of bladder cancer prevalent cases were muscle-invasive bladder cancer patients, from which about 8% had metastatic tumors. Conclusion: Researchers and policymakers can utilize the findings of this study to conduct economic burden analyses and plan resource allocation.