Practical Hurdles Research Articles

Renewable Energy Subsidies and WTO Law: Time to Rethink the Case for Reform Beyond Canada – Renewable Energy/Fit Program

Since the Canada – Renewable Energy/FIT Program (2013) dispute at the World Trade Organization (WTO), it has become almost conventional wisdom in the literature that a clash exists between international climate change mitigation goals and WTO law, with a growing consensus (if not anxiety) that WTO subsidy rules ought to be reformed in order to safeguard ‘policy space’ for government support to renewable energy. It is contended here that, in several ways, such a call for reform has been misconceived and needs to be recalibrated. This is mainly because the case for reform has been seldom evaluated in light of State practice beyond that particular WTO dispute, nor informed by an in-depth assessment of how different green energy subsidies will fare under existing WTO subsidy disciplines. Our aim here is to fill this gap in the existing literature. In particular, our analysis shows that the main problem is neither feed-in tariffs per se, nor the multilateral disputes that have been brought before the WTO dispute settlement bodies. For this reason, we argue that the applicability of Article XX GATT to the Agreement on Subsidies and Countervailing Measures (SCM Agreement), which has been often suggested in the scholarship, is not the solution towards ensuring greater supportiveness between international trade and climate change regimes. In fact, such an avenue will provide no legal shelter for those climate-friendly energy subsidies that have actually been at a higher risk under current WTO rules (i.e., through unilateral remedial action). Conversely, the other common proposal of introducing a specific exemption into the SCM Agreement for certain ‘good’ RE subsidies appears most effective from a mutual supportiveness perspective, but faces considerable political and practical hurdles at the present junction.

Abstract 1421: Flexible tools for the development and performance verification of customized target enrichment panels

Abstract Implementation of next generation sequencing for variant identification and discovery presents difficulties both in the selection of genomic loci for inclusion in a panel, as well as the ability to effectively verify the performance of the assay based on the content selected. Balancing the relevance of genomic content with the practical hurdles of developing specific assays necessitates new approaches for the application of next generation sequencing toward precision medicine that are aimed at providing the flexibility of content to efficiently provide data capable of testing fundamental biological hypotheses. NEBNext Direct Custom Ready Panels overcome these obstacles by enabling the rapid development and deployment of customized target enrichment panels. This offering allows researchers to select from a large library of genes for which baits have been developed and optimized to produce sequencing data with extremely high specificity and coverage uniformity. These panels are effective in targeting a wide range of content, from highly focused, single-gene panels, to comprehensive panels comprised of hundreds of genes. In a similar approach for the verification and validation of new panels, SeraCare has developed the VariantFlex™ system, which is comprised of a broad library of mutations to develop custom controls and reference materials for NGS-based assays. These biosynthetic constructs contain variants such as SNVs, indel, frameshift and fusion variants that can be used to formulate controls across a range of variant allele frequencies, providing the necessary content and flexibility to verify assay performance. Here we will present data demonstrating the combined utility of these offerings to assess target enrichment panel performance with a range of genomic content, panel sizes and variant allele frequencies. Citation Format: Cynthia L. Hendrickson, Evan Mauceli, Andrew Barry, Kruti Patel, Catherine Huang, Scott Adams, Bharathi Anekella. Flexible tools for the development and performance verification of customized target enrichment panels [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1421.

Glioma imaging in Europe: A survey of 220 centres and recommendations for best clinical practice

ObjectivesAt a European Society of Neuroradiology (ESNR) Annual Meeting 2015 workshop, commonalities in practice, current controversies and technical hurdles in glioma MRI were discussed. We aimed to formulate guidance on MRI of glioma and determine its feasibility, by seeking information on glioma imaging practices from the European Neuroradiology community.MethodsInvitations to a structured survey were emailed to ESNR members (n=1,662) and associates (n=6,400), European national radiologists’ societies and distributed via social media.ResultsResponses were received from 220 institutions (59% academic). Conventional imaging protocols generally include T2w, T2-FLAIR, DWI, and pre- and post-contrast T1w. Perfusion MRI is used widely (85.5%), while spectroscopy seems reserved for specific indications. Reasons for omitting advanced imaging modalities include lack of facility/software, time constraints and no requests. Early postoperative MRI is routinely carried out by 74% within 24–72 h, but only 17% report a percent measure of resection. For follow-up, most sites (60%) issue qualitative reports, while 27% report an assessment according to the RANO criteria. A minority of sites use a reporting template (23%).ConclusionClinical best practice recommendations for glioma imaging assessment are proposed and the current role of advanced MRI modalities in routine use is addressed.Key Points• We recommend the EORTC-NBTS protocol as the clinical standard glioma protocol.• Perfusion MRI is recommended for diagnosis and follow-up of glioma.• Use of advanced imaging could be promoted with increased education activities.• Most response assessment is currently performed qualitatively.• Reporting templates are not widely used, and could facilitate standardisation.

Intensive home treatment for patients in acute psychiatric crisis situations: a multicentre randomized controlled trial

BackgroundHospitalization is a common method to intensify care for patients experiencing a psychiatric crisis. A short-term, specialised, out-patient crisis intervention by a Crisis Resolution Team (CRT) in the Netherlands, called Intensive Home Treatment (IHT), is a viable intervention which may help reduce hospital admission days. However, research on the (cost-)effectiveness of alternatives to hospitalisation such as IHT are scarce. In the study presented in this protocol, IHT will be compared to care-as-usual (CAU) in a randomized controlled trial (RCT). CAU comprises low-intensity outpatient care and hospitalisation if necessary. In this RCT it is hypothesized that IHT will reduce inpatient days by 33% compared to CAU while safety and clinical outcomes will be non-inferior. Secondary hypotheses are that treatment satisfaction of patients and their relatives are expected to be higher in the IHT condition compared to CAU.MethodsA 2-centre, 2-arm Zelen double consent RCT will be employed. Participants will be recruited in the Amsterdam area, the Netherlands. Clinical assessments will be carried out at baseline and at 6, 26 and 52 weeks post treatment allocation. The primary outcome measure is the number of admission days. Secondary outcomes include psychological well-being, safety and patients’ and their relatives’ treatment satisfaction. Alongside this RCT an economic evaluation will be carried out to assess the cost-effectiveness and cost-utility of IHT compared to CAU.DiscussionRCTs on the effectiveness of crisis treatment in psychiatry are scarce and including patients in studies performed in acute psychiatric crisis care is a challenge due to the ethical and practical hurdles. The Zelen design may offer a feasible opportunity to carry out such an RCT. If our study finds that IHT is a safe and cost-effective alternative for CAU it may help support a further decrease of in-patient bed days and may foster the widespread implementation of IHT by mental health care organisations internationally.Trial registrationThe trial is registered in the Netherlands Trial Register as # NTR-6151. Registered 23 November 2016.

The Curious Case of Colonel Kumar Lama: Its Origins and Impact in Nepal and the United Kingdom, and Its Contribution to the Discourse on Universal Jurisdiction

This paper, in essence, is a case study of Colonel Kumar Lama, marking almost a year since his acquittal, 6 September 2016. The prosecution for alleged acts of torture committed in Nepal was brought in the UK courts, under universal jurisdiction, against Kumar Lama: a Nepalese army officer. However, Lama was acquitted due to a hung jury and the Crown Prosecution Services' decision not to retry the case. The case thus far has not been the subject of detailed academic study, perhaps due to the lack of information available in public as the trial transcript is not published. Nonetheless, it represents one of the few instances of the use of this jurisdictional basis before the UK courts; its analysis will therefore provide important insights into the practical limits of universal jurisdiction. The present work adopts a socio-legal approach in uncovering the origins of the Lama case and exploring its diverse effects in Nepal and the UK. This in turn facilitates a discussion of its wide-ranging contribution to the discourse on universal jurisdiction. The empirical research undertaken, semi-structured interviews, allows this paper to communicate valuable opinions gathered from those involved in the case, organisations and lawyers, as well as high-ranking state officials and army officers in Nepal with thought-provoking perspectives on the impact achieved by this case. The case had more to it than meets the eye. If one goes on media reports only, a certain opinion would be reached. A deeper analysis of the case revealed a different conclusion. This research discovered that the Lama case played a vital role in raising awareness in Nepal and triggered legal and practical responses towards strengthening its transitional justice process. Above all, it allowed the victims' painful stories to be heard which reawakened their hope towards justice. The case also revealed the strategy behind the litigation in the UK and the practical hurdles encountered, which helped construct informed suggestions, such as creating specialised units, for more effective litigation of universal jurisdiction cases in the future. An important line of criticism of international law was deduced from some interviews in Nepal, backed up by scholarly critique, which contributes to the bigger picture of comprehending universal jurisdiction in practice. Overall, the current developments and the practical improvements identified indicates a relatively positive future direction of universal jurisdiction as a tool to ensure accountability for international crimes. A reflection on its landmark cases revealed that it takes decades of perseverance by transnational actors globally for such cases to succeed in court. This leads the paper to conclude that while universal jurisdiction may be a commendable legal principle, it is often overwhelmed by practical and political interruptions which need to be tackled carefully and collectively.

Conservation Introductions for Biodiversity Adaptation under Climate Change

AbstractAnthropogenic climate change represents a wicked problem, both for the Earth’s natural systems and for biodiversity conservation law and policy. Legal frameworks for conservation have a critical role to play in helping species and ecosystems to adapt as the climate changes. However, they are currently poorly equipped to regulate adaptation strategies that demand high levels of human intervention. This article investigates law and policy for conservation introductions, which involve relocating species outside their historical habitat. It takes as a case study Australian law on conservation introductions, demonstrating theoretical and practical legal hurdles to these strategies at international, national and subnational levels. The article argues that existing legal mechanisms may be repurposed, in some cases, to better regulate conservation introduction projects. However, new legal mechanisms are also needed, and soon, to effectively conserve species and ecosystems in a period of unprecedented ecological change.

In the Mouths of Babes

This article explores the development of a methodological approach to interviewing children based on semi-directive projective interviews, as used in my PhD entitled Child and Nation (2012). It raises some of the ethical, epistemological and practical hurdles when interviewing children in middle childhood and presents the solutions that were found to address these issues.

A Community-Based IoT Personalized Wireless Healthcare Solution Trial.

This paper presents an advanced Internet of Things point-of-care bio-fluid analyzer; a LoRa/Bluetooth-enabled electronic reader for biomedical strip-based diagnostics system for personalized monitoring. We undertake test simulations (technology trial without patient subjects) to demonstrate potential of long-range analysis, using a disposable test ‘key’ and companion Android app to form a diagnostic platform suitable for remote point-of-care screening for urinary tract infection (UTI). The 868 MHz LoRaWAN-enabled personalized monitor demonstrated sound potential with UTI test results being correctly diagnosed and transmitted to a remote secure cloud server in every case. Tests ranged over distances of 1.1–6.0 Km with radio path losses from 119–141 dB. All tests conducted were correctly and robustly received at the base station and relayed to the secure server for inspection. The UTI test strips were visually inspected for correct diagnosis based on color change and verified as 100% accurate. Results from testing across a number of regions indicate that such an Internet of Things medical solution is a robust and simple way to deliver next generation community-based smart diagnostics and disease management to best benefit patients and clinical staff alike. This significant step can be applied to any type of home or region, particularly those lacking suitable mobile signals, broadband connections, or even landlines. It brings subscription-free long-range bio-telemetry to healthcare providers and offers savings on regular clinician home visits or frequent clinic visits by the chronically ill. This paper highlights practical hurdles in establishing an Internet of Medical Things network, assisting informed deployment of similar future systems.

Properties and potential optoelectronic applications of lead halide perovskite nanocrystals.

Semiconducting lead halide perovskites (LHPs) have not only become prominent thin-film absorber materials in photovoltaics but have also proven to be disruptive in the field of colloidal semiconductor nanocrystals (NCs). The most important feature of LHP NCs is their so-called defect-tolerance-the apparently benign nature of structural defects, highly abundant in these compounds, with respect to optical and electronic properties. Here, we review the important differences that exist in the chemistry and physics of LHP NCs as compared with more conventional, tetrahedrally bonded, elemental, and binary semiconductor NCs (such as silicon, germanium, cadmium selenide, gallium arsenide, and indium phosphide). We survey the prospects of LHP NCs for optoelectronic applications such as in television displays, light-emitting devices, and solar cells, emphasizing the practical hurdles that remain to be overcome.

Impact Of Using Overall Survival Or Progression-Free Survival In Outcomes-Based Pricing Arrangements

Outcomes-based pricing arrangements (OBPA) can be attractive for payers to address uncertainty. In oncology overall survival (OS) is considered the gold standard outcomes measure. However, implementing OBPA based on OS poses significant practical hurdles. Here we assess the feasibility and impact of using progression-free survival (PFS) as an alternative measure to enable OBPA. A three-part, mixed-methods study was performed to assess the use of OBPA in oncology. A scoping review was conducted to identify current and past OBPA. Further, the impact of OBPA - using either OS or PFS - on savings and health improvements in the population the payer is paying for was modelled for four metastatic cancer compounds. (Ex-) payers’ perceptions and attitudes where also explored through semi-structured qualitative interviews. In the metastatic setting OBPA based on OS or PFS can both address uncertainty around health outcomes and costs. In the four compounds, OBPA based on OS had a greater impact on payers’ outcomes in the population the payer is paying for (increase in median OS of 6.9 months compared to 2.8 months in median PFS) and potential savings (15% compared to 10%). Although PFS has a smaller impact, the time to trigger a payback was reduced between 18.9 and 4.9 months in the 4 compounds. The definition of a relevant and measurable endpoint is necessary to increase the use of OBPA. OS is seen as the ultimate outcome by the interviewees and is beneficial to payers in terms of health outcomes in the population they pay for and savings. However, it is often not feasible to implement because of the long follow-up time required. Using PFS might be a good alternative to OS in the metastatic setting. More research is needed to further explore alternative outcome measures to successfully support OBPA.

Evaluation of Practical Interpretation Hurdles in 68Ga-PSMA PET/CT in 55 Patients: Physiological Tracer Distribution and Incidental Tracer Uptake.

To investigate the physiologic Ga-PSMA distribution and evaluate focal or diffuse radiotracer uptake in nonprostate cancer malignancies and in incidental findings. Ga-PSMA PET/CT scans in 55 men performed for prostate cancer (49) or renal cell carcinoma (6) staging were analyzed retrospectively. Two radiologists evaluated the datasets in 2 reading sessions. First, physiological Ga-PSMA uptake was evaluated. Second, scans were analyzed for incidental uptake. SUVmax and SUVmean were recorded. Other imaging modalities, histopathology, or clinical follow-up served as standard of reference. Homogenous Ga-PSMA uptake of the lacrimal glands (SUVmax, 15.7 ± 7.2), parotid glands (SUVmax, 24.4 ± 8.1), submandibular glands (SUVmax, 26.7 ± 7.1), vocal cords (SUVmax, 8.4 ± 3), Waldeyer ring (SUVmax, 10.4 ± 4.3), liver (SUVmax, 8.2 ± 2.5), spleen (SUVmax, 10.9 ± 3.9), kidneys (SUVmax, 66.4 ± 25.4), and pars descendens duodeni (SUVmax, 17.6 ± 8.9) was observed in all patients. In 65% and 36%, respectively, homogenous Ga-PSMA uptake of the colon descendens (SUVmax, 10.6 ± 9.2) and the rectum (SUVmax, 3.7 ± 1.1) was found. Approximately 22% exhibited a Ga-PSMA uptake of the thyroid (SUVmax, 4.5 ± 1.2), and 21% exhibited a Ga-PSMA uptake of the knee's synovia (SUVmax, 2.9 ± 0.2). Furthermore, Ga-PSMA uptake was found in 1 patient because of fibrous dysplasia of the right os ilium (SUVmax, 7.7). Physiologic distribution of Ga-PSMA comprises uptake in lacrimal and salivary glands, vocal cords, Waldeyer ring, liver, spleen, and kidneys as well as various parts of the intestine. Moreover, nonspecific tracer uptake is regularly found in the thyroid and the synovia of the knee. Incidental Ga-PSMA uptake can occasionally reveal nonprostate cancer-associated remodeling processes, such as fibrous dysplasia.

Calera: Entrepreneurship, Innovation, and Sustainability

A high-risk, highly capital-intensive start-up had confirmed its product's scalability and must then decide what business model made sense. It's biomimicry-inspired, environmentally sustainable cement product and related processes had the potential to lower greenhouse gas emissions, possibly sequester carbon, and even assist in potable water production. If everything worked as hoped, Calera's method seemed like a magic sponge capable of absorbing multiple pollutants and transforming them into desirable products. The reality, though full of possibilities, was complex, with many practical hurdles. Excerpt UVA-ENT-0160 Rev. Sept. 27, 2010 Calera: Entrepreneurship, Innovation, and Sustainability Introduction Brent Constantz had three decades of entrepreneurial experience starting companies based on how cements formed in coral reefs and seashells. Yet those same reefs and shells were threatened by ocean acidification from anthropogenic carbon dioxide emissions (Exhibit 1). Constantz had a simple insight: If humans could make cement as marine life did (through biomimicry) without burning fuel and converting minerals in high-temperature processes, then greenhouse gas (GHG) emissions would be significantly reduced. With that idea, Calera Corporation was born. Calera's goal was to make synthetic limestone and carbonate cement, both used as major feedstock for concrete, by mimicking nature's low-energy process. Calera's process aimed to precipitate carbonate cement from seawater (ideally retentate left by desalination) and combine it with a strong alkaline base. When Constantz accidently discovered carbon dioxide (CO2) could enhance his process, he realized he needed a source of CO2. When he brought his technology and his challenge to cleantech venture capitalist Vinod Khosla, Calera suddenly became a carbon capture and sequestration (CCS) technology company, one with massive storage potential if located proximate to point sources of pollution: Power plants emitted 40% of U.S. carbon dioxide in 2008 and industrial process facilities dispersed another 20%. Yet a high level of technical risk and a number of unknowns remained about the breadth of applicability due to the requirement for brines and alkaline materials. Khosla, as the principal investor, shared Constantz's vision and saw the huge promise and the attendant risk of failure as a high-risk high-impact potential home run that would completely change assumptions about the power and cement industry or a strikeout. . . .

Stent-mediated gene and drug delivery for cardiovascular disease and cancer: A brief insight.

This review concisely recapitulates the different existing modes of stent-mediated gene/drug delivery, their considerable advancement in clinical trials and a rationale for other merging new technologies such as nanotechnology and microRNA-based therapeutics, in addition to addressing the limitations in each of these perpetual stent platforms. Over the past decade, stent-mediated gene/drug delivery has materialized as a hopeful alternative for cardiovascular disease and cancer in contrast to routine conventional treatment modalities. Regardless of the phenomenal recent developments achieved by coronary interventions and cancer therapies that employ gene and drug-eluting stents, practical hurdles still remain a challenge. The present review highlights the limitations that each of the existing stent-based gene/drug delivery system encompasses and therefore provides a vision for the future with respect to discovering an ideal stent therapeutic platform that would circumvent all the practical hurdles witnessed with the existing technology. Further study of the improvisation of next-generation drug-eluting stents has helped to overcome the issue of restenosis to some extent. However, current stent formulations fall short of the anticipated clinically meaningful outcomes and there is an explicit need for more randomized trials aiming to further evaluate stent platforms in favour of enhanced safety and clinical value. Gene-eluting stents may hold promise in contributing new ideas for stent-based prevention of in-stent restenosis through genetic interventions by capitalizing on a wide variety of molecular targets. Therefore, the central consideration directs us toward finding an ideal stent therapeutic platform that would tackle all of the gaps in the existing technology.

Cell Isolation and Recovery Using Hollow Glass Microspheres Coated with Nanolayered Films for Applications in Resource-Limited Settings

Established cell isolation and purification techniques such as fluorescence-activated cell sorting (FACS), isolation through magnetic micro/nanoparticles, and recovery via microfluidic devices have limited application as disposable technologies appropriate for point-of-care use in remote areas where lab equipment as well as electrical, magnetic, and optical sources are restricted. We report a simple yet effective method for cell isolation and recovery that requires neither specialized lab equipment nor any form of power source. Specifically, self-floating hollow glass microspheres were coated with an enzymatically degradable nanolayered film and conjugated with antibodies to allow both fast capture and release of subpopulations of cells from a cell mixture. Targeted cells were captured by the microspheres and allowed to float to the top of the hosting liquid, thereby isolating targeted cells. To minimize nonspecific adhesion of untargeted cells and to enhance the purity of the isolated cell population, an antifouling polymer brush layer was grafted onto the nanolayered film. Using the EpCAM-expressing cancer cell line PC-3 in blood as a model system, we have demonstrated the isolation and recovery of cancer cells without compromising cell viability or proliferative potential. The whole process takes less than 1 h. To support the rational extension of this platform technology, we introduce extensive characterization of the critical design parameters: film formation and degradation, grafting with a poly(ethylene glycol) (PEG) sheath, and introducing functional antibodies. Our approach is expected to overcome practical hurdles and provide viable targeted cells for downstream analyses in resource-limited settings.

A novel design for stable self-assembly cubosome precursor-microparticles enhancing dissolution of insoluble drugs

Cubosomes have been presented to enhance dissolution of insoluble drugs, but their applications are limited by the practical hurdles associated with both preparation and storage instability, resulting in drug delivery failure. In the present study, an innovative cubosome precursor-microparticles (CPMs) spray dried from an aqua-free precursor solution was developed to improve cubosome stability during both preparation and storage as well as to enhance the dissolution of insoluble drugs. These CPMs spontaneously self-assembled in situ forming homogeneous cubosome dispersion by hydration and disintegration after exposure to the aqueous medium. The stable cubosome dispersion was obtained from self-assembly (SA) of CPMs after administration instead of fragmentation of bulk cubic phase gel into cubosomes, which settled the preparation instability due to avoidance of high energy fragmentation (e.g. ultrasonic effect, high speed shear and high pressure homogenization). Also, the subsequent storage instability issue can be excluded as the CPMs were stored in a solid stable form. The CPMs disintegration and cubosome SA were demonstrated by the notable morphology variation and the distinct microparticle size decrease from CPMs (10–20 μm) to SA-cubosomes (150–200 nm). The cumulative release of docetaxel (DTX, model insoluble drug) incorporated in CPMs increased to 96.4% within 120 minutes compared with only 75.2% for blank CPMs and DTX physical mixture, demonstrating that CPMs significantly enhanced the dissolution extent of insoluble drug. The SA-cubosomes possessed quite high drug entrapment efficiency (>95%) and an integrated drug dissolution content, which significantly increased the drug utilization rate.

Back to Basics

Nonprofits are under increased accountability pressures to demonstrate their effectiveness. Output measurement (how much is produced) is disregarded as simplistic. Emphasis is made instead on measuring outcomes (changes in the lives of beneficiaries) or impacts (effects developed relative to the mission of the nonprofit, or the overall public good), and a growing portion of organizations state that they measure these effects. However, we question the assumption that outputs such as the number of beneficiaries served are being adequately measured. We first review existing research gaps on results measurement practices and discuss the main types of obstacles to the quality and utility of evaluation data. In this context, we argue for the need to reground nonprofit evaluation in the profound knowledge available about beneficiary populations. We discuss the potential and limitations of reach, a basic output indicator that is defined as the number of individuals directly affected by a nonprofit, and explore the organizational drivers of reach measurement. Evidence from 2,229 nonprofits shows they still lack adequate data on the beneficiaries they serve, face relevant conceptual and practical hurdles when trying to identify them, and are significantly influenced by organizational factors in their capacity to track them. Our research not only shows that nonprofits fail to adequately measure outputs, but also that measuring the number of beneficiaries served and how they are served is not as straightforward as outcome and impact advocates suggest. Practitioners and funders are reminded of the need to place beneficiaries at the core of their evaluation efforts.

New Guidance for an Old Problem

Early release of seriously ill and elderly prisoners is possible in several countries, but only few prisoners gain such exemption. We identified hurdles to the implementation of early release laws in Europe by analyzing legal requirements for such release and with 40 stakeholder qualitative interviews. Provisions are based on prisoners’ health status and the ability to care for them in prison. Interviews revealed three barriers: practical hurdles, penological goals, and multiple interests. Finally, early release is obstructed because three justifications are often confounded: compassion, the principle of equivalence, and practical concerns, such as costs and overcrowding.

The insights of health and welfare professionals on hurdles that impede economic evaluations of welfare interventions

ABSTRACTBackground: Four hurdles associated with economic evaluations in welfare interventions were identified and discussed in a previous published literature review. These hurdles include (i) ‘Ignoring the impact of condition-specific outcomes’, (ii) ‘Ignoring the impact of QoL externalities’, (iii) ‘Calculation of costs from a too narrow perspective’ and (iv) ‘The lack of well-described & standardized interventions’. This study aims to determine how healthcare providers and social workers experience and deal with these hurdles in practice and what solutions or new insights they would suggest.Methods: Twenty-two professionals of welfare interventions carried out in Flanders, were interviewed about the four described hurdles using a semi-structured interview. A thematic framework was developed to enable the qualitative analysis. The analysis of the semi-structured interviews was facilitated through the use of the software program QRS NVivo 10.Results: The interviews revealed a clear need to tackle these hurdles. The interviewees confirmed that further study of condition-specific outcomes in economic evaluations are needed, especially in the field of mental health and stress. The proposed dimensions for the condition-specific questionnaires varied however between the groups of interviewees (i.e. general practitioners vs social workers). With respect to QoL externalities, the interviewees confirmed that welfare interventions have an impact on the social environment of the patient (friends and family). There was however no consensus on how this impact of QoL externalities should be taken into account in welfare interventions. Professionals also suggested that besides health care costs, the impact of welfare interventions on work productivity, the patients’ social life and other items should be incorporated. Standardization appears to be of limited added value for most of the interviewees because they need a certain degree of freedom to interpret the intervention. Furthermore, the target population of the interventions is diverse which requires a tailor-made approach.Conclusion: This qualitative research demonstrated that these hurdles occur in practice. The proposed solutions for these hurdles can contribute to the improvement of the methodological quality of economic evaluations of welfare interventions.

OA14.05 A Framework to Support the Lung Cancer Nurse Specialist in the Development and Evaluation of Nurse-Led Clinics

The United Kingdom National Lung Cancer Forum for Nurses Workshop 2015 produced guidance to support Lung Cancer nurse Specialists in developing and evaluating nurse-led clinics. Nurse-led clinics have been in existence for years with little guidance on structure and evaluation. They are safe and effective. Nurses provide individual care that makes a difference to patient outcomes. There is vast evidence available for nurse-led services but significantly less on lung cancer specific services despite a growing body of evidence to support this. A literature search was performed. This included developing a lung cancer nurse-led clinic, evaluation, audit tool and measurement. The initial search found limited number of relevant documents. Therefore the search was widened to include developing general nurse-led services. The NLCFN members were surveyed to evaluate current nurse-led clinics. The questionnaire comprised of eighteen questions incorporating all aspects of nurse-led follow up. 60% responded, suggesting a high interest in the area. Over half of the respondents ran nurse-led clinics. These included telephone, results, post-surgery, Health & Well being, TKI and breathlessness clinic. However 67% had not evaluated or audited these, 74% didn’t have patient information leaflets and 96% had access to medical cover. The seven most important steps in developing a lung cancer nurse-led clinic are: Aims and Objectives, Planning and Consultation, Multidisciplinary Support, Infrastructure, promoting the nurse-led service, Professional Development and Audit and Evaluation. These formed the basis of this framework. NICE (2011), suggests that patients should be offered a “follow-up led by a LCNS.” However, nurse-led clinics are challenging and there are many practical and emotional hurdles to be overcome. This framework supports LCNS’s in developing and evaluating nurse-led clinics . It gives clear guidance to be considered when developing and new service as well as advising on audit/evaluation tools and developing patient information leaflets.

Development of European standards for evaluative reporting in forensic science

Criminal justice authorities of EU countries currently engage in dialogue and action to build a common area of justice and to help increase the mutual trust in judicial systems across Europe. This includes, for example, the strengthening of procedural safeguards for citizens in criminal proceedings by promoting principles such as equality of arms. Improving the smooth functioning of judicial processes is also pursued by works of expert working groups in the field of forensic science, such as the working parties under the auspices of the European Network of Forensic Science Institutes (ENFSI). This network aims to share knowledge, exchange experiences and come to mutual agreements in matters concerning forensic science practice, among them the interpretation of results of forensic examinations. For example, through its Monopoly Programmes (financially supported by the European Commission), ENFSI has funded a series of projects that come under the general theme ‘Strengthening the Evaluation of Forensic Results across Europe’. Although these initiatives reflect a strong commitment to mutual understanding on general principles of forensic interpretation, the development of standards for evaluation and reporting, including roadmaps for implementation within the ENFSI community, are fraught with conceptual and practical hurdles. In particular, experience through consultations with forensic science practitioners shows that there is a considerable gap between the intentions of a harmonised view on principles of forensic interpretation and the way in which works towards such common understanding are perceived in the community. In this paper, we will review and discuss several recurrently raised concerns. We acknowledge practical constraints such as limited resources for training and education, but we shall also argue that addressing topics in forensic interpretation now is of vital importance because forensic science continues to be challenged by proactive participants in the legal process that tend to become more demanding and less forgiving.