Preliminary Recommendations Research Articles

PP502 AQuAS Learnings From Implementing GRADE Approach, Especially The Evidence To Decision Framework And Multidisciplinary Final Consensus

IntroductionIn recent years, the GRADE system has been adopted internationally to make judgments about evidence and/or recommendations. Recently, the Spanish Network of HTA (RedETS) has promoted among its members the use of the GRADE system, especially the “Evidence to Decision” tool (EtD) where a multidisciplinary panel is involved. The objective is to describe the methodological approach with the first AQuAS experience using this methodology in HTA, focused on inclusion/exclusion of these technologies in the Spanish National Health Service (NHS) portfolio.MethodsThe standard EtD tool was used for clinical and financial decisions. Four multidisciplinary panels were constituted by relevant professionals in clinical practice and, where possible, patients. The four panels discussed on the following four interventions: in two cases, AQuAS prepared preliminary recommendations and participants provided feedback, while in the other two cases, experts received the evidence review and were asked to formulate recommendations. These recommendations were voted on and, in the case of disagreement, adapted and then voted on for a second time. Finally, any discrepancies were noted in the report. Evaluated interventions were: maxillofacial 3D-reconstruction, cataract surgery equipment, non-invasive surgery in obesity and pharmacological treatment in secondary fracture prevention.ResultsEspecially when more than one evaluative question was addressed in the HTA report the EtD and the consensus results required discussion. Consensus was fast but not immediate. Meeting length depended on the number of HTA questions and the amount of original disagreement in the recommendations. The nuances on how to write recommendations also affected the panel duration. All panels were successful in formulating the final recommendations.ConclusionsStandardizing methodologies increased the homogeneity across HTA reports. The GRADE system is a feasible and useful tool because it favors transparency and rigor in drawing up recommendations on the inclusion/exclusion of technologies in the NHS portfolio. The EtD framework complements GRADE tables, which display the relevant evidence in a way that can be used by multidisciplinary groups to reach a consensual recommendation.Although all participants received a short training video, more experience in the use of these methodologies might shorten the duration of the process and facilitate reaching consensus. Some considerations on how to overcome the difficulties and complexity of this methodological approach are discussed.

Seizure detection devices: A survey of needs and preferences of patients and caregivers

AimsSeizure detectors could have many positive effects on the quality of life of people with epilepsy (PWE) such as alarms to reduce seizure-related injuries or reliable seizure counts leading to improved epilepsy management. As seizure detection gains increasing interest within the epilepsy research community, guidelines for patient-centered designs are needed. This study aims to detail the preferences, needs and concerns regarding potential seizure detectors, of PWE and their caregivers across Canada. MethodsTwo questionnaires were designed to survey PWE and their caregivers on seizure detection acceptability and to collect general clinical characteristics. The surveys were available online for nine weeks and were promoted by Canadian organizations of PWE. Participation was voluntary and anonymous. ResultsResponses from 221 PWE and 171 caregivers were collected. Ninety-seven percent of PWE and 99% of caregivers expressed interest in seizure detection. Most would use seizure detectors continuously, in conjunction with a seizure diary, and wanted automated alarms. Smartwatches and bracelets/rings were considered most acceptable and would be worn continuously by 58% and 61% of PWE, respectively. Additional value was attributed to multimodal seizure detection. Responders were most concerned about false negatives, comfort and cost. They expected seizure detection to improve their quality of life and quality of care, and felt confident in their ability to use a seizure detector. ConclusionsWhile PWE and caregivers in Canada show great enthusiasm for seizure detection, their opinions are shaped by their perception of the effectiveness and reliability of this technology and its cost. A preliminary technology acceptance model and recommendations promoting the development of seizure detectors demonstrating an understanding of their future users are presented. Future investigations should focus on a larger population of patients who have previously used seizure detection devices to assess user-feedback.

Differential effects of token production and exchange on responding of children with developmental disabilities

Token economies are commonly used in educational and clinical settings as tools for reinforcing appropriate behavior. However, little applied research has been conducted to investigate the behavioral mechanisms involved. What’s more, research with non-human animals suggests that tokens may serve discriminative functions which may actually suppress responding under high schedule requirements. This study explores the relationship between schedules of token production (i.e., dense, lean, and yoked reinforcement) and response patterns in three children with autism spectrum disorders (ASD). Relative to yoked reinforcement schedules, token production corresponded with higher response rates and shorter pre-ratio pauses (PRPs) under low schedule requirements. Under high schedule requirements, all three participants demonstrated higher response rates and shorter PRPs in the yoked reinforcement condition relative to either token production condition. These findings are consistent with research involving non-human animals suggesting that, under high schedule requirements, tokens may signal lengthy delays to reinforcement and potentially even suppress responding. Thus, we provide preliminary recommendations for using token reinforcement systems most effectively in applied contexts.

Mapping the landscape of male-on-male rape in London: an analysis of cases involving male victims reported between 2005 and 2012

ABSTRACT Male-on-male rape remains an under-researched area, and little is known about the characteristics and outcomes of this type of crime. This study examines 122 rape cases involving young adult and adult male victims reported to the London Metropolitan Police Service between 2005 and 2012. Overall, there were a number of similarities with cases involving female victims; however, male cases were more likely to involve strangers, substance use, and a victim with mental health issues, alluding to specific vulnerabilities. Moreover, younger victims, victims with poor mental health, and victims who had consumed alcohol or drugs were less likely to have their cases referred to prosecutors and more likely to be ‘no-crimed’ by police. This paper provides unique insight into the profile and trajectories of male-on-male rape cases, and preliminary recommendations for both police practice and future research are provided.

Recommendations for rheumatology ultrasound training and practice in the UK.

The aim of this paper is to present a UK-based consensus of principles and recommendations to guide rheumatology US training and practice. A Delphi process was conducted involving 19 US experts representing each of the 14 regions of the UK. A working group of experienced British Society for Rheumatology Ultrasound Special Interest Group (BSRUSSIG) members made seven proposals that were presented to the whole group for further discussion. This resulted in minor modifications and seven preliminary recommendations. Members were then asked to anonymously agree or disagree with each recommendation using an electronic ballot. A threshold of 75% was used to determine consensus agreement. Results were collated by an independent chairperson and presented to the BSRUSSIG in a face to face meeting where agreement for each recommendation was ratified and an action plan agreed for dissemination of the results and future development work. Using a validated process, experts in rheumatology US have worked through an iterative process and have unanimously agreed seven recommendations for rheumatology training and practice. These cover a hierarchy of practice indications, education and training, including the need for practitioners to demonstrate lifelong learning, as well as a commitment to support mentors and trainers through the BSRUSSIG. These are the first specific education and practice recommendations for rheumatology US in the UK and have been developed and endorsed by the BSRUSSIG. We intend that these proposals will help to support and validate rheumatology US practice and inform the development of future rheumatology training curricula and education programmes.

Controversies in airway management of COVID-19 patients: updated information and international expert consensus recommendations

Controversies in airway management of COVID-19 patients: updated information and international expert consensus recommendations

COVID‐19 coagulopathy in pregnancy: Critical review, preliminary recommendations, and ISTH registry—Communication from the ISTH SSC for Women’s Health

BackgroundNovel coronavirus (SARS‐CoV‐2), which causes COVID‐19, has thus far affected more than 15 million individuals, resulting in more than 600 000 deaths worldwide, and the number continues to rise. In a large systematic review and meta‐analysis of the literature including 2567 pregnant women, 7% required intensive care admission, with a maternal mortality ~1% and perinatal mortality below 1%. There has been a rapid increase in publications on COVID‐19–associated coagulopathy, including disseminated intravascular coagulopathy and venous thromboembolism, in the non‐pregnant population, but very few reports of COVID‐19 coagulopathy during pregnancy; leaving us with no guidance for care of this specific population. MethodsThis is a collaborative effort conducted by a group of experts that was reviewed, critiqued, and approved by the International Society on Thrombosis and Haemostasis Subcommittee for Women's Health Issues in Thrombosis and Hemostasis. A structured literature search was conducted, and the quality of current and emerging evidence was evaluated. Based on the published studies in the non‐pregnant and pregnant population with a moderate to high risk of bias as assessed by Newcastle‐Ottawa scale and acknowledging the absence of data from randomized clinical trials for management of pregnant women infected with SARS‐CoV‐2, a consensus in support of a guidance document for COVID‐19 coagulopathy in pregnancy was identified. Results and ConclusionsSpecific hemostatic issues during pregnancy were highlighted, and preliminary recommendations to assist in the care of COVID‐19–affected pregnant women with coagulopathy or thrombotic complications were developed. An international registry to gather data to support the management of COVID‐19 and associated coagulopathy in pregnancy was established.

Steps toward a Study of Symeon the Stylite the Younger and His Saint’s Cult*

A large dossier of primary sources survives for Symeon the Stylite the Younger from Late Antiquity. These sources include not only hagiographical evidence, but also archaeological remains from his cult site, homilies, and at least one letter. They offer insight into the varied voices which shaped Symeon’s identity, sanctity, and ministry in the sixth and early seventh centuries CE. The state of scholarship on these sources is uneven, however, with the result that scholars have primarily studied the saint and his cult through the lens of the hagiographic material, the Life of Symeon Stylites the Younger in particular. In order to lay the foundation for a full inquiry into the saint and his cult, this article disentangles the dossier of evidence on Symeon in Late Antiquity. It introduces each source in chronological order; provides an overview of authorship, date, and the state of scholarship for each source; and makes preliminary recommendations for paths forward. It is meant to be a guide for art historians and archaeologists unfamiliar with the sizeable literary corpus, textual scholars who do not often work with material sources, and, for both groups, an introduction to problems in the dossier. It encourages scholars to treat each source on its own terms and re-evaluate the rich interconnections between the textual and archaeological evidence.

International Recommendations for the Management of Adults Treated With Ketogenic Diet Therapies.

To evaluate current clinical practices and evidence-based literature to establish preliminary recommendations for the management of adults using ketogenic diet therapies (KDTs). A 12-topic survey was distributed to international experts on KDTs in adults consisting of neurologists and dietitians at medical institutions providing KDTs to adults with epilepsy and other neurologic disorders. Panel survey responses were tabulated by the authors to determine the common and disparate practices between institutions and to compare these practices in adults with KDT recommendations in children and the medical literature. Recommendations are based on a combination of clinical evidence and expert opinion regarding management of KDTs. Surveys were obtained from 20 medical institutions with >2,000 adult patients treated with KDTs for epilepsy or other neurologic disorders. Common side effects reported are similar to those observed in children, and recommendations for management are comparable with important distinctions, which are emphasized. Institutions differ with regard to recommended biochemical assessment, screening, monitoring, and concern for long-term side effects, and further investigation is warranted to determine the optimal clinical management. Differences also exist between screening and monitoring practices among adult and pediatric providers. KDTs may be safe and effective in treating adults with drug-resistant epilepsy, and there is emerging evidence supporting the use in other adult neurologic disorders and general medical conditions as well. Therefore, expert recommendations to guide optimal care are critical as well as further evidence-based investigation.

Ethical challenges for women’s healthcare highlighted by the COVID-19 pandemic

Healthcare policies developed during the COVID-19 pandemic to safeguard community health have the potential to disadvantage women in three areas. First, protocols for deferral of elective surgery may assign a...

Experts document on methotrexate use in combined therapy with biological or targeted synthetic disease modifying drugs in patients with rheumatoid arthritis.

We aimed to develop recommendations for the management of methotrexate (MTX) when considering the combination with biological (b) or targeted synthetic (ts) disease modifying drugs (DMARDs) in rheumatoid arthritis (RA). Eleven experts on RA were selected. Two coordinators formulated 13 questions about the combination therapy of MTX with bDMARDs or tsDMARDs. A systematic review was conducted to answer the questions. Inclusion and exclusion criteria were established as well as the search strategies (Medline, Embase and the Cochrane Library were searched up to January 2019). Two reviewers selected the articles and collected data. Simultaneously, EULAR and ACR meeting abstracts were evaluated. Based on this evidence, the coordinators proposed preliminary recommendations that the experts discussed and voted in a nominal group meeting. The level of evidence and grade of recommendation was established using the Oxford Center for Evidence Based Medicine and the level of agreement with a Delphi. Agreement was established if at least 80% of the experts voted 'yes' (yes/no). The systematic review retrieved 513 citations of which 61 were finally included. A total of 10 recommendations were generated, voted and accepted. The level of agreement was very high in all of them and it was achieved in the first Delphi round. Final recommendations cover aspects such as the optimal MTX dosage, tapering strategy or patients' risk management. This document is intended to help clinicians solve usual clinical questions and facilitate decision making when treating RA patients with MTX in combination with bDMARDs or tsDMARDs.

Next Steps in the Evolution of the Scratchpads Virtual Research Platform: A framework for the evaluation of data storage alternatives for Scratchpads

The Scratchpads virtual research platform is widely used by more than a thousand communities to share and manage biodiversity data. It is an open source project that can be run by any individual, but most sites are hosted on a dedicated service run by the Natural History Museum London. After 12 years of use and several major upgrades, the size and complexity of the Scratchpads codebase makes it increasingly difficult to maintain. The underlying content management system (Drupal 7) reaches its end of support in November 2022, providing a further justification to migrate Scratchpad sites to a new, more sustainable platform, at the same time allowing us to improve standards compliance and add functionality for users. Building on the work initiated at the Biodiversity_Next symposium SI46 Biodiversity Virtual Research Environments: past, present & possible futures, we identified the need to decouple the front and backend components of the architecture. This allows for a simpler migration path for our existing sites, allowing us to migrate the Scratchpad data to alternative backend platforms while retaining the familiar front end experience for users. This decoupling approach is more sustainable, affording potential for deep collaboration on the backend and its associated API (application programming interface). Analysis of current Scratchpad user activities shows that the data requirements of Scratchpads sites vary significantly. To support this variation, a successor platform must incorporate a well-defined API that can give an individual site flexibility in the choice of a backend. In this presentation we will update the community on our efforts to evaluate alternative backend platforms (both domain-specific and generalist), considering an assessment derived from the Technology Readiness Level (TRLs) of these systems, and their functionality fit with current Scratchpad features. We will discuss our evaluation approach and the results of this study, taking into account the diverse nature of these systems and their fit to our criteria. This approach may be useful to others when addressing similar challenges for evaluating choices on platform migration, and may help to identify gaps or overlapping features in the virtual research software ecosystem. These gaps and overlaps can then be addressed in collaboration with other platform developers. Finally, we will present our preliminary recommendations and invite further input from developers and stakeholders.

The devil is in the details: How arbitration system design and training facilitate and inhibit repeat‐player advantages in private and state‐run arbitration hearings

AbstractThis article demonstrates that arbitration system design and the training that arbitrators receive shape the extent to which repeat players gain advantages in arbitration hearings. While prior arbitration research does suggest that arbitrator training matters, this is the first article to show how it matters, as we observe actual arbitration hearings in private and state‐run arbitration systems in two states. Our comparative analysis links three literatures interested in how seemingly interest‐neutral institutions, like disputing forums, serve in practice to reinforce dominant norms, values, and hierarchies: (1) sociolegal studies of repeat‐player advantages in disputing, (2) studies of occupational socialization in educational settings, and (3) neoinstitutional organizational sociology studies of how managerial values influence the way in which organizations construct law. We bridge these literatures by showing how arbitrator system design and the occupational socialization that arbitrators receive in private arbitration are primary mechanisms through which managerial values influence the arbitration process, ultimately providing a pathway for repeat‐player advantages in hearings. Because our analysis compares two distinct arbitration systems, we identify variation in these processes and offer preliminary but tangible policy recommendations for the design and implementation of arbitration systems that best protect civil and consumer rights within arbitral forums that the Supreme Court continually upholds.

Advancing Our Pharmacy Reformation - Accelerating Education and Practice Transformation: Report of the 2019-2020 Argus Commission

The Argus Commission examined changes that should be considered by colleges and schools of pharmacy to meet the bold aim of better integrating pharmacists' and physicians' practices articulated by President Sorensen. The Commission assessed the readiness of pharmacy educators to contribute to the acceleration of practice transformation. The primary focus of the report is on how the doctor of pharmacy curriculum and post-graduate training might be modified and better aligned to ensure that graduates complete their education ready to engage in roles partnered with primary care clinicians. The aim is to achieve comprehensive medication management and other pharmacist patient care services as standards of care. The Argus Commission provides preliminary recommendations for new or more intensified priorities by the 2020-21 AACP Strategic Planning Committee as they update the AACP plan. This includes the recommendation that AACP should create the Center for Academic Innovation and Practice Transformation, a hub to coordinate many current and emerging activities relevant to accelerating change in pharmacy education and practice.

The analysis of factors influencing the trajectory of the vibrating screen

Due to the fact that the shape of the trajectory of the sieve vibrating screen significantly affects the efficiency of cleaning the drilling mud from the drilled rock, this article identifies and analyzes the factors influencing the formation of the trajectory of the sieve. The study of the nature of the motion of the particles of the drilled rock is carried out. The motion-equation of the point of the jigging frame, respectively, and a certain section of the screen can be described by an non-homogeneous second-order differential equation (Newton equation). The equation of the trajectory of the jigging frame is also considered. The influence of the amount of drilling mud, which is on the vibrating screen at a certain time-point, on the trajectory is taken into account in this equation. The drilling mud complex system consisting of liquid and solid fractions – sludge, sand and sludge – is taken into account. In this case, the fluid and clay move without separation from the sieve, and sludge and coagulated clay – with separation from the transport surface. Depending on the position on the sieve, each component of the drilling mud at different time periods moves with different trajectories and different other variable parameters along the length of the sieve. Therefore, the main purpose of the research is to obtain a graphical real trajectory of the selected point of the jigging frame of vibrating screens, to compare it with theoretical graphical dependences and to establish parameters that affect the change in the amplitude of jogging frame vibrations in real operating conditions. The coverage of the problem and the main results of the research are performed in real conditions (when vibrating screens work on the drilling rigs). The research is performed using simple recording devices installed at six places – on the left and right sides of the jigging frame above the front and rear shock absorbing springs, and in the center of stuff – between springs. All the real trajectories of certain points of the jigging frame and screen can be described using certain Lissajous figures. However, it was found that not all trajectories coincide completely with the classic Lissajous figures, because the trajectory is influenced by external factors that cause chaotic motion of the jigging frame – the Sommerfeld effect, as well as non-uniformity of drilling fluid delivery. The nature of the movement of the vibrating plane - the screen - is also affected by the rigidity of the vibrating support, including the entire structure of the vibrating screens. The phenomenon of resonance is possible in the area of ​​vibration supports. In addition, it was previously established that the trajectory of the point of a certain area of ​​the screen is a spatial figure that requires additional theoretical and experimental studies. When moving the drilling fluid on the sieve with the toss, the cleaning efficiency will be much higher due to the increase in vibration force. Based on the analysis of the results of the factors influencing the trajectory of the sieve, preliminary recommendations are given for the correct adjustment of the vibrating screen.

African League Against Rheumatism (AFLAR) preliminary recommendations on the management of rheumatic diseases during the COVID-19 pandemic

ObjectivesTo develop recommendations for the management of rheumatic and musculoskeletal diseases (RMDs) during the COVID-19 pandemic.MethodA task force comprising of 25 rheumatologists from the 5 regions of the continent was formed and operated through a hub-and-spoke model with a central working committee (CWC) and 4 subgroups. The subgroups championed separate scopes of the clinical questions and formulated preliminary statements of recommendations which were processed centrally in the CWC. The CWC and each subgroup met by several virtual meetings, and two rounds of voting were conducted on the drafted statements of recommendations. Votes were online-delivered and recommendations were pruned down according to predefined criteria. Each statement was rated between 1 and 9 with 1–3, 4–6 and 7–9 representing disagreement, uncertainty and agreement, respectively. The levels of agreement on the statements were stratified as low, moderate or high according to the spread of votes. A statement was retired if it had a mean vote below 7 or a ‘low’ level of agreement.ResultsA total of 126 initial statements of recommendations were drafted, and these were reduced to 22 after the two rounds of voting.ConclusionsThe preliminary statements of recommendations will serve to guide the clinical practice of rheumatology across Africa amidst the changing practices and uncertainties in the current era of COVID-19. It is recognized that further updates to the recommendations will be needed as more evidence emerges.Key Points• AFLAR has developed preliminary recommendations for the management of RMDs in the face of the COVID-19 pandemic.• COVID-19 is an unprecedented experience which has brought new concerns regarding the use of some disease-modifying anti-rheumatic drugs (DMARDs), and these recommendations seek to provide guidelines to the African rheumatologists.• Hydroxychloroquine shortage has become rampart across Africa as the drug is being used as prophylaxis against COVID-19 and this may necessitate a review of treatment plan for some patients with RMDs.• Breastfeeding should continue for as long as possible if a woman is positive for SARS-CoV-2 as there is currently no evidence that the infection can be transmitted through breast milk.

Constructing Rules on Exclusions (Debarment) Under a Post-Brexit Regime on Public Procurement: A Preliminary Analysis

This current initiative to reform public procurement after Brexit raises the question of how to deal with exclusions (debarment) in the UK legal system. This area has received little attention in the past but Brexit offers both more legal flexibility and a political opportunity to address the topic. Against this background and to inform and stimulate the reform debate this paper identifies the key issues and make some preliminary recommendations for the post-Brexit exclusion regime. The paper argues, first and foremost, that there is a strong argument for a more centralised approach. Such an approach, if properly operated and resourced, can potentially have many benefits in addressing corruption and other policy problems, in improving performance of public contracts and in providing better protection for suppliers. More specifically the paper, first, argues that there should be centrally-administered mandatory exclusions for integrity breaches, which should cover wider grounds than current mandatory exclusions and should not be limited to cases where the supplier has a criminal conviction or other formal judgment against it. The paper also considers certain issues relating to the detail of such exclusions, including the role of the central agency, and coordination with the criminal justice system. The paper also discusses the potential role of centralisation in relation to exclusions for poor past performance, arguing that centralisation also has an important role in this area, too, as well as in helping individual procuring entities to assess suppliers’ technical competence. The paper also proposes setting up a general framework for mandatory exclusions in other policy areas that might be considered suitable for mandatory exclusions in future. Finally, it examines the extent to which discretionary exclusions for individual entities should be retained or added to the legal regime against the background of the paper’s proposals for mandatory exclusions.

4.A. Round table: Points of entry in light of the COVID-19 outbreak – a European perspective

Points of entry (PoE) have a crucial role in responding to a public health event of international concern (PHEIC) such as COVID-19. Border measures such as entry screening, quarantine and communication are implemented to stop or slow down the spread of COVID-19. Temperature screening at airports, denied access to ports for cruise ships with suspected cases on-board, long-lasting quarantine on board of a cruise ship or temporary suspending cross-border train traffic are just some examples of how PoE are affected by the current outbreak situation.Using the network of the EU Joint Action Healthy Gateways group (JAHG) on preparedness and action at PoE, this workshop aims to highlight strategies and experiences across Europe with respect to awareness, prevention, detection and control of COVID-19 at PoE. The workshop will give a short overview of the current situation in Europe and briefly elaborate on expected and unexpected roles of PoE during the COVID-19 outbreak. Selected key aspects and case-based reports regarding COVID-19 management at PoE will be lined out and discussed: Experiences, challenges and needs of PoE in Europe.Communication and information strategies are crucial in an outbreak situation. The workshop will display case-based examples and emphasize on the challenges and efficacy of different strategies during the COVID-19 outbreak. In addition, the need for and experiences of information exchange between POE will be stressed and illustrated.An outbreak situation with a formerly unknown, novel virus such as Sars-CoV-2 requires specific education and training at POE. Practice examples of educational measures (such as e. g. personal instructions, written material, webinars etc.) as well as challenges in rapid development of training material and in assessing specific training needs will be highlighted.What can we learn so far from COVID-19 outbreak management at PoE in Europe? Some preliminary practice recommendations for PoE will be put to discussion. Preliminary results of a survey on how POE dealt with COVID-19 and the specific training needs PoE encountered in this situation will also be presented at the workshop.PoE in Europe, and all over the world, play an important role in the COVID-19 outbreak. This session provides the opportunity to discuss experiences and challenges of COVID-19 outbreak management at PoE from European countries and thereby contributes to skill building and knowledge exchange among experts from the field to learn for future outbreaks.Key messages COVID-19 is a major challenge for PoE across Europe. Diverse and partly non-coherent measures for the outbreak management have been put in place at PoE leaving room for harmonization.Communication and information as well as specific education and training on site are particularly challenging and put burden on PoE staff. Adaptive communication and training strategies are needed. Panelists: Aura Timen RIVM, Bilthoven, NetherlandsContact: Aura.timen@rivm.nl Martin Dirksen-Fischer Institute of Hygiene and the Environment, Ministry of Federal Health and Consumer Protection, Hamburg, GermanyContact: martin.dirksen-fischer@hu.hamburg.de Brigita Kairiene Department of Communicable Diseases Management, National Public Health Centre, Klaipeda, LithuaniaContact: brigita.kairiene@nvsc.lt Evelien Belfroid RIVM, Bilthoven, NetherlandsContact: evelien.belfroid@rivm.nl Doret de Rooij RIVM, Bilthoven, NetherlandsContact: doret.de.rooij@rivm.nl

Systematic review examining the evidence for impact of school policies on physical activity

Abstract Background Epidemiological evidence has demonstrated that physical activity can have substantive health benefits for children and young people. The 'Policy Evaluation Network' is a multi-disciplinary research network across 7 European countries and New Zealand aimed at building capacity and evaluating the level of impact of policy interventions for promoting healthy lifestyles. The Toronto Charter identified 'whole-of-school' programmes as one of seven key investments for promotion of PA. This paper presents results of a SLR, designed to assess the level of evidence for policies within the school setting that contribute directly or indirectly to increasing PA. Methods Researchers searched six online databases for scientific literature regarding PA policy interventions in the school setting using key concepts of policy, school, PA and evaluation. Risk of bias will be assessed with tools appropriate to the design of the studies considered. Evidence of actual or potential positive PA outcomes arising directly or indirectly from policy actions will be catalogued. Results Preliminary searches identified 2327 unique scientific articles. 1938 (83.3%) were excluded on first reading and 189 (8.8%) were included for full text analysis. Initial findings suggest that organisational policies, for example avoiding overcrowding in playgrounds during school breaks, may be a promising policy action. Detailed analysis revealing other potential policy actions supported by evidence will be presented (SLR in progress). Conclusions Preliminary findings suggest that few studies link policy actions in the school setting to PA outcomes. However, studies that have investigated the effects of changes to the school environment on PA levels may provide evidence for policy actions. Preliminary recommendations include strengthening the evidence base for school-based PA policy by supporting studies into the effects of particular policy or legislative changes on PA outcomes. Key messages School physical activity policies are an underappreciated public health intervention. More studies should link policy changes to physical activity outcomes.

Evaluation of cooling effect and pavement performance for thermochromic material modified asphalt mixtures under solar radiation

The thermal effect of asphalt pavements on the surrounding environment in summer is of increasing concern since they absorb a great deal of heat from solar radiation and contribute greatly to the urban heat island effect. A novel thermochromic material modified asphalt binder is proposed to modulate pavement temperature by reversibly changing colors and reflectivity to solar radiation in response to temperature variations. In this study, an attempt is extended into the mixture scale. The cooling effect and pavement performance of thermochromic material modified asphalt mixtures are evaluated using a proposed solar radiation simulation test and various mechanical tests. The thermochromic material modification mechanism is revealed from the physical and chemical points of view. It is found that the addition of thermochromic additive to base binders has a significant cooling effect on asphalt pavements in summer. The maximum temperature reduction is observed at the bottom of the top asphalt layer and the top of the middle asphalt layer. Two types of thermochromic additives show positive and negative effects on rutting resistance. Thermochromic material modification has little effect on low-temperature cracking resistance and all thermochromic material modified mixtures exhibit good moisture stability. Preliminary recommendations on the optimum additive type and content of thermochromic material are proposed. The characteristics of coating, dispersion, and intactness of thermochromic additives in base binders significantly affect the pavement performance of asphalt mixtures. The particle size of the thermochromic additive and the chemical composition of shell material are critical to binder modification.