Real World Research Articles

Cost Asymmetry, Commodity Taxes and Antidumping Policies

We examine how the presence of a commodity tax affects the superiority of an antidumping duty and a price undertaking policy under cost asymmetry between the foreign and domestic firms. We obtain several interesting results as follows. First, the domestic welfare under a price undertaking is higher than that under an antidumping duty, if the domestic firm is more efficient than the foreign firm and the normal value is large. Second, the presence of a commodity tax usually leads the domestic government to be more likely to choose an antidumping duty. Third, the presence of a commodity tax leads the foreign firm to prefer a price undertaking to an antidumping duty. The first two results show that the domestic firm’s lower efficiency and the commodity tax can explain why the cases involving adopting a price undertaking are far fewer than those concerned with an antidumping duty in the real world.

Generative AI for Health Technology Assessment: Opportunities, Challenges, and Policy Considerations - an ISPOR Working Group Report

ObjectiveTo provide an introduction to the uses of generative Artificial Intelligence (AI) and foundation models, including large language models (LLMs), in the field of health technology assessment (HTA). MethodsWe reviewed applications of generative AI in three areas: systematic literature reviews, real world evidence (RWE) and health economic modeling. Results(1) Literature reviews: generative AI has the potential to assist in automating aspects of systematic literature reviews by proposing search terms, screening abstracts, extracting data and generating code for meta-analyses; (2) Real World Evidence (RWE): generative AI can facilitate automating processes and analyze large collections of real-world data (RWD) including unstructured clinical notes and imaging; (3) Health economic modeling: generative AI can aid in the development of health economic models, from conceptualization to validation. Limitations in the use of foundation models and LLMs include challenges surrounding their scientific rigor and reliability, the potential for bias, implications for equity, as well as nontrivial concerns regarding adherence to regulatory and ethical standards, particularly in terms of data privacy and security. Additionally, we survey the current policy landscape and provide suggestions for HTA agencies on responsibly integrating generative AI into their workflows, emphasizing the importance of human oversight and the fast-evolving nature of these tools. ConclusionsWhile generative AI technology holds promise with respect to HTA applications, it is still undergoing rapid developments and improvements. Continued careful evaluation of their applications to HTA is required. Both developers and users of research incorporating these tools, should familiarize themselves with their current capabilities and limitations.

Standardised and Reproducible Phenotyping Using Distributed Analytics and Tools in the Data Analysis and Real World Interrogation Network (DARWIN EU)

ABSTRACTPurposeThe generation of representative disease phenotypes is important for ensuring the reliability of the findings of observational studies. The aim of this manuscript is to outline a reproducible framework for reliable and traceable phenotype generation based on real world data for use in the Data Analysis and Real‐World Interrogation Network (DARWIN EU). We illustrate the use of this framework by generating phenotypes for two diseases: pancreatic cancer and systemic lupus erythematosus (SLE).MethodsThe phenotyping process involves a 14‐steps process based on a standard operating procedure co‐created by the DARWIN EU Coordination Centre in collaboration with the European Medicines Agency. A number of bespoke R packages were utilised to generate and review codelists for two phenotypes based on real world data mapped to the OMOP Common Data Model.ResultsCodelists were generated for both pancreatic cancer and SLE, and cohorts were generated in six OMOP‐mapped databases. Diagnostic checks were performed, which showed these cohorts had broadly similar incidence and prevalence figures to previously published literature, despite significant inter‐database variability. Co‐occurrent symptoms, conditions, and medication use were in keeping with pre‐specified clinical descriptions based on previous knowledge.ConclusionsOur detailed phenotyping process makes use of bespoke tools and allows for comprehensive codelist generation and review, as well as large‐scale exploration of the characteristics of the resulting cohorts. Wider use of structured and reproducible phenotyping methods will be important in ensuring the reliability of observational studies for regulatory purposes.

Real world effectiveness of oral semaglutide: Focus on patients with type 2 diabetes older than 75 years

AimData on the efficacy of oral semaglutide (OS) in elderly patients with type 2 diabetes are still lacking. This study evaluates the effectiveness of OS in a real world setting with a large ≥75 year old population. MethodsThis study includes all type 2 diabetic patients who started OS between October 2021 and December 2023 in seven diabetes centers. Data were collected at baseline, 6 (T6) and 12 (T12) months. Effectiveness measures were assessed on the total sample and by patient age (<65, 65–75, >75 years). ResultsOverall 1824 patients started OS, of those 18.7 % were over 75 years (>75 yr). OS resulted in a significant reduction in rate of patients using sulphonylureas, rapid and basal insulin therapy, HbA1c reduced by 0.87 % at T6 and at T12 (both p < 0.0001), body weight by 2.78 Kg (p < 0.0001) at T6 and 3.89 Kg (p < 0.0001) at T12. Similarly, >75 yr showed HbA1c reduction at T6 (p < 0.0001) and T12 (p = 0.0003), body weight significantly reduced (p for interaction 0.005) both at T6 (−1.57 Kg; p = 0.0003) and T12 (−2.74 Kg; p < 0.0001). ConclusionIn our study, OS results efficacy in non-elderly and elderly patients, making it an effective treatment option also for very elderly type 2 diabetic patients.

Bridging Real and Virtual: An Ecological Approach to Prevent Cyberviolence Against Women

ABSTRACTWomen experience gender violence more than men, in the digital world as well as offline. To understand and prevent this phenomenon, we must consider the continuum between the virtual and the real world and highlight that cyberviolence and offline violence follow the same patterns. Therefore, to comprehend cyberviolence against women, the present study aimed to examine the feelings and emotions of those who have had direct and indirect experiences with it. The research involved 43 young Italians, aged 20–35 and used a narrative approach with a stimulus composed of six questions. The textual material was analysed using reflexive thematic analysis and four main themes emerged: Emotional experiences of cyberviolence; the amplification of cyberviolence in the offline world; the role of bystanders; and actions to prevent cyberviolence. The results highlighted the importance of approaching cyberviolence against women from a holistic and multidimensional perspective through an ecological approach that integrates different levels of action: collective, organisational, interpersonal and individual. Cyberviolence against women entails interventions that are complex and multi‐focused on all those who inhabit the virtual dimension, as well as the offline dimension, where the consequences of online violence become evident.

Exploring the Effect of Viewing Attributes of Mobile AR Interfaces on Remote Collaborative and Competitive Tasks.

Mobile devices have the potential to facilitate remote tasks through Augmented Reality (AR) solutions by integrating digital information into the real world. Although prior studies have explored Mobile Augmented Reality (MAR) for co-located collaboration, none have investigated the impact of various viewing attributes that can influence remote task performance, such as target object viewing angles, synchronization styles, or having a secondary small screen showing other users current view in the MAR environment. In this paper, we explore five techniques considering these attributes, specifically designed for two modes of remote tasks: collaborative and competitive. We conducted a user study employing various combinations of those attributes for both tasks. In both instances, results indicate users' optimal performance and preference for the technique that allows asynchronous viewing of object manipulations on the small screen. Overall, this paper contributes novel techniques for remote tasks in MAR, addressing aspects such as viewing angle and synchronization in object manipulation alongside secondary small-screen interfaces. Additionally, it presents the results of a user study evaluating the effectiveness, usability, and user preference of these techniques in remote settings and offers a set of recommendations for designing and implementing MAR solutions to enhance remote activities.

P275 A real world study (LADDER) of characteristics, treatment patterns and clinical outcomes among high-risk non-muscle invasive bladder cancer patients - preliminary results

P275 A real world study (LADDER) of characteristics, treatment patterns and clinical outcomes among high-risk non-muscle invasive bladder cancer patients - preliminary results

Senescence, change, and competition: When the desire to pick one model harms our understanding

The question of why we age is a fundamental one. It is about who we are, and it also might have critical practical aspects as we try to find ways to age slower. Or to not age at all. Different reasons point at distinct strategies for the research of anti-ageing drugs. While the main reason why biological systems work as they do is evolution, for quite a while, it was believed that aging required another explanation. Aging seems to harm individuals so much that even if it has group benefits, those benefits were unlikely to be enough. That has led many scientists to propose non-evolutionary explanations as to why we age. But those theories seem to fail at explaining all the data on how species age. Here, I will show that the insistence of finding the one idea that explains it all might be at the root of the difficulty of getting a full picture. By exploring an evolutionary model of aging where locality and temporal changes are fundamental aspects of the problem, I will show that environmental change causes the barrier for group advantages to become much weaker. That weakening might help small group advantages to add up to the point they could make an adaptive difference. To answer why we age, we might have to abandon asking which models are correct. The full answer might come from considering how much each hypothesis behind each existing model, evolutionary and non-evolutionary ones, contributes to the real world’s solution.

Electrochemical self-doping in intrinsically ionic, thermally activated delayed fluorescence materials enables high-performance light-emitting electrochemical cells

Intrinsically ionic, thermally activated delayed fluorescence (TADF) materials are promising active materials for solid-state light-emitting electrochemical cells (LECs), but the origin for their superior device performances has remained elusive and how to further boost their device performances toward real world applications has remained an open question. Here, three TADF materials containing the same TADF unit have been prepared, which include a neutral one (R), an ionic one with an imidazolium cation being anchored to the acceptor through an alkyl chain (E1), and an intrinsically ionic one with an imidazolium cation being directly anchored to the acceptor (E2). By comparison between R, E1 and E2, it is revealed that n-type electrochemical self-doping occurs in E2 upon electron-injection onto its acceptor in operating LECs, due to in-situ formed, closely bound [electron-imidazolium cation] pair, which significantly enhances the device performance. By enhancing the chemical stability of the material and centering the carrier recombination zone in the active layer, the green LECs afford peak brightness up to 1461cd/m−2, external quantum efficiencies (EQEs) up to 9.1 %, and half-lifetimes up to 371h at constant current of 50 A/m−2. Peak brightness/EQE/half-lifetime at 322 cd/m−2/10.1 %/∼1800 h has further been achieved at constant current of 10 A/m−2. These LECs represent the most efficient, bright, and stable TADF LECs reported so far. The work clarifies the great advantage and huge potential of intrinsically ionic TADF materials, with unique electrochemical self-doping capacity, for fabricating efficient, bright and stable light-emitting devices.

DUETS for Light's in separating exudate from transudate.

Fifty years since its inception, Light's criteria have aided in classifying pleural effusions (PEs) as exudates if 1 or more criteria are met. Thoracic ultrasound (US) emerges as a non-invasive technique for point of care use especially if pleural procedures are contemplated. We aimed to develop a score based on radiological and US features that could separate exudates from transudates without serum and pleural fluid biochemical tests necessary for Light's criteria. A prospective review of consecutive patients with PE who underwent thoracocentesis was performed. CXRs were evaluated for laterality followed by US for echogenicity, pleural nodularity, thickening and septations. PE was classified as exudate or transudate according to Light's criteria and corroborated with albumin gradient. A score combining radiological and US features was developed. We recruited 201 patients with PE requiring thoracocentesis. Mean age was 64 years, 51% were females, 164 (81.6%) were exudates, and 37 (18.4%) were transudates. Assigning 1-point for Diaphragmatic nodularity, Unilateral, Echogenicity, Pleural Thickening and Septations, DUETS ranged from 1 to 5. DUETS ≥2 indicated high likelihood for exudate (PPV 98.8%, NPV 100%) with 1% misclassification versus 6.9% using Light's criteria (p < 0.001). DUETS separated exudates from transudates with good accuracy, and could obviate paired serum and pleural fluid tests necessary for Light's criteria computation. Our study reflected real world practice where DUETS performed better than Light's criteria for PE that arose from more than one disease processes, and in the evaluation of patients with PE who have received diuretics.

Treatment patterns and outcomes in patients with non-small cell lung cancer.

Over the last decade, innovative treatments have enlarged the therapeutic arsenal against NSCLC. Although there is clinical evidence supporting treatment options, controversy surrounds the impact of their combinations and sequence. The goal of this study was to fill this gap using real world data (Symphony Health).9676 Patients with a diagnosis of non-metastatic (NM) and metastatic (M) NSCLC between July 2016 and December 2016 were included and followed till December 2021. The following data were collected: diagnostic date, age, gender, comorbidities, metastases, treatments (SUrgery, RAdiotherapy, CHemotherapy, IMmunotherapy, and TArgeted therapies), sequence (L1-L4), and death. Treatment patterns (Sankey graphs), and outcomes (Kaplan-Meyer and Cox regressions) were derived.Amongst NM patients, the most frequently observed treatments were RA, IM, IM and CH in first, second, third and fourth lines respectively. In M patients, the most frequent treatments were CH, IM, IM, and IM in first, second, third and fourth lines respectively. The overall 5-years survival in the cohort was 23.7% (36% in NM, 16% in M). The corresponding median survival time were 1.98 years (3.2 NM, 1.27 M). In NM, best median survival times were recorded for those with only one line SU. For patients who had 2 lines, CH→IM; 3 lines, CH→IM→CH. In M, best median survival times were recorded for those with only one line RA. For patients who had 2 lines CH→IM; 3 lines CH→IM→CH.These new insights could guide further studies and improve the management of patients with NSCLC.

P200 Retrospective observational study on patients with metastatic renal cell carcinoma treated in first line with Pembrolizumab + Axitinib: A real world project of the campania oncology network

P200 Retrospective observational study on patients with metastatic renal cell carcinoma treated in first line with Pembrolizumab + Axitinib: A real world project of the campania oncology network

Outcomes of percutaneous versus endoscopic transmural necrosectomy for necrotizing pancreatitis: A propensity score-matched study

BackgroundFew published studies exist that compare the outcomes of different endoscopic necrosectomy methods for necrotizing pancreatitis (NP). We compared the safety and efficacy of percutaneous versus transmural endoscopic necrosectomy for NP patients. MethodsIn this retrospective cohort study, we analyzed adult NP patients who underwent either percutaneous endoscopic necrosectomy (PEN) or endoscopic transmural necrosectomy (ETN), and compared safety and efficacy between the two groups. Propensity score-matched analysis and multivariable logistic regression analysis were conducted. ResultsA total of 280 patients were enrolled, among which 142 underwent PEN and 138 underwent ETN. There were differences in baseline characteristics between the two groups, including body mass index, C-reactive protein, systemic inflammatory response syndrome score. The incidences of sepsis, respiratory failure, and intensive care unit stay were higher among patients who underwent PEN than those who underwent ETN (all P < 0.01). Ninety-one pairs were matched with comparable baseline characteristics and severity. The incidence of postoperative complications, open surgery, clinical success, radiological success, collection recurrence, and reintervention were not significantly different between the ETN group and PEN group (all P > 0.05). Multivariate analysis also showed that the approaches (PEN vs ETN) was not associated with postoperative complications or mortality. ConclusionsIn real world setting, sicker patients tend to be more effectively managed through PEN compared to ETN. PEN demonstrates comparable efficacy and safety to ETN in the treatment of NP patients.

Initiatives to improve lung and sleep health in children: Delphi consensus from the pediatrics, pulmonary, and sleep conference.

The lung and sleep health of adults is heavily influenced by early factors, both genetic and environmental; therefore, optimizing respiratory health begins in childhood. Multiple barriers impede improvements in lung and sleep health for children. First, the traditional siloing between general pediatric care in the community, pediatric pulmonary and sleep subspecialty care, and the research community limits the translation of knowledge into practice. Additionally, identifying and addressing health disparities remains a challenge. The 2021 NHLBI-sponsored workshop "Defining and Promoting Pediatric Pulmonary Health (DAP3H)" was a first step in defining critical gaps in our current healthcare system in identifying and optimizing lung and sleep health in children. The workshop identified key opportunities including measuring pulmonary function in young children, sleep-focused outcomes, developing biomarkers, and longitudinal research cohorts. To expand on the work of DAP3H and continue initiatives to improve childhood lung and sleep health, the Pediatrics & Pulmonary Network: Improving Health Together conference was held in 2023. A modified Delphi process was applied to form consensus surrounding gaps, barriers, and action items, with the goal of identifying the most urgent opportnities for improving childhood lung and sleep health. Cross-cutting foundational principles were identified as: (1) Authentic Stakeholder Collaboration & Engagement, (2) Reach & Implementation in Real World Settings, (3) Understanding Current Landscape & Resources and (4) Purposeful Diversity, Equity, & Inclusion Initiatives. To improve lung and sleep health in children, these principles should be the foundation for research design, development, and implementation.

P187 Redefining care of elderly patients with renal carcinoma, real world data results from the Spanish RENO study

P187 Redefining care of elderly patients with renal carcinoma, real world data results from the Spanish RENO study

OA08 Ocrelizumab in pregnancy in a patient with juvenile onset systemic lupus erythematosus

Abstract Introduction Juvenile-onset systemic lupus erythematosus (jSLE) is a multisystem autoimmune disease that results in increased disease activity compared to adult-onset SLE. jSLE in pregnancy results in a greater incidence of disease flares as well as adverse pregnancy outcomes. Management of SLE in pregnancy is particularly difficult due to lack of safety data for immunosuppressant medications and is therefore limited. Ocrelizumab is a humanised monoclonal antibody that selectively targets CD20 B cells and is approved for the treatment of multiple sclerosis. Despite never being trialled in a patient with active SLE in pregnancy, this case demonstrates its use with a successful outcome. Case description An 18-year-old female was diagnosed at age 14 with juvenile onset systemic lupus erythematosus with the presence of a photosensitive malar rash, arthralgia, alopecia, aphthous ulcers and headache. At the time of diagnosis her investigations revealed ANA 1:5120 with homogenous pattern, high dsDNA, low C3 and C4, thrombocytopenia, antibodies to Smith, Ro, RNP, anti-Rib-P, strongly positive lupus anticoagulant antibodies and low titre anti-cardiolipin IgG and IgM. Previous treatment included methotrexate, mycophenolate mofetil and cyclosporin which were discontinued either due to patient choice, inefficacy or adverse reaction. Azathioprine was contraindicated due to low TMPT. Rituximab was trialled and although effective had to be stopped due to adverse reaction. Unfortunately, she experienced a primigravida pregnancy loss at 15-20 weeks secondary to active SLE and pre-eclampsia. Shortly after this, she developed a rare case of anti-fascin antibody neuropathy and was treated with ocrelizumab. Six months later during her second pregnancy, she was treated with hydroxychloroquine 400 mg, aspirin 150 mg, folic acid 5 mg and low molecular weight heparin prophylaxis which were continued throughout the pregnancy. Due to concerns of active lupus at 13 weeks due to facial rash and fatigue, prednisolone was commenced at 10 mg daily and continued. After careful consideration, Ocrelizumab was given in the second trimester at 17 and 19 weeks’ gestation. Following this, symptoms remained under control and disease activity was low with normal C3/C4 and dsDNA levels without significant proteinuria. A newborn baby was delivered at 38 weeks by caesarean section without complication or foetal abnormalities. Both the mother and baby remain under close follow- up but have not demonstrated adverse outcomes at 3 months postpartum. Discussion This case demonstrates the use of Ocrelizumab in the second trimester of a high-risk pregnancy complicated by active jSLE. At present, there is no license for use of Ocrelizumab in SLE and no safety data on its use in pregnancy. However, there was a good outcome for this patient which resulted in no antenatal or postpartum complications and the successful birth of a healthy newborn without foetal abnormalities. Ocrelizumab is used for the treatment of early relapsing-remitting multiple sclerosis (RRMS) and is increasingly used by neurologists in women of childbearing age despite being unlicensed for use in pregnancy. Concerns of its use in pregnancy surround B cell depletion in the neonate which while tends to be transient, causes significant concern regarding long term immunological development and response to vaccination. B cell depleting therapies are widely used in the context of active and refractory SLE and therefore use of Ocrelizumab has been evaluated in cases of SLE in two phase III clinical trials. The first study examined the efficacy of Ocrelizumab in SLE without renal involvement (BEGIN) and the second recruited patients with lupus nephritis (BELONG). The BEGIN study was terminated early due to lack of response and the BELONG study was terminated due to a significant increase in serious infections (in the Ocrelizumab plus mycophenolate treatment group). However, results on disease activity were positive with complete renal response being achieved non-statistically more frequently in the Ocrelizumab treated patients versus placebo. Real world evidence shows the importance of achieving disease control in SLE around pregnancy to prevent adverse outcomes. The decision for the use of Ocrelizumab therefore needs to be balanced carefully against potential harm to the baby either from direct foetal exposure to the drug, or from gestation in an immunocompromised mother. Key learning points • Pre-pregnancy counselling is of paramount importance in severe cases of active SLE and when possible, pregnancy should be postponed in these instances until disease activity is stabilised with contraception counselling offered to those on teratogenic immunosuppressive agents. • A multidisciplinary approach to the management of complex SLE in pregnancy in essential with obstetrician, midwife, maternal medicine physician and rheumatologist input. • The benefit of potentially life-saving immunosuppressive treatment should be carefully balanced against the poor outcomes of active SLE in pregnancy and decisions should be made on a case-by-case basis.

P143 Safety and oncological outcomes of patients with metastatic hormone sensitive prostatecancer: A real world multicentric experience in a chemo naïve setting

P143 Safety and oncological outcomes of patients with metastatic hormone sensitive prostatecancer: A real world multicentric experience in a chemo naïve setting

Ultrahypofractionated Adjuvant Breast Radiotherapy (+/- Boost) and Virtual Consultations: Patient Perspectives at One Year

Purpose/Objectives: In March 2020, a 1 week ultrahypofractionated adjuvant breast radiotherapy schedule, 26 Gy in 5 fractions and telehealth were adopted to reduce the risk of COVID-19 for staff and patients. This study describes real world 1 year late toxicity for ultrahypofractionation (including a sequential boost) and patient perspectives on this new schedule and telehealth workflows. Materials and Methods: Consecutive patients were enrolled Mar-Aug 2020. Patient reported outcome measures including the presence of breast pain, swelling, firmness, and others were recorded using the EORTC QLQ BR45 at baseline, 3 months, 6 months and 1 year. Virtual teleconferencing without video was utilised. Patients were invited to use video at 1 year for a physician based assessment including breast inspection. Patient reported experience measures were also collected at 1 year to capture how a shortened schedule and telehealth influenced patient experience. ResultsIn total, 121/135 patients completed at least two assessments of which 33 (25%) received a sequential boost. The majority of patients reported no toxicity or a mild toxicity at all three time points, 76% at 3 months, 76% at 6 months, and 82% at 1 year. When comparing 26Gy in 5 fractions alone versus 26 Gy in 5 fractions followed by a sequential boost, there was no difference in toxicity reported at one year.94% felt supported by the medical team throughout their treatment course using telehealth only consultations. Only 27% actually agreed to video consultation for the purpose of breast inspection when offered. ConclusionsUltrahypofractionated breast radiotherapy leads to acceptable late toxicity at 1 year even when followed by a hypofractionated tumour bed boost. Patient satisfaction with ultrahypofractionated treatment and virtual consultations without video was high. Further investigation concerning the patient acceptance of video consultations for a physician-based assessment including breast inspection is warranted.

Hydrology on Solid Grounds? Integration Is Key to Closing Knowledge Gaps Concerning Landscape Subsurface Water Storage Dynamics

ABSTRACTIndividual approaches to observe water dynamics across our landscape, from the land surface to groundwater, are many though they individually only provide glimpses into the real world due to their specific space–time scales. Comprehensive integration across all available observations is still largely lacking, limiting both our ability to reduce scientific knowledge gaps, and to guide land and water management using the best available scientific evidence. We argue that a stronger focus on integration of observational products, while utilising machine learning and accounting for current perceptual understanding is urgently needed to overcome this limitation. Since Europe is warming faster than any other continent, central Europe is undergoing a dramatic hydroclimatic transition about which such integrated observations would provide timely and valuable insights. Here, we present potential and gaps of current and planned observational methods. We argue that hyperresolution (sub km) integrated estimates of landscape water dynamics are feasible, which could significantly improve our ability to simulate vadose zone and groundwater dynamics, ultimately closing gaps in our current perception of hydrological processes in a temperate region under strong influence from climate change. We close by arguing that an interdisciplinary effort of various scientific communities is needed to enable this advancement.

GPS-free autonomous navigation in cluttered tree rows with deep semantic segmentation

Segmentation-based autonomous navigation has recently been presented as an appealing approach to guiding robotic platforms through crop rows without requiring perfect GPS localization. Nevertheless, current techniques are restricted to situations where the distinct separation between the plants and the sky allows for the identification of the row’s center. However, tall, dense vegetation, such as high tree rows and orchards, is the primary cause of GPS signal blockage. In this study, we increase the overall robustness and adaptability of the control algorithm by extending the segmentation-based robotic guiding to those cases where canopies and branches occlude the sky and prevent the utilization of GPS and earlier approaches. An efficient Deep Neural Network architecture has been used to address semantic segmentation, performing the training with synthetic data only. Numerous vineyards and tree fields have undergone extensive testing in both simulation and real world to show the solution’s competitive benefits. The system achieved unseen results in orchards, with a Mean Average Error smaller than 9% of the maximum width of each row, improving state-of-the-art algorithms by disclosing new scenarios such as close canopy crops. The official code can be found at: https://github.com/PIC4SeR/SegMinNavigation.git.