15 research outputs found
Improving patient access to novel medical technologies in Europe
No full textThe European Society of Cardiology (ESC) organized a one-day workshop with clinicians, health economic experts, and health technology appraisal experts to discuss the equity of patient access to novel medical technologies in Europe. Two index technologies were considered: implantable cardioverter defibrillators (ICDs) and drug-eluting stents (DES). The use of ICDs range from 35 implants/million population in Portugal to 166 implants/million population in Germany, whereas for implants of DES (as percentage of total stents) it is lowest in Germany at 14% and high in Portugal at 65%. These differences can in part be explained by a lack of structured implementation of guidelines, the direct cost in relation to the overall healthcare budget, and to differences in procedures and models applied by Health Technology Assessment (HTA) agencies in Europe. The workshop participants concluded that physicians need to be involved in a more structured way in HTA and need to become better acquainted with its methods and terminology. Clinical guidelines should be systematically translated, explained, disseminated, updated, and adopted by cardiologists in Europe. Clinically appropriate, consistent and transparent health economic models need to be developed and high-quality international outcome and cost data should be used. A process for funding of a technology should be developed after a positive recommendation from HTA agencies. Both the ESC and the national cardiac societies should build-up health economic expertise and engage more actively in discussions with stakeholders involved in the provision of healthcare
Green Production of Anionic Surfactant Obtained from Pea Protein
No full textA pea protein isolate was hydrolyzed by a double enzyme treatment method in order to obtain short peptide sequences used as raw materials to produce lipopeptides-based surfactants. Pea protein hydrolysates were prepared using the combination of Alcalase and Flavourzyme. The influence of the process variables was studied to optimize the proteolytic degradation to high degrees of hydrolysis. The average peptide chain lengths were obtained at 3–5 amino acid units after a hydrolysis of 30 min with the mixture of enzymes. Then, N-acylation in water, in presence of acid chloride (C12 and C16), carried out with a conversion rate of amine functions of 90%, allowed to obtain anionic surfactant mixtures (lipopeptides and sodium fatty acids). These two steps were performed in water, in continuous and did not generate any waste. This process was therefore in line with green chemistry principles. The surface activities (CMC, foaming and emulsifying properties) of these mixtures were also studied. These formulations obtained from natural renewable resources and the reactions done under environmental respect, could replace petrochemical based surfactants for some applications
European collaboration on health Technology assessment: looking backward and forward
No full textThe establishment of health technology assessment (HTA) has been an important topic in Europe for many years. There have been a series of activities starting with first projects in 1994 leading to joint actions from the European Network of HTA (EUnetHTA) ending in 2021. This long interval of engagement with HTA structures, methodology, and processes by all member states led to a reliable basis for European collaboration in HTA. This article shows milestones and developments from EUR-ASSESS in 1994 through the progress of EUnetHTA and the accompanying EU-HTA-Network up to the recent elaboration of the EU-HTA-Regulation. With the EU-HTA-Regulation HTA collaboration is taken out of the trial phase of more than 15 years. Through the previous EU HTA collaboration, the appreciation and understanding of the differences and complexities behind the HTA processes in the EU healthcare systems have improved. It is now necessary to make the final steps toward a sustainable European Network for HTA.S
ASO Author Reflections: Preoperative Embolization or Arterial Reconstruction for Distal Pancreatectomy with Celiac Axis Resection
No full textInternational audienc
Developing the HTA core model for the online environment
No full textBackground: A framework for collaborative production and sharing of HTA information, the HTA Core Model, was originally developed within EUnetHTA in 2006-08. In this paper, we describe the further development of the Model to allow implementation and utilization of the Model online. The aim was to capture a generic HTA process that would allow effective use of the HTA Core Model and resulting HTA information while at the same time not interfering with HTA agencies' internal processes. Methods: The work was coordinated by a development team in Finland, supported by an international expert group. Two pilot testing rounds were organized among EUnetHTA agencies and two extensive core HTA projects tested the tool in a real setting. The final work was also formally validated by a group of HTA agencies. Results: The HTA Core Model Onlineavailable at http://www.corehta.infois a web site hosting a) a tool to allow electronic utilization of the HTA Core Model and b) a database of produced HTA information. While access to the HTA information is free to all, the production features are currently available to EUnetHTA member agencies only. A policy was crafted to steer the use of the Model and produced information. Conclusions: We have successfully enabled electronic use of the HTA Core Model and agreed on a policy for its utilization. The system is already being used in subsequent HTA projects within EUnetHTA Joint Action 2. Identified shortcomings and further needs will be addressed in subsequent development.The HTA Core Model Online Working Group consists of (in addition to the authors) L Akiola (THL/FINOHTA, Finland), C. De Laet (KCE, Belgium), C. Filippi (Regione del Veneto, Italy), T. Gasparetto (Regione del Veneto, Italy), W. Goettsch (CVZ, the Netherlands), R. Grilli (Regione Emilia Romagna, Italy), G. Jamtvedt (NOKC, Norway), T. Jefferson (AGENAS, Italy), M. Perrini (AGENAS, Italy), M. Rosen (SBU, Sweden), I. Saeterdal (NOKC, Norway), N. Vicari (AGENAS, Italy). The views expressed herein are the responsibility of the authors and do not necessarily reflect the views of EUnetHTA. EUnetHTA assumes no liability for the contents or use thereof. EUnetHTA Joint Action was supported by a grant from the European Commission, Agreement number 2009 23 02. The sole responsibility of this article lies with the author(s) and neither the Commission nor EUnetHTA is responsible for any use that may be made of the information contained therein
Comparison of a static and a dynamic in vitro model to estimate the bioaccessibility of As, Cd, Pb and Hg from food reference materials Fucus sp. (IAEA-140/TM) and Lobster hepatopancreas (TORT-2)
No full textBioaccessibility, the fraction of an element solubilized during gastrointestinal digestion and available for absorption, is a factor that should be considered when evaluating the health risk of contaminants from food. Static and dynamic models that mimic human physiological conditions have been used to evaluate bioaccessibility. This preliminary study compares the bioaccessibility of arsenic (As), cadmium (Cd), lead (Pb) and mercury (Hg) in two food certified reference materials (CRMs) (seaweed: Fucus sp., IAEA-140/TM; Lobster hepatopancreas: TORT-2), using two in vitro gastrointestinal digestion methods: a static method (SM) and a dynamic multicompartment method (TIM-1). There are significant differences (p < 0.05) between the bioaccessible values of As, Cd, Pb and Hg obtained by SM and TIM-1 in the two CRMs. The specific form in which the elements studied are present in the CRM may help to explain the bioaccessibility values obtained. © 2010 Elsevier B.V.This research was supported by project MCyT AGL2006-00619. Silvia Torres-Escribano received a Personnel Training Grant from the CSIC in the I3P program cofunded by the European Social Fund to carry out this study. The author also received I3P assistance for a short attachment at the University of Auvergne (Clermont-Ferrand)
Human colonic organoids for understanding early events of familial adenomatous polyposis pathogenesis
No full textInternational audiencePatients with familial adenomatous polyposis (FAP) harbor mutations in the APC gene and will develop adenoma and early colorectal cancer. There is no validated treatment, and animal models are not sufficient to study FAP. Our aim was to investigate the early events associated with FAP using the intestinal organoid model in a single‐center study using biopsies from nonadenomatous and adenomatous colonic mucosa of FAP patients and from healthy controls (HCs). We analyzed intestinal stem cell (ISC) activity and regulation through organoid development and expression of mRNA and proteins, as well as within colonic crypts. We used several compounds to regulate the signaling pathways controlling ISCs, such as WNT, EGFR, PI3K‐AKT, TGF‐β, yes‐associated protein (YAP), and protease‐activated receptors. In addition to their high proliferative capacity, nonadenomatous and adenomatous organoids were characterized by cysts and cysts with buds, respectively, suggesting abnormal maturation. Adenomatous organoids were enriched in the stem cell marker LGR5 and dependent on EGF and TGF‐β for their growth. Downstream of EGFR, AKT, β‐catenin, and YAP were found to be activated in the adenomatous organoids. While the p110β isoform of PI3K was predominant in adenomatous organoids and essential for their growth, p110α was associated with the immature state of nonadenomatous organoids. We conclude that organoids offer a relevant model for studying FAP, and this work highlights abnormal behaviors of immature cells in both nonadenomatous and adenomatous mucosa of FAP patients, which could be targeted therapeutically. © 2024 The Author(s). The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland
Online and digital media usage on cell phones among low-income urban youth in Cape Town
No full textIncludes bibliographical references (leaves 69-76).Cell phones introduce a range of new possibilities for the use and production of media, for social networking and communication, political activism, and social development. For this study, 441 grade 11 students at nine schools in low-income areas in Cape Town, South Africa were surveyed about their use of cell phones. These young South Africans have adopted a number of ways to use the Web and mobile Instant Messaging. They also commonly access, produce, and share digital media via their phones and the Internet. Internet access has, until recently, only been accessible to the wealthiest fraction of South African society (about 10% of the population) and so this is a highly significant development. Until now, little quantitative data has been available to describe exactly to what extent and how this cohort is beginning to access and use the Internet and digital media on cell phones. The students reported intensive use of cell phones to access mobile Internet applications, at a far greater level than they report using desktop computers to access the Web. Mobile Internet is considerably more accessible to these students than computer-based Internet access and they are choosing to use the Internet primarily for mobile instant messaging and other characteristic forms of mobile media use. This suggests that these students encounter a distinct, mobile version of the Internet. Their experience of Internet access and digital media may consequently be quite different to that of their computer-using peers. An exploratory media and technology usage approach was chosen to determine first, the availability of cell phones and specific features to the students, and, second, the extent to which online and digital media are being accessed, produced, or shared. A detailed questionnaire was distributed to all students from thirteen grade 11 classes at nine schools (n=441). The schools were chosen as random cluster samples from all public secondary schools located in the city's 50% most deprived areas in order to provide a detailed assessment of cell phone usage in an environment similar to that which prevails in many urban South African schools. Activity-based questions indicate that a majority of respondents (68%) have used a cell phone on the previous day to access the Internet, while half of all respondents (49%) used the mobile Internet to access the Web on the previous day. Interpersonal communication was still the most common use of phones, with 87% of respondents making calls or sending SMS messages on a typical day. A significant minority (23%) of students did not own their own personal handset, despite the near universal use of cell phones among all respondents (96% use one on a typical day). While phone ownership correlated strongly with a sense of economic deprivation as well as lower academic performance, there was no significant difference between both groups in terms of their mobile Internet usage. Thus the fact that some students do not own a phone does not seem to create a 'mobile divide' or automatically lead to exclusion from the possibilities of mobile Internet access. Online media were found to be less frequently used than broadcast and print sources. Nonetheless, the fact that 28% of low-income urban youth access online news about once every day, or more often, may have significant implications for South Africa's news media, particularly in the future. Despite the geographical limitations of this study, the results provide an illuminating snapshot of mobile media use by low-income school-going youth in urban Cape Town
