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The aim of this study was first, to introduce a comprehensive, de-novo health economic (HE) model incorporating the full range of activities involved in toileting and containment care (T&CC) for people with incontinence, capturing all the potential benefits and costs of existing and future Digital Health Technologies (DHT) aimed at improving continence care, for both residential care and home care. Second, to use this novel model to evaluate the cost-effectiveness of the DHT TENA SmartCare Identifi in the implementation of person-centred continence care (PCCC), compared with conventional continence care for Canadian nursing home residents. The de-novo HE model was designed to evaluate technologies across different care settings from the perspective of several stakeholders. Health states were based on six care need profiles with increasing need for toileting assistance, three care stages with varying degrees of toileting success, and five levels of skin health. The main outcomes were incremental costs and quality-adjusted life years. The effectiveness of the TENA SmartCare Identifi was based primarily on trial data combined with literature and expert opinion where necessary. Costs were reported in CAD 2020. After 2 years, 21% of residents in the DHT group received mainly toileting as their continence care strategy compared with 12% in the conventional care group. Conversely, with the DHT 15% of residents rely mainly on absorbent products for incontinence care, compared with 40% with conventional care. On average, residents lived for 2.34 years, during which the DHT resulted in a small gain in quality-adjusted life years of 0.015 and overall cost-savings of $1,467 per resident compared with conventional care. Most cost-savings were achieved through reduced costs for absorbent products. Since most, if not all, stakeholders gain from use of the DHT-assisted PCCC, widespread use in Canadian residential care facilities should be considered, and similar assessments for other countries encouraged.

ObjectiveInefficiencies and high administrative burdens are commonly reported in multidisciplinary tumour boards (TBs). The objective of the study was to evaluate the impact of a digital solution on the common challenges encountered in the urogenital and gynaecology cancer TBs in Central Netherlands.MethodsA single-arm, mixed-methods observational study was conducted over 32 weeks in 2023. Data were collected from surveys and the Vitaly system across baseline and post implementation TB meetings.ResultsThe implementation of Vitaly resulted in a 43% reduction in preparation time for urology TBs and a 44% reduction for gynaecology TBs. Postponement rates decreased by nearly 50% for urology and maintained significantly below the 5% acceptable threshold, for both urology and gynaecology TBs.Discussion and conclusionsDespite challenges in data collection due to varied hospital environments, the study showed positive outcomes that underscore the potential benefits of such digital transformation and broader applicability and scalability across various clinical settings.

Cochlear Implant (CI) has been shown to improve speech comprehension, sound localization and tinnitus in adults with Single-Sided-Deafness (SSD) compared to standard treatment currently available in the Dutch setting such as a CROS (Contralateral Routing of Signals) hearing device or a BCD (Bone Conduction Device). Also, for the pediatric population with SSD, CI has shown to be clinically meaningful. Because currently no information is available on the health economic effects of CI in adults and children with SSD in the Netherlands, a cost-utility analysis was conducted. We developed a Markov cohort model, for both the adult and pediatric SSD population, with three states: implant, no implant, and dead. CI was compared with the Bone Conduction Device (BCD) treatment, requiring surgery and no specific treatment. The time horizon of the model was lifelong, costs were discounted with 3% and effects with 1.5%. A societal perspective was taken, including productivity costs in the analysis, with costing data based on publicly available prices for the Netherlands. Values for clinical outcome parameters, i.e. hearing gain, and event probabilities were based on existing literature. Deterministic and probabilistic sensitivity analyses as well as scenario analyses were performed to outline uncertainty of individual and combined parameters. Mean per patient costs for CI in the adult population were €194,051 (95%-CrI €177,274 to €211,108) compared to the total costs of €185,310 (95%-CrI €182,367 to €194,142) for BCD resulting in a cost difference of €8,826 (95%-CrI -€5,020 to €18,252). Compared to no treatment, the cost difference was -€25,089 (95%-CrI -€31,678 to -€6,003). Adults who were treated with CI gained 18.41 (95%-CrI 18.07 to 18.75) quality adjusted life years (QALY) whereas BCD patients gained 15.81 QALYs (95%-CrI 15.53 to 16.10), a difference of 2.60 QALYs (95%-CrI 2.15 to 3.05). The Incremental Cost Effectiveness Ratio (ICER) for adults with CI was determined to be €3,494/QALY gained. Patient without treatment gained 13.46 QALY (95%-CrI 13.20 to 13.73), a difference of 4.95 (95%-CrI 4.87 to 5.01) resulting in CI dominating no treatment. The ICER remained below the Dutch threshold of €20,000/QALY. The probabilistic sensitivity analyses confirmed the results. For children, CI dominated when compared to BCD and when compared to no treatment. Compared to BCD, CI led to a cost saving of €29,611 (95%-CrI -€126,800 to €54,375) and compared to no treatment, CI resulted in a cost saving of €57,658 (95%-CrI -€146,687 to €5,919). The incremental QALY gain compared to BCD was 7.22 (95%-CrI 4.19 to 8.55) and 26.03 (95%-CrI 20.82 to 31.06) compared to no treatment. Based on the results of this health economic evaluation with a Markov cohort model, it is very likely that CI is cost-effective compared to BCD and to no treatment in the Dutch adult and pediatric population with SSD. In both populations the ICER was below the Dutch cost-effectiveness threshold of €20,000/QALY.

The development and strengthening of health technology assessment (HTA) capacity on the individual and organizational level and the wider environment is relevant for cooperation on HTAs. Based on the Maltese case, we provide a blueprint for building HTA capacity. A set of activities were developed based on Pichler et al.'s framework and the starting HTA capacity in Malta. Individual level activities focused on strengthening epidemiological and health economic skills through online and in-person training. On the organizational level, a new HTA framework was developed which was subsequently utilized in a shadow assessment. Awareness campaign activities raised awareness and support in the wider environment where HTAs are conducted and utilized. The time needed to build HTA capacity exceeded the planned two years accommodating the learning progress of the assessors. In addition to the planned trainings, webinars supplemented the online courses, allowing for more knowledge exchange. The advanced online course was extended over time to facilitate learning next to the assessors' daily tasks. Training sessions were added to implement the new economic evaluation framework, which was utilized in a second shadow assessment. Awareness by decision-makers was achieved with reports, posters, and an article on the current and developing HTA capacity. It takes time and much (hands-on) training to build skills for conducting complex assessment such as HTAs. Facilitating exchange with knowledgeable parties is crucial for succeeding as well as the buy-in of local managers motivating staff. Decision-makers need to be on-boarded for the continued success of HTA capacity building.

IntroductionMost European countries use Health Technology Assessment (HTA) as input for decisions on reimbursement of (new) medicines. In 2018, following the approval of European Social Funding, the Directorate for Pharmaceutical Affairs (DPA) within the Malta Ministry for Health led a specific Work Package aimed at enhancing knowledge, skills and HTA processes to inform reimbursement decisions.MethodsSince the start of the project, the Institute for Medical Technology Assessment (iMTA) and the National Health Care Institute of the Netherlands (ZIN) collaborate in providing guidance and training to DPA on relative effectiveness assessments (REAs) and pharmacoeconomic assessments (PEAs) of pharmaceuticals. Several activities were organized: site visits, face-to face interviews with stakeholders, a qualitative assessment of the core process of the Maltese system, health economics training and tutorials, meetings introducing the European Network for Health Technology Assessment (EUnetHTA) and Dutch HTA processes, development of a new framework for assessment, and a shadow assessment.ResultsOur assessment identified important methodological challenges and crucial processes interdependencies to optimize within the Maltese system. Based on the learnings, DPA created a template based on the EUnetHTA REA assessment format. IMTA created a template to perform PEAs. Currently, a shadow assessment is ongoing in which DPA performs the REA and PEA of a pharmaceutical using the new templates. ZIN and iMTA will provide feedback to DPA on several aspects, including, but not limited to, the PICO, assessment of therapeutic efficacy and safety, identifying uncertainties, input costs and effects, and formulating a clear discussion of the assessment. If necessary, the templates will be adapted during the process. The project will be evaluated and finalized in 2022.ConclusionsWith the guidance and training provided by iMTA and ZIN, DPA structured and aligned their REA and PEA to enhance their assessment process and to improve the presentation of their HTA report to the two appraisal committees. This project emphasizes the importance of international collaboration to enhance HTA processes within the

Adapting user interfaces to a user's cultural background can increase satisfaction, revenue, and market share. Conventional approaches to cateringfor culture are restricted to adaptations for specific countries and modify only a limited number of interface components, such as the language or date and time formats. We argue that a more comprehensive personalization of interfaces to cultural background is needed to appeal to users in expanding markets. This paper introduces a low-cost, yet efficient method to achieve this goal: cultural adaptivity. Culturally adaptive interfaces are able to adapt their look and feel to suit visual preferences. In a design science approach, we have developed a number of artifacts that support cultural adaptivity, including a prototype web application. We evaluate the efficacy of the prototype's automatically generated interfaces by comparing them with the preferred interfaces of 105 Rwandan, Swiss, Thai, and multicultural users. The findings demonstrate the feasibility of providing users with interfaces that correspond to their cultural preferences in a novel yet effective manner.

The CORDEX-CORE initiative was developed with the aim of producing homogeneous regional climate model (RCM) projections over domains world wide. In its first phase, two RCMs were run at 0.22° resolution downscaling 3 global climate models (GCMs) from the CMIP5 program for 9 CORDEX domains and two climate scenarios, the RCP2.6 and RCP8.5. The CORDEX-CORE simulations along with the CMIP5 GCM ensemble and the most recently produced CMIP6 GCM ensemble are analyzed, with focus on several temperature, heat, wet and dry hazard indicators for present day and mid-century and far future time slices. The CORDEX-CORE ensemble shows a better performance than the driving GCMs for several hazard indices due to its higher spatial resolution. For the far future time slice the 3 ensembles project an increase in all temperature and heat indices analyzed under the RCP8.5 scenario. The largest increases are always shown by the CMIP6 ensemble, except for Tx > 35 °C, for which the CORDEX-CORE projects higher warming. Extreme wet and flood prone maxima are projected to increase by the RCM ensemble over the la Plata basin in South America, the Congo basin in Africa, east North America, north east Europe, India and Indochina, regions where a better performance is obtained, whereas the GCM ensembles show small or negligible signals. Compound hazard hotspots based on heat, drought and wet indicators are detected in each continent worldwide in region like Central America, the Amazon, the Mediterranean, South Africa and Australia, where a linear relation is shown between the heatwave and drought change signal, and region like Arabian peninsula, the central and south east Africa region (SEAF), the north west America (NWN), south east Asia, India, China and central and northern European regions (WCE, NEU) where the same linear relation is found for extreme precipitation and HW increases. Although still limited, the CORDEX-CORE initiative was able to produce high resolution climate projections with almost global coverage and can provide an important resource for impact assessment and climate service activities.

Artificial light at night (ALAN) is increasing exponentially worldwide, accelerated by the transition to new efficient lighting technologies. However, ALAN and resulting light pollution can cause unintended physiological consequences. In vertebrates, production of melatonin—the “hormone of darkness” and a key player in circadian regulation—can be suppressed by ALAN. In this paper, we provide an overview of research on melatonin and ALAN in vertebrates. We discuss how ALAN disrupts natural photic environments, its effect on melatonin and circadian rhythms, and different photoreceptor systems across vertebrate taxa. We then present the results of a systematic review in which we identified studies on melatonin under typical light-polluted conditions in fishes, amphibians, reptiles, birds, and mammals, including humans. Melatonin is suppressed by extremely low light intensities in many vertebrates, ranging from 0.01–0.03 lx for fishes and rodents to 6 lx for sensitive humans. Even lower, wavelength-dependent intensities are implied by some studies and require rigorous testing in ecological contexts. In many studies, melatonin suppression occurs at the minimum light levels tested, and, in better-studied groups, melatonin suppression is reported to occur at lower light levels. We identify major research gaps and conclude that, for most groups, crucial information is lacking. No studies were identified for amphibians and reptiles and long-term impacts of low-level ALAN exposure are unknown. Given the high sensitivity of vertebrate melatonin production to ALAN and the paucity of available information, it is crucial to research impacts of ALAN further in order to inform effective mitigation strategies for human health and the wellbeing and fitness of vertebrates in natural ecosystems.

The added value of using regional climate models (RCMs) to downscale data from general circulation models (GCMs) has often been questioned and researched. Although several studies have used different methods to identify (and in some cases quantify) the added value, there is still a need to find a general metric that quantifies the added value of any variable. This paper builds on past studies to propose a new metric of added value in the simulation of present-day climate which measures the difference in the probability density functions (PDFs) at each grid-cell between a model and an observation source, and then compares the results of the RCM and GCM in order to spatially compute the added value index. The same method is also adapted to quantify the climate change downscaling signal in a way that is consistent with the present-day metric. These new metrics are tested on the daily precipitation output from the EURO-CORDEX and CORDEX-CORE projection ensembles and reveal an overall positive added value of RCMs, especially at the tail-end of the distribution. Higher added value is obtained in areas of complex topography and coast-lines, as well as in tropical regions. Areas with large added value in present-day climate are consistent with areas of significant climate change downscaling signal in the RCP 8.5 far future simulations, and when the analysis is repeated at a low-resolution. The use of different resolution observations shows that the added value tends to decrease when models are compared to low-resolution observation datasets.

The new Coordinated Output for Regional Evaluations (CORDEX-CORE) ensemble provides high-resolution, consistent regional climate change projections for the major inhabited areas of the world. It serves as a solid scientific basis for further research related to vulnerability, impact, adaptation and climate services in addition to existing CORDEX simulations. The aim of this study is to investigate and document the climate change information provided by the CORDEX-CORE simulation ensemble, as a part of the World Climate Research Programme (WCRP) CORDEX community. An overview of the annual and monthly mean climate change information in selected regions in different CORDEX domains is presented for temperature and precipitation, providing the foundation for detailed follow-up studies and applications. Initially, two regional climate models (RCMs), REMO and RegCM were used to downscale global climate model output. The driving simulations by AR5 global climate models (AR5-GCMs) were selected to cover the spread of high, medium, and low equilibrium climate sensitivity at a global scale. The CORDEX-CORE ensemble has doubled the spatial resolution compared to the previously existing CORDEX simulations in most of the regions (25 km (0.22 ∘ ) versus 50 km (0.44 ∘ )) leading to a potentially improved representation of, e.g., physical processes in the RCMs. The analysis focuses on changes in the IPCC physical climate reference regions. The results show a general reasonable representation of the spread of the temperature and precipitation climate change signals of the AR5-GCMs by the CORDEX-CORE simulations in the investigated regions in all CORDEX domains by mostly covering the AR5 interquartile range of climate change signals. The simulated CORDEX-CORE monthly climate change signals mostly follow the AR5-GCMs, although for specific regions they show a different change in the course of the year compared to the AR5-GCMs, especially for RCP8.5, which needs to be investigated further in region specific process studies.