Exploring facilitators and barriers to introducing health technology assessment: a systematic review

Objective This study aims to identify and codify the facilitators and barriers to help implementing partners institutionalize health technology assessment (HTA) successfully and navigate complex systems for health-related policy making. Methods We searched for peer-reviewed and gray literature articles examining HTA programs globally using six databases. Keywords used as a guide for capturing articles included “health technology assessment,” “barrier,” and “facilitator” and their synonyms. Search results were scrutinized for duplicates and screened through a review of titles and abstracts. A full-text review was conducted exploring articles’ coverage of twenty-seven evaluation criteria across four primary areas of interest: barriers/facilitators, motivations, guidelines, and institutional frameworks. Results A total of 18,599 records were identified for duplication check, title, and abstract review. A total of 1,594 articles underwent full-text review, leading to a final synthesis of 262 studies. We found that ninety-seven articles discussed barriers/facilitators, with fifty-three of those discussing local capacity and unavailable human resources. Out of the sixty-six articles discussing motivations, forty-two cited the interest in supporting the decision-making process for, and promoting, appropriate resource allocation. Of the sixty-one articles that discussed guidelines and institutional framework, twenty-one articles described HTA as an independent national unit, and sixteen described their HTA unit as a unit within the Ministry of Health (MOH). Conclusions This systematic review unpacks the dynamic and relevant contexts for understanding the HTA institutionalization process to help policy makers and practitioners achieve tangible progress in confronting the most critical issues facing priority setting and HTA institutionalization.

Impact of KRAS, BRAF and microsatellite instability status after cytoreductive surgery and HIPEC in a national cohort of colorectal peritoneal metastasis patients

Background Patients with metastatic colorectal cancer (mCRC) carrying BRAF (mutBRAF) or KRAS mutation (mutKRAS) have an inferior prognosis after liver or lung surgery, whereas the prognostic role in the context of peritoneal metastasis (PM) after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been less investigated. Methods In total, 257 patients with non-appendiceal PM-CRC were included from the Norwegian National Unit for CRS-HIPEC. Results In total, 180 patients received CRS-HIPEC with Mitomycin C, 77 patients received palliative surgery only. In the CRS-HIPEC group, mutBRAF was found in 24.7%, mutKRAS 33.9% and double wild-type 41.4% without differences in survival. MSI was found in 29.3% of mutBRAF cases. Patients with mutBRAF/MSI had superior 5-year survival compared to mutBRAF with MSS (58.3% vs 25.2%, P = 0.022), and better 3-year disease-free survival (DFS) compared to mutKRAS (48.6% vs 17.2%, P = 0.049). Peritoneal Cancer Index and the number of lymph node metastasis were prognostic for OS, and the same two, location and gender prognostic for DFS in multivariate analysis. Conclusions PM-CRC with CRS-HIPEC patients has a surprisingly high proportion of mutBRAF (24.7%). Survival was similar comparing mutBRAF, mutKRAS and double wild-type cases, whereas a small subgroup with mutBRAF and MSI had better survival. Patients with mutBRAF tumours and limited PM should be considered for CRS-HIPEC.

Political History of Zimbabwe Since 1980

The political history of Zimbabwe has been one of radical shifts and turns. Winning its political independence from white minority rule in 1980, Zimbabwe emerged as a promising nation. The new prime minister, Robert Gabriel Mugabe, preached hope and reconciliation. There was euphoria at independence as the nation celebrated political freedom achieved through war and highly emotive negotiations at Lancaster House Conference. Before the first half of the decade passed, the new government was already engaged in a war against its citizens, dubbed Gukurahundi. By the end of the decade, it was also clear that its socialist rhetoric and corruption, among other things, were plunging the nation into an economic crisis, which drove the nation into the jaws of the IMF and World Bank. The economic crisis only worsened, and the so-called neoliberal era in the 1990s sent the nation into an economic quagmire. The economy has always been inextricably intertwined with the politics of the country. Political (mis)calculations triggered economic problems, while on other occasions the reverse was true. The years 2000–2009, in particular, were truly a lost decade. The century began with the controvertible Fast Track Land Reform Programme (FTLRP). After a period of extreme political tensions in the country, a Government of National Unit (GNU) was established in 2009 in which the ruling party, the Zimbabwe African National Union–Patriotic Front (ZANU PF), and the opposition party, the Movement for Democratic Change (MDC), came to form a government. The period from 2010 to 2013 seemed to offer some relief to the nation, partly as a result of the GNU. However, this honeymoon was short-lived. As soon as ZANU PF regained power after the contested 2013 elections, there was a noticeable decline of the economy. Meanwhile, as the economy melted, power struggles intensified within ZANU PF. These reached their peak in 2017, culminating in what has come to be known as the November coup that saw the demise of Mugabe and the takeover by his deputy, Emmerson Dambudzo Mnangagwa, as president. The post-coup era in Zimbabwe has been a period of political drama and deeper economic challenges.

Epidemiology of craniosynostosis in Norway

OBJECTIVEThe authors present population-based epidemiological data for craniosynostosis regarding incidence, age at diagnosis, sex differences, and frequency of syndromic and familial cases.METHODSThe prospective registry of the Norwegian National Unit for Craniofacial Surgery was used to retrieve data on all individuals with craniosynostosis treated between 2003 and 2017. The cohort was divided into three 5-year groups based on year of birth: 2003–2007, 2008–2012, and 2013–2017.RESULTSThe authors identified 386 individuals with craniosynostosis. Of these, 328 (85%) consented to be registered with further information. The incidence increased significantly during the study period and was 5.5 per 10,000 live births (1/1800) in the last 5-year period. The increase was seen almost exclusively in the nonsyndromic group. Syndromic craniosynostosis accounted for 27% of the cases, and the incidence remained stable throughout the three 5-year periods. Both syndromic and nonsyndromic craniosynostosis were highly suture specific. There was a male preponderance (male/female ratio 2:1), and males accounted for 75% of the individuals with midline synostosis. Overall, 9.5% were index individuals in families with more than one affected member; of these, 73% were nonsyndromic cases.CONCLUSIONSThe incidence of craniosynostosis increased during the study period, and the observed incidence is among the highest reported. The authors attribute this to increasing awareness among healthcare professionals. The number of syndromic cases was high, likely due to a broader definition compared to the majority of earlier reports. The study revealed a high number of familial cases in both syndromic and nonsyndromic craniosynostosis, thus highlighting the importance of genetics as an underlying cause of craniosynostosis.

Detecting Twitter's Impact on COVID-19 Pandemic in India

India has etched a higher place in the economy as a fast growing country with a large population. India is one of the leading Twitter usage countries, with 13.15 million users as ofApril2020[1].A novel coronavirus(COVID-19), which is a pand emic, has been threatening nearly everywhere. This terrible disea se started at the end of 2019 from WUHAN in China and is sprea ding very quickly virtually all over the world. This disease's whist leblower Dr. Li Wenliang also died from coronavirus on Feb 7, 2 020.According to the WHO, on 30 January 2020, the outbreak w as declared a public health emergency. In response to COVID19 he called for National Unit and Global Solidarity. All the countries in the world are linked with each other due to globalization, the proportion of labor finances migrating economically. In this paper, Twitter reflects the reality of the world. The main issue like signs and symptoms, prevention measures, and medicines which are related to this disease are discussed. Twitter is used for detecting this disease by analyzing data on social media. Nowadays social media sites are very fast and less costly for communication and exchange of information, ideas, and thoughts. This disease is being monitored by Twitter. If there is any delay it will result in a big damage to not only society but also the country. There are two methods: 1. Monitoring system 2. Awareness and alertness

From Event Reports to Protest Analysis

This chapter introduces the main elements of the research design for the empirical chapters in the book. Starting with the event reports provided by the Mass Mobilization in Autocracies Database, the chapter develops a research design that studies variation in local Internet penetration and anti-regime protest. The chapter motivates the choice of the sub-national unit of observation (cities), and temporal units of analysis (years, weeks). It introduces a new measure of Internet penetration derived from network measurements, developed in collaboration with computer scientists. The high level of spatial and temporal resolution allows for one of the most detailed analyses so far in the study of mass protest. The chapter also introduces the statistical models used for the analysis. The book relies on Bayesian multilevel models, a framework that takes into account the hierarchical structure of the data and has advantages in the analysis of data with skewed dependent variables.

THE ETHNIC POLICY OF THE RULING GOVERNMENTS IN IRAN UNTIL THE END OF THE PAHLAVI DYNASTY

Many of the world's political analysts who have contributed to the theory and study of contradictions and crises, they agree that today, unlike the past, the main sources of conflicts and crises on the global level are not the economy. But the main source of challenges and contradictions is ethnic, cultural conflict and many of the countries that were born in the past with a painful process of nation-building. Now they have been questioned as a national unit, and the moves of ethnicity and separatism have absorbed them. Purpose: Attention to traditional and ethnic structures and the entry and presence of the government in the field of policy and political management of tribal diversity in Iran, which has been followed up by regulating ethnicity, state, and supervision of the movements of the ethnic groups (Jenkins, Richard, 1997). Method: The practices and methods and rules have been examined by governments and regulating their interactions and relations with their relatives and their management and policy. As a result, Iran is described as a tumultuous society in which various ethnic and tribal groups have been in constant conflict with the state and with each other.

A fourth transformation of democracy? Liquid democracy, supra-national democracy and the fate of participation

ABSTRACT Liquid democracy is defined as a cyber democracy that combines representative democracy and spontaneous direct democracy by using technologies of the web 2.0. In recent years, some political theorists and actors have been optimistic that liquid democracy could make a more participatory and direct democracy possible to fulfil the democratic promise of freedom and equality of the people. One could even ask if a supra-national system could become a democratic option by using digital technologies for discussions and deciding. After the historical transformations of democracy, from the Greek city state via the nation-state to a global or supra-national unit, and the second and third ones came or come with a loss of participation, there could be, according to net-optimists, a fourth and more participatory transformation of democracy. This article doubts the emancipatory and participatory potential of liquid democracy (especially for a supra-national system), and I choose the classical theoretical perspective of democracy's ancient core elements of free and equal participation. By analysing the arguments of net-optimists the problems for participation in a political sphere are shown. The point the paper wants to make is that under the circumstances of a (digital) oligopoly-capitalism, fragmentation, and digital divide, or in short, the omnipresent influence of big social inequalities, a cyber-democracy is an unlikely ideal. Keywords: Civic participation, ICT, Global democracy, Liquid democracy, Republicanism transformation

Mental health services for adolescents and adults with intellectual disabilities in Norway: a descriptive study

Purpose The purpose of this paper is to present and discuss mental health services for people with intellectual disability (ID) in Norway. Design/methodology/approach A literature review and a survey were conducted to map services for people with ID and mental health problems in Norway. Findings The results were sparse and confirmed what is already known among clinicians working with these patients. The Norwegian services are fragmented and there are geographical differences. Research limitations/implications There are no special services for children with ID developing mental illness. For offenders with ID, a national unit assesses and follows up, also when the person is sentenced to compulsory care and services are provided in their home municipality. Practical implications More data about both the patients and the services are needed in order to improve mental health services for people with ID in Norway. Originality/value This paper describes mental health services for people with ID in Norway.