Cabazitaxel for Hormone-Relapsed Metastatic Prostate Cancer Previously Treated With a Docetaxel-Containing Regimen: An Evidence Review Group Perspective of a NICE Single Technology Appraisal

As part of its single technology appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the company that manufactures cabazitaxel (Jevtana(®), Sanofi, UK) to submit evidence for the clinical and cost effectiveness of cabazitaxel for treatment of patients with metastatic hormone-relapsed prostate cancer (mHRPC) previously treated with a docetaxel-containing regimen. The School of Health and Related Research Technology Appraisal Group at the University of Sheffield was commissioned to act as the independent Evidence Review Group (ERG). The ERG produced a critical review of the evidence for the clinical and cost effectiveness of the technology based upon the company's submission to NICE. Clinical evidence for cabazitaxel was derived from a multinational randomised open-label phase III trial (TROPIC) of cabazitaxel plus prednisone or prednisolone compared with mitoxantrone plus prednisone or prednisolone, which was assumed to represent best supportive care. The NICE final scope identified a further three comparators: abiraterone in combination with prednisone or prednisolone; enzalutamide; and radium-223 dichloride for the subgroup of people with bone metastasis only (no visceral metastasis). The company did not consider radium-223 dichloride to be a relevant comparator. Neither abiraterone nor enzalutamide has been directly compared in a trial with cabazitaxel. Instead, clinical evidence was synthesised within a network meta-analysis (NMA). Results from TROPIC showed that cabazitaxel was associated with a statistically significant improvement in both overall survival and progression-free survival compared with mitoxantrone. Results from a random-effects NMA, as conducted by the company and updated by the ERG, indicated that there was no statistically significant difference between the three active treatments for both overall survival and progression-free survival. Utility data were not collected as part of the TROPIC trial, and were instead taken from the company's UK early access programme. Evidence on resource use came from the TROPIC trial, supplemented by both expert clinical opinion and a UK clinical audit. List prices were used for mitoxantrone, abiraterone and enzalutamide as directed by NICE, although commercial in-confidence patient-access schemes (PASs) are in place for abiraterone and enzalutamide. The confidential PAS was used for cabazitaxel. Sequential use of the advanced hormonal therapies (abiraterone and enzalutamide) does not usually occur in clinical practice in the UK. Hence, cabazitaxel could be used within two pathways of care: either when an advanced hormonal therapy was used pre-docetaxel, or when one was used post-docetaxel. The company believed that the former pathway was more likely to represent standard National Health Service (NHS) practice, and so their main comparison was between cabazitaxel and mitoxantrone, with effectiveness data from the TROPIC trial. Results of the company's updated cost-effectiveness analysis estimated a probabilistic incremental cost-effectiveness ratio (ICER) of £45,982 per quality-adjusted life-year (QALY) gained, which the committee considered to be the most plausible value for this comparison. Cabazitaxel was estimated to be both cheaper and more effective than abiraterone. Cabazitaxel was estimated to be cheaper but less effective than enzalutamide, resulting in an ICER of £212,038 per QALY gained for enzalutamide compared with cabazitaxel. The ERG noted that radium-223 is a valid comparator (for the indicated sub-group), and that it may be used in either of the two care pathways. Hence, its exclusion leads to uncertainty in the cost-effectiveness results. In addition, the company assumed that there would be no drug wastage when cabazitaxel was used, with cost-effectiveness results being sensitive to this assumption: modelling drug wastage increased the ICER comparing cabazitaxel with mitoxantrone to over £55,000 per QALY gained. The ERG updated the company's NMA and used a random effects model to perform a fully incremental analysis between cabazitaxel, abiraterone, enzalutamide and best supportive care using PASs for abiraterone and enzalutamide. Results showed that both cabazitaxel and abiraterone were extendedly dominated by the combination of best supportive care and enzalutamide. Preliminary guidance from the committee, which included wastage of cabazitaxel, did not recommend its use. In response, the company provided both a further discount to the confidential PAS for cabazitaxel and confirmation from NHS England that it is appropriate to supply and purchase cabazitaxel in pre-prepared intravenous-infusion bags, which would remove the cost of drug wastage. As a result, the committee recommended use of cabazitaxel as a treatment option in people with an Eastern Cooperative Oncology Group performance status of 0 or 1 whose disease had progressed during or after treatment with at least 225 mg/m(2) of docetaxel, as long as it was provided at the discount agreed in the PAS and purchased in either pre-prepared intravenous-infusion bags or in vials at a reduced price to reflect the average per-patient drug wastage.

Land, Power and Technology : Essays on Political Economy and Historical Development

Land Ownership and Development: Evidence from Postwar Japan This paper analyzes the effect of land ownership on technology adoption and structural transformation. A large-scale land reform in postwar Japan enforced a large number of tenant farmers who were cultivating land to become owners of this land. I find that the municipalities which had many owner farmers after the land reform tended to experience a quick entry of new agricultural machines which became available after the reform. The adoption of the machines reduced the dependence on family labor, and led to a reallocation of labor from agriculture to industries and service sectors in urban centers when these sectors were growing. I also analyze the aggregate impact of labor reallocation on economic growth by using a simple growth model and micro data. I find that it increased GDP by about 12 percent of the GDP in 1974 during 1955-74. I also find a large and positive effect on agricultural productivity. Loyalty and Treason: Theory and Evidence from Japan's Land Reform A historically large-scale land reform in Japan after World War II enforced by the occupation forces redistributed a large area of farmlands to tenant farmers. The reform demolished hierarchical structures by weakening landlords' power in villages and towns. This paper investigates how the change in the social and economic structure of small communities affects electoral outcomes in the presence of clientelism. I find that there was a considerable decrease in the vote share of conservative parties in highly affected areas after the reform. I find the supporting evidence that the effect was driven by the fact that the tenant farmers who had obtained land exited from the long-term tenancy contract and became independent landowners. The effect was relatively persistent. Finally, I also find the surprising result that there was a decrease, rather than an increase, in turnout in these areas after the reform.  Geography and State Fragmentation We examine how geography affects the location of borders between sovereign states in Europe and surrounding areas from 1500 until today at the grid-cell level. This is motivated by an observation that the richest places in this region also have the highest historical border presence, suggesting a hitherto unexplored link between geography and modern development, working through state fragmentation. The raw correlations show that borders tend to be located on mountains, by rivers, closer to coasts, and in areas suitable for rainfed, but not irrigated, agriculture. Many of these patterns also hold with rigorous spatial controls. For example, cells with more rivers and more rugged terrain than their neighboring cells have higher border densities. However, the fragmenting effects of suitability for rainfed agriculture are reversed with such neighbor controls. Moreover, we find that borders are less likely to survive over time when they separate large states from small, but this size-difference effect is mitigated by, e.g., rugged terrain.

Technology is Set to Change Real Estate Forever

Major developments in the technological environment can become commonplace very quickly. They are now impacting upon a broad range of information-based service sectors, as high growth Internet-based firms, such as Google, Amazon, Facebook and Airbnb, and financial technology (Fintech) start-ups expand their product portfolios into new markets. Real estate is one of the information-based service sectors that is currently being impacted by this new type of competitor and the broad range of disruptive digital technologies that have emerged. Due to the vast troves of data that these Internet firms have at their disposal and their asset-light (cloud-based) structures, they are able to offer highly-targeted products at much lower costs than conventional brick-and-mortar companies.

Wearing Eye Tracking Technology During Batting Practice: Assessing the Experiences of Professional Baseball Athletes

Utilizing wearable technology in sport allows for the collection of motor behavior data during task engagement. This data can be assessed in real-time or retrospectively. Although enriching the scope of performance data, the consequences of wearable technology on the athlete-user, specifically the cognitive effects, has not been fully investigated, hence the purpose of this study. This qualitative study examines the cognitions of 57 professional baseball players who wore eye tracking technology whilst engaged in batting practice. Their verbal self-reports were framed by temporal context: before-during-after task. Three themes emerged during the pre-task segment: social appearance anxiety, claimed self-handicapping, and curiosity. During the task of batting, verbal behavior contained motivational and instructional overt self-talk while claimed self-handicapping was sustained. The final, post-performance segment was marked by the re-emergence of curiosity from the pre-task period as well as self-evaluation/appraisal. Given the participants were professional athletes, their performance has greater career implications than amateur competitors. Nonetheless, the verbal behavior elicited while wearing eye tracking technology indicates an awareness of the equipment by the user. This study found cognitive effects from wearable technology; more research is required to under-stand the scope and nature of those effects on cognitive and motor behaviors.

Knowledge Workers and Associative Activity: An Examination of Knowledge Work Systems and Settings

Thesis (Ph.D.)--University of Washington, 2016-08

Tackling Ageing Continence through Theory, Tools & Technology (TACT3)

The complexity of issues surrounding continence management, have been investigated by a UK multi-disciplinary research team working under the project title Tackling Ageing Continence through Theory Tools and Technology (TACT3). The team comprising engineers, chemists, health researchers, designers and social anthropologists is funded by the New Dynamics of Ageing Programme, ‘a seven year multidisciplinary research initiative with the ultimate aim of improving quality of life of older people. The programme is a unique collaboration between five UK Research Councils , and is the largest and most ambitious research programme on ageing ever mounted in the UK’ (www.newdynamics.group.shef.ac.uk). The TACT3 project comprises four work packages that are individually managed by members of the research team. One work package focuses solely on knowledge transfer of the research outputs and the management of the overall project. Another work package, entitled ‘Challenging Environmental Barriers’ has focused on the barriers in the built environment that prevent older people with continence concerns from participating in wider social life, namely access to publicly available toilet facilities. We also have a work package entitled ‘Improving Continence Interventions and Services’ which is exploring patient, carer and service providers experiences in receiving and delivering National Health Service (NHS) continence management treatments. The fourth workpackage ‘Developing Assistive Technologies’ has worked with users to develop devices that promote confidence, improve health and therefore may facilitate greater social interaction for older people with continence management concerns.

Gaining by Giving? Peer Research into Service User and Carer Perceptions of Inclusivity in Higher Education

Service users and carers (SUAC) have made significant contributions to professional training in social work courses in Higher Education (HE) over the past decade in the UK. Such participation has been championed by government, academics and SUAC groups from a range of theoretical and political perspectives. Most research into the effectiveness of SUAC involvement at HE has come from the perspectives of academics and very little SUAC-led research exists. This qualitative peer research was led by two members of the University of Worcester’s SUAC group. Findings were that SUAC perceived their involvement brought benefits to students, staff, the University and the local community. Significant personal benefits such as finding a new support network, increased self-development and greater confidence to manage their own care were identified in ways that suggested that the benefits that can flow from SUAC involvement at HE are perhaps more far-reaching than previously recognised. Barriers to inclusion were less than previously reported in the literature and the humanising effects of SUAC involvement are presented as a partial antidote to an increasingly marketised HE culture.

Role of assessment components and recent adverse outcomes in risk estimation and prediction: use of the Short Term Assessment of Risk and Treatability (START) in an adult secure inpatient mental health service

The Short Term Assessment of Risk and Treatability is a structured judgement tool used to inform risk estimation for multiple adverse outcomes. In research, risk estimates outperform the tool's strength and vulnerability scales for violence prediction. Little is known about what its’component parts contribute to the assignment of risk estimates and how those estimates fare in prediction of non-violent adverse outcomes compared with the structured components. START assessment and outcomes data from a secure mental health service (N=84) was collected. Binomial and multinomial regression analyses determined the contribution of selected elements of the START structured domain and recent adverse risk events to risk estimates and outcomes prediction for violence, self-harm/suicidality, victimisation, and self-neglect. START vulnerabilities and lifetime history of violence, predicted the violence risk estimate; self-harm and victimisation estimates were predicted only by corresponding recent adverse events. Recent adverse events uniquely predicted all corresponding outcomes, with the exception of self-neglect which was predicted by the strength scale. Only for victimisation did the risk estimate outperform prediction based on the START components and recent adverse events. In the absence of recent corresponding risk behaviour, restrictions imposed on the basis of START-informed risk estimates could be unwarranted and may be unethical.

Evaluating the use of mobile collaborative augmented reality within field service networks: the case of Océ Italia – Canon Group

The adoption of Augmented Reality (AR) technologies can make the provision of field services to industrial equipment more effective. In these situations, the cost of deploying skilled technicians in geographically dispersed locations must be accurately traded off with the risks of not respecting the service level agreements with the customers. This paper, through the case study of a leading OEM in the production printing industry, presents the challenges that have to be faced in order to favour the adoption of a particular kind of AR named Mobile Collaborative Augmented Reality (MCAR). In particular, this study uses both qualitative and quantitative research. Firstly, a demonstration to show how MCAR can support field service was settled in order to achieve information about the use experience of the people involved. Then, the entire field force of Océ Italia – Canon Group was surveyed in order to investigate quantitatively the technicians’ perceptions about the usefulness and ease of use of MCAR, as well as their intentions to use this technology.

Key factors affecting purchase intention in Russian online context

Russian e-commerce has drawn a lot of attention in academic publications as well as in public media lately. The market is growing with a speed of rocket offering companies enormous business opportunities. However, combination of Russian culture, consumer online purchasing and decision-making process forms a subject yet completely unknown. From international online business perspective it is vital for companies to know how a culture affects consumer’s purchase decision and what are the key elements that need to be modified in order to successfully expand online operations to Russian market. Here, the main purpose is to define the key factors affecting Russian consumer’s online purchase intention. In order to answer the main research question, firstly the role of culture in purchase intention context is researched. Secondly, focus is drawn to the factors that affect online purchase intention. Lastly, it is researched how Russian culture is affecting e-commerce attributes modification. The objective is not only to expand the theoretical understanding of the subject but also to provide companies with a clear vision on how the online operations should be conducted in Russian online market. Ranganathan’s and Jha’s conceptual framework was chosen as a ground theory in this study. Here, three main categories Computer Self-Efficacy and Past Online Experience, Website Quality and Costumer Concerns form basis for the study. Various articles and academic literature supplemented this theoretical approach. Qualitative research method was adapted and the study was conducted through five expert interviews. As a conclusion it can be stated that culture forms a ground for entire purchase decision-making process in online context. Results from the interviews were grouped according to main three theoretic categories and placed with Ranganathan’s and Jha’s original framework. This formed a new theoretical framework that defines diverse factors affecting specifically Russian consumer’s online purchase intention. This study suggests that following factors need to be taking into serious consideration in Russian online context: photography style, detailed product and company information, colors, language, product variety, reviews, recommendations, strong social media presence, fast check out and minimalistic order information, counterfeit fear, cash on delivery payment, training and guidance, extensive customer service, consumers’ insecurity, inexperience, high interest for technology and their individualistic personality.

A mandate to self archive? The role of open access institutional repositories

This paper argues that the best way to achieve major improvements in scholarly communication in the short and medium term is to make it mandatory to deposit research papers in open access institutional repositories. This is what the House of Commons Science and Technology Committee report of 2004 on scientific publishing recommended. The paper defines what open access repositories are and explains why they should be institutional. It also deals with question of what should be deposited in institutional repositories and why these improve scholarly communication. It then deals with the issue of mandating deposition: why deposition should be mandatory, who should mandate deposition and who should carry out deposition. The paper concludes with an analysis of the wider implications of mandating deposition in institutional repositories and a summary of the existing situation in the UK and elsewhere. The paper discusses the Select Committee report and the UK Government response in relation to institutional repositories.

Bolton College: Improve your service platform

In 2013 Bolton College’s senior management team began to take a fresh look at its information and learning technology (ILT) and explore new ways to deliver more choice, provide tailored support for learners and achieve business efficiencies.

Derby Adult Learning Service case study

Case study on how peer support tutor service leads to embedded use of technology in curriculum activities