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Target product profiles (TPPs) can be used to outline the minimal and desirable characteristics of a health technology to meet a particular health need. They have been used by industry, regulators, and international health agencies to guide product development and facilitate communication across stakeholders, but there appears to have been limited consideration of their utility within HTA.
Methods
We completed a narrative review of academic and grey literature on uses of TPPs across the product development, regulatory, and HTA pathway and considered areas within HTA where TPPs could have a role. We then developed a case study alongside an assessment of virtual ward platforms for acute respiratory infection. This case study aimed to explore whether it was possible to construct a TPP to support guidance based on HTA committee discussions and to consider associated opportunities and challenges. We also compared our TPP with other product specifications used within NHS England to support commissioning.
Results
There has been discussion about how industry can build HTA perspectives into TPPs. However, we did not identify use of TPPs led by HTA agencies. Two use cases of TPPs were identified: (i) to support demand signaling for areas of unmet need and (ii) to provide a framework for class-based recommendations. HTA committee discussions supported the development of a TPP for virtual ward platforms with domains relating to patient population, technological specification, evidence requirements, and other factors (e.g., patient choice). Challenges around the time needed to consider both evidence and desired attributes and overlap with approaches used in commissioning were identified.
Conclusions
TPPs may have a role to play within HTA to highlight areas of unmet need or to support innovative approaches to guidance. Digital health technologies may be particularly amenable to these approaches due to the larger range of similar products and ease of replicability. Further work should define how TPPs can be used to their full potential.
This secondary analysis examined the influence of changes in physical activity (PA), sedentary time and energy expenditure (EE) during dietary energy restriction on the rate of weight loss (WL) and 1-year follow-up weight change in women with overweight/obesity. Measurements of body weight and composition (air displacement plethysmography), RMR (indirect calorimetry), total daily EE (TDEE) and activity EE (AEE), minutes of PA and sedentary time (PA monitor) were taken at baseline, after 2 weeks, after ≥5 % WL or 12 weeks of continuous (25 % daily energy deficit) or intermittent (75 % daily energy deficit alternated with ad libitum day) energy restriction, and at 1-year post-WL. The rate of WL was calculated as total %WL/number of dieting weeks. Data from both groups were combined for analyses. Thirty-seven participants (aged 35 (sd 10) years; BMI = 29·1 (sd 2·3) kg/m2) completed the intervention (WL = –5·9 (sd 1·6) %) and 18 returned at 1-year post-WL (weight change=+4·5 (sd 5·2) %). Changes in sedentary time at 2 weeks were associated with the rate of WL during energy restriction (r = –0·38; P = 0·03). Changes in total (r = 0·54; P < 0·01), light (r = 0·43; P = 0·01) and moderate-to-vigorous PA (r = 0·55; P < 0·01), sedentary time (r = –0·52; P < 0·01), steps per d (r = 0·39; P = 0·02), TDEE (r = 0·46; P < 0·01) and AEE (r = 0·51; P < 0·01) during energy restriction were associated with the rate of WL. Changes in total (r = –0·50; P = 0·04) and moderate-to-vigorous PA (r = –0·61; P = 0·01) between post-WL and follow-up were associated with 1-year weight change (r = –0·51; P = 0·04). These findings highlight that PA and sedentary time could act as modifiable behavioural targets to promote better weight outcomes during dietary energy restriction and/or weight maintenance.
Adaptive thermogenesis (AT) has been proposed to be a compensatory response that may resist weight loss (WL) and promote weight regain. This systematic review examined the existence of AT in adults after a period of negative energy balance (EB) with or without a weight stabilisation phase. Studies published until 15 May 2020 were identified from PubMed, Cochrane Library, EMBASE, MEDLINE, SCOPUS and Web of Science. Inclusion criteria included statistically significant WL, observational with follow-up or experimental studies, age > 18y, sample size ≥10 participants, intervention period ≥ 1week, published in English, objective measures of total daily energy expenditure (EE) (TDEE), resting EE (REE) and sleeping EE(SEE). The systematic review was registered at PROSPERO (2020 CRD42020165348). A total of thirty-three studies comprising 2528 participants were included. AT was observed in twenty-seven studies. Twenty-three studies showed significant values for AT for REE (82·8 %), four for TDEE (80·0 %) and two for SEE (100 %). A large heterogeneity in the methods used to quantify AT and between subjects and among studies regarding the magnitude of WL and/or of AT was reported. Well-designed studies reported lower or non-significant values for AT. These findings suggest that although WL may lead to AT in some of the EE components, these values may be small or non-statistically significant when higher-quality methodological designs are used. Furthermore, AT seems to be attenuated, or non-existent, after periods of weight stabilisation/neutral EB. More high-quality studies are warranted not only to disclose the existence of AT but also to understand its clinical implications on weight management outcomes.
In order to maximize the utility of future studies of trilobite ontogeny, we propose a set of standard practices that relate to the collection, nomenclature, description, depiction, and interpretation of ontogenetic series inferred from articulated specimens belonging to individual species. In some cases, these suggestions may also apply to ontogenetic studies of other fossilized taxa.
Errors inherent in self-reported measures of energy intake (EI) are substantial and well documented, but correlates of misreporting remain unclear. Therefore, potential predictors of misreporting were examined. In Study One, fifty-nine individuals (BMI = 26·1 (sd 3·8) kg/m2, age = 42·7 (sd 13·6) years, females = 29) completed a 14-d stay in a residential feeding behaviour suite where eating behaviour was continuously monitored. In Study Two, 182 individuals (BMI = 25·7 (sd 3·9) kg/m2, age = 42·4 (sd 12·2) years, females = 96) completed two consecutive days in a residential feeding suite and five consecutive days at home. Misreporting was directly quantified by comparing covertly measured laboratory weighed intakes (LWI) with self-reported EI (weighed dietary record (WDR), 24-h recall, 7-d diet history, FFQ). Personal (age, sex and %body fat) and psychological traits (personality, social desirability, body image, intelligence quotient and eating behaviour) were used as predictors of misreporting. In Study One, those with lower psychoticism (P = 0·009), openness to experience (P = 0·006) and higher agreeableness (P = 0·038) reduced EI on days participants knew EI was being measured to a greater extent than on covert days. Isolated associations existed between personality traits (psychoticism and openness to experience), eating behaviour (emotional eating) and differences between the LWI and self-reported EI, but these were inconsistent between dietary assessment techniques and typically became non-significant after accounting for multiplicity of comparisons. In Study Two, sex was associated with differences between LWI and the WDR (P = 0·009), 24-h recall (P = 0·002) and diet history (P = 0·050) in the laboratory, but not home environment. Personal and psychological correlates of misreporting identified displayed no clear pattern across studies or dietary assessment techniques and had little utility in predicting misreporting.
Conventional OLS fixed-effects and GLS random-effects estimators of dynamic models that control for individual-effects are known to be biased when applied to short panel data (T ≤ 10). GMM estimators are the most used alternative but are known to have drawbacks. Transformed-likelihood estimators are unused in political science. Of these, orthogonal reparameterization estimators are only tangentially referred to in any discipline. We introduce these estimators and test their performance, demonstrating that the unused orthogonal reparameterization estimator in particular performs very well and is an improvement on the commonly used GMM estimators. When T and/or N are small, it provides efficiency gains and overcomes the issues GMM estimators encounter in the estimation of long-run effects when the coefficient on the lagged dependent variable is close to one.
Knowing the biological signals associated with appetite control is crucial for understanding the regulation of food intake. Biomarkers of appetite have been defined as physiological measures that relate to subjective appetite ratings, measured food intake, or both. Several metabolites including amino acids, lipids and glucose were proposed as key molecules associated with appetite control over 60 years ago, and along with bile acids are all among possible appetite biomarker candidates. Additional metabolites that have been associated with appetite include endocannabinoids, lactate, cortisol and β-hydroxybutyrate. However, although appetite is a complex integrative process, studies often investigated a limited number of markers in isolation. Metabolomics involves the study of small molecules or metabolites present in biological samples such as urine or blood, and may present a powerful approach to further the understanding of appetite control. Using multiple analytical techniques allows the characterisation of molecules, such as carbohydrates, lipids, amino acids, bile acids and fatty acids. Metabolomics has proven successful in identifying markers of consumption of certain foods and biomarkers implicated in several diseases. However, it has been underexploited in appetite control or obesity. The aim of the present narrative review is to: (1) provide an overview of existing metabolites that have been identified in human biofluids and associated with appetite control; and (2) discuss the potential of metabolomics to deepen understanding of appetite control in humans.
This review examines the metabolic adaptations that occur in response to negative energy balance and their potential putative or functional impact on appetite and food intake. Sustained negative energy balance will result in weight loss, with body composition changes similar for different dietary interventions if total energy and protein intake are equated. During periods of underfeeding, compensatory metabolic and behavioural responses occur that attenuate the prescribed energy deficit. While losses of metabolically active tissue during energy deficit result in reduced energy expenditure, an additional down-regulation in expenditure has been noted that cannot be explained by changes in body tissue (e.g. adaptive thermogenesis). Sustained negative energy balance is also associated with an increase in orexigenic drive and changes in appetite-related peptides during weight loss that may act as cues for increased hunger and food intake. It has also been suggested that losses of fat-free mass (FFM) could also act as an orexigenic signal during weight loss, but more data are needed to support these findings and the signalling pathways linking FFM and energy intake remain unclear. Taken together, these metabolic and behavioural responses to weight loss point to a highly complex and dynamic energy balance system in which perturbations to individual components can cause co-ordinated and inter-related compensatory responses elsewhere. The strength of these compensatory responses is individually subtle, and early identification of this variability may help identify individuals that respond well or poorly to an intervention.
The expanding literature on growth regimes has recently been applied to explain the growth of populist movements across the OECD. Such applications posit a stand-off between debtors and creditors as the core conflict that generates populism. While insightful, the theory has problems explaining why, in some European countries, such movements pre-date both the global financial crisis and the austerity measures that followed, factors that are commonly seen as causing the rise of populism. This article takes a different tack. It derives shifts in both political parties and party systems from the growth regime framework. In doing so it seeks to explain the evolution of the cartel form of party that dominated the political systems of Europe from the late 1990s through to the current period and why that form proved unable to respond meaningfully to both the financial crisis and the political crisis that followed it.
From many field observations, it has become well known that pancake ice is ubiquitous in a wave-dominated sea. These strikingly uniform circular floes are consistently found in the Antarctic seas during the ice-formation season. Their presence has also been reported in the Bering Sea, the Greenland Sea and in polynyas and leads within pack ice. In one estimate made by P. Wadhams (personal communication, 1991) the areal coverage of pancake ice in the Southern Ocean marginal ice zone is around 6 × 106 km2. Pancake ice forms through a combination of thermodynamic growth and mechanical thickening, caused by rafting of floes that is driven by wave motion This complex growth process is much faster than pure thermodynamic growth and hence may be the main factor responsible for ice-edge advance in marginal ice zones. In this paper we simulate wave/ice-floe dynamics by combining a new three-dimensional discrete element model with wave hydrodynamics. In one set of simulations we calculate ice-drift speed as a function of wave amplitude and ice collisional dynamics. In a second set of simulations we place a non-reflecting vertical barrier meant to simulate the fast-ice edge. The simulation results show the rate of increase of the ice impact force on the barrier, and the accompanying thickening of the rafted region in front of the barrier, as a function of wave amplitude. Results from this study will help quantify the formation process for pancake-ice covers in a wave field.
It is well known that waves jostle frazil-ice crystals together, providing opportunities for them to compact into floes. The shape of these consolidated floes is nearly circular, hence the name: pancakes. From field and laboratory observations, the size of these pancakes seems to depend on the wavelength. Further aggregation of these individual pancakes produces the seasonal ice cover. Pancake-ice covers prevail in the marginal ice zone of the Southern Ocean and along the edges of many polar and subpolar seas. This theoretical paper describes conceptually the formation process of a pancake-ice cover in a wave field. The mechanisms that affect the evolution of the entire ice cover are discussed. Governing equations for the time-rate change of the floe diameter, its thickness and the thickness of the ice-cover are derived based on these mechanisms. Two criteria are proposed to determine the maximum floe size under a given wave condition, one based on bending and the other on stretching. Field and laboratory observations to date are discussed in view of this theory.
A discrete-element model of sea ice is used to study how a 90˚ change in wind direction alters the pattern of faults generated through mechanical failure of the ice. the sea-ice domain is 400 km in size and consists of polygonal floes obtained through a Voronoi tessellation. Initially the floes are frozen together through viscous–elastic joints that can break under sufficient compressive, tensile and shear deformation. A constant wind-stress gradient is applied until the initially frozen ice pack is broken into roughly diamond-shaped aggregates, with crack angles determined by wing-crack formation. Then partial refreezing of the cracks delineating the aggregates is modelled through reduction of their length by a particular fraction, the ice pack deformation is neglected and the wind stress is rotated by 90˚. New cracks form, delineating aggregates with a different orientation. Our results show the new crack orientation depends on the refrozen fraction of the initial faults: as this fraction increases, the new cracks gradually rotate to the new wind direction, reaching 90˚ for fully refrozen faults. Such reorientation is determined by a competition between new cracks forming at a preferential angle determined by the wing-crack theory and at old cracks oriented at a less favourable angle but having higher stresses due to shorter contacts across the joints.
A dynamic model of dry snow deformation is developed using a discrete-element technique to identify microstructural deformation mechanisms and simulate creep densification processes. The model employs grain-scale force models, explicit geometric representations of individual ice grains, and snow microstructure using assemblies of grains. Ice grains are randomly oriented cylinders of random length with hemispherical ends. Particle contacts are detected using a novel and efficient method based on the dilation operation in mathematical morphology. Grain-scale ice interaction algorithms, based on observed snow and ice microscale behavior, are developed and implemented in the model. These processes include grain contact sintering, grain boundary sliding and rotation at contacts, and grain contact deformation in tension, compression, shear, torsion and bending. Grain-scale contact force algorithms are temperature- and rate-dependent, with both elastic and viscous components. Grain bonds rupture when elastic stresses exceed ice tensile or shear strengths, after which intergranular friction and particle rearrangement control deformation until the snow compacts to its critical density. Simulations of creep settlement using 1000-grain model snow samples indicate the bulk viscosity of snow is controlled by the grain contact viscosity and area, grain packing and the increased number of frozen bonds that form during settlement. A linear relationship between contact viscosity and bulk snow viscosity at any specified density indicates that the linear model parameters can be accurately scaled, allowing simulations to be conducted for a broad range of dynamic and viscous creep deformation problems.
Although the effects of dietary fat and carbohydrate on satiety are well documented, little is known about the impact of these macronutrients on food hedonics. We examined the effects of ad libitum and isoenergetic meals varying in fat and carbohydrate on satiety, energy intake and food hedonics. In all, sixty-five overweight and obese individuals (BMI=30·9 (sd 3·8) kg/m2) completed two separate test meal days in a randomised order in which they consumed high-fat/low-carbohydrate (HFLC) or low-fat/high-carbohydrate (LFHC) foods. Satiety was measured using subjective appetite ratings to calculate the satiety quotient. Satiation was assessed by intake at ad libitum meals. Hedonic measures of explicit liking (subjective ratings) and implicit wanting (speed of forced choice) for an array of HFLC and LFHC foods were also tested before and after isoenergetic HFLC and LFHC meals. The satiety quotient was greater after ad libitum and isoenergetic meals during the LFHC condition compared with the HFLC condition (P=0·006 and P=0·001, respectively), whereas ad libitum energy intake was lower in the LFHC condition (P<0·001). Importantly, the LFHC meal also reduced explicit liking (P<0·001) and implicit wanting (P=0·011) for HFLC foods compared with the isoenergetic HFLC meal, which failed to suppress the hedonic appeal of subsequent HFLC foods. Therefore, when coupled with increased satiety and lower energy intake, the greater suppression of hedonic appeal for high-fat food seen with LFHC foods provides a further mechanism for why these foods promote better short-term appetite control than HFLC foods.
Assessment of ontogenetic and geographic variation can have substantial influence on species delimitation and thereby on perceived patterns of species-level morphological variation and diversity in space and time. Here we describe the ontogeny and intraspecific variation of the early Cambrian trilobite, Zacanthopsis palmeri n. sp., based on silicified material from east-central Nevada, USA. Zacanthopsis palmeri is the oldest documented Cambrian corynexochine to shift from possessing a fused rostal-hypostomal plate to a functional hypostomal suture in mature specimens during ontogeny. Six geographically distinct samples of mature Z. palmeri from a single silicified limestone bed traceable over tens of kilometers in east-central Nevada permit exploration of geographic variation within this species using geometric morphometric methods. No one sample encompasses all of the shape variation expressed by Z. palmeri and several geographically segregated samples show some degree of morphological separation in pairwise comparison. Nonetheless, these samples are not qualitatively or quantitatively different from one another when all samples are taken into account. The degree of variation within Z. palmeri is similar in magnitude to the differences between other species in the genus known from much less material.
The idea of body weight regulation implies that a biological mechanism exerts control over energy expenditure and food intake. This is a central tenet of energy homeostasis. However, the source and identity of the controlling mechanism have not been identified, although it is often presumed to be some long-acting signal related to body fat, such as leptin. Using a comprehensive experimental platform, we have investigated the relationship between biological and behavioural variables in two separate studies over a 12-week intervention period in obese adults (total n 92). All variables have been measured objectively and with a similar degree of scientific control and precision, including anthropometric factors, body composition, RMR and accumulative energy consumed at individual meals across the whole day. Results showed that meal size and daily energy intake (EI) were significantly correlated with fat-free mass (FFM, P values < 0·02–0·05) but not with fat mass (FM) or BMI (P values 0·11–0·45) (study 1, n 58). In study 2 (n 34), FFM (but not FM or BMI) predicted meal size and daily EI under two distinct dietary conditions (high-fat and low-fat). These data appear to indicate that, under these circumstances, some signal associated with lean mass (but not FM) exerts a determining effect over self-selected food consumption. This signal may be postulated to interact with a separate class of signals generated by FM. This finding may have implications for investigations of the molecular control of food intake and body weight and for the management of obesity.
Although cities take only 1.5%–2% of the Earth's land surface, due to their dense population, settlement structure, transportation networks, energy use and altered surface characteristics, they dramatically change the regional and global nitrogen cycle. Cities import and concentrate Nr in the form of food and fuel, and then disperse it as air and water pollution to other ecosystems covering much larger areas.
Approaches
A mass-balance approach was used in order to quantify the fluxes of reactive nitrogen (Nr) in and out of cities.
Cities can be characterised either as a source of Nr (i.e. emitting large amounts as liquid or solid household waste, automobile exhaust, air pollution from power plants) or a sink of Nr (through importing more food, fossil fuels, etc., and having fewer emissions to the air and water).
Paris metropolitan area is used as a case study, which represents an evolving European capital with much available data.
Key findings/state of knowledge
The Paris Metropolitan Area changed from being a sink in the eighteenth and nineteenth centuries to a source of Nr today. Major changes in the city functioning occurred before 1950, but especially recent decades have been characterised by an unprecedented amplification of those changes.
The future effects of nitrogen in the environment will depend on the extent of nitrogen use and the practical application techniques of nitrogen in a similar way as in the past. Projections and scenarios are appropriate tools for extrapolating current knowledge into the future. However, these tools will not allow future system turnovers to be predicted.
Approaches
In principle, scenarios of nitrogen use follow the approaches currently used for air pollution, climate, or ecosystem projections. Short-term projections (to 2030) are developed using a ‘baseline’ path of development, which considers abatement options that are consistent with European policy. For medium-term projections (to 2050) and long-term projections, the European Nitrogen Assessment (ENA) applies a ‘storyline’ approach similar to that used in the IPCC SRES scenarios. Beyond 2050 in particular, such storylines also take into account technological and behavioral shifts.
Key findings/state of knowledge
The ENA distinguishes between driver-oriented and effect-oriented factors determining nitrogen use. Parameters that cause changes in nitrogen fixation or application are called drivers. In a driver-based approach, it is assumed that any variation of these parameters will also trigger a change in nitrogen pollution. In an effect-based approach, as the adverse effects of nitrogen become evident in the environment, introduction of nitrogen abatement legislation requiring the application of more efficient abatement measures is expected. This approach needs to rely on a target that is likely to be maintained in the future (e.g. human health). Nitrogen abatement legislation based on such targets will aim to counter any growth in adverse environmental effects that occur as a result of increased nitrogen application.