2. Wochenbericht TRR 181 Cruise Poseidon 523 [POS523]

2 — 23 May 2018, Malaga - Ponto Delgad

3. Wochenbericht TRR 181 Cruise Poseidon 523 [POS523]

2 — 23 May 2018, Malaga - Ponto Delgad

2. Wochenbericht TRR 181 Cruise Poseidon 523 [POS523]

2 — 23 May 2018, Malaga - Ponto Delgad

1. Wochenbericht TRR 181 Cruise Poseidon 523 [POS523]

2 — 23 May 2018, Malaga - Ponto Delgad

1. Wochenbericht Poseidon 516 [POS516]

TRR 181 Cruise, 29. Juli - 18. August 201

2. Wochenbericht Poseidon 516 [POS516]

TRR 181 Cruise, 29. Juli - 18. August 201

Comparison of tools for assessing the methodological quality of primary and secondary studies in health technology assessment reports in Germany

Health care policy background: Findings from scientific studies form the basis for evidence-based health policy decisions. Scientific background: Quality assessments to evaluate the credibility of study results are an essential part of health technology assessment reports and systematic reviews. Quality assessment tools (QAT) for assessing the study quality examine to what extent study results are systematically distorted by confounding or bias (internal validity). The tools can be divided into checklists, scales and component ratings. Research questions: What QAT are available to assess the quality of interventional studies or studies in the field of health economics, how do they differ from each other and what conclusions can be drawn from these results for quality assessments? Methods: A systematic search of relevant databases from 1988 onwards is done, supplemented by screening of the references, of the HTA reports of the German Agency for Health Technology Assessment (DAHTA) and an internet search. The selection of relevant literature, the data extraction and the quality assessment are carried out by two independent reviewers. The substantive elements of the QAT are extracted using a modified criteria list consisting of items and domains specific to randomized trials, observational studies, diagnostic studies, systematic reviews and health economic studies. Based on the number of covered items and domains, more and less comprehensive QAT are distinguished. In order to exchange experiences regarding problems in the practical application of tools, a workshop is hosted. Results: A total of eight systematic methodological reviews is identified as well as 147 QAT: 15 for systematic reviews, 80 for randomized trials, 30 for observational studies, 17 for diagnostic studies and 22 for health economic studies. The tools vary considerably with regard to the content, the performance and quality of operationalisation. Some tools do not only include the items of internal validity but also the items of quality of reporting and external validity. No tool covers all elements or domains. Design-specific generic tools are presented, which cover most of the content criteria. Discussion: The evaluation of QAT by using content criteria is difficult, because there is no scientific consensus on the necessary elements of internal validity, and not all of the generally accepted elements are based on empirical evidence. Comparing QAT with regard to contents neglects the operationalisation of the respective parameters, for which the quality and precision are important for transparency, replicability, the correct assessment and interrater reliability. QAT, which mix items on the quality of reporting and internal validity, should be avoided. Conclusions: There are different, design-specific tools available which can be preferred for quality assessment, because of its wider coverage of substantive elements of internal validity. To minimise the subjectivity of the assessment, tools with a detailed and precise operationalisation of the individual elements should be applied. For health economic studies, tools should be developed and complemented with instructions, which define the appropriateness of the criteria. Further research is needed to identify study characteristics that influence the internal validity of studies

Mediastinal widening on chest radiography caused by combined aortic valve disease and primary large B-cell lymphoma

Poststenotic aortic root dilatation in patients with aortic valvular stenosis may result in mediastinal widening on chest radiograph. Main differential diagnosis of mediastinal widening is a tumour. In fact, besides atypical chest pain or dyspnoea at exertion secondary to compression of intrathoracic structures in the latter, symptoms may be absent. This article reports a case of combined aortic valve disease and additional primary large B-cell lymphoma.peer-reviewe

Interventions for increasing uptake in screening programmes

Introduction: Opportunities for the early detection of disease are not sufficiently being taken advantage of. Specific interventions could increase the uptake of prevention programmes. A comprehensive analysis of effectiveness and cost-effectiveness of these interventions with reference to Germany is still needed. Objectives: This report aimed to describe and assess interventions to increase uptake in primary and secondary prevention and to explore the assessment of their cost-effectiveness. Methods: 29 scientific databases were systematically searched in a wide strategy. Additional references were located from bibliographies. All published systematic reviews and primary studies were assessed for inclusion without language restrictions. Teams of two reviewers identified the literature, extracted data and assessed the quality of the publications independently. Results: Four HTA reports and 22 systematic reviews were identified for the medical evaluation covering a variety of interventions. The economic evaluation was based on two HTA-reports, one meta-analysis and 15 studies. The evidence was consistent for the effectiveness of invitations and reminders aimed at users, and for prompts aimed at health care professionals. These interventions were the most commonly analysed. (Financial) Incentives for users and professionals were identified in a small number of studies. Limited evidence was available for cost-effectiveness showing incremental costs for follow-up reminders and invitations by telephone. Evidence for ethical, social and legal aspects pointed to needs in vulnerable populations. Discussion: The material was heterogeneous regarding interventions used, study populations and settings. The majority of references originated from the United States and focused on secondary prevention. Approaching all target groups by invitations and reminders was recommended to increase uptake in prevention programmes in general. Conclusions: Further research should aim to focus on primary prevention. Future research should also focus on specific interventions aiming to include vulnerable target groups and individuals, who have not previously made use of opportunities for prevention

Evidence of eddy-related deep-ocean current variability in the northeast tropical Pacific Ocean induced by remote gap winds

There has been a steady increase in interest in mining of deep-sea minerals in the Clarion–Clipperton Zone (CCZ) in the eastern Pacific Ocean during the last decade. This region is known to be one of the most eddy-rich regions in the world ocean. Typically, mesoscale eddies are generated by intense wind bursts channeled through gaps in the Sierra Madre mountains in Central America. Here, we use a combination of satellite and in situ observations to evaluate the relationship between deep-sea current variability in the region of potential future mining and eddy kinetic energy (EKE) in the vicinity of gap winds. A geometry-based eddy detection algorithm has been applied to altimetry sea surface height data for a period of 24 years, from 1993 to 2016, in order to analyze the main characteristic parameters and the spatiotemporal variability of mesoscale eddies in the northeast tropical Pacific Ocean (NETP). Significant differences between the characteristics of eddies with different polarity (cyclonic vs. anticyclonic) were found. For eddies with lifetimes longer than 1 d, cyclonic polarity is more common than anticyclonic rotation. However, anticyclonic eddies are larger in size, show stronger vorticity, and survive longer in the ocean than cyclonic eddies (often 90 d or more). Besides the polarity of eddies, the location of eddy formation should be taken into consideration when investigating the impacted deep-ocean region as we found eddies originating from the Tehuantepec (TT) gap winds lasting longer in the ocean and traveling farther distances in a different direction compared to eddies produced by the Papagayo (PP) gap winds. Long-lived anticyclonic eddies generated by the TT gap winds are observed to travel distances up to 4500 km offshore, i.e., as far as west of 110∘ W. EKE anomalies observed in the surface of the central ocean at distances of ca. 2500 km from the coast correlate with the seasonal variability of EKE in the region of the TT gap winds with a time lag of 5–6 months. A significant seasonal variability of deep-ocean current velocities at water depths of 4100 m was observed in multiple-year time series data, likely reflecting the energy transfer of the surface EKE generated by the gap winds to the deep ocean. Furthermore, the influence of mesoscale eddies on deep-ocean currents is examined by analyzing the deep-ocean current measurements when an anticyclonic eddy crosses the study region. Our findings suggest that despite the significant modulation of dominant current directions driven by the bottom-reaching eddy, the current magnitude intensification was not strong enough to trigger local sediment resuspension in this region. A better insight into the annual variability of ocean surface mesoscale activity in the CCZ and its effects on deep-ocean current variability can be of great help to mitigate the impact of future potential deep-sea mining activities on the benthic ecosystem. On an interannual scale, a significant relationship between cyclonic eddy characteristics and El Niño–Southern Oscillation (ENSO) was found, whereas a weaker correlation was detected for anticyclonic eddies