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Urologists not adhering to an AS protocol or participating in a clinical trial appear to apply less rigorous criteria for both eligibility and monitoring in AS.

The tendency of urban environments to produce anxiety is well documented in a range of theoretical and historical literature, but there is little current work that considers how public spaces might be designed to alleviate anxiety among their users. This paper presents a series of case studies taken from a lighting design project on the Kentish Town Road in north London to show how urban design can create a more psychologically inclusive public realm — one that offers greater psychological comfort — by enhancing the engagement between users of urban spaces and their environment. The argument is presented in the context of broader issues of social inclusion and other current movements in urban design.

217 Background: Active surveillance (AS) is a recognized treatment option for patients with low-risk prostate cancer (PCa). We carried out a web-based survey to evaluate how AS is practiced by European urologists and to review criteria for patient selection, follow up and indications for intervention. Methods: 2959 potential participants were identified via various European urological association databases and invited via email to complete an online survey consisting of 19 questions. Only urologists practising in an EU country were eligible to participate. Results: 226 urologists participated in the survey corresponding to a response rate of 8%. None of the 19 questions were answered by all urologists, therefore results exclude the missing data. 220 (97%) urologists offer AS. 48% (n=103/216) and 24% (n=53/216) urologists offer AS within the context of an official protocol or clinical trial respectively. The most used factors in selecting patients are Gleeson score (GS) ≤3+3=6 (n=174/202, 86%) and PSA ≤10ng/ml (n=171/200, 85%). 48% (n=96/201) only include patients with ≤2 cores positive while 18% (n=37/201) include those with <50% positive biopsy cores. 41% urologists (n=82/202) only include patients with a clinical stage ≤T1cN0M0. MRI pelvis is performed as a baseline investigation by only 28% (n=57/200). All responding urologists (n=194) use serial PSA to follow up their patients. 89% (n=172/194) carry out serial DRE while 83% (n=161/194) perform repeated prostate biopsy. Re-biopsy is performed within the first year of AS by 77% of urologists (n=131/171). Only 8% (n=15/193) use serial MRI pelvis to monitor their patients. The follow up intensity also varies widely. GS progression was the most frequently cited trigger for intervention (n=168/192, 87%) followed by PSA doubling time of ≤3 years (n=115/192, 60%). Conclusions: Several internationally published guidelines on PCa treatment have recommended AS as a therapeutic option for patients with low-risk PCa. However presently there is a lack of consensus on an optimal AS protocol. This survey shows the wide variation in the practice of AS across Europe and highlights the need for patients to be included in clinical trials to enable an evidence-based guideline to be established.

A89 net searches of relevant websites (such as different health technology assessment agencies in Europe). Researchers conducted discussions with payers and biopharma experts to identify the perceived differences in pricing negotiations between countries. RESULTS: There are distinctive differences in the approaches to pricing negotiations between payers in the US and Europe. These lead to determinable patterns in the methods that biopharma companies leverage to price their products and in the methods that payers use, by either working with the biopharma companies or creating reimbursement mechanisms to guide the appropriate utilization of these products. European payers have more central negotiating leverage and more formalized health technology assessments, which enable them to negotiate and even mandate prices and/or develop outcome-based contracts. CONCLUSIONS: Unlike European payers, most US payers do not have the support of similar governmentbacked organizations for negotiating price, and most cannot optimally leverage health technology assessments. This forces US payers to seek more creative ways of managing the utilization of products through medical policies, prior authorizations and creative reimbursement methods.