Disinvestment in healthcare: An overview of HTA agencies and organizations activities at European level

Background: In an era of a growing economic pressure for all health systems, the interest for "disinvestment" in healthcare increased. In this context, evidence based approaches such as Health Technology Assessment (HTA) are needed both to invest and to disinvest in health technologies. In order to investigate the extent of application of HTA in this field, methodological projects/frameworks, case studies, dissemination initiatives on disinvestment released by HTA agencies and organizations located in Europe were searched. Methods: In July 2015, the websites of HTA agencies and organizations belonging to the European network for HTA (EUnetHTA) and the International Network of Agencies for HTA (INAHTA) were accessed and searched through the use of the term "disinvestment". Retrieved deliverables were considered eligible if they reported methodological projects/frameworks, case studies and dissemination initiatives focused on disinvestment in healthcare. Results: 62 HTA agencies/organizations were accessed and eight methodological projects/frameworks, one case study and one dissemination initiative were found starting from 2007. With respect to methodological projects/frameworks, two were delivered in Austria, one in Italy, two in Spain and three in U.K. As for the case study and the dissemination initiative, both came from U.K. The majority of deliverables were aimed at making an overview of existing disinvestment approaches and at identifying challenges in their introduction. Conclusions: Today, in a healthcare context characterized by resource scarcity and increasing service demand, "disinvestment" from low-value services and reinvestment in high-value ones is a key strategy that may be supported by HTA. The lack of evaluation of technologies in use, in particular at the end of their lifecycle, may be due to the scant availability of frameworks and guidelines for identification and assessment of obsolete technologies that was shown by our work. Although several projects were carried out in different countries, most remain constrained to the field of research. Disinvestment is a relatively new concept in HTA that could pose challenges also from a methodological point of view. To tackle these challenges, it is necessary to construct experiences at international level with the aim to develop new methodological approaches to produce and grow evidence on disinvestment policies and practices

The role of camouflage in the management of skin damages in oncologic patients

Neoplastic disease and its therapeutic options have a huge impact on the patient's quality of life from both the emotional and the working point of view. Sociological research has revealed that gender also plays an important role in the emotional reaction to the disease. When faced with a neoplastic disease, men and women show significantly different reactions: women, as wives and mothers, are more subject and vulnerable to stress and they can have major psychological implications for the severe impact on body image. In 2002, at the Dermatological Clinic of the University of Naples "Federico II", Corrective Dermacosmetological Laboratory was activated to teach the most suitable techniques in order to disguise skin imperfections by means of an easily reproducible maquillage. Since 2010 the Laboratory is activating to help oncologic patients learn the best way of hiding temporary or permanent skin damages that cause serious discomfort because of the aesthetic modifications of their image. The corrective dermacosmetological camouflage is a technique aiming to learn to oncologic patients the best way of hiding temporary or permanent skin damages related to chemotherapy and radiotherapy: it is also important to contain any cicatricial results. At the laboratories of Naples 36 patients have been treated, 31 women and 5 men, aged between 19 and 72 years. The camouflage technique depends basically on the use of a number of opaque covering non irritant, hypoallergenic creams and powders of superior duration if compared to standard cosmetics. Results were supported by photos showing the excellent results achieved with this technique. Furthermore, an improvement in psychological problems caused by skin damages related to chemotherapy, radiotherapy and surgery therapy was observed in all patients

Mobile underwater sensor networks for protection and security: field experience at the UAN11 experiment

The EU-funded project UAN (Underwater Acoustic Network) was aimed at conceiving, developing, and testing at sea an innovative and operational concept for integrating underwater and above-water sensors in a unique communication system to protect offshore and coastline critical infrastructures. This work gives details on the underwater part of the project. It introduces a set of original security features and gives details on the integration of autonomous underwater vehicles (AUVs) as mobile nodes of the network and as surveillance assets, acoustically controlled by the command and control center to respond against intrusions. Field results are given of the final UAN project sea trial, UAN11, held in May 2011 in Norway. During the experimental activities, a UAN composed of four fixed nodes, two AUVs, and one mobile node mounted on the supporting research vessel was operated continuously and integrated into a global protection system. In this article, the communication performance of the network is reported in terms of round-trip time, packet loss, and average delivery ratio. The major results of the experiment can be thus summarized: the implemented network structure was successful in continuously operating over five days with nodes seamlessly entering and exiting the network; the performance of the network varied greatly with fluctuations in the acoustic channel; the addition of security features induced a minor degradation in network performance with respect to channel variation; the AUVs were successfully controlled from a remote station through acoustic signals routed by the network

Investigation on genetically modified soybean (RoundUp Ready) in goat nutrition: DNA detection in suckling kids

The presence of plant DNA fragments in blood, kidney, hearth, liver, spleen and muscle tissue from suckling kids was investigated by using PCR approach. Fragments of high copy number chloroplast and low copy soybean lectin genes were found in several samples of kids whose mother were fed diet containing conventional (control) or transgenic soybean (treated). Only in treated group, fragments of 35S and CP4 epsps soybean genes were found in several samples

The Bright and Dark Sides of High-Redshift starburst galaxies from {\it Herschel} and {\it Subaru} observations

We present rest-frame optical spectra from the FMOS-COSMOS survey of twelve $z \sim 1.6$ \textit{Herschel} starburst galaxies, with Star Formation Rate (SFR) elevated by $\times$8, on average, above the star-forming Main Sequence (MS). Comparing the H$\alpha$ to IR luminosity ratio and the Balmer Decrement we find that the optically-thin regions of the sources contain on average only $\sim 10$ percent of the total SFR whereas $\sim90$ percent comes from an extremely obscured component which is revealed only by far-IR observations and is optically-thick even in H$\alpha$. We measure the [NII]$_{6583}$/H$\alpha$ ratio, suggesting that the less obscured regions have a metal content similar to that of the MS population at the same stellar masses and redshifts. However, our objects appear to be metal-rich outliers from the metallicity-SFR anticorrelation observed at fixed stellar mass for the MS population. The [SII]$_{6732}$/[SII]$_{6717}$ ratio from the average spectrum indicates an electron density $n_{\rm e} \sim 1,100\ \mathrm{cm}^{-3}$, larger than what estimated for MS galaxies but only at the 1.5$\sigma$ level. Our results provide supporting evidence that high-$z$ MS outliers are the analogous of local ULIRGs, and are consistent with a major merger origin for the starburst event.Comment: 6 pages, 4 figures, Accepted for publication in ApJ Letter

In vitro fermentation of ten cultivars of barley silage.

The fermentation characteristics of whole-crop barley silages from ten different cultivars were evaluated by the in vitro gas production technique. The organic matter degradability of barley silage (62.9% in average) was comparable to those reported in our previous trials for oat (59.7%) and sorghum silages (65.5%); while the maximum gas production rate (5.38 ml/h in average) was slightly lower respect to oat (6.71 ml/h) and sorghum silage (6.74 ml/h). The mean nutritive value (4.00 MJ/kg DM) calculated on the basis of both chemical composition and in vitro fermentation data was comparable to that (4.16 MJ/kg DM) obtained in our previous research performed on corn silage, from crop sowed in the same area

Anemia correction by erythropoietin reduces BNP levels, hospitalization rate, and NYHA class in patients with cardio-renal anemia syndrome.

Little is known about the effect of anemia correction with erythropoietin (EPO) on B-type natriuretic peptide (BNP) levels, NYHA class, and hospitalization rate. The aim of the study was to investigate, in patients with cardio-renal anemia syndrome, the effects of EPO on hemochrome and renal function parameters and BNP levels. We also analyzed the effect of EPO therapy on hospitalization rate and NYHA class after 12 months in comparison with a population undergoing to standard therapy. We performed a randomized double-blind controlled study of correction of the anemia with subcutaneous ? (group A n = 13) or ? (group B n = 14) EPO for 12 months in addition to standard therapy with oral iron in 27 subjects. Control group (n = 25 patients) received only oral iron. Significant increase in hemoglobin (Hb), hematocrit (Hct), and red blood cells (RBC) were revealed in EPO groups at 12 months; Hb, group A 12.3 ± 0.6; group B 11.7 ± 0.8; control group 10.6 ± 0.5 g/dl P < 0.0001; Hct group A 34.2 ± 2.3, group B 34 ± 2, control group 32.3 ± 1.8% P < 0.01; RBC, group A 3.9 ± 0.2, group B 3.8 ± 0.2, control group 3.3 ± 0.2, (P < 0.0001). Plasma BNP levels in EPO groups were significantly reduced after 12 months (group A: 335 ± 138 vs. group B: 449 ± 274 pg/ml control group 582 ± 209 pg/ml (P < 0.01). After 12 months of treatment, hospitalization rate and NYHA class were reduced in EPO groups with respect to control group (P < 0.05). Finally, an inverse correlation was observed between BNP and Hb levels in EPO Groups (r = -0.70 P < 0.001). EPO treatment reduces BNP levels and hospitalization rate in patients with cardio-renal anemia syndrome. The correction of anemia by EPO treatment appears able to improve clinical outcome in this subset of patients with heart failur