Prospects for combined analyses of hadronic emission from γ\gamma-ray sources in the Milky Way with CTA and KM3NeT

The Cherenkov Telescope Array and the KM3NeT neutrino telescopes are major upcoming facilities in the fields of $\gamma$-ray and neutrino astronomy, respectively. Possible simultaneous production of $\gamma$ rays and neutrinos in astrophysical accelerators of cosmic-ray nuclei motivates a combination of their data. We assess the potential of a combined analysis of CTA and KM3NeT data to determine the contribution of hadronic emission processes in known Galactic $\gamma$-ray emitters, comparing this result to the cases of two separate analyses. In doing so, we demonstrate the capability of Gammapy, an open-source software package for the analysis of $\gamma$-ray data, to also process data from neutrino telescopes. For a selection of prototypical $\gamma$-ray sources within our Galaxy, we obtain models for primary proton and electron spectra in the hadronic and leptonic emission scenario, respectively, by fitting published $\gamma$-ray spectra. Using these models and instrument response functions for both detectors, we employ the Gammapy package to generate pseudo data sets, where we assume 200 hours of CTA observations and 10 years of KM3NeT detector operation. We then apply a three-dimensional binned likelihood analysis to these data sets, separately for each instrument and jointly for both. We find that the largest benefit of the combined analysis lies in the possibility of a consistent modelling of the $\gamma$-ray and neutrino emission. Assuming a purely leptonic scenario as input, we obtain, for the most favourable source, an average expected 68% credible interval that constrains the contribution of hadronic processes to the observed $\gamma$-ray emission to below 15%.Comment: 18 pages, 15 figures. Submitted to journa

Embedded Software of the KM3NeT Central Logic Board

The KM3NeT Collaboration is building and operating two deep sea neutrino telescopes at the bottom of the Mediterranean Sea. The telescopes consist of latices of photomultiplier tubes housed in pressure-resistant glass spheres, called digital optical modules and arranged in vertical detection units. The two main scientific goals are the determination of the neutrino mass ordering and the discovery and observation of high-energy neutrino sources in the Universe. Neutrinos are detected via the Cherenkov light, which is induced by charged particles originated in neutrino interactions. The photomultiplier tubes convert the Cherenkov light into electrical signals that are acquired and timestamped by the acquisition electronics. Each optical module houses the acquisition electronics for collecting and timestamping the photomultiplier signals with one nanosecond accuracy. Once finished, the two telescopes will have installed more than six thousand optical acquisition nodes, completing one of the more complex networks in the world in terms of operation and synchronization. The embedded software running in the acquisition nodes has been designed to provide a framework that will operate with different hardware versions and functionalities. The hardware will not be accessible once in operation, which complicates the embedded software architecture. The embedded software provides a set of tools to facilitate remote manageability of the deployed hardware, including safe reconfiguration of the firmware. This paper presents the architecture and the techniques, methods and implementation of the embedded software running in the acquisition nodes of the KM3NeT neutrino telescopes

The Power Board of the KM3NeT Digital Optical Module: design, upgrade, and production

The KM3NeT Collaboration is building an underwater neutrino observatory at the bottom of the Mediterranean Sea consisting of two neutrino telescopes, both composed of a three-dimensional array of light detectors, known as digital optical modules. Each digital optical module contains a set of 31 three inch photomultiplier tubes distributed over the surface of a 0.44 m diameter pressure-resistant glass sphere. The module includes also calibration instruments and electronics for power, readout and data acquisition. The power board was developed to supply power to all the elements of the digital optical module. The design of the power board began in 2013, and several prototypes were produced and tested. After an exhaustive validation process in various laboratories within the KM3NeT Collaboration, a mass production batch began, resulting in the construction of over 1200 power boards so far. These boards were integrated in the digital optical modules that have already been produced and deployed, 828 until October 2023. In 2017, an upgrade of the power board, to increase reliability and efficiency, was initiated. After the validation of a pre-production series, a production batch of 800 upgraded boards is currently underway. This paper describes the design, architecture, upgrade, validation, and production of the power board, including the reliability studies and tests conducted to ensure the safe operation at the bottom of the Mediterranean Sea throughout the observatory's lifespa

Health Systems that Meet the Health Needs of Refugees and Migrants

This article discusses strategies designed to assist European Union (EU) health systems respond to the urgent health needs of refugees and migrants, assessing the situation from both an EU and global perspective. The article provides an overview of the legal framework, political policies, actions taken and the funding issues facing European institutions and international organizations as they seek to strengthen their response to healthcare needs of refugees and migrants. This article argues that EU member states need to be committed to improving the health status of refugees and migrants and reinforce their capabilities to advocate for respect for their basic right to health. © 2019 SAGE Publications

Measuring the efficiency of medical tourism industry in EU member states

Purpose: Under the Directive 2011/24/EU, medical tourism and cross-border health are interrelated terms regarding the freedom to move to get the most accessible medical treatment into EU Member State within the defined procedures for reimbursement. Little known empirically regarding the efficiency of the cross-border health/medical tourism industry. This study aims to measure its efficiency in Europe for the years 2010-2014, by using Data Envelopment Analysis (DEA). Design/methodology/approach: Data obtained from OECD and the European Core Health Indicators (ECHI), which is collecting the data through Eurostat. Eurostat collects data on health-care activities and provides data on hospital discharges, including the hospital discharges of non-residents and these include hospital discharges of in-patients and day care patients. The analysis uses “DEA.P, 2.1 for windows” by Coelli (1996). Findings: The results show that the Members States health systems were very efficient in handling non-residents in-patients; however, when managing day cases/outpatients, the efficiency scores dropped. Practical implications: The findings would have significant associations affecting intentions to revisit clinics and the destination country. In addition, will be useful to those seeking a better understanding of the cross-border health and medical tourism industry efficiency. Originality/value: Extending the findings of the European Commission report (2015c) by examining how well medical tourists are informed about the decision they are making, would be of perceived value. These are important indicators at European level by helping each Member State to measure its medical tourism services. © 2019, Lorena Androutsou and Theodore Metaxas

Efficiency assessment across homogeneous specialty clinics in the region of thessaly, Greece

Background: Hospital care expenditure is the most significant cost driver in the health care sector. Reductions in public hospitals' expenses are among the principal austerity measures included in the memorandum recommendations. However, health policy decision-making seems to be a political rather than a technical issue. Objective: The aim of this paper is to assess performance by using Data Envelopment Analysis(DEA) among homogeneous specialties in the General Medicine(GM) and surgical clinics, across all hospitals operating in the Regional Health Authority of Thessaly(RHAT), over the period of 2002-2006. Methods: Two output-oriented DEA models have been adapted, separated in homogeneous GM and surgical clinics, for both constant(CRS) and variable returns to scale(VRS). The unit of analysis is the clinic. A total of 175 decision-making units(DMUs) have been composed. The number of inpatients and inpatient days are considered as outputs whereas the number of the personnel employed and beds as labour and capital inputs respectively. Results: Highest efficiency scores overtime were achieved by the GM clinics of the University District Hospital of Larissa. In surgical specialties, the ophthalmology clinic of the general hospital(GH) of Larissa and the urology of GH of Karditsa achieved the highest efficiency scores. Inefficiencies among GM and surgical clinics per year were also found. Both homogeneous groups followed similar trends in the curves. Five GM and ten surgical DMUs under both VRS and CRS remained fully efficient. Conclusions: The economic crisis Greece is facing, necessitates the assessment of National Health System(NHS) hospitals' performance in order to support health policy decision-making and resources allocation. © Geitona et al.; Licensee Bentham Open

Measuring efficiency and productivity across hospitals in the Regional Health Authority of Thessaly, in Greece

The aim of the article is to assess performance in seven homogenous specialty clinics across all National Health System (NHS) hospitals in the Regional Health Authority of Thessaly (RHAT), over the period 2002-2006. Data Envelopment Analysis by using the Malmquist Productivity Index and its decompositions has been applied in order to measure the technical efficiency and productivity. Clinics were considered to transform inputs labour (medical and nursing staff) and capital (hospital beds) into health services, approximated by the number of in-patient discharges and in-patient days, used as outputs. The model is output-oriented and assumes variable return to scale. Data were collected from hospitals' records. Overall productivity progressed in all clinics. Technical change progressed except the general medicine clinics. Technical efficiency regressed in four clinics. Diachronically the size of the clinics influences the overall effects on hospital performance and the maximum level of outputs produced has not been achieved using the given labour and capital inputs, except orthopaedic clinics. Homogeneity in assessing hospitals' performance provides evidence on the efficiency and productivity gains among clinics and suggests improvements in those which appear inefficient. The difficult economic situation Greece is facing nowadays makes the assessment of NHS hospitals' performance a priority in the decision-making. © 2011 Indian Institute of Health Management Research SAGE Publications

Cost estimation of patients admitted to the intensive care unit: A case study of the Teaching University Hospital of Thessaly

Objective: This study aimed to estimate the cost of patients admitted to the Intensive Care Unit (ICU) of the Teaching University Hospital of Thessaly (TUHT) in 2006 and to demonstrate discrepancies between actual hospitalisation cost and social funds' reimbursement. Methods: Cost analysis was performed using a macro-costing approach, which focused on the estimation of nominal and actual cost per ICU patient. Data were derived from the annual records of resources consumed in each hospital unit and from hospital balance sheets. Sensitivity analysis was also performed by inflating nominal costs to present values. Results: There were 312 patients admitted to the ICU. Mean actual cost per ICU patient was estimated at €16,516, whereas actual reimbursement from social funds was only €1,671. This means that reimbursement accounted for just 10 of the actual hospitalisation cost. Once nominal costs were inflated to present values, the reimbursement accounted for 25 of the actual hospitalisation cost. The major cost drivers of ICU hospitalisation were personnel costs followed by infrastructure, hotel services and pharmaceutical expenditure. These results may be limited by a lack of consideration for clinical outcomes along with a high level of aggregation in cost data. Conclusion: Reimbursement should be re-adjusted in order to balance public hospital deficits and make public-private mix viable. This way, intensive care capacity would increase and allow a more equitable distribution of healthcare resources. © 2010 Informa UK Ltd. All rights reserved