The role of GP’s compensation schemes in diabetes care: evidence from panel data

The design of incentive schemes that improve quality of care is a central issue for the healthcare sector. Nowadays we observe many pay-for-performance programs, where payment is contingent on meeting indicators of provider effort, but also other alternative strategies have been introduced, for example programs rewarding physicians for participation in diseases management plans. Although it has been recognised that incentive-based remuneration schemes can have an impact on GP behaviour, there is still weak empirical evidence on the extent to which such programs influence health outcomes. We investigate the impact of financial incentives in Regional and Local Health Authority contracts for primary care in the Italian Region Emilia Romagna for the years 2003-05. We focus on avoidable hospitalisations (Ambulatory Care Sensitive Conditions) for patients affected by type 2 diabetes mellitus, for which the assumption of responsibility and the adoption of clinical guidelines are specifically rewarded. We estimate a panel count data model using a Negative Binomial distribution to test the hypothesis that, other things equal, patients under the responsibility of GPs receiving a higher share of their income through these programs are less likely to experience avoidable hospitalisations. Our findings support the hypothesis that financial transfers may contribute to improve quality of care, even when they are not based on the ex-post verification of performances.

Chaotic dynamics in a storage-ring Free Electron Laser

The temporal dynamics of a storage-ring Free Electron Laser is here investigated with particular attention to the case in which an external modulation is applied to the laser-electron beam detuning. The system is shown to produce bifurcations, multi-furcations as well as chaotic regimes. The peculiarities of this phenomenon with respect to the analogous behavior displayed by conventional laser sources are pointed out. Theoretical results, obtained by means of a phenomenological model reproducing the evolution of the main statistical parameters of the system, are shown to be in a good agreement with experiments carried out on the Super-ACO Free Electron Laser.Comment: submitted to Europ Phys. Journ.

From radio-quiet to radio-silent: low luminosity Seyfert radio cores

A strong effort has been devoted to understand the physical origin of radio emission from low-luminosity AGN (LLAGN), but a comprehensive picture is still missing. We used high-resolution ($\le$1 arcsec), multi-frequency (1.5, 5.5, 9 and 14 GHz) NSF's Karl G. Jansky Very Large Array (VLA) observations to characterise the state of the nuclear region of ten Seyfert nuclei, which are the faintest members of a complete, distance-limited sample of 28 sources. With the sensitivity and resolution guaranteed by the VLA-A configuration, we measured radio emission for six sources (NGC3185, NGC3941, NGC4477, NGC4639, NGC4698 and NGC4725), while for the remaining four (NGC0676, NGC1058, NGC2685 and NGC3486) we put upper limits at tens uJy/beam level, below the previous 0.12 mJy/beam level of Ho&Ulvestad (2001), corresponding to luminosities down to L$\le10^{19}$ W/Hz at 1.5 GHz for the highest RMS observation. Two sources, NGC4639 and NGC4698, exhibit spectral slopes compatible with inverted spectra ($\alpha\le$0, $S_{\nu}\,\propto\,{\nu}^{-\alpha}$), hint for radio emission from an optically-thick core, while NGC4477 exhibits a steep (+0.52$\pm$0.09) slope. The detected sources are mainly compact on scales $\le$ arcseconds, predominantly unresolved, except NGC3185 and NGC3941, in which the resolved radio emission could be associated to star-formation processes. A significant X-ray - radio luminosities correlation is extended down to very low luminosities, with slope consistent with inefficient accretion, expected at such low Eddington ratios. Such sources will be one of the dominant Square Kilometre Array (SKA) population, allowing a deeper understanding of the physics underlying such faint AGN.Comment: accepted for publication on MNRAS (19 pages, 26 figures

Implementing Session Centered Calculi

Recently, specific attention has been devoted to the development of service oriented process calculi. Besides the foundational aspects, it is also interesting to have prototype implementations for them in order to assess usability and to minimize the gap between theory and practice. Typically, these implementations are done in Java taking advantage of its mechanisms supporting network applications. However, most of the recurrent features of service oriented applications are re-implemented from scratch. In this paper we show how to implement a service oriented calculus, CaSPiS (Calculus of Services with Pipelines and Sessions) using the Java framework IMC, where recurrent mechanisms for network applications are already provided. By using the session oriented and pattern matching communication mechanisms provided by IMC, it is relatively simple to implement in Java all CaSPiS abstractions and thus to easily write the implementation in Java of a CaSPiS process

A fast heuristic for routing in post-disaster humanitarian relief logistics

In the last decades, natural disasters have been affecting the human life of millions of people. The impressive scale of these disasters has pointed out the need for an effective management of the relief supply operations. One of the crucial issues in this context is the routing of vehicles carrying critical supplies and help to disaster victims. This problem poses unique logistics challenges, including damaged transportation infrastructure and limited knowledge on the road travel times. In such circumstances, selecting more reliable paths could help the rescue team to provide fast services to those in needs. The classic cost-minimizing routing problems do not properly reflect the relevant issue of the arrival time, which clearly has a serious impact on the survival rate of the affected community. In this paper, we focus specifically on the arrival time objective function in a multi-vehicle routing problem where stochastic travel times are taken into account. The considered problem should be solved promptly in the aftermath of a disaster, hence we propose a fast heuristic that could be applied to solve the problem

Chemotherapy accelerates immune-senescence and functional impairments of Vδ2pos T cells in elderly patients affected by liver metastatic colorectal cancer.

Human (gamma delta) γδ T cells are unconventional innate-like lymphocytes displaying a broad array of anti-tumor activities with promising perspectives in cancer immunotherapy. In this context, Vδ2pos T cells represent the preferential target of several immunotherapy protocols against solid tumors. However, the impact of both aging and chemotherapy (CHT) on Vδ2pos T cells is still unknown. The present study evaluates with multi-parametric flow cytometry the frequencies, terminal differentiation, senescence and effector-functions of peripheral blood and tumor infiltrating Vδ2pos T cells purified from liver metastases (CLM) of patients affected by colorectal cancer (CRC) compared to those of sex- and age-matched healthy donors. The peripheral blood of CLM patients underwent CHT is characterized by decreased amounts of Vδ2pos T cells showing a relative increase of terminally-differentiated CD27neg/CD45RApos (TEMRA) cells. The enrichment of this latter subset is associated with an increased expression of the senescent marker CD57. The acquisition of CD57 on TEMRA Vδ2pos T cells is also coupled with impairments in cytotoxicity and production of TNF-α and IFN-γ. These features resemble the acquisition of an immune-senescent profile by Vδ2pos T cells from CLM patients that received CHT, a phenomenon that is also associated with the loss of the co-stimulatory marker CD28 and with the induced expression of CD16. The group of CLM patients underwent CHT and older than 60 years old showed higher frequencies of CD57pos and TEMRA Vδ2pos T cells. Similar results were found for tumor infiltrating Vδ2pos T cell subset purified from CLM specimens of patients treated with CHT. The toxicity of CHT regimens also affects the homeostasis of Vδ2pos T cells by inducing higher frequencies of circulating CD57pos TEMRA subset in CLM underwent CHT and younger than 60 years old. Taken together, our data demonstrate that the enrichment of senescent Vδ2pos T cells in CLM patients is not only induced by patients' aging but also by the toxicity of CHT that further accelerates the accumulation of CD57pos TEMRA cells highly dysfunctional in their anti-tumor activities. These results are important to both predict the clinical outcome of CLM and to optimize those protocols of cell cancer immunotherapy employing unconventional Vδ2pos T cells

Metric Perturbation Approach to Gravitational Waves in Isotropic Cosmologies

Gravitational waves in isotropic cosmologies were recently studied using the gauge-invariant approach of Ellis-Bruni. We now construct the linearised metric perturbations of the background Robertson-Walker space-time which reproduce the results obtained in that study. The analysis carried out here also facilitates an easy comparison with Bardeen.Comment: 29 pages, Latex file, accepted for publication in Physical Review

Are Simple Real Pole Solutions Physical?

We consider exact solutions generated by the inverse scattering technique, also known as the soliton transformation. In particular, we study the class of simple real pole solutions. For quite some time, those solutions have been considered interesting as models of cosmological shock waves. A coordinate singularity on the wave fronts was removed by a transformation which induces a null fluid with negative energy density on the wave front. This null fluid is usually seen as another coordinate artifact, since there seems to be a general belief that that this kind of solution can be seen as the real pole limit of the smooth solution generated with a pair of complex conjugate poles in the transformation. We perform this limit explicitly, and find that the belief is unfounded: two coalescing complex conjugate poles cannot yield a solution with one real pole. Instead, the two complex conjugate poles go to a different limit, what we call a ``pole on a pole''. The limiting procedure is not unique; it is sensitive to how quickly some parameters approach zero. We also show that there exists no improved coordinate transformation which would remove the negative energy density. We conclude that negative energy is an intrinsic part of this class of solutions.Comment: 13 pages, 3 figure

More than one dynamic crossover in protein hydration water

Studies of liquid water in its supercooled region have led to many insights into the structure and behavior of water. While bulk water freezes at its homogeneous nucleation temperature of approximately 235 K, for protein hydration water, the binding of water molecules to the protein avoids crystallization. Here we study the dynamics of the hydrogen bond (HB) network of a percolating layer of water molecules, comparing measurements of a hydrated globular protein with the results of a coarse-grained model that has been shown to successfully reproduce the properties of hydration water. With dielectric spectroscopy we measure the temperature dependence of the relaxation time of protons charge fluctuations. These fluctuations are associated to the dynamics of the HB network of water molecules adsorbed on the protein surface. With Monte Carlo (MC) simulations and mean--field (MF) calculations we study the dynamics and thermodynamics of the model. In both experimental and model analyses we find two dynamic crossovers: (i) one at about 252 K, and (ii) one at about 181 K. The agreement of the experiments with the model allows us to relate the two crossovers to the presence of two specific heat maxima at ambient pressure. The first is due to fluctuations in the HB formation, and the second, at lower temperature, is due to the cooperative reordering of the HB network