Fiscal sustainability and policy implications for the euro area.

In this paper we examine the sustainability of euro area public finances against the backdrop of population ageing. We critically assess the widely used projections of the Working Group on Ageing Populations (AWG) of the EU's Economic Policy Committee and argue that ageing costs may be higher than projected in the AWG reference scenario. Taking into account adjusted headline estimates for ageing costs, largely based upon the sensitivity analysis carried out by the AWG, we consider alternative indicators to quantify sustainability gaps for euro area countries. With respect to the policy implications, we assess the appropriateness of different budgetary strategies to restore fiscal sustainability taking into account intergenerational equity. Our stylised analysis based upon the lifetime contribution to the government's primary balance of different generations suggests that an important degree of pre-funding of the ageing costs is necessary to avoid shifting the burden of adjustment in a disproportionate way to future generations. For many euro area countries this implies that the medium-term targets defined in the context of the revised stability and growth pact would ideally need to be revised upwards to significant surpluses.Population Ageing ; Fiscal Sustainability ; Generational Accounting ; Medium-term Objectives for Fiscal Policy

Passive SOBP generation from a static proton pencil beam using 3D-printed range modulators for FLASH experiments

The University Proton Therapy facility in Dresden (UPTD), Germany, is equipped with an experimental room with a beamline providing a static pencil beam. High proton beam currents can be achieved at this beamline which makes it suitable for FLASH experiments. However, the established experimental setup uses only the entrance channel of the proton Bragg curve. In this work, a set of 3D-printed range modulators designed to generate spread out Bragg peaks (SOBPs) for radiobiological experiments at ultra-high dose rate at this beamline is described. A new method to optimize range modulators specifically for the case of a static pencil beam based on the central depth dose profile is introduced. Modulators for two different irradiation setups were produced and characterized experimentally by measurements of lateral and depth dose distributions using different detectors. In addition, Monte Carlo simulations were performed to assess profiles of the dose averaged linear energy transfer (LETD) in water. These newly produced range modulators will allow future proton FLASH experiments in the SOBP at UPTD with two different experimental setups

Prognostic significance of non-HPV16 genotypes in oropharyngeal squamous cell carcinoma

Recent studies have found that cases with oropharyngeal squamous cell carcinoma (OPSCC) positive for HPV16 genotype have better overall survival compared with cases positive for other HPV genotypes. We sought to further replicate these studies and determine if this relationship is modified by expression of p16 tumor suppressor protein

Learning object relationships which determine the outcome of actions

Peer reviewedPublisher PD

Patterns of use of perioperative angiotensin-converting enzyme inhibitors in coronary artery bypass graft surgery with cardiopulmonary bypass: Effects on in-hospital morbidity and mortality

Background-Despite proven benefit in ambulatory patients with ischemic heart disease, the pattern of use of angiotensin-converting enzyme inhibitors (ACEIs) in coronary artery bypass graft surgery has been erratic and controversial. Methods and Results-This is a prospective observational study of 4224 patients undergoing coronary artery bypass graft surgery. The cohort included 1838 patients receiving ACEI therapy before surgery and 2386 (56.5%) without ACEI exposure. Postoperatively, the pattern of ACEI use yielded 4 groups: continuation, 915 (21.7%); withdrawal, 923 (21.8%); addition, 343 (8.1%); and no ACEI, 2043 (48.4%). Continuous treatment with ACEI versus no ACEI was associated with substantive reductions of risk of nonfatal events (adjusted odds ratio for the composite outcome, 0.69; 95% confidence interval, 0.52-0.91; P=0.009) and a cardiovascular event (odds ratio, 0.64; 95% confidence interval, 0.46-0.88; P=0.006). Addition of ACEI de novo postoperatively compared with no ACEI therapy was also associated with a significant reduction of risk of composite outcome (odds ratio, 0.56; 95% confidence interval, 0.38-0.84; P=0.004) and a cardiovascular event (odds ratio, 0.63; 95% confidence interval, 0.40-0.97; P=0.04). On the other hand, continuous treatment of ACEI versus withdrawal of ACEI was associated with decreased risk of the composite outcome (odds ratio, 0.50; 95% confidence interval, 0.38-0.66; P<0.001), as well as a decrease in cardiac and renal events (P<0.001 and P=0.005, respectively). No differences in in-hospital mortality and cerebral events were noted. Conclusions-Our study suggests that withdrawal of ACEI treatment after coronary artery bypass graft surgery is associated with nonfatal in-hospital ischemic events. Furthermore, continuation of ACEI or de novo ACEI therapy early after cardiac surgery is associated with improved in-hospital outcomes

A compact Time-Of-Flight detector for space applications: The LIDAL system

Abstract LIDAL (Light Ion Detector for ALTEA system) is a compact detector designed to upgrade ALTEA (Anomalous Long Term Effects on Astronauts) silicon detector apparatus, in order to study in detail the low-Z part of ions spectrum inside the International Space Station (ISS) and to enhance the Particle Identification (PID) capability of the system. The new detector is designed to trigger ALTEA and to perform Time-Of-Flight measurements. It is based on plastic scintillators for fast timing applications read by Photo-Multiplier-Tubes (PMTs). A custom Front End Electronics (FEE) has been designed to reach time resolutions less than 100 ps ( σ ) for protons. A LIDAL prototype has been developed at the University of Rome Tor Vergata to test the timing performance of the scintillators, the PMTs and of the custom FEE using the proton beam line at the TIFPA (Trento Institute for Fundamentals Physics Applications) center in Trento, Italy. The results of these tests are reported and discussed. They have also been used for a preliminary evaluation of the Particle Identification (PID) capability of the final LIDAL-ALTEA detector system in response to the ions spectra expected on-board the ISS

High concordance of KRAS status between primary colorectal tumors and related metastatic sites: implications for clinical practice.

Purpose. Several studies have suggested that KRAS somatic mutations may predict resistance to cetuximab- and panitumumab-based treatments in metastatic colorectal cancer (CRC) patients. Nevertheless, most experiences were conducted on samples from primaries. The aim of this study was to evaluate the grade of concordance in terms of KRAS status between primaries and related metastases. Patients and Methods. We analyzed KRAS codon 12 and 13 mutations from formalin-fixed sections of 107 CRC primaries and related metastases. Eight pairs were excluded from the analysis because of the low amount of tumor tissue in the available samples. The main characteristics were: 50 men, 49 women; median age at diagnosis, 71 years (range, 41-84). The metastatic sites analyzed were the liver in 80 patients (80.8%), lung in seven patients (7.1%), and other sites in 12 patients (12.1%). Results. A KRAS mutation was found in 38 (38.4%) primary tumors and in 36 (36.4%) related metastases. The rate of concordance was 96.0% (95% confidence interval, 90.0%-98.9%). Discordance was observed in only four (4%) patients. Conclusions. Our results indicate that the detection of KRAS mutations in either primary or metastatic tumors from patients with CRC is concordant and this assessment could be used to predict response to targeted therapies such as cetuximab and panitumumab

QBeRT: An innovative instrument for qualification of particle beam in real-time

This paper describes an innovative beam diagnostic and monitoring system composed of a position sensitive detector and a residual range detector, based on scintillating optical fiber and on an innovative read-out strategy and reconstruction algorithm. The position sensitive detector consists of four layers of pre-aligned and juxtaposed scintillating fibres arranged to form two identical overlying and orthogonal planes. The 500 μm square section fibres are optically coupled to two Silicon Photomultiplier arrays using a channel reduction system patented by the Istituto Nazionale di Fisica Nucleare. The residual range detector is a stack of sixty parallel layers of the same fibres used in the position detector, each of which is optically coupled to a channel of Silicon Photomultiplier array by wavelength shifting fibres. The sensitive area of the two detectors is 9 × 9 cm2. After being fully characterized at CATANA proton therapy facility, the performance of the prototypes was tested during last year also at TIFPA proton irradiation facility. The unique feature of these detectors is the possibility to work in imaging conditions (e.g. a particle at a time up to 106 particles per second) and in therapy conditions up to 109 particles per second. The combined use of the two detectors, in imaging conditions, as an example of application, allows the particle radiography of an object. In therapy conditions, in particular, the system measures the position, the profiles, the energy and the fluence of the beam