SCOPE: a scorecard for osteoporosis in Europe

Summary The scorecard summarises key indicators of the burden of osteoporosis and its management in each of the member states of the European Union. The resulting scorecard elements were then assembled on a single sheet to provide a unique overview of osteoporosis in Europe. Introduction The scorecard for osteoporosis in Europe (SCOPE) is an independent project that seeks to raise awareness of osteoporosis care in Europe. The aim of this project was to develop a scorecard and background documents to draw attention to gaps and inequalities in the provision of primary and secondary prevention of fractures due to osteoporosis. Methods The SCOPE panel reviewed the information available on osteoporosis and the resulting fractures for each of the 27 countries of the European Union (EU27). The information researched covered four domains: background information (e.g. the burden of osteoporosis and fractures), policy framework, service provision and service uptake e.g. the proportion of men and women at high risk that do not receive treatment (the treatment gap). Results There was a marked difference in fracture risk among the EU27. Of concern was the marked heterogeneity in the policy framework, service provision and service uptake for osteoporotic fracture that bore little relation to the fracture burden. For example, despite the wide availability of treatments to prevent fractures, in the majority of the EU27, only a minority of patients at high risk receive treatment for osteoporosis even after their first fracture. The elements of each domain in each country were scored and coded using a traffic light system (red, orange, green) and used to synthesise a scorecard. The resulting scorecard elements were then assembled on a single sheet to provide a unique overview of osteoporosis in Europe. Conclusions The scorecard will enable healthcare professionals and policy makers to assess their country’s general approach to the disease and provide indicators to inform future provision of healthcare

Intervention thresholds for osteoporosis in men and women: A study based on data from Sweden

The aim of this study was to determine the threshold of fracture probability at which interventions became cost-effective in men and women, based on data from Sweden. We modeled the effects of a treatment costing $500 per year given for 5 years that decreased the risk of all osteoporotic fractures by 35$200-500/year). Data on costs and risks were from Sweden. Costs included direct costs, but excluded indirect costs due to morbidity. A threshold for cost-effectiveness of approximately $45,000/QALY gained was used. Cost of added years was included in a sensitivity analysis. With the base case ($500 per year; 35% efficacy) treatment in women was cost-effective with a 10-year hip fracture probability that ranged from 1.2% at the age of 50 years to 7.4% at the age of 80 years. Similar results were observed in men except that the threshold for cost-effectiveness was higher at younger ages than in women (2.0 vs 1.2%, respectively, at the age of 50 years). Intervention thresholds were sensitive to the assumed effectiveness and intervention cost. The exclusion of osteoporotic fractures other than hip fracture significantly increased the cost-effectiveness ratio because of the substantial morbidity from such other fractures, particularly at younger ages. We conclude that the inclusion of all osteoporotic fractures has a marked effect on intervention thresholds, that these vary with age, and that available treatments can be targeted cost-effectively to individuals at moderately increased fracture risk

The risk and burden of vertebral fractures in Sweden

The aim of this study was to determine the risk and burden of vertebral fractures judged as those coming to clinical attention and as morphometric fractures. Incidence and utility loss were computed from data from Malmo, Sweden. Clinical fractures accounted for 23% of all vertebral deformities in women and for 42% in men. The average 10-year fracture probability for morphometric fractures increased with age in men from 2.9% at the age of 50 years (7.2% in women) to 8.4 at the age of 85 years (26.7% in women). As expected, probabilities increased with decreasing T-score for hip BMD. Cumulative utility loss from a clinical vertebral fracture was substantial and was 50-62% of that due to a hip fracture depending on age. When incidence of fractures in the population was weighted by disutility, all spine fractures accounted for more morbidity than hip fracture up to the age of 75 years. We conclude that vertebral fractures have a major personal and societal impact that needs to be recognised in algorithms for assessment of risk and in health economic strategies for osteoporosis

Volcanic Risk System (SRV): ASI Pilot Project to Support The Monitoring of Volcanic Risk In Italy by Means of EO Data

The ASI-SRV(Sistema Rischio Vulcanico) project started at the beginning of the 2007 is funded by the Italian Space Agency (ASI) in the frame of the National Space Plan 2003-2005 under the Earth Observations section for natural risks management. Coordinated by the Istituto Nazionale di Geofisica e Vulcanologia (INGV), which is responsible at national level for the volcanic monitoring, the project has as main objective to develop a pre-operative system based on EO data and ground measurements integration to support the volcanic risk monitoring of the Italian Civil Protection Department. The project philosophy is to implement specific modules which allow to process, store and visualize through Web GIS tools EO derived parameters considering three activity phases: 1) knowledge and prevention; 2) crisis; 3) post crisis. In order to combine effectively the EO data and the ground networks measurements the system will implement a multi-parametric analysis tool, which represents and unique tool to analyze contemporaneously a large data set of data in “near real time”. The SRV project will be tested his operational capabilities on three Italian Volcanoes: Etna,Vesuvio and Campi Flegrei

Volcanic Risk System (SRV): ASI Pilot Project to Support The Monitoring of Volcanic Risk In Italy by Means of EO Data

The ASI-SRV(Sistema Rischio Vulcanico) project started at the beginning of the 2007 is funded by the Italian Space Agency (ASI) in the frame of the National Space Plan 2003-2005 under the Earth Observations section for natural risks management. Coordinated by the Istituto Nazionale di Geofisica e Vulcanologia (INGV), which is responsible at national level for the volcanic monitoring, the project has as main objective to develop a pre-operative system based on EO data and ground measurements integration to support the volcanic risk monitoring of the Italian Civil Protection Department. The project philosophy is to implement specific modules which allow to process, store and visualize through Web GIS tools EO derived parameters considering three activity phases: 1) knowledge and prevention; 2) crisis; 3) post crisis. In order to combine effectively the EO data and the ground networks measurements the system will implement a multi-parametric analysis tool, which represents and unique tool to analyze contemporaneously a large data set of data in “near real time”. The SRV project will be tested his operational capabilities on three Italian Volcanoes: Etna,Vesuvio and Campi Flegrei.I.N.G.V. - O.V. SEZIONE DI NAPOLI I.R.E.A. - C.N.R. E.S.A. A.S.I.PublishedNapoli1.10. TTC - Telerilevamentoope

Volcanic Risk System (SRV): ASI Pilot Project to Support The Monitoring of Volcanic Risk In Italy by Means of EO Data

The ASI-SRV(Sistema Rischio Vulcanico) project started at the beginning of the 2007 is funded by the Italian Space Agency (ASI) in the frame of the National Space Plan 2003-2005 under the Earth Observations section for natural risks management. Coordinated by the Istituto Nazionale di Geofisica e Vulcanologia (INGV), which is responsible at national level for the volcanic monitoring, the project has as main objective to develop a pre-operative system based on EO data and ground measurements integration to support the volcanic risk monitoring of the Italian Civil Protection Department. The project philosophy is to implement specific modules which allow to process, store and visualize through Web GIS tools EO derived parameters considering three activity phases: 1) knowledge and prevention; 2) crisis; 3) post crisis. In order to combine effectively the EO data and the ground networks measurements the system will implement a multi-parametric analysis tool, which represents and unique tool to analyze contemporaneously a large data set of data in “near real time”. The SRV project will be tested his operational capabilities on three Italian Volcanoes: Etna,Vesuvio and Campi Flegrei

Recent deformation at Campi Flegrei caldera (Italy) detected by DinSar and leveling techniques

The Campi Flegrei caldera, a volcanic and densely populated area located to the west of Napoli (Italy), was characterized by rapid ground deformation during 1970-72 and 1982-84, for a total amount of 3.5 m in the city of Pozzuoli. Since 1985 a slow deflation was active, with episodic microcrises of uplifts. A new and consistent uplift event is now going on, beginning in November 2004, as revealed by spatial and terrestrial geodetic techniques. In particular, we adopt almost all the available ENVISAT ASAR data acquired from both ascending and descending orbits during 2002-2006, to generate mean deformation velocity maps and time series with spatial resolution of about 100 m. The maps are computed following the Small BAseline Subset (SBAS) approach (Berardino et al., 2002), that implements an appropriate combination of differential interferograms generated from SAR data pairs (60 SAR images for this work). In addition to satellite observations, we show data from the high precision levelling network of the INGV-Osservatorio Vesuviano, consisting in about 320 benchmarks. Levelling measurements are regularly carried out on both the whole network and along the coast line; in case of a bradyseismic crisis, the temporal sampling is strongly increased. Both DInSAR and levelling data evidence the maximum value of the vertical displacement near the city of Pozzuoli. We model the observed deformation by means of 3D pressurized point-source and extended source, performing inversions to constrain their shape and location. The resulting sources are also compared with that inverted for the 1982-84 unrest.UnpublishedWienope

Potential of a cyclone prototype spacer to improve in vitro dry powder delivery

Copyright The Author(s) 2013. This article is published with open access at Springerlink.com. This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are creditedPurpose: Low inspiratory force in patients with lung disease is associated with poor deagglomeration and high throat deposition when using dry powder inhalers (DPIs). The potential of two reverse flow cyclone prototypes as spacers for commercial carrierbased DPIs was investigated. Methods: Cyclohaler®, Accuhaler® and Easyhaler® were tested with and without the spacers between 30-60 Lmin-1. Deposition of particles in the next generation impactor and within the devices was determined by high performance liquid chromatography. Results: Reduced induction port deposition of the emitted particles from the cyclones was observed due to the high retention of the drug within the spacers (e.g. salbutamol sulphate (SS): 67.89 ± 6.51 % at 30 Lmin-1 in Cheng 1). Fine particle fractions of aerosol as emitted from the cyclones were substantially higher than the DPIs alone. Moreover, the aerodynamic diameters of particles emitted from the cyclones were halved compared to the DPIs alone (e.g. SS from the Cyclohaler® at 4 kPa: 1.08 ± 0.05 μm vs. 3.00 ± 0.12 μm, with and without Cheng 2, respectively) and unaltered with increased flow rates. Conclusion: This work has shown the potential of employing a cyclone spacer for commercial carrier-based DPIs to improve inhaled drug delivery.Peer reviewe