Informing the Financing of Universal Energy Access: An Assessment of Current Flows

Energy poverty is widely recognized as a major obstacle to economic and social development and poverty alleviation. To help inform the design of appropriate and effective policies to reduce energy poverty, we present a brief analysis of the current macro financial flows in the electricity and gas distribution sectors in developing countries. We build on the methodology used to quantify the flows of investment in the climate change area. This methodology relies on national gross fixed capital formation, overseas development assistance, and foreign direct investment. These high-level and aggregated investment figures provide a sense of scale to policy-makers, but are only a small part of the information required to design financial vehicles. In addition, these figures tend to mask numerous variations between sectors and countries, as well as trends and other temporal fluctuations. Nonetheless, for the poorest countries, one can conclude that the current flows are considerably short (at least five times) of what will be required to provide a basic level of access to clean, modern energy services to the “energy poor”.Energy Access, Energy Finance, Financial flows

Belfast: spazio urbano, identita' e conflitto

La città influenza la società, le sue percezioni, le sue abitudini e i suoi comportamenti e questi elementi a loro volta influenzano, plasmano e cambiano la città. Lo studio e l'analisi della città e dei suoi cambiamenti possono aiutare a comprendere i mutamenti della società. Un punto di vista privilegiato da cui osservare la società e la città è quello del conflitto: infatti i conflitti si possono accentuare o dirimere a partire da determinate configurazioni spaziali. Per questo è importante analizzare la spazializzazione del conflitto e della sua trasformazione. La tesi analizza la città di Belfast prendendo in considerazione sia gli spazi contesi e divisi, come ad esempio, la presenza di mura e barriere o di zone esclusive/escludenti, sia le esperienze di spazi condivisi in cui è possibile l'incontro dell'altro. Belfast, città polarizzata o etnopolitica e città contesa o divisa, presenta due tipi di segregazione: la divisione tra gruppi etnico-politici opposti in una situazione di post-conflitto e quella tra ricchi e poveri tipica delle città del mondo globalizzato. La prima divisione coinvolge due gruppi di etnie, lingue, religioni e posizioni politiche diverse che hanno trasformato lo spazio in cui vivono e attraverso quello esprimono e danno dignità alla propria identità. Hanno modificato il territorio con l'esposizione di simboli (bandiere o cartelli stradali o marciapiedi colorati), con i murales, e con i vari monumenti commemorativi. Con questi simboli e con parate, festival e commemorazioni (marce e parate orangiste, bonfires da una parte o ricordo di hunger strike e easter rising dall'altra) i due gruppi fanno un uso del territorio che vuole affermare la loro identità all'interno del proprio gruppo e fuori. La territorializzazione si manifesta anche con la costruzione di barriere fisiche tra le due comunità. Veri e propri muri che inaspriscono le divisioni e fanno si’ che la città sia vissuta in modi diversi, ognuno nella propria enclave sicura e protetta, evitando i territori nemici, il confronto, l'incontro (mappe mentali). La separazione fisica di muri e barriere inasprisce le divisioni mentali e psicologiche in quanto non permette il contatto e la conoscenza dell’altro. La città, in quanto luogo di relazioni democratiche e promozione sociale, dovrebbe promuovere spazi condivisi che permettano l'incontro fra le differenze e la conoscenza dell’altro. L'altra divisione in Belfast e' più tipica delle attuali dinamiche urbane. E' la divisione tra middle e upper class e working class. La middle class ha sempre vissuto una Belfast diversa. Si e' tirata fuori dal conflitto, rimanendo in disparte. Sono i poveri legati alle loro religioni e visioni politiche estreme e polarizzate che combattono una lotta violenta e disumana. La middle class ha vissuto una Belfast senza vedere il conflitto. Le conseguenze del conflitto sulle loro vite era tuttavia limitata (problemi nel traffico per lo scoppio di una bomba; carenza di svaghi notturni; ma non la paura costante di vivere gli attacchi o il dolore della perdita di qualche membro della famiglia). Questa parte della popolazione ancora oggi non vede. Non vede la divisione che ancora esiste nella parte più povera: non vede la povertà, la scarsità di risorse, la violenza e l'alcolismo. Vive in quartieri residenziali belli e protetti. Frequenta zone esclusive e rinnovate nelle quali non esiste la memoria della la divisione etnopolitica. La rigenerazione post conflitto che si e' concentrata sul centro città ha preferito evitare toni scottanti come l'identità per creare un volto nuovo alla città che non potesse essere conteso. Ha voluto dare un volto “normale” alla città ricadendo cosi in quartieri anonimi e che si potrebbero trovare in qualsiasi altra città moderna basata sul modello del consumismo (City centre e Victoria square.). Mentre per quanto riguarda le riqualificazioni residenziali (River Lagan, Titanic quarter, Cathedral quarter) sono state costruiti edifici non accessibili a quella fascia di popolazione più bisognosa di case (gentrification). La middle class si e' voluta riprendere indietro la città ora che le acque si sono relativamente calmate e l'ha fatto in modo di non ricordare e allontanare il più possibile il ricordo dei Troubles e delle divisioni etnicopolitiche. Attraverso la rigenerazione post conflitto sarebbe stato possibile esplorare i bisogni della comunità e trasformare il conflitto positivamente. Ma cosi non e' stato. Di che cosa ha bisogno Belfast? Dell’abbattimento di barriere fisiche e mentali. Di spazi per l'incontro e la conoscenza dell'altro. Spazi per aprire canali comunicativi e affrontare il conflitto. Di esplorare e di rispondere alle esigenze dei più' poveri e disagiati. Di riconoscere a tutti il diritto di esistenza e dignità. Il passato e' stato violento e doloroso, questo dev'essere riconosciuto e da questo si deve imparare per un futuro condiviso e migliore. Associazioni, organizzazioni e persone stanno lavorando in questa direzione ma il processo di pace e' lento e non privo di ostacoli

Quantum Fluctuations for Gravitational Impulsive Waves

Quantum fluctuations for a massless scalar field in the background metric of spherical impulsive gravitational waves through Minkowski and de Sitter spaces are investigated. It is shown that there exist finite fluctuations for de Sitter space.Comment: Submitted to Int. J. Mod. Phys.

Impact of the 2014 American Academy of Pediatrics recommendation and of the resulting limited financial coverage by the Italian Medicines Agency for palivizumab prophylaxis on the RSV-associated hospitalizations in preterm infants during the 2016-2017 epidemic season: a systematic review of seven Italian reports

Background: The only pharmacologic prophylaxis against respiratory syncytial virus (RSV) infection in preterm infants is the humanized monoclonal antibody palivizumab. After the 2014 modification of the American Academy of Pediatrics (AAP) recommendations, the Italian Medicines Agency (AIFA) limited the financial coverage for palivizumab prescriptions to otherwise healthy preterm infants with < 29 weeks of gestational age (wGA) aged < 12 months at the beginning of the 2016-2017 RSV season. However, due to the effect on disease severity and hospitalizations following this limitation, shown by several Italian clinical studies, in November 2017 AIFA reinstated the financial coverage for these infants. In this systematic review, we critically summarize the data that show the importance of palivizumab prophylaxis. Methods: Data from six Italian pediatric institutes and the Italian Network of Pediatric Intensive Care Units (TIPNet) were retrieved from the literature and considered. The epidemiologic information for infants 29-36 wGA, aged < 12 months and admitted for viral-induced acute lower respiratory tract infection were retrospectively reviewed. RSV-associated hospitalizations were compared between the season with running limitation, i.e. 2016-2017, versus 2 seasons before (2014-2015 and 2015-2016) and one season after (2017-2018) the AIFA limitation. Results: During the 2016-2017 RSV epidemic season, when the AIFA limited the financial coverage of palivizumab prophylaxis based on the 2014 AAP recommendation, the study reports on a higher incidences of RSV bronchiolitis and greater respiratory function impairment. During this season, we also found an increase in hospitalizations and admissions to the Pediatric Intensive Care Units and longer hospital stays, incurring higher healthcare costs. During the 2016-2017 epidemic season, an overall increase in the number of RSV bronchiolitis cases was also observed in infants born full term, suggesting that the decreased prophylaxis in preterm infants may have caused a wider infection diffusion in groups of infants not considered to be at risk. Conclusions: The Italian results support the use of palivizumab prophylaxis for otherwise healthy preterm (29-36 wGA) infants aged < 6 months at the beginning of the RSV season

Use of ultrasonography to discriminate psoriatic arthritis from fibromyalgia: A post‐hoc analysis of the ulisse study

In psoriatic arthritis (PsA) patients with concomitant chronic widespread pain, the differential diagnosis with fibromyalgia syndrome (FMS) can be challenging. We evaluated whether ultrasound (US) examination of entheseal sites can distinguish pain from (PsA) enthesitis versus FMS. PsA and FMS patients underwent clinical evaluation and gray‐scale (GS; B‐mode) and power Doppler (PD) US examination of the entheses. At least one enthesis with GS‐ and PD‐mode changes was found in 90% and 59.3% of PsA patients (n = 140) and 62.7% and 35.3% of FMS patients (n = 51), respectively. GS and PD identified changes in 49.5% and 19.2% of the 840 PsA entheses and 22.5% and 7.9% of the 306 FMS entheses, respectively. Receiver operating characteristic curve analysis showed an area under the curve of 0.77 and 0.66 for B‐ and PD‐mode, respectively, 3.5 being the best cut‐off GS‐score to discriminate the two conditions. Multivariate regression showed that Achilles and proximal patellar tendon enthesitis (B‐mode) were strongly associated with PsA (odds ratio, ~2). Principal component analysis (B‐mode) confirmed that PsA patients have a higher number of involved entheses and patterns of entheseal involvement than FMS patients. US evaluation of the entheses may help differentiate chronic widespread pain from PsA versus FMS

Impact of supporting people with advanced Parkinson’s disease on carer’s quality of life and burden

Purpose: The aim of this study was to assess the burden and the quality of life (QoL) perceived by caregivers assisting advanced Parkinson’s disease (PD) patients. Patients and Methods: Consecutive advanced PD patients treated with levodopa/carbidopa intestinal gel (LCIG) or continuous subcutaneous apomorphine infusion (CSAI) or care as usual (CU) and their care partners were recruited during routine visits according to a cross-sectional design. Caregiver’s distress was assessed by Zarit Burden Interview (ZBI) and a QoL survey to evaluate and understand the burden experienced by care partners during family and working activities. Results: A total of 126 patients (53 LCIG, 19 CSAI and 54 CU) and their care partners were enrolled. The ZBI score boxplot showed that LCIG and CU populations have a similar distribution (ZBI inter-quartile range [IQR] values respectively 18–42 for LCIG and 19–43 for CU group), while the CSAI group has a wider score range (IQR 16–52). Caregivers assisting patients in treatment with LCIG have more time to perform family or household duties (p=0.0022), or to engage in leisure activities (p=0.0073) compared to CU, while no difference was found when compared to CSAI group. Approximately 50% of the care partners showed mood changes in the last 6 months and LCIG and CSAI had less impact on caregiver’s mood compared to CU. Patients treated with LCIG were more independent in taking a bath or shower without assistance and were more able to move and walk without assistance. Conclusion: Care partners of advanced PD patients treated with device-aided therapies have more time for their own life and a better perception of their QoL with a tendency to an improvement of mood compared with those of patients treated with CU

Non-infectious uveitis burden on quality of life and work impairment assessed through different psychometric questionnaires

Background: The purpose of this study was to evaluate the association between a novel psychometric 12-item questionnaire (U-qest) and other validated questionnaires to assess quality of life and work impairment in patients with non-infectious uveitis. Methods: Data were collected at baseline and 3 months postbaseline using U-qest and two other validated questionnaires: The National Eye Institute 25-Item Visual Function Questionnaire (VFQ-25) and the 12-Item Short-Form Health Survey (SF-12). Results: A total of 136 patients (52.2% female) aged 47.9 ± 14.8 years (mean ± SD) were enrolled in 14 uveitis referral centres. U-qest correlated moderately with VFQ-25 and SF-12 at baseline and at 3 months. Both U-qest and VFQ-25 scores improved as disease improved; however, U-qest also detected improvement in patients for whom VFQ-25 scores did not improve. Disease activity was shown to significantly affect activity impairment. Patients and physicians expressed positive perceptions regarding the use and benefit of this instrument. U-qest showed very good reliability in terms of internal consistency (Cronbach’s alpha = 0.91). Conclusions: U-qest can be considered a useful tool to assess the burden of uveitis on quality of life

Caregiver burden and its related factors in advanced Parkinson’s disease: data from the PREDICT study

Introduction: Caring for a person with Parkinson’s disease (PD) is associated with an increased risk of psychiatric morbidity and persistent distress. The objective of this study was to describe the burden and the related factors of caregivers of advanced PD (APD) patients either treated with continuous dopaminergic delivery systems or standard therapy. Methods: This cross-sectional, epidemiologic study conducted in 13 Italian sites enrolled PD patients treated with continuous dopaminergic delivering systems [either levodopa/carbidopa intestinal gel (LCIG) infusion or continuous subcutaneous apomorphine infusion (CSAI)] or continuation of standard of care (SOC) with a caregiver. Patient quality of life (QoL) and caregiver burden were assessed using the Parkinson’s Disease Questionnaire (PDQ-8) and Zarit Burden Inventory (ZBI), respectively. Results: 126 patients (mean age 69.3 ± 8 years) and their caregivers (mean age 57.9 ± 12.9) were enrolled. Most caregivers were spouses. Fifty-three patients were treated with LCIG, 19 with CSAI, and 54 with SOC. Mean ZBI scores were 29.6 ± 14.4 for LCIG, 35.8 ± 20.2 for CSAI, and 31.4 ± 16.0 for SOC. Caregivers of LCIG, CSAI, and SOC patients showed no burden or mild/moderate burden in 74, 53, and 63% of the cases, respectively. Mean PDQ-8 scores were 11.25 ± 5.67, 11.26 ± 5.55, and 14.22 ± 6.51 in LCIG, CSAI, and SOC patients. Neurologists considered patients “very much or much improved” in 89, 58, and 13% of the LCIG, CSAI, and SOC groups using the Clinical Global Impression–Global Improvement Scale. Predictors significantly associated with caregiver burden were patients and caregivers’ judgment of QoL and caregivers’ need to change work. Conclusions: Caregiver burden showed a tendency to be lower when patients are treated with LCIG than with CSAI or SOC

Patients' preferences for chronic lymphocytic leukemia treatment: The CHOICE study

Chronic lymphocytic leukemia (CLL) therapies differ in efficacy, side effects, route, frequency, and duration of administration. We assessed patient preferences for treatment attributes and evaluated associations with disease stage, treatment line, and socio-demographic characteristics in a cross sectional, observational study conducted at 16 Italian hematology centers. Study visits occurred between February and July 2020; 401 adult patients with CLL (201 Watch and Wait (W & W), 200 treated) participated in a discrete choice experiment (DCE), composed of 8 choices between pairs of treatment profiles with different levels of 5 attributes of currently available CLL treatments (length of response, route and duration of administration, risk of side effects including diarrhea, infections, or organ damage). Health-related quality of life was assessed with the EQ-5D-5L, EORTC QLQ-C30 and QLQ CLL-16. Previously treated patients had longer disease duration (7 vs. 5 years), higher prevalence of serious comorbidities (45.5% vs. 36.2%) and high-risk molecular markers (unmutated IGHV 55.6% vs. 17.1%; TP53 mutation 15.2% vs. 4.0%). Health-related quality of life scores were similar between groups. In the DCE, W & W patients rated "possible occurrence of infections" highest (relative importance [RI] = 36.2%), followed by "treatment and relevant duration" (RI = 28.0%) and "progression-free survival (PFS)" (RI = 16.9%). Previously treated patients rated "treatment and relevant duration" highest (RI = 33.3%), followed by "possible occurrence of infections" (RI = 28.8%), "possible occurrence of organ damage" (RI = 19.4%), and "PFS" (RI = 9.8%). Concern over infection was rated highest overall; unexpectedly PFS was not among the most important criteria in either group, suggesting that the first COVID-19 pandemic wave may have influenced patient preferences and concerns about CLL therapy options

HIDRAdisk: validation of an innovative visual tool to assess the burden of hidradenitis suppurativa

Background Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin disease characterized by painful inflamed nodules, recurrent abscesses and fistulas located in apocrine gland–bearing body sites. The negative impact of HS on patient's quality of life (QoL) has been reported to be greater than other dermatologic conditions as psoriasis and atopic eczema, and its improvement is an important goal in disease management. Nowadays, there are no specific validated QoL instruments available for HS and generic dermatologic questionnaires are used. Objective The objective of this study was to demonstrate the validity, reliability and responsiveness of HIDRAdisk, a new innovative tool designed for rapid assessment of HS burden and, at the same time, an intuitive graphic visualization of the measurement outcome. Methods A multicentre, longitudinal, observational study was conducted to validate the HIDRAdisk compared with other validated questionnaires [Skindex‐16, Dermatology Life Quality Index (DLQI), Work Productivity and Activity Impairment–General Health (WPAI:GH)] and to evaluate its correlation with disease severity in Italian patients with any degree of HS severity, as measured by Hurley stage and HS Physician Global Assessment (HS‐PGA). Results A total of 140 patients (59% women; mean age 34.9 ± 11.0 years) were enrolled in 27 dermatologic centres. HIDRAdisk showed a strong correlation with Skindex‐16 and DLQI, and a good one with WPAI:GH (correlation coefficient: 0.7568, 0.6651 and 0.5947, respectively) and a statistically significant correlation with both Hurley stage and HS‐PGA. Very good internal consistency (Cronbach coefficient >0.80; intraclass correlation coefficient >0.6), with correlation between the 10 items, good test–retest reliability (Spearman correlation coefficient, 0.8331; P < 0.0001) and responsiveness to changes were demonstrated. Conclusion Our study shows that HIDRAdisk, a short and innovative visual HS QoL instrument, has been psychometrically validated in Italian language and it may help improve the management of HS once implemented in routine clinical practice