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.

Enabling solid biomass fired small scale cogeneration systems with the twin screw wet steam expander technology

Distributed power generation in industrial, urban and commercial applications is a key topic for the strategic development and implementation of modern energy policies. Solid biomass fired small scale cogeneration plants can play an important role in Europe to improve environmental and economic impact of such policies. As a result of advances in the design and development of twin-screw wet steam expanders, they now appear as an efficient enabling technology for this small scale de-centralized cogeneration plants. Same as backpressure turbines, twinscrew steam expander can generate power by reducing the pressure between the steam source and the downstream steam/heat user, but with the advantage of adopting wet steam as working fluid. The paper will describe the principles of steam screw expander operation and performance characterization and discuss installations of the expander genset in various industrial and urban (district heating) applications where steam is generated with solid biomass fired saturated steam boilers

MiR-205-5p inhibition by locked nucleic acids impairs metastatic potential of breast cancer cells

Mir-205 plays an important role in epithelial biogenesis and in mammary gland development but its role in cancer still remains controversial depending on the specific cellular context and target genes. We have previously reported that miR-205-5p is upregulated in breast cancer stem cells targeting ERBB pathway and leading to targeted therapy resistance. Here we show that miR-205-5p regulates tumorigenic properties of breast cancer cells, as well as epithelial to mesenchymal transition. Silencing this miRNA in breast cancer results in reduced tumor growth and metastatic spreading in mouse models. Moreover, we show that miR-205-5p knock-down can be obtained with the use of specific locked nucleic acids oligonucleotides in vivo suggesting a future potential use of this approach in therapy

Exploring infrasound wavefields to characterize volcanic eruptions

Thesis (Ph.D.) University of Alaska Fairbanks, 2020Infrasound has become an increasingly popular way to monitor and characterize volcanic eruptions, especially when combined with multidisciplinary observations. Regardless of how close the infrasound instruments are to the eruption, the effects from propagation must be considered prior to characterizing and quantifying the source. In this dissertation, we focus on modeling the effects of the atmosphere and topography on the recorded infrasound waveforms in order to better interpret the acoustic source and its implications on the volcanic eruption as a whole. Alaska has 54 historically active volcanoes, one third of which have no local monitoring equipment. Therefore, remote sensing (including that of infrasound arrays) is relied upon for the detection, location, and characterization of volcanic eruptions. At long ranges, the wind and temperature structure of the atmosphere affects infrasound propagation, however, changes in these conditions are variable both in time and space. We apply an atmospheric reconstruction model to characterize the atmosphere and use infrasound propagation modeling techniques for a few recent eruptions in Alaska. We couple these atmospheric propagation results with array processing techniques to provide insight into detection capability and eruption dynamics for both transient and long-duration eruptions in Alaska. Furthermore, we explore the future implementation of this long-range infrasound propagation modeling as an additional monitoring tool for volcano observatories in real time. The quantication of volcanic emissions, including volume flow rate and erupted mass, is possible through acoustic waveform inversion techniques that account for the effects of propagation over topography. Previous volcanic studies have generally assumed a simple acoustic source (monopole), however, more complex source reconstructions can be estimated using a combination of monopole and dipole sources (multipole). We deployed an acoustic network around Yasur volcano, Vanuatu, which has eruptions every 1-4 minutes, including acoustic sensors along a tethered aerostat, allowing us to better constrain the acoustic source in three dimensions. We find that the monopole source is a good approximation when topography is accounted for, but that directionality cannot be fully discounted. Inversions for the dipole components produce estimates consistent with observed ballistic directionality, though these inversions are somewhat unstable given the station conguration. Future work to explore acoustic waveform inversion stability, uncertainty, and robustness should be performed in order to better estimate and quantify the explosion source. Volcanic explosions can produce large, ash-rich plumes that pose great hazard to aviation. We use a single co-located seismic and infrasound sensor pair to characterize 21 explosions at Mount Cleveland, Alaska over a four-year study period. While the seismic explosion signals were similar, the acoustic signals varied between explosions, with some explosions exhibiting single main compressional phase while other explosions had multiple compressions in a row. A notable observation is that the seismo-acoustic time lag varied between explosions, implying a change in the path between the source and receiver. We explore the influence of atmospheric effects, nonlinear propagation, and source depth within the conduit on this variable seismo-acoustic time lag. While changes in the atmospheric conditions can explain some of the observed variation, substantial residual time lags remain for many explosions. Additionally, nonlinear propagation does not result in a measurable difference for the acoustic onset. Therefore, using methods such as seismic particle motion analysis and cross correlation of waveforms between events, we conclude that varying source depth within the conduit likely plays a key role in the observed variation in the seismo-acoustic time lags at Mount Cleveland.National Science Foundation Grants EAR-1331084 (AMI and DF), EAR-1620576 (RSM), and EAR-1847736 (RSM), Alaska Volcano Observatory, New Zealand Strategic Science InvestmentChapter 1: General introduction -- Chapter 2: Application of an updated atmospheric model to explore volcano infrasound propagation and detection in Alaska -- Chapter 3: Three-dimensional acoustic multipole waveform inversion at Yasur Volcano, Vanuatu -- Chapter 4: Seismo-acoustic characterization of Mount Cleveland Volcano explosions -- Chapter 5: general Conclusion

A lunar space station

A concept for a space station to be placed in low lunar orbit in support of the eventual establishment of a permanent moon base is proposed. This space station would have several functions: (1) a complete support facility for the maintenance of the permanent moon base and its population; (2) an orbital docking area to facilitate the ferrying of materials and personnel to and from Earth; (3) a zero gravity factory using lunar raw materials to grow superior GaAs crystals for use in semiconductors and mass produce inexpensive fiber glass; and (4) a space garden for the benefit of the air food cycles. The mission scenario, design requirements, and technology needs and developments are included as part of the proposal

Split crest technique for implant treatment of agenesis of the upper lateral incisors: results of a randomized pilot histological and clinical study at 24-month follow-up

Agenesis of lateral incisors, besides the functional issues, represents a great esthetic drawback. The selection of an appropriate treatment is a complex decision, which should consider the stability of the clinical outcomes over time. The aim of the present study was a histological and clinical comparison of two-stage split crest technique (SCT), with bone chips alone or mixed with porcine bone in patients affected by unilateral and bilateral agenesis of the upper lateral incisors. Eleven patients were enrolled, and randomly assigned to receive a treatment with autologous bone chips (group 1) or autologous bone chips mixed 1:1 to porcine-derived xenogenic bone (group 2). After a 2-month healing period, implants were placed and biopsies harvested for histomorphometrical evaluation. Clinical assessment, according to ICOI PISA health scale, and radiographic marginal bone loss evaluation at 12- and 24-month follow-ups were conducted. The histomorphometry showed significantly greater new bone formation (p > 0.0229) in group 2. At 12- and 24-month follow-ups, all the evaluated implants, regardless of the group they were allocated, could be categorized as "success" in the ICOI Pisa Health Scale for Dental Implants, and did not show significant difference in crestal bone loss. To the best of our knowledge, these are the first histological and clinical outcomes indicating that the use of bone chips mixed 1:1 to porcine bone in SCT could be a promising technique for the rehabilitation of patients with agenesis of the upper lateral incisors, although studies with a larger number of patients and implants, and a longer follow up are needed