Budgeting and health technology assessment: First evidence obtained from proposal forms used to submit the adoption of new technology

Objectives: The aim of this study was to benchmark the proposal forms used by a sample of Italian hospitals to inform the budget process for the adoption of new technology to understand the relationship with the guidelines provided by the Health Technology Assessment (HTA) literature. Methods: A literature review was first undertaken to identify the frameworks developed to support decision making regarding new technology at a hospital level. A checklist of criteria drawn up according to five main perspectives (technology, patient, organization, economics, and level of evidence) has been formalized to review and compare the collected proposal forms. Results: The “technology” perspective appears to have been broadly covered. The “patient” perspective has focused to clinical issues and partially neglects other dimensions such as patient satisfaction and potential adverse events. The “organization” dimension has paid little attention to change management. The “economics” dimension has been broadly covered, even though a sensitivity analysis has not been considered. The “level of evidence” that is required for submitting the proposal form is little. Conclusions: The proposal forms used to inform the budget process regarding the adoption of new technology are accountable for a limited set of dimensions from among those proposed in literature. Further research is required to understand how to render technology assessment multidimensional, multidisciplinary, evidence-based, and accountable at a hospital leve

Performance-based assessment of seismic-resilient steel moment resisting frames equipped with innovative column base connections

Low-damage and self-centring column base connections have been proposed in the last two decades as innovative solutions able to provide the seismic resilience in Moment Resisting Frames (MRFs). Although many works have demonstrated the benefits deriving from the adoption of these systems, only a few research studies investigated the significant parameters influencing their self-centring capability. This paper investigates the influence of the frame layout (i.e., sto-reys and bays number) on the seismic performance of perimeter MRFs equipped with damage-free self-centring column bases previously studied by the authors. Nine case-study perimeter steel MRFs are designed and modelled in OpenSees. Incremental Dynamic Analyses are per-formed monitoring both global and storey-level Engineering Demand Parameters, including peak and residual interstorey drifts. Fragility curves are successively used to evaluate the self-centring capability of the structures. The present study provides insights on the use of the adopted con-nections for the residual drift reduction of MRFs and defines the boundaries of the investigated parameters for their application. Results highlight that the self-centring behaviour is particularly sensitive to the number of storeys and tends to reduce with the increasing height of MRFs equipped with the proposed connections

Fair design of CCS infrastructure for power plants in Qatar under carbon trading scheme

Qatar is currently the highest emitter per capita and targets emission reduction by exercising tight controls on gas flaring. In order to limit the emission under allowances, the power plants have two options: investing in carbon capture and storage (CCS) systems or buying carbon credits for the excess emissions above their allowances. However, CCS systems are expensive for installation and operation. In this paper, a mixed integer linear programming (MILP) model is developed for the design of integrated carbon capture, transport and storage infrastructure in Qatar under carbon trading scheme. We first investigate the critical carbon credit prices to decide under which price it is more beneficial to invest on CCS systems or to buy carbon credits via carbon trading. Then the fair design of the CCS infrastructure is obtained under two fairness scenarios: the same saving ratio and the game theory Nash approach. Fair cost distribution among power plants in Qatar is obtained by selecting the CO2 resources (power plants) to be captured with available capture technologies and materials, designing the transportation pipeline network to connect the resources with the sequestration and/or utilisation sites and determining the carbon trading price and amount among power plants. Under different fairness scenarios, the total costs are slightly higher than that from minimising the total cost to obtain the fair cost distribution. Power plants with higher CO2 emissions determine to install CCS system, while other power plants buy the carbon credits from domestic or international market to fulfil their carbon allowance requirements. The future work includes extending the current model by considering power generation distribution and designing the pipeline network with the selection of pump locations and pipe diameters

Recent advances in smart biotechnology: Hydrogels and nanocarriers for tailored bioactive molecules depot

Over the past ten years, the global biopharmaceutical market has remarkably grown, with ten over the top twenty worldwide high performance medical treatment sales being biologics. Thus, biotech R&D (research and development) sector is becoming a key leading branch, with expanding revenues. Biotechnology offers considerable advantages compared to traditional therapeutic approaches, such as reducing side effects, specific treatments, higher patient compliance and therefore more effective treatments leading to lower healthcare costs. Within this sector, smart nanotechnology and colloidal self-assembling systems represent pivotal tools able to modulate the delivery of therapeutics. A comprehensive understanding of the processes involved in the self assembly of the colloidal structures discussed therein is essential for the development of relevant biomedical applications. In this review we report the most promising and best performing platforms for specific classes of bioactive molecules and related target, spanning from siRNAs, gene/plasmids, proteins/growth factors, small synthetic therapeutics and bioimaging probes.Istituto Italiano di Tecnologia (IIT)COST Action [CA 15107]People Program (Marie Curie Actions) of the European Union's Seventh Framework Program under REA [606713 BIBAFOODS]Portuguese Foundation for Science and Technology (FCT) [PTDC/AGR-TEC/4814/2014, IF/01005/2014]Fundacao para a Ciencia e Tecnologia [SFRH/BPD/99982/2014]Danish National Research Foundation [DNRF 122]Villum Foundation [9301]Italian Ministry of Instruction, University and Research (MIUR), PRIN [20109PLMH2]"Fondazione Beneficentia Stiftung" VaduzFondo di Ateneo FRAFRAinfo:eu-repo/semantics/publishedVersio

Use of health apps and wearable devices: Survey among Italian associations for patient advocacy

Background: Technological tools such as Web-based social networks, telemedicine, apps, or wearable devices are becoming more widespread in health care like elsewhere. Although patients are the main users, for example, to monitor symptoms and clinical parameters or to communicate with the doctor, their perspective is seldom analyzed, and to the best of our knowledge, no one has focused on the patients’ health care advocacy associations’ point of view. Objective: The objective of this study was to assess patients’ health care advocacy associations’ opinions about the use, usefulness, obstacles, negative aspects, and impact of health apps and wearable devices through a Web-based survey. Methods: We conducted a Web-based survey through SurveyMonkey over nearly 3 months. Participants were contacted via an email explaining the aims of the survey and providing a link to complete the Web-based questionnaire. All the 20 items were mandatory, and the anonymized data were collected automatically into a database. Only fully completed questionnaires were considered for analysis. Results: We contacted 1998 patients’ health care advocacy associations; a total of 258 questionnaires were received back (response rate 12.91%), and 227 of the received questionnaires were fully completed (completion rate 88.0%). Informative apps, hospital apps for viewing medical reports or booking visits, and those for monitoring physical activity are the most used. They are considered especially useful to improve patients’ engagement and compliance with treatment. Wearable devices to check physical activity and glycemia are the most widespread considering, again, their benefits in increasing patients’ involvement and treatment compliance. For health apps and wearable devices, the main obstacles to their use are personal and technical reasons; the risk of overmedicalization is considered the most negative aspect of their constant use, while privacy and confidentiality of data are not rated a limitation. No statistical difference was found on stratifying the answers by responders’ technological level (P=.30), age (P=.10), and the composition of the association’s advisory board (P=.15). Conclusions: According to responders, health apps and wearable devices are sufficiently known and used and are considered potential supports for greater involvement in health management. However, there are still obstacles to their adoption, and the developers need to work to make them more accessible and more useful. The involvement of patients and their associations in planning services and products based on these technologies (as well as others) would be desirable to overcome these barriers and boost awareness about privacy and the confidentiality of dat

Community Supported Stardust Compendia

The Stardust cometary and interstellar collections present unprecedented challenges in sample preparation and analysis. The ensemble of approx.80 tracks and dozens of foil craters from the cometary collection for which we have analyses exhibits a bewildering complexity and diversity of materials. The interstellar collection is even more challenging, because of the extremely low fluence of interstellar dust, a relatively large background of secondary ejecta from impacts on the spacecraft, and the small size of interstellar dust, approximately three orders of magnitude smaller in mass than typical cometary particles. Unlike with the other returned sample collections, characterization of these samples beyond basic photo-documentation is not generally practical at JSC. Even among the other small-particle collections, currently the cosmic dust and Hayabusa samples, SEM/EDX can provide basic chemistry. This is not possible with Stardust particles without destructive and invasive sample preparation. Furthermore, SEM/EDX requires isolating small grains from adhering aerogel. A reliable technique to carry out this task does not exist. Complete characterization of particles requires coordinated analyses using synchrotron and electron-beam microprobes, which do not exist at any one lab. Thus, it was recognized since the Stardust Preliminary Examination in 2006 that characterization of the samples would rely on the worldwide community of Stardust Investigators. Here we announce the development of community-editable, wiki-style Stardust compendia that will support this effort. Our intention is that this will facilitate sample requests by providing basic characterization of tracks. We expect that this will also support comprehensive meta-analyses (global syntheses of analyses) of the collections

Emotionotopy in the human right temporo-parietal cortex

AbstractHumans use emotions to decipher complex cascades of internal events. However, which mechanisms link descriptions of affective states to brain activity is unclear, with evidence supporting either local or distributed processing. A biologically favorable alternative is provided by the notion of gradient, which postulates the isomorphism between functional representations of stimulus features and cortical distance. Here, we use fMRI activity evoked by an emotionally charged movie and continuous ratings of the perceived emotion intensity to reveal the topographic organization of affective states. Results show that three orthogonal and spatially overlapping gradients encode the polarity, complexity and intensity of emotional experiences in right temporo-parietal territories. The spatial arrangement of these gradients allows the brain to map a variety of affective states within a single patch of cortex. As this organization resembles how sensory regions represent psychophysical properties (e.g., retinotopy), we propose emotionotopy as a principle of emotion coding

Superconducting properties of nanocrystalline MgB2_2 thin films made by an in situ annealing process

We have studied the structural and superconducting properties of MgB$_2$ thin films made by pulsed laser deposition followed by in situ annealing. The cross-sectional transmission electron microscopy reveals a nanocrystalline mixture of textured MgO and MgB$_2$ with very small grain sizes. A zero-resistance transition temperature ($T_{c0}$) of 34 K and a zero-field critical current density ($J_c$) of $1.3 \times 10^6$ A/cm$^2$ were obtained. The irreversibility field was $\sim$ 8 T at low temperatures, although severe pinning instability was observed. These bulk-like superconducting properties show that the in situ deposition process can be a viable candidate for MgB$_2$ Josephson junction technologies

PLXNA1 and PLXNA3 cooperate to pattern the nasal axons that guide gonadotropin-releasing hormone neurons

Gonadotropin-releasing hormone (GnRH) neurons regulate puberty onset and sexual reproduction by secreting GnRH to activate and maintain the hypothalamic-pituitary-gonadal axis. During embryonic development, GnRH neurons migrate along olfactory and vomeronasal axons through the nose into the brain, where they project to the median eminence to release GnRH. The secreted glycoprotein SEMA3A binds its receptors neuropilin (NRP) 1 or NRP2 to position these axons for correct GnRH neuron migration, with an additional role for the NRP co-receptor PLXNA1. Accordingly, mutations in SEMA3A, NRP1, NRP2 and PLXNA1 have been linked to defective GnRH neuron development in mice and inherited GnRH deficiency in humans. Here, we show that only the combined loss of PLXNA1 and PLXNA3 phenocopied the full spectrum of nasal axon and GnRH neuron defects of SEMA3A knockout mice. Together with Plxna1, the human orthologue of Plxna3 should therefore be investigated as a candidate gene for inherited GnRH deficiency

Plxna1 and Plxna3 cooperate to pattern the nasal axons that guide gonadotropin-releasing hormone neurons

The gonadotropin releasing hormone (GnRH) neurons regulate puberty onset and sexual reproduction by secreting GnRH to activate and maintain the hypothalamic-pituitary gonadal axis. During embryonic development, GnRH neurons migrate along olfactory and vomeronasal axons through the nose into the brain, where they project to the median eminence to release GnRH. The secreted glycoprotein SEMA3A binds its receptors neuropilin (NRP) 1 or NRP2 to position these axons for correct GnRH neuron migration, with an additional role for the NRP co-receptor PLXNA1. Accordingly, mutations in SEMA3A, NRP1, NRP2 and PLXNA1 have been linked to defective GnRH neuron development in mice and inherited GnRH deficiency in humans. Here, we show that only the combined loss of PLXNA1 and PLXNA3 phenocopied the full spectrum of nasal axon and GnRH neuron defects of SEMA3A knockout mice. Together with Plxna1, the human ortholog of Plxna3 should therefore be investigated as a candidate gene for inherited GnRH deficiency