Healthcare digitalization and pay-for-performance incentives in smart hospital project financing

This study aims to explore the impact of healthcare digitalization on smart hospital project financing (PF) fostered by pay-for-performance (P4P) incentives. Digital platforms are a technology-enabled business model that facilitates exchanges between interacting agents. They represent a bridging link among disconnected nodes, improving the scalable value of networks. Application to healthcare public-private partnerships (PPPs) is significant due to the consistency of digital platforms with health issues and the complexity of the stakeholder’s interaction. In infrastructural PPPs, public and private players cooperate, usually following PF patterns. This relationship is complemented by digitized supply chains and is increasingly patient-centric. This paper reviews the literature, analyzes some supply chain bottlenecks, addresses solutions concerning the networking effects of platforms to improve PPP interactions, and investigates the cost-benefit analysis of digital health with an empirical case. Whereas diagnostic or infrastructural technology is an expensive investment with long-term payback, leapfrogging digital applications reduce contingent costs. “Digital” savings can be shared by key stakeholders with P4P schemes, incentivizing value co-creation patterns. Efficient sharing may apply network theory to a comprehensive PPP ecosystem where stakeholding nodes are digitally connected. This innovative approach improves stakeholder relationships, which are re-engineered around digital platforms that enhance patient-centered satisfaction and sustainability. Digital technologies are useful even for infectious disease surveillance, like that of the coronavirus pandemic, for supporting massive healthcare intervention, decongesting hospitals, and providing timely big data

Energy performance contracting and public-private partnership: how to share risks and balance benefits

Public private partnerships (PPPs) are a well-known instrument used worldwide by public administration (PA) to build public infrastructure using private knowhow and financial resources, and sharing risks. In recent years, PPPs have been widely adopted to develop energy efficiency projects between public and private sectors. In this context, a successful project requires a contractual arrangement based on energy performance contracting (EPC) that balances the interests of the two parties. This paper aims to answer two questions: how to share the benefits between the contractual parties and reach an optimal long-term contractual agreement; and which type of contract ensures a consistent risk transfer to the private partner, allowing the PA an "off balance"accounting treatment. The research questions are answered through the development of a mathematical equation able to calculate the optimal percentage of benefits sharing between partners in a long-term contractual agreement. The results are tested with a simulation based on a case study about the energy efficiency project of an Italian hospital. The paper is innovative because it provides suggestions to improve the EPC-PPP contractual structure and realize a balanced agreement between the public and private partners. Moreover, it analyzes the different allocation of risks in EPC contracts to identify the implication for the PA in terms of on-off balance accounting treatment in energy efficiency investment. We show how a successful long-term EPC-PPP can benefit from a mixed contractual structure in which profit-sharing percentage changes during the contract's life to ensure the same net present value (NPV) to both public and private partners. This paper supports public decision making in order to choose contracts that are able to transfer energy and management risks. Moreover, it helps to understand the balance between public and private interests in a long-term EPC-PPP contract

Can public-private partnerships foster investment sustainability in smart hospitals?

This article addresses the relationship between Public-Private Partnerships (PPP) and the sustainability of public spending in smart hospitals. Smart (technological) hospitals represent long-termed investments where public and private players interact with banking institutions and eventually patients, to satisfy a core welfare need. Characteristics of smart hospitals are critically examined, together with private actors' involvement and flexible forms of remuneration. Technology-driven smart hospitals are so complicated that they may require sophisticated PPP. Public players lack innovative skills, whereas private actors seek additional compensation for their non-routine efforts and higher risk. PPP represents a feasible framework, especially if linked to Project Financing (PF) investment patterns. Whereas the social impact of healthcare investments seems evident, their financial coverage raises growing concern in a capital rationing context where shrinking public resources must cope with the growing needs of chronic elder patients. Results-Based Financing (RBF) is a pay-by-result methodology that softens traditional PPP criticalities as availability payment sustainability or risk transfer compensation. Waste of public money can consequently be reduced, and private bankability improved. In this study, we examine why and how advanced Information Technology (IT) solutions implemented in "Smart Hospitals" should produce a positive social impact by increasing at the same time health sustainability and quality of care. Patient-centered smart hospitals realized through PPP schemes, reshape traditional healthcare supply chains with savings and efficiency gains that improve timeliness and execution of care

iGlarLixi effectively reduces residual hyperglycaemia in patients with type 2 diabetes on basal insulin: A post hoc analysis from the LixiLan-L study

Globally, nearly half of patients with type 2 diabetes (T2D) do not successfully achieve target HbA1c with basal insulin, despite meeting fasting plasma glucose (FPG) targets. In this post hoc analysis of the LixiLan-L study, we determined whether iGlarLixi, a fixed-ratio combination of insulin glargine Gla-100 (iGlar) and the glucagon-like peptide-1 receptor agonist lixisenatide (Lixi), addresses the challenge of reducing residual hyperglycaemia in patients with T2D. In LixiLan-L, a randomized, open-label study, 1018 patients with T2D on basal insulin for ≥6 months ± oral antidiabetes drugs entered a 6-week run-in period, during which they were switched to and/or optimized for a daily dose of iGlar while continuing only metformin. Following the run-in period, 736 patients were then randomized to receive iGlarLixi or were continued on iGlar for 30 weeks ± metformin. Residual hyperglycaemia was defined as HbA1c ≥ 7.0% despite FPG of <140 mg/dL. The proportion of patients with residual hyperglycaemia was similar in both treatment arms at screening (~~42%), and increased after the run-in period (~~62%). After 30 weeks, the proportion of patients with residual hyperglycaemia declined to 23.8% in the iGlarLixi versus 47.1% in the iGlar arm (P <.0001). The proportion of patients achieving both HbA1c (<7.0%) and FPG (<140 mg/dL) targets was higher in the iGlarLixi compared with the iGlar arm (50.3% vs. 27.4%, respectively; P <.0001). iGlarLixi effectively reduces residual hyperglycaemia in patients with T2D on basal insulin therapy

Sustainability Study of a New Solid-State Aluminum Chips Recycling Process: A Life Cycle Assessment Approach

Nowadays, reducing greenhouse gas emissions in all human activities has become crucial. This article presents a life cycle assessment (LCA) investigation conducted to evaluate the environmental benefits of a newly developed solid-state recycling process for aluminum chips, involving two steps: direct rolling and accumulative roll bonding. A comparison was made between this process and two current industrial methods of recycling aluminum scraps to obtain wrought products, which involve melting, casting, and subsequent rolling. The LCA analysis considered a scenario where 50% of the total electric requirement was met by photovoltaic energy. The results of the study indicate that in all examined impact categories, direct rolling has a lower environmental footprint compared to both traditional recycling and twin-roll cast technology. These results suggest that this new solid-state recycling procedure has significant potential to replace environmentally harmful melting processes

Selective Disruption of Perineuronal Nets in Mice Lacking Crtl1 is Sufficient to Make Fear Memories Susceptible to Erasure

The ability to store, retrieve, and extinguish memories of adverse experiences is an essential skill for animals' survival. The cellular and molecular factors that underlie such processes are only partially known. Using chondroitinase ABC treatment targeting chondroitin sulfate proteoglycans (CSPGs), previous studies showed that the maturation of the extracellular matrix makes fear memory resistant to deletion. Mice lacking the cartilage link protein Crtl1 (Crtl1-KO mice) display normal CSPG levels but impaired CSPG condensation in perineuronal nets (PNNs). Thus, we asked whether the presence of PNNs in the adult brain is responsible for the appearance of persistent fear memories by investigating fear extinction in Crtl1-KO mice. We found that mutant mice displayed fear memory erasure after an extinction protocol as revealed by analysis of freezing and pupil dynamics. Fear memory erasure did not depend on passive loss of retention; moreover, we demonstrated that, after extinction training, conditioned Crtl1-KO mice display no neural activation in the amygdala (Zif268 staining) in comparison to control animals. Taken together, our findings suggest that the aggregation of CSPGs into PNNs regulates the boundaries of the critical period for fear extinction

Composition of KBO (50000) Quaoar

Aims. The objective of this work is to investigate the physical properties of objects beyond Neptune-the new frontiers of the Solar System-and in particular to study the surface composition of (50 000) Quaoar, a classical Transneptunian (or Kuiper Belt) object. Because of its distance from the Sun, Quaoar is expected to have preserved, to a degree, its original composition. Our goals are to determine to what degree this is true and to shed light on the chemical evolution of this icy body. Methods. We present new near-infrared (3.6 and 4.5 mu m) photometric data obtained with the Spitzer Space Telescope. These data complement high resolution, low signal-to-noise spectroscopic and photometric data obtained in the visible and near-infrared (0.4-2.3 mu m) at VLT-ESO and provide an excellent set of constraints in the model calculation process. We perform spectral modeling of the entire wavelength range-from 0.3 to 4.5 mu m by means of a code based on the Shkuratov radiative transfer formulation of the slab model. We also attempt to determine the temperature of H(2)O ice making use of the crystalline feature at 1.65 mu m. Results. We present a model confirming previous results regarding the presence of crystalline H(2)O and CH(4) ice, as well as C(2)H(6) and organic materials, on the surface of this distant icy body. We attempt a measurement of the temperature and find that stronger constraints on the composition are needed to obtain a precise determination. Conclusions. Model fits indicate that N(2) may be a significant component, along with a component that is bright at lambda > 3.3 mu m, which we suggest at this time could be amorphous H(2)O ice in tiny grains or thin grain coatings. Irradiated crystalline H(2)O could be the source of small-grained amorphous H(2)O ice. The albedo and composition of Quaoar, in particular the presence of N(2), if confirmed, make this TNO quite similar to Triton and Pluto

On the possibility of measuring relativistic gravitational effects with a LAGEOS-LAGEOS II-OPTIS-mission

In this paper we wish to preliminary investigate if it would be possible to use the orbital data from the proposed OPTIS mission together with those from the existing geodetic passive SLR LAGEOS and LAGEOS II satellites in order to perform precise measurements of some general relativistic gravitoelectromagnetic effects, with particular emphasis on the Lense-Thirring effect.Comment: Abridged version. 16 pages, no figures, 1 table. First results from the GGM01C Earth gravity model. GRACE data include

Enhancement and Suppression of Transmission in 3-D Nanoslits Arrays with 1-and 2-D Periodicities

ABSTRACT We investigate the transmission properties of arrays of three-dimensional (3-D) gold patches having one-and twodimensional (1-and 2-D) periodicities, and describe the interaction of cavity and surface plasmon modes. We vary the main geometrical parameters to assess similarities and emphasize differences between 1-D and 2-D periodic patterns. We analyze the spectral response as a function of incident angle and polarization to corroborate our findings. We will also consider form and air filling factors of the grating to assess our ability to control the transmission spectrum. In particular, we observe strong inhibition of the transmission when the impinging wave-vector parallel to the surface of the metal matches the surface plasmon wave-vector of the unperturbed air-gold interface when added to the grating lattice wave-vector. This phenomenon favors the opening of a plasmonic band gap, featuring the suppression of transmission and simultaneous coupling to back-radiation (reflections) of the unperturbed surface plasmon. High-Q, resonating modes occur at the edges of the forbidden band, boosting the energy transfer across the grating thus providing enhanced transmission and broadside directivity at the exit side of the grating

The hArtes Tool Chain

This chapter describes the different design steps needed to go from legacy code to a transformed application that can be efficiently mapped on the hArtes platform