Disinvestment in healthcare: An overview of HTA agencies and organizations activities at European level

Background: In an era of a growing economic pressure for all health systems, the interest for "disinvestment" in healthcare increased. In this context, evidence based approaches such as Health Technology Assessment (HTA) are needed both to invest and to disinvest in health technologies. In order to investigate the extent of application of HTA in this field, methodological projects/frameworks, case studies, dissemination initiatives on disinvestment released by HTA agencies and organizations located in Europe were searched. Methods: In July 2015, the websites of HTA agencies and organizations belonging to the European network for HTA (EUnetHTA) and the International Network of Agencies for HTA (INAHTA) were accessed and searched through the use of the term "disinvestment". Retrieved deliverables were considered eligible if they reported methodological projects/frameworks, case studies and dissemination initiatives focused on disinvestment in healthcare. Results: 62 HTA agencies/organizations were accessed and eight methodological projects/frameworks, one case study and one dissemination initiative were found starting from 2007. With respect to methodological projects/frameworks, two were delivered in Austria, one in Italy, two in Spain and three in U.K. As for the case study and the dissemination initiative, both came from U.K. The majority of deliverables were aimed at making an overview of existing disinvestment approaches and at identifying challenges in their introduction. Conclusions: Today, in a healthcare context characterized by resource scarcity and increasing service demand, "disinvestment" from low-value services and reinvestment in high-value ones is a key strategy that may be supported by HTA. The lack of evaluation of technologies in use, in particular at the end of their lifecycle, may be due to the scant availability of frameworks and guidelines for identification and assessment of obsolete technologies that was shown by our work. Although several projects were carried out in different countries, most remain constrained to the field of research. Disinvestment is a relatively new concept in HTA that could pose challenges also from a methodological point of view. To tackle these challenges, it is necessary to construct experiences at international level with the aim to develop new methodological approaches to produce and grow evidence on disinvestment policies and practices

Correlated Component Analysis for diffuse component separation with error estimation on simulated Planck polarization data

We present a data analysis pipeline for CMB polarization experiments, running from multi-frequency maps to the power spectra. We focus mainly on component separation and, for the first time, we work out the covariance matrix accounting for errors associated to the separation itself. This allows us to propagate such errors and evaluate their contributions to the uncertainties on the final products.The pipeline is optimized for intermediate and small scales, but could be easily extended to lower multipoles. We exploit realistic simulations of the sky, tailored for the Planck mission. The component separation is achieved by exploiting the Correlated Component Analysis in the harmonic domain, that we demonstrate to be superior to the real-space application (Bonaldi et al. 2006). We present two techniques to estimate the uncertainties on the spectral parameters of the separated components. The component separation errors are then propagated by means of Monte Carlo simulations to obtain the corresponding contributions to uncertainties on the component maps and on the CMB power spectra. For the Planck polarization case they are found to be subdominant compared to noise.Comment: 17 pages, accepted in MNRA

Analysis of a spontaneous mutant and selected clones of cv. Italia (Vitis vinifera) by AFLP markers

A spontaneously formed mutant and selected clones (from clonal selection) of the table grape cv. Italia (Vitis vinifera) were evaluated with regard to the the possible use of molecular markers for grapevine clone differentiation. The identified off-type grapevine, which presents a mutated branch and a normal one on the same plant, removes any doubt as to its origin and allows a better evaluation of the suitability of molecular markers for the differentiation of grape clones. AFLPs were used as molecular markers because a large number of loci can be screened in a single assay, which is useful for any study on genotype relationships when a large number of bands (variables) is required. Different primer combinations (49) produced 3880 scorable AFLP bands but none showed any polymorphism among clones. Nevertheless it is suggested to use both AFLP and morphological markers for the differentiation of grapevine clones. The AFLPs would confirm the high level of DNA similarity among the suspected clones while morphological characters would allow to verify, through appropriate field experimental designs, the reliability of the phenotypic differences detected among grape clones.

Intervento di sismica passiva all'Isola di Stromboli durante l'eruzione del Dicembre 1985

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Minimal prescription corrected spectra in heavy quark decays

The Minimal Prescription procedure is applied to tame the Landau pole singularities of resummed formulae for heavy quark decays. Effects of the final quark mass are taken into account. Explicit expressions are obtained for the t->b and b->c transitions for both the frozen coupling approximation and in the QCD running coupling case.Comment: Text revised, as accepted by Phys Rev D. Same content, formulas and conclusions. Title changed, one figure and appendix added. 24 pages, 10 figure

A high sensitivity, low noise and high spatial resolution multi-band infrared reflectography camera for the study of paintings and works on paper

Infrared reflectography (IRR) remains an important method to visualize underdrawing and compositional changes in paintings. Older IRR camera systems are being replaced with near-infrared cameras consisting of room temperature infrared detector arrays made out of indium gallium arsenide (InGaAs) that operate over the spectral range of ~900 to 1700 nm. Two camera types are becoming prevalent. The first is staring array infrared cameras having 0.25–1 Megapixels where the camera or painting is moved to acquire tens of individual images that are later mosaicked together to create the infrared reflectogram. The second camera type is scanning back cameras in which a small InGaAs array (linear or area array) is mechanically scanned over a large image formed by the camera lens to create the reflectogram, typically 16 Megapixels. Both systems have advantages and disadvantages. The staring IR array cameras offer more flexible collection formats, provide live images, and allow for the use of spectral bandpass filters that can provide reflectograms with better contrast in some cases. They do require a mechanical system for moving the camera or the artwork and post-capture image mosaicking. Scanning back cameras eliminate or reduce the amount of mosaicking and movement of the camera, however the need to minimize light exposure to the artwork requires short integration times, and thus limits the use of spectral bandpass filters. In general, InGaAs cameras are not sensitive in the 1700 to ~2300 nm spectral region, which has been identified in prior studies as useful for examining paintings with copper green pigments or thick lead white paints. Prior studies using cameras with sensitivity from 1000 to 2500 nm have found in general the performance at wavelengths longer than 1700 nm degraded relative to the performance at shorter wavelengths. Thus, there is interest in a camera system having improved performance out to 2500 nm that can utilize spectral bandpass filters

Climate change adaptation cycle for pilot projects development in small municipalities: The northwestern Italian regions case study

More than half of the European population live in small and medium size municipalities, where climate adaptation planning is an under-researched topic within the climate change field. Many constraints might hinder the implementation of adaptation pilot projects due to lack of economic, knowledge, and technical available resources. Local institutions find difficulties in building a coherent local adaptation planning and design processes with international and national frameworks. In this context, this article proposes a methodology based on the available international frameworks to support the small communities with the aim to implement adaptation pilot projects within different sectors. In doing so, this paper tests a climate change adaptation cycle for pilot projects development in small municipalities; the first in Italy for small municipalities under 20.000 inhabitants. The proposed methodology could lead local adaptation initiatives in climate change risk assessment by supporting the research communities in developing a coherent vision for the local territories and to identify proper oriented measures to enhance demonstrative pilot projects and to increase the level of resilience in small municipalities, avoiding maladaptation

Fluid-structure interaction and homogenization: from spatial averaging to continuous wavelet transform

Fluid-structure interaction (FSI) is classicaly modeled according a separated and local approach. It enables to take full advantage of the numerical methods specifically designed for each medium. However, it requires to take great care of the interface, and to exchange, between the algorithms, the information related to boundary conditions [1]. This treatment of the interface can quickly become too cumbersome in complex flow geometries, as in the industrial case study driving this work: an inviscid compressible flow interacting with French PWR fuel assemblies (Fig. 1a). In such specific applications, where the solid medium exhibits a discontinuous but periodic design, an homogenized and global approach is preferred [2]. Inspired by porous media [3, 4], multiphase flows, or Large Eddy Simulation (LES), it relies on a spatial averaging of the balance equations, thus allowing to remove all interfaces. However, such filtering techniques exhibit two major limitations: first, they do not deal properly with boundary conditions, due to the non-commutativity between the filtering operator and spatial derivatives, as detailed in [5, 6, 7] for LES; second, filtering implies loss of microscopic information, and thus requires a closure model to describe interactions between resolved and unresolved scales

Grapevine cvs Primitivo, Zinfandel and Crljenak kastelanski: Molecular analysis by AFLP

Research Not