Cost-effectiveness of a melanoma screening programme using whole disease modelling

OBJECTIVE: To assess the potential impact of a melanoma screening programme, compared with usual care, on direct costs and life expectancy in the era of targeted drugs and cancer immunotherapy. METHODS: Using a Whole Disease Model approach, a Markov simulation model with a time horizon of 25 years was devised to analyse the cost-effectiveness of a one-time, general practitioner-based melanoma screening strategy in the population aged over 20, compared with no screening. The study considered the most up-to-date drug therapy and was conducted from the perspective of the Veneto regional healthcare system within the Italian National Health Service. Only direct costs were considered. Sensitivity analyses, both one-way and probabilistic, were performed to identify the parameters with the greatest impact on cost-effectiveness, and to assess the robustness of our model. RESULTS: Over a 25-year time horizon, the screening intervention dominated usual care. The probabilistic sensitivity analyses confirmed the robustness of these findings. The key drivers of the model were the proportion of melanomas detected by the screening procedure and the adherence of the target population to the screening programme. CONCLUSIONS: The screening programme proved to be a dominant option compared with usual care. These findings should prompt serious consideration of the design and implementation of a regional or national melanoma screening strategy within a National Health Service

Infrapatellar fat pad gene expression and protein production in patients with and without osteoarthritis

Osteoarthritis (OA) is one of the most common joint disorders. Evidence suggests that the infrapatellar fat pad (IFP) is directly involved in OA pathology. However, a comparison between OA versus non-OA IFP is still missing. Thus, the aim of this study was to compare IFP molecular, adipocytes and extracellular matrix characteristics of patients affected by OA, and patients undergoing anterior cruciate ligament (ACL) reconstruction. We hypothesized that not only inflammation but also changes in adipocytes and extracellular matrix (ECM) composition might be involved in OA pathogenesis. Fifty-three patients were enrolled. IFP biopsies were obtained, evaluating: (a) lymphocytic infiltration and vascularization; (b) adipocytes area and number; (c) adipo-cytokines and extracellular matrix gene expression levels; (d) IL-6 and VEGF protein production; (e) collagen fibers distribution. OA IFP was more inflamed and vascularized compared to ACL IFP. OA IFP adipocytes were larger and numerically lower (1.3-fold) than ACL IFP adipocytes. An increase of gene expression of typical white adipose tissue genes was observed in OA compared to ACL IFP. Collagen-types distribution was different in the OA IFP group compared to controls, possibly explaining the change of the biomechanical characteristics found in OA IFP. Statistical linear models revealed that the adipocyte area correlated with BMI in the OA group. In conclusion, inflammation and fibrotic changes of OA IFP could represent novel therapeutic targets to counteract OA

Online Trajectory Generation for Mobile Robots with Kinodynamic Constraints and Embedded Control Systems

The paper describes trajectory generation and tracking control algorithms, respectively based on nonlinear filtering and dynamic feedback linearization, for mobile robots. A main feature of proposed algorithms is that they are suitable for the implementation on embedded systems with limited computational resources. The trajectory generator is based on nonlinear filters and logic-based management of reference inputs and dynamic constraints, allowing online smoothing of straight-line reference paths. Sparse via-points along a path can be assigned by a global planner based on obstacle avoidance algorithms and can be changed at any time during motion. Moreover, the trajectory generated by the nonlinear filter can be fed into a control loop based on the dynamic model of the robot, so that accurate tracking can be achieved. The paper includes practical remarks for efficient fixed-point implementation of the proposed trajectory generator

Job requirements in the hospitality industry: Technical or general skills? the dilemma for academic education

This paper identifies the professional profiles of graduates for job positions in the accommodation sector, in particular, whether specific skills of the position or skills related to the tourism sector are preferred. A conjoint design is applied, which presents the more realistic context of asking respondents to evaluate potential \u201cproduct\u201d profiles. Managers of accommodation facilities expressed their preferences on four hypothetical profiles of candidates for five job positions: receptionist, administrative clerk, human resources professional, web marketing specialist, revenue manager. Six attributes (academic degree and level, among others) are used to describe the candidate profiles. The data were analysed through a multinomial logit model and an ordinary least squares regression model that highlighted the preferred characteristics of the candidates for the considered job positions. The main findings show that recruitment in accommodation facilities looks at specialized skills and academic programmes appropriate for the specific job positions. Knowledge of the desired characteristics of graduates, which could affect a possible recruitment, is important for designing effective academic curricula

A Participative Process for the Definition of a Human Capital Indicator

In this paper, we discuss a method for defining the hierarchical structure of a composite indicator of graduate human capital that could be used to measure the educational effectiveness of Italian universities. The structure and weights of the dimensions of graduate human capital, and the set and weights of the elementary indicators, were determined using a three-round Delphi-like procedure. We contacted the rectors, the presidents of the evaluation boards and other qualified professors at Italian universities, as well as representatives of worker unions and entrepreneur associations. Our exercise shows that most dimensions of graduate human capital are related to the educational role of universities and that weights and indicators of the dimensions can plausibly be measured with the participation of the concerned individuals

A Participative Process for the Definition of a Human Capital Indicator

In this paper, we discuss a method for defining the hierarchical structure of a composite indicator of graduate human capital that could be used to measure the educational effectiveness of Italian universities. The structure and weights of the dimensions of graduate human capital, and the set and weights of the elementary indicators, were determined using a three-round Delphi-like procedure. We contacted the rectors, the presidents of the evaluation boards and other qualified professors at Italian universities, as well as representatives of worker unions and entrepreneur associations. Our exercise shows that most dimensions of graduate human capital are related to the educational role of universities and that weights and indicators of the dimensions can plausibly be measured with the participation of the concerned individuals

Effectiveness of Repair of Aortic Coarctation in Neonates: A Long-Term experience

To evaluate early and long-term results of surgical treatment of aortic coarctation (CoAo) in neonates. This is a retrospective clinical review of neonates with CoAo, who underwent surgery between 1995 and 2019. Data were retrieved from our institutional database, to identify preoperative and postoperative characteristics. Statistical analysis was performed by means of relative risk ratio and Cox and logistic multivariate analysis. 218 consecutive neonates (M/F: 129/89, median age 11\ua0days, IQR 7\u201317\ua0days) were included; 202 (92.7%) had a left thoracotomy; 178 underwent extended end-to-end anastomosis (EEEA, 81.6%). Hypoplastic aortic arch (HAA) was present in 102 patients (46.8%); complex cardiac anomalies in 85 (39%). Significant postoperative complications occurred in 20 (9.2%). Thirty-day mortality was 2.3% (most in complex types). At a median follow-up of 10.4\ua0years (IQR 5.6\u201315.0\ua0years; FU completeness 95.9%), there were 8 late deaths (3.7%), all associated to complex CoAo. Among 196 survivors, 177 (93.2%) were in NYHA class I; re-interventions on aortic arch occurred in 9.2% (2.0% were surgical). Freedom from mortality and re-intervention on aorta at 10\ua0years were 94.3% and 96.7%, respectively. Surgical repair of CoAo in newborns without CPB in our series was safe and low-risk, with excellent early and late outcomes