Energy efficiency: measurement and impacts

In this paper we argue that energy efficiency and environmental efficiency are two aspects of the same problem. To show this, we assess the analytical utility of the well-known IPACT and ImPACT models, presenting here a new developed identity named Augmented ImPACT. For Italy, our findings suggest that over the last twenty years the rise of energy efficiency has been accompanied by a controversial consumption of environmental resources and of CO2 accumulation. Specifically, the italian sector of services appears to be highly inefficient. In the second part of the paper we use a VAR model to estimate the impact of energy efficiency on economy, looking at employment value added and polluted emissions. Our results suggest that a rise in energy efficiency can help in improving both economic and environmental scenarios.Contabilità ambientale; efficienza energetica e ambientale; VAR; simulazioni di risposta all'impulso

Efficienza energetica: misurazioni e impatti

In this paper we argue that energy efficiency and environmental efficiency are two aspects of the same problem. To show this, we assess the analytical utility of the well-known IPACT and ImPACT models, presenting here a new developed identity named Augmented ImPACT. For Italy, our findings suggest that over the last twenty years the rise of energy efficiency has been accompanied by a controversial consumption of environmental resources and of CO2 accumulation. Specifically, the italian sector of services appears to be highly inefficient. In the second part of the paper we use a VAR model to estimate the impact of energy efficiency on economy, looking at employment value added and polluted emissions. Our results suggest that a rise in energy efficiency can help in improving both economic and environmental scenarios

Efficienza energetica: misurazioni e impatti

In this paper we argue that energy efficiency and environmental efficiency are two aspects of the same problem. To show this, we assess the analytical utility of the well-known IPACT and ImPACT models, presenting here a new developed identity named Augmented ImPACT. For Italy, our findings suggest that over the last twenty years the rise of energy efficiency has been accompanied by a controversial consumption of environmental resources and of CO2 accumulation. Specifically, the italian sector of services appears to be highly inefficient. In the second part of the paper we use a VAR model to estimate the impact of energy efficiency on economy, looking at employment value added and polluted emissions. Our results suggest that a rise in energy efficiency can help in improving both economic and environmental scenarios

Il settore costruzioni in Italia: crisi e opportunità nell’ultimo decennio.

In questo lavoro si presenta una mappa delle grandi trasformazioni del settore costruzioni italiano avvenute nell’ultimo decennio. Il lavoro è articolato in due parti. La prima ricostruisce il quadro macroeconomico delle costruzioni attraverso i dati Istat. La seconda, ha un impianto microeconomico e analizza i dati di bilancio AIDA delle imprese del settore costruzioni. Dai dati emerge una dinamica settoriale complessivamente recessiva fino al 2013, con alcuni recenti segnali di ripresa che vanno consolidati. Interventi di politica attiva nel mercato del lavoro, e per gli investimenti in nuove costruzioni e riqualificazione abitativa, sembrano essere le misure più auspicabili. Classificazione JEL: J08, E22, G3. Parole chiave: Settore Costruzioni; Investimento; Finance. The construction industry in Italy: crisis and opportunities over the last decade This paper presents a map of the great transformations of the Italian construction sector that took place in the last decade. The paper is divided into two parts. The first one reconstructs the macroeconomic transformations of this sector by means of data provided by Istat. The second one has a microeconomic content and analyzes the AIDA balance sheet data of companies acting in the construction sector. Data shows an overall recessional dynamics up to 2013, with some recent signs of rebound but still to consolidate. Active policies in the labor market and subsidies for investments in environmental sustainable construction, and building improvement schemes seem to be the most desirable measures to relaunch the sector. JEL classification:. JEL: J08, E22, G3. Keywords: Constructuin industry; Employment; Finance

The impact of a Clinical Decision Support System on allergen immunotherapy prescription in children and adults with seasonal allergic rhinitis

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@IT2020: An innovative algorithm for allergen immunotherapy prescription in seasonal allergic rhinitis

Background: Allergen immunotherapy (AIT) is the only disease-modifying treatment in patients with seasonal allergic rhinoconjunctivitis (SAR). Its efficacy depends on the precise identification of the triggering allergen. However, diagnostics based on retrospective clinical history and sensitization to whole extracts (SWE) often leads to equivocal results. Objectives: To assess the usability and impact of a recently established algorithm for a clinical decision support system (@IT2020-CDSS) for SAR and its diagnostic steps [anamnesis, SWE (skin prick test or serum IgE), component resolved diagnosis, CRD, and real-time digital symptom recording, eDiary] on doctor's AIT prescription decisions. Methods: After educational training on the @IT2020-CDSS algorithm, 46 doctors (18 allergy specialists, AS, and 28 general practitioners, GP) expressed their hypothetical AIT prescription for 10 clinical index cases. Decisions were recorded repeatedly based on different steps of the algorithm. The usability and perceived impact of the algorithm were evaluated. Results: The combined use of CRD and an eDiary increased the hypothetical AIT prescriptions, both among AS and GP (p < .01). AIT prescription for pollen and Alternaria allergy based on anamnesis and SWE was heterogeneous but converged towards a consensus by integrating CRD and eDiary information. Doctors considered the algorithm useful and recognized its potential in enhancing traditional diagnostics. Conclusions and clinical implications: The implementation of CRD and eDiary in the @IT2020-CDSS algorithm improved consensus on AIT prescription for SAR among AS and GP. The potential usefulness of a CDSS for aetiological diagnosis of SAR and AIT prescription in real-world clinical practice deserves further investigation

Validation Parameters of Patient-Generated Data for Digitally Recorded Allergic Rhinitis Symptom and Medication Scores in the @IT.2020 Project: Exploratory Study

Background: Mobile health technologies enable allergists to monitor disease trends by collecting daily patient-reported outcomes of allergic rhinitis. To this end, patients with allergies are usually required to enter their symptoms and medication repetitively over long time periods, which may present a risk to data completeness and quality in the case of insufficient effort reporting. Completeness of patient’s recording is easily measured. In contrast, the intrinsic quality and accuracy of the data entered by the patients are more elusive. Objective: The aim of this study was to explore the association of adherence to digital symptom recording with a predefined set of parameters of the patient-generated symptom and medication scores and to identify parameters that may serve as proxy measure of the quality and reliability of the information recorded by the patient. Methods: The @IT.2020 project investigates the diagnostic synergy of mobile health and molecular allergology in patients with seasonal allergic rhinitis. In its pilot phase, 101 children with seasonal allergic rhinitis were recruited in Rome and instructed to record their symptoms, medication intake, and general conditions daily via a mobile app (AllergyMonitor) during the relevant pollen season. We measured adherence to daily recording as the percentage of days with data recording in the observation period. We examined the patient’s trajectories of 3 disease indices (Rhinoconjunctivitis Total Symptom Score [RTSS], Combined Symptom and Medication Score [CSMS], and Visual Analogue Scale [VAS]) as putative proxies of data quality with the following 4 parameters: (1) intravariation index, (2) percentage of zero values, (3) coefficient of variation, and (4) percentage of changes in trend. Lastly, we examined the relationship between adherence to recording and each of the 4 proxy measures. Results: Adherence to recording ranged from 20% (11/56) to 100% (56/56), with 64.4% (65/101) and 35.6% (36/101) of the patients’ values above (highly adherent patients) or below (low adherent patients) the threshold of 80%, respectively. The percentage of zero values, the coefficient of variation, and the intravariation index did not significantly change with the adherence to recording. By contrast, the proportion of changes in trend was significantly higher among highly adherent patients, independently from the analyzed score (RTSS, CSMS, and VAS). Conclusions: The percentage of changes in the trend of RTSS, CSMS, and VAS is a valuable candidate to validate the quality and accuracy of the data recorded by patients with allergic rhinitis during the pollen season. The performance of this parameter must be further investigated in real-life conditions before it can be recommended for routine use in apps and electronic diaries devoted to the management of patients with allergic rhinitis

Heterogeneous validity of daily data on symptoms of seasonal allergic rhinitis recorded by patients using the e‐diary AllergyMonitor®

Background: Patient-generated symptom and medication scores are essential for diagnostic and therapeutic decisions in seasonal allergic rhinitis (SAR). Previous studies have shown solid consistencies between different scores at population level in real-life data and trials. For clinicians, the evaluation of individual data quality over time is essential to decide whether to rely on these data in clinical decision-making. Objective: To analyze the consistency of different symptom (SS) and symptom medication scores (SMSs) at individual level in two study cohorts with different characteristics and explore individual patient trajectories over time. Methods: Within the pilot phase of the @IT.2020 project on diagnostic synergy of mobile health and molecular IgE assessment in patients with SAR, we analyzed data of 101 children and 93 adults with SAR and instructed them to record their symptoms and medication intake daily via the mobile app AllergyMonitor®. We then assessed the correlation between different SMS and a visual analogue scale (VAS) on the impact of allergy symptoms on daily life at population and individual level. Results: At population level, the Rhinoconjunctivitis total symptom score (RTSS) correlated better with VAS than the combined symptom and medication score (CSMS). At individual level, consistency among RTSS and VAS was highly heterogeneous and unrelated to disease severity or adherence to recording. Similar heterogeneity was observed for CSMS and VAS. Conclusions: The correlation of clinical information provided by different disease severity scores based on data collected via electronic diaries (e-diaries), is sufficient at population level, but broadly heterogeneous for individual patients. Consistency of the recorded data must be examined for each patient before remotely collected information is used for clinical decision making

Prospective (e-diary) vs retrospective (ARIA) measures of severity in allergic rhinoconjunctivitis: an observational compatibility study

Severity assessment in relation to allergen exposure is an essential part of the diagnostic work-up for seasonal allergic rhinoconjunctivits (AR). Regularly recorded patient-reported symptom data may support the physician's decision-making on etiological diagnosis and therapeutic success of a pharmacological treatment or allergen-specific immunotherapy (AIT). Although several mobile applications facilitate the prospective collection of symptom data via e-diaries, severity measures often still rely on retrospective questionnaires and studies on data quality and validation in longitudinal data sets are scarce. In this analysis, we aim to investigate whether and how prospectively acquired measures of disease severity (e-diary) relate to those retrospectively assessed via the Allergic Rhinitis and its Impact on Asthma (ARIA) questionnaire in grass pollen allergic patients

Adherence to Prescribed E-Diary Recording by Patients With Seasonal Allergic Rhinitis: Observational Study

Background: Complete diagnosis and therapy of seasonal allergic rhinoconjunctivitis require evidence that exposure to the sensitizing pollen triggers allergic symptoms. Electronic clinical diaries, by recording disease severity scores and pollen exposure, can demonstrate this association. However, patients who spontaneously download an e-diary app show very low adherence to their recording. Objective: The objective of our study was to assess adherence of patients with seasonal allergic rhinitis to symptom recording via e-diary explicitly prescribed by an allergist within a blended care approach. Methods: The @IT-2020 project is investigating the diagnostic synergy of mobile health and molecular allergology in patients with seasonal allergic rhinitis. In the pilot phase of the study, we recruited Italian children (Rome, Italy) and adults (Pordenone, Italy) with seasonal allergic rhinitis and instructed them to record their symptoms, medication intake, and general conditions daily through a mobile app (Allergy.Monitor) during the relevant pollen season. Results: Overall, we recruited 101 Italian children (Rome) and 93 adults (Pordenone) with seasonal allergic rhinitis. Adherence to device use slowly declined during monitoring in 3 phases: phase A: first week, ≥1267/1358, 90%; phase B: second to sixth week, 4992/5884, 80% to 90%; and phase C: seventh week onward, 2063/2606, 70% to 80%. At the individual level, the adherence assessed in the second and third weeks of recording predicted with enough confidence (Rome: Spearman ρ=0.75; P<.001; Pordenone: ρ=0.81; P<.001) the overall patient adherence to recording and was inversely related to postponed reporting (ρ=-0.55; P<.001; in both centers). Recording adherence was significantly higher during the peak grass pollen season in Rome, but not in Pordenone. Conclusions: Adherence to daily recording in an e-diary, prescribed and motivated by an allergist in a blended care setting, was very high. This observation supports the use of e-diaries in addition to face-to-face visits for diagnosis and treatment of seasonal allergic rhinitis and deserves further investigation in real-life contexts