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

Dynamic modeling of three-phase upflow fixed-bed reactor including pore diffusion

The dynamics of a three-phase upflow fixed-bed reactor are investigated using a non-isothermal heterogeneous model including gas–liquid and liquid–solid mass transfer and diffusion/reaction phenomena inside the catalyst. The partial differential and algebraic equations involving three integration variables (time and two space coordinates) are solved via discretization of the spatial coordinates coupled with the Gear method. For a multistep hydrogenation on a shell catalyst, the model exhibits significant effects of the external and above all internal resistance to hydrogen transfer but also non-trivial internal hydrocarbons concentration profiles. A simplified model is compared with the extended one and with experimental data in transient regime. In the investigated conditions—hydrocarbons in large excess—the diffusion of hydrocarbons appears to be actually not limiting, so that the simplest model predicts accurately the transient reactor behavior

PGM-Free Biomass-Derived Electrocatalysts for Oxygen Reduction in Energy Conversion Devices: Promising Materials

Biomass is a low-cost, abundant and renewable resource that can be used to manufacture porous carbon-based materials for a variety of applications. Different mesoporous carbon supports can be obtained from the various synthetic approaches that are aimed at increasing the specific surface area and functionalization. Currently, most of the biomass is used for energy recovery. The circular economy approach could lead to the development of cheap and sustainable materials, and turning of wastes into a precious resource. In this review, we provide the recent advances in the field of electrochemistry for porous carbon materials derived from biomass, which offers wider applications in proton exchange membrane fuel cells (PEMFCs), anion exchange membrane fuel cells (AEMFCs) and Zn-air batteries (ZABs). The focus is on understanding the required properties of the materials and the role of synthetic pathways in platinum group metal (PGM) free electrocatalysts. The most promising materials are evaluated towards the oxygen reduction reaction (ORR) in PEMFC, AEMFC, and ZAB. The results achieved showed that the expected performances on these energy conversion devices still lack for deployment in practice, especially if compared with commercially available PGM-free electrocatalysts. This review article provides insights on how to improve the actual electrocatalytic activity of biomass-derived materials. Graphical Abstract: [Figure not available: see fulltext.

Faults Affecting Energy-Harvesting Circuits of Self-Powered Wireless Sensors and Their Possible Concurrent Detection

We analyze the effects of faults on an energy-harvesting circuit (EHC) providing power to a wireless biomedical multisensor node. We show that such faults may prevent the EHC from producing the power supply voltage level required by the multisensor node. Then, we propose a low-cost (in terms of power consumption and area overhead) additional circuit monitoring the voltage level produced by the EHC continuously, and concurrently with the normal operation of the device. Such a monitor gives an error indication if the generated voltage falls below the minimum value required by the sensor node to operate correctly, thus allowing the activation of proper recovery actions to guarantee system fault tolerance. The proposed monitor is self-checking with regard to the internal faults that can occur during its in-field operation, thus providing an error signal when affected by faults itself

Persistent organochlorine compounds in fetal and maternal tissues: evaluation of their potential influence on several indicators of fetal growth and health

Some organochlorine compounds, such as polychlorinated biphenyls (PCBs), have a tendency to bioaccumulate in humans and predators at the top of the food chain. We have recently confirmed the transplacental transfer of these compounds and the present study has been designed on the same material with the aim of investigating their potential health effects on newborns from 70 pregnant women, resident in a Northern Italy industrial town. Organochlorine compounds [namely, p,p'-dichlorodiphenyltrichloroethane (p,p'-DDT), p,p'-dichlorodiphenyldichloroethene (p,p'-DDE), hexachlorobenzene (HCB), and PCBs] have been analyzed both in cord and maternal serum, placenta, and maternal subcutaneous adipose tissue by GC-MSD. p,p'-DDT levels in the adipose tissue resulted significantly (p<0.05) related to birth length. Mothers of neonates born by preterm programmed caesarean delivery showed significantly (p<0.005 for both) higher serum p,p'-DDE serum concentrations and p,p'-DDT levels in the adipose tissue, as compared to mothers delivering at term

Nanopore Sequencing in Blood Diseases: A Wide Range of Opportunities

The molecular pathogenesis of hematological diseases is often driven by genetic and epigenetic alterations. Next-generation sequencing has considerably increased our genomic knowledge of these disorders becoming ever more widespread in clinical practice. In 2012 Oxford Nanopore Technologies (ONT) released the MinION, the first long-read nanopore-based sequencer, overcoming the main limits of short-reads sequences generation. In the last years, several nanopore sequencing approaches have been performed in various “-omic” sciences; this review focuses on the challenge to introduce ONT devices in the hematological field, showing advantages, disadvantages and future perspectives of this technology in the precision medicine era

Immunomodulatory drugs in acute myeloid leukemia treatment

Immunomodulatory drugs (IMiDs) are analogs of thalidomide. They have immunomodulatory, antiangiogenic and proapoptotic properties and exert a role in regulating the tumor microenvironment. Recently IMiDs have been investigated for their pleiotropic properties and their therapeutic applications in both solid tumors (melanoma, prostate carcinoma and differentiated thyroid cancer) and hematological malignancies. Nowadays, they are applied in de novo and relapsed/ refractory multiple myeloma, in myelodysplastic syndrome, in del5q syndrome with specific use of lenalidomide and B-cell lymphoma. Several studies have been conducted in the last few years to explore IMiDs possible use in acute myeloid leukemia treatment. Here we report the mechanisms of action of IMiDs in acute myeloid leukemia and their potential future therapeutic application in this disease

FLT3 mutational analysis in acute myeloid leukemia: Advantages and pitfalls with different approaches

FMS-like tyrosine kinase 3 (FLT3) is one of the most closely studied genes in blood diseases. Numerous methods have been adopted for analyses, mainly in acute myeloid leukemia (AML) diagnostic work-up. According to international recommendations, the current gold standard approach allows FLT3 canonical mutations to be investigated, providing the main information for risk assessment and treatment choice. However, the technological improvements of the last decade have permitted “black side” gene exploration, revealing numerous hidden aspects of its role in leukemogenesis. The advent of the next-generation sequencing era emphasizes lights and shadows of FLT3 conventional mutational analysis, highlighting the need for a more comprehensive study of the gene. However, more extensive analysis is opening new, unexplored questions whose impact on clinical outcomes is still unknown. The present work is focused on the main topics regarding FLT3 mutational analysis in AML, debating the strengths and weaknesses of the current gold standard approach. The rights and wrongs of NGS introduction in clinical practice will be discussed, showing that a more extensive knowledge of FLT3 mutational status could lead to reconsidering its role in AML management

Can the new and old drugs exert an immunomodulatory effect in acute myeloid leukemia?

Acute myeloid leukemia (AML) is considered an immune-suppressive neoplasm capable of evading immune surveillance through cellular and environmental players. Increasing knowledge of the immune system (IS) status at diagnosis seems to suggest ever more attention of the crosstalk between the leukemic clone and its immunologic counterpart. During the last years, the advent of novel immunotherapeutic strategies has revealed the importance of immune dysregulation and suppression for leukemia fitness. Considering all these premises, we reviewed the “off-target” effects on the IS of different drugs used in the treatment of AML, focusing on the main advantages of this interaction. The data reported support the idea that a successful therapeutic strategy should consider tailored approaches for performing leukemia eradication by both direct blasts killing and the engagement of the IS

An Overview of Ecological Indicators of Fish to Evaluate the Anthropogenic Pressures in Aquatic Ecosystems: From Traditional to Innovative DNA-Based Approaches

In order to halt the loss of global biodiversity and considering the United Nations Decade for Ocean Conservation Agenda, increasing efforts to improve biomonitoring programs and assessment of ecosystem health are needed. Aquatic environments are among the most complex to monitor, requiring an array of tools to assess their status and to define conservation targets. Although several parameters need to be considered for a comprehensive ecological status assessment, it is important to identify easy-to-apply high-resolution monitoring methods. Shifts in fish composition and abundance are often good indicators of ecosystem health status in relation to anthropogenic activities. However, traditional monitoring methods are strictly related to the habitat under study and cannot be applied universally. This review summarizes the importance of ecological indicators for aquatic environments subjected to anthropogenic stressors, with a particular focus on fish communities and transitional water ecosystems. We describe the main characteristics of both traditional and novel methods for fish monitoring, highlighting their advantages and shortcomings in an attempt to identify simple and reliable ways for a correct evaluation of the dynamics of aquatic ecosystems