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

Molecular complexity of diffuse large B-cell lymphoma: Can it be a roadmap for precision medicine?

Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma; it features extreme molecular heterogeneity regardless of the classical cell-of-origin (COO) classification. Despite this, the standard therapeutic approach is still immunochemotherapy (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone—R-CHOP), which allows a 60% overall survival (OS) rate, but up to 40% of patients experience relapse or refractory (R/R) disease. With the purpose of searching for new clinical parameters and biomarkers helping to make a better DLBCL patient characterization and stratification, in the last years a series of large discovery genomic and transcriptomic studies has been conducted, generating a wealth of information that needs to be put in order. We reviewed these researches, trying ultimately to understand if there are bases offering a roadmap toward personalized and precision medicine also for DLBCL

The effect of Fe, Co, and Ni structural promotion of cryptomelane (KMn8O16)(KMn_8O_{16}) on the catalytic activity in oxygen evolution reaction

Transition metal (Fe, Co, Ni)-doped cryptomelane materials (K-OMS-2) were synthesized and characterized with the use of XRD, Raman spectroscopy, XPS, N2-BET, H2-TPR, and SEM. The electrocatalytic reactivity in oxygen evolution was evaluated with the use of the rotating disk electrode. It was found that the electrocatalytic activity is substantially enhanced for the cobaltdoped material, while iron and nickel doping have no, or even, negative effect on K-OMS-2. The structure of the material bulk is preserved in all cases, but the formation of additional birnessite phases can be evidenced for the iron and cobalt dopants. It is discussed that the reactivity enhancement of Co/K-OMS-2 can be related not only to the formation of cobalt-doped heterophases (cobaltane, birnessite) but also to the changes of the properties of pristine cryptomelane

PET waste as organic linker source for the sustainable preparation of MOF-derived methane dry reforming catalysts

A catalyst made of Ni0 nanoparticles highly dispersed on a lamellar alumina support was prepared by an environmentally-friendly route. The latter involved the synthesis of an aluminum-containing metalorganic framework (MOF) MIL-53(Al) in which the linkers were derived from the depolymerization of polyethylene terephthalate (PET) originating from plastic wastes. After demonstrating the purity and structure integrity of the PET-derived MIL-53(Al), this MOF was impregnated with nickel nitrate salt and then calcined to form a lamellar Ni-Al2O3 mixed metal oxide with a high surface area (SBET = 1276 m2 g-1, N2 sorption). This mixed oxide consisted of nickel aluminate nanodomains dispersed within amorphous alumina, as revealed by PXRD and TPR analyses. Subsequent reduction under H2 resulted in the formation of well-dispersed 5 nm Ni0 nanoparticles homogeneously occluded within the interlamellar porosity of the γ-alumina matrix, as attested by electron microscopy. This waste-derived catalyst displayed catalytic performances in the reaction of dry reforming of methane (DRM) as good as its counterpart made from a MOF obtained from commercial benzene-1,4-dicarboxylic acid (BDC). Thus, under similar steady state conditions, at 650 °C and 1 bar, the PET-derived catalyst led to CH4 and CO2 conversions as high as those on the BDC-derived catalyst, and its catalytic stability and selectivity towards DRM were excellent as well (no loss of activity after 13 h and H2:CO products ratio remaining at 1). Moreover, both catalysts were much better than those of a reference nickel alumina catalyst prepared by conventional impregnation route. This work therefore demonstrates the possibility of using plastic wastes instead of commercial chemicals to prepare efficient porous nickel-alumina DRM catalysts from MOFs, fostering the concept of circular economy

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

Effects of synthesis parameters on the properties and photocatalytic activity of the magnetic catalyst TiO2/CoFe2O4 applied to selenium photoreduction

intake to human health. Heterogeneous photocatalysis can be successfully applied to remove selenium ions from water, but the photocatalyst recovery in the end of the process still needs improvement. The application of a magnetic photocatalyst (TiO2/CoFe2O4) in the Se(IV) photoreduction was investigated, with emphasis in the catalyst magnetic separation. The photocatalyst was synthetized via a simple sol-gel method and a central composite design was considered to evaluate the effects of titanium isopropoxide mass ratio used in the synthesis, calcination temperature and pH on Se(IV) reduction. Calcination temperature showed a strong influence in the photocatalytic activity, and the catalyst calcined at 381 ◦C presented the best performance. In the bests test, at pH 2.61, it was possible to remove >99% selenium after 2 min of exposure to radiation. Photocatalysts containing great amounts of rutile phase produced the lowest removal results. The TiO2/CoFe2O4 photocatalyst was magnetically separable, however its saturation magnetization (2.7 emu g 1) was considerably smaller than pure CoFe2O4 (84.6 emu g 1) and the photocatalyst magnetic separation from the aqueous medium was about 11 times slower in comparison to pure cobalt ferrite. The synthetized photocatalyst was able to satisfactorily photoreduce Se(IV) (96.5%) even after five cycles of photocatalysis