Persistence as a Robust Indicator of Medication Adherence-Related Quality and Performance.

Medication adherence is a priority for health systems worldwide and is widely recognised as a key component of quality of care for disease management. Adherence-related indicators were rarely explicitly included in national health policy agendas. One barrier is the lack of standardised adherence terminology and of routine measures of adherence in clinical practice. This paper discusses the possibility of developing adherence-related performance indicators highlighting the value of measuring persistence as a robust indicator of quality of care. To standardise adherence and persistence-related terminology allowing for benchmarking of adherence strategies, the European Ascertaining Barriers for Compliance (ABC) project proposed a Taxonomy of Adherence in 2012 consisting of three components: initiation, implementation, discontinuation. Persistence, which immediately precedes discontinuation, is a key element of taxonomy, which could capture adherence chronology allowing the examination of patterns of medication-taking behaviour. Advances in eHealth and Information Communication Technology (ICT) could play a major role in providing necessary structures to develop persistence indicators. We propose measuring persistence as an informative and pragmatic measure of medication-taking behaviour. Our view is to develop quality and performance indicators of persistence, which requires investing in ICT solutions enabling healthcare providers to review complete information on patients' medication-taking patterns, as well as clinical and health outcomes

Persistence as a robust indicator of medication adherence-related quality and performance

Medication adherence is a priority for health systems worldwide and is widely recognised as a key component of quality of care for disease management. Adherence-related indicators were rarely explicitly included in national health policy agendas. One barrier is the lack of standardised adherence terminology and of routine measures of adherence in clinical practice. This paper discusses the possibility of developing adherence-related performance indicators highlighting the value of measuring persistence as a robust indicator of quality of care. To standardise adherence and persistence-related terminology allowing for benchmarking of adherence strategies, the European Ascertaining Barriers for Compliance (ABC) project proposed a Taxonomy of Adherence in 2012 consisting of three components: initiation, implementation, discontinuation. Persistence, which immediately precedes discontinuation, is a key element of taxonomy, which could capture adherence chronology allowing the examination of patterns of medication-taking behaviour. Advances in eHealth and Information Communication Technology (ICT) could play a major role in providing necessary structures to develop persistence indicators. We propose measuring persistence as an informative and pragmatic measure of medication-taking behaviour. Our view is to develop quality and performance indicators of persistence, which requires investing in ICT solutions enabling healthcare providers to review complete information on patients’ medication-taking patterns, as well as clinical and health outcomes

Differential protein folding and chemical changes in lung tissues exposed to asbestos or particulates

Environmental and occupational inhalants may induce a large number of pulmonary diseases, with asbestos exposure being the most risky. The mechanisms are clearly related to chemical composition and physical and surface properties of materials. A combination of X-ray fluorescence (\u3bcXRF) and Fourier Transform InfraRed (\u3bcFTIR) microscopy was used to chemically characterize and compare asbestos bodies versus environmental particulates (anthracosis) in lung tissues from asbestos exposed and control patients. \u3bcXRF analyses revealed heterogeneously aggregated particles in the anthracotic structures, containing mainly Si, K, Al and Fe. Both asbestos and particulates alter lung iron homeostasis, with a more marked effect in asbestos exposure. \u3bcFTIR analyses revealed abundant proteins on asbestos bodies but not on anthracotic particles. Most importantly, the analyses demonstrated that the asbestos coating proteins contain high levels of \u3b2-sheet structures. The occurrence of conformational changes in the proteic component of the asbestos coating provides new insights into long-term asbestos effects

Spin states of asteroids in the Eos collisional family

Eos family was created during a catastrophic impact about 1.3 Gyr ago. Rotation states of individual family members contain information about the history of the whole population. We aim to increase the number of asteroid shape models and rotation states within the Eos collision family, as well as to revise previously published shape models from the literature. Such results can be used to constrain theoretical collisional and evolution models of the family, or to estimate other physical parameters by a thermophysical modeling of the thermal infrared data. We use all available disk-integrated optical data (i.e., classical dense-in-time photometry obtained from public databases and through a large collaboration network as well as sparse-in-time individual measurements from a few sky surveys) as input for the convex inversion method, and derive 3D shape models of asteroids together with their rotation periods and orientations of rotation axes. We present updated shape models for 15 asteroids and new shape model determinations for 16 asteroids. Together with the already published models from the publicly available DAMIT database, we compiled a sample of 56 Eos family members with known shape models that we used in our analysis of physical properties within the family. Rotation states of asteroids smaller than ~20 km are heavily influenced by the YORP effect, whilst the large objects more or less retained their rotation state properties since the family creation. Moreover, we also present a shape model and bulk density of asteroid (423) Diotima, an interloper in the Eos family, based on the disk-resolved data obtained by the Near InfraRed Camera (Nirc2) mounted on the W.M. Keck II telescope.Comment: Accepted for publication in ICARUS Special Issue - Asteroids: Origin, Evolution & Characterizatio

Implementing cost-optimal methodology in existing public buildings

This study presents some preliminary results of an on-going European Project, RePublic_ZEB, where an analysis is conducted for identifying the cost optimal levels for the existing buildings, towards nearly Zero Energy Buildings (nZEB) performance. The analysis is applied to the reference building for an existing office building in five different countries: Italy, Portugal, Romania, Spain and Greece. The evaluation tool uses a new cost optimization procedure based on a sequential search- optimization technique considering discrete options is applied and the results will be presented in terms of optimal “package of measures”, energy consumption and global costs. Finally a cross-country analysis will be performed

Asteroids' physical models from combined dense and sparse photometry and scaling of the YORP effect by the observed obliquity distribution

The larger number of models of asteroid shapes and their rotational states derived by the lightcurve inversion give us better insight into both the nature of individual objects and the whole asteroid population. With a larger statistical sample we can study the physical properties of asteroid populations, such as main-belt asteroids or individual asteroid families, in more detail. Shape models can also be used in combination with other types of observational data (IR, adaptive optics images, stellar occultations), e.g., to determine sizes and thermal properties. We use all available photometric data of asteroids to derive their physical models by the lightcurve inversion method and compare the observed pole latitude distributions of all asteroids with known convex shape models with the simulated pole latitude distributions. We used classical dense photometric lightcurves from several sources and sparse-in-time photometry from the U.S. Naval Observatory in Flagstaff, Catalina Sky Survey, and La Palma surveys (IAU codes 689, 703, 950) in the lightcurve inversion method to determine asteroid convex models and their rotational states. We also extended a simple dynamical model for the spin evolution of asteroids used in our previous paper. We present 119 new asteroid models derived from combined dense and sparse-in-time photometry. We discuss the reliability of asteroid shape models derived only from Catalina Sky Survey data (IAU code 703) and present 20 such models. By using different values for a scaling parameter cYORP (corresponds to the magnitude of the YORP momentum) in the dynamical model for the spin evolution and by comparing synthetics and observed pole-latitude distributions, we were able to constrain the typical values of the cYORP parameter as between 0.05 and 0.6.Comment: Accepted for publication in A&A, January 15, 201

New challenge of the public buildings: nZEB findings from IEE RePublic_ZEB Project

Nearly Zero-Energy Buildings (nZEBs) have received increased attention in recent years as a result of constant concerns for energy supply constraints, decreasing energy resources, increasing energy costs and rising impact of greenhouse gases on world climate. The EPBD recast directive [1] requests all new buildings to meet higher levels of performance than before, by exploring more the alternative energy supply systems available locally on a cost-efficiency basis and without prejudicing the occupants’ comfort. To this end, after 2020, all new buildings should become “nearly zero-energy” and after 31 December 2018, the same requirement is applied for new buildings occupied and owned by public authorities. Furthermore, the EPBD recast states that MS must ensure that minimum energy performance requirements for buildings are set with a view to achieving cost-optimal levels according to the Commission Delegated Regulation (EU) No 244/2012 of 16 January 2012. In this context, the authors of this paper, who are participants in the recent started European project RePublic_ZEB, are willing to share the initial findings from on- going research work. Public buildings constitute a specific class of buildings that require a complex analysis from the statistic point of view taking into consideration the definition and typologies and other specific parameters related with. Thus, this paper will focus on the analysis of public building stocks in the countries covered by the project consortium with the view to define relevant parameters characterizing the reference public buildings that will be considered in the further analysis regarding the assessment of cost-effective packages of solutions towards nZEB levels of performance. A review of nZEB holistic approach, definitions and existing implemented policies in the participant countries, will be presented as well

Randomised controlled trial comparing single agent paclitaxel vs epidoxorubicin plus paclitaxel in patients with advanced ovarian cancer in early progression after platinum-based chemotherapy: an Italian Collaborative Study from the ‘Mario Negri’ Institute, Milan, G.O.N.O. (Gruppo Oncologico Nord Ovest) group and I.O.R. (Istituto Oncologico Romagnolo) group

The aim of the study was to evaluate the role of epidoxorubicin plus paclitaxel combination (ET) vs single agent paclitaxel (T), as second-line chemotherapy treatment in advanced ovarian cancer patients in early progression within 12 months after platinum-based chemotherapy. From October 1994 up to June 1999, 234 patients from 34 Italian hospitals were randomised to receive: (A) epidoxorubicin (E) 80 mg m(-2) + paclitaxel (T) 175 mg m(-2) (3 h infusion), every 21 days for 4-6 cycles. (B) Paclitaxel 175 mg m(-2) (3 h infusion) every 21 days for 4-6 cycles. Evaluable for survival analysis were 106 and 106 patients in ET and T arm, respectively. Platinum-based monochemotherapy was the first-line treatment in 43% patients, while polichemotherapy containing anthracyclines was the preferred first-line therapy in 22% patients. The median time from the end of first-line therapy to randomisation was 3 months. Treatment was completed in 87 and 85% of T and ET arm, respectively. Haematological toxicity was significantly more common in ET group (ECOG grade 3-4 neutropenia: 37.4% in ET vs 18.2% in T arm). Neuropathies were similar in both arms (sensory: ECOG grade 2-3: 12.1% in ET vs 14.7% in T arm, motor: 6.1% in ET vs 5.3% in T arm). Objective response was achieved in 37.4% of patients in ET group and in 46.9% of patients in T arm. At a median follow-up of time of 48 months, a total of 180 patients progressed and 163 patients died. Survival analysis showed no difference between ET and T (median time to progression: 6 months for both regimens, median survival: 12 and 14 months for ET and T, respectively; hazard ratio for mortality of ET vs T: 1.17 (95% CI 0.86-1.59; P=0.33). The ET regimen does not seem to be more effective than T in refractory advanced ovarian cancer patients in early progression after platinum-based chemotherapy. Despite an acceptable response rate, the control of disease progression remains poor

The present state of research into industrial clusters and districts. Content analysis of material published 1997-2006

[EN] The aim of this work is to help gain a better understanding of the research conducted on territorial agglomerations of firms at a multidisciplinary level. To this end, an analysis was performed of the contents of the most significant scientific literature on economics, management, planning and development, urban studies and geography published over the period 1997-2006. From the results, a database of 142 papers from 43 journals was then elaborated. An analysis of these works reveals the level of development of the main lines of research in this field and, consequently, makes it possible to detect the topics that require greater attention and that can be the object of future research for researchers and academics. The main conclusions include the growing number of studies conducted on the subject in recent years, as well as a greater predominance of empirical research over conceptual work, and the existence of a significant change in the topics or lines of research throughout the period under study. © 2012 Copyright Taylor and Francis Group, LLC.This research was financed by the Spanish Ministry of Education and Science, National R&D & Innovation Plan 2007–2010, under the project entitled “El Distrito Industrial: el impacto del Capital Social sobre la Gestio´n de la Cadena de Suministro” (The Industrial District: the impact of Social Capital on the management of the Supply Chain) (SEJ2007- 62876/ECON).Martinez-Fernandez, M.; Capó Vicedo, J.; Vallet-Bellmunt, T. (2012). The present state of research into industrial clusters and districts. Content analysis of material published 1997-2006. European Planning Studies. 20(2):281-304. doi:10.1080/09654313.2012.650906S28130420

Tourism, inclusive growth and decent work: a political economy critique

This paper interrogates the ideas of ‘sustained’ and ‘inclusive’ growth that are intrinsic to one of three UN Sustainable Development Goals (SDG 8 - Decent Work and Growth) adopted by the UN World Tourism Organisation’s (UNWTO) 2030 sustainable tourism agenda. It provides a Marxian-inspired political economy critique of the UNWTO’s embrace of SDG8 and highlights the blind spot within the UNWTO’s inclusive growth-led SDG agenda with respect to questions of equity and social justice. The paper contends that the UNWTO’s SDG-led agenda is contradicted by the logics of growth, competitiveness and profit-making that drive the continued expansion and development of tourism. Rather than addressing the structural injustices that entrench inequalities and reproduce exploitative labour practices, the notion of sustained and inclusive growth reinforces the primacy of capital and market notions of justice and continues to perpetuate a growth driven tourism development model. The paper contributes to a critical theorization of sustainable tourism and offers an informed critique of the current political agenda for sustainable tourism and its potential outcomes