Transparency in multilateral climate politics: Furthering (or distracting from) accountability?

This article analyzes the interplay between transparency and accountability in multilateral climate politics. The 2015 Paris Agreement calls for a “pledge-and-review” approach to collective climate action with an “enhanced transparency framework” as a key pillar of the Agreement. By making visible who is doing what, transparency is widely assumed to be vital to holding countries to account and building trust. We explore whether transparency is generating such effects in this context, by developing and applying an analytical framework to examine the link between transparency and accountability. We find that the scope and practices of climate transparency reflect (rather than necessarily reduce) broader conflicts over who should be held to account to whom and about what, with regard to responsibility and burden sharing for ambitious climate action. We conclude that the relationship between transparency and accountability is less straightforward than assumed, and that the transformative promise of transparency needs to be reconsidered in this light

An Integrated Circuit for Signal Processing of the AMS RICH Photmultipliers Tubes

An analog integrated circuit has been designed, in a BiCMOS 0.8 micron technology, for the feasability study of the signal processing of the AMS RICH photomultiplier tubes. This low power, three channel gated integrator includes its own gate and no external analog delay is requiered. It processes PMT pulses over a dynamic range of more than 100. A logic output that indicates whether the analog charge has to be considered is provided. This gated integrator is used with a compact DSP based acquisition system in a 132 channels RICH prototype. The charge calibration of each channel is carried out using a LED. The pedestal measurement is performed on activation of a dedicated input. The noise contribution study of the input RC network and amplifiers is presented.Comment: IEEE symp. on Nucl. Sci. and Med. Imaging, Toront

Inname aan zware metalen en nitraat door jonge kinderen

Innameberekeningen zijn uitgevoerd voor zware metalen, nitraat en zout op basis van metingen uit een duplicaat voedingsstudie bij baby's en deze zijn vergeleken met innameberekeningen op basis van monitoringsdata uit de KAP-databank. Voor de duplicaat voedingen is gebruik gemaakt van data verzameld in de EUBABY-studie van baby’s van 8 tot 12 maande

Health-economic modelling of infectious disease diagnostics: current approaches and future opportunities

Objectives: Antimicrobial resistance (AMR) is a public health threat; infections with resistant organisms are estimated to cause over 650.000 infections and over 30.000 deaths in Europe. AMR is associated with antibiotic consumption: appropriate prescribing of antibiotics is key in combating AMR. To fight this threat, it has been suggested that point-of-care diagnostics to inform antibiotics prescribing are an important tool in reducing antibiotics prescriptions. With the objective of knowing the state of the art, we reviewed diagnostic cost-effectiveness analyses (CEAs) for infectious disease, focussing on model types, effects on prescriptions and AMR.  Methods: We searched the literature comprehensively through the PUBMED, Web of Science and EMBASE databases, as well as grey literature for the period 2000-2018. We included economic evaluations for diagnostic strategies for infectious disease in all geographic areas. Data extraction was based on the Consolidated Health Economic Evaluation Reporting Standards statement, with an additional focus on the modelling type and inclusion of AMR.Results: In general, CEAs of diagnostics for infectious disease fall in two categories: trial-based cost-effectiveness, focusing on short-term outcomes, and long-term models, focusing on outcomes extrapolated beyond the trial. Outcomes measured are for example prescriptions saved or hospitalizations saved. Cost-utility analyses seem to be difficult, as QALY differences between various diagnostic strategies are minor. Antimicrobial resistance is considered indirectly: as an ICER with prescriptions saved as an outcome; by calculating the threshold cost of resistance that would change the conclusion of cost-effectiveness; or as a point estimate; often, it is not considered at all.Conclusions: CEAs of diagnostic strategies for infectious disease are relatively scarce and it can be challenging to prove the cost-effectiveness of diagnostic strategies, especially in the context of relatively inexpensive treatments, such as antibiotics. However, there is an important opportunity of including the societal costs of AMR in future CEAs.<br/

Cost-effectiveness analysis of a first-trimester screening test for preterm preeclampsia in the Netherlands

Objectives: The risk of preterm preeclampsia (PT PE) can significantly be reduced by starting acetylsalicylic acid ≤ 16 weeks of gestational age. First trimester predictive models based on maternal risk factors to effectively start this therapy lacked sufficient power, but recent studies showed that these models can be improved by including test results of biochemical and/or -physical markers. To investigate whether testing a biochemical marker in the first trimester is cost-effective in the Netherlands, a cost-effectiveness analysis was performed in this study. Study design: The outcome of this study was expressed as an incremental cost-effectiveness ratio (ICER) with as effect prevented PT PE cases. To evaluate the impact of each model parameter and to determine model uncertainties, both univariate and probabilistic sensitivity analyses were performed. Results: When compared to the baseline strategy, the test strategy is estimated to save almost 4 million euros per year on a national scale and at the same time this would prevent an additional 228 PT PE cases. The sensitivity analyses showed that the major drivers of the result are the costs to monitor a high-risk pregnancy and the specificity and that most of the model simulations were in the southeast quadrant: cost saving and more prevented complications. Conclusions: This study showed that a first-trimester test strategy to screen for PT PE in the first trimester is potentially cost-effective in the Dutch healthcare setting. The fact that the specificity is a major driver of the ICER indicates the importance for a (new) screening model to correctly classify low-risk pregnancies.</p

Cost-effectiveness and budget impact of a lifestyle intervention to improve cardiometabolic health in patients with severe mental illness

Introduction: This study assessed the cost-effectiveness and budget impact of a lifestyle intervention to improve cardiometabolic health in severe mentally ill (SMI) patients in the LION trial.Methods: Patients (n = 244) were randomized to receive either care-as-usual or a lifestyle intervention in which mental health nurses coached patients in changing their lifestyle by using a web tool. Costs and quality of life were assessed at baseline and at 6 and 12 months. Incremental costs per centimeter waist circumference (WC) lost and per Quality-Adjusted Life Year (QALY) gained were assessed. Budget impact was estimated based on three intervention-uptake scenarios using a societal and a third-party payer perspective.Results: Costs and reduction in WC were higher in the intervention (n = 114) than in the control (n = 94) group after 12 months, although not statistically significant, resulting in (sic)1,370 per cm WC lost. QALYs did not differ between the groups, resulting in a low probability of the intervention being cost-effective in cost/QALY gained. The budget impact analysis showed that for a reasonable participation of 43%, total costs were around (sic)81 million over 5 years, or on average (sic)16 million annually (societal perspective).Conclusions: The intervention is not cost-effective at 12 months and the budget impact over 5 years is substantial. Possibly, 12 months was too short to implement the intervention, improve cardiometabolic health, and reduce care costs. Therefore, the incentive for this intervention cannot be found in short-term financial advantages. However, there may be benefits associated with lifestyle interventions in the long term that remain unclear.</p