The role of GP’s compensation schemes in diabetes care: evidence from panel data

The design of incentive schemes that improve quality of care is a central issue for the healthcare sector. Nowadays we observe many pay-for-performance programs, where payment is contingent on meeting indicators of provider effort, but also other alternative strategies have been introduced, for example programs rewarding physicians for participation in diseases management plans. Although it has been recognised that incentive-based remuneration schemes can have an impact on GP behaviour, there is still weak empirical evidence on the extent to which such programs influence health outcomes. We investigate the impact of financial incentives in Regional and Local Health Authority contracts for primary care in the Italian Region Emilia Romagna for the years 2003-05. We focus on avoidable hospitalisations (Ambulatory Care Sensitive Conditions) for patients affected by type 2 diabetes mellitus, for which the assumption of responsibility and the adoption of clinical guidelines are specifically rewarded. We estimate a panel count data model using a Negative Binomial distribution to test the hypothesis that, other things equal, patients under the responsibility of GPs receiving a higher share of their income through these programs are less likely to experience avoidable hospitalisations. Our findings support the hypothesis that financial transfers may contribute to improve quality of care, even when they are not based on the ex-post verification of performances.

Pandemic recession, helicopter money and central banking: Venice, 1630

This paper analyses the monetary policy that the Most Serene Republic of Venice implemented in the years of calamities using a modern equivalent of helicopter money, precisely an extraordinary money issuing, coupled with capital losses for the issuer. We consider the 1629 famine and the 1630-1631 plague as a negative macroeconomic shock that the incumbent government addressed using fiscal monetization. Consolidating the balance sheets of the Mint and of the Giro Bank, and having heterogenous citizens - inequality matters - we show that the Republic implemented what was, in effect, helicopter money driven by political economy reasons, in order to avoid popular riots

Effectiveness of defatted seed meals from Brassicaceae with or without crude glycerin against black grass ( Alopecurus myosuroides Huds.)

Herbicide resistance has become an increasing problem, and at the same time pesticide usage is declining due to stringent EU pesticide legislation which aims to reduce the impact on environment and human health. For these reasons, new alternative integrated weed management approaches are becoming increasingly relevant. Formulations based on Brassica defatted seed meals (DSMs) and glycerin, have previously been shown to be effective in reducing the germination of lettuce seed. In this work five DSMs, formulated with and without crude glycerin, were chosen for in vitro and glasshouse experiments: i) Brassica nigra, ii) Brassica tournefortii, iii) Eruca sativa, iv) Rapistrum rugosum and v) Sinapis alba. Black-grass (Alopecurus myosuroides), a weed demonstrating extensive herbicide resistance, was used as a target, and the germination inhibition caused on this weed by Brassica defatted seed meals was assessed. In both in vitro and in vivo experiments, the most effective DSM for inhibiting germination of both lettuce and black-grass seeds was the sinigrin containing DSM, Brassica nigra. The aim of the manuscript was to suggest a new high value application for Brassicas derived DSM as a co-products from the vegetable oil production chain. The proposed treatments could represent an interesting and 100% novel natural alternative to the conventional herbicides

Charge Management for Gravitational Wave Observatories using UV LEDs

Accumulation of electrical charge on the end mirrors of gravitational wave observatories, such as the space-based LISA mission and ground-based LIGO detectors, can become a source of noise limiting the sensitivity of such detectors through electronic couplings to nearby surfaces. Torsion balances provide an ideal means for testing gravitational wave technologies due to their high sensitivity to small forces. Our torsion pendulum apparatus consists of a movable Au-coated Cu plate brought near a Au-coated Si plate pendulum suspended from a non-conducting quartz fiber. A UV LED located near the pendulum photoejects electrons from the surface, and a UV LED driven electron gun directs photoelectrons towards the pendulum surface. We have demonstrated both charging and discharging of the pendulum with equivalent charging rates of $\sim$$10^5 e/\mathrm{s}$, as well as spectral measurements of the pendulum charge resulting in a white noise level equivalent to $3\times10^5 e/\sqrt{Hz}$.Comment: 5 pages, submitted to PR

Diagnostic testing for SARS-CoV-2 infection in HHT patients: nasopharyngeal versus oropharyngeal swab

On March 11, 2020, WHO has defined the novel coronavirus disease SARS-CoV-2 (COVID-19) outbreak as a pandemic that still today continues to affect much of the world. Among the reasons for the rapid spread of SARS-CoV-2 infection, there is the role of asymptomatic or minimally symptomatic carriers. Therefore diagnostic testing is central to contain the global pandemic. Up to now real-time reverse transcriptase polymerase chain reaction-based molecular assays for detecting SARS-CoV-2 in respiratory specimens is the current reference standard for COVID-19 diagnosis. Based on current knowledge regarding the sensitivity of the molecular test, the highest positive detection rate is from lower respiratory tract specimens; alternatively it is possible to perform a nasopharyngeal or oropharyngeal swab. Nasopharyngeal swab is the preferred choice for SARS-CoV-2 testing since it seems to have a greater sensitivity; however the procedure is not always free of complications and an epistaxis can occur. Among patients with greatest risk of massive nosebleed there are HHT patients. Hereditary hemorrhagic telangiectasia is an autosomal dominant disease that leads to multiregional mucocutanous telangiectases and visceral arteriovenous malformations. Clinically, the presence of telangiectases in nasal mucosa is the cause of recurrent epistaxis. In HHT patients the execution of the nasopharyngeal swab can determine from little or no consequences to a massive epistaxis leading to the necessity of nasal packing generally followed by hospital admission. In HHT patients undergoing a diagnostic test to evaluate the SARS-CoV-2 infection status, especially in those patients with frequent epistaxis with a history of anemia and repeated hospitalizations, it is therefore advisable to perform an oropharyngeal swab. This, compared to the nasopharyngeal swab, exposes to a lower risk of severe nosebleeds related treatments, such as blood transfusions or invasive procedures. According to the risk-benefit assessment and based on our experience, we consider that, despite a lower diagnostic sensitivity, oropharyngeal swab is preferable to nasopharyngeal swab for the diagnosis of SARS CoV-2 infection in patients with HHT

Gitelman syndrome associated with chondrocalcinosis and severe neuropathy: a novel heterozygous mutation in SLC12A3 gene

Gitelman syndrome (GS) is an inherited salt-wasting tubulopathy characterized by hypocalciuria, hypokalemia, hypomagnesemia and metabolic alkalosis, due to inactivating mutations in the SLC12A3 gene. Symptoms may be systemic, neurological, cardiovascular, ophthalmological or musculoskeletal. We describe a 70 year-old patient affected by recurrent arthralgias, hypoesthesia and hyposthenia in all 4 limbs and severe hypokalemia, complicated by atrial flutter. Moreover, our patient reported eating large amounts of licorice, and was treated with medium-high dosages of furosemide, thus making diagnosis very challenging. Genetic analysis demonstrated a novel heterozygous mutation in the SLC12A3 gene; therefore, we diagnosed GS and started potassium and magnesium replacement. GS combined with chondrocalcinosis and neurological involvement is quite common, but this is the first case of an EMG-proven severe neuropathy associated with GS. Herein, we underline the close correlation between hypomagnesemia, chondrocalcinosis and neurological involvement. Moreover, we report a new heterozygous mutation in exon 23 (2738G>A), supporting evidence of a large genetic heterogeneity in this late-onset congenital tubulopathy

Scattering into Cones and Flux across Surfaces in Quantum Mechanics: a Pathwise Probabilistic Approach

We show how the scattering-into-cones and flux-across-surfaces theorems in Quantum Mechanics have very intuitive pathwise probabilistic versions based on some results by Carlen about large time behaviour of paths of Nelson diffusions. The quantum mechanical results can be then recovered by taking expectations in our pathwise statements.Comment: To appear in Journal of Mathematical Physic

Reduction and reconstruction of stochastic differential equations via symmetries

An algorithmic method to exploit a general class of infinitesimal symmetries for reducing stochastic differential equations is presented and a natural definition of reconstruction, inspired by the classical reconstruction by quadratures, is proposed. As a side result the well-known solution formula for linear one-dimensional stochastic differential equations is obtained within this symmetry approach. The complete procedure is applied to several examples with both theoretical and applied relevance