Comparative health technology assessment of robotic-assisted, direct manual laparoscopic and open surgery:a prospective study

Background: Despite many publications reporting on the increased hospital cost of robotic-assisted surgery (RAS) compared to direct manual laparoscopic surgery (DMLS) and open surgery (OS), the reported health economic studies lack details on clinical outcome, precluding valid health technology assessment (HTA). Methods: The present prospective study reports total cost analysis on 699 patients undergoing general surgical, gynecological and thoracic operations between 2011 and 2014 in the Italian Public Health Service, during which period eight major teaching hospitals treated the patients. The study compared total healthcare costs of RAS, DMLS and OS based on prospectively collected data on patient outcome in addition to healthcare costs incurred by the three approaches. Results: The cost of RAS operations was significantly higher than that of OS and DMLS for both gynecological and thoracic operations (p < 0.001). The study showed no significant difference in total costs between OS and DMLS. Total costs of general surgery RAS were significantly higher than those of OS (p < 0.001), but not against DMLS general surgery. Indirect costs were significantly lower in RAS compared to both DMLS general surgery and OS gynecological surgery due to the shorter length of hospital stay of RAS approach (p < 0.001). Additionally, in all specialties compared to OS, patients treated by RAS experienced a quicker recovery and significantly less pain during the hospitalization and after discharge. Conclusions: The present HTA while confirming higher total healthcare costs for RAS operations identified significant clinical benefits which may justify the increased expenditure incurred by this approach

Innovation in rehabilitation technology: technological opportunities and socio-economic implications

Innovation in stroke rehabilitation technology is discussed that, based on published epidemiological and economic data, represents an urgent case to deal with adopting a multidisciplinary perspective. A theoretical model is proposed for the evaluation of socioeconomic implications related to an early diagnosis and early and timely adjustments in the stroke treatment strategy. The model is applied to the case of a new rehabilitation technology: the ALLADIN diagnostic device. The model compares a traditional approach – ‘trial and error strategy’ – to the innovative one – ‘in progress evaluation’, considering the diagnostic and rehabilitative steps of the patient’s assistive route and assessing social and economic benefits of the innovative device. The new technology allows a precise initial assessment of both the severity of stroke and the level of lost functionality, as long as an evaluation of the expected return from different potential therapies. Moreover, supposing that higher severity of stroke implies higher level of disabilities and social costs, and that the negative impact increases as the level of disability increases, the use of innovative rehabilitation technologies would be more effective in the case of patients with severe and very severe stroke

The languages of peace during the French religious wars

The desirability of peace was a common topos in sixteenth-century political rhetoric, and the duty of the king to uphold the peace for the benefit of his subjects was also a long-established tradition. However, the peculiar circumstances of the French religious wars, and the preferred royal policy of pacification, galvanized impassioned debate among both those who supported and those who opposed confessional coexistence. This article looks at the diverse ways in which peace was viewed during the religious wars through an exploration of language and context. It draws not only on the pronouncements of the crown and its officials, and of poets and jurists, but also on those of local communities and confessional groups. Opinion was not just divided along religious lines; political imperatives, philosophical positions and local conditions all came into play in the arguments deployed. The variegated languages of peace provide a social and cultural dimension for the contested nature of sixteenth-century French politics. However, they could not restore harmony to a war-torn and divided kingdom

Non-Hermitian matrix description of the PT symmetric anharmonic oscillators

Schroedinger equation H \psi=E \psi with PT - symmetric differential operator H=H(x) = p^2 + a x^4 + i \beta x^3 +c x^2+i \delta x = H^*(-x) on L_2(-\infty,\infty) is re-arranged as a linear algebraic diagonalization at a>0. The proof of this non-variational construction is given. Our Taylor series form of \psi complements and completes the recent terminating solutions as obtained for certain couplings \delta at the less common negative a.Comment: 18 pages, latex, no figures, thoroughly revised (incl. title), J. Phys. A: Math. Gen., to appea

Numerical convergence of the block-maxima approach to the Generalized Extreme Value distribution

In this paper we perform an analytical and numerical study of Extreme Value distributions in discrete dynamical systems. In this setting, recent works have shown how to get a statistics of extremes in agreement with the classical Extreme Value Theory. We pursue these investigations by giving analytical expressions of Extreme Value distribution parameters for maps that have an absolutely continuous invariant measure. We compare these analytical results with numerical experiments in which we study the convergence to limiting distributions using the so called block-maxima approach, pointing out in which cases we obtain robust estimation of parameters. In regular maps for which mixing properties do not hold, we show that the fitting procedure to the classical Extreme Value Distribution fails, as expected. However, we obtain an empirical distribution that can be explained starting from a different observable function for which Nicolis et al. [2006] have found analytical results.Comment: 34 pages, 7 figures; Journal of Statistical Physics 201

Multifrequency monitoring of the blazar 0716+714 during the GASP-WEBT-AGILE campaign of 2007

Since the CGRO operation in 1991-2000, one of the primary unresolved questions about the blazar gamma-ray emission has been its possible correlation with the low-energy (in particular optical) emission. To help answer this problem, the Whole Earth Blazar Telescope (WEBT) consortium has organized the GLAST-AGILE Support Program (GASP) to provide the optical-to-radio monitoring data to be compared with the gamma-ray detections by the AGILE and GLAST satellites. This new WEBT project started in early September 2007, just before a strong gamma-ray detection of 0716+714 by AGILE. We present the GASP-WEBT optical and radio light curves of this blazar obtained in July-November 2007, about various AGILE pointings at the source. We construct NIR-to-UV spectral energy distributions (SEDs), by assembling GASP-WEBT data together with UV data from the Swift ToO observations of late October. We observe a contemporaneous optical-radio outburst, which is a rare and interesting phenomenon in blazars. The shape of the SEDs during the outburst appears peculiarly wavy because of an optical excess and a UV drop-and-rise. The optical light curve is well sampled during the AGILE pointings, showing prominent and sharp flares. A future cross-correlation analysis of the optical and AGILE data will shed light on the expected relationship between these flares and the gamma-ray events.Comment: 5 pages, 5 figures, to be published in A&A (Letters); revised to match the final version (changes in Fig. 5 and related text

Multiwavelength observations of 3C 454.3. III. Eighteen months of AGILE monitoring of the "Crazy Diamond"

We report on 18 months of multiwavelength observations of the blazar 3C 454.3 (Crazy Diamond) carried out in July 2007-January 2009. We show the results of the AGILE campaigns which took place on May-June 2008, July-August 2008, and October 2008-January 2009. During the May 2008-January 2009 period, the source average flux was highly variable, from an average gamma-ray flux F(E>100MeV) > 200E-8 ph/cm2/s in May-June 2008, to F(E>100MeV)~80E-8 ph/cm2/s in October 2008-January 2009. The average gamma-ray spectrum between 100 MeV and 1 GeV can be fit by a simple power law (Gamma_GRID ~ 2.0 to 2.2). Only 3-sigma upper limits can be derived in the 20-60 keV energy band with Super-AGILE. During July-August 2007 and May-June 2008, RXTE measured a flux of F(3-20 keV)= 8.4E-11 erg/cm2/s, and F(3-20 keV)=4.5E-11 erg/cm2/s, respectively and a constant photon index Gamma_PCA=1.65. Swift/XRT observations were carried out during all AGILE campaigns, obtaining a F(2-10 keV)=(0.9-7.5)E-11 erg/cm2/s and a photon index Gamma_XRT=1.33-2.04. BAT measured an average flux of ~5 mCrab. GASP-WEBT monitored 3C 454.3 during the whole 2007-2008 period from the radio to the optical. A correlation analysis between the optical and the gamma-ray fluxes shows a time lag of tau=-0.4 days. An analysis of 15 GHz and 43 GHz VLBI core radio flux observations shows an increasing trend of the core radio flux, anti- correlated with the higher frequency data. The modeling SEDs, and the behavior of the long-term light curves in different energy bands, allow us to compare the jet properties during different emission states, and to study the geometrical properties of the jet on a time-span longer than one year.Comment: Accepted for publication in ApJ. Adapted Abstract. 17 pages, 19 Figures, 5 Table

Response of a two-level atom to a narrow-bandwidth squeezed-vacuum excitation

Using the coupled-system approach we calculate the optical spectra of the fluorescence and transmitted fields of a two-level atom driven by a squeezed vacuum of bandwidths smaller than the natural atomic linewidth. We find that in this regime of squeezing bandwidths the spectra exhibit unique features, such as a hole burning and a three-peak structure, which do not appear for a broadband excitation. We show that the features are unique to the quantum nature of the driving squeezed vacuum field and donor appear when the atom is driven by a classically squeezed field. We find that a quantum squeezed-vacuum field produces squeezing in the emitted fluorescence field which appears only in the squeezing spectrum while there is no squeezing in the total field. We also discuss a nonresonant excitation and find that depending on the squeezing bandwidth there is a peak or a hole in the spectrum at a frequency corresponding to a three-wave-mixing process. The hole appears only for a broadband excitation and results from the strong correlations between squeezed-vacuum photons

Non-conventional yeasts as sources of ene-reductases for the bioreduction of chalcones

Thirteen Non-Conventional Yeasts (NCYs) have been investigated for their ability to reduce activated C=C bonds of chalcones to obtain the corresponding dihydrochalcones. A possible correlation between bioreducing capacity of the NCYs and the substrate structure was estimated. Generally, whole-cells of the NCYs were able to hydrogenate the C=C double bond occurring in (E)-1,3-diphenylprop-2-en-1-one, while worthy bioconversion yields were obtained when the substrate exhibited the presence of a deactivating electron-withdrawing Cl substituent on the B-ring. On the contrary, no conversion was generally found, with a few exceptions, in the presence of an activating electron-donating substituent OH. The bioreduction aptitude of the NCYs was apparently correlated to the logP value: Compounds characterized by a higher logP exhibited a superior aptitude to be reduced by the NCYs than compounds with a lower logP value