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

The Coulomb phase shift revisited

We investigate the Coulomb phase shift, and derive and analyze new and more precise analytical formulae. We consider next to leading order terms to the Stirling approximation, and show that they are important at small values of the angular momentum $l$ and other regimes. We employ the uniform approximation. The use of our expressions in low energy scattering of charged particles is discussed and some comparisons are made with other approximation methods.Comment: 13 pages, 5 figures, 1 tabl

Isotopic distribution of fission fragments in collisions between 238U beam and 9Be and 12C targets at 24 MeV/u

Inverse kinematics coupled to a high-resolution spectrometer is used to investigate the isotopic yields of fission fragments produced in reactions between a 238U beam at 24 MeV/u and 9Be and 12C targets. Mass, atomic number and isotopic distributions are reported for the two reactions. These informations give access to the neutron excess and the isotopic distribution widths, which together with the atomic-number and mass distributions are used to investigate the fusion-fission dynamics.Comment: Submitted to PR

Pair correlations in nuclei involved in neutrinoless double beta decay: 76Ge and 76Se

Precision measurements were carried out to test the similarities between the ground states of 76Ge and 76Se. The extent to which these two nuclei can be characterized as consisting of correlated pairs of neutrons in a BCS-like ground state was studied. The pair removal (p,t) reaction was measured at the far forward angle of 3 degrees. The relative cross sections are consistent (at the 5% level) with the description of these nuclei in terms of a correlated pairing state outside the N=28 closed shells with no pairing vibrations. Data were also obtained for 74Ge and 78Se

Peripheral Nα\alpha Scattering: A Tool For Identifying The Two Pion Exchange Component Of The NN Potential

We study elastic N$\alpha$ scattering and produce a quantitative correlation between the range of the effective potential and the energy of the system. This allows the identification of the waves and energies for which the scattering may be said to be peripheral. We then show that the corresponding phase shifts are sensitive to the tail of the NN potential, which is due to the exchange of two pions. However, the present uncertainties in the experimental phase shifts prevent the use of N$\alpha$ scattering to discriminate the existing models for the NN interaction.Comment: 19 pages, 6 PostScript figures, RevTeX, to be appear in Phys. Rev.

Direct mass measurements of 19B, 22C, 29F, 31Ne, 34Na and other light exotic nuclei

We report on direct time-of-flight based mass measurements of 16 light neutron-rich nuclei. These include the first determination of the masses of the Borromean drip-line nuclei $^{19}$B, $^{22}$C and $^{29}$F as well as that of $^{34}$Na. In addition, the most precise determinations to date for $^{23}$N and $^{31}$Ne are reported. Coupled with recent interaction cross-section measurements, the present results support the occurrence of a two-neutron halo in $^{22}$C, with a dominant $\nu2s_{1/2}^2$ configuration, and a single-neutron halo in $^{31}$Ne with the valence neutron occupying predominantly the 2$p_{3/2}$ orbital. Despite a very low two-neutron separation energy the development of a halo in $^{19}$B is hindered by the 1$d_{5/2}^2$ character of the valence neutrons.Comment: 5 page

Surgical site infection after caesarean section. Space for post-discharge surveillance improvements and reliable comparisons

Surgical site infections (SSI) after caesarean section (CS) represent a substantial health system concern. Surveying SSI has been associated with a reduction in SSI incidence. We report the findings of three (2008, 2011 and 2013) regional active SSI surveillances after CS in community hospital of the Latium region determining the incidence of SSI. Each CS was surveyed for SSI occurrence by trained staff up to 30 post-operative days, and association of SSI with relevant characteristics was assessed using binomial logistic regression. A total of 3,685 CS were included in the study. A complete 30 day post-operation follow-up was achieved in over 94% of procedures. Overall 145 SSI were observed (3.9% cumulative incidence) of which 131 (90.3%) were superficial and 14 (9.7%) complex (deep or organ/space) SSI; overall 129 SSI (of which 89.9% superficial) were diagnosed post-discharge. Only higher NNIS score was significantly associated with SSI occurrence in the regression analysis. Our work provides the first regional data on CS-associated SSI incidence, highlighting the need for a post-discharge surveillance which should assure 30 days post-operation to not miss data on complex SSI, as well as being less labour intensive

Elements Discrimination in the Study of Super-Heavy Elements using an Ionization Chamber

Dedicated ionization chamber was built and installed to measure the energy loss of very heavy nuclei at 2.7 MeV/u produced in fusion reactions in inverse kinematics (beam of 208Pb). After going through the ionization chamber, products of reactions on 12C, 18O targets are implanted in a Si detector. Their identification through their alpha decay chain is ambiguous when their half-life is short. After calibration with Pb and Th nuclei, the ionization chamber signal allowed us to resolve these ambiguities. In the search for rare super-heavy nuclei produced in fusion reactions in inverse or symmetric kinematics, such a chamber will provide direct information on the nuclear charge of each implanted nucleus.Comment: submitted to NIMA, 10 pages+4 figures, Latex, uses elsart.cls and grahpic

Whole-brain histogram and voxel-based analyses of apparent diffusion coefficient and magnetization transfer ratio in celiac disease, epilepsy, and cerebral calcifications syndrome

BACKGROUND AND PURPOSE: Diffusion and magnetization transfer (MT) techniques have been applied to the investigation with MR of epilepsy and have revealed changes in patients with or without abnormalities on MR imaging. We hypothesized that also in the coeliac disease (CD), epilepsy and cerebral calcifications (CEC) syndrome diffusion and MT techniques could reveal brain abnormalities undetected by MR imaging and tentatively correlated to epilepsy. MATERIALS AND METHODS: Diffusion and MT weighted images were obtained in 10 patients with CEC, 8 patients with CD without epilepsy and 17 healthy volunteers. The whole brain apparent diffusion coefficient (ADC) and MT ratio (MTR) maps were analyzed with histograms and the Statistical Parametric Mapping 2 (SPM2) software. We employed the non-parametric Mann-Whitney U test to assess differences for ADC and MTR histogram metrics. Voxel by voxel comparison of the ADC and MTR maps was performed with 2 tails t-test corrected for multiple comparison. RESULTS: A significantly higher whole brain ADC value as compared to healthy controls was observed in CEC (P = 0.006) and CD (P = 0.01) patients. SPM2 showed bilateral areas of significantly decreased MTR in the parietal and temporal subcortical white matter (WM) in the CEC patients. CONCLUSION: Our study indicates that diffusion and MT techniques are also capable of revealing abnormalities undetected by MR imaging. In particular patients with CEC syndrome show an increase of the whole brain ADC histogram which is more pronounced than in patients with gluten intolerance. IN CEC patients, voxel-based analysis demonstrates a localized decrease of the MTR in the parieto-temporal subcortical WM