506 research outputs found
Water Management and Institutional Adaptation Strategies in the Irrigation Sector: Two Experiences in Emilia-Romagna
No full textClimate change is putting pressure on economic sectors, especially agriculture, because of the increase of extreme events, like water scarcity and droughts, that call for impellent adaptation strategies in water management oriented toward the lining of water demand up to future water availability. The EU institutions have worked intensely in recent years for defining a policy guidance on the quantitative management of water resources to complement the Water Framework Directive. The outcome is a Blueprint for the safeguard of water resources which stresses, inter alia, the necessity of implementing in the recent future measures that induce a more rational use of water resources such to reduce the inefficiencies and to improve the allocation mechanisms by fostering, whenever possible, the equalization between water needs and economic values of water use. The chapter proposes the study of two experiences of irrigation water management in the Italian region of Emilia-Romagna whose outcomes thoroughly reflect the achievement of the recent policy objectives. The first is the case of the irrigation district Tarabina, in which a change in the tariff system from area-based to volume-based has yielded a more equitable distribution of water and related costs among users along with a remarkable reduction in water use. The second is the experience of the institution of voluntary irrigation boards for the management of small water harvesting catchments and related infrastructures whose governance is inspired by use efficiency criteria, with an opening toward the allocation mechanism of water transfers. A polyhedric approach for the management of water resources in the light of climate change is essential for the correct analysis of current issues and for the implementation of suited adaptation strategies that reflect the potentialities of governance improvements in line with the recommendations provided by the EU institutions
L'uso dei farmaci antimicrobici in terapia intensiva - Letteratura ragionata dell'antibiogramma
No full text
Incentive Pricing Mechanisms For Irrigation Water Under Asymmetric Information
No full textThe study compares the discriminatory pricing strategies of an Italian water authority with a per area basis tariff (no discrimination) and with an alternative discriminatory pricing strategy that faces both the issues of adverse selection and moral hazard. The aim of the study is to analyse the relevant impact on users’ benefits of both the current case study discriminatory strategies and the alternative discriminatory strategy with respect to no discrimination. This allows to criticise water tariffs as an instrument aimed at incentivising efficient water uses under conditions of non-metering. Thus, the study challenges the practicability of a tariff design that is able to deal with biases in information between the regulator and its beneficiaries
Ex-post analyses of agri-environment schemes: a comparative analysis using expert judgement and multicriteria analysis
No full textThis chapter illustrates an ex-post evaluation of the performance of agri-environment scheme (AES) implementation in three case study regions in the EU. Due to a lack of available environmental data, we devised a methodology to assess environmental performance of AESs in the case study areas. The methodology is based on the combination of a harmonised framework for characterising environmental objectives, expert judgement, aimed at assessing environmental effectiveness, and multicriteria analysis techniques, aimed at producing an aggregated judgement about single case studies. Our experience shows the potential practical application of this methodology, especially in formalising the evaluation process. In particular, the methodology connecting the evaluation process with design parameters helps to identify specific causes of lower effectiveness. The methodology could also be used to conduct an exante evaluation (based on experts’ predictions of environmental performance criteria), and is especially suited to learning how to improve the environmental performance of schemes
L'uso dei Farmaci Antifungini nel Paziente Critico. Le Infezioni Fungine nel Paziente Critico dal Laboratorio alla Clinica per Ottimizzare la Diagnosi e la Terapia
No full textMono vs. combo regimens with novel beta-lactam/beta-lactamase inhibitor combinations for the treatment of infections due to carbapenemase-producing Enterobacterales: insights from the literature
No full textCeftazidime–avibactam (CZA), meropenem–vaborbactam (MVB) and imipenem–relebactam (I–R) are combinations of old ß-lactams with novel non-ß-lactam ß-lactamase inhibitors (BLBLIs) able to inhibit some carbapenemases, such as the KPC-type, thus are becoming the standard for difficult-to-treat carbapenemase-producing Enterobacterales (CPE); a practical question is whether these novel BLBLIs should be used as monotherapy or as part of a combination regimen with other antibiotics, and if so, with which ones, to reduce the emergence of resistant strains and to optimize their efficacy. In this short review, we assessed clinical outcomes in patients with CPE-infections treated with the novel BLBLIs as mono- or combo-regimens, and laboratory studies on the synergistic effects with other antimicrobials. Available evidence on combination therapy is scarce and mainly limited to retrospective studies involving 630 patients treated with CZA: aminoglycosides were used in 39.6% of 336 patients treated with combo-regimens, followed by polymyxin B/colistin (24.4%), tigecycline (24.1%), carbapenems (13.4%) and fosfomycin (5.4%). Aminoglycosides could be useful in case of bloodstream and severe urinary infections. Pneumonia is a risk factor for CZA-resistance emergence: fosfomycin, due to favorable lung pharmacokinetics/pharmacodynamics, could represent an interesting partner; fosfomycin could be added also for osteomyelitis. Tigecycline could be preferred for intrabdominal and skin-soft tissue infections. Due to nephrotoxicity and lack of in vitro synergy, the association CZA/colistin seems not optimal. MVB and I–R were mostly used as monotherapies. Currently, there is no definitive evidence whether combinations are more effective than monotherapies; further studies are warranted, and to date only personal opinions can be provided
Contract design in agri-environmental schemes with fixed private transaction costs and countervailing incentives
No full textThe aim of this paper is to test the relevance of considering private fixed transaction costs for contract design of Agri-Environmental Schemes, when transaction costs are negatively correlated to marginal compliance costs. In order to do so, a principal-agent model of contract design under adverse selection, including fixed private transaction costs, is developed. The model is applied to the design of payments in the Emilia Romagna region of Italy. The results show that fixed transaction costs in the range of those actually faced by farmers may significantly affect the optimal amount of environmental good to be produced by each farm type. In some cases, fixed transaction costs can even reverse the standard insight that more of a public good should be produced when the cost of its provision is lower (countervailing incentives). The results call for a higher attention to private transaction costs in the design of agri-environmental contracts.Agri-environmental schemes, principal-agent, countervailing incentives, Environmental Economics and Policy,
An Evidence-Based Multidisciplinary Approach Focused at Creating Algorithms for Targeted Therapy of BSIs, cUTIs, and cIAIs Caused by Enterobacterales in Critically Ill Adult Patients
No full textMilo Gatti,1,2 Bruno Viaggi,3 Gian Maria Rossolini,4– 6 Federico Pea,1,2 Pierluigi Viale1,7 1Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; 2SSD Clinical Pharmacology, IRCCS Azienda Ospedaliero Universitaria Sant’Orsola, Bologna, Italy; 3Neurointensive Care Unit, Department of Anesthesiology, Careggi, University Hospital, Florence, Italy; 4Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; 5Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy; 6IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy; 7Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria Sant’Orsola, Bologna, ItalyCorrespondence: Federico PeaDepartment of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Massarenti, 9, Bologna, 40138, ItalyTel +39 051 214 3199Email [email protected]: Prompt implementation of appropriate targeted antibiotic therapy represents a valuable approach in improving clinical and ecological outcome in critically septic patients. This multidisciplinary opinion article focused at developing evidence-based algorithms for targeted antibiotic therapy of bloodstream (BSIs), complicated urinary tract (cUTIs), and complicated intrabdominal infections (cIAIs) caused by Enterobacterales. The aim was to provide a guidance for intensive care physicians either in appropriately placing novel antibiotics or in considering strategies for sparing the broadest-spectrum antibiotics. A multidisciplinary team of experts (one intensive care physician, one infectious disease consultant, one clinical microbiologist and one MD clinical pharmacologist), performed several rounds of assessment to reach agreement in developing six different algorithms according to the susceptibility pattern (one each for multi-susceptible, extended-spectrum beta-lactamase-producing, AmpC beta-lactamase-producing, Klebsiella pneumoniae carbapenemase (KPC)-producing, OXA-48-producing, and Metallo-beta-lactamase (MBL)-producing Enterobacterales). Whenever multiple therapeutic options were feasible, a hierarchical scale was established. Recommendations on antibiotic dosing optimization were also provided. In order to retrieve evidence-based support for the therapeutic choices proposed in the algorithms, a comprehensive literature search was performed by a researcher on PubMed-MEDLINE from inception until March 2021. Quality and strength of evidence was established according to a hierarchical scale of the study design. Only articles published in English were included. It is expected that these algorithms, by allowing prompt revision of antibiotic regimens whenever feasible, appropriate place in therapy of novel beta-lactams, implementation of strategies for sparing the broadest-spectrum antibiotics, and pharmacokinetic/pharmacodynamic optimization of antibiotic dosing regimens, may be helpful either in improving clinical outcome or in containing the spread of antimicrobial resistance.Keywords: critically ill patients, targeted antibiotic therapy, antimicrobial stewardship, Enterobacterales, multidisciplinary taskforce, PK/PD dosing optimizatio
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