1,720,975 research outputs found
Valutazione di efficienza nella somministrazione dell’ormone della crescita (GH)
Full text linkTreatment with growth hormone (somatropin) is effective in six different medical conditions: growth hormone deficiency
(GHD), Turner syndrome (TS), growth retardation in children born small for gestational age (SGA), Prader-Willi syndrome
(PWS), growth retardation due to chronic renal insufficiency (CRI), growth retardation associated with a deficiency of the
gene SHOX (Short Stature HOmeoboXContaining gene). The treatment proved to be also effective in adults who have an
impaired growth hormone (acquired in adulthood or childhood).
The growth hormone (GH) is generally cost effective and, therefore, is usually reimbursed by public health services. In
financial terms, GH is a major cost item for health systems. According to the Report OSMED 2010, GH ranks first in Italy
between systemic hormonal preparations, excluding sex hormones, distributed by public system, with an annual value of
approximately € 88 million (+ 12.7% compared to 2009).
Considering the increasing need to control pharmaceutical expenditure, there is a strong interest for the efficient supply
of the hormone by the regional health service. From this point of view, the comparison of the specialties on the market is
normally carried out on the basis of the cost per mg; this approach, also used in the main studies of cost-effectiveness, is
derived from a logic of cost minimization, but it may still be distorting, not taking into account the efficiency of devices
used for the administration of the hormone.
The proposed analysis verifies the efficiency of different available devices, evaluating the potential waste of product, depending
both on the device used and on the characteristics of the population exposed to the treatment.
Only in the case of single-dose and disposable formulations is theoretically possible to have zero waste and thus an equivalence
between the actual cost of the treatment and the price charged. In other cases, the inefficiency causes a deviation
between the actual cost and price. In the latter cases, since the theoretical amount of the population exposed to the treatment,
it is estimated that the total share of potentially unused product can vary between 208,000 mg / year to 750,000 mg
/ year, depending on the device used. In particular, there is an actual average cost of treatment ranging between +9.9% and
+11.4% of the ex-factory price; depending on the different doses and even between the different devices, the difference
between the actual price and the theoretical price varies from a minimum of +6.9% and a maximum of +18.7
Improving flood risk analysis for effectively supporting the implementation of flood risk management plans: The case study of “Serio” Valley
No full textThe EU Flood Directive 2007/60 requires the assessment and delineation of flood risk maps. The latter should provide the required knowledge for the development of flood risk management plans (FRMPs), that should deal with all features of risk management: e.g. preparation, protection and prevention, comprising also the phase of the flood forecasting and warning systems, in addition to the emergency management. The risk maps, delineated through the expert-drive qualitative (EDQ) approach currently adopted in several European countries, such as Italy, fail to represent the information base that needed by stakeholders for selecting the suitable objectives and designing the appropriate mitigation actions for flood risk management. In the EDQ approach, the flood hazard and the potential damage degree maps are combined by means of a matrix to obtain a qualitative flood risk map. However, the performance of the risk matrix is not usually rigorous validated and, therefore, presents limits, such as subjective and not careful explained interpretation of rating and poor resolution, (due to range compression), that can produce errors in comparative ranking of risk areas. In this context, this paper proposes the FloodRisk approach that aims to improve the efficacy of flood risk map overcoming the limits of EDQ approach in supplying the knowledge base that allow to analyze costs and benefits of potential mitigation measures. However, the proposed approach is also able to involve the citizens in the flood management process, enhancing their awareness. An application of FloodRisk procedure is showed on a pilot case in “Serio” Valley, (North Italy), and its strengths and limits, in terms of additional efforts required in its application compared with EDQ procedure, have been discussed focusing on the efficacy of the outcomes provided for the fulfillment of FRMPs. The results have demonstrated the ability of FloodRisk, respect to EDQ approach, to distinguish successfully different levels of vulnerability of exposure elements, thanks to the use of asset value and depth-damage curves, that allows a suitably evaluation of the effectiveness of risk mitigation strategies. In this light, a successfully application of a cost-benefit analysis of FloodRisk approach on a portfolio of alternative mitigation actions, (i.e. structural and non-structural measurements), has been demonstrated on the proposed study case. However, FloodRisk requires additional information, e.g. water depths assessment and assets values, and it needs a proper analysis and communication of the uncertainty in its results. Although they still exist limitations that impede, at present, the FloodRisk application without an adequate understanding and a critical consideration of the hazard, exposure and vulnerability characteristics of the study area, considerations are supplied on how the utilization of this approach can be maximized in the light of the next flood risk maps revision due by December 2019
The impact of real practice inappropriateness and devices inefficency to variability in growth hormone consumption
Full text linkThe impact of real practice inapropriateness and devices inefficency to variability in growth hormone consumption
No full textEvaluation of friction between archwire and slot in self-ligating brackets and no-friction
No full textPrevalenza della fibrillazione atriale, eleggibilità al trattamento e consumo di anticoagulanti orali nelle Aziende Sanitarie italiane: impatto dei nuovi anticoagulanti
Full text linkBackground. Atrial fibrillation (AF) increases significantly the risk of comorbidities and premature death.
This paper aims to estimate: 1) the current prevalence of AF in Italy as a whole and within individual local
health authorities (LHA); 2) the proportion of strongly eligible patients receiving oral anticoagulants; 3) the
impact of non-vitamin K antagonist oral anticoagulants (NOACs).
Methods. The prevalence of AF and the proportion of patients strongly eligible for anticoagulant treatment
(defined by a CHADS2 score ≥2) were obtained by applying the results of a systematic literature
search to the Italian population stratified by gender, age and LHA. The consumption of oral anticoagulants
in eligible patients within each LHA was derived from Intercontinental Marketing Services data.
Results. Altogether, the detected prevalence of AF in Italy is 1.7%, i.e. 1 036 448 cases. Of these, 62.6%,
i.e. 648 832 subjects, are estimated to have a CHADS2 ≥2 and therefore strongly eligible for anticoagulant
treatment. The estimated percentage of eligible treated patients in 2015 was 43.7%, significantly greater
compared to 2014 (31.3%), with local and regional variabilities. In 2015 the estimated use of NOACs for
AF was 36.4% of all oral anticoagulants, with marked local and regional variabilities. NOAC prescription
appears influenced by financial limitations and by factors related to the network of anticoagulation services.
Conclusions. The present analysis shows a prevalence of AF in Italy of 1.7%. The overall rate of anticoagulant
use is increasing, but is still insufficient, with marked regional and local variations. In 2015, approximately
one third of oral anticoagulation in eligible patients was based on NOACs
Collaborative Strategies for Sustainable EU Flood Risk Management: FOSS and Geospatial Tools—Challenges and Opportunities for Operative Risk Analysis
Full text linkAn analysis of global statistics shows a substantial increase in flood damage over the past few decades. Moreover, it is expected that flood risk will continue to rise due to the combined effect of increasing numbers of people and economic assets in risk-prone areas and the effects of climate change. In order to mitigate the impact of natural hazards on European economies and societies, improved risk assessment, and management needs to be pursued. With the recent transition to a more risk-based approach in European flood management policy, flood analysis models have become an important part of flood risk management (FRM). In this context, free and open-source (FOSS) geospatial models provide better and more complete information to stakeholders regarding their compliance with the Flood Directive (2007/60/EC) for effective and collaborative FRM. A geospatial model is an essential tool to address the European challenge for comprehensive and sustainable FRM because it allows for the use of integrated social and economic quantitative risk outcomes in a spatio-temporal domain. Moreover, a FOSS model can support governance processes using an interactive, transparent and collaborative approach, providing a meaningful experience that both promotes learning and generates knowledge through a process of guided discovery regarding flood risk management. This article aims to organize the available knowledge and characteristics of the methods available to give operational recommendations and principles that can support authorities, local entities, and the stakeholders involved in decision-making with regard to flood risk management in their compliance with the Floods Directive (2007/60/EC)
A GIS tool for mapping dam-break flood hazards in Italy
Full text linkMapping the delineation of areas that are flooded due to water control infrastructure failure is a critical issue. Practical difficulties often present challenges to the accurate and effective analysis of dam-break hazard areas. Such studies are expensive, lengthy, and require large volumes of incoming data and refined technical skills. The creation of cost-efficient geospatial tools provides rapid and inexpensive estimates of instantaneous dam-break (due to structural failure) flooded areas that complement, but do not replace, the results of hydrodynamic simulations. The current study implements a Geographic Information System (GIS) based method that can provide useful information regarding the delineation of dam-break flood-prone areas in both data-scarce environments and transboundary regions, in the absence of detailed studies. Moreover, the proposed tool enables, without advanced technical skills, the analysis of a wide number of case studies that support the prioritization of interventions, or, in emergency situations, the simulation of numerous initial hypotheses (e.g., the modification of initial water level/volume in the case of limited dam functionality), without incurring high computational time. The proposed model is based on the commonly available data for masonry dams, i.e., dam geometry (e.g., reservoir capacity, dam height, and crest length), and a Digital Elevation Model. The model allows for rapid and cost-effective dam-break hazard mapping by evaluating three components: (i) the dam-failure discharge hydrograph, (ii) the propagation of the flood, and (iii) the delineation of flood-prone areas. The tool exhibited high accuracy and reliability in the identification of hypothetical dam-break flood-prone areas when compared to the results of traditional hydrodynamic approaches, as applied to a dam in Basilicata (Southern Italy). In particular, the over- and under-estimation rates of the proposed tool, for the San Giuliano dam, Basilicata, were evaluated by comparing its outputs with flood inundation maps that were obtained by two traditional methods whil using a one-dimensional and a two-dimensional propagation model, resulting in a specificity value of roughly 90%. These results confirm that most parts of the flood map were correctly classified as flooded by the proposed GIS model. A sensitivity value of over 75% confirms that several zones were also correctly identified as non-flooded. Moreover, the overall effectiveness and reliability of the proposed model were evaluated, for the Gleno Dam (located in the Central Italian Alps), by comparing the results of literature studies concerning the application of monodimensional numerical models and the extent of the flooded area reconstructed by the available historical information, obtaining an accuracy of around 94%. Finally, the computational efficiency of the proposed tool was tested on a demonstrative application of 250 Italian arch and gravity dams. The results, when carried out using a PC, Pentium Intel Core i5 Processor CPU 3.2 GHz, 8 GB RAM, required about 73 min, showing the potential of such a tool applied to dam-break flood mapping for a large number of dams
Flood damage assessment and uncertainty analysis: The case study of 2006 flood in Ilisua basin in Romania
No full textFlood damage assessments supply crucial information to support authorities, local entities, and the stakeholders involved in decision-making regarding flood risk management in their compliance with the Floods Directive (2007/60/EC). Specifically, the estimation of economic flood damage provides objective results and rational procedure in so that relate legislative planning instruments in flood risk management can be understood, accepted and shared among stakeholders. However, flood damages assessment is specifically tailored to characteristics of the flooding and objects in the considered country. Moreover, the necessary information for this analysis are not always available for all European Countries, in particular regarding the damage functions which assumptions have large effects on flood damages estimation; therefore, the existence of uncertainties that may affect the final choice needs to be considered as in any decision process. In this paper, we have made an attempt to use different damage functions, collected and harmonized by the European Joint Research Centre (JRC), utilized in several European countries, for the flood losses assessment in Romania where these functions are not available. Moreover, we have compared the assessed damage obtained through the use of the JRC damages functions and real, surveyed damage in a case study in North-Western Romania, (i.e. Ilişua Basin), regarding the flood that occurred in June 2006, and analyze uncertainties. The performed analysis has demonstrated that the outcomes are influenced by the selection and testing of vulnerability curves. Our results show that overall applicability and transferability of depth-damage curves to other geographical regions is still a major gap in current flood damage modeling, but the quantification of the uncertainties and its communication to stakeholders are the first step for the maximization of effectiveness of quantitative approach, towards flood risk management objectives of the Flood Directive, ensuring that risk information is robust, credible and transparent
LA STIMA DELLA PERICOLOSITÀ IDRAULICA PER EVENTI PLUVIOMETRICI ESTREMI IN AREE URBANE: IL RUOLO DELLA MODELLAZIONE IDRODINAMICA
No full textLe alluvioni rappresentano un problema estremamente diffuso sul territorio nazionale. L'urbanizzazione incontrollata, ovvero una copertura permanente del terreno e del relativo suolo con materiale artificiale non permeabile, contribuisce ad alterare il regime delle acque superficiali e sotterranee. Infatti, la ridotta capacità delle aree urbane di assorbire le acque di precipitazione per infiltrazione, comporta un notevole aumento in termini di volumi, portate e velocità del deflusso idrico superficiale. Tutto ciò, unito all'aumento dell'intensità e della frequenza di eventi estremi di precipitazione, attribuiti ai processi di cambiamento climatici, aggrava le ripercussioni degli stessi eventi.
In questo contesto è rappresentativo il caso di studio della città di Matera, la quale nel corso degli ultimi anni è stata interessata più volte da eventi di precipitazione intensa che hanno causato importanti disagi per la popolazione e diversi danni. L'ultimo evento in ordine cronologico risale allo scorso novembre, quando un fiume di acqua e fango è penetrato nelle abitazioni allagando i piani più bassi ed ha interrotto in più tratti la circolazione. Non avendo, per il caso di studio, a disposizione dati rilevati in-situ rispetto ai quali validare le simulazioni idrodinamiche, si sono confrontati i risultati delle simulazioni condotte con i modelli idrodinamici bidimensionali FLORA-2D (Cantisani et al., 2014) e LISFLOOD-FP (Bates, 2007) con la finalità di ricercare procedure operative e strumenti per una gestione delle inondazioni per scopi sia di previsione e allertamento che relativi alla pianificazione territoriale (ex ante). Il modello FLORA-2D, che trascura i termini convettivi delle equazioni delle acque basse, è stato inizialmente sviluppato con lo scopo di simulare la propagazione delle piene in aree pianeggianti con la possibilità di tenere conto della variazione spazio-temporale della scabrezza in base alle caratteristiche della vegetazione e, successivamente, è stato modificato, inserendo la possibilità di ricevere in input ietogrammi di pioggia efficace variabili spazialmente con il tipo di suolo, al fine di consentire anche la simulazione di allagamenti in ambito urbano generati da precipitazioni estreme. Invece, il modello LISFLOOD-FP ha la peculiarità di poter scegliere alternativamente diversi schemi numerici, che si differenziano in base ai termini delle equazioni delle acque basse considerati, che rendono la sua applicazione flessibile in base ai dati disponibili, ed agli scopi dello studio. Nel presente lavoro sono stati testati, sul caso di studio di Matera, tre schemi numerici: lo schema Acceleration che trascura l'accelerazione convettiva, il Flow-Limited che oltre a quella convettiva trascura l'accelerazione locale, e, infine, lo schema Roe, che tratta le equazioni complete.
Le simulazioni con un modello idraulico bidimensionale sono importanti in ambito urbano ogni qual volta il tempo di ritorno della precipitazione supera quello di progettazione della fognatura. Infatti, spesso i sistemi di drenaggio urbani vanno in crisi in occasione di eventi di precipitazione intensi per diverse cause, quali: un progetto originario per tempi di ritorno non particolarmente elevati (es. Tr=10 anni), l’aggiunta di nuovi rami di rete senza un suo adeguamento complessivo, l’incremento delle portate dovuto all'impermeabilizzazione del suolo o ai cambiamenti climatici. In tutti i casi di insufficienza della rete di drenaggio, l’uso di un modello idrodinamico bidimensionale consente di valutare sia il perimetro delle aree allagabili che le caratteristiche dell’allagamento quali le altezze d’acqua e le velocita
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