To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The pan-Canadian Oncology Drug Review (pCODR) evaluates new cancer drugs for public funding recommendations. While pCODR's deliberative framework evaluates overall clinical benefit and includes considerations for exceptional circumstances, rarity of indication is not explicitly addressed. Given the high unmet need that typically accompanies these indications, we explored the impact of rarity on oncology HTA recommendations and funding decisions.
We examined pCODR submissions with final recommendations from 2012 to 2017. Incidence rates were calculated using pCODR recommendation reports and statistics from the Canadian Cancer Society. Indications were classified as rare if the incidence rate was lower than 1/100,000 diagnoses, a definition referenced by the Canadian Agency for Drugs and Technologies in Health. Each pCODR final report was examined for the funding recommendation/justification, level of supporting evidence (presence of a randomized control trial [RCT]), and time to funding (if applicable).
Of the ninety-six pCODR reviews examined, 16.6 percent were classified as rare indications per above criteria. While the frequency of positive funding recommendations were similar between rare and nonrare indication (78.6 vs. 75 percent), rare indications were less likely to be presented with evidence from RCT (50 vs. 90 percent). The average time to funding did not differ significantly across provinces.
Rare indications appear to be associated with weaker clinical evidence. There appears to be no association between rarity, positive funding recommendations, and time to funding. Further work will evaluate factors associated with positive recommendations and the real-world utilization of funded treatments for rare indications.
Formal thought disorder is a cardinal feature of psychosis. However, the extent to which formal thought disorder is evident in ultra-high-risk individuals and whether it is linked to the progression to psychosis remains unclear.
Examine the severity of formal thought disorder in ultra-high-risk participants and its association with future psychosis.
The Thought and Language Index (TLI) was used to assess 24 ultra-high-risk participants, 16 people with first-episode psychosis and 13 healthy controls. Ultra-high-risk individuals were followed up for a mean duration of 7 years (s.d.=1.5) to determine the relationship between formal thought disorder at baseline and transition to psychosis.
TLI scores were significantly greater in the ultra-high-risk group compared with the healthy control group (effect size (ES)=1.2), but lower than in people with first-episode psychosis (ES=0.8). Total and negative TLI scores were higher in ultra-high-risk individuals who developed psychosis, but this was not significant. Combining negative TLI scores with attenuated psychotic symptoms and basic symptoms predicted transition to psychosis (P=0.04; ES=1.04).
TLI is beneficial in evaluating formal thought disorder in ultra-high-risk participants, and complements existing instruments for the evaluation of psychopathology in this group.
Lombardy has been the centre of northern Italy not only geographically but also, for long periods in its history, politically and economically. It was always the heart of the Italian kingdom, originally named the regnum Langobardorum. Its political centre and capital was initially Pavia, but the nearby metropolis of Milan and its archbishops became increasingly important, as demonstrated in the coronation of the kings of Italy in the venerable Milanese abbey church of Sant'Ambrogio. The growing importance of Milan coincided with the weakening of the centralised royal administration in the region and the crystallisation of communal structures and institutions during the eleventh and twelfth centuries. Tension between Milan and Pavia alongside the ascent of the former determined the political framework of Lombardy for centuries, while the rise of other important cities in the region such as Bergamo, Brescia, Como, Cremona, Lodi and Mantua completed the picture. In the Middle Ages, the geographical concept of Longobardia or Lombardia extended beyond the confines of the modern region to comprehend such cities as Novara, Vercelli and Tortona in the Piedmont and Piacenza and Parma in Emilia. Contemporaries even described places as far away as Asti, Modena and Reggio as Lombard. Together with modern Lombardy, they formed a large but only vaguely defined region referred to here as ‘greater Lombardy’.
The traditional mints of Pavia and Milan also determined the pattern of the currency in the region. Pavia and its coinage were more influential in the west, reaching far into Liguria and the Piedmont, while Milan was more important in central and eastern areas. Milan's dominance over the other Lombard mints began to extend westwards in the thirteenth century,but it was only with the formation of the Milan-centred Visconti state in the fourteenth century that the metropolis gained undisputed supremacy. The development of the coinage in Lombardy thus mirrored political circumstances. From the 1420s, however, the expansion of Venice on to the so-called Terraferma, the mainland beyond the Venetian lagoons, stretched into Lombardy with the conquest of Brescia, Bergamo and Lodi.
The difficulties inherent in selecting the most suitable forms for personal and place names in a reference work of this sort are discussed in MEC 1, xxi; MEC 14, xix–xx; and most recently in MEC 6, xxvi–xxxi. In this volume, the approach differs from the one adopted for MEC 1 and 14 in that English is used for personal names only for kings, emperors and popes. For the most part, other individuals are referred to by the ‘national’ forms of their names, which has become more common in the literature in English over the past few decades. Most rulers in northern Italy during the period under consideration are thus identified by the modern Italian forms of their names, but there are some notable exceptions. Foreign rulers who exercised authority over parts of northern Italy at one time or another are identified either by the national forms of their names or, in the case of foreign kings or emperors, by the English equivalents. The Angevin kings of Naples who governed parts of the Piedmont in the thirteenth and fourteenth centuries and the kings of France who sometimes ruled over Asti, Genoa and Milan are thus identified by the English forms of their names. In some cases, however, it is more appropriate to identify local rulers in northern Italy by their German names. The early patriarchs of Aquileia and the counts of Gorizia and Tyrol were Germanic and ruled over parts of northern Italy where Germanic peoples probably made up significant proportions of the population. In Italy's South Tyrol, even today, some three-quarters of the inhabitants speak German as their first language.
For place names, common English forms are used whenever they exist – such as Genoa rather than Genova, Milan rather than Milano, Venice rather than Venezia and so on – but conventional modern forms are otherwise used. This volume therefore uses the modern Cortemilia instead of the older form Cortemiglia, which is perhaps more familiar in the numismatic literature, and Masserano instead of the now antiquated Messerano. In discussing the coinage of the counts of Tyrol, both German and Italian forms are often given for the places covered, first the German and then the Italian in brackets since German was and still is the predominant language in the region.
Coins were occasionally given official names in mint ordinances, proclamations, etc., but are more often described as denari or grossi, terms that initially implied a specific identity or value but were also used in the general sense of ‘coin’, so that some further description was often necessary, e.g. grosso da dodici denari (‘groat of twelve pennies’).Official names were in any case supplemented by a variety of popular names, often of a mocking character.
The list that follows covers the medieval coin names of northern Italy, together with a few names of weights and of coins that did not originate in the area but were familiar there and occur in its records. Some coin names are based on terms of value, but the majority, at least initially, referred to specific coins. Confusion can arise from the way in which coin names that were initially specific, and based on the type (e.g. ambrosino) or value (e.g. sesino), could be generalised to cover coins of a particular size or denomination and then used for ones on which these particular features are absent or the values to which they referred no longer held good.
The most useful collection of Italian coin names and numismatic terms is in Martinori (1915), though its identifications and explanations are not always correct. For coin names alone, there is now also the glossary in Travaini (2003) for which the author draws directly on coin lists in medieval arithmetic tracts and merchants'manuals. The strong Mediterranean orientation inMateu y Llopis (1946) and the author's familiarity with both Spanish and Italian medieval documentary records likewise makes this a valuable reference. For similar reasons, the glossary in MEC 6 on the coinage of the Iberian peninsula is also helpful. The better German and French numismatic dictionaries are often useful for northern Italy, where cross-border influence was sometimes considerable (Schrotter 1930; Belaubre 1996; Amandry 2001). Etymologies proposed in standard dictionaries, however, are often unsatisfactory and should not be relied upon, since their authors have usually known little or nothing about the coins. Edler's otherwise very useful glossary of medieval Italian business terms (1934) pays little attention to coinage.