Research (NIHR), was set up in 1993.It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS.'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC).HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'.The HTA programme is needs led in that it fills gaps in the evidence needed by the NHS.There are three routes to the start of projects.First is the commissioned route.Suggestions for research are actively sought from people working in the NHS, from the public and consumer groups and from professional bodies such as royal colleges and NHS trusts.These suggestions are carefully prioritised by panels of independent experts (including NHS service users).The HTA programme then commissions the research by competitive tender.Second, the HTA programme provides grants for clinical trials for researchers who identify research questions.These are assessed for importance to patients and the NHS, and scientific rigour.Third, through its Technology Assessment Report (TAR) call-off contract, the HTA programme commissions bespoke reports, principally for NICE, but also for other policy-makers.TARs bring together evidence on the value of specific technologies.Some HTA research projects, including TARs, may take only months, others need several years.They can cost from as little as £40,000 to over £1 million, and may involve synthesising existing evidence, undertaking a trial, or other research collecting new data to answer a research problem.The final reports from HTA projects are peer reviewed by a number of independent expert
There were over fifty treaties directly relating to the Italian Wars of 1494 to 1559. Only one of them involved solely Italian powers, and only one of the major leagues was formed on the initiative of Italian states. France was a party to two‐thirds of the treaties, and most of the remainder were directed against France, a reflection of the importance of the dynastic ambitions of the French kings in initiating and continuing the conflicts throughout the wars, but the final Treaty of Cateau‐Cambrésis left Spain as the unchallenged dominant power in Italy.
Questions concerning access to, qualifications for, and the distribution of offices were central to practical politics in Italian republics. Equality was the main principle invoked, but often equality was qualified or limited by other considerations. The principle of rotation of office-holding was cherished by many, but the principle of equality of access to office conflicted with the recognition that some were better fitted to govern than others. The proprietorial attitude to office and government characteristic of the citizens of Italian republics affected their attitude to the question of the admission of new men to the regime. The technicalities of electoral procedures were matters of vital interest to citizens because they were so influential in determining the chances of sharing in the benefits and honours, which, rather than participation in decision-making, was for many the principal reason for desiring political office.
Background. Considerable changes have occurred over the last 5 years in the organization of out-of-hours care in the UK. Users' experiences of their care are an important part of 'quality of care' and are valuable for identifying areas for improvement.
Italy was a political community, one that was held together and divided not just by leagues and alliances, but by networks of agreements linking stronger powers to weaker ones. Lesser states had significant roles to play as participants in their own right and as the objects of competition and contention among the major players. Accepting the protection of a stronger power could be seen as defending, not compromising, libertà. Citizens of republics who exalted their own libertà as a quasi-sacred value never questioned their right to make other communities, for whom libertà could be just as potent a concept, subject to them. This complex system was radically changed by the Italian Wars (1494-1559). The ultramontane powers who wanted to establish themselves in Italy could play by different rules, but sometimes had to at least appear to adapt to the principles governing relations between states, as Italians understood them, and the importance attached to the concept of libertà.
Maxims on how any government would prefer to deal with those in power in another state rather than with their exiles, or on how those ‘inside’ would always be held in higher regard than those forced ‘outside’, can have carried only limited conviction for the politicians of Renaissance Italy. They would know of too many instances when rival powers had been happy to have dealings with both a regime and its exiles, too many episodes when the exiles of a rival power formed an integral part of an enemy's assault. Exiles might be prone to nourishing unrealistic hopes not just of sympathy but of money and men to help them return, but their hopes were not always ill-founded.
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