Use of risk adjustment in setting budgets and measuring performance in primary care I: how it works

Summary points: Primary care groups and general practices will be funded largely through capitation based formulas, and their performance will be monitored more closely. Current methods of funding primary care trusts and general practices, and of monitoring their performance, do not take into account differences in case mix. Risk adjustment methods have been developed in the United States to allow measurement ofcase mix and morbidity of primary care populations. Risk adjustment methods are now being used to set capitation rates for health services in the United States

Microscopic study of freeze-out in relativistic heavy ion collisions at SPS energies

The freeze-out conditions in the light (S+S) and heavy (Pb+Pb) colliding systems of heavy nuclei at 160 AGeV/$c$ are analyzed within the microscopic Quark Gluon String Model (QGSM). We found that even for the most heavy systems particle emission takes place from the whole space-time domain available for the system evolution, but not from the thin ''freeze-out hypersurface", adopted in fluid dynamical models. Pions are continuously emitted from the whole volume of the reaction and reflect the main trends of the system evolution. Nucleons in Pb+Pb collisions initially come from the surface region. For both systems there is a separation of the elastic and inelastic freeze-out. The mesons with large transverse momenta, $p_t$, are predominantly produced at the early stages of the reaction. The low $p_t$-component is populated by mesons coming mainly from the decay of resonances. This explains naturally the decreasing source sizes with increasing $p_t$, observed in HBT interferometry. Comparison with S+S and Au+Au systems at 11.6 AGeV/$c$ is also presented.Comment: REVTEX, 26 pages incl. 9 figures and 2 tables, to be published in the Physical Review

Iron Oxide Nanoparticles Employed as Seeds for the Induction of Microcrystalline Diamond Synthesis

Iron nanoparticles were employed to induce the synthesis of diamond on molybdenum, silicon, and quartz substrates. Diamond films were grown using conventional conditions for diamond synthesis by hot filament chemical vapor deposition, except that dispersed iron oxide nanoparticles replaced the seeding. X-ray diffraction, visible, and ultraviolet Raman Spectroscopy, energy-filtered transmission electron microscopy , electron energy-loss spectroscopy, and X-ray photoelectron spectroscopy (XPS) were employed to study the carbon bonding nature of the films and to analyze the carbon clustering around the seed nanoparticles leading to diamond synthesis. The results indicate that iron oxide nanoparticles lose the O atoms, becoming thus active C traps that induce the formation of a dense region of trigonally and tetrahedrally bonded carbon around them with the ensuing precipitation of diamond-type bonds that develop into microcrystalline diamond films under chemical vapor deposition conditions. This approach to diamond induction can be combined with dip pen nanolithography for the selective deposition of diamond and diamond patterning while avoiding surface damage associated to diamond-seeding methods

School dropout, problem behaviour and poor academic achievement : a longitudinal view of portuguese male offenders

This study examines school drop outs from the perspective of male adults themselves through interviews with offenders currently serving sentences. Participants were 10 Portuguese male inmates, between the ages of 19 and 46 years of age, incarcerated in two prison facilities of the Azores. Qualitative and interpretative methods were carried out using a semi-structured in-depth individual interview that was audiorecorded and conducted on the basis of a list of topics. Interview transcripts and thematic analysis were used in data treatment and analysis. The findings primarily indicate that poor academic achievement and emotional and behavioural difficulties of participants played a particular role in early school drop out. The trajectories these individuals followed within the education system presented problem behaviour, learning disabilities, and/or foster care interventions. While school drop out circumstances were apparently various, analysis showed that they were underpinned by three distinct sets of conditions generally not addressed by the education system. The analysis of the triggering factors and the maintenance dynamics of school drop outs indicated three distinct types: retention/absenteeism, life turning points and positive resolution. Implications for secondary prevention and screening practices are discussed.FCT (SFRH/ BD/ 44245/ 2008)CIEC - unidade de investigação 317 da FC

Nucleosomes in gene regulation: theoretical approaches

This work reviews current theoretical approaches of biophysics and bioinformatics for the description of nucleosome arrangements in chromatin and transcription factor binding to nucleosomal organized DNA. The role of nucleosomes in gene regulation is discussed from molecular-mechanistic and biological point of view. In addition to classical problems of this field, actual questions of epigenetic regulation are discussed. The authors selected for discussion what seem to be the most interesting concepts and hypotheses. Mathematical approaches are described in a simplified language to attract attention to the most important directions of this field

Novel genetic loci associated with hippocampal volume

The hippocampal formation is a brain structure integrally involved in episodic memory, spatial navigation, cognition and stress responsiveness. Structural abnormalities in hippocampal volume and shape are found in several common neuropsychiatric disorders. To identify the genetic underpinnings of hippocampal structure here we perform a genome-wide association study (GWAS) of 33,536 individuals and discover six independent loci significantly associated with hippocampal volume, four of them novel. Of the novel loci, three lie within genes (ASTN2, DPP4 and MAST4) and one is found 200 kb upstream of SHH. A hippocampal subfield analysis shows that a locus within the MSRB3 gene shows evidence of a localized effect along the dentate gyrus, subiculum, CA1 and fissure. Further, we show that genetic variants associated with decreased hippocampal volume are also associated with increased risk for Alzheimer's disease (rg =-0.155). Our findings suggest novel biological pathways through which human genetic variation influences hippocampal volume and risk for neuropsychiatric illness

Comparing Presenting Clinical Features in 48 Children With Microscopic Polyangiitis to 183 Children Who Have Granulomatosis With Polyangiitis (Wegener's) : an ARChiVe Cohort Study

OBJECTIVE: To uniquely classify children with microscopic polyangiitis (MPA), to describe their demographic characteristics, presenting clinical features, and initial treatments in comparison to patients with granulomatosis with polyangiitis (Wegener's) (GPA). METHODS: The European Medicines Agency (EMA) classification algorithm was applied by computation to categorical data from patients recruited to the ARChiVe (A Registry for Childhood Vasculitis: e-entry) cohort, with the data censored to November 2015. The EMA algorithm was used to uniquely distinguish children with MPA from children with GPA, whose diagnoses had been classified according to both adult- and pediatric-specific criteria. Descriptive statistics were used for comparisons. RESULTS: In total, 231 of 440 patients (64% female) fulfilled the classification criteria for either MPA (n\u2009=\u200948) or GPA (n\u2009=\u2009183). The median time to diagnosis was 1.6 months in the MPA group and 2.1 months in the GPA group (ranging to 39 and 73 months, respectively). Patients with MPA were significantly younger than those with GPA (median age 11 years versus 14 years). Constitutional features were equally common between the groups. In patients with MPA compared to those with GPA, pulmonary manifestations were less frequent (44% versus 74%) and less severe (primarily, hemorrhage, requirement for supplemental oxygen, and pulmonary failure). Renal pathologic features were frequently found in both groups (75% of patients with MPA versus 83% of patients with GPA) but tended toward greater severity in those with MPA (primarily, nephrotic-range proteinuria, requirement for dialysis, and end-stage renal disease). Airway/eye involvement was absent among patients with MPA, because these GPA-defining features preclude a diagnosis of MPA within the EMA algorithm. Similar proportions of patients with MPA and those with GPA received combination therapy with corticosteroids plus cyclophosphamide (69% and 78%, respectively) or both drugs in combination with plasmapheresis (19% and 22%, respectively). Other treatments administered, ranging in decreasing frequency from 13% to 3%, were rituximab, methotrexate, azathioprine, and mycophenolate mofetil. CONCLUSION: Younger age at disease onset and, perhaps, both gastrointestinal manifestations and more severe kidney disease seem to characterize the clinical profile in children with MPA compared to those with GPA. Delay in diagnosis suggests that recognition of these systemic vasculitides is suboptimal. Compared with adults, initial treatment regimens in children were comparable, but the complete reversal of female-to-male disease prevalence ratios is a provocative finding