Volume and diagnosis: an approach to cross-border care in eight European countries

Objectives: Mobility of patients is a pertinent issue on the European Union's agenda. This study aimed to estimate the volume and main diagnoses of cross-border care in eight European countries, in order to provide policy makers with background information about the nature of patient mobility in Europe. Methods: This article reports the combined findings from three independent studies that compiled self-reported information on admissions data and main diagnoses from more than 200 hospitals in eight European countries. Results: The average volume of cross-border patients accounted for less than 1% of total admissions in the hospitals studied here. Diseases of the circulatory system (mainly acute myocardial infarction) and fractures were the most common reasons for hospitalisation of European patients abroad. Deliveries and other diagnoses related to pregnancy, pneumonia, appendicitis and other diseases of the digestive system, aftercare procedures, and disorders of the eye and adnexa were also common diagnoses for this population. Conclusions: Hospitals should reinforce their efforts to adapt the care provided to the needs of foreign patients in treatment areas that cover the most frequent pathologies identified in this populatio

Quad-Chip Double-Balanced Frequency Tripler

Solid-state frequency multipliers are used to produce tunable broadband sources at millimeter and submillimeter wavelengths. The maximum power produced by a single chip is limited by the electrical breakdown of the semiconductor and by the thermal management properties of the chip. The solution is to split the drive power to a frequency tripler using waveguides to divide the power among four chips, then recombine the output power from the four chips back into a single waveguide. To achieve this, a waveguide branchline quadrature hybrid coupler splits a 100-GHz input signal into two paths with a 90 relative phase shift. These two paths are split again by a pair of waveguide Y-junctions. The signals from the four outputs of the Y-junctions are tripled in frequency using balanced Schottky diode frequency triplers before being recombined with another pair of Y-junctions. A final waveguide branchline quadrature hybrid coupler completes the combination. Using four chips instead of one enables using four-times higher power input, and produces a nearly four-fold power output as compared to using a single chip. The phase shifts introduced by the quadrature hybrid couplers provide isolation for the input and output waveguides, effectively eliminating standing waves between it and surrounding components. This is accomplished without introducing the high losses and expense of ferrite isolators. A practical use of this technology is to drive local oscillators as was demonstrated around 300 GHz for a heterodyne spectrometer operating in the 2-3-THz band. Heterodyne spectroscopy in this frequency band is especially valuable for astrophysics due to the presence of a very large number of molecular spectral lines. Besides high-resolution radar and spectrographic screening applications, this technology could also be useful for laboratory spectroscopy

IL28B SNP screening and distribution in the French Canadian population using a rapid PCR-based test

Single nucleotide polymorphisms (SNPs) in the proximity of the interleukin-28B (IL28B) gene can predict spontaneous resolution of hepatitis C virus (HCV) infection and response to interferon therapy. Screening for this polymorphism has become part of the standard criteria for the management of HCV-infected patients, hence the need for a rapid, cost-effective screening method. Here, we describe a rapid PCR-based test to screen for two IL28B SNPs (rs12979860 and rs8099917). We used this test to investigate IL28B polymorphism and prevalence in a cohort of French Canadian injection drug users who are part of a unique population known to have a strong genetic founder effect. This population had lower linkage disequilibrium between the two tested SNPs as compared to other cohorts (|d′| = 0.68, r = 0.59). The special genetic makeup should be considered in the management of HCV-infected patients within that population

An elasto-visco-plastic model for immortal foams or emulsions

A variety of complex fluids consist in soft, round objects (foams, emulsions, assemblies of copolymer micelles or of multilamellar vesicles -- also known as onions). Their dense packing induces a slight deviation from their prefered circular or spherical shape. As a frustrated assembly of interacting bodies, such a material evolves from one conformation to another through a succession of discrete, topological events driven by finite external forces. As a result, the material exhibits a finite yield threshold. The individual objects usually evolve spontaneously (colloidal diffusion, object coalescence, molecular diffusion), and the material properties under low or vanishing stress may alter with time, a phenomenon known as aging. We neglect such effects to address the simpler behaviour of (uncommon) immortal fluids: we construct a minimal, fully tensorial, rheological model, equivalent to the (scalar) Bingham model. Importantly, the model consistently describes the ability of such soft materials to deform substantially in the elastic regime (be it compressible or not) before they undergo (incompressible) plastic creep -- or viscous flow under even higher stresses.Comment: 69 pages, 29 figure

Experimental study of Taylor's hypothesis in a turbulent soap film

An experimental study of Taylor's hypothesis in a quasi-two-dimensional turbulent soap film is presented. A two probe laser Doppler velocimeter enables a non-intrusive simultaneous measurement of the velocity at spatially separated points. The breakdown of Taylor's hypothesis is quantified using the cross correlation between two points displaced in both space and time; correlation is better than 90% for scales less than the integral scale. A quantitative study of the decorrelation beyond the integral scale is presented, including an analysis of the failure of Taylor's hypothesis using techniques from predictability studies of turbulent flows. Our results are compared with similar studies of 3D turbulence.Comment: 27 pages, + 19 figure

Zitterbewegung and semiclassical observables for the Dirac equation

In a semiclassical context we investigate the Zitterbewegung of relativistic particles with spin 1/2 moving in external fields. It is shown that the analogue of Zitterbewegung for general observables can be removed to arbitrary order in \hbar by projecting to dynamically almost invariant subspaces of the quantum mechanical Hilbert space which are associated with particles and anti-particles. This not only allows to identify observables with a semiclassical meaning, but also to recover combined classical dynamics for the translational and spin degrees of freedom. Finally, we discuss properties of eigenspinors of a Dirac-Hamiltonian when these are projected to the almost invariant subspaces, including the phenomenon of quantum ergodicity

How We Know It Hurts: Item Analysis of Written Narratives Reveals Distinct Neural Responses to Others' Physical Pain and Emotional Suffering

People are often called upon to witness, and to empathize with, the pain and suffering of others. In the current study, we directly compared neural responses to others' physical pain and emotional suffering by presenting participants (n = 41) with 96 verbal stories, each describing a protagonist's physical and/or emotional experience, ranging from neutral to extremely negative. A separate group of participants rated “how much physical pain”, and “how much emotional suffering” the protagonist experienced in each story, as well as how “vivid and movie-like” the story was. Although ratings of Pain, Suffering and Vividness were positively correlated with each other across stories, item-analyses revealed that each scale was correlated with activity in distinct brain regions. Even within regions of the “Shared Pain network” identified using a separate data set, responses to others' physical pain and emotional suffering were distinct. More broadly, item analyses with continuous predictors provided a high-powered method for identifying brain regions associated with specific aspects of complex stimuli – like verbal descriptions of physical and emotional events.United States. Air Force Office of Scientific Research (Office of Naval Research, grant number N000140910845

Infrared problem for the Nelson model on static space-times

We consider the Nelson model with variable coefficients and investigate the problem of existence of a ground state and the removal of the ultraviolet cutoff. Nelson models with variable coefficients arise when one replaces in the usual Nelson model the flat Minkowski metric by a static metric, allowing also the boson mass to depend on position. A physical example is obtained by quantizing the Klein-Gordon equation on a static space-time coupled with a non-relativistic particle. We investigate the existence of a ground state of the Hamiltonian in the presence of the infrared problem, i.e. assuming that the boson mass tends to 0 at infinity

Involvement of patients or their representatives in quality management functions in EU hospitals:implementation and impact on patient-centred care strategies

OBJECTIVE: The objective of this study was to describe the involvement of patients or their representatives in quality management (QM) functions and to assess associations between levels of involvement and the implementation of patient-centred care strategies. DESIGN: A cross-sectional, multilevel STUDY DESIGN: that surveyed quality managers and department heads and data from an organizational audit. SETTING: Randomly selected hospitals (n = 74) from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). PARTICIPANTS: Hospital quality managers (n = 74) and heads of clinical departments (n = 262) in charge of four patient pathways (acute myocardial infarction, stroke, hip fracture and deliveries) participated in the data collection between May 2011 and February 2012. MAIN OUTCOME MEASURES: Four items reflecting essential patient-centred care strategies based on an on-site hospital visit: (1) formal survey seeking views of patients and carers, (2) written policies on patients' rights, (3) patient information literature including guidelines and (4) fact sheets for post-discharge care. The main predictors were patient involvement in QM at the (i) hospital level and (ii) pathway level. RESULTS: Current levels of involving patients and their representatives in QM functions in European hospitals are low at hospital level (mean score 1.6 on a scale of 0 to 5, SD 0.7), but even lower at departmental level (mean 0.6, SD 0.7). We did not detect associations between levels of involving patients and their representatives in QM functions and the implementation of patient-centred care strategies; however, the smallest hospitals were more likely to have implemented patient-centred care strategies. CONCLUSIONS: There is insufficient evidence that involving patients and their representatives in QM leads to establishing or implementing strategies and procedures that facilitate patient-centred care; however, lack of evidence should not be interpreted as evidence of no effect

Exogenous WNT5A and WNT11 proteins rescue CITED2 dysfunction in mouse embryonic stem cells and zebrafish morphants

Mutations and inadequate methylation profiles of CITED2 are associated with human congenital heart disease (CHD). In mouse, Cited2 is necessary for embryogenesis, particularly for heart development, and its depletion in embryonic stem cells (ESC) impairs cardiac differentiation. We have now determined that Cited2 depletion in ESC affects the expression of transcription factors and cardiopoietic genes involved in early mesoderm and cardiac specification. Interestingly, the supplementation of the secretome prepared from ESC overexpressing CITED2, during the onset of differentiation, rescued the cardiogenic defects of Cited2-depleted ESC. In addition, we demonstrate that the proteins WNT5A and WNT11 held the potential for rescue. We also validated the zebrafish as a model to investigate cited2 function during development. Indeed, the microinjection of morpholinos targeting cited2 transcripts caused developmental defects recapitulating those of mice knockout models, including the increased propensity for cardiac defects and severe death rate. Importantly, the co-injection of anti-cited2 morpholinos with either CITED2 or WNT5A and WNT11 recombinant proteins corrected the developmental defects of Cited2-morphants. This study argues that defects caused by the dysfunction of Cited2 at early stages of development, including heart anomalies, may be remediable by supplementation of exogenous molecules, offering the opportunity to develop novel therapeutic strategies aiming to prevent CHD.Agência financiadora: Fundação para a Ciência e a Tecnologia (FCT) Comissão de Coordenação e Desenvolvimento Regional do Algarve (CCDR Algarve) ALG-01-0145-FEDER-28044; DFG 568/17-2 Algarve Biomedical Center (ABC) Municipio de Louléinfo:eu-repo/semantics/publishedVersio