The self-regulatory German health care system between growing competition and state hierarchy

This article focuses on the changing role of the state in financing, providing and regulating health care services under the German health care system from 1970-2000. While a reduced role of the state can be observed in terms of financing, our analysis of service provision indicates inconsistent developments. Monetary resource flow analyses indicate a decrease in private service provision as a percentage of total health expenditure, but when analysing the development of health employment we see a growth in “private” health care personnel. The most important changes, however, have taken place in terms of regulation. Since the early 1990s, the traditionally self-regulatory German health care system has simultaneously faced growing competition and state hierarchy

Integración espacial y cointegración: una aplicación al mercado de cereales en España.

Postprint (published version

On the concentration and size distribution of sub-micron aerosol in the Galápagos Islands

During the CHARLEX campaign in the Galápagos Islands, a Scanning Particle Mobility Sizer was deployed on San Cristobal Island in July-August 2011 to carry out size-resolved measurements of the concentration of submicron aerosols. To our knowledge these are the first measurements of aerosol concentrations in this unique environment. The particles with marine origin displayed a tri-modal number size distribution with peak diameters of 0.016 μm, 0.050 μm and 0.174 μm and a cloud-processed intermodal minimum at 0.093 μm. The mean total aerosol number concentration for the marine contribution was 470 ± 160 cm. A low particle concentration of 70 ± 50 cm for the nucleation size range was measured, but no evidence of new particle production in the atmospheric marine boundary layer (MBL) was observed. The concentration of the Aitken size mode was found to be related to aerosol entrainment from the free troposphere off the coast of Chile followed by transport within the MBL to the Galápagos Islands. Cloud processing may activate the particles in the Aitken size range, growing through 'in-cloud' sulphate production and increasing the particle concentration in the accumulation size range. The 0.093 μm cloud processed minima suggests that the critical supersaturation at which the particle is activated to a cloud droplet is in the 0.14-0.21% range. The daytime marine particle background concentration was influenced by human activity around the sampling site, as well as by new particle formation triggered by biogenic emissions from the vegetation cover of the island's semiarid lowlands. Effective CCN formation may play a role in the formation and properties of the stratus clouds, which permanently cover the top of the windward side of the islands and establish one of their characteristic climatic bands.Peer Reviewe

Clinical and Economic Evaluation after Adopting Contingent Cell-Free DNA Screening for Fetal Trisomies in South Spain.

Contingent cell-free (cf) DNA screening on the basis of the first-trimester combined test (FCT) results has emerged as a cost-effective strategy for screening of trisomy 21 (T21). Objectives: To assess performance, patients’ uptake, and cost of contingent cfDNA screening and to compare them with those of the established FCT. Methods: This is a prospective cohort study including all singleton pregnancies attending to their FCT for screening of T21 at 2 university hospitals in South Spain. When the FCT risk was ≥1:50, there were major fetal malformations, or the nuchal translucency was ≥3.5 mm, women were recommended invasive testing (IT); if the risk was between 1:50 and 1:270, women were recommended cfDNA testing; and for risks bellow 1:270, no further testing was recommended. Detection rate (DR), false-positive rate (FPR), patients’ uptake, and associated costs were evaluated. Results: We analyzed 10,541 women, including 46 T21 cases. DR of our contingent strategy was 89.1% (41/46) at 1.4% (146/10,541) FPR. Uptake of cfDNA testing was 91.2% (340/373), and overall IT rate was 2.0%. The total cost of our strategy was €1,462,895.7, similar to €1,446,525.7 had cfDNA testing not been available. Conclusions: Contingent cfDNA screening shows high DR, low IT rate, and high uptake at a similar cost than traditional screening.pre-print133 K

Detection of a G-Quadruplex as a Regulatory Element in Thymidylate synthase for Gene Silencing Using Polypurine Reverse Hoogsteen Hairpins

Thymidylate synthase (TYMS) enzyme is an anti-cancer target given its role in DNA biosynthesis. TYMS inhibitors (e.g., 5-Fluorouracil) can lead to drug resistance through an autoregulatory mechanism of TYMS that causes its overexpression. Since G-quadruplexes (G4) can modulate gene expression, we searched for putative G4 forming sequences (G4FS) in the TYMS gene that could be targeted using polypurine reverse Hoogsteen hairpins (PPRH). G4 structures in the TYMS gene were detected using the quadruplex forming G-rich sequences mapper and confirmed through spectroscopic approaches such as circular dichroism and NMR using synthetic oligonucleotides. Interactions between G4FS and TYMS protein or G4FS and a PPRH targeting this sequence (HpTYMS-G4-T) were studied by EMSA and thioflavin T staining. We identified a G4FS in the 5'UTR of the TYMS gene in both DNA and RNA capable of interacting with TYMS protein. The PPRH binds to its corresponding target dsDNA, promoting G4 formation. In cancer cells, HpTYMG-G4-T decreased TYMS mRNA and protein levels, leading to cell death, and showed a synergic effect when combined with 5-fluorouracil. These results reveal the presence of a G4 motif in the TYMS gene, probably involved in the autoregulation of TYMS expression, and the therapeutic potential of a PPRH targeted to the G4FS

Improving Cognitive Visual-Motor Abilities in Individuals with Down Syndrome

Down syndrome causes a reduction in cognitive abilities, with visual-motor skills being particularly affected. In this work, we have focused on this skill in order to stimulate better learning. The proposal relies on stimulating the cognitive visual-motor skills of individuals with Down Syndrome (DS) using exercises with a gestural interaction platform based on the KINECT sensor named TANGO:H, the goal being to improve them. To validate the proposal, an experimental single-case study method was designed using two groups: a control group and an experimental one, with similar cognitive ages. Didactic exercises were provided to the experimental group using visual cognitive stimulation. These exercises were created on the TANGO:H Designer, a platform that was designed for gestural interaction using the KINECT sensor. As a result, TANGO:H allows for visual-motor cognitive stimulation through the movement of hands, arms, feet and head. The “Illinois Test of Psycholinguistic Abilities (ITPA)” was applied to both groups as a pre-test and post-test in its four reference sections: visual comprehension, visual-motor sequential memory, visual association, and visual integration. Two checks were made, one using the longitudinal comparison of the pre-test/post-test of the experimental group, and another that relied on comparing the difference of the means of the pre-test/post-test. We also used an observational methodology for the working sessions from the experimental group. Although the statistical results do not show significant differences between the two groups, the results of the observations exhibited an improvement in visual-motor cognitive skills

Effective antimicrobial materials based on low-density polyethylene (LDPE) with zinc oxide (ZnO) nanoparticles

La versión de editor/PDF no puede utilizarse. Debe enlazar a la versión de editor con DOI. Author's post-print must be released with a Creative Commons Attribution Non-Commercial No Derivatives License.[EN] Effective antimicrobial polymeric nanocomposites were prepared with low density polyethylene (LDPE) and zinc oxide nanoparticles by melt compounding. These nanoparticles (~17 nm) obtained by the sol¿gel method, were used both as-synthesized and modified organically with oleic acid (Mod-ZnO). Young¿s modulus increased ~15 and 18% for LDPE/ZnO and LDPE/Mod-ZnO, respectively, compared to neat LDPE. When these composites were irradiated with white light, they showed an increase with nanoparticle incorporation, and the antimicrobial properties against E. coli were ~96¿99%. The release of the Zn cations was related to the antimicrobial properties. These nanocomposites are attractive for use as food packaging without external irradiation.Financial support provided by the Innovation Found for Competitiveness of the Chilean Economic Development Agency (CORFO) under Grant 13CEI2-21839 is gratefully acknowledged.Rojas, K.; Canales, D.; Amigo, N.; Montoille, L.; Cament, A.; Rivas, LM.; Gil-Castell, O.... (2019). Effective antimicrobial materials based on low-density polyethylene (LDPE) with zinc oxide (ZnO) nanoparticles. Composites Part B Engineering. 172:173-178. https://doi.org/10.1016/j.compositesb.2019.05.054S17317817

Near-earth object 2012XJ112 as a source of bright bolides of achondritic nature

We analyse the likely link between the recently discovered near-Earth object 2012XJ112 and a bright fireball observed over the south of Spain on 2012 December 27. The bolide, with an absolute magnitude of -9 ± 1, was simultaneously imaged during the morning twilight from twometeor stations operated by the SPanish Meteor Network (SPMN). It was also observed by several casual witnesses. The emission spectrum produced during the ablation of the meteoroid in the atmosphere was also recorded. From its analysis, the chemical nature of this particle was inferred. Although our orbital association software identified several potential parent bodies for this meteoroid, the analysis of the evolution of the orbital elements performed with the MERCURY 6 symplectic integrator supports the idea that NEO 2012XJ112 is the source of this meteoroid. The implications of this potential association are discussed here. In particular, the meteoroid bulk chemistry is consistent with a basaltic achondrite, and this emphasizes the importance to deduce from future Earth approaches the reflectance spectrum and taxonomic nature of 2012XJ112. © 2014 The Author. Published by Oxford University Press on behalf of the Royal Astronomical Society.Ministerio de Ciencia y Educación AYA2009-13227, AYA2011-26522, AYA2009-06330-EJunta de Andalucía P09-FQM- 455

Socio-economic status and the risk of developing hand, hip or knee osteoarthritis: a region-wide ecological study

SummaryObjectiveTo determine the association between socio-economic status (SES) and risk of hand, hip or knee osteoarthritis (OA) at a population level.DesignRetrospective ecological study using the System for the Development of Research in Primary Care (SIDIAP) database (primary care anonymized records for >5 million people in Catalonia (Spain)). Urban residents >15 years old (2009–2012) were eligible. Outcomes: Validated area-based SES deprivation index MEDEA (proportion of unemployed, temporary workers, manual workers, low educational attainment and low educational attainment among youngsters) was estimated for each area based on census data as well as incident diagnoses (ICD-10 codes) of hand, hip or knee OA (2009–2012). Zero-inflated Poisson models were fitted to study the association between MEDEA quintiles and the outcomes.ResultsCompared to the least deprived, the most deprived areas were younger (43.29 (17.59) vs 46.83 (18.49), years (Mean SD), had fewer women (49.1% vs 54.8%), a higher percentage of obese (16.2% vs 8.4%), smokers (16.9% vs 11.9%) and high-risk alcohol consumption subjects (1.5% vs 1.3%). Compared to the least deprived, the most deprived areas had an excess risk of OA: age-sex-adjusted Incidence Rate Ratio (IRR) 1.26 (1.11–1.42) for hand, 1.23 (1.17–1.29) hip, and 1.51 (1.45–1.57) knee. Adjustment for obesity attenuated this association: 1.06 (0.93–1.20), 1.04 (0.99–1.09), and 1.23 (1.19–1.28) respectively.ConclusionsDeprived areas have higher rates OA (hand, hip, knee). Their increased prevalence of obesity accounts for a 50% of the excess risk of knee OA observed. Public health interventions to reduce the prevalence of obesity in this population could reduce health inequalities