Population based resource allocation: The use of hybrid risk adjustment

The emphasis on integrated care implies new incentives that promote coordination between levels of care. Considering a population as a whole, the resource allocation system has to adapt to this environment. This research is aimed to design a model that allows for morbidity related prospective and concurrent capitation payment. The model can be applied in publicly funded health systems and managed competition settings. Methods: We analyze the application of hybrid risk adjustment versus either prospective or concurrent risk adjustment formulae in the context of funding total health expenditures for the population of an integrated healthcare delivery organization in Catalonia during years 2004 and 2005. Results: The hybrid model reimburses integrated care organizations avoiding excessive risk transfer and maximizing incentives for efficiency in the provision. At the same time, it eliminates incentives for risk selection for a specific set of high risk individuals through the use of concurrent reimbursement in order to assure a proper classification of patients. Conclusion: Prospective Risk Adjustment is used to transfer the financial risk to the health provider and therefore provide incentives for efficiency. Within the context of a National Health System, such transfer of financial risk is illusory, and the government has to cover the deficits. Hybrid risk adjustment is useful to provide the right combination of incentive for efficiency and appropriate level of risk transfer for integrated care organizations.Health expenditures, hybrid risk-adjustment, morbidity, clinical risk groups

Abrupt climate changes of the last deglaciation detected in a Western Mediterranean forest record

Abrupt changes in Western Mediterranean climate during the last deglaciation (20 to 6 cal ka BP) are detected in marine core MD95-2043 (Alboran Sea) through the investigation of high-resolution pollen data and pollen-based climate reconstructions by the modern analogue technique (MAT) for annual precipitation (Pann) and mean temperatures of the coldest and warmest months (MTCO and MTWA). Changes in temperate Mediterranean forest development and composition and MAT reconstructions indicate major climatic shifts with parallel temperature and precipitation changes at the onsets of Heinrich stadial 1 (equivalent to the Oldest Dryas), the Bölling-Allerød (BA), and the Younger Dryas (YD). Multi-centennial-scale oscillations in forest development occurred throughout the BA, YD, and early Holocene. Shifts in vegetation composition and (Pann reconstructions indicate that forest declines occurred during dry, and generally cool, episodes centred at 14.0, 13.3, 12.9, 11.8, 10.7, 10.1, 9.2, 8.3 and 7.4 cal ka BP. The forest record also suggests multiple, low-amplitude Preboreal (PB) climate oscillations, and a marked increase in moisture availability for forest development at the end of the PB at 10.6 cal ka BP. Dry atmospheric conditions in the Western Mediterranean occurred in phase with Lateglacial events of high-latitude cooling including GI-1d (Older Dryas), GI-1b (Intra-Allerød Cold Period) and GS-1 (YD), and during Holocene events associated with high-latitude cooling, meltwater pulses and N. Atlantic ice-rafting. A possible climatic mechanism for the recurrence of dry intervals and an opposed regional precipitation pattern with respect to Western-central Europe relates to the dynamics of the westerlies and the prevalence of atmospheric blocking highs. Comparison of radiocarbon and ice-core ages for well-defined climatic transitions in the forest record suggests possible enhancement of marine reservoir ages in the Alboran Sea by 200 years (surface water age 600 years) during the Lateglacial

Influencia de los factores geográficos en las inundaciones de los valles cantábricos navarros

Los valles cantábricos navarros han padecido numerosas inundaciones, que han generado cuantiosos daños. Este artículo, que tiene como objetivo el estudio de los factores geográficos que las originan, contempla cinco apartados: el clima y las precipitaciones; el relieve, en el que inciden la pendiente, orientación, y naturaleza del terreno; la vegetación; el comportamiento hidrológico de los ríos; y los obstáculos creados por el hombre que alteran las condiciones naturale

El crowdfunding como herramienta de financiación inmobiliaria: realidades y problemas.

En este trabajo vamos a examinar una nueva forma de financiación o inversión en el mercado inmobiliario, y de las operaciones patrimoniales inmobiliarias que en el mismo se generan, como es el crowdfunding: sistema de financiación colectiva o participativa. Se trata de un tipo especial de crowdfunding, con características propias que suscita interrogantes jurídicos y problemas todavía sin resolver por lo novedoso de su regulación y su reciente aparición en el escenario inmobiliario. Pretendemos en este trabajo delimitar el concepto restringido de crowdfunding inmobiliario, y examinar, con respecto a él, sus principales características, ventajas y riesgos para el inversor, para concluir si se trata de una forma de financiación inmobiliaria realmente alternativa a las tradicionales o por el contrario todavía no puede sustituirlas, por los interrogantes legales que todavía plantea que pueden generar inseguridad jurídica para el crédito territorial.post-print579 K

El sentido del gusto como símbolo de comunicación e introversión en Laura Esquivel: Como agua para chocolate

“Como agua para chocolate” es una novela en la que la protagonista, Tita, enamorada de Pedro, verá cómo éste se casa con su hermana Rosaura, ya que ella cuidará de su madre según dice la tradición. Esa misma tradición impide la abierta expresión de los sentimientos a Tita que los canalizará a través de su pasión por la “comida-cocina”. Ésta es pues, la hipótesis de mi trabajo, mostrar que el sentido del gusto puede tener significados simbólicos y comunicar más de lo que lo hacen las palabras o los hechos, pero también refugiarse a través del gusto en los recuerdos.Like Water for Chocolate is a novel in which the protagonist, Tita, is in love with Pedro. Tita will see Pedro marry her sister Rosaura, since she looks after her mother, as is dictated by tradition. This same tradition impedes the open expression of Tita´s feelings, which Tita channels into her passion for food and cooking. This is, then, the hypothesis of my work: to show that the sense of taste can have symbolic meaning and communicate more than can be said in words or deeds, but also be a refuge through the memory of taste

DOCENTES Y ALUMNOS EN LA UNIVERSIDAD: SUBJETIVIDAD EN CONTEXTOS DE INCERTIDUMBRE.

En este trabajo nos proponemos desplegar los obstáculos y resistencias que afectaron a docentes y alumnos en los nuevos escenarios pedagógicos configurados a partir de transformaciones en el plan de estudios de la carrera de Ciencias de la Educación de la Facultad de Ciencias Humanas de la Universidad Nacional del Centro de la Provincia de Buenos Aires. La necesidad de otorgar flexibilidad al plan de estudios así como de acercar la formación al quehacer laboral fueron objetivos consensuados por docentes y alumnos que, no obstante, debieron afrontar en la práctica diversos obstáculos que tendían a perpetuar el antiguo modelo. Describiremos aquí los que, como docentes del Espacio de Prácticas en Psicopedagogía, comprometieron nuestra subjetividad y la de los alumnos en escenarios complejos e impredecibles

Generalisation in students with autism spectrum disorder: an exploratory study of strategies

Generalisation is a skill that enables learners to acquire knowledge in general, and mathematical knowledge in particular. It is a core aspect of algebraic thinking and, in particular, of functional thinking, as a type of algebraic thinking. Introducing primary school children to functional thinking fosters their ability to generalise, explain and reason with mathematical relationships. It also helps them overcome difficulties in understanding functions when they are exposed to the idea more formally in secondary education. Although more and more special education students are enrolled in mainstream schools, little is known about algebraic thinking in that community, especially in the case of students with autism spectrum disorder (ASD). Students with ASD often exhibit deficits that interfere directly with mathematical learning. The study discussed here, which was conducted in the context of algebraic reasoning, was aimed primarily at identifying and describing the strategies and representations observed in 26 ASD primary education students when performing a task that involved a linear function, and describing the generalisations they performed. The 26 participants were enrolled in 19 mainstream Spanish schools. The tools used, a questionnaire and semi-structured interview, were designed to explore their ability to generalise in a problem involving the function f(x) = 2x + 2. The strategies identified included: (a) bald answering; (b) modelling with manipulatives; (c) drawing; (d) counting and (e) operating. The strategy most frequently observed was operating, represented verbally or symbolically, followed by drawing. Only three students generalised but did not reach the highest level of functional thinking, namely, ‘functions as objects’. The results are compared with findings for mainstream students of similar ages. Conjectures around the possible relationships between some findings and the type of thinking characteristic of autism spectrum disorder are put forward. The results carry implications for research with and teaching of students with ASD.Spain's National Research AgencyEuropean Commission EDU2016-75771-P EDU2017-84276-R PID2019-105677RB-I00 PID2020-113601GB-I00regional Government of Cantabria's Concepcion Arenal Grant

Effects of radio-frequency fields on bacterial cell membranes and nematode temperature-sensitive mutants

Membrane-related bioeffects have been reported in response to both radio-frequency (RF) and extremely low-frequency (ELF) electromagnetic fields (EMFs), particularly in neural cells. We have tested whether RF fields might cause inner membrane leakage in ML35 E. coli cells, which express β-galactosidase (lacZ) constitutively, but lack the lacY permease required for substrate entry. The activity of lacZ (indicating substrate leakage through the inner cell membrane) was increased only slightly by RF exposure (1 GHz, 0.5 W) over 45 min. Since lacZ activity showed no further increase with a longer exposure time of 90 min, this suggests that membrane permeability per se is not significantly affected by RF fields, and that slight heating (≤ 0.1°C) could account for this small difference. Temperature-sensitive (ts) mutants of the nematode, Caenorhabditis elegans, are wild-type at 15°C but develop the mutant phenotype at 25°C; an intermediate temperature of 21°C results in a reproducible mixture of both phenotypes. For two ts mutants affecting transmembrane receptors (TRA-2 and GLP-1), RF exposure for 24 h during the thermocritical phase strongly shifts the phenotype mix at 21°C towards the mutant end of the spectrum. For ts mutants affecting nuclear proteins, such phenotype shifts appear smaller (PHA-1) or non-significant (LIN-39), apparently confirming suggestions that RF power is dissipated mainly in the plasma membrane of cells. However, these phenotype shifts are no longer seen when microwave treatment is applied at 21°C in a modified exposure apparatus that minimises the temperature difference between sham and exposed conditions. Like other biological effects attributed to microwaves in the C. elegans system, phenotype shifts in ts mutants appear to be an artefact caused by very slight heating

Una Estimación Del Consumo De Madera En España Entre 1860 Y 1935

The main objective of this paper is to contribute a continuous annual series of timber consumption in Spain for the period 1860-1935, an unexplored topic in Spanish economic history. Then the paper estimates a standard consumption function trying to explain the behavior of the serie. The main conclusion is that Spanish timber consumption had a positive GDP elasticity (0,47) with a growth in both traditional and new utilities of timber, regardles of the evolution of the prices of the product. This suggests that the economic growth of the period was not only based on new technologies and new raw materials, but also on a growing use of an organic and traditional product like timber.timber, comsumption function

Not Only Subterranean Forests: Wood Consumption And Economic Development In Britain (1850-1938)

The essential aim of this paper is to analyze wood consumption in Great Britain over the period 1850-1938. We calculate the apparent consumption of wood in Britain, taking into account both net imports of wood and the home harvest of wood. Then we develop some quantitative exercises which correlate wood consumption with GDP, and with prices of wood and iron (as an alternative material to wood). The main conclusion is that, although wood had lost its economic centrality after the energetic transition, wood consumption continued to grow in Britain both in absolute and relative terms, showing a positive elasticity to GDP superior to the unity. The decline of wood prices in the long run, the innovations affecting wood exploitation and treatment, and the fact that wood was used in a wide range of economic activities, can explain that growth in consumption. Britain faced the increase in wood demand relying almost totally on imports. Thus, although British economic development was to a great extent focussed on what has been called the “subterranean forests” of coal, simultaneously supported large tracts of foreign forest.wood, forest history, industrialization, consumption function