'Aus oekonomischer Sicht ...'

Economists, and notably health economists, very often add to their policy recommendations the formula ,from an economic point of view'. The contribution starts by exploring what the message of this clause to non-economists might be. The vagueness that it brings about as to the general acceptability of claims to ,rational' allocation, ,best' outcomes etc. is then, first, assessed with respect to the recent debate about IQWiG's (the German equivalent to Britain's NICE) unorthodox methodology of health care evaluation. Weaknesses within the theoretical basis of standard health economist's evaluations, well-known by theoretical economists but rarely mentioned when it comes to policy advice, are then, second, pointed out. Finally, some consequences are drawn for what has to be done to enhance the quality and impact of policy advice in the area of health resource allocation.health economics, policy recommendations, economic point of view, methodology, rationality, maximization

Medication adherence in patients with myotonic dystrophy and facioscapulohumeral muscular dystrophy

Myotonic dystrophy (DM) and facioscapulohumeral muscular dystrophy (FSHD) are the two most common adult muscular dystrophies and have progressive and often disabling manifestations. Higher levels of medication adherence lead to better health outcomes, especially important to patients with DM and FSHD because of their multisystem manifestations and complexity of care. However, medication adherence has not previously been studied in a large cohort of DM type 1 (DM1), DM type 2 (DM2), and FSHD patients. The purpose of our study was to survey medication adherence and disease manifestations in patients enrolled in the NIH-supported National DM and FSHD Registry. The study was completed by 110 DM1, 49 DM2, and 193 FSHD patients. Notable comorbidities were hypertension in FSHD (44 %) and DM2 (37 %), gastroesophageal reflux disease in DM1 (24 %) and DM2 (31 %) and arrhythmias (29 %) and thyroid disease (20 %) in DM1. Each group reported high levels of adherence based on regimen complexity, medication costs, health literacy, side effect profile, and their beliefs about treatment. Only dysphagia in DM1 was reported to significantly impact medication adherence. Approximately 35 % of study patients reported polypharmacy (taking 6 or more medications). Of the patients with polypharmacy, the DM1 cohort was significantly younger (mean 55.0 years) compared to DM2 (59.0 years) and FSHD (63.2 years), and had shorter disease duration (mean 26 years) compared to FSHD (26.8 years) and DM2 (34.8 years). Future research is needed to assess techniques to ease pill swallowing in DM1 and to monitor polypharmacy and potential drug interactions in DM and FSHD

Fabrication and performance of Nd1.95NiO4+δ (NNO) cathode supported microtubular solid oxide fuel cells

Trabajo presentado al 10th European Solid Oxide Fuell Cell Forum celebrado en Lucerna (Suiza) del 26 al 29 de Junio de 2012.Microtubular SOFC present significant advantages in comparison with the traditional planar SOFC configuration. In particular, the tubular design facilitates sealing and also reduces thermal gradients. As a consequence, rapid starts up times are possible. In addition, another advantage of the microtubular configuration is their higher power density per unit volume. Due to these properties, those devices are especially attractive for portable applications. There has been a great interest in microtubular SOFCs in the recent years, mainly using anode supported cells. Electrolyte supported cells have also been reported, but there are relatively few investigations using the cathode as the support. In the present paper, Nd1.95NiO4+δ (NNO) has been chosen as the cathode support, as it presents superior oxygen transport properties in comparison with other commonly used cathode materials, such as LSCF or LSM, and these material has been proven as an excellent cathode for SOFC and SOEC applications. Results on the fabrication and characterization of NNO cathode supported SOFC will be presented. The tubes were fabricated by cold isostatic pressing (CIP) using NNO powders and corn starch as the pore former. The electrolyte (GDC based) was deposited by wet powder spray (WPS) on top of the pre-sintered tubes and then co-sintered. Finally, a NiOGDC paste was dip-coated as the anode. Optimization of the fabrication process as well as the electrochemical performance of single cells will be further discussed.The authors thank grant MAT2009-14324-C02-01, financed by the Spanish Government (Ministerio de Ciencia e Innovación) and Feder program of the European Community, for funding the project. M.A.L.-B. thanks the JAE program (CSIC) for financial support.Peer Reviewe

Electrochemical performance of Nd1.95NiO4+δ cathode supported microtubular solid oxide fuel cells

Nd1.95NiO4+δ (NNO) cathode supported microtubular cells were fabricated and characterized. This material presents superior oxygen transport properties in comparison with other commonly used cathode materials. The supporting tubes were fabricated by cold isostatic pressing (CIP) using NNO powders and corn starch as pore former. The electrolyte (GDC, gadolinia doped ceria based) was deposited by wet powder spraying (WPS) on top of pre-sintered tubes and then co-sintered. Finally, a NiO/GDC suspension was dip-coated and sintered as the anode. Optimization of the cell fabrication process is shown. Power densities at 750°C of ~40 mWcm-2 at 0.5V were achieved. These results are the first electrochemical measurements reported using NNO cathode-supported microtubular cells. Further developments of the fabrication process are needed for this type of cells in order to compete with the standard microtubular solid oxide fuel cells (SOFC).The authors thank grant MAT2009-14324-C02-01 and MAT2012-30763, financed by the Spanish Government (Ministerio de Ciencia e Innovación) and Feder program of the European Community, for funding the project.Peer Reviewe

Development And Testing Of Irradiation-Tolerant High-Entropy Alloys

High entropy alloys (HEAs) are a novel class of alloys made of multiple principal elements in near equal proportions. They have been observed to possess an array of useful engineering properties, such as good ductility and fracture toughness, high temperature strength, oxidation and corrosion resistance and irradiation resistance. This makes them promising candidates for harsh environments, especially nuclear reactors. These properties could potentially realize advanced Gen IV nuclear reactor designs. However, most HEA compositions contain Co, which activates under irradiation, generating safety and waste management concerns. This work studies three compositions of Co-free HEAs whose strength and microstructures are evaluated for high temperature irradiation resistance. Although HEAs have often been studied for their tendency to form simple solid solutions, the resulting mechanical strength is often low. Introducing precipitates, grain boundaries and high dislocation densities can help increase the strength of HEAs at both room temperature and high temperatures. Many of these features will also serve as defect sinks under irradiation, further enhancing HEAs’ natural irradiation resistance. Thus, multiple fabrication methods were compared in this study to alter the alloy properties and microstructure, including traditional casting and aging, high pressure torsion (HPT) and additive manufacturing (AM). AM especially is likely to be employed in nuclear reactors due to the need for complex internal geometries. The effect of these different processing parameters and microstructures will allow the development of HEAs for different harsh environment applications -- Abstract, p. i

Forage Availability and Quality of No-till Forage Crops for Grazing Cattle

No-till forage crops were planted to determine forage quantity and quality for grazing cattle. Seven combinations were evaluated using different mixtures containing forage peas, oats, winter triticale, turnips, radishes, clover, vetch, and sunflower. The cover crops were planted April 9 and sampled three times (day 54, 70, and 86 after planting) to determine forage mass and nutrient content. Mixtures containing forage peas and oats yielded the greatest quantity of DM/acre. The NDF and CP content of the mixtures are comparable to native range during the growing season. When used in place of fallow in crop rotations, grazing cover crops may provide an alternativeto native range

Cardiovascular Effects of Sodium Glucose Cotransporter-2 Inhibition in the Setting of Ischemia/Reperfusion Injury

Background: Recent evidence indicates that sodium glucose cotransporter-2 inhibitors (SGLT2i) significantly reduce the incidence of major adverse cardiovascular events in high risk patients. However, the specific effects of SGLT2i on the cardiovascular system remain poorly defined. This study was designed to test the hypothesis that SGLT2i improves cardiac function and mitigates myocardial infarct size following regional myocardial ischemia and reperfusion injury. Methods: Lean domestic swine received placebo (n=6) or canagliflozin (n=6; 300 mg PO) 24 hours prior to and the morning of an experiment. Hemodynamics, left ventricular pressure and volume were measured in open chest, swine at baseline, during a 60 min coronary occlusion, and during a 2-hour reperfusion period. The degree of myocardial infarction was assessed by staining with 1% tetrazolium. Results: At the onset of ischemia, SGLT2i produced a significant parallel increase in both left ventricular end diastolic (85 ± 9 mL to 129 ± 10 mL; P < 0.05) and end systolic volumes (29 ± 8 mL to 78 ± 9 mL; P < 0.01). This increase in ventricular filling was associated with significant increases in stroke volume (P < 0.05) and stroke work (P < 0.05) relative to untreated controls swine during ischemia. SGLT2i decreased infarct size from 9.4 ± 2.1% in control swine to 3.1% ± 0.98% in SGLT2i treated swine. Conclusion: SGLT2 inhibitors significantly improve cardiac contractile function and mitigate myocardial infarct size following regional myocardial ischemia and reperfusion injury in domestic swine

Adolescent Depression, Sensitivity to Social Feedback, and Social Functioning

Major depression is particularly prevalent in adolescence, especially for girls (Hankin & Abela, 2005). Important in this phase of life is social functioning, as it can determine a variety of factors later in life (Spear, 2011). Thus, elucidating the ways in which depression affects social functioning is of special importance. The present study was conducted with the aims of reinforcing the existing literature linking depression to deficits in social functioning for adolescent females (Aim 1) as well as identifying two important mechanisms that mediate this relation: individual differences in sensitivity to social reward and sensitivity to social punishment (Aim 2). A sample of 112 female adolescents (M = 16.89, SD = 1.47) was used to investigate whether depressive symptoms were associated with decreased approach to social reward and increased avoidance of social punishment, with each in turn related to deficits in social functioning. Moderate support for hypotheses was found using a behaviorally informed multi-method design