EU Cohesion policy 2007-13 and the implications for Spain : who gets what, when and how?

The recent negotiation of the EU budget and the associated reform of EU Cohesion policy have had major policy implications for Spain, the country in receipt of most Cohesion policy support in the current programming period (2000-06). EU enlargement, combined with relatively rapid growth in Spain, impacted on the eligibility of Spanish regions for Cohesion support while also taking the country as a whole beyond the eligibility threshold for the Cohesion Fund. As a result, based on the original Commission budget proposals of February 2004, Spain was facing a reduced Cohesion policy budget of at least a half (to below €30 billion). This paper first reviews the budget negotiations from a Spanish (Cohesion policy) perspective, identifying the key negotiating goals and the extent to which they were achieved. It then looks at the outcome of the negotiations for Spain, initially at the national level and then in the regions. It highlights the significant differential impacts of the cutbacks in Cohesion policy allocations at the regional level and the pressures on the Spanish government to modulate the regional impact of the budgetary changes. Having considered the direct funding implications of the new Cohesion policy, the second half of the paper is concerned with the regulatory, institutional and economic impacts of the new policy regime. Many of the reform proposals fit with Spanish priorities, not least the new rationale for Cohesion policy (with its stress on the Lisbon and Gothenburg agendas) and the new policy architecture (with all regions eligible for some form of support and with a related shift from a geographic to more of a thematic focus). The retention of the key Structural Funds principles has also been welcomed in Spain, unsurprising given the wealth of experience and expertise built up over three (high-spending) programming cycles. As in most Member States, the main regulatory concern relates to the extent to which a more simplified and devolved approach to Funds' implementation will be achieved in practice. As regards policy and institutional impacts, the paper brings together regional views on the new budgetary and regulatory frameworks and reviews how the new regulations are being implemented in practice. A discussion of the developing National Strategic Reference Framework and the related Operational Programmes makes clear that the strong emphasis on the Lisbon agenda is not viewed as a constraint in Spain; rather, it is felt to fit well with recent Spanish developments and goals. Finally, the paper considers the economic implications of the reductions in Cohesion policy support. On the basis of evaluation studies, it highlights the positive impact the Funds have had in the past and the potentially quite varied regional impacts the reductions in funding may have in the future

Colaboración y liderazgo

La colaboración y el liderazgo son dos atributos esenciales del Rol Avanzado en Enfermería (Hamric 2005). Analizar a fondo conceptos como la colaboración y el liderazgo es una tarea compleja (Marquis & Huston 2009). El presente trabajo se limita a definir y justificar la importancia de los conceptos de colaboración y liderazgo desde el punto de vista de la Práctica Avanzada en Enfermería y a examinar algunos factores identificados reiterativamente en la literatura como precursores de su ejercicio efectivo

Factores del entorno de trabajo que influyen en la ocurrencia de errores de administración de medicación

Fundamento. La incidencia de errores de administración de medicación (EAM) es alta y costosa para pacientes e instituciones sanitarias. En su ocurrencia intervienen factores humanos y del entorno de trabajo. El objetivo de este trabajo es identificar los factores del entorno de trabajo que se relacionan con la ocurrencia de EAMs en el ámbito hospitalario. Metodología. Se llevó a cabo una revisión narrativa de la literatura. Se incluyeron 8 artículos tras revisar las bases de datos MEDLINE, CINAHL y COCHRANE LIBRARY, durante el periodo 2002-2012. Resultados. Las distracciones e interrupciones, la sobrecarga de trabajo, el diseño de las unidades y las características del material han sido destacados entre los factores del entorno de trabajo que intervienen en la ocurrencia de errores de administración de medicación. Conclusiones. La creación de artefactos organizacionales para reducir las interrupciones; la implicación del paciente en la administración de medicación; la introducción de nuevas tecnologías y la mejora del etiquetado de los medicamentos puede ayudar a reducir la incidencia de errores de administración de medicación. Para avanzar en la identificación y gestión de factores precursores de errores de administración de medicación se recomienda la realización de estudios de cohortes prospectivas o revisiones.Background. The incidence of medication administration errors (MAE) is high and costly for patients and health institutions. Human factors and factors relating to the work context intervene in their occurrence. The aim of this article is to identify the role of factors in the work setting related to occurrence of MAEs in the hospital field. Methods. A narrative review of the literature. Eight articles were included following a review of MEDLINE, CINAHL and COCHRANE LIBRARY databases for the 2002-2012 period. Results. Distractions and interruptions, work overload, design of units and characteristics of the material stood out amongst the work context factors intervening in the occurrence of medication administration errors. Conclusions. The creation of organizational artefacts to reduce interruptions; patient involvement in medication administration; the introduction of new technologies and improving the labelling of medications can help reduce the incidence of medication administration errors. To advance in identifying and managing factors that are precursors of medication administration errors, we recommend the carrying out of studies or reviews of prospective cohorts

Breastfeeding modifies the impact of diarrhoeal disease on relative weight: a longitudinal analysis of 2–12 month-old Filipino infants

Undernutrition and diarrhoeal disease are major causes of infant mortality. We investigated the combined roles of breastfeeding and diarrhoea on infant size in 2940 infants from the Cebu Longitudinal Health and Nutrition Survey. The study aimed to assess whether breastfeeding status modified the deficits associated with diarrhoeal disease. The primary exposures were combinations of current breastfeeding status (yes/no), the presence of diarrhoeal disease in previous week (yes/no) and a categorical survey variable (six surveys taken at bimonthly intervals when infants were 2–12 months of age). Relative weight (weight-for-length z-scores), calculated using the WHO growth standards, was estimated using sex-stratified, fixed-effects longitudinal models that also adjusted for energy from complementary foods. Post-estimation Wald tests were conducted to identify subgroup differences in relative weight. Diarrhoea was associated with reduced relative weight in both breastfed and non-breastfed infants of 6–12 months. Diarrhoea-related deficits in relative weight were significantly exacerbated in non-breastfed girls of 6 and 8 months. Importantly, in infants <6 months, being breastfed and having diarrhoea was still associated with greater relative weight compared with being non-breastfed and diarrhoea-free. Breastfeeding emerged as a strong contributor to relative weight in younger infants (<6 months) while diarrhoeal disease strongly contributed to deficits in relative weight in older infants (6–12 months). These findings underscore the importance of breastfeeding for promoting infant nutritional status in infants with or without diarrhoea from birth to 12 months

Monitoring new long-lasting intravitreal formulation for glaucoma with vitreous images using optical coherence tomography

Intravitreal injection is the gold standard therapeutic option for posterior segment patholo-gies, and long-lasting release is necessary to avoid reinjections. There is no effective intravitreal treatment for glaucoma or other optic neuropathies in daily practice, nor is there a non-invasive method to monitor drug levels in the vitreous. Here we show that a glaucoma treatment combining a hypotensive and neuroprotective intravitreal formulation (IF) of brimonidine–Laponite (BRI/LAP) can be monitored non-invasively using vitreoretinal interface imaging captured with optical coherence tomography (OCT) over 24 weeks of follow-up. Qualitative and quantitative characterisation was achieved by analysing the changes in vitreous (VIT) signal intensity, expressed as a ratio of retinal pigment epithelium (RPE) intensity. Vitreous hyperreflective aggregates mixed in the vitreous and tended to settle on the retinal surface. Relative intensity and aggregate size progressively decreased over 24 weeks in treated rat eyes as the BRI/LAP IF degraded. VIT/RPE relative intensity and total aggregate area correlated with brimonidine levels measured in the eye. The OCT-derived VIT/RPE relative intensity may be a useful and objective marker for non-invasive monitoring of BRI/LAP IF

A novel compartment, the 'subqpical stem' of the aerial hyphae, is the location of a sigN-dependent, developmentally distinct transcription in Streptomyces coelicolor.

Streptomyces coelicolor has nine SigB-like RNA polymerase sigma factors, several of them implicated in morphological differentiation and/or responses to different stresses. One of the nine, SigN, is the focus of this article. A constructed sigN null mutant was delayed in development and exhibited a bald phenotype when grown on minimal medium containing glucose as carbon source. One of two distinct sigN promoters, sigNP1, was active only during growth on solid medium, when its activation coincided with aerial hyphae formation. Transcription from sigNP1 was readily detected in several whi mutants (interrupted in morphogenesis of aerial mycelium into spores), but was absent from all bld mutants tested, suggesting that sigNP1 activity was restricted to the aerial hyphae. It also depended on sigN, thus sigN was autoregulated. Mutational and transcription studies revealed no functional significance to the location of sigN next to sigF, encoding another SigB-like sigma factor. We identified another potential SigN target, nepA, encoding a putative small secreted protein. Transcription of nepA originated from a single, aerial hyphae-specific and sigN-dependent promoter. While in vitro run-off transcription using purified SigN on the Bacillus subtilis ctc promoter confirmed that SigN is an RNA polymerase sigma factor, SigN failed to initiate transcription from sigNP1 and from the nepA promoter in vitro. Additional in vivo data indicated that further nepA upstream sequences, which are likely to bind a potential activator, are required for successful transcription. Using a nepA–egfp transcriptional fusion we located nepA transcription to a novel compartment, the ‘subapical stem’ of the aerial hyphae. We suggest that this newly recognized compartment defines an interface between the aerial and vegetative parts of the Streptomyces colony and might also be involved in communication between these two compartments

Study of factors influencing preoperative detection of alveolar antral artery by CBCT in sinus floor elevation

This study aimed at assessing the prevalence of alveolar antral artery (AAA) detection by CBCT, its related variables, and at describing explanatory models useful in surgical planning, by retrospective evaluation of CBCT explorations. The modelling of the probability for detecting AAA was undertaken using logistic generalized additive models (GAM). The capacity for discriminating detection/no detection was assessed by receiver operating characteristic curves. A total of 466 sinuses were studied. Univariate models showed detection probability was linked to sinus width and thickness of the lateral bony wall, together with the shape and height of the osseous crest. AAA detection probability increased steadily until the thickness of the bony wall reached 6 mm. Multivariate models resulted good discriminators for AAA detection, particularly for females, showing an area under the curve (AUC) of 0.85. Models considering patients altogether, and those including only males offered slightly lower values (AUC = 0.79). The probability of AAA detection by CBCT was influenced by gender (higher in males and for narrow sinuses) and increases with the thickness of the sinus lateral bony wall and the height of the residual alveolar ridge. Besides, and particularly for women, the thickness of the ridge at the basal level seems to improve the explanatory model for AAA detection

Influence of chronic ocular hypertension on emmetropia: Refractive, structural and functional study in two rat models

Chronic ocular hypertension (OHT) influences on refraction in youth and causes glaucoma in adulthood. However, the origin of the responsible mechanism is unclear. This study analyzes the effect of mild-moderate chronic OHT on refraction and neuroretina (structure and function) in young-adult Long-Evans rats using optical coherence tomography and electroretinography over 24 weeks. Data from 260 eyes were retrospectively analyzed in two cohorts: an ocular normotension (ONT) cohort (20 mmHg), in which OHT was induced either by sclerosing the episcleral veins (ES group) or by injecting microspheres into the anterior chamber. A trend toward emmetropia was found in both cohorts over time, though it was more pronounced in the OHT cohort (p < 0.001), especially in the ES group (p = 0.001) and males. IOP and refraction were negatively correlated at week 24 (p = 0.010). The OHT cohort showed early thickening in outer retinal sectors (p < 0.050) and the retinal nerve fiber layer, which later thinned. Electroretinography demonstrated early supranormal amplitudes and faster latencies that later declined. Chronic OHT accelerates emmetropia in Long–Evans rat eyes towards slowly progressive myopia, with an initial increase in structure and function that reversed over time. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Developing and Evaluating a Game for the Assessment of Spatial Memory Using Auditory Stimuli

The combination of natural user interfaces and smart devices has become a new technological option to be exploited for the assessment of spatial memory. In this paper, we present an interactive game for assessing spatial memory using auditory stimuli. The distinct feature of our game is that it assesses the two types of information (i.e., acoustic and spatial) at the same time. We compared the performance of 100 children and 48 adults on the game with traditional neuropsychological tests. The performance on the game correlated with the performance on other traditional neuropsychological tests for the assessment of spatial short-term memory. Children and adults considered our game as easy to use, and all of them were satisfied with it. The results suggest that our game could be a valid tool for the identification of alterations in the spatial memory in both children and adults

Nurses' protocol-based care decision-making: a multiple case study

Aim: To describe and explain nurses' protocol-based care decision-making. Background: Protocol-based care is a strategy to reduce variability in clinical practice. There are no studies looking at protocol-based care decision-making. Understand this process is key to successful implementation. Method: A multiple embedded case study was carried out. Nurses' protocol-based care decision-making was studied in three inpatient wards (medical, surgical and medical-surgical) of a university hospital in northern Spain. Data collection was performed between 2015 and 2016 including documentary analysis, non-participant observations, participant observations and interviews. Analysis of quantitative data involved descriptive statistics and qualitative data was submitted to Burnard's method of content analysis (1996). The data integration comprised the integration of the data set of each case separately and the integration of the findings resulting from the comparison of the cases. The following the thread method of data integration was used for this purpose. The SRQR guideline was used for reporting. Results: The multiple embedded case study revealed protocol-based care decision-making as a linear and variable process that depends on the context and consists of multiple interrelated elements, among which the risk perception is foremost. Conclusion: This study has allowed progress in protocol-based care decision-making characterisation. This knowledge is crucial to support the design of educational and management strategies aimed at implementing protocol-based care. Relevance to clinical practice: Strategies to promote protocol-based care should address the contexts of practice and the ability of professionals' to accurately assess the degree of risk of clinical activity. Hence, it will promote quality of care, patient safety and efficiency in healthcare cost