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

Tasas de erosión, transporte y sedimentación en un medio estuárico: el Río Miñor (Ría de Vigo, Pontevedra)

The Miñor river is one o f the 35 minor currents entering the Ría de Vigo (Pontevedra) at Baiona Bay,; close to the SE margin o f the Ría. The present study was carried out over two periods: from May 97 to July 98 and from May 00 to May 01. In this paper we carry out a hydraulic and sedimentologic approach o f the Miñor river, making an estimation of the total fresh-water discharge and sediment input transported as suspended and dissolved loads. The final aim of this study is to calculate erosion rates at the catchment, sediment yield, transport and the nature of the sediments accumulated at the estuarine area. In view of the average discharge for both periods o f time (2.7 m3/s y 6.7 m3/s) and the catchment area (75.6 m2) is possible to estimate suspended and dissolved sediment yields. Mean values for suspended sediments are 25.76 t/km2a for 97/98 and 139.74 t/ km2a for 00/01 and those for dissolved loads of 109 t/km2a y 204 t/km2a, respectively. Finally, considering an average rock density of 2 .7 g/cm3 we can estimate mechanical denudation rates of 9.54 m3/km2a during 97/98 and 51.76 m3/km2a during 00/01. Chemical denudation rates are 40.46 m3/km2a for the first period and 75.56 m3/km2a for the second. Data obtained during 00/01 interval can be considered as maximum values, bearing in mind the very unusually high rainfall conditions

Chemical factors controlling the steady-state distribution of mixed carbonate-siliciclastic sediments in Bayona Bay (northwest Spain)

The relative space distributions of single mineral constituents in mixed terrigenous-carbonated sediments of the Bayona Bay have been analysed. In order to determine the existence of different mixing mechanisms, a study comparing the general sedimentary trends resulting from the average patterns and the single mineral behaviour, reflected in the single-mineral mapping, was carried out. The relative abundance of all mineral phases in surface sediment samples was first determined by quantitative X-ray powder diffraction data, using the Rietveld method. This procedure enabled us to create specific maps for both the minerals forming the terrigenous fraction and the different calcium carbonate polymorphs involved in the carbonatic component. A cross-linked behaviour between the carbonate facies and the terrigenous minerals involved in the calcium carbonate generation was found, suggesting the existence of a chemical control mechanism which, through dissolution-crystallization processes, constrains the mixed environment's long-term evolution. In the general framework of the region studied, these relations operate for the relative amount of plagioclase to calcium carbonate. The existence of dissolution and growth between both minerals, favoured by the high rate of removal, is proposed, yielding a final crossed pattern, representative of the steady-state. Furthermore, a specific analysis, restricted to the region of low rate of material removal and maximum amount of intermixed sediments, clearly shows an anisotropic distribution for every calcium carbonate polymorph (calcite and aragonite). These correlate with the biotite distribution, and can be connected to local variations in seawater Mg/Ca ratio, induced by biotite weathering.En este trabajo se analiza de forma específica la distribución espacial de cada uno de los minerales involucrados en sedimentos mixtos terrígenos-carbonatados de la bahía de Bayona y se compara con la distribución global de sedimentos, tal como resulta de análisis granulométricos, con el fin de determinar la existencia de diferentes mecanismos de mezcla entre los minerales de ambas fracciones. El contenido porcentual en peso de cada fase mineral, en muestras superficiales de sedimento, se determinó a partir de datos cuantitativos de DRX, empleando el método de Rietveld. Este procedimiento nos ha permitido realizar mapas específicos de distribución, tanto para cada mineral de la fracción terrígena como para cada uno de los diferentes polimorfos de carbonato cálcico en la componente carbonatada. Como resultado de este estudio comparativo, se ha encontrado una correlación, en la distribución espacial y granulométrica, de las facies carbonatadas y los minerales terrígenos implicados en la generación de carbonato cálcico. Un posterior análisis de este resultado sugiere la presencia de mecanismos químicos de control que regulan la interacción entre siliciclastos y carbonatos mediante procesos de disolución-cristalización mediados por el agua del mar. El estudio se ha realizado a dos escalas. En el ámbito general de la bahía de Bayona, las relaciones de distribución observadas entre plagioclasas y carbonato cálcico pueden ser explicadas, dentro del balance global del Ca³⁺ disuelto en el agua del mar, mediante la meteorización química de las plagioclasas y la consiguiente generación de carbonatos. En este caso, los patrones de distribución reflejan la aproximación a un estado estacionario mediante sucesivos eventos de mezcla asociados a la alta removilización material en el medio, tanto para la distribución porcentual en peso como para la distribución granulométrica entre ambos minerales. Finalmente, se realiza un análisis particularizado en una región con baja tasa de removilización y donde la interacción entre sedimentos de ambas fracciones es máxima. El resultado muestra claramente una distribución espacial anisótropa para cada uno de las fases de carbonato cálcico (calcita y aragonito). La abundancia relativa de cada uno de los polimorfos, así como el contenido en Mg³⁺ de la calcita, ha sido correlacionado con la distribución de la biotita y explicado a partir de las diferencias de solubilidad en función de la alta relación Mg³⁺ /Ca³⁺ en el agua de mar que resulta, localmente, de la meteorización química de dicho mineral.Instituto Español de Oceanografí

Gait kinematic analysis in patients with a mild form of central cord syndrome

<p>Abstract</p> <p>Background</p> <p>Central cord syndrome (CCS) is considered the most common incomplete spinal cord injury (SCI). Independent ambulation was achieved in 87-97% in young patients with CCS but no gait analysis studies have been reported before in such pathology. The aim of this study was to analyze the gait characteristics of subjects with CCS and to compare the findings with a healthy age, sex and anthropomorphically matched control group (CG), walking both at a self-selected speed and at the same speed.</p> <p>Methods</p> <p>Twelve CCS patients and a CG of twenty subjects were analyzed. Kinematic data were obtained using a three-dimensional motion analysis system with two scanner units. The CG were asked to walk at two different speeds, at a self-selected speed and at a slower one, similar to the mean gait speed previously registered in the CCS patient group. Temporal, spatial variables and kinematic variables (maximum and minimum lower limb joint angles throughout the gait cycle in each plane, along with the gait cycle instants of occurrence and the joint range of motion - ROM) were compared between the two groups walking at similar speeds.</p> <p>Results</p> <p>The kinematic parameters were compared when both groups walked at a similar speed, given that there was a significant difference in the self-selected speeds (p < 0.05). Hip abduction and knee flexion at initial contact, as well as minimal knee flexion at stance, were larger in the CCS group (p < 0.05). However, the range of knee and ankle motion in the sagittal plane was greater in the CG group (p < 0.05). The maximal ankle plantar-flexion values in stance phase and at toe off were larger in the CG (p < 0.05).</p> <p>Conclusions</p> <p>The gait pattern of CCS patients showed a decrease of knee and ankle sagittal ROM during level walking and an increase in hip abduction to increase base of support. The findings of this study help to improve the understanding how CCS affects gait changes in the lower limbs.</p

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Sarcopenia in patients undergoing dialysis: prevalence and association with functional capacity

Sin financiación3.374 JCR (2020) Q3, 93/146 Endocrinology & Metabolism0.926 SJR (2020) Q2, 636/2446 Medicine (miscellaneous)No data IDR 2020UE