Estimates of patient costs related with population morbidity: Can indirect costs affect the results?

A number of health economics works require patient cost estimates as a basic information input. However the accuracy of cost estimates remains in general unspecified. We propose to investigate how the allocation of indirect costs or overheads can affect the estimation of patient costs in order to allow for improvements in the analysis of patient costs estimates. Instead of focusing on the costing method, this paper proposes to highlight changes in variance explained observed when a methodology is chosen. We compare three overhead allocation methods for a specific Spanish population adjusted using the Clinical Risk Groups (CRG), and we obtain different series of full-cost group estimates. As a result, there are significant gains in the proportion of the variance explained, depending upon the methodology used. Furthermore, we find that the global amount of variation explained by risk adjustment models depends mainly on direct costs and is independent of the level of aggregation used in the classification system.Patient costs, Clinical Risk Groups, Variation explained, Overhead allocation

Laccases stabilization with phosphatidylcholine liposomes

In recent years, there has been an upsurge of interest in enzyme treatment of textile fibres. Enzymes are globular proteins whose catalytic function is due to their three dimensional structure. For this reason, stability strategies make use of compounds that avoid dismantling or distorting protein 3D structures. This study is concerned with the use of microencapsulation techniques to optimize enzyme stabilization. Laccases were embedded in phophatidylcholine liposomes and their encapsulation capacity was assessed. Their enzymatic activity and stability were analyzed, comparing free-enzymes, enzymes in liposomes, and the lipid fraction separated from the aqueous fraction. An increase in their encapsulation efficiency was found at higher lipid/laccase ratios. Relative activity of enzyme-containing vesicles has also been shown to be retained much more than that of free native enzymes. The loss of activity of laccases entrapped in the vesicles in the total stability process is lower than 10% compared with 40% to 60% of loss of free-laccases after heating the samples for 3 days. Laccase stabilization could be of interest to future textile or cosmetic applications because of their potential for environmentally friendly oxidation technologies

Liposome formation with wool lipid extracts rich in ceramides

Internal wool lipids (IWLs) are rich in cholesterol, free fatty acids, cholesteryl sulfate, and, mainly, ceramides. The repairing effect of these lipids structured as liposomes was demonstrated by reinforcing the skin-barrier integrity and increasing the water-holding capacity when applied onto the skin. This work was focused on the formation of liposomes with IWLs rich in ceramides, obtained at pilot plant level with organic solvent extraction by using methanol and acetone. The lipid composition of the two extracts was quantitatively analyzed. IWL extracts containing different amounts of sterol sulfate were used to form liposomes at physiologic pH. Vesicle size distribution, polydispersity index, and zeta potential of all liposomes were determined to characterize them and to study their stability. The results obtained showed that IWL extract composition, which was different depending on the extraction methodologies used, greatly influences the characteristics of the liposomes formed. Vesicular size and polydispersity index liposomes were smaller when the extract composition contained a higher proportion of either free fatty acids or sterol sulfate. Moreover, liposome stability was improved when some amount of sterol sulfate was added to the composition of methanol and acetone extracts. This natural mixture with keratinaceous origin could have a special interest for cosmetic or dermopharmaceutical companies.We acknowledge Mr. G. von Knorring for his expert technical assistance. We are also indebted to the DGICYT Program (PPQ 2002-94136-C02-01 and C02-02) for financial support

Asymptotic Expansions for Stationary Distributions of Perturbed Semi-Markov Processes

New algorithms for computing of asymptotic expansions for stationary distributions of nonlinearly perturbed semi-Markov processes are presented. The algorithms are based on special techniques of sequential phase space reduction, which can be applied to processes with asymptotically coupled and uncoupled finite phase spaces.Comment: 83 page

Conjunto de viviendas - Barcelona – España

This article presents a preliminary study of a typical giant block from which conclusions and practical applications are drawn for many other cases. &#13; The many contrasts of the planform and façades endows the unit with great gracefulness and a most dynamic impression, avoiding the monotony that the repetition of a module usually implies. &#13; A great diversity of the types of housing and the possibility of easy variations have been achieved, with gardens nearby and a subterranean parking lot, with great capacity, under the walks for pedestrians.<br><br>Se presenta en este artículo el estudio de una supermanzana, de la cual se sacan conclusiones y aplicaciones prácticas para muchos casos. &#13; La gran movilidad de las plantas y alzados presta una gracia y una dinámica de gran efecto al conjunto, evitando la monotonía que habitualmente se deduce de la repetición de un módulo. &#13; Se ha conseguido una gran diversidad de tipos de viviendas y la posibilidad de fáciles variantes, con zonas verdes próximas a ellas y aparcamiento subterráneo, de gran capacidad, bajo las calles peatonales. Antes de entrar en la descripción del grupo de viviendas que se exponen en este artículo, se hace la exposición somera de una supermanzana tipo, con cuya construcción se está llevando a cabo investigaciones interesantes, a base de una trama urbana con calles en curva de gran circulación y calles rectas de longitud limitada, calles y plazas

Vivienda unifamiliar en Barcelona – España

This permanent residence was constructed on a lot with a large number of trees in the Bonanova «Ciudad Jardín». &#13; The different areas of the program are distributed on its three levels in a clearly differentiated manner. Thus, in the semibasement, the general installations are found; on the ground floor,, the living areas, bedrooms and servants' quarters, adequately communicated; and on the top leveí, overlooking the surrounding panorama, the master suite.&#13; In the architectural treatment, the large Windows of the ground floor stand out which, at the same time as they integrate the combination of the brick surface with the numerous bodies which project and jut inward brought about by the irregularity of the floor plans.&lt;br&gt;&lt;br&gt;En una parcela profusamente arbolada, de la Ciudad Jardín de Bonanova, se ha realizado esta vivienda. &#13; En sus tres niveles distribuye las distintas dependencias del programa de forma claramente diferenciada. Así, en el semisótano se encuentran las instalaciones generales; en la planta baja las zonas nobles, de dormitorios y de servicio, adecuadamente comunicadas entre sí; y en el nivel superior, dominando el panorama circundante, la suite del matrimonio. &#13; En el tratamiento arquitectónico sobresalen los grandes ventanales de la planta baja que, al tiempo que integran el ajardinamiento con las habitaciones, resaltan los numerosos cuerpos entrantes y salientes originados por la irregularidad de las plantas

Genome evolution and plasticity of <em>Serratia marcescens</em>:an important multidrug resistant nosocomial pathogen

Serratia marcescens is an important nosocomial pathogen that can cause an array of infections, most notably of the urinary tract and bloodstream. Naturally, it is found in many environmental niches, and is capable of infecting plants and animals. The emergence and spread of multidrug-resistant strains producing extended-spectrum or metallo beta-lactamases now pose a threat to public health worldwide. Here we report the complete genome sequences of two carefully selected S. marcescens strains, a multidrug-resistant clinical isolate (strain SM39) and an insect isolate (strain Db11). Our comparative analyses reveal the core genome of S. marcescens and define the potential metabolic capacity, virulence, and multidrug resistance of this species. We show a remarkable intraspecies genetic diversity, both at the sequence level and with regards genome flexibility, which may reflect the diversity of niches inhabited by members of this species. A broader analysis with other Serratia species identifies a set of approximately 3,000 genes that characterize the genus. Within this apparent genetic diversity, we identified many genes implicated in the high virulence potential and antibiotic resistance of SM39, including the metallo beta-lactamase and multiple other drug resistance determinants carried on plasmid pSMC1. We further show that pSMC1 is most closely related to plasmids circulating in Pseudomonas species. Our data will provide a valuable basis for future studies on S. marcescens and new insights into the genetic mechanisms that underlie the emergence of pathogens highly resistant to multiple antimicrobial agents

Vivienda unifamiliar en Barcelona – España

This permanent residence was constructed on a lot with a large number of trees in the Bonanova «Ciudad Jardín». The different areas of the program are distributed on its three levels in a clearly differentiated manner. Thus, in the semibasement, the general installations are found; on the ground floor,, the living areas, bedrooms and servants' quarters, adequately communicated; and on the top leveí, overlooking the surrounding panorama, the master suite. In the architectural treatment, the large Windows of the ground floor stand out which, at the same time as they integrate the combination of the brick surface with the numerous bodies which project and jut inward brought about by the irregularity of the floor plans.En una parcela profusamente arbolada, de la Ciudad Jardín de Bonanova, se ha realizado esta vivienda. En sus tres niveles distribuye las distintas dependencias del programa de forma claramente diferenciada. Así, en el semisótano se encuentran las instalaciones generales; en la planta baja las zonas nobles, de dormitorios y de servicio, adecuadamente comunicadas entre sí; y en el nivel superior, dominando el panorama circundante, la suite del matrimonio. En el tratamiento arquitectónico sobresalen los grandes ventanales de la planta baja que, al tiempo que integran el ajardinamiento con las habitaciones, resaltan los numerosos cuerpos entrantes y salientes originados por la irregularidad de las plantas

Sede del Instituto Francés, 1972 Barcelona-España

Instead of linking with the building existing on the same lot, according to the project of City Hall, the headquarters of the French Institute has been carried out separately, even though area approved for building has been sacrificed way it was felt that this was the only way to provide it witch a nature in accordance with its functional purpose, without having to relate it in any way whatsoever to the other construction, which has a completely different use. It consists of: basement, for parking and facilities; ground floor with mezzanine, occupied by the administration, secretariat and living quarters for the concierge; six upper floors, with classrooms; and a top floor, offset, which houses the living quarters of the director. In its composition as regards the facade, the garden with the rooms, emphasize the narrow vertical empty spaces stands out, lending the building its marked personality.En lugar de enlazar con el edificio existente en el mismo solar, según el proyecto del Ayuntamiento, la sede del Instituto Francés se ha realizado exenta, aun perdiendo edificabilidad, por considerarse que era la única forma de conferirle un carácter acorde con su funcionalidad, sin tener que relacionarse de alguna manera con la otra construcción, de uso radicalmente distinto. Consta de: 2 sótanos, dedicados a garaje e instalaciones; planta baja con entreplanta, ocupadas por la administración, secretaría y vivienda del conserje; seis plantas superiores, con los locales de enseñanza; y una última planta, retranqueada, que aloja la vivienda del director. En su composición exterior sobresale la combinación de la plaqueta cerámica, con los estrechos huecos verticales, que otorga al edificio su marcada personalidad