Performance of Long-Term Care Systems in Europe. ENEPRI Research Report No. 117, 21 December 2012

This report evaluates the performance of long-term care (LTC) systems in Europe, with a special emphasis on four countries that were selected in Work Package 1 of the ANCIEN project as representative of different LTC systems: Germany, the Netherlands, Spain and Poland. Based on a performance framework, we use the following four core criteria for the evaluation: the quality of life of LTC users, the quality of care, equity of LTC systems and the total burden of LTC (consisting of the financial burden and the burden of informal caregiving). The quality of life is analysed by studying the experience of LTC users in 13 European countries, using data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Older persons with limitations living at home have the highest probability of receiving help (formal or informal) in Germany and the lowest in Poland. Given that help is available, the sufficiency of the help is best ensured in Switzerland, Italy and the Netherlands. The indirectly observed properties of the LTC system are most favourable in France. An older person who considers all three aspects important might be best off living in Belgium or Switzerland. The horizontal and vertical equity of LTC systems are analysed for the four representative countries. The Dutch system scores highest on overall equity, followed by the German system. The Spanish and Polish systems are both less equitable than the Dutch and German systems. To show how ageing may affect the financial burden of LTC, projections until 2060 are given for LTC expenditures for the four representative countries. Under the base scenario, for all four countries the proportions of GDP spent on public and private LTC are projected to more than double between 2010 and 2060, and even treble in some cases. The projections also highlight the large differences in LTC expenditures between the four countries. The Netherlands spends by far the most on LTC. Furthermore, the report presents information for a number of European countries on quality of care, the burden of informal caregiving and other aspects of performance. The LTC systems for the four representative countries are evaluated using the four core criteria. The Dutch system has the highest scores on all four dimensions except the total burden of care, where it has the second-best score after Poland. The German system has somewhat lower scores than the Dutch on all four dimensions. The relatively large role for informal care lowers the equity of the German system. The Polish system excels in having a low total burden of care, but it scores lowest on quality of care and equity. The Spanish system has few extreme scores. Policy implications are discussed in the last chapter of this report and in the Policy Brief based on this report.

Phorbol-12-myristate-13-acetate induces nociceptin in human Mono Mac 6 cells via multiple transduction signalling pathways.

BACKGROUND Nociceptin in the peripheral circulation has been proposed to have an immunoregulatory role with regards to inflammation and pain. However, the mechanisms involved in its regulation are still not clear. The aim of this study was to investigate signalling pathways contributing to the regulation of the expression of nociceptin under inflammatory conditions. METHODS Mono Mac 6 cells (MM6) were cultured with or without phorbol-12-myristate-13-acetate (PMA). Prepronociceptin (ppNOC) mRNA was detected by RT-qPCR and extracellular nociceptin by fluorescent-enzyme immunoassay. Intracellular nociceptin and phosphorylated kinases were measured using flow cytometry. To evaluate the contribution of various signalling pathways to the regulation of ppNOC mRNA and nociceptin protein, cells were pre-treated with specific kinase inhibitors before co-culturing with PMA. RESULTS ppNOC mRNA was expressed in untreated MM6 at low concentrations. Exposure of cells to PMA upregulated ppNOC after nine h compared with controls without PMA (median normalized ratio with IQR: 0.18 (0.15-0.26) vs. 0 (0-0.02), P<0.01). Inhibition of mitogen-activated protein kinases specific for signal transduction reversed the PMA effects (all P<0.001). Induction of nociceptin protein concentrations in PMA stimulated MM6 was prevented predominantly by identity of ERK inhibitor (P<0.05). CONCLUSIONS Upregulation of nociceptin expression by PMA in MM6 cells involves several pathways. Underlying mechanisms involved in nociceptin expression may lead to new insights in the treatment of pain and inflammatory diseases.

Sea surface temperture reconstruction and planktonic foraminifera of ODP Hole 117-723A

In the western Arabian Sea (WAS), the highest seasonal sea surface temperature (SST) difference presently occurs between May and August. In order to gain an understanding on how monsoonal upwelling modulates the SST difference between these two months, we have computed SST for the months of May and August based on census counts of planktonic foraminifers by using the artificial neural network (ANN) technique. The SST difference between May and August exhibits three distinct phases: i) a moderate SST difference in the late Holocene (0-3.5 ka) is attributable to intense upwelling during August, ii) a minimum SST difference from 4 to 12 ka is due to weak upwelling during the month of August, and iii) the highest SST difference during the last glacial interval (19 to 22 ka) with high Globigerina bulloides % could have been caused by the occurrence of a prolonged upwelling season (from May through July) and maximum difference in the incoming solar radiation between May and August. Overall, variations in the SST difference between May and August show that the timing of intense upwelling in the Western Arabian Sea over the last 22 kyr has been variable over the months of June, July and August.

Ueber die gottheiten von Samothrace. Vorgelesen in der öffentlichen sitzung der Baier'schen akademie der wissenschaften am namenstage des königes den 12. oct. 1815 ...

"Beylage zu den Weltaltern." A fragment, with title "Die weltalter", was found among the manuscripts of the author and is included in his "Sämmtliche werke", 1. abth., 8. bd., p. [195]-344.

Chemistry of interstitial waters of ODP Leg 117 samples (Table 1)

Interstitial water analyses made at 12 sites during Leg 117 are used to define the nature of diagenetic reactions in organic-rich sediments on the Owen Ridge and Oman Margin. Minor variations in chloride concentration profiles are ascribed to past changes in bottom water salinity at two mid-depth margin sites and to upward migration of low salinity water at another. There is no evidence for subsurface brine movement, unlike the case on the Peru Margin. Dolomitization is widespread and accounts for the depletions of magnesium observed in pore waters at variable depths at nearly all sites. The mineral occurs both as disseminated euhedral limpid crystals and, in at least one location, in massive stringers. Formation of the latter is suggested to reflect precipitation during sea level transgressions when the sedimentation rate was low, but when productivity was high. Authigenic carbonate fluorapatite is also widespread, the phosphorus being derived from the breakdown of organic matter. Sulfate is quantitatively depleted at depth at most locations but the rate of depletion is markedly less than that observed on the Peru Margin where sedimentation is also similarly influenced by high rates of upwelling. The reason for this contrast is not clear and merits further investigation.

Stable oxygen and carbon isotope ratios of the planktonic foraminifera Pulleniatina obliquiloculata and the benthic foraminifera Uvigerina excellens of ODP Site 117-723 in the Arabian Sea (Table 1)

Site 723 is located in a water depth of 808 m at the center of the oxygen minimum zone and the middle part of the main thermocline on the Oman Margin. Oxygen isotope curves of planktonic delta18OP and benthic delta18OB can be traced back continuously to Stage 23 with high resolution measurements. A tentative correlation to Stage 53 has been tried using oxygen isotope stratigraphy. The amplitudes of the fluctuations of the benthic delta18OB curve are small, compared with the planktonic delta18OP curve. The delays of benthic oxygen isotopes delta18OB related to the planktonic delta18OP appear in the transgressive stages. Carbon isotopes of benthic delta13CB and planktonic delta13CP generally show an inverse correlation with oxygen isotope values delta18OB and delta18OB and delta18OP, however, the changes of delta13C are more gradual than those of delta18O during transgressive stages in spite of the synchronized changes of delta13C with those of delta18O during regressive stages. The difference of oxygen isotope between benthic and planktonic foraminifers represents the degree of pushing up the thermocline by upwelling, and the difference of carbon isotope represents the relative amount of upwelling Sigma[CO2] to the biological uptake in the surface water. These isotopic differences can be used as indicators of upwelling and show strong upwelling in the interglacial and weak upwelling in the glacial stages. The organic carbon content is correlated with the isotopic upwelling indicators, and higher content is correlated with the isotopic upwelling indicators and higher content appears in the interglacial stages. The calculated rate of sedimentation based on oxygen isotope stratigraphy in glacial stages is significantly high, two to four times that of interglacial stages, and the absolute flux of fluvial sediments with variability of lithofacies increased in the glacial stage. The present glacial-interglacial cycle with the fluctuation of upwelling relating to the southwest monsoon can be traced back to Stage 8, 250 ka. From Stage 8 to 12, 250-450 ka, the upwelling indicator of oxygen isotope difference did not show such distinct cyclicity. For Stages 12-15, 450-600 ka, the upwelling can be estimated as strong as in interglacial stage of the present cycles, with slightly weak upwelling in the glacial stage. This upwelling and climate can be traced back to the late Pliocene. The strongest upwelling can be estimated in the Pliocene-Pleistocene time by the isotopic indicators and the high organic carbon content.

The Pocket Statistician: A Practical Guide to Quality Improvement by Shirley Coleman, Tony Greenfield, Roger Jones, Clare Morris and Ian Puzey. Arnold . 1996. 252 pages. £12.99 [Book review]

Abstract not available