Search

This paper aims to: (1) provide a brief overview of hospital sector characteristics in 11 Central and Eastern European countries (Bulgaria, Czech Republic, Estonia, Croatia, Latvia, Lithuania, Hungary, Poland, Romania, Slovakia, Slovenia); (2) compare recent (2008 – 2019) hospital reforms in these countries; and (3) identify common trends, success factors and challenges for reforms. Methods applied involved five stages: (1) a theoretical framework of hospital sector reforms was developed; (2) basic quantitative data characterizing hospital sectors were compared; (3) a scoping review was performed to identify an initial list of reforms per country; (4) the list was sent to national researchers who described the top three reforms based on a standardized questionnaire; (5) received questionnaires were analysed and validated with available literature. Results indicate that the scope of conducted reforms is very broad. Yet, reforms related to hospital sector governance and changes in purchasing and payment systems are much more frequent than reforms concerning relations with other providers. Most governance reforms aimed at transforming hospital infrastructure, improving financial management and/or improving quality of care, while purchasing and payment reforms focused on limiting hospital activities and/or on incentivising a shift to ambulatory/day care. Three common challenges included the lack of a comprehensive approach; unclear outcomes; and political influence. Given similar reform areas across countries, there is considerable potential for shared learning.

The aim of this study is to contribute to understanding the mechanisms underlying the formation of biologically relevant minerals by comparing the properties of solid phases formed in calcium phosphate (CaP) or calcium carbonate (CaCO3) precipitation systems, at defined initial experimental conditions: supersaturation, constituent ions ratio, ionic strength, and/or presence of relevant inorganic ions. Thus, three systems of different chemical complexities were investigated: (a) system containing constituent ions, (b) system containing additional co-ions, and (c) system with higher ionic strength and addition of Mg2+. The respective precipitation diagrams were constructed, and supersaturation domains of different CaP and CaCO3 solid phases formation were identified. The obtained results may have implications not only for biomineralization and geochemistry, but also for materials science in general.

Despite tremendous progress in genome sequencing, the basic goal of producing a phased (haplotype-resolved) genome sequence with end-to-end contiguity for each chromosome at reasonable cost and effort is still unrealized. In this study, we describe an approach to performing de novo genome assembly and experimental phasing by integrating the data from Illumina short-read sequencing, 10X Genomics linked-read sequencing, and BioNano Genomics genome mapping to yield a high-quality, phased, de novo assembled human genome.

This work focuses on systematic research of spontaneous precipitation of calcium oxalate in model systems mimicking the chemical conditions typical for hyperoxaluria. For this purpose, model systems of three different complexities (simple, NaCl and artificial urine system) and two initial pH (pHi = 5.0 and pHi = 9.0) at 37 ºC are studied. In all investigated systems, dominant precipitation of calcium oxalate monohydrate (COM) is observed, except in artificial urine system at pHi = 9.0, ci(C2O42-) ≥ 6.0 mmol dm-3 and ci(Ca2+) ≥ 7.5 mmol dm-3 where precipitation of a mixture of calcium oxalate monohydrate and calcium oxalate dihydrate (COD) occurrs. The significant difference is mainly observed in COM crystal morphology. In a simple system, COM precipitates in a dendritic form, in NaCl system dendritic form and irregular shapes are found, while in the artificial urine, prismatic hexagonal and aggregated COM crystals precipitate.

Uvod: Cijepljenje je najučinkovitija preventivna mjera koja pored sprječavanja i/ili smanjenja obo-lijevanja od zaraznih bolesti kao dodanu vrijednost zdravstvenom sustavu donosi smanjenje troškova liječenja i boravka u bolnici. Cjeloživotno cijepljenje predstavlja cijepljenje u različitim uzrastima ti-jekom života i uključuje cijepljenje i docjepljivanje protiv bolesti kojima možemo biti izloženi u okruženju u kojem živimo i radimo ili kojima možemo biti izloženi na putovanjima u strane zemlje. Ka-da se govori o cijepljenju, uobičajeni fokus jest cijepljenje djece, dok se o važnosti cijepljenja u odraslih i starijih osoba, osobito onih s postojećim kroničnim stanjima još uvijek dovoljno ne govori. Cilj rada bio je prikazati dodanu vrijednost cjeloživotnog cijepljenja u obliku smanjenja troškova u zdravstvu uslijed liječenja i boravka u bolnici i smanjenja propisivanja antibiotika. Metode: Pregled i analiza publikacija i izvješća o cijepljenju Hrvatskog zavoda za javno zdravstvo i dostupne literature u bibliografskoj bazi PubMed. Pregled literature učinjen je prema ključnim riječima „vaccination“ i „costs“, a u analizu su uključeni radovi na engleskom jeziku publicirani u periodu od 2010. do 2019. godine. Za potrebe ovog rada analizirano je ukupno 10 publikacija. Rezultati i diskusija: Podaci iz literature pokazuju kako se cjeloživotno cijepljenje najčešće razmatra u kontekstu cijepljenja mladeži i odraslih protiv humanog papiloma virusa (HPV), kroničnih bolesnika (kao što su kardiovaskularne bolesti, kronična opstruktivna bolest pluća (KOPB), dijabetes) protiv gripe te cijepljenjem odraslih i starijih osoba protiv pneumokoka. Cijepljenje predškolske i školske djece pov-ezuje se najčešće s cijepljenjima u sklopu nacionalnih programa cijepljenja i postojećim preporukama. U Hrvatskoj se cijepljenjem predškolske i školske djece postižu zadovoljavajući cjepni obuhvati za obavezna cijepljenja. Kada se radi o cijepljenju odraslih osoba, osobito kroničnih bolesnika, dostupni su samo podatci o cjepnim obuhvatima protiv gripe i tetanusa. Cijepljenje protiv tetanusa se provodi u sklopu programa obaveznog cijepljenja i izvješće o cijepljenju za 2017. godini pokazuje cjepni obuhvat manji od 50%. Protiv gripe se prošle sezone u Hrvatskoj cijepilo manje od 10% populacije, među kojim je oko 30% starijih osoba što je značajno manje od preporuka Svjetske zdravstvene organizacije. Prema dostupnim objavljenim podacima o cijepljenju kroničnih bolesnika protiv gripe nije moguće odrediti o kojim kroničnim stanjima se radi. Podaci za zemlje koje imaju obuhvat za cijepljenje protiv gripe viši od 20%, kao što je Nizozemska i Ujedinjena Kraljevina pokazuju smanjenje hospitalizacija za više od 20%, dok se na primjeru Kanade cijepljenje protiv gripe može dovesti u vezu sa smanjenjem propisivanja antibiotika za gotovo od 50%. Istraživanje provedeno u najvećim europskim zemljama pokazalo je da se trošak cijepljenja pojedinca tijekom života kreće od 443€ za zdravu mušku osobu u Švedskoj (10 antigena) do 3 395€ za žensku osobu koja boluje od kronične bolesti u Ujedinjenom Kraljevstvu (15 antigena) što je i dalje ekonomski povoljnije od liječenja i zbrinjavanja mogućih posljedica bolesti. Zaključak: Unatoč postojećim dokazima o dobrobiti cijepljenja tijekom cijelog života i preporukama za cijepljenje odraslih i starijih osoba protiv gripe i pneumokoka, praksa cjeloživotnog cijepljenja u Hrvat-skoj još uvijek ne pokazuje rezultate vidljive na populacijskoj razini, a koji bi mogli ostvariti mjerljiv učinak na uštede u zdravstvenom sustavu. Kako bi se sagledao pravi potencijal cjeloživotnog cijepljenja kao strategije ne samo za prevenciju bolesti i komorbiditeta nego i u svrhu smanjenja troškova u zdravstvu ova tema mora zaživjeti izvan stručnih krugova, a na populacijskoj razini trebalo bi postići da pojedinci i zajednice razumiju vrijednost cjepiva i potražuju cijepljenje kao njihovo pravo i odgo-vornost., Introduction: Vaccination is the most effective preventative measure that, in addition to preventing and / or reducing infectious diseases, adds value to the health care system by reducing the costs of treatment and hospitalization. Lifelong vaccination is a vaccination at different ages through life and includes vaccination and revaccination against diseases that we may be exposed in the environment in which we live and work or when traveling abroad. When it comes to vaccination, the usual focus is on vaccination of children, while the importance of vaccination during adulthood and in older age, or es-pecially with pre-existing chronic conditions, is still insufficient. The aim of the paper is to present the added value of lifelong vaccination in the form of cost reduc-tions in healthcare resulting from treatment, hospitalizations and reduction of prescribing of antibiotics. Materials and methods: Review and analysis of publications and vaccination reports of the Croatian Institute of Public Health and available literature in the bibliographic database PubMed. The literature review was conducted according to the keywords „vaccination“ and „costs“. We have included in the analysis English-language papers published between 2010 and 2019. A total of 10 publications were analysed for the purposes of this paper. Results and discussion: Literature data showed that lifelong vaccination is most often considered in the context of vaccination of young people and adults against human papillomavirus (HPV), chronic patients (such as cardiovascular disease, chronic obstructive pulmonary disease, diabetes) against influ-enza, and vaccination of adults and the elderly person against pneumococcal disease. Vaccinations of preschool and school children are most commonly associated with vaccinations from the national vac-cination programs and with existing experts recommendations. In Croatia we are achieving satisfactory vaccination coverage for preschool and school children vaccinations from compulsory vaccination schedule. Tetanus vaccination is part of a compulsory vaccination program and the vaccination report for 2017 showed a vaccine coverage of less than 50%. Last year, less than 10% of the population was vaccinated against flu, including about 30% of the elderly, significantly less than the World Health Organization's recommendations. According to the available published data on the vaccination of chronic flu patients, it is not possible to determine what chronic conditions were involved. Data for countries with an influenza vaccination coverage of more than 20%, such as the Netherlands and the United Kingdom, showed a reduction in hospitalizations of more than 20%, while in Canada, for example, influenza vaccination may be reduced by almost 50%. A study conducted in the largest European countries found that the cost of a lifetime vaccination for an individual ranges from € 443 for a healthy male in Sweden (10 antigens) to € 3 395 for a female patient with chronic illness in the United Kingdom (15 antigens), which is still more economically viable than treating the disease and the possible consequences of the disease. Conclusions: Despite existing evidence of lifelong vaccination benefits and recommendations for vac-cination of adults and the elderly against influenza and pneumococcus, lifelong vaccination practices in Croatia do not yet show results visible at the population level that could have a measurable effect on savings in the health care system. To see the true potential of lifelong vaccination as a strategy not only for the prevention of disease and comorbidity, but also for the purpose of reducing health care costs, this theme should go beyond profession, and at the population level, individuals and communities should recognize the value of vaccines and seek for vaccination as a their right and responsibility.

Rotavirusi, a posebno vrsta Rotavirus A(RVA), široko su rasprostranjeni uzročnici crijevnih infekcija iz porodice Reoviridae. Iako se javljaju u različitih vrsta sisavaca i ptica, najznačajniji problem predstavljaju u intenzivnom uzgoju mlađih dobnih kategorija goveda i svinja, a primarni su uzrok i akutnog proljeva u djece do pet godina starosti. Rotavirusi pripadaju porodici virusa s dvolančanim i segmentiranim RNA genomom (Reoviridae) koji ponekad uvjetuje pojavu genomskog preslagivanja između humanih i životinjskih sojeva RVA, a time i nastanak novih emergentnih sojeva. Cilj ovog istraživanja je bio utvrditi prisutnost i proširenost rotavirusa A u različitih vrsta životinja, ljudi i okolišu na jednoj mikrolokaciji, u sklopu obiteljskog poljoprivrednog gospodarstva u Sisačko-moslavačkoj županiji. Tijekom istraživanja uzorkovano je ukupno 117 uzoraka goveđih, ovčjih, svinjskih, magarećih, konjskih, psećih i mačjih fecesa ; devet uzoraka fecesa ljudi i tri uzorka vode. Metodom RT-PCR u stvarnom vremenu prisustvo RVA utvrđeno je u ukupno 21 uzorku (16, 28%) ; 20 uzoraka fecesa životinja i jednom uzorku površinske vode. Distribucija pozitivnih uzoraka po vrstama značajno se razlikovala. Tako su pozitivni uzorci utvrđeni u 42, 3% (11/26) pretraženih goveda, 30, 8% (8/26) svinja te 14, 3% (1/7) mačaka. Kod teladi u predtovu prevalencija RVA bila je izrazito visoka, čak 61, 11% (11/18). U pretraživanom uzgoju ustanovljen je visok stupanj subkliničke infekcije, prevalencija infekcije RVA kod životinja bez proljeva iznosi 37, 5% kod goveda i 30, 8% kod svinja. Potrebna su daljnja istraživanja na većem broju uzoraka unutar kategorija pojedinih vrsta, sa šireg geografskog područja uz obaveznu genotipizaciju i utvrđivanje molekularnih značajki cijelog genoma različitih sojeva RVA. Jedino tako ćemo u skladu s načelom „Jedno zdravlje“ moći procjeniti njihov zoonotski potencijal.

Urolithiasis, the formation of urinary stones in different parts of kidney or bladder, is a specific form of pathological biomineralization. Recently, an increasing prevalence of kidney stones in kidney stones in industrial countries is observed and the interest of scientists to explain their pathogenesis with a special focus on calcium oxalate stones is renewed. Calcium oxalates crystallize in the form of hydrated salts: thermodynamically stable calcium oxalate monohydrate (COM, CaC2O4·H2O), metastable dihydrate (COD, CaC2O4·2H2O) and trihydrate (COT, CaC2O4·3H2O). The kidney stones formation under biological conditions can be triggered by various metabolic disorders such as: hypercalciuria, hypocitraturia, hyperoxaluria and the change in the urine acidity. The mechanisms and the conditions under which they crystallize are still not completely clarified. In this work, the spontaneous precipitation and characterization of calcium oxalate monohydrate under conditions of hiperoxaluria (ci(Ca2+) = 7.5 ∙ 10-3 mol dm-3 and ci(C2O42-) = 6.0 ∙ 10-3 mol dm-3) is reported. The experiments were conducted in a model system (Ic = 0.3 mol dm-3 NaCl, which imitates the physiological conditions in the human body) at two initial pH (pHi = 5.0 and 9.0) and with the addition of amino acids reportedly important for pathologic biomineralization. The amino acids selected for the addition are often found in the urine of healthy people and in the organic matrix which is an integral part of kidney stones. The reactant solutions were mixed under controlled hydrodynamic and thermodynamic conditions. Changes in the structure and morphology of precipitated calcium oxalate monohydrate were observed by means of PXRD, SEM, IR and TGA.

Cjeloživotno cijepljenje predstavlja cijepljenje u različitim uzrastima tijekom života i uključuje cijepljenje i docjepljivanje protiv bolesti kojima možemo biti izloženi u okruženju u kojem živimo i radimo ili kojima možemo biti izloženi na putovanjima u strane zemlje. Cilj rada bio je prikazati dodanu vrijednost cjeloživotnog cijepljenja u obliku smanjenja troškova u zdravstvu uslijed liječenja i boravka u bolnici i smanjenja propisivanja antibiotika.Pregled literature učinjen je prema ključnim riječima „vaccination“ i „costs“, a u analizu su uključeni radovi na engleskom jeziku publicirani u periodu od 2010. do 2019. godine. Za potrebe ovog rada analizirano je ukupno 10 publikacija.Cijepljenje predškolske i školske djece pov-ezuje se najčešće s cijepljenjima u sklopu nacionalnih programa cijepljenja i postojećim preporukama. U Hrvatskoj se cijepljenjem predškolske i školske djece postižu zadovoljavajući cjepni obuhvati za obavezna cijepljenja. Kada se radi o cijepljenju odraslih osoba, osobito kroničnih bolesnika, dostupni su samo podatci o cjepnim obuhvatima protiv gripe i tetanusa. Cijepljenje protiv tetanusa se provodi u sklopu programa obaveznog cijepljenja i izvješće o cijepljenju za 2017. godini pokazuje cjepni obuhvat manji od 50%. Protiv gripe se prošle sezone u Hrvatskoj cijepilo manje od 10% populacije, među kojim je oko 30% starijih osoba što je značajno manje od preporuka Svjetske zdravstvene organizacije.Unatoč postojećim dokazima o dobrobiti cijepljenja tijekom cijelog života i preporukama za cijepljenje odraslih i starijih osoba protiv gripe i pneumokoka, praksa cjeloživotnog cijepljenja u Hrvat-skoj još uvijek ne pokazuje rezultate vidljive na populacijskoj razini, a koji bi mogli ostvariti mjerljiv učinak na uštede u zdravstvenom sustavu.

Sequencing the genomes of individual cancer cells provides the highest resolution of intratumoral heterogeneity. To enable high throughput single cell DNA-Seq across thousands of individual cells per sample, we developed a droplet-based, automated partitioning technology for whole genome sequencing. We applied this approach on a set of gastric cancer cell lines and a primary gastric tumor. In parallel, we conducted a separate single cell RNA-Seq analysis on these same cancers and used copy number to compare results. This joint study, covering thousands of single cell genomes and transcriptomes, revealed extensive cellular diversity based on distinct copy number changes, numerous subclonal populations and in the case of the primary tumor, subclonal gene expression signatures. We found genomic evidence of positive selection – where the percentage of replicating cells per clone is higher than expected – indicating ongoing tumor evolution. Our study demonstrates that joining single cell genomic DNA and transcriptomic features provides novel insights into cancer heterogeneity and biology.SIGNIFICANCEWe conducted a massively parallel DNA sequencing analysis on a set of gastric cancer cell lines and a primary gastric tumor in combination with a joint single cell RNA-Seq analysis. This joint study, covering thousands of single cell genomes and transcriptomes, revealed extensive cellular diversity based on distinct copy number changes, numerous subclonal populations and in the case of the primary tumor, subclonal gene expression signatures. We found genomic evidence of positive selection where the percentage of replicating cells per clone is higher than expected indicating ongoing tumor evolution. Our study demonstrates that combining single cell genomic DNA and transcriptomic features provides novel insights into cancer heterogeneity and biology.

There is concern that the stresses of inducing pluripotency may lead to deleterious DNA mutations in induced pluripotent stem cell (iPSC) lines, which would compromise their use for cell therapies. Here we report comparative genomic analysis of nine isogenic iPSC lines generated using three reprogramming methods: integrating retroviral vectors, non-integrating Sendai virus and synthetic mRNAs. We used whole-genome sequencing and de novo genome mapping to identify single-nucleotide variants, insertions and deletions, and structural variants. Our results show a moderate number of variants in the iPSCs that were not evident in the parental fibroblasts, which may result from reprogramming. There were only small differences in the total numbers and types of variants among different reprogramming methods. Most importantly, a thorough genomic analysis showed that the variants were generally benign. We conclude that the process of reprogramming is unlikely to introduce variants that would make the cells inappropriate for therapy., It is feared that reprogramming may introduce DNA mutations. Here Bhutani et al. take three different reprogramming methods and using comparative whole genome analyses do identify nucleotide variations that are different in reprogrammed cells from the original fibroblasts, but none convey oncogenic potential.

Comprehensive whole-genome structural variation detection is challenging with current approaches. With diploid cells as DNA source and the presence of numerous repetitive elements, short-read DNA sequencing cannot be used to detect structural variation efficiently. In this report, we show that genome mapping with long, fluorescently labeled DNA molecules imaged on nanochannel arrays can be used for whole-genome structural variation detection without sequencing. While whole-genome haplotyping is not achieved, local phasing (across >150-kb regions) is routine, as molecules from the parental chromosomes are examined separately. In one experiment, we generated genome maps from a trio from the 1000 Genomes Project, compared the maps against that derived from the reference human genome, and identified structural variations that are >5 kb in size. We find that these individuals have many more structural variants than those published, including some with the potential of disrupting gene function or regulation.

In this study, the influence of Mg2+ on the aggregation and morphology of precipitated aragonite crystals is investigated at different temperatures. Different from some investigations described in the literature, aragonite precipitates in chemical systems in which Mg2+ acts specifically as crystal habit modifiers and not as polymorphic selectors. The results show that at increased Mg2+ concentration and temperature the aragonite crystals are less aggregated and that the amount of crystals sharing {; ; 110}; ; faces and having larger extension of {; ; 001}; ; faces increases. These outcomes may be relevant in biological, geochemical and technological contexts.

Amorphous calcium carbonate (ACC) and calcium phosphate (ACP) increasingly attract attention as initial solid phases in vertebrate and invertebrate hard tissue formation, as well as in materials science as a possible new synthetic route for advanced materials preparation. Although much is known about these two amorphous phases and similarities in the mechanisms of their formation are recognized, no attempt has been made to investigate their formation under defined and comparable initial experimental conditions viz supersaturation, constituent ions ratio, ionic strength and presence of relevant inorganic additives. In this paper, the formation of ACC and ACP in three model precipitation systems of increased chemical complexity were investigated: (a) systems containing constituent ions, (b) systems containing additional co-ions, and (c) systems with higher ionic strength and addition of Mg2+. The results have shown that ACP is more stable and was formed at lower relative supersaturations in comparison to ACC. The precipitation domain of both phases expanded with increasing complexity of precipitation systems, with the ACP precipitation domains always being larger than that of ACC. In addition to stability, the presence of inorganic ions, especially Mg2+, influences the composition of both amorphous phases. The obtained results indicate that general similarity between ACC and ACP exists, but it could also be concluded that similar chemical environment in which they form not necessary lead to similar structural properties.

Parenteralna prehrana omogućuje i osigurava povećani unos nutrijenata kod bolesnika kod kojih je uzimanje obične hrane neprikladno, a davanje enteralne prehrane neizvedivo ili nedovoljno, kontraindicirano ili neprihvaćeno od strane pacijenta. Pothranjenost i kaheksija se često pojavljuju kod onkoloških bolesnika i indikatori su loše prognoze i kao takvi za posljedicu imaju povećan morbiditet i mortalitet. Standardizirani nutricijski režimi se mogu preporučiti kod kratkotrajne parenteralne prehrane, dok se bolesnicima s kaheksijom preporučuju parenteralni nutricijski režimi koji uključuju visok omjer masti i glukoze. Adekvatna prehrana onkoloških bolesnika, bila ona enteralna, parenteralna ili pak njihova kombinacija, nužna je za njihov brz oporavak i prevenciju malnutricije. S gledišta zdravstvenog radnika, onkološki bolesnici s katabolizmom su u visokom riziku od smrti i za njih je važno brzo i točno odrediti vrstu i količinu parenteralnog pripravka koji će im se primijeniti. Kako bi određivanje nutritivnog statusa onkološkog bolesnika te prilagođavanje parenteralne prehrane svakom od njih ponaosob bilo što jednostavnije, B Braun je za zdravstvene djelatnike lansirao aplikacije za stolna računala i pametne telefone - NuTRIscreen i NuTRIsuite. Nakon što se uz NuTRIscreen aplikaciju, koja koristi općeprihvaćene smjernice za određivanje nutritivnog statusa, potvrdi da je onkološki bolesnik u nutritivnom riziku pristupa se aplikaciji NuTRIsuite kojom se bira između B Braunovih proizvoda za parenteralnu prehranu. Sudionici će prisustvovanjem radionici moći svojim uređajima pristupiti aplikacijama i direktno sudjelovati u procjeni i odabiru odgovarajuće parenteralne prehrane.

Temeljni cilj ove knjige jest odgovoriti na pitanje zašto se potrebne promjene u zdravstvu Republike Hrvatske ne provode, ili se odvijaju presporo. Pronalaženje odgovora zamišljeno je kao sinteza znanstvenih i stručnih spoznaja s analizama stanja i trendova u zdravstvu RH. Knjiga je nastala kao rezultat višegodišnjeg rada troje autora koji su, samostalno ili u timovima, ne samo pratili i analizirali zdravstveni sustav, već su često i sudjelovali u procesima uvođenja promjena. Većina tema obrađenih u ovoj knjizi proizašla je iz rezultata znanstvenih istraživanja, javnih rasprava, te zaključaka stručnih skupova. Knjiga obuhvaća različite tekstove: narative, prikaze slučajeva, analize, osvrte, zapažanja, te praktične alate i preporuke. Prikazi slučajeva iz realiteta zdravstvenog sustava u Hrvatskoj izabrani su da doprinesu razumijevanju problema interregnuma. Slijedi blok propitivanja iz perspektive stewardshipa, a ključno mu je pitanje kako i zašto sustav opstaje usprkos interregnumu. Na njega se nastavlja serija priloga koji odgovaraju na pitanje zašto Hrvatska ne može izaći iz interregnuma. U posljednjem dijelu su sadržaji namijenjeni kao pomoć za gradnju strategije izlaska iz interregnuma.

According to the latest epidemiological studies, the prevalence of urolithiasis has been increasing for the past few decades, especially in industrialised countries, possibly due to improved standard of living and modern dietary habits. Urolithiasis is the formation of crystals in the urinary tract and is a specific form of pathological biomineralisation. It is a result of physiochemical mechanisms and involves the processes of nucleation, crystal growth and aggregation. Many factors may contribute to crystallisation and urinary stone formation including pH, ionic strength and the presence or absence of substances that can promote or inhibit the process [1]. Different metabolic disorders, which can be inherited or developed, are considered to be important risk factors and include hyperoxaluria, hypercalciuria, hypocitraturia and changes in acidity of the urine. Hyperoxaluria is associated with oxalate urinary tract stones and oxalate crystal deposition in tissue [2]. In this work, systematic research of spontaneous calcium oxalate precipitation in three systems with different levels of complexity (simple, NaCl and artificial urine system) and two different initial pHs (pHi = 5.0 and 9.0) was conducted. In all investigated systems which simulate the conditions of hyperoxaluria, a dominant precipitation of calcium oxalate monohydrate (COM) was noted, except in the artificial urine system at pHi = 9.0, where precipitation of a mixture of calcium oxalate monohydrate (COM) and calcium oxalate dihydrate (COD) occurred. The most pronounced difference was observed in COM morphology. In the simple system crystals precipitated in dendritic form, in the NaCl system they took a dendritic form with more or less irregular shaped crystals, while in artificial urine aggregated and prismatic hexagonal COM crystals precipitated.

Background: The connection between socio-economic status and health is documented, yet not fully understood. The goal of this research was to analyze the relationship between socio-economic status, lifestyle and health status, availability of health-care, social capital, and satisfaction with life. Subjects and methods: Subjects were 1117 women aged 25-65 years divided in two groups. Group 1 consisted of women who receive public assistance (N1=591), while Group 2 consisted of women who do not (N2=526). The sample was stratified by random choice into multiple stages based on six regions of Croatia, residential area size, and the age of respondents. Visiting nurses surveyed the deprived population, while in Group 2 self-interviewing was conducted. A questionnaire entitled “Inequalities in health” was used. The respondents participated in this research voluntarily and anonymously. Results: Socially deprived women consume spirits and wine more often (p

Temeljem prirodnih resursa i njihovih značajki, prikazanih u ovoj analizi stanja poljoprivrede na prostoru općine Dvor nameće se zaključak da je istraživani prostor izrazito povoljan za razvitak poljoprivrede i prehrambene industrije. Ova analiza stanja se temelji na optimalnom korištenju prirodnih resursa u obiteljskom poljoprivrednom gospodarstvu, kao temeljnoj gospodarsko-socijalnoj jedinici u razvitku poljoprivrede ovog kraja. Zaključci izneseni na kraju svakoga poglavlja u ovoj analizi u suglasju su s modernim zahtjevima ekološki održivog gospodarenja prirodnim resursima u poljoprivredi. Uzgoj poljoprivrednih kultura i držanje stoke prema ekološkim principima na ovim prostorima ima značajnu perspektivu uslijed dugogodišnje neobrađenosti površina a i vrlo male količine primjenjivanih mineralnih gnojiva te ostalih agrokemikalija. Navedeni oblik poljoprivrede, kao i agrošumarstvo mogli bi biti jedan od pokretača razvoja cijeloga prostora općine Dvor. Da bi se navedeno u budućnosti provelo smatramo da bi u narednim koracima trebalo provesti slijedeće: • Provoditi stalnu godišnju kontinuiranu edukaciju zainteresiranih poljoprivrednika u cilju ulaganja u ljudski kapital koji će dovesti do razvoja obiteljskih poljoprivrednih gospodarstava koja svoju budućnost i razvoj vide utemeljenu na znanju i primjeni najsuvremenijih agrotehničkih mjera, • Izraditi detaljniju pedološku kartu (cca M 1 : 50 000). Na osnovu utvrđenih osnovnih fizikalnih i kemijskih pokazatelja preporučiti će se agrotehničke mjere uređenja tala u cilju povećanja njihove plodnosti. Također ova karta bi trebala sadržavati i stanje kvalitete tla, tj. potencijalnu onečišćenost organskim i anorganskim polutantima, • Provesti istraživanje o kvaliteti poljoprivrednih proizvoda i šumskih plodova sa ovoga prostora, • Agrotehničke i ekonomske mjere za privođenje u korištenje trenutno nekorištenih poljoprivrednih površina, • Na osnovu ekonomskih pokazatelja kontinuirano ukazivati na prednosti okrupnjavanja poljoprivrednih površina, • Izraditi mjere za povećanje konkurentnosti poljoprivrednih proizvoda kroz poticanje tehničkoj opremljenosti poljoprivrednih gospodarstava, • Izraditi mjere u cilju povećanja stočnog fonda i uzgoj autohtonih pasmina kao i tradicionalnog načina uzgoja i držanja stoke, • Poticati proizvodnju autohtonih i tradicijskih poljoprivrednih proizvoda od lokalnih sirovina • Ukazati na mogućnosti razvoja djelatnosti komplementarnih poljoprivredi u okviru ruralnoga prostora, • Poraditi na povećanju informatičke pismenosti svih članova poljoprivrednoga gospodarstva, • Utvrditi stanje šumske vegetacije definirajući ekološke, socijalne i proizvodne uloge šume, • Stručna i znanstvena pomoć poljoprivrednim gospodarstvima na veće korištenje poljoprivredno okolišnih mjera i očuvanja biološke raznolikosti područja, • Izraditi mjere za povećanje skladišnih kapaciteta, te dorade i prerade poljoprivrednih proizvoda, • Javno izlaganje ostvarenih rezultata na prostoru općine Dvor tijekom provedenih istraživanja.

Background Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20– 29 years to 70–79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age- group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence- mean association, to the change in prevalence of raised blood pressure. Results In 2005–16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region- sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence- mean association. Conclusions Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood- pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups.

This paper analyses price and income elasticity of demand as one of the main indicator of the market response to certain price or income changes. Price and income elasticity can be easily empirically established and directly used for planning various price and tax policies. Therefore, one of the most frequently investigated statistical correlation is the correlation between prices and income and consumption of petroleum products. For this reason, the demand for petroleum products is expressed as a multiplicative function between driving efficiency, mileage per car and car ownership. In a world where energy and energy supply is one of the fundamental obligations of a country, car demand has attracted great attention from scientific researchers. Theoretical overview of elasticities (price, income and cross-elasticity of demand for petroleum products) are analyzed in the first part with special accent to the difference between the short-run and long-run effects on the elasticity of demand. Fiscal policy and its influence on the elasticity of demand is also investigated in first part of the paper. Overview of global studies of price and income elasticity of demand for petroleum products are investigated in second part of the paper. The conclusion which is imposed from all the analyzed studies is that the elasticity of demand for petroleum products (price and income) has decreased from 1970.

The aim of this study was to assess the value of the “Health-Plan for It” Program for the capacity of Croatian counties to plan health and implement services based on locally recognized health needs. From 2002 to 2008, the county health teams formed in twenty Croatian counties passed the first set of training modules. First assessment was conducted in 2006. Based on assessment results, in 2008-2009 a new set of training modules was organized and attended by six counties. In second assessment conducted in 2012, three instruments were applied: Local Public Health Practice Performance Measures Instrument and Procedure Chart as self-reporting instruments, and tutorial notes assembled/analyzed by the Faculty. All 13 county health teams that participated in second assessment showed an increase in the 2012 score compared to 0-point. The score change showed statistical significance on both the overall core public health functions and on any of its components (assessment, policy development, assurance). All counties showed improvement in assessment and policy development functions. The assurance function was improved in counties that attended the second set of training modules. The Procedure Charts showed that all counties had developed their own health profiles and health plans, with prioritized health needs and identified actions to address them. Like the first evaluation workshop in 2006, results of the second evaluation workshops in 2012 showed that the Program increased the counties’ public health capacity. Two of the counties that had enrolled late in the Program (2007/2008) achieved much better results than ‘older’ counties, showing that the time spent in the Program was not a key factor contributing to local project success. Different levels of achievement due to ‘institutional or personal capacity to change’, reported by other authors, are in line with our findings that individual county success in the Program depended on the team composition and the level of (regional) political stability. In conclusion, the program showed improvement of all core public health functions in all counties. Assurance function showed generally a higher change in counties that had passed both sets of modules. The counties’ capacity for change differed and the Program was not equally efficient in all of them. The differences in county achievements could be explained by stability of political support at the county level, team composition, and commitment of the team leader., Cilj ovoga istraživanja bio je ocijeniti vrijednost učinaka programa “Rukovođenje i upravljanje za zdravlje” na sposobnost hrvatskih županija da planiraju za zdravlje te implementiraju programe temeljene na lokalno prepoznatim zdravstvenim potrebama u podizanju javnozdravstvene i upravne kompetencije hrvatskih županija dvanaest godina nakon pokretanja toga Programa. U razdoblju od 2002. do 2008. godine svih dvadeset županijskih timova za zdravlje provedeno je kroz prvi set edukacijskih modula. Prva evaluacija Programa napravljena je 2006. godine. Temeljem rezultata evaluacije izrađen je drugi set edukacijskih modula kroz koji je, u razdoblju od 2008. do 2009. godine provedeno šest županijskih timova. U drugoj evaluaciji Programa održanoj 2012. godine primijenjena su tri evaluacijska instrumenta: Matrica temeljnih funkcija javnog zdravstva (Local Public Health Practice Performance Measures Instrument) i hodogram aktivnosti županijskih timova (Procedure Chart) kao instrumenti za samoprocjenu te zabilješke/zapažanja mentora sa Škole narodnog zdravlja “Andrija Štampar”. Rezultati timova za zdravlje trinaest županijskih timova, sudionika u drugom krugu evaluacije u 2012. godini bolji su u usporedbi s njihovim početnim stanjem (0-point). Promjene u rezultatima pokazuju statistički značajnu razliku kako u ukupnom zbroju (sve tri temeljne funkcije zajedno) tako i za svaku funkciju pojedinačno (procjena stanja, oblikovanje zdravstvene politike, osiguravanje resursa). Sve su županije pokazale napredak u funkciji procjene stanja i oblikovanja zdravstvene politike. Funkcija osiguravanja sredstava bila je unaprijeđena kod županija sudionica u drugom setu edukacijskih modula. Hodogrami aktivnosti županijskih timova pokazali su da su sve županije (sudionice u evaluaciji) izradile Županijske slike zdravlja i Planove za zdravlje s jasno definiranim prioritetima i aktivnostima kojima ih namjeravaju riješiti. Rezultati evaluacije provedene 2012. godine, kao i rezultati evaluacije iz 2006. pokazuju da su Programom unaprijeđene javnozdravstvene kompetencije županija. Dvije županije uključene u Program tek 2007./2008. godine postigle su bolje rezultate od „starih“ (ranije uključenih) županija te time pokazale da vrijeme provedeno u programu nije ključni čimbenik uspješnosti projekta lokalno. Razlika u postignućima može se pripisati „institucionalnom ili osobnom kapacitetu za promjenu“ o kojem izvještavaju i drugi autori. Ovdje prikazani rezultati ukazuju na to da je razlika u postignućima u Programu među županijskim timovima bila uvjetovana sastavom tima i političkom stabilnosti lokalno. Programom su unaprijeđene sve temeljne javnozdravstvene funkcije u županijama sudionicama Programa. Funkciju osiguravanja sredstava najviše su unaprijedile županije uključene u oba seta edukacijskih modula. Županije imaju različit kapacitet za uvođenje promjene pa sudjelovanje u Programu nije kod svih polučilo jednako dobre rezultate. Razlike u razini postignuća između županija moguće je objasniti postojanjem (ili odsustvom) kontinuirane političke potpore na županijskoj razini, sastavom tima i predanošću njegovog voditelja.

Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups. © The Author(s) 2018.

Objectives: There are still controversies in the literature and various clinical recommendations regarding fixed partial dentures (FPDs) splinting natural teeth and implant abutments. This type of FPD has been reported prone to several types of complications. The authors decided to perform a retrospective study on a large sample and suggest recommendations based on those results. Subjects and methods: In 197 patients residual teeth served as abutments in 217 combined tooth (754) and implant (781) supported cement retained FPDs and were retrospectivelly evaluated after a period 12 to 72 months. Inclusion criteria were normal periodontal support and adequate oral hygiene. The FPDs were constructed in both jaws, and were devided into 3 topographic categories (lateral- linear bridge, arch-linear bridge, and full arch bridge) and relative to the type of distal abutment (tooth-ending and implant-ending). Complications were organized into technical and biological. Descriptive statistics, ANOVA (p

Calcium carbonate (CaCO3) is an abundant mineral ; it makes up approximately 5 wt% of the Earth's crust, [1] but it can also be found in organisms and biological systems, like mollusks and egg shells, pearls, corals and exoskeletons of arthropods.[2] Calcium carbonate precipitates in the form of several distinct solid phases: amorphous calcium carbonate (ACC), two hydrates (monohydrate and hexahydrate), and three anhydrous polymorphs (calcite, aragonite and vaterite) of which calcite is the most stable form under standard conditions. Aragonite occurs mainly in skeletons of mollusks and corals, in pearls and in hot springs' sediment.[3, 4] Magnesium ions and temperature are two key parameters which control the aragonite formation. In this study, the influence of Mg2+ and temperature on the phase composition, aggregation and morphology of precipitated calcium carbonate crystals is investigated. However, the supersaturation was also considered as a critical parameter of precipitation. It was found that in the low- supersaturation system, at increased Mg2+ concentration and at increased temperature, the aragonite crystals are less aggregated. In addition the amount of crystals sharing {; ; 110}; ; faces and having larger extension of {; ; 001}; ; faces increases. On the contrary, in the high- supersaturation system formation of high magnesium calcite was observed. The obtained results may be relevant in biological, geochemical and technological contexts. [1] W. D. Carlson, Rev. Mineral., 1983, 11, 191–225. [2] G. Falini and S. Fermani, Cryst. Res. Technol., 2013, 48, 864–876. [3] G. Falini, S. Fermani and S. Goffredo, Semin. Cell Dev. Biol., 2015, 46, 17–26. [4] C. Perdikouri, A. Kasioptas, T. Geisler, B. C. Schmidt and A. Putnis, Geochim. Cosmochim. Acta, 2011, 75, 6211–6224.

Main focus of presented investigations are precipitation processes of CaCO3, specifically in the context of biomineralization. To investigate these processes poly aspartic acid and poly glutamic acid were used as synthetic analogues of the natural acidic proteins present in biominerals. Inhibition of CaCO3 precipitation and change of morphology of CaCO3 that we observed when polyaspartic and poly glutamic acid were added into the precipitation systems are direct consequence of a strong adsorption of the chosen acidic polypeptides to the crystal surface.

Arterijska hipertenzija (AH) vodeći je uzrok pobola i smrti u svijetu, pa tako i u Hrvatskoj. Prema podacima EH-UH 1 istraživanja, koje je završeno prije 15 godina, prevalencija AH- a iznosila je 37%, uz vrlo lošu kontrolu liječenja - oko 20%. Jedan od glavnih razloga velike prevalencije i loše kontrole je prekomjeran unos kuhinjske soli koji prema rezultatima istraživanja u Hrvatskoj iznosi više od 11 grama dnevno. Podaci su bili temelj za izradu Strateškoga plana Vlade RH za smanjivanje unosa kuhinjske soli. Cilj projekta je: 1) na temelju podataka iz arhive prethodno provedenog istra živanja (EH-UH1) pozvati na kontrolni pregled sve ispitanike, pratiti klinički tijek bolesti i njen ishod ovisno o ulaznim pokazateljima ; 2) na način kako je rađeno i u EH- UH1, u EH-UH2 randomizirati novi uzorak opće populacije u Hrvatskoj, koristiti isti upitnik i način pregleda, mjerenja arterijskoga tlaka (AT) i određivanja pridruženih čimbenika rizika te odrediti prevalenciju, svjesnost, liječenje i kontrolu hipertoničara kao i dinamiku kretanja hipertenzije u Hrvatskoj tijekom 10 godina ; 3) u obje skupine ispitanika (post - EH- UH 1 i tijekom EH-UH 2) odrediti unos kuhinjske soli mjerenjem 24-satne na triurije ; 4) u istom uzorku urina odrediti količinu joda s ciljem utvrđivanja neškodljivosti smanjivanja unosa kuhinjske soli. Rezultati će omogućiti utvrđivanje najznačajnijih čimbenika za razvoj AH-a i njihove povezanosti s kliničkim ishodima.

The work, results, and thoughts of Andrija Štampar are recognized globally as a public health heritage (1). They encompass the vision of health as a state of overall well-being, society as the key responsible health care provider, and a set of values and guiding principles underlining the importance of optimal health. The reasons behind their adoption worldwide lie in the success of public health projects in Croatia (former Yugoslavia) in 1920s promoted by Zagreb School of Public Health (SPH) (later SPH A. Štampar), established in 1927. The key mission of the SPH was to develop further the public health practice and promote Štampar’s public health principles (2). Andrija Štampar’s principles (Box 1) advocate universal and widely understood values in different social contexts. Apart from their widely understood meaning, the principles also serve as a guideline for policy makers and governments to promote a just and fair society, equality, and equity (3). Whereas these principles illustrate the general determinants of health system organization in some societies, in Croatia they have been acclaimed and accepted in general as a comprehensive and best public health practice. In some way, we have kept the inherited Štampar principles and practice as a professional “dogma” and unquestionable public health business model.

Poly-L-glutamic (pGlu) and poly-L-aspartic (pAsp) acids, as analogues of naturally occurring soluble acidic proteins, were used to investigate specific interactions between the acidic polypeptides and calcite as a mineral surface. A basic polypeptide (poly-L-lysine, pLys) served as a negative control for testing the role of conformity between the substrate and the adsorbed polypeptides in biomineralization processes. The kinetics of calcite crystal growth was determined in a simplified precipitation model system by inoculating well defined calcite seed crystals into a moderately supersaturated solution containing one of the polypeptides. From the kinetic data, the mode and extent of the calcite/polypeptide interactions were determined. The parabolic rate law was found to be valid for the calcite crystal growth, the integration of ions into the spiral steps at the calcite crystal surface being the rate-determining mechanism. Small amounts of pGlu or pAsp caused an inhibition of calcite crystal growth, the effect being pAsp > pGlu, and the exponential dependence of the growth rate on supersaturation confirmed that surface nucleation was the growth controlling mechanism in the presence of the two acidic polypeptides. The pLys non-selective, weak, electrostatic adsorption at the crystal surface was probably responsible for increasing the calcite growth rate at low concentrations and for inhibiting it at higher concentrations. The strongest interactions between the crystal surfaces and the polypeptides were observed for the calcite/pAsp systems. They could be accounted for by coordinative interactions between the side chain carboxylic groups of the predominantly planar arrangement of the pAsp structure (β -pleated sheet) and Ca2+ ions from the calcite surface.

This paper reports on the precipitation of CaCO3 polymorphs, having various crystal morphologies under different conditions. In particular, systems that were subject to ultrasonic irradiation were compared to the corresponding reference systems in the absence of such a treatment. The application of ultrasonic irradiation predominantly resulted in a change of particle size distribution and polymorphic composition of the precipitate, in comparison to the reference systems. Thus, it was found that the supersaturation and temperature influenced the size distribution, in both the reference and sonicated systems. A mixture of calcite, vaterite and aragonite was obtained in all reference systems, at 25 °C. At this temperature, the sonication caused the vaterite content to increase, while aragonite was not detected. In reference and sonicated systems at 80 °C, only aragonite precipitated. The results also indicate that the principle parameter responsible for the morphology of vaterite was the initial supersaturation: at higher supersaturation spherical vaterite particles precipitated, while at lower supersaturation hexagonal platelets were obtained. The morphological investigations also indicated different mechanisms of vaterite formation in the systems in which precipitation was initiated at higher supersaturation: spherulitic growth of vaterite was observed in sonicated systems, while the aggregation of primary particles was predominant in the reference systems. At lower supersaturation, the effect of c(Ca2+)/c(CO32-) on the morphology of hexagonal platelets of vaterite was observed as well. By varying the c(Ca2+)/c(CO32-), significant changes of the polymorphic composition were observed only in the sonicated systems, at 25 ˚C.

Objective Whole-genome sequencing of circulating cell free (ccf) DNA from maternal plasma has enabled noninvasive prenatal testing for common autosomal aneuploidies. The purpose of this study was to extend the detection to include common sex chromosome aneuploidies (SCAs): [47,XXX], [45,X], [47,XXY], and [47,XYY] syndromes. Method Massively parallel sequencing was performed on ccf DNA isolated from the plasma of 1564 pregnant women with known fetal karyotype. A classification algorithm for SCA detection was constructed and trained on this cohort. Another study of 411 maternal samples from women with blinded-to-laboratory fetal karyotypes was then performed to determine the accuracy of the classification algorithm. Results In the training cohort, the new algorithm had a detection rate (DR) of 100% (95%CI: 82.3%, 100%), a false positive rate (FPR) of 0.1% (95%CI: 0%, 0.3%), and nonreportable rate of 6% (95%CI: 4.9%, 7.4%) for SCA determination. The blinded validation yielded similar results: DR of 96.2% (95%CI: 78.4%, 99.8%), FPR of 0.3% (95% CI: 0%, 1.8%), and nonreportable rate of 5% (95%CI: 3.2%, 7.7%) for SCA determination Conclusion Noninvasive prenatal identification of the most common sex chromosome aneuploidies is possible using ccf DNA and massively parallel sequencing with a high DR and a low FPR. © 2013 John Wiley & Sons, Ltd. Supporting information may be found in the online version of this article. Funding sources: Sequenom, Inc. and Sequenom Center for Molecular Medicine (SCMM). The sponsors participated in the design of the study, data collection, data management, data analysis, decision to submit the report for publication, manuscript preparation, and review. Conflicts of interest: Mazloom, Dzakula, Wang, Oeth, Jensen, Tynan, McCullough, Saldivar, Bombard, and Deciu are employees of Sequenom Center for Molecular Medicine and Sequenom shareholders. Ehrich, van den Boom, Maeder, and McLennan are employees of Sequenom, Inc. and Sequenom shareholders. Palomaki and Canick were members of the Sequenom Clinical Advisory Board between November 2007 and October 2008 and resigned when they received study funding. Palomaki and Canick were Co-Principal Investigators for a Women & Infants Hospital of Rhode Island project fully funded to through a grant from Sequenom, Inc., between October 2008 and February 2012.