Back to the Future: The Managed Care Revolution

The evolution to a managed care system did not achieve the complete, fundamental change in the health care delivery system that was envisioned by some of its early proponents. As the managed care movement evolved beyond the prepaid group practice model, it focused primarily on methods used to spread the cost of health care services

Amino acid residues 24-31 but not palmitoylation of cysteines 30 and 45 are required for membrane anchoring of glutamic acid decarboxylase, GAD65.

The smaller isoform of the GABA synthesizing enzyme glutamic acid decarboxylase, GAD65, is synthesized as a soluble protein that undergoes post-translational modification(s) in the NH2-terminal region to become anchored to the membrane of small synaptic-like microvesicles in pancreatic beta cells, and synaptic vesicles in GABA-ergic neurons. A soluble hydrophilic form, a soluble hydrophobic form, and a hydrophobic firmly membrane-anchored form have been detected in beta cells. A reversible and hydroxylamine sensitive palmitoylation has been shown to distinguish the firmly membrane-anchored form from the soluble yet hydrophobic form, suggesting that palmitoylation of cysteines in the NH2-terminal region is involved in membrane anchoring. In this study we use site-directed mutagenesis to identify the first two cysteines in the NH2-terminal region, Cys 30 and Cys 45, as the sites of palmitoylation of the GAD65 molecule. Mutation of Cys 30 and Cys 45 to Ala results in a loss of palmitoylation but does not significantly alter membrane association of GAD65 in COS-7 cells. Deletion of the first 23 amino acids at the NH2 terminus of the GAD65 30/45A mutant also does not affect the hydrophobicity and membrane anchoring of the GAD65 protein. However, deletion of an additional eight amino acids at the NH2 terminus results in a protein which is hydrophilic and cytosolic. The results suggest that amino acids 24-31 are required for hydrophobic modification and/or targeting of GAD65 to membrane compartments, whereas palmitoylation of Cys 30 and Cys 45 may rather serve to orient or fold the protein at synaptic vesicle membranes

Hepatitis induced by noni juice from Morinda citrifolia: A rare cause of hepatotoxicity or the tip of the iceberg?

A 24-year-old female patient presented to her community hospital with mild elevations of serum transaminase and bilirubin levels. Because of multiple sclerosis, she was treated with interferon beta-la for 6 weeks. After exclusion of viral hepatitis due to hepatitis A-E, interferon beta-la was withdrawn under the suspicion of drug-induced hepatitis. One week later, she was admitted again to her community hospital with severe icterus. The transaminase and bilirubin levels were highly elevated, and a beginning impairment of the liver synthesis was expressed by a reduced prothrombin time. The confinement to our department occurred with a fulminant hepatitis and the suspicion of beginning acute liver failure. There was no evidence for hepatitis due to potentially hepatotoxic viruses, alcoholic hepatitis, Budd-Chiari syndrome, hemochromatosis, and Wilson's disease. In her serum there were high titers of liver-kidney microsomal type 1 autoantibody; the serum gamma globulin levels were in the normal range. Fine-needle aspiration biopsy of the liver ruled out an autoimmune hepatitis but showed signs of drug-induced toxicity. During the interview, she admitted that for `general immune system stimulation' she had been drinking Noni juice, a Polynesian herbal remedy made from a tropical fruit (Morinda citrifolia), during the past 4 weeks. After cessation of the Noni juice ingestion, her transaminase levels normalized quickly and were in the normal range within 1 month. Copyright (c) 2006 S. Karger AG, Basel

Fast quadrature techniques for retarded potentials based on TT/QTT tensor approximation

We consider the Galerkin approach for the numerical solution of retarded boundary integral formulations of the three dimensional wave equation in unbounded domains. Recently smooth and compactly supported basis functions in time were introduced which allow the use of standard quadrature rules in order to compute the entries of the boundary element matrix. In this paper we use TT and QTT tensor approximations to increase the effciency of these quadrature rules. Various numerical experiments show the substantial reduction of the computational cost that is needed to obtain accurate approximations for the arising integrals

Discrimination against Turkish minorities in Germany and the Netherlands: field experimental evidence on the effect of diagnostic information on labour market outcomes.

Previous studies have found that the labour market outcomes of Turkish minorities are slightly better in Germany than in the Netherlands. In this paper we test one of the explanations: differences in ethnic discrimination in hiring. We use a harmonised field experiment to test whether discrimination against job candidates of Turkish origin (age 23–25) varies across Germany and the Netherlands, while holding individual characteristics of job seekers constant. We find that, compared to majority candidates, job candidates of Turkish origin are on average eleven percentage points less likely to receive a positive call-back. Moreover, we find that discrimination against Turkish minorities is significantly higher in the Netherlands than in Germany. In Germany, job candidates of Turkish origin are five percentage points less likely to receive a call-back than equally qualified majority candidates, whereas in the Netherlands this ethnic gap is fifteen percentage points. However, the presented evidence does not support the often-mentioned argument that the amount of diagnostic information in application materials explains why discrimination against Turkish minorities is lower in Germany. Overall, adding diagnostic information has little effect on the relative employment chances of job applicants of Turkish origin, both in Germany and the Netherlands

Modelle und Methoden für die Bestandsauslegung in Heijunka-nivellierten Supply Chains

In dieser Arbeit werden analytische Bestandsmodelle für die Heijunka-Nivellierung unter Berücksichtigung schwankender Nachfrage- und Produktionsprozesse entwickelt. Dies ist in der Praxis von größerer Bedeutung, als die bisherigen wissenschaftlichen Modelle mit dem Ziel einer möglichst gleichmäßigen Produktionssequenz. Es werden Fragestellungen beantwortet, die bei der Auslegung der Nivellierung in der Industrie immer wieder auftreten, wie z.B. die Auslegung bei saisonalem Nachfrageverlauf