Policyholder Control of a Mutual Life Insurance Company

From time to time during the last hundred years or more, there have been discussions concerning the control or the lack of control by policyholders of mutual life insurance companies. While this is certainly not a new issue, there have been several recent developments. One recent development is a so-called class action suit brought in October 1972 against four large mutual life insurance companies in the United States District Court for the Southern District of New York. This antitrust suit was brought on behalf of three policyholders as representatives of a class consisting of all mutual life insurance policyholders. The complaint alleges, among other things, a conspiracy among defendant insurance companies to use outdated and antiquated mortality tables, to charge unreasonably high and redundant premium rates, and to create self-perpetuating management

Pre- and post-bronchodilator lung function as predictors of mortality in the Lung Health Study

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is supposed to be classified on the basis of post-bronchodilator lung function. Most longitudinal studies of COPD, though, do not have post-bronchodilator lung function available. We used pre-and post bronchodilator lung function data from the Lung Health Study to determine whether these measures differ in their ability to predict mortality. METHODS: We limited our analysis to subjects who were of black or white race, on whom we had complete data, and who participated at either the 1 year or the 5 year follow-up visit. We classified subjects based on their baseline lung function, according to COPD Classification criteria using both pre- and post-bronchodilator lung function. We conducted a survival analysis and logistic regression predicting death and controlling for age, sex, race, treatment group, smoking status, and measures of lung function (either pre- or post-bronchodilator. We calculated hazard ratios (HR) with 95% confidence intervals (CI) and also calculated area under the curve for the logistic regression models. RESULTS: By year 15 of the study, 721 of the original 5,887 study subjects had died. In the year 1 sample survival models, a higher FEV1 % predicted lower mortality in both the pre-bronchodilator (HR 0.87, 95% CI 0.81, 0.94 per 10% increase) and post-bronchodilator (HR 0.84, 95% CI 0.77, 0.90) models. The area under the curve for the respective models was 69.2% and 69.4%. Similarly, using categories, when compared to people with normal lung function, subjects with Stage 3 or 4 disease had similar mortality in both the pre- (HR 1.51, 95% CI 0.75, 3.03) and post-bronchodilator (HR 1.45, 95% CI 0.41, 5.15) models. In the year 5 sample, when a larger proportion of subjects had Stage 3 or 4 disease (6.4% in the pre-bronchodilator group), mortality was significantly increased in both the pre- (HR 2.68, 95% CI 1.51, 4.75) and post-bronchodilator (HR 2.46, 95% CI 1.63, 3.73) models. CONCLUSIONS: Both pre- and post-bronchodilator lung function predicted mortality in this analysis with a similar degree of accuracy. Post-bronchodilator lung function may not be needed in population studies that predict long-term outcomes

Non-reversible airway obstruction in never smokers: Results from the Austrian BOLD study

SummaryBackgroundThe presence of non-reversible airway obstruction (AO) in never smokers has only received limited attention until now.MethodsWe analyzed data from the Austrian Burden of Obstructive Lung Disease (BOLD) study. We defined non-reversible AO as post-bronchodilator FEV1/FVC <0.7 which corresponds to COPD I and higher (COPD I+) according to current GOLD guidelines. Significant AO was defined as FEV1/FVC <0.7 and FEV1 <80% predicted (GOLD II and higher, GOLD II+). The prevalence and characteristics of non-reversible AO in never smokers were analyzed in relation to the severity of the disease.ResultsNever smokers comprised 47.3% of the study population. Non-reversible AO was seen in 18.2% of never smokers, and 5.5% of never smokers fulfilled criteria for significant non-reversible AO (GOLD stage II+). Therefore, the resulting population prevalence of significant non-reversible AO (GOLD stage II+) was 2.6%. Never smokers with non-reversible AO were predominantly female and slightly older. The airway obstruction was found to be less severe as compared with ever smokers. Despite this, 20% of never smokers with significant non-reversible AO (GOLD stage II+) reported respiratory symptoms and 50% reported impairment of quality of life. This burden of illness in never smokers was similar to that in smokers when severity of AO was taken into account.ConclusionApproximately every third subject with non-reversible AO has never smoked, yet still demonstrates a substantial burden of symptoms and impairment of quality of life. Never smokers should receive far greater attention when efforts are undertaken to prevent and treat chronic airway obstruction

Novel mechanism of bacteriocin secretion and immunity carried out by lactococcal multidrug resistance proteins

A natural isolate of Lactococcus lactis was shown to produce two narrow spectrum class II bacteriocins, designated LsbA and LsbB. The cognate genes are located on a 5.6-kb plasmid within a gene cluster specifying LmrB, an ATP-binding cassette-type multidrug resistance transporter protein. LsbA is a hydrophobic peptide that is initially synthesized with an N-terminal extension. The housekeeping surface proteinase HtrA was shown to be responsible for the cleavage of precursor peptide to yield the active bacteriocin. LsbB is a relatively hydrophilic protein synthesized without an N-terminal leader sequence or signal peptide. The secretion of both polypeptides was shown to be mediated by LmrB. An L. lactis strain lacking plasmid-encoded LmrB and the chromosomally encoded LmrA is unable to secrete either of the two bacteriocins. Complementation of the strain with an active LmrB protein resulted in restored export of the two polypeptides across the cytoplasmic membrane. When expressed in an L. lactis strain that is sensitive to LsbA and LsbB, LmrB was shown to confer resistance toward both bacteriocins. It does so, most likely, by removing the two polypeptides from the cytoplasmic membrane. This is the first report in which a multidrug transporter protein is shown to be involved in both secretion and immunity of antimicrobial peptides.

Implications of coping characteristics and social status for welfare and production of paired growing gilts

This paper considers the question whether knowledge on individual coping characteristics of growing pigs may be used to improve welfare and production after mixing. Gilts with either reactive or proactive coping characteristics were identified according to behavioural resistance in a backtest, respectively, being low (LR) and high resistant (HR) in this test. At 7 weeks of age, several pairs of unfamiliar gilts were formed, and pairs and dominance relationships were studied over a 3-week period. The following pairs (combinations) were established: two LR gilts (LR/LR; n = 12), two HR gilts (FIRM; n = 12), one LR and one HR gilt (LR gilt dominant: LR(d)/HR; n = 11), and one LR and one HR gilt (HR gilt dominant: LR/HR(d); n = 12). Results showed that on the day of mixing, aggression subsided less quickly and increases in body temperature were higher in LR/ HR(d) and HR/HR pairs. Also, during the first week post-mixing, feed efficiency was lower and skin damage was higher in LR/HR(d) and HR/HR pairs. Mixing of two HR gilts caused highest levels of stress, indicated by greater catecholamine concentrations in urine following the day of mixing, and higher baseline levels of plasma ACTH at I week post-mixing. The lower tendency of fearfulness. In contrast to gilts within HR/HR pairs to contact a novel object may present higher those of LR/HR(d) pairs, responses of LR(d)/HR pairs revealed much lower levels of stress, which emphasised the importance of dominance relationships, being independent of coping characteristics of individual gilts. We speculate that in LR/HR pairs, dominant LR gilts were able to suppress aggressiveness of HR subordinates. HR or proactive gilts, however, may become aggressive when being dominant. General effects of social status, independent of combination, were also found. Compared to dominants, subordinates showed higher acute cortisol, body temperature and vocal responses to mixing. In the longer term, they showed a higher vocal and parasympathetic responsitivity towards the novel object, and their body growth was impaired. Measures not influenced by combination and social status included those of leucocyte subsets, prolactin, and average heart rates during novelty tests. To conclude, aggressive conditions in newly formed groups. and consequently welfare and production, may largely depend on coping characteristics of individual pigs, but also on dominance relationships. Accordingly, the practical value of the backtest is being discussed. (C) 2002 Elsevier Science B.V. All rights reserved

Fifty years in inborn errors of metabolism : from urine ferric chloride to mass spectrometry and gene analysis

Electronic version does not contain associated previously published materialPrefatory material introducing a collection of articles spanning fifty years of research into inborn errors of metabolism. Table of Contents: 1. Introduction -- 2. Background information about inborn errors of metabolism -- 3. Lessons from phenylketonuria [PKU] -- 4. My role in developing new medical foods -- 5. My role in solving an epidemic of benzyl alcohol poisoning in premature infants -- 6. My role in galactosaemia research -- 7. My start in the metabolic world - screening tests in urine -- 8. My experiences in disaster relief -- 9. My first appearance in the medical literature -- 10. A selection of rare and unusual diseases -- 11. Tyrosinaemia type II; tyrosine aminotransferase deficiency -- 12. Iminodipeptiduria due to prolidase deficiency -- 13. Citrullinaemia -- 14. Rippling muscle disease -- 15. A fatal X-linked disorder of diarrhoea, diabetes mellitus and immune dysregulation -- 16. Infantile Refsum disease -- 17. Hereditary hypocalcuric hypercalcaemia -- 18. Carbohydrate deficient glycoprotein disease type IAPKU -- 19. Thiamine-responsive diabetes and deafness -- 20. Folinic acid-responsive seizures: a false alarm -- 21. S-adenosylmethionine hydrolase deficiency -- 22. Deficiency of complex III of the respiratory chain -- 23. Current research: quantitation of infant sucking behaviour -- 24. Discussion and summar