States, Branches of Industry and Education Levels. Who will Benefit in Germany from a Transatlantic Trade and Investment Partnership (TTIP)? Final Report, Part 2: Microeconomic Effects in Germany

In the first part of this study we examined the macroeconomic effects of a transatlantic trade and investment partnership (TTIP) between the European Union and the USA1. The main focus was on changes in trade structure, real income and employment provoked by the TTIP. Using a general equilibrium model, aggregated effects were examined for more than 120 countries. Adaptation of the aggregated price index in all these countries and the feedback effects on gross domestic products were considered in doing so, as was the full matrix of trade effects (even those between countries only indirectly affected) and thus all worldwide trade diversion effects. However, the broad geographic scale and the focus on macro-economic results made it impossible to draw more precise conclusions within individual countries. The second part of the study is intended to close that gap for Germany

Somatomedin C in dairy cows related to energy and protein supply and to milk production

Somatomedin C and other hormones, as well as blood metabolites, were measured during the dry period and during lactation in dairy cows, given different amounts of energy and protein, to study metabolic and endocrine adaptations. Somatomedin C, specifically measured by radioimmunoassay after separation from its binding protein, did not exhibit typical diurnal variations, in contrast to somatotropin and insulin, which increased particularly after concentrate intake. Somatomedin C markedly decreased at parturition and reached lowest values around the peak of lactation, while levels of somatotropin, nonesterified fatty acids and ketone bodies were high and those of glucose, insulin, thyroxine and triiodothyronine were low. Thereafter somatomedin C values slowly increased up to the 12th week of lactation and remained elevated. Low energy and protein balances were characterized by particularly low somatomedin C concentrations. An additional protein deficit at peak lactation, when cows were already provided with low amounts of energy, did not further decrease somatomedin C levels. However, when high amounts of energy were given in the form of starch or crystalline fat, somatomedin C increased. Overall, there was a positive correlation of somatomedin C primarily with energy, but also with protein balances and a negative correlation with milk yield. Conversely, somatotropin increased markedly after parturition and was positively correlated with milk production and negatively with protein and energy balances. Thus, somatomedin C levels were paradoxically low in the presence of high circulating somatotropin. Insulin most closely paralleled somatomedin C levels. Therefore the anabolic state of metabolism at the end of pregnancy was characterized by high somatomedin C and insulin and relatively low somatotropin, whereas the catabolic state of early lactation was characterized by high somatotropin, low somatomedin C, insulin and thyroid hormone

Lean Transformation in Healthcare a Case Study at Skaraborgs Sjukhusgrupp

The quality of the Swedish healthcare has a prominent position internationally, but long queues for various treatments, are today often criticized and debated. However, patient queues and delays are often not the result of resource problems - they are the result of ow problems. The trend in recent years has been a knowledge transfer from the manufacturing industry to healthcare on how to create ow. Lean Manufacturing, which originates from the Toyota production system, has received a lot of attention. While Lean Manufacturing is a well described management framework, the proceeding to become \Lean", referred to as a \Lean Transformation" is considered more contextual. This study, conducted in 2010, investigates how to achieve sustainable Lean Transformations in the context of the Swedish healthcare system, with a focus on the patient ow through surgery departments. The methodology was designed as a qualitative case study, with a triangulation of data sources: a main case (KSS Sk ovde) and a reference case (SUS Lund), combined with the breadth of view from literature. In the main case, the author participated in a process improvement team as an action researcher. The reference case was investigated with interviews. The concrete measures identified on how to improve the patient ow, are very similar between the two cases, and are also well in line with basic Lean concepts. This suggests that other Swedish hospitals, who are in the beginning of a Lean transformation, have much to gain from studying the findings from others. The great challenge is however to create sustainability, which is basically a question of suitable leadership and cultural change. Even if these areas are less tangible, the issues and findings from the two cases have a lot in common, most of which references can be found in Lean literature. The report also discusses how Lean is not an option in the healthcare system - it is a necessity. Moreover, it is argued why the entrepreneurial drive is something that possibly needs attention in the healthcare Lean work, despite the Lean literature in general advocates the opposite

“When Will the Time Finally Come When There Will Only Be Humans”: An Unknown Letter from Beethoven to Heinrich von Struve

Transcription, translation, and discussion of a recently discovered letter from Ludwig van Beethoven to Heinrich von Struve from 1795. In the letter, Beethoven expresses a yearning for a time when there are only humans, without distinctions of rank and class. This sentiment accords with Schiller’s ode An die Freude, which Beethoven set to music more than once