Health plan pricing behaviour and managed competition

In the Dutch social health insurance scheme, health plans operate in a managed competition framework. Essential features of this framework are risk adjustment, open enrolment and community rating. The objective is to study how health plans determine their community rated premiums. Using a panel data set for all health plans operating in the Dutch social health insurance market over the period 1996-2004, we estimate a premium model to determine which factors explain the price setting behaviour of health plans. Our empirical results indicate that competition did not play a major role in premium setting by health plans. We find that financial stability rather than profit maximisation offers the best explanation for health plan pricing behaviour. The forecast of next year's health-care expenditure by the government and the adjusted forecast by the insurers' association play a major role in health plans' pricing decisions. The introduction of a national health insurance scheme in 2006 urged all citizens to reconsider their health plan choice. The threat of losing customers had a profound impact on health plans' pricing behaviour. In sharp contrast to the period 1996-2005, in 2006 competition seems to play a dominant role in insurers' pricing decisions. Whether this will be a temporary or a lasting phenomenon is hard to predict.

Implemetasi Data Warehouse pada Bagian Pemasaran Perguruan Tinggi

Transactional data are widely owned by higher education institutes, but the utilization of the data to support decision making has not functioned maximally. Therefore, higher education institutes need analysis tools to maximize decision making processes. Based on the issue, then data warehouse design was created to: (1) store large-amount data; (2) potentially gain new perspectives of distributed data; (3) provide reports and answers to users' ad hoc questions; (4) perform data analysis of external conditions and transactional data from the marketing activities of universities, since marketing is one supporting field as well as the cutting edge of higher education institutes. The methods used to design and implement data warehouse are analysis of records related to the marketing activities of higher education institutes and data warehouse design. This study results in a data warehouse design and its implementation to analyze the external data and transactional data from the marketing activities of universities to support decision making

Angiotensin II and Aldosterone Increase with Fasting in Breeding Adult Male Northern Elephant Seals (Mirounga angustirostris)

The renin‐angiotensin‐aldosterone system (RAAS) appears to contribute significantly to osmoregulation of fasting northern elephant seal (Mirounga angustirostris) pups; however, RAAS has not been characterized in fasting adult seals. Therefore, this study examined the contribution of RAAS to water turnover rates in fasting adult male northern elephant seals. Blood samples were obtained twice during their breeding fast at an interval of 6.5 wk, and water efflux rate was estimated by isotopic dilution during the same period. Serum electrolytes (Na+, K+, Cl−) and osmolality were unaltered between the two sampling periods, indicating ionic and osmotic homeostasis during the fast. Despite the lack of an increase in vasopressin, serum angiotensin II and aldosterone were increased and were significantly and positively correlated. Changes in aldosterone concentration and water efflux rate were significantly and negatively correlated, suggesting that the greater the increase in aldosterone, the smaller the loss of water. Adult male seals maintain ionic and osmotic homeostasis similar to that of fasting weaned pups, and this homeostasis appears to be mediated, at least in part, by RAAS, which probably contributes to increased water retention as well. The hormonal mechanisms by which northern elephant seals maintain water and electrolyte balance during fasting conditions appear to be similar regardless of age

The role of interstitial binding in radiation induced segregation in W-Re alloys

Due to their high strength and advantageous high-temperature properties, tungsten-based alloys are being considered as plasma-facing candidate materials in fusion devices. Under neutron irradiation, rhenium, which is produced by nuclear transmutation, has been found to precipitate in elongated precipitates forming thermodynamic intermetallic phases at concentrations well below the solubility limit. Recent measurements have shown that Re precipitation can lead to substantial hardening, which may have a detrimental effect on the fracture toughness of W alloys. This puzzle of sub-solubility precipitation points to the role played by irradiation induced defects, specifically mixed solute-W interstitials. Here, using first-principles calculations based on density functional theory, we study the energetics of mixed interstitial defects in W-Re, W-V, and W-Ti alloys, as well as the heat of mixing for each substitutional solute. We find that mixed interstitials in all systems are strongly attracted to each other with binding energies of -2.4 to -3.2 eV and form interstitial pairs that are aligned along parallel first-neighbor strings. Low barriers for defect translation and rotation enable defect agglomeration and alignment even at moderate temperatures. We propose that these elongated agglomerates of mixed-interstitials may act as precursors for the formation of needle-shaped intermetallic precipitates. This interstitial-based mechanism is not limited to radiation induced segregation and precipitation in W-Re alloys but is also applicable to other body-centered cubic alloys.Comment: 8 pages, 7 figure

Developing Novel Platelet-Based Targeting Strategies for Thrombolytics

Use of plasminogen activators (PAs) as thrombolytic drugs is restricted to life threatening thrombotic settings because these therapies are associated with a high risk of bleeding. We hypothesize that platelet-delivered PAs would preferentially lyse nascent, pathological clots that are actively recruiting platelets, while sparing pre-formed hemostatic clots. Two potential approaches were pursued: 1) PA-loaded platelets that release the thrombolytic from its granular stores upon activation, and 2) a thrombolytic chimeric protein that specifically binds to human platelets and activated when the platelets are incorporated into a growing thrombus. In our first approach, we desired to develop a strategy for producing platelets ex-vivo from cultured megakaryocytes that ectopically expressed urokinase-PA (uPA). No group had successfully produced sufficient ex-vivo generated platelets before, to side step this issue we infused ex-vivo generated megakaryocytes and showed that we can achieve a significant number of donor-derived platelets from these infused megakaryocytes in a murine model. The resulting platelets were normal in size, surface markers, circulating half-life, and were functional. Infused megakaryocytes localized to the pulmonary vasculature to shed platelets. We demonstrated, beginning with megakaryocytes derived from a transgenic mouse that ectopically express and store uPA in their alpha-granules that we can interfere with thrombosis by platelets generated from these megakaryocytes. In the second approach we produced a chimeric protein by fusing a single chain variable fragment (scFv) directed to the human-αIIb (hαIIb) platelet receptor subunit, with a human thrombin activatable pro-urokinase (uPA-T). The fusion protein (anti-PLT scFv/uPA-T) bound specifically to human and to transgenic mice platelets that expressed hαIIb, termed hαIIb+ mice, but did not bind to wildtype (WT) mouse platelets. Anti-PLT scFv/uPA-T retained its zymogenic properties until activated by thrombin. HαIIb+ mice were protected from forming occlusive thrombi for at least 10 hrs post anti-PLT/uPA-T treatment in contrast to the short functional half-life of soluble uPA-T. Thus this dissertation presents two distinct strategies that in proof of principle studies are each promising as approaches for effective and targeted platelet directed thrombolytic, which merit further study to test clinical applicability

A Chandra observation of GRO J1744-28: the bursting pulsar in quiescence

We present a Chandra/ACIS-I observation of GRO J1744-28. We detected a source at a position of R.A = 17h 44m 33.09s and Dec. = -28degr 44' 27.0'' (J2000.0; with a 1sigma error of ~0.8 arcseconds), consistent with both ROSAT and interplanetary network localizations of GRO J1744-28 when it was in outburst. This makes it likely that we have detected the quiescent X-ray counterpart of GRO J1744-28. Our Chandra position demonstrates that the previously proposed infrared counterpart is not related to GRO J1744-28. The 0.5-10 keV luminosity of the source is 2 - 4 x 10^{33} erg/s (assuming the source is near the Galactic center at a distance of 8 kpc). We discuss our results in the context of the quiescent X-ray emission of pulsating and non-pulsating neutron star X-ray transients.Comment: Accepted for publication in ApJ Letters, 20 February 200

Hormone and Metabolite Changes associated with Extended Breeding Fasts in Male Northern Elephant Seals (Mirounga Angustirostris)

We measured metabolic hormones and several key metabolites in breeding adult male northern elephant seals to examine the regulation of fuel metabolism during extended natural fasts of over 3 months associated with high levels of energy expenditure. Males were sampled twice, early and late in the fast, losing an average of 23% of body mass and 47% of adipose stores between measurements. Males exhibited metabolic homeostasis over the breeding fast with no changes in glucose, non-esterified fatty acids, or blood urea nitrogen. Ketoacids increased over the fast but were very low when compared to other fasting species. Changes within individuals in total triiodothyronine (tT3) were positively related to daily energy expenditure (DEE) and protein catabolism. Differences in levels of thyroid hormones relative to that observed in weaned pups and females suggest a greater deiodination of T4 to support the high DEE of breeding males. Relative levels of leptin and ghrelin were consistent with the suppression of appetite but a significant reduction in growth hormone across the fast was contrary to expectation in fasting mammals. The lack of the increase in cortisol during fasting found in conspecific weaned pups and lactating females may contribute to the ability of breeding males to spare protein despite high levels of energy expenditure. Together these findings reveal significant differences with conspecifics under varying nutrient demands, suggesting metabolic adaptation to extended high energy fasts

Normalized Legal Drafting and the Query Method

Normalized legal drafting is a mode of expressing ideas in statutes, regulations, contracts, and other legal documents in such a way that the syntax that relates the constituent propositions is simplified and standardized. This normalization results in documents that are easier to understand in the dual sense that they can be read faster and more accurately than corresponding documents that are not normalized. The query method is a technique for familiarizing learners with normalized drafting and providing practice in some of the easier aspects of doing it