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PubMed1999

Improvements in human health through production of human milk proteins in transgenic food plants.

Plants are particularly suitable bioreactors for the production of proteins, as their eukaryotic nature frequently directs the appropriate post-translational modifications of recombinant proteins to retain native biological activity. The autotrophic growth of plants makes this in vivo biosynthesis system economically competitive for supplementation or replacement of conventional production systems in the future. For the production of biologically active proteins, food plants provide the advantage of direct delivery via consumption of transformed plant tissues. Here we describe the production of recombinant human milk proteins in food plants for improvements in human nutrition and health, with emphasis on enhanced nutrition for non-breast fed infants as well as children and adults. Nutritional improvements in edible plants generated through advancements in recombinant DNA technology are rapidly repositioning the world for enjoyment of a more healthful diet for humans in all age groups.

Adult↗
PubMed1985

The two "faces" of Antillean prostitution.

Prostitutes who operate in the refinery town of St. Nicholas, the second largest urban center in Aruba, Netherlands Antilles, fall into two categories: temporary migrants from Colombia, who live and work for 3-month periods in the saloon-cribs along the main street; and permanently resident Dominican Republicans, who live and work in the village ghetto. The Colombians receive encomia, the Dominican Republicans, opprobria. In addition to addressing the differential statuses, prognoses, and earnings of the two groups, this paper also examines the historical background to the development of the differential assessments and offers ethnographic support for the continuation of the structural oppositions that separate the two groups. It is suggested that local perceptions of "other" people (including prostitutes) are tied to specific social and economic circumstances. Variables such as economic competition, ethnicity, length of employment in a low-status occupation, and the generally favored position accorded to "people like us," in contrast to the negative attitude held toward "people like them," are examined in terms of their relevance to the differential status of the two groups. It is also suggested that the underlying as well as the overt bases for these stereotypical ascriptions may have broader applicability: differential rather than unilateral assessments may indeed be the norm rather than a peculiarly Antillean perception.

Colombia↗
PubMed2003

[Clinical pathways: effective and efficient inpatient treatment].

The new hospital funding system based on a diagnosis-related group (DRG) system and the economic competition involved require large-scale changes in hospital structures and processes. Clinical pathways are multidisciplinary plans of best clinical practice for specified groups of patients with a particular diagnosis that aid the coordination and delivery of high quality care. The clinical pathway originally used in the USA and Australia was aimed at shortening the hospital stay and reducing healthcare costs, which has become an increasingly important issue in medicine. Furthermore, it is an appropriate tool to standardize medical care and increase patient satisfaction. Clinical pathways are able to standardize care for patients with a similar diagnosis, procedure, or symptom. There are four essential components of a clinical pathway: a timeline, the categories of care or activities and their interventions, intermediate- and long-term outcome criteria, and the variance record. In contrast to practice guidelines, protocols, and algorithms, clinical pathways are utilized by a multidisciplinary team and focus on quality and coordination of care.

Algorithms↗
PubMed2006

Renewable stationary phase liquid magnetochromatography: determining aspartame and its hydrolysis products in diet soft drinks.

A new chromatographic modality that does not require high pressures and also allows renewal of the stationary phase as desired is reported. The technique is based on a thin layer paramagnetic stationary phase (Fe3O4-SiO2) retained on the inner wall of a minicolumn through the action of an external magnetic field, which also plays an important role in separating the analytes. Accordingly, the name "renewable stationary phase liquid magnetochromatography", or RSP-LMC, has been proposed for it. The technique was used to separate and quantify the sugar substitute alpha-aspartame and its constituent amino acids (hydrolysis products), L-aspartic acid and L-phenylalanine, in diet fizzy soft drinks. When the results obtained for alpha-aspartame were compared with those obtained using HPLC as a reference method, no significant differences were observed. The system proposed is fully automated, making it an economic, competitive alternative to conventional methods of determining alpha-aspartame and its amino acid components.

Journal Article↗
PubMed2005

Feasibility of acrylic acid production by fermentation.

Acrylic acid might become an important target for fermentative production from sugars on bulk industrial scale, as an alternative to its current production from petrochemicals. Metabolic engineering approaches will be required to develop a host microorganism that may enable such a fermentation process. Hypothetical metabolic pathways for insertion into a host organism are discussed. The pathway should have plausible mass and redox balances, plausible biochemistry, and plausible energetics, while giving the theoretically maximum yield of acrylate on glucose without the use of aeration or added electron acceptors. Candidate metabolic pathways that might lead to the theoretically maximum yield proceed via beta-alanine, methylcitrate, or methylmalonate-CoA. The energetics and enzymology of these pathways, including product excretion, should be studied in more detail to confirm this. Expression of the selected pathway in a host organism will require extensive genetic engineering. A 100,000-tons/year fermentation process for acrylic acid production, including product recovery, was conceptually designed based on the supposition that an efficient host organism for acrylic acid production can indeed be developed. The designed process is economically competitive when compared to the current petrochemical process for acrylic acid. Although the designed process is highly speculative, it provides a clear incentive for development of the required microbial host, especially considering the environmental sustainability of the designed process.

Acrylates↗
PubMed2005

[Cardiovascular medicine in the German diagnosis-related group--(G-DRG) system 2005].

The German diagnosis-related Group (G-DRG) System has recently been published in its third version. From 2005 on, this system will be the definite measure for the budgets of nearly all german hospitals. The preliminary phase with no budget reduction or redistribution being made and in which an inappropriate classification system had no negative impact on reimbursement has, thus, come to an end. At present, many hospitals are struggling in an economic competition about the independence or maintenance of the hospital or several sub-departments. The changes in the classification system with regard to a marked increase in the number of G DRGs, a modified grouping-logic, more properly determined reductions and extra charges for low and high outlier as well as the introduction of further additional charges contribute thereby to a better covering of services and treatments of cardiovascular patients. However, while many of the known problems have been eliminated, there are still weaknesses in the G-DRG System even concerning cardiovascular medicine. The G-DRG System has to be adapted continuously with consultation of the clinical expertise of the respective medical societies. The most important new aspects and changes in the G-DRG System 2005 and the accompanied execution regulations are explained with special view on cardiology.

Ambulatory Surgical Procedures↗
PubMed2004

Drug price regulation under consumer moral hazard. Two-part tariffs, uniform price or third-degree price discrimination?

Drug price differences across national markets as they exist in the EU are often justified by the concept of Ramsey prices: with fixed costs for R&D, the optimal mark-ups on marginal costs are inversely related to the price elasticity in the individual markets. This well-known result prevails if consumer moral hazard is taken into account. Contrary to the situation without moral hazard, the uniform price does not necessarily dominate discriminatory pricing in welfare terms. The two-part tariff is a better alternative as it allows governments to address moral hazard. A uniform price combined with lump-payments reflecting differences in the willingness to pay and the moral hazard in member states appears to be an attractive option for a common EU drug market.

Cost Control↗
PubMed1986

Development of a computerized reference retrieval system: a behavior therapy training tool.

The vastness of the behavior therapy literature base often poses problems for beginning therapists who need greater familiarity with assessment and intervention literature. Hence a computerized reference retrieval system was developed for trainees to access behavior therapy references efficiently. The system contains over 1600 references from 158 problem categories and is economically competitive with commercial systems. Similar systems can be established using currently available microcomputer technology. The present system is primarily used by doctoral and masters students to assist in case conceptualizations and decision making during practicum courses.

Behavior Therapy↗
PubMed1994

Global information infrastructure.

The High Performance Computing and Communications Program (HPCC) is a multiagency federal initiative under the leadership of the White House Office of Science and Technology Policy, established by the High Performance Computing Act of 1991. It has been assigned a critical role in supporting the international collaboration essential to science and to health care. Goals of the HPCC are to extend USA leadership in high performance computing and networking technologies; to improve technology transfer for economic competitiveness, education, and national security; and to provide a key part of the foundation for the National Information Infrastructure. The first component of the National Institutes of Health to participate in the HPCC, the National Library of Medicine (NLM), recently issued a solicitation for proposals to address a range of issues, from privacy to 'testbed' networks, 'virtual reality,' and more. These efforts will build upon the NLM's extensive outreach program and other initiatives, including the Unified Medical Language System (UMLS), MEDLARS, and Grateful Med. New Internet search tools are emerging, such as Gopher and 'Knowbots'. Medicine will succeed in developing future intelligent agents to assist in utilizing computer networks. Our ability to serve patients is so often restricted by lack of information and knowledge at the time and place of medical decision-making. The new technologies, properly employed, will also greatly enhance our ability to serve the patient.

Computer Communication Networks↗
PubMed1991

NASA spinoffs to bioengineering and medicine.

Through the active transfer of technology, the National Aeronautics and Space Administration (NASA) Technology Utilization (TU) Program assists private companies, associations, and government agencies to make effective use of NASA's technological resources to improve U.S. economic competitiveness and to provide societal benefit. Aerospace technology from areas such as digital image processing, space medicine and biology, microelectronics, optics and electrooptics, and ultrasonic imaging have found many secondary applications in medicine. Examples of technology spinoffs are briefly discussed to illustrate the benefits realized through adaptation of aerospace technology to solve health care problems. Successful implementation of new technologies increasingly requires the collaboration of industry, universities, and government, and the TU Program serves as the liaison to establish such collaborations with NASA. NASA technology is an important resource to support the development of new medical products and techniques that will further advance the quality of health care available in the U.S. and worldwide.

Aerospace Medicine↗
PubMed1989

Economics of practice and inpatient care.

The nature and structure of inpatient psychiatric services are rapidly evolving. This article identifies and explores how these changes are being influenced by four interrelated areas: rapid growth in general and private hospital psychiatric practice; increased connections of public, private, and voluntary sectors of care; the emergence and quick acceptance of capitated and managed care programs; and dramatic change and growth in the insurance industry. These four interrelated areas further the development of a two-tier system in psychiatry: one for those with insurance, and one of the poor and the severely disabled. The changes in these four areas have also led to greater demand for increased economic competition among services, and new alliances and innovations in the delivery of treatment. This article discusses how the four areas have combined to support a two-tier system and how they are likely to affect the future evolution of general and private hospital inpatient psychiatric practice.

Cost Control↗
PubMed1987

Market share and the illusion of power. Can Blue Cross force hospitals to discount?

Researchers in health care financing have claimed that large private insurers like Blue Cross frequently exercise monopsony power to obtain discounts from normal hospital charges. They claim that the monopsony power derives from a large Blue Cross share of a given hospital 'cost shifting', whereby hospitals offset the discount by raising charges to less powerful customers. This paper re-examines both theoretically and empirically the conditions necessary for a private insurer to extract discounts from a hospital. We demonstrate that the theoretical conditions necessary for Blue Cross to force a discount do not exist in the Indiana market. Using revenue data from 110 Indiana hospitals we reject the traditional claim that Blue Cross pays less than other insurers as a function of market share.

Blue Cross Blue Shield Insurance Plans↗