When is it OK to ration healthcare? We must rationally and fairly make decisions about life-saving resources.
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National policy on organ transplantation is made by the United Network for Organ Sharing (UNOS), a representative body composed of health care professionals and patients. Standardized criteria for determining when a patient should be placed on the waiting list for heart transplantation are now in effect nationwide. Current and future directions to maximize the utilization of available donated organs are explored.
With a system of modeling, simulation, animation of information, communication in medicine (mosaic-m) the structures of organisation and information in a level 1 trauma center were analysed and animated as a virtual environment on screen in a first step. One result: in existing paper orientated documentation 50% of documentation was redundant. In a second step the requirements of the future information system were described systematically, user- and organisation-oriented. All components (hard- and software) were simulated an screen that the user could work virtually in the future working place. With mosaic-m the user is fully integrated in analysing and developing a new information system in the clinic.
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The successful attempt is presented to engineer an enzyme with respect to its technical application by the use of computer-aided protein design techniques. Based on a modeled 3-D structure a number of mutants of a subtilisin-like protease was designed with the aim to increase its washing performance. The model of the highly alkaline subtilisin protease OPTICLEAN from Bacillus alcalophilus was developed by the process of 'modeling by homology' starting with the structure of subtilisin Carlsberg 1CSE.BRK from the Brookhaven protein databank. Amino acid changes and deletions were performed with the graphic protein design program BRAGI. Force field calculations and molecular dynamic simulations were made with AMBER 3.0. The comparison of the model and the later solved X-ray structure of OPTICLEAN shows a high similarity between the two structures. On the other hand, interesting deviations between the two structures were observed in some external loop regions. The comparison shows that the deviations are due to difficulties in the prediction of correct main chain torsion angles of additional prolines and the selection of correct loops in deletion or insertion regions.
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