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Medical Sciences	75%

Selected Abstracts

Florida's Pension Election: From DB to DC and Back

JOURNAL OF RISK AND INSURANCE, Issue 3 2004
Moshe A. Milevsky
During the year 2002, the State of Florida's 600,000 public employees were given the choice of converting their traditional defined benefit (DB) pension plan into an individual-account defined contribution (DC) plan with full control over asset allocation and investment decisions. To mitigate some of the risk and uncertainty in the decision, the State granted each employee electing the DC plan an additional option to switch back (i.e., change their mind once) at any point prior to retirement. This option has been labeled the 2nd election by the State and the cost of reentry is fixed at the accumulated benefit obligation of their pension entitlement, which is the present value of the life annuity. Our article presents some original analytic insights relating to the optimal time and financial value of this unique 2nd election. Although our model is deterministic in nature, we believe that it provides a number of intuitive insights that are quite robust. Our results can be contrasted with Lachance, Mitchell, and Smetters (2003). We estimate that the increase in retirement wealth that arises from having the 2nd election is equivalent to at most 30 percent in future value, and only when utilized optimally. Furthermore, for most State employees above the age of 45, the 2nd election has little economic value because the DB plan dominates the DC plan from day one. Of course, it remains to be seen what percent of Florida's 600,000 employees will elect to behave rationally with their newfound pension autonomy. [source]

Rapid improvement of recalcitrant disseminated granuloma annulare upon treatment with the tumour necrosis factor-, inhibitor, infliximab

BRITISH JOURNAL OF DERMATOLOGY, Issue 3 2005
M.S. Hertl
Summary Granuloma annulare (GA) is a chronic inflammatory disorder of unknown aetiology, which is characterized clinically by erythematous plaques preferentially localized to the distal extremities, although disseminated variants exist. In light of the chronic relapsing nature of GA and lack of satisfactory treatment options, we initiated treatment with infliximab in a patient with chronic disseminated GA that was recalcitrant to standard treatment. The 59-year-old female patient with insulin-dependent diabetes had experienced GA lesions for more than 4 years despite various systemic and topical treatments. Systemic glucocorticoids were not a therapeutic option because of the preexisting unstable insulin-dependent diabetes. Infliximab was administered intravenously at 5 mg kg,1 day,1 at weeks 0, 2 and 6 and thereafter at a monthly interval for an additional 4 months. Most of the GA plaques resolved within 4,6 weeks, leaving postinflammatory brownish macules. Newly arising plaques disappeared within 2 weeks and new GA lesions were not observed during the entire observation period of more than 16 months. Infliximab may be an additional option in the treatment of recalcitrant forms of GA as well as in other chronic granulomatous skin disorders, such as sarcoidosis and necrobiosis lipoidica. [source]

Lower airway humidification in spontaneously breathing tracheostomized patients: Comparative study of trachea spray versus heated humidifier

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2008
Tilman Keck MD
Abstract Background. Our aim was to compare inhalation with molecular water (vaporizing humidifier) and particulate water (trachea spray) in spontaneously breathing tracheostomized patients. Methods. We performed a randomized, 2-way crossover study and a prospective, comparative, nonblinded study. Tracheal humidity and temperature were measured before and after use of a humidifier and spray for 1 week. Results. After both inhalation and spray, the tracheal temperature and total water content increased significantly (study 1). The temperature gradient between ambient and tracheal air was significantly higher after spray, but not after inhalation (study 2). The water gradient increased nonsignificantly after spray and inhalation. The water gradient after inhalation or spray did not differ significantly. Conclusions. Molecular water is not superior to particulate water because of temperature and humidity increase after both forms of water delivery. Because of its easy use, portability, and moisturizing effect, a trachea spray may offer additional options in postoperative tracheostomy care. © 2007 Wiley Periodicals, Inc. Head Neck, 2008 [source]

Pancreatic stem cells: a therapeutic agent that may offer the best approach for curing type 1 diabetes

PEDIATRIC DIABETES, Issue 4 2001
M Chaudhari
Chaudhari M, Cornelius JG, Schatz D, Peck AB, Ramiya VK. Pancreatic stem cells: a therapeutic agent that may offer the best approach for curing type 1 diabetes. Abstract: Type 1 (insulin-dependent) diabetes is one of the most costly chronic diseases of children and adolescents in North America and Europe. It occurs in genetically predisposed individuals when the immune system attacks and destroys specifically the insulin-producing beta cells of the pancreatic islets of Langerhans. Although routine insulin injections can provide diabetic patients their daily insulin requirements, non-compliance commonly results in blood glucose excursions that eventually lead to microvascular and macrovascular complications and early death. The only real ,cure' for type 1 diabetes is replacement of the beta-cell mass which, today, is either an ectopancreatic transplant or an islet of Langerhans implant. Two new developments may offer additional options: surrogate, non-endocrine cells genetically modified to secrete insulin in response to high blood glucose levels; and stem cells that possess the capacity to differentiate to endocrine pancreas. In this short review, we discuss the efforts currently being made to regulate pancreatic stem cell growth in order to produce large numbers of functional islets that can be used as implants. Hopefully, autologous stem cell-derived islet cell implants without lifelong immunosuppressive therapy may one day be realized. [source]