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This theoretical study draws on the insights of Georg Wilhelm Friedrich Hegel to suggest certain aspects of communities and other groups that would tend to make them more resilient in the face of climate change. While Hegel addresses resilient dimensions at the societal level, this study interprets Hegel's work to derive aspects of groups within society that would tend to make them resilient.

The properties of endodontic glass ionomer sealers are summarized and compared to properties of Grossman's ideal sealer and a typical ZOE sealer. A review of the literature regarding glass ionomer and other endodontic sealers also is included. Endodontic glass ionomer sealer appears to be an alternative to conventional ZOE sealers in canals that are adequately isolated, instrumented, and dried.

The effects of endodontic irrigants and calcium hydroxide on lipopolysaccharide (LPS; endotoxin) were analyzed using the highly selective technique of mass spectrometry/gas chromatography with selected ion monitoring. An aqueous solution of LPS was mixed with one of a variety of endodontic irrigants for 30 min. Because it is a commonly used interappointment dressing, calcium hydroxide was also applied to LPS for 1, 2, or 5 days. LPS inactivation was measured by quantitation of free fatty acid release. Water, EDTA, ethanol, 0.12% chlorhexidine, chlorhexidine + sodium hypochlorite, and sodium hypochlorite alone showed little breakdown of LPS. Long-term calcium hydroxide--as well as 30-min exposure to an alkaline mixture of chlorhexidine, ethanol, and sodium hypochlorite--did detoxify LPS molecules by hydrolysis of ester bonds in the fatty acid chains of the lipid A moiety.

Bacteria from infected root canals can invade dentinal tubules, thus dentin disinfection is an important aspect of endodontic therapy. This study compares three endodontic irrigants for efficiency in killing bacteria established within human dentinal tubules. Root canals in extracted teeth were prepared and sterilized. Broth cultures of Enterococcus faecalis were allowed to grow within the canals to penetrate dentinal tubules. The infected canals were exposed individually to each of the irrigants for 1 min. Irrigants were 0.525% sodium hypochlorite, Tubulicid (0.2% EDTA), and 0.12% chlorhexidine (Peridex). Sterile water was the control. Viable bacteria were analyzed by drilling incrementally into dentin from the cementum toward the canal. Smaller diameter drills were used for each depth. Shavings were cultured at three depths, for each of three root levels: coronal, midroot, and apical. Although considerable variation occurred between roots, sodium hypochlorite seemed to be superior. Tubulicid and Peridex were better than water. More bacteria remained viable at greater distances from the pulp. These observations apparently apply to all levels in the canal.

17a of the German hospital financing law constitutes the basis for the evaluation of not justified hospital admission. It demands not to admit patients into hospital who do not need inpatient treatment or, treat them in an inpatient-setting longer than medical required. Unjustified inpatient treatment results from faulty decision with regard to admission, to adequate intensity of medical care or duration of stay. The priority of outpatient treatment over the pre-, post-, partial and complete inpatient treatment must be taken into consideration at each decision. The following items can indicate unjustified inpatient treatment already prior to the detailed examination of a hospital; length of stay higher than average, a lot of patients staying only a short time, high rate of self-admission, long preoperative period, inadequate relations between age and diagnosis groups, increasing frequency of unspecified symptoms and syndromes in the main treatment diagnosis, peculiarities concerning the categorisation of nursing care etc. The systematic approach to the analysis of unjustified hospital admission requires the evaluation of clinical pictures with the question as to the primary necessity of inpatient treatment, the adequate length of stay and whether there are alternatives of medical care as an outpatient. Testing parameters are, among others, occasion of admission, severity of illness, indication for complete in-patient treatment, utilisation of alternatives to medical care (outpatient, pre-, post-, partial inpatient treatment), adequacy of diagnostic or therapeutic intervention with regard to the disease, intensity, respectively chronological sequence of medical procedures, efficiency of organizational processes, transfer or discharge in time. The evaluation of unjustified admission to inpatient treatment should be conducted with a systematic approach including standardised methods and an adequate sample size on the basis of the individual medical report. In 1995 an outline as to testing of unjustified hospital admission as already presented by Bundes-Arbeltsgemeinschaft der Medizinischen Dienste der Krankenversicherung.

The structural Health Care Law (GSG) of the Federal Republic of Germany provides in section 275a, Volume V of the Social Legislation Code (SGB), for a model project to assess the necessity of hospital admittances. To facilitate a comparison on a national level it is intended that in each Federal state one hospital from each of the different levels of provision, which are established regionally by each state, should be included in the model project. In Schleswig-Holstein all admissions to the departments of internal medicine and surgery of the participating hospitals-over 2 periods of 3 weeks in both 1994 and 1995-will be examined retrospectively on the basis of the medical records, this examination being carried out by specialist physicians from the Medizinischer Dienst der Krankenversicherung-MDK (Medical Service of the Health Insurance Funds). The data required is presently collected in three parts: The first part includes all the structural and associated data of the catchment area of each particular hospital. The second part collects all relevant data on patients, this data being rendered anonymous and collected using software specially developed by a national team of the MDK. The third part of the examination of data requires a specialist evaluation of the necessity of each recorded hospital admittance to be made by the specialist physician of the MDK. The results of each part are being evaluated by the MDK Schleswig-Holstein.(ABSTRACT TRUNCATED AT 250 WORDS)

The new Health Care Structural Law (GSG) brings about changes in e.g. medical care in hospitals, the consequences of which are of utmost significance. New forms of payment challenge hospitals to take into account in the hospital management the various forms of payment, to define new programmes of hospital performance and the realise competitive aspects while maintaining the quality of medical care. For the first time ever the new system of nursing fees focuses on the performance of the hospital instead of on its costs. The GSG induces a need to act in various areas of medical care in hospitals: The nursing staff regulation and the psychiatry staff ordinance require a procedure that leads to feasible results in contract negotiations, planning decisions and budget negotiations. In the model project in accordance with section 275a SGB V the necessity of the stay in hospital will be examined to verify that ambulant medical care takes precedence over medical care in hospital. The implementation of section 301 SGB V "Hospitals" is to guarantee a correct accounting with hospitals and is intended to enable the statutory health insurance institutions to perform their task as established by law to examine the necessity and duration of patient's stay in hospital. The evaluation and implementation of these tasks require solutions that do not focus on the individual case but lead to a systematic approach. Future examination procedures have to take the local conditions into account. The contents of the examinations must be standardised to facilitate a comparison on a regional and national level.

The search for a precise metabolic explanation for the capacity of some individuals to resist the development of dietary-induced hypercholesterolemia, thus avoiding attendant cardiovascular atherosclerotic complications, has long been the focus of our research. From 1 New Zealand white rabbit that failed to show any cholesterolemic response, we have, over the course of 10 years, established a partially inbred strain of strongly cholesterol-resistant rabbits. This achievement has resulted in the production of a large number of cholesterol-resistant animals for study; more importantly, it has shown that a strong genetic factor operates in dietary regulation of plasma cholesterol levels. We have focused our research on the different possibilities associated with this genetic predisposition. Since the cholesterol-resistant rabbits do not accumulate cholesterol or its esters in plasma or in any tissue compartments, we investigated several biochemical pathways involved in cholesterol metabolism. We have recently concentrated on the enzyme cholesterol 7 alpha-hydroxylase and liver bile acid metabolism. We have cloned the complete gene and partial cDNAs for cholesterol 7 alpha-hydroxylase from both normal and cholesterol-resistant rabbits. This has allowed the discovery of changes in the transcription of this gene in the cholesterol-resistant rabbits compared with normal littermates. These cholesterol-resistant rabbits have provided a model demonstrating that there are biological means to prevent large dietary loads of cholesterol from accumulating in plasma or tissues. Our hypothesis is that cholesterol-resistant animals increase cholesterol turnover by increasing bile acid excretion, thus providing a way to reduce plasma cholesterol of either dietary or endogenous origin. The methods and observations of our research are presented chronologically in this review.

A retrospective study was performed on all cases of malaria recorded in the Federal Republic of Germany between 1963 and 1988. The questionnaires evaluated by the Federal Bureau of Public Health showed a total of 8049 cases, of which 3991 concerned malaria tropica, and 173 deaths. During this 26-year period, 90% of the patients suffering from malaria tropica had contracted the disease in Africa. Deaths from malaria had shown a constant figure of almost 10% between 1963 and 1978, but after that there was a distinct drop. Differentiated analysis revealed that between 1979 and 1988 the death rate for malaria tropica acquired in Africa had been 3.3%. This was clearly dependent on chemoprophylaxis behaviour, on the time of initiation of treatment and on the age of the patients; if tablets were taken regularly, the death rate was 2.3%, rising to 3.1% on irregular intake and to 5.4% without chemoprophylaxis. If therapeutic measures were initiated on the 1st to 5th day of onset, the death rate was 0.6%, on the 6th to 10th day 2.4%, on the 11th to 15th day 2.5% and on the 16th to 20th day 16.7%. In the age group between 60 and over 60 years the lethality was 15.9%. In the course of this study the authors worked out a new malaria questionnaire for the Federal Bureau of Public Health.

An assay which permitted a comparison of insulin receptor tyrosine phosphorylation induced under in vivo and in situ conditions was developed. It was demonstrated that the level of tyrosine phosphorylation of the receptor induced by insulin under in situ conditions exceeded by 2.3-fold the level of tyrosine phosphorylation induced under in vitro conditions. In addition, chronically treated, down-regulated cells demonstrated a significant decrease in the level of insulin receptor tyrosine phosphorylation compared to cells acutely treated with insulin. The procedure utilized an antibody specific for the insulin receptor which allowed separation of the receptor from other cellular proteins which are potential substrates for tyrosine phosphorylation. A second iodinated antibody specifically directed against phosphotyrosine residues allowed quantitation of the phosphorylated residues. Since the use of 32P-labeled substrates for phosphorylation was not required, this procedure allowed a comparison of protein phosphorylation induced under in vitro and in situ conditions. This procedure should permit investigations into the roles of other cellular factors, such as phosphatases and serine kinases, in modulating protein tyrosine phosphorylation.

A simple method is described for the purification of murine monoclonal antibodies of the IgM class. Ascites fluid was subjected to ammonium sulfate precipitation. The precipitate was redissolved and dialyzed and subsequently subjected to gel filtration chromatography on Ultrogel AcA22 and finally ion exchange chromatography on DEAE-Sepharose. The purity of the antibody was assessed by reducing SDS gel electrophoresis, and estimated to be greater than 85% pure after gel filtration, and greater than 95% pure after the ion exchange chromatography. The immuno-activity of the antibody was assessed throughout the purification scheme by the ability of the antibody to bind to immunogen immobilized to nitrocellulose. Approximately 50% antibody activity was recovered from this purification scheme after gel filtration, but only 10% of the initial activity could be recovered after ion exchange chromatography. This result with ion exchange chromatography underscores the lability of IgM antibodies to immobilization. Therefore, if the recovery of immunoreactive IgM antibody is a goal, purification schemes of IgM antibodies should avoid ion exchange or affinity chromatography.