Health care network formation and policyholders' welfare

We develop a model in which two insurers and two health care providers compete for a fixed mass of policyholders. Insurers compete in premium and offer coverage against financial consequences of health risk. They have the possibility to sign agreements with providers to establish a health care network. Providers, partially altruistic, are horizontally differentiated with respect to their physical address. They choose the health care quality and compete in price. First, we show that policyholders are better off under a competition between conventional insurance rather than under a competition between integrated insurers (Managed Care Organizations). Second, we reveal that the competition between a conventional insurer and a Managed Care Organization (MCO) leads to a similar equilibrium than the competition between two MCOs characterized by a different objective i.e. private versus mutual. Third, we point out that the ex ante providers’ horizontal differentiation leads to an exclusionary equilibrium in which both insurers select one distinct provider. This result is in sharp contrast with frameworks that introduce the concept of option value to model the (ex post) horizontal differentiation between providers.

Formation and circulation of the cold intermediate layer in the Gulf of Saint Lawrence

[ 1] The local heat content and formation rate of the cold intermediate layer (CIL) in the Gulf of Saint Lawrence are examined using a combination of new in situ wintertime observations and a three-dimensional numerical model. The field observations consist of five moorings located throughout the gulf over the period of November 2002 to June 2003. The observations demonstrate a substantially deeper surface mixed layer in the central and northeast gulf than in regions downstream of the buoyant surface outflow from the Saint Lawrence Estuary. The mixed-layer depth in the estuary remains shallow (< 60 m) throughout winter, with the arrival of a layer of near-freezing waters between 40 and 100 m depth in April. An eddy-permitting ice-ocean model with realistic forcing is used to hindcast the period of observation. The model simulates well the seasonal evolution of mixed-layer depth and CIL heat content. Although the greatest heat losses occur in the northeast, the most significant change in CIL heat content over winter occurs in the Anticosti Trough. The observed renewal of CIL in the estuary in spring is captured by the model. The simulation highlights the role of the northwest gulf, and in particular, the separation of the Gaspe Current, in controlling the exchange of CIL between the estuary and the gulf. In order to isolate the effects of inflow through the Strait of Belle Isle on the CIL heat content, we examine a sensitivity experiment in which the strait is closed. This simulation shows that the inflow has a less important effect on the CIL than was suggested by previous studies.

Later Pleistocene evolution of the Exe valley: a chronostratigraphic model of terrace formation and its implications for Palaeolithic archaeology

This paper presents the first systematic chronostratigraphic study of the river terraces of the Exe catchment in South West England and a new conceptual model for terrace formation in unglaciated basins with applicability to terrace staircase sequences elsewhere. The Exe catchment lay beyond the maximum extent of Pleistocene ice sheets and the drainage pattern evolved from the Tertiary to the Middle Pleistocene, by which time the major valley systems were in place and downcutting began to create a staircase of strath terraces. The higher terraces (8-6) typically exhibit altitudinal overlap or appear to be draped over the landscape, whilst the middle terraces show greater altitudinal separation and the lowest terraces are of a cut and fill form. The terrace deposits investigated in this study were deposited in cold phases of the glacial-interglacial Milankovitch climatic cycles with the lowest four being deposited in the Devensian Marine Isotope Stages (MIS) 4-2. A new cascade process-response model is proposed of basin terrace evolution in the Exe valley, which emphasises the role of lateral erosion in the creation of strath terraces and the reworking of inherited resistant lithological components down through the staircase. The resultant emergent valley topography and the reworking of artefacts along with gravel clasts, have important implications for the dating of hominin presence and the local landscapes they inhabited. Whilst the terrace chronology suggested here is still not as detailed as that for the Thames or the Solent System it does indicate a Middle Palaeolithic hominin presence in the region, probably prior to the late Wolstonian Complex or MIS 6. This supports existing data from cave sites in South West England.

Inhibition of coxsackie B virus infection by soluble forms of its receptors: Binding affinities, altered particle formation, and competition with cellular receptors

We previously reported that soluble decay-accelerating factor (DAF) and coxsackievirus-adenovirus receptor (CAR) blocked coxsackievirus 133 (CVB3) myocarditis in mice, but only soluble CAR blocked CVB3-mediated pancreatitis. Here, we report that the in vitro mechanisms of viral inhibition by these soluble receptors also differ. Soluble DAF inhibited virus infection through the formation of reversible complexes with CVB3, while binding of soluble CAR to CVB induced the formation of altered (A) particles with a resultant irreversible loss of infectivity. A-particle formation was characterized by loss of VP4 from the virions and required incubation of CVB3-CAR complexes at 37 degrees C. Dimeric soluble DAF (DAF-Fc) was found to be 125-fold-more effective at inhibiting CVB3 than monomeric DAF, which corresponded to a 100-fold increase in binding affinity as determined by surface plasmon resonance analysis. Soluble CAR and soluble dimeric CAR (CAR-Fc) bound to CVB3 with 5,000- and 10,000-fold-higher affinities than the equivalent forms of DAF. While DAF-Fc was 125-fold-more effective at inhibiting virus than monomeric DAF, complement regulation by DAF-Fc was decreased 4 fold. Therefore, while the virus binding was a cooperative event, complement regulation was hindered by the molecular orientation of DAF-Fc, indicating that the regions responsible for complement regulation and virus binding do not completely overlap. Relative contributions of CVB binding affinity, receptor binding footprint on the virus capsid, and induction of capsid conformation alterations for the ability of cellular DAF and CAR to act as receptors are discussed.

Hydrogen-bonded dimer can mediate supramolecular beta-sheet formation and subsequent amyloid-like fibril formation: a model study

FT-IR data of six terminally blocked tripeptides containing Acp (epsilon-aminocaproic acid) reveals that all of them form supramolecular beta-sheets in the solid state. Single crystal X-ray diffraction studies of two peptides not only support this data but also disclose the fact that the supramolecular beta-sheet formation is initiated via dimer formation. The Scanning Electron Microscopic images of all peptides exhibit amyloid-like fibrils that show green birefringence after binding with Congo red, which is a characteristic feature of many neurodegenerative disease causing amyloid fibrils. (C) 2004 Elsevier Ltd. All rights reserved.

Wormlike micelle formation and flow alignment of a pluronic block copolymer in aqueous solution

The self-assembly into wormlike micelles of a poly(ethylene oxide)-b-poly(propylene oxide)-b-poly(ethylene oxide) triblock copolymer Pluronic P84 in aqueous salt solution (2 M NaCl) has been studied by rheology, small-angle X-ray and neutron scattering (SAXS/SANS), and light scattering. Measurements of the flow curves by controlled stress rheometry indicated phase separation under flow. SAXS on solutions subjected to capillary flow showed alignment of micelles at intermediate shear rates, although loss of alignment was observed for high shear rates. For dilute solutions, SAXS and static light scattering data on unaligned samples could be superposed over three decades in scattering vector, providing unique information on the wormlike micelle structure over several length scales. SANS data provided information on even shorter length scales, in particular, concerning "blob" scattering from the micelle corona. The data could be modeled based on a system of semiflexible self-avoiding cylinders with a circular cross-section, as described by the wormlike chain model with excluded volume interactions. The micelle structure was compared at two temperatures close to the cloud point (47 degrees C). The micellar radius was found not to vary with temperature in this region, although the contour length increased with increasing temperature, whereas the Kuhn length decreased. These variations result in an increase of the low-concentration radius of gyration with increasing temperature. This was consistent with dynamic light scattering results, and, applying theoretical results from the literature, this is in agreement with an increase in endcap energy due to changes in hydration of the poly(ethylene oxide) blocks as the temperature is increased.

Cyclopropylidenes, bicyclopropylidenes, and vinylcarbenes - some modes of formation and preparative applications

The routes of transformation of the simplest bicyclopropylidene into the derivatives of the second and third generations and synthesis of perspirocyclopropanated [3]rotane and linear spiral [4]- and [5]triangulanes are discussed.

Technological innovation in the context of PPPs: incentives, opportunities and actions

From a construction perspective, Public-Private Partnership projects (PPPs) are often credited as providing real incentives for the actors involved as well as a business environment that is conducive to innovation and improved practices. The validity of four common rhetorical arguments used to promote the PPP procurement route is explored: collaborative working, design freedom, long-term commitment and risk transfer. Particular interest is given to the extent to which espoused intentions correlate with experienced realities in allowing actors involved in the design and construction phases to be presented with, and able to exploit, opportunities for technological innovation. It is argued that there is reason to be cautious in fully accepting the purported benefits of the PPP framework and that the arguments often presented need to be revised. Alternative interpretations are provided.

Potato glycoalkaloids: formation and strategies for mitigation

With the increasing production and consumption of potato and its products, glycoalkaloid (GA) formation and toxicity are likely to become an important focus for food safety researchers and public health agencies. Not only the presence of GA, particularly in the form of a-solanine and a-chaconine, but also the changes occurring as a result of various post-harvest handling practices and storage, are critical issues influencing the quality of stored potatoes. Studies on various factors (pre-harvest, during harvest anal post-harvest) affecting GA have been carried out from time to time, but it is difficult to compare the results of one study with another due to wide variation in the parameters chosen. This review aims to develop a clear understanding of these issues. Published information on the types of GA, their effects on health, their typical concentrations in potatoes, their formation mechanisms, and how their levels can be controlled by following appropriate post harvest practices and storage regimes are critically analysed. The levels of GA in potato can be controlled effectively by adopting appropriate post-harvest practices. Further studies are necessary, however, to investigate best practices, which either check completely or retard substantially their formation. (C) 2008 Society of Chemical Industry.