Improving materials management through re-engineering.

Activities related to the purchase, distribution, and management of supplies account for about one-third of the operating costs of healthcare facilities. Under a free-for-service reimbursement system, the use of supplies generates revenue; there is little motivation to control supply costs, and the goal in most facilities is to ensure abundant availability of supplies to both patient care staff and patients. As the reimbursement picture changes, however, and supplies become expenses instead of revenue generators, facilities are being forced to scrutinize all activities, including materials management, that influence operating costs and to identify and seize cost-reduction opportunities. One approach to improving materials management to reduce the cost of supplies is re-engineering. A successful re-engineering effort involves six basic steps: 1) recognizing the need for change, 2) establishing guidelines, 3) forming a team, 4) analyzing current processes and costs, 5) redesigning processes, and 6) implementing and managing the changes. In this article, a case study illustrates the possible benefits of re-engineering materials management processes.

Plexin B3 is genetically associated with verbal performance and white matter volume in human brain.

The presence of genetic influences on cognitive performance and brain volume is well established. However, specific genetic determinants of the variance of these quantitative traits are not yet known. Plexins act as receptors for semaphorins and are implicated in axon guidance, which is a key process in brain development. We have previously shown that plexin B3 is a highly potent stimulator of neurite outgrowth, which makes its gene PLXNB3 an intriguing candidate gene for traits related to human brain development and cerebral connectivity. We identified several polymorphisms in PLXNB3 predicting changes of amino acids (V598I, E1156D and V1596E) conserved at the corresponding positions of the orthologs in mouse and chimpanzee. PLXNB3 was genotyped in 303 healthy volunteers and 42 male patients with schizophrenia. Cognitive performance was measured with the vocabulary test (Wortschatztest (WST)), a method to estimate roughly general intelligence (g). Brain morphology was characterized by magnetic resonance imaging. Compared to subjects not carrying the modern, human-specific haplotype A, carriers of A scored higher in vocabulary test (WST) irrespective of diagnosis (P=0.0004). This effect could be observed in three independent groups (healthy males: P=0.048; schizophrenic males: P=0.034 and healthy females: P=0.037). Additionally, the haplotype A was associated with increased volume of brain white matter that in turn correlated with performance in the vocabulary test. These findings suggest that plexin B3 may influence cognitive performance, and the development of white matter in vivo in a way similar to its known stimulating effect on neurite outgrowth in vitro. These novel observations warrant further replication in independent samples.

[Contact allergy to rubber, surgical and vinyl gloves]. / Kontaktallergien auf Gummi-, Operations- und Vinylhandschuhe.

Thirty-one patients with a contact allergy to gloves made from rubber or vinyl were investigated in a retrospective and prospective study. Sensitivity to rubber gloves used in the household and in industry occurred most frequently (64%), followed by surgical gloves (26%) and vinyl gloves (10%). Health service worker and housewife were the professions in which the allergy was most frequently present. The main sensitizers were found to be the rubber accelerators of the thiuram and carbamate group. A series of various gloves (household, surgical, vinyl) yielded extremely different results when tested epicutaneously on the rubber-sensitized individuals. Vinyl gloves, surgical gloves made from pure latex or surgical gloves with an inner plastic coating may alternatively be used by these patients.