The Magnitude and Nature of Risk Selection in Employer-Sponsored Health Plans

Most existing studies of risk selection in the employer-sponsored health insurance market are case studies of a single employer or of an employer coalition in a single market. We examine risk selection in the employer-sponsored market by applying a switcher' methodology to a national, panel data set of enrollees in employer-sponsored health plans. We find that people who switched from a non-HMO to an HMO plan used 11 percent fewer medical services in the period prior to switching than people who remained in the non-HMO plan, and that this relatively low use persists once they enroll in an HMO. Furthermore, people who switch from an HMO to a non-HMO plan used 18 percent more medical services in the period prior to switching than those who remained in an HMO plan. HMOs would most likely continue to experience favorable risk selection if employers adjusted health plan payments based on enrollees' gender and age because the selection appears to occur based on enrollee characteristics that are difficult to observe such as preferences for medical care and health status.

Juice Processing Effects on Small Scale not from Concentrate Rabbiteye Blueberry Juice Production: The Evaluation of Juice Recovery and Identification of Anthocyanins and Anthocyanidins through Processing Steps

The order and combination of juicing steps can change a blueberry’s bioactive phytochemicals and effect juice recovery. In addition to physical treatments such as pressing, recovery is also affected by heat and enzymes steps. Not optimizing juicing methods affect juice quality and leave many bioactive components in the press cake. To evaluate pre-press treatments, southern highbush and rabbiteye blueberries were individually pressed in a bench top press at varying temperatures. The temperature treatments included fresh, thawed, frozen and heating to 95 °C. Two pectinase enzymes, Rohapect 10L and Pectinex BEXXL, were individually used to assess impact on juice extraction. Juice recovery was averaged from three press replications for each treatment. Frozen berries which were heated to 95 °C and treated with enzyme had the highest recovery at 68.6 ± 1.1%. This process was then transferred to a pilot scale press. Pilot scale juice recovery was calculated at 74.0 ± 0.9%. Using data from the initial pilot presses, a full pilot scale experiment was triplicated. ‘Tifblue’ rabbiteye blueberries were heated in a steam jacketed kettle to 95 °C for three minutes followed by a Rohapect 10L enzyme treatment before pressing. The resulting juice from the pilot press was then filtered and pasteurized. Unfiltered juice was also pasteurized. Press cake was collected and frozen. Samples of raw berries, filtered and unfiltered juice, pasteurized juice, and press cake were taken to identify anthocyanin compounds and changes caused by juice processes using LC-MS/MS. Samples were also hydrolyzed for anthocyanidin quantification using UPLC-UV. Ten major anthocyanins were identified, including 5 arabinoside and 5 pyranoside anthocyanins and three minor anthocyanins. The five anthocyanidins, cyanidin, delphinidin, malvidin, peonidin, and petunidin, were quantified. Raw berries and press cake contained the highest anthocyanidin contents with 85.1 mg/100 g and 265.6 mg/100 g respectively. Decreases of 67% loss after pressing and 10% loss after pasteurization were determined for anthocyanins and anthocyanidins in juices. However, three new conjugated anthocyanins were found in processed juices which have not previously been reported in rabbiteye. This contributes to the value and interest of press cake for use in other food and non-food products

A Qualitative Evaluation of Student Leadership Learning Outcomes from Study Abroad and the Clifton StrengthsFinder Assessment

College campuses are challenged with developing leaders. Universities create formal leadership programs for students to develop their leadership prowess. It is critical for universities to be aware of the outcomes of student experiences when implementing programming. The purpose of this study is to describe the leadership learning outcomes of The Maroon & White Leadership Fellows who participated in a study abroad or Clifton StrengthsFinder experience. Qualitative research methods were used to complete this study. Data were provided by, The Maroon & White Leadership program, a student leadership program at Texas A&M University through written or oral guided reflections. A blended framework encompassing Kolb’s model of experiential learning and the Leadership Identity Development model was created to evaluate the student learning outcomes. The first phase of this study evaluated leadership learning outcomes of students who completed study abroad as an education experience within The Maroon & White Leadership program. Emergent themes were cultural awareness, leadership understanding, understanding of the role of a leader, self-awareness, awareness of future benefits of studying abroad, and benefits of diversity. The results suggest that leadership learning outcomes of students who participate in study abroad are tangible, yet different, than learning outcomes of students who participate in study abroad as part of a differing curriculum. The second phase of this study evaluated leadership learning outcomes of students who completed a Clifton StrengthsFinder workshop as a training experience within The Maroon & White Leadership program. Self-awareness, understanding of the role of a leader, understanding the value of knowing one’s strengths, and development of one’s personal leadership identity emerged as themes. It can be determined from these results that students gain leadership knowledge from participating in a Clifton StrengthsFinder-related experience and completing an accompanying guided reflection

A Qualitative Evaluation of Student Leadership Learning Outcomes from Study Abroad and the Clifton StrengthsFinder Assessment

College campuses are challenged with developing leaders. Universities create formal leadership programs for students to develop their leadership prowess. It is critical for universities to be aware of the outcomes of student experiences when implementing programming. The purpose of this study is to describe the leadership learning outcomes of The Maroon & White Leadership Fellows who participated in a study abroad or Clifton StrengthsFinder experience. Qualitative research methods were used to complete this study. Data were provided by, The Maroon & White Leadership program, a student leadership program at Texas A&M University through written or oral guided reflections. A blended framework encompassing Kolb’s model of experiential learning and the Leadership Identity Development model was created to evaluate the student learning outcomes. The first phase of this study evaluated leadership learning outcomes of students who completed study abroad as an education experience within The Maroon & White Leadership program. Emergent themes were cultural awareness, leadership understanding, understanding of the role of a leader, self-awareness, awareness of future benefits of studying abroad, and benefits of diversity. The results suggest that leadership learning outcomes of students who participate in study abroad are tangible, yet different, than learning outcomes of students who participate in study abroad as part of a differing curriculum. The second phase of this study evaluated leadership learning outcomes of students who completed a Clifton StrengthsFinder workshop as a training experience within The Maroon & White Leadership program. Self-awareness, understanding of the role of a leader, understanding the value of knowing one’s strengths, and development of one’s personal leadership identity emerged as themes. It can be determined from these results that students gain leadership knowledge from participating in a Clifton StrengthsFinder-related experience and completing an accompanying guided reflection

Young people's perceptions of youth-oriented health services in urban Soweto, South Africa: a qualitative investigation.

BACKGROUND: In 2006, the South African Department of Health adopted and scaled-up loveLife's Youth Friendly Services (YFS) initiative to a national policy to improve youth utilization of health programmes by strengthening community sensitisation and counselling services. As these services roll-out, alternative services to target young people are also becoming more popular. Success of any of these services, however, is dependent upon young people's perceptions of these health services as a whole. This paper aims to examine the knowledge and perceptions of current health services oriented towards young people and examine potential alternative approaches to health service delivery. METHODS: The study was conducted in urban Soweto, South Africa. Twenty-five in-depth interviews were conducted between May-July 2012. Twenty-three of these were analysed according to modified grounded theory. RESULTS: Knowledge of YFS was very low with no thorough knowledge of the programme's purpose or activities. In general, young people were dissatisfied with the current health services in Soweto citing a lack of resources, long waiting times, and poor quality of care heightened by an underlying lack of choice and perceived inequity. When compared to alternative models of service delivery, no particular model was preferred over another. CONCLUSIONS: Greater knowledge of whether and to what extent local clinics in Soweto are implementing YFS standards is needed. If implemented, improved outreach and advertisement is suggested. In-service training of nurses should be prioritized with a focus on sensitivity and equitable treatment to all

Immunohistochemical expression of epithelial and stromal immunomodulatory signalling molecules is a prognostic indicator in breast cancer

<p>Abstract</p> <p>Background</p> <p>The immune system has paradoxical roles during cancer development and the prognostic significance of immune modulating factors is controversial. The aim of this study was to determine the expression of cyclooxygenase 2 (COX-2), transforming growth factor-beta (TGF- beta), interleukin-10 (IL-10) and their prognostic significance in breast cancers. Ki67 was included as a measure of growth fraction of tumor cells.</p> <p>Methods</p> <p>On immunohistochemical stained slides from 38 breast cancer patients, we performed digital video analysis of tumor cell areas and adjacent tumor stromal areas from the primary tumors and their corresponding lymph node metastases. COX-2 was recorded as graded staining intensity.</p> <p>Results</p> <p>The expression of TGF-beta, IL-10 and Ki67 were recorded in tumor cell areas and adjacent tumor stromal areas. In both primary tumors and metastases, the expression of COX-2 was higher in the tumor stromal areas than in the tumor cell areas (both <it>P </it>< 0.001). High stromal staining intensity in the primary tumors was associated with a 3.9 (95% CI 1.1-14.2) times higher risk of death compared to the low staining group (<it>P </it>= 0.036). The expression of TGF-beta was highest in the tumor cell areas of both primary tumors and metastases (both <it>P </it>< 0.001). High stromal expression of TGF-beta was associated with increased mortality. For IL-10, the stromal expression was highest in the primary tumors (<it>P </it>< 0.001), whereas in the metastases the expression was highest in tumor cell areas (<it>P </it>< 0.001). High IL-10 expression in tumor- and stromal cell areas of primary tumors predicted mortality. Ki67 was higher expressed in tumor stromal areas of the metastases, and in tumor cell areas of the primary tumors (<it>P </it>< 0.001). Ki67 expression in tumor cell areas and stromal areas of the metastases was independently associated with breast cancer mortality.</p> <p>Conclusions</p> <p>Stromal expression of COX-2, TGF-beta and Ki67 may facilitate tumor progression in breast cancer.</p

Restoring Treatment Response in Colorectal Cancer Cells by Targeting MACC1-Dependent ABCB1 Expression in Combination Therapy

Treatment failure of solid cancers, represented by the development of drug resistance in the primary tumor or later outgrowth of drug resistant metastases, is the major cause of death for cancer patients. It represents an urgent clinical need for predictive biomarkers which indicate the success or failure of standard treatment regimens. Besides treatment prediction, interfering with cellular processes associated with drug resistance might improve treatment response by applying combination therapies. Metastasis-associated in colon cancer (MACC) 1 was identified in our group as a prognostic biomarker in human colorectal cancer, and has been established as key player, prognostic, and predictive biomarker for tumor progression and metastasis in a variety of solid cancers. Besides increased cell proliferation and motility, subsequently contributing to growth and metastatic spread of the primary tumor, MACC1 has also been shown to dysregulate apoptosis and is contributing to treatment resistance. Here we report the MACC1 dependent treatment resistance of colorectal cancer (CRC) cells to standard therapeutics like doxorubicin by upregulating ATP-binding cassette subfamily B member 1 (ABCB1) protein. Overexpression of MACC1 in CRC cells increased both its presence on the ABCB1 promoter and its transcriptional activity, resulting in elevated ABCB1 expression and thus treatment resistance to standard therapeutics. In contrast, depleting MACC1 increased intracellular drug concentrations, leading to better treatment response. We already identified the first MACC1 transcriptional inhibitors, such as lovastatin, by high-throughput screening of clinically approved small molecule drugs. These compounds inhibited cell motility in vitro but also restricted metastasis development in xenograft mouse models by reducing MACC1 expression. Here we report, that treating high MACC1 expressing CRC cells with a combination of statins and standard therapeutics increased the rate of cytotoxicity and resulted in higher treatment response