Health Savings Account - Eligible High Deductible Health Plans: Updating the Definition of Prevention

High-deductible health plans (HDHPs) are an important and growing part of the health insurance landscape. By some estimates, as many as 80 percent of large employers may offer an HDHP in 2014. In 2013, more than 15 million Americans received health coverage through an HDHP, a more than a threefold increase since 2007.As outlined by the U.S. Treasury Department, individuals with an HSA-eligible HDHP are required to pay the full cost of most medications and services -- in theory utilizing pre-tax HSA funds -- until deductibles are met. However, the 2003 authorizing legislation and further guidance include a safe harbor allowing plans to cover primary preventive services, those typically deemed to prevent the onset of disease, before the deductible is satisfied.Services or benefits meant to treat "an existing illness, injury or condition," are excluded from first-dollar coverage in HSA-eligible HDHPs, which encompasses most secondary preventive services. For example, plans are prohibited from providing first dollar coverage of disease management services such as insulin, eye and foot exams, and glucose monitoring supplies for patients with diabetes.As chronic disease conditions currently make up 75 percent of total U.S. health spending, appropriate chronic disease management is an important tool to lower long-term health care costs. As the market for HDHPs grow, it is important that they maintain the flexibility to allow for effective health management of all beneficiaries. This report addresses the strict definition of prevention that an HDHP must follow for it to include a pre-tax health savings account (HSA), and how this restriction limits the effectiveness of current plans. A potential solution - allowing HSA-eligible HDHPs to provide first-dollar coverage for targeted, evidence-based, secondary preventive services that prevent chronic disease progression and related complications - can improve patient-centered outcomes, add efficiency to medical spending, and enhance HDHP attractiveness.A multi-disciplinary research team from the University of Michigan's Center for Value-Based Insurance Design, Harvard Medical School, and the University of Minnesota conducted a multi-part project to investigate the impact of updatingthe definition of prevention for HDHPs to include selected secondary preventive services that are frequently used as health plan quality metrics and included as elements of pay-for-performance programs. Specifically, the project aimed to: 1) determine the premium effect, actuarial value, and estimated market uptake of the novel HDHP plan that covers these evidence-based services outside the deductible, and 2) explore through interviews whether insurance industry experts found coverage of secondary preventive services a worthwhile endeavor

Breeding Sustainable Beef Cows: Reducing Weight and Increasing Productivity

Programs for sustainable beef production are established, but the specific role of beef cows in these systems is not well defined. This work characterized cows for two traits related to sustainability, cow weight (CW) and cumulative weight weaned (WtW). Cow weight indicates nutrient requirements and enteric methane emissions. Cumulative weight weaned reflects reproductive performance and avoidance of premature culling for characteristics related to animal health, welfare, and worker safety. Both traits were evaluated with random regression models with records from a crossbred population representing 18 breeds that conduct US national cattle evaluations. The genomic REML analyses included additive and dominance components, with relationships among 22,776 animals constructed from genotypes of 181,286 potentially functional variants imputed from a low-pass sequence. Projected to 8 years of age, the additive heritability estimate for CW was 0.57 and 0.11 for WtW. Dominance heritability was 0.02 for CW and 0.19 for WtW. Many variants with significant associations with CW were within previously described quantitative trait loci (QTL) for growthrelated production, meat, and carcass traits. Significant additive WtW variants were covered by QTL for traits related to reproduction and structural soundness. All breeds contributed to groups of cows with high and low total genetic values (additive + dominance effects) for both traits. The high WtW cows and cows above the WtW mean but below the CW mean had larger heterosis values and fewer bases in runs of homozygosity. The high additive heritability of CW and dominance effects on WtW indicate that breeding to improve beef cow sustainability should involve selection to reduce CW and mate selection to maintain heterosis and reduce runs of homozygosity. Simple Summary: Improving the sustainability of beef cows involves reducing feed costs and enteric methane emissions and increasing calf production while addressing concerns including animal health and welfare and worker safety. Reducing cow weight can favorably impact feed costs and methane emissions. Cumulative weight weaned observed throughout a cow’s productive life directly addresses calf production and indirectly addresses other concerns—cumulative production is higher for cows who wean healthy calves and avoid culling because of reproductive failure, unsoundness, and dangerous behavior. Using functional variant genotypes imputed from the low-coverage whole genome sequence, this examination of cow weight and cumulative weight weaned in a herd of crossbred cattle resulted in additive heritability estimates of 0.57 for cow weight and 0.11 for weight weaned by 8-year-old cows. Corresponding dominance heritability estimates were 0.02 for cow weight and 0.19 for weight weaned. All breeds were represented by cows projected to have high and low cow weights and weight weaned. Heterosis was higher and genomic inbreeding, measured by runs of homozygosity, was lower among high-weight weaned cows. These results suggest selection should be effective in reducing cow weight. Selection to increase weight weaned will be slow but can be hastened with crossbreeding. Especially when pedigree is not available to estimate heterosis, runs of homozygosity may be a useful indicator of heterosis and a predictor of cumulative productivity. Beef cow sustainability can be improved with appropriate crossbreeding and selection, and may be accelerated by incorporating functional variants associated with sustainability-related traits

Survival and Cardioprotective Benefits of Long-Term Blueberry Enriched Diet in Dilated Cardiomyopathy Following Myocardial Infarction in Rats

Despite remarkable progress in treatment of chronic heart failure (CHF) over the last two decades, mortality, personal suffering and cost remain staggering, and effective interventions are still a challenge. Previously we reported that a blueberry-enriched diet (BD) attenuated necroapoptosis and inflammation in periinfarct area in a rat model of myocardial infarction (MI).To test the hypothesis that BD will attenuate the course of CHF, including mortality and cardiac remodeling during the first year after induction of MI in rats.Two weeks after coronary artery ligation, rats were divided into two groups of similar average MI size, measured by echocardiography, and then 12-mo dietary regimens were initiated as follows: ad libitum regular diet (control, CD, n = 27) and isocaloric food with 2% blueberry supplement (BD, n = 27) also available ad libitum. These dietary groups were compared to each other and to sham group (SH). Mortality over the 12 mo was reduced by 22% in BD compared with CD (p<0.01). In the course of developing CHF, BD had no effect on the body weight, heart rate or blood pressure. Bi-monthly Echo revealed significant attenuation of the LV chamber remodeling, LV posterior wall thinning, and MI expansion in BD compared with CD. In fact, BD arrested the MI expansion.This is the first experimental evidence that a blueberry-enriched diet has positive effects on the course of CHF and thus warrants consideration for clinical evaluation

Comparison of different functions to describe growth from weaning to maturity in crossbred beef cattle

Cow mature weight (MWT) has increased in the past 30 yr. Larger cows cost more to maintain, but their efficiency—and thus profitability— depends on the production environment. Incorporating MWT effectively into selection and mating decisions requires understanding of growth to maturity. The objective of this study was to describe growth to maturity in crossbred beef cattle using Brody, spline, and quadratic functions. Parameter estimates utilized data on crossbred cows from cycle VII and continuous sampling phases of the Germplasm Evaluation Program at the U.S. Meat Animal Research Center. The MWT were estimated at 6 yr from the fitted parameters obtained from the Brody (BMWT), spline (SMWT), and quadratic (QMWT) functions. These were defined as BMWT, SMWT, and QMWT for the Brody, spline, and quadratic functions, respectively. Key parameters from the Brody function were BMWT and maturing constant. The spline was fitted as piecewise linear where the two linear functions joined at a knot. Key parameters were knot position and SMWT. For the quadratic model, the main parameter considered was QMWT. Data were scaled for fitting such that 180 d was the y-intercept with the average weight at 180 d (214.3 kg) subtracted from all weights. Weights were re-expressed by adding 214.3 kg after analysis. Once data were edited, with outliers removed, there were parameter estimates for 5,156, 5,041, and 4,905 cows for the Brody, spline, and quadratic functions, respectively. The average maturing constant (SD) was 0.0023 d−1 (0.0008 d−1). The mean MWT estimates (SD) from the Brody, spline, and quadratic functions were 650.0 kg (64.0 kg), 707.3 kg (79.8 kg), and 597.8 kg (116.7 kg), respectively. The spline function had the highest average R2 value when fit to individual cows’ data. However, the Brody function produced more consistent MWT estimates regardless of the timeframe of data available and produced the fewest extreme MWT. For the spline and quadratic functions, weights through 4 and 5 yr of age, respectively, were needed before consistent estimates of MWT were obtained. Of the three functions fitted, the Brody was best suited for estimating MWT at a later age in crossbred beef cattle

Comparison of different functions to describe growth from weaning to maturity in crossbred beef cattle

Cow mature weight (MWT) has increased in the past 30 yr. Larger cows cost more to maintain, but their efficiency—and thus profitability— depends on the production environment. Incorporating MWT effectively into selection and mating decisions requires understanding of growth to maturity. The objective of this study was to describe growth to maturity in crossbred beef cattle using Brody, spline, and quadratic functions. Parameter estimates utilized data on crossbred cows from cycle VII and continuous sampling phases of the Germplasm Evaluation Program at the U.S. Meat Animal Research Center. The MWT were estimated at 6 yr from the fitted parameters obtained from the Brody (BMWT), spline (SMWT), and quadratic (QMWT) functions. These were defined as BMWT, SMWT, and QMWT for the Brody, spline, and quadratic functions, respectively. Key parameters from the Brody function were BMWT and maturing constant. The spline was fitted as piecewise linear where the two linear functions joined at a knot. Key parameters were knot position and SMWT. For the quadratic model, the main parameter considered was QMWT. Data were scaled for fitting such that 180 d was the y-intercept with the average weight at 180 d (214.3 kg) subtracted from all weights. Weights were re-expressed by adding 214.3 kg after analysis. Once data were edited, with outliers removed, there were parameter estimates for 5,156, 5,041, and 4,905 cows for the Brody, spline, and quadratic functions, respectively. The average maturing constant (SD) was 0.0023 d−1 (0.0008 d−1). The mean MWT estimates (SD) from the Brody, spline, and quadratic functions were 650.0 kg (64.0 kg), 707.3 kg (79.8 kg), and 597.8 kg (116.7 kg), respectively. The spline function had the highest average R2 value when fit to individual cows’ data. However, the Brody function produced more consistent MWT estimates regardless of the timeframe of data available and produced the fewest extreme MWT. For the spline and quadratic functions, weights through 4 and 5 yr of age, respectively, were needed before consistent estimates of MWT were obtained. Of the three functions fitted, the Brody was best suited for estimating MWT at a later age in crossbred beef cattle

Genetic parameters, heterosis, and breed effects for body condition score and mature cow weight in beef cattle

Understanding the genetic relationship between mature cow weight (MWT) and body condition score (BCS) is useful to implement selection programs focused on cow efficiency. The objectives of this study were to estimate genetic parameters, heterosis, and breed effects for MWT and BCS. In total, 25,035 and 24,522 overlapping records were available for MWT and BCS on 6,138 and 6,131 cows, respectively, from the Germplasm Evaluation program, a crossbred beef population at the U.S. Meat Animal Research Center. Pedigree was available for 48,013 individuals. Univariate animal models were used to estimate heritabilities for each trait by parity. Bivariate animal models were used to estimate genetic correlations between parities within a trait and between traits within parities. Bivariate repeatability animal models were used to estimate genetic correlations between traits across parities. Estimates of heritability for different parities ranged from 0.43 ± 0.05 to 0.55 ± 0.07 for MWT and from 0.12 ± 0.03 to 0.25 ± 0.04 for BCS and were lower with the repeatability model at 0.40 ± 0.02 and 0.11 ± 0.01 for MWT and BCS, respectively. Estimates of repeatability were high for MWT (0.67 ± 0.005) and low for BCS (0.22 ± 0.006). Estimates of genetic correlation for MWT and BCS between parities were, in general, high, especially between consecutive parities. Estimates of genetic correlation between MWT and BCS were positive and moderate, ranging from 0.32 ± 0.09 to 0.68 ± 0.14. The direct heterosis estimates were 21.56 ± 3.53 kg (P ≤ 0.001) for MWT and 0.095 ± 0.034 (P ≤ 0.001) for BCS. Ordered by decreasing MWT, the breeds ranked Brahman, Charolais, Angus, Simmental, Salers, Hereford, Santa Gertrudis, Chiangus, Brangus, Red Angus, Shorthorn, Maine-Anjou, Gelbvieh, Beefmaster, Limousin, and Braunvieh. Ordered by decreasing BCS, the breeds ranked Brahman, Red Angus, Charolais, Angus, Hereford, Brangus, Beefmaster, Chiangus, Salers, Simmental, Maine-Anjou, Limousin, Santa Gertrudis, Shorthorn, Gelbvieh, and Braunvieh. Estimates of breed differences for MWT were also adjusted for BCS (AMWT), and in general, AMWT depicted smaller differences between breeds with some degree of re-ranking (r = 0.59). These results suggest that MWT and BCS are at least moderately genetically correlated and that they would respond favorably to selection. Estimates of breed differences and heterotic effects could be used to parameterize multibreed genetic evaluations for indicators of cow maintenance energy requirements

Multichannel response analysis on 2D projection views for detection of clustered microcalcifications in digital breast tomosynthesis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134871/1/mp8694.pd

VAST: An ASKAP Survey for Variables and Slow Transients

The Australian Square Kilometre Array Pathfinder (ASKAP) will give us an unprecedented opportunity to investigate the transient sky at radio wavelengths. In this paper we present VAST, an ASKAP survey for Variables and Slow Transients. VAST will exploit the wide-field survey capabilities of ASKAP to enable the discovery and investigation of variable and transient phenomena from the local to the cosmological, including flare stars, intermittent pulsars, X-ray binaries, magnetars, extreme scattering events, interstellar scintillation, radio supernovae and orphan afterglows of gamma ray bursts. In addition, it will allow us to probe unexplored regions of parameter space where new classes of transient sources may be detected. In this paper we review the known radio transient and variable populations and the current results from blind radio surveys. We outline a comprehensive program based on a multi-tiered survey strategy to characterise the radio transient sky through detection and monitoring of transient and variable sources on the ASKAP imaging timescales of five seconds and greater. We also present an analysis of the expected source populations that we will be able to detect with VAST.Comment: 29 pages, 8 figures. Submitted for publication in Pub. Astron. Soc. Australi

Computerâ aided detection of clustered microcalcifications in multiscale bilateral filtering regularized reconstructed digital breast tomosynthesis volume

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134920/1/mp0955.pd

Discrimination of conventional and organic white cabbage from a long-term field trial study using untargeted LC-MS-based metabolomics

The influence of organic and conventional farming practices on the content of single nutrients in plants is disputed in the scientific literature. Here, large-scale untargeted LC-MS-based metabolomics was used to compare the composition of white cabbage from organic and conventional agriculture, measuring 1,600 compounds. Cabbage was sampled in 2 years from one conventional and two organic farming systems in a rigidly controlled long-term field trial in Denmark. Using Orthogonal Projection to Latent Structures-Discriminant Analysis (OPLS-DA), we found that the production system leaves a significant (p = 0.013) imprint in the white cabbage metabolome that is retained between production years. We externally validated this finding by predicting the production system of samples from one year using a classification model built on samples from the other year, with a correct classification in 83% of cases. Thus, it was concluded that the investigated conventional and organic management practices have a systematic impact on the metabolome of white cabbage. This emphasizes the potential of untargeted metabolomics for authenticity testing of organic plant products