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

Emotional and Adrenocortical Responses of Infants to the Strange Situation: The Differential Function of Emotional Expression

The aim of the study was to investigate biobehavioural organisation in infants with different qualities of attachment. Quality of attachment (security and disorganisation), emotional expression, and adrenocortical stress reactivity were investigated in a sample of 106 infants observed during Ainsworth’s Strange Situation at the age of 12 months. In addition, behavioural inhibition was assessed from maternal reports. As expected, securely attached infants did not show an adrenocortical response. Regarding the traditionally defined insecurely attached groups, adrenocortical activation during the strange situation was found for the ambivalent group, but not for the avoidant one. Previous ndings of increased adrenocortical activity in disorganised infants could not be replicated. In line with previous ndings, adrenocortical activation was most prominent in insecure infants with high behavioural inhibition indicating the function of a secure attachment relationship as a social buffer against less adaptive temperamental dispositions. Additional analyses indicated that adrenocortical reactivity and behavioural distress were not based on common activation processes. Biobehavioural associations within the different attachment groups suggest that biobehavioural processes in securely attached infants may be different from those in insecurely attached and disorganised groups. Whereas a coping model may be applied to describe the biobehavioural organisation of secure infants, an arousal model explanation may be more appropriate for the other groups

Feasibility of using the Automated Self-Administered 24-hour (ASA-24) dietary assessment tool in older adults

Background Dietary patterns can impact the trajectories of healthy aging. However, dietary assessment tools can be challenging to use. With the increased use of technology in older adults, we aimed to evaluate the feasibility of older adults completing the online, Automated Self-Administered 24-h (ASA-24) dietary assessment tool. Methods We conducted a randomized, two-period, two-sequence, crossover design of twenty community-dwelling older adults (≥65 years) comparing their preference for completing the ASA-24 alone versus with a research assistant (RA). Participants were recruited via ResearchMatch.com and randomly allocated 1:1 to a sequence of completing both an ASA-24 alone or with an RA, separated by one week. After each session, participants completed an online 11-item feasibility survey (Likert-scale range of 1–5, strongly disagree to strongly agree). Mean and standard deviations were reported for each question. Results Mean age was 69 ± 3.5 years (90% females), with no differences were observed for sex, age, race, ethnicity, education, or income. Neither group felt a need for RA assistance (p = 0.34). However, both groups felt the system was easier to follow with the help of an RA (RA: 4.4 ± 1.3, vs. SA 4.6 ± 0.5, p = 0.65), particularly when they completed the ASA-24 alone, first (p = 0.04). When conducting the ASA-24 alone, there was less confidence the system could be learned quickly (SA 4.5 ± 0.5→3.4 ± 1.0 vs RA 3.4 ± 1.0→3.4 ± 0.7, p = 0.001). The ASA-24 was thought to be less cumbersome after repeated exposure in those concluding with the RA. Conclusion While older adults were able to complete the ASA-24 independently, the use of an RA led to improved confidence. Enhancing the sample diversity in a larger number of participants could provide helpful data to improve the science of dietary assessment

Rumen bacterial community structure impacts feed efficiency in beef cattle

The importance of the rumen microbiota on nutrient cycling to the animal is well recognized; however, our understanding of the influence of the rumen microbiome composition on feed efficiency is limited. The rumen microbiomes of two large animal cohorts (125 heifers and 122 steers) were characterized to identify specific bacterial members (operational taxonomic units [OTUs]) associated with feed efficiency traits (ADFI, ADG, and G:F) in beef cattle. The heifer and steer cohorts were fed a forage-based diet and a concentrate-based diet, respectively. A rumen sample was obtained from each animal via esophageal tubing and bacterial community composition was determined through 16S rRNA gene sequencing of the V4 region. Based on a regression approach that used individual performance measures, animals were classified into divergent feed efficiency groups. Within cohort, an extreme set of 16 animals from these divergent groups was selected as a discovery population to identify differentially abundant OTUs across the rumen bacterial communities. The remaining samples from each cohort were selected to perform forward stepwise regressions using the differentially abundant OTUs as explanatory variables to distinguish predictive OTUs for the feed efficiency traits and to quantify the OTUs collective impact on feed efficiency phenotypes. OTUs belonging to the families Prevotellaceae and Victivallaceae were present across models for heifers, whereas OTUs belonging to the families Prevotellaceae and Lachnospiraceae were present across models for steers. Within the heifer cohort, models explained 19.3%, 25.3%, and 19.8% of the variation for ADFI, ADG, and G:F, respectively. Within the steer cohort, models explained 27.7%, 32.5%, and 26.9% of the variation for ADFI, ADG, and G:F, respectively. Overall, this study suggests a substantial role of the rumen microbiome on feed efficiency responses

Frack Off: Climate Change, CSR, Citizen Activism and the Shaping of National Energy Policy

The chapter explores the often overlooked significance of citizen activism in advancing notions of corporate responsibility and shaping more sustainable energy policies and legislation at the regional, national and transnational level. This idea is developed with respect to the development of hydraulic fracturing (fracking) in the US and Europe. It shows how activists and protestors can play a central role in shifting public attitudes, changing the terms of debate, influencing political policy and shaping national legislation. While such anti-fracking movements may not always be successful, in parts of Europe particularly, they have helped shape national debates and policy outcomes around fracking. The chapter argues that in light of current warnings around the need to shift from fossil fuels to avoid catastrophic impacts of climate change that such protest movements are the only responsible response to corporate and government failures and can be seen as a driver of long-term progress towards a more sustainable and socially responsible energy sector

Formation and Evolution of Planetary Systems (FEPS): Properties of Debris Dust around Solar-type Stars

We present Spitzer photometric (IRAC and MIPS) and spectroscopic (IRS low resolution) observations for 314 stars in the Formation and Evolution of Planetary Systems (FEPS) Legacy program. These data are used to investigate the properties and evolution of circumstellar dust around solar-type stars spanning ages from approximately 3 Myr to 3 Gyr. We identify 46 sources that exhibit excess infrared emission above the stellar photosphere at 24um, and 21 sources with excesses at 70um. Five sources with an infrared excess have characteristics of optically thick primordial disks, while the remaining sources have properties akin to debris systems. The fraction of systems exhibiting a 24um excess greater than 10.2% above the photosphere is 15% for ages < 300 Myr and declines to 2.7% for older ages. The upper envelope to the 70um fractional luminosity appears to decline over a similar age range. The characteristic temperature of the debris inferred from the IRS spectra range between 60 and 180 K, with evidence for the presence of cooler dust to account for the strength of the 70um excess emission. No strong correlation is found between dust temperature and stellar age. Comparison of the observational data with disk models containing a power-law distribution of silicate grains suggest that the typical inner disk radius is > 10 AU. Although the interpretation is not unique, the lack of excess emission shortwards of 16um and the relatively flat distribution of the 24um excess for ages <300~Myr is consistent with steady-state collisional models.Comment: 85 pages, 18 figures, 4 tables; accepted for publication in ApJ

Debris Disks in the Upper Scorpius OB Association

We present MIPS 24um and 70um photometry for 205 members of the Upper Scorpius OB Association. These data are combined with published MIPS photometry for 15 additional association members to assess the frequency of circumstellar disks around 5 Myr old stars with spectral types between B0 and M5. Twelve stars have a detectable 70um excess, each of which also has a detectable 24um excess. A total of 54 stars are identified with a 24um excess more than 32% above the stellar photosphere. The MIPS observations reveal 19 excess sources -- 8 A/F/G stars and 11 K/M stars -- that were not previously identified with an 8um or 16um excess. The lack of short-wavelength emission and the weak 24um excess suggests that these sources are debris systems or the remnants of optically thick primordial disks with inner holes. Despite the wide range of luminosities of the stars hosting apparent debris systems, the excess characteristics are consistent with all stars having dust at similar orbital radii after factoring in variations in the radiation blowout particle size with spectral type. The results for Upper Sco are compared to similar photometric surveys from the literature to re-evaluate the evolution of debris emission. After considering the completeness limits of published surveys and the effects of stellar evolution on the debris luminosity, we find that the magnitude of the 24um excess around F-type stars increases between ages of 5 and 17 Myr as found by previous studies, but at < 2.6 sigma confidence. For B7-A9 and G0-K5 stars, any variations in the observed 24um excess emission over this age range are significant at less than 2 sigma confidence.Comment: 34 pages, 9 figures, 4 tables, accepted by Ap

AdaptMap: exploring goat diversity and adaptation

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Population ecology of the sea lamprey (Petromyzon marinus) as an invasive species in the Laurentian Great Lakes and an imperiled species in Europe

The sea lamprey Petromyzon marinus (Linnaeus) is both an invasive non-native species in the Laurentian Great Lakes of North America and an imperiled species in much of its native range in North America and Europe. To compare and contrast how understanding of population ecology is useful for control programs in the Great Lakes and restoration programs in Europe, we review current understanding of the population ecology of the sea lamprey in its native and introduced range. Some attributes of sea lamprey population ecology are particularly useful for both control programs in the Great Lakes and restoration programs in the native range. First, traps within fish ladders are beneficial for removing sea lampreys in Great Lakes streams and passing sea lampreys in the native range. Second, attractants and repellants are suitable for luring sea lampreys into traps for control in the Great Lakes and guiding sea lamprey passage for conservation in the native range. Third, assessment methods used for targeting sea lamprey control in the Great Lakes are useful for targeting habitat protection in the native range. Last, assessment methods used to quantify numbers of all life stages of sea lampreys would be appropriate for measuring success of control in the Great Lakes and success of conservation in the native range