85 research outputs found
Stress and Obesity: Are There More Susceptible Individuals?
PURPOSE OF REVIEW: Stress has long been suspected to be interrelated to (abdominal) obesity. However, interindividual differences in this complex relationship exist. We suggest that the extent of glucocorticoid action partly explains these interindividual differences. We provide latest insights with respect to multiple types of stressors.RECENT FINDINGS: Increased long-term cortisol levels, as measured in scalp hair, are strongly related to abdominal obesity and to specific mental disorders. However, not all obese patients have elevated cortisol levels. Possibly, the interindividual variation in glucocorticoid sensitivity, which is partly genetically determined, may lead to higher vulnerability to mental or physical stressors. Other evidence for the important role for increased glucocorticoid action is provided by recent studies investigating associations between body composition and local and systemic corticosteroids. Stress may play a major role in the development and maintenance of obesity in individuals who have an increased glucocorticoid exposure or sensitivity. These insights may lead to more effective and individualized obesity treatment strategies
Competing for What?: Linking Competition to Performance in Social Service Contracting
This article explores the links between competition and contractor performance often assumed by market theory. Using data from Florida social service contracting, the authors test to see if competitively procured vendors outperform their noncompetitive peers regarding adherence to contract terms. It is found that, contrary to market theory, this is not the case. It is also found that district management capacity is positively related to performance and the performance of nonprofit vendors is indistinguishable from for-profits (whereas both appear to be outperformed by other government contractors). Finally, this study finds little evidence that performance or competition is related to the likelihood of maintaining contracts.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline
Beyond the Search for Competition in Social Service Contracting: Procurement, Consolidation, and Accountability
The authors argue it is time to move beyond thinking of competition in social service contracting simply in terms of whether competitive tendering procedures are used. Although the procurement process is important, other factors should be examined as well. In particular, they look at how market consolidation and accountability are related to competitive procurement. Findings indicate that demand side—driven consolidation (i.e., governments purposely choosing to go with fewer and larger contracts in which lead agencies manage vendor networks) has both competitive and noncompetitive aspects that are in need of further study and that the competition—accountability link is more complex than generally assumed. Although, as expected, there is evidence that competition, in and of itself, leads to some contractor turnover, it does not appear that competitive vendors are held to higher standards than their noncompetitive counterparts regarding performance (as measured by adherence to contract terms).Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline
Application of a risk-management framework for integration of stromal tumor-infiltrating lymphocytes in clinical trials
Stromal tumor-infiltrating lymphocytes (sTILs) are a potential predictive biomarker for immunotherapy response in metastatic triple-negative breast cancer (TNBC). To incorporate sTILs into clinical trials and diagnostics, reliable assessment is essential. In this review, we propose a new concept, namely the implementation of a risk-management framework that enables the use of sTILs as a stratification factor in clinical trials. We present the design of a biomarker risk-mitigation workflow that can be applied to any biomarker incorporation in clinical trials. We demonstrate the implementation of this concept using sTILs as an integral biomarker in a single-center phase II immunotherapy trial for metastatic TNBC (TONIC trial, NCT02499367), using this workflow to mitigate risks of suboptimal inclusion of sTILs in this specific trial. In this review, we demonstrate that a web-based scoring platform can mitigate potential risk factors when including sTILs in clinical trials, and we argue that this framework can be applied for any future biomarker-driven clinical trial setting
Privatization and the New Public Management
Privatization is now commonplace throughout the world: in communist, socialist, and capitalist countries; in developed and developing countries; in democracies and dictatorships. It is no longer a partisan or ideological issue, but rather a pragmatic and increasingly routine approach to governing and to managing public services. In short, privatization, properly carried out, works well and produces benefits. It requires a different role for government, and it calls for more brain cells and fewer muscle cells in the public service
It\u27s Time To Privatize
Schools are failing, crime is commonplace, streets are filthy, transportation is a test of endurance, drug addiction is a curse, and millions have fled the city seeking a higher quality of life. The problem? New York City government. This paper argues that to fix the myriad of problems facing New Yorkers, the only solution is a restructuring of government that would lead to a privatization, allowing New Yorkers to rely more heavily on private industry instead of government. This system would force public agencies and private firms to compete for the privilege of providing public services and thereby earning taxpayers\u27 money
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