Flavor of fresh blueberry juice and the comparison to amount of sugars, acids, anthocyanidins, and physicochemical measurements.

Six cultivars of southern highbush (SHB) and rabbiteye (RE) blueberry samples were harvested on 2 different dates. Each treatment combination was pressed 2 times for repeated measures. Fresh juice was characterized for 18 flavor/taste/feeling factor attributes by a descriptive flavor panel. Each sample was measured for sugars, acids, anthocyanidins, Folin-Ciocalteu, soluble solids (BRIX), titratable acidity (TA), and antioxidant capacity (ORACFL ). Flavors were correlated with the composition and physicochemical data. Blueberry flavor correlated with 3 parameters, and negatively correlated with 2. Strawberry correlated with oxalic acid and negatively correlated with sucrose and quinic acid. Sweet aroma correlated with oxalic and citric acid, but negatively correlated with sucrose, quinic, and total acids. Sweet taste correlated with 11 parameters, including the anthocyanidins; and negatively correlated with 3 parameters. Neither bitter nor astringent correlated with any of the antioxidant parameters, but both correlated with total acids. Sour correlated with total acids and TA, while negatively correlating with pH and BRIX:TA. Throat burn correlated with total acids and TA. Principal component analysis negatively related blueberry, sweet aroma, and sweet to sour, bitter, astringent, tongue tingle, and tongue numbness. The information in this component was related to pH, TA, and BRIX:TA ratio. Another principal component related the nonblueberry fruit flavors to BRIX. This PC, also divided the SHB berries from the RE. This work shows that the impact of juice composition on flavor is very complicated and that estimating flavor with physicochemical parameters is complicated by the composition of the juice.

Intervention impact on depression product appraisal and purchasing behavior by employers: a randomized trial.

BACKGROUND: Employers can purchase high quality depression products that provide the type, intensity and duration of depression care management shown to improve work outcomes sufficiently for many employers to achieve a return on investment. The purpose of this randomized controlled trial was to test an intervention to encourage employers to purchase a high quality depression product for their workforce. METHODS: Twenty nine organizations recruited senior health benefit professional members representing public or private employers who had not yet purchased a depression product for all 100+ workers in their company. The research team used randomization blocked by company size to assign eligible employers to: (1) a presentation encouraging employers to purchase a high quality depression product accompanied by a scientifically-derived return on investment estimate, or (2) a presentation encouraging employers to work with their most subscribed health plan to improve depression treatment quality indicators. Two hundred ninety three employers (82.3% of 356) completed baseline data immediately before learning that 140 employers had been randomized to the evidence-based (EB) depression product presentation and 153 had been randomized to the usual care (UC) depression treatment quality indicator presentation. Analysis of 250 (85.3% of 293) employers who completed web-based interviews at 12 and/or 24 months was conducted to determine presentation impact on depression product appraisal and purchasing behavior. RESULTS: The intervention had no impact on depression product appraisal in 232 subjects (F = 2.36, p = .07) or depression product purchasing (chisquare = 1.82, p = .44) in 250 subjects. Depression product appraisal increased in companies with greater health benefit generosity whose benefit professionals were male. Depression product purchasing behavior increased in small companies compared to large companies, companies who knew a vendor that sold depression products at baseline, companies with greater health benefit risk taking, and companies with less politicalization of health care benefit decision making. CONCLUSIONS: Policy makers need to build innovative bridges to the employer community to convince them to purchase evidence-based benefits, even when benefits offer potential financial savings. CLINICAL TRIALS REGISTRATION NUMBER: NCT01013220.

Improving public health through state health improvement planning: a framework for action.

BACKGROUND: State health improvement plans (SHIPs) identify priorities for making the greatest impacts on health promotion and disease prevention, specific to the needs of state populations. Both SHIPs and the state health assessments on which they are based are prerequisites for Public Health Accreditation Board national accreditation. OBJECTIVE: To identify and evaluate existing SHIPs to develop guidance to support health departments in the state health improvement planning process. DESIGN: In 2010, the Association of State and Territorial Health Officials (ASTHO) conducted a comprehensive search for existing SHIPs. A systematic evaluation of existing SHIPS was accomplished by means of primary source document review using a standardized data collection form. Using data derived from these SHIPs and guidance from a workgroup of practitioners, ASTHO developed the ASTHO SHIP Guidance and Resources (SHIP Guidance) Framework. RESULTS: The search yielded 25 states (49%) having a SHIP completed or in progress. Fifteen states (29%) had no SHIP but had a Healthy People plan, and 10 states (20%) had no SHIP or Healthy People plan. No information was available for 1 state. Findings were reviewed, evaluated, and incorporated into the SHIP Guidance. The SHIP Guidance provides a framework for the implementation, monitoring, and evaluation of a SHIP process using 12 key steps. CONCLUSIONS: As public health/health care integration and accreditation readiness activity grows, multisector engagement through a SHIP will continue to be a priority for state public health and improving health outcomes. The SHIP Guidance provides a systematic, flexible approach for states conducting or updating state health assessments and SHIPs.

Do employers know the quality of health care benefits they provide? Use of HEDIS depression scores for health plans.

OBJECTIVE Dissemination of health quality measures is a necessary ingredient of efforts to harness market-based forces, such as value-based purchasing by employers, to improve health care quality. This study examined reporting of Healthcare Effectiveness Data and Information Set (HEDIS) measures for depression to firms interested in improving depression care. METHODS During surveys conducted between 2009 and 2011, a sample of 325 employers that were interested in improving depression treatment were asked whether their primary health plan reports HEDIS scores for depression to the National Committee for Quality Assurance (NCQA) and if so, whether they knew the scores. Data about HEDIS reporting by the health plans were collected from the NCQA. RESULTS HEDIS depression scores were reported by the primary health plans of 154 (47%) employers, but only 7% of employers knew their plan's HEDIS scores. Because larger employers were more likely to report knowing the scores, 53% of all employees worked for employers who reported knowing the scores. A number of structural, health benefit, and need characteristics predicted knowledge of HEDIS depression scores by employers. CONCLUSIONS The study demonstrated that motivated employers did not know their depression HEDIS scores even when their plan publicly reported them. Measures of health care quality are not reaching the buyers of insurance products; however, larger employers were more likely to know the HEDIS scores for their health plan, suggesting that value-based purchasing may have some ability to affect health care quality.

Biology and efficacy of Aprostocetus (Eulophidae: Hymenoptera) as a parasitoid of the blueberry gall midge complex: Dasineura oxycoccana and Prodiplosis vaccinii (Diptera: Cecidomyiidae).

In the southeastern United States, bud-infesting larvae of two gall midge species, Dasineura oxycoccana (Johnson) and Prodiplosis vaccinii (Felt), destroy from 20 to 80% of the rabbiteye blueberry crop, Vaccinium virgatum Aiton (syn. V. ashei Reade). These midge larvae are attacked by five species of parasitoid wasps. The most effective of these is the bivoltine eulophid Aprostocetus sp. nr. marylandensis (Eulophidae), whose adults constitute one-third of the gall midge parasitoids, active in both conventional and organic blueberry fields. Broods of Aprostocetus use several reproductive strategies to keep sole possession of their larval hosts. As solitary endoparasitoids as well as facultative hyperparasitoids, precocial larvae of Aprostocetus devour hosts organs along with any younger siblings and rival parasitoid broods. Although larger hosts are preferred, any sized larvae can be parasitized, which reduces brood congestion and infanticide. An Aprostocetus female spends an hour or more in a systematic hunt for hosts, during which time 40 to 100% of midge larvae encountered are parasitized. Aprostocetus females could have located hosts more quickly had they recognized host-feeding scars as cues. Even so, high rates of larval parasitism achieved by Aprostocetus may kill as many midges as insecticides do.

Depression care management: can employers purchase improved outcomes?

Fourteen vendors are currently selling depression care management products to US employers after randomized trials demonstrate improved work outcomes. The research team interviewed 10 (71.4%) of these vendors to compare their products to four key components of interventions demonstrated to improve work outcomes. Five of 10 depression products incorporate all four key components, three of which are sold by health maintenance organizations (HMOs); however, HMOs did not deliver these components at the recommended intensity and/or duration. Only one product delivered by a disease management company delivered all four components of care at the recommended intensity and duration. This "voltage drop," which we anticipate will increase with product implementation, suggests that every delivery system should carefully evaluate the design of its depression product before implementation for its capacity to deliver evidence-based care, repeating these evaluations as new evidence emerges.

Marketing depression care management to employers: design of a randomized controlled trial.

BACKGROUND: Randomized trials demonstrate that depression care management can improve clinical and work outcomes sufficiently for selected employers to realize a return on investment. Employers can now purchase depression products that provide depression care management, defined as employee screening, education, monitoring, and clinician feedback for all depressed employees. We developed an intervention to encourage employers to purchase a depression product that offers the type, intensity, and duration of care management shown to improve clinical and work outcomes. METHODS: In a randomized controlled trial conducted with 360 employers of 30 regional business coalitions, the research team proposes to compare the impact of a value-based marketing intervention to usual-care marketing on employer purchase of depression products. The study will also identify mediators and organizational-level moderators of intervention impact. Employers randomized to the value-based condition receive a presentation encouraging them to purchase depression products scientifically shown to benefit the employee and the employer. Employers randomized to the usual-care condition receive a presentation encouraging them to monitor and improve quality indicators for outpatient depression treatment. Because previous research demonstrates that the usual-care intervention will have little to no impact on employer purchasing, depression product purchasing rates in the usual-care condition capture vendor efforts to market depression products to employers in both conditions while the value-based intervention is being conducted. Employers in both conditions are also provided free technical assistance to undertake the actions each presentation encourages. The research team will use intent-to-treat models of all available data to evaluate intervention impact on the purchase of depression products using a cumulative incidence analysis of 12- and 24-month data. DISCUSSION: By addressing the 'value to whom?' question, the study advances knowledge about one of the most pivotal problems in the translation of evidence-based care to 'real world' settings: whether purchasers can be influenced to buy healthcare products on the basis of value and not exclusively on the basis of cost. If value-based marketing increases depression product purchase rates over usual care, this study will provide encouragement to market new healthcare products on the basis of the product's value to the purchaser as well as the recipient of care. CLINICAL TRIALS REGISTRATION NUMBER: NCT01013220.

Blood pressure control among diabetes patients within a managed care setting.

Blood pressure (BP) control is a key component of diabetes management. BP control in patients with diabetes was assessed across 4 Colorado health plans. BP was obtained through retrospective chart reviews, and BP control was defined as <130/80 mm Hg. The study included 1,445 diabetic patients in 2004 and 1,423 diabetic patients in 2005. BP control did not improve significantly from 2004 to 2005; in 2004, 33.1% had controlled BP, compared with 35.2% in 2005. Women were more likely to have controlled BP than men, and younger patients were more likely to have controlled BP than older patients. Two of the 4 plans showed significant improvement in BP control, whereas the proportion of patients with BP controlled declined in 2 health plans. More aggressive disease management and pharmacologic treatment of blood pressure is needed to improve the cardiovascular health of patients with diabetes.

Penetration of fluids into periodontal pockets using a powered toothbrush/irrigator device.

UNLABELLED: This study was a single-blind, randomized, controlled clinical trial. The researchers evaluated a powered brush/irrigating device (HydraBrush Oral Health System; OHS) for its safety and ability to deliver a solution to the bottom of 5-6 mm pockets, compared to rinsing alone with a solution following brushing with a powered toothbrush (Sonicare Elite 7800; SE). An evaluation technique to measure the quantity and quality of solution able to enter the pocket was also introduced in this project. METHODS: Subjects were randomized in one of two-groups: brush plus simultaneous irrigation (OHS) versus brush plus rinsing (SE). Subjects used their devices at home for two weeks. At the measurement visit, subjects used the OHS to irrigate and brush simultaneously for 1 minute (30 seconds per each side of the mouth) with a 0.01% erythrosine disclosing solution in 10 oz of distilled water. Control subjects brushed for 2 minutes with a SE followed by a 1 minute rinse with an identical disclosing solution. A blinded evaluator collected six samples of approximately of 1 microL of sucular fluid from six 5-6 mm evaluation sites. This was accomplished by inserting a microcapillary tip with a 20 microL micropipette in the sulcus. Two-group repeated measures ANOVA was used to examine differences in two measures of the disclosing solution between OHS and SE subjects; the spectrometer reading of the disclosing solutions, and by visual inspection of the samples (positive/negative) to determine the presence or absence of solution in the samples. Subjects' diaries were collected. Bleeding and discomfort during the evaluation period was reported. RESULTS: Visually, OHS had a significantly greater proportion of solution taken from the base of 5-6 mm sites than the SE (p=0.0001). However, there was no statistical difference between the two groups (p=.1359) in the spectrophotometer readings. CONCLUSION: The experimental device is more efficient in delivering a solution to the base of 5-6 mm pockets than rinsing following use of a control powered toothbrush. Both devices have demonstrated they are safe and well accepted by patients. The technique developed provides a useful method for quantitative and qualitative studies of solutions from the base of periodontal pockets.

Early renal benefit of rapamycin combined with reduced calcineurin inhibitor dose in pediatric heart transplantation patients.

BACKGROUND: Calcineurin inhibitors such as cyclosporine are effective in preventing rejection in recipients of solid organ transplants. Unfortunately, the prolonged use of calcineurin inhibitors may result in progressive renal injury. METHODS: We studied the renal function of 15 pediatric heart transplant recipients who were taking calcineurin inhibitors. Their renal function was studied before and after rapamycin was introduced to their immunosuppression regimen. With the introduction of rapamycin, the patients were given a lower dose of calcineurin inhibitors, and the calcineurin inhibitor was discontinued in 5 patients. RESULTS: Renal function improved significantly in the patients by 30 days after these changes in the calcineurin inhibitor dose were instituted. Mean levels of blood urea nitrogen and mean serum creatinine decreased, and mean creatinine clearance increased. Pre-rapamycin, the patients' mean level of blood urea nitrogen was 27.1 +/- 12.4 mg/dl and post-rapamycin they decreased to 18.6 +/- 11.1 mg/dl (p = 0.014). Similarly, creatinine decreased from 1.0 +/- 0.5 mg/dl to 0.8 +/- 0.3 mg/dl (p = 0.019). Their creatinine clearance increased from 88 +/- 28 ml/min/1.73 mol/liter2 to 105 +/- 27 ml/min/1.73 mol/liter2 (p = 0.008). The patients' lipid levels did not change after they were prescribed rapamycin. Biopsy-negative rejection developed in 2 patients. CONCLUSIONS: The introduction of rapamycin to the immunosuppressive regimen of patients taking calcineurin inhibitors, with a concomitant reduction of the calcineurin inhibitor dose, may improve renal function within 30 days, without a significant increase in rejection.

Neuroleptic drug exposure and incidence of tardive dyskinesia: a records-based case-control study.

BACKGROUND: With the introduction of atypical neuroleptic medications into the marketplace, the use of conventional neuroleptics has fallen, attendant with the perception of a more favorable side-effect profile for the atypical neuroleptics. OBJECTIVE: The purpose of this study was to determine the risk of tardive dyskinesia (TD) associated with atypical and conventional neuroleptics. METHODS: Subjects were adult users of the Veterans Administration Puget Sound Health Care System (VA-PSHCS) who received >or=1 prescription for neuroleptic medications during the study period. Electronic medical and pharmacy records were used to obtain neuroleptic drug exposure, exclusionary diagnosis, diagnosis for TD, and select demographic data. Medical records were reviewed to collect demographic data not available electronically. Controls were randomly selected from a cohort of neuroleptic users without TD. The case-defining event was the diagnosis of TD. RESULTS: There were 42 cases and 160 controls for the final analysis. The only demographic difference found was a higher proportion of Caucasians (90%) in the TD group compared to the control group (76%). There was no significant difference in the risk of TD for patients on conventional neuroleptics compared to the atypical neuroleptic users (OR=1.29; 95% CI=0.71-2.34). After adjusting for age, gender, race, schizophrenia, schizoaffective disorder, depression, and anti-Parkinson drugs, there was still no significant difference in risk of TD between cases and controls (OR=1.02; 95% CI=0.465-2.232). CONCLUSION: This study did not find a statistically significant difference in the risk of TD for users of conventional neuroleptics versus users of atypical neuroleptics.