Assessment of Chronic Disease Management Strategies Among Health Care Practices in Medically Underserved South Carolina Counties

Diabetes and heart disease are among the leading causes of death and disability in the United States, and these conditions are especially prevalent in the South. South Carolina’s persistent racial and socioeconomic disparities in chronic disease outcomes are well-documented, yet little is known about how health care practices in medically underserved areas are addressing these challenges. Data were collected through a cross-sectional survey as part of two complementary 5-year cooperative agreements between the Centers for Disease Control and Prevention and the Division of Diabetes and Heart Disease Management (the Division) at the South Carolina Department of Health and Environmental Control. The Division fielded a survey to (a) assist in determining which Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) were best poised to implement specific strategies as part of these cooperative agreements and (b) provide data to establish the baseline for performance measures. FQHCs and RHCs in the top 25% of counties with the highest diabetes and heart disease burden were surveyed about eight domains: staffing/services, electronic health records, team-based care policies, lifestyle change programs, medication therapy management, telehealth, quality improvement collaboratives, and patient demographics. Data representing 71 practices revealed contrasts between RHCs and FQHCs and opportunities for improvement. For example, while most practices reported they were not implementing evidence-based lifestyle change programs (e.g., the National Diabetes Prevention Program), most RHCs and FQHCs expressed interest in starting such programs. Findings are being used to guide efforts to improve diabetes and heart disease prevention and management in South Carolina.

Market Concentration and its Impact on Liner Shipping in Ghana

Ever since the introduction of ocean liner shipping in the maritime trade industry, there has been a great and positive impact on the maritime industry in terms of trade. Liner shipping lines enjoy degrees of antitrust immunity in various parts of the world. With about 400 liner shipping lines presently and still counting the industry experiences very high concentration in the market. Few of the liner shipping lines occupy a maximum portion of the industry’s market shares whereas the remaining occupy very less or insignificant market shares. In order to survive the oligopolistic nature and concentration of the market, firms seek to cooperative agreements where they are able to share assets and in some cases go as far as merging. Mergers and acquisitions involve the risk of high cost of investment therefore it is not always the option for the relative smaller firms as a means of increasing market shares, but this cannot be said for the larger firms. Consortia, and global strategic alliances do not require such investment. These cooperative agreements rather help member firms to utilize assets and enjoy economies of scale and as a result increase firm growth. Liner shipping lines also as a means of increasing market shares, decrease freight rates and offer value added services to their customers.

Theoretical Intakes of Modern-Day Paleo Diets: Comparison to U.S. Dietary Reference Intakes

Objectives To evaluate the nutrient adequacy of theoretical, modern-day Paleo meal plans relative to the U.S. Dietary Reference Intakes (DRIs). Methods This analysis used data from the Adhering to Dietary Approaches for Personal Taste (ADAPT) Feasibility Study, which captured data on 9 726 self-reported, popular diet followers. Paleo respondents (N = 925) reported sources of recipes and diet guidance. Five days from each of the top six sources were used to generate 30 days of meal plans among a random sample of n = 200 Paleo respondents. Nutrition Data System for Research (NDSR) was used to estimate daily nutrient content of meal plans which was compared to DRIs and recommendations, as follows: recommended daily allowances (RDAs) for vitamins D, E, and folate, which do not vary by age (years, y)/sex; sex and age-specific RDAs for vitamins A, C, calcium (Ca), magnesium (Mg), and iron (Fe); adequate intakes (AIs) for potassium (K) and fiber; upper intake level (UL) for sodium (Na); and Dietary Guidelines for Americans (DGA) upper threshold to limit saturated fat and Na. Results Estimated daily nutrient intakes of theoretical Paleo meal plans met or exceeded RDAs for the following (Paleo vs. RDA): vitamin A for men or women (1481 RAE µg vs. 900 μg and 700 µg), vitamin D (56 µg vs. 15 μg), vitamin E (27 mg vs. 15 mg), folate (489 µg vs. 400 μg), vitamin C for men or women (225 mg vs. 90 mg and 75 mg), Mg for men and women 31–70 y (539 mg vs. 420 mg and 320 mg), and Fe for men (16 mg vs. 8 mg). Theoretical estimates did not meet the following: RDAs for carbohydrate (91 g vs. 130 g), Fe for women 19–50 y (16 g vs.18 mg), Ca for men and women 61–70 y (562 mg vs. 1000 mg and 1200 mg), and AI for K (4027 mg vs. 4700 mg) or dietary fiber (25 g vs. 28 g/2000 kcal). Estimated levels of Na exceeded the UL (2763 mg vs. 2300 mg), saturated fat exceeded the DGA (19% vs. 10% kcal), and added sugar levels fell within the recommendation (1% vs. 10%). Conclusions While certain aspects of the Paleo diet offer improvements over typical reported intakes of US adults, saturated fat is high, and carbohydrate, fiber, Ca, and K levels of these theoretical diets do not meet DRIs. High levels of saturated fat present concern for cardiovascular health. Optimal nutrition may be challenging to sustain on a Paleo diet. Funding Sources Supported by USDA Cooperative Agreements 58-8050-9-004 and 58-8050-9-003.

Self-Reported Duration of Adherence to a Plant-Based Diet Is Associated With Better Food Purchasing Habits and Behaviors Related to Food Availability

Objectives To assess self-reported differences in food purchasing habits and diet-consistent food availability among recent vs. long-term plant-based diet (PBD) followers compared to those who are not actively following a specific diet but report “trying to eat healthy” (TTEH). Methods The sample consisted of PBD (n = 1820, whole-food plant based/vegan) and TTEH (n = 292) followers enrolled in Adhering to Dietary Approaches for Personal Taste (ADAPT), an online study conducted in self-identified popular diet followers. PBD followers were classified as recent (RF) (<2 years, n = 723) or long-term followers (LF) (2 + years, n = 1097). We compared food shopping habits, grocery expenses, and perceived influence of the food environment between RF and LF, as well as to those who self-identified as TTEH (69% reported TTEH for 5 + years). ANCOVA was used to compare the groups adjusting for age and sex. Results Mean BMI was significantly higher in the TTEH (26.3 kg/m2) compared to RF (24.9 kg/m2) and LF (23.0 kg/m2). The majority of all responders (97%) reported they independently shop and prepare food, and 93% reported that it is “extremely easy” to find foods consistent with their diet. A significantly greater proportion of LF compared to RF (91% vs. 86%, P = 0.003) reported food in the home as ‘extremely consistent’ with their diet vs. only 67% of TTEH (P < 0.0001). Sixty-one % of LF, 76% of RF and 93% of TTEH reported having inconsistent food in the home, with 56%, 65% and 88%, respectively, identifying themselves as bringing this food into the home (P < 0.001 for all). No significant differences were observed in reported mean grocery expenses; however, compared to LF and RF, TTEH spent significantly more on meals/snacks purchased outside the home ($54 and $42, respectively). Further adjustment for physical activity, education, marital status and BMI did not alter the findings. Conclusions Individuals following PBD reported greater consistency in the home food environment and lower expenses on food and snacks purchased outside the home compared to TTEH. Cultivating a consistent food environment may help individuals sustain healthier dietary patterns. Funding Sources USDA Cooperative Agreements 58–8050-9–004 and 58–8050-9–003, General Mills Bell Institute of Health & Nutrition.

Development and Evaluation of Cooperative Healthcare Bidirectional People-to-People Exchanges

Bidirectional, interdisciplinary cultural exchanges result in increased understanding of cultural differences allowing for better international collaboration. The success and sustainability of cooperative agreements depend on regular continued communication with each partner institution, along with a key contact person “on the ground” in each participating country. International efforts represent an exciting beginning of people-to-people involvement in the global quest for improved access to safe surgical, anesthesia, and medical care in developing countries. Academic institutions are uniquely positioned to make a global impact helping others through the bidirectional exchange of education, research, and culture. International efforts can have a recognizable impact on partner locations. All individuals and institutions involved continue to learn from the knowledge and examples of others to further enhance their impact. Continued evaluation and reevaluation are important to improve the experience and achieve the needs and objectives for all involved participants.

Enabling Technologies and the Role of Private Firms: A Machine Learning Matching Analysis

Investments in enabling technologies—including the fifth-generation technology standard for broadband cellular networks (5G), artificial intelligence (AI), and light detection and ranging (LIDAR) technology—are important strategic decisions for firms. This paper asks how inventions that private firms developed with (versus without) public-sector partners differ in their enabling technology trajectory. Using a novel method of machine learning matching, we compare patented technologies generated from more than 30,000 public–private relationships with comparable technologies invented by private firms alone during a 21-year period. To measure the enabling potential of a technology, we introduce a new enabling technology index. The findings show that private-firm relationships with the public sector—in particular cooperative agreements and grants with mission agencies (National Aeronautics and Space Administration and Department of Defense)—are likely starting points for enabling technology trajectories. We thus put a spotlight on organizational arrangements that combine the breadth of exploration (agreements, grants) with deep exploitation in a particular domain (mission agency). A key contribution is a better understanding of the types of private-firm efforts that are associated with enabling technologies. We also challenge the common assumption that enabling technologies have their origins only in public-sector projects and show how private firms are involved. Our significant contribution is to show how private firms can change evolution of ecosystems through technology development.

AN APPROACH TO THE COOPERATION FOR INNOVATION IN THE SERVICE SECTOR

This study examines how firms cooperate for innovation in the services sector. We tested the theoretical development using cluster analysis and ordinal logit regression analysis with firm-level data collected from the Spanish Technological Innovation Panel (PITEC) for the period 2011–2013. Overall, 2,622 service firms have been used. This research contributes as follows: first, the findings show that the greater degree of penetration into the innovation modes of the firms means that the intensity of the use of cooperative agreements as well as the diversity of cooperative partners increases. Second, the empirical evidence for the taxonomy of innovation development in the service sector provides firms with the ways how to innovate based on their strategic orientation.