Rhodococcus rhodochrous DAP 96253, a well-known industrial bacterium, had various 1-hexene monooxygenase (1-HMO) activities when grown on YEMEA plates supplemented with eight different carbohydrates. Besides, 1-HMO exhibited different storage temperature preferences. Lactose could induce the highest 1-HMO activity in R. rhodochrous DAP 96253 while the cells showed the lowest 1-HMO activity when trehalose was the supplement. The 1-HMO activity of R. rhodochrous DAP 96253 was not maintained when stored at 37°C as well as at 4°C and 25°C. Trehalose-induced 1-HMO activity of R. rhodochrous DAP 96253 was more stable from Day 0 to Day 21 at all these three temperatures, compared with the other seven carbohydrates. Immobilization of enzymes can maintain enzyme activity longer, offer easier enzyme storage conditions and make some enzymes reusable, much research has been done in this area. In this study, R. rhodochrous DAP 96253, grown on YEMEA plates supplemented by glucose and urea, was investigated using whole bananas as the inducer of 1-HMO activity and different immobilization methods to maintain this enzyme activity. It was shown that calcium-alginate polyvinyl alcohol (PVA) beads could maintain 1-HMO activity of R. rhodochrous DAP 96253 more stable than calcium-alginate beads. Whole bananas exhibited very obvious effects of inducing 1-HMO activity of R. rhodochrous DAP 96253. A number of recent studies have clearly demonstrated that induced cells of R. rhodochrous DAP 96253 can prolong the shelf-life of post-harvested fruits. With USDA estimates of 40% of all harvested produce in the US not being consumed because of loss of quality, the ability to extend the period of ripeness of produce has great potential to improve the quality of nutrition. Modification or degradation of those signals (primary and secondary) associated with ripening in fruit or the perception of those signals represents a potential mode of action for delayed ripening by induced cells of R. rhodochrous DAP 96253. Ethylene and cyanide are the two primary signals in ripening. In this study, the role of 1-HMO from induced cells was investigated by time-course experiments focusing on 1-HMO activity and stability. In addition, fruit volatile organic compounds (VOCs) were detected and compared by GC-FID and GC/MS over the course of fruit ripening. The results show a correlation between 1-HMO activity and stability in delayed fruit ripening. It was further demonstrated that the presence of secondary signal fruit VOCs enhanced 1-HMO activity. Aromatic profiles of treated fruits, by GC-FID and GC/MS, show a consistent picture of VOCs associated with earlier fruit ripening stages.

Purpose: This study examined differences in oral health status and dental treatment needs by HMO regions in Virginia. Methods: The Division of Dental Health (DDH), Virginia Department of Health (VDH), completed the 1999 Virginia Oral Health Needs Assessment (VSOHNA) with the cooperation of the Virginia Department of Education. The survey used a probability proportional to size (PPS) sample design in selecting school children from public schools in the Commonwealth of Virginia. Surface (DMFS/dfs) and tooth-level (DMFT/dft) data were collected as indicators of dental disease on all children. Child-level data was also recorded for each student consisting of age, race, gender, enrollment in a free and reduced lunch program, medical insurance status, dental insurance status, and history of dental visits. A descriptive and regression analysis was completed to examine the relationship between HMO regions and oral health status indicators. Results: The survey included more than 5,000 children in 200 schools and 52 school districts. The mean DMFT/dft levels were 1.47 (.33) and 1.7 (.03), respectively. The mean level of untreated decay (dt) for all schoolchildren was 0.66 (0.01). First graders had the highest levels of untreated disease at 0.71, while third graders had a mean of 0.66. The Central region of the state appeared to have the highest level of untreated decay. Conclusion: There were no significant differences in the percentage of "caries-free" children between the HMO regions. Untreated dental disease of Virginia schoolchildren varied according to the region in which they lived.

This study examines specific organizational, operational, financial and environmental characteristics to identify factors that are associated with increased likelihood of hospitals' CPOE adoption decision in six rollout regions of the Leapfrog initiatives.Resource dependence theory provides theoretical basis for the study. The study is retrospective observational in design. Individual hospitals are the unit of analysis. The Leapfrog Group's 2002-survey collection serves the primary data source. Univariate statistical methods along with bivariate and ordinal logistic regression models are used to analyze the data. The models provided support for multiple hypotheses for both the adoption and early adoption decisions of study hospitals. The operational characteristics of ownership, in-house physician staff, case mix index and the environmental characteristic of HMO penetration rate had a positive effect on management's adoption decisions. The operational characteristic excess capacity, the organizational characteristic community orientation, the financial characteristic of operating income per admission, and the environmental characteristic of number of HMO contracts had a significant negative effect on CPOE adoption decisions.

There is some controversy which centers around the question of whether a particular government policy or program may be Judged successful. This dissertation takes the position, with due respect to the difficulties of such a task, that policy success can be evaluated and that it is important that such evaluations be made. Traditionally, health care in the United States has been delivered by the solo medical practitioner on a fee-for-service basis. A relatively new concept in the health care delivery system combines group practice with prepayment for services. These types of practices were designated as Health Maintenance Organizations in 1970 by the Nixon Administration.The major question of this dissertation is whether or not the HMO policy of the federal government has been a success. Along with this question the primary focus of this dissertation is upon the development and evolution of the federal HMO program.

In this dissertation, I examine individual decisions in occupational choice, labor supply, and health care utilization. Occupational choice decisions of female college graduates on whether to teach or not are analyzed to understand the role of fertility and relative wages using a panel estimation method. I also compare the behavioral changes in the labor force participation among teachers and non-teachers conditional on the presence of a new-born baby. Using the human capital model where a worker decides her hours of work responding to wages, and her human capital is accumulated proportional to her hours of work, I predict that the positive relationship between entry wages and post wages. Empirical evidence suggests that the shock in entry wages may be attributed to post wage differentials. I examine individuals?? choice of health insurance plan and utilization of health care services. Empirical evidence shows that there is favorable self-selection into health maintenance organizations (HMOs) plans and that HMO members use more of office-based and hospital outpatient services. It suggests ineffectiveness of HMO plans in reducing utilization.

In this dissertation, I examine individual decisions in occupational choice, labor supply, and health care utilization. Occupational choice decisions of female college graduates on whether to teach or not are analyzed to understand the role of fertility and relative wages using a panel estimation method. I also compare the behavioral changes in the labor force participation among teachers and non-teachers conditional on the presence of a new-born baby. Using the human capital model where a worker decides her hours of work responding to wages, and her human capital is accumulated proportional to her hours of work, I predict that the positive relationship between entry wages and post wages. Empirical evidence suggests that the shock in entry wages may be attributed to post wage differentials. I examine individuals?? choice of health insurance plan and utilization of health care services. Empirical evidence shows that there is favorable self-selection into health maintenance organizations (HMOs) plans and that HMO members use more of office-based and hospital outpatient services. It suggests ineffectiveness of HMO plans in reducing utilization.

Managed care plans purport to improve the health of their members with chronic diseases. How has the growing adoption of Medicare Advantage (MA), the managed care program for Medicare beneficiaries, affected the progression of chronic disease? The literature is rich with articles focusing on managed care organizations' impacts on quality of care, access, patient satisfaction, and costs. However, few studies have analyzed these impacts with respect to market penetration of Medicare managed care. The objective of this research has been to analyze the relationships between the market penetration of MA plans and the progression of chronic diseases among Medicare beneficiaries. The Chronic Disease Severity Index scale (CDSI) was constructed to represent beneficiaries' overall chronic disease states for survey or claims-based data, when more direct clinical measures of disease progression are not available. Using the CDSI on the MEPS survey dataset from AHRQ, we sought to assess the impacts of MA market penetration and other covariates on the overall chronic disease state of Medicare beneficiaries from 2004 through 2008. Though the model explains much of the variation in CDSI change, the author expected the multilevel model would show that MA penetration explains a significant level of variation in CDSI change. However, this hypothesis was not substantiated, and the findings suggest that unmeasured factors may be contributing to additional unexplained heterogeneity. Policymakers should explore opportunities to refine the current MA program. The MA program costs the federal government more than the Traditional Fee-for-Service Medicare program, and there is no definitive evidence that outcomes differ. Within both programs, there is opportunity to experiment with different models of payment, healthcare service delivery and care coordination. The Patient Protection and Affordable Care Act (ACA) contains provisions for innovative demonstration projects in delivery and payment. The effectiveness of these ACA initiatives must be monitored, both for impacts on health outcomes and for economic effects. This research can inform future approaches to outcomes assessment using the CDSI, and multilevel modeling methodologies similar to those employed here. Firms offering MA health plans would be prudent to proactively demonstrate their value to beneficiaries and taxpayers. They should explore means of better monitoring and reporting the longitudinal outcomes of their enrolled beneficiaries. Demonstrating that they can bring value in terms of improved health outcomes will help insure their long-term survival, both in the marketplace and in the political arena. / Graduation date: 2012

La tesi approfondisce il complesso rapporto tra diritto, religione e sanità nella realtà americana, concentrandosi in particolare sulle problematiche scaturenti dall’orientamento religioso del paziente, del care provider e della struttura sanitaria. La prima sezione si propone di studiare, sempre in chiave giuridica, l’evoluzione del rapporto tra fede e medicina, presentando altresì due casi di studio: i nativi americani e christian science. Nella seconda sezione, invece, si ricostruiscono le linee interpretative essenziali del primo emendamento con specifico approfondimento tanto della Free exercise clause che dalla establishment clause. Parimenti, viene tracciato un disegno di sintesi del sistema sanitario americano, soffermandosi tanto sugli aspetti pubblicistici che su quelli privatistici dello stesso. La ricerca, poi, si sofferma sull’analisi dettagliata delle problematiche evidenziate dalla giurisprudenza americana con riferimento al care receiver, al care provider e, soprattutto, al contenzioso in materia pediatrica. L’ultima parte è dedicata allo sviluppo di due distinti filoni, ovvero: il rapporto tra scienza e diritto ed il ruolo dell’economia. Questo ultimo aspetto viene approfondito sotto due diversi punti di vista. In primo luogo si ricostruisce l’impatto economico delle policy che garantiscono la libertà religiosa sul “sistema sanità”. In secondo luogo, si approfondisce il tema dell’influenza del dato economico sullo sviluppo della libertà religiosa in ambito sanitario. / This work deals with the complex relationship between law, religion and the sanitary system in the U.S. setting, by focusing on the problems emerging from the religious view of the patient, of the care provider and the religious orientation of the hospital or HMO. The first section of the work aims to study, from a legal point of view, the evolution of the relationship “medicine-religion”, and focuses on two case studies: native Americans and Christian science. In the second section the essential interpretative streamlines about the first amendment are presented, through a deep analysis of the Free Exercise Clause and of the Establishment Clause. At the same time, the American (U.S.) sanitary system is deeply studied both in the private sector and the public one. The research then focuses on a detailed analysis of the jurisprudence related to the care provider and the care receiver, while a specific section is dedicated to the litigation concerning pediatric patients and the related litigation cases. The last part develops two different subjects: the relationship between science and law, and the role of economy. This last subject is deeply analyzed under two different points of view: the economic impact of the religious freedom on the “sanitary system” on the one hand; and the influence of the economic data on the development of religious freedom in the health care system setting on the other.