Dental practice satisfaction with preferred provider organizations

<p>Abstract</p> <p>Background</p> <p>Despite their increasing share of the dental insurance market, little is known about dental practices' satisfaction with preferred provider organizations (PPOs). This analysis examined practice satisfaction with dental PPOs and the extent to which satisfaction was a function of communications from the plan, claims handling and compensation.</p> <p>Methods</p> <p>Data were collected through telephone surveys with dental practices affiliated with MetLife between January 2002 and December 2004. Each respondent was asked a series of questions related to their satisfaction with a systematically selected PPO with which they were affiliated. Six different PPO plans had sufficient observations to allow for comparative analysis (total n = 4582). Multiple imputation procedures were used to adjust for item non-response.</p> <p>Results</p> <p>While the average level of overall satisfaction with the target plan fell between "very satisfied" and "satisfied," regression models revealed substantial differences in overall satisfaction across the 6 PPOs (p < .05). Statistically significant differences between plans in overall satisfaction were largely explained by differences in the perceived adequacy of compensation. However, differences in overall satisfaction involving two of the PPOs were also driven by satisfaction with claims handling.</p> <p>Conclusion</p> <p>Results demonstrate the importance of compensation to dental practice satisfaction with PPOs. However, these results also highlight the critical role of service-related factors in differentiating plans and suggest that there are important non-monetary dimensions of PPO performance that can be used to recruit and retain practices.</p

Effects of experimentally added salmon subsidies on resident fishes via direct and indirect pathways

Artificial additions of nutrients of differing forms such as salmon carcasses and analog pellets (i.e. pasteurized fishmeal) have been proposed as a means of stimulating aquatic productivity and enhancing populations of anadromous and resident fishes. Nutrient mitigation to enhance fish production in stream ecosystems assumes that the central pathway by which effects occur is bottom-up, through aquatic primary and secondary production, with little consideration of reciprocal aquatic-terrestrial pathways. The net outcome (i.e. bottom-up vs. top-down) of adding salmon-derived materials to streams depend on whether or not these subsidies indirectly intensify predation on in situ prey via increases in a shared predator or alleviate such predation pressure. We conducted a 3-year experiment across nine tributaries of the N. Fork Boise River, Idaho, USA, consisting of 500-m stream reaches treated with salmon carcasses (n = 3), salmon carcass analog (n = 3), and untreated control reaches (n = 3). We observed 2–8 fold increases in streambed biofilms in the 2–6 weeks following additions of both salmon subsidy treatments in years 1 and 2 and a 1.5-fold increase in standing crop biomass of aquatic invertebrates to carcass additions in the second year of our experiment. The consumption of benthic invertebrates by stream fishes increased 110–140% and 44–66% in carcass and analog streams in the same time frame, which may have masked invertebrate standing crop responses in years 3 and 4. Resident trout directly consumed 10.0–24.0 g·m-2·yr-1 of salmon carcass and \u3c1–11.0 g·m-2·yr-1 of analog material, which resulted in 1.2–2.9 g·m-2·yr-1 and 0.03–1.4 g·m-2·yr-1 of tissue produced. In addition, a feedback flux of terrestrial maggots to streams contributed 0.0–2.0 g·m-2·yr-1 to trout production. Overall, treatments increased annual trout production by 2–3 fold, though density and biomass were unaffected. Our results indicate the strength of bottom-up and top-down responses to subsidy additions was asymmetrical, with top-down forces masking bottom-up effects that required multiple years to manifest. The findings also highlight the need for nutrient mitigation programs to consider multiple pathways of energy and nutrient flow to account for the complex effects of salmon subsidies in stream-riparian ecosystems

“An important cog in the wheel”, but not the driver: Coaches’ perceptions of their role in doping prevention

Objectives: Under the World Anti-Doping Code coaches have designated anti-doping roles and responsibilities. Yet, their experiences, opinions and behaviours in relation to these expectations are poorly understood. This study responds directly to this absence of evidence in order to move the field forward. Design: A qualitative thematic analysis approach. Method: Twelve football and rugby league coaches, working in a performance development context, took part in semi-structured interviews to explore their (anti-)doping experiences, opinions and behaviours. Nine coaches participated in follow-up interviews where particular attention was paid to existing anti-doping policy directives. All interviews were analysed using inductive thematic analysis. Results: Coaches were supportive of anti-doping efforts and exerted their influence by monitoring, giving advice and creating the ‘right’ culture. Performance prioritisation rendered coaches reluctant to engage proactively in addressing anti-doping in their practice; a situation exacerbated by a lack of self-efficacy to advise/act in accordance with the rules. Consequently, coaches tended to rely on others (both internally and externally to their club) to provide anti-doping support, and anti-doping is deemed unnecessary/irrelevant. Critically, coaches’ current behaviours were not driven by policy, as they were unaware of expectations and consequences outlined in the Code. Conclusions: Coaches are willing to support anti-doping efforts, but are generally passive in their everyday practice. The gulf between anti-doping policy and coaching practice raises cause for concern for anti-doping policy makers. To bridge this gap systematic programming of activities designed to ensure coaches are able and willing to take a proactive role in doping prevention is required

Data from: Dissolved organic carbon modulates mercury concentrations in insect subsidies from streams to terrestrial consumers

Mercury (Hg) concentrations in aquatic environments have increased globally, exposing consumers of aquatic organisms to high Hg levels. For both aquatic and terrestrial consumers, exposure to Hg depends on their food sources as well as environmental factors influencing Hg bioavailability. The majority of the research on the transfer of methylmercury (MeHg), a toxic and bioaccumulating form of Hg, between aquatic and terrestrial food webs has focused on terrestrial piscivores. However, a gap exists in our understanding of the factors regulating MeHg bioaccumulation by non-piscivorous terrestrial predators, specifically consumers of adult aquatic insects. Because dissolved organic carbon (DOC) binds tightly to MeHg, affecting its transport and availability in aquatic food webs, we hypothesized that DOC affects MeHg transfer from stream food webs to terrestrial predators feeding on emerging adult insects. We tested this hypothesis by collecting data over two years from 10 low-order streams spanning a broad DOC gradient in the Lake Sunapee watershed in New Hampshire. We found that streamwater MeHg concentration increased linearly with DOC concentration. However, streams with the highest DOC concentrations had emerging stream prey and spiders with lower MeHg concentrations than streams with intermediate DOC concentrations; a pattern that is similar to fish and larval aquatic insects. Furthermore, high MeHg concentrations found in spiders show that MeHg transfer in adult aquatic insects is an overlooked but potentially significant pathway of MeHg bioaccumulation in terrestrial food webs. Our results suggest that although MeHg in water increases with DOC, MeHg concentrations in stream and terrestrial consumers did not consistently increase with increases in streamwater MeHg concentrations. In fact, there was a change from a positive to a negative relationship between aqueous exposure and bioaccumulation at streamwater MeHg concentrations associated with DOC above around 5 mg/L. Thus, our study highlights the importance of stream DOC for MeHg dynamics beyond stream boundaries, and shows that factors modulating MeHg bioavailability in aquatic systems can affect the transfer of MeHg to terrestrial predators via aquatic subsidies