Conventional Positions Research Articles

Development of a 3D-printed phantom for total skin electron therapy dose assessment.

Total skin electron therapy (TSET) is a complex radiotherapy technique, posing challenges in commissioning and quality assurance (QA), especially due to significant variability in patient body shapes. Previous studies have correlated dose with factors such as obesity index, height, and gender. However, current treatment planning systems cannot simulate TSET plans, necessitating heavy reliance on QA methods using standardized anthropomorphic phantoms and in-vivo dosimetry. Given the relatively few studies on rotational techniques, comprehensive data in commissioning could streamline the process. Developing a full-body phantom would enable a more thorough TSET commissioning process, including testing for position-specific dose distributions and comprehensive measurements across all body surfaces, unlike the typical torso-only phantoms. This was created using digital modeling software, fabricated using 3D-printing FDM technology, and filled with tissue-equivalent gelatine. The phantom was positioned at an SSD of 340cm and irradiated with a standard rotational TSET plan using the 6E HDTSE mode on a Varian TrueBeam linac at gantry angles of±18° from the horizontal. The dose was measured at over 50 points across the surface using Gafchromic EBT3 film. Dose distributions were generally consistent with existing literature values from in-vivo dosimetry, with several position-specific differences identified, including the hands and scalp compared to conventional positions. Hotspots were observed for the mid-dorsum of the foot and nose, with areas under 80% of the dose identified as the soles of the feet, perineum, vertex of the scalp, top of the shoulder, and palm of the hand. Additionally, analysis using an interpolated dose heatmap found that 90% of the pixel area received a dose within 10% of the prescribed dose, indicating good uniformity with the commissioned technique. With high agreement with the current literature, a 3D-printed phantom proves effective for measuring doses in areas typically unmeasurable in TSET commissioning.

INFLUENCE OF CHANGING PORTRAYALS OF WOMEN IN HINDI CINEMA ON YOUTH’S PROGRESSIVE GENDER ATTITUDES

This research paper examines the impact of evolving portrayals of women in Hindi cinema on the progressive gender attitudes of contemporary youth. In recent decades, Hindi cinema has increasingly shifted from portraying women primarily in conventional and submissive positions to presenting them in more forward-thinking and active roles. The objective of this study is to examine the impact of these alterations in cinematic portrayals on the perceptions and attitudes of young individuals towards gender equality. Through the use of a mixed-methods methodology including quantitative surveys and qualitative interviews, this study examines the relationship between film depictions and changes in gender attitudes among young people. Empirical evidence suggests that favourable depictions of women in contemporary Hindi film are linked to more progressive gender perspectives among young people, underscoring the capacity of media to influence society standards and behaviours.

Women's experience of adopting lateral positions during the second stage of labour compared with conventional lithotomy positions: A cross-sectional study

AimsMaternal positions during childbirth play an important role in safe vaginal births and might also influence women's childbirth experiences greatly. Lateral positions, as a potential position to reduce negative maternal and neonatal outcomes, have become popular in recent years, especially in China where the adoption of conventional lithotomy positions is still common. However, the childbirth experience of those who gave birth in lateral positions has been rarely studied. This study aimed to describe and compare women's childbirth experiences of adopting the newly introduced lateral positions and the conventional lithotomy positions during the second stage of labour. Study designA cross-sectional study was conducted in two tertiary hospitals in China involving a total of 658 primiparous and parous women who adopted lateral and lithotomy positions during the second stage of labour from July to November 2020. Sociodemographic characteristics, maternal and neonatal outcomes as well as childbirth experience assessed by the Childbirth Experience Questionnaire (CEQ) were collected. This study followed the STROBE guidelines. ResultsWomen who once adopted lateral positions during the second stage of labour had better positive childbirth experiences compared with those in the lithotomy positions group, as demonstrated by their overall higher CEQ scores. Women in the lateral position group also reported better participation and perceived safety, and a greater sense of control during childbirth. Lateral positions remained an influential factor in CEQ scores after controlling for potential confounders. In this study, adverse maternal and neonatal outcomes were rare. Women in lateral positions had comparatively better perineal outcomes. ConclusionThis study described and compared women's childbirth experiences of adopting conventional lithotomy positions and lateral positions during the second stage of labour using a valid instrument. Women who adopted lateral positions during the second stage of labour reported better childbirth experiences than those giving birth in the conventional lithotomy positions. Thus, assisting women in giving birth in lateral positions might be a promising way to improve women's childbirth experience.

Risks of Unemployment in the Future for Workers as India's Labour Sectors Embrace Automation, Robots, and Artificial Intelligence

This article examines the immediate concerns of unemployment that workers in India face due to implementation of automation, robotics, and artificial intelligence (AI) become more prevalent in the labour sectors. The swift progress of technology poses a danger to conventional manual labour positions, resulting in a large scale loss of jobs and unstable economic conditions. The impacts of automation are most likely to affect marginalized communities, aggravating already existing disparities. To lessen(minimalize/reduce) the negative impacts of mass unemployment, industry stakeholders, governments, and civil society must adopt proactive steps. These are necessary because of the social and political implications of this issue. India's workforce may move towards a more sustainable and fair future by supporting inclusive economic development, encouraging entrepreneurship, and investing in vocational training.

Ethics of care in Chicana lesbian writers

Chicana Lesbians: The Girls our Mothers Warned Us About (1991) by Carla Trujillo challenged conventional positions and ideology about gender and sexual roles when it was published. The controversial issue of the ethics of care, discussed and understood in ecofeminist theories as the imperative of heteropatriarchal societies towards women to become caretakers, finds in these texts reflections from the queer identities of their authors, transforming their actions into positive interactions. In this volume, relationships of sorority, expressing love and care for one another abound as the writers in the compilation explore new alternatives of building families aside from heteropatriarchal role models. Among these explorations, the different poems and essays included in the volume established a communication through eroticism and sexuality, and discussed their implications openly, in order to overcome the problematics of an imposed heterosexuality and, even, an imposed motherhood. This collection expresses how, thanks to all this previous work by writers and critics such as Gloria Anzaldúa, Ana Castillo, Cherrie Moraga, Emma Pérez or Carla Trujillo herself, whose stories are included in the volume, Chicana lesbian writers today can escape essentialist visions that place women and queers as closer to nature in order to undervalue both and find the justification to oppress them. On the contrary, Trujillo’s volume opens an avenue towards a more post anthropocentric attitude, exercising empathy towards the human and the more-than-human world in relation to making these writers aware of the influence of their origins, and the embracement of their roots through the expression of love and caring for other women.

Crossed raised arm position improves the flow of contrast medium in torso contrast-enhanced computed Tomography

IntroductionThis retrospective cohort study examined the effects of the crossed raised arm (CRA) position in contrast-enhanced computed tomography (CECT) on contrast medium influx and image quality relative to the conventional position. MethodsContrast medium influx into the collateral veins on CECT images was evaluated in 92 participants. The CT values of the pulmonary artery, descending aorta, and spleen were obtained in both positions and compared. Anatomical changes in the diameters and area of the subclavian vein and costoclavicular distance were also analyzed. ResultsContras 27 and 6 patients in the conventional and CRA positions, respectively. The influx risk ratio in the CRA position versus that in the conventional position was 0.22 (95% confidence interval, 0.10–0.51). Elevations in the median CT value of the pulmonary artery, descending aorta, and spleen in the CRA position were 7.0% (p < .001), 7.4% (p < .001), and 9.8% (p < .001), respectively. Enlargements in the major and minor diameters of the subclavian vein, subclavian vein area, and costoclavicular distance in the CRA position versus those in the conventional position were 19.3% (p < .001), 28.1% (p < .001), 53.6%, and 30.0% (p < .001), respectively. ConclusionThe CRA position effectively prevented contrast medium influx into the collateral veins due to SVS and increased CT values in the target organs in CECT. The diameters and area of the subclavian vein and costoclavicular distance were enlarged at the thoracic outlet, which improved the flow of the contrast medium into the targeted organs. Implications for practiceThe CRA position can contribute to obtaining better CECT images during common clinical assessments at no additional cost.

Estimating organ dose with optimized peak dose index in cone-beam CT scans

PurposeOrgan dose evaluation is important for optimizing cone beam computed tomography (CBCT) scan protocols. However, an evaluation method for various CBCT scanners is yet to be established. In this study, we developed scanner-independent conversion coefficients to estimate organ doses using appropriate peak dose (f(0)) indices. MethodsThis study included various scanners (angiography scanners and linear accelerators) and protocols for the head and body (thorax, abdomen, and pelvis) scan regions. f(0) was measured at five conventional positions (center position (f(0)c) and four peripheral positions (f(0)p) at 90° intervals) in the CT dose index (CTDI) phantom. To identify appropriate measurement positions for organ dose estimation, various f(0) indices were considered. Organ doses were measured by using optically stimulated luminescence dosimeters positioned in an anthropomorphic phantom. Thereafter, the conversion coefficients were calculated from each obtained f(0) value and organ or tissue dose using a linear fit for all scanners, and the coefficient of variation (CV) of the conversion coefficients was calculated for each organ or tissue. The f(0) index with the minimum CV value was proposed as the appropriate index. ResultsThe appropriate f(0) index was determined as f(0)c for the body region and a maximum of four f(0)p values for the head region. Using the proposed conversion coefficients based on the appropriate f(0) index, the organ/tissue doses were well estimated with a mean error of 14.2% across all scanners and scan regions. ConclusionsThe proposed scanner-independent coefficients are useful for organ dose evaluation using CBCT scanners.

Structures of CTCF-DNA complexes including all 11 zinc fingers.

The CCCTC-binding factor (CTCF) binds tens of thousands of enhancers and promoters on mammalian chromosomes by means of its 11 tandem zinc finger (ZF) DNA-binding domain. In addition to the 12-15-bp CORE sequence, some of the CTCF binding sites contain 5' upstream and/or 3' downstream motifs. Here, we describe two structures for overlapping portions of human CTCF, respectively, including ZF1-ZF7 and ZF3-ZF11 in complex with DNA that incorporatesthe CORE sequence together with either 3' downstream or 5' upstream motifs. Like conventional tandem ZF array proteins, ZF1-ZF7 followthe right-handed twist of the DNA, with each finger occupying and recognizing one triplet of three basepairs in the DNA major groove. ZF8 plays a unique role, acting as a spacer across the DNA minor groove and positioning ZF9-ZF11 to make cross-strand contacts with DNA. We ascribe the difference between the two subgroups of ZF1-ZF7 and ZF8-ZF11 to residues at the two positions -6 and -5 within each finger, with small residues for ZF1-ZF7 and bulkier and polar/charged residues for ZF8-ZF11. ZF8 is also uniquely rich in basic amino acids, which allows salt bridges to DNA phosphates in the minor groove. Highly specific arginine-guanine and glutamine-adenine interactions, used to recognize G:C or A:T base pairs at conventional base-interacting positions of ZFs, also apply to the cross-strand interactions adopted by ZF9-ZF11. The differences between ZF1-ZF7 and ZF8-ZF11 can be rationalized structurally and may contribute to recognition of high-affinity CTCF binding sites.

Supine magnetic resonance image registration for breast surgery: insights on material mechanics.

Breast conserving surgery (BCS) is a common procedure for early-stage breast cancer patients. Supine preoperative magnetic resonance (MR) breast imaging for visualizing tumor location and extent, while not standard for procedural guidance, is being explored since it more closely represents the surgical presentation compared to conventional diagnostic imaging positions. Despite this preoperative imaging position, deformation is still present between the supine imaging and surgical state. As a result, a fast and accurate image-to-physical registration approach is needed to realize image-guided breast surgery. In this study, three registration methods were investigated on healthy volunteers' breasts ( ) with the supine arm-down position simulating preoperative imaging and supine arm-up position simulating intraoperative presentation. The registration methods included (1)point-based rigid registration using synthetic fiducials, (2)nonrigid biomechanical model-based registration using sparse data, and (3)a data-dense three-dimensional diffeomorphic image-based registration from the Advanced Normalization Tools (ANTs) repository. Additionally, deformation metrics (volume change and anisotropy) were calculated from the ANTs deformation field to better understand breast material mechanics. The average target registration errors (TRE) were , , and (mean ± standard deviation) and the average fiducial registration errors (FRE) were , , and for the point-based rigid, nonrigid biomechanical, and ANTs registrations, respectively. The mechanics-based deformation metrics revealed an overall anisotropic tissue behavior and a statistically significant difference in volume change between glandular and adipose tissue, suggesting that nonrigid modeling methods may be improved by incorporating material heterogeneity and anisotropy. Overall, registration accuracy significantly improved with increasingly flexible and data-dense registration methods. Analysis of these outcomes may inform the future development of image guidance systems for lumpectomy procedures.

Operation Techniques of PICC Catheterization in Special Positions

Background: Peripherally inserted central venous catheter (PICC) is a reliable and safe method of central venous catheterization. Objectives: This study aimed to investigate the operation techniques of PICC catheterization in special positions. Methods: From January 2015 to August 2020, 52 cases in special positions were successfully catheterized and divided into four types. The characteristics of body positions, the principle of position placement and sterile sheet laying, the position of the operator, the evaluation before the catheterization, the preparation of related equipment for the catheterization, and the technical points of the catheterization operation were analyzed among these four types. Results: By adopting different techniques (patient position placement, disinfection, sterile sheet laying, operator location, and operation key points) according to different patient positions, PICC catheters were successfully inserted in 52 patients. Conclusion: When PICC catheterization objects cannot be placed in conventional positions, an individualized analysis should be carried out. According to the characteristics of their positions, special evaluation, position placement, disinfection and draping, and the preparation of special equipment to assist individualized catheterization operations should be carried out.

The First Direct Measurement of Gravitational Potential Decay Rate at Cosmological Scales and Improved Dark Energy Constraint

The integrated Sachs–Wolfe (ISW) effect probes the decay rate (DR) of large-scale gravitational potential and therefore provides a unique constraint on dark energy (DE). However, its constraining power is degraded by the ISW measurement, which relies on cross-correlating with the large-scale structure (LSS) and suffers from uncertainties in galaxy bias and matter clustering. In combination with lensing-LSS cross correlation, DR can be isolated in a way free of uncertainties in galaxy bias and matter clustering. We applied this proposal to the combination of the Data Release 8 galaxy catalog of DESI imaging surveys and Planck cosmic microwave background maps. We achieved the first DR measurement, with a total significance of 3.2σ. We verified the measurements at three redshift bins ([0.2, 0.4), [0.4, 0.6), [0.6, 0.8]), with two LSS tracers (the “low-density points” and the conventional galaxy positions). Despite its relatively low signal-to-noise ratio, the addition of DR significantly improves dark energy constraints, over Sloan Digital Sky Survey baryon acoustic oscillation (BAO) data alone or Pantheon supernovae (SNe) compilation alone. For flat wCDM cosmology, the improvement in the precision of Ω m is a factor of 1.8 over BAO and 1.5 over SNe. For the DE equation of state w, the improvement factor is 1.3 over BAO and 1.4 over SNe. These improvements demonstrate DR as a useful cosmological probe, and therefore we advocate its usage in future cosmological analysis.

AAPM WGPDMP Report 373: The content, structure, and value of the Professional Doctorate in Medical Physics (DMP)

The Professional Doctorate in Medical Physics (DMP) was originally conceived as a solution to the shortage of medical physics residency training positions. While this shortage has now been largely satisfied through conventional residency training positions, the DMP has expanded to multiple institutions and grown into an educational pathway that provides specialized clinical training and extends well beyond the creation of additional training spots. As such, it is important to reevaluate the purpose and the value of the DMP. Additionally, it is important to outline the defining characteristics of the DMP to assure that all existing and future programs provide this anticipated value. Since the formation and subsequent accreditation of the first DMP program in 2009–2010, four additional programs have been created and accredited. However, no guidelines have yet been recommended by the American Association of Physicists in Medicine. CAMPEP accreditation of these programs has thus far been based only on the respective graduate and residency program standards. This allows the development and operation of DMP programs which contain only the requisite Master of Science (MS) coursework and a 2‐year clinical training program. Since the MS plus 2‐year residency pathway already exists, this form of DMP does not provide added value, and one may question why this existing pathway should be considered a doctorate. Not only do we, as a profession, need to outline the defining characteristics of the DMP, we need to carefully evaluate the potential advantages and disadvantages of this pathway within our education and training infrastructure. The aims of this report from the Working Group on the Professional Doctorate Degree for Medical Physicists (WGPDMP) are to (1) describe the current state of the DMP within the profession, (2) make recommendations on the structure and content of the DMP for existing and new DMP programs, and (3) evaluate the value of the DMP to the profession of medical physics.

Position Deployment Optimization of Maneuvering Conventional Missile Based on Improved Whale Optimization Algorithm

To reasonably allocate mobile conventional missile battle positions and improve the survivability and combat effectiveness of the missile weapon system, a missile position deployment optimization design model based on Mixed-Integer Nonlinear Programming (MINLP) is established. First, for the multilevel position network, an optimization model with the goal of maximizing the viability is established, and a two-stage solution method is proposed. Second, the whale optimization algorithm (WOA) is improved, and the convergence factor which changes nonlinearly with the number of evolution is introduced to coordinate the local development and global search ability of the algorithm. The diversity mutation operation is carried out on the optimal individual to reduce the probability of premature convergence of the algorithm, and the improved whale algorithm is used to solve the optimization model. Finally, the performance of the improved algorithm is verified by example analysis and simulation experiments, which provides a reference for the deployment mode of mobile missile positions.

Bio-Inspired Rhythmic Locomotion for Quadruped Robots

The mechanisms of locomotion in mammals have been extensively studied and inspire the related researches on designing the control architectures for the legged robots. Reinforcement learning (RL) is a promising approach allowing robots to automatically learn locomotion policies. However, careful reward-function adjustments are often required via trial-and-error until achieving a desired behavior, as RL policy behaviors are sensitive to the rewards. In this paper, we draw inspiration from the rhythmic locomotion behaviors of animals and propose a new control architecture by incorporating a rhythm generator to naturally stimulate periodic motor patterns, which actively participates in the timing of phase transitions in the robot step cycle. To speed up training, we use the joint position increments rather than the conventional joint positions as the outputs of the RL policy. During deployment, the rhythm generator can be reused for the state estimation of quadruped robots. We validate our method by realizing the full spectrum of quadruped locomotion in both simulated and real-world scenarios.

Rethinking the Pharmacy Workforce Crisis by Exploring Unconventional and Emerging Career Pathways and Training

Given the limited availability of conventional pharmacy positions, pharmacy programs face a challenge in ensuring that all graduates obtain jobs that fulfill their goals and ambitions. Thus, it is imperative to explore and discuss unconventional but promising positions, specifically regarding their availability and needs. In exploring these positions, it is important to recognize technical and nontechnical skill sets that pharmacy graduates possess at graduation, identify unique pathways to help students explore job alternatives, and educate faculty and students about employment opportunities beyond the traditional setting if desired or necessary. Students must become aware of the opportunities that exist in both conventional (pharmacist clinician) and unconventional (pharmacist innovator) pharmacy careers and be able to articulate the translational skills from their training. Pharmacy programs and faculty can better support students by fostering the development and marketing of their skills.

Does the bra change the parameters of ECG?

Performing an electrocardiogram (ECG) is a daily practice in cardiology. In women, some have the bra removed because of a possible change in parameters. However, no study exists to explore the possible influences of the bra on ECG. Removing the bra could be considered intrusive or traumatic for some patients. The aim of the study is to analyze whether the basic parameters of the ECG are modified by the wearing of the bra. During the year 2019, the patients were offered to perform an ECG with and without a bra after information about the aim of the study. These patients had no cardiovascular risk factors or events and had a baseline ECG normal. Consent is obtained before the examination. The examination was carried out at the same time of consultation a few minutes apart. The parameters analyzed are the duration of the P wave, the PR space, the width of the QRS, the QT space and the axis of the QRS. Except the axis of QRS in degree, all parameters were in milliseconds, the existence or not of a frame on the bras. Forty-eight patients accepted the study protocol. The mean age is 51 years. I found no significant difference on all of the ECG parameters with or without a bra. P wave duration with versus without was 101.06 vs. 101.85 ( P = 0.70), PR space 154.64 vs. 55.04 ( P = 0.927), Width of QRS 84.12 vs. 83.93 ( P = 0.91), axis of QRS 28.75 vs. 27.96 ( P = 0.88), QT duration 380.6 vs. 378.12 ( P = 0.656). Forty-three patients had a frame on their bra. In these patients, there is also no significant difference in the data analyzed, compared to the average of all the data without bra. P wave duration with frame 101.16 ( P = 0.74), PR space 154.16 ( P = 0.84), width of QRS 84.49 ( P = 0.76), axis of QRS 27.67 ( P = 0.96), QT duration 381.44 ( P = 0.574) ( Table 1 ). This study does not find any influence of the bra on the results of the ECG. By maintaining the conventional positions of the electrodes, there is no point in removing the bra in women to perform an ECG.

MEANING OF LIFE AS THE BASIS FOR THE CONSTRUCTION OF AT THE AGE OF ADULTHOOD

The aim of the study was to explore the relationship between the meaningfulness of life and the career plans of an individual in the professional and family spheres at the age stage of emerging adulthood. A family career represents a sequential change in conventional family role positions and the development of relevant competencies in accordance with the life cycle of the family and self-determination of the individual. We used the test of meaningful life orientations and the author's questionnaire of family and professional careers. The sample consisted of 167 students aged 17-22. The results allowed us to identify three groups of respondents, differing in the level of meaningfulness of life. It was found that a high level of life meaningfulness is combined with a certainty of career plans in the sphere of family and profession and a high level of their consistency. Respondents with a low level of meaningfulness in life are characterized by an insufficient balance of professional and family career plans. Orientation towards a professional career with insufficient attention to life plans in the family sphere is combined with an external locus of control.

Impact of deformation on a supine-positioned image-guided breast surgery approach.

To reduce reoperation rates for image-guided breast-conserving surgery, the enhanced sensitivity of magnetic resonance (MR) supine imaging may be leveraged. However, accurate tissue correspondence between images and their physical counterpart in the surgical presentation is challenging due to breast deformations (e.g., from patient/arm position changes, and operating room table rotation differences). In this study, standard rigid registration methods are employed and tissue deformation is characterized. On n = 10 healthy breasts, surface displacements were measured by comparing intraoperative fiducial locations as the arm was moved from conventional MR scanning positions (arm-down and arm-up) to the laterally extended surgical configuration. Supine MR images in the arm-down and arm-up positions were registered to mock intraoperative presentations. Breast displacements from a supine MR imaging configuration to a mock surgical presentation were 28.9 ± 9.2mm with shifts occurring primarily in the inferior/superior direction. With respect to supine MR to surgical alignment, the average fiducial, target, and maximum target registration errors were 9.0 ± 1.7mm, 9.3 ± 1.7mm, and 20.0 ± 7.6mm, respectively. Even when maintaining similar arm positions in the MR image and mock surgery, the respective averages were 6.0 ± 1.0mm, 6.5 ± 1.1mm, and 12.5 ± 2.8mm. From supine MR positioning to surgical presentation, the breast undergoes large displacements (9.9-70.1mm). The data also suggest that significant nonrigid deformations (9.3 ± 1.7mm with 20.0mm average maximum) exist that need to be considered in image guidance and modeling applications.

Narratives of Change: Identity and Recognition Dynamics in the Process of Moving Away From a Life Dominated by Drug Use

The concepts of identity and recovery capital are recognized as being an embedded part of moving away from a life dominated by drug use. However, the link between these two concepts and the effect of broader social structures, and the normative assumptions underpinning the condition of recovery, is less explored. This article focuses on the social practices of everyday life in the foreground of identity formation, meaning that “who I am” is an inseparable part of “what I do.” A narrative approach was employed to analyze qualitative follow-up data extracted from 48 in-depth interviews with 17 males and females with drug-using experience that were conducted posttreatment on three separate occasions over a period of 2.5 years. Theories of identity formation were employed to analyze the interdependent dynamic between social structure, persona and social resources, and way of life and identity. The analyses identified four narratives related to how people present themselves through the process of changing practices. Following the work of Honneth, we argue that the positive identity formation revealed in these narratives is best understood as a struggle for recognition via the principle of achievement. However, the participants’ self-narratives reflected cultural stories—specified as formula stories—of “normality,” “addiction,” and the “addict,” which work into the concepts of self and confine options of storying experiences during the recovery process. This study demonstrate that the process of recovery is culturally embedded and constitutes a process of adaption to conventional social positions and roles. We suggest challenging dominant discourses related to “addiction as a disease” and “normality” in order to prevent stigma related to drug use and recovery. In so doing, it may contribute to broaden conditions for identity (trans)formation for people in recovery.

The Structure and Financing of Health Care Systems Affected How Providers Coped With COVID-19.

Policy Points We compared the structure of health care systems and the financial effects of the COVID‐19 pandemic on health care providers in the United States, England, Germany, and Israel: systems incorporating both public and private insurers and providers.The negative financial effects on health care providers have been more severe in the United States than elsewhere, owing to the prevalence of activity‐based payment systems, limited direct governmental control over available provider capacity, and the structure of governmental financial relief.In a pandemic, activity‐based payment reverses the conventional financial positions of payers and providers and may prevent providers from prioritizing public health because of the desire to avoid revenue loss caused by declines in patient visits.