Singular Focus Research Articles

Science Teacher Noticing via Video Annotation: Links between Complexity and Knowledge-Based Reasoning

ABSTRACT This study adds to the construct of science teacher noticing through an analysis that integrates concepts from pedagogical content knowledge (PCK) frameworks. It examines 929 instances of science teacher noticing made via video annotation tools (VATs) over the course of 38 early-career, secondary science teachers’ participation in a two-year professional learning experience. This study asked specifically about: 1) interacting elements of a classroom (students, practice, content) teachers noticed in videos of their own practice, 2) patterns in knowledge-based reasoning evidenced in noticing, and 3) the role of content knowledge in such knowledge-based reasoning. Using mixed methods analysis, we found that the majority of annotations exhibited a singular focus (i.e. students, teacher practice, or content) and tended to focus on students and/or practice, with less attention to content. However, we also identified a statistically significant relationship between complexity of noticing (i.e. attention to multiple foci) and the presence of knowledge-based reasoning. Further qualitative analysis of the subset of annotations that attended to content suggested that such attention to content could be an important link within teacher noticing to connect practice to student thinking. This study highlights the value of scaffolding attention to content and to multiple foci within science teacher noticing. It also demonstrates the potential for VATs to facilitate noticing.

An Overview of Intellectual Disability: Definition, Diagnosis, Classification, and Systems of Supports (12th ed.).

An Overview of Intellectual Disability: Definition, Diagnosis, Classification, and Systems of Supports (12th ed.).

Exploring the Lived Experience of Food Insecure African Americans with Type 2 Diabetes Living in the Inner City.

Despite evidence that food insecure African Americans with type 2 diabetes are at particularly high risk for poor health outcomes, there is currently a lack of information on their lived experience. This qualitative study aimed to identify challenges, facilitators, and barriers to effective diabetes care for food insecure African Americans with type 2 diabetes residing in an inner city. In fall 2018, we conducted two focus groups attended by a total of 16 food insecure adults with type 2 diabetes residing in the inner city of Milwaukee, Wisconsin. A standardized moderator guide included questions to explore the role of food insecurity in managing diabetes, and facilitators that improve diabetes management within the context of food insecurity. Focus groups were audio recorded and recordings were transcribed by a professional transcription service. A grounded theory approach was used for analysis. Six major challenges existed at the individual level (diet/nutrition, exercise, diabetes knowledge and skills, complications from diabetes, a family history of diabetes, and a preoccupation with food). Five major barriers and facilitators existed both internally and externally to the individuals (access to food, medications, stress, cost of health-related needs and religion/spirituality). This study identified multiple challenges, barriers, and facilitators to effective care for food insecure African American adults with type 2 diabetes. It is imperative to incorporate this understanding in future work by using an ecological approach to investigate strategies to address food insecurity beyond a singular focus on access to food.

Students’ Etiquette towards Teachers According to Syaikh Burhanuddin Az-Zarnuji

A deterioration in students' morality and etiquette in the classroom is a result of Indonesian education virtually losing its status as the study idol of the students. As a result, education becomes purely goal-oriented, with a singular focus on receiving a diploma. In actuality, one must first show respect to their teacher in order to learn, and then the effects might become apparent later. This study aims to: (1) Discover the concepts of students’ etiquette to teachers according to Syaikh Burhanuddin Az-Zarnuji in the book of Ta'lim Muta'allim Tariq At-Ta'allum in Fashl Ta'dzimul Ilmi wa Ahlih (2) Discover the pattern in learning about students’ etiquette to their teachers according to Syaikh Burhanuddin in the book of Ta'lim Muta'allim Tariq At-Ta'allum in Fashl Ta'dzimul Ilmi wa Ahlih. This study used a qualitative approach. The method used was descriptive. The data collection implemented was library research. The object being researched, as well as the data source, was the book Ta'alim Muta'alim by Syaikh Burhanuddin Az-Zarnuzi. The data collection method uses descriptive methods and the author performed content analysis. The results showed that students' etiquette towards teachers are students must always respect the teacher and the teacher's family, protect the rights of the teacher, do not walk in front of the teacher, do not sit in the teacher's place, do not start a conversation without the teacher’s permission, do not ask something when the teacher is bored, be on time, do not knock on the door of the teacher's house but be patient waiting for the teacher to come out.

Student mental health in higher education: the contextual influence of "cuts, competition & comparison".

The mental health of students in UK higher education (HE) is receiving increased attention, and support services for students are under increased pressure. Drawing on ecological systems theory (EST), this study sought to explore possible contextual influences, over time, on student distress within HE. We conducted a two-stage Delphi study, first asking UK professionals (n = 236) from primary, secondary, further education, and HE to provide possible reasons for increases in student distress. The material was reduced to 58 representative statements across all sectors with a further 10 specific to HE. In stage 2, 89 participants rated each statement in terms of whether it: (1) takes place and (2) contributes to distress. The results suggest multiple contextual influences potentially contributing to student distress. They can be summarized using the words: cuts, competition, and comparison. Education professionals in our sample reported that, upstream from HE, pressures on schools and colleges have led to a narrowing of curricula, with a more singular focus on assessment. Reduced teaching teams and pressurized staff unintentionally embed an assessment focus within students who unhelpfully compare themselves with peers while also struggling with wider societal cuts, austerity, and political uncertainty. The discussion draws on the peer-reviewed literature and relevant reports, discussing them in the context of EST, finding considerable support for these influences. The potential importance of adopting a contextual approach and incorporating this knowledge into the way we understand and tackle students' distress and their preparedness for HE is discussed.

Синдром дисмобільності: зміна парадигми в царині профілактики переломів

Остеопоротичні переломи зумовлюють серйозні витрати на охорону здоров’я, знижують незалежність/якість життя пацієнта і підвищують ризик смерті. Незважаючи на різні види терапії щодо зниження ризику майбутніх переломів, мало хто проходить лікування навіть після перелому стегна. Очевидно, що підходи минулого, спрямовані на зниження ризику остеопоротичних переломів, насамперед шляхом діагностики остеопорозу і призначення препаратів, що впливають на кісткову тканину, не були успішними. Потрібен інший підхід; таке зміщення фокуса й обговорюється в даній статті. Кажучи коротко, відповідно до концепції синдрому дисмобільності остеопоротичний перелом розглядають як клінічний результат наслідку і вважають, що остеопороз є лише частиною синдрому, який призводить до перелому, «пов’язаного з остеопорозом». Іншими компонентами цього синдрому є саркопенія, ожиріння, діабет, остеоартрит і теоретично безліч інших факторів, що збільшують ризик падінь із супутнім підвищеним ризиком перелому. Таким чином, концепція синдрому дисмобільності зрушує галузь дослідження, а також, що важливо, вивчення даних у літніх людей, у яких можливі остеопоротичні переломи, за межі єдиного фокуса на кістку для більш закономірного зосередження на цілісному підході до зниження ризику переломів.

CitSci.org & PPSR Core: Sharing biodiversity observations across platforms

CitSci.org is a global citizen science software platform and support organization housed at Colorado State University. The mission of CitSci is to help people do high quality citizen science by amplifying impacts and outcomes. This platform hosts over one thousand projects and a diverse volunteer base that has amassed over one million observations of the natural world, focused on biodiversity and ecosystem sustainability. It is a custom platform built using open source components including: PostgreSQL, Symfony, Vue.js, with React Native for the mobile apps. CitSci sets itself apart from other Citizen Science platforms through the flexibility in the types of projects it supports rather than having a singular focus. This flexibility allows projects to define their own datasheets and methodologies. The diversity of programs we host motivated us to take a founding role in the design of the PPSR Core, a set of global, transdisciplinary data and metadata standards for use in Public Participation in Scientific Research (Citizen Science) projects. Through an international partnership between the Citizen Science Association, European Citizen Science Association, and Australian Citizen Science Association, the PPSR team and associated standards enable interoperability of citizen science projects, datasets, and observations. Here we share our experience over the past 10+ years of supporting biodiversity research both as developers of the CitSci.org platform and as stewards of, and contributors to, the PPSR Core standard. Specifically, we share details about: the origin, development, and informatics infrastructure for CitSci our support for biodiversity projects such as population and community surveys our experiences in platform interoperability through PPSR Core working with the Zooniverse, SciStarter, and CyberTracker data quality data sharing goals and use cases. the origin, development, and informatics infrastructure for CitSci our support for biodiversity projects such as population and community surveys our experiences in platform interoperability through PPSR Core working with the Zooniverse, SciStarter, and CyberTracker data quality data sharing goals and use cases. We conclude by sharing overall successes, limitations, and recommendations as they pertain to trust and rigor in citizen science data sharing and interoperability. As the scientific community moves forward, we show that Citizen Science is a key tool to enabling a systems-based approach to ecosystem problems.

Patient‐centered outcomes: Domain importance predicts health care use following physical therapy

Identifying patients with musculoskeletal pain who are at risk for additional health care use is important for improving the value of physical therapists' services. We previously identified three subgroups based on the importance attached by patients to improvements in outcome domains including a (1) Pain and Function Outcomes Important subgroup; (2) Pain Important subgroup; and (3) Multiple Outcome Domains Important subgroup. The primary aim was to determine whether subgroups based on patient-determined outcomes of importance predicted any additional pain-related health care use after an episode of physical therapy. A secondary aim was to determine if subgroup membership predicted use of specific services. Secondary analysis of a longitudinal cohort. Ambulatory outpatient physical therapy clinics. Two hundred forty-six patients seeking physical therapy recruited from the Optimal Screening for Prediction of Referral and Outcome (OSPRO) cohort study. Patients completed a demographic and health history questionnaire, numeric pain rating scale, region-specific disability measure, and Charlson Comorbidity Index. Subgroup membership was determined based on responses to the Patient Centered Outcome Questionnaire. At 1 year, patients reported use of health care since discharge from physical therapy. Separate logistic regression models determined whether subgroup membership predicted additional health care use. Compared to the Pain and Function Outcomes Important subgroup, the Pain Important subgroup had higher adjusted odds (95% confidence interval [CI]) for the primary outcome of any additional health care use (adjusted odds ratio [aOR]2.47, 95% CI 1.01-6.00) and secondary outcomes of opioid use (aOR 9.45, 95% CI 2.87-31.17), injection (aOR 4.09, 95% CI 1.25-13.41), and surgery (aOR 5.10, 95% CI 1.15-22.67). There were no significant differences in health care utilization between the Pain and Function Outcomes Important and Multiple Outcome Domains Important subgroups. In this cohort, patients with a singular focus on pain improvements were at higher risk for additional health care, including opioid use, injection, and surgery. These findings are exploratory and need to be confirmed in other cohorts.

A metabolic daylength measurement system mediates winter photoperiodism in plants.

Plants have served as a preeminent study system for photoperiodism due to their propensity to flower in concordance with the seasons. A nearly singular focus on understanding photoperiodic flowering has prevented the discovery of other photoperiod measuring systems necessary for vegetative health. Here, we use bioinformatics to identify photoperiod-induced genes in Arabidopsis. We show that one, PP2-A13, is expressed exclusively in, and required for, plant fitness in short, winter-like photoperiods. We create a real-time photoperiod reporter, using the PP2-A13 promoter driving luciferase, and show that photoperiodic regulation is independent of the canonical CO/FT mechanism for photoperiodic flowering. We then reveal that photosynthesis combines with circadian-clock-controlled starch production to regulate cellular sucrose levels to control photoperiodic expression of PP2-A13. This work demonstrates the existence of a photoperiod measuring system housed in the metabolic network of plants that functions to control seasonal cellular health.

Dark Side Case: Tyson Foods during COVID-19 Pandemic

The case discusses Arkansas-based meat processing company Tyson Foods Inc.’s alleged negligent practices with regard to the safety of its workers during the COVID-19 pandemic. Critics contended that workers at Tyson’s meat processing facility at Waterloo, Iowa, worked in closed production lines with no masks or personal protective equipment, and social distancing norms were violated, exposing them to the virus. They also alleged that even workers who felt ill were instructed by plant managers to ignore the COVID-19 symptoms and continue working. Consequently, the families of three workers who died due to COVID-19 at its Waterloo plant filed a lawsuit against Tyson Foods claiming that the managers had lied to the workers about the spread of COVID-19, that the company had failed to implement adequate workplace safety measures, and that supervisors had encouraged sick workers showing COVID-19 symptoms to continue working. In December 2020, Tyson Foods faced more scrutiny from regulators regarding its business practices during the pandemic. Critics felt that the situation at Tyson Foods and several other meat packing facilities in the US had only gone to show the kind of disregard in which such companies held their workers and portrayed contemporary capitalism at its worst. They opined that corporate greed and the singular focus on making profits had put workers’ lives at risk since the workers had to report to work despite having COVID-19 symptoms. Going forward, what should Tyson Foods do to provide a safe working environment to its workers? What role can regulators and employers such as Tyson play in improving the working conditions for employees at the workplace? Amidst the pandemic, how do the management of companies such as Tyson Foods balance the need for providing essentials to customers with the need to keep their workers and customers safe?

In and out of Othello

Othello has been the play that seems to speak to current issues of racism and sexism for the last couple of decades. Recent Indian productions have stretched its relevancies further, particularly addressing the politics of identity, of individual and state, of belonging and othering. The 2014 award-winning Assamiya film Othello (We Too Have Our Othellos) appropriates and radicalizes the main concerns of the play to embody and critique the movements for self-determination that continue to rage in the state. The article examines this unusual Indian adaptation of Shakespeare that locates the play directly within the public sphere of the politics of the state through its singular focus on Othello as an ‘outsider’ figure paralleled by other such figures of contemporary Assamese society. It will contextualize the discussion of this film, its production and positioning within the film industry of Assam and attempt to define the nature of its adaptation. It will also glance at its similarities with the earlier film In Othello (2003), which too connected Shakespeare and Assam to illustrate the volatile configurations of the outsider/insider status in contemporary India.

Beyond social withdrawal: New perspectives on the effects of inflammation on social behavior

Decades of research in animals and humans show that inflammation is an important regulator of social behavior. While much research in this area has concluded that inflammation causes a withdrawal from social interaction, closer examination of the literature reveals that the effects of inflammation on social behavior are much more nuanced. Indeed, while many studies do show that increases in inflammation lead to social withdrawal, other studies show the exact opposite, finding that inflammation leads to an increase in social approach behavior. Critically, whether an organism withdraws or approaches when inflamed may depend on the whether the target of the behavior is a close other or a stranger. In the present paper, we review both animal research and our initial research in humans that has utilized experimental manipulations of inflammation and examined their effects on social approach behavior. We argue, based on complementary theoretical perspectives and supporting evidence from the literature, that there are three critical next steps for translational work examining the effects of inflammation on social behavior: (1) We need to study actual social behavior, as expressed toward both close others and strangers; (2) We should examine not just the social behavior of the inflamed individual, but also the behavior of others interacting with an inflamed individual; and (3) We must consider the relative increases in inflammation (i.e., higher vs. lower) as a contributor to social withdrawal vs. approach. Ultimately, we urge the field to move beyond a singular focus on inflammation and social withdrawal so that we can develop a more comprehensive understanding of the effects of inflammation on a variety of social behaviors.

Monitoring the Spatiotemporal Evolution of the Green Dam in Djelfa Province, Algeria

Green walls and green dams are increasingly being considered as part of many national and international desertification initiatives. This paper studies the spatiotemporal evolution of the green dam in the Moudjbara region (Djelfa Province, Algeria), from 1972 to 2019, by using Landsat imagery, Land Change Modeler, and OpenLand package. The future evolution of pine plantations, for the year 2029, was also forecasted, based on an anthropogenic scenario (i.e., anthropogenic pressure is the main driver of the green dam destruction). Our findings revealed that the green dam project was successful for a few years, but, after that, pine plantations deteriorated significantly, due to forest harvesting, livestock overgrazing, and the proliferation of the pine caterpillar processionary, which destroyed most of the reforestation. Land change modeler predicted a huge degradation of pine plantations for the year 2029, and if the deforestation continues at the same rate, the green dam in the Moudjbara region will disappear during the next few decades. Being aware of this threat, the Algerian authorities are now planning to reforest more than 1.2 million ha under the latest rural renewal policy, by introducing new principles related to sustainable development, fighting desertification, and climate change adaptation. We strongly recommend moving away from the singular tree planting focus, to diversifying desertification control methods.

Did the poor gain from India\u2019s health policy interventions? Evidence from benefit-incidence analysis, 2004\u20132018

BackgroundHealth policy interventions were expected to improve access to health care delivery, provide financial risk protection, besides reducing inequities that underlie geographic and socio-economic variation in population access to health care. This article examines whether health policy interventions and accelerated health investments in India during 2004–2018 could close the gap in inequity in health care utilization and access to public subsidy by different population groups. Did the poor and socio-economically vulnerable population gain from such government initiatives, compared to the rich and affluent sections of society? And whether the intended objective of improving equity between different regions of the country been achieved during the policy initiatives? This article attempts to assess and provide robust evidence in the Indian context.MethodsEmploying Benefit-Incidence Analysis (BIA) framework, this paper advances earlier evidence by highlighting estimates of health care utilization, concentration and government subsidy by broader provider categories (public versus private) and across service levels (outpatient, inpatient, maternal, pre-and post-natal services). We used 2 waves of household surveys conducted by the National Sample Survey Organisation (NSSO) on health and morbidity. The period of analysis was chosen to represent policy interventions spanning 2004 (pre-policy) and 2018 (post-policy era). We present this evidence across three categories of Indian states, namely, high-focus states, high-focus north eastern states and non-focus states. Such categorization facilitates quantification of reform impact of policy level interventions across the three groups.ResultsUtilisation of healthcare services, except outpatient care visits, accelerated significantly in 2018 from 2004. The difference in utilisation rates between poor and rich (between poorest 20% and richest 20%) had significantly declined during the same period. As far as concentration of healthcare is concerned, the Concentrate Index (CI) underlying inpatient care in public sector fell from 0.07 in 2004 to 0.05 in 2018, implying less pro-rich distribution. The CI in relation to pre-natal, institutional delivery and postnatal services in government facilities were pro-poor both in 2004 and 2018 in all 3 groups of states. The distribution of public subsidy underscoring curative services (inpatient and outpatient) remained pro-rich in 2004 but turned less pro-rich in 2018, measured by CIs which declined sharply across all groups of states for both outpatient (from 0.21 in 2004 to 0.16 in 2018) and inpatient (from 0.24 in 2004 to 0.14 in 2018) respectively. The CI for subsidy on prenatal services declined from approximately 0.01 in 2004 to 0.12 in 2018. In respect to post-natal care, similar results were observed, implying the subsidy on prenatal and post-natal services was overwhelmingly received by poor. The CI underscoring subsidy for institutional delivery although remained positive both in 2018 and 2004, but slightly increased from 0.17 in 2004 to 0.28 in 2018.ConclusionsImprovement in infrastructure and service provisioning through NHM route in the public facilities appears to have relatively benefited the poor. Yet they received a relatively smaller health subsidy than the rich when utilising inpatient and outpatient health services. Inequality continues to persist across all healthcare services in private health sector. Although the NHM remained committed to broader expansion of health care services, a singular focus on maternal and child health conditions especially in backward regions of the country has yielded desired results.

Comparing the regulation and incentivization of e-cigarettes across 97 countries

E-cigarette use continues to increase globally despite uncertainty regarding their long-term health impacts and around their effectiveness for tobacco smoking cessation. This uncertainty creates unique challenges for governments as they attempt to optimally regulate and positively or negatively incentivize these products in a way that maximizes the public's health. Current approaches to e-cigarette regulation and incentivization fall within a spectrum of options ranging from a singular focus on health protection, whereby policies intend to prevent the dangers of e-cigarettes, to a singular focus on using e-cigarettes for harm reduction, whereby policies intend to reduce the more harmful effects of smoking tobacco. Regulation options include prohibition, component ban, and regulation as medicinal products, poisons, tobacco products, consumer products, and/or unique products. Incentivization options include taxation, subsidization, and providing a financial reward. Through comparative public policy analysis, this study describes, compares and assesses the variety of approaches that 97 countries have taken to regulate and incentivize e-cigarettes. The goal is to inform future decisions by governments on how they approach the public health challenge posed by e-cigarettes, building on a nuanced understanding of the complexities of this challenge and what other jurisdictions have already implemented and learned.

Womb to womb: Maternal litter size and birth weight but not adult characteristics predict early neonatal death of offspring in the common marmoset monkey.

A singular focus on maternal health at the time of a pregnancy leaves much about perinatal mortality unexplained, especially when there is growing evidence for maternal early life effects. Further, lumping stillbirth and early neonatal death into a single category of perinatal mortality may obscure different causes and thus different avenues of screening and prevention. The common marmoset monkey (Callithrix jacchus), a litter-bearing nonhuman primate, is an ideal species in which to study the independent effects of a mother's early life and adult phenotypes on pregnancy outcomes. We tested two hypotheses in 59 marmoset pregnancies at the Southwest National Primate Research Center and the Barshop Institute for Longevity and Aging Studies. We explored 1) whether pregnancy outcomes were predicted independently by maternal adult weight versus maternal litter size and birth weight, and 2) whether stillbirth and early neonatal death were differentially predicted by maternal variables. No maternal characteristics predicted stillbirth and no maternal adult characteristics predicted early neonatal death. In univariate Poisson models, triplet-born females had a significantly increased rate of early neonatal death (IRR[se] = 3.00[1.29], p = 0.011), while higher birth weight females had a decreased rate (IRR[se] = 0.89[0.05], p = 0.039). In multivariate Poisson models, maternal litter size remained an independent predictor, explaining 13% of the variance in early neonatal death. We found that the later in the first week those neonates died, the more weight they lost. Together these findings suggest that triplet-born and low birth weight females have distinct developmental trajectories underlying greater rates of infant loss, losses that we suggest may be attributable to developmental disruption of infant feeding and carrying. Our findings of early life contributions to adult pregnancy outcomes in the common marmoset disrupt mother-blaming narratives of pregnancy outcomes in humans. These narratives hold that the pregnant person is solely responsible for pregnancy outcomes and the health of their children, independent of socioecological factors, a moralistic framing that has shaped clinical pregnancy management. It is necessary to differentiate temporal trajectories and causes of perinatal loss and view them as embedded in external processes to develop screening, diagnostic, and treatment tools that consider the full arc of a mother's lived experience, from womb to womb and beyond.

Who Votes Without Identification? Using Individual‐Level Administrative Data to Measure the Burden of Strict Voter Identification Laws

Legal disputes over laws that require certain forms of identification (ID) to vote mostly focus on the burden placed on people who do not possess ID. We contend that this singular focus ignores the burden imposed on people who do possess ID, but nonetheless cannot access it when voting. To measure this alternative conception of burden, we focus on Michigan, which allows anyone who lacks access to ID to vote after signing an affidavit. A sample of affidavits filed in the 2016 presidential election from a random set of precincts reveals that about 0.45 percent of voters lacked access to ID. Consistent with our broader conception of the burden of voter ID laws, nearly all voters who filed an affidavit were previously issued a still‐active state ID. Importantly, we show minority voters were about five times more likely to lack access to ID than white voters. We also present survey evidence suggesting that people who live in states where voters are asked to show ID, as in Michigan, are more likely to incorrectly believe that access to ID is required to vote than are people who live in states that do not ask voters to show ID.

Good communication was valued as more important than accessibility according to 707 Nordic primary care patients: a report from the QUALICOPC study

Objective To explore Nordic patients’ ranking of the importance of different aspects of general practice. Design Patients ranked the importance of 47 statements reflecting five quality domains: communication, involvement, accessibility, continuity, and comprehensiveness. Setting Nordic general practice. Subjects Patients ≥18 years in general practitioners waiting rooms. Main outcome measures Items rated as important or very important by ≥ 90% in all countries were identified. Associations with patient characteristics were analysed by logistic regression. Results 209 Danish, 175 Norwegian, 129 Finnish, 112 Swedish and 82 Icelandic patients responded. Ten statements were ranked as important or very important by ≥90% in each country. Six pertained to communication, three to patient involvement and one to the comprehensiveness of care. No items regarding accessibility or continuity exceeded the 90% limit. The item most frequently rated as very important was ‘I understand what the GP explains’’. Female patients were more likely to value personal treatment (OR = 2.9; 95%CI 1.5–5.5) and receiving instructions if things went wrong (1.7; 1.2–2.2). Older patients >65 years put less emphasis than those <35 on whether the GP takes them seriously (0.4; 0.3–0.5) and on the importance of instructions (0.5; 0.4–0.7). Patients with chronic diseases were less concerned (0.6; 0.4–0.8) with receiving instructions, but valued strongly that a GP knows when to refer (2.2; 1.5–3.3). Conclusion Patients in all countries assigned high value to good communication. Availability was deemed important but came secondary to good communication. Implications Organisational framework for general practice must allow for acceptable communication quality as well as availability. Key points In order to identify relevant service areas for quality improvement in primary care, we aimed to increase knowledge of patient ranked importance of different dimensions of care. Nordic primary care patients valued good communication and involvement in decisions higher than accessibility to care. A singular focus on the access of care when developing services may not be in accordance with patient preferences.

Todd R. Klaenhammer, an inspirational food microbiologist who leaves a lasting legacy

Todd R. Klaenhammer (1951–2021) dedicated his professional life to the study of bacteria of importance to food. He conducted his doctorate under the guidance of Larry McKay at the University of Minnesota, who inspired him to apply the newest advances in bacterial genetics to the lactic acid bacteria, responsible for many food fermentations. Todd stood out from his peers at an early age. He was offered a position and started his 40-year academic career in the prestigious Food Science Department at North Carolina State University before he had even defended his doctorate. Todd always had a singular focus. While most food scientists followed the lead of the funding agencies and “better” journals by working on foodborne pathogens responsible for infectious diseases, he preferred to study the beneficial bacteria associated with food. Todd forged his illustrious career by working on commercially important bacteria, such as the dairy starter cultures responsible for cheese fermentations and probiotics that were associated with diverse health benefits. Over his long career, Todd managed to combine fundamental science with commercially relevant research. It is a measure of his accomplishments that you could spend a long time in your university library reading the many influential scientific articles Todd wrote, but if you took a lunch break and went to the dairy section of the canteen you could also choose from a variety of cheeses that were made with phage-resistant starter cultures that he generated, or perhaps enjoy a yogurt formulated with some of the health-promoting probiotics he pioneered. Todd R. Klaenhammer. Image credit: North Carolina State University/Marc Hall. Throughout his career, Todd navigated the food microbiology research landscape with flair and intuition. He was always true to his favored lactic acid bacteria, but he repeatedly and skillfully adjusted the focus of his laboratory group, often leading the field … [↵][1]1To whom correspondence may be addressed. Email: rbarran{at}ncsu.edu. [1]: #xref-corresp-1-1

Subscriptions for Prescriptions: Implications and Execution of the 'Netflix Model'

Several states in the U.S. have piloted a type of subscription model for prescription drugs, under which a state pays a fixed amount to a pharmaceutical manufacturer for a targeted population (e.g., inmates) over a contract horizon. We analyze the implications of executing the subscription model by characterizing a healthcare provider’s drug-administering decisions, which entails delivering both services and products. In a public-health setting in which service delivery is commonly contracted out using a capitation system, the subscription model additionally contracts out product delivery, meaning drug-administering decisions are subject to a global budget cap. Thus, pressures to minimize costs can lead to the rationing of care despite the promise of unlimited drug supply. We characterize the provider’s cost-minimizing decisions and show increasing the capped amount does not change the propensity for rationing. To induce the provider away from a singular focus on cost minimization, we analyze a case in which the provider faces two objectives — maximizing cures and minimizing mortality — subject to a budget constraint. We develop a novel approach that determines the efficient frontier of this bi-objective problem in a polynomial time; our approach entails converting the bi-objective problem into a tri-objective problem, which is then decomposed into multiple subproblems. The efficient frontier captures trade-offs resulting from the provider’s actions. In addition, and importantly, we show the efficient frontier can be attained through a variety of performance-based incentive schemes.