The Impact of Managed Care Payer Contracts on the Subspecialty Medical Provider: Policy Implications that Impact on the Care of Disabled Children

This Note explores the impact of current managed care contractual practices on the subspecialty provider\u27s ability to deliver health care to chronically ill and disabled children. In doing so, it delves into the historical events giving rise to the development of health care reform. It then reviews various physician agreements with several managed care organizations ( MCOs ) to demonstrate how contract conditions affect compensation for pediatric neurosurgical services. This Note then details the impact of managed care on the management of the chronic health problems of such children and proposes alternative solutions for affordable health care delivery systems for poor, medically fragile groups with complex health problems

ACSME 2019 Special Issue – Editorial

The Australian Conference of Science and Mathematics Education (ACSME) has long had a strong culture of interdisciplinary collaboration and has provided an opportunity to share the experiences of our colleagues around Australia. As both long-time attendees, the lessons we have learned from our colleagues within chemistry, physics, biology, mathematics, and others have certainly influenced and inspired our own practice and research. More so than in previous years, 2020 has challenged us to rapidly innovate whilst dealing with anxious and uncertain times. So, it is especially refreshing to read about, and reflect on, successes and creativity in the tertiary, and secondary, education sectors - reinforcing the idea that we are one community and being one community is our strength. While this special issue was planned, and submissions received, prior to the COVID-19 pandemic, the three papers presented in this issue provide insight into three unique perspectives from our community. This includes the reflection of a group of academics, learning from one another on their path to improving their teaching practice and creating positive learning environments in their classrooms; an example of collaborative research between undergraduate students and academics exploring the potential of modern technologies, such as VR, in the chemistry classroom; and an investigation into how our students think, and importantly, how we can scaffold their learning to develop their scientific thinking skills both inside and outside the classroom. Looking ahead into future years and the uncertainty of what our classrooms will look like, we would like to extend an invitation to all within our communities to engage in scholarly learning and teaching innovations - which we encourage you to share with the community in our journal, IJISME. The ambitious leaps taken this year across the country, and worldwide, to find creative solutions to teaching online leaves us with the question - what will you be keeping as you plan for 2021 and onwards? Speaking from our own discussions in writing this, we are already identifying teaching innovations that are now being recognised as strengths around which we could centre our teaching in future years. We acknowledge and pay respect to the Gadigal people of the Eora Nation, the traditional owners of the land on which we research, teach, and collaborate at the University of Sydney and the University of New South Wales

The Factory and the Beehive III: PTFEB132.707+19.810, a Low-Mass Eclipsing Binary in Praesepe Observed by PTF and K2

Theoretical models of stars constitute a fundamental bedrock upon which much of astrophysics is built, but large swaths of model parameter space remain uncalibrated by observations. The best calibrators are eclipsing binaries in clusters, allowing measurement of masses, radii, luminosities, and temperatures, for stars of known metallicity and age. We present the discovery and detailed characterization of PTFEB132.707+19.810, a P=6.0 day eclipsing binary in the Praesepe cluster ($\tau$~600--800 Myr; [Fe/H]=0.14$\pm$0.04). The system contains two late-type stars (SpT$_P$=M3.5$\pm$0.2; SpT$_S$=M4.3$\pm$0.7) with precise masses ($M_p=0.3953\pm0.0020$~$M_{\odot}$; $M_s=0.2098\pm0.0014$~$M_{\odot}$) and radii ($R_p=0.363\pm0.008$~$R_{\odot}$; $R_s=0.272\pm0.012$~$R_{\odot}$). Neither star meets the predictions of stellar evolutionary models. The primary has the expected radius, but is cooler and less luminous, while the secondary has the expected luminosity, but is cooler and substantially larger (by 20%). The system is not tidally locked or circularized. Exploiting a fortuitous 4:5 commensurability between $P_{orb}$ and $P_{rot,prim}$, we demonstrate that fitting errors from the unknown spot configuration only change the inferred radii by <1--2%. We also analyze subsets of data to test the robustness of radius measurements; the radius sum is more robust to systematic errors and preferable for model comparisons. We also test plausible changes in limb darkening, and find corresponding uncertainties of ~1%. Finally, we validate our pipeline using extant data for GU Boo, finding that our independent results match previous radii to within the mutual uncertainties (2--3%). We therefore suggest that the substantial discrepancies are astrophysical; since they are larger than for old field stars, they may be tied to the intermediate age of PTFEB132.707+19.810.Comment: Accepted to ApJ; 36 pages, 19 figures, 8 tables in two-column AASTEX6 forma

Interactive Effects of Climate Change-Induced Range Shifts and Wind Energy Development on Future Economic Conditions of the Atlantic Surfclam Fishery

Rising water temperatures along the northeastern U.S. continental shelf have resulted in an offshore range shift of the Atlantic surfclam Spisula solidissima to waters still occupied by ocean quahogs Arctica islandica. Fishers presently are prohibited from landing both Atlantic surfclams and ocean quahogs in the same catch, thus limiting fishing to locations where the target species can be sorted on deck. Wind energy development on and around the fishing grounds will further restrict the fishery. A spatially explicit model of the Atlantic surfclam fishery (Spatially Explicit Fishery Economics Simulator) has the ability to simulate the consequences of fishery displacement due to wind energy development in combination with fishery and stock dynamics related to the species\u27 overlap with ocean quahogs. Five sets of simulations were run to determine the effect of varying degrees of species overlap due to Atlantic surfclam range shifts in conjunction with fishing constraints due to wind farm development. Simulations tracked changes in relative stock status, fishery performance, and the economic consequences for the fishery. Compared to a business-as-usual scenario, all scenarios with less-restrictive fishing penalties due to species overlap exhibited higher raw catch numbers but also greater reductions in revenue and increases in cost after the implementation of wind farms. This analysis serves to demonstrate the response of the Atlantic surfclam fishery to combined pressures from competing ocean uses and climate change and emphasizes the potential for economic disruption of fisheries as climate change interacts with the evolution of ocean management on the continental shelf

Systematic Review of Gut Microbiota and Major Depression

Background: Recently discovered relationships between the gastrointestinal microbiome and the brain have implications for psychiatric disorders, including major depressive disorder (MDD). Bacterial transplantation from MDD patients to rodents produces depression-like behaviors. In humans, case-control studies have examined the gut microbiome in healthy and affected individuals. We systematically reviewed existing studies comparing gut microbial composition in MDD and healthy volunteers.Methods: A PubMed literature search combined the terms “depression,” “depressive disorder,” “stool,” “fecal,” “gut,” and “microbiome” to identify human case-control studies that investigated relationships between MDD and microbiota quantified from stool. We evaluated the resulting studies, focusing on bacterial taxa that were different between MDD and healthy controls.Results: Six eligible studies were found in which 50 taxa exhibited differences (p &lt; 0.05) between patients with MDD and controls. Patient characteristics and methodologies varied widely between studies. Five phyla—Bacteroidetes, Firmicutes, Actinobacteria, Fusobacteria, and Protobacteria—were represented; however, divergent results occurred across studies for all phyla. The largest number of differentiating taxa were within phylum Firmicutes, in which nine families and 12 genera differentiated the diagnostic groups. The majority of these families and genera were found to be statistically different between the two groups in two identified studies. Family Lachnospiraceae differentiated the diagnostic groups in four studies (with an even split in directionality). Across all five phyla, nine genera were higher in MDD (Anaerostipes, Blautia, Clostridium, Klebsiella, Lachnospiraceae incertae sedis, Parabacteroides, Parasutterella, Phascolarctobacterium, and Streptococcus), six were lower (Bifidobacterium, Dialister, Escherichia/Shigella, Faecalibacterium, and Ruminococcus), and six were divergent (Alistipes, Bacteroides, Megamonas, Oscillibacter, Prevotella, and Roseburia). We highlight mechanisms and products of bacterial metabolism as they may relate to the etiology of depression.Conclusions: No consensus has emerged from existing human studies of depression and gut microbiome concerning which bacterial taxa are most relevant to depression. This may in part be due to differences in study design. Given that bacterial functions are conserved across taxonomic groups, we propose that studying microbial functioning may be more productive than a purely taxonomic approach to understanding the gut microbiome in depression