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ItemHealth Organizational Design: Information Exchange and Accountability(Wiley StatsRef: Statistics Reference Online, 2020-05-16) Lee, Soo-Hoon; Dai, Tinglong; Phan, Philip H.In this article, we introduce two essential components of the field of healthcare organizational design: information exchange and accountability. We emphasize how the limitations from information-exchange and accountability theories can be bridged by operations management principles to improve patient outcomes through redesigning healthcare delivery processes. We also highlight managerial implications for health organizations and venues for future investigation. Item“We Can't Give Up Now”: Global Health Optimism and Polio Eradication in Pakistan(Informa UK Limited)The Polio Eradication Initiative, the largest coordinated public health project in history, is currently facing serious difficulties. For years, it has tried and failed to eliminate polio from its last strongholds in Afghanistan, Pakistan, and Nigeria. Drawing on document analysis as well as participant observation and interviews in Pakistan, Atlanta, Geneva, and Montreal, I explore how officials in the Polio Eradication Initiative systematically devalued or quieted evidence that eradication was not achievable and emphasized evidence that it was achievable, thus creating a string of optimistic projections. Polio eradication's culture of optimism ensures the continuation of the project by convincing donors and officials alike that eradication is immanent. At the same time, it prevents open, objective analysis of the problems the project faces. ItemPediatric outpatient utilization by differing Medicaid payment models in the United States(Springer Science and Business Media LLC) ItemWhy We Must Provide Better Support for Pakistan's Female Frontline Health Workers(Public Library of Science (PLoS))Summary Points As the Global Polio Eradication Initiative deploys its endgame strategy, the commitment and effectiveness of field health workers in polio-endemic countries is critical. Ongoing attacks on Lady Health Workers and other frontline health staff in Pakistan appear to be an unintended consequence of the high political profile of polio eradication. Achieving polio eradication and strengthening Pakistan's health system now depends on a shift in the center of gravity of international engagement, away from high-profile engagement with federal leaders and towards supportive partnerships with Lady Health Workers and other ground-level staff. Nearly all women who work on the health frontline in Pakistan do so because poverty and a lack of other opportunities force them to accept a job with pay of under US$5 per day. Steps to support Lady Health Workers and to engage them as strong partners should include paying a living wage, developing world-class security strategies, and providing opportunities for career development and advancement. ItemBiocultural Lactation: Integrated Approaches to Studying Lactation Within and Beyond Anthropology(Annual Reviews)This review examines anthropological contributions over the past decade into the biocultural processes and practices of lactation via the analytical pillars of colonialism, racial capitalism, and medicalization. The nexus of these three processes has been foundational to the profound disruption and decline of breastfeeding in the mid-twentieth century and is still impacting ongoing efforts to restore and facilitate breastfeeding. Anthropologists have helped expose and challenge biocapitalist, medicalized conceptualizations of lactation that undermine breastfeeding often even when they claim to support it. Moreover, they have highlighted how ethnocentric cultural ideologies shape biomedical categories of “normal” infant feeding and lactation and have demonstrated the variability of these processes and practices. While these efforts have yielded important interventions into anthropology and a range of other disciplines, significant work remains to integrate efforts across the subfields and to challenge racist, oppressive systems that continue to shape both the study and the practice of lactation. Expected final online publication date for the Annual Review of Anthropology, Volume 52 is October 2023. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates. ItemConstitutively active ESR1 mutations in gynecologic malignancies and clinical response to estrogen-receptor directed therapies(Elsevier BV)OBJECTIVE: Endocrine therapy is often considered as a treatment for hormone-responsive gynecologic malignancies. In breast cancer, activating mutations in the estrogen receptor (mutESR1) contribute to therapeutic resistance to endocrine therapy, especially aromatase inhibitors (AIs). The purpose of this study was to evaluate the frequency and clinical relevance of ESR1 genomic alterations in gynecologic malignancies. METHODS: DNA from FFPE tumor tissue obtained during routine clinical care for 9645 gynecologic malignancies (ovary, fallopian tube, uterus, cervix, vagina, vulvar, and placenta) was analyzed for all classes of genomic alterations (base substitutions (muts), insertions, deletions, rearrangements, and amplifications) in ESR1 by hybrid capture next generation sequencing. A subset of alterations was characterized in laboratory-based transcription assays for response to endocrine therapies. RESULTS: A total of 295 ESR1 genomic alterations were identified in 285 (3.0%) cases. mutESR1 were present in 86 (0.9%) cases and were more common in uterine compared to other cancers (2.0% vs <1%, respectively p < 0.001). mutESR1 were enriched in carcinomas with endometrioid versus serous histology (4.4% vs 0.2% respectively, p < 0.0001 in uterine and 3.5% vs 0.3% respectively, p = 0.0004 in ovarian carcinomas). In three of four patients with serial sampling, mutESR1 emerged under the selective pressure of AI therapy. Despite decreased potency of estrogen receptor (ER) antagonists in transcriptional assays, clinical benefit was observed following treatment with selective ER-targeted therapy, in one case lasting >48 months. CONCLUSIONS: While the prevalence of ESR1 mutations in gynecologic malignancies is low, there are significant clinical implications useful in guiding therapeutic approaches for these cancers.