Exploring the Membership Pharmacy Model: Initial impact and feasibility.

BACKGROUND: There is a need to shift pharmacy payment models, given the expanding role of the community pharmacist in improving patient outcomes, misaligned incentives of the existing reimbursement model, and deleterious effects of a lack of transparency on prescription costs. OBJECTIVES: The primary objective of this paper was to develop a payment strategy for a Membership Pharmacy Model within an independent community pharmacy setting. A secondary objective of this paper is to explore the early impact of a novel value-based pharmacy payment model on patients, pharmacies, and self-insured employers. PRACTICE DESCRIPTION: Good Shepherd Pharmacy, a nonprofit Membership Pharmacy founded in Memphis, TN, in 2015. PRACTICE INNOVATION: We discuss a novel, value-based payment model for community pharmacy, which involves a partnership between pharmacy and employer, without the use of a pharmacy benefit manager, using a recurring (i.e., membership pharmacy) business revenue model. EVALUATION METHODS: The pilot program was assessed using the RE-AIM framework. RESULTS: The pilot enrolled 34 patients for whom 1399 prescriptions were filled spanning 13 quarterly refill cycles from January 2019-March 2022. After the intervention, proportion of days covered for diabetes and cholesterol medications both increased: 96.7% and 100% (P < 0.05); 90.3% and 98.1% (P > 0.05). Financial savings for the employer group were realized across both fee charges and prescription medication costs. The net savings provided to the employer was $67,843, a 35% reduction in topline pharmacy spending. Revenue for the pharmacy was realized exclusively through synchronization fees of $30 per fill. Synchronization fees for the entire study totaled $41,970, and the average revenue per quarterly batch refill was $3228. CONCLUSION: The Membership Pharmacy Model represents a potentially viable alternative to traditional fee-for-service, buy-and-bill pharmacy payment models through its use of medication pricing based on actual acquisition costs, lean pharmacy operations, and value-based reimbursement methods.

Maximising the wealth of few at the expense of the health of many: a public health analysis of market power and corporate wealth and income distribution in the global soft drink market.

BACKGROUND: Many of the harms created by the global soft drink industry that directly influence human and planetary health are well documented. However, some of the ways in which the industry indirectly affects population health, via various socio-economic pathways, have received less attention. This paper aimed to analyse the extent to which market power and corporate wealth and income distribution in the global soft drink market negatively impact public health and health equity. In doing so, the paper sought to contribute to the development of a broad-based public health approach to market analysis. A range of dimensions (e.g., market concentration; financial performance; corporate wealth and income distribution) and indicators (e.g., Herfindahl Hirschman Index; earnings relative to the industry average; effective tax rates; and shareholder value ratios) were descriptively analysed. Empirical focus was placed on the two dominant global soft drink manufacturers. RESULTS: Coca-Cola Co, and, to a lesser extent, PepsiCo, operate across an extensive patchwork of highly concentrated markets. Both corporations control vast amounts of wealth and resources, and are able to allocate relatively large amounts of money to potentially harmful practices, such as extensive marketing of unhealthy products. Over recent decades, the proportion of wealth and income transferred by these firms to their shareholders has increased substantially; whereas the proportion of wealth and income redistributed by these two firms to the public via income taxes has considerably decreased. Meanwhile, the distribution of soft drink consumption is becoming increasingly skewed towards population groups in low and middle-income countries (LMICs). CONCLUSIONS: Market power and corporate wealth and income distribution in the global soft drink market likely compound the market's maldistribution of harms, and indirectly influence health by contributing to social and economic inequalities. Indeed, a 'double burden of maldistribution' pattern can be seen, wherein the wealth of the shareholders of the market's dominant corporations, a group over-represented by a small and wealthy elite, is maximised largely at the expense of the welfare of LMICs and lower socioeconomic groups in high-income countries. If this pattern continues, the appropriate role of the global soft drink market as part of sustainable economic development will require rethinking.

Australia in 2030: what is our path to health for all?

CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping individuals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide examples of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development.

The influence of corporate market power on health: exploring the structure-conduct-performance model from a public health perspective.

BACKGROUND: The detrimental impact of dominant corporations active in health-harming commodity industries is well recognised. However, to date, existing analyses of the ways in which corporations influence health have paid limited attention to corporate market power. Accordingly, the public health implications of concentrated market structures, the use of anti-competitive market strategies, and the ways in which market power mediates the allocation and distribution of resources via market systems, remain relatively unexplored. To address this gap, this paper aimed to identify and explore key literature that could inform a comprehensive framework to examine corporate market power from a public health perspective. The ultra-processed food (UPF) industry was used to provide illustrative examples. METHODS: A scoping review of a diverse range of literature, including Industrial Organization, welfare economics, global political economy and antitrust policy, was conducted to identify important concepts and metrics that could be drawn upon within the field of public health to understand and explore market power. The Structure-Conduct-Performance (SCP) model, a guiding principle of antitrust policy and the regulation of market power, was used as an organising framework. RESULTS: We described each of the components of the traditional SCP model and how they have historically been used to assess market power through examining the interrelations between the structure of industries and markets, the conduct of dominant firms, and the overall ability of markets and firms to efficiently allocate and distribute the scarce resources. CONCLUSION: We argue that the SCP model is well-placed to broaden public health research into the ways in which corporations influence health. In addition, the development of a comprehensive framework based on the key findings of this paper could help the public health community to better engage with a set of policy and regulatory tools that have the potential to curb the concentration of corporate power for the betterment of population health.

Quantitative biomonitoring of polycyclic aromatic compounds (PACs) using the Sydney rock oyster (Saccostrea glomerata).

Increasing our understanding of the bioavailable fractions of polycyclic aromatic compounds (PACs) in an aquatic environment is important for the assessment of the environmental and human health risks posed by PACs. More importantly, the behaviour of polar polycyclic aromatic hydrocarbons (polar PAHs), which are metabolites of legacy PAHs, are yet to be understood. We, therefore, carried out a study involving Sydney rock oysters (Saccostrea glomerata) sourced from two locations, that had been exposed to PAH contamination, within an Australian south-east estuary. Biomonitoring of these oysters, following relocation from the estuary to a relatively isolated waterway, was done at 24 and 72 h after deployment and subsequently at 7, 14, 28, 52 and 86 days. Control samples from Camden Haven River were sampled for PAC analyses just before deployment, after 28 days and at the end of the study (day 86). Lipid-normalised concentrations in oyster tissues across the 86-day sampling duration, elimination rate constants (k2), biological half-lives (t1/2) and time required to reach 95% of steady-state (t95) were reported for parent PAHs and the less-monitored polar PAHs including nitrated/oxygenated/heterocyclic PAHs (NPAHs, oxyPAHs and HPAHs) for the three differently sourced oyster types. Most of the depurating PAHs and NPAHs, as well as 9-FLO (oxyPAH), had k2 values significantly different from zero (p < 0.05). All other oxyPAHs and HPAHs showed no clear depuration, with their concentrations remaining similar. The non-depuration of polar PAHs from oyster tissues could imply greater human health risk compared to their parent analogues.

Bioavailability of polycyclic aromatic compounds (PACs) to the Sydney rock oyster (Saccostrea glomerata) from sediment matrices of an economically important Australian estuary.

Improving risk assessment and remediation rests on better understanding of contaminant bioavailability. Despite their strong toxicological attributes, little is known about the partitioning behaviour and bioavailability of polar polycyclic aromatic hydrocarbons (PAHs) in aquatic environments. The present study provides an insight into the bioavailable fractions of polar PAHs and their parent analogues in the tissues of the Sydney rock oyster, Saccostrea glomerata, a model aquatic bio-indicator organism. The concentration and distribution patterns of parent and polar PAHs including oxygenated PAHs (oxyPAHs), nitrated PAHs (NPAHs) and heterocyclic PAHs (HPAHs) were determined in water, sediment and oysters from an ecologically and economically important estuary of New South Wales, Australia. Total concentrations of PAHs, oxyPAHs, NPAHs and HPAHs were higher in sediments compared to oyster tissue and water. For most polar PAHs, total concentrations for water, sediment and oyster samples were <1 µg/g (µg/l for water) while parent PAH concentrations were several orders of magnitude higher. Computed biota-sediment accumulation factors (BSAFs) on lipid-normalized oyster concentrations revealed that while ∑oxyPAHs and ∑HPAHs exhibited low accumulation from sediment to oyster tissues (BSAF <1), ∑PAHs and ∑NPAH were found to be accumulated at high levels (BSAF >1). BSAF individual computation showed that bioaccumulation of nine investigated HPAHs in oyster tissues were relatively low and only 2-EAQ (oxyPAH) and 1N-NAP (NPAH) showed high levels of accumulation in oyster tissues, similar to parent PAHs. To the best of our knowledge, this is the first known study on the bioavailability of polar and non-polar PAHs in an Australian aquatic environment. The outcome of this study might be a useful indicator of the potential risks of polar PAHs to humans and other living organisms.

The role of Australian local governments in creating a healthy food environment: an analysis of policy documents from six Sydney local governments.

OBJECTIVE: This paper examines policies from six local governments (LGs) relevant to promoting a healthy food supply and consumer food environment. METHODS: We analysed the six LGs' food and nutrition policies against a framework based on Australian literature and international policy frameworks. Policy content was collected by searching LG websites and analysed with reference to recommended policy actions in the framework. RESULTS: All LGs took action on reducing food waste, providing food/meal services for disadvantaged groups, and providing information/education on food and nutrition. A sub-set also supported urban/local food production and markets selling fresh, healthy food. Our search did not identify any indication of a comprehensive policy framework to guide action on food and nutrition, nor did we find policies restricting opening of unhealthy food outlets, encouraging the opening of healthy food outlets, or reducing unhealthy food marketing. CONCLUSIONS: Local governments in Australia are implementing policies to support improved nutrition. However, there are further opportunities for action, including discouraging unhealthy food outlets and restricting unhealthy food marketing. Implications for public health: The legal remit of LGs includes responsibilities relevant to food and nutrition. Further research is needed regarding how their powers could be better leveraged to improve diet-related health.

Diarrhetic Shellfish Toxin Monitoring in Commercial Wild Harvest Bivalve Shellfish in New South Wales, Australia.

An end-product market survey on biotoxins in commercial wild harvest shellfish (Plebidonax deltoides, Katelysia spp., Anadara granosa, Notocallista kingii) during three harvest seasons (2015⁻2017) from the coast of New South Wales, Australia found 99.38% of samples were within regulatory limits. Diarrhetic shellfish toxins (DSTs) were present in 34.27% of 321 samples but only in pipis (P. deltoides), with two samples above the regulatory limit. Comparison of these market survey data to samples (phytoplankton in water and biotoxins in shellfish tissue) collected during the same period at wild harvest beaches demonstrated that, while elevated concentrations of Dinophysis were detected, a lag in detecting bloom events on two occasions meant that wild harvest shellfish with DSTs above the regulatory limit entered the marketplace. Concurrently, data (phytoplankton and biotoxin) from Sydney rock oyster (Saccostrea glomerata) harvest areas in estuaries adjacent to wild harvest beaches impacted by DSTs frequently showed elevated Dinophysis concentrations, but DSTs were not detected in oyster samples. These results highlighted a need for distinct management strategies for different shellfish species, particularly during Dinophysis bloom events. DSTs above the regulatory limit in pipis sampled from the marketplace suggested there is merit in looking at options to strengthen the current wild harvest biotoxin management strategies.

Interdisciplinary treatment of an adult with bilateral cleft lip and palate with missing premaxilla: The prosthodontic perspective.

Conventional orthognathic surgery and orthodontic techniques occasionally fail to completely correct the occlusal relationship and esthetic deficits of patients with cleft lip and palate and severe midface deficiency. Prosthodontic rehabilitation is often required to establish adequate occlusion and provide a more proportional facial appearance. This clinical report describes the interdisciplinary management of an adult with complete bilateral cleft lip and palate who was treated with distraction osteogenesis using a rigid external distraction device for maxillary advancement and his prosthodontic rehabilitation with a dual path removable partial overdenture to develop definitive facial and dental esthetic form.

What event-related potentials (ERPs) bring to social neuroscience?

Social cognitive neuroscience is a recent interdisciplinary field that studies the neural basis of the social mind. Event-related potentials (ERPs) provide precise information about the time dynamics of the brain. In this study, we assess the role of ERPs in cognitive neuroscience, particularly in the emerging area of social neuroscience. First, we briefly introduce the technique of ERPs. Subsequently, we describe several ERP components (P1, N1, N170, vertex positive potential, early posterior negativity, N2, P2, P3, N400, N400-like, late positive complex, late positive potential, P600, error-related negativity, feedback error-related negativity, contingent negative variation, readiness potential, lateralized readiness potential, motor potential, re-afferent potential) that assess perceptual, cognitive, and motor processing. Then, we introduce ERP studies in social neuroscience on contextual effects on speech, emotional processing, empathy, and decision making. We provide an outline of ERPs' relevance and applications in the field of social cognitive neuroscience. We also introduce important methodological issues that extend classical ERP research, such as intracranial recordings (iERP) and source location in dense arrays and simultaneous functional magnetic resonance imaging recordings. Further, this review discusses possible caveats of the ERP question assessment on neuroanatomical areas, biophysical origin, and methodological problems, and their relevance to explanatory pluralism and multilevel, contextual, and situated approaches to social neuroscience.

Quantification of blood velocity and flow rates in the uterine vessels using echo planar imaging at 0.5 Tesla.

PURPOSE: To measure uterine artery and vein blood velocity and flow rate profiles using MRI during normal pregnancy. MATERIALS AND METHODS: A two-shot velocity magnitude-encoded echo planar imaging (EPI) sequence is used at a magnetic field 0.5T. Data analysis procedures, necessary to overcome problems associated with low signal to noise ratio (SNR), and a spatial resolution comparable to the vessel size were used. RESULTS: The measured blood flow values averaged over nine volunteers for the mean velocity are 5.33 and 3.97 cm/s and for the unilateral flow rate are 203 and 274 mL/min (for the arteries and veins respectively). Values for the flow rate are consistent with ultrasound Doppler studies. Arterial velocity measurements are more pulsatile than venous ones and validation calculations performed on average velocity values would suggest that the nature of blood flow in the uterine vessels is laminar. CONCLUSION: This study presents the first report of noninvasive quantitative measurements of uterine artery and vein blood velocity and flow rate profiles using MRI during normal pregnancy. Consistent and reproducible measurements have been obtained by subject specific sequence optimization and data analysis procedures.

Haplotypes of the angiotensin II receptor genes AGTR1 and AGTR2 in women with normotensive pregnancy and women with preeclampsia.

Angiotensin II (AII) acts as a growth factor in local systems, mediating diverse effects such as cellular proliferation and apoptosis. These effects are controlled through two main receptor subtypes: AGTR1 and AGTR2. We studied the haplotype frequencies of both receptor genes in women with preeclamptic pregnancies and normotensive pregnant women. We also looked for any association between AGTR1 genotype at sites in the 5' flanking region and binding of AII to platelets, which express AGTR1, in 58 normotensive pregnant women. There were nine common haplotypes of AGTR1, with no significant difference in haplotype frequency between the two groups of women. Platelet AII binding in normotensive pregnant women was associated with the genotype at g.5245C>T in the 5' flanking region of AGTR1 (GenBank AF245699.1), with CC homozygotes at g.5245 having the lowest levels, and g.5245 TT homozygotes having the highest levels (P=0.05). Two novel polymorphisms were identified in AGTR2 (GenBank AY324607.1) at nucleotides g.1701T>C and g.2184A>T. Variation of AGTR2 could be explained by the existence of four common haplotypes. There was evidence for a significant increase in the frequency of the haplotype TAATGC at nucleotides g.1701, g.2041, g.2184, g.4673, g.4679, and g.4975, respectively (P=0.004), in women with preeclampsia.