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Rejecting both a sweeping public Covid-vaccination-passport scheme and a ban on private certification is an easy call. In navigating the large, complex space in between, policymakers should consider the nature of privileged activities and the identity of the regulator.

Free and Charitable ClinicsFree clinics can help overcome financial and logistic barriers to care. But stable and predictable funding, as well as a better understanding of such clinics and their work, is required.

Data Mining: Practical Machine Learning Tools and Techniques offers a thorough grounding in machine learning concepts as well as practical advice on applying machine learning tools and techniques in real-world data mining situations. This highly anticipated third edition of the most acclaimed work on data mining and machine learning will teach you everything you need to know about preparing inputs, interpreting outputs, evaluating results, and the algorithmic methods at the heart of successful data mining. Thorough updates reflect the technical changes and modernizations that have taken place in the field since the last edition, including new material on Data Transformations, Ensemble Learning, Massive Data Sets, Multi-instance Learning, plus a new version of the popular Weka machine learning software developed by the authors. Witten, Frank, and Hall include both tried-and-true techniques of today as well as methods at the leading edge of contemporary research. *Provides a thorough grounding in machine learning concepts as well as practical advice on applying the tools and techniques to your data mining projects *Offers concrete tips and techniques for performance improvement that work by transforming the input or output in machine learning methods *Includes downloadable Weka software toolkit, a collection of machine learning algorithms for data mining tasks-in an updated, interactive interface. Algorithms in toolkit cover: data pre-processing, classification, regression, clustering, association rules, visualization

Private equity has rapidly enlarged its presence in the health care sector, expanding its investment targets from hospitals and nursing facilities to physician practices. The incursion of private equity is the latest manifestation of a long trend toward the corporatization and financialization of medicine. Private equity pools investments from large private investors to buy controlling stakes in companies through leveraged buyouts or similar arrangements that use the companies' own assets to finance debt. These investors seek to earn handsome profits by rapidly increasing revenues before selling off the investment. Private equity's incursion into health care is especially concerning. The drive for quick revenue generation threatens to increase costs, lower health care quality, and contribute to physician burnout and moral distress. These harms stem from market consolidation, overutilization and upcoding, constraints on physicians' clinical autonomy, and compromises in patient care. Policymakers attempting to counter these threats can barely keep up. Like a cloud of locusts, private equity moves so quickly that by the time lawmakers become aware of the problem and researchers study the effects, private equity has moved on to other investment targets. While it remains unclear whether private equity investment is fundamentally more threatening to health policy than other forms of acquisition and financial investment - whether by publicly traded companies, conglomerate health systems, or health insurers - private equity presents a heightened threat of commercialization. Even if private equity is not uniquely harmful, it is extremely adept at identifying and exploiting market failures and payment loopholes. The emphasis on short-term returns and exit, the heavy reliance on debt, and the insulation from professional and ethical norms make private equity investors more avid to exploit revenue opportunities than institutional repeat players. Thus, this article's central claim is that the influx of private equity into health care poses sufficient risks to warrant an immediate legal and policy response. Public policy should primarily target market failures and payment loopholes and only secondarily curb private equity investment per se. The good news is that we already have many tools under federal and state law with the potential to address the harms of commercialization. These can be used or sharpened to address the particular concerns raised by private equity's incursion into physician markets. Key tools include antitrust oversight, fraud and abuse enforcement, and state laws regulating the corporate practice of medicine and the terms of physician employment. In some instances, legislative or regulatory action may be needed to adapt existing laws. In other instances, new laws may be needed to close payment loopholes or correct market distortions. A leading example is the recent 'No Surprises Act', which curtails surprise outof-network medical billing. While the article lays out a roadmap for additional legal and policy actions to protect the health system from the acute risks of private equity, these are patches rather than systemic solutions. If these patches fail to stave off the incessant march toward commercialization of health care, we may see renewed calls to fundamentally rethink the market orientation of the US health system.

Background A family member’s negative experiences with medical care have long-term effects on a patient’s attitudes and emotions. However, the impact of family members’ experiences on patients’ trust in their own physicians and in physicians generally is poorly understood. This study aims to quantify these associations. Methods A cross-sectional online survey involving adults with non-communicable diseases (cardiac disease, diabetes, cancer, depression, and rheumatic disease) was conducted in Japan during April 2020. The main exposure variable was dissatisfaction with the medical care that family members had received. The main outcomes were patients’ ( N  = 661) own trust in their personal physicians and in physicians generally. The study adopted the Japanese version of the Abbreviated Wake Forest Physician Trust Scales. Both 5-item scales (general and individual physician trust) were translated and validated for the study. The total scores were transformed into a scale of 0-100 points. A series of linear mixed-effects models with consideration for clustering effect by prefectures were fit. Results The results showed a lower rating for trust in physicians generally as compared to trust in the respondent’s personal physician (mean 57.0 vs. 66.4 points; p  < 0.001). Furthermore, dissatisfaction with a family member’s medical care was associated with lower trust in physicians generally (mean difference − 9.58, 95 %CI -12.4 to -6.76). Interestingly, dissatisfaction with a family member’s care was also associated with lower trust in the respondent’s personal physician (mean difference − 3.19, 95 %CI -6.02 to -0.36), but the magnitude of this association was weaker. The lower trust in personal physicians may be mediated by reduced trust in physicians generally. Conclusions We suggest that physicians enquire about past patients’ negative experiences, including dissatisfaction with family members’ medical care, to repair hidden loss of trust, when they sense that patients doubt them or physicians generally.

ABSTRACT Maintaining beneficial interactions with microbial symbionts is vital for animal health. Yet, for social insects, the stability of microbial associations within and between cohorts is largely unknown. We investigated temporal changes in the microbiomes of nine stingless bee (Tetragonula carbonaria) colonies at seven timepoints across a 10-month period when moved between two climatically and florally different sites. Bacterial 16S rRNA gene and fungal ITS amplicon sequencing confirmed that microbiomes varied considerably between colonies initially at site one. However, following relocation, considerable changes occurred in bacterial community composition within each colony, and the microbiome composition became more similar across colonies. Notably, Snodgrassella disappeared and Zymobacter appeared as relatively abundant taxa. Remarkably, bacterial communities within colonies continued to shift over time but remained similar across colonies, becoming dominated by Acinetobacter six months after returning to the original site. Our results indicate that the stingless bee microbiome can undergo major changes in response to the environment, and that these changes can be long-lasting. Such legacy effects have not been reported for corbiculate bees. Further understanding the microbial ecology of stingless bees will aid future management of colonies used in agricultural production. The microbial communities associated with stingless bees showed rapid and long-lasting changes when colonies were moved between two locations across a 10-month period.

Latine populations in the United States continue to be disproportionately affected by COVID-19 with high rates of infection and mortality. Our community-based participatory research partnership examined factors associated with COVID-19 testing and vaccination within a particularly hidden, underserved, and vulnerable population: Spanish-speaking Latines. In 2023, native Spanish-speaking Latine interviewers conducted phone-based structured individual assessments with 180 Spanish-speaking, predominantly immigrant Latines across North Carolina. We used univariate and multivariable logistic regression analyses to examine associations between participant characteristics and COVID-19 testing and vaccination. Participant mean age was 41.7 (SD = 13), and 77.2% of the sample reported being cisgender women. Most participants reported immigrating from Latin American countries (89.9%), being uninsured (66.1%), and lacking US immigration documentation (51.1%). While most reported ever being COVID-19 tested (83.3%) and ever being vaccinated against COVID-19 (84.4%), only 24% were up to date with vaccination. Nearly half of the sample reported one or more barriers to COVID-19 testing, and over one-quarter reported one or more barriers to COVID-19 vaccination. Higher educational attainment was significantly associated with ever being tested (P = .031). Fewer concerns about the vaccine, including fewer worries about side effects and having more confidence in vaccine effectiveness and safety, was associated with ever being vaccinated (P < .001). Spanish-speaking Latines face barriers to getting tested and vaccinated against COVID-19. Although ever testing and ever vaccination rates were high, being up to date with recommended vaccinations was low. Educational attainment and concerns about the vaccine were associated with COVID-19 testing and vaccination, respectively. Our findings suggest the need for culturally congruent strategies to address the challenges facing Spanish-speaking Latines in the United States.

Legal scholars, the mockingbirds of the academy, are great borrowers of scholarly methods. We experiment with the tools of historians, economists, sociologists, literary theorists, moral philosophers, and others, often to great effect. Yet despite these innovative efforts to study legal doctrines and institutions through different lenses, legal scholars have yet to identify their own unique 'empirical' methodology. Instead, empirical legal methods are often standard applications of basic social science methods to subjects of (sometimes trifling) legal interest. In doing this kind of work, law professors may ably step into the shoes of social scientists, but their methods are not uniquely or especially legal methods. They have only a weak claim to engaging in a distinct disciplinary approach. Social scientists trained in disciplines other than law can do what empirical legal scholars do equally well or better.

Latine communities in the United States have been disproportionately affected by COVID-19. It is critical to gain a better understanding of the sociocultural determinants that challenge and facilitate COVID-19 testing, vaccination, and booster uptake within these vulnerable communities to inform culturally congruent strategies and interventions. In summer 2022, our community-based participatory research partnership conducted 30 key informant interviews and 7 focus groups with 64 Spanish-speaking Latine participants in North Carolina. Interviewees consisted of representatives from health and service organizations, most of whom were engaged with direct service to Spanish speakers. Interviews were conducted in either English or Spanish, depending on the preference of the participant; all focus groups were conducted in Spanish. Interviews and focus groups were conducted in person or by videoconference. Twenty themes emerged that we organize into four domains: general perceptions about COVID-19; barriers to COVID-19 testing, vaccination, and booster uptake; facilitators to COVID-19 testing, vaccination, and booster uptake; and recommendations to promote testing, vaccination, and booster uptake. Results underscore important sociocultural determinants of ongoing COVID-19 testing, vaccination, and booster uptake to consider in developing interventions for Spanish-speaking Latines in the United States. Based on this formative work, our partnership developed Nuestra Comunidad Saludable (Our Healthy Community). We are implementing the intervention to test whether trained peer navigators can increase COVID-19 testing, vaccination, and booster uptake among Spanish-speaking Latines through blending in-person interactions and mHealth (mobile health) strategies using social media.