Linking Decision Theory and Quantitative Microbial Risk Assessment: Tradeoffs Between Compliance and Efficacy for Waterborne Disease Interventions

Achieving health gains from the U.N. Sustainable Development Goals of universal coverage for water and sanitation will require interventions that can be widely adopted and maintained. Effectiveness—how an intervention performs based on actual use—as opposed to efficacy will therefore be central to evaluations of new and existing interventions. Incomplete compliance—when people do not always use the intervention and are therefore exposed to contamination—is thought to be responsible for the lower‐than‐expected risk reductions observed from water, sanitation, and hygiene interventions based on their efficacy at removing pathogens. We explicitly incorporated decision theory into a quantitative microbial risk assessment model. Specifically, we assume that the usability of household water treatment (HWT) devices (filters and chlorine) decreases as they become more efficacious due to issues such as taste or flow rates. Simulations were run to examine the tradeoff between device efficacy and usability. For most situations, HWT interventions that trade lower efficacy (i.e., remove less pathogens) for higher compliance (i.e., better usability) contribute substantial reductions in diarrheal disease risk compared to devices meeting current World Health Organization efficacy guidelines. Recommendations that take into account both the behavioral and microbiological properties of treatment devices are likely to be more effective at reducing the burden of diarrheal disease than current standards that only consider efficacy.     

Do Interactions Between Environmental Chemicals and the Human Microbiome Need to Be Considered in Risk Assessments?

One of the most dynamic and fruitful areas of current health‐related research concerns the various roles of the human microbiome in disease. Evidence is accumulating that interactions between substances in the environment and the microbiome can affect risks of disease, in both beneficial and adverse ways. Although most of the research has concerned the roles of diet and certain pharmaceutical agents, there is increasing interest in the possible roles of environmental chemicals. Chemical risk assessment has, to date, not included consideration of the influence of the microbiome. We suggest that failure to consider the possible roles of the microbiome could lead to significant error in risk assessment results. Our purpose in this commentary is to summarize some of the evidence supporting our hypothesis and to urge the risk assessment community to begin considering and influencing how results from microbiome‐related research could be incorporated into chemical risk assessments. An additional emphasis in our commentary concerns the distinct possibility that research on chemical–microbiome interactions will also reduce some of the significant uncertainties that accompany current risk assessments. Of particular interest is evidence suggesting that the microbiome has an influence on variability in disease risk across populations and (of particular interest to chemical risk) in animal and human responses to chemical exposure. The possible explanatory power of the microbiome regarding sources of variability could reduce what might be the most significant source of uncertainty in chemical risk assessment.     

The Politics of Expanding Healthcare Access to the Poor and Informal Sectors

How do the politics of agenda setting and policy adoption operate in the arena of healthcare reform in the industrializing world? Literature on the twenty‐first‐century developmental state emphasizes the role of democratic competition and civil society in causing political parties to take up new agendas, while power resources theory stresses the role of left‐wing political parties and labor unions in policy adoption. Yet, core tenets of these theories have not been considered extensively in light of dynamics in the industrializing world. This article examines the politics of policy adoption in countries that have recently aimed to provide healthcare access and financial protection to the poor and people in the informal sector in Mexico and Turkey. In line with literature on the twenty‐first‐century developmental state, we find democratic competition to play an important role in causing political parties to take up new agendas. However, examination of the cases illuminates surprising dynamics that challenge important elements of sociological theory: right‐leaning political parties played important roles in adoption, while labor unions and left‐wing parties oppose reform in the cases. Public health‐minded physicians leading change teams played important roles in agenda setting and leading the process of implementation.     

Vocational education,self‐employment and burnout among Australian workers

We examine the relationship between vocational education and occupational burnout among workers in different forms of employment. Although the self‐employed enjoy higher levels of job autonomy and work‐related satisfaction, we do not know whether they experience lower rates of occupational burnout, and whether vocational education plays a role in this relationship. This latter consideration is important, given that vocational qualifications often lead to self‐employment and prior research demonstrated that formal training may reduce burnout. However, formal education was previously measured in years of schooling, without considering the distinction between academically‐oriented and vocational courses. Therefore, using data from a 2001 national survey of working Australians, we first establish that the self‐employed are significantly less likely to experience burnout. We then demonstrate that some resilience to burnout can be attributed to the attainment of skilled vocational training, net of employment characteristics which are also very important.     

Reciprocal Family,Friendship and Church Support Networks of African Americans: Findings from the National Survey of American Life

This study examined reciprocal support networks involving extended family, friends and church members among African Americans. Our analysis examined specific patterns of reciprocal support (i.e., received only, gave only, both gave and received, neither gave or received), as well as network characteristics (i.e., contact and subjective closeness) as correlates of reciprocal support. The analysis is based on the African American subsample of the National Survey of American Life. Overall, our findings indicate that African Americans are very involved in reciprocal support networks with their extended family, friends and church members. Respondents were most extensively involved in reciprocal supports with extended family members, followed closely by friends and church networks. Network characteristics (i.e., contact and subjective closeness) were significantly and consistently associated with involvement with reciprocal support exchanges for all three networks. These and other findings are discussed in detail. This study complements previous work on the complementary roles of family, friend and congregational support networks, as well as studies of racial differences in informal support networks.     

Strategic Design Responsiveness: An Empirical Analysis of US Retail Store Networks

This study uses a service operations management (SOM) strategy lens to investigate chain store retailers' strategic design responsiveness (SDR)—a term that captures the degree to which retailers dynamically coordinate investments in human and structural capital with the complexity of their service and product offerings. Labor force and physical capital are respectively used as proxies for investments in human capital and structural capital, whereas gross margins are proxies for product/service offering complexity. Consequently, SDR broadly reflects three salient complementary choices of SOM design strategy. We test the effects of “brick and mortar” chain store retailers' SDR on current and future firm performance using publically available panel data collected from Compustat and the University of Michigan American Customer Satisfaction Index databases for the period 1996–2011. We find that retailers that fail to keep pace with investments in both structural and human capital exhibit short‐term financial benefits, but have worse ongoing operational performance. These findings corroborate the importance of managers strategically maintaining the complementarity of design‐related choices for improving and maintaining business performance.     

The Effects of Multitasking on Operations Scheduling

This study considers a typical scheduling environment that is influenced by the behavioral phenomenon of multitasking. Under multitasking, the processing of a selected job suffers from interruption by other jobs that are available but unfinished. This situation arises in a wide variety of applications; for example, administration, manufacturing, and process and project management. Several classical solution methods for scheduling problems no longer apply in the presence of multitasking. The solvability of any scheduling problem under multitasking is no easier than that of the corresponding classical problem. We develop optimal algorithms for some fundamental and practical single machine scheduling problems with multitasking. For other problems, we show that they are computationally intractable, even though in some cases the corresponding problem in classical scheduling is efficiently solvable. We also study the cost increase and value gained due to multitasking. This analysis informs companies about how much it would be worthwhile to invest in measures to reduce or encourage multitasking.     

Consumption Dynamics During Recessions

Are there times when durable spending is less responsive to economic stimulus? We argue that aggregate durable expenditures respond more sluggishly to economic shocks during recessions because microeconomic frictions lead to declines in the frequency of households' durable adjustment. We show this by first using indirect inference to estimate a heterogeneous agent incomplete markets model with fixed costs of durable adjustment to match consumption dynamics in PSID microdata. We then show that aggregating this model delivers an extremely procyclical Impulse Response Function (IRF) of durable spending to aggregate shocks. For example, the response of durable spending to an income shock in 1999 is estimated to be almost twice as large as if it occurred in 2009. This procyclical IRF holds in response to standard business cycle shocks as well as in response to various policy shocks, and it is robust to general equilibrium. After estimating this robust theoretical implication of micro frictions, we provide additional direct empirical evidence for its importance using both cross‐sectional and time‐series data.