June 26, 2020

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

June 26, 2020

Prevalence Of Tooth Loss Among Older Adults, 2015-2018

A June 2020 Data Brief from the National Center for Health Statistics (NCHS) indicates that the prevalence of complete tooth loss among adults aged 65 and over was 12.9% and increased with age: 8.9% (ages 65– 69), 10.6% (ages 70–74), and 17.8% (ages 75 and over). Non-Hispanic black older adults (25.4%) had a higher prevalence of complete tooth loss than Hispanic (15.3%) and non-Hispanic white (10.9%) older adults. Prevalence of complete tooth loss was higher for older adults with less than a high school education (31.9%) compared with those with a high school education or greater (9.5%). From 1999–2000 through 2017–2018, the age-adjusted prevalence of complete tooth loss among all older adults declined significantly. Nevertheless, complete tooth loss can diminish quality of life by limiting food choices and impeding social interaction. Reducing this problem is a national health goal monitored by Healthy People.

Opioid-Involved Emergency Department Visits, Hospitalizations, And Deaths

A National Health Statistics Report on June 16, 2020 reveals that in the 2014 National Hospital Care Survey (NHCS), there were 15,495 patients with an opioid-involved ED-only visit and 24,059 patients with an opioid-involved hospitalization. Of the patients with an opioid-involved hospitalization, 1,805 died (9%) within one year of discharge. Of these deaths, 341 (19%) resulted from a drug overdose. Opioids most frequently mentioned included heroin (46%), fentanyl (20%), oxycodone (13%), methadone (12%), and morphine (12%). These categories are not mutually exclusive because a death may involve more than one drug. For approximately 22% of patients who died of an opioid-involved drug overdose in 2014, their last ED-only visit or hospitalization was opioid-involved. While lockdowns stemming from COVID-19 are aimed at preventing fatal infections, a concern is that social isolation may lead to increases in drug overdoses, suicides, and other health problems. Future studies will uncover the extent of such occurrences.

HEALTH TECHNOLOGY CORNER

Personalized Mapping Of Drug Metabolism By The Human Gut Microbiome

Previous studies have examined how single species of gut bacteria can metabolize oral medications, but a new framework enables the evaluation of an individual's entire intestinal microbial community at once. A research team at Princeton University used an approach to evaluate the gut microbiome's effect on hundreds of common medications already on the market by indicating how the microbial community in the intestines can chemically transform, or metabolize, oral medications in ways that have an impact on safety and efficacy. According to a study published on June 10, 2020 in the journal Cell, researchers identified 57 cases in which gut bacteria can alter existing oral medications. Eighty percent of those had not been previously reported, emphasizing the potential of the method for revealing unknown drug-microbiome interactions. The new methodology could aid the development of medications that are more effective, have fewer side effects, and are personalized to an individual's microbiome.

Magnetoelectric Materials For Miniature, Wireless Neural Stimulation At Therapeutic Frequencies

A major challenge for miniature bioelectronics is wireless power delivery deep inside the body. Electromagnetic or ultrasound waves suffer from absorption and impedance mismatches at biological interfaces. Magnetic fields do not suffer these losses, which has led to magnetically powered bioelectronic implants based on induction or magnetothermal effects. These approaches have yet to produce, however, a miniature stimulator that operates at clinically relevant high frequencies. A manuscript published on June 8, 2020 in the journal Neuron describes study results suggesting that using magnetoelectric materials for wireless power delivery is more than a novel idea. These materials are viewed as being excellent candidates for clinical-grade, wireless bioelectronics. Tiny implants capable of modulating activity of the brain and nervous system could have wide-ranging implications and could be useful for treating depression, obsessive-compulsive disorders and more than a third of patients who suffer from chronic, intractable pain that often leads to anxiety, depression and opioid addiction.

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DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

June 26, 2020

As summer moves forward, administrators of academic institutions at all levels continue to be plagued by doubts and uncertainties regarding whether schools should be reopened and students readmitted in coming months. When infections occur, youth cohorts have not been affected as drastically by COVID-19 in comparison to adult groups, especially patients 80 years of age and older. Nonetheless, once infected, even if asymptomatically, students have the potential to transmit this deadly disease to adults with whom they come in contact, such as teachers, and older relatives. A significant unknown is the extent to which parents are willing to have their offspring attend school as long as there is a perceived threat of infection.

What Will The College Football Season Look Like This Year?

Many colleges, and even high schools, depend on financial support derived from athletics. College football is a bountiful source of revenue as evidenced by stadiums that seat more than 100,000 fans who not only buy tickets, but even spend generously on concessions. Enlightened officials at some institutions have seen the value of adding alcoholic beverages to what is sold to patrons as a means of enhancing the amount of money flowing into school coffers. Players already are in training on some campuses and reports indicate that some of them are testing positive for the coronavirus. Although many are in superb physical condition, it is not uncommon for offensive and defensive linemen who weigh more than 300 pounds to be classified officially as being obese, a condition that has contributed to mortality outcomes among other segments of the population with this condition who became infected. Given the airborne capability of the coronavirus to be transmitted over a considerable distance by screaming fans at these events, a challenge is presented in figuring out how to adjust social distancing patterns safely in arenas. Fewer seats that are filled also can exert a negative impact on revenues.

Institutions Are Unequal In their Ability To Withstand Revenue Shortfalls

Apart from any health dangers posed by the presence of the appearance of a deadly infectious disease on school grounds, there can be severe financial consequences for failing to reopen some academic institutions. Publicly-funded schools are somewhat shielded from hazards associated with reductions in tuition income and student fee revenues, but the same cannot be said of their counterparts in the private realm. Prior to the appearance of the coronavirus, many states already were reeling financially because of increased pressures arising from growing expenditures in their Medicaid programs. As job losses began occurring on a massive scale in the U.S. beginning in March of this year, that economic contraction typically was accompanied by cancellations of health insurance coverage that is connected to employment status. Individuals so affected by losing their health insurance now have to rely on Medicaid coverage, which adds to the financial woes of many states that will find it increasingly difficult to devote resources to an ailing educational sector. Moreover, a related concern is that revenue obtained through fund raising and philanthropic contributions may not be as robust as it has been previously.

Rethinking Accreditation And Quality Assurance

The past several years have been characterized by a shared sense that current quality review needs to be reimagined to serve students and society more effectively. Judith Eaton, President of the Council for Higher Education Accreditation (CHEA), expressed her thoughts on this matter in June 2020 by identifying five specific steps that can lead to reinventing a review of quality in higher education, a post-Covid redesign of accreditation and quality assurance that, if effective, will establish a foundation for the next era of these important efforts. Accreditation and quality assurance are needed that capture quality, while embracing new providers and creatively using technology that brings students greater opportunity, access, and progress in furthering their education. The five steps are:

Sustain the fundamental value commitments of higher education
Expand the range of activity and scrutiny of quality review
Modify the primary purposes of accreditation and quality assurance
Enlarge the universe of accreditation/quality assurance providers themselves
Redesign the accreditation/quality assurance review process

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HEALTH REFORM DEVELOPMENTS

Kristen Truong

June 26, 2020

The appearance of COVID-19 in the United States has had a major impact on the nation’s health care delivery system. Lockdowns in many states are viewed as being successful in slowing down the rate at which new cases of the disease occur. Now that such restrictions have been loosened, in many jurisdictions there is a resurgence in the number of new cases as businesses reopen and some individuals choose to refrain from wearing masks when in public settings. The number of hospital admissions continues to grow in certain states, heightening a concern that the ability to treat newly infected patients may be compromised if hospital facilities become sufficiently overwhelmed.

Older Americans are disproportionately affected by this disease. Data released by the Centers for Medicare & Medicaid Services (CMS) on June 22, 2020 show that that more than 325,000 Medicare beneficiaries had a diagnosis of COVID-19 between January 1 and May 16 of this year, which translates to 518 COVID-19 cases per 100,000 beneficiaries. The data also indicate that nearly 110,000 beneficiaries were hospitalized for COVID-19-related treatment, which equals 175 COVID-19 hospitalizations per 100,000 beneficiaries. Blacks were hospitalized with COVID-19 at a rate nearly four times higher than whites. Disparities go beyond race/ethnicity and suggest the impact of social determinants of health, particularly socio-economic status. End-stage renal disease (ESRD) patients (individuals with chronic kidney disease undergoing dialysis) had the highest rate of hospitalization among all Medicare beneficiaries, with 1,341 hospitalizations per 100,000 beneficiaries. These patients also are more likely to have chronic comorbidities associated with increased COVID-19 complications and hospitalization, such as diabetes and heart failure.

Medicare And The Health Care Delivery System

The Medicare Payment Advisory Commission’s June 2020 Report to the Congress: Medicare and the Health Care Delivery System was issued on June 15, 2020. The Commission believes that unless substantial changes are made to the way Medicare pays for services and to how beneficiary care is organized and delivered, the cost of the Medicare program will remain on an unsustainable trajectory. The Part A trust fund is projected to exhaust its reserves in 2026, which will force Medicare to reduce payment rates sharply for hospitals and other Part A providers unless policymakers take some other action. The Commission asserts that the use of fee-for-service payment for Medicare services should be replaced, over time and to the degree feasible, by payment to accountable systems of care that have incentives to: provide preventive services and early disease detection, improve the quality and beneficiary experience of care; avoid delivering unnecessary or inappropriate services; control the costs of providing necessary services in the most appropriate care setting; deliver chronic care services through care coordination among providers; coordinate both the medical and nonmedical needs of beneficiaries; and enhance the use of technologies that improve quality and reduce program costs. Moreover, serious attention must be given to new innovations, for example, changing how hospitals are paid and giving providers incentives to manage the cost of medications.

Report To Congress On Medicaid And CHIP

The Medicaid program was instrumental in providing coverage to the uninsured when the Patient Protection and Affordable Care Act became law in 2010. Medicaid is playing this same role during the COVID-19 pandemic. Unemployment that results in loss of health insurance coverage through one’s job has helped to fuel a surge in the rolls of Medicaid beneficiaries. The Medicaid and CHIP Payment and Access Commission (MACPAC) on June 15, 2020 submitted its June 2020 Report to Congress on Medicaid and CHIP. This document contains six chapters addressing three fundamental challenges facing Medicaid: (1) improving integration of care for low-income seniors and individuals with disabilities who are dually eligible for Medicaid and Medicare; (2) ensuring that Medicaid is the payer of last resort when beneficiaries also have coverage from another insurance program; and (3) addressing concerns about high rates of maternal morbidity and mortality. A focus is on integrating Medicaid and Medicare, two separate programs that were not designed to work together, for beneficiaries who are eligible for both entities. Dually eligible beneficiaries account for a disproportionate share of Medicaid and Medicare service use and spending. Integrating the delivery and financing of their care is viewed as having a potential to address better the totality of their needs and reduce spending.

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CONGRESS IN A TIME OF CORONAVIRUS

Kristen Truong

June 26, 2020

A presidential election year can produce distortions in how Congress normally functions. The party in control of the White House typically stands to benefit in an election year from the passage of legislation that is popular with the electorate. Developments of that nature furnish a rationale for proclaiming why it is imperative that the political party in power remain in that position to ensure that good times continue to roll forward. The opposition party views the situation quite differently, finding it more convenient to prevent the passage of progressive legislation. That stance enables them to point an accusative finger at incumbents as being ineffective in accomplishing what is necessary. Their rationale is that it is high time for positive changes to occur and they inform the electorate in loud and clear terms that they are the political party with the ability to achieve desirable outcomes.

The year 2020 is proving to be vastly different. A main reason is that COVID-19 persists in being a major concern as of the end of June. As lockdowns have been loosened around the U.S., new cases of this disease continue to appear and hospitalizations are on the rise. Additional remedies are sought and can be implemented, but it is patently clear that agreements of a bipartisan nature are required. A recent example of a willingness to work cooperatively is a letter by a bipartisan group of 30 U.S. senators that was sent on June 15 to Majority Leader Mitch McConnell (R-KY) and Minority Leader Charles Schumer (D-NY), asking them to make permanent certain provisions from the bipartisan CONNECT for Health Act that were included in previous COVID-19 legislation. These provisions led to an important expansion of access to telehealth services for Medicare beneficiaries during the pandemic.

The reason for advocating increased access to telehealth stems from its potential to expand availability of health care, reduce costs, and improve health outcomes. Telehealth has proven to be pivotal for many patients during the current pandemic, ensuring that they receive the care they need while reducing the risk of infection and the further spread of COVID-19. Expanded Medicare coverage of telehealth services on a permanent basis, where clinically appropriate and with appropriate guardrails and beneficiary protections in place, would ensure that telehealth continues to be an option for all Medicare beneficiaries after the pandemic ends.

Supporters of this initiative believe that the population has benefited significantly from this expansion of telehealth and have come to rely on its availability. They stress that Congress should expand access to telehealth services on a permanent basis so that telehealth remains an option for all Medicare beneficiaries both now and after the pandemic. Doing so would assure patients that their care will not be interrupted when the pandemic ends. It also would provide certainty to health care providers that the costs to prepare for and use telehealth would be a sound long-term investment.

Apart from telehealth, other major decisions are pending on the near horizon. One of them has to do with deciding if a federal supplemental unemployment benefit of $600 per month should be extended beyond July 31 when it is scheduled to end. From a health professions workforce standpoint, S. 3993 is a bill introduced in the Senate on June 17 to permit a licensed health care provider to offer health care services to individuals in one or more States in which the provider is not licensed.

Return to June 2020 TRENDS

PRESIDENT’S CORNER

Kristen Truong

June 25, 2020

Leadership During Change

Higher education is in the midst of transformational change due to the pandemic. It has been experiencing pressures to change for some time now. The pandemic has just accelerated and significantly disrupted any sense of tradition activity. Leaders have had to react and recover, and now must reinvent their future as the political, economic, social and cultural ramifications of this disruption become known. Universities are forming partnerships, restructuring campus units, consolidating programs, and elevating the importance of their teaching and learning center and IT departments to adapt to new ways of learning.

Whether you are a program director, department chair, or dean, the recent confluence of events is testing your leadership like never before. Common advice for leaders during this time is to first and foremost make health and safety the top priority for everyone. Engaging parties from all units on campus in strategic planning should include staying true to your mission, protecting the health and safety of students and employees, and adopting flexibility, creativity and adaptability as means of preserving your future.

Leaders can help their teams with transition by working with campus administration to clarify the vision and establish structures that support change. It is important to keep the whole college and campus in mind when making changes as actions taken in one program or department can affect the entire college and campus. Feedback on proposed changes should come from both inside and outside of the university to reach various stakeholders and receive diverse perspectives from which to make better informed decisions.

In order to get the support of those affected by change, the rationale or purpose of the change must be clearly conveyed. Clear, open, authentic and consistent communication is key to earning support for change from others. This can be done through multiple channels including email, teleconferencing, newsletters, etc. Encouraging questions and feedback indicates a leader’s receptiveness to listening and understanding others’ viewpoints.

Modeling a positive response to organizational change and conveying trust in campus leadership can also provide additional assurance to your team that change is being handled with competence. For more insights on leadership during change, I encourage you to use your ASAHP membership network, attend ASAHP’s ongoing webinars, join ASAHP’s online communities, and watch for a series of upcoming virtual presentations on current topics.

“Be the Change You Want to See in the World” ...... Mahatma Gandhi

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COVID-19 VACCINE CLINICAL TRIAL CONCERNS

Kristen Truong

June 25, 2020

Announcements have been made that Moderna, the University of Oxford and AstraZeneca, and Johnson & Johnson independently of one another will begin testing proposed coronavirus vaccines in stage three trials beginning in July 2020. Related to the important matter of whether these attempts or any related investigations will yield products that protect against the onset of COVID-19 is the essential question of which kinds of individuals will benefit from this research. Key demographic characteristics, such as age, gender, and race/ethnicity help to distinguish one person from another. Unless the pool of participants in these clinical trials adequately reflects such differences, then the overall impact of any vaccine may be limited to representatives of groups taking part in such studies.

Major shortcomings presently exist in the composition of participants in clinical trials. As reported in the March 2020 issue of the journal Contemporary Clinical Trials Communications, adult participation in U.S. cancer clinical trials is at less than 10% of cancer patients, with even lower rates for racial and ethnic minority groups. For example, African Americans comprise 5% of patients enrolled in trials that support FDA approval of new drugs, while representing 13.3% of the general U.S. population. Cancer is the leading cause of death for Asian Americans, yet they comprise just 3% of cancer participants in clinical trials. Also, Hispanics represent less than 3% of participants in similar investigations, despite accounting for an estimated 17.8% of the U.S. population.

An under-representation of older adults in cancer clinical trials remains an ongoing concern. Consequently, optimal treatment in this group remains undefined. The January 2020 issue of the Journal of Geriatric Oncology describes challenges involving efforts to increase their level of participation. Older adult cancer patients, differ from younger adults since they often possess more comorbidities, take more medications, and have diminishing organ function, which often excludes them from clinical investigations. Furthermore, older adults enrolled in studies tend to be fitter and healthier than the average older patient seen in clinics, which leads to uncertainty about the risks, benefits, and tolerability of systemic therapies in the older population.

Potential barriers to enrollment of older adults in trials have been identified. One reason for non-accrual of older adults is due to trial unavailability or patient ineligibility. Strict exclusion criteria, especially those related to functional status, organ function, and comorbidities, which are common in older patients, can serve as major enrollment barriers.

Mortality data for victims of the COVID-19 epidemic show that some portions of the U.S. population have been devastated more than other demographic segments. Patients 80 years of age and older residing in long-term care facilities have been particularly hard hit. African American males also have died at significantly higher rates than their proportion of the population would suggest. Thus, it would be most prudent to ensure that stage three vaccine trials represent these groups adequately.

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RETHINKING THE “BENCH” AND “BEDSIDE” DICHOTOMY

Kristen Truong

May 26, 2020

Seventy-five years ago, Vannevar Bush, director of the U.S. Office of Scientific Research and Development, submitted his landmark report “Science, the Endless Frontier” to President Franklin D. Roosevelt. Along with sweeping structural and operational recommendations, the report elevated a key conceptual dichotomy that would have profound consequences for the future of American science: the distinction between ‘basic’ research and ‘applied’ research, thereby setting the tone for modern U.S. science policy. Concepts of ‘basic’ research and ‘applied’ research loosely can translate to the notions of ‘bench’ research and ‘bedside’ research. Yet, the road from fundamental biological insight to patient care (or vice versa) can be strewn with many obstacles that hamper the efforts of even the most qualified clinicians. Overcoming these roadblocks demands that the many aspects of the life sciences–medicine continuum be addressed.

According to a paper appearing in the April 2020 issue of the journal Nature Medicine, Congress subsequently approved funding for the Medical Scientist Training Program (MSTP) to bridge gaps between the domains of ‘basic’ research and ‘applied’ research in the biomedical context, effectively creating a new type of career: the dual-degree, MD/PhD physician-scientist. In the nearly 60 years since the creation of the MSTP, much has been learned about the complex terrain between bench and bedside and the institutional ingredients needed to realize this vision. By 2016, it was being argued that research activities might be understood better in the context of ‘discovery–invention cycles’ rather than a basic/ applied dichotomy. Building on a wealth of historical knowledge, this argument holds that research exists in virtuous cycles in which some periods are dominated by knowledge creation (discovery) and others are dominated by the creation of new tools or processes (invention). A suggestion is that a boundary be drawn, and even then, a fluid one between research and development, rather than between basic sciences and applied sciences. Instead, research should be thought of as an ‘unscheduled activity’ in the pursuit of new knowledge and inventions. Development is viewed as a ‘scheduled activity’ directed at converting the fruits of research into new products and services.

Return to may 2020 TRENDS

ADDRESSING THE 60-30-10 CHALLENGE

Kristen Truong

May 26, 2020

Modern healthcare systems may be characterized as possessing a numbers problem: specifically, 60, 30, and 10. Despite all the resourcefulness and efforts of the past 30 years, the healthcare delivery cart is viewed as remaining locked in a debilitating underperformance rut, according to a paper reported in the periodical BMC Medicine on May 4, 2020. Care that adheres to guidelines hovers at 60% as shown by large empirical studies of multiple conditions in adults and children in the USA, England, and Australia. Some 30% of care is waste, duplication, or of low value, according to several authoritative sources including the Organisation for Economic Co-operation and Development (OECD), for which considerable expenditure cannot be justified. Many studies also have documented how iatrogenic harm or adverse events befall at least 10% of patients globally.

Headline numbers in health care persist and may become worse when taking into consideration everything that is flowing through the health innovation pipeline. Advances in precision medicine, genomics, new generation drugs, artificial intelligence, and brain sciences all are in various stages of development or implementation in health care, with the potential to do both good and harm to the system. If the 60-30-10 challenge represents a strong signal that the system is not fit currently for purpose, how will it cope with an avalanche of these advanced technologies? New evidence as it materializes has the potential to deliver new cures and to save and extend lives, but if not adopted effectively, or across-the-board, then the proportion of evidence-based care could fall, not rise. New technologies also increase the complexity of care and add more risk. If they do not provide an adequate return on investment may add more waste. They also could introduce more potential for increased iatrogenic harm. The authors conclude that the 60-30-10 challenge is impeding progress.

Return to may 2020 TRENDS

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Kristen Truong

May 26, 2020

What COVID-19 Epidemiologic Models Can And Cannot Tell Us

Epidemiologic models are critical planning tools for policymakers, clinicians, and public health practitioners. Infectious disease modeling is an expansive field with a long history, encompassing a range of methods and assumptions that are not necessarily directly comparable, or even designed for the same purpose. An article published on May 15, 2020 in the New England Journal of Medicine identifies the following questions to ask about model results: (1) What is the purpose and time frame of this model? For example, is it a purely statistical model intended to provide short-term forecasts or a mechanistic model investigating future scenarios? These two types of models have different limitations; (2) What are the basic model assumptions? What is being assumed about immunity and asymptomatic transmission, for example? How are contact parameters included? (3) How is uncertainty being displayed? For statistical models, how are confidence intervals calculated and displayed? Uncertainty should increase as we move into the future. For mechanistic models, what parameters are being varied? Reliable modeling descriptions usually will include a table of parameter ranges to check to see whether those ranges make sense; (4) If the model is fitted to data, which data are used? Models fitted to confirmed COVID-19 cases are unlikely to be reliable. Models fitted to hospitalization or death data may be more reliable, but their reliability will depend on the setting; and (5) Is the model general, or does it reflect a particular context? If the latter, is the spatial scale — national, regional, or local — appropriate for the modeling questions being asked and are the assumptions relevant for the setting? Population density will play an important role in determining model appropriateness, for example, and contact-rate parameters are likely to be context-specific. The article can be obtained here.

Supporting Student Health And Mental Well-Being

Recent surveys of college and university presidents show there is real concern about how the disruption of in-person classes will affect students' already-rising rates of anxiety and depression. The April 2020 Pulse Point Survey by the American Council on Education (ACE) of these administrators suggests that a little over a third of presidents surveyed plan on making more investments in student mental health due to COVID-19. The brief, “Mental Health, Higher Education, and COVID-19: Strategies for Leaders to Support Campus Well-Being” reflects on data and offers examples and resources to help guide decision-making, including ways that leadership can adopt an equity lens with each mental health strategy. It also identifies three major strategies for leaders to consider as they respond to support student mental health during COVID-19 and beyond: (1) Ensure that communication to students is consistent, caring, and clear; (2) Consider the mental health and well-being of all campus community members, including faculty and staff who are on the front lines of serving and supporting students; and (3) Inform decision-making through assessments. The brief can be obtained here.

Caregiving In The United States 2020

A report from AARP on the state of caregiving in the U.S. finds that nearly one in five adults is an unpaid caregiver for an adult with health or other functional problems, up from around one in six in 2015. Nearly a quarter of individuals caring for more than one person indicate they are having difficulty coordinating care; that they're caring for someone with Alzheimer's disease or dementia; or that their health has gotten worse as a result of their caregiving duties. The report can be obtained here.

Return to may 2020 TRENDS

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

May 26, 2020

Births: Provisional Data For 2019

A report from the National Center for Health Statistics (NCHS) in May 2020 reveals that the provisional number of births for the U.S. in 2019 was 3,745,540, down 1% from 2018. The general fertility rate was 58.2 births per 1,000 women aged 15–44, down 2% from 2018 to reach a record low for the U.S. The total fertility rate was 1,705.0 births per 1,000 women in 2019, down 1% from 2018 to reach another record low for the nation. Birth rates declined for nearly all age groups of women under 35, but rose for women in their early 40s. The rate for women aged 35–39 was essentially unchanged in 2019. The birth rate for teenagers aged 15–19 declined by 5% in 2019 to 16.6 births per 1,000 females; rates declined for both younger (aged 15–17) and older (aged 18–19) teenagers. The cesarean delivery rate decreased to 31.7% in 2019; the low risk cesarean delivery rate decreased to 25.6%. The pre-term birth rate rose for the fifth year in a row to 10.23% in 2019.

Effects Of The COVID-19 Pandemic On Routine Pediatric Vaccine Ordering And Administration

The Morbidity and Mortality Report from the CDC on May 15, 2020 shows that Vaccine Tracking System data indicate a notable decrease in orders for Vaccines for Children Program (VFC)-funded, ACIP- recommended non-influenza childhood vaccines and for measles-containing vaccines during period two (1/6/20-4/19/20) compared with period one (1/7/19 and 4/21/19). The decline began the week after the national emergency declaration by President Donald Trump on March 13, 2020. Similar declines in orders for other vaccines also were observed. The ongoing COVID-19 pandemic is a reminder of the importance of vaccination. The identified declines in routine pediatric vaccine ordering and doses administered might indicate that U.S. children and their communities face increased risks for outbreaks of vaccine-preventable diseases. Parental concerns about potentially exposing their children to COVID-19 during well-child visits might contribute to the declines observed.

HEALTH TECHNOLOGY CORNER

Non-Invasive And Reversible Modulation Of Neuronal Activity To Diagnose And Treat Brain Disorders

About one in eight individuals over the age of 12 take antidepressants for mental disorders, such as depression and anxiety. A quarter of those have done so for 10 years or more according to a 2017 study by the National Center for Health Statistics and the use of antidepressants increased 65% from 1999 to 2014. New research indicates that treatments of brain disorders possibly may not have to require drugs or invasive surgery at all, just sound waves. As reported in a paper that was published on May 20, 2020 in the journal Science Advances, low-intensity ultrasound can be applied to the brain non-invasively to modulate neural activity with spatial specificity superior to other non-invasive methods, such as transcranial electrical or magnetic stimulation. Sound waves of high frequencies (ultrasound) have shown promise in this respect, combining the ability to modulate neuronal activity with sharp spatial focus. No pain, discomfort, or surgical technique are involved.

Cracking Nature’s Most Common Chemical Bond To Improve Drug Effectiveness

As reported in the May 15, 2020 issue of the journal Science, the most common chemical bond in the living world -- that between carbon and hydrogen -- has long resisted attempts by chemists to crack it open, thwarting efforts to add new exciting features to old carbon-based molecules. Now, after nearly 25 years of work by chemists at the University of California, Berkeley, those hydrocarbon bonds, two-thirds of all the chemical bonds in petroleum and plastics, have yielded fully, creating a possibility of synthesizing a large range of novel organic molecules, including drugs based on natural compounds. A potential application is altering natural compounds to improve them. Biologics, i.e., organic molecules, such as proteins, used as drugs also could be altered with this reaction to improve their effectiveness.

Return to may 2020 TRENDS

DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

May 26, 2020

A source of entertainment for many readers over the decades is Mad magazine. With its covers graced by the image of Alfred E. Neuman, a gap-toothed lad with a moronic grin plastered on his face whose motto that signified an intellectual absence of any curiosity was “Quid Me Anxius Sum?” (What, me worry?), his visage calls to mind a fairly common reaction to a series of decisions this month by govern- ment jurisdictions around the U.S. that led to reducing lock-down restrictions sparked by the COVID-19 pandemic. May 16, 2020 marked the official opening of beaches on the Outer Banks, NC. A cursory inspection by your TRENDS newsletter’s occasionally intrepid editor of the passing pageant in the town of Kill Devil Hills failed to reveal a single individual wearing a mask or practicing social distancing. Instead, young (including toddlers) and old alike gleefully cavorted in sand and surf, apparently blissfully unaware of the purported dangers posed by the presence of the invisible coronavirus.

A photo taken on May 7, 2020 revealed a tightly packed group of students celebrating graduation outside a home in Boulder, CO sans masks and social distancing. It is likely that similar festivities have taken place around the nation. Refusal to abide by public health recommendations aimed at preventing the spread of infectious disease provides a hint of what might transpire on college and university campuses if a decision is made to reopen them for the fall semester. Refusing to allow students to return in the name of sound health policy implementation could have consequences that will be nothing short of catastrophic for some institutions that are teetering financially. Meanwhile, a paramount concern that cannot be defined with any exactitude is the probability that the coronavirus will return even more forcefully this autumn than what characterized its highly robust appearance earlier this year.

Distribution Of Coronavirus Stimulus Funding To Colleges And Universities

The Coronavirus Aid, Relief, and Economic Security (CARES) Act establishes and funds the Higher Education Emergency Relief Fund (HEERF). Institutions of higher education are directed to use no less than 50% of funds received under Sections 18004(a)(1) and 18004(c) of the law to provide emergency financial aid grants to students for expenses related to the disruption of campus operations due to coronavirus, such as food, housing, course materials, technology, health care, and childcare. This economic rescue package enables $6 billion to be provided to colleges and universities, but subsequent guidance from officials at the U.S. Department of Education indicates that money can go only to students who qualify for federal financial aid, i.e., U.S. citizens and some legal permanent residents. Although the law has no explicit restrictions on which students could receive the emergency grants, individuals who are protected under the Deferred Action for Childhood Arrivals (DACA) program will be excluded.

The Department of Education on May 21, 2020 produced an updated statement on its guidance portal, indicating that “guidance documents lack the force and effect of law.”

Return to april 2020 TRENDS

HEALTH REFORM DEVELOPMENTS

Kristen Truong

May 26, 2020

The Patient Protection and Affordable Care Act of 2010, also known as the Affordable Care Act (ACA) and Obamacare, has remained intact for the most part since its inception. In the process of doing so, it has made it possible for millions of Americans to obtain health insurance coverage who previously lacked it. A significant feature of this legislation was a requirement that insurance companies had to allow coverage for all individuals regardless of any preexisting health conditions, which previously had led to their being denied such protection.

Along the way, there were setbacks for the law that have occurred over the decade. Seventeen months after the ACA’s enactment, the HHS Secretary announced that the Community Living Services and Supports (CLASS) Act, which was meant to address the costs of long-term care, was abandoned because it was considered unsound financially. In 2017 as part of a successful attempt to overhaul U.S. tax law aimed at energizing the economy, Congressional Republicans were able to zero out the individual mandate penalty. That occurrence led to a claim that once the mandate was stripped of its penalty for not purchasing health insurance, this provision no longer was enforceable and could not be considered as being constitutional.

An extension of that line of reasoning subsequently led to a conclusion that since this essential component of the Affordable Care Act was eliminated, then the entire law now should be struck down. Whether or not such an event will occur has yet to be resolved in the courts. ACA opponents in Congress also were successful in repealing the health insurance tax beginning in 2021, along with the so-called Cadillac tax on beneficiaries who have expensive insurance policies, and the medical device tax beginning in 2020. A problem is that revenue from these taxes was intended to cover the costs of expanding health insurance coverage under the law.

A centerpiece of the ACA was the formation of accountable care organizations (ACOs) in the Medicare program. As described in the April 2020 issue of this newsletter, results of a survey conducted that month by the National Association of ACOs (NAACOS) indicate that these entities are highly concerned about the effects of COVID-19 on their organizations. A possibility is that many respondents in risk-based models reported they are likely to quit the ACO program to avoid financial losses stemming from the pandemic. Apart from legislative and judicial battles, this example demonstrates how unfavorable economic conditions also can influence the outcome envisioned by Congress in 2010.

Medicaid Program In A Time Of COVID-19

Just as the recent pandemic has the potential to have a negative impact on the Affordable Care Act, it also can result in positive developments. An example involves the federal-state Medicaid program, which is considered to be countercyclical in nature. When the economy heads south, which it did quite dramatically causing millions of workers to become unemployed and advised to stay locked down in their homes. A great many of these individuals lost their health insurance coverage as a result. An option for them is to seek to enroll in Medicaid. Prior to the appearance of COVID-19, many states around the nation already were financially strapped because of an existing burden that compels them to meet rising program costs at the expense of being forced to reduce spending in other important categories, such as providing funds for higher education.

Just as health spending undergoes an increase, state income tax revenues derived from workers is decreased, along with taxes on restaurants and other venues where these employees worked and the general public patronized. Fortunately, the federal government has come to the rescue. A form of aid is represented by the Families First Coronavirus Response Act (P.L. 116-127) that authorized a 6.2% increase in the federal match rate (retroactive to January 1, 2020) available if states meet certain “maintenance of eligibility” requirements. Provisions include two weeks (up to 80 hours) of paid sick leave at the employee’s regular rate of pay when quarantined and/or experiencing COVID-19 symptoms and seeking a medical diagnosis; or the same amount of paid sick leave because an employee is unable to work because of a bona fide need to care for an individual subject to quarantine or to care for a child under the age of 18.

Return to may 2020 TRENDS

PRESIDENT’S CORNER

Kristen Truong

May 26, 2020

BY ASAHP PRESIDENT PHYLLIS KING

While you work on plans to address the rapid changes occurring in education and health care, ASAHP is here to serve as a valuable resource to support and advance your efforts. A new strategic plan has been designed to navigate a more unpredictable future. Infused in this planning are core values of providing high quality education, interprofessional collaboration, connecting education and health, innovation, leadership, and diversity. ASAHP’s mission of advancing health through interprofessional collaboration is supported by five strategic objective areas and associated success measures.

Strategic Objectives and Success measures

Communication, PR, and Marketing
- Membership growth
- Social media/website upgrades
- Search engine optimization
- Communication and marketing plan implemented
Leadership Development
- Leadership Development Program expanded
- Peer mentoring implemented
- Faculty networking, alumni, graduate events created
- Speaker bureau plan created
- Program for awards/recognitions created
Education
- Regional summits implemented
- Mentoring process created
- New interprofessional collaborations formed
- Internal academic speakers bureau created
Partnerships, Alliances, and Advocacy
- Alliances with professional organizations developed
- Healthcare partnerships developed
- Advocacy engagements
Research, Discovery, and Innovation
- Annual conferences implemented
- Special summits implemented
- IPE research grant created
- Create a platform and process to enable research collaboration and sharing of best practices among members

The Association is demonstrating adaptability and responsiveness to the immediate needs of members to address current issues such as disruptions in clinical education, the rise of telehealth, and many more. Leadership mobilized to create quality webinars attracting hundreds of participants. More webinars are forthcoming. Check out the website for up-to-date information and use the online communities to share information, network and learn from one another how to face this unprecedented time together.

Please remember that the next ASAHP Webinar, Considerations in Reintegrating Students into Clinical Settings, will occur on May 29, 2020 at 2 PM—3 PM, EDT.

Return to april 2020 TRENDS

HEROES ACT PASSED IN HOUSE

Kristen Truong

May 26, 2020

Round five in a sustained effort to deal with economic problems resulting from the COVID-19 pandemic was passed by the U.S. House of Representatives in a close 208-199 vote on May 15, 2020 that occurred mostly along party lines (only one Republican voted for it). Called the Health and Economic Recovery Omnibus Emergency Solutions (Heroes) Act, (H.R. 6800), this spending package would provide another $3 trillion in supplemental funds.

Among its major features, the proposed legislation would furnish an additional $100 billion for the provider relief fund initially established in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116-136) and also would expand the Paycheck Protection Program and Health Care Enhancement Act (P.L. 116-139). The bill also is aimed at improving the Accelerated and Advanced Payment Program by lowering the interest rate for loans to Medicare providers, reducing the per-claim recoupment percentage, and extending the period before repayment begins.

Additional measures include:

Providing $26.7 billion in emergency aid to public higher education institutions and $7 billion in emergency aid to private institutions for “education and general expenditures (including defraying expenses due to lost revenue, reimbursement for expenses already incurred, and payroll) and grants to students for expenses directly related to coronavirus.”
Extending the suspension of payments for federal student loans, interest accrual, and interest capitalization through September 30, 2021. Ten thousand dollars of loan forgiveness on all federal and privately held loans for economically distressed borrowers would be provided.
Available through September 2024, $4.7 billion would be invested for the National Institutes of Health to prevent, prepare for, and respond to the coronavirus, including $3 billion designated for offsetting the costs related to reductions in lab productivity as a result of the pandemic.
Increasing Federal Medical Assistance Percentage payments to state Medicaid programs by a total of 14%, starting July 1, 2020, through June 30, 2021.
Republican opposition indicates that the legislation already is considered dead on arrival in the Senate. A major concern is that money will go to states that have a long history of mismanaging their own respective finances. Senate Republicans have expressed interest in requiring that liability protection be included for businesses and academic institutions. Otherwise, they believe there is little guarantee that the unemployed will be able to return to their jobs and that normal functions on the nation’s campuses will be resumed any time soon. Some members of the G.O.P. also would prefer that states and local governments be given much more flexibility regarding how they can use existing relief money for operating expenses. The gradual relaxation of lockdown requirements by many jurisdictions around the U.S. will produce results about the spread of the disease and its lethality that may influence any future legislation, which possibly could be enacted into law.

Return to may 2020 TRENDS

RESEARCH AND EDUCATION AFTER THE PANDEMIC

Kristen Truong

May 26, 2020

COVID-19 is having a dramatic impact on the delivery of health services as well as on the nation’s economy. A cornucopia of research topics will become available for study once the pandemic has been relegated to the past tense. As an illustration, eventual findings from retrospective reviews to create improved understandings of how to keep patients from being assigned to various settings, such as intensive care units could influence health professions education by enabling students through the use of case studies to learn about what worked effectively and what failed to do so in patient care during a pandemic.

Research wise, each year approximately 40% of the manuscripts submitted to the Association’s Journal of Allied Health are rejected, often because of serious research methodology flaws. An article that appeared in the May 2020 issue of the Journal of Clinical Epidemiology sheds light on a common obstacle encountered by many investigators, which is the ability to recognize how “confounding” threatens the process of causal inference. The authors posit that a sound understanding of confounding within the counterfactual framework of causation enables better anticipation and dealing with this source of bias in research practice.

As a remedy, they propose a simplified explanation of the counterfactual definition of confounding based on a non-technical and graphical presentation of the central role of exchangeable background risks. As a first step, the following definition from the Dictionary of Epidemiology is offered: “The distortion of a measure of the effect of an exposure on an outcome due to the association of the exposure with other factors that influence the occurrence of the outcome. Confounding occurs when all or part of the apparent association between the exposure and the outcome is in fact accounted for by other variables that affect the outcome and are themselves not affected by the exposure.”

An exposure is broadly defined as being subjected to some kind of determinant, either harmful (risk factor) or beneficial (protective factor), or to a certain intervention or treatment. Like exposures, outcomes of interest in clinical epidemiological research also are broadly defined, for example, the occurrence or cure of a certain disease or health-related condition. It is assumed for ease of explanation that exposures and outcomes are dichotomous and are related positively, e.g., exposure to a risk factor leads to more disease or exposure to treatment produces a cure. Concepts to be explained also apply, however, to exposures and outcomes that are non-dichotomous or inversely related.

Consequently, when not appropriately accounted for by design or in the analysis of an investigation, confounding may bias study findings by distorting the association measures used for quantifying the nature and magnitude of the relation between the primary exposure and outcome. A key implication regarding what may need to be emphasized from an educational perspective is that this approach could serve in a valuable way for introducing researchers and students to the underlying concepts of confounding as explained from a counterfactual viewpoint.

Return to may 2020 TRENDS

ESTABLISHING HIGH PERFORMING TEAMS: HEALTH CARE LESSONS

Kristen Truong

April 27, 2020

Why is it that teams following the same best practices can achieve different results? According to a study published on February 25, 2020 in the MIT Sloan Management Review, clinics took three prototypical approaches to establishing team-based care. An aim of this research was to obtain an understanding of why some teams succeed while others struggle. Deploying effective team-based care is recognized as an essential component of three organizational priorities in health care: high-quality, patient-centered care; continuous quality improvement; and enhanced clinical work satisfaction. These objectives broadly align with the three recognized objectives of teams more generally: achieving the team’s shared goal, improving as a team, and growth of individual members. In this investigation, among clinics taking approaches to establishing team-based care, some groups pursued functional change only, with a focus on continuous improvement skills. Others pursued cultural change only, focusing on shifting team members’ roles and relationships. Another set of groups blended the two, pursuing both functional and cultural change processes simultaneously.

Functional Change Processes concerned practical, operational aspects of teaming. Clinic staff were trained on continuous improvement skills. Some clinics strategically integrated continuous improvement into everyday work, encouraging staff to identify process improvement opportunities and test new team approaches. Cultural Change Processes indicate that in order to implement new continuous improvement practices, it will require changing old ideas about personnel roles; reexamining who had authority to take initiative and lead innovation; and how “lower status” team members’ contributions were invited and valued by traditionally “higher status” colleagues. The results show that while both change processes were individually important, they were most effective when mobilized in tandem. The recursive, mutually reinforcing relationship between functional and cultural change processes was key to the effectiveness (or its lack) of team-based care.

Return to april 2020 TRENDS

RACIAL DISPARITIES IN AUTOMATED SPEECH RECOGNITION SYSTEMS

Kristen Truong

April 27, 2020

Automated speech recognition (ASR) systems, which use sophisticated machine-learning algorithms to convert spoken language to text, have become increasingly widespread, powering popular virtual assistants, facilitating automated closed captioning, and enabling digital dictation platforms for health care. This technology is employed in myriad applications used by millions of individuals worldwide. Some examples include virtual assistants built into mobile devices, home appliances, and in-car systems; digital dictation for completing medical records; automatic translation; automated subtitling for video content; and hands-free computing. Over the last several years, the quality of these systems has dramatically improved, due both to advances in deep learning and to the collection of large-scale datasets used to train the systems. Some concern exists, however, that these tools do not work equally well for all subgroups of the population.

As described in an article published in the April 7, 2020 issue of the journal Proceedings of the National Academy of Sciences of the United States of America, researchers examined the ability of five state-of-the-art ASR systems developed by Amazon, Apple, Google, IBM, and Microsoft to transcribe structured interviews conducted with 42 white speakers and 73 black speakers. This corpus in total spans five U.S. cities and consists of 19.8 hours of audio matched on the age and gender of the speaker. The study indicates that all five ASR systems exhibited substantial racial disparities, with an average word error rate (WER) of 0.35 for black speakers compared with 0.19 for white speakers. The investigators trace these disparities to the underlying acoustic models used by the ASR systems as the race gap was equally large on a subset of identical phrases spoken by black and white individuals in the corpus. They conclude by proposing strategies, such as using more diverse training datasets that include African American Vernacular English, to reduce these performance differences and ensure speech recognition technology is inclusive.

Return to april 2020 TRENDS

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Kristen Truong

April 27, 2020

Brain Health Across The Lifespan

Brain health affects Americans across all ages, genders, races, and ethnicities. Enriching the body of scientific knowledge around brain health and cognitive ability has the potential to improve quality of life and longevity for many millions of Americans and their families. To explore issues related to brain health throughout the life span, from birth through old age, a public workshop entitled Brain Health Across the Life Span was convened on September 24-25, 2019, by the Board on Population Health and Public Health Practice in the Health and Medicine Division of the National Academies. The Centers for Disease Control and Prevention estimate that as many as five million Americans were living with Alzheimer's disease in 2014. That same year, more than 800,000 children were treated for concussion or traumatic brain injuries in U.S. emergency departments. Each year, more than 795,000 individuals in the United States have a stroke. Developing more effective treatment strategies for brain injuries and illnesses is essential, but brain health is not focused exclusively on disease, disorders, and vulnerability. It is equally important to better understand the ways human brains grow, learn, adapt, and heal. Addressing all these domains to optimize brain health will require consideration about how to define brain health and resilience and about how to identify key elements to measure those concepts. A summary of the workshop can be obtained here.

Leading In A Time Of Crisis: Corporate America And COVID-19

New research from the Global Strategy Group reveals the opportunities and risks facing corporate leaders as they respond to COVID-19. While the economics of the pandemic will come into view in the months and years to come, right now, individuals in the U.S. are focused squarely on the safety, health, and well-being of their family, friends, communities, and the nation at large and they believe that corporations must do likewise. CEOs must counter the existing perception that they are focused most on the bottom line and work to support their employees and beyond by providing important benefits like paid leave; producing needed equipment and materials; and working in close cooperation with the government to respond to the pandemic. Companies are viewed as needing to tell the story of what they are doing and who they are helping with the stimulus dollars they receive to overcome negative perceptions. Eventually, they will be defined by what they do now. The reputational costs could be high. Research results can be obtained here.

Confronting Rural America’s Health Care Crisis

The rapid spread of COVID-19 has awakened the nation to the dire access problems that have long plagued rural communities and has underscored the need for immediate change. The current pandemic has highlighted the fragility of the rural health care system, in which hundreds of hospitals have already closed or are in imminent risk of folding. The Bipartisan Policy Center’s Rural Health Task Force has developed recommendations over the last year to stabilize and improve the urgent problems challenging rural communities and to do it permanently. The aim was to produce policy recommendations to stabilize and transform rural health infrastructure; promote the uptake of value-based and virtual care; and ensure access to local providers. These recommendations are contained in an April 2020 report. In addition to addressing telehealth, the task force recommendations include short-term stabilization for struggling rural hospitals and multiple pathways to transform into models that are customized to meet the needs of individual communities. The report can be obtained here.

Return to april 2020 TRENDS

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

April 27, 2020

Lifetime Prevalence Of Self-Reported Work-Related Health Problems Among U.S. Workers

The April 3, 2020 issue of the CDC’s Morbidity and Mortality Weekly Report indicates that approximately 2.8 million nonfatal workplace illnesses and injuries were reported in the United States in 2018. Current surveillance methods might underestimate the prevalence of occupational injuries and illnesses. One way to obtain more information on occupational morbidity is to assess workers’ perceptions about whether they have ever experienced health problems related to work. Using data from the 2018 version of the SummerStyles survey, overall, 35.1% of employed respondents had ever experienced a work-related health problem. The most commonly reported work-related problem was back pain (19.4%). Among industries, construction (48.6%) had the highest prevalence of any work-related health problems. A conclusion is that workplace injury and illness prevention programs are needed to reduce the prevalence of work-related health problems, especially in higher-risk industries.

National Health Expenditure Projections, 2019-2028

According to an article in the April 2020 issue of the journal Health Affairs, national health expenditures are projected to grow at an average annual rate of 5.4% for 2019–28 and to represent 19.7% of gross domestic product by the end of the period. Meanwhile, growth in the gross domestic product during the projection period is expected to average 4.3%. Price growth for medical goods and services is projected to accelerate, averaging 2.4% per year for 2019–28, which partly reflects faster expected growth in health-sector wages. Among all major payers, Medicare is expected to experience the fastest spending growth (7.6% per year), largely as a result of having the highest projected enrollment growth, reflecting the continued shift of the baby-boom generation out of private health insurance and into Medicare. The share of health care spending financed by federal, state, and local governments is expected to increase by two percentage points during 2019–28, reaching 47% in 2028.

HEALTH TECHNOLOGY CORNER

Skin-Interfaced Biosensors For Wireless Physiological Monitoring In Neonatal And Pediatric Intensive-Care Units
Standard clinical care in neonatal and pediatric intensive-care units (NICUs and PICUs, respectively) involves continuous monitoring of vital signs with hard-wired devices that adhere to the skin and, in certain instances, can involve catheter-based pressure sensors inserted into the arteries. These systems entail risks of causing iatrogenic skin injuries, complicating clinical care and impeding skin-to-skin contact between parent and child. Described in the March 2020 issue of the journal Nature Medicine is a wireless, non-invasive technology that not only offers measurement equivalency to existing clinical standards for heart rate, respiration rate, temperature, and blood oxygenation, but also provides a range of important additional features, as supported by data from pilot clinical studies in both the NICU and PICU. These new modalities include tracking movements and body orientation, quantifying the physiological benefits of skin-to-skin care and capturing acoustic signatures of cardiac activity.

Bacterial Colonization Reprograms The Neonatal Gut Metabolome

A team of researchers at Children's Hospital of Philadelphia has characterized how the gut microbiome develops in the first hours of infancy, providing a critical baseline for how changes in this environment can have an impact on health and disease later in life. The findings were published on April 13, 2020 online by the journal Nature Microbiology. The gut in children eventually will hold hundreds of different species of bacteria, but at birth, there might only be 10 or fewer species. The investigation aimed to understand why those particular bacteria are the first to emerge and what they are doing in those first hours of life. The researchers evaluated the gut microbiome, proteome, and metabolome in 88 African-American newborns using fecal samples collected in the first few days of life. Detailed analysis of the three most common species, Escherichia coli, Enterococcus faecalis, and Bacteroides vulgatus, did not suggest a genomic signature for neonatal gut colonization. Evidence is provided that fermentation of amino acids provides a mechanism for the initial growth of E. coli, the most common early colonizer, under anaerobic conditions.

Return to april 2020 TRENDS

DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

April 27, 2020

ASAHP conducted a webinar on April 17, 2020 that attracted 245 participants from 96 institutions. Discussions occurred on several topics that included the following:

How are academic programs and clinical partnerships meeting mutual needs?
What disciplines are allowed to remain on service and which are prohibited?
What criteria will determine when settings will again take students?

The Winter 2019 issue of the Journal of Allied Health featured the article entitled, “Clinical Education in Transition: Recommendations and Strategies,” which offered five recommendations that stem from a review of literature pertaining to current changes in the healthcare sector and higher education that challenge the availability of allied health clinical education. The paper can be obtained here.

Statement Of Principles On Acceptance Of Academic Credit

The American Council on Education and other major educational organizations joined together to write about one particular issue that they all will face: how to manage and evaluate academic credit and assess student transcripts that have been affected by the current crisis and, indeed, by their substantial efforts to provide flexibility to students and faculty. Institutions already are deciding how best to manage credit within their own educational contexts and that is wholly appropriate. One size does not fit all, however, and that is not and should not be an aspiration. Similarly, there is no single approach or one system that should apply to how institutions evaluate and accept credits when students seek to transfer between institutions, seek approval for nontraditional coursework, or apply to graduate and professional programs. Nevertheless, there is a set of common principles that institutions should keep in mind when developing policies regarding credit acceptance. They are:

(1) Institutional policies and the evaluation of grades and credit should recognize the extraordinary burden placed on students during this time. (2) Institutional policies and practices should recognize that traditional inequities are exacerbated in the current crisis and that “equal” treatment of students’ transcripts is unlikely to result in “equitable” outcomes. (3) Institutional policies and practices should, therefore, be as holistic as possible, taking into account the range of situational and behavioral circumstances in which students find themselves. (4) Institutional policies should, wherever practicable, provide flexibility in the timely reporting of grades and other markers of achievement, understanding that the aforementioned dislocations also are present for faculty, staff, and others. (5) Institutional policies should aim for complete transparency. (6) This transparency should extend inside as well as outside the institution. (7) Institutional decision-making regarding individual students should be swift and definitive. Finally, (8) Institutions should clarify their policies as soon as possible.

Should Regional Accreditation Go National?

The publication Inside Accreditation by the Council for Higher Education Accreditation (CHEA) features an article by Judith Eaton, that organization’s President, on the issue of whether regional accreditation should go national. During negotiated rulemaking in 2019, the U.S. Department of Education indicated that regional accrediting organizations could now be free to accredit anywhere in the United States to achieve the goal of opening up the institutional accreditation system to competition. Reasons she identified for having these organizations remain regional include: composition, culture, additional workloads, and it could lead to institutions embarking on “accreditation shopping” or a “race to the bottom.” Reasons for going national include: becoming national is acknowledgment of reality since they all operate outside their regions; increased growth opportunities; further affirming the commitment to creativity and innovation in higher education; and competition may not be negative and could emerge as valuable to strengthening accreditation.

Return to april 2020 TRENDS

HEALTH TECHNOLOGY CORNER

More June 2020 TRENDS Articles

COVID-19 VACCINE CLINICAL TRIAL CONCERNS

PRESIDENT’S CORNER

EFFECTIVE CORONAVIRUS MESSAGES FROM ACADEMIC INSTITUTIONS

CONGRESS IN A TIME OF CORONAVIRUS

HEALTH REFORM DEVELOPMENTS

DEVELOPMENTS IN HIGHER EDUCATION