August 18, 2021

DEVELOPMENTS IN HIGHER EDUCATION

August 18, 2021

Approximately 23 million student-loan borrowers have benefited from a moratorium policy, which temporarily enables them to withhold making monthly payments on their federal debt load. Relating to the onset of the coronavirus pandemic, the pause on loan repayments and interest accrual went into effect on March 13, 2020 and was extended once to the end of that year. President Biden then extended it until September 30, 2021. In August, the moratorium was extended until January 31, 2022. It pertains to all loans held by the U.S. Department of Education, including Stafford, Grad PLUS, and consolidation loans. Some loans that originated under the Federal Family Education Loan (FFEL) are not eligible, however, since they are owned by private lenders.

Prior to these pauses, many students as a result of being unemployed or working in low paying jobs have found it impossible to pay their educational debts. Prominent Democrats have recommended using executive power to cancel as much as $50,000 of this debt for each borrower, while President Biden has indicated that it would be fair to do so in the amount of $10,000. Many congressional Republicans are less eager to provide such levels of relief. Depending on an individual’s status, debt has a differential impact on borrowers. One group of students who owe money consists partly of individuals who left school prior to completing degree programs. They are least likely to derive income from employment that enables them to pay back their loans. Another group is made up of students who might have debt as high as hundreds of thousands of dollars, but as graduates of post baccalaureate degree programs in medicine, law, and business, they are in a much stronger position to earn high paying salaries upon completing school.

Addressing The Educational Needs Of The Incarcerated

Individuals who enter penal institutions are not in an especially advantageous position to return to society upon being released from incarceration with a set of job skills in high demand by the employment sector. Instead, a further life of crime may be the only realistic way of producing income. Congress instituted a ban on the use of federal Pell Grants by incarcerated students in the Violent Crime Control and Law Enforcement Act of 1994 (P.L. 103-322). According to The Education Trust, the number of education programs in prisons subsequently dropped from more than 350 in 1990 to only a dozen in 2005. The percentage of incarcerated individuals participating in postsecondary education programs also dropped from 14% in 1991 to 7% in 2004.

The situation improved to some degree in December 2020 when Congress passed the Free Application for Federal Student Aid (FAFSA) Simplification Act, which reinstated prisoners’ access to Pell Grants. A next step is for the U.S. Department of Education to reverse Pell Grant restrictions. Otherwise, attainment of a college degree for prisoners remains challenging. The Education Trust indicates that correctional education programs reduce the rate of recidivism by 43%, increase the rate of employment after release by 13%, and are associated with fewer violent incidents in participating prisons. These programs are considered to result in net savings to taxpayers and are significantly more cost-efficient than incarceration alone. They also represent an essential strategy for breaking the cycles of incarceration and poverty, and helping formerly incarcerated individuals reintegrate into society.

New Negotiated Rulemaking Committee Meeting

The U.S. Department of Education on August 6, 2021 announced it will publish a notice in the Federal Register establishing a negotiated rulemaking committee that will meet virtually beginning in October of this year to rewrite regulations for Public Service Loan forgiveness, income-contingent repayment plans, and borrower defense to repayment, among other issues. These regulations will help borrowers manage repayment or receive a discharge or forgiveness of their federal student loans. The committee also will establish regulations to implement Pell Grant eligibility for incarcerated individuals, which will be discussed in a subcommittee. In the notice, the Department requests nominations for negotiators and sub- committee members and sets dates for negotiation sessions.

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Kristen Truong

August 18, 2021

THE CHALLENGING ROAD TO ENACTING LAWS

Kristen Truong

August 18, 2021

Each year, thousands of bills are introduced in Congress. The 1st Session of the 117th Congress in 2021 is no exception. As of August 13 this year, 5,039 bills were introduced in the House and 2,712 in the Senate as of August 11. Any measure perceived as being of great national importance may undergo certain stages. Once it is referred to a particular committee, members of that group may invite both government and non-government experts to testify at a public hearing about the necessity of having such legislation be enacted into law. A related step is to have the Congressional Budget Office (CBO) produce a score regarding a proposal’s potential budgetary impact.

Although this information may come from numerous sources, according to the Congressional Research Service (CRS), Congress generally relies on estimates provided by CBO and the Joint Committee on Taxation (JCT) when determining whether proposed legislation complies with congressional budgetary rules. Generally, CBO and JCT estimates include projections of the budgetary effects that would result from proposed policy changes, and incorporate anticipated individual behavioral responses to the policy. The estimates, however, do not typically include the macroeconomic effects of those individual behavioral responses that would alter gross domestic product (GDP). In recent decades, Congress sometimes has required that JCT and CBO provide estimates that incorporate such macroeconomic effects on overall economic output. i.e., GDP. These estimates often are referred to as dynamic estimates or dynamic scores.

A good example of proposed legislation that recently underwent this level of scrutiny is H.R. 3684, The INVEST in America Act. It was introduced in the House on June 4, 2021 and was passed by the Senate on a 69-30 Yea-Nay Vote on August 10. This bill addresses provisions related to federal-aid highway, transit, highway safety, motor carrier, research, hazardous materials, and rail programs of the Department of Transportation (DOT). CBO found that the roughly $1 trillion infrastructure bill would widen the budget deficit by $256 billion over 10 years, which is in contrast to bill negotiators’ claims that the cost of the legislation would be covered by new revenue and savings measures. Legislators who supported passage indicated that the CBO assessment does not reflect savings and additional revenue identified in other estimates, noting that the agency is limited in what it can include in its formal score.

Whether H.R. 3684 will be enacted into law depends on whether a second piece of major legislation favored by Democrats that is considered as complementary to H.R. 3684, and estimated by its supporters as costing $3.5 trillion, also is approved by Congress. Senate Democrats approved a budget resolution (Senate Concurrent Resolution 14) for that amount on August 11. These large sums of money call to mind two sagacious aphorisms. One of them was made by Niels Bohr, a Danish scientist who won a Nobel Prize in Physics in 1922. He stated, “Prediction is very difficult, especially if it's about the future,” a comment that is quite apropos in the context of estimating projected legislative revenues and costs over the next 10 years. Former Senate Minority Leader (from 1959-1969) Everett Dirksen (R-IL) once quipped at a time when a billion dollars seemed like an enormous amount of money, “A billion here, a billion there, and pretty soon you're talking about real money."

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Kristen Truong

August 18, 2021

IMPORTANCE OF ACCURATE FRAMING

Kristen Truong

August 18, 2021

Depending on how any issue is framed, it can have an impact on how: a problem will be defined, its etiology will be delineated, and remedies will be formulated. In an article published in the January 30, 1981 issue of the journal Science, a pair of Israeli psychologists, Daniel Kahneman and Amos Tversky, shed early light on the relevance of this topic by discussing how health messages can be framed in either the benefits of engaging in a recommended behavior (gain-framed messages) or the costs of not engaging in that behavior (loss-framed messages). Although conveying essentially identical information, one form of message-framing may be more effective at promoting health behavior change than the other.

For example, they conducted a study in which they asked respondents to imagine that the U.S. is preparing for the outbreak of an unusual Asian disease, which is expected to kill 600 victims. Two alternative programs to combat the disease were proposed. These researchers found that choices involving gains are often risk averse and choices involving losses are often risk taking. The only effective difference between the two programs is that outcomes were described in one problem by the number of lives saved and in the other by the number of lives lost. Kahneman’s doctorate is from Berkeley and while serving at Princeton, he was awarded the Nobel Prize in Economics in 2002 for his body of work. Tversky died in 1996. Nobel awards are not made posthumously.

Unlike their study, today the world actually continues to experience the ill effects of a coronavirus pandemic. As a means of preventing a future outbreak of a highly deadly communicable disease, it is important to learn how COVID-19 originated. One school of thought proposes that the cause was natural, resulting from the consumption of food by humans in the form of bat and pangolin meat sold in wet markets in China. An entirely different frame asks whether the disease emerged as a result of a leak in a Wuhan virology laboratory where gain-of-function research was conducted to convert a virus into a more deadly and transmissible form. Each frame differs considerably from the perspective of the kinds of effective safeguards to construct to prevent the appearance of a similar pandemic anytime in the future.

Another major concern of policymakers in the U.S. is an opioid epidemic that continues to produce fatal consequences for users of addictive substances. One approach is to frame the problem as a health issue. Corrective measures might focus on: prevention, development of improved treatment protocols, increased financial support for recovery facilities, and discovery of less addictive substances and more effective non-medication kinds of interventions to reduce levels of pain. An entirely different approach would be to frame the opioid problem as essentially being of a law enforcement nature. Proposed remedies could include tighter restrictions at the nation’s southern border to prohibit the criminal activity of drug cartels and the infliction of harsher penalties when drug dealers are apprehended. Perhaps implementing a combination of the two approaches might work best, but when resources are limited, it may be necessary to select one choice to the possible detriment of the other alternative.

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Kristen Truong

June 17, 2021

ANIMAL PREDATORS AND ACHIEVEMENT OF HUMAN SOCIAL GOOD

Kristen Truong

June 17, 2021

Wolves represent a type of predator threatening livestock, such as cattle and sheep. Able to cover vast distances traveling in packs, the species canis lupus, the gray wolf, can develop an enormous appetite on long journeys in search of food. Any creatures unfortunate enough to be in their path soon become a tasty comestible on such occasions. Wolves generally are not associated with pleasant imagery, a view revealed in the tale of Little Red Riding Hood or by the expression “a wolf in sheep’s clothing,” which reflects an unsavory human character. A more recent appraisal, however, suggests that wolves may have the capacity to add to human betterment.

Humans nearly eradicated the species from the continental U.S. by the 1960s, but legal protections strengthened during the latter half of the 20th century made it possible for about 5,500 wolves to exist in 10 coterminous states today. According to an article published on June 1, 2021 in the journal Proceedings of the National Academy of Sciences of the USA, researchers quantified the effects of restoring wolf populations by evaluating their influence on deer–vehicle collisions (DVCs) in Wisconsin. They show that, for the average county, wolf entry reduced DVCs by 24%, yielding an economic benefit that is 63 times greater than the costs of verified wolf predation on livestock. Most of the reduction is due to a behavioral response of deer to wolves rather than through a deer population decline from wolf predation. Findings suggest that wolves control economic damages from overabundant deer populations in ways that human deer hunters cannot. Deer numbers have surged, increasing from about 2-4 deer per km2 in the precolonial era to 15-50 deer per km2 in some areas, affecting ecosystems by suppressing forest regeneration; altering the composition of tree and herbaceous plant species: contributing to the spread of invasive species; and causing Lyme disease through deer tick infestation.

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Kristen Truong

June 17, 2021

TECHNOLOGY, HEALTH MONITORING, AND PRECISION HEALTH

Kristen Truong

June 17, 2021

Technological advances exert a vast impact on health care and the future promises to bring forth new developments that will affect health monitoring and precision health. As described in the June 2021 issue of the journal Science Translational Medicine, genomic analysis has allowed for even more precise risk assessment, and the current pace of technological advancement could make it feasible to genotype infants at or before birth. The genome is far from the only contributor to disease and must be considered in conjunction with its complement the “exposome,” which comprises the totality of environmental exposures over the course of one’s lifetime, including internal exposures, such as the body’s microbiome and oxidative stresses. Personalized disease risk can be determined from genetic and exposure risk factors and used to create an individualized model of health. Meanwhile, a broader understanding of health status is being pursued in efforts such as Project Baseline (www.projectbaseline.com/) and the Precision Medicine Initiative “All of Us” cohort (https://allofus.nih.gov/), which are collecting data from tens of thousands of participants to build a model of human health and disease. This model provides an individualized baseline for personalized health, and the collective data can be used to build a framework for population-based health predictions.

Wearable health monitoring devices have become increasingly prevalent among consumers. The development of flexible electronics has further expanded the field of wearable technologies into textiles and beyond. Additionally, tear biomarker discovery is at an early stage of development for conditions other than ocular disease. Saliva also is being investigated as a diagnostic fluid and is a noninvasive source of many of the same biomarkers that are present in serum, even biomarkers for nonoral cancers for example. Also, sweat analysis recently has been reported in a headband and wristband containing flexible sensors that are capable of processing and transmitting data regarding hydration and electrolyte concentrations. All these innovations have significant potential to improve the health status of individuals, but key challenges exist. There will be no shortage of health data from continuous health monitoring sensors and efforts such as Project Baseline and All of Us, but proper interpretation of these datasets will be challenging. The unprecedented influx of continuous health monitoring data for parameters that are not normally measured at such frequencies will require an entirely new process for validation and guidelines on interpretation. Another hurdle will be management of the sheer amount of data generated. Further hurdles in the path of precision health include issues of privacy and regulatory oversight, as well as the behavioral psychology of keeping users engaged in various practices.

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Kristen Truong

June 17, 2021

HEALTH REFORM DEVELOPMENTS

Kristen Truong

June 17, 2021

In his book, Reflections On The Revolution In France, Edmund Burke stated in 1790: “When I see the spirit of liberty in action, I see a strong principle at work; and this, for a while, is all I can possibly know of it. The wild gas, the fixed air is plainly broke loose: but we ought to suspend our judgment until the first effervescence is a little subsided, till the liquor is cleared, and until we see something deeper than the agitation of a troubled and frothy surface.” Some ambitious plans by President Biden and congressional Democrats are at a juncture where various restraints in policy-making progress are beginning to manifest themselves as both intra- and inter-party disagreements become more prominent, revealing that some early froth has begun to subside.

June 17, 2021 marked another important day in the history of the Affordable Care Act. The U.S. Supreme Court on a 7-2 vote ruled that a lawsuit led by several Republican states and the former Trump administration challenging the constitutionality of this legislation did not have legal standing because the provision did not injure the plaintiffs. The decision preserves the law, thus guaranteeing continued access to health plans by its beneficiaries. The case centered upon the constitutionality of maintaining the ACA in place after the penalty for the individual mandate, a requirement that individuals enroll in a health insurance plan, had been zeroed out. In a decision in 2012, the court ruled on a 5-4 vote that the penalty was a tax. When a 2017 reform law eliminated the tax, plaintiffs argued that the entire law no longer was constitutional.

Medicare’s Role In Meeting The Costs Of Vaccinations For COVID-19

As a major force in the provision and financing of health care services, the Medicare program is making it possible to furnish assistance for home-bound beneficiaries who have difficulty meeting the costs of being vaccinated during the current pandemic. The agency has agreed to pay an additional $35 per dose for COVID-19 vaccine administration in that setting. The purpose is to facilitate access to immunization for individuals who find it difficult either to leave their homes or seek vaccinations in a community setting. The Centers for Medicaid & Medicaid Services (CMS) estimates that the policy will aid 1.6 million adults age 65 and older. An additional payment increases the cost per vaccine dose from $40 to $75, depending on geographic location to account for costs associated with providing the vaccine at home and monitoring patients after the drug is administered.

In a related action, U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra notified insurers and providers in a letter sent on June 9, 2021 to remind them that they have signed agreements to cover the administration of COVID-19 vaccines free-of-charge to patients, and group health plans and health insurers of their legal requirement to provide coverage of COVID-19 vaccinations and diagnostic testing without patients encountering any cost.

Limits Imposed On Use Of The Reconciliation Mechanism For Budgetary Matters

The December 2020-January 2021 issue of the newsletter in this column explained how Congress is able to use budget reconciliation procedures to pass some tax and spending measures in areas, such as Affordable Care Act enhancement, pandemic relief, and climate change. The process begins with a budget resolution. Next, reconciliation legislation is then considered using a fast-track process that can be passed by a simple majority without having to be filibustered in the Senate. This approach has attractive features since the Senate is split 50-50. Democrats expressed considerable enthusiasm over the prospect of using multiple reconciliation initiatives to advance President Biden’s Build Back Better, which is a comprehensive undertaking aimed at enacting the American Jobs Plan, the American Families Plan, and various health care reform proposals designed to expand the Medicare program and lower the price of prescription drugs.

Their hopes were dashed, however, when Senate Parliamentarian Elizabeth MacDonough ruled that Democrats can only use the budget reconciliation process one more time during 2021 to pass one legislative package with a simple-majority vote. Her position is that a revision to the 2021 budget resolution cannot be discharged automatically from the Senate Budget Committee, requiring Democrats to secure at least one Republican vote on a panel where members are split 11-11 along party lines.

Return to June 2021 TRENDS

Kristen Truong

June 17, 2021

PROJECTED GOVERNMENT SPENDING

Kristen Truong

June 17, 2021

Coming weeks and months will help to define how much money the federal government will allocate for a wide variety of purposes that affect health care and higher education both in calendar year 2021 and in the upcoming new fiscal year that begins next October 1. Spending occurs in three major ways.

Mandatory spending represents the largest share of the government’s budget. Amounts are not fixed and some money is directed to what are called entitlement programs, such as Medicare and Social Security. The key determinant is eligibility to participate in these programs. Once individuals are deemed eligible, the government is obliged to pay whatever costs are involved in meeting its obligations.

Expenditures that tend to merit the most attention in the mass media are called discretionary. They can vary in amounts from one year to the next and depend on agreements being reached on how much of a President’s proposed budget will be accepted by Congress. Oftentimes, amounts for the 12 major categories are not agreed upon for the start of a new fiscal year. Whenever that situation occurs, either short-term or long-term continuing resolutions known as CR’s enable the government to continue functioning uninterrupted. Sometimes, the final outcome is the enactment of omnibus legislation that encompasses several of the 12 appropriation bills.

A third important type of spending affects the academic community and it involves student financial support. One aspect pertains to student loans, a topic that regularly is addressed in this newsletter. Congress sets the terms regarding how much money will be dispersed to colleges and universities to benefit student borrowers. Current overall student debt is approximately $1.7 trillion. Many individuals find it extremely difficult to repay their loans. Policymakers often debate whether it is feasible to forgive a portion of this debt.

As reported on this page in the April 2021 issue of this newsletter, the Biden administration submitted a preliminary budget proposal to Congress on the 9th of that month for FY 2022. A more complete version was sent on May 22. Some of its main spending requests include:

$131.8 billion for Department of Health & Human Services (23.5% increase over FY 2021)
$51.9 billion for National Institutes of Health (21% increase over FY 2021)
$9.5 billion for Centers for Disease Control & Prevention (21.4% over FY 2021)
$7.8 billion for Health Resources & Services Administration (8.5% over FY 2021)
$854 million for HRSA’s Title VII Health Professions and Title VIII Nursing (12.1 % over FY 2021)

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Kristen Truong

June 17, 2021

DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

June 17, 2021

Occupants of the White House can change whenever an election occurs. Regardless of whether a presidential administration is Democrat or Republican, its members tend to focus on many of the same issues that characterize the sphere of higher education. Now that President Biden’s team is firmly established at the U.S. Department of Education, an effort will be made not only to undo various policies implemented during the Trump administration, but also to place greater emphasis on topics which it perceives as being essential.

Efforts to make changes will include altering Title IX regulations installed by former Education Secretary Betsy DeVos regarding sexual misconduct at schools and colleges. Another topic that has attracted an increased amount of attention in recent months in various states is the issue of transgender students and their desire to play scholastic sports on women's teams. For-profit colleges’ policies also will come under review since the previous administration either scaled back or eliminated rules involving “gainful employment” regulations that were formulated during the Obama administration.

Mandatory Requirements Involving Vaccinations And Mask Wearing

Many colleges and universities around the nation are faced with the more immediate task of deciding which safety policies need to be in place as students return to campus this coming fall. The kinds of questions posed by academic administrators include whether to require or just recommend that students be vaccinated. Related matters entail which vaccines have been fully approved by the U.S. Food & Drug Administration. Compared to individuals age 65 and older, college age students are at less risk of: being infected by the coronavirus, experiencing deadly symptoms if they do contract the disease, and spreading it after becoming infected. A debatable proposition advanced by some critics of vaccination policy is whether any student who already has antibodies from COVID-19 should be vaccinated at all.

Beginning with the appearance of this disease, individuals of all ages were required to wear masks. Campus administrators have to decide which procedure to mandate. Current guidance from the Centers for Disease Control & Prevention stipulate that wearing masks is optional only for individuals who are fully vaccinated. Part of the uncertainty is whether to require that masks be worn indoors or should the same restriction apply to outdoors on campus? A related consideration is whether football stadiums be open to fans who can fill every available seat or should the number be limited because of social distance policies?

International And Domestic Student Enrollment Trends

The Institute of International Education on June 10, 2021 released the findings of its fourth survey in the organization’s COVID-19 Snapshot Survey Series, examining the effects of the COVID-19 pandemic on international educational exchange to and from the United States. The new survey data find that U.S. institutions are focusing on bringing students back to campus, with 86% planning some type of in-person study in fall 2021. None of the reporting institutions intends to offer virtual instruction only. Mirroring this finding, 90% of institutions plan to offer in-person study to international students. For that group, applications are up 43% for the 2021-2022 academic year, almost double the increases reported one year ago by institutions.

Meanwhile, the National Student Clearinghouse Research Center provided a final tally of the enrollment decline in higher education experienced during the spring term of 2021. Total college enrollment declined 3.5% percent from a year earlier, a shortfall of 603,000 students, which is seven times worse than the reduction one year earlier. Male student enrollment was down 5.5%, or 400,000 students, from a year ago compared with a drop of only 2%, for women, or 203,000 students. Although enrollment fell in almost every undergraduate major tracked by the research center, psychology, and computer and information science were among the few bright spots at four-year institutions. Enrollment in those majors was up 4.8% percent and 3%, respectively, from a year ago.

Return to June 2021 TRENDS

Kristen Truong

June 17, 2021

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

June 17, 2021

Rural-Urban Disparity In Mortality In The U.S. From 1999 To 2019

According to an article in the June 8, 2021 issue of the Journal of the American Medical Association, less is known about recent trends in rural-urban differences in age-adjusted mortality rates (AAMRs) overall in the U.S. So, investigators analyzed all deaths occurring in the U.S. using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database from 1999 to 2019. Rural residents experienced greater mortality and the disparity between rural and large metropolitan areas tripled from 1999 to 2019. Even though there were reductions in AAMRs for all ages, there was a 12.1% increase in the AAMR for rural residents aged 25 to 64 years, which was driven by an increasing AAMR among Non-Hispanic White individuals. Non-Hispanic Blacks, however, had greater AAMRs across all three U.S. Census–categorized areas than all other racial/ethnic groups. These trends could be exacerbated further by rural hospital closures and the COVID-19 pandemic.

Less Traffic, Fewer Collisions, Increased Motor Vehicular Deaths In 2020

Many individuals started working from home in March 2020 because of COVID-19, removing a commute from their daily routine. Yet, motor vehicle deaths in 2020 are estimated to be the highest since 2007 despite the decrease in miles driven, and surveys show that dangerous driving behaviors actually have increased during the pandemic. The National Safety Council (NSC) estimates that 42,060 passengers died on U.S. roads in 2020, which is an 8% increase over 2019. Despite a 13% decline in vehicle-miles traveled, the preliminary estimated rate of death on U.S. roads rose 24% year over year, which is the largest increase measured since 1924, nearly a century. While there have been fewer drivers on the road, data from traffic analytics firm Inrix show a speed increase in the country’s most congested urban areas during 2020. Data show that compared to 2019, the rate of collisions in the U.S. decreased by 30% in 2020, but according to The Travelers Cos. Inc.’s 2021 Travelers Risk Index, dangerous driving behaviors also have increased.

HEALTH TECHNOLOGY CORNER

Brain Areas Involved In Seeking Information About Bad Possibilities

The term “doomscrolling” describes the act of endlessly scrolling through bad news on social media and reading every worrisome tidbit that materializes. Similarly, specific areas and cells in the brain become active when an individual is faced with the choice to learn or hide from information about an unwanted aversive event, such as a punishment that cannot be prevented. As reported in a study described on June 11, 2021 in the journal Neuron, researchers at Washington University School of Medicine discovered that by examining the anterior cingulate cortex (ACC) and the ventrolateral prefrontal cortex (vlPFC), attitudes toward punishment and reward information are not tied strictly to each other. Individuals with similar preferences for reward information can have strikingly different attitudes toward punishment information. Although the investigation studied monkeys, understanding the brain’s neural circuits underlying uncertainty may lead to better therapies for conditions, such as anxiety and obsessive-compulsive disorder.

Astronomy Meets Pathology In Developing Predictive Biomarker Signatures For Immuno-Oncology

The discovery of new predictive biomarkers is critical to improving an ability to (1) predict whether a patient is likely to respond to available drugs and (2) guide treatment decisions for advanced metastatic cancers using immunotherapy. Platforms that can elucidate the spatial relationship between immune system cells and the tumor are critical to this endeavor. According to an article published on June 11 in the journal Science, recent advances in multiplex immunofluorescence (mIF) have made it possible to map the tumor microenvironment across an entire tissue section mounted on a microscope slide with single-cell resolution. An innovative approach has been developed at Johns Hopkins University to analyze large mIF datasets using celestial object–mapping algorithms to identify optimized predictive phenotypic signatures rapidly. This interdisciplinary platform, called AstroPath, makes use of immunology, pathology, computer science, and astronomy to lay the foundation for rapid, efficient biomarker discovery.

Return to June 2021 TRENDS

Kristen Truong

June 17, 2021

HOME CARE IN THE HEALTH SPECTRUM

Kristen Truong

June 17, 2021

Donald Berwick, former president of the Institute for Healthcare Improvement who also served as acting administrator of the Centers for Medicare & Medicaid Services (CMS) during the Obama administration, indicated in a webinar on value-based care sponsored by the Duke Margolis Center for Health Policy on June 10, 2021 that “the reliance on hospitals is one of the biggest mistakes in design we have -- home is the hub. Anything the Center for Medicare and Medicaid Innovation (CMMI) can do to advance the shift of the center of care to home and community is good.” Assuming that a widespread transformation of that nature is on the horizon, there will be significant impacts on the workforce needed to provide health and health-related social services. A related aspect is the extent to which technology will play a role in efforts to address the requirements of patients with multiple chronic ailments. The U.S. population not only is experiencing a growth in the number of individuals aged 65 and older, but many of them also will live alone and will require various forms of assistance if an aim is to enable them to continue to exist independently.

One element in the technological armamentarium is the employment of robots as assistive devices. The entire May 2021 issue of the journal Cyberpsychology, Behavior, and Social Networking was devoted to this topic. A rationale for doing so is that pandemic living has blurred the boundary between what is “real” and what is “virtual,” merging the computer-generated and the physical in a tightly woven web. Although research about technology development during this pandemic is only just now becoming available, an observable truth is that COVID-19 has increased a reliance on technology, and that likely includes robots. While in 2018, global sales of consumer robots totaled an estimated $5.6 billion, the market is expected to more than triple to $19 billion by the end of 2025 because robotics are perceived as going from a nascent industry to a more robust presence in furnishing patient care. A major objective is to manufacture social robots able to engage with humans and to provoke an emotional connection so that interactions between the two will feel much more like a relationship with a “someone” rather than a “something.”

A common belief is that robots eventually will become sophisticated enough that they will be indistinguishable from humans, but this assumption begets two questions. First, is existing theorizing about interpersonal, human-human relationships applicable to studying human–robot relationships? Secondly, given the present state of knowledge, should human-robot interaction designers’ goal be to mimic them? Among the topics discussed in this journal issue is the notion of peer pressure on human risk-taking behavior. The results of one investigation show both possible benefits and perils that robots might pose to human decision-making. Although increasing risk-taking behavior in some cases has obvious advantages, it also could have detrimental consequences that only now are beginning to emerge. An example of a possible negative outcome is whether robots could increase risky behaviors such as smoking and substance abuse. Clearly, any possible happenings of that nature should be avoided vigorously.

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Kristen Truong

May 18, 2021

IMPACT OF MARRIAGE, DIVORCE, AND WIDOWHOOD ON HEALTH STATUS

Kristen Truong

May 18, 2021

Marriage, divorce, and widowhood each represent significant events in the lives of anyone who has ever been married, but they especially are prevalent among the older population. Older adults have rich marital histories that reflect both partnership and loss over their lifetime, according to a U.S. Census Bureau report entitled, “Number, Timing, and Duration of Marriages and Divorces: 2016” that became available on April 22, 2021. Divorce is not the only marital disruption that older adults face, however, because they also disproportionately constitute a large percentage of those who become widows or widowers in a given year. Among adults age 15 or older who became widowed in the preceding 12 months, 71% of men and 69% of women were 65 or older, although this age group comprises only 19% of all individuals in the 15 or older age group. Widowhood is particularly common among older women compared to older men due to differences in life expectancies. Women on average live longer than men. Among those 75 years or older who had ever married, 58% of women and 28% of men had experienced the death of a spouse in their lifetime, making this stage of life particularly difficult. The proportion of individuals who currently are widowed is relatively lower than for those widowed at one point because some respondents who lost a spouse eventually remarried, becoming "currently married" instead of "currently widowed." Nonetheless, differences between the sexes persist among those 75 years or older: 54% of women and 20% of men were currently widowed at the time of interview.

Women in particular face major challenges in being able to live with independence and dignity as they age. With longer lives, higher rates of disability and chronic health problems and lower incomes than men on average, many women need long-term care services without having the resources to pay for them. Apart from their own health problems, some women also serve as primary providers of long-term care for an older relative. The vast majority of both paid formal long-term care workers and unpaid informal caregivers are women. Millions of older women cannot afford to pay for long-term care services because of low income. A major factor affecting income is marital status. Married couples have higher incomes than single persons. Older women are much more likely than older men to live alone, meaning that they have no other individual in their household to help with daily activities and pay for services to address unmet health and health-related social needs.

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COGNITIVE EPIDEMIOLOGY, INTELLIGENCE, HEALTH, AND DEATH

Kristen Truong

May 18, 2021

Cognitive epidemiology as a separate line of inquiry emerged in the early 2000s. Its purpose is to study how and why individual differences in intelligence (especially when measured in childhood or young adulthood) associate with later differences in health, illness, and death. An article published in the April 2020 issue of the journal Nature Human Behaviours examines how an understanding of the association between intelligence and health/mortality has been refined with the advent of new, population-scale data and genetic tools. The manuscript looks at the associations between intelligence and, in turn, all-cause mortality, specific causes of mortality, physical illnesses, and health-related biomarkers. Possible causes of the observed associations (education, health behaviors and literacy, and genetics), are not mutually exclusive.

Although the causes underlying the associations between intelligence and health/mortality remain an open question, research over the past decade has provided results and fingerposts for further progress. As a way of obtaining a clearer understanding, the authors discuss how intelligence relates to specific causes of death, diseases/diagnoses, and biomarkers of health through the adult life course. They examine the extent to which mortality and health associations with intelligence might be attributable to differences in education, other indicators of socioeconomic status, health literacy, and adult environments and behaviors. Finally, they discuss whether genetic data provide new tools to understand parts of the intelligence–health associations. Social epidemiologists, differential psychologists and behavioral and statistical geneticists, among others, contribute to cognitive epidemiology. Any advances that occur will do so by building on a common cross-disciplinary knowledge base.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

May 18, 2021

Emergency Departments For Bicycle-Related TBIs: United States, 2009-2018

Bicycling leads to the highest number of sport and recreation–related emergency department (ED) visits for traumatic brain injuries (TBIs) in the United States. Because bicycling continues to grow in popularity, primarily among U.S. adults, examining the strategies that mitigate the risk for TBI is important. According to the May 14, 2021 issue of the Morbidity and Mortality Weekly Report, CDC analyzed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) to determine the incidence of EDs for bicycle-related TBIs during 2009–2018. An estimated 596,972 ED visits for bicycle-related TBIs occurred in the United States during the study period. Rates of ED visits were highest among adult males (aged ≥18 years) and among children and adolescents aged 10–14 years during 2009–2018. Overall, the rate of ED visits for bicycle-related TBIs decreased by approximately one half (48.7%) among children and by 5.5% among adults.

Medicare, Medicaid, Children’s Health Insurance Program Enrollment: 2020

Government involvement in the financing of health care is substantial. According to recent estimated average monthly data from the Centers for Medicare & Medicaid Services, in calendar year 2020: Medicare had a total of 62.8 million enrollees among whom 54.5 million are aged and 7.3 million are disabled. An additional breakdown shows that 37.7 million beneficiaries are enrolled in Original Medicare and the rest are in the Medicare Advantage Plan and the Prescription Drug Plan. Medicaid, a jointly administered federal-state plan, had a total of 76.5 million enrollees in Fiscal Year 2020. Major groups include: 6.4 million aged individuals, 11.0 blind and disabled persons, and 28.9 children—the largest single group numerically. Another 7.4 million individuals are enrolled in the Children’s Health Insurance Program (CHIP) on average each month based on the latest available data.

HEALTH TECHNOLOGY CORNER

Ventilating The Rectum To Support Respiration

The coronavirus pandemic has overwhelmed the clinical need for ventilators and artificial lungs, resulting in a critical shortage of available devices and endangering patients’ lives worldwide. As described in an article published on May 14, 2021 in the journal Med, inspired by organisms such as catfish that use intestinal air breathing, researchers at Tokyo Medical and Dental University show the effectiveness of an enteral ventilation approach in attaining systemic oxygenation in both rodent (e.g., mice) and porcine (e.g., pig) models. Intra-rectal delivery of a liquid form of O2 known as conjugated perfluorocarbon, a compound historically used in clinics for liquid ventilation through airway administration, is highly tolerable and efficacious in ameliorating severe respiratory failure. By repurposing the distal gut as an accessary breathing organ, enteral ventilation therapy offers an alternative paradigm as an adjunctive means to patients who are in critical need of respiratory support.

Opening A Window Into Alzheimer's Disease

According to new research by scientists at the UCSF Weill Institute for Neurosciences, retinal scans can detect key changes in blood vessels that may provide an early sign of Alzheimer's. An article published on May 11, 2021 in the journal Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring offers some important insights into how one of the most common Alzheimer's risk genes contributes to the disease. Researchers have indicated that the most prevalent genetic risk for Alzheimer's disease is a variant of the APOE gene, known as APOE ε4. Although it is not entirely clear how this variant increases risk of brain degeneration, it does appear to do so and the risk is modified by sex, race, and lifestyle. The results of the study reported in this article suggest that APOE ε4 affects capillary health in humans and that retinal capillary measures could serve as surrogates for brain capillaries, providing an opportunity to study microangiopathic contributions to neurodegenerative disorders directly in humans.

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DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

May 18, 2021

The arrival of the coronavirus pandemic resulted in college and university campuses having to begin shutting down in March 2020. Many were able to do so without suffering painful losses of valuable forms of income derived from fees associated with tuition, dormitory living, provision of food services, and a variety of activities, such as rental of campus property in the summer and sales of tickets and concessions for football and basketball games. Not every institution was so fortunate, however, and have had to offset reductions in revenue by laying off personnel involved in teaching and administration. Worst of all, some smaller schools without endowments are confronted with the danger of having to close their doors permanently.

One means of offsetting a decline in revenue was to substitute in-class learning with instruction that is provided online. Schools that already offered courses in that manner were able to continue doing so without having to make any major adjustments. Institutions that were not in a similar position had to convert a great many courses that formerly were furnished exclusively in classrooms. Not all students and their families believed that these new products were valuable substitutes and they consequently have been unwilling to pay for them.

Another consideration is more of a downstream nature. Since March 2020, many students throughout the U.S. at elementary and high school levels have not been in classrooms for the latter part of the 2019-2020 academic year and almost all of the 2020-2021 school year. Prior to the pandemic, some students admitted to college typically are academically underprepared and must be provided with remediation services. Students who already were in their third year of high school in spring 2020 are graduating in virtual ceremonies either this month or will do so in June. Many of them may be even less prepared to enroll in college than previous cohorts of students that did so before the pandemic struck the nation.

Student Loan Tax Elimination Act

A chronic problem for many students and their families is mounting educational debt. Individuals at the postgraduate level who attend MBA programs, law chools, and medical schools may assume mountains of such debt, but they are in a favorable and enviable position to move into high paying jobs upon graduation. Less fortunate are those students who complete their formal education at the baccalaureate level with majors that lead to few, low remunerative forms of employment. Even worse off are students who drop out of school without ever completing a degree program, but who still managed to borrow substantial amounts of money for education purposes.

A common aspiration expressed by many Democrat candidates who competed to be nominated by their party for the 2020 presidential election was to address the problem either by forgiving all or a portion of this educational debt. A step in that direction is a bipartisan bill introduced on March 18, 2021 in Congress, the Student Loan Tax Elimination Act (S. 847), a measure designed to eliminate origination fees on all federal direct student loans disbursed on or after March 27, 2020. Presently, by taking as much as 4% of the proceeds of a federal student loan, a strong influence is placed on students regarding their decision whether to pursue and complete a degree program.

Similar legislation was introduced on June 3, 2019. Supporters of the bill view origination fees as reducing the amount of loan dollars disbursed to borrowers by 1% percent for Direct Stafford Loans and 4% for Direct PLUS Loans. This levy is considered to create confusion among students and increase costs for borrowers, who are responsible not only for repaying the withheld amount, but also the interest accruing on that amount. The result can be hundreds or thousands of additional dollars owed, depending on loan type, loan amount, and program length.

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HEALTH REFORM DEVELOPMENTS

Kristen Truong

May 18, 2021

As noted in the Quick STAT page of this issue of the newsletter, in calendar year 2020, the Medicare program had a total of 62.8 million enrollees. As described in an article published on April 27, 2021 in JAMA Network Open, overuse is defined as the delivery of tests and procedures that provide little or no clinical benefit, are unlikely to have an impact on clinician decisions, increase health care spending without improving health outcomes, or risk patient harm in excess of potential bene-fits.Estimates suggest that overuse contributes $75.7 billion to $101.2 billion to wasted U.S. health care spending annually. Results of a cross-sectional study involving 1,325,256 services performed at 3,351 hospitals show that measurements of low-value services using Medicare claims data can be applied to individual hospitals to compare their overall rates of overuse. The analysis revealed differences in overuse by hospital characteristics such as teaching status, region, and nonprofit status. Researchers found that hospitals in the South, for-profit hospitals, and nonteaching hospitals were associated with the highest rates of overuse. Investigations of this nature are critical to developing remedies to curb unnecessary spending. A steady increase in the number of aged beneficiaries who become eligible to participate in the Medicare program means that a corresponding growth will occur in the amount of health services that must be provided for them. Constant efforts are needed to ensure that an ever growing amount of expenditures for such care is used effectively and appropriately. Biden Administration Begins Reversing Policies Established By The Previous AdministrationA common practice in recent years is for an incoming U.S. presidential administration to review health policies instituted by its predecessor administration and decide to reverse them. Along lines of efforts to prevent unnecessary spending in the Medicare program, the Biden administration decided to freeze an effort implemented by the Trump administration to create a new Medicare coverage and reimbursement pathway for “breakthrough” medical devices as its term drew to a close. A final rule known as the Medicare Coverage of Innovative Technology (MCIT) pathway that was published on January 14, 2021 in the Federal Register would have established a mechanism to provide national Medicare coverage for a period of four years after the date of U.S. Food & Drug Administration approval. The final ruling was to become effective on March 1 of this year. An argument opposed to implementing the rule is based on an assessment by the Biden team that the proposed acceleratedpathway fails to protect patients adequately or ensures that such breakthrough devices are effective or appropriate for the Medicare population Another illustration of an attempt to erase policies established by the preceding administration is that the Biden group will enforce legal protections against discrimination for gay and transgender patients seeking health care under the Affordable Care Act (ACA). During the Trump administration, a policy was implemented that aimed to define the scope of sex discrimination under the health law more narrowly than what was prescribed during the Obama Administration. The most recent ruling is based on a Supreme Court decision in 2020 that allows in a more expansive way the U.S. Department of Health & Human Services to interpret the antidiscrimination section of the ACA by forbidding bias “on the basis of race, color, national origin, sex, age or disability.” American Rescue Plan Act And The Affordable Care ActCongress passed the American Rescue Plan Act (ARPA) using what is known as the “budget reconcilia-tion process” that requires only a Senate majority rather than the sixty votes normally needed to over-come a filibuster. President Biden signed it into law on March 11, 2021. The aim of this legislation is to enable a temporary expansion of the ACA’s premium tax credits and to allow increases in federal financial incentives for states that have not yet done so to expand their Medicaid programs to low-income adults. A recent broadened enrollment period has resulted in an increase in the number of beneficiaries wanting to participate in this program. ARPA also provides incentives for the twelve states that have not yet expanded their Medicaid programs to all adults with incomes up to 138% of the federal poverty level.Meanwhile, the fate of the ACA will depend on a decision that soon will be made by the U.S. Supreme Court on a case that has attracted enormous interest in health policy circles.

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A MAJOR FOCUS ON GOVERNMENT SPENDING

Kristen Truong

May 18, 2021

Now that the current fiscal year is going to draw to a close on September 30, greater attention is being paid to Congressional appropriations. The House Appropriations Committee plans to mark up the 12 annual spending bills for fiscal year 2022 in June this year, ahead of floor votes that are scheduled for this July. Recent years have witnessed a failure to complete all necessary business pertaining to appropriations by the coming October 1. If that pattern repeats itself this year, then one or more stopgap spending measures will have to be relied upon as a means of avoiding a federal government shutdown of the federal government.

A new twist in the present arrangement goes to prove that many old and highly cherished notions truly die rather hard. While certain revered ideas can languish for lengthy periods of time, they can reappear with renewed vigor as evidenced by the rebirth of “earmarks,” an excellent illustration of a time-honored approach of dispensing funds appropriated by Congress. Earlier, wags with a penchant for unseasonable japery could hardly wait for former Democrat Senator William Proxmire from Wisconsin to issue his Golden Fleece Award every month between March 1975 and December 1988. The purpose of this dubious honor was to acknowledge “wasteful, ridiculous or ironic use of the taxpayers’ money.” A famous example was a $190 million bridge to a sparsely populated island in Alaska at a cost of $13,786 per local inhabitant.

House Democrats recently unveiled a plan to restore earmarks under the new heading, “Community Project Funding,” thus ending a decade-long policy that forbade the practice. A proposal released by Rosa DeLauro (D-CT), Chairwoman of the House Appropriations Committee, would allow the inclusion of money in annual spending bills to benefit specific projects with the amount capped at 1% of discretionary spending, Lawmakers would be permitted to submit a maximum of 10 project requests, along with evidence to justify their requests from their communities. Funds could not be allocated, however, to benefit for-profit recipients. Joining in this renewal effort, the House Republican Conference has voted to restore earmarks and Senate appropriators also have released their plan to jettison the present ban.

Apart from the important work of introducing and passing necessary legislation, another key function performed on Capitol Hill is to conduct hearings. The Senate Committee on Health, Education Labor & Pensions did so on May 11, 2021. The event on “Efforts to Combat COVID-19” featured testimony by Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases; David Kessler, Chief Science Officer at the U.S. Department of Health and Human Services; Rochelle Walensky, CDC Director; and Peter Marks, Director of the Center for Biologics Evaluation and Research at the Food & Drug Administration. The following day, a hearing on the topic of “COVID-19 Variants and Evolving Research Needs” was held by the Subcommittee on Investigations and Oversight of the House Committee on Science, Space and Technology. Testimony was provided by experts from Columbia University, Yale University, Johns Hopkins University, and the Argonne National Laboratory.

Statements made at both hearings can be obtained from the websites of these committees in print and video formats.

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FUTURE TIME PERSPECTIVE IN MID–TO-LATER LIFE

Kristen Truong

March 22, 2021

Future time perspective (FTP), or the way individuals orient to and consider their futures, is considered fundamental to motivation and well-being. Given FTP’s relevance to healthy adaptation, recent work has described its contributing factors, especially age, health, and personality. Yet, the extant literature is plagued by inconsistent FTP conceptualizations and sample characteristics. Specifically, although relationships between FTP and its contributors seem dependent on both FTP conceptualization and sample life-span stage, much existing literature emphasizes differing FTP conceptualizations and young adult samples, complicating cross-study conclusions. As reported in the March 2021 issue of The Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, a study was conducted that explored the ways in which age, health, and personality simultaneously contribute to FTP in mid-to-later life with machine-learning techniques.

Until now, no studies regarding how these factors jointly contribute to FTP have been conducted and it is unclear as to whether complex interactions exist among these predictors in their relation to FTP. Personality, especially neuroticism, extraversion, conscientiousness, and agreeableness, had the most influence on FTP. Age and health were not among the most salient FTP contributors in mid-to-later life. Furthermore, decision tree analyses uncovered interactive effects of personality. Several profiles of neuroticism, extraversion, and conscientiousness were linked with differing FTP levels. Although current literature has indicated that FTP, age, and health are inextricably tied, these results indicate that there is more variability to be explained in FTP, perhaps especially when looking within specific age groups.

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EMERGING CLINICAL ROLE OF WEARABLES

Kristen Truong

March 22, 2021

Wearable technology, also known as “wearable devices” or simply “wearables,” generally refers to any miniaturized electronic device that easily can be donned on and off the body, or incorporated into clothing or other body-worn accessories. While wearables have established utility in the fitness, gaming, and entertainment industries, their role in the healthcare environment remains less clear. According to a manuscript published on March 10, 2021 online in the journal npj Digital Medicine, to date most commercially available wearables are limited in scope, tracking one or two health-related variables, and have yet to produce accurate measurement of many markers of health status that they attempt to assess such as heart rate variability, nutrition, and mood. To the extent that wearables overcome these limitations, they hold much promise towards expanding the clinical repertoire of patient-specific measures. They are considered an important tool for the future of precision health. For example, physical activity is a well-established marker of current health status and future health risks, it is a useful estimate of real-life functional performance, and it has been tracked in health research using body-worn sensors for many decades. Given the ubiquity of physical activity monitors, it is surprising their effective incorporation into clinical care remains a challenge, especially in face of the multiple known health benefits of physical activity and the many healthcare scenarios where physical activity information has a clinical use.

Two of the NIH’s Big Data to Knowledge Centers of Excellence organized a workshop on potential clinical applications of wearables to address various challenges. A workgroup from diverse backgrounds (hospital administration, clinical medicine, academia, insurance, and the commercial device industry) discussed two successful digital health interventions that involve wearables to identify common features responsible for their success. Seven features were identified including: a clearly defined problem, integration into a system of healthcare delivery, technology support, personalized experience, focus on end-user experience, alignment with reimbursement models, and inclusion of clinician champions. For each feature, problems are outlined within the patient domain that are addressed per feature and specific representative examples of solutions are provided for these problems by the two sample digital health programs. Health providers and systems eager to establish new models of care inclusive of wearables may consider these features during program design. A better understanding of these features is necessary to guide future clinical applications of wearable technology.

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OBTAINABLE RESOURCES

Kristen Truong

March 22, 2021

Academic Incentives And Research Impact

The road to tenure can be viewed as paved with measures of peer-reviewed publications, first authorships, citations, journal impact, grant funding, and national or international reputation. According to the author of a paper that was prepared for the organization AcademyHealth, a proposition is offered that for the most part, measures of research impact on societal problems are missing in action from performance evaluation criteria within academic disciplines. So, the paper aims to encourage creative thinking around academic incentives and research impact by challenging existing orthodoxies, generating new insights, and stimulating a productive debate within the discipline. As a means of accomplishing these objectives, cases are presented to explore efforts challenging the status quo of academic research incentives and realigning them to focus more on societal impact. The cases are organized around a system-, institutional-, and individual-level framework. Examples are furnished that highlight the range of efforts explored more fully in the paper to align academic incentives with societal impact. The paper can be obtained here.

Student Debt And Its Impact On Black Americans

As more students take out more loans at higher amounts, the issue of student debt and proposals to mitigate it has taken greater prominence in national policy debates. According to a report from the Brookings Institution, the problem especially is pertinent for Black households, for whom a lack of generational wealth risks making student debt a long-term financial burden. After graduation, loans quickly balloon, delaying or even preventing Black Americans from building wealth. Based on the 2018 Survey of Income and Program Participation (SIPP), the authors indicate that because student debt disproportionately harms the wealth-poor, and the Black wealth-poor in particular, student debt cancellation could be a powerful tool in dismantling institutional discrimination and shrinking racial wealth disparities if implemented correctly. They center the Black experience in their consideration of student loan debt and draw from their own analysis to argue for debt cancellation that is not means-tested (predicated upon household income) as an important mechanism for closing the racial wealth gap. They compare the effects of cancelling debt against the status quo, and at three different levels of intervention: 1) $10,000 cancelled for all (as President Joe Biden has proposed); 2) up to $50,000 cancelled based on means-testing for households earning under $100,000 and a sliding scale cancellation for households earning up to $250,000 (as Senator Elizabeth Warren [D-MA] has proposed); and 3) total debt cancellation (as Senator Bernie Sanders [I-Vt.] has proposed). They find that the more student debt that is cancelled, the greater the effect increasing Black wealth, particularly for households below the wealth median. The report can be obtained here.

Adult Family Care As An Alternative To Nursing Homes

A report from AARP that was written for consumers, advocates, and state policy staff, summarizes some key features of Adult Family Care (AFC), along with ideas for expanding its availability. Individuals who need long-term services and supports want alternatives to nursing homes as living options. AFC, which is not as well known among consumers as home care and assisted living, gives older adults and persons with disabilities a viable alternative. In AFC, sometimes called adult foster care or adult family homes, residents live full-time in a house or other small residential setting where they receive assistance with activities of daily living, personal care, and help with medications and other health care tasks, in collaboration with health care professionals. More than 40 years ago, Oregon and Washington were the first states to establish AFCs as an option for both private pay residents and those receiving public funds. Many jurisdictions have had difficulty recruiting providers and consumers since then. The report can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

March 22, 2021

U.S. State Life Tables, 2018

A new report from the National Center for Health Statistics presents the first set of annual complete period life tables for each of the 50 states and the District of Columbia (D.C.) for the year 2018. The period life table does not represent the mortality experience of an actual birth cohort. Rather, it presents what would happen to a hypothetical cohort if it experienced throughout its entire life the mortality conditions of a particular period in time. Life tables were produced for the total, male, and female populations of each state and D.C. based on age-specific death rates for that year. Among the 50 states and the District of Columbia, Hawaii had the highest life expectancy at birth, 81.0 years in 2018, and West Virginia had the lowest, 74.4 years. Life expectancy at age 65 ranged from 17.5 years in Kentucky to 21.1 years in Hawaii. Life expectancy at birth was higher for females in all states and D.C. The difference in life expectancy between females and males ranged from 3.8 years in Utah to 6.2 years in New Mexico.

Prescription Drugs For Older Adults And The Risk Of Falling

Published on February 3, 2021 in Pharmacoepidemiology and Drug Safety, a study reported from the University at Buffalo examined data on deaths due to falls and prescription fills among patients 65 and older from the National Vital Statistics System and the Medical Expenditure Panel Survey. Age-adjusted mortality due to falls increased from 29.40 per 100,000 in 1999 to 63.27 per 100,000 in 2017. The percent of individuals who received at least one prescription for a fall risk increasing drug, including antidepressants, anticonvulsants, antipsychotics, antihypertensives (for high blood pressure), opioids, sedative hypnotics, and benzodiazepines (tranquilizers such as Valium and Xanax) increased from 57% in 1999 to 94% in 2017. Fall risk increasing drugs may partially explain the increase in mortality due to falls, but cannot be firmly concluded from the current study. Future research involving nationally representative person‐level data are needed.

HEALTH TECHNOLOGY CORNER

Sex Differences In Neurodegenerative Diseases

Many neurodegenerative diseases, including Alzheimer's disease, Parkinson's disease, multiple sclerosis, and motor neuron disease, demonstrate clear sexual dimorphisms. While sex as a biological variable must now be included in animal studies, sex rarely is included in in vitro models of human neurodegenerative disease. A review published on March 16, 2021 online in APL Bioengineering describes these sex-related differences in neurodegenerative diseases and the blood–brain barrier (BBB), whose dysfunction is linked to neurodegenerative disease development and progression. The authors from the University of Maryland highlight a growing body of research suggesting sex differences play roles in how patients respond to these ailments. The authors note that some research suggests the barrier can be stronger in women than men, and the barriers in men and women are built and behave differently. They hope their article will serve as a reminder across the sciences, that accounting for sex differences leads to better results.

Female College Athletes And Traumatic Brain Injury

Female athletes are under-studied in the field of concussion research, despite evidence of higher injury prevalence and longer recovery time. Hormonal fluctuations caused by the natural menstrual cycle (MC) or hormonal contraceptive (HC) use have an impact on both post-injury symptoms and neuroimaging findings, but the relationships among hormone, symptoms, and brain-based measures have not been jointly considered in concussion studies. A preliminary investigation from the Northwestern University Feinberg School of Medicine published on February 24, 2021 in the Journal of Neurotrauma compared cerebral blood flow (CBF) measured with arterial spin labeling between concussed female club athletes 3–10 days after mild traumatic brain injury (mTBI) and demographic, HC/MC matched controls (CON). Researchers tested whether CBF statistically mediates the relationship between progesterone serum levels and post-injury symptoms, which may support a hypothesis for that hormone's role in neuroprotection. The findings support a hypothesis for its having a neuroprotective role after concussion and highlight the importance of controlling for the effects of sex hormones in future concussion studies.

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HEALTH TECHNOLOGY CORNER

More May 2021 TRENDS Articles

MINISCULE CREATURES OF HUGE IMPORTANCE

A MAJOR FOCUS ON GOVERNMENT SPENDING

HEALTH REFORM DEVELOPMENTS