INCORPORATING CULTURE IN HEALTH COMMUNICATIONS RESEARCH

Because it has been found to enhance the relevance and impact of health messages, making health communication and other behavior change programs culturally sensitive has become a core principle of public health. As noted in the Annual Review of Public Health 2024, while it is normative for researchers and practitioners to develop, select, or adapt evidence-based interventions for their population and setting of interest, the extent to which principles of cultural sensitivity are applied in health communication and other behavior change interventions has not been examined adequately. The goal of a manuscript in that periodical is to examine how cultural sensitivity has been used to tailor health communication to change health behavior. The authors explore if the inability to optimize the practice of making health communication culturally sensitive is due to a lack of rigor in the application of the principles and strategies or if the issue is with the principles and practices.

These investigators examined progress and challenges in designing, implementing, and evaluating culturally sensitive behavioral interventions by tailoring health communication to groups or individuals. After defining common tailoring constructs (i.e., culture, race, and ethnicity), cultural sensitivity, and cultural tailoring, they looked at when it is useful to tailor and address cultural sensitivity in health communication by group tailoring or individual tailoring and when tailoring health communication may not be necessary or appropriate for achieving behavior change. After reviewing selected approaches to cultural tailoring, they critiqued the quality of research in this domain with a focus on the internal validity of empirical findings. Next, they explored the ways in which cultural sensitivity, group targeting, and individual tailoring have incorporated culture in health promotion and health communication. They concluded by articulating yet unanswered questions and suggesting future directions to advance the field forward. Determining whether culturally tailored messages are in fact perceived as being more relevant and salient, leading to increased receptivity to behavior change messages, remains an important research priority if the goal is to reduce health inequities, improve the health of specific populations, or pursue health equity.

CONFRONTING WORK-RELATED PSYCHOSOCIAL HAZARDS

Exposure to work-related psychosocial hazards is projected to become a major occupational health and safety threat, with significant implications for workers, businesses, and the national economy.  These hazards are on the verge of surpassing many other occupational hazards in their contribution to ill-health; injury; disability; direct and indirect costs; and impact on business and national productivity. The risks associated with exposure to psychosocial hazards at work are compounded by the increasing background prevalence of mental health disorders in the working-age population. According to a manuscript published in the June 2024 issue of the American Journal of Industrial Medicine, extensive and cumulative impacts of these exposures represent an alarming public health problem that merits immediate, increased attention. A threat is envisioned that may affect many of the 169.6 million U.S. workers by 2030 and result in adverse mental and physical health, leading to increased morbidity, mortality, and disability. 

Given the growing evidence of the connections between work and health outcomes, there is a pressing need to prevent work-related psychosocial hazards and the adverse cognitive, emotional, behavioral, physiological, and economic effects associated with them. The paper described in that journal is a commentary on the critical national problem of exposure to psychosocial hazards and resultant adverse effects. The authors review the linkage between work-related psychosocial hazards and adverse effects, their economic burden, and interventions to prevent and control these hazards. They identify six crucial societal actions: (1) increase awareness of this critical issue through a comprehensive public campaign; (2) increase etiologic, intervention, and implementation research; (3) initiate or augment surveillance efforts; (4) increase translation of research findings into guidance for employers and workers; (5) increase the number and diversity of professionals skilled in preventing and addressing psychosocial hazards; and (6) develop a national regulatory or consensus standard to prevent and control work-related psychosocial hazards. A conclusion reached in this investigation is that when done comprehensively, preventing and addressing work-related psychosocial hazards will help protect workers and promote work as a means to achieving greater health and well-being for all.

OBTAINABLE RESOURCES

INTERVENTIONS TO PREVENT FALLS IN COMMUNITY DWELLING OLDER ADULTS 

The U.S. Preventive Services Task Force (USPSTF) on June 4, 2024 released a final recommendation statement on interventions to prevent falls in community-dwelling older adults. The Task Force recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older at increased risk for falls. The USPSTF recommends that clinicians individualize the decision to offer multifactorial interventions to prevent falls to community-dwelling adults 65 years or older who are at increased risk for falls. Existing evidence indicates that the overall net benefit of routinely offering multifactorial interventions to prevent falls is small. When determining whether this service is appropriate for an individual, patients and clinicians should consider the balance of benefits and harms based on the circumstances of prior falls, presence of comorbid medical conditions, and the patient's values and preferences. Additional interventions might be helpful for some older adults. The recommendation, the evidence on which it is based, and a summary for clinicians can be viewed here. 

SERIOUS ILLNESS CARE RESEARCH

To explore the current and future state of serious illness care research, the National Academies Roundtable on Quality Care for People with Serious Illness hosted a public workshop in November 2023. Speakers identified research gaps and challenges, and explored strategies and opportunities to further develop the evidence base to improve care for all those living with serious illness, their families, and care partners. Proceedings of the Workshop summarizes the presentations and discussions that occurred at this event and can be obtained here.

IMPROVING ASIAN AMERICAN HEALTH OUTCOMES   

According to the U.S. Census Bureau report, Asian Americans account for 7% of the U.S. population, totaling over 24 million individuals. Between 2000 and 2023, Asian Americans were the fastest growing minority group and by 2060, they are projected to make up 9% of the U.S. population, accounting for around 39 million inhabitants of this nation. Despite this increase, health challenges faced by Asian Americans largely are unrecognized. A question-and-answer session occurred on May 24, 2024 to discuss the health challenges that this demographic group faces and what hospitals can do to reduce disparities affecting them. It can be obtained here.

  PEOPLE WITH DISABILITIES: HEALTH WORKFORCE AND PROVIDER TRAINING

An estimated 13% of the U.S. population reported having a disability in 2021, according to the Annual Disability Statistics Compendium analysis of the U.S. Census Bureau data. People with disabilities are less likely to be employed, and may be underrepresented in certain health care occupations compared to those without disabilities. People with disabilities comprised an estimated 8% of those employed in health care support, such as home health aides, and an estimated 4% of health care practitioners and technicians. A GAO report released on May 30, 2024 shows that most health care providers would benefit from more training on meeting the needs of people with disabilities even though such training is not widely required. It is available here.

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Health Insurance Coverage

Since 2001, the National Center for Health Statistics (NCHS) National Health Interview Survey (NHIS) Early Release Program has furnished selected estimates of health and health care for the civilian noninstitutionalized U.S. population. A NCHS report released in May 2024 provides quarterly estimates of health insurance coverage disaggregated by age group and family income as a percentage of the federal poverty level (FPL) for the civilian noninstitutionalized U.S. population based on data from the July–September 2023 NHIS. Quarterly population estimates are presented of health insurance coverage disaggregated by age group, along with quarterly estimates of health insurance coverage for adults aged 18–64 disaggregated by race and ethnicity. Quarterly estimates of health insurance coverage for adults aged 18–64 are disaggregated by region. Quarterly estimates for October– December 2022 through July–September 2023 also are presented for comparison.  

Epidemiology Of Parkinson Disease

Recent decades have shown that epidemiological understanding of Parkinson disease (PD) has evolved significantly. Major discoveries in genetics and large epidemiological investigations have enabled a better understanding of the genetic, behavioral, and environmental factors that play a role in the pathogenesis and progression of this disease. A review appearing in the June 2024 issue of the journal Current Neurology and Neuroscience Reports has an epidemiological update of PD with a particular focus on advances in the last five years of published literature.  Included are an overview of PD pathophysiology, followed by a detailed discussion of the known distribution of disease and varied determinants of disease. Investigations of risk factors for PD are described and a critical summary of current knowledge, knowledge gaps, and both clinical and research implications is provided. Recent paradigm shifts in the conceptualization of PD as a biological entity will have an impact on research moving forward and will guide further work in this field. 

HEALTH TECHNOLOGY CORNER 

Predicting First Time Depression Onset In Pregnancy

Approximately 15% of individuals report depressive symptoms at some point in their pregnancy, with instances of major depression occurring among roughly 12% of pregnancies. A simple survey delivered during the first trimester through digital pregnancy support app MyHealthyPregnancy predicted which mothers went on to develop moderate to severe depression with a high level of accuracy. As reported in a study by University of Pittsburgh investigators published on May 22, 2024 in the Archives of Women’s Health, the approach is considered to be unique because it predicts who is likely to develop depression in the future. A conclusion from the study is that a relatively small amount of self-report data produced a highly predictive model of first time depression among pregnant individuals. The researchers analyzed data from 944 patients who used the app as part of a larger study and did not have a history of depression.

Accuracy Of Online Artificial Intelligence Models In Primary Care Settings

As patients increasingly turn to online resources for supplementary advice, the role of artificial intelligence (AI) in providing accurate and reliable information has emerged. A study described in the June 2024 issue of the American Journal of Preventive Medicine aimed to assess ChatGPT-4’s and Google Bard's capacity to deliver accurate recommendations in preventive medicine and primary care. After reaching a consensus, 28.6% of ChatGPT-4-generated answers were deemed accurate, 28.6% inaccurate, and 42.8% accurate with missing information. In comparison, 53.6% of Bard-generated answers were deemed accurate, 17.8% inaccurate, and 28.6% accurate with missing information. Responses to CDC and immunization-related questions showed notable inaccuracies (80%) in both models, while they also demonstrated potential in offering accurate information in preventive care. Additionally, they brought to light the critical need for regular updates, particularly in the rapidly evolving areas of medicine.

DEVELOPMENTS IN HIGHER EDUCATION

A fact of academic life at many higher education institutions is that decisions regarding promotions and tenure relate to research productivity and publication in respected peer review periodicals. As noted in a manuscript published in the April 2024 issue of the journal Scientometrics, collaboration among scholars has emerged as a significant characteristic of contemporary science. Consequently, the number of authors listed in publications continues to rise steadily. Unfortunately, determining the authors to be included in the byline and their respective order entails multiple difficulties which often lead to conflicts.

Sole authorship (one publication-one author), which was a common practice until the 20th century, has transformed over time to co-authorship (one publication-multiple authors), with an ever-increasing number of authors listed on papers. Unfortunately, determining which authors should be listed in the byline and their respective order encompasses multiple challenges. To address this gap, an international, cross-disciplinary survey was conducted that involved 752 academics from 41 fields of research and 93 countries. The findings show that nearly one out of four participants have reported at least one conflict with an advisor either during work for Masters or PhD degrees. The results also suggest that roughly one-half of the study participants have experienced a conflict with their peers, which seems to escalate with age and experience.  

Simply from a numerical perspective, a manuscript that stands out over the years is entitled, “Combined Measurement of the Higgs Boson Mass in pp Collisions at √s =7 and 8 TeV with the ATLAS and CMS Experiments.” The article was published in the May 15, 2015 issue of the journal Physical Review Letters. Consisting of a total of  33-pages, it took 24 and-one-half pages to list the names of 5,154 authors and their academic affiliations. The Journal of Allied Health, a publication of the Association of Schools Advancing Health Professions (ASAHP), may appear somewhat miserly in contrast because it limits authorship to six individuals who can demonstrate they played a constructive role in the preparation of a paper. 

Condition of Education 2024

The latest version of the Condition of Edition 2024, a publication released on May 30, 2024 by the National Center for Education Statistics (NCES), is an annual report mandated by the U.S. Congress and is designed to help policymakers and the public monitor the condition and progress of education in the United States. Some key findings from the section on postsecondary education indicate that the overall   immediate college enrollment rate in 2022 was not measurably different from the rate a decade earlier in 2012, or from the rate in 2021,but the total number of undergraduates enrolled decreased by 13% over this period. In 2022, some 45% of high school completers immediately enrolled in four-year institutions and 17% immediately enrolled in two-year institutions. In academic year 2021–22, postsecondary institutions conferred about 5.1 million awards. The number of bachelor’s, master’s, and doctor’s degrees conferred increased between 2011–12 and 2021–22, while the number of certificates and associate’s degrees conferred was about 1.0 million each in both years. Of the degrees conferred by postsecondary institutions in 2021–22, science, technology, engineering, and mathematics (STEM) fields made up 8% of associate’s degrees, 22% of bachelor’s degrees, 16% of master’s degrees, and 16% of doctor’s degrees.

Congressional Action Proposed To Improving Ihe FAFSA

A troubled rollout of revisions to the Free Application for Federal Student Aid (FAFSA) has resulted in major delays in the transmission of data from the federal government to colleges and universities. Because of these delays, many institutions have been unable to deliver financial aid offers to admitted students in a timely manner. As noted in another section of this newsletter regarding events unfolding in Congress, many legislators are considering the necessity of making changes to ensure that the FAFSA process is more efficient and effective, particularly for the upcoming 2025-26 cycle. An example would be to mandate that the FAFSA be made available by October 1 of each year instead of the current deadline, which is January 1.

HEALTH REFORM DEVELOPMENTS

The health care sector can be characterized as a complex set of mutual interactions between patients and consumers seeking to enhance personal health status through disease prevention initiatives or by obtaining care for health problems and the professional caregivers who furnish these services. The interactions occur in the wider context of a culture that undergoes steady alterations in ways that contribute to the onset of new health problems. An example of an emerging trend involves cannabis. It was not so long ago that individuals who either used marijuana or distributed it to other users could be incarcerated. Presently, cannabis products are available legally for recreational purposes at commercial dispensaries around the nation. Simultaneously, research findings illustrate some dangers associated with the use of these substances. As reported in the March 5, 2024 issue of the Journal of the American Heart Association, cannabis use has strong, statistically significant associations with adverse cardiovascular outcomes independent of tobacco use. The data suggest that cannabis use may be a risk factor for experiencing cardiovascular disease and premature cardiovascular disease, such as a heart attack and stroke.  

Displays by beach goers and athletes on television currently provide evidence that wearing bodily tattoos has entered the mainstream of American life. Tattoo ink often contains carcinogenic chemicals, e.g., primary aromatic amines, polycyclic aromatic hydrocarbons, and metals. The tattooing process invokes an immunologic response that causes translocation of tattoo ink from the injection site. Deposition of tattoo pigment in lymph nodes has been confirmed. In a study reported in the June 2024 issue of the journal cClinical Medicine, tattooed individuals had a higher adjusted risk of overall lymphoma. The results suggest they have a 21% increased risk of overall lymphoma relative to non-tattooed individuals. The authors note that causality cannot be conferred from a single epidemiologic study and acknowledge that more research is needed.

Rural Hospital Closures

According to the May 2024 issue of the Journal of Health Care for the Poor and Underserved, between 1990 and 2020, 334 rural hospitals closed in the United States. Since 2011 hospital closures have outnumbered new hospital openings. A scoping review in that publication evaluates peer-reviewed studies published since 1990 with a focus on rural hospital closures, synthesizing studies across six themes: 1) health care policy environment, 2) precursors to rural hospital closures, 3) economic impacts, 4) effects of rural hospital closures on access to care, 5) health and community impacts, and 6) definitions of rural hospitals and communities. In the 1990s, rural hospitals that closed were smaller, while rural hospitals that closed in the 2010s tended to have more beds. An observation is that given the accelerated rate of hospital closures, more attention should be paid to hospitals that serve rural communities of color and low-income communities. Approximately 46 million individuals live in rural places across the U.S., accounting for nearly 14% of the nation’s population. Rural communities account for two-thirds of primary care health professional shortage areas (HPSAs), a situation exacerbated by their disproportionate risk of hospital closure. Given that rural communities generally are older with higher multi-morbidity and higher preventable mortality, the disparate impact of hospital closures is of great concern.

Politics And Health Spending

Section 508 of Public Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 raised certain hospitals’ regulated payments. A paper in the May 2024 issue of the Journal of Health Economics analyzes the interplay between congressional politics, the actions of the executive branch, and hospitals’ regulated Medicare payments. It shows that Medicare payments are malleable and can be influenced by political dynamics. In the cross-section, hospitals represented by members of Congress who voted “yea” on the MMA were more likely to receive Section 508 payment increases. These increases were designed to win support for the law. They also raised hospitals’ activity and spending. Members of Congress representing recipient hospitals received increased campaign contributions after the increases were extended. Ultimately, the analysis highlights how Medicare payment increases can serve as an appealing tool for legislative leaders working to win votes for wider pieces of legislation. 

FY 2025 APPROPRIATIONS PROCESS

Each calendar year, it is customary to complete legislation on appropriations that should have been finished by the previous October 1 deadline when a new fiscal year when into effect. Almost immediately, however, work must begin to produce a new set of spending bills to meet the next October 1 deadline. The year 2024 is proving to be no exception to this process. 

House Republicans have announced a plan to complete all 12 appropriation bills by the start of the August 2024 recess. If history serves as a reliable guide, it may be quite challenging to fulfill that aim. A possible obstacle is that these individuals have just a paltry two-vote margin over Democrats. A GOP subgroup called the Freedom Caucus is no advocate of increasing the amount of spending and contributing to an  ever growing amount of federal debt. Although it never is assured, it always is possible that a handful of Democrats could support particular spending bills that they like, which could help to offset any defections by Freedom Caucus members. The overall political context also has potential to complicate what happens in the appropriations arena. For example, as a response to the conviction of former President Donald Trump at the end of May in a New York City courtroom, in retaliation, 10 Republican Senators expressed an intention to block certain appropriation measures from being passed in their chamber.  

An uncomfortable reality is that interest payments on the national debt are beginning to surpass spending on major initiatives, such as defense and Medicare. The Congressional Budget Office (CBO) on May 21, 2024 released a report indicating that if current laws governing revenues and spending generally remained unchanged, the federal budget deficit would increase significantly in relation to gross domestic product (GDP) over the next 30 years, driving up federal debt. The amount of debt held by the public would soar from 99% of GDP in 2024 to 166% of GDP in 2054—exceeding any previously recorded level and on track to increase further. While these projections are not predictions of budgetary outcomes, they provide lawmakers a benchmark for measuring the effects of policy options or proposed legislation. 

Meanwhile, tumult associated with the rollout of revisions to the Free Application to Federal Student Aid (FAFSA) form has prevented many higher education institutions from delivering financial aid offers to students and their families in a timely manner. A result is that some members of Congress are interested in making legislative changes to ensure that the FAFSA process is more efficient and effective. Nonetheless, despite the wrangling that often characterizes what transpires on Capitol Hill, an example was provided in the May 2024 issue of this newsletter of the many occasions when bipartisan harmony is achieved. The purpose of S. 2016, CONNECT for Health Act of 2023, is to expand coverage of telehealth services through Medicare, make permanent telehealth flexibilities that were enacted during COVID, make it easier for patients to connect with their doctors, and help improve health outcomes. The bill had 65 Senate co-sponsors in May. That number remains unchanged.

HIGHER EDUCATION REDUX

The Spring 2024 issue of Daedalus, Journal of the American Academy of Arts & Sciences, is devoted to the topic of higher education. A series of articles indicates  that American leadership in higher education—as in other areas—is under great stress, particularly in its public universities, but also in its distinguished private universities, which have become lightning rods in current political and culture wars. In this nation, 43 of all 50 states have disinvested in higher education since 2008. Because public universities educate the majority of American students, these states have disinvested in their own future and the nation's future. The University of California, Berkeley, is the flagship of what has been the greatest system of public higher education in the world. California would not be the well-known state that it is without its signature network of public universities. Today, Berkeley is a bellwether for the future of American universities, nearly brought to its knees by a series of massive budget cuts, a poster child of the enduring unwillingness of the American public to support public higher education. 

The “mission” of a sector of society can encompass a range of possibilities. Missions serve as guideposts that articulate a central purpose or goal, which should help to structure decisions and actions: who should be served, exactly what should be done, how the work is carried out, which measures can determine whether the mission actually is being realized, and, if not, how a course can and should be corrected. As expressed in one paper in Daedalus, the concept of mission becomes more vexed in the higher education sector. 

Tertiary institutions all over the globe exist for a range of purposes, i.e., to provide professional training; teach and conduct research in an ever-expanding array of disciplines; educate underserved populations; focus explicitly on globalization, climate change, the arts, and cultivate specific political viewpoints and orientations. Many institutions have different stated missions. Extensive research focused on liberal arts and sciences at universities in the U.S. provides a troubling perspective. A disturbing lack of consensus exists among key individuals about the purpose(s) of higher education, both within single institutions and across the sector. Most notable, while students, parents, alumni, and trustees view a university primarily as the necessary path toward a future job, most faculty and administrators believe that the university experience is an opportunity for intellectual transformation, the time and place to prepare students for lifelong learning and citizenship.  

Two reasons underlie this major misalignment. One explanation is mission sprawl, the promotion of multiple missions on a single campus. Rather than a set of focused goals, institutions attempt to pursue a myriad of goals for too many disparate groups in the population, thus obscuring their own primary reason(s) for existing. A second explanation involves universities that not only try to do too much, but also appear to be conflicted about what they are trying to do. Sometimes, single institutions promote explicit missions, clear and accessible statements of intent often found on their website and in their brochures, alongside implicit missions, underlying messages that all too often conflict with what is stated publicly.

HEALTH REFORM DEVELOPMENTS

Health care policy in the United States is dominated by three major concerns: reducing the number of individuals who lack insurance coverage, improving quality of health services, and reducing health costs. Considerations about the health workforce relate to the latter two of these concerns, but the   topic does not always receive the attention it deserves. While the federal government has some jurisdiction over workforce issues, the nation’s 50 states represent battlegrounds where organizations in the health professions compete over scope of practice issues. Members of some professions argue that they are capable of independently providing high quality care at lower cost, but they are opposed by claims that patient safety would be compromised if the scope of practice is broadened to include other groups. 

Meanwhile, the U.S. population continues to grow larger and much of that growth occurs among the oldest cohorts. Advancing age often is accompanied by increases in chronic disease and disability,   placing greater demands on the necessity of having a sufficient cadre of competently-prepared health care practitioners. Occasionally, studies are done that shed valuable light on what is occurring within the health professions. For example, a cross-sectional study published on April 9, 2024 in JAMA Network Open involved 7,887 nurses who were employed in a non–health care job, not currently employed, or retired, the top contributing factors for leaving health care employment were planned retirement (39% of nurses), burnout or emotional exhaustion (26%), insufficient staffing (21%), and family obligations (18%). Age distributions of nurses not employed in health care were similar to nurses currently employed in health care. Although the increase in new registered nurses is expected to outpace retirements, health care systems continue to struggle with recruiting and retaining these individuals.  It certainly would be of immense value to have similar investigations undertaken in order to develop clearer profiles of other groups, such as physical therapists, occupational therapists, and medical laboratory personnel. 

U.S. Dementia Care Spending By State: 2010–2019

A separate item in this issue of the newsletter is about dementia from the standpoint of biomarker     testing. According to a paper appearing in the April 2024 issue of the journal Alzheimer’s and           Dementia, the fourth largest cause of death for individuals 70 years of age and older in the United States is dementia. It is tremendously costly, leading to $80 billion per year in direct medical spending attributable to this disorder. Given the progressive nature of cognitive and functional impairment that accompanies dementia and the associated caregiving needs, the cost of informal care can elevate these cost estimates.

Still, a concern is that existing estimates of the indirect costs of dementia are dated and do not report on differences across the nation. Researchers used data from multiple surveys to create cost estimates and projections for informal dementia caregiving at the state level from 2010 through 2050. In 2019, the annual replacement cost of informal caregiving was $42,422 per prevalent case, and the forgone wage cost was $10,677 per prevalent case ($58 billion overall). In 2019, it would have cost $230 billion to hire home health aides to provide all this care. If past trends persist, this cost is expected to grow to $404 billion per year in 2050.

Vaccination For Healthy Aging

As noted above, the population is aging. In a paper in the May 2024 issue of the periodical Science    Translational Medicine, the WHO estimates that the number of individuals 65 years of age and older will grow to 2.1 billion during the next three decades, nearly doubling as a proportion of the global  population that is 65 and older and tripling the number of persons 80 and older. Also, as the world’s population ages, vaccination is becoming a key strategy for promoting healthy aging. Despite scientific progress in adult vaccine development, obstacles such as immune-senescence and vaccine hesitancy remain. In order to unlock the potential of adult vaccines fully, immunization programs must be enhanced, misinformation dispelled, and investments made in research that deepens an understanding of aging and immunity. A strategy for harnessing the full potential contribution of vaccination to healthy aging entails key actions, e.g. expanding the knowledge base and allowing for timely development of new vaccines.

REDEFINING HOW TO DEFINE AND DESCRIBE DEMENTIA

Progress is being made in moving away from diagnosing dementia solely based on symptoms and going toward a new era of molecular-based diagnosis and disease-modifying treatment. As described in a manuscript published on May 2, 2024 in the periodical Neurology Today, clinicians indicate that advances provide them with new tools to discuss the underlying pathology driving their patients’ cognitive complaints and potential symptoms. It is a time of transition in dementia-related care as the increasing availability of biomarker testing allows for more precise diagnosis and the identification of patients who may benefit from a newly available disease-modifying therapy for Alzheimer’s disease (AD). Clinicians are able to converse with greater clarity with patients about the underlying pathology driving their cognitive complaints and about the expected symptoms patients may see in the future. For example, regarding the question of what is going on in the patient’s brain at the microscopic level, one expert noted that with the availability of anti-amyloid therapies, there is now much more reason to use biomarker proof to answer that query.  

The medication Lecanemab, designed to clear amyloid-beta plaque from the brain, received full U.S. Food and Drug Administration (FDA) approval last year for patients with mild cognitive impairment (MCI) or mild dementia with a biomarker-confirmed diagnosis of AD. Another expert asserted that a key question that will have to be resolved is how to define, and in turn explain to patients, biomarker-positive presymptomatic AD, which will likely become a more common scenario as biomarker testing expands—through imaging, cerebrospinal fluid, or blood sampling. Underscoring this perspective is that in a paper published on October 16, 2024 in JAMA Neurology, a team of experts proposed a “new framework for dementia nomenclature.” The authors stated that their recommendations could help guide communication about cognitive impairment among older adults and lead to consistency in the language used in both clinical practice and research. Another salient observation is that the use of biomarker testing and disease-modifying therapy will have to expand to include primary care providers and other community-based doctors because specialty centers will not be able to accommodate the demand for services.

VALUE STRUCTURE UNDERLYING SHARED DECISION MAKING

Shared decision making (SDM) is a treatment decision model that has been incorporated in many nations. It is viewed as a collaborative process between patients and clinicians in which medical evidence, providers’  expertise, and the values, preferences, and context of patients are used to develop tailored treatment decisions for an individual patient. Despite the increased importance attached to SDM, no unified definition exists according to investigators in an article published in the July 2024 issue of the journal Patient Education and Counseling. Nonetheless, multiple SDM models have been developed for various health care settings, describing in successive steps how the approach should be performed in clinical practice. SDM can be considered a service, with underlying values facilitating a particular type of communication regarding treatment decision making between clinicians and patients and their relatives. References to explicit values underlying SDM are seldom made. Yet, these researchers note that the identification of SDM’s underlying values would enable a comparison with the values of its users and can therefore contribute to the alignment of both. 

Schwartz’s value theory was employed in this study because it is well grounded in empirical research, comprehensive in included value types, and used in numerous studies, including more recently in studying patients’ and health professionals’ values in decision making. The theory has not been applied to SDM yet to the best of their knowledge. They aimed to construct a value structure characterizing SDM that may be used to compare it with those of specific groups using SDM, and to incorporate patients’ values into treatment decision making. They sought to identify how values manifest in scientific articles that describe SDM models and provide an overview of how the identified values of SDM models interrelate. They concluded that the study unraveled the value structure underlying SDM and shows that SDM can be realized through an interplay of various values. The value structure shows that besides knowledge and skills, support, and a good relationship with health professionals. it also enables patients’ Achievement and Self-Direction and facilitates Universalism.

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Cigarette Smoking Among Pregnant Women During the Perinatal Period

Cigarette smoking has wide-ranging adverse health consequences. When it occurs during pregnancy, there are increased risks of pregnancy complications and adverse outcomes for infants. According to the May 2, 2024 issue of Morbidity and Mortality Weekly Report, in 2021, among women with a recent live birth, 12.1% reported smoking before pregnancy, 5.4% reported smoking during pregnancy, and 7.2% reported doing so during the postpartum period. Smoking behaviors varied by demographic characteristics and jurisdiction. Overall, 73.7%, 93.7%, and 57.3% of women reported being asked about smoking by a health care provider at any health care visit before pregnancy, at any prenatal visit, and at a postpartum checkup, respectively. An implication is that routine assessment of smoking behaviors among pregnant and postpartum women can guide the development and implementation of evidence-based tobacco control measures.  

The Re-emerging Suicide Crisis In The U.S.: Patterns, Causes And Solutions

The suicide rate in the U.S. has risen nearly 40% since 2000, which is puzzling because rates had been falling for decades at the end of the 20th century. A paper in the Spring 2024 issue of the Journal of Policy Analysis and Management  has a review of important facts about the changing rate. General trends do not tell the story of important differences across groups. Suicide rates rose substantially among middle-aged persons between 2005 and 2015, but have fallen since. Among youth, rates began a rapid rise after 2010 that has not abated. The economic hardship caused by the Great Recession played an important role in rising suicide among prime-aged Americans. Among those under 25, nearly all the increase in suicide mortality during the 2010s can be explained by an increase in the prevalence of depression. Bullying victimization of LGBTQ youth also could account for part of the rise in suicide. The evidence that access to firearms or opioids are major drivers of recent suicide trends is less clear.  

HEALTH TECHNOLOGY CORNER 

A Machine-Learning-Enabled Smart Neckband For Monitoring Dietary Intake

The increasing need for precise dietary monitoring across various health scenarios has led to innovations in wearable sensing technologies, however, continuously tracking food and fluid intake during daily activities can be complex. These devices must be able to distinguish eating and drinking from similar movements, such as speaking and walking. A machine-learning-powered smart neckband that features wireless connectivity and a comfortable, foldable design is described in a study that was published on May 7, 2024 in PNAS Nexus. Initially considered beneficial for managing conditions, such as diabetes and obesity by facilitating dietary control, the device's utility extends beyond these applications. Initially considered beneficial for managing those conditions by facilitating dietary control, utility extends beyond these applications. Smart neckbands have proved to be valuable for sports enthusiasts, individuals focused on diet control, and general health monitoring.  

Nitrogen Dioxide Exposure And Health Outcomes Due To Combustion By U.S. Stoves

Gas and propane stoves emit nitrogen dioxide (NO2) pollution indoors, but the exposures of different U.S. demographic groups are unknown. These household implements increase long-term NO2 exposure 4.0 parts per billion volume on average across the United States, which is 75% of the World Health Organization’s exposure guideline. According to an article published on May 3, 2024 in the journal Science Advances, this increased exposure likely causes ~50,000 cases of current pediatric asthma from long-term NO2 exposure alone. Short-term NO2 exposure from typical gas stove use frequently exceeds both WHO and U.S. Environmental Protection Agency benchmarks. Individuals living in residences <800 ft2 in size incur four times more long-term NO2 exposure than inhabitants of residences >3000 ft2 in size. American Indian/Alaska Native and Black and Hispanic/Latino households incur 60% and 20% more NO2 exposure, respectively, than the national average.

DEVELOPMENTS IN HIGHER EDUCATION

As indicated by the American Council on Education (ACE), the troubled rollout of revisions to the Free Application for Federal Student Aid (FAFSA) form has produced a twofold crisis for higher education. First, far fewer high school seniors than usual have applied for financial aid, which threatens to shrink the college pipeline. Second, there have been major delays in the transmission of FAFSA data from the federal government to colleges and universities. Those delays have prevented many institutions from delivering financial aid offers to admitted students in a timely manner. The U.S. Department of Education responded on April 30, 2024 by announcing changes to systems to allow applicants and contributors without a Social Security number (SSN) to access the online 2024-25 FAFSA form immediately after creating a StudentAid.gov account.  

These changes should streamline the application process significantly for students who have contributors without an SSN. Students and contributors without SSNs cannot be matched with the Internal Revenue Service (IRS), which means that they they must continue to enter their tax information manually. Students without an SSN must verify their eligible noncitizen status through their school before they receive any federal funds. They will not have to wait, however, to have their identity validation completed before they can use their account username and password to access and complete the online 2024-25 FAFSA form.  

Demographic Change And Race-Conscious Affirmative Action In Higher Education

The Georgetown University Center on Education and the Workforce on April 30, 2024 released the report, Progress Interrupted: Evaluating a Decade of Demographic Change at Selective and Open-Access        Institutions Prior to the End of Race-Conscious Affirmative Action, which demonstrates that even with race-conscious affirmative action, diversity gains made at the nation’s most selective colleges and         universities were incremental at best. The document, an update to an earlier work on America’s separate and unequal colleges and universities, is a retrospective analysis of the changing demographics at both   selective and open-access institutions from 2009 to 2019, a time when race/ethnicity could be considered explicitly in the college admissions process. The analysis demonstrates that even with race-conscious    affirmative action,  diversity gains made at the nation’s most selective institions were marginal. Achieving equitable enrollment in higher education in a post-affirmative action society will require changes at all    levels of students’ educational journeys, beginning in K–12, and for selective institutions to overhaul their admissions policies. The full report can be viewed here.

Final Title IX Rule Issued By U.S. Department Of Education

April 19, 2024 was the occasion for the Department of Education to release a 1,577-page rule that amends the regulations implementing Title IX of the Education Amendments of 1972. The purpose of these changes is to achieve a better alignment of the Title IX regulatory requirements with Title IX’s nondiscrimination mandate. The amendments clarify the scope and application of Title IX and the obligations of recipients of Federal financial assistance from the Department, including elementary schools, secondary schools, postsecondary institutions, and other recipients to provide an educational environment free from discrimination on the basis of sex, including through responding to incidents of sex discrimination. These final regulations, which become effective on August 1 of this year will enable all recipients to meet their obligations to comply with Title IX while providing them with appropriate discretion and flexibility to account for variations in school size, student populations, and administrative structures. The new regulations introduce significant shifts in the ways in which academic institutions address sexual harassment and assault allegations while also expanding protections for LGBTQ+ and pregnant students. It is expected that conservative organizations and some Republican attorneys general in the states will sue to prevent implementation of the rule.

A TYPICAL DAY ON CAPITOL HILL

It should come as no surprise that having 535 federal legislators representing a wide range of political beliefs and opinions on any given day would provide a vibrant scene for the exchange of opposing ideas on how best to address the wide ranging needs of the U.S. citizenry. Adding to the zest is the fact that the House of Representatives currently is ruled by Republicans, but only by the slimmest of majorities. All it takes is for just one or two of them to stray from political party colleagues and mayhem quickly is ensued. Already in recent months, Speaker Kevin McCarthy (R-CA) was deposed from that position for failing to satisfy a small group of other Republicans. Meanwhile, his successor Michael Johnson (R-LA) recently is being threatened with a similar ouster by another small group of dissidents. 

An important function for members of Congress is to enact 12 major spending bills ech year to keep federal machinery afloat. As in past years, they were not successful in doing so until six months after fiscal year 2024 began on October 1, 2023. Domestic issues, such as abortion and initiatives in foreign affairs, involving military aid for Ukraine, Israel, and Taiwan are sufficiently powerful for matters pertaining to appropriations legislation to grind to an immediate halt. Another key function for federal legislators is to furnish oversight of activities of the executive branch of government. Congressional hearings always have the potential to turn into a vast playground where invited witnesses are badgered by indignant legislators. Also, a threat of impeachment can hang in the air over some contentious deliberations. 

Often lost in the fog of various controversies, however, are the many occasions when bipartisan harmony is achieved. During COVID-19, social lockdowns required patients to remain at home where they were unable to leave to obtain health services. Telehealth made it possible for them to receive care in a different manner. Another group that has benefited from this technology consists of rural residents who may reside many miles from clinicians and health facilities. Presently, S. 2016, CONNECT for Health Act of 2023, has 65 co-sponsors in the Senate. The purpose is to expand coverage of telehealth services through Medicare, make permanent telehealth flexibilities that were enacted during COVID, make it easier for patients to connect with their doctors, and help improve health outcomes. Some features are: 

· Permanently removing all geographic restrictions on telehealth services and expand originating sites to include the home and other sites

· Permanently allowing health centers and rural health clinics to provide telehealth services

· Allowing more eligible health care professionals to utilize telehealth services

· Removing unnecessary in-person visit requirement for telemental health services

· Allowing for the waiver of telehealth restrictions during public health emergencies

· Requiring more published data to learn more about how telehealth is being used, impacts of quality of care, and how it can be improved to support patients and health care providers.

TECHNOLOGY AND HEALTH CARE

Similar to what is occurring in other sectors of the U.S. economy, developments in technology already play a role in transforming the health care sphere. Artificial intelligence and virtual reality are expected to continue making significant inroads in health professions education and patient care. Another facet of technology that also attracts increased attention is patient wearables. The New England Journal of Medicine is one of many periodicals that has had a focus on this topic. A final review of a series on wearable digital health technologies (DHTs) appeared in the March 21, 2024 issue. 

It highlights important challenges that must be met to integrate these devices into clinical guidelines and practice. The narrative deliberately is grounded in what is possible today, but speculations also are made about specific uses of wearable DHTs in the future. Six interlocking and vexing issues are identified as being at the foundation of delivering DHT-informed care. They are:  

Data Ownership

Who owns the raw and derivative data obtained from wearable DHTs? Ownership can be unclear, since data collection involves multiple stakeholders, including patients, device manufacturers, app providers, and data aggregators.

Patient Trust, Literacy, and Access

Fear that personal health data may be compromised or misused, especially with the increasing use of AI, is one of the most important trust issues. 

Standards and Interoperability

Although the broad field of DHTs, which includes electronic health records and telemedicine, has adopted data standards, the field of wearable DHTs, which is characterized by ongoing development, lacks such standards.

Integration into Clinical Environments

Integrating wearable DHTs into clinical care presents several workflow challenges that can affect both health care professionals and patients. One of the biggest challenges is the sheer volume of data generated by wearable DHTs, which can be overwhelming.

Patient Empowerment and Agency

For patients to have agency and empowerment in using data from their wearable DHTs, the challenges of control over the data, an understanding of how the data can be used effectively, and trust in the systems managing the data will need to be addressed.

Reimbursement and Return on Investment for Health Care Systems

A set of Current Procedural Terminology (CPT) codes exists for remote patient monitoring with wearables. Devices and procedures that do not meet existing CPT definitions still present serious challenges in securing reimbursement. 

HEALTH REFORM DEVELOPMENTS

Health care policy in the United States is dominated by three major concerns: reducing the number of individuals who lack insurance coverage, improving quality of health services, and reducing health costs. Considerations about the health workforce relate to the latter two of these concerns, but the   topic does not always receive the attention it deserves. While the federal government has some jurisdiction over workforce issues, the nation’s 50 states represent battlegrounds where organizations in the health professions compete over scope of practice issues. Members of some professions argue that they are capable of independently providing high quality care at lower cost, but they are opposed by claims that patient safety would be compromised if the scope of practice is broadened to include other groups. 

Meanwhile, the U.S. population continues to grow larger and much of that growth occurs among the oldest cohorts. Advancing age often is accompanied by increases in chronic disease and disability,   placing greater demands on the necessity of having a sufficient cadre of competently-prepared health care practitioners. Occasionally, studies are done that shed valuable light on what is occurring within the health professions. For example, a cross-sectional study published on April 9, 2024 in JAMA      Network Open involved 7,887 nurses who were employed in a non–health care job, not currently      employed, or retired, the top contributing factors for leaving health care employment were planned    retirement (39% of nurses), burnout or emotional exhaustion (26%), insufficient staffing (21%), and family obligations (18%). Age distributions of nurses not employed in health care were similar to     nurses currently employed in health care. Although the increase in new registered nurses is expected to outpace retirements, health care systems continue to struggle with recruiting and retaining these        individuals.  It certainly would be of immense value to have similar investigations undertaken in order to develop clearer profiles of other groups, such as physical therapists, occupational therapists, and      medical laboratory personnel. 

U.S. Dementia Care Spending By State: 2010–2019

A separate item in this issue of the newsletter is about dementia from the standpoint of biomarker     testing. According to a paper appearing in the April 2024 issue of the journal Alzheimer’s and           Dementia, the fourth largest cause of death for individuals 70 years of age and older in the United States is dementia. It is tremendously costly, leading to $80 billion per year in direct medical spending attributable to this disorder. Given the progressive nature of cognitive and functional impairment that accompanies dementia and the associated caregiving needs, the cost of informal care can elevate these cost estimates. 

Still, a concern is that existing estimates of the indirect costs of dementia are dated and do not report on differences across the nation. Researchers used data from multiple surveys to create cost estimates and projections for informal dementia caregiving at the state level from 2010 through 2050. In 2019, the annual replacement cost of informal caregiving was $42,422 per prevalent case, and the forgone wage cost was $10,677 per prevalent case ($58 billion overall). In 2019, it would have cost $230 billion to hire home health aides to provide all this care. If past trends persist, this cost is expected to grow to $404 billion per year in 2050. 

Vaccination For Healthy Aging

As noted above, the population is aging. In a paper in the May 2024 issue of the periodical Science    Translational Medicine, the WHO estimates that the number of individuals 65 years of age and older will grow to 2.1 billion during the next three decades, nearly doubling as a proportion of the global  population that is 65 and older and tripling the number of persons 80 and older. Also, as the world’s population ages, vaccination is becoming a key strategy for promoting healthy aging. Despite scientific progress in adult vaccine development, obstacles such as immune-senescence and vaccine hesitancy remain. In order to unlock the potential of adult vaccines fully, immunization programs must be        enhanced, misinformation dispelled, and investments made in research that deepens an understanding of aging and immunity. A strategy for harnessing the full potential contribution of vaccination to healthy aging entails key actions, e.g. expanding the knowledge base and allowing for timely development of new vaccines.

TRANSLATING CLINICAL RESEARCH INTO PRACTICE

A well-characterized gap exists between establishing scientific evidence and integrating it into routine clinical practice. It often is noted that only a small proportion of scientific innovation is translated into routine clinical practice and that even then, the process can take more than a decade, according to a manuscript in the April 2024 issue of the journal Mayo Clinic Proceedings. Whereas this lag may vary by measurement approach, funding mechanism, and other factors, more recently published estimates indicate that it takes an average of 14 years and $2 billion to bring a new drug or medical device from conception to market. This research-to-practice gap has not historically been an important consideration in academic clinical research. The clinical research enterprise typically rewards the conduct of descriptive or mechanistic studies that are highly controlled. Although growing attention has focused on the need to accelerate translation of knowledge into clinical practice, protocolized intervention trials for evidence generation are often designed without appreciable attention paid to evidence translation and therefore do not lend themselves to integration of innovation into feasible and sustainable health care programs and policies in real-world settings. Integration of translational and implementation science principles and practices into clinical research can advance the translation of scientific innovation into improved patient care and population health.  

The authors aim to prioritize and guide efforts to create greater efficiency and speed of scientific innovation across the translational science continuum to improve patient and population health. Key principles and practices rooted in translational and implementation science may be incorporated into clinical trials research, particularly pragmatic trials, to improve the relevance and impact of scientific innovation. Their thematic review intends to raise awareness on the value of translational and implementation science in clinical research and to encourage its use in designing and implementing clinical trials across the translational research continuum. These investigators describe the gap in translating research findings into clinical practice, introduce translational and implementation science, and describe the principles and practices from implementation science that can be used in clinical trial research across the translational continuum to inform clinical practice, improve population health impact, and address health care inequities.  

ROBOTS AND THE ART OF HUMAN SYNCHRONY

Currently a global multibillion-dollar industry, the increasing demand for robots with human-like social intelligence marks a significant milestone in technological history. Once primarily confined to dull, dirty, and dangerous work, such as stocking shelves, cleaning floors, and deactivating bombs—robots presently are elevated to join the human social world, with immense transformative potential for society. A good example is the provision of health and social assistance services to patients who live alone and are confined to their homes. According to the March 2024 issue of the journal Science Robotics, although their physical appearance is impressive, interactions with robots often are clunky, stilted, and awkward. One critical limitation is that current social robots lack the art of social synchrony, where nods, smiles, gestures, and speech are orchestrated carefully across conversation partners. For social robots to engage in human social interactions, social synchrony skills are essential. A paper in that issue of this periodical addressed the art of social synchrony by endowing one such humanoid social robot, Emo, with it.  

The device is a soft-skinned anthropomorphic facial robot that can display a wide range of nuanced facial expressions using 26 magnet-controlled facial actuators. It also has high-resolution cameras in its eye sockets to detect different types of facial expressions. Although Emo can mimic the human facial expressions that it detects, engaging in social synchrony involves a more refined planning and execution of responses. To achieve this outcome, Emo was trained using neural networks to predict the facial expressions of its human interlocutors based on their early facial movements. Emo’s predictive ability enables it to plan and execute its own facial expressions in response, achieving a more human-like social synchrony. Researchers also upgraded Emo’s processing capacity to run on lightweight computing facilities, freeing up processing power for the development of other functions, such as speech and listening. Using this simple and elegant approach, Emo’s social interaction skills have been upgraded from mere mimicry to the art of social synchrony. Such a development has profound implications for the future of social robots.  

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

The Gut Microbiota And Chronic Pain  

Emerging evidence, though much in animal models, suggests that gut health, or dysfunction (i.e., dysbiosis), may play a crucial role in modulating pain perception and contributing to development of various chronic pain conditions. A review article in the April 2024 issue of the journal Current Pain and Headache Reports aims to explore the current state of knowledge regarding the intricate relationship between the gut microbiome and pain. The paper furnishes a broad overview of the bidirectional communication between the gut microbiome and the central nervous system, the potential mechanisms by which gut microbes influence pain in select chronic pain phenomena, and the therapeutic potential of targeting the gut microbiome to alleviate pain. As the concern about opiate medications (e.g., “opioid epidemic”) grows, so does interest in other medications and interventions, such as lifestyle modification, with less perceived consequences.  

COVID: Dental Utilization And Expenditures, U.S. 2019-2021

The COVID-19 pandemic exacerbated the already low utilization of oral healthcare services across the United States. In Statistical Brief #555 in March 2024 of the Medical Expenditure Panel Survey, a comparison is made of dental service utilization and expenditures for the U.S. civilian noninstitutionalized population aged 2 and older from 2019 through 2021. Dental utilization and expenditures in the United States both declined in the first year of the COVID-19 pandemic. Total dental expenditures declined by 16.1% from 2019 to 2020, the number of individuals using dental services declined by 12.5%, and the total number of dental visits decreased by 19.0%. In 2020, around 131 million persons utilized dental care (40.8% of the total U.S. civilian noninstitutionalized population aged 2 and over), 18 million fewer than the year before (149 million; 46.7%). In 2020, the monthly dental visit volume dipped substantially for three consecutive months compared to the same months in 2019. 

HEALTH TECHNOLOGY CORNER 

A Fully Integrated Wearable Ultrasound System To Monitor Deep Tissues In Moving Subjects

Recent advances in wearable ultrasound technologies have demonstrated the potential for hands-free data acquisition, but technical barriers remain as these probes require wire connections, can lose track of moving targets, and create data-interpretation challenges. The March 2024 issue of the journal Nature Biotechnology has a report on a fully integrated autonomous wearable ultrasonic-system-on-patch (USoP). A miniaturized flexible control circuit is designed to interface with an ultrasound transducer array for signal pre-conditioning and wireless data communication. Machine learning is used to track moving tissue targets and assist data interpretation. The researchers demonstrate that the USoP allows continuous tracking of physiological signals from tissues as deep as 164 mm. On mobile subjects, the USoP can monitor those signals continuously, including central blood pressure, heart rate, and cardiac output, for as long as 12 hours.  

Noninvasive Diagnostic Tool For Ovarian Cancer

Ovarian cancer causes more deaths than any other gynecologic malignancy, with a five-year survival rate below 30% for patients diagnosed at advanced stages. Current serum-based biomarkers do not sufficiently detect all occurrences of early-stage ovarian cancer. A critical need exists for both additional detection methods and new targeted therapies that can improve patient survival. A new radiotheranostic system has the ability to detect and treat this disease noninvasively, according to new research published in the April 2024 issue of The Journal of Nuclear Medicine. A theranostic approach integrates the diagnostic and therapeutic agent into a single platform. This method offers great potential to solve the challenges presented by late-stage diagnosis and poor therapeutic response. Combining the highly specific huAR9.6 antibody with PET and therapeutic radionuclides, this theranostic platform may provide more personalized treatment to improve health outcomes for patients with ovarian cancer.

DEVELOPMENTS IN HIGHER EDUCATION

Inside Higher Ed’s 2024 Survey of College and University Presidents was conducted by Hanover Research. The study included 380 presidents from public and private nonprofit institutions, for a margin of error of 4.66%. Altogether, 380 presidents from 206 public and 174 private, nonprofit institutions participated. As is often the case, presidents generally viewed their own institutions more positively than higher education as a whole. The study included questions on such issues as campus speech, public perceptions of higher education, race on campus, artificial intelligence, general financial and economic confidence, and mental health. 

Currently in its 14th year, the survey has evolved in accordance with higher education trends. The 2024 edition marks the first time presidents were asked about artificial intelligence. They expressed decidedly mixed views on the technology: 50% of survey respondents said they were somewhat or very optimistic about the rise of AI, but only a third said they somewhat or strongly believe that their institution is  prepared to navigate its rise. Looking further afield, only 17% indicated they think the higher education sector as a whole is prepared to handle the technology. Not quite one in five presidents (18%) said their  institution has published a policy governing the use of AI, including in teaching and research. 

Renewed Efforts To Expand Student Loan Debt Forgiveness

The March 2024 issue of this newsletter indicated that efforts by the Biden Administration resulted in the automatic discharge of  $1.2 billion in loans for nearly 153,000 borrowers who are eligible for the  shortened time to forgiveness benefit under the Saving on a Valuable Education (SAVE) Plan. More recently, the April 6, 2024 issue of the Wall Street Journal reported that the administration is poised to issue a proposal aimed at reducing or eliminating student loan balances for millions of borrowers, marking President Biden's second attempt at large-scale loan forgiveness. The proposed regulation is anticipated to outline several categories that would qualify borrowers for debt relief, including financial hardship. Under the plan, borrowers with high debt loads and low incomes could see their loan balances reduced or eliminated. It also could outline a path to relief for borrowers who have carried their debt for decades; who now owe more than their initial loan amount because interest has accumulated; or who are eligible for relief through other federal programs, but they haven't applied.  

Regulations, which are set to be issued, come after the U.S. Supreme Court last year overturned the administration's first debt-cancellation plan that would have wiped away as much as $20,000 in student debt for borrowers making less than $125,000 a year. The exact timing of the renewed effort will depend on how quickly the administration can finalize the regulations. It is expected that once the proposal is completed, it is likely to face legal action from Republican attorneys general, who again will try to persuade the courts to block it. The Supreme Court in June 2023 did not approve the first student loan forgiveness plan.  

Student Mental Health And Well-Being

The American Council on Education (ACE) understands that institutional practices around campus mental health and well-being play a critical role in student success. Students with poor mental health are at risk of a lower GPA, discontinuous enrollment, or dropping out. ACE’s research and insights on campus mental health and well-being look to provide higher education leaders with the tools that they need for their institution to address mental health on their campus.​​​ Portion of a podcast by the ACE on March 21, 2024 was about the mental health crisis in higher education. The organization would like Congress to provide adequate funding to undertake campus initiatives in research and training, and enable academic institutions to have an increased ability to offer interstate mental health services.