John Colbert

November 25, 2019

WHY AN INSECT APOCALYPSE MATTERS

John Colbert

November 25, 2019

In the grand cosmological scheme, insects although being relatively small and occasionally quite annoying, it is highly unlikely that the human species could survive without them. In marked contrast, the Anthropocene (the current geological age, viewed as the period during which human activity has been the dominant influence on climate and the environment) may be characterized as placing a much larger focus in the form of conservation efforts and public attention on big, charismatic mammals and birds, such as tigers, pandas, and penguins. Nevertheless, the bulk of animal life, whether measured by biomass, numerical abundance, or numbers of species, consists of invertebrates such as insects. According to a paper appearing in the October 7, 2019 issue of the journal Current Biology, recent studies from Germany and Puerto Rico suggest that insects may be in a state of catastrophic population collapse. German data describe a 76% decline in biomass over 26 years, while the Puerto Rican study estimates a decline of between 75% and 98% over 35 years. Corroborative evidence suggests that such declines are not isolated. Causes are much debated, but almost certainly include habitat loss, chronic exposure to pesticides, and climate change. The consequences are clear. Insects are integral to every terrestrial food web, being food for numerous birds, bats, reptiles, amphibians, and fish, and performing vital roles such as pollination, pest control, and nutrient recycling. Also, terrestrial and freshwater ecosystems will collapse without insects.

Occasionally, this ASAHP newsletter has served as a vehicle for demonstrating how humans stand to benefit from research involving other species. An article published on October 22, 2019 in the journal eLIFE discusses, for example, how ants, despite their behavioral simplicity, have managed the tour de force of avoiding the formation of traffic jams at high density. At the macroscopic level, ant traffic is best described by a two-phase flow function. At low densities there is a clear linear relationship between ant density and the flow, while at large density, the flow remains constant and no congestion occurs. From a microscopic perspective, the individual tracking of ants under varying densities revealed that ants adjust their speed and avoid time consuming interactions at large densities. The results point to strategies by which ant colonies solve the main challenge of transportation by self-regulating their behavior. Humans and ants are among the few species that engage in two-way traffic. Maintaining a smooth and efficient traffic flow while avoiding collisions is challenging for humans while ants seem to be masters of traffic management. They efficiently can move back and forth between their nests and food without overtaking or passing each other, forming a steady stream of traffic. Studying ant traffic management has been a source of inspiration for scientists working with large groups of interacting particles in many fields, including molecular biology, statistical physics, and telecommunications. It also has relevance for managing human traffic, particularly as scientists and engineers develop autonomous vehicles that might be programmed to work together cooperatively as ants.

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

November 25, 2019

Trends Archives

Dialogue About The Workforce For Population Health Improvement

The Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine on March 21, 2019 convened a one-day workshop to explore the broad and multidisciplinary nature of the population health workforce. The event included speakers from professional and accrediting organizations, community health workers, supervisors, and policy experts and featured national and local examples of cross-sectoral collaboration to advance population health. The main objectives of the workshop were to explore the following topics that resulted from the Statement of Task for the workshop: (1) Facilitating a population health orientation/perspective among public health and health care leaders and professionals; (2) Framing the work of personnel such as community health workers (CHWs), health navigators, and peer-to-peer chronic disease management educators within the context of population health; and (3) Leveraging the competencies of public and private sector workforces, such as education, transportation, and planning, that are working to include a “health in all policies,” community livability, or well-being orientation in their activities. Workshop proceedings can be obtained here.

Economic Consequences Of Millennial Health

A new report by Moody’s Analytics revealed the serious impact millennials' health could have on the U.S. economy. Compared to when Generation X was the same age, millennials are projected to experience slower economic growth and pay more in health care costs over the next decade, which could have a crippling effect on the economy. Two different scenarios of millennial health and what the impact may be over the next decade are described in the study. If millennial health continues to decline and goes unaddressed over the next 10 years, the report predicts that in comparison to Gen Xers at the same age, millennials may experience some of the following outcomes: Health care treatment costs could rise as much as 33%; Mortality rates could rise as much as 40%; and Millennials’ annual income may, on average, be reduced by as much as $4,500 per person, as poor health will likely lead to job loss or reduced working hours. Moody’s Analytics analyzed the Blue Cross Blue Shield Health Index SM, which quantifies more than 300 health conditions to identify which may affect Americans’ longevity and quality of life. It is powered by annual data from more than 41 million commercially insured Blue Cross and Blue Shield (BCBS) members nationwide. The report can be obtained here.

Driving Toward Age-Friendly Care For The Future

The concept of age-friendly health systems resonates with most older patients and their caregivers, especially patients with multiple chronic conditions, according to a survey by WebMD released by the John A. Hartford Foundation. In general, caregivers perceived the older adults they cared for as having more chronic conditions. Age-friendly health systems focus on prioritizing the “4Ms” of care: what matters to patients; promoting mobility; ensuring medications do not interfere with quality of life; and treating dementias, depression and other mentation-associated conditions. Age-friendly health systems require attention to what matters to older individuals and their caregivers in order to ensure high-value care resulting in consumer satisfaction. The good news is that 87% of the more than 2,700 respondents to this survey of older adults and family caregivers report satisfaction with the care they have received in the past 12 months. This high satisfaction, however, has some caveats. For instance, it decreases as a patient’s health becomes more complicated and the number of health conditions increase. Survey results can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

November 25, 2019

Trends Archives

Adolescents’ Engagement With Unhealthy Food And Beverage Brands On Social Media

According to an article in the latest issue (March 2019) of the journal Appetite, which still is in progress, 70% of adolescents reported engaging with any food/beverage brands on social media and 35% engaged with 5 + brands. Non-Hispanic Black and less-acculturated Hispanic adolescents were more likely than non-Hispanic White adolescents to engage with brands. Approximately one-half reported engaging with brands of fast food (54% of participants), sugary drinks (50%), candy (46%), and snacks (45%), while just 7% reported engaging with all other categories of food/beverage brands. Watching television more than 2 hours-per-day was associated with any brand engagement; while using other screens more than 2 hours-per-day was associated with following 5 + brands. The study surveyed U.S. teens in the age bracket 13-17 about their engagement (liking, sharing, or following) with food and beverage brands on social media, such as Facebook; their time spent watching TV and other screens (cellphones); and demographic characteristics.

Emergency Department Visits For Sport And Recreational Activity Injuries

National Health Statistics Reports on November 15, 2019 indicates that during 2010–2016, approximately 2.7 million annual ED visits for sports injuries were made by patients aged 5–24 years. The top five most frequent activities that caused ED visits for sports injuries were football (14.1%), basketball (12.5%), pedal cycling (9.9%), soccer (7.1%), and ice or roller skating or skateboarding (6.9%). Visits caused by playing football and basketball accounted for a higher percentage of visits by males than females (20.2% compared with 2.2%, and 14.3% compared with 8.9%, respectively), whereas visits caused by gymnastics and cheerleading accounted for a higher percentage of visits by females (11.8% compared with 2.1%). Visits for injuries to the upper extremities decreased with increasing age (37.1% for those aged 5–9 to 27.4% for those aged 20–24), whereas visits for injuries to the lower extremities increased with increasing age (16.2%) for those aged 5–9 to 41.0% for those aged 20–24).

HEALTH TECHNOLOGY CORNER

3D Bioprinting Of A Vascularized And Perfusable Skin Graft Using Human Keratinocytes

Researchers at Rensselaer Polytechnic Institute have developed a way to 3D print living skin, complete with blood vessels. The advancement, published online in the journal Tissue Engineering Part A on November 1, 2019 is considered a significant step toward creating grafts that are more like the skin that human bodies produce naturally. Presently, whatever is available as a clinical product is similar to a fancy Band-Aid, according to investigators participating in the study, because although it may provide some accelerated wound healing, it eventually just falls off and never really integrates with the host cells. A significant barrier to that integration has been the absence of a functioning vascular system in the skin grafts. More work will need to be done to address the challenges associated with burn patients, which include the loss of nerve and vascular endings. The grafts this study’s team has created bring researchers closer to helping individuals with more discrete issues, such as diabetic or pressure ulcers.

Jointly Optimized Microscope Hardware For Accurate Image Classification

Since its invention, the microscope has been optimized for interpretation by a human observer. With the recent development of deep learning algorithms for automated image analysis, there now is a clear need to re-design the microscope’s hardware for specific interpretation tasks. To increase the speed and accuracy of automated image classification, according to an article published on December 1, 2019 in the journal Biomedical Optics Express, engineers at Duke University present a method to co-optimize how a sample is illuminated in a microscope, along with a pipeline to classify automatically the resulting image, using a deep neural network. They demonstrate how their learned sensing approach for illumination design automatically can identify malaria-infected cells with up to 5-10% greater accuracy than standard and alternative microscope lighting designs and show how the new procedure can translate across different experimental setups while maintaining high accuracy.

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DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

November 25, 2019

Trends Archives

November 20, 2019 marked the occasion for the release of data on first-year earnings of college graduates according to the academic programs in which they matriculated that are broken down for the first time by program level. Derived from federal tax data, information can be obtained for more than 40,000 programs, showing that median debt exceeded median first-year earnings by more than $1,000 for 6,520 of them.

A dollars and cents analysis should be of value as families decide how much they are willing to invest in programs that ultimately could lead to financial outcomes commensurate with the amount of money spent to obtain proper academic credentials needed for entry into the employment market. A potential downside is that decisions will be made that displace passion in order to acquire more earthly gains in the form of future salaries. A job provides one kind of satisfaction while having a passion for a particular field produces a feeling of satiety and self-fulfillment of a quite different nature. Students and their families must cope with the difficulty of deciding whether to pursue academic preparation in a field that one loves, which may not pay well later on, for an alternative that may be much less interesting, but substantially more remunerative.

Student Assistance, Recognition Of Accrediting Agencies, And State Agency Procedures

The Secretary of the U.S. Department of Education (USDE) on November 1, 2019 amended regulations governing the recognition of accrediting agencies, certain student assistance general provisions, and institutional eligibility, as well as making various technical corrections. The revised regulations continue the emphasis on accountability that has been characterizing federal involvement in accreditation, and providing additional opportunity for accreditation to embrace innovation, along with some streamlining of federal recognition (the periodic review of accreditation). Revised regulations addressing accountability: (1) Increase expectations by USDE concerning student achievement through the collection and analysis of key data and indicators, including institution’s or program’s performance and measures of student achieve- ment; (2) Require more transparency on regional accreditor websites regarding the states in which the organizations operate; (3) Mandate institutional disclosure to accreditors of any law enforcement actions or prosecutions that lead to adverse action; and (4) Protect students through enhanced institutional disclosure requirements about whether programs lead to licensure or qualification to sit for a licensing exam.

Revised regulations addressing innovation: (1) Provide more flexibility for innovation for institutions and accrediting organizations by encouraging accreditors to establish different methods of monitoring institutional success and provide opportunities for experimentation; (2) Open the door to student aid for non-institutional educational offerings from colleges and universities, including partnerships with alternative providers; (3) Provide a simpler path for new accrediting organizations to gain recognition to give priority to student needs and outcomes rather than traditional measurements; and (4) Enable more dual enrollment opportunities through flexibility in standards allowing high school teachers in certain circum- stances to teach these courses.

State Authorization of Distance and Correspondence Education regulations also have been updated and streamlined. The revisions make clear an institution’s responsibilities and the role of State reciprocity agreements while ensuring students have the information they need to make informed decisions. States that join a reciprocity agreement can no longer layer additional State higher education authorization requirements on institutions that participate, but can continue to apply other State laws and regulations that apply to all entities doing business in a State. The final regulations will provide students with more options to pursue a higher education credential of value, transfer credits between institutions, and qualify for career advancement.

Most provisions in the final rule are scheduled to take effect on July 1, 2020. Sections that include State Authorization were effective November 1, 2019. Sections that modify the timeline that accrediting organizations are to follow to become federally recognized will be effective on July 1, 2021.

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HEALTH REFORM DEVELOPMENTS

John Colbert

November 25, 2019

Trends Archives

Political campaigns for elected office can be exhaustive affairs for voters, particularly when they occur in months and even more than one year in advance of an election. A more optimistic view of the matter suggests, however, that these contests are enormously valuable in shedding light on the nature of important social issues and how best to address them.

Health care represents close to 20% of the U.S. economy, the largest in the world. Even when healthy, individuals want to know they are protected to a great extent from the ravages of illness and disease by being able to have insurance coverage. In its simplest form, they want to derive comfort from knowing that cost will not inhibit them from obtaining the care that they need when they need it from the providers they wish to furnish treatment.

Presently, several candidates are competing to determine which one will secure the nomination for the presidency in 2020. Rightfully so, they focus much of their potential electability in the eyes of voters on how they plan to address health care issues in this country. Proponents of a Medicare For All initiative promise to offer an extensive range of benefits by the government at no cost to patients. Their appeals differ on the basis of details, such as the time needed to implement the new program and how to pay for it. Other candidates stress the need to maintain a system of private insurance coverage.

As debates continue to unfold, policy analysts who support as well as those who oppose such proposals weigh in with their respective critiques of what is being touted as an overhaul of a a remarkably complex system. An advantage of their doing so is that a clearer picture emerges of whether ideas currently being proposed will represent either an improved or perhaps even a worse future arrangement.

Hospital Compare Data On Quality

November 4, 2019 began a 30-day preview period for hospitals to see the data that will be reported publicly on Hospital Compare next year. As part of the Inpatient Psychiatric Facility Quality Reporting (IPFQR), Hospital Inpatient Quality Reporting (IQR), Hospital Outpatient Quality Reporting (OQR), and Prospective Payment System (PPS)-Exempt Cancer Hospitals Quality Reporting (PCHQR) programs, hospitals have 30 days to preview their data prior to public reporting on Hospital Compare. As part of this preview, hospitals (excluding cancer hospitals) also will see an updated Overall Hospital Quality Star Rating that publicly will be reported on Hospital Compare next year.

Hospital Price Disclosure Rule

On November 15, 2019, the Centers for Medicare & Medicaid Services (CMS) finalized policies that follow directives in President Trump’s Executive Order, entitled “Improving Price and Quality Transparency in American Healthcare to Put Patients First,” that lay the foundation for a patient-driven healthcare system by making prices for items and services provided by all hospitals in the United States more transparent for patients so that they can be more informed about what they might pay for hospital items and services.

CMS is finalizing the proposal to define hospital “items and services” to mean all items and services, including individual items and services and service packages, that could be provided by a hospital to a patient in connection with an inpatient admission or an outpatient department visit for which the hospital has established a standard charge. Examples of these items and services would be supplies, procedures, room and board, use of the facility and other items (generally described as facilities fees), services of employed physicians and non-physician practitioners (generally reflected as professional charges), and any other items or services for which a hospital has established a standard charge.

It is highly likely that the hospital industry will mount a legal challenge to the imposition of this rule. At issue is a requirement that hospitals make public the rates they negotiate with insurers for all services.

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MASS MEDIA FOCUS ON CAPITOL HILL

John Colbert

November 25, 2019

Trends Archives

Recent weeks have involved an enormous amount of attention on Capitol Hill by the mass media, primarily due to events involving an effort to impeach President Donald Trump. Whatever the outcome of an attempt to unseat him as the White House’s occupant, a significant amount of important business continues to be pursued by members of both the Senate and the House of Representatives. Funding for key governmental operations is on temporary hold until disagreements can be resolved about what to fund and for what amounts.

Unable to complete business by the start of a new fiscal year on October 1, a continuing resolution (CR) was used to maintain operations until November 21. Recognizing that much appropriations business remains unfinished, members of both the House and Senate approved a second continuing resolution (CR) to fund the federal government through December 20. President Trump signed it on November 21.

The Patient Protection and Affordable Care Act of 2010 (ACA) resulted in the creation of the Patient-Centered Outcomes Research Institute (PCORI). As an example of that agency’s operations, on November 19 of this year its Board of Governors approved $70 million to fund 21 studies and related projects designed to improve care for health conditions that impose high burdens on patients, their families, and the healthcare system. Eighteen of the awards, totaling about $65 million, will fund studies comparing the most effective ways to treat a range of illnesses and health conditions. Three of these investigations focus on health issues of concern to older adults—two on hearing loss and one on safer prescribing of glucose- lowering drugs for individuals with Type 2 diabetes. Three other studies focus on children’s health issues; two seek to improve treatment of anxiety in children and adolescents; and one seeks to prevent obesity among preschoolers in rural, underserved areas.

Many federal initiatives, such as the Higher Education Act (HEA) and PCORI must be reauthorized at stated intervals to continue operating. Even when they no longer are authorized, there is pressure to enable them to continue functioning because of the essential functions that they perform. Some programs tend to be more vulnerable than others, however, and there always is a risk that an unauthorized entity could be eliminated. For example, the past few decades have involved several attempts to jettison the Agency for Healthcare Research and Quality. A way of reducing such danger is to seek the enactment of reauthorization legislation. A step in that direction was launched on November 19, 2019 with the introduction of S. 2897, a measure to reauthorize PCORI in order to boost research into health care costs.

Even when legislators agree on the importance of existing programs, technical difficulties can obstruct further progress. A case in point is funding for historically black colleges and other minority-serving institutions, which recently expired. Both Senate Republicans and Democrats support reauthorizing $255 million a year, but cannot agree on the best mechanism for doing so. A Republican proposal is to furnish permanent funding by including the measure in reauthorization of the Higher Education Act (HEA), which has not been reauthorized for the past six years. Critics among Democrats object to holding this form of support as hostage in a much larger bill that is not destined to go anywhere soon because of its complex nature.

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PRESIDENT’S CORNER

John Colbert

November 25, 2019

Trends Archives

BY ASAHP PRESIDENT PHYLLIS KING

A New....

Decade (2020 – 2029)

Association Name (Association of Schools Advancing Health Professions)

President (Phyllis King)

Strategic Plan (2020 – 2025)

I am honored, eager, and ready to serve ASAHP as your new President. Past leadership has positioned the Association well from a staffing, budget, and leadership perspective to enable the Association to sustain effective practices and take on new initiatives that advance and enhance the Association’s mission and vision. Special appreciation goes to Susan Hanrahan and the board for their great work.

The ASAHP Board is holding a strategic planning retreat in January. We will revisit what strategies and initiatives have and are serving the Association well, and what new actions should be taken to meet the needs of the Association in a rapidly changing environment. The outcomes of this retreat will be shared with the membership for feedback and endorsement. We will welcome your volunteerism to support the new plan.

Ongoing activities currently include tweaking the Institutional Profile Survey for administration to institutions in 2020, planning for the 2020 Leadership Development Program (applications are now being accepted for participants), generating publications and presentations on Interprofessional Education, surveillance and engagement in federal and legislative policies and actions affecting health care education, research and practice, advancing the work of the International Task Force and Tri-Alliance to develop a global rehabilitation health worker certification in rehabilitation, and supporting Alpha Eta.

The future of health and health care will likely be driven by digital transformation. Exponential change and innovations in healthcare practice will continue. I invite you to join me in embracing change and designing our destiny. This will require activism, engagement, education, strategy, and partnerships. Together we can do this!

I wish you a safe and joyous holiday season.

Phyllis King

Get to know your President here.

Photos of the Board of Directors can be obtained here.

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TECHNOLOGICAL IMPERATIVE CHALLENGES

John Colbert

November 25, 2019

Trends Archives

A technological imperative is just one of many conceptual tools (e.g., economic, preventive, and epidemiological) that offer a convenient framework for considering the health care realm. Readers of Victor Hugo’s novel Notre-Dame de Paris may recall his vivid characterization of the hunchback Quasimodo. It is less likely, however, that there will be any similar recollection of a depiction in the book of cathedral archdeacon Claude Frollo, whose famous slogan was “Ceci tuera cela” (This will kill that), which occurred to him as he touches a printed book while glancing nostalgically at the church towers. “This” (signifies the book), while “that” (represents the medieval cathedral and the entire world it symbolizes).

What Frollo had in mind is the disruptive potential of technological innovations. The invention of the printing press meant that the flock of spiritual followers no longer would have to rely exclusively on clerical proclamations to discover and interpret information, which heretofore would have remained unknown to them. As noted in the book, Creative Economy and Culture: Challenges, Changes and Futures for the Creative Industries, a chapter on Ceci tuera cela points out that democratic, secular print culture would supersede the authority of the church, along with the system of beliefs and images embodied in the great edifice where action is portrayed.

It appears reasonably clear that a constant array of technological innovations has the potential to have a transformative influence on the health care sphere. Many new developments are intended as improvements. Nonetheless, it is the unintended negative consequences of various changes to the existing order that sometimes prove to be worrisome challenges due to the prospect that technological advances often bring in their wake many impacts of a mixed blessings nature.

February 2019 marked the 10th anniversary of passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act, an effort to accelerate the conversion of physician and hospital paper charts to electronic records, but widespread adoption not always has been accompanied by projected benefits. Instead, EMRs are associated with the onset of physician “burnout” and also in disrupting effective communication patterns between clinicians and their patients. Moreover, a finding reported in the November 2019 issue of the journal Health Affairs indicated that while hospitals gave 95% of discharged patients access to view, download, and transmit their information, only about 10% of those with access used it. Underuse can produce its own train of undesirable side effects.

As more applications are integrated into everyday life, artificial intelligence (AI) is predicted to have a globally transformative influence on economic and social structures similar to the effect that other general‐purpose technologies, such as electricity have had. A manuscript in the November 2019 issue of the American Journal of Industrial Medicine introduces a cautionary note, however, regarding key issues for occupational safety and health, along with selected implications that include job displacement from automation and management of human‐machine interactions. Hence, as technology unfolds, it continues to warrant close scrutiny.

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LEARNING ABOUT FIDGETING WHILE FIDGETING

John Colbert

October 22, 2019

Trends Archives

Since it is more than quite likely that the editor of the Association’s newsletter experienced some fidgeting while preparing this edition, it is possible that some readers also could undergo something comparable while reading it. According to an article that was published in the October 2019 issue of the journal Nature Neuroscience, psychologists have ascribed fidgeting to boredom, a form of stress relief, or perhaps as a subconscious way to increase memory. Also, fidgeting may take place even when one seemingly is engaged actively in a task. It is unclear, however, the process by which fidgets go about modulating their neural activity across the brain. Certain brain regions drive actions (such as motor cortex) and many others receive this information (such as sensory areas), in part to distinguish self-generated from movements that are not self-generated. Investigators who participated in the study reported in the aforementioned publication show that in expert mice performing a task, movements that are not task-related dominate the single-trial neural activity. This finding is exciting because it underlines why measuring behavior and other variables are key for exploring the neural code. Apart from whatever value might be associated with this discovery, as an aside it also might be somewhat comforting to know that somewhere out there, a group of expert mice is working on our behalf to enhance a more human-oriented understanding of neural activity.

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PARKINSON’S DISEASE AFFECTS WOMEN AND MEN DIFFERENTLY

John Colbert

October 22, 2019

Trends Archives

Not all demographic groups are affected by disease pathophysiology in the same way as shown in a review published in the August 2019 issue of the Journal of Parkinson's Disease. Growing evidence indicates that Parkinson's disease (PD) affects women and men differently. The article presents the most recent knowledge about these sex-related differences and highlights the significance of estrogens, which play an important role in the sex differences in PD. Although the risk of developing this disease is twice as high in men than women, it is women who experience a more rapid disease progression and a lower survival rate. By drawing attention to sex-related differences and disparities in PD, the investigators hope that recently gained knowledge will further encourage the scientific community and policy makers to foster the development of tailored interventions and the design of innovative programs - for example in care practices - that meet the distinct requirements of women and men with PD.

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EVIDENCE FOR LATINO PREFERENCES FOR METAPHOR AND ANALOGY

John Colbert

October 22, 2019

Trends Archives

It is not too surprising to come to a realization that individuals from different cultures may be inclined to communicate and describe the world differently. A manuscript in the November 2019 issue of the Personality and Social Psychology Bulletin documents one such cultural difference previously unexplored by psychologists: receptiveness to metaphors. Spanish-speaking Latinos were contrasted with Anglo-Americans, Asian Americans, and Latinos who do not habitually speak Spanish. Across four experiments, the investigators showed that relative to these other groups, Spanish-speaking Latinos show stronger preferences for metaphoric definitions, better recall of metaphors, greater trust in both scientific and political arguments that use metaphor, and stronger liking for and desire to connect with persons who use metaphoric speech. Given the substantial representation of Latinos throughout the United States, it definitely is worth considering future directions and implications for improving cross-cultural communication.

Recognizing that Spanish-speaking Latinos display a relatively stronger preference for metaphors in defining abstract constructs and in demonstrating enhanced memory for metaphors in narratives, the findings are particularly relevant in the health care arena. Great emphasis is placed today on how health status is affected by social determinants. Language differences can have a decisive impact on the ability to achieve positive health outcomes. Thus, both from the perspective of patients describing their symptoms to health care practitioners and in their obtaining a greater understanding of diagnostic terminology, the use of metaphors is a tool that can play a highly valuable role.

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

October 22, 2019

Trends Archives

Preparing The Current And Future Health Care Workforce For Interprofessional Practice

The Health Resources & Services Administration published a report, "Preparing the Current and Future Health Care Workforce for Interprofessional Practice in Sustainable, Age-Friendly Health Systems." It is the the 17th Annual Report authored by the Advisory Committee on Interdisciplinary Community-Based Linkages (ACICBL) to the Secretary of the United States Department of Health and Human Services and to the Congress. ACICBL is a Federal Advisory Committee that provides advice and recommendations to the Secretary on a broad range of issues dealing with programs and activities authorized under Title VII, Part D of the Public Health Service (PHS) Act. Recommendations provided in this iteration are designed to promote broad changes within the health care system to advance age-friendly practices, train the health care workforce in age-friendly care, and improve the care of older adults, while also facilitating the reduction of burnout and the promotion of wellness and resilience among health care providers. The report can be obtained here.

Integrating Social Care Into The Delivery Of Health Care

How can services that address social needs be integrated into clinical care? What kind of infrastructure will be needed to facilitate that integration? To begin answering such questions, the National Academies of Sciences, Engineering, and Medicine assembled an expert committee to examine the potential for integrating social care services into the delivery of health care with the ultimate goal of achieving better and more equitable health outcomes. The resulting report, Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health, identifies and assesses current and emerging approaches and recommends ways to expand and optimize social care in the health care setting. It can be obtained here.

Older Americans’ Views On Navigating The Health Care System

A majority of older Americans who are ages 60+ (79%) are prepared to age well, but nearly 7 in 10 (68%) are at least somewhat concerned about their health as they age, and nearly half (46%) need assistance understanding their health insurance benefits once they have chosen a plan. A survey conducted by The Harris Poll, commissioned by Anthem, Inc. and the National Association of Area Agencies on Aging reveals that while most respondents are confident in some aspects of navigating the health care system, there is opportunity for better understanding of their benefits, bill, diagnosis, and treatment. Among the respondents, which included U.S. adults, 65% reported that they had some type of Medicare insurance coverage. The report can be obtained here.

Survey On State And Local Income, Poverty, And Health Insurance Statistics

The U.S. Census Bureau released its most detailed look at America’s inhabitants, places, and economy. New state and local statistics on income, poverty, and health insurance are available in briefs, detailed tables, data profiles, and more. The American Community Survey (ACS) also produces statistics for more than 40 other topics. Results can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

October 22, 2019

Trends Archives

Death Rates By Marital Status For Adults Age 25 And Older: United States, 2010-2017

A new report from the National Center for Health Statistics (NCHS) presents trends for 2010–2017 in age-adjusted death rates by marital status (married, never married, divorced, or widowed) at the time of death for adults aged 25 and over. The age-adjusted death rate for married persons aged 25 and over was lower than for those who were never married, divorced, or widowed. It declined 7% (839.8 per 100,000 U.S. standard population), while the rate for never-married persons also declined, by 2% (from 1,466.1 to 1,443.6). The rate for widowed persons was the highest of all marital status groups and increased 6% during the period, from 1,567.2 in 2010 to 1,656.9 in 2017. The rate for divorced persons aged 25 and over was stable during the period and was 1,368.8 in 2017. Rates for married men were the lowest of all marital status groups and declined 7% from 2010 (1,012.1) to 2017 (942.9) while for women, rates also declined 7% between 2010 (612.1) and 2017 (569.3).

Prevalence Of Screening For Social Determinants Of Health

Social needs are linked to health outcomes. Identifying patients with unmet social needs is a necessary first step to addressing these needs, yet little is known about the prevalence of screening. Most hospitals and physician practices don’t screen patients for social determinants of health such as food insecurity, housing instability, utility and transportation needs, and interpersonal violence, according to a study described in the journal JAMA Network Open on September 18, 2019. Surveys administered from June 2017 to August 2018 to 2,190 physician practices and 739 hospitals found that about 16% of practices and 24% of hospitals reported screening for all five factors, while 8% of hospitals and 33% of practices screened for none. The most commonly screened-for factor was interpersonal violence, occurring at 75% of hospitals and 56% of practices. Almost 50% of academic hospitals reported screening, compared with 23% of hospitals overall. Facilities that serve economically disadvantaged patients were more likely to screen.

HEALTH TECHNOLOGY CORNER

Hierarchical Encoding Of Attended Auditory Objects In Multi-Talker Speech Perception

Humans easily can focus on one speaker in a multi-talker acoustic environment, but how different areas of the human auditory cortex (AC) represent the acoustic components of mixed speech is unknown. A team of Columbia University neuroengineers has uncovered the steps that take place in the brain to make this feat of picking out a single voice possible, according to an online article that became available in the journal Neuron on October 21, 2019. The discovery helps to solve a long-standing scientific question as to how the auditory cortex, the brain's listening center, can decode and amplify one voice over others -- at lightning-fast speeds. This new-found knowledge also stands to spur development of hearing-aid technologies and brain-computer interfaces that more closely resemble the brain. An end goal is to understand better how the brain enables individuals to hear so well, plus to create technologies so that stroke survivors can speak to loved ones, or to enable the hearing-impaired to converse more easily in a crowded setting.

Exergaming And Virtual Reality For Health: Implications For Cardiac Rehabilitation

According to an article published online September 12, 2019 in the journal Current Problems in Cardiology, cardiac rehabilitation (CR) programs focused on improving the health trajectory of patients with cardiovascular disease strive to increase physical activity (PA) and cardiorespiratory fitness. However, historically low compliance with recommended PA has prompted exploration of alternatives to traditional courses of exercise therapy. One alternative, exergaming, or the requirement of physical exercise inherent to a video game's activities, has shown to have a promising impact in improving patient self-efficacy for exercise training using digital hardware (e.g., the Wii or the Xbox Kinect). Moreover, novel technologies in virtual reality can provide an engaging, immersive environment for exergaming techniques, maximizing goal-oriented training, and building self-efficacy for patients during CR. The concept of a “Clinical Arcade” is introduced as a new approach to integration of these techniques in CR care.

return to october 2019 trends

DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

October 22, 2019

Trends Archives

Apart from legislation that emerges on Capitol Hill, the regulatory arena plays a key role in determining how policies are implemented. A recent example occurred during the week of October 14, 2019 when the federal Office of Management and Budget (OMB) gave the necessary go-ahead signal to the Department of Education’s final proposal to overhaul college accreditation. This approval means the final regulation likely will be published soon. The proposed rule is intended to ease some requirements that college accreditors must meet to obtain federal recognition, an important status that enables the institutions they accredit to be eligible for federal student aid. An ongoing criticism by the Trump Administration is that the existing college accreditation system is too costly and burdensome.

Protecting Students From Sudden College Closures

Throughout 2019, administrators at some small institutions have announced that their doors soon will be closed. Declining student enrollment and an inability to finance rising costs often are cited as reasons for this decision. In response, on October 3, 2019, Representatives Donna Shalala (D-FL), Peter King (R-NY) and Sean Casten (D-IL) introduced a bill aimed at protecting students in the event of the sudden closure of a higher education institution. As of October 22, the measure had 11 co-sponsors. Among its various provisions, the Stop College Act of 2019 (H.R. 4615) would require accrediting organizations to:

Review teach-out plans and agreements when the accreditor is notified by the U.S. Department of Education (USDE) of problems pointing to the potential closure of a college or university, a state removes an institution’s license to operate, or accrediting organizations place an institution on probation, show-cause, or equivalent status.
Monitor institutions whose ability to meet accreditation standards has declined, particularly related to financial responsibility requirements, as identified by USDE, an auditor or the accrediting organization, which may indicate that a closure is imminent.
Respond to complaints, monitor, and assess an institution’s records of student complaints within 30 days and submit such complaints to USDE and state agencies when appropriate.

Reauthorization Of The Higher Education Act

This important piece of legislation last was reauthorized in 2008. Early in 2019, there were hopes that reauthorization would occur by the end of this year. Hearings were held, key issues were identified, and legislators in both political parties have attempted to bring a comprehensive bill to fruition. On October 15, 2019 the House Committee on Education and Labor introduced the College Affordability Act (H.R. 4674), which is designed to achieve: a comprehensive overhaul of the higher education system that lowers the cost of college for students and families, improves the quality of higher education through stronger accountability, and expands opportunities by providing students the support and flexibility they need to succeed. Some of the main provisions under Title 1 of this proposed legislation are:

Ensures programs lead to gainful employment
Protects the integrity of non-profit institutions of higher education
Improves available post-secondary data
Improves the Federal Student Aid (FSA) office
Establishes an enforcement unit

return to october 2019 trends

HEALTH REFORM DEVELOPMENTS

John Colbert

October 22, 2019

Trends Archives

Earlier this month, President Trump announced an Executive Order charging the Centers for Medicare & Medicaid Services (CMS) to propose annual changes to combat waste, fraud, and abuse in the Medicare program. From its inception in 1966, there have been policy concerns about installing program integrity methods to better protect taxpayers from fraud, waste, and abuse in Medicare. The challenge is to “pay it right,” which translates into paying the right amount, to legitimate providers, for covered, reasonable and necessary services made available to eligible beneficiaries while taking aggressive actions to eliminate fraud, waste, and abuse.

Government watchdogs routinely identify concerns about waste and abuse. The Government Accountability Office (GAO) has designated Medicare as a High Risk program since 1990 because of its size, complexity, and susceptibility to improper payments. In 2018, improper payments accounted for 5% of the total $616.8 billion of Medicare's net costs. As programs, such as Medicare and Medicaid become more complex, program integrity risks become increasingly difficult to recognize. New provider types have entered the program, including hospices, home health agencies, and federally qualified health centers. More challenging cross-ownership issues have emerged, such as one corporate parent owning various providers and provider types. Increasingly complex webs of affiliations can allow unscrupulous providers to simply appear, disappear if they come under scrutiny, and then re-appear as “new” entities.

When enacted into law, Medicare had 19 million beneficiaries. Today, there are almost 61 million of them and 10,000 new enrollees are added every day. When the programs began, Medicare and Medicaid accounted for only 2.3% of federal spending. That paltry amount has grown to 23.5% of federal outlays today. Some candidates hoping to be elected president of the U.S. are in favor of expanding Medicare, including making it a program that covers everyone in the U.S. even to the extent of eliminating private insurance coverage obtained through employment. Yet, rarely is it clearly stated how this expansion will be paid for without raising taxes nor is there any recognition of what mechanisms will be installed to combat chronic problems involving waste, fraud, and abuse.

Reducing Healthcare Administrative Costs

Following the success of enacting Medicare and Medicaid legislation in 1965 and making these programs available the next year, a steady drumbeat occurred throughout the remaining 1960s and much of the 1970s to expand the scope of coverage. The emphasis back then was to enact health insurance legislation to benefit a wider segment of the U.S. population. Health spending in the year 1960 was 5.2% of Gross Domestic Product (GDP). By 1970, it had increased to 6.9% while it currently is approaching nearly 20% of the world’s largest economy. The average cost of a stay in a hospital was $68 per day in 1970, but there were predictions that it could rise to $98 per day by 1973. Those figures seem risible in light of current health care spending patterns.

In late September 2019, the Omnibus Burden Reduction (Conditions of Participation) Final Rule came into effect in an effort to strengthen patient safety by removing unnecessary, obsolete, or excessively burdensome health regulations on hospitals and other healthcare providers. This rule is intended to advance CMS’s “Patients over Paperwork” initiative by saving providers an estimated 4.4 million hours previously spent on paperwork annually, with overall total provider savings projected to be approximately $8 billion over the next 10 years, giving physicians more time to spend with their patients.

Thousands upon thousands of regulations affect Medicare and Medicaid. CMS officials need to stay on the alert to determine where changes to obsolete, duplicative, or unnecessary requirements can be made to improve healthcare delivery and reduce unnecessary spending. An overall aim should be to improve patient care, jettison burdensome rules, and eliminate duplicative regulations. Voters would benefit from learning how political candidates for high public office would perform to achieve such objectives.

return to october 2019 trends

THE DANCE OF LEGISLATION

John Colbert

October 22, 2019

Trends Archives

A book published in 1973 with the title, “The Dance of Legislation” by Eric Redman provided a thorough, credible account of the legislative process involving an effort to pass S.4106, the National Health Service Bill. The essence of the book’s material enables readers to appreciate the various forms of bureaucratic infighting that occurred, political prerogatives, and Congressional courtesies required to achieve a favorable outcome.

While the assortment of lions and lionesses on Capitol Hill back then has long since departed the legislative scene, a strong case may be made that nothing significant has changed over the past several decades. The current political scene includes talk of impeaching President Trump, but that distraction is just one of many factors contributing to a general sense of paralysis affecting the ability to pass needed forms of legislation. A case in point is the necessity of reauthorizing the Higher Education Act (HEA).

Last reauthorized in 2008 for a five-year period, the six years since then have enabled the contents of this legislation to continue to be implemented. Fortunately, although technically it could be declared null and void at any time, its provisions are too important to be placed on the chopping bock. A downside, however, is that changes need to be made in order to achieve a more perfect accommodation with changing times and situations since 2008.

This piece of legislation, along with other important considerations such as immigration policy, constitute bottlenecks that can erupt at many different points. Apart from partisan disagreements that can lead to delays, even when both chambers are ruled by the same party, important differences may exist. The fact that in 2019 Democrats are the majority in the House of Representatives while Republicans have more favorable numbers in the Senate adds to the challenge of overcoming certain impediments that result in legislation being stalled.

Even within the two parties, disagreements may arise. A member from a state with strong agricultural interests may not always share the same outlook of a colleague whose constituents may have a stronger maritime focus. The same holds true when a member of Congress represents predominantly urban rather than rural interests. Ultimately, each Representative and Senator is beholden to addressing the needs and interests of voters back home. If perceived as failing to do so, there is a risk of not being reelected.

Strenuous efforts continue to be exerted to pass appropriations legislation. The 2020 fiscal year began on October 1 of this year without funding bills being signed into law. One or more continuing resolutions (CRs) enable the government to continue operating until such time that a more permanent agreement can be reached. It will not be long until the end of the calendar year is reached and a new Congressional session will begin next January.

The year 2020 will involve a national election, including who will occupy the White House in 2021. Republicans campaigning will blame Democrats for blocking legislative achievements. Democrats will point to their do-nothing Republican opponents and insist on voting them out of office. Some things never change, thus ensuring that the dance of legislation will continue uninterrupted for the forseeable future.

return to october 2019 trends

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

October 22, 2019

Trends Archives

By Susan N. Hanrahan, ASAHP President

Well, I am ‘fresh off” the Annual Conference and what a week it was. I am not sure I have a favorite time, place or event but all of the speakers and activities had significance and seemed to resonate with one or more aspects of my life. Thanks to everyone who was able to attend. For those that did not, you can check out our website and access some of the plenary and concurrent session presentations----it was a very inspirational week.

Here are a couple of things you might have missed. We did approve to change the name of our organization to “Association of Schools Advancing Health Professions”. The logo “appears” the same but is a little more dynamic to fit the nature of our ever evolving world. People seemed excited about it and we are ready to move forward. The name change is also a perfect segue to our Strategic Planning Initiative announced by your new President, Phyllis King. This will happen in January and I am sure there will be opportunities for you to provide input.

For those that participated in the Institutional Profile Survey, you received your copy of the report prior to the Annual Conference. It is broken out into three sections---all institutions, academic health centers and 4-year institutions. Our contract group, Altegra Tech, has been instrumental in almost all aspects of the development of the survey and its reporting. The more all of us work on it, the more everyone understands the intricacies of the data and the questions themselves. We still have some minor tweaks for the 2018-2019 data collection instrument (i.e., survey) but it will be available soon for your university numbers. If you want to get the final survey report for 2018-2019, you have to participate in this year’s reporting so check your inbox in the next few weeks for a request to participate.

For the current data set, we will be working to share some additional reports as we continue to refine the data. If there are particular questions you would like for us to answer or tables you would like to see, please let Kristen Truong know. By the way, she received the President’s Award at the conference and deserved every accolade she received. She has been a tremendous asset for ASAHP and I want to thank her, Kate Aultman (former member who validated our data), all of the subcommittees, task forces members that helped prepare questions and edit the survey and Chris Yokely and his team at Altegra Tech for their work on the IPS. Thanks to all of you again for your patience.

Since this will be my last note to you (except for the Annual Report synopsis), let me just say I hope you feel more connected to each other. The Member Q&As were meant to “share secrets” about some of us that we often never “learn” in our associations with one another. In addition, the dedicated list serve (was a member request) was deployed so I hope you will increase your utilization of it with information you might want to share with members or for questions that need to be answered. I want to thank my BOD for their support over my 2-year presidency, the committee and task force chairs and their members that worked to get even more accomplished on our behalf and to the ASAHP staff (including Tom Elwood who produces this letter). I hope each of you will take some time to personally invest in ASAHP—it is a rewarding effort. Phyllis King will be awaiting your volunteerism call. I will serve one more year as past president so please continue to reach out to me for “anything” the Association can help you with.

A new decade—a new Association name—a new President --- a new strategic plan (in progress). Here we go!!!! Let’s have more fun!!

Susan Hanrahan, President/Past President

return to october 2019 trends

THE VALUE OF GLANCING IN THE REARVIEW MIRROR

John Colbert

October 22, 2019

Trends Archives

Characteristically, many readers of periodicals look forward to each new issue to obtain valuable insights. Yet, there also may be considerable value in exploring professional literature archives as a means of obtaining an enhanced understanding of current challenges and perceived dilemmas. During the October 2019 conference of the Association of Schools of Allied Health Professions, it was announced that as of that day the new name would be the Association of Schools Advancing Health Professions, a term that represents the third occasion such a change has occurred since the organization was founded in 1967.

Allied health has a rich history. The federal government provided $276,495,000 between 1967 and 1979 after the Allied Health Professions Personnel Act became law in 1966. While that amount may not sound like much, as measured by its value in purchasing power in dollars in the year 2019, it equates to more than $1.498 billion. Significantly, a portion of that money was directed to the Association and many institutions that belonged to it during that time period.

The Journal of Allied Health was founded in 1972. During its second year of existence, ASAHP’s first President—Darrel Mase—penned an article, “Allied Health-Today and Tomorrow” (reprinted in the Winter 2010 issue). In it, he discussed: interprofessional education; how professional territoriality can impede effective utilization of health manpower; the difficulty of obtaining hard data regarding manpower needs to determine numbers and kinds of allied health personnel needed; the proper ratio of auxiliary to primary personnel; and evaluation of the effects of expanded functions of auxiliary personnel on patient dynamics or practice economics.

That particular manuscript was preceded by an article in the New England Journal of Medicine on April 27, 1972 with the title, “Allied Health Manpower-Solution or Problem?” It contained a discussion of how health manpower analysis and inventories have produced an inappropriate concern with numbers rather than with actual job content, flexibility, and development. Moreover, if non-physician medical manpower is to improve the health system, tasks rather than numbers must be studied, management must be given more authority, and professionalism must be curtailed. Apart from the fact that the term manpower has been replaced by the expression workforce, much of the contents of both papers have relevance today.

To cite work in another field where it may be valuable to glance occasionally in the rearview mirror, it is worth noting that developments in genomics are anticipated to exert meaningful impacts on patient care. Issue 2 in 2006 of the journal Epigenetics furnishes a brief historical account of genetics and developmental biology, and how they diverged for a major part of the 20th century. Epigenetics is the field that attempted to unite them and provide new insights into the mechanisms for unfolding the genetic program for development. That achievement has the potential to affect the ability to continue experimenting with genome editing technologies, such as CRISPR (clustered regularly interspaced short palindromic repeats) to go beyond only tweaking what already exists in a genome.

return to october 2019 trends

THE ROLE OF ACCIDENTS ON THE PATHWAY TO INJURY AND DEATH

John Colbert

September 19, 2019

Trends Archives

As the third leading cause of death in the U.S., accidents involve all age groups. Adoption of prevention measures has enormous potential to avoid such outcomes, but producing an accident-free environment continues to be a major uphill struggle. Motor vehicle crashes are the leading cause of injury and death for adolescents in this country. A possible developmental source of crash risk is working memory (WM). Results of a study published on September 13, 2019 in JAMA Network Open suggest that a relatively slower WM growth trajectory is associated with young driver crashes. Routine assessment of WM across adolescence may help to identify opportunities for providing adaptive interventions. Meanwhile, a correspondent who occasionally provides information proved useful for inclusion among views expressed in ASAHP’s newsletter TRENDS confessed earlier this month to incurring a severe wound by attempting to remove an avocado pit with a knife. The injury occurs frequently enough that it is referred to as “avocado hand,” a condition that results in making a dash to an emergency room for treatment. More precisely, the expression “post-brunch surge” of avocado-related injuries is being used to describe hand wounds sustained on Saturdays. A suggested remedy is to post safety labels on this fruit.

return to september 2019 trends

UNCERTAINTY IN RELATION TO EXISTENTIALISM

Indicates the importance of conducting more research on the topic of uncertainty, an incompletely understood phenomenon. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference from the standpoint of speakers, a leadership panel, and the Business Meeting, along with updated information about the Association’s Institutional Profile Survey. Read More

AVOIDING A GOVERNMENT SHUTDOWN

Describes legislation involving appropriations for fiscal year 2020 that begins on October 1, 2019 and action underway to reduce pharmaceutical costs. Read More

HEALTH REFORM DEVELOPMENTS

Discusses questions pertaining to enactment of proposed Medicare For All Legislation. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes finalization of stricter rules for student loan claims and trends in the ratio of the Pell Grant to total price of attendance and federal loan receipt. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Mortality Patterns Between States With Highest Death Rates And States With Lowest Death Rates
Comparing Retail Clinics With Other Sites Of Care
The Use Of Small-Scale, Soft Continuum Robots To Navigate In Cerebrovascular Areas
The Use Of “Phyjamas” In Health Care Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Hospital Concentration Index
Reducing Inequities In Healthy Life Expectancy
Investing In Interventions That Address Non-Medical, Health-Related Social Needs Read More

BALEFUL IMPACT OF WORKPLACE INCIVILITY ON HEALTH

Mentions how dissimilarity in political identity can relate to reducing the quality of interpersonal interactions and subsequent well-being of workers. Read More

“BURNOUT” AND EARLIER SOMATIC PHENOMENA

Refers to a possible relationship between burnout in the 21st century and neurasthenia in an earlier century. Read More

John Colbert

September 19, 2019

Trends Archives

“BURNOUT” AND EARLIER SOMATIC PHENOMENA

John Colbert

September 19, 2019

Trends Archives

Professional health literature is replete with examples of how clinicians are adversely affected by burnout, a term applied to a variety of imprecise symptoms associated with the onset of conditions involving stress, fatigue, and depression. A question worth pondering is whether burnout is the equivalent terminologically of old wine in a new bottle? A paper appearing in the September 2019 issue of the periodical The Journal of Nervous and Mental Disease rephases the questions as follows: Is today's 21st century burnout an earlier century's neurasthenia? Viewed in this light, the author advances a proposition that "stress" of all kinds (itself a fuzzy concept), including overwork, discouragement, disillusionment, demoralization, and even suicide, have been known as an accompaniment of training and practice for decades. Is something catastrophic happening or are practitioners merely being swept along in a profound, but ill-defined contagious tide of discontent? Is burnout merely this era's zeitgeist, the remnant of "compassion fatigue" of "wounded warriors" of years past, or neurasthenia of the 1900s? In an effort to conclude on a positive note, an observation is made that hysteria, neurasthenia, hypochondriasis, and other conditions all have had their day and cultish followers. With better definition of the problem(s) comes more effective interventions. The author considers the possibility that burnout most likely will experience the same historical reality of earlier variants.

return to september 2019 trends

UNCERTAINTY IN RELATION TO EXISTENTIALISM

Indicates the importance of conducting more research on the topic of uncertainty, an incompletely understood phenomenon. Read More

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

Susan Hanrahan offers her thoughts on the upcoming ASAHP Annual Conference from the standpoint of speakers, a leadership panel, and the Business Meeting, along with updated information about the Association’s Institutional Profile Survey. Read More

AVOIDING A GOVERNMENT SHUTDOWN

Describes legislation involving appropriations for fiscal year 2020 that begins on October 1, 2019 and action underway to reduce pharmaceutical costs. Read More

HEALTH REFORM DEVELOPMENTS

Discusses questions pertaining to enactment of proposed Medicare For All Legislation. Read More

DEVELOPMENTS IN HIGHER EDUCATION

Summarizes finalization of stricter rules for student loan claims and trends in the ratio of the Pell Grant to total price of attendance and federal loan receipt. Read More

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Mortality Patterns Between States With Highest Death Rates And States With Lowest Death Rates
Comparing Retail Clinics With Other Sites Of Care
The Use Of Small-Scale, Soft Continuum Robots To Navigate In Cerebrovascular Areas
The Use Of “Phyjamas” In Health Care Read More

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Hospital Concentration Index
Reducing Inequities In Healthy Life Expectancy
Investing In Interventions That Address Non-Medical, Health-Related Social Needs Read More

BALEFUL IMPACT OF WORKPLACE INCIVILITY ON HEALTH

Mentions how dissimilarity in political identity can relate to reducing the quality of interpersonal interactions and subsequent well-being of workers. Read More

THE ROLE OF ACCIDENTS ON THE PATHWAY TO INJURY AND DEATH

Examines factors pertaining to death and injury of adolescents from motor vehicle accidents and adult mishaps stemming from attempts to remove an avocado pit with a knife. Read More

More Articles from November 2019 TRENDS

TECHNOLOGICAL IMPERATIVE CHALLENGES

PRESIDENT’S CORNER

MASS MEDIA FOCUS ON CAPITOL HILL

HEALTH REFORM DEVELOPMENTS

DEVELOPMENTS IN HIGHER EDUCATION

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY