September 22, 2020

COMPOSITION AND CAPACITY OF THE GENETICS WORKFORCE

September 22, 2020

As genetics increasingly becomes integrated into all areas of health care and the use of complex genetic tests continues to grow, the clinical genetics workforce likely will face greatly increased demand for its services. Genetic testing in clinical settings has increased significantly over the past 10 years. The trend has been driven in part by the rapid decline in the cost of sequencing and been accompanied by the advent of clinical genome-wide sequencing (GWS). Consequently, demand for counseling and consultations with clinical genetics professionals has grown rapidly, resulting in concerns about potential workforce shortages and insufficient health system capacity to meet this growing demand. As a means of informing strategic planning by health-care systems to prepare to meet this future demand, the results of a scoping review of the genetics workforce in high-income countries, summarizing all available evidence on its composition and capacity published between 2010 and 2019, are reported in the September 2020 issue of the journal Genetics in Medicine.

The evidence presented includes the composition and size of the workforce; the scope of practice for genetics and non-genetics specialists; the time required to perform genetics-related tasks; caseloads of genetics providers; and opportunities to increase efficiency and capacity. Allied health care providers, along with nurses and pharmacists are considered to be among non-genetics specialists. Presently, there is a shortage of genetics providers and a lack of consensus about the appropriate boundaries between the scopes of practice for genetics and non-genetics personnel. A concern is that continued growth in the clinical implementation of GWS is likely to add further pressure on this segment of the health workforce because it requires more intensive decisional support for both patients and health-care practitioners than for less comprehensive genetic tests. Reasons why include the possibility of secondary findings, privacy concerns, difficulty in interpreting test results, and the need to support patients faced with the complex and often unanticipated psychological and informational impacts of genomic testing.

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Kristen Truong

September 22, 2020

Scorecard On State Health System Performance

Well before the appearance of COVID-19 in the U.S., there were worrying signs on the horizon for health care in this nation. The Commonwealth Fund’s latest Scorecard on State Health System Performance identifies a range of problems that likely were made worse by the pandemic. In assessing health care in every state and the District of Columbia on 49 measures, this new report finds that:

Americans are living shorter lives than they did in 2014, and Black Americans are nearly twice as likely as whites to die from treatable conditions.
Health coverage gains have stalled, while affordability of insurance and out-of-pocket costs have worsened.
Public health dollars are being stretched thin at a time when states face unprecedented challenges from COVID-19.

The scorecard has information about these trends, enabling readers to make comparisons among states, and it can be obtained here.

Racial Disparities In Cancer

The American Association for Cancer Research has released its first report on racial disparities in cancer. Even though the disparity in cancer deaths between Black and white individuals has been reduced from 33% in 1990 to 14% in 2016, the report states that Black Americans have had the highest death toll from cancer among all racial groups in the U.S. for the past 40 years. At the same time, individuals from non-white backgrounds have at least twice the rate of death from stomach cancer than white patients with the disease. The inequities exist beyond racial lines. Other marginalized groups, including bisexual women and those with low incomes, tend to have higher cancer rates. The report also outlines how disparities in underlying risk factors, such as HIV and hepatitis infections, contribute to inequities in cancer rates, as do lower rates of cancer screening and insurance in vulnerable portions of the population. The report can be obtained here.

The State of Obesity 2020: Better Policies For A Healthier America

According to a report from Trust for America's Health (TFAH), the U.S. adult obesity rate stands at 42.4%, the first time the national rate has passed the 40% mark, and further evidence of the country’s obesity crisis. The national adult obesity rate has increased by 26% since 2008. Based in part on newly released 2019 data from the Centers for Disease Control and Prevention’s Behavioral Risk Factors Surveillance System (BFRSS) and analysis by TFAH, this report provides an annual snapshot of rates of overweight and obesity nationwide including by age, gender, race and state of residence. Obesity rates vary considerably between states and regions of the country. Mississippi has the highest adult obesity rate in the country at 40.8% and Colorado has the lowest at 23.8%. Twelve states having adult rates above 35% percent are: Alabama, Arkansas, Indiana, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Oklahoma, South Carolina, Tennessee and West Virginia. As recently as 2012, no state had an adult obesity rate above 35%; in 2000 no state had an adult obesity rate above 25%. Rates of childhood obesity are also increasing with the latest data showing that 19.3% of U.S. youth ages 2 to 19 have obesity. In the mid-1970s, 5.5% of youth had obesity. Being overweight or having obesity at a young age places these individuals at higher risk for having obesity and its related health risks as an adult. Furthermore, children are exhibiting earlier onset of what used to be considered adult conditions, including hypertension and high cholesterol. The report can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

September 22, 2020

Delaying Or Avoiding Health Care During The Pandemic Because Of Concerns About COVID-19

According to the September 11, 2020 issue of Morbidity And Mortality Weekly Report, as of June 30, 2020, an estimated 41% of U.S. adults reported having delayed or avoided medical care during the pandemic because of concerns about COVID-19, including 12% who reported having avoided urgent or emergency care. These findings align with recent reports that hospital admissions, overall emergency department (ED) visits, and the number of ED visits for heart attack, stroke, and hyperglycemic crisis have declined since the start of the pandemic, and that excess deaths directly or indirectly related to COVID-19 have increased in 2020 versus prior years. Delayed or avoided medical care might increase morbidity and mortality associated with both chronic and acute health conditions. Avoidance of urgent or emergency care was more prevalent among unpaid caregivers for adults, individuals with underlying medical conditions, Black adults, Hispanic adults, young adults, and persons with disabilities.

Trends And Patterns In Menarche In The United States: 1995 Through 2013–2017

A report on September 10, 2020 from the National Center for Health Statistics (NCHS) presents national estimates of age at first menstrual period for women aged 15–44 in the United States in 2013–2017 based on data from the National Survey of Family Growth (NSFG). The median age at menarche decreased from 1995 (12.1) to 2013–2017 (11.9). The cumulative probability of menarche at young ages was higher in 2013 –2017 compared with 1995. Differences in age at menarche exist by Hispanic origin and race, mother’s education, and living arrangement at age 14. A decreasing linear trend in the probability of age at first sexual intercourse by age at menarche was seen. Earlier age at menarche has been associated with greater risk of health problems including breast cancer, obesity, diabetes, liver disease, depression, eating disorders, and substance abuse during adolescence.

HEALTH TECHNOLOGY CORNER

Machine Learning Maps Research Needs In COVID-19 Literature

Since the start of the COVID-19 pandemic, scientific and medical journals have published more than 100,000 studies on SARS-CoV-2. According to data scientists who created a machine-learning tool to analyze the deluge of publications, however, basic lab-based studies on the microbiology of the virus, including research on its pathogenesis and mechanisms of viral transmission, are lacking. Their analysis was published on September 16, 2020 in the journal Patterns. Topic modeling indicates that COVID-19 publications have focused on public health, outbreak reporting, clinical care, and testing for 30 coronaviruses, as opposed to the more limited number focused on basic microbiology, including pathogenesis and transmission. A fast, scalable, and reusable framework to parse novel disease literature, machine learning approaches rapidly can survey the actual text of publication abstracts to identify research overlap between COVID-19 and other coronaviruses, research hotspots, and areas warranting exploration.

Rapid Blood Test Could Detect Brain Injury In Minutes

A blood protein test could detect the severity of head trauma in under 15 minutes, according to research published on September 14, 2020 in the Journal of Neurotrauma. By showing that glial fibrillary acidic protein (GFAP) can determine the severity of a brain injury through a blood test accurately, a research team at the University of Pittsburgh advanced the development of a point-of-care testing device designed to help clinicians assess traumatic brain injury (TBI) in minutes. For the rapid test, the vision included using a hand-held device with a cartridge that would measure GFAP in a patient’s blood. Researchers at Abbott Laboratories, a global health care company, will need to finalize the test for the i-STAT device, which already is used by the military and health care providers around the world to perform several common blood tests within minutes. The blood test would reveal a patient’s GFAP level. An advantage is that guesswork will be eliminated in diagnosing TBIs and learning whether a patient requires further treatment.

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DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

September 22, 2020

Several issue of this newsletter over the months and years have provided information about an important piece of federal legislation known as reauthorization of the Higher Education Act (HEA). Typically, each new session of Congress begins with a pronouncement that the long-awaited reauthorization will occur in coming months. Senator Lamar Alexander (R-TN), chairman of the Health, Education, Labor and Pensions Committee, on several occasions has established reauthorization as a top personal priority that he wanted to see achieved before retiring from Congress this year. Hearings are conducted annually and in October 2019, the House Education and Labor Committee was successful in producing a huge overhaul of higher education programs in the bill H.R. 4674, but it has not been enacted into law.

Had Congress been successful this year, the HEA would have been reauthorized for the first time since 2008. That previous reauthorization expired in 2013. Similar to pubic health pieces of legislation, such as health professions education, existing programs continue to be funded. Technically, they should expire if left unauthorized, but that step would be too disastrous to take. Even though the HEA as a whole was left unaddressed this year, last December 19th some constructive action did occur. P.L. 116-91, ‘‘Fostering Undergraduate Talent by Unlocking Resources for Education Act’’ or the ‘‘FUTURE Act,’’ provides $225 million in annual funding to historically Black colleges and universities and minority-serving institutions; the Free Application for Federal Student Aid process was simplified; and repayment for certain student loan borrowers was streamlined. Meanwhile, the COVID-19 pandemic helped play a decisive role in obstructing any progress in reauthorizing the HEA in 2020. Instead, whatever appropriations legislation or continuing resolutions are produced for FY 2021, which begins on October 1 of this year, it is expected that higher education programs will continue to be funded at existing levels,

Final Distance Education And Innovation Regulations

The U.S. Department of Education (USDE) on September 2, 2020 published in the Federal Register its final Distance Education and Innovation regulations. These measures will become effective on July 1, 2021. The regulations were developed as a result of a 2019 USDE negotiated rulemaking in which the committee reached consensus on the proposed regulations after seeking comments on what was being proposed prior to issuing final regulations. On the topic of distance learning, it was noted that during the COVID–19 pandemic, some accrediting agencies and State licensing boards are beginning to recognize opportunities presented by distance learning and are permitting certain portions of programs to be provided through distance modalities. The Department will continue to rely on accrediting agencies and State licensing boards to determine if and when distance learning opportunities meet the education and training needs of students in particular fields. Other provisions that pertain to accreditation include:

Providing flexibility for distance education and competency-based education, relying on a demonstration of learning rather than “seat time.”
More clearly defining the requirements for “regular and substantive interaction” in distance education and the permissibility of engaging instructional teams in its delivery.
Providing flexibility to institutions to modify their curricula at the recommendations of industry advisory boards without relying on a traditional faculty-led decision-making process.
Clarifying that an institution may demonstrate a reasonable relationship between the length of a program and the entry-level requirements of the occupation for which that program prepares students.

Rescinding USDE Guidance Documents

The Department announced on August 31, 2020 that it is rescinding several guidance documents because they are outdated and superseded either by subsequent amendments or enactments. Examples are: Institutional Accreditation for Distance Learning Programs (issued September 28, 2006), State authorization under the Program Integrity Regulations (issued April 21, 2011), Implementing Program Integrity Regulations (issued July 20, 2011), and Clarifying flexibility for accrediting agencies (issued November 5, 2015).

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HEALTH REFORM DEVELOPMENTS

Kristen Truong

September 22, 2020

Although the availability and accessibility of high quality health care services play an obvious and indispensable role in enhancing individual and community health status, health care by itself is not sufficient to produce desirable outcomes. Family history helps to determine the degree to which an individual may be at a higher risk for acquiring various ailments, such as cancer and cardiovascular disease. Poverty can affect the ability to obtain an education, live in a safe neighborhood in housing that is not substandard, afford a nutritious diet, have access to suitable transportation, and be able to meet any out-of-pocket health care expenses. Lifestyle factors from the standpoint of avoiding substance abuse and engaging in risky behavior that increases the risk of accidents also will be determinants of health status.

Poverty Rates For Blacks And Hispanics Reach Historic Lows

The state of the U.S. economy influences the kinds and availability of employment opportunities open to individuals seeking jobs. Positions that pay a satisfactory wage and include health insurance coverage contribute to improved health. In 2019, the poverty rate in this nation was 10.5%, the lowest since estimates were first released for 1959. Poverty rates declined between 2018 and 2019 for all major race and Hispanic origin groups. Blacks and Hispanics, reached historic lows in their poverty rates in 2019. The rate for Blacks was 18.8% and for Hispanics, it was 15.7%. These estimates were released on September 16, 2020 by the U.S. Census Bureau. They are from the Current Population Survey Annual Social and Economic Supplement. Nonetheless, it remains significant that inequalities persist. Even with these gains, Blacks and Hispanics continue to be over-represented in the population in poverty relative to their representation in the overall population.

In 2019, the share of Blacks in poverty was 1.8 times greater than their share among the general population. Blacks represented 13.2% of the total population in the United States, but 23.8% of the poverty population. The share of Hispanics in poverty was 1.5 times more than their share in the general population. Hispanics comprised 18.7% of the total population, but 28.1% of the population in poverty. In contrast, non-Hispanic Whites and Asians were under-represented in the poverty population. Non-Hispanic Whites made up 59.9% of the total population but only 41.6% of the population in poverty. Asians represented 6.1% of the population and 4.3% of the population in poverty. These disparities are especially pronounced among children and individuals ages 65 and older.

Necessity Of Having An Adequate Supply Of Competently-Prepared Health Personnel

Much emphasis is placed on health policy development regarding the provision of health insurance coverage and beneficiary ability to obtain care. An aspect that deserves considerably more attention is the health workforce. An implicit assumption seems to be that everything will fall into place nicely once the insurance coverage and access to health care parts of the puzzle are resolved. A different kind of problem that needs to be addressed is whether there is a proper mix of health professionals and the extent to which they are distributed evenly in all regions of the U.S. where their services are required. For example, rural areas tend to experience severe shortages of all kinds of health personnel. A key ingredient in the ability to produce an adequate supply of competently-prepared health professionals is scope of practice legislation where the major focus is at the state rather than the federal level.

States across the nation represent battlegrounds where different professional groups (e.g. psychiatrists vs, psychologists, dentists vs. dental therapists, anesthesiologists vs. nurse anesthetists) vie with one another to determine which practitioners should be given sole authority to treat patients. Claims for exclusivity tend to be based on protecting the safety of patients. California in September 2020 is the scene of a dispute between physicians and nurse practitioners. AB 890 is a hotly contested bill that would grant full practice authority to nurse practitioners by allowing them to practice without physician supervision. The Golden State is behind most other states in empowering nurse practitioners. Currently, nearly 40 other states grant some level of independence to the nursing group and 22 states grant full independence. Nurse practitioners argue that the measure would ease primary care shortages, especially in rural areas, a problem exacerbated by the COVID-19 pandemic. Physicians counter with a view that eliminating oversight by them would lead to a lower standard of care, while also expressing doubt that nurse practitioners would go to rural areas once unencumbered by medical supervision.

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WHISTLING THE COLLEGE HORNPIPE

Kristen Truong

September 22, 2020

In the novel David Copperfield by Charles Dickens, Mister Micawber gave young Copperfield a piece of advice that may exceed in prescience the cumulative wisdom of all treatises ever written on the subject of home economics.

“Annual income twenty pounds, annual expenditure nineteen nineteen six, result happiness.
Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery.

The blossom is blighted, the leaf is withered, the God of day goes down upon the dreary scene, and-and in short you are for ever floored. As I am.”

In order to underscore the grave and serious nature of his contention, Mr. Micawber then drank a glass of punch with an air of great enjoyment and satisfaction, and whistled the college hornpipe.

As shown in 2020 because of COVID-19, excessive debt can be ruinous, destroying households and business enterprises alike. Government in the U.S. at state and local levels also has been devastated by debt. Meanwhile, along lines of whistling the college hornpipe the federal government continues to thrive despite adding trillions of dollars to an ever growing mountain of debt that already exceeded 20 trillion dollars at the beginning of this year. The difference is that Congress can appropriate funding for emergency purposes while the Federal Reserve can purchase debt instruments, lower interest rates, and print money.

Even when Congress is unable to reach agreement on additional sources of pandemic-related funding, as mentioned in the previous issue of this newsletter, the nation’s president can sign executive orders that influence the flow of money and other policies. During the month of August 2020, President Donald Trump released a series of orders that include: a payroll tax deferral for workers, provision of weekly federal jobless benefits, expansion of a congressionally-approved eviction moratorium that expired in July 2020, relief for student borrowers, increased access to telehealth, support for rural hospitals, and the production of more drugs made in America while loosening federal drug-safety and environmental regulations that are perceived as placing domestic producers at a disadvantage.

Similar to previous years when Congress is unable to complete work on 13 separate appropriation bills by the start of a new fiscal year each October 1, to avoid an impending shutdown one or more short-term continuing resolutions (CRs) are implemented. Currently envisioned is a stopgap spending measure that would be effective until December 11. Despite it being an election year that will reduce the amount of time available to pass other bills while House and Senate members are on the campaign trail, the House Energy and Commerce Committee was able to consider 26 health bills during a September 9 markup that involved expanding access to mental health services, combating the opioid epidemic, and reauthorizing key public health programs. The vast majority of more than 8,349 House bills (1,037 for health) and 4,656 Senate bills (585 for health) introduced in the 116th Congress as of September 22, 2020 will not be passed and enacted, but could be reintroduced beginning next year.

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A QUASI-CATEGORICAL DEMURRAL

Kristen Truong

September 22, 2020

Harvard University Professor Arthur Scheslinger, Jr. served as a special assistant and “court historian” to President John Kennedy until the latter’s death in November 1963. Two years later, his book “A Thousand Days: John F. Kennedy in the White House” was published. Around that same time, when interviewed he was asked to assess the impact of the Kennedy presidency. He easily could have stated that it still is too soon to offer a complete assessment, but instead he indicated that it was best to characterize the situation as a quasi-categorical demurral.

While recognizing it may be highly unlikely that many individuals would express their views in this kind of parlance, for the sake of argument let’s assume for the purpose of the following brief disquisition that the professor’s use of this terminology can be applied constructively to COVID-19 and its imagined aftermath. As indicated by an article on page five of this issue of TRENDS, more than 100,000 scientific publications already have been published about the coronavirus, but until it runs its final course, presumably any satisfying definitive analysis will have to remain a work in progress for the nonce.

The purported necessity of closing down a major portion of the U.S. economy, the largest in the world, is a topic that undoubtedly will attract considerable attention. One aspect certainly will include whether deleterious health impacts, such as increases in child/intimate partner abuse, alcohol/drug substance use/abuse, suicidal ideation, homelessness, and lost educational opportunities for students ultimately proved to be more devastating than COVID-19 itself.

Closer to home regarding the academic community, some insights are provided by an editorial published in the August 29, 2020 issue of the British medical journal The Lancet. For example, the pandemic is undermining the ability of researchers to do their jobs and of universities to provide a high-quality and safe educational experience for students. Moreover, the pandemic will have complex, unexpected, and long-term implications for research that must be anticipated now. Essential pillars are under threat, such as a workforce with the skills, training, experience, relationships, and networks needed for research excellence; necessary resources, including funding; and multidisciplinary perspectives supported by science. Spending on education and research is threatened by economic downturns with academic budgets squeezed by COVID-19, jeopardizing jobs and research funding.

An effective vaccine soon may become available. According to information appearing in the August 29-September 4, 2020 issue of The Economist, the pollster YouGov reveals that only 37% of Republicans and 61% of Democrats say they would be vaccinated for COVID-19. The figure is barely 30% for middle-aged and less-educated individuals on the right end of the political spectrum. Not only in the U.S., but among other nations “anti-vaxx” sentiments have many followers who are even more distrustful about vaccine safety and effectiveness than U.S. residents. Hence, while there is value in looking ahead to a time when this coronavirus disappears, it essentially remains much too soon to understand its full impact.

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PRESIDENT’S CORNER

Kristen Truong

August 27, 2020

Some Reflections On The Health Workforce In A Time Of Pandemic

Surges of COVID-19 patients have influenced state officials across the nation to take numerous steps to remove health workforce barriers. An example is a significant expansion of scopes of practice for various clinicians who were and are being educated today in institutions belonging to ASAHP, e.g., physical therapists, occupational therapists, respiratory therapists, and speech‐language pathologists. Other key changes have included:

Allowing some students in professions, such as medicine and nursing, to perform services they are competent to provide by lessening restrictions involving education requirements.
Granting temporary licenses or allowing certain kinds of students to provide services without a license.
Suspending prohibitions that prevent clinicians from other states from providing care via telemedicine.

Advances in technology will influence how health care services are delivered. For example, articles in issues of the journal Science Robotics in July 2020 and in the July/August 2020 issue of MIT’s Technology Review discuss the enhanced potential for the use of assistive robots during infectious disease outbreaks. Hospitals in Texas are using them to help nurses with tasks involving disinfection, patient intake, and delivery of supplies, such as laboratory samples, intravenous pumps, medications, and protective gear during the current pandemic. As technological developments progress, it becomes increasingly likely that robots not only will assist, but might even replace health workers in the performance of other routine tasks.

As described in an a manuscript in the November 2020 issue of the journal Addictive Behaviors, the COVID-19 pandemic has resulted in unprecedented stress on health care systems throughout the world. Health care workers are bearing the burden of caring for those afflicted with COVID-19, a consequence of which is direct and sustained infection risk. As essential workers are compelled to confront these increased infection risks, they also are faced with a risk of experiencing higher rates of stress from the pandemic.

A tool recently developed that is called COVID Stress Scales categorizes stressors from the pandemic into five categories: danger and contamination fear, social and economic stress, traumatic stress symptoms, checking and reassurance seeking behavior, and xenophobia. In the general population, each factor can contribute to increased substance use and abuse risk. Also of significance is that these factors can be compounded in essential workers, placing this group at particularly high risk for these problems.

This constellation of stressors is viewed as warranting unique programs of intervention to manage drug use and abuse. Research to develop such programs is needed, particularly in consideration of the broad impact of COVID-19. Researchers are encouraged to tackle these important issues systematically in preparation for challenges that individuals may face with substance use and abuse in the face of current pandemic-related circumstances, post-COVID-19, and for future pandemics. It also would seem prudent for faculty members who provide instruction for and clinical supervision of health professions students to consider ways in which education programs can assist these individuals in being better prepared to meet the challenges of working in highly stressful circumstances when they enter the workplace.

TV and the Internet have provided vivid examples of many different kinds of allied health professionals leaving the safety of their homes to commute via public transportation to furnish care for patients in hospitals who are being treated for COVID-19 infection. They place their own lives at risk in order to save the lives of individuals stricken with this disease. Today’s children are witnesses to the efforts being made by these first responders to help others who are less fortunate. It is worth pondering the extent to which these images will inspire the youth of today to desire to become part of the future health workforce.

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AUTOPSIES, HEALTH DISPARITIES, AND INFORMED CONSENT

Kristen Truong

August 25, 2020

A popular ingredient in stories of crime in movies and television programs is the defining moment when a detective and the pathologist are able to solve a puzzling death based on autopsy findings. In contrast to forensic autopsies mandated by law, clinical autopsies are performed to clarify diagnoses. Rates of the latter procedure have declined from a high of 19% (1950s-1970s) to 8% (2007). This decrease is related to financial, legal, and administrative disincentives, along with perceptions that diagnostic improvements render autopsies obsolete. Patient and caregiver factors also may be related to declining rates. Across all conditions, black individuals had a significantly higher rate of autopsies compared with white individuals (difference between races: 0.9% in cancer and 5.6% in cardiovascular disease). According to an item published on June 29, 2020 in the journal JAMA Internal Medicine, it is hypothesized that the higher rate of autopsies in black decedents may reflect health disparities. Less-aggressive diagnostic workups in black patients may translate into less-established diagnoses before death, possibly associated with the rates of autopsies. The higher rate also could reflect altruism, obtaining autopsies for the promotion of science, and perhaps even may represent caregivers wanting to know the “real cause of death,” suggesting mistrust of the health care system.

Another element that may be of some interest is that pathologists likely will incorporate genetic testing into routine autopsies. An article published in the June 2020 issue of the Archives of Pathology & Laboratory Medicine poses the question, should specific consent for genetic autopsy testing be required? An individual consenting to an autopsy should know that genetic testing will be performed and may lead to information that directly will have an impact on the decedent’s family, e.g., an increased risk of untreatable neurodegenerative disease. The author indicates that the person giving informed consent for the autopsy needs to know, understand the benefits, limitations, and alternatives of genetic testing and be able to refuse genetic testing in a private autopsy. Clearly, details of how best to obtain consent for genetic testing in autopsies is a needed area for future discussion and clarification.

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RACIAL DISPARITIES AND NOMENCLATURE IN NEUROSCIENCE

Kristen Truong

August 25, 2020

Minority racial groups are exposed differentially to environmental risk factors (e.g., early life adversity) that are known to play a role in a variety of psychiatric disorders. According to a paper in the July 2020 issue of the journal Neuropsychopharmacology, a significant potential for racial disparities in environmental risk factors to moderate the relationship between neurobiology and psychiatric disorder development currently is unexplored. Early life events, such as childhood trauma, maternal stress, immune system activation, and other risk factors show clear effects on the neural substrates of emotion and stress regulation. Minority racial groups also have lower family income and wealth, and often live in areas with greater disadvantage compared with non-minority racial groups. Recent research further suggests minority racial groups have increased exposure to toxins throughout life which can have potentially deleterious effects on physical and mental health. Racial discrimination also can be damaging psychologically and further alter the neurobiology of psychiatric disorders.

Viewed from a different perspective, neuropsychiatric symptoms are a core feature of Alzheimer’s disease and related dementias. Successful information exchange between clinicians and family caregivers is critical for facilitating effective management of these symptoms. This communication often is challenging, however, due to inconsistent terminology and classification of symptoms, and limited understanding of how family caregivers recognize and describe symptoms. A study reported in the August 2020 issue of the journal The Gerontologist examined the language family caregivers’ use to describe and contextualize neuropsychiatric symptoms. Family caregivers of patients with dementia use a wide range of terminology in their descriptions. Their nomenclature and sense-making appear to contrast with clinical and research classification of neuropsychiatric symptoms that is predominantly deficit-oriented. Thus, reliance on effective communication between caregivers and their clinical teams for effective symptom management may require adopting caregivers’ language or explicit development of shared nomenclature.

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Kristen Truong

August 25, 2020

Sharing Clinical Trial Data: Challenges And A Way Forward

Responsible sharing of clinical trial data is widely recognized as serving the public interest. Data sharing helps maximize the contributions to scientific knowledge made by clinical trial participants, benefiting patients today and in the future. Clinical trial data sharing can enable reproducibility of research findings, analyses for other areas of study, and exploratory work to generate new research hypotheses. While progress has been made in the endeavor of improving clinical trial data sharing, challenges still remain. On November 18 and 19, 2019, the National Academies of Sciences, Engineering, and Medicine hosted a public workshop, in Washington, DC, titled “Sharing Clinical Trial Data: Challenges and a Way Forward.” The workshop followed the release of the 2015 Institute of Medicine (IOM) consensus study, Sharing Clinical Trial Data: Maximizing Benefits, Minimizing Risks, and was designed to examine the current state of clinical trial data sharing and reuse since the report release. The workshop considered ways in which policy, technology, incentives, and governance could be leveraged to overcome remaining barriers and further facilitate data sharing. These proceedings summarize presentations and points made at the workshop in 2019 and can be obtained here.

The 2015 consensus study can be obtained here.

National Inpatient Hospital Costs: The Most Expensive Conditions By Payer, 2017

A Statistical Brief from the Agency for Healthcare Research and Quality (AHRQ) presents data from the Healthcare Cost and Utilization Project (HCUP) on costs of hospital inpatient stays in the United States using the 2017 National Inpatient Sample (NIS). It describes the distribution of costs by primary expected payer and illustrates the conditions accounting for the largest percentage of each payer's hospital costs. Hospital charges were converted to costs using HCUP Cost-to-Charge Ratios. The expected payers examined are Medicare, Medicaid, private insurance, and self-pay/no charge. Because of the large sample size of the NIS data, small differences can be statistically significant. Thus, only differences greater than or equal to 10% are noted in the text. Hospital costs in this Statistical Brief represent the hospital's costs to produce the services, not the amount paid for services by payers, and they do not include separately billed physician fees associated with the hospitalization. Healthcare spending in the United States increased 4.2% between 2016 and 2017 to $3.5 trillion, or $10,739 per person, and accounted for 17.9% of the Gross Domestic Product. Constituting nearly one-third of all healthcare expenditures, hospital spending rose 4.7% to $1.1 trillion during the same time period. Although this growth represented deceleration compared with the 5.8% increase between 2014 and 2015, the consistent year-to-year rise in hospital-related expenses remains a central concern among policymakers. In 2016, there were over 35 million hospital stays, equating to 104.2 stays per 100,000 population. The average cost per hospital stay was $11,700, making hospitalization one of the most expensive types of healthcare utilization. Higher costs are documented for stays among patients with an expected payer of Medicare compared with stays with other expected payers ($13,600 for Medicare vs. $9,300-$12,600 for other payers). The Brief can be obtained here.

Racial and Ethnic Disparities Among COVID-19 Cases in Workplace Outbreaks

Data from the Morbidity and Mortality Weekly Report of August 21, 2020 show that during March 6–June 5, 2020, workplace outbreaks occurred in 15 Utah industry sectors; 58% of workplace outbreak-associated COVID-19 cases were in three sectors: Manufacturing, Wholesale Trade, and Construction. Despite representing 24% of Utah workers in all affected sectors, Hispanic and nonwhite workers accounted for 73% of workplace outbreak-associated COVID-19 cases. The report can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

August 25, 2020

The COVID-19 Pandemic And Exacerbation Of Physical Intimate Partner Violence

During the COVID-19 pandemic, social distancing and stay-at-home orders have been enacted throughout the world to stop disease transmission and keep individuals safe, but for victims of intimate partner violence (IPV), being quarantined with an abuser means that home may be the most dangerous place to be. In a study published on August 13, 2020 in the journal Radiology, a team led by investigators at Brigham and Women's Hospital in Boston assessed the incidence, pattern, and severity of injuries related to IPV in patients at the facility during the spring of 2020. The researchers found that the incidence of physical abuse IPV and severity of injuries was greater during the pandemic. They also observed a higher incidence of victims of high-risk abuse, including strangulation, use of weapons, stab, and burns. A conclusion reached is that radiologists and other health care providers should proactively participate in identifying IPV victims and reach out to vulnerable communities as an essential service during the pandemic and other crises.

Mental Health, Substance Use, And Suicidal Ideation During The Coronavirus Pandemic

As indicated on August 14, 2020 in the Morbidity and Mortality Weekly Report, during June 24–30, 2020, U.S. adults reported considerably elevated adverse mental health conditions associated with COVID-19. These conditions are affecting specific populations disproportionately, especially young adults, Hispanic persons, black persons, essential workers, unpaid caregivers for adults, and those receiving treatment for preexisting psychiatric conditions. These individuals are experiencing disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation. Unpaid caregivers for adults, many of whom are currently providing critical aid to persons at increased risk for severe illness from COVID-19, had a higher incidence of adverse mental and behavioral health conditions compared with others. Although unpaid caregivers of children were not evaluated in this study, approximately 39% of unpaid caregivers for adults shared a household with children (compared with 27% of other respondents).

HEALTH TECHNOLOGY CORNER

Digital Biomarker Of Diabetes From Smartphone-Based Vascular Signals

Smartphone-based photoplethysmography (PPG) provides a readily attainable, non-invasive digital biomarker of prevalent diabetes. According to an article published on August 17, 2020 in the journal Nature Medicine, PPG is a non-invasive optical technique that detects blood flow changes through a vascular bed. It involves shining light into tissue, such as the fingertip or wrist, and quantifying the backscattered light that corresponds with changes in blood volume. Until recently, PPG recording required specialized equipment, however, technological developments have enabled PPG measurement from sensors on smart devices, such as smartphones. Researchers at the University of California San Francisco developed this biomarker to detect Type 2 diabetes, one of the world's top causes of disease and death, potentially providing a low-cost, in-home alternative to blood draws and clinic-based screening tools. Type 2 diabetes can raise the risk of diseases affecting nearly every organ system, including coronary heart disease.

Using Smartphone Accelerometers To Sense Gait Impairments Due To Alcohol Intoxication

Sensing alcohol intoxication in real time could offer opportunities for triggering just-in-time interventions aimed at improving prevention and treatment of alcohol use disorders. In a laboratory study described on August 18, 2020 in the Journal of Studies on Alcohol and Drugs, researchers found that smartphones can capture unique gait features that are sensitive to alcohol intoxication, classifying it within individuals with an accuracy of around 90%. The findings extend prior published research examining the use of phone sensors to detect gait changes related to alcohol. Despite acknowledged limitations, this proof-of-concept study provides a foundation for future research on using smartphones to detect alcohol-related impairments remotely. Current tools to measure alcohol consumption and/or impairment remotely either require the purchase of additional hardware or the burden of manual recording of consumption. A mobile application could be built to sense periods of walking, measure accelerometer signals, and when sway patterns are recognized, trigger either just-in-time support or use further techniques to improve classification further.

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DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

August 25, 2020

Education administrators at levels ranging from pre-K to colleges and universities, along with public health officials throughout the U.S., continue to observe their best laid plans being stymied by a virus known as COVID-19 that refuses to conform to expectations. Some higher education officials decided that if instruction were to be provided during the fall semester, it would be offered electronically instead of in classrooms. Other administrators were willing to admit students, but had a backup plan ready that would enable a rapid conversion to online education either for a certain number of weeks or for the entire semester in the event a spike in infections occurred. Installing hygienic measures on school grounds and promoting social distancing policies were viewed as measures that would allow students to return safely. Unfortunately, for some college students the urge to socialize and attend large parties both on- and off-campus has contributed to a rise in the number of individuals becoming infected with the coronavirus. Even if extraordinary efforts have been made for a campus to be a safe environment, off-campus gatherings and the arrival of students each day who do not reside on school property are examples of the major challenges involved in efforts to achieve and maintain high standards of hygiene.

Financial Aspects Of An Inability To Be On Campus And Attend Classes

A major item in the budgets of a great many families with college-age offspring is the costs of higher education. Factors such as tuition, room and board, and activity fees often are beyond reach from the standpoint of being able to finance them out-of-pocket. Assistance in the form of loans has become a necessity. Whether students ever graduate within six years, and many of them never do, with and without degrees they are saddled with substantial loans that will take many years of payments before their debt is settled. Accordingly, many families currently are unwilling to pay on-campus rates, particularly when education has shifted to online instruction because of the pandemic. Some institutions have responded by reducing tuition rates for courses offered online or by offering to defer payment until the fall semester in 2021. Meanwhile, litigation moves forward throughout the U.S. by students and families seeking to obtain refunds for unoccupied dormitories and unused food serve halls that were closed in the spring semester when students were compelled to leave campus after the coronavirus emerged as a serious threat.

Addressing The Need And The Demand For Mental Health Services For Students

Even before the appearance of COVID-19 earlier this year, many campus mental health centers were unable to provide assistance to the large number of students who sought help for conditions, such as depression and high anxiety. Currently, most of these same individuals are at home and they are joined by other students who find it difficult to cope with the strains imposed by social lockdowns and worries about what the future may have in store for them. As this infectious disease subsides and the economy achieves a fuller recovery, millions of unemployed workers will be eager to return to whatever old jobs still exist or seek new opportunities. Recent graduates and the class of 2021 may find it difficult to compete with that group of recently displaced individuals. As depicted on page six of the July-August 2020 issue of this newsletter, the Morbidity and Mortality Weekly Report for August 14 of this year indicates that younger adults in the 18-24 age group are among the groups reported having experienced disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation. College-age students that are part of this cohort may benefit through telehealth interventions emanating from campus, but the quality of assistance could vary from what occurs in face-to-face encounters in a clinical setting.

Expansion Of Educational Opportunities For Students

An announcement from the U.S. Department of Education on August 19, 2020 describes a new grant program designed to help institutions of higher education emerge from the coronavirus pandemic more resilient and better able to expand educational opportunities for students. The grants can be used in a variety of ways that include resuming operations, supporting students, reducing disease transmission, and developing more agile instructional delivery models for students who cannot or choose not to attend classes in person. This program also recognizes the benefits to high school students of starting their college career early, while still in high school, and gives priority to applicants who plan to expand those opportunities to students who live or attend high school in an Opportunity Zone or rural community. More information can be obtained here.

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HEALTH REFORM DEVELOPMENTS

Kristen Truong

August 24, 2020

Longstanding health policy concerns over the decades involve covering the uninsured, enhancing access to health care services, and improving the quality of those services. The Patient Protection and Affordable Care Act, also more commonly known as the Affordable Care Act, that became law in 2010 represented a major thrust in a comprehensive effort to address these important concerns. Although progress has been made during the past decade, the arrival of COVID-19 has presented several major challenges in the fulfillment of key policy aims.

Apart from health insurance provided by the public-sector Medicare and Medicaid programs, until recently approximately 180 millions workers relied on coverage obtained through employment in the private sector of the economy. The appearance of COVID-19 subsequently led to major job losses and unemployment that affected millions of workers, which in many cases was accompanied by a loss of coverage. As an important safety net program, the federal-state Medicaid program has made it possible for some unemployed workers to become eligible for participation in it.

The U.S. health domain consists of a complex web of interlocking components, both public and private. Important federal policymaking roles are played by the Centers for Disease Control & Prevention and the Center for Medicare & Medicaid Services, while agencies at state and lower government levels enjoy much autonomy regarding resource allocation. While all these entities may unite in trying to reduce health disparities affecting certain population sub-groups, practices beyond the health realm can pose significant obstacles. For example, a higher chance of mortgage application denial for black applicants tends to reduce black home ownership and increase the likelihood of renting, which lowers the accumulation of home equity. Less availability of that resource adds to the difficulty of meeting out-of-pocket health expenses. A related impediment is described in the following section.

Associations Between Historical Redlining And Birth Outcomes

An article in the journal PLOS ONE on August 7, 2020 describes a study of the association between historical redlining and preterm birth, low birth weight, small-for-gestational age, and perinatal mortality over a 10-year period in California. Although since repealed, historical segregation policies may perpetuate current health disparities by outliving their implementation period and continuing to contribute to the existence of this problem. Residential segregation can affect access to education, income, healthcare, and clean environments. Researchers examined the role of historical redlining, the practice of categorizing perceived neighborhood mortgage investment risk, on present birth outcomes. Historical redlining maps, also called Security Maps, were created more than 80 years ago for over 200 cities across the U.S. by the federal Home Owners’ Loan Corporation (HOLC), a government body founded in 1934 with the goal of rescuing homeowners from default by issuing replacement mortgages. These maps shaded neighborhoods one of four colors, corresponding to perceive investment risk, with red indicating the highest risk. The investigators hypothesized that the odds of adverse birth outcomes would increase as historical HOLC grade worsened. They indicate that achieving health equity across racial/ethnic and class lines requires a better understanding of how historically discriminatory policies, such as redlining, continue to shape current U.S. patterns of health disparities.

Obtaining Coverage Through Short-Term Health Insurance Plans

The Trump Administration has pursued several objectives since 2017 aimed at dismantling key elements of the Affordable Care Act, including an effort to enable individuals to purchase short-term health insurance plans. The U.S. Court of Appeals for the District of Columbia Circuit on July 17, 2020 upheld a decision allowing the sale of such plans that do not comply with the Affordable Care Act, making it possible to undermine the health law by expanding access to cheaper, less comprehensive insurance. The case stems from a rule the Administration released in August 2018 that expanded access to this form of coverage. Previously, the plans could be carried for only 90 days, but the rule allows for total coverage as long as 36 months. Generally lower priced, they can deny coverage based on pre-existing conditions. The Association for Community Affiliated Health Plans, which in 2018 sued to prevent the allowance of short-term plans, is expected to appeal the recent court decision.

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LEGISLATION VS. EXECUTIVE ORDERS

Kristen Truong

August 24, 2020

Given its size (535 members), complexity of a broad range of legislative issues, partisan differences, and conflicting views between the two chambers, Congress sometimes proves to be an unwieldy place to produce bills that can be forwarded to the President of the U.S. to be signed into law. Currently, the presence of the coronavirus that is ravaging portions of the population creates a sense of urgency in dealing with important problems involving both health care and the economy. Whenever nettlesome situations occur in governance and action must be taken, it is not unusual for Presidents to rely on producing executive orders instead of continuing to wait for legislative solutions to emerge.

During the month of August 2020, President Donald Trump exercised that option by releasing a series of orders after Congress was unable to reach agreement on a new coronavirus relief package. Democrats in the House previously had approved a $3 trillion bill and offered to lower the amount to $2 trillion. White House officials remained steadfast, however, in supporting the Senate’s $1 trillion proposal, while some Senate Republicans have been opposed to any additional funding. In response to an inability to reach agreement, Senate Majority Leader Mitch McConnell (R-KY) then decided to recess the Senate after discussions collapsed on August 7. That legislative branch will not reconvene until September 8, but its members are prepared to return if the stalemate is overcome and a vote is scheduled.

The executive orders by President Trump include a payroll tax deferral for workers from September through December who make less than $100,000 a year, provision of weekly federal jobless benefits, expansion of a congressionally-approved eviction moratorium that expired in July 2020, relief for student borrowers, increased access to telehealth, support for rural hospitals, and the production of more drugs made in America while loosening federal drug-safety and environmental regulations that are perceived as placing domestic producers at a disadvantage. Perhaps the most controversial of these actions is the one involving the payroll tax deferral.

Democrats instantly expressed their disapproval by referring to where the “power of the purse” is vested. According to the U.S. Constitution. Article 1, Section 7, Clause 1: “All Bills for raising Revenue shall originate in the House of Representatives; but the Senate may propose or concur with amendments as on other Bills.” The Constitution also contains the following provision in Article 1, Section 9, Clause 7: “No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law; and a regular Statement and Account of the Receipts and Expenditures of all public Money shall be published from time to time.” Some Republicans were not surprised at objections raised by Democrats, recalling that they also were upset when as part of the Affordable Care Act, President Barack Obama issued an executive order creating subsidies for insurance companies, thereby spending money that had not been appropriated by Congress as the power of the purse demands.

The full impact of these actions by President Trump has yet to be determined. Given the litigious nature of much that characterizes the relationship between Congress and the White House, a likelihood remains that this new set of differences between them will be referred to the courts for a resolution.

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ANHEDONIA AND MORE PLEASURABLE TIMES

Kristen Truong

August 24, 2020

The term anhedonia could serve as the name of a mythical kingdom in a 1930’s movie about a place ruled by a madcap assortment of ardent Marxists (Groucho, Harpo, Chico, Gummo, and Zeppo). Instead, it denotes a clinical term to classify a condition that involves a diminished capacity to experience pleasure in acts that normally produce it. In his novel A Tale of Two Cities, Charles Dickens began the book with the following passage, “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us (Dickens continued with additional contrasts, but the general thrust of his thinking seems evident).

The year 2020 began on a relatively positive note. The stock market was booming much to the benefit of retirement plans, unemployment was at all-time low levels, the upcoming college football series was on the near horizon, basketball’s March Madness was directly ahead, and students could look forward to colorful graduation ceremonies in late spring. Then, a malady known as COVID-19 entered the picture and hopes and dreams across the globe underwent a giant pause in fulfillment. Gloom and doom were accompanied by mass weeping, wailing, and gnashing of teeth as age-old darker thoughts regarding the loneliness of the soul and the human heart in conflict with itself began to resurface more forcefully.

The floodgates gradually opened and unparalleled amounts of information about this invisible intruder began to appear in mass media outlets, social media, and respected professional journals. Regarding the latter, an article published in the journal Science on May 29 of this year indicated that the COVID-19 literature had grown to more than 31,000 papers since January and by one estimate was on pace to reach more than 52,000 by mid-June. Reasonable queries seem justified, such as how is it humanly possible to stay abreast of the voluminous information being generated, and perhaps even more importantly, to what extent do all these articles meet acceptable standards associated with methodological rigor and the ability to draw accurate conclusions from the purported data?

Much research addresses broad categories involving vaccine development, treatment of patients, harmful impacts on health care personnel (e.g., PTSD and staff burnout), and incidence of community problems that pertain to domestic/child abuse, substance abuse disorders, and suicide. Widely heralded findings on remedial treatments, such as convalescent plasma and hydroxychloroquine, that are greeted with immediate approbation in some quarters soon are debunked by other investigators who insist that the results are uninterpretable due to non-randomized studies and lack of placebo controls. Meanwhile, excitement and enthusiasm precede the expected arrival of one or more vaccines to prevent the occurrence of infections. The following considerations remain pending: which population sub-groups should be vaccinated first, how long will protection be conferred, how safe is any new vaccine, and how effective will it be if the virus undergoes mutation?

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EFFECTIVE CORONAVIRUS MESSAGES FROM ACADEMIC INSTITUTIONS

Kristen Truong

June 26, 2020

Students and their families eagerly await messages from colleges and universities. The firm Eduventures conducts a Student Sentiment Survey annually to understand better how college-bound high school students research colleges and how they perceive institutional recruitment outreach. This year’s data include responses from 6,100 high school seniors, juniors, and sophomores across the nation. Respondents were asked whether they recalled a school that communicated particularly well during the crisis, and if so, what that communication entailed. Sixty-eight percent of seniors had positive experiences with institutional COVID-19 messaging . The top five communicators based on frequency and consistency of mention are listed in no particular order as follows:

Alvernia University
Prairie View A&M University
Southern Utah University
Oregon State University
University of Texas Rio Grande Valley

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TRANSHUMANISM AND THE PROSPECT OF NEVER HAVING TO DIE

Kristen Truong

June 26, 2020

Each passing day furnishes new evidence that the coronavirus has not yet fully completed its grim work of increasing the human ranks of the dearly departed. How refreshing then to come upon an article in the June 20-21, 2020 weekend edition of The Wall Street Journal that discusses optimistic views on the topic of transhumanism, the idea of using technology to overcome sickness and aging. Financial support for life-extension research has been provided by well-heeled investors as optimism abounds in some quarters that not only is it possible to live to the ripe age of 500, a time may arrive when individuals in middle age may have a fair chance of never dying. Starting with the premise that transhumanism promises that death can be conquered physically, not just spiritually, it appeared worth an effort to go to the professional literature to assess what progress is being made in achieving such lofty outcomes.

If an article appearing in May 2020 in the journal Clinical and Translational Science can be viewed as a reliably authoritative source for current thinking on such matters, then despite regenerative medicine (RM) being one of the hottest topics in biotechnology for the past three decades, it generally is acknowledged that the field’s performance at the bedside has been somewhat disappointing. RM is seen as having had an undeniable positive influence on the process of bench to bedside research. Preclinically, it has helped identify limitations of evidence‐based medicine and contributed to the paradigm shift to the trial‐and‐error method. If the translation of RM therapies is to be improved, however, many challenges to be overcome lie in the early stages of therapy development, such as identifying mechanism(s) of action, validating preclinical experimental models, and incentivizing translational research for basic scientists. Regulatory changes have been made in later stages, but much still needs to be addressed, such as adoption of clinical trials that are more rigorous and include long‐term follow‐up studies; development of appropriate manufacturing technology; synchronization of regulatory agencies, and a clear plan for reimbursement strategies.

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NIH FUNDING AND THE PURSUIT OF EDGE SCIENCE

Kristen Truong

June 26, 2020

With an annual budget of more than $37 billion, the National Institutes of Health (NIH) plays a critical role in funding scientific endeavors in biomedicine. Funding innovative science is an essential element of the NIH’s mission, but the ability to fulfill this aim has been questioned. Based on an analysis of a comprehensive corpus of published biomedical research articles (more than 24,000,000 of them in the MEDLINE database), a study was conducted to measure whether the NIH succeeds in funding work with novel ideas, referred to as “edge science.” The results are described in the June 2, 2020 issue of the journal Proceedings of the National Academy of Sciences of the USA. As background, it may be worth noting that both scientific and political considerations may lead the NIH to underfund trying out new ideas. First, because the NIH visibly spends public money, it needs to show discrete manifestations of improvements in health, as well as technological breakthroughs, arising from its supported research. This consideration can lead to a preference to support ideas that already have shown promise, rather than edge science. Second, NIH scientific review panels, for reasons related to their constitution, tend to reward projects that evidently are feasible over novel projects.

This investigation shows that edge science is more often NIH-funded than less novel science, but with a delay. Papers that build on more recent ideas are NIH-funded less often than are papers that build on ideas that have had a chance to mature for at least seven years. Three key findings are: First, the tendency to fund edge science is limited mostly to basic science. Papers that build on novel clinical ideas are not more often NIH-funded than are papers that build on well-established clinical knowledge. Second, novel papers tend to be NIH-funded more often because there are more NIH-funded papers in innovative areas of investigation, rather than because the NIH funds innovative papers within research areas. Third, the NIH’s tendency to have funded papers that build on the most recent advances has declined over time. In this regard, NIH funding has become more conservative despite initiatives to increase funding for innovative projects. Given the focus in this particular study on published papers, the findings reflect both the funding preferences of the NIH and the composition of the applications it receives.

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Kristen Truong

June 26, 2020

Advancing Adolescent Flourishing: Moving Policy Upstream

A new report, Advancing Adolescent Flourishing: Moving Policy Upstream, on teen well-being in the U.S. finds that 60% of those ages 13-18 are not thriving, which is defined as experiencing positive emotions as well as positive emotional and social functioning. Teens also are reporting higher stress levels than older adults, the majority of which is due to mass shootings, concern about peers with anxiety and depression, and rising suicide rates. Majorities of teens also have been discriminated against, and almost all report hearing the word "gay" used disparagingly at school. The report identifies 47 action items that policymakers at local, state, and national levels can take to improve the well-being of teens. These items range from engaging with social media platforms and influencers to promote more content that encourages teens to spend time helping others in their community to encouraging lawmakers to design budgets with teenage well-being in mind. Enhanced teen-focused health policies at local, state, and federal levels of government will contribute greatly to the larger enterprise of healing the nation for all. Yet, current national investment in adolescents is lacking. The analysis includes action items and recommendations that are promising for advancing teen psychological, social, and emotional well-being. The report can be obtained here.

Preparing For The Next Pandemic

U.S. Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN) released a White Paper, Preparing For The Next Pandemic, on June 9, 2020 that calls for public comment on five recommended areas for near-term congressional action to learn from the COVID-19 response and better prepare for future pandemics. He noted in an executive summary that “In the midst of responding to COVID-19, the United States Congress should take stock now of what parts of the local, state, and federal response worked, what could work better and how, and be prepared to pass legislation this year to better prepare for the next pandemic, which will surely come.” He outlined five main recommendations to improve the country’s preparation for future pandemics:

Accelerating research and development of tests, treatments, and vaccines.
Enhancing disease surveillance.
Addressing federal and state stockpiles, distribution, and surge capacity.
Improving state and local public health capabilities.
Improving coordination of federal agencies.

The White Paper can be obtained here.

New Data On Community Resilience

Community resilience is the capacity of individuals and households within a community to absorb, endure, and recover from the impacts of a disaster. The U.S. Census Bureau on June 22, 2020 released the Community Resilience Estimates to measure the ability of a population to be successful in responding to situations that include weather-related and disease-related hazard events such as COVID-19. Estimates are based on information on individuals and households from the 2018 American Community Survey (ACS), the Census Bureau’s Population Estimates Program, and National Health Interview Survey (NHIS) data. A tool showing risk level by state, county, and tract can be obtained here.

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More September 2020 TRENDS Articles

A QUASI-CATEGORICAL DEMURRAL

WHISTLING THE COLLEGE HORNPIPE

HEALTH REFORM DEVELOPMENTS

DEVELOPMENTS IN HIGHER EDUCATION

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY