INTERSECTING VULNERABILITIES AND CASCADING CONSEQUENCES

A separate article in the current issue of this newsletter discusses how the health care sphere in the U.S. can be characterized as consisting of dynamic multiscale systems. Tackling problems effectively in diverse areas will require not only linking vast datasets that encompass numerous components and spatio-temporal scales, but also bringing together multiple disciplines, institutions, departments, and programs. A related way of viewing how to move forward is described in a paper appearing in the March/April 2022 issue of the MIT Technology Review. A case is made for meeting the biggest challenges of today and the future by mobilizing leadership roles across the technology industry, academia, and government so that they act in concert in an innovation ecosystem. A good example demonstrating the power of such a system when mobilized in a crisis is the speed with which vaccines against COVID-19 were developed and deployed.

Vaccines alone have not overcome this pandemic because this disease has revealed weaknesses in the health care system, supply chains, labor markets, social safety net, and even the political system as a way to mount coherent responses to a complex problem. The pandemic also exposed a deeper truth, i.e., that certain triggering events leave the U.S. population subject to intersecting vulnerabilities, with cascading consequences. The appearance and spread of COVID is such a triggering event. In a deeply interconnected world with inherent instabilities that include climate change, inadequate cybersecurity, non-state bad actors, and geopolitical tensions of all kinds, such triggering events are likely to become more frequent if work is not undertaken to forestall them. The risks are not merely economic that hurt both knowledge and a technology-intensive economy, they also are strategic that threaten national and global security. A powerful innovation ecosystem needs to become both more agile and more robust in the face of these risks. Moreover, risk assessments at the federal level must become more holistic and integrated, examining the effect of one danger on another. In conjunction with universities and industry, a government coordinating body should be planning for hazards that could compound other hazards, and offering strategic focus and funding for discoveries and innovations designed to respond to and mitigate them as part of an overall innovation policy.

OBTAINABLE RESOURCES

Medication Literacy And Medication Decision Making Among Older Adults

While health literacy is widely understood as a quality measure of health care decision making, another related measure calls for increased attention, particularly regarding older adults: medication literacy. While researchers have developed several medication literacy measures, they neither have received broad validation nor enjoyed wide application. A report from AARP indicates that understanding the broader category of health literacy may be the first step to understanding medication literacy among older Americans. According to the National Assessment of Adult Literacy (NAAL), 36% of American adults have limited health literacy skills, meaning that an individual has basic or below basic skills to perform simple and everyday literacy activities, such as reading and understanding information in simple documents or locating numbers and using them to solve simple, one-step problems. Older adults have the highest rates of low health literacy among all age groups: 59% of individuals ages 65 and older had basic or below basic health literacy levels and have significantly lower rates of both proficient (3%) and intermediate (38%) levels of health literacy. Today, 86% of adults in that age group take at least one prescription medication, while 42% take five or more drugs, with the average Medicare beneficiary taking 4.6 prescriptions per month. Additional information can be obtained in the report here.

Lessons Learned In Health Professions Education During The COVID-19 Pandemic

The COVID-19 pandemic arguably was the greatest disrupter health professional education (HPE) has ever experienced. To explore how lessons learned from this unprecedented event could inform the future of HPE, the Global Forum on Innovation in Health Professional Education of the National Academies of Sciences, Engineering, and Medicine convened a virtual workshop series in 2020 and 2021. The first workshop focused on identifying challenges faced by educators, administrators, and students amidst the pandemic and how the different stakeholder groups shifted and adapted in response. The second workshop explored how experts from various health professions might respond to hypothetical, but realistic future world situations having an impact on HPE. The final two workshops contemplated the future of HPE post-COVID and explored next steps for applying lessons learned from the workshop series to allow educators to test and evaluate educational innovations in real time. The Proceedings of a Workshop summarizes discussions from the second, third, and fourth workshops in this series and can be obtained here.

Organizing Shared Equity Leadership

Even after decades of programmatic efforts and interventions, institutions continue to struggle to find ways to make a difference in the success of racially minoritized, low-income, and first-generation students, whose populations are increasing on college campuses. Higher education remains inequitable, and most institutions have not made the transformational changes necessary to create truly inclusive environments and equitable outcomes for students. A critical component to realize such transformation is the role of institutional leadership at all levels. Few guidelines exist, however, for higher education leaders who want to scale deep, meaningful, and lasting change to the policies, practices, and structures that have long sustained inequity on their campuses and in the higher education system at large. The American Council on Education (ACE) and the Pullias Center for Higher Education at the University of Southern California (USC) formed a partnership to conduct a study of shared equity leadership team structures. This effort benefits the higher education sector by filling a critical gap, providing a fuller understanding of what it means when leaders share leadership in service of equity goals. This project consisted of semi-structured interviews with groups of leaders at four institutions representing different institutional types, contexts, and regions, making it possible to learn more about shared equity leadership and the structures that support it. The report can be obtained here.

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Structural Racism As A Mediator Of Disparities In Acute Myeloid Leukemia

Black and Hispanic individuals with acute myeloid leukemia (AML) in greater Chicago were more likely to die from the disease than their non-Hispanic white counterparts, with a 59% and 25% greater risk, respectively, according to a new study led by University of Illinois Chicago researchers that was published online January 21, 2022 in the journal Blood. Researchers examined how structural violence, neighborhood disadvantage, perpetuated by social, economic and political systems, can set the stage for poorer outcomes in patients with AML. Strikingly, census tract measures accounted for nearly all of the disparity in leukemia death. Treatment patterns, including induction intensity and allogeneic transplant, as well as treatment complications, as assessed by ICU admission during induction chemotherapy, were additional mediators of survival disparities. The study highlights the need to investigate mechanisms by which structural racism (e.g., segregation) interacts with known prognostic and treatment factors to influence leukemia outcomes.

Suicide Mortality In The United States, 2000–2020

In 2020, suicide was the 12th leading cause of death for all ages in the United States, changing from the 10th leading cause in 2019 due to the emergence of COVID-19 deaths and increases in deaths from chronic liver disease and cirrhosis. As the second leading cause of death for individuals aged 10–34 and the fifth leading cause in the age group 35–54, suicide is a major contributor to premature mortality according to a March 2022 data brief from the National Center for Health Statistics (NCHS). Suicide rates increased from 2000 to 2018, but recent data have shown declines between 2018 and 2020. The leading means of suicide for females in 2020 was firearm-related, a change from previous years, while rates for males have continued to increase. This report presents final suicide rates from 2000 through 2020, in total and by sex, age group, and means of suicide, using mortality data from the National Vital Statistics System (NVSS). This report updates a provisional 2020 report and a previous report with final data through 2019.

HEALTH TECHNOLOGY CORNER

Exposure To Adverse Lead Levels In Early Childhood

Lead is a developmental neurotoxicant in wide industrial use that once was broadly distributed in the environment. The extent of the US population exposed in early life to high levels of lead is unknown, as are the consequences for population IQ. Little evidence is available on the harms past lead exposures continue to hold for yesterday’s children, who are victims of what is termed legacy lead exposures, according to an article published on March 7, 2022 in Proceedings of the National Academy of Sciences of the USA. Investigators estimate that more than 170 million Americans alive today were exposed to high-lead levels in early childhood, several million of whom were exposed to five-plus times the current reference level. These estimates allow future work to plan for the health needs of these Americans and to inform estimation of the true contributions of lead exposure to population health. The researchers estimate population-level effects on IQ loss and find that lead is responsible for the loss of 824,097,690 IQ points as of 2015.

Ants Can Detect Cancer Cells Through Volatile Organic Compounds

Cancer detection is a major public health challenge. Methods, such as MRIs and mammograms available to achieve it often are expensive and invasive, which limits large-scale use. An alternative method being explored by scientists from the CNRS, Université Sorbonne Paris Nord, Institut Curie involves the sense of smell of the species of ants, Formica fusca. As described in a paper appearing in the March 18, 2022 issue of the journal iScience, after a few minutes of training, these insects, which use smell for daily tasks, were able to differentiate healthy human cells from cancerous human cells. Cancer cells are characterized by an altered metabolism, producing unique patterns of volatile organic compounds (VOCs) that can be used as biomarkers. Each cell line had its own smell that could be used by the ants to detect them. The efficacy of this method must now be assessed using clinical trials on a human being, but this first study shows that ants have high potential, are capable of learning quickly, at lower cost, and are efficient.

DEVELOPMENTS IN HIGHER EDUCATION

Another section of this issue of the newsletter describes how omnibus appropriations legislation will increase funding for various government agencies in the health domain. The field of education also will benefit from the availability of added money. The enactment of Consolidated Appropriations Act, 2022 (H.R. 2471) will provide $3 billion for higher education to fund increases for most Title IV programs at the U.S. Department of Education. The maximum Pell Grant will undergo a $400 increase that raises it to $6,895. Although the boost is a welcome development, an aim is to double the grant, an objective that was advocated by some Democrats during the campaign for the presidency in 2020. Compared to funding in FY 2021, Federal Work-Study, Federal Supplemental Educational Opportunity Grants, TRIO, and GEAR UP are among the other programs benefiting from modest increases for FY 2022.

Historically Black colleges and universities (HBCUs), tribal colleges and universities, and other primarily minority serving institutions (MSIs) are highly important entities that will experience an increase of $96 million compared to the previous fiscal year. The overall amount of funding is $885 for these institutions. A related consideration is that HBCUs and MSIs will have more flexibility regarding how COVID-19 relief aid is spent. Another noteworthy feature pertains to the acquisition of real property or construction directly related to preventing, preparing for, and responding to the coronavirus.

While acknowledging these gains, within the education community there is a concern that other unresolved issues warrant additional government action. An example is the necessity of addressing the student debt crisis. Thus far, the Biden administration has approved approximately $16 billion in targeted forgiveness, according to the Education Department. Students who qualify for the total and permanent discharge program due to disability, who qualify for the Public Service Loan Forgiveness program with nonprofit or government work, or who were misled by fraudulent schools have been the beneficiaries of this forgiveness. A partial remedy is that payments on student loans have been paused by the federal government since March 2020 because of the COVID-19 pandemic. Unless further action is taken, payments will resume in May of this year.

The Changing Face Of Federal Regulations

The Higher Education Act (HCE) is a vital piece of legislation that undergirds a great many key governmental activities. Initially passed in 1965, it has been rewritten on eight separate occasions since that year. In its most current version, although originally destined to expire at the end of 2013, the law has been extended by Congress. It remains unclear when the next reauthorization will take place. Until then, however, agencies achieve their respective agendas by using regulations to do so. A concern is that some regulations can be guaranteed to be reversed whenever a new occupant resides in the White House. It used to be more the case that once regulations were formulated, they tended to remain in place for lengthy periods of time. The current pattern is for rules to come and go in cycles that reflect which political party is in control of the executive branch. The result affecting colleges and universities can be somewhat chaotic when they attempt to implement official guidance that experiences constant revisions.

The Negotiated Rulemaking Process

Typically, the Department of Education develops its proposed regulations without public input and then publishes them in the Federal Register for comment by the public. The published document is known as a Notice of Proposed Rulemaking, or NPRM. Under negotiated rulemaking, the Department works to develop an NPRM in collaboration with representatives of the parties who will be affected significantly by the regulations. A series of meetings is conducted during which these representatives, referred to as negotiators, work with the Department to reach consensus on the Department’s proposed regulations. The Institutional and Programmatic Eligibility Committee had its 1st session on January 18-21, its 2nd session on February 14-18, and the 3rd session on March 14-18. Gainful employment is an example of a topic discussed at these sessions. Registration links closer to the start of negotiations are posted at www2.ed.gov/ policy/highered/reg/hearulemaking/2021/index.html, along with recordings and transcripts of the meetings on that site.

HEALTH REFORM DEVELOPMENTS

The arrival of the COVID-19 pandemic in early 2020 enabled telehealth to begin to play a more prominent role in dealing with this disease in ways that have affected both patients and caregivers significantly. This technology initially appeared in the 1960s and over time it gradually had a positive impact on the delivery of health care services in remote settings. More recently, COVID served as a prompt for the Centers for Medicare & Medicaid Services (CMS) to allow broader use of Medicare telehealth services. The declaration of a public health emergency made it possible under the National Emergencies Act to issue waivers and modifications under section 1135 of the Social Security Act affecting Medicare, Medicaid, and the Health Insurance Portability and Accountability Act (HIPAA). The Coronavirus Preparedness and Response Supplemental Appropriations Act on March 6, 2020 enabled the waiver of Medicare restrictions and requirements for telehealth services, which expanded outpatient telehealth reimbursement and access to services for Medicare fee-for-service beneficiaries.

Apart from funding provisions, the approval by Congress of the Consolidated Appropriations Act, 2022 (H.R. 2471) includes an extension of several Medicare telehealth waiver authorities. Examples are the expansion of originating sites and eligible practitioners, along with extending telehealth services to Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs). A temporary measure will allow employers to resume covering telehealth for employees with health savings accounts (HSAs) before annual deductibles are met. That kind of flexibility went into effect as a result of previous legislation, which expired at the end of 2021. The new provision will apply from April 1 to the end of 2022.

Advanced Research Projects Authority For Health (ARPA-H)

Senate Health, Education, Labor, and Pensions (HELP) Committee Chair, Senator Patty Murray (D-WA), and Ranking Member, Senator Richard Burr (R-NC), introduced the ARPA-H Act on March 10, 2022 to establish the Advanced Research Projects Authority for Health (ARPA-H), which would be housed in the National Institutes of Health and support cutting-edge, high-reward biomedical research. This new agency, originally proposed in President Biden’s fiscal year 2022 budget, and funded in the amount of $1 billion in the omnibus spending bill, would focus on transforming and advancing areas of biomedicine that cannot be accomplished readily through traditional research or commercial activity, and also developing transformative technologies in an effort to improve the prevention, diagnosis, mitigation, treatment, and cure of health conditions. The aim is to create an environment that remains concentrated on emerging new technologies and can help accelerate the development of those it deems most beneficial to advancing biomedicine and improving health. By working as an independent entity within the structure of the NIH, ARPA-H will have the ability to identify and invest in the best new ideas and technologies coming from the private sector and academia. The legislation would authorize such sums as may be necessary to carry out ARPA-H for each of fiscal years 2023 through 2027, and clarifies that the ARPA-H budget request must be separate from NIH budget requests.

Centers For Medicare & Medicaid Services (CMS) Recent Track Record

Since the start of 2021, CMS has been successful in expanding health care coverage to a record 14.5 million individuals through the Health Insurance Marketplaces. States around the nation were encouraged to extend Medicaid coverage for a full 12 months after childbirth. Access to home and community-based services for seniors and persons with disabilities also has increased. A new set of reforms, developed by and implemented through the Department of Health and Human Services (HHS), aims to improve the safety and quality of nursing home care, hold these facilities accountable for the care they provide, and make the quality of care and facility ownership more transparent so that potential residents and their loved ones can make informed decisions about care. Related initiatives entail having every nursing home provide a sufficient number of staff who are adequately trained to provide high quality care. CMS presently is striving to address provider shortages in Medicaid by building a larger and more diverse workforce that will ensure patients can obtain needed mental health services they need. A major objective is to achieve a dramatic expansion in the supply, diversity, and cultural competency of the mental health and substance use disorder workforce, from psychiatrists to psychologists, peers to paraprofessionals, and increase both opportunity and incentive for them to practice in areas of highest need.

OMNIBUS SPENDING PACKAGE APPROVED

Once again, the clock was ticking and a continuing resolution (CR) that provided funds for the federal government to continue operating was about to expire on March 11. With only a single day to go before another CR might have to be created, legislators in both chambers rose to the occasion by producing an omnibus bill, the Consolidated Appropriations Act, 2022 (H.R. 2471), for President Biden to sign into law to furnish money for the remainder of FY 2022. Although the achievement required nearly six months of effort after the current fiscal year began last October, a collective sigh of relief throughout the government accompanied this outcome.

Despite being at loggerheads on many issues in a Congress almost evenly divided between Democrats and Republicans serving in both House and Senate, the results were greeted with general satisfaction by both groups. Weighing in at a colossal 2,700 pages, 1.5 trillion dollars now can be divided in varying amounts among all 12 fiscal year 2022 spending categories. Division H of the bill pertains to the Labor-HHS-Education section. For example, $45 billion is designated for the National Institutes of Health (NIH), representing a $2.5 billion (4.7%) increase over the comparable FY 2021 funding level, the seventh consecutive increase since FY 2016. The CDC has been awarded $8.4 billion, an increase of $582.4 million (7.4%) above the FY 2021 program level. The Agency for Healthcare Research and Quality (AHRQ) will receive $350 million, an increase of $12.4 million (3.7%) above the FY 2021 spending level. The Health Resources and Services Agency (HRSA), an entity that has a major focus on the health workforce, will benefit from obtaining $799 million for Title VII Health Professions and Title VIII Nursing Workforce Development Programs, a $45.1 million (5%) increase above FY 2021 comparable levels.

Disagreements over how much funding to provide for defense and non-defense purposes account for some of the delay that occurs each year in the appropriations process. Democrats tend to place more emphasis on supporting various social programs rather than defense activities, while Republicans generally are more inclined to do the opposite. For FY 2022, the omnibus legislation allows for almost equal increases in defense and nondefense spending from FY 2021 levels, with a $42 billion ( 5.6%) increase in defense accounts and $46 billion or a 6.7% boost for nondefense programs. Democrats originally hoped to double that amount. Another factor that helps to slow down the speed of legislation is an attempt by Democrats each year since 1976 to override the Hyde Amendment, a provision barring the use of federal funds to pay for abortion, except to save the life of a woman, or if her pregnancy arises from incest or rape. That component remains intact.

Appropriations legislation from previous years was famous for including “earmarks” for special endeavors favored by members from each party in both chambers. Senator William Proxmire (D-WI) became famous for creating what he called the “Golden Fleece Award.” From 1975 to 1988, he issued on a monthly basis 168 such honors. His purpose was to expose to public view the somewhat less than noble ways in which the federal government wastes the hard-earned money of taxpayers. Banned 11 years ago, the new round of spending includes some 5,000 separate earmarks at a cost of $9.7 billion.

DYNAMIC MULTISCALE SYSTEMS

The health care sphere can be characterized as consisting of dynamic multiscale systems. Typically, it is viewed as comprising silos that often function independently of one another in ways that lessen the likelihood of achieving effective outcomes. A positive intervention constructed in recognition of this problem is the ongoing creation of activities that place a much greater focus on interprofessional cooperation. One form occurs at educational institutions where students from different professions are given opportunities to learn more about what other disciplines have to offer in the provision of clinical services. The workplace is a related venue where many kinds of clinicians must work together seamlessly to deliver optimal patient care.

Occasionally, this newsletter has apprised readers of other developments that are not viewed necessarily as pertaining exclusively to the health domain, but still have considerable relevance. As an illustration of this wider viewpoint involving the Anthropocene (the current geological period during which human activity has been the dominant influence on climate and the environment), the May 2021 issue of TRENDS featured a discussion of how the insect world is influenced adversely by human activity, such as habitat loss occurring when humans move to previously uninhabited locales and use of pesticides. Insects play a vital role in a terrestrial food web that affects many species of birds, bats, reptiles, amphibians and fish, while also performing essential functions involving pollination, pest control, and nutrient recycling.

Along similar lines, it is worth noting that biological challenges facing the world are complex, multi-factorial, and intimately tied to the future of human health, welfare, and stewardship of the earth. Tackling problems constructively in diverse areas, such as agriculture, ecology, and health care will require linking vast datasets that encompass numerous components and spatio-temporal scales. The December 2021 issue of the journal Integrative and Comparative Biology became available earlier this month. An article in it on the “Axes of Life,” provides a new framework and a road map for using experiments and computation to understand dynamic biological systems that span multiple scales. Theories are offered that can help understand complex systems and highlight the limitations of existing methodologies.

Meanwhile, there are barriers to bringing together all disciplines, institutions, departments, and programs successfully because of disciplinary variations, such as language, terminology, and definition. It also could be due to self-imposed barriers that limit interactions among disciplines. A tendency to gravitate toward like-minded individuals reduces cross-pollination that could bolster advances in interdisciplinary science. Different disciplines may approach similar problems from different perspectives, which causes a separation in focus when disparate groups try to answer similar questions. One remedy might be to produce more journals that are interdisciplinary. ASAHP’s Journal of Allied Health furnishes a positive example of the wisdom of implementing such an approach.

DISABILITY TRAINING FOR HEALTH WORKERS

Steady growth in the portion of the population age 65 and older in the U.S. and other nations is associated with an increase in the onset of various disabilities. As noted in an article published in January 2022 in the Disability and Health Journal, individuals with disabilities often face significant barriers to health care, including lack of accessible transport and facilities; limited financial protection; poor health worker attitudes that result in worse outcomes; or limited health worker training on disability. Moreover, even in countries where there is guaranteed universal access and financial protection, health workers’ unfamiliarity with disability, or negative attitudes toward patients with disabilities, not only could foster an unwelcoming environment, but also contribute to high rates of patient safety issues and lower quality care. A principal aim described in this journal article was to understand the published literature on training health workers about disability.

The investigators searched five databases for relevant peer-reviewed articles published between January 2012 and January 2021. Studies that focused on training health care workers to improve knowledge, confidence, self-efficacy, and competence to support individuals with physical, sensory, or intellectual impairments were included. Data about the details of the intervention (setting, participants, format, impact assessments, etc.) and its effects were extracted. They found that there is an array of highly local tools to train health workers across stages of their training and careers (preservice, in-service, and continuing professional development). Studies involving patients with disabilities in the training, community placements, simulations, or interactive sessions were found to be most effective in improving knowledge, confidence, competency, and self-efficacy. These researchers concluded that as part of initiatives to build inclusive health systems and improve health outcomes, health workers around the world need to receive appropriate and evidence-based training that combines multiple methods and involves people with disabilities. To monitor progress on the impact of training, there also should be a standardized measure of impact on core outcomes. Additionally, while focusing on training by impairment is useful, there also is a need to have holistic disability training. Improving the standardization of core competencies that training on disability should address and measures of impact for disability training can further improve progress in this area.

EXPANDING GLOBAL ACCESS TO GENETIC THERAPIES

Another section of this newsletter includes an item that discusses how supporters of the human genome project advocate probing yet further “beneath the skin” to demonstrate that the massive investment in genome-wide association studies and the coalescence of these findings into polygenic scores will open up new avenues for prevention. As described in the January 2022 issue of the journal Nature Biotechnology, a goal of advancing science and technology should be to solve global health challenges by developing new therapies, treatments, and preventive measures that directly could contribute to the enhancement of the collective well-being of societies. Human genome editing innovations should endeavor to move in this direction, and any that did not, or that were potentially harmful, should not be allowed to continue. Technologies that should not be allowed at all include those attempting heritable germline human genome editing because of the risks and safety concerns surrounding current technology and also because of the new and possibly unique ethical challenges they would introduce.

Instead, somatic gene editing therapies, by contrast, do not present the same risks and challenges, promising to provide treatments for a wide range of diseases and conditions, including cancers, blindness, and hemophilia. The era of genetic therapies, both gene-editing treatments and gene therapies, several of which currently are on the market, has arrived for rare disease. As more of these therapies come online, however, it is time to explore how current business models based on patents and restrictive licensing limit access to treatments. It also is time to explore whether there are other ways in which patents can still reward innovators and protect investments while ensuring that the widest number of patients who need these treatments can receive them. An example of a strategy possibly worth pursuing would be to reduce the cost of premium-priced gene therapies through the use of patent pools, which have been applied successfully in the technology and electronics world.

OBTAINABLE RESOURCES

Integrating Serious Illness Care Into Primary Care Delivery

Approximately 5% of Medicare beneficiaries (2.2 million Americans) are living with serious illness, as are many other non-Medicare eligible individuals. This number is expected to grow rapidly as the population ages and the prevalence of progressive illness increases. In many communities, particularly urban and rural underserved areas, primary care clinicians are the main workforce caring for patients with serious illness, which underscores the need to integrate high quality serious illness care into primary care delivery. As a means of better understanding the challenges and opportunities for integrating serious illness care into primary care settings, the National Academies of Sciences, Engineering, and Medicine’s Roundtable on Quality Care for People with Serious Illness hosted a virtual workshop on June 10 and 17, 2021. The workshop, called Integrating Serious Illness Care into Primary Care Delivery, explored the shared principles of primary and serious illness care, the interdisciplinary teams that power both disciplines, the policy issues that can act as barriers to or incentives for integration, and best practices for integrating primary care and serious illness care. The workshop proceedings summarize the presentations and discussions that occurred during the event. The document can be obtained here.

The Colleges Where Low-Income Students Enjoy The Highest ROI

College typically pays off for low-income students, but not as much as it does for their peers. Low-income students have a lower return on investment (ROI) than all students across public and private institutions and certificates, associate’s degrees, and bachelor’s degrees, largely because they tend to earn less as adults, according to a new report from the Georgetown University Center on Education and the Workforce (CEW). The Colleges Where Low-Income Students Get the Highest ROI finds that overall, these students receive the best financial returns from attending public institutions, where costs are generally lower. Low-income students, whose families earn $30,000 or less per year, comprise more than one-third of college students. Among institutions that primarily award bachelor’s degrees, public institutions generally lead to the highest ROI for these students during a 40-year timeframe ($951,000), followed by private nonprofit institutions ($863,000) and for-profit colleges ($763,000). Although for-profit colleges have the lowest overall returns among institutions that predominantly award bachelor’s degrees, their student bodies have the greatest share of Pell Grant recipients (56%), followed by those of public institutions (36%) and private nonprofit institutions (35%).

The report and rankings can be obtained here.

National Six-Year College Completion Rate For Students Starting College In 2015

The national six-year completion rate for students who started college in 2015 reached 62.2%, according to a new report from the National Student Clearinghouse Research Center. That rate is an increase of 1.2 percentage points over the fall 2014 cohort and 1.5 percentage points over the 2013 cohort. The report tracks enrollment and completion outcomes for all students who entered higher education for the first time in fall 2015, enrolling full-time or part-time at more than 3,600 two-year and four-year institutions, through June 2021. Students from all starting institution types saw increases in completion rates, with the largest increase among community colleges starters (+1.5 pp). Completion rates increased for White, Latinx, and Black students this year, with the largest jump among Black students (+1.9 pp), while Asian student completion rates remained virtually unchanged. Adult learners (older than 24 at first entry) showed the largest completion rate increases, particularly at the public four -year and community college sectors. Traditional college-age students continue to see higher completion rates than older students of both genders. The report can be obtained here.

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Self-Related Physical Health Along The Rural-Urban Continuum, United States, 2021

Poor self-rated physical health is strongly associated with morbidity and premature mortality. As indicated in the February 4, 2022 issue of the CDC ‘s Morbidity and Mortality Weekly Report, an analysis used data from the National Well-being Survey (NWS), a national sample of approximately 4,000 U.S. working-aged adults conducted during February and March 2021, to examine differences in self-rated physical health among residents of large urban; medium/small urban; metro-adjacent rural; and remote rural counties. Residents of medium/small urban, metro-adjacent rural, and remote rural counties had significantly higher probabilities of reporting fair/poor self-rated physical health than their large urban county peers. There were no significant differences by sex or race/ethnicity in self-rated physical health. Although there is no single solution to reducing rural-urban health disparities, these findings suggest that reducing socioeconomic disparities is essential.

Demographic Variation In Health Insurance Coverage: United States, 2020

According to data published on February 11, 2022 in National Health Statistics Reports, in 2020, 31.6 million (9.7%) individuals of all ages were uninsured at the time of the interview. This figure includes 31.2 million (11.5%) people under age 65. Among children, 3.7 million (5.0%) were uninsured, and among working-age adults (aged 18–64), 27.5 million (13.9%) were uninsured. Among the under age 65 group, 64.3% were covered by private health insurance, including 56.6% with employment-based coverage and 6.7% with directly purchased coverage. Moreover, 4.0% were covered by exchange-based coverage, a type of directly purchased coverage. Under age 65, about two in five children and one in five adults were covered by public health coverage, mainly by Medicaid and the Children’s Health Insurance Program (CHIP). Among adults aged 65 and over, the percentage covered by private health insurance varied by age, family income level, education level, and race and Hispanic origin.

HEALTH TECHNOLOGY CORNER

Exercise After Vaccination Increases Serum Antibody Level

Researchers at Iowa State University found 90 minutes of mild- to moderate-intensity exercise directly after a flu or COVID-19 vaccine may provide an extra immune boost. In a study published in the upcoming May 2022 issue of the journal Brain, Behavior, and Immunity, participants who cycled on a stationary bike or took a brisk walk for an hour-and-a-half after obtaining a jab produced more antibodies in the following four weeks compared to participants who sat or continued with their daily routine post-immunization. Nearly half of the participants in the experiment had a BMI in the overweight or obese category. During 90 minutes of exercise, they focused on maintaining a pace that kept their heart rate around 120–140 beats per minute rather than distance. A shorter 45-minute workout did not increase the participants’ antibody levels. The researchers found similar results when they ran an experiment with mice and treadmills. These investigators also are tracking the antibody response six months post-immunization.

Smartphone App To Determine How Well Blood Clots

Researchers at the University of Washington have developed a new blood-clotting test that uses only a single drop of blood and a smartphone vibration motor and camera. The system includes a plastic attachment that holds a tiny cup beneath the phone's camera. An individual adds a drop of blood to the cup, which contains a small copper particle and a chemical that starts the blood-clotting process. Next, the phone's vibration motor shakes the cup while the camera monitors the movement of the particle, which slows down and then stops moving as the clot forms. The researchers showed that this method falls within the accuracy range of the standard instruments of the field. The team published these findings on February 11, 2022 in the journal Nature Communications. Tubes of blood used to be rocked back and forth manually to monitor how long it took a clot to form, which requires a lot of blood, making it infeasible to use in home settings. The vibration motor on a smartphone, can do the same thing, except with a single drop of blood.

DEVELOPMENTS IN HIGHER EDUCATION

Previous issues of this newsletter have described developments involving reauthorization of the Higher Education Act (HEA). It is an important topic that does not always receive the attention of Congress it merits. The HEA is the primary law through which the U.S. Department of Education administers a wide range of programs and activities that include financial assistance for students, such as Pell grants, accreditation, and oversight of various rules and regulations. This legislation initially was passed in 1965. It has been rewritten on eight separate occasions since that year. In its most current iteration, although it was destined to expire at the end of 2013, the law has been extended by Congress. It is not clear when the next reauthorization will take place.

The U.S. Department of Education plays many fundamental roles. An example is enforcement in relation to civil rights at institutions that accept federal funds. Another key function is to collect data on colleges and universities around the United States. A valuable resource in that effort is the National Center for Education Statistics (NCES), which produces The Digest of Education Statistics, a comprehensive reference for all levels of education. The 2020 version that was released in February 2022 is the 56th in a series of publications initiated in 1962. A compilation of statistical information covering the broad field of education from prekindergarten through graduate school, the Digest contains data on a variety of topics, including the number of schools and colleges, enrollments, graduates, educational attainment, finances, and federal funds for education.

Department Of Education Releases Updates To Its College Scoreboard

Updates to the Department’s College Scorecard were announced by the Department in February 2022. The effort includes an improved interactive web tool, along with the restoration of several metrics that assist students in gauging how their prospective institution compares to other colleges across costs, graduation rates, post-college earnings, and related metrics. An objective is to have these modifications reflect the Department's priority of supporting and encouraging inclusive, affordable postsecondary programs that provide strong career outcomes for students. Borrowers will be able to use this tool to determine cumulative student loan debt at both the institution-level and by field of study within each institution, as well as federal student loan repayment rates for the institution. The Department is publishing for the first time since 2018, both in the data files and on the consumer site, institution-level earnings data to provide an overall sense of the career outcomes for alumni. Additional information is furnished about graduates who are better off by having attended college, by showing the percentage of those earning more than the typical worker with only a high school diploma.

Renewal Of The Gainful Employment Plan

As reported on February 10, 2022 by Inside Higher Ed, the Department has proposed to impose regulations again to measure the gainful employment of graduates of for-profit colleges and nondegree programs at nonprofit colleges. The proposal was made in advance of upcoming continuation of negotiated rule making on various student aid regulations. The Education Department proposals would return to a system of measuring earnings versus debt of graduates of college programs. They also would require all institutions, including those that aren’t governed by gainful employment, to provide the department with information on completion rates, debt, and other trends by program. This topic has been the subject of intense debate for more than a decade. If the regulation takes effect, it would compare students’ earnings after graduation to their student-loan debts. Programs where graduates earn too little over a three-year period could lose access to federal student aid. Penalties would apply only to programs at for-profit colleges as well as nondegree programs at public or private nonprofit colleges. The Department’s proposals would return to a system of measuring earnings versus debt of graduates of college programs. They also would require all institutions, including those that aren’t governed by gainful employment, to provide information on completion rates, debt, and other trends by program.

HEALTH REFORM DEVELOPMENTS

The COVID-19 pandemic has been instrumental in further exacerbating problems in the U.S. health care realm that have existed for decades. Three principal aspects that continue to be of major concern are cost, quality, and accessibility. With the rare exception of the Patient Protection and Affordable Care Act (ACA) that became law in 2010, most efforts to improve matters have occurred incrementally rather than from a more sweeping perspective. Much progress has been made in efforts to lower costs, enhance quality in the delivery of health care services, and provide adequate health insurance coverage for individuals who lack it. Despite some impressive advances in all three areas, health care expenditures are fast approaching 20% of GDP, serious disparities exist that are harmful for several population subgroups, and substantial differences exist depending on whether individuals live in rural or urban areas. Regarding the latter consideration, as critical as personal genetic codes may be in governing the quality of health outcomes, Zip codes also play a determinative role in the availability and accessibility of essential health care services.

Physician Compensation And Financial U.S. Public Health System Care Developments

Since passage of the ACA, public and private payers in the U.S. have undertaken various payment reforms to improve quality and reduce spending. Alternative payment models (APMs) and value-based payment (VBP) seek to redirect the health system’s focus toward producing value instead of volume. Public and private payers continue to expand use of alternative payment models, aiming to use value-based payment to affect the care delivery of their contracted health system partners. In parallel, health systems and their employment of physicians continue to grow. A good question is the degree to which health system physician compensation reflects an orientation toward value, rather than volume. As reported on January 28, 2022 in JAMA Health Forum, an investigation that was a component of a larger RAND Health System Study was conducted with senior leaders among a purposive sample of health systems in California, Minnesota, Wisconsin, and Washington that were selected because of their advanced collection and public reporting of physician organization performance data through health care measurement and improvement collaboratives, and because they represented diverse market characteristics.

This cross-sectional mixed methods study of 31 physician organizations affiliated with 22 U.S. health systems found that volume was a component of primary care and specialist compensation for most physician organizations. Volume was the most common form of base compensation by a wide margin, being included by more than 80% and 90% of physician organizations and primary care physicians, respectively, and representing more than two-thirds of compensation when included. While most primary care and specialist compensation arrangements included performance-based incentives, they averaged less than 10% of compensation. These study results suggest that despite growth in value-based payment arrangements from payers, health systems currently incentivize physicians to maximize volume, thereby maximizing health system revenues. Increasing the volume of services was the most commonly cited action for physicians to increase compensation, reported as the top action by 22 physician organizations (70.0%) for primary care physicians and specialists. A conclusion is that greater translation of the value-over-volume incentives of payers into physician compensation may be necessary to realize the full potential of value-oriented payment reform.

Adequacy Of The Federal Response To COVID_19

The Government Accountability Office (GAO), the auditing arm of the U.S. Congress that is the equivalent of a federal watchdog, has criticized the Department of Health and Human Services (HHS) for “persistent difficulties” in its response to the coronavirus pandemic and past public health emergencies. For example, HHS still is viewed as having no comprehensive COVID-19 testing strategy, according to a report from the GAO that was released on January 27, 2022. The problems date back more than 10 years to other crises, including the H1N1 influenza pandemic, the Zika and Ebola virus outbreaks, and public health threats posed by natural disasters, such as hurricanes. These failures are viewed as leaving the nation vulnerable to future viruses and weather events, according to the report. In tandem with the release of the document, GAO announced it has added HHS leadership and public health emergency coordination to its list of “high-risk” issues that Congress and the executive branch should address. The list now highlights 37 problems at more than a dozen agencies, with some dating back to 1990.

APPROPRIATIONS RICORSO

Each year, this newsletter serves as a vehicle for describing actions by Congress to appropriate funds that enable the federal government to continue its operations. A movie released in 1993 called “Groundhog Day” is about a television weather reporter who awakes each day and relives it repeatedly while he is in the town of Punxsutawney, PA to film a report about annual Groundhog Day festivities. A proposition is advanced that the appropriations cycle each fiscal year on Capitol Hill is somewhat reminiscent of that same situation.

Fiscal year 2022 began on October 1, 2021 with no permanent funding in place for the next 12 months. Short-term remedies had to be devised in the form of one or more continuing resolutions (CRs). The most recent one expired on February 18, 2022. Legislators had two choices. The most desirable option would be to pass an omnibus bill that encompass 12 different categories of spending. Otherwise, another short-term CR is needed to prevent the government from shutting down. A new CR is in effect until March 11, 2022.

A disadvantage of functioning under a CR is that departments and agencies must operate with last year’s funding levels. An inability to know how much money Congress eventually will provide for a wide assortment of programs means that long-term budget planning is upended. It also remains unclear whether new initiatives either can or should be set in motion. Another serious drawback affects government staffing levels because of the uncertainty of not knowing whether positions will continue to be funded. The Health Resources and Services Administration (HRSA) within the U.S. Public Health Services is an example of an agency influenced negatively by the prevailing uncertainty. Important programs involving community health centers for the delivery of needed services and health workforce training are two of many entities to benefit immensely by having clearer funding signposts in efforts to go forward effectively.

Giambattista Vico (1668-1744) was the author of La Scienza Nuova, a book that he wrote to decipher the history, mythology, and laws of the ancient world. His conception of history is that it unfolds in four stages: theocratic, aristocratic, democratic, and chaotic. In the last phase, everything falls apart, producing a ricorso that results in a return to the theocratic phase where the cycle begins all over again.

Perhaps a way of viewing the annual funding cycle on Capitol Hill might be to consider it as occurring in the following stages:

Dread—Funding finally was approved for this year. Is it really time to begin once again?
Conflict—Why cannot colleagues on the other side of the aisle simply agree with us this time?
Anxiety—Will an omnibus bill ever be passed before the current fiscal year ends?
Satiety—We did it.

Lastly, related to determining if passage of omnibus legislation is achievable, the issue of parity tends to arise every year. If money for social programs is going to be increased, shouldn’t funding for military purposes be increased equally? The same quagmire holds true vice versa.

DUELING IHD “SKIN” NARRATIVES

The genesis of the Framingham heart study in 1948 and the onset of the great era of cardiovascular core risk factor identification (e.g., high lipid levels) are credited with a precipitous decline in ischemic heart disease (IHD) mortality. Rather than lauding this triumph, some epidemiologists have mounted a substantial critique of “risk-factor” epidemiology in IHD, notwithstanding its documented public health value. This critique arises from quite different directions as described in the January 2022 issue of the journal Epidemiology.

Proponents of the social determinants of health argue that it is necessary to move far “above the skin” by examining larger social forces that give rise to the biologic markers conventional epidemiology has treated as causal factors in IHD. Conversely, supporters of the human genome project advocate probing yet further “beneath the skin” to demonstrate that the massive investment in genome-wide association studies and the coalescence of these findings into polygenic scores will open up new avenues for prevention. The two positions to some extent reflect the contrast between the reductionism attractive to molecular biologists and the holism to which social scientists are drawn.

The debate is enriched in the Epidemiology issue by inclusion of a study that brings together genetic and sociodemographic antecedents, providing a welcome attempt at integrating risk factors operating across different levels of organization. Sophisticated mathematical and statistical tools used in the study are indifferent to preconceived causal structures and they have the additional benefit of helping to constrain the prejudices of investigators. The commonality linking the two schools of thought represented is not often recognized. Both argue that it is a mistake to see conventional cardiovascular risk factors as causes. Both agree that they are mere biologic intermediaries determined by factors operating long before they are evident, whether those factors can be social forces or genetic differences.

Both schools also argue that it is necessary to go beyond conventional thinking about cardiovascular risk factors to understand fully the causes of IHD. As has often been noted, causality is not a straight line, but a messy matrix of interacting and intersecting factors operating at different times and at different levels. This consideration especially is true for IHD, which has no singular cause. Although this nexus frequently has been described as a web of causation, that metaphor does not do full justice to the complexity of influences operating on several levels.

Another paper appearing in the January 2022 issue of the journal Nature Genetics complements what is known about cardiovascular disease. Efforts to elucidate causal mechanisms, including large-scale sequencing studies, have resulted in thousands of genes being associated with cardiovascular and cardiometabolic diseases with varying degrees of evidence. The traditional reductionist paradigm, i.e., one disease–one target–one drug, or, if need be, a combination thereof, is insufficient to provide mechanistic explanations and enable actionable subtyping or endotyping of diseases for precision medicine.

PATIENT SATISFACTION AND EXPERIENCE WITH TELEMEDICINE

Telemedicine, a potentially disruptive innovation, has emerged as an indispensable pathway to provide continued health care services and improvise public health outcomes during the COVID-19 pandemic. Following the global appearance of the coronavirus, health care providers began postponing several routines, elective care, and outpatient services due to extensive deployment of medical resources in the treatment of patients and to decrease the risk of virus transmission. Another consequence is that face-to-face consultations were disrupted because of hesitation in consulting physicians in the hospital setting. As discussed in an article about patients’ satisfaction and experience with telemedicine that was published in the December 2021 issue of the journal Telemedicine and e-Health, partial or complete disruption of health care services for non-COVID diseases in many countries involved hypertension; diabetes and diabetes-related complications; cancer screening and treatment; cardiovascular emergencies; and rehabilitation. The most common reasons cited for disruption of health care services were lack of health workers’ availability, diversion of health workers to COVID-19 management, cancellation of planned treatments, and risk of virus transmission during on-site patient visits.

Telemedicine became a useful alternative towards streamlined response to the pandemic. Per the WHO, this modality is defined as the delivery of health care services by health care professionals using technology entailing the exchange of medical information for the diagnosis, treatment, and prevention of diseases and injuries. It includes synchronous mode (e.g., video visits, audio visits), asynchronous mode (e.g., emails), and remote monitoring of patients. Researchers sought to identify relevant studies published between December 2019 and August 2020 that highlighted patients’ satisfaction and experience with the use of telemedicine during the pandemic. The findings based upon 48,144 surveyed patients and 146 providers in 12 different countries revealed high satisfaction with virtual encounters across a spectrum of diseases. Telemedicine was found satisfactory on various outcome measures, such as addressing patients’ concerns, communication with health care providers, usefulness, and reliability. Most common advantages were time saved due to lesser traveling and waiting time, better accessibility, convenience, and cost efficiency. Age and sex did not have any significant impacts on satisfaction levels. Physicians and patients both showed a strong preference for continued usage and agreed upon telemedicine's potential to complement the regular health care services even after the pandemic.

THE CRISPR CHILDREN THREE YEARS LATER

The September 2021 issue of the newsletter TRENDS, featured an article on the topic of biological technology prospects, with an emphasis on CRISPR (clustered regularly interspaced short palindromic repeats). Designed as a tool for editing human genes, since it began to attract attention in the media in 2012, ethical discussions about the legal status of such editing have been generated. Shocking reactions occurred around the world in November 2018 when it was learned that two babies had been born in China with DNA edited while they were embryos, a development in genetics as dramatic as the 1996 cloning of Dolly the sheep. Presently, the fate of these three-year-old toddlers remains shrouded in secrecy amid swirls of rumors. Many individuals who were contacted for an article published in the December 2021 issue of the journal Nature Biotechnology refused to speak about the children, who purportedly are healthy. Some respondents agreed to do so only on condition of anonymity.

The original goal of these heritable gene edits was to generate HIV-resistance by introducing germline mutations. The effort was roundly criticized by researchers and ethicists. Thus far, the children themselves have not received much attention. They are considered both celebrities and victims, with their health and well-being a closely held secret. Initially, it was envisioned that development and health would be monitored until their 18th birthdays. Upon reaching adulthood, the girls would be asked to re-consent in order for the testing to continue. An anonymous source indicates that the babies reportedly had medical checkups at birth, at one and six months of age, and at one year. Establishing how the edits to their genomes will translate into health benefits or risks later in life is challenging. Because of widely differing viewpoints on the potential impact of these edits on their physical and mental health, it is difficult to know what lies ahead for the girls.

OBTAINABLE RESOURCES

U.S. Healthcare Quality And Disparities
The Agency for Healthcare Research and Quality (AHRQ) has released its 2021 National Healthcare Quality and Disparities Report, which details the state of healthcare quality and disparities in the United States. Additionally, improvements in HIV and colon cancer care, nursing home care, and medication prescribing to older adults are identified. The report also indicates that more work needs to be performed to address disparities in important areas. Among the findings are the following:

• The numbers of individuals covered by health insurance and those who have a usual source of healthcare have increased significantly.

• Personal spending on health insurance and healthcare services decreased for those under age 65 with public insurance and increased for holders of private insurance coverage.

• Access to dental care and oral healthcare services remains low and has not substantially improved, particularly for individuals who have low income or who live in rural areas.

• A multiyear rise in opioid-related hospitalizations had been tapering off prior to the COVID-19 pandemic, but the opioid crisis has worsened markedly since then. Suicide death rates were rising in all groups for more than a decade before the pandemic. Since then, suicide deaths have decreased in White populations, but continue to rise in racial and ethnic minority populations. Limited access to substance abuse and mental health treatment may have contributed to these crises.

• Although Black, Hispanic, American Indian, and Alaska Native communities have experienced substantial improvements in healthcare quality, significant disparities in all domains of quality persist. Even when rates of improvement in quality exceeded those experienced by White Americans, the improvements have not been enough to eliminate disparities. The report can be obtained here.

State Trends In Employer Premiums And Deductibles, 2010–2020
Employer health insurance coverage has been relatively stable in recent years, falling only slightly during the COVID-19 pandemic. That news for the most part is encouraging, but costs for this coverage are on the rise. Unfortunately, the increase is constituting a larger share of workers’ paychecks. A new Commonwealth Fund report analyzing trends in employer plan premiums and deductibles across all states finds that over the last decade, incomes have not kept pace with health insurance costs, which are driven largely by high prices for drugs and health care services. In 37 states, premium contributions and deductibles together consumed as much as 10% or more of median household income in 2020, up from just 10 states a decade earlier. For single and family insurance policies, the average total cost of premiums and potential deductible spending ranged from a low of $6,528 in Hawaii to a high of more than $9,000 in five states, including Florida and Texas. The report can be obtained here.

Medicare Beneficiaries’ Use Of Telehealth In 2020
A new report from the U.S. Department of Health and Human Services (HHS) found that massive increases in the use of telehealth helped maintain some health care access during the COVID-19 pandemic, with specialists like behavioral health providers seeing the highest telehealth utilization relative to other providers. The report, which was produced by researchers in the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) analyzes Medicare fee for service (FFS) data in 2019 and 2020 and also highlights that telehealth services were accessed more in urban areas than rural communities. Black Medicare beneficiaries were less likely than White beneficiaries to use telehealth. The share of Medicare visits conducted through telehealth in 2020 increased 63-fold, from approximately 840,000 in 2019 to 52.7 million. States with the highest use of telehealth in 2020 included Massachusetts, Vermont, Rhode Island, New Hampshire and Connecticut. States with the lowest use of telehealth in 2020 included Tennessee, Nebraska, Kansas, North Dakota, and Wyoming. The report can be obtained here.

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

COVID Impact On Employment Status Of LGBTQ+ Individuals
COVID-19 has had a disproportionate impact on employment for minority population sub-groups resulting in higher unemployment rates and health care concerns, according to a study from Rutgers University that was published on November 13, 2021 in the journal Sexuality Research and Social Policy. The aim of the investigation was to identify the specific effects of job loss trends on LGBTQ+ individuals in the U.S. The results indicate that employment of members of this group has been undermined by COVID-19, but as with all population segments, those individuals with multiple minority identities, such as Black or HIV+ and LGBTQ+, have been affected most severely. This study highlights the need for national data collection on sexual orientation and gender identity for unemployment as well as the need for substantive policies, such as expanding unemployment to assist in the economic recovery for population groups most affected by COVID-19, along with the Equality Act to offer further workplace protections.

Trends In Adolescent Cannabis-Related Hospitalizations By State Legalization Laws, 2008-2019
The impact of cannabis legalization on adolescent cannabis-related hospitalizations remains unknown. An investigation described in the December 2021 issue of the Journal of Adolescent Health sought to assess whether state cannabis legalization is associated with adolescent cannabis-related hospitalizations. The study involved states with no legal use to medical cannabis laws (MCLs) and states with MCLs to nonmedical (>21 years old) cannabis laws (NMCLs). Of 1,898,432 adolescent hospitalizations in 18 states and Washington, DC, there were 37,562 (2%) hospitalizations with a cannabis-related diagnosis, with 8,457 (23%) in states with no legal use, 20,444 (54%) in MCL states, and 8,661 (23%) in NMCL states. Among the conclusions reached, cannabis-related adolescent hospitalizations at children’s hospitals are increasing, with a disproportionate increase post-legalization in states with NMCLs. Interventions are warranted to increase cannabis use identification and treatment among at-risk adolescents in the hospital-based setting.

HEALTH TECHNOLOGY CORNER

Factors Involving 10-Year Declines in Physical Health and Function Among Women During Midlife
Women in midlife often develop chronic conditions and experience declines in physical health and function. Identifying factors associated with declines in physical health and function among these women may allow for targeted interventions. As reported in a cohort study described on January 10, 2011 in the journal JAMA Network Open, the objective by investigators at Brigham and Women’s Hospital was to examine factors associated with clinically important 10-year declines in the physical component summary score (PCS) of the Short Form 36 (SF-36), a widely used patient-reported outcome measure, in women in midlife. The findings reveal that clinically important declines in women’s physical health and function were relatively common between ages 55 and 65 years. Several variables associated with these declines were identified as potentially useful components in a clinical score identifying women at increased risk of physical health and functional declines.

How Skin Cells Form A First Line Of Defense Against Cancer
A study published on January 11, 2011 in the journal Cell Reports reveals important insights into the molecular mechanisms that underpin the body’s natural defenses against the development of skin cancer. The findings offer new clues into the behavior of skin cancer at the cellular level, paving the way for potential new therapeutic targets to treat the disease. The investigation by researchers at the Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology in Spain, indicates that the protein CSDE1 coordinates a complex chain of events that enable senescence in skin cells. The senescent cells act as a firewall against cancer, suppressing the formation of tumors. The findings are surprising because CSDE1 previously has been linked to driving the formation of cancers. The study is one of the few to examine the role of RNA-binding proteins in establishing cell senescence, which is an important new frontier in cancer research.

DEVELOPMENTS IN HIGHER EDUCATION

The year 2022 began with the number of Covid-19 case counts mounting steadily due to the more transmissible Omicron variant. Some leaders of higher education institutions have responded by either choosing to begin the spring semester online or delay the date when faculty, staff, and students will be allowed to return to campus. Administrators in school districts around the nation have had to make similar decisions for elementary and secondary institutions. Apart from risks associated with experiencing physical symptoms of the disease, adverse mental health effects related to the coronavirus also are considered to be quite worrisome.

The Biden Administration has played an active role in trying to keep schools safely open for full-time, in-person instruction. These efforts have resulted in 96% of schools opening on an in-person basis in January 2022, up from 46% of schools in January 2021. New initiatives will lead to an increase in the number of COVID-19 tests available to schools by 10 million per month. During the past year, federal funding provided to states and school districts across the nation, including $130 billion in the Elementary and Secondary School Emergency Relief is directed toward safely reopening schools and addressing students’ academic and mental health needs. Another $10 billion in the Epidemiology and Laboratory Capacity (ELC) cooperative agreement is being used to support COVID-19 testing for students and staff.

Unified Agenda And Regulatory Plan
The Fall 2021 Unified Agenda and Regulatory Plan was published on December 10, 2021. The U.S. Department of Education anticipates issuing the Title IX notice of proposed rulemaking by April 2022, a month earlier than the May 2022 date listed in the Spring 2021 Unified Agenda. The Department is deeply committed to: ensuring that schools are providing students with educational environments free from discrimination in the form of sexual harassment; ensuring that schools have grievance procedures that provide for the fair, prompt, and equitable resolution of reports of sexual harassment and other sex discrimination; and addressing discrimination based on sex, including sexual orientation and gender identity, in educational environments. In line with those commitments, the Department also has expressed its intent to propose amendments to its regulations implementing Title IX to address these issues.

Student Loan Pause Extended
The Department on December 22, 2021 announced a 90-day extension of the pause on student loan repayment, interest, and collections through May 1, 2022. The extension will allow the Administration to assess the impacts of the Omicron variant on student borrowers and provide additional time for borrowers to plan for the resumption of payments and reduce the risk of delinquency and defaults after restart. The pause will help 41 million borrowers save $5 billion per month. This action is part of a series of steps the Biden Administration has taken to support students and borrowers, make higher education more affordable, and improve student loan servicing, including providing nearly $13 billion in targeted loan relief to over 640,000 borrowers. Specific examples include providing $7.0 billion in relief for 401,000 borrowers who have a total and permanent disability, and helping 30,000 small business owners with student loans seeking help from the Paycheck Protection Program.

Negotiated Rule-Making Committee Expected To Address Unresolved Issues
As the year 2022 unfolds, it is likely that efforts will be undertaken by the Department’s Negotiated Rule-Making Committee to reach agreement on some contentious issues. Prominent examples are:

• How the Education Department processes and adjudicates claims for loan forgiveness by borrowers who are defrauded by their college as well as the circumstances in which borrowers are entitled to loan forgiveness when their college suddenly closes.

• How to structure the administration’s new income-driven repayment plan and how to expand the Public Service Loan Forgiveness program.