Culture

A recent study found strong associations between the financial holdings of legislators in the U.S. House of Representatives and how those lawmakers voted on key financial legislation. The study suggests that many lawmakers voted in ways that benefited their personal finances, regardless of whether those votes were consistent with their espoused politics.

"Broadly speaking, we found that House members who owned stocks in firms that would benefit from financial deregulation voted for financial deregulation," says study co-author Jordan Carr Peterson, an assistant professor of political science at North Carolina State University. "And House members who had invested in financial and automotive stocks supported legislation aimed at bailing out the financial and auto sectors.

"Honestly, we were surprised that nobody had done this analysis before, given that all this data was publicly available," Peterson says. "It required a fair amount of tedious work, which may explain it."

Specifically, the researchers did a detailed examination of the financial holdings of all House members who voted on five key pieces of economic legislation between 1999 and 2008: the Gramm-Leach-Bliley bill in 1999 (which repealed Glass-Steagall); the Commodity Futures Modernization Act of 2000 (which involved substantial deregulation to the financial industry); the two 2008 votes on the Troubled Assets Relief Program (which bailed out major banks); and the Auto Industry Financing and Restructuring Act in 2008 (which bailed out the auto industry).

"We chose those five roll-call votes because, unlike many other roll-call votes, the legislation had immediate and direct impacts on the stock market in general - and in particular on the stock prices of individual firms that were regulated by the relevant bills," Peterson says.

In four of the five instances, legislators largely voted in line with what was most beneficial to their financial interests. The sole exception was the Commodity Futures Modernization Act of 2000 - though that may be due to the fact that the bill was bundled into a much larger omnibus legislation package at the tail end of a lame-duck congressional session.

"Our findings indicate that many legislators are more likely to vote in support of their own financial holdings, rather than in line with the political positions they espouse on the campaign trail," Peterson says. "That's clearly problematic - and we don't have to do things this way. For example, an easy fix would be to require that members of Congress not own individual stocks, instead moving their investments into mutual funds or a blind trust.

"And the finding also raises some interesting questions about similar potential conflicts in other governmental institutions," Peterson says.

The spectacular and complex visual patterns created by animal groups moving together have fascinated humans since the beginning of time. Think of the highly synchronized movements of a flock of starlings, or the circular motion of a school of barracudas. Using state-of-the-art robotics, a research team from the University of Konstanz, Science of Intelligence, and the Leibniz Institute of Freshwater Ecology and Inland Fisheries (IGB) shows that animals' speed is fundamental for collective behavioral patterns, and that ultimately it is the faster individuals that have the strongest influence on group-level behavior. The study, published in Biology Letters of the Royal Society, gives new insights on complex collective behavioral patterns in nature, and provides knowledge that could help develop robotic systems that move collectively, such as robot swarms, driverless cars, and drones.

Researchers have long focused on identifying the emergence of collective patterns. Thanks to a combination of behavioral experiments, computer simulations, and field observations, it is clear that many seemingly complex patterns can actually be explained by relatively simple rules: move away from others if they get too near, speed up towards others if they get too far away, and otherwise move at the same speed and align with your group mates.

"Besides understanding the rules that individuals follow when interacting with others, we need to consider the behaviors and characteristics of those individuals that make up the group and determine their influence for collective outcomes"says Dr. Jolle Jolles, scientist at the Zukunftskolleg, University of Konstanz, and lead author of the study. "Across the animal kingdom, it has been found again and again that animals tend to differ considerably from one another in their behavior such as in terms of their activity, risk-taking, and social behavior". What are the consequences of this behavioral heterogeneity when it comes to collective behavior? And how can one test for its social consequences?

The Robofish is recognized as a conspecific

To disentangle the role of individual differences in collective behavior and the mechanisms underlying this type of behavior, the research team built "Robofish", a robotic fish that not only realistically looks and behaves like a guppy - a small tropical freshwater fish - , but also interacts with the live fish in a natural way. The experimenters paired the robotic fish with a guppy and programmed it to always follow its partner and copy its movements, lacking however any movement preferences of its own. The team then used high-definition video tracking and a closed-loop feedback system to let the robotic fish respond to the live fish's actions in real-time.

"One of Robofish's simple interaction rules was to keep a constant distance to its shoal mate" explains Dr. David Bierbach, who works within the Berlin-based Excellence Cluster 'Science of Intelligence' at the HU Berlin and the IGB, and is senior author on the paper. "Using this rule, our Robofish tried to keep the same distance to the live fish by accelerating and decelerating whenever the live fish did. Also, programming the robotic fish without any own movement preferences gave us the unique opportunity to investigate how individual differences in the behavior of the live fish led to group-level differences. In short, with our unique approach, we could isolate the effect of the fish's movement speed on the pair's collective behavior".

Fast guppies become stronger leaders

The researchers first quantified the guppies' natural movement speed by observing their movements when alone in an open environment, and found that there were large individual differences in how fast guppies tended to move. When the fish were subsequently tested with Robofish, the fish and Robofish tended to swim naturally together as a pair. However, the researchers observed that there were large differences in the social behaviors between the pairs: pairs in which the guppy had a faster movement speed tended to be much more aligned, more coordinated, and less cohesive, and the guppy emerged as a clearer leader. As Robofish behaved according to the same identical rules with each and every guppy, it is the individual speed of the guppies that must have led to these differences in group-level properties.

By involving state-of-the-art robotics, this research shows that individual speed is a fundamental factor in the emergence of collective behavioral patterns. As individual differences in speed are associated with a broad range of phenotypic traits among grouping animals, such as their size, age, and hunger level, the results of this study may help understand the role of such heterogeneity in animal groups.

Future studies using the interactive Robofish will focus on other aspects of collective behavior: For example, how can animals act in synchrony if they just respond to the actions of their neighbors? "We want to improve Robofish's software so that it can predict and anticipate the live fish's next steps, which is assumed to be how animals do it." says David Bierbach.

Understanding these mechanisms is not only fundamentally important as it reveals information about the mechanisms that underlie collective behavior and decisions, but also because this knowledge can be applied to artificial systems and used to develop machines that move collectively, such as robot swarms, driverless cars, and drones.

NASA's Aqua satellite captured a visible image of Tropical Depression Rene as it was dissipating in the central North Atlantic Ocean.

The Moderate Resolution Imaging Spectroradiometer or MODIS instrument that flies aboard NASA's Aqua satellite captured a visible image of Rene on Sept. 15 at 12:30 p.m. EDT. Rene appeared elongated from wind shear (outside winds blowing at different levels of the atmosphere) battering the storm. Over the next couple of hours, visible satellite imagery showed that Rene opened into a trough (elongated area) of low pressure and was no longer a tropical cyclone. Several hours later, Rene dissipated into a remnant low-pressure area.

Satellite imagery was created using NASA's Worldview product at NASA's Goddard Space Flight Center in Greenbelt, Md.

Rene's Curtain Call

At 5 p.m. EDT (2100 UTC) on Sept. 15, NOAA's National Hurricane Center (NHC) issued the final advisory on Rene, citing that the storm had dissipated. The remnants of Rene were located near latitude 26.9 degrees north and longitude 49.3 degrees west. Rene was located about 1,045 miles (1,685 km) northeast of the Leeward Islands. The remnants were moving toward the west-southwest near 7 mph (11 kph) and this general motion will likely continue for another day or two. Maximum sustained winds were near 30 mph (45 kph) with higher gusts.

The remnants of Rene are expected to move generally southwestward for the next day or two while the associated winds slowly subside.

About NASA's Worldview and Aqua Satellite

NASA's Earth Observing System Data and Information System (EOSDIS) Worldview application provides the capability to interactively browse over 700 global, full-resolution satellite imagery layers and then download the underlying data. Many of the available imagery layers are updated within three hours of observation, essentially showing the entire Earth as it looks "right now."

NASA's Aqua satellite is one in a fleet of NASA satellites that provide data for hurricane research.

Tropical cyclones/hurricanes are the most powerful weather events on Earth. NASA's expertise in space and scientific exploration contributes to essential services provided to the American people by other federal agencies, such as hurricane weather forecasting.

For updated forecasts, visit: http://www.nhc.noaa.gov

By Rob Gutro
NASA's Goddard Space Flight Center

Published in the journal Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]), the study shows that it is the absence of quality connections with people and not the lack of contact that predicts the onset of type 2 diabetes, suggesting that helping people form and experience positive relationships could be a useful tool in prevention strategies for type 2 diabetes.

The results have implications in light of recent findings that people with diabetes are at greater risk of dying from COVID-19. The study indicates that prolonged loneliness may influence the development of diabetes, suggesting the experience of lockdown could potentially compound people's vulnerability in this pandemic if the loneliness continues for some time.

Loneliness occurs when an individual perceives that their social needs are not being met and reflects an imbalance between desired and actual social relationships. A fifth of adults in the UK and a third of adults in the USA report feeling lonely sometimes.

There is a growing interest in the role of loneliness in health and previous research has associated loneliness with increased risk of death and heart disease. This is the first study to investigate the experience of loneliness with later onset of type 2 diabetes.

The study analysed data from the English Longitudinal Study Ageing on 4112 adults aged 50 years and over which was collected at several times from 2002 to 2017. At the start of data collection all participants were free of diabetes and had normal levels of blood glucose.

The study showed that over a period of 12 years 264 people developed type 2 diabetes. and the level of loneliness measured at the start of data collection was a significant predictor of the onset of type 2 diabetes later on in life. This relationship remained intact when accounting for smoking, alcohol, weight, level of blood glucose, high blood pressure and cardiovascular disease. The association was also independent of depression, living alone and social isolation.

Lead author Dr Ruth Hackett from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) King's College London said: 'The study shows a strong relationship between loneliness and the later onset of type 2 diabetes. What is particularly striking is that this relationship is robust even when factors that are important in diabetes development are taken into account such as smoking, alcohol intake and blood glucose as well as mental health factors such as depression. The study also demonstrates a clear distinction between loneliness and social isolation in that isolation or living alone does not predict type 2 diabetes whereas loneliness, which is defined by a person's quality of relationships, does.

She continued: 'I came up with the idea for the research during UK lockdown for the COVID-19 pandemic as I became increasingly aware and interested in how loneliness may affect our health, especially as it is likely that many more people were experiencing this difficult emotion during this period.'

According to the study a possible biological reason behind the association between loneliness and type 2 diabetes could be the impact of constant loneliness on the biological system responsible for stress, which, over time affects the body and increases the risk for diabetes.

'If the feeling of loneliness becomes chronic,' explained Dr Hackett. 'Then everyday you're stimulating the stress system and over time that leads to wear and tear on your body and those negative changes in stress-related biology may be linked to type 2 diabetes development.'

Another explanation for the findings could be biases in our thinking that may perpetuate the association between loneliness and diabetes as when people feel lonely, they expect people will react to them negatively which makes it more difficult to form good relationships.

New research provides a global analysis of the footprint of storm surges, providing a first step toward helping decision-makers coordinate flood management and emergency response plans across borders.

When Category 4 Hurricane Laura made landfall, the biggest cause of alarm was a projected "un-survivable" 20-foot storm surge. A storm surge is the sudden rise in sea level generated by a storm that can produce powerful currents, flood roads and destroy infrastructure.

Hurricane Laura's storm surge wound up being just half as high as feared, but storm-associated coastal flooding is expected to become more frequent with sea level rise. Better understanding storm surges and their spatial distribution can help coastal communities prepare for these dangerous flooding events.

New research in AGU's Journal of Geophysical Research: Oceans suggests the footprints of storm surges are more dependent on storm track direction than the intensity of the storm, and that both contiguous and unconnected stretches of coast can be simultaneously impacted by the same event. To reach their conclusion, the authors statistically analyzed both observed surge data from tide gauges and simulated storm surge data to understand how storm surges would simultaneously impact different coastline stretches around the world.

The authors provide a new framework to identify the patterns of coastal hazards. They demonstrate that simulated storm surge data can broadly reproduce the spatial footprints of storm surges obtained from observations, allowing them to analyze storm surge footprints in areas with limited tide gauge data and produce a global picture of storm surge footprints.

This information can be used to improve global coastal risk analysis, emergency plans and adaptation measures, according to the authors. They also conclude that their results, which show that storm surges can impact coastlines across state and national boundaries, highlight the importance of inter-state and international collaboration for disaster preparedness and response plans.

DETROIT - A recent study from the Henry Ford Sports Medicine Research team suggests that high school athletes competing, not only in football, but in soccer, hockey, basketball, swimming, cheerleading and other sports are not only at risk for concussions, but may need a longer recovery than first thought.

The study's results published by Orthopedics, a nationally recognized, peer-reviewed journal for orthopedic surgeons found that the most common sports for brain injuries were indeed football, hockey and soccer.

"We thought that concussion issues would be very short-lived," said Vasilios (Bill) Moutzouros, M.D., chief of Sports Medicine at Henry Ford and a study co-author, "That they wouldn't have as many attention issues, that they'd be able to recover for their sport much more quickly. Our study found just the opposite."

"The two sports, other than football, where concussions are common are soccer and hockey, although brain injuries can happen in any sport," said Meaghan Rourke, one of more than 30 Henry Ford athletic trainers who support sports programs at over 20 high schools, colleges and universities and professional teams in the tri-county area.

Michigan Gov. Gretchen Whitmer's latest executive order allows the high school football season to begin September 18. Football was reinstated by the Michigan High School Athletic Association (MHSAA) after initially being postponed until spring 2021. With football back in action with an adjusted six-game season, athletic trainers will once again be patrolling the sidelines and be on the lookout for signs of concussions. Other sports given the green light to compete this fall include soccer, volleyball, swimming and diving. These competitions will also present the potential for brain injuries from collisions, falls and impacts with the field of play.

"I went through a four-year period as an athletic trainer where I had at least one swimmer suffer a concussion. That's a sport you don't really think about in terms of concussions," said Rourke. She explained that in one instance a swimmer miscalculated her distance to the pool wall while doing the backstroke and bumped her head against the wall. As a result, the swimmer was out for more than a month with a concussion. Diving is another sport susceptible to brain injuries as the divers' heads impact the surface of the water at high speeds generated from their dives. In reality, all sports have the potential for concussions since athletics involve physical activity and competition.

"Competitive cheerleading is another sport where I've seen concussions happen. The kids get very high in the air, and if they slip and fall when they are coming down, they can suffer serious head injuries," said Rourke, "We usually have one or two athletes in that sport suffer concussions. Overall, I've probably had to deal with a concussion in every sport, including golf."

The retrospective study looked at Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) scores at baseline testing and following concussions performed by neuropsychologists. The study found that memory ImPACT scores increased as players suffered repeated concussions.

ImPACT is the brain injury testing protocol developed in the late 1990s at the University of Pittsburgh and released in the early 2000s. The testing protocol is the only FDA-approved tool for concussion assessment and is the national testing used by healthcare, educational and sports organizations to help assess and manage concussions. The protocol defines a concussion as "a disturbance in brain function that occurs following either a blow to the head or as a result of the violent shaking of the head." Symptoms of a concussion can include a combination of headaches, nausea, vomiting, balance problems, dizziness, fatigue, visual problems and a host of other brain-associated symptoms.

The study examined the records of 357 high school athletes who were treated for concussions at Henry Ford from 2013 to 2016. The athletes age averaged between 14-18 with nearly 62% being males. Football yielded the most concussions (27.7%), followed by hockey (21.8%), soccer (17%), basketball (9 %) and cheerleading (4.2%). From the study's participants, 72 played in "Other" sports and accounted for 20.3% of the total number of concussions. Overall, 14 % reported suffering from amnesia and 33 % reported a history of concussions.

Henry Ford athletic trainers use internationally approved guidelines to accurately diagnose concussions, appropriately manage the recovery process, and safely return athletes back to their game. They use sideline tools such as the Sports Concussion Assessment Tool 5 (SCAT5) to immediately evaluate cognitive function and, if needed, additional neuropsychological tests may be administered by a physician to track progression through the recovery process. SCAT5 is a standardized concussion assessment used by licensed healthcare providers when a concussion is suspected in athletes ages 12 and older.

Current MHSAA protocols call for a player showing concussion symptoms to be sidelined for at least 24 hours. Athletes at high schools staffed with a Henry Ford athletic trainer are sidelined for at least five days and follow a strict return to play protocol, "We're going to slowly bring them back," said Rourke. "We don't want to just throw them out there where they're going to get hit again, and then they're dealing with prolonged symptoms."

The Henry Ford research team found that athletes with only one concussion required at least 30 days of recovery prior to returning to their sport while others who reported a second or more concussions required more recovery time. They also learned that visual motor speed and reaction time scores decreased with recurrent concussions, and that male and female athletes with a previous history of concussion, and those with delayed diagnosis, required more time before returning to competition.

The study team hopes that the results help start the conversation on how to more safely return student athletes to their sport after a brain injury. "When you recognize that it can be up to 30 days to get a young student athlete back, you're going to change your mind-set on how you advance them, in terms of how you push them, in terms of how you test them," said Dr. Moutzouros.

Previously, it was believed that brain injuries were related to a player's age. The younger the player, the shorter the recovery time. "We need more studies on the younger athletes," said Dr. Moutzouros, "Many of us have children. We're all worried about them and we want them to be safe. So, we need to recognize that this is a problem for the youth athlete."

Rural Counties With Access to Obstetrics Have Healthier Infant Birth Outcomes

Rural areas with local access to obstetrical care report better infant health outcomes, including lower infant mortality rates and fewer babies delivered underweight. The retrospective cohort study compared the birth outcomes of rural counties in Alabama with in-county obstetrical care to those without over a 12-year span from 2003 to 2017. Across all four outcome measures--including infant, perinatal, and neonatal mortality rates as well as low birthrate deliveries--counties with access to obstetrical care had significantly better infant birth outcomes. The authors were not able to control for race or other social factors and report that areas with no obstetrical care access were also more likely to have a higher percentage of underrepresented minority residents. This study does not prove a causal link between access to obstetrical care and infant health outcomes, but it does suggest that obstetrical access may play a role in these disparities. These findings have broader implications for the more than half of all rural counties in the United States that do not have access to hospital-based obstetrical care.

Effect of Access to Obstetrical Care in Rural Alabama on Perinatal, Neonatal, and Infant Outcomes: 2003-2017
John B. Waits, MD, et al
Cahaba Medical Care, Centreville, Alabama
https://www.annfammed.org/content/18/5/446

Freezing of gait, one of the most incapacitating symptoms of Parkinson’s disease, manifests as sudden, short episodes of an inability to move the feet forward despite the intention to walk. Researchers at the University of São Paulo (USP) in Brazil have shown that the disorder can be mitigated by means of a complex physical exercise protocol designed to stimulate different motor and cognitive skills simultaneously. An article on the study is published in the journal Movement Disorders.

The study, supported by FAPESP, also showed that resistance training with instability modified brain regions associated with the physiological alterations typical of gait freezing, boosted neuron activation, and enhanced brain plasticity in the affected regions.

“In addition to positive reports from the patients who took the training, clinical trials also evidenced significant improvements, especially a 60% reduction in gait freezing and a 70% reduction in motor symptoms of the disease. Another important outcome concerned the restoration of brain regions directly linked to the problem. Brain plasticity in these areas is a predictor of gait freezing mitigation,” Carla da Silva Batista, a researcher in USP’s School of Physical Education and Sports and first author of the article, told Agência FAPESP.

Reactivation of brain regions was verified by functional magnetic resonance imaging (fMRI). The protocol is the first to reduce symptoms of gait freezing, clinically assessed in an objective manner, and to record the associated pathophysiologic alterations in the brain.

The study was part of Batista’s postdoctoral research, and some of it was conducted at Oregon Health and Science University (OHSU) in the United States with support from FAPESP via a scholarship for a research internship abroad.

According to Batista, activation of the cerebellar area, associated with gait automaticity, and the mesencephalic locomotor region, associated with gait initiation and postural control, explains the reversal of gait freezing after adapted resistance training.

Common cause of falls

There are no specific treatments for gait freezing, which is one of the most common causes of falls among Parkinson’s patients and, alongside tremor and cognitive impairment, responsible for loss of quality of life.

Gait freezing is estimated to affect some 26% of moderate patients and 80% of advanced-stage patients. It usually occurs while the patient is walking: feet appear to be “stuck” but the upper body continues to move, and fractures, as well as falls, may result, leading to premature hospitalization. It also occurs when the patient is rising from a seated position and stumbles. “We don’t know the exact cause but we know of several key predictors, such as heavy use of medications for Parkinson’s, progress of the disease, severe cognitive decline, stress, and anxiety,” Batista said, adding that patients may have all or several of the predictors without suffering from freezing of the gait.

Adapted resistance training with instability

The study conducted by the USP research group had 32 participants in stages 3 and 4 of the disease (deemed to have five stages). They were randomly divided into two groups. One comprised 15 patients and received conventional rehabilitation physical therapy, serving as a control group. The other, with 17 patients, took the complex training program designed by the researchers. The program consisted of 36 sessions spread over a 12-week period and involving exercises that combined instability, weight lifting, motor coordination, and cognitive demands.

“The exercises are intense and must be performed concurrently to cause complexity. This demands considerable effort from the patient and confidence on the part of the trainer, who will invariably have to give patients some support so they don’t fall,” Batista said.

Complexity is necessary to achieve the desired result. “Exercises involving motor complexity are known to be more effective when performed together. Studies in animal models confirm this, enhancing neuroplasticity by forming neurons and synapses in certain brain regions. This is exactly what we wanted to achieve,” she explained.

The degree to which the disorder was mitigated and brain plasticity enhanced was assessed using a fMRI analysis model developed previously by researchers affiliated with USP in partnership with colleagues in the UK and US, including one at OHSU, and published in Scientific Reports in 2017.

“Using this model they measured activity in the brain regions involved in freezing of gait before and after 12 weeks of training,” Batista said. “The methodology proved reversal of the disorder and enhanced plasticity in the brain regions concerned.”

In the study no improvement was observed in the control group. “It’s important to stress that the traditional exercises were unable to mitigate the severity of gait freezing or bring about positive alterations to brain regions,” Batista said.

Combined exercises

Although the causes of gait freezing are poorly understood, the researchers designed the training program to address the difficulties typically experienced by patients with the disorder, and hence to include sensorimotor, weightlifting, motor coordination and cognitive demand exercises simultaneously.

Most patients who suffer from gait freezing experience difficulties with proprioception (how the body senses its position in space), motor coordination, muscular strength, and cognitive function. “This is why we use exercises that involve strength and coordination while trying to maintain balance [on a half-ball or disk],” Batista said. “Cognitive impairment is also a predictor of gait freezing, so we include cognitive tasks and dual-task exercises that require simultaneous attention to two activities or mental flexibility to switch from one task to another as necessary.”

Strength training is also important for Parkinson’s patients, as muscle weakness is another symptom of the disease. “Weights are part of most exercises in our program, which isn’t easy. It demands quite a lot of the patient. Many volunteers in our study said they enjoyed the challenge and felt stronger as time passed, which motivated them to continue,” Batista said.

A study by researchers at Kaiser Permanente in Denver, Colorado evaluated the stability of thyroid stimulating hormone (TSH) in patients using synthetic medication versus those using desiccated thyroid products to treat hypothyroidism. The results showed no difference in TSH stability over a three-year period between patients taking desiccated thyroid products and those on synthetic levothyroxine, an unanticipated finding given concerns about variability among batches of desiccated thyroid, which is prescribed much less frequently than synthetic levothyroxine.

In an accompanying editorial, Jill Schneiderhan and Suzanna Zick argue in favor of a patient-centered approach as opposed to relying primarily on laboratory results when determining the best way to manage hyperthyroidism. Emerging evidence shows that for many patients taking levothyroxine, symptoms persist despite lab results indicating normal TSH values. Further, these patients may feel invalidated and not in control of their treatment decisions. Schneiderhan and Zick conclude, "[k]eeping desiccated thyroid medications as an option in our tool kit will allow for improved shared decision making, while allowing for patient preference, and offer an option for those patients who remain symptomatic on levothyroxine monotherapy."

Telehealth Supports Collaborative Care Model in Addressing Mental Health Needs of Rural Patients

Traditionally, primary care clinics connect patients who have mental health care needs to specialists like psychiatrists in a collaborative care model. However, rural clinics often lack the workforce capacity to provide collaborative behavioral health services. In a new qualitative study, rural Washington primary care clinics adopted telehealth methods to connect remotely with specialists. The study found that telepsychiatric collaboration prepared primary care physicians and rural clinic staff to deliver high quality mental health care in underserved areas.

Study authors interviewed 17 clinical, support and administrative staff members of three rural primary care clinics. They found that through telepsychiatric consultation, all members of the clinic learned how to better serve the needs of mental health patients. Primary care doctors learned to work proficiently with these patients. Care managers learned to appreciate how medical issues affect mental health and how to diagnose and assess mental health issues, and consulting psychiatrists learned how to coach a primary care team, serve as educators and lead program implementation. The collaborative care model provides important benefits that other rural primary care clinics should consider adopting to help meet the needs of patients with mental health disorders.

Telepsychiatric Consultation as a Training and Workforce Development Strategy for Rural Primary Care
Morhaf Al Achkar, MD, PhD, et al
Department of Family Medicine, University of Washington, Seattle
https://www.annfammed.org/content/18/5/438

Vaping marijuana and vaping nicotine rose sharply in the past three years among college-age (19-22 years old) adults, according to 2019 survey results from the Monitoring the Future (MTF) study. The percentage of college students who said they vaped marijuana in the past 30 days rose from 5.2% in 2017 to 14% in 2019. The corresponding percentages for their non-college-attending peers increased from 7.8% in 2017 to 17% in 2019.

MTF, an ongoing study of the trends in substance use by adolescents and adults in the United States, is funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. The survey is conducted by scientists at the University of Michigan's Institute for Social Research, Ann Arbor.

The percentage of college-age adults aged 19 to 22 who vaped nicotine also rose dramatically between 2017 and 2019. In 2017, 6.1% of college students and 7.9% of those not in college said they vaped nicotine in the past month, rising to 22% and 18%, respectively, in 2019. These increases in vaping marijuana and nicotine are among the largest increases in use for any substance reported by the study in its 45-year history.

"We are seeing an increasingly concerning trend," said Nora D. Volkow, M.D., director of NIDA. "Many young people may view vaping and cannabis use as 'safer', but the reality is that nicotine is highly addictive, and cannabis can also be addictive, particularly in younger adults for whom the brain is still developing."

The MTF study has been annually tracking substance use among college students and non-college adults since 1980. Results are based on data from college students one to four years beyond high school graduation who are enrolled full-time in a two- or four-year college in March of the given year, compared with same-age high school graduates not enrolled full-time in college. These 2019 survey results are now online.

The 2019 data also revealed a continued high prevalence of marijuana use among young adults, who are 19 to 22 years old. In 2018, 43% of this group--regardless of college attendance--reported using marijuana in the past year, and this percentage was unchanged in 2019. Particularly notable is the prevalence of daily, or near-daily, use of marijuana among those not attending college in 2019--at 15%, it is at the highest level since the survey began. This compares to 5.9% of college students who reported daily, or near-daily, use of marijuana.

The 2019 MTF survey data reflect drug use patterns prior to the outbreak of the COVID-19 pandemic. The pandemic's impact on substance use and related behaviors and attitudes among the nation's young adults may be reflected in future MTF survey results. The 2020 MTF middle and high school student findings are due to be released later in 2020.

Other highlights from the 2019 survey results on college-age adults include:

Cigarette smoking continued a downward trend, with 7.9% of college students reporting having smoked in the past month. Among their peers who are not in college, 16% reported having smoked in the past month, an all-time low.

Binge drinking (five or more drinks in a row in the past two weeks), which has been declining gradually over the past few decades, showed no significant changes for young adults attending or not attending college. In 2019, 33% of college students and 22% of same-age adults not in college reported binge drinking. High-intensity drinking (10 or more drinks in a row in the past two weeks) has stayed level at about 11% since 2015 for people between the ages of 19 and 22, regardless of college attendance.

Prescription opioid misuse continued to decline, with 1.5% of college students and 3.3% of those not attending college reporting non-medical use of opioids (narcotic drugs other than heroin) in the past year. This represents a significant five-year decline from rates of 4.8% and 7.7%, respectively, in 2014.

Amphetamine use continued to decline, with 8.1% of college students and 5.9% of noncollege respondents reporting non-medical use of amphetamines in the past year.

Information on previous years' MTF survey findings and other resources, including an infographic, can be found on NIDA's College-Age & Young Adults webpage.

Canada is the first country to facilitate provision of medical abortion in primary care settings through evidence-based deregulation of mifepristone, which is considered the 'gold standard' for medical abortion. A Canadian study investigated the factors that influence successful initiation and ongoing provision of medical abortion services among Canadian health professionals and how these factors relate to abortion policies, systems and service access throughout the country.

Results suggest that Health Canada's initial restrictions discouraged physicians from prescribing mifepristone and were inconsistent with provincial licensing standards, thereby limiting patient access. During, and after removal of, these restrictions, researchers identified four barriers to utilizing/prescribing the drug, including the initial federal restrictions which made mifepristone "more complicated than it needs to be"; navigating the "huge bureaucratic process" of organizational implementation; challenges with diffusion and dissemination of policy information; and adoption by physicians as "a process rather than an event."

This study, the authors write, is relevant to other nations experiencing challenges to accessing family planning services. Amidst the COVID-19 pandemic, U.S. policies restricting access to mifepristone have reached the Supreme Court after a federal district court judge temporarily suspended strict FDA regulations that require patients to visit a hospital or clinic in-person to obtain mifepristone. In Canada, ongoing implementation of mifepristone will require organizations to create tailored solutions to barriers, which may include creating new medical billing codes, provincial policy advocacy efforts, specifically in Quebec, which added its own restriction requiring accredited training in surgical abortion for any mifepristone provider, and conducting physician engagement to raise awareness to access barriers.

This study found an association between improved physician-patient relationships and improved patient-reported health status. Researchers at Case Western Reserve University found over a one-year period that while consistent access to a provider is important, the quality of each clinical encounter is equally as important in shaping a patient's reported overall health outcomes, as measured by the SF-12 quality of life questionnaire.

The authors also found some evidence that adults with five or more diagnosed conditions experience physician-patient relationships that are significantly lower in quality than those reported by adults without multimorbidity. This discrepancy may reflect unmet physician-patient relationship needs among adults bearing multimorbidity burdens and indicate another opportunity for intervention. The study findings can potentially inform health care strategies and health policy aimed at improving patient-centered health outcomes.

Processes Supportive of Patient Engagement are Boosted by Full Staffing, Daily Huddles, Responsible Leadership and Performance Improvement Discussions

VA researchers whose aim was to identify organizational and contextual factors associated with greater use of patient engagement processes found that high performing clinics were more likely to have fully-staffed primary care teams, clearly defined roles for team members, leadership responsible for implementing team-based care, and team meetings to discuss performance improvement, compared to clinics that performed poorly with regard to use of patient engagement processes.

Previous research has found that patients who are actively engaged in their own care are more likely to adhere to treatment, perform regular self-monitoring, have better intermediate health outcomes, and report better mental health and physical functioning. for engaging patients in self-management include involving patients in long-term planning and goal setting, training providers in motivational interviewing, and promoting the use of shared medical appointments, group visits, peer support, and home telehealth. Improving organizational functioning of primary care teams may enhance patient engagement in care.

Care Practices to Promote Patient Engagement in VA Primary Care: Factors Associated With High Performance
David A. Katz, MD, MSc, et al
Iowa City VA Medical Center and the University of Iowa, Departments of Medicine and Epidemiology, Iowa City
https://www.annfammed.org/content/18/5/397

New research from UBC finds that after a night of shorter sleep, people react more emotionally to stressful events the next day--and they don't find as much joy in the good things. The study, led by health psychologist Nancy Sin, looks at how sleep affects our reaction to both stressful and positive events in daily life.

"When people experience something positive, such as getting a hug or spending time in nature, they typically feel happier that day," says Nancy Sin, assistant professor in UBC's department of psychology. "But we found that when a person sleeps less than their usual amount, they don't have as much of a boost in positive emotions from their positive events."

People also reported a number of stressful events in their daily lives, including arguments, social tensions, work and family stress, and being discriminated against. When people slept less than usual, they responded to these stressful events with a greater loss of positive emotions. This has important health implications: previous research by Sin and others shows that being unable to maintain positive emotions in the face of stress puts people at risk of inflammation and even an earlier death.

Using daily diary data from a national U.S. sample of almost 2,000 people, Sin analyzed sleep duration and how people responded to negative and positive situations the next day. The participants reported on their experiences and the amount of sleep they had the previous night in daily telephone interviews over eight days.

"The recommended guideline for a good night's sleep is at least seven hours, yet one in three adults don't meet this standard," says Sin. "A large body of research has shown that inadequate sleep increases the risk for mental disorders, chronic health conditions, and premature death. My study adds to this evidence by showing that even minor night-to-night fluctuations in sleep duration can have consequences in how people respond to events in their daily lives."

Chronic health conditions--such as heart disease, diabetes, and cancer--are prevalent among adults, especially as we grow older. Past research suggests that people with health conditions are more reactive when faced with stressful situations, possibly due to wear-and-tear of the physiological stress systems.

"We were also interested in whether adults with chronic health conditions might gain an even larger benefit from sleep than healthy adults," says Sin. "For those with chronic health conditions, we found that longer sleep--compared to one's usual sleep duration--led to better responses to positive experiences on the following day."

Sin hopes that by making sleep a priority, people can have a better quality of life and protect their long-term health.