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Tag Archives: Medical

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Is the pandemic to blame for lower college enrollments?

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As is customary for a high school principal who lives in the community that he serves, when I see my former students out and about in town I always ask them how they are doing and what they have been up to since graduation.

This season, I have been surprised to hear about the number of my students who have chosen to defer their freshman year of college. Among all of the reasons given, these three pandemic-related ones are often cited:

  • Uncomfortability with living in a dorm during the pandemic.
  • Dislike for a remote learning format (especially if paying the same tuition rate as an in person format).
  • Lack of money/finances due to other constraints in the family.

This trend is not just reserved for undergraduates. In the last three months, I have hired five of my recent graduates as temporary teachers because they finished their undergraduate degree but want to put off starting graduate school for the same reasons listed above.

I know my students’ situations are not unique, but rather part of a global trend. It seems, for the 20-something Generation Zers in our society, the pandemic has put many of their educational plans on hold for now.

Recently, Mind/Shift’s Elissa Nadworny reported that fall 2020 college enrollment plummeted for first-year students. Nadworny writes, “According to new data from the National Student Clearinghouse, undergraduate enrollment this fall declined by 3.6% from the fall of 2019. That’s more than 560,000 students and twice the rate of enrollment decline seen last year. Most of that decline occurred at community colleges, where enrollment fell by more than 10%, or more than 544,000 students.”

Indeed, according to the National Student Clearinghouse, which tracks college admissions, matriculation, and compilation rates, first-year college enrollments for the class of 2020 is down 22%, compared to the class of 2019. Perhaps the most alarming part of this statistic, according to National Student Clearinghouse Research Center Executive Director Doug Shapiro, is this: “…the pandemic impacted high school graduates in their immediate college enrollment, and those from high poverty, low income, and urban high schools have been hit the hardest.”

As Nadworny reports, the trend has put many colleges and universities into dire financial situations, with community colleges and other small schools feeling the brunt of the impact. This has forced many colleges to take drastic measures, including furloughs/layoffs for staff, cancellation of athletics and other programs, and cutting of academic courses, programs, and/or degrees.

The short supply of students is a problem that will continue to plague these schools even after the pandemic ends. A national trend of fewer live births equates to a downward enrollment in K-12 schools which will mean that the number of U.S. high school graduates will peak in 2025, and then start a decline that could last as long as 2037. This will greatly disrupt how colleges operate and plan for future budgets.

What will be the long-term impact of a decline in college degrees among Generation Zers? I predict two social trends will fill the void to address this:

  1. We will see an increasing number of students enter the trades. This move started before the pandemic, as I reported in this 2019 MultiBriefs Exclusive.
  2. We will see an increasing number of employers embed on-the-job training, licensure programs, and tuition reimbursement so that they can hire students directly from high school without formal college degrees.
  3. High schools will continue to fill the gap of providing students with entry-level college coursework through dual enrollment and industry-certification programming, subsidized by states and other organizations.

For years, we as educators conditioned our graduating seniors to believe that the logical next step to high school was a college degree. Will the pandemic disrupt this? I believe it will, but the scale of the disruption won’t be felt fully for several years to come.

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Costa Rica slowly opens to US travelers

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Costa Rica intends to allow all U.S. residents to visit the country as of Nov. 1. This move marks a radical departure from its policy of partial openings that started in the beginning of September. That allowed visitors from limited U.S. states to enter the country. The list later grew to 20 states and territories in recent weeks as conditions changed. Although waves of spikes continue to ripple through various U.S. states, Costa Rica still remains on target to uphold the November date.

Costa Rica currently remains the only country to allow Americans entry depending on their state of origin.

But there are still hurdles for those who want to head to the pristine rainforests and soft white beaches of this Central American tourism mecca, although officials only recently removed a requirement that visitors present a negative RT-PCR test result.

“As of October 26, all local and foreign passengers who entered Costa Rica by air must not present a RT-CPCR diagnostic test with a negative result,” the Costa Rica Tourist Board noted in a website update.

But there remains in place a provision called the “Health Pass,” a digital epidemiological form all visitors must complete. In the event of having to quarantine or accrue medical expenses during a stay, visitors will have to purchase travel insurance covering accommodations and any medical services. Policies can be purchased from an international company or bought in Costa Rica.

As of September, all hotels throughout the Costa Rica have been allowed to operate at 100% capacity, although common areas, like restaurants, gyms and swimming pools, operate at only 50% capacity.

Costa Rica’s opening to international tourism will continue to be responsible, careful and gradual, and will go hand-in-hand with the promotion of local tourism.

“I reiterate the call for joint responsibility to protect people’s health, and at the same time, the jobs that we hope to recover. If we all adhere to the protocols, the measures will be sustainable over time,” said Tourism Minister Gustavo Segura.

For those U.S. citizens flying in privately, private flights from the United States are now allowed to enter, but under the same requirements as described apply. Private yachts are also able to enter with the mitigating requirements. It is not clear if maritime passengers will need to bring a negative PCR test with them and whether, if they set sail from a city or country that has not been authorized, they will receive a quarantine health order. If so, the days they have been at sea will be deducted from the last sailing recorded in the yacht’s log. Top harbors for entry into Costa Rica are in Golfito, Los Sueños, Pez Vela, Banana Bay and Papagayo.

Costa Rica closed its borders to foreigners in March but reopened in August for visitors from the European Union, the United Kingdom and Canada. Asian countries, Australia, New Zealand and Uruguay were added the list in the ensuing weeks.

U.S. citizens began arriving in September from the cleared states of Connecticut, Maine, Maryland, New York, New Jersey, New Hampshire, Vermont and Virginia, plus the District of Columbia. On Sept. 15, Arizona, Colorado, Massachusetts, Michigan, New Mexico, Oregon, Pennsylvania, Rhode Island, Washington and Wyoming travelers joined the crowds, and as of Oct. 1, California and Ohio gained visitation privileges.

As of early October, American Airlines announced its preflight coronavirus (COVID-19) testing program for customers traveling to international destinations and Hawaii. The initial launch, scheduled for Oct. 15 for passengers traveling from the airline’s hub at Dallas/Fort Worth International Airport (DFW) to Hawaii, will now also include passengers traveling to Costa Rica.

The airline plans to launch a testing program at its Miami International Airport (MIA) hub for passengers traveling to Jamaica, the Bahamas and Costa Rica as well. American is also working with CARICOM, an integrated grouping of 20 Caribbean countries, to expand the program to additional markets in the region.

The preflight testing program at DFW for travel to Costa Rica is in partnership with LetsGetChecked and CareNow. But customers will be responsible for testing costs.

American is offering three options for preflight testing to customers with flights from DFW to Costa Rica:

  • At-home test from LetsGetChecked, observed by a medical professional via virtual visit, with results expected in 48 hours on average.
  • In-person testing at a CareNow urgent care location.
  • On-site rapid testing, administered by CareNow, at DFW.

Customers traveling from MIA to Costa Rica will initially have one option for preflight testing, with more options becoming available after the program launches at the hub. That is the at-home test from LetsGetChecked, with results expected in 48 hours on average.

Testing must be completed within 72 hours of the final leg of departure and tourists who test negative will be exempt from the country’s 14-day quarantine. Negative test results must be uploaded to the country’s Health Pass.

American resumed its operation in Costa Rica in September with service from its DFW and MIA hubs to San Jose (SJO). In early October, the airline resumed service to Liberia (LIR) from DFW and MIA, and now operates a total of 19 weekly flights to the country.

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Hawaii inches toward opening for tourism

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Traveling to Hawaii has never been tougher. The Aloha State, which saw visitor numbers nearing 10.5 million in 2019 has seen visitation decrease by some 50% this year so far. In May alone, that dip was down 98.9%. That number came to 9,116 visitors, and they traveled to Hawaii by air. That figure compared to 841,376 total visitors that entered by air and cruise ships during the same month a year ago.

On the upside, a new pre-travel testing program recently began in October that will allow visitors in Hawaii who test negative for COVID-19 to avoid the two weeks of mandatory quarantine Hawaii has had in place since the pandemic began.

Air Care

Hawaiian Airlines is now offering travelers visiting or returning to the Hawaiian Islands from the U.S. mainland a pre-travel COVID-19 test they can take from the comfort of their home to qualify to be exempt from the state of Hawai’i quarantine.

The tests can order the $150 mail-in saliva test online through Vault Health. The test kit, which is available for travelers of all ages including children, will be express mailed overnight to travelers who will self-collect their sample with assistance from a testing supervisor in a video call. The kit is express shipped overnight to Vault’s lab, which will process and analyze the sample and provide travelers their results electronically within 24 hours.

Travelers with a negative COVID-19 test taken at a state-approved testing facility within 72 hours of departure will be exempt from Hawaii’s 14-day quarantine upon arrival.

Hawaiian Airline’s new at-home COVID-19 test option adds to the carrier’s partnership with Worksite Labs that will provide guests exclusive access to drive-through PCR testing ($90 for results within 36 hours, or $150 for day-of-travel express service) from dedicated, conveniently located labs near Los Angeles (LAX) and San Francisco (SFO) international airports, with more testing locations coming soon to its other U.S. mainland gateways.

Hawaiian’s comprehensive health and safety program covers all aspects of the travel journey, starting at check-in, when guests must complete a health acknowledgment form indicating they are free of COVID-19 symptoms and will wear an adequate face mask or covering at the airport and during the flight.

Hawaiian’s enhanced cleaning includes frequent disinfecting of lobby areas, kiosks, and ticket counters, electrostatic aircraft cabin spraying, plexiglass barriers at staffed airport counters, and sanitizer wipe distribution to all guests. The carrier, which has been operating a reduced schedule since March and will continue to cap cabin capacity at 70% through Dec. 15 to allow for onboard distancing.

Hawaii Hotels Step Up

Through this jigsaw profile, some hotels and resorts are taking matters into their own hands and reopening now in anticipation of official opening announcements by the governor. One of those resorts is the Four Seasons Resort Maui at Wailea, which will be welcoming guests back on November 20.

The resort’s new Safe on Maui program is in place to ensure a comfortable and healthy environment for guests as they travel and through the duration of their stay. Along with state mandated negative test results, Four Seasons requires guests to present proof of a negative result upon arrival at the hotel as well.

“There’s no question that, right now, our guests’ and employees’ biggest concern is safety. So we focused efforts on reimagining safer travel that will both help protect our guests and, ultimately, our employees as well,” says General Manager Marc Bromley. “Our guests will enjoy the resort with the assurance that Four Seasons Maui has gone above and beyond.”

Meanwhile, the Four Seasons Resort Hualalai in Kona is embarking on a resort-wide renovation with plans to open up again on December 1. The multi-million dollar enhancement program will update almost every aspect of the Resort, further enhancing the guest experience while maintaining the distinct, authentic character of the Resort.

All rooms and suites in the Resort will be extensively renovated with updated finishes and furnishings. A new bungalow consisting of six oceanfront guest rooms, including a suite with a private pool, will be constructed adjacent to Kumukea Beach on the Resort’s northern edge, providing excellent views from its ocean front location.

The top three villas at the Resort — Hawaii Loa, Makaloa and Ho’onanea — will each be expanded to add a second story and unique design elements as they vie to become the largest and most luxurious villa room product in Hawaii.

Amenities across the property will be updated. King’s Pond, Hualalai’s 1.8 million-gallon swimmable aquarium, will receive a dramatic update with the addition of a new elevated swimming pool, lounge deck, and Marine Activity Center. Seashell Pool, the Resort’s family-friendly pool, will receive new tiling and finishes to complement the updated poolside furniture and umbrellas added in 2019. A dedicated Culinary Academy will also be added upstairs of ULU Ocean Grill + Sushi Lounge, hosting a plethora of interactive culinary experiences and guest chefs.

The entire golf experience is also receiving considerable attention. Hualalai recently announced a new addition to its award-winning golf program, the Hualalai Golf Hale. This 3,000-square-foot instruction and practice facility will be the ultimate destination for golf enthusiasts of all ages.

Beyond the Beach

As for activities and attractions, Blue Hawaiian Helicopters reopened in mid-October at its base on Maui. It is the only helicopter tour company serving all four major islands, and will be reopening additional bases on the Big Island and Kauai in November, followed by Oahu.

Visitors to Maui will have the option to choose from its two top selling scenic tours: Maui Spectacular and the Waterfalls of West Maui & Molokai. A maximum of six guests may join each tour.

To safely accommodate those customers, guests will be required to undergo non-contact infrared temperature checks, practice proper social distancing from other guests outside their personal group and maintain proper health and hygiene with hand sanitizer and hand washing stations throughout. Masks for employees and guests will also be mandated at all times upon arrival to the base and throughout the tour aboard the helicopter. Only one tour group (maximum of six guests) can enter the base at any given time. Extensive cleaning procedures are in place for cleaning bases and craft at the beginning of each day, every hour and at the end of the day.

Travelers can find the latest State of Hawaii guidelines, which continue to evolve, here.

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4 AI startups that you should know about

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There’s a good chance that you’ve heard about how artificial intelligence (AI) will transform the world forever, but you might not be aware that AI startups are already gaining traction. Artificial intelligence will eventually change every aspect of our daily lives, even if some might downplay it as another technological trend that they don’t know much about.

In the near future, there won’t be a sector that isn’t somehow affected by AI. McKinsey, one of the largest management consulting firms in the world, believes that AI could deliver $13 trillion worth of “global economic activity” by 2030.

Some of these AI startups are focused on improving the healthcare sector, while others might help companies communicate and engage with customers better than ever before. Here are some AI startups that you should know about.

Tempus

There are some AI startups that are still searching for funding, but Tempus certainly doesn’t have that issue. In fact, the company is already valued at $5 billion, and it was founded by Eric Lefkofsky, a co-founder of Groupon. The company, founded in 2015, has already raised hundreds of millions of dollars in funding. Tempus already reportedly works with 30% of all of the oncologists in the United States.

Tempus uses AI to analyze health data, and the hope is that this information will help doctors to personalize medical treatments of all kinds. Tempus also licenses out the anonymized data to drug companies, providing another source of revenue.

Dixa

Some AI startups aren’t trying to tackle diseases but are instead focused on how to help organizations generate more revenue. Dixa, a Copenhagen-based AI startup, is focused on using artificial intelligence to personalize customer support. The company calls itself a “customer friendship platform,” and it has already raised millions in funding.

Dixa is focused on catering to customer needs, allowing them to communicate on their preferred platform. The company hopes to strengthen customer engagement for large companies, and it boasts that Dixa can be up and running for clients in just one business day.

JukeDeck

When you think about AI startups, many individuals immediately think about organizations that will use AI to improve healthcare or automate business processes for maximum efficiency. Jukedeck, however, is an AI startup that develops royalty-free music using artificial intelligence technology. In fact, Bytedance, the company behind the massively successful TikTok app, has acquired the company. Tiktok has been downloaded over 1.5 billion times.

Many viral Tiktok videos use music that is owned by record labels, and it is suggested that this is Bytedance’s way of avoiding having to pay out royalties to these music companies. Before Jukedeck was even acquired, it had raised $2.5 million in funding. It is unclear exactly how Tiktok will utilize Jukedeck, although many believe that Bytedance will be creating its own AI-generated music, since music is such an integral part of Tiktok.

Five

Some of the most powerful tech giants in the world are interested in driverless cars, including companies such as Google and Tesla. Five is also a known player in the space, and has already raised millions, like many other AI startups. Five was formerly known as FiveAI.

Five originally planned to build their own fleet of self-driving cars, but it appears to be moving in a different direction. Specifically, Five hopes to license its technology to other organizations so that they can build their own autonomous cars, as well as determine the accuracy of driving systems, as well.

For those who are wondering about the name, autonomous cars are said to reach “Level 5” when they are truly autonomous. The company announced $41 million in funding several months ago.

Conclusion

It is hard to tell which AI companies will be able to thrive over the next several years, and there’s a good chance that smaller AI firms will become larger players once they secure specific clients and contracts. However, it’s clear that many investors are extremely interested in AI-related companies, as AI startups raised over $18 billion just last year — a new funding record.

Some of the companies listed here are already worth over a billion dollars, which probably means that they have the resources and connections to compete successfully. Either way, one thing is for sure: all of these AI startups are worth watching!

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Take a hike, for your health

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There are 60,000 miles of hiking trails in the United States. A brisk walk will boost your mood, but it could also improve your body’s response to vaccination, and that’s worth talking about during flu season and a global pandemic.

What is Vaccination Response?

When you get a vaccine, your body responds by improving your immunity to the disease the vaccine prevents. So, while vaccines are important, vaccination response is equally essential.

Vaccination response is “a measure of integrated immune function elicited by antigen exposure and measured by antibody titer and/or cell-mediated response.

Aggregate alterations in vaccine response can affect the prevalence of severe cases and deaths, and thus vaccination programs themselves.

Behavioral alterations that improve vaccination response, like exercise, are fantastic because they can significantly affect immunity quickly and affordably.

Yes, a hike (or even walk) can make a difference.

Exercise and Vaccination Response

Now is the perfect time to start thinking about how exercise benefits your health.

“Physical activity improves the immune system in general, and as antibodies are an important part of the immune system, they too are impacted by increased activity,” said Tim Church, M.D., M.P.H., Ph.D., a national leader in exercise and obesity research and Chief Medical Officer at Naturally Slim. “A consistent, moderate exercise program is associated with improved immune function, which includes antibody formation.”

But that’s not all. Many studies are showing that regular exercise improves our response to vaccination. For example, in a 10-month randomized control trial, Woods and colleagues demonstrated that exercise produced better vaccination responses. In their study, cardiovascular exercise significantly increased seroprotection 24 weeks after vaccination in previously sedentary but healthy older adults.

Participants who received flexibility and balance training instead of cardiovascular exercise did not experience similar increases in seroprotection. Participants assigned to the cardiovascular exercise group performed 45-60 minutes of endurance exercise at 60-70% maximal oxygen uptake three times a week.

In another study, regular exercise improved response to novel antigens. Participants who had participated in ten months of cardiovascular training had better vaccination responses than those who did flexibility training, as evidenced by IgG1 and IgM concentrations after Keyhole limpet hemocyanin (K.L.H.) vaccination.

A growing body of literature supports the notion that “regular exercise improves immune function, which is reflected in greater antibody or cell-mediated responses to vaccination, especially in older adults.

Even a single bout of exercise, performed alongside vaccination, can improve our immune response after vaccination.

In one study, researchers compared the vaccination response of those who completed exercise (15 min resistance band task) or rest before receiving a pneumococcal vaccine and those who received a full dose or half dose of the vaccine. Exercise groups had more robust responses than control groups when collapsed against all doses. Still, when looking at only groups who received the full vaccination dose, vaccination responses were similar between control and exercise groups. Intriguingly, in groups that received a half dose of vaccine, five strains had better responses in the exercise group than the control group.

Future studies are likely to continue investigating the value of acute exercise as a supplement to be administered in conjunction with vaccination. Information about the amount and type of training will be especially useful when using physical activity as an adjuvant to vaccination among the elderly who can have reduced responses to vaccination alongside a decline in immune function.

Get Your Heart Rate Up. Go Hike!

It seems that habitual cardiovascular exercise has the most significant effect on vaccination response. But some movement is always better than none. So, make the most of hiking before the weather gets too cold, and afterward, consider getting your flu vaccine.

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Learning disabilities, ADHD, and the psychopharmacologist

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About one-third of individuals diagnosed with learning disabilities have also been diagnosed with ADHD.

The treatment of ADHD, particularly with the use of medication, has proven to be extraordinarily successful and unbelievably beneficial to the quality of life for the great majority of people. This article will provide a substantial understanding to the psychopharmacology of ADHD. Although the FDA has designated very specific medications that have been indicated for ADHD, the use of these medicines off label may, in fact, be helpful to those individuals with and without ADHD. This was demonstrated as far back as the 1940s.

ADHD has been described as a group of symptoms associated with the nervous system, particularly the prefrontal cortex. Medication approaches generally will increase two of the three major chemicals that nerves have used to talk with each other: norepinephrine and dopamine. They are presumed to be lower in individuals that have ADHD.

The specialist in ADHD medications, the psychopharmacologist, has separated medicine treatments into two groups called stimulants and non-stimulants, and divided ADHD into three major cognitive behavioral symptom subsets.

Why? The “inattentive symptoms” such as difficulty with sustained attention, or getting distracted easily, have responded best to the medicines called stimulants. Next, behaviors associated with “impulsivity and/or hyperactivity” such as actions completed without thinking of consequences, or the display of excessive motoric activity, have been treated successfully by both non-stimulants and stimulants. However, the third area described by the psychopharmacologist, executive function which denotes the ability to organize material and place information in a hierarchy, does not have a specific medication intervention found to be effective.

Most people generally respond well to stimulants regardless of age. Youngsters up to the age of puberty have been found to respond best to methylphenidates (Ritalin, Concerta, etc.). Beyond puberty, amphetamine-based medicines (Dexedrine, Adderall, etc.) have been shown as the most effective stimulant type.

Since stimulants have been the most commonly prescribed medications for ADHD, and the methylphenidates seem to be used prior to puberty and amphetamines after puberty, how does one choose which specific medications are best within the methylphenidate family and the amphetamine family? Each of these stimulant families have members that are liquid, tablets, orally disintegrating tablets, and capsules. The preferential method of swallowing medication has been used to make that decision. The duration of action desired would follow.

The ideal medication would last the entire day after one morning dose. Sometimes a booster in the afternoon is necessary. Timing of the dose has been shown to be an important factor. For instance, the time in the morning for the medication to kick in and work may be critical in some individuals. A recently developed stimulant taken at night that does not become active until one has woken up in the morning has become available.

Sometimes, there are multiple medications with the same duration of action yet may be drastically different in cost and quality.

Generic formulations have certain mandated parameters of equivalence in relationship to the brand medicine. Still, the clinical effect can vary generic to generic, because of the differences in fillers, dissolving and absorption properties, etc.

One should keep track of the pharmaceutical companies making the medicine, and if there are changes in what has been given, as well as to the response to that specific generic. Generics are much less expensive, except if there are certain pharmaceutical companies with special discounts that want you to try their brand. Always check with the pharmaceutical company for discount coupons, and with companies that discount generic medications at specific pharmacies, and with your insurance company.

Before starting any medication, make sure that all causes of the symptoms are seriously considered — psychological, medical, medication, substance usage, etc. Always verify that a person has been deemed medically safe and psychologically appropriate for any given medication.

ADHD may coexist with other problems. These comorbid conditions each have their own treatment protocol. Trichotillomania, tics, Tourette’s, epilepsy, insomnia, anorexia/bulimia/orthorexia, obesity, short stature, structural heart problems, arrhythmias, high and low blood pressure, diabetes, substance abuse, — all have unique treatment options that may supersede intervention for ADHD. Disorders such as obsessive compulsive, bipolar and unipolar, anxiety, insomnia, short stature, oppositional defiant, as well as autistic spectrum disorder have potentially confounding medical aspects that often must be considered prior to ADHD treatments.

The use of stimulants has always carried risks of misuse, diversion, and potential medical and psychiatric side effects such as growth issues, heart and blood pressure issues, and uncommonly mood disorders. Even if an individual has not demonstrated ADHD symptoms, stimulants may enhance ease of learning.

Since World War II, various preparations have been given to certain non-ADHD combatants to maximize focus, duration of attention, etc., but all with a potential risk. Every physician has to assess the risk to benefit ratio for each patient, and above all else, do no harm. These medications have FDA approval often solely limited to professionally diagnosed ADHD.

Medication combinations have been rationally prescribed within medical parameters. A long acting methylphenidate might have a short acting methylphenidate booster. A long acting amphetamine could have a short acting amphetamine booster. Generally, methylphenidates and amphetamines are not mixed together.

Each individual medicine has its own guidance on dosing determined by the manufacturer. When using several stimulants in a family, the sum amount of medications must always be considered. If multiple non-related medications have been suggested together, the psychopharmacologist must consider drug-drug interactions and metabolism of each medication individually, as well as the total effect of all the medicines together.

The non-stimulants can be used singly, or in combination with stimulants, and possibly even with other non-stimulants. The non-stimulant category members that have been FDA approved for ADHD include atomoxetine (Strattera), and the alpha adrenergic antihypertensives guanfacine ER (Intuniv) and clonidine ER (Kapvay). Atomoxetine has often been used alone especially in people that have extraordinarily high anxiety states, and possibly on the autistic spectrum. The alpha adrenergics have been used alone especially if the person presented solely with impulsivity/hyperactivity.

The non-stimulants have often been used first in people with tics, Tourette’s, sensitivity to getting high blood pressure, issues with poor appetite, or those that have addiction tendencies. The non-stimulants (particularly the antihypertensives) have been used as adjuncts to stimulants especially when there has been residual impulsivity and hyperactivity. However, in the past, there have been extraordinarily rare cardiac issues when the antihypertensives are combined with stimulants. Very special caution should be used when one has determined the combination may be beneficial. Atomoxetine has augmented stimulants as well as the alpha adrenergic antihypertensives especially when inattentive symptoms have not been totally ameliorated.

Off label use of medications has been helpful under certain circumstances, especially in adults. Different bupropions (Wellbutrin, Aplenzin, etc.) may help not only ADHD, but also depression, etc. Modafinil (Provigil, Nuvigil) has helped with the focus and energy issues experienced by adults.

Each medicine has its own specific side effect profile and contraindications. These issues must be discussed with the physician. For many years, especially on the East Coast, tricyclic antidepressants and monoamine oxidase inhibitors, both not especially common nowadays because of serious side effects, have been used carefully in adult ADHD. Venlafaxines (Effexors) which increase serotonin, norepinephrine, and at higher doses dopamine, have been used off label for ADHD.

Finally, ADHD is often a subset of a larger syndrome/illness, or a common comorbidity to many many issues, especially learning disabilities. The specific learning disability that has involved executive function may be the most problematic portion of ADHD for a person, or as a separate disability itself.

As of yet, the FDA has not approved any medications for difficulties with executive function or any other learning disabilities. Various studies regarding the use of medicines for the many aspects of processing speed, for example, have yielded conflicting results.

In conclusion, anyone that has been diagnosed with learning disabilities should be thoroughly evaluated with great care and precision for medical, psychological, environmental factors, and comorbidities. The coexistence of other difficulties has been found to be very common, particularly ADHD. The most effective intervention for all learning disabilities has been to consider each and every coexisting condition and the risk to benefit ratio in the treatment (and non-treatment) of all entities. Precision diagnoses along with exacting interventions by an astute, experienced clinician will yield the best results in an individual’s quality of life.

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Will rapid COVID-19 tests help K-12 schools?

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Shortly before he was diagnosed with COVID-19, President Trump announced that the federal government would begin distributing millions of rapid coronavirus tests. The goal is to use them to urge faster reopening of K-12 schools. As virus cases continue to pile up, some school districts have announced staggered and hybrid learning modules for fall 2020 and beyond.

About Abbott Laboratories’ BinaxNOW tests

The tests are a part of the previously announced supply of 150 million ordered from Abbott Laboratories. A total of 100 million tests will be distributed to the states, according to their population. While ostensibly they are to be used as governors see fit, the Trump administration is emphasizing testing and prioritizing K-12 schools.

The reason, according to the administration, is simple. They feel regularizing learning is important to the physical, social and emotional development of students.

The Abbott tests, the size of a credit card, deliver results in about 15 minutes without the need for special computer equipment. They not only deliver rapid results but are also low-cost and come in an easy-to-use format. They cost about $5 to $6 apiece, compared to the traditional swab, which is $100 a piece.

Parents and schools will immediately know whether an asymptomatic child has COVID-19. Some states could opt for baseline surveillance and test a certain proportion of students per week or month.

Will the tests help?

Abbott’s tests will help meet the testing backlog for COVID-19, which has led to repeated delays in reporting results in the past months. High-grade medical laboratories are more accurate, but they take several days to process. Abbott reported positive cases may still have to be sent to higher-grade labs for confirmation, but the overall backlog could reduce.

There is one major cause of worry, though. State officials feel that many tests are going unreported because the tests are often performed outside the healthcare system. It could skew the government data needed to track the virus and lead to undercounts of new cases.

According to a report by the nonprofit Rockefeller Foundation, the U.S. will need roughly 200 million tests per month to reopen schools safely. Right now, we are averaging fewer than 30 million tests per month.

How are states responding?

Oklahoma announced that it had received about 77,000 rapid point-of-care COVID-19 tests. The Oklahoma State Department of Health will prioritize the distribution of these Abbott Laboratories BinaxNOW tests and equipment to K-12 schools. Next, they are deploying them to health care workers and vulnerable populations.

Arizona, which will get more than 2 million rapid COVID-19 tests from the federal government, announced that it, too, will prioritize K-12 schools. County health experts and local authorities will decide which schools and facilities will get the tests. Next, they will focus on vulnerable populations, including those with developmental disabilities and foster care.

Tennessee’s governor echoed the above statements and said that its first 133,000 of the projected 2 million tests would be deployed to reopen public K-12 schools across the state. The rapid point-of-care coronavirus test kits will also help the state in its continued approach to protect the elderly in nursing homes and long-term care facilities.

Washington state and Oregon are ready to deploy the rapid tests as well. The former expects to receive 2.3 million of the rapid tests by the end of the year. Oregon will receive 60,000 to 80,000 new rapid Abbott BinaxNOW antigen tests per week through the end of the year. The increased testing capacity will help diagnose and treat more people quickly, isolate and quarantine people, helping contain the virus. The more it is contained, the easier it will be to reopen schools and help life get back to normal.

While there are concerns about the authenticity of reporting and meeting backlog effectively, state leaders and public health officials hope that the rapid tests will make them more agile in making public health decisions related to business operations and school reopening. The administration hopes that the tests will help schools to stay open, and parents return to work.

With the renewed panic of the second wave of COVID-19, the tests will help diagnose people fast. Some states are already reporting a spike, provoking fears in the populace.

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Algorithm could help keep consumers safe from illegal online pharmacies

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It might be tempting to purchase your medicines from an online pharmacy to save money, but beware. Some online pharmacies are selling ineffective and even dangerous products.

The National Association of Boards of Pharmacy (NABP) reported this year that it identified dozens of illicit online pharmacies (IOPs) selling drugs marketed as treatments for COVID-19, drugs that would normally require a prescription.

“Rogue internet pharmacy networks are run by criminal opportunists, and the coronavirus disease 2019 (COVID-19) pandemic has provided the perfect opportunity for illegal online drug sellers to prey on fearful consumers,” the NABP says in its “Rogue Rx Activity Report.”

But now, researchers at Penn State University have developed an algorithm that may be able to identify which online pharmacies are legitimate and which ones are not. They wrote about their findings in the Journal of Medical Internet Research.

IOPs are a serious problem, says Soundar Kumara, Ph.D., the Allen E. Pearce and Allen M. Pearce Professor of Industrial Engineering. Illegal pharmacies can, for example, sell unwitting customers drugs mixed with ineffective ingredients like corn starch.

“If they’re adulterated,” says Kumara, “you cannot get the right dosage. So the effectiveness of the drug could be wrong, and, people could die.”

“In addition, some expensive drugs can be counterfeited,” he says. “So, for example, if someone wants to buy a drug for an immune-compromised disease that costs $3,000, and they go online and the online pharmacy says, ‘We can give you the drug for $1,000,’ that person may feel that it’s great and get it, but it might not have the potency that is needed.”

Moreover, some IOPs sell highly addictive drugs such as oxycodone and other opioids without the required prescription from a physician, Kumara says.

“So, there are so many problems associated with having IOPs,” he says.

In a warning letter from the Food and Drug Administration (FDA) in September, the agency notified a number of rogue online pharmacies that they were in violation of the U.S. Food, Drug and Cosmetic Act by:

“Offering for sale unapproved prescription drugs of unknown origin, safety, and effectiveness; offering prescription drugs without a prescription; offering prescription drugs without adequate directions for safe use; and offering prescription drugs without FDA-required warnings to consumers about the serious health risks associated with the prescription drug.”

In its BeSafeRx campaign, the FDA says, “A safe, legal internet pharmacy always requires a doctor’s prescription, has a physical address and phone number in the United States, is licensed by the state where they are doing business and has a state-licensed pharmacist on staff to answer questions by the patient.”

But catching and stopping IOPs is difficult for several reasons, says Hui Zhao, Ph.D., a Penn State associate professor of supply chain and information systems and the Charles and Lilian Binder Faculty Fellow in the Smeal College of Business.

“Nobody really knows how many are out there,” she says. “But there are at least 30,000 to 35,000.”

“But we don’t really know because of the dynamic nature of online pharmacies,” she says. “Online markets come and go easily. They disappear here and pop us somewhere else with a different URL.”

So Kumara, Zhao and Sowmyasri Muthupandi, a former research assistant, developed an algorithm to distinguish IOPs from the legal online pharmacies.

Using a dataset of 763 online pharmacy websites, the researchers examined web traffic and engagement data to observe the different ways consumers find and engaged with the online pharmacies. In particular, they focused on referral links between websites.

If customers consistently come upon an online pharmacy through referral links that regularly link to illicit pharmacies, chances are the online pharmacy is also illicit, Zhao says.

“On the other hand,” says Zhao, “if I find that website X has been referenced by a site that mostly refers to the legal ones, then I would say there’s a higher likelihood that X is a legal one.”

“Think about your social network,” she says. “If a person hangs out with bad guys, then likely, if he hangs out with another person, that person likely belongs to this similar group.”

Their prediction models achieved an accuracy rate of more than 95%in identifying IOPs, she says. The prediction models could have many applications, Kumara and Zhao say.

In their journal article, they write that search engines, online retailers as well as credit card and other payment companies could someday use the models to either filter out IOPs or consider the status of an online pharmacy when ranking search results.

The tool could also be used to fashion a warning system that could notify consumers as to which pharmacies are legal and which ones are not, they say.

“Policy makers, government agencies, patient advocacy groups and drug manufacturers may also use such a system to identify, monitor, curb IOPs, and educate consumers.”

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Improving senior care by mimicking natural light cycles with LED technology

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Numerous studies have identified the need for better lighting conditions in senior care facilities. Residents often have too little exposure to natural light during the day and are subjected to leaks from artificial lighting during the night. This can lead to a range of health problems, from erratic sleep patterns to impaired cognition to listlessness and depression.

Recent developments in LED technology may provide a solution by creating interior lighting conditions that change throughout the day and night, mimicking the natural light cycle to which the body is attuned.

Results of studies on sleep quality and lighting examined as part of a comprehensive literature review of research on older adults’ visual and nonvisual performance conducted by a team from the University of Florida, Gainesville (including Nam-Kyu Park with the Department of Interior Design) indicate that “daylight exposure benefits older adults’ sleep quality, and nighttime/evening lighting exposure has a negative impact on older adults’ sleep quality.”

Other studies have shown that lighting levels affect the production of melatonin that helps to regulate the body’s circadian rhythms, which, in turn, affect sleep patterns. As we age, changes occur which alter normal circadian rhythms, as can conditions such as Alzheimer’s, making this a critical issue in senior care.

The authors of a paper advocating for human-centric lighting design, recently published in the journal Lighting Research and Technology, point out that while lighting for visibility, visual comfort and visual amenity is important, equally important is recognizing how light and lighting influence non-visual responses in humans. “Circadian, neuroendocrine and neurobehavioural responses are important for human health and should be considered on-par with visual responses,” they state. “This awareness leads toward lighting design solutions with increased contrast between day and night.”

Previous attempts to simulate the quality and level of natural light in senior care have produced mixed results because the technology was not adequate or relied on manual controls. The introduction of LED technology has changed that. In 2013, faculty members from the College of Engineering at Drexel University presented a paper in which they announced that they were developing an “energy-conserving diurnal daylight-matching LED luminaire to improve health outcomes for the elderly at St. Francis Country House near Philadelphia, Pennsylvania.”

In 2016, the U.S. Department of Energy published a report of a project it funded under its GATEWAY program, Tuning the Light in Senior Care, which summarizes the results of a trial installation of light-emitting diode (LED) lighting systems in several spaces within the ACC Care Center in Sacramento, California. The study used solid-state LED technology to “tune” the lighting to different levels at different times of the day in order to mimic natural light cycles.

In some areas, the lighting was controlled manually by the staff. The corridor lighting was programmed to change automatically but could be overridden with a manual control. Among the health benefits observed by the staff that may have been attributable to the change in lighting were a 41% reduction in yelling, agitation and crying for three residents, improved sleep without interruption, and reduction in the use of sleep and psychotropic medications.

More recently, a team led by researchers from the Brown University School of Public Health’s Center for Long-Term Care Quality & Innovation (and including Eunice Noelle-Wagner, president, Center of Design for an Aging Society) conducted an additional research study at the ACC Care Center that expanded the scope and employed the use of automated tuned lighting to change color and intensity settings automatically during the course of the day and night.

At the end of the two-month intervention, they found that the residents in those areas with autotuned lighting experienced half as many nighttime sleep disturbances as did the control group that were exposed to static lighting conditions. Unlike the previous study, they did not observe significant differences in agitate behaviors.

While more research is needed, the results of these studies is promising. The authors of the literature review cited above caution that some studies to date point to “other related physical environment factors, such as noise, that may interact or coincide with lighting and affect sleep quality.” Even so, advances in lighting technology appear to open new avenues for addressing a major issue in the design of interior environments in senior care facilities.

As the authors of the paper on human-centric lighting design state in their conclusion, “The parties responsible for addressing non-visual responses to light and lighting are evolving. Architects, lighting professionals, lighting equipment manufacturers, medical professionals, building owners and individuals all have a stake.” That includes interior designers as well.

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Why post-COVID-19 U.S. education will be even less like it used to be than you think

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When COVID-19 first became a national conversation topic, sometime this past March, a flurry of articles in major U.S. publications followed proposing what, post-COVID-19, would remain the same and what would be different. Since then, fewer articles have appeared with each succeeding month.

There seems to be an assumption that these issues have largely been resolved, that while we may not like every change, we at least have a pretty good idea of what post-COVID U.S. education will look like. A previous experience with the interaction of a school system and a disaster this century, Hurricane Katrina, should warn us that we’re probably underestimating how extensive and profound those changes are likely to be.

The Neglected Lesson of Katrina

In a prescient article written back in April, Brookings fellow Douglas N. Harris reminds us that after Katrina education in New Orleans was profoundly different: “The state took over almost all the city’s public schools,” “teacher tenure and the union contract ended,” and students were no longer assigned to specific schools based on where they lived.

Consider that achieving a similar (and still imperfect) disconnect between where students live and where they go to school took about 12 years in Boston. After Katrina, this was achieved almost immediately and was only one of at least four major changes in how education worked in New Orleans. It seems unrealistic to think that U.S. education post-COVID — a disaster that exceeds Katrina by at least an order of magnitude — will look much like it did in 2019.

Yet, according to a late September Pew Research Center poll, nearly half of all Americans expect life will “basically go back to normal,” once the pandemic is over. So far as education is concerned, there’s at least one good reason why this is unlikely.

The End of the Classroom?

One of the most basic changes, post-COVID, could be an end to classroom teaching entirely. To some extent, this change was already coming before COVID emerged. The current model, one teacher in the same room with a finite number of students, often around 30, doesn’t fit digital technology particularly well.

Writing for Microsoft, Geoff Spencer has proposed that the push for major changes was already underway before the pandemic struck and that they will “go far beyond just online lessons at home.” He proposes a general shift away from a teaching culture to what he calls “a learning culture,” where, more often, the teacher will act remotely as a one-on-one facilitator helping students with particular learning needs as they progress through AI-enhanced learning processes where interaction is already built into the learning programs.

How Change May Come

Changing where education takes place implicates almost everything else: some costs will go down (physical classroom building and maintenance), others will rise (digital support and social outreach personnel).

Once the connection between residential location and school is broken, parents (and teachers, too!) may insist on greater economic equality in K-12 education generally. That the quality of public-school education a child receives depends upon how much housing costs in their neighborhood has always been implicitly undemocratic and, ultimately, negatively affects our productivity, leaving potentially productive citizens without the education they need to thrive and contribute.

If shifting from classroom to remote education becomes extensive and permanent, American family life will also change. At first the changes will be difficult, but as families adapt, there will be offsetting benefits. Daily commutes for workers and students alike may become “very 20th century,” and the home may regain the social centrality it enjoyed before the rise of public education and the dominance of large corporations that housed their employees in elaborate and expensive office spaces miles away from their neighborhoods.

As we progress through this pandemic — which may cycle in intensity several times over another year to a year and a half before it’s finally defeated — we may discover unforeseen difficulties and opportunities. But I think we’ll do well to accept that there’s little chance that education will return to the way it was before COVID-19 happened and that, regarding the reinstitution of classroom-based learning, skepticism is particularly appropriate.

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