The best medicine for a COVID-19 economy? More education and training

Reading the tea leaves of a U.S. economy reshaped by COVID-19 has sent economic analysts and prognosticators into overdrive. Many see a move away from big cities and into simpler, socially distanced life in small towns. If this happens at scale, it could be a boon to heretofore “left-behind” places in the Midwest and other regions.

Others predict significant drops in demand for jobs with low education and training requirements, driven by automation and the growth of technology needed to operate socially distanced offices, warehouses, manufacturing facilities and even restaurants. A recently released analysis by the Federal Reserve Bank of Philadelphia lends support to this idea.

Policymakers can adopt policies to help improve wages and opportunities in jobs with fewer credentialing requirements, for example by helping smaller manufacturers and boosting the minimum wage. But policy also needs to directly address the need for more workers with higher skills due both to the pandemic and longer-run economic trends. In many of the new and growing jobs, these higher skill requirements can best be met by providing workers with more extensive and affordable post-secondary opportunities.

As one of us argued earlier this year in the New York Times, some industries will benefit from the COVID-19-related economic crisis, but those most likely to do so – in fields such as health care, medical devices and communications – require workers with associate degrees or short-term certifications of the sort available at community colleges. A society that moves fast to retrain its work force for these new opportunities will recover more quickly than one that does not.

Deep recessions like the one we are currently in accelerate existing trends towards automation and change the skills demanded by employers. Again, this poses a particular challenge for manufacturing-reliant regions that have been hard-hit by the coronavirus and were already home to an aging workforce lagging in rates of postsecondary education.

The U.S. needs a nationwide program that offers tuition-free education to adult workers, much like the GI Bill for returning servicemen and women after World War II. As Congress continues to debate its financial response to the COVID-19-induced recession, it is worth noting that such a program would require a relatively small investment, costing barely $5 billion over four years even if the take-up rate is very high.

In Michigan, the Futures for Frontliners program, created with federal money by Gov. Gretchen WhitmerGretchen WhitmerBiden leads Trump by 8 points in Michigan: poll The Hill’s Campaign Report: Debate fallout l Trump clarifies remarks on Proud Boys l Down to the wire in South Carolina Michigan governor extends state of emergency due to COVID-19 through October MORE, will cover community college tuition and fees for essential workers without college degrees. It represents one possible model, and the enthusiastic early response suggests that such initiatives would be welcomed.

The worry about diverging economic opportunities for differentially educated people and places is nothing new. The gap in earnings based on education was widening even before the pandemic and is

Memorial Hermann rolls out breast cancer prevention program as screening rates plummet

As Breast Cancer Awareness Month begins, Jessica Jones, assistant professor of oncology at McGovern Medical School at UTHealth and an attending physician at Memorial Hermann Cancer Center, is working to get the word out to women that it is never too early to work toward preventing breast cancer.

“It’s important to dispel the fear surrounding mammograms during COVID-19 because some frightening statistics are coming our way with mammograms down by 86 percent,” Jones said.

An IQVIA Institute for Human Data Science report published in April shows that a reduction of cancer screenings in the three months leading up to June 5 may have resulted in 36,000 delayed breast cancer diagnoses in the United States.

“We have missed 36,000 (cases) of breast cancer already so this breast cancer awareness month is more important than ever,” Jones said.

Coincidentally, Memorial Hermann recently rolled out its Breast Cancer Prevention Program at both the Texas Medical Center and UT Physicians Multispecialty Clinic-Bayshore as less women get screened for breast cancer due to COVID-19.

The Breast Cancer Prevention Program specializes in treating women who have higher risks of breast cancer with medication and additional screening. The program has been in the works for one year due to women getting less and less breast cancer screenings, Jones said. Although it’s currently only at two locations, the program is available for patients of any Memorial Hermann hospital in the Houston area.

“Research has shown that with medication, MRIs and mammograms we can effectively reduce breast cancer risks by 50 percent and curative rate, if we catch it early, is at 98 percent,” Jones said. “Every woman can get a personalized risk assessment predicting her chance of breast cancer.

“A lot of women, when they start doing their mammograms at the age of 40, they get used to that feeling of always getting a callback every six months. No. You don’t need to do that. We can find ways to help you so you don’t get the six month callback.”

The breast cancer prevention program, currently accepting new patients, sits down with patients and a multidisciplinary team focused on breast health. The team assess risks factors, breast density, hormones, height, family history and weight to help a patient through the process before prescribing medication, like Tamoxifen, which is used to prevent and treat breast cancer. Patients who are found to have increased risk qualify for additional screening and imaging.

If anything, Jones said she wants women to get screened for breast cancer regularly and to act on the results, especially if they are abnormal, because cancer can be prevented.

“Part of the problem is that the knowledge lies in a cancer doctor in a cancer when it’s this specialized,” Jones said. “That is why this clinic is so important. It’s utilizing my knowledge of breast cancer to prevent for a woman who

Cell Therapy for Anthracycline Cardiomyopathy Safe, Feasible

In yet another trial of cell therapy for heart failure, this time in cancer survivors with anthracycline-induced cardiomyopathy (AIC), administration of allogeneic bone marrow-derived mesenchymal stromal cells (allo-MSCs) was shown to be safe and feasible.

The phase 1 SENECA trial was conducted at multiple sites under the auspices of the Cardiovascular Cell Therapy Research Network (CCTRN) and was published online September 30 in JACC CardioOncology.

“This is the first in-human clinical trial of cell therapy for patients with anthracycline-induced cardiomyopathy, a very serious disease with a very grim prognosis which is actually worse than ischemic cardiomyopathy, and for which treatment options are very limited at the moment,” first author Roberto Bolli, MD, professor of medicine and director of the University of Louisville’s Institute of Molecular Cardiology in Louisville, Kentucky, told | Medscape Cardiology.

Dr Roberto Bolli

“The study was successful in showing that the treatment is safe, we did not have any serious adverse events, and that it is feasible in all patients,” Bolli said. “We also wanted to see if there was a signal for efficacy, but I want to stress that this was a small study and was not powered or designed to establish efficacy,” he added.

SENECA included 31 patients. Most (68%) were women; 32% were non-White; 14% Hispanic; and the mean age was 56.6 years (range 44.8 to 68.4 years). The most common cancer was breast cancer, in 48%, followed by non-Hodgkin lymphoma (19%), leukemia (10%), Hodgkin lymphoma (3%), and sarcomas (3%).

The average interval since cancer diagnosis was 17.7 ± 8.9 years, and since the last cancer treatment, it was 15.2 ± 8.4 years. The average time since AIC diagnosis was 7.5 ± 5.5 years.

After an open-label lead-in phase done in 6 volunteer patients established that the procedure was safe, the 31 patients were randomly assigned to receive either allo-MSCs (n = 14) or cell-free placebo (n = 17) administered via 20 transendocardial, electromechanically-guided injections.

Baseline variables were similar in both groups. The average left ventricular ejection fraction was 33 ± 5.3%, 84% of patients were in New York Heart Association functional class II, and the average NT-proBNP value was 1426 pg/mL. All were receiving maximally tolerated medical therapy for heart failure, and 58% had an implantable cardioverter-defibrillator or pacemaker.

The patients were followed up for 12 months. A total of 93 adverse events were reported in 27 study participants. Forty-two of these met the definition of serious adverse events; however, none of the 93 events were deemed to be related to treatment with allo-MSCs.

All patients randomly assigned to receive allo-MSCs were able to receive the protocol-specified dose of cells, thus proving feasibility.

Although SENECA was not designed to show efficacy, the researchers explored whether allo-MSCs produced a trend toward improved left ventricular function and functional status when compared with placebo. Variables that were evaluated included ventricular volumes, ejection fraction, and scar size as measured by MRI; 6-minute walking distance; NT-proBNP blood levels; and changes in quality of life as measured

How Chrissy Teigen’s openness can impact public perceptions of pregnancy loss

Chrissy Teigen’s recent announcement that she’d suffered a second-trimester pregnancy loss shocked her fans, not just because the news was devastating but also because of the heartbreaking photographs and caption she shared to social media.

The model, who was expecting her third child with singer John Legend, had been giving her 32 million Instagram followers regular updates about her complicated pregnancy, including details of her recent hospitalization and needing two blood transfusions.

And then, on Wednesday night, she posted a series of black-and-white images that laid bare the pain of her loss and the physically taxing process of childbirth, along with a note to the “little guy” she and Legend named Jack.

“To our Jack – I’m so sorry that the first few moments of your life were met with so many complications, that we couldn’t give you the home you needed to survive,” she wrote. “We will always love you.”

The post prompted an avalanche of support, with more than 10 million people “liking” it and thousands leaving comments. And despite the fact that some questioned Teigen’s rationale for opening up about the experience, experts told “Good Morning America” that her bravery could help remove some of the stigma associated with pregnancy loss.

Why women typically don’t discuss pregnancy loss

Pregnancy loss is disturbingly common in the United States, though it remains a taboo topic of conversation for many. Typically, medical professionals use the term “miscarriage” when referring to a loss before 20 weeks gestation, while “stillbirth” is used to describe a loss at 20 weeks or later. The American College of Obstetricians and Gynecologists reports that at least 10% of clinically recognized pregnancies end in miscarriage, though that number is likely higher because many women miscarry before they’ve confirmed they’re expecting. Stillbirth is considered by ACOG to be “one of the most common adverse pregnancy outcomes,” affecting 1 in 160 deliveries in the United States every year, or about 23,600 babies.

Ivy Margulies, a Los Angeles-based a clinical psychologist who specializes in pregnancy and infant loss, told “Good Morning America” the main reason many women don’t discuss their losses is because they feel guilty about them.

“They feel like they failed, their body failed and their body didn’t protect their baby — it didn’t do what it was supposed to do,” she said. “They feel culpable and like it’s their fault. It’s so emotionally complicated.”

Most of the time, no one is to blame. ACOG reports that 50% of miscarriages are due to a chromosomal abnormality, while “a significant portion” of stillbirths remain unexplained.

“It is very rare that anyone is at fault for a pregnancy loss. It is almost never the fault of the mom,” said Dr. Elizabeth Langen, a practicing OBGYN and clinical associate professor at the University of Michigan. “Women often ask about what they ate or how much they did or did not exercise and if that made a difference. As much as we want everyone to be as healthy as possible, these decisions

Depression and Biologic Use in Arthritis: Chicken or Egg?

Among patients with inflammatory rheumatic diseases, the initiation of a biologic treatment or switching to another biologic was associated with an increased likelihood of the use of antidepressants and anxiolytics, Greek researchers found.

In a multivariate analysis that adjusted for age, sex, type of underlying disease, and concomitant treatment with glucocorticoids and conventional disease-modifying antirheumatic drugs (DMARDs), there was a positive association between starting treatment with a biologic agent and the use of antidepressants (OR 1.248, 95% CI 1.153-1.350, P<0.0001) or anxiolytics (OR 1.178, 95% CI 1.099-1.263, P<0.0001), according to Petros P. Sfikakis, MD, of the National and Kapodistrian University of Athens, and colleagues.

Similarly, there was a positive association between switching to a different biologic and the use of antidepressants (OR 1.502, 95% CI 1.370-1.646, P<0.0001) or anxiolytics (OR 1.161, 95% CI 1.067-1.264, P=0.001), the researchers reported online in RMD Open: Rheumatic & Musculoskeletal Diseases.

“The relationship between mood disorders and inflammation seems to be bi-directional, as chronic pain and inflammation are considered to be important mediators of depression, while at the same time depression affects perception of pain and reduces response to treatment, possibly by minimizing patient adherence to medication,” Sfikakis and co-authors explained.

Despite the recognized association between inflammation and depression or anxiety, little is known about the effects of initiation or switching biologics in patients with the inflammatory rheumatic diseases rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS).

To address this knowledge gap, the researchers conducted a retrospective study using nationwide data from the Greek Government Center for Social Security Services medical database, which covers almost 100% of the country’s population.

A total of 42,815 patients with inflammatory rheumatic diseases were registered in the database, with 18,925 being treated with conventional DMARDs alone, usually methotrexate. During the 2-year period of 2016 to 2018, 23,890 patients initiated or continued treatment with a biologic, which was usually a tumor necrosis factor (TNF) inhibitor, including 12,002 patients with RA, 5,465 with PsA, and 6,423 with AS.

More patients with PsA (18%) switched from one biologic to another compared with those with RA (13%) or AS (13.5%), and women more often switched than men in all disease subtypes (P>0.0001 for all):

Patients with PsA who switched were younger than nonswitchers (54.96 vs 56.20 years, P=0.007), were slightly younger in the RA group (63.06 vs 63.80, P=0.051), and were similar ages in the AS group (50.79 vs 51.24, P=0.351).

The use of antidepressants or anxiolytics, respectively, was reported in 24% and 43% of patients with RA, 19% and 36% of those with PsA, and 16% and 30% of those with AS.

After adjustment for age, sex, disease subtype, and concomitant medication use, the likelihood of using antidepressants was higher in patients with AS than in those with PsA (OR 1.130, 95% CI 1.031-1.238, P=0.009), while the likelihood was lower for those with RA (OR 0.880, 95% CI 0.821-0.943, P<0.0001).

In addition, compared with the PsA group, those

With the country making no progress on average daily Covid-19 cases last month, officials fear a coming crisis

The US made no progress in lowering its baseline of Covid-19 cases in the past month despite experts’ urgent admonitions to reduce the daily count of new cases before the challenging fall and winter seasons.

a group of people sitting in a grassy field: People are socially distanced as they listen to music of the Kansas City Symphony on the lawn at the Liberty Memorial Saturday, Sept. 19, 2020, in Kansas City, Mo. (AP Photo/Charlie Riedel)

© Charlie Riedel/AP
People are socially distanced as they listen to music of the Kansas City Symphony on the lawn at the Liberty Memorial Saturday, Sept. 19, 2020, in Kansas City, Mo. (AP Photo/Charlie Riedel)

Hours before President Trump announced Friday that he and his wife tested positive for the virus, the average of daily new cases nationwide stood around 42,785. That’s about 500 more than on September 1, data from Johns Hopkins University shows, and more than double what the US saw in June, when lockdown restrictions began to ease.


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“No matter how you slice it, that’s not good,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a member of the White House Coronavirus Task Force, said last week. “We’re looking at 40,000 new cases per day. That’s unacceptable and that is what we’ve got to get down before we go into the more problematic winter.”

The Trumps, whose test result announcement came hours after the President revealed one of his closest aides had tested positive, will remain in the White House as they recover, his physician said.

“We will begin our quarantine and recovery process immediately,” Trump tweeted early Friday. “We will get through this TOGETHER!”

‘We are nearing a crisis’

Experts like Fauci say now is the time for cities and states to double down on safety measures to help combat a coming surge of Covid-19 cases. Among those measures are face masks, which remain the country’s most powerful tool against the virus until a vaccine becomes available.

If 95% of Americans wore masks, around 96,000 lives could be saved by January, according to projections from the University of Washington’s Institute for Health Metrics and Evaluation (IHME).

The institute’s director, Dr. Chris Murray, has warned of an explosion of Covid-19 cases in the coming months and a “deadly December” coming up. The IHME projects the US could see more than 3,000 daily deaths by the end of this year.

It also projects more than 370,000 Americans will have died by January. More than 208,000 have already died in the US since the start of the pandemic, and more than 7.3 million have been infected.

States setting Covid records

Local leaders across the US are stressing similar warnings, with 25 states reporting more new Covid-19 cases than the previous week.

On Friday, Kentucky reported 1,039 new cases of Covid-19, the second-highest number of new cases the state has reported since the pandemic began, Gov. Andy Beshear said in pre-recorded remarks he shared on his Facebook account.

The state has seen the highest four-day period of new cases in the last four days, Beshear said.

“This week is going to shatter last week’s record for number of cases. We have to do better,” the governor said.

Trump Has Treatment Options for Coronavirus. None of Them Are Good.

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President Donald Trump and first lady Melania Trump are infected with the SARS-CoV-2 virus that causes the dangerous disease COVID-19. Some of the president’s staff and individuals he has met recently have also tested positive for the virus, and results on a long list of White House and campaign staff are pending. Trump was taken to Walter Reed Military Medical Center Friday afternoon, where he will remain, White House officials say, for a few days. But what awaits him—and the country he still leads—as he deals with this virus?

Despite his 74 years and overweight frame, Trump has always tried to portray himself as vigorous, healthy, and even athletic. While depicting his thinner 77-year-old opponent Joe Biden as doddering, slow, and senile, Trump has tried to give the impression that he is Biden’s junior by far, more than the three chronological years that separate them.

He has similarly, and repeatedly, depicted the COVID-19 risk as somebody else’s problem. Older people with heart conditions might have to be concerned—certainly not Trump.

On Sept. 21, Trump looked out over a mostly mask-free crowd in Swanton, Ohio, and beamed, “Wow, this is a big crowd. This is a big crowd.” The crowd roared. And Trump brushed off concern about masks and COVID-19, saying: “It affects elderly people. Elderly people with heart problems. If they have other problems, that’s what it really affects. That’s it. … But it affects virtually nobody. It’s an amazing thing.”

The federal government defines “seniors and elderly,” for most medical, retirement, and tax purposes, as individuals over 65 years of age, which clearly puts Trump in the category he dismissed in Swanton as “virtually nobody.” Does he suffer from any underlying conditions, other than his weight, that may put him at additional risk? We don’t really know, because in his constant struggle to appear youthful, covering up his thinning hair and playing record-breaking hours of presidential golf, Trump has made sure that no genuine medical work-up reaches the public.

His Manhattan physician, Harold Bornstein—a wild-haired, colorful figure who looks more like a hippie than a board-certified gastroenterologist—in August 2016 certified, “His health is excellent, especially his mental health.” And in a December 2015 statement he said was dictated to him by a Trump aide and written hastily while a limousine waited outside, he wrote that then-candidate Trump’s physical strength and stamina were “extraordinary.”

Former White House physician Ronny Jackson, who is now the Republican Party’s candidate for the 13th Congressional District in Texas, has benefited tremendously since coming to the president’s attention in 2017. White House staff and Trump campaign officials have raised funds for his shot at a congressional seat and advised his campaign. Back in January 2018,

MA Coronavirus Daily Case Count Highest In Months

BOSTON — An additional 753 people tested positive for the coronavirus, the Massachusetts Department of Public Health reported Friday, bringing the statewide total to 131,214.

The numbers mark the largest daily increase since spring.

There were 10 people who died across the commonwealth because of complications relating to it, according to the daily report. The number of new cases was also above 700, Thursday, with the bulk of the cases coming from Middlesex, Suffolk and Essex counties.

The number of cases has been ticking upward, as have the number of people in hospitals because of the virus.

There were 21,451 new molecular tests conducted, bringing the percent positive rate to 1.7 percent, up from 0.8 percent in early September.

Health officials say positive test results need to stay below 5 percent for two weeks or longer and, preferably, be closer to 2 percent, for states to safely ease restrictions.

This comes the day after a new report showed Massachusetts has spent $838 million of the $1.1 billion it set aside in a supplemental budget bill for fighting the coronavirus crisis.

The total number of hospitalizations, which had been rising daily for the past week, ticked downward overall with 421 people in the hospital because of the virus. Of those in the hospital 79 people are in the ICU and 34 patients are intubated.

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This article originally appeared on the Boston Patch

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Joan Marks, Doyenne of Genetic Counselors, Dies at 91

Joan H. Marks, who was a pioneer in genetic counseling, the practice of helping patients understand their risk of an inherited medical condition, and who developed it into a full-blown profession, died on Sept. 14 at her home in Manhattan. She was 91.

Her son Dr. Andrew Marks said the cause was heart failure.

Ms. Marks was the director of the graduate program in genetic counseling at Sarah Lawrence College in Bronxville, N.Y., for 26 years. When she started, in 1972, the program, the first in the nation to educate genetic counselors, was three years old.

During her tenure, she developed it into the largest such program in the country, which it remains, and helped to establish a new health care field. Today there are thousands of certified genetic counselors in the United States — professionals trained in both genetics and counseling who help patients and their families confront a variety of inherited conditions.

But when Ms. Marks began, doctors were skeptical that anyone without a medical degree could understand the intricacies of genetics. So the role of talking with patients and their families about inherited disorders and potential birth defects was often left to nurses and others.

Ms. Marks saw a glaring need for skilled counselors who could explain genetics in plain language to patients, listen with empathy and guide them through a complex web of emotional, ethical and legal choices.

“We created the concept that a non-physician genetic counselor could not only assume some of the responsibilities of physicians in terms of medical genetic care, but also would do a better job because they were better trained in genetics and in counseling,” Ms. Marks told The New York Times in 1994.

Genetic testing was once primarily used for diagnosing genetic defects in fetuses and newborns, but by the mid-1990s it was able to predict the risk of developing a wide variety of adult conditions, including breast cancer and ovarian cancer. Today, more advanced tests can detect more than 6,000 genetic disorders, according to the Genetic Disease Foundation. Many are fatal or severely debilitating, and the need for trained counselors to help patients understand the test results has increased exponentially.

“Joan recognized the need for professionals to help people cope with the anxiety of living with the results of their genetic tests,” Mary-Claire King, a geneticist at the University of Washington in Seattle and a research partner of Ms. Marks, said in a phone interview.

“Women who learned they carried devastating mutations needed to decide what to do to save their own lives,” Ms. King said. (A prominent example is the actress Angelina Jolie, who has a family history of ovarian cancer and who, as a preventive measure, had a double mastectomy and later had her ovaries and fallopian tubes removed.)

“She taught her students how to empower their patients,” Ms. King added. “Her standards define the field.”

Joan Harriet Rosen was born on Feb. 4, 1929, in Portland, Maine. Her mother, Lillian (Morrison) Rosen, played the piano for

22 soldiers receive elite field medicine badge at Fort Carson ceremony | Military

The soldiers were elated and proud as they stood in formation in the morning sun, waiting for their loved ones or colleagues to pin their newly earned badges to their uniforms.

They were also exhausted, having just completed a 12-mile foot march — carrying heavy rucksacks, no less — as the final labor of an intense two-week competition for the right to wear the coveted insignia.

The troops lined up Sept. 25 to receive the Expert Field Medical Badge in a brief, socially distanced ceremony at Fort Carson. The badge represents the elite of the Army medical community: Less than 10% of its soldiers are authorized to wear it, according to Capt. Alyssa Schlegel, who helped run the grueling test.

The competition has about an 80% attrition rate. Fort Carson officials said 113 soldiers began the journey two weeks ago, and only 22 completed it.

“You are truly the best of the best,” said guest speaker Travis Worrell, a retired combat medic who earned the badge in 2010.

Combat medics need to know a lot more than how to treat battle wounds. They must possess daytime and nighttime land-navigation skills and working knowledge of Army communication systems. And they have to be ready and able to use a weapon in a firefight.

The curriculum tests soldiers on these skills, and more.

In order to be eligible for the competition, soldiers must have high physical fitness test scores, knowledge of small weapon systems and a current CPR certification.

During the course, they must successfully complete more than three dozen arduous tasks, including treating simulated wounds, moving injured soldiers out of the line of fire, and mastering an 80-question written exam covering the massive amounts of information they have to absorb.

“We have a lot of things to learn in a short amount of time,” said 1st Lt. Claire Schmelzenbach, one of the group’s top graduates. “It’s very intense.”

The foot march is the culminating event, and it takes place before dawn on the morning of graduation. Soldiers must complete the 12-mile hike in three hours or less, or they fail.

Col. Scott Knight, senior trainer and evaluator, said that occasionally a candidate will fight and claw through the entire two weeks, only to have to drop out just hours before graduation because they failed to complete the march in the requisite three hours.

“We lost two (candidates) like that this morning,” Knight said after the ceremony. “It’s a challenge all the way to the end.”

The possibility of failing, right up to graduation day, made3 success that much sweeter for the 22 soldiers left standing at the end.

“My feet hurt a little, and I’ve been up since 2:30 this morning,” Schmelzenbach said. “But I’m excited, and very proud.”

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