Federal Level Research Articles

Nonfatal injury emergency department visits and inpatient hospitalizations among persons under age 65 with an intellectual and developmental disability or deaf or hard of hearing disability

BackgroundVulnerable populations at risk of injury include persons with intellectual and developmental disabilities (IDD), and persons who are deaf or hard of hearing (DHH). The purpose of this study was to describe and compare emergency department and inpatient hospitalization (ED + IP) injury rates and rate ratios by injury type among persons under age 65 with IDD or with DHH to those without IDD or DHH.MethodsThis is a descriptive population-based retrospective cross-sectional study of injuries among patients under the age of 65 with an IDD disability or a DHH disability using Kentucky ED + IP discharge datasets from 2019 to 2023. Injury rates and injury rate ratios were calculated for those under the age of 65 with an IDD or a DHH disability and without an IDD or a DHH disability, using number of persons under age 65 with or without the related disability as the denominator.ResultsThe overall injury rate was lower for persons under age 65 with an IDD or DHH compared to those without those disabilities in 2023 (1 and 3 per 100,000 population, respectively). IDD or DHH disability types had significantly lower overall ED + IP injury rate ratios compared to those without those disabilities (IDD: 0.667 [95% CI: 0.640–0.694], DHH: 0.658 [95% CI: 0.633–0.683]). When ED + IP injury type rate ratios were compared, IDD or DHH persons had higher injury rate ratios for self-harm (IDD: 8.740 [95% CI: 7.783–9.815], DHH: 1.7846 [95% CI: 1.402–2.272]), assault (IDD: 1.386 [95% CI: 1.173–1.637], DHH: 1.310 [95% CI: 1.115–1.540]), unintentional falls (IDD: 1.540 [95% CI: 1.436–1.633], DHH: 1.283 [95% CI: 1.201–1.372]), and drug poisonings (IDD: 2.401 [95% CI: 2.103–2.740], DHH:1.620 [95% CI: 1.391–1.886]) compared to those without such disabilities. Those with IHH or DHH who were treated for injuries incurred triple the charges of patients without these conditions (~$17,086 IDD; $19,550 DHH; and $5,216 no IDD or DHH disabilities).ConclusionsThese findings have implications for health policy at the state and federal level. Clinical care interventions to reduce assault, self-harm, drug poisonings and unintentional injuries and healthcare utilization in persons with IDD or DHH should be publicly funded or covered by health insurance.

Social choices in platform design: technology from a workers’ standpoint in digital platform cooperatives

Digital technology is a key driver of social inequality in the gig economy, but little is known about how platform technologies can be tailored to workers’ needs. To fill this gap, the article examines social design choices by workers in digital platform cooperatives of the CoopCycle federation, an association of worker-owned cooperatives operating in the bicycle delivery sector. Based on empirical interviews, it is shown that by developing their own platform technology, the workers tailor it to the riders’ tacit knowledge and self-organization. In light of this, social choices of platform design are traced at three levels: the organization of work in the immediate labour process, the business decisions at the cooperative level, and the strategic course-setting at the federation level. To reconstruct this, the article draws on labour process theory and the STS concept of social choices in the design of workplace technology. With these concepts, social choices on technology in digital platform cooperatives can be explained by changed power relations in worker-owned corporations and their specific market environments enabling design paths for a technology from a worker’s standpoint.

Food Access in New York City During the COVID-19 Pandemic: Social Media Monitoring Study.

The COVID-19 pandemic exacerbated issues of poverty and food insecurity in New York City, and many residents experienced difficulty accessing available resources to help them get food on the table. Social media presents an opportunity to observe and understand the barriers people face in accessing affordable, nutritious, and culturally appropriate foods. This study aims to explore the food access discourse during the COVID-19 pandemic on Twitter (subsequently rebranded as X) in New York City by analyzing publicly available tweets posted from March 1, 2020, to March 31, 2021. Tweets posted by individuals in New York City during the first 13 months of the COVID-19 pandemic were collected using the observation platform Talkwalker. We categorized a list of multiple keywords into related groups (search strings). Data were cleaned to keep only tweets relevant to food insecurity and food access in New York City and remove duplicate tweets. The software Botometer was used to remove accounts considered to be bots. Topic modeling was used to group these tweets into relevant themes, which were analyzed. The top viral tweets (ie, tweets that received the highest number of retweets in New York City) from this period were further analyzed. We identified 6 major themes (with subthemes) that emerged from the analysis (in order of popularity): community efforts, public assistance programs, grocery shopping and food workers, school foods, millions go hungry, and food justice. Interesting terms that emerged from the data were also identified. Overall, quantities of tweets increased in correlation with current events, such as the closure of New York City public schools; the expansion of the Supplemental Nutrition Assistance Program and unemployment benefits; the proliferation of mutual aid groups in the spring of 2020; and the May Day Instacart, Amazon, and Target strike in 2020. Findings revealed that in the earliest months of the COVID-19 pandemic, Twitter users in New York City quickly responded to the wave of need by sharing information and resources about food access in their communities. Some users turned to Twitter to either solicit or offer help finding food. Furthermore, the platform lent itself to many conversations about the policies enacted on a federal, state, and city level to help feed New Yorkers in need. Future research on this topic should include an analysis of social media posting on platforms such as Facebook, as well as languages other than English. Results from this type of research can provide information to community leaders and elected officials to better address future crises.

The Impact of Employment Status, Income, and Occupation on the Association Between Workplace Benefits and Health-Related Work Absences.

Workplace benefits such as paid sick leave and employer-sponsored health insurance influence workers' ability to take time off when ill or injured. We examined whether and to what extent these workplace benefits complement each other in affecting health-related work absences, and whether associations varied by employment status, income, and occupation. This cross-sectional study analyzed pooled data from the 2021 and 2023 National Health Interview Survey (NHIS), a nationally representative survey of US adults. The sample included 31,280 employed adults. Workers were classified into four workplace benefits groups: paid sick leave only, employer-sponsored health insurance only, both benefits, and neither benefit. The primary outcome was health-related work absence in the past 12 months. Interaction terms assessed differences in probability of absence by employment status (full-time vs. part-time), income (< 400% vs. ≥ 400% of the federal poverty level), and occupation type (Management, Professional, Service, Sales, and Production). Compared to those with neither benefit, the probability of work absence was 7.3 points higher with employer-sponsored health insurance only (p < 0.001), 4.6 points higher with paid sick leave only (p = 0.002), and 12.0 points higher with both benefits (p < 0.001). The association between workplace benefits and health-related work absence varied by employment status, income level, and occupation type (p < 0.001 for all interactions). Access to paid sick leave and health insurance increased the likelihood of taking time off due to illness or injury, with differences by employment status, income, and occupation.

Recovery‐focused groups feeling especially exposed to cost‐cutting

Mass uncertainty about the extent of threatened government cuts to human‐services programs has placed organizations that are at the forefront of the recovery movement in what one national advocate calls a “freeze.” Feeling unable to count on the sustainability of their main funding sources at the federal or state level, many recovery support organizations are already pulling back programs and dismissing staff even before budget decisions have been finalized, though many have not yet gone public with their actions.

Empowering Educators to Advocate Locally, Statewide, and Nationally

Advocacy is important in educator preparation programs, equipping future teachers with the knowledge, skills, and mindset to support students, schools, and communities. Educators are critical in driving policy change and supporting students with disabilities. This article explores how educator preparation programs can engage in advocacy at the local, state, and federal levels. The authors share strategies and insights for involving undergraduate and graduate students in advocacy work within communities and local school districts and building relationships with key stakeholders at the state and federal levels. By prioritizing advocacy, educator preparation programs encourage future teachers to actively engage with the broader educational ecosystem, collaborate with stakeholders, and become change agents in schools and communities.

Introduction to Special Education Policy for Higher Education Faculty

Policy plays a crucial role in shaping special education practices. It is essential that special education professionals, particularly those in higher education, understand the policies that shape programs and practices and take an active role in their ongoing development. This article will provide historical context for special education law and policy. The authors also emphasize key components at the local, state, and federal levels. Finally, the article will highlight the critical role of higher education faculty engagement in policy development and implementation, including actionable steps for faculty to undertake.

Challenging Anti-Diversity, Equity, and Inclusion Laws: A Stand for Moral Courage.

Diversity, equity, and inclusion (DEI) are three interrelated and critically important constructs in physical therapy education programs that promote positive learning environments to mitigate discrimination, bias, and various forms of "-isms" including racism, sexism, ableism, and ageism. Unfortunately, a growing number of conservative jurisdictions have introduced or passed anti-DEI laws aimed to restrict the implementation of DEI, belonging, antiracism, and social justice initiatives in higher education, particularly public institutions. The purpose of this position paper is to highlight the reasons why physical therapy education program faculty, both individually and collectively, should be aware of anti-DEI laws and empowered to demonstrate moral courage, or bravery despite risks, to challenge them. Faculty in physical therapy education programs must confront their professional and personal fears while demonstrating moral courage in response to the growing prevalence of anti-DEI laws at federal levels. Faculty who remain informed about and challenge these anti-DEI laws will enhance their capacity to counter misinformation and misconceptions about DEI to foster diverse, equitable, and inclusive learning environments for students and faculty. Challenging anti-DEI laws is crucial for fostering diverse, inclusive, and equitable physical therapy education programs that support critical dialogue and understanding. Faculty, both individually and collectively, who confront their fears about challenging these laws will gain the moral courage to take a stance against them. Ultimately, standing against anti-DEI laws not only enriches the learning experience but also strengthens our profession's commitment to DEI, belonging, justice, and antiracism.

Centers for geriatric trauma DGU® : Distribution and development in Germany

Due to the demographic changes, including the need for more orthogeriatric co-management, addressing the healthcare of geriatric patients is an important issue. The aim of this study was to create an overview of the fundamental characteristics of centers for geriatric trauma ATZ-DGU including the distribution of departments and cooperations as well as the level of trauma care. The distribution of sites across Germany was compared to hospital and population data. Certified German ATZ-DGU were assigned to Trauma Center DGU® (TC) certification data (levelsIII-I) via institutional numbers. They were evaluated descriptively and correlations with several parameters at the federal states level were added. Due to cooperations 188 institutions formed 147 ATZ-DGU and 152 provided orthogeriatric co-management in domo. Of the facilities with trauma surgery departments 86% (n = 168) were certified as TCs (level II = 33% > III = 30% > I = 22%). The number of ATZ-DGU per German state was correlated with the number of hospitals (rs = 0.88), inhabitants (rs = 0.92) and cases in total (rs = 0.92, p < 0.001 each) but not with the proportion of people older than 65years (p > 0.05). With only 14facilities, the new federal states of Germany seemed to be disadvantaged and also showed great disparities compared to each other. The levels of trauma care revealed adistribution referring to the different focus of the two certificates: treatment of the severely injured vs. geriatric co-treatment. On average, the population in the new German states was older, while there were less ATZ-DGU; however, there seemed to be aslight tendency towards improvement.

The demographics, training, and job functions of the United States Public Health Service Commissioned Corps nursing workforce.

The demographics, training, and job functions of the United States Public Health Service Commissioned Corps nursing workforce.

"But who takes care of the mom?": The daily experiences of immigrant mothers navigating health in family life.

"But who takes care of the mom?": The daily experiences of immigrant mothers navigating health in family life.

Effects of Expanding Medicaid Dental Coverage on General Health Status of Low-Income Adults.

Oral health is considered a key component of general health. However, causal evidence examining the effects of dental coverage on general health is sparse. To examine the effects of the Affordable Care Act (ACA) Medicaid expansions with extensive dental benefits versus less generous dental benefits on the general health status of individuals with low income. A difference-in-differences design comparing states that expanded Medicaid eligibility in 2014 by whether they offered extensive or less generous dental benefits. Adults aged 18-64 years below 138% of the federal poverty level who participated in the 2011-2022 Behavioral Risk Factor Surveillance System surveys. Self-rated general health status and number of days not in good physical health or good mental health in the past 30 days. The likelihood of fair/poor rated health status declined with extensive dental benefits, including by 2.3 (95% CI: -3.90 to -0.69) percentage-points when aggregating 2014-2022, with declines first observed in 2015 and almost all years after. There were no statistically significant effects on days not in good physical or mental health when aggregating 2014-2022. There were fewer mentally unhealthy days with extensive dental benefits by 0.93 days in 2019 and 2021 (95% CI: -1.80 to -0.06 and -1.70 to -0.15, respectively). The findings suggest that extensive dental coverage improves self-rated general health status among low-income adults. There is suggestive evidence of improved mental health in 2 but not all years and no discernable effect on days not in good physical health.

Association of Reproductive Access Restrictions and Out-of-State Abortion Care in Colorado, an Interrupted Time Series Analysis for 2018-2024.

Association of Reproductive Access Restrictions and Out-of-State Abortion Care in Colorado, an Interrupted Time Series Analysis for 2018-2024.

Social Determinants of Health and Unmet Needs for Services Among Young Adults With HIV: Medical Monitoring Project, 2018-2021.

Persons aged 13-24 years are a priority population in the National HIV/AIDS Strategy. Young adults with HIV have poorer health outcomes-including not being retained in care, antiretroviral nonadherence, and not being virally suppressed-than other persons with HIV. Centers for Disease Control and Prevention's Medical Monitoring Project data collected June 2018 through May 2022. We compared demographic characteristics, social determinants of health, and mental health between persons aged 18-24 years with HIV versus persons aged ≥25 years with HIV. Among those aged 18-24 years, we analyzed total and unmet needs for ancillary services, defined as those that support care engagement, viral suppression, and overall health and well-being among people with HIV. Persons aged 18-24 years were more likely to have a household income <100% of the federal poverty level (48% vs. 39%), and experience unstable housing or homelessness (37% vs. 18%) or hunger/food insecurity (29% vs. 18%) than those aged ≥25 years. Persons aged 18-24 years had higher median HIV stigma scores (40 vs. 29) and were more likely to experience symptoms of generalized anxiety disorder (21% vs. 15%) than those aged ≥25 years. Of persons aged 18-24 years, 96% had a need for ≥1 ancillary service, of whom 56% had ≥1 unmet need; unmet needs were highest for subsistence services (53%) and non-HIV medical services (41%). Addressing unmet needs for subsistence and non-HIV medical services could help reduce disparities in social determinants of health and mental health that drive inequities in health outcomes among persons with HIV aged 18-24 years.

Predicting the Adoption of Clean Energy Vehicles: A Machine Learning-Based Market Analysis

Switching towards clean energy vehicles (CEVs) is a key measure in curbing greenhouse gas emissions and fighting climate change in the USA. Yet, despite mounting environmental consciousness and policy stimulus, the uptake of CEVs is still quite low. The main aim of this research is the creation of a market analysis framework based on machine learning for the prediction of CEV adoption. Utilizing supervised learning algorithms—Random Forest, Logistic Regression, and Decision Tree—the research compares their performance in segmenting prospective CEV adopters in terms of infrastructural, environmental, and socio-economic variables. The dataset included an extensive list of variables designed to capture the various factors that drive clean energy vehicle (CEV) adoption. It includes demographic variables like age, income, educational level, and geographical region, as well as economic variables like vehicle price, purchase incentives, and cost of ownership. In addition, it covers environmental attitudes, captured in terms of questionnaire responses on climate change concerns as well as sustainability values. We initiated this research using a range of machine learning models for the prediction of clean energy vehicle adoption, each of which was used for its particular strengths. To assess the performance of our predictive models, we utilized an extensive range of evaluation metrics: Accuracy, Precision, Recall, F1 Score, and ROC-AUC. Perfect scores on all metrics were recorded for the Decision Tree model, with 100% accuracy, precision, recall, and F1-score. Meanwhile, slightly lower overall performance values were reported for both Logistic Regression and Random Forest models. Sophisticated CEV adoption models' granular outputs can be directly applied in designing and implementing clean vehicle incentive structures at local, state, and federal levels. Knowing the particular socioeconomic, demographic, and geospatial drivers or impediments of adoption in specific regions allows policymakers to craft optimally effective incentive structures. Sophisticated insights derived from patterns of CEV adoption provide irreplaceable value for automotive companies and clean technology firms working in the US market. Future demand for CEVs is important for successful infrastructure planning, especially for the siting of electric charging stations. Monitoring CEV adoption rates is critical for measuring progress towards emissions reduction targets and facilitating broader sustainability planning activities.

How Medical Marijuana Policies Reproduce the Status Quo

Public attitudes have dramatically transformed from stigmatization to acceptance of medical marijuana legalization. However, the federal government upholds its Schedule I Classification, preventing medical access and barring scientific research. States rapidly working towards the legalization of medical marijuana points to progressive future policies, but as long as the federal government fails to acknowledge marijuana’s medicinal properties and continues the War on Drugs, legal changes remain at a standstill. This paper uses the umbrella term conflict paradigm to incorporate common ideological tenets of conflict theories. In relation to medical marijuana legislation, the law is viewed as repressive via differential law enforcement. In addition, the law is not considered value-neutral in relation to economic accessibility seemingly skewed toward the wealthy. Lastly, the law functions as a tool for the powerful elite as noted through discarded scientific research and links to special interest groups. As illustrated by the conflict paradigm, racist legal prejudices, economic burdens, and the politicized federal hesitancy to legalize medical marijuana portray how current medical marijuana laws reproduce social hegemony. In utilizing this theoretical framework to evaluate Pennsylvania’s Medical Marijuana Program, this review argues that without movement on the federal level, states’ medical marijuana policies will fail to provide relief to many vulnerable populations and reproduce social inequalities.

Title IX: The Obstacles Still Faced in Leveling the Playing Field

Sports hold an immense amount of power. They have been a common passion and past time for Americans throughout the centuries, providing mutual grounds for those who may otherwise be divided. Sports are also vital aspects of American schooling- a concept that is uniquely promoted in the United States- as they are seen to be beneficial in educating the whole person. By combining the rigors of academics and intellect with sports, it was believed that a person's full character could be developed efficiently. It is no wonder, then, that sports became the central debate of an act passed under the Higher Education Act called Title IX. The provision of the act stated simply that no one, on the basis of sex, could face discrimination or be denied participation in any educational institution that received federal aid but ironically did not include the words "athletics" or "sports" anywhere in the law. Title IX changed the face of athletics for women and continues to do so today especially on college campuses. Despite the increased participation of women in sports, often promoted vociferously using statistical evidence, there are still major obstacles that need to be addressed inregards to Title IX. The deficient implementation and enforcement of the law, the lack of support it offers inincreasing women in administration and coaching positions, and the focus on revenue-producing sports are all areas where Title IX falls short in ensuring total gender equality; however, these issues can be countered with a more positive promotion of women in sports in our culture and a more structured program at the federal level that will assist in guaranteeing the implementation of the law on all college campuses across America. Title IX: The Obstacles Still Faced in Leveling the Playing Field by Maura McKenna is licensed under a Creative Commons Attribution 4.0 International License

Advocacy for Patients and the Profession.

Every aspect of our professional lives as orthopaedic surgeons, regardless of practice model, is affected by the policies and laws passed by the US Congress and implemented by the federal regulatory agencies. Similar dynamics play out at the state level for many other issues that affect orthopaedic practices. The United States spends 18% of our gross domestic product on health care, 2 to 3 times as much as the other developed countries in the world, with less-than-ideal outcomes for health metrics. Recognizing the challenges faced by the US healthcare system is fundamental to understanding the importance of advocacy in shaping the conversation on Capitol Hill. All healthcare advocacy is based on preserving the doctor-patient relationship, ensuring access to appropriate care, and improving the quality of that care. Advocating on behalf our patients is part of our physicians' contract with society. Physicians are the secondary beneficiary of effective patient advocacy. Understanding how practicing orthopaedic surgeons can have a positive effect on the decisions that are made at the federal and state level is of critical importance in the increasingly complex healthcare dynamic that affects our patient's lives and our profession.

Impacts of local, provincial, and federal immigration policies on health and social services access among women with precarious immigration status

ObjectivesIm/migrant women (e.g., non-status immigrants, refugee claimants, students, temporary foreign workers, visitors, and other migrants) face structural barriers to health and social services access. While immigration is an increasingly recognized social determinant of health, there remains a gap in literature on how structural determinants such as immigration policies and practices (e.g., ‘status-checking’, immigration status) shape im/migrant women’s experiences navigating health and social services. This study aimed to examine the ways in which local, provincial, and federal immigration policies shape health and social services access among im/migrant women with precarious status.MethodsBetween December 2018 and February 2020, we conducted and thematically analyzed qualitative in-depth interviews with im/migrant women (N = 51), and service providers (N = 10) across Metro Vancouver. Data were collected as part of the IRIS study, which is a community-based, mixed-methods study of im/migrants’ healthcare access prior to and during the COVID-19 pandemic.ResultsDespite policies that purportedly aim to grant access to health and social services in Vancouver regardless of immigration status, participants routinely described ineligibility and fear of detention and/or deportation as pervasive barriers to accessing services, including routine, preventive, and emergency health services, and enrolment of children in schools. Women described social isolation and exclusion as key consequences of federal immigration policies that produced precariousness through temporary and undocumented status. Overall, participants recommended for the elimination of immigration law enforcements and ‘status-checking’ practices in health and social settings.ConclusionSanctuary City policies are recommended to advance im/migrants’ human rights, reduce instances of delayed or denied care, untreated illnesses, and social isolation. Full implementation of Sanctuary principles at the local level (i.e., reduced collaboration between local service providers and federal immigration enforcement) is needed to improve access to health and other services based on need, regardless of immigration status. At the provincial level, elimination of 'status checking' in health settings and expansion of eligibility criteria for health, social, and education programs (e.g., Medical Services Plan, subsidized housing, and BC’s School Act) to include all im/migrants should be considered. At the federal level, increased funding for programs that address inequities in health and social services produced by restrictive immigration policies and ensure pathways to more secure immigration status are recommended. Together, these policy reforms have the potential to address the structural barriers to im/migrant women's health and social services access, and ultimately improve overall public health outcomes.

URBAN AGRICULTURE: A PATHWAY TO SUSTAINABLE URBAN DEVELOPMENT

This study explores the stakeholders' perspectives in urban agriculture (UA) toward sustainable urban development, expanding the discussion on the social, economic, and environmental potential and its challenges, thereby proposing a framework of action plans to support UA. Grounded on stakeholder theory, this study employed a qualitative approach using semi-structured interviews. A total of 15 stakeholders were selected from different authority levels in Malaysia consisting of the Department of Agriculture Malaysia and PLANMalaysia (federal level), Department of Agriculture Perak (state level), Subang Jaya City Council (local level), private property managers (real estate practitioners) and academicians (university). These stakeholders were top management, practitioners, and officers with the related background, knowledge, and experience in urban agriculture, urban planning, and real estate. The findings illustrate a framework of actionable plans centred on social, economic, environmental, policy, and technological innovation to highlight the importance of strategic initiatives in UA toward sustainable urban development. This framework contributes to the existing knowledge by proposing action plans based on sustainability pillars to advance UA as a pathway toward sustainable urban development. This study provides helpful strategies for policymakers and urban planners and guides them in making effective action plans for UA.