Population-based study shows air pollution exposure contributes to childhood asthma

Children born in Sarnia, Ontario at higher risk of developing asthma, compared to neighbouring cities

LAWSON HEALTH RESEARCH INSTITUTE

Research News

 

LONDON, ON - New findings from Ontario have shown that children born in Sarnia have a higher risk of developing asthma compared to neighbouring cities. A research team from Lawson Health Research Institute and Western University, using provincial data from ICES, found that higher air pollution exposure in the first year of life very likely contributed to this higher risk. Their results are published today in CMAJ Open.

Summary of study results:

-Children born in Sarnia in the 1990s and early 2000s were disproportionally at a higher risk of developing asthma in the first few years of life, compared to neighbouring cities.

-Air pollution exposure in the first year was found to be associated with the development of asthma in children.

-Overall rates of new childhood asthma diagnosis in Southwestern Ontario have been decreasing over time in parallel to decreases in air pollution levels.

"It's known that cities in Southwestern Ontario have varied levels of air pollution because of differences in industry and traffic. For example, Sarnia is home to the 'Chemical Valley' where numerous chemical plants and oil refineries are clustered," says Dr. Dhenuka Radhakrishnan, an Adjunct ICES Scientist, formerly working out of ICES Western in London, and Pediatric Respirologist at CHEO. "We wanted to see if children born in three cities - London, Windsor and Sarnia - had a different risk of developing asthma due to the differing air pollution levels in the three regions, even though the people living in these cities are otherwise comparable in many ways."

The researchers followed 114,427 children born in these cities between 1993 and 2009 for 10 years, and found that those in Sarnia were at the highest risk of developing asthma. The researchers found that by the age of 10, nearly 24 per cent of children in Sarnia were diagnosed with asthma, compared to 21 per cent in Windsor and 17 per cent in London. The differences were also present after accounting for many risk factors associated with asthma, such as sex, socioeconomic status and urban versus rural setting. The findings were most apparent in the first two years of life, but persistent beyond the age of six.

"Reassuringly, we found the asthma risk for children has reduced in more recent years as pollution levels have also decreased," adds Dr. Radhakrishnan.

Asthma is the most common chronic disease in Canadian children and has significant impact on quality of life. Asthma is the leading cause of emergency department visits and hospital admissions in this age group.

"It's important to find strategies to prevent asthma development and this study suggests that reducing air pollution exposure, including environmental causes, might reduce the number of children who suffer from asthma," explains Dr. Salimah Shariff, Associate Scientist at Lawson, Adjunct Professor at Western and Scientist at ICES Western.

There is also growing evidence that exposure during pregnancy can influence development of asthma in children. "We need to carefully examine how reducing air pollution exposures within a geographic area translates to reductions in asthma development. Understanding the amount of air pollution that a mother and infant are exposed to, and how this impacts their personal risk, could enable regions to target safer levels for their residents," adds Dr. Shariff.

Wednesday, May 5 is World Asthma Day (WAD). Recognizing symptoms of asthma early is the best a parent can do to improve the health of their child, so they can be diagnosed quickly and start appropriate treatments. If a parent notices their child has wheezing, persistent cough or difficulty with exercise, they are encouraged to bring this to the attention of a health care provider.

###

SHORT EXPLAINER VIDEO: https://youtu.be/lfp7522tEQI

DOWNLOADABLE IMAGES: https://www.lawsonresearch.ca/children-born-sarnia-higher-risk-developing-asthma-compared-london-and-windsor

ABOUT LAWSON HEALTH RESEARCH INSTITUTE - @LawsonResearch

Lawson Health Research Institute is one of Canada's top hospital-based research institutes, tackling the most pressing challenges in health care. As the research institute of London Health Sciences Centre and St. Joseph's Health Care London, our innovation happens where care is delivered. Lawson research teams are at the leading-edge of science with the goal of improving health and the delivery of care for patients. Working in partnership with Western University, our researchers are encouraged to pursue their curiosity, collaborate often and share their discoveries widely. Research conducted through Lawson makes a difference in the lives of patients, families and communities around the world.

ABOUT WESTERN - @WesternU

Western delivers an academic experience second to none. Since 1878, The Western Experience has combined academic excellence with life-long opportunities for intellectual, social and cultural growth in order to better serve our communities. Our research excellence expands knowledge and drives discovery with real-world application. Western attracts individuals with a broad worldview, seeking to study, influence and lead in the international community.

ABOUT ICES - @ICESOntario

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name.

Air pollution linked to high blood pressure in children; other studies address air quality and the heart

AMERICAN HEART ASSOCIATION

Research News

 

DALLAS, May 4, 2021 -- A meta-analysis of 14 air pollution studies from around the world found that exposure to high levels of air pollutants during childhood increases the likelihood of high blood pressure in children and adolescents, and their risk for high blood pressure as adults. The study is published in a special issue on air pollution in the Journal of the American Heart Association, an open access journal of the American Heart Association.

Other studies look at: the effects of diesel exhaust on the muscle sympathetic nerve; the impact of pollutants on high blood pressure; rates of hospital readmission for heart failure among those exposed to high levels of ambient air pollution; and risk of stroke and heart attack after long-term exposure to high levels of particulate matter. The studies include health outcomes of people who were exposed to pollutants in the United States, China and Europe.

High blood pressure during childhood and adolescence is a risk factor for hypertension and heart disease in adulthood. Studies on air pollution and blood pressure in adolescents and children, however, have produced inconsistent conclusions. This systematic review and meta-analysis pooled information from 14 studies focused on the association between air pollution and blood pressure in youth. The large analysis included data for more than 350,000 children and adolescents (mean ages 5.4 to 12.7 years of age).

"Our analysis is the first to closely examine previous research to assess both the quality and magnitude of the associations between air pollution and blood pressure values among children and adolescents," said lead study author Yao Lu, M.D., Ph.D., professor of the Clinical Research Center at the Third Xiangya Hospital at Central South University in Changsha, China, and professor in the department of life science and medicine at King's College London. "The findings provide evidence of a positive association between short- and long-term exposure to certain environmental air pollutants and blood pressure in children and adolescents."

The analysis included 14 studies published through September 6, 2020, exploring the impact of long-term exposure (?30 days) and/or short-term exposure (<30 days) of ambient air pollution on blood pressure levels of adolescents and/or children in China and/or countries in Europe.

The studies were divided into groups based upon length of exposure to air pollution and by composition of air pollutants, specifically nitrogen dioxide and particulate matter with diameter ?10 μm or ?2.5 μm. (The majority of research linking heart disease with particulate matter focuses on particle matter mass, which is categorized by aerodynamic diameter - μm or PM.) Fine particles are defined as PM2.5 and larger; coarse particles are defined at PM10; and the concentrations of particulate matter are typically measured in their mass per volume of air (μg/m3).

The meta-analysis concluded:

• Short-term exposure to PM10 was significantly associated with elevated systolic blood pressure in youth (the top number on a blood pressure reading).
• Periods of long-term exposure to PM2.5, PM10 and nitrogen dioxide were also associated with elevated systolic blood pressure levels.
• Higher diastolic blood pressure levels (the bottom number on a blood pressure reading) were associated with long-term exposure to PM2.5 and PM10.

"To reduce the impact of environmental pollution on blood pressure in children and adolescents, efforts should be made to reduce their exposure to environmental pollutants," said Lu. "Additionally, it is also very important to routinely measure blood pressure in children and adolescents, which can help us identify individuals with elevated blood pressure early."

The results of the analysis are limited to the studies included, and they did not include data on possible interactions between different pollutants, therefore, the results are not generalizable to all populations. Additionally, the analysis included the most common and more widely studied pollutants vs. air pollutants confirmed to have heart health impact, of which there are fewer studies.

###

The study was funded by the National Natural Science Foundation of China; Hunan Youth Talent Project; the Natural Science Foundation of Hunan Province; and the Fundamental Research Funds for Central Universities of Central South University.

Co-authors of the meta-analysis are Miao Huang, M.D.; Jingyuan Chen, M.D.; Yiping Yang, B.M.; Hong Yuan, M.D., Ph.D.; and Zhijun Huang, M.D. Author disclosures are listed in the manuscript.

Additional original articles published in JAHA's spotlight on air pollution include:

• Acute exposure to diesel exhaust increases muscle sympathetic nerve activity in humans, Bosson et al.
• Short-term Effects of Particle Size and Constituents on Blood Pressure in Healthy Young Adults in Guangzhou, China, Dong et al.
• Lead and Cadmium as Cardiovascular Risk Factors: Has the Burden of Proof Been Met?, Lamas et al.
• Particulate air pollution and risk of cardiovascular events among adults with a history of stroke or acute myocardial infarction, Liao et al.
• Long-term Exposure to Particulate Air Pollution is Associated with 30-day Readmissions and Hospital Visits Among Heart Failure Patients, Ward-Caviness et al.

Additional Resources:

Multimedia is available on the right column of release link: https://newsroom.heart.org/news/air-pollution-linked-to-high-blood-pressure-in-children-other-studies-address-air-quality-and-the-heart?preview=21700d0a86c1830864668eda0f74acb4
After May 4, view this manuscript and others from the JAHA Spotlight Issue on Air Pollution online.
What is High Blood Pressure?
High Blood Pressure in Children
Understanding Blood Pressure Readings
Counties with dirtier air have more stroke deaths
Regular exercise helps prevent high blood pressure, even in areas of high air pollution
Particulate Matter Air Pollution and Cardiovascular Disease
Leading cardiovascular organizations call for urgent action to reduce air pollution

Follow AHA/ASA news on Twitter @HeartNews

Follow news from the Journal of the American Heart Association @JAHA_AHA

Statements and conclusions of studies published in the American Heart Association's scientific journals are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association's overall financial information is available here.

Bringing up baby: A crocodile's changing niche

UNIVERSITY OF TENNESSEE AT KNOXVILLE

Research News

 

Relatives of the giant crocodile might have been kings of the waterways during the Cretaceous period, eating anything--including dinosaurs--that got a little too close to the water's edge, but the largest of these apex predators still started off small. Figuring out how these little crocs grew up in a world surrounded by giants is no small task. Now crocs fossils from Texas are shedding light on how these animals changed their diets as they grew, helping them find a place of their own in environments alongside their bigger, badder relatives.

According to the study, published by Cambridge University Press, the crocodiless in question are members of the Deltasuchus motherali and lived along the coastline of Texas 96 million years ago. Previously known from a single adult skull, this 20-foot-long crocodile left behind bite marks on turtles and, yes, dinosaurs. The new discoveries include at least 14 more members of Deltasuchus, ranging from sizes as large as the original specimen down to a paltry (if still snappy) four feet in length.

Having so many crocs from the same fossil population is not common, and the smaller, more delicate bones of juveniles often did not survive the fossilization process.

"So many fossil groups are only known from one or a handful of specimens," said paleontologist Stephanie Drumheller, lead author of the study and a lecturer of earth and planetary sciences at the University of Tennessee, Knoxville. "It can be easy to fall into the trap of only thinking about the adults." The researchers ran into challenges piecing together this ancient ecosystem, however. Deltasuchus wasn't alone in its coastal swamps.

Living alongside Deltasuchus were other large crocs, like Terminonaris and Woodbinesuchus.

"These two large croc species were comparable in size to an adult Deltasuchus, but because they had long, narrow snouts with slender interlocking teeth, they were targeting smaller prey in the environment," said Thomas Adams, co-author of the new study and curator of paleontology and geology at the Witte Museum in San Antonio.

A smaller crocodile, Scolomastax, lived in the area as well, but its unusual jaw and chunky dentition hint that it preferred hard food and maybe even plants.

"These results confirm previous work that shows fossil crocs were much more diverse and creative when it came to coexisting in the same environments," said Chris Noto, co-author and associate professor at the University of Wisconsin-Parkside. "The very warm conditions of the Cretaceous supported a greater number of reptiles and allowed them to explore new niches not possible in the present day."

When these crocodiles died, their skeletons fell apart as they fossilized, getting jumbled together and complicating efforts to tell which bones went with which animal. To help solve this puzzle, the team turned to 3D scanning technology to help reconstruct the skulls. UT undergraduate student Hannah Maddox meticulously scanned each piece and stitched them together into 3D models of complete skulls.

"It was like solving a great puzzle," said Maddox. "Every piece brought you closer to seeing a toothy grin that hadn't been seen in millions of years."

As the models came together, a more complete picture of how Deltasuchus lived started to take shape.

The juveniles had lighter, skinnier snouts and teeth than their older relatives--faces better suited to snap up quicker, softer prey than the heavier, powerful jaws of their parents. This might have helped make sure that little Deltasuchus were not in direct competition with the similarly sized hard-prey specialists in their environments, but as they grew they had other neighbors to consider. The large-bodied, slender-snouted role was already filled by other species. So Deltasuchus shifted in another direction as it grew, bulking up and taking on the heavy jaws and sturdy teeth of an ambush predator.

"This is an amazing fossil discovery where we not only have a population of a single species, but in an ecosystem that has multiple predators coexisting by filling separate niches," said Adams.

Similar results were found in recent analyses of young tyrannosaurs, which spent their teenaged years outcompeting other medium-sized predators in their ecosystems.

###

One step closer to efficient cannabis production

Bringing a technique that has been a boon to other plants to the budding cannabis industry

UNIVERSITY OF CONNECTICUT

Research News

 

IMAGE: MICROPROPAGATION COULD MAKE CULTIVATING CANNABIS A MUCH EASIER TASK. view more 

CREDIT: JESSICA LUBELL-BRAND

As nurseries and garden centers fill up with spring landscaping plants, home gardeners owe a lot to a technique called micropropagation, which has proven beneficial to many plants - perhaps soon to include cannabis, thanks to work by UConn researchers in the College of Agriculture, Health, and Natural Resources.

Micropropagation is a technique used for growing large quantities of new plants from fewer "parent" plants, yielding clones with the same, predictable qualities. The cannabis (Cannabis sativa) industry, however, has been largely left out of this beneficial technique, because this species of plant is extremely difficult to micropropagate.

Researchers from UConn - including Associate Professor Jessica Lubell-Brand, Ph.D. student Lauren Kurtz, and Professor Mark Brand, in the Department of Plant Science and Landscape Architecture - have worked through some of the challenges of cannabis micropropagation of hemp. Their method was recently published in HortTechnology.

Currently, the commercial cannabis industry relies on other propagation techniques, such as collecting seeds or taking carefully timed cuttings from stock "mother" plants. These methods require a lot of space and maintenance, since multiple specimens of each line of stock plants must be kept in the event of disease outbreak or plant death.

"Micropropagation produces many more clones than other methods. Since it is not relying on seed, the clones are uniform, and they will perform similarly to the parent plant. Plants that come out of tissue culture also have the benefit of being disease-free, they frequently show enhanced vigor, and you can grow a lot more in less space," says Lubell-Brand.

Plants in tissue culture depend on the grower to assume the role of nature to provide the right balance of nutrients and growth hormones in the culture media, to regulate temperature and light -- everything. For some plants, micropropagation is easy to accomplish, where explants placed in the growing medium will multiply readily. For others, like cannabis, the process requires quite a bit of refining to ensure the production of a large number of healthy plants.

"Cannabis does not really want to be in tissue culture. This research is a lot of trying to figure out, What more does the plant need?" says Lubell-Brand.

Realizing the potential to help meet the needs of the rapidly growing medical cannabis industry, the researchers set out to answer this question and decipher the needs of cannabis in tissue culture. The process requires a lot of trial and error, Lubell-Brand explains.

"We start the culture using shoot tips from greenhouse-grown plants. Then we subculture those and if we suspect something is lacking, for instance, that the plant isn't getting what it needs in the media, we experiment with nutrients like calcium, magnesium, phosphorus, and nitrogen to try to increase the length of time that they grow in culture."

Lubell-Brand says one of the issues with hemp micropropagation is hyperhydricity of the shoots: when the shoots get saturated with water, they become brittle, and they don't grow well.

Lubell-Brand explains that by adjusting the media for the first six weeks in culture while also using vented vessels to increase air flow, they were able to avoid hyperhydricity.

"In addition to creating large quantities of clones of the parent plant, micropropagated plants will very likely show enhanced growth vigor compared to conventional stem propagated plants," she says.

In the medical cannabis industry, consistency and reliability in crops is highly sought after, and micropropagation could deliver both. For growers to get started with the micropropagation technique, some equipment is needed, such as an autoclave and a laminar flow bench to ensure a sterile environment. However, for operations already using tissue culture techniques, the equipment is the same, says Lubell-Brand.

Kurtz says the research has been met with some excitement: "Tissue culture is not that well worked-out for cannabis in the literature. People are aware of the complications, problems, and downfalls, so people have been pretty receptive to the paper."

Lubell-Brand says the research is continuing, with Kurtz planning further studies to refine the process, such as determining the optimal timing of rooting and the length of time shoots can remain in culture.

The cultivars the researchers are working with are cannabidol (CBD) cultivars lacking psychoactive amounts of tetrahydrocannabinol (THC), but their micropropagation technique can be applied to THC-dominant cultivars as well. One day, maybe not so far in the future, the majority of cannabis may be micropropagated using tissue culture, though Lubell-Brand says there are still improvements to be made.

"Despite all our efforts, it's still not easy to grow cannabis in tissue culture. However, now we can multiply shoots, root shoots, and transition them from the lab to the greenhouse, which is a step forward."

###

Team cracks century-old mystery over the health struggles of explorer Ernest Shackleton

The severe nutrient deficiency beriberi is found to be the primary cause of Shackleton's bouts of breathlessness and weakness

MASSACHUSETTS GENERAL HOSPITAL

Research News

 

BOSTON - Researchers from Massachusetts General Hospital (MGH) appear to have solved the 120-year-old mystery surrounding the failing health of famed Antarctic explorer Sir Ernest Shackleton over the course of his daring expeditions to Antarctica in the early part of the twentieth century. In a paper published online in the Journal of Medical Biography, the team moved beyond past theories of congenital heart defect and scurvy advanced by physicians and historians to conclude that the British explorer suffered from beriberi, a serious and potentially life-threatening condition caused by a deficiency of the nutrient thiamine.

"Historians have traditionally looked at Shackleton's symptoms in isolation and speculated about their cause," says lead author Paul Gerard Firth, MD, head of the Division of Community and Global Health in the Department of Anesthesia, Critical Care and Pain Medicine at MGH. "We looked at other explorers on the expedition, as well as members of other early expeditions, and found that some had symptoms--such as breathlessness, neuropathy and effort intolerance--similar to Shackleton's that could be attributed to beriberi. With the benefit of what we now know about nutritional diseases, we believe that beriberi-induced cardiomyopathy--a disease of the heart muscle that makes it difficult for the heart to pump blood--is the correct diagnosis for Ernest Shackleton's deteriorating health."

The researchers learned that Edward Wilson, one of two physicians on Shackleton's first voyage to Antarctica beginning in 1901--when the explorer fell seriously ill and had to return home after voyaging closer to the South Pole than any previous human--may have suspected beriberi after consulting his medical textbooks, but didn't settle on that diagnosis at a time when so little was known about the condition. Instead, the prolonged bouts of extreme shortness of breath and physical weakness Shackleton experienced on the British "Discovery" expedition of 1901 to 1903 were ascribed by his contemporaries and subsequent historians to scurvy or underlying heart disease.

"While Wilson concluded that Shackleton's condition was the result of scurvy--a vitamin C deficiency--that appeared to us to be an incomplete explanation for his labored breathing," says Firth. "Shackleton, after all, had very slight symptoms of scurvy when his breathing difficulties began, and mild scurvy does not cause heart problems."

This careful parsing of the historical evidence led Firth and his colleagues to an alternative nutritional cause of Shackleton's health struggles. "Many of the signs and symptoms of beriberi seen in early explorers developed after three months of thiamine deficiency," explains co-author Lauren Fiechtner, MD, director of the Center for Pediatric Nutrition at MGH. "And that would be consistent with a thiamine-deficient diet they experienced during the grueling months of winter explorations. Fortunately, replacement of thiamine with vitamin B1 supplements can resolve the deficiency within days or hours, although that was not known at the time."

Even severe health challenges were not enough to prevent Shackleton from setting out on a third attempt to reach the South Pole in 1914, a fateful voyage since recounted in books and movies of how his ship Endurance became trapped in packed ice and broke apart, with all 28 crewmen reaching safety after two years and two heroic rescue efforts engineered by Shackleton. In late 1921, the intrepid explorer embarked on his fourth expedition, but suffered a heart attack on January 5, 1922, and died on his ship at age 47.

"The exact nature of Ernest Shackleton's faltering health has puzzled historians and the public for years," says Firth, "and almost 100 years after the start of his fourth and final expedition we're satisfied that we have finally uncovered a medically and scientifically valid explanation."

###

Firth is a pediatric anesthesiologist at MGH. Fiechtner is a pediatric gastroenterologist at MGH. Co-author Oscar Benavidez, MD, is division chief of Pediatric/Congenital Cardiology at MGH.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2020, Mass General was named #6 in the U.S. News & World Report list of "America's Best Hospitals."

Research reveals Medicaid expansion is still improving hospital finances

A new study analyzes critical data at state and national levels

UNIVERSITY OF COLORADO ANSCHUTZ MEDICAL CAMPUS

Research News

A new study published in Medical Care Research and Review found that the Affordable Care Act, which expanded Medicaid programs to cover people previously uninsured, provided a financial boost to hospitals.

The study conducted by faculty at the Colorado School of Public Health on the University of Colorado Anschutz Medical Campus is the first to investigate the effects of Medicaid expansion by comparing estimates using data from both the Internal Revenue Service (IRS) and the Centers for Medicare and Medicaid Services (CMS).

"The IRS and CMS data sources serve as primary resources for assessing the impact of Medicaid expansion on hospitals' financial status. The comparison of the two is timely and can inform the decisions of health practitioners, policymakers and regulators at a state and national level," said lead author Tatiane Santos, MPH, PhD, faculty at the Colorado School of Public Health and fellow at the Wharton School and Leonard Davis Institute of Health Economics at the University of Pennsylvania.

Santos adds, "This is especially relevant in the context of the recently passed American Rescue Plan Act of 2021, which provides additional incentives for the 12 states that have not yet expanded Medicaid."

The researchers examined the state-level impact of Medicaid expansion on hospital finances and based on the IRS data found that uncompensated care costs declined by 28 percent in states that expanded Medicaid relative to uncompensated care costs in 2013, the year before Medicaid expansion (9.3 percent of operating expenses in 2013). The findings based on the CMS data showed that there was a 32 percent decline in uncompensated care costs relative to costs in 2013 (5.0 percent of operating expenses in 2013).

These results are in line with previous studies that have reported that expansion has resulted in substantial reductions in hospitals' uncompensated care costs and increases in their Medicaid shortfalls (these shortfalls are the difference between Medicaid reimbursement and what it costs providers to care for patients).

Nationally, the estimated net effect of expansion reduced not-for-profit hospital costs by two percentage points based on IRS data and 0.83 percentage points based on CMS data. Across expansion states, the estimated net effects varied widely with approximately a 10-fold difference for hospitals based on IRS data and a two-fold difference based on CMS data.

Another key finding revealed that the increase in hospital's Medicaid shortfalls has been occurring more gradually, a result that may be partially attributable to a growing Medicaid population in expansion states.

The authors mention that while Medicaid expansion has clearly had an impact on hospitals' financial status, assessment of the actual magnitude of the effects is sensitive to the data sources used.

"Expansion effects have also varied by state, which may be an indicator of how states may potentially weather the COVID-19 pandemic financial shocks, including unemployment and increasing Medicaid enrollment. These are important findings for future consideration as Medicaid expansion continues to be a source of debate across the United States as a health policy initiative," added Santos.

The authors suggest that future studies should further explore the differences across IRS and CMS data. They suggest that as the pandemic unfolds Medicaid will be especially critical in serving the most vulnerable populations. States will need to make difficult financial decisions to protect their safety net hospitals and hospitals at highest risk of financial distress.

###

About the University of Colorado Anschutz Medical Campus

The University of Colorado Anschutz Medical Campus is a world-class medical destination at the forefront of transformative science, medicine, education, and patient care. The campus encompasses the University of Colorado health professional schools, more than 60 centers and institutes, and two nationally ranked independent hospitals that treat more than two million adult and pediatric patients each year. Innovative, interconnected and highly collaborative, together we deliver life-changing treatments, patient care, professional training, and conduct world-renowned research. For more information, visit http://www.cuanschutz.edu.

AMERIKAN FASCISM
The GOP's devotion to Trump threatens to destroy American democracy

With its cultish devotion to Donald Trump, the majority of the Republican Party is choosing a wannabe-autocrat over the political system that made the United States the world's most powerful nation and its dominant democracy.

 Former U.S. President Donald Trump acknowledges people as he gets in his SUV outside Trump Tower in the Manhattan borough of New York City, New York, U.S., March 9, 2021. REUTERS/Carlo Allegri

The ex-President is showing that he doesn't have to be in the Oval Office to damage faith in US elections and to trash truth, as his movement based on lies and personal homage takes an increasingly firm grip of the Republican Party. The widespread mistrust he continues to foster in the fairness of the US political system among millions of voters poses grave risks to democracy itself.


Trump, using his bond with the conservative grassroots, has effectively made fealty to his false claims of a fraudulent election last year the price of entry for any Republican candidate in any race. Under his influence, one of America's two great political parties has effectively shed its belief in democracy -- a dereliction that is massively significant for the country's future.

As he seeks personal revenge, Trump is also mobilizing to try to destroy the political viability of any GOP office holders who tell the truth about the Capitol insurrection he inspired like Rep. Liz Cheney of Wyoming and Sen. Lisa Murkowski of Alaska.

He is celebrating the boos that Sen. Mitt Romney, a former Republican presidential nominee, received from activists in Utah over the weekend, after voting to convict Trump over his abuses of power in two separate impeachment trials.

The former President retains an extraordinary ability to dictate the beliefs of his followers and the orthodoxy of the GOP on a daily basis.

"The Fraudulent Presidential Election of 2020 will be, from this day forth, known as THE BIG LIE!" Trump decreed in a statement Monday, literally reversing the facts about last November's free and fair election that he lost.

Cheney may well be sacrificing her own political career as one of the few GOP lawmakers with the guts to speak truth about Trump's anti-democratic attacks. A new effort is underway among the ex-President's acolytes in Congress to strip her of her No. 3 position in the House only three months after she comfortably retained it in a secret ballot election. Cheney's ability to fight off a pro-Trump primary opponent in her home state of Wyoming is questionable. Her transgression is to simply keep pointing out the truth: that last year's election wasn't stolen by President Joe Biden.

CNN reported Monday that Cheney said at a behind-closed-doors conference in Georgia that Trump's behavior was a "poison in the bloodstream of our democracy." She added: "We can't whitewash what happened on January 6 or perpetuate Trump's big lie. It is a threat to democracy. What he did on January 6 is a line that cannot be crossed."


Trump's power grows out of office

Trump is answering one question that was often asked in his dark last days in office -- would he be as powerful in private life as he was with the trappings of presidential office? If anything the former President wields even more control of his party now than he did over the last five years , a fact made more remarkable by the social media silence enforced by bans from major social media platforms.

And there are very clear signs that Trump's assault on American democracy is working. In a CNN poll released last week, only 23% of Republican voters believed that Biden legitimately won sufficient votes to win the election last year. This follows a Quinnipiac poll in February that showed that 76% of Republicans believe that there was widespread fraud in the election.

Court after court threw out Trump's spurious claims of election fraud after his defeat to Biden. There is no evidence that he was unfairly deprived of office. In fact, the only person who tried to steal the election was Trump, with his bid to disrupt Congress certifying the results by inciting a crowd of supporters that mobbed the Capitol, sending lawmakers fleeing.

Trump's manufactured crisis of legitimacy will effectively taint the midterm polls in 2022, which the former President is trying to use to tighten his stamp on the party. And even if Trump doesn't try to reclaim the White House in 2024, his pernicious influence will mean that the idea that the last election was stolen will remain a false article of faith for Republicans going forward.

A flurry of recent developments prove Trump's power in the GOP and his undiminished threat to trust in the electoral system, and show that the fight for American democracy merely entered a new phase when he left office.

A slew of Republican state legislatures have passed laws making it more difficult for Democrats, and especially Black voters, to cast ballots. They often cite voter mistrust in the electoral system as a rationale for those changes. But the chief cause of that mistrust is the relentless campaign by Trump to discredit the election he lost, both before and after voters went to the polls.

In another sign of Trump's malign influence, the state Senate in Arizona is conducting a sham recount of votes in crucial Maricopa County that helped Biden win the state, despite repeated statements and rulings by electoral officials and courts that the President's narrow victory was genuine.

Republican officials who once had the courage to condemn Trump's insurrectionist rhetoric are now seeking to ingratiate themselves with his supporters -- especially those who may run for President in future, including former South Carolina Gov. Nikki Haley and ex-New Jersey Gov. Chris Christie. House Minority Leader Kevin McCarthy, who at first said Trump bore responsibility for the January 6 riot, quickly visited the former President at his Mar-a-Lago resort and is anchoring his effort to win back the House for Republicans next year on the former President and his movement.

Any idea that the GOP will shed its fealty to Trump was exposed as a pipe dream by the poor showing of Marine veteran Michael Wood, who ran in a special election for a House seat in Texas at the weekend on an anti-Trump platform and lost badly in a jungle primary with only 3% or the vote.

"There is a sickness in our party that must be acknowledged and addressed," Wood wrote in a message to voters after his defeat.

"We are too much a cult of personality and a vehicle for the grievances of Donald Trump. We are too comfortable with conspiracy theories."

The former President sent out a statement claiming credit for the showing of Susan Wright, the wife of Rep. Ron Wright who died from Covid-19, after she moved into a run-off for the seat following the ex-President's endorsement.


Trump sketches a new alternate reality for his followers

The secret of Trump's appeal from the start of his presidential campaign in 2015 was that he channeled the distrust many conservatives felt towards the Washington establishment and the political system itself. He gave people a kind of permission to believe in what they felt viscerally rather than facts and truth. His attempt to destroy trust in the electoral system is creating another false reality with a built-in belief system that is deeply attractive to his voters. The fact that none of it is true does not detract from the power of his appeal.

But it is still extraordinary that the Republican Party, which in recent memory styled itself as the guardian of democracy and boasted about winning the Cold War against tyranny, could transform in this manner.

"It is just mind boggling to me that Republicans could be this way," said Dave Millage, who was forced to resign his post as chair of the Scott County, Iowa, Republican Party after backing Trump's impeachment over the Capitol insurrection. Millage slammed his fellow Republicans for "worshipping at the altar of Trump" during an appearance on CNN's "Newsroom" on Monday.

"He was attacking American democracy itself. Yet they are standing by him. It just astounds me."

The electoral impact of Trump's dominance over his party will be tested next year as Republicans have a historically good chance of overhauling the thin Democratic majority in the House, since new Presidents often get a rebuke. Since most mid-terms, especially House races, are heavily influenced by base turnout, the GOP may profit from Trump's continuing ability to inspire the party's most loyal voters.

But it is less clear that a slate of pro-Trump, Capitol insurrection denialists will help Senate Minority Leader Mitch McConnell's bid to reclaim control of the Senate -- or that this message carried by Trump or anyone else is a winning one in 2024.

After all, the former President managed to lose control of the House, the Senate and the White House with an approach that electrified the GOP base but alienated many suburban voters and those horrified with his handling of the pandemic.

Former Arizona Sen. Jeff Flake, who paid with his political career for being an early critic of Trump's presidency, warned that his party was making a huge mistake by not shaping a more compelling appeal to a wider group of voters.

"With the Democratic Party moving more progressive, there is plenty of room there," Flake told CNN's Jim Sciutto on Monday. "And we could do well in the midterms but not if we continue this craziness of questioning the last election and going after those who aren't completely devoted to the former President."

KULTURKAMPF
Gov. Noem: Biggest cultural challenge is 'defeating anti-American indoctrination'

Morgan Matzen, Sioux Falls Argus Leader 


The biggest cultural challenge of this lifetime is “defeating anti-American indoctrination,” Gov. Kristi Noem said in a Fox News opinion piece co-signed by Dr. Ben Carson and published Monday morning.

© Erin Bormett / Argus Leader Governor Kristi Noem gives the State of the State address on Tuesday, January 12, in the House of Representatives at the South Dakota State Capitol in Pierre.

The politicians shared they’ve signed on to the "1776 Pledge to Save Our Schools," which commits that K-12 public education will restore “honest, patriotic education that cultivates in our children a profound love for our country.”

Noem is widely considered a potential 2024 Republican presidential candidate. Her signature comes as she proclaims Monday through Friday is Teacher Appreciation Week in South Dakota.

Carson was the 17th U.S. secretary of Housing and Urban Development, and a member of President Trump’s advisory 1776 Commission.

In the column, Noem and Carson criticize President Joe Biden for canceling and disbanding President Trump’s 1776 Commission, which released a controversial 1776 Report two days before the end of Trump’s term, on Martin Luther King Jr. Day, and attempted to end a “radicalized view of American history.”


More: Republican state lawmakers want to punish schools that teach the 1619 Project

The pledge also promotes curriculum that teaches all children are created equal, prohibits curriculum that “pits students against one another on the basis of race or sex,” and prohibits any curriculum that requires students to protest and lobby during or after school.

In the column, Noem shares concerns about giving up and abandoning altogether “the teaching of our children the true and inspiring story of America,” and that children should be taught about the country’s values, history and heroes. LIKE CUSTER

Noem and Carson also said it’s “alarming” that students are “being subjected to the radical concept known as critical race theory, which pits them against one another on the basis of race and gender under the guise of achieving ‘equity.’”

Critical race theory sows division and cripples the nation from within, “one brainwashed and resentful student at a time,” the pair argue.

America’s most defining principle, the pair argue, is that as individuals, “we are all created equal by God.”

Noem has shared similar concerns about the concept of indoctrination in the past. She's written a column for the Federalist with worries about the nation’s failure “to educate generations of our children about what makes America unique,” and for the “left’s indoctrination” of students.

At the time, local educators like Tim Eckart, president of the Sioux Falls Education Association, were not happy. Eckart said the suggestion that educators were indoctrinating students was "incredibly insulting."

The conservative governor also successfully pushed for $900,000 in state funding to create new civics curriculum to meet her goal of educating why the "U.S. is the most special nation in the history of the world," while efforts to mandate instruction on the state's tribal history, culture and government failed in the legislative session this spring.

A new state-specific curriculum has yet to be seen months after Noem pushed for it, but the South Dakota Department of Education has a two-year project to develop and prepare it for schools to use if they wish to do so.

This article originally appeared on Sioux Falls Argus Leader: Gov. Noem: Biggest cultural challenge is 'defeating anti-American indoctrination'

GHOST IN THE MACHINE

House hearing interrupted by sound from 'Galaxy Quest' and the Village People

By Kristin Wilson, CNN 

A year after Zoom hearings became an everyday reality for much of America, technical glitches are still tripping up Congress.

A hearing of the House Appropriations Subcommittee on Energy and Water Development on Monday was interrupted and briefly recessed by audio of the Village People's "In the Navy" and the audio of the movie "Galaxy Quest"

The committee continued holding the hearing with the movie and song playing in the background for nearly 20 minutes before subcommittee Chairwoman Marcy Kaptur, a Democrat from Ohio, was forced to call a recess to fix the technical difficulties.

"We've been informed that we have to take a brief recess now because we're having technical issues," Kaptur said. "And we're going to be briefly recessing for a second here, let them address those and we'll be back very quickly."

"Sorry to do this, this hasn't happened before, but it's a new age," she said.

To their credit, members were able to continue testifying while the movie track and music played in the background. During the testimony of Democratic Rep. Sheila Jackson Lee of Texas, a character in the movie could be heard cheering, "Never give up!"

The hearing later resumed but was somewhat less interesting without the heroic music playing.

LIKE ALBERTA' S

Manitoba education reform bill built on ‘false, divisive premises’: former administrators

WHEN TORIES CHANGE CURRICULUM 

IT'S FORWARD TO THE PAST

By Maggie Macintosh, 

Local Journalism Initiative 

Winnipeg Free Press
Mon., May 3, 2021


Thirty retired superintendents have signed an open letter against Bill 64, in the hopes of halting the province’s sweeping reforms to K-12 education.

The collective of former Manitoba educators, who have worked in all corners of the province, argues the Education Modernization Act will lead to the politicization of public education and harm the collaborative culture in and among schools.

The legislation, which the province unveiled March 15, alongside the education review and a plan to act on its recommendations, aims to replace English school boards with a centralized authority run by government appointees.

The province claims the changes will boost student outcomes and amplify parent voices through new school councils.

“Bill 64 is based on false and divisive premises and promises — of quality (test scores vs. poverty); participation (individual parents vs. school boards); collegiality and professionalism (principals vs. teachers); and, efficiency (extreme centralization vs. local discretion),” states the superintendents’ letter, which was sent to provincial officials and education stakeholders.

Coralie Bryant, co-author and signatory, takes issue with plans to eliminate paid, elected trustee positions and hand off some of their current roles, such as budget planning, to volunteer parents. Many caregivers do not have time to engage with existing parent councils, let alone revamped ones with robust responsibilities, said the retired superintendent of Seven Oaks School Division.

“The current government does not have our permission to do this. They didn’t mention it in the election of 2019,” said Ken Klassen, a former superintendent in the Hanover School Division, adding he fears the new set up could see any government appoint partisan directors of education.


Among the group’s concerns: the removal of principals from the teachers union, how all students will be represented (particularly in Winnipeg, if the capital is home to only one region), and the impact child poverty continues to have on Manitoba’s lagging test scores.

In a prepared statement, Education Minister Cliff Cullen said the province has asked educational leaders to put their names forward for new task forces and advisory panels to shape the new system.

Cullen added: “We all share the same common goal and that is to ensure student success is the top priority, so we welcome their input on our engagement, task forces and advisory panels.