Patterns in Geographic Distribution of Substance Use Disorder Treatment Facilities in the US and Accepted Forms of Payment From 2010 to 2021.

Importance: The drug overdose crisis is a continuing public health problem and is expected to grow substantially in older adults. Understanding the geographic accessibility to a substance use disorder (SUD) treatment facility that accepts Medicare can inform efforts to address this crisis in older adults. Objective: To assess whether geographic accessibility of services was limited for older adults despite the increasing need for SUD and opioid use disorder treatments in this population. Design, Setting, and Participants: This longitudinal cross-sectional study obtained data on all licensed SUD treatment facilities for all US counties and Census tracts listed in the National Directory of Drug and Alcohol Abuse Treatment Programs from 2010 to 2021. Main Outcomes and Measures: Measures included the national proportion of treatment facilities accepting Medicare, Medicaid, private insurance, or cash as a form of payment; the proportion of counties with a treatment facility accepting each form of payment; and the proportion of the national population with Medicare, Medicaid, private insurance, or cash payment residing within a 15-, 30-, or 60-minute driving time from an SUD treatment facility accepting their form of payment in 2021. Results: A total of 11 709 SUD treatment facilities operated across the US per year between 2010 and 2021 (140 507 facility-year observations). Cash was the most commonly accepted form of payment (increasing slightly from 91.0% in 2010 to 91.6% by 2021), followed by private insurance (increasing from 63.5% to 75.3%), Medicaid (increasing from 54.0% to 71.8%), and Medicare (increasing from 32.1% to 41.9%). The proportion of counties with a treatment facility that accepted Medicare as a form of payment also increased over the same study period from 41.2% to 53.8%, whereas the proportion of counties with a facility that accepted Medicaid as a form of payment increased from 53.5% to 67.1%. The proportion of Medicare beneficiaries with a treatment facility that accepted Medicare as a form of payment within a 15-minute driving time increased from 53.3% to 57.0%. The proportion of individuals with a treatment facility within a 15-minute driving time that accepted their respective form of payment was 73.2% for those with Medicaid, 69.8% for those with private insurance, and 71.4% for those with cash payment in 2021. Conclusions and Relevance: Results of this study suggest that Medicare beneficiaries have less geographic accessibility to SUD treatment facilities given that acceptance of Medicare is low compared with other forms of payment. Policy makers need to consider increasing reimbursement rates and using additional incentives to encourage the acceptance of Medicare.

Modelling the impact of social distancing and targeted vaccination on the spread of COVID-19 through a real city-scale contact network.

We use mobile device data to construct empirical interpersonal physical contact networks in the city of Portland, Oregon, both before and after social distancing measures were enacted during the COVID-19 pandemic. These networks reveal how social distancing measures and the public's reaction to the incipient pandemic affected the connectivity patterns within the city. We find that as the pandemic developed there was a substantial decrease in the number of individuals with many contacts. We further study the impact of these different network topologies on the spread of COVID-19 by simulating an SEIR epidemic model over these networks and find that the reduced connectivity greatly suppressed the epidemic. We then investigate how the epidemic responds when part of the population is vaccinated, and we compare two vaccination distribution strategies, both with and without social distancing. Our main result is that the heavy-tailed degree distribution of the contact networks causes a targeted vaccination strategy that prioritizes high-contact individuals to reduce the number of cases far more effectively than a strategy that vaccinates individuals at random. Combining both targeted vaccination and social distancing leads to the greatest reduction in cases, and we also find that the marginal benefit of a targeted strategy as compared to a random strategy exceeds the marginal benefit of social distancing for reducing the number of cases. These results have important implications for ongoing vaccine distribution efforts worldwide.

Trends in visits to substance use disorder treatment facilities in 2020.

OBJECTIVE: To describe weekly changes in the number of substance use disorder treatment (SUDT) facility visits in 2020 compared to 2019 using cell phone location data. METHODS: We calculated the percentage weekly change in visits to SUDT facilities from the week of January 5 through the week of October 11, 2020, relative to the week of January 6 through the week of October 13, 2019. We stratified facilities by county COVID-19 incidence per 10,000 residents in each week and by 2018 fatal drug overdose rate. Finally, we conducted a multivariable linear regression analysis examining percent change in visits per week as a function of county-level COVID-19 tercile, a series of calendar month indicators, and the interaction of county-level COVID-19 tercile and month. We repeated the regression analysis replacing COVID-19 tercile with overdose tercile. RESULTS: Beginning the eleventh week of 2020, the number of visits to SUDT facilities declined substantially, reaching a nadir of 48% of 2019 visits in early July. In contrast to January, there were significantly fewer visits in 2020 compared to 2019 in all subsequent months (p < 0.01 in all months). Multivariable regression results found that facilities in the tercile of counties experiencing the most COVID-19 cases had a significantly greater reduction in the number of SUDT visits in 2020 for the months of June through August than facilities in counties with the fewest COVID-19 rates (p < 0.05). The study found no statistically significant difference in the change in the number of visits by facilities in counties with historically different overdose rates. DISCUSSION: Our findings support the hypothesis that a reduction has occurred in the average weekly number of visits to SUDT facilities. The size of the effect differs based on the number of COVID-19 cases but not on historical overdose rate.

The promise of organ and tissue preservation to transform medicine.

The ability to replace organs and tissues on demand could save or improve millions of lives each year globally and create public health benefits on par with curing cancer. Unmet needs for organ and tissue preservation place enormous logistical limitations on transplantation, regenerative medicine, drug discovery, and a variety of rapidly advancing areas spanning biomedicine. A growing coalition of researchers, clinicians, advocacy organizations, academic institutions, and other stakeholders has assembled to address the unmet need for preservation advances, outlining remaining challenges and identifying areas of underinvestment and untapped opportunities. Meanwhile, recent discoveries provide proofs of principle for breakthroughs in a family of research areas surrounding biopreservation. These developments indicate that a new paradigm, integrating multiple existing preservation approaches and new technologies that have flourished in the past 10 years, could transform preservation research. Capitalizing on these opportunities will require engagement across many research areas and stakeholder groups. A coordinated effort is needed to expedite preservation advances that can transform several areas of medicine and medical science.

Understanding attitudes toward affirmative action programs in employment: summary and meta-analysis of 35 years of research.

Affirmative action programs (AAPs) are controversial employment policies in the United States and elsewhere. A large body of evidence about attitudinal reactions to AAPs in employment has accumulated over 35 years: at least 126 independent samples involving 29,000 people. However, findings are not firmly established or integrated. In the current article, the authors summarize and meta-analytically estimate relationships of AAP attitudes with (a) structural features of such programs, (b) perceiver demographic and psychological characteristics, (c) interactions of structural features with perceiver characteristics, and (d) presentation of AAP details to perceivers, including justification of the AAP. Results are generally consistent with predictions derived from self-interest considerations, organizational justice theory, and racism theories. They also suggest practical ways in which AAPs might be designed and communicated to employees to reduce attitudinal resistance.

How effective are the cross-examination and expert testimony safeguards? Jurors' perceptions of the suggestiveness and fairness of biased lineup procedures.

Mock jurors (N = 800) viewed a videotaped trial that included information about a lineup identification procedure. Suggestiveness of the eyewitness identification procedure varied in terms of foil, instruction, and presentation biases. Expert testimony regarding the factors that influence lineup suggestiveness was also manipulated. Criteria included juror ratings of lineup suggestiveness and fairness, ratings of defendant culpability, and verdicts. Jurors were sensitive to foil bias but only minimally sensitive to instruction and presentation biases. Expert testimony enhanced juror sensitivity only to instruction bias. These results have implications for the effectiveness of cross-examination and expert testimony as safeguards against erroneous convictions resulting from mistaken identifications.