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Wednesday, May 1, 2024

CVS Health misses on profit, revenue; slashes earnings outlook

 CVS Health missed Street estimates for its top- and bottom-lines and lowered its full-year outlook, citing higher medical costs in the insurance industry. 

CVS, which owns health insurance giant Aetna,  reported net income of $1.12 billion, or $0.88 per share, for the quarter ended March 31, compared to net income of $2.14 billion, or $1.65 per share, for the year-ago quarter. Adjusted earnings per share were $1.31, missing analysts’ estimates of $1.69 per share.

Revenue rose 3.7% to $88.44 billion, driven by growth in its health care benefits and pharmacy & consumer wellness segments, which were partially offset by a decline in the health services segment. Analyst had expected sales of $89.21 billion.

Total revenues increased 2.9% in the pharmacy & consumer wellness segment, primarily driven by increased prescription volume, including increased contributions from vaccinations, improved drug purchasing and decreased operating expenses. 

The increases were partially offset by continued pharmacy reimbursement pressure. Prescriptions filled increased 3.2%.

Revenues at the health services segment, which includes  pharmacy benefit manager Caremark, CVS' health clinics and home health services, fell 9.7% to $40.3 billion.

“The current environment does not diminish our opportunities, enthusiasm, or the long-term earnings power of our company,” stated Karen S. Lynch, president and CEO, CVS Health. “We are confident we have a pathway to address our near-term Medicare Advantage challenges. We remain committed to our strategy and believe that we have the right assets in place to deliver value to our customers, members, patients, and shareholders.

While Medicare Advantage has been a major source of growth and profits for the insurance industry, investors have become concerned about the runaway costs associated with the plans, according to a report by CNBC. CVS is also facing challenges from the federal government’s 2025 reimbursement rates, which did not increase payments for Medicare Advantage plans as much as the industry has hoped.

CVS said it now expects 2024 adjusted earnings of at least $7 per share, down from its previous guidance of at least $8.30 per share.

https://chainstoreage.com/cvs-health-misses-profit-revenue-slashes-earnings-outlook

House Approves 'Antisemitism Awareness Act' Aimed At Cracking Down On Campus Protests

 Late in the afternoon Wednesday the House approved a bill which seeks to crackdown on antisemitism on college and university campuses following days of protests and unrest driven by pro-Palestinian activists.

The Antisemitism Awareness Act has been approved in a 320-91 vote and will now head to the Senate. But the central question is: how and by what measure will federal authorities crack down on speech deemed "antisemitic"?

Will criticism of the government of Israel be deemed antisemitic? Will highlighting alleged war crimes or human rights abuses by the IDF be considered so? Will involvement in the BDS movement be deemed anti-Jewish? Will slogans such as "from the river to the sea, Palestine will be free" be illegal according to federal law? Will criticizing the US $3+ billion in annual foreign aid be considered anti-Jewish? 

Already, active participation in causes boycotting Israel is 'illegal' in a number of US states (typically taking the form of prohibiting state agencies from engaging with contracts or business with companies involved in BDS).

According to an explanation of the definition of antisemitism outlined by the new House-passed bill

The bill would require the Department of Education to use the International Holocaust Remembrance Alliance’s (IHRA) working definition of antisemitism when enforcing antidiscrimination laws.

The group defines antisemitism as “a certain perception of Jews, which may be expressed as hatred toward Jews” and says “Rhetorical and physical manifestations of antisemitism are directed toward Jewish or non-Jewish individuals and/or their property, toward Jewish community institutions and religious facilities.”

The organization provides a number of examples for what qualifies as antisemitism, including calling for the harming of Jews in the name of a radical ideology or an extremist view of religion, and accusing Jewish individuals as inventing or exaggerating the Holocaust.

By this measure, even theoretical historical discussion or interpretation could be considered illegal (such has long been the case in some European countries). Like with any attempt to legislate limits related to the 1st Amendment, this is certainly going to prove very slippery — especially if it gets signed into law and then comes the question of actual enforcement on the ground.

A tiny minority of Republicans are voicing fierce opposition to the bill...

Currently and historically, pro-Israel hawks who advocate for sending billions in American taxpayer dollars to Israel each year tend to accuse any and all opponents of such policies of being antisemitic. Some independent journalists say they've struggled to find blatant examples of people being targeted in antisemitic attacks for the sole reason of being Jewish

So if the federal government gets involved in these polemical and semantic games, where will it end? 

https://www.zerohedge.com/political/house-approves-antisemitism-bill-aimed-cracking-down-campus-protests

Title IX Rules: 6 More States Sue Biden Admin Over "Radical And Illegal" Changes

by Katabella Roberts via The Epoch Times,

A group of six Republican state attorneys general filed a lawsuit against the Biden administration’s Department of Education on Tuesday over what they said were “radical and illegal” changes to Title IX rules.

The lawsuit, led by Kentucky Attorney General Russell Coleman and Tennessee Attorney General Jonathan Skrmetti, was filed in the U.S. District Court for the Eastern District of Kentucky.

In their legal filing, the GOP attorneys general argued that the department overstepped its authority when rolling out new updates to Title IX rules that expanded protections to students by incorporating gender identity into the legal text.

They further claimed the changes to the rules override state laws and will harm Tennessee students, families, and schools. The attorneys general called on the court to pause and overturn the newly expanded policy.

“The U.S. Department of Education has no authority to let boys into girls’ locker rooms,” Mr. Skrmetti said in a statement.

“In the decades since its adoption, Title IX has been universally understood to protect the privacy and safety of women in private spaces like locker rooms and bathrooms. Federal bureaucrats have no power to rewrite laws passed by the people’s elected representatives, and I expect the courts will put a stop to this unconstitutional power grab.”

Mr. Coleman, meanwhile argued the new changes to Title IX rules would “rip away 50 years of Title IX’s protections for women and put entire generations of young girls at risk.”

“As Attorney General, it is my duty to protect the people of Kentucky. As a Dad, it is my duty to protect my daughters,” Mr. Coleman said. “Today, I do both.”

Biden Admin Unveils Changes to Rules

The Kentucky attorney general added that his office is joining the lawsuit to “lead this fight for our daughters, granddaughters, nieces, and all the women of our Commonwealth.”

Title IX of the Education Amendments of 1972 is a longstanding policy designed to protect people from discrimination based on sex in schools.

Specifically, the protections prohibit sex-based discrimination in any school or any other education program that receives funding, either directly or indirectly, from the federal government.

However, the Department of Education last week rolled out newly updated Title IX rules that include expanded protections for LGBTQ students for the first time.

Under the updated rules, the prohibition against discrimination based on “sex” has been updated to include a prohibition against discrimination “based on sex stereotypes, sex-related characteristics (including intersex traits), pregnancy or related conditions, sexual orientation, and gender identity.”

The new rules also dictate that any K-12 school or institution of higher education that receives any federal funding may not separate or treat individuals differently based on sex “in a manner that subjects that person to more than de minimis harm,” which Republicans say will lead to shared bathrooms, locker rooms and more.

It does, however, clarify that such separations are allowed “in the context of sex-separate living facilities and sex-separate athletic teams.”

The rules also state that all “non-confidential” school employees are required to notify a Title IX coordinator if they learn of any violations.

According to the Biden administration, the new regulations are set to take effect on Aug. 1.

President Joe Biden (R) speaks in the Roosevelt Room of the White House, on June 30, 2023. (Jim Watson/AFP via Getty Images)

‘Radical, Illegal Attempt to Rewrite the Statute’

In a statement announcing the newly updated rules, U.S. Secretary of Education Miguel Cardona said they “build on the legacy of Title IX by clarifying that all our nation’s students can access schools that are safe, welcoming, and respect their rights.”

“The final regulations promote educational equity and opportunity for students across the country as well as accountability and fairness while empowering and supporting students and families,” the department said.

However, the attorneys general of Kentucky and Tennessee claim the new rules could put schools at risk of losing federal education funding, including access to free and reduced lunch programs and Individuals with Disabilities Education Act (IDEA) grants if they fail to abide by them.

The new rules would also require K-12 schools, colleges, and universities to “allow males identifying as females access to women’s sports, bathrooms and locker rooms,” they said.

“Under this radical and illegal attempt to rewrite the statute, if a man enters a woman’s locker room and a woman complains that makes her uncomfortable, the woman will be subject to investigation and penalties for violating the man’s civil rights,” Mr. Skrmetti said.

“Federal bureaucrats have no power to rewrite laws passed by the people’s elected representatives, and I expect the courts will put a stop to this unconstitutional power grab.”

The attorneys general of Indiana, Ohio, West Virginia, and Virginia have also joined the lawsuit with Tennessee and Kentucky.

It marks the latest lawsuit against the new Title IX changes after Republican attorneys general from nine states including Alabama and Louisiana filed similar legal challenges against the newly updated protections on Monday.

The Texas attorney general also has filed a lawsuit against the expanded rules, calling them “unlawful” and claiming they mandate schools comply with a “radical gender ideology.”

https://www.zerohedge.com/political/title-ix-rules-6-more-states-sue-biden-admin-over-radical-and-illegal-changes

Study finds ChatGPT fails at heart risk assessment

 Despite ChatGPT's reported ability to pass medical exams, new research indicates it would be unwise to rely on it for some health assessments, such as whether a patient with chest pain needs to be hospitalized.

In a study involving thousands of simulated cases of patients with , ChatGPT provided inconsistent conclusions, returning different heart risk assessment levels for the exact same patient data. The generative AI system also failed to match the traditional methods physicians use to judge a patient's cardiac risk. The findings were published in the journal PLOS ONE.

"ChatGPT was not acting in a consistent manner," said lead author Dr. Thomas Heston, a researcher with Washington State University's Elson S. Floyd College of Medicine. "Given the exact same data, ChatGPT would give a score of low risk, then next time an intermediate risk, and occasionally, it would go as far as giving a high risk."

The authors believe the problem is likely due to the level of randomness built into the current version of the software, ChatGPT4, which helps it vary its responses to simulate natural language. This same randomness, however, does not work well for health care uses that require a single, consistent answer, Heston said.

"We found there was a lot of variation, and that variation in approach can be dangerous," he said. "It can be a useful tool, but I think the technology is going a lot faster than our understanding of it, so it's critically important that we do a lot of research, especially in these high-stakes clinical situations."

Chest pains are common complaints in emergency rooms, requiring doctors to rapidly assess the urgency of a patient's condition. Some very serious cases are easy to identify by their symptoms, but lower risk ones can be trickier, Heston said, especially when determining whether someone should be hospitalized for observation or sent home and receive outpatient care.

Currently medical professionals often use one of two measures that go by the acronyms TIMI and HEART to assess heart risk. Heston likened these scales to calculators with each using a handful of variables including symptoms, health history and age. In contrast, an AI  like ChatGPT can assess billions of variables quickly, meaning it could potentially analyze a complex situation faster and more thoroughly.

For this study, Heston and colleague Dr. Lawrence Lewis of Washington University in St. Louis first generated three datasets of 10,000 randomized, simulated cases each. One dataset had the seven variables of the TIMI scale, the second set included the five HEART scale variables and a third had 44 randomized health variables.

On the first two datasets, ChatGPT gave a different risk assessment 45% to 48% of the time on individual cases than a fixed TIMI or HEART score. For the last data set, the researchers ran the cases four times and found ChatGPT often did not agree with itself, returning different assessment levels for the same cases 44% of the time.

Despite the negative findings of this study, Heston sees great potential for generative AI in health care—with further development.

For instance, assuming privacy standards could be met, entire  could be loaded into the program, and an in an emergency setting, a doctor could ask ChatGPT to give the most pertinent facts about a patient quickly. Also, for difficult, complex cases, doctors could ask the program to generate several possible diagnoses.

"ChatGPT could be excellent at creating a  and that's probably one of its greatest strengths," said Heston.

"If you don't quite know what's going on with a patient, you could ask it to give the top five diagnoses and the reasoning behind each one. So it could be good at helping you think through a problem, but it's not good at giving the answer."

More information: Thomas F. Heston et al, ChatGPT provides inconsistent risk-stratification of patients with atraumatic chest pain, PLOS ONE (2024). DOI: 10.1371/journal.pone.0301854


https://medicalxpress.com/news/2024-05-chatgpt-heart.html

Study sheds light on debate on 2 types of shoulder replacement surgery for osteoarthritis

 Study sheds light on the debate around two types of shoulder replacement surgery for osteoarthritis

Anatomical and reverse total shoulder replacements. Anatomical total shoulder replacement—prosthetic ball and socket replacement that matches normal ball and socket anatomy of shoulder joint. Reverse total shoulder replacement—prosthetic ball and socket replacement that reverses normal ball and socket anatomy of shoulder joint. Credit: BMJ (2024) DOI: 10.1136/bmj-2023-077939

A new study has provided valuable insights into the ongoing debate surrounding two types of shoulder replacement surgery: reverse total shoulder replacement and anatomical total shoulder replacement as a treatment for patients with osteoarthritis.

The research, led by the University of Oxford and involving researchers from the University of Bristol, has found that reverse total  replacements (RTSR) provide similar long-term outcomes to traditional anatomical total shoulder replacements (TSR) for patients aged 60 years or older with osteoarthritis (OA) and intact rotator cuff tendons.

The study was published in the BMJ.

Shoulder OA is a common and debilitating condition, and shoulder replacement surgery is an effective treatment option for end-stage disease. TSR has long been considered the gold standard for treating patients with OA and intact rotator cuff tendons. However, the RTSR has surged in popularity since 2008 in the UK. Originally designed for a completely different surgical indication, it is now often used instead of TSR in this patient group.

This shift in practice is growing despite a lack of supporting evidence, and in 2020, the National Institute for Health and Care Excellence (NICE) identified this as a key research priority. Researchers from NDORMS, University of Oxford, and involving experts from the University of Bristol set out to provide high-quality evidence to help address this uncertainty.

Epaminondas Markos Valsamis, NIHR Doctoral Research Fellow at the University of Oxford and lead author, explained, "In recent years, the use of RTSR has increased, even for patients with intact rotator cuffs—a group traditionally treated with TSR. But treatment choices are being made without any good evidence, leading to concerns from health care agencies and patients about which procedure is the safest and most effective option."

Dr. Adrian Sayers, Senior Research Fellow in the Bristol Medical School: Translational Health Sciences (THS) and co-author, added, "This work shows the tremendous potential of routinely collected data in answering questions that are important to patients in a timely manner.

"It is reassuring for patients and surgeons to know that either reverse or traditional anatomic shoulder replacement for osteoarthritis is a safe and effective procedure. This question was asked and answered in a fraction of the time and cost of conventional randomized clinical studies."

The research team conducted a population-based cohort study using linked data from the National Joint Registry and NHS Hospital Episode Statistics for England. Over 12,000 patients aged 60 years or older who underwent RTSR or TSR for OA with intact rotator cuff tendons between 2012 and 2020 were included in the study.

The researchers compared the outcomes of patients for each of the two types of procedures, focusing on factors such as revision surgery, serious adverse events, reoperations, hospital stay duration, and lifetime costs to the health care system.

The findings revealed that while TSR had a higher risk of revision surgery in the first three years after surgery, there was no important difference in the longer term, and both procedures were equally safe for patients.

"By the end of the study period we found no 'clinically important' difference in any outcome," said Epaminondas. "This provides reassurance to patients and surgeons that RTSR is an acceptable alternative for this patient group, and we found no evidence to change the growing surgical trend of offering RSTR to them."

While further research is needed to explore functional outcomes and to inform a full cost-effectiveness comparing RTSR and TSR, this study provides valuable insights that can help guide  by supporting  and surgeons to make more informed decisions about the best treatment options in order to optimize patient outcomes.

More information: E M Valsamis et al, Reverse total shoulder replacement versus anatomical total shoulder replacement for osteoarthritis: population based cohort study using data from the National Joint Registry and Hospital Episode Statistics for England. BMJ (2024) DOI: 10.1136/bmj-2023-077939www.bmj.com/content/385/bmj-2023-077939


https://medicalxpress.com/news/2024-05-debate-shoulder-surgery-osteoarthritis.html

'Ethical use of video technology to support patients at risk of falls'

 Video-enabled glasses have the potential to support patients at risk of falls by allowing medical staff to monitor how they move around their homes and their community. However, with privacy concerns at the forefront of this new technology, academics at Northumbria University have carried out a cutting-edge study into the ethical use of AI to ensure video footage can be obscured to ensure patient privacy.

Traditionally, patients at risk of falls have been assessed based on information they provide themselves in diaries or during short in-clinic observation appointments. However, these do not provide clinical teams with objective,  on how patients move around outdoors and in their home environments—the areas in which they are most likely to have a fall.

Trials of inertial wearable technology worn on the lower back—similar to that used in a smart watch—to track patients' walking movements, known as gait, are proving valuable but there are still pitfalls due to a lack of contextual information around where a patient is, who they are walking with and what activities they are carrying out.

In a bid to both improve, and personalize, patient care for those at risk of falls through illness or age, experts have been keen to explore how they can improve assessments and gain a fuller picture of what might be contributing to any abnormal gait data captured by the wearable devices.

Asking patients to also wear video-enabled glasses will provide much more accurate information on how they move depending on their surroundings, including obstacles and other hazards, where they are at the time and what might be putting them at increased risk of falls.

However, although the use of video technology has many , patients wearing these video-enabled glasses—and their families—must be able to maintain their privacy.

To test how these privacy concerns could be overcome, a group of computing and digital health experts ran a technology pilot to test the application of new AI software that can blur  and information captured by video glasses—for example photographs around the home, footage of children or confidential paperwork.

They found that the AI software could successfully analyze the raw  and detect and blur details such as faces, letters and laptop or phone screens, ensuring  could be maintained.

Their research has now been published in npj Digital Medicine.

Dr. Alan Godfrey, Associate Professor in Computer and Information Sciences at Northumbria University, said, "As you can imagine the variability in how people move when they're completing different tasks is enormous.

"The data or information provided from an inertial wearable device attached to someone when they're wandering around their house will inevitably differ from the same person when they're outdoors or walking more quickly to get somewhere or to keep up with someone. This means that while the use of an inertial wearable alone is helpful, it tells us nothing about the context in which a fall may occur.

"Having absolute clarity about the environment and what people are doing is key."

He added, "We wanted to assess how new developments in AI would allow us to provide video-enabled glasses that would allow medical staff to observe patients' movements in real environments over a longer time period without invading their privacy."

The paper demonstrates that by combining information from the wearable device that records gait data with footage captured by video glasses which is obscured where necessary thanks to the ethical use of AI, clinicians have a much more comprehensive picture of how patients' move in their own surroundings.

This could lead to significant improvements in the accuracy of patient fall risk assessment and in the decision-making process around .

Speaking on the study, lead researcher and Ph.D. student Jason Moore, from the Department of Computer and Information Sciences at Northumbria University, said, "Traditionally the use of video within the home has caused some apprehension among patient populations as a result of privacy concerns owing to what else may be captured on camera.

"However, through the use of AI software that can identify and obscure personal or sensitive information we can effectively capture the contextual information that will allow us to better understand abnormal gait data, while overcoming the concerns patients may have around the use of video technology in their own homes.

"The benefit of providing this contextual information is that clinicians will have a fuller picture for each individual patient which could ultimately allow them to provide more informed care plans and potentially keep more patients in their own homes for longer."

The research involved experts from Northumbria's departments of Computer and Information Sciences; Nursing, Midwifery and Health; and Sport, Exercise and Rehabilitation, as well as representatives from Northumbria Healthcare NHS Foundation Trust, and the Cumbria, Northumberland and Tyne & Wear NHS Trust.

Dr. Godfrey continued, "The suggested application of this technology is unique. The way it works means that the raw footage would never be seen by clinicians; however, the contextual information it could provide when it comes to identifying potential reasoning for abnormal variability or asymmetry in gait—effectively the way patients carry themselves and move around which are signs of elevated fall risk—is invaluable.

"Without this context patients with numerous clinical conditions, for example, Parkinson's, those who've suffered strokes or even just those who are suffering from frailty, could find themselves being classed as high risk for falls and ultimately face difficult decisions around moving out of their own environment earlier than necessary. It also alleviates the pressures on patients to travel to bespoke clinics for monitoring replacing this with a community-based approach."

"It could go a long way to help us truly understand the fall risk of a patient and to provide personalized care solutions that are most appropriate to the individual and their needs."

Following on from this initial research paper, the team will examine habitual fall risk in people with Parkinson's disease and are now recruiting people with Parkinson's to wear the technology in their homes and local communities. This will enable the research team to refine and improve their AI algorithms and in the future help inform personalized approaches to reduce fall risk in those living with Parkinson's.

Speaking on the project, co-author and Consultant Physician at Northumbria Healthcare NHS Foundation Trust, Professor Richard Walker, said, "People with Parkinson's have increasing mobility issues as their Parkinson's progresses. Falls can lead to major injuries, such as hip fractures, so anything we can do to try and prevent them would be of great benefit.

"This new technology will hopefully provide us with unique information around the circumstances of falls in order to help us advise on the most appropriate preventive measures."

More information: Jason Moore et al, Contextualizing remote fall risk: Video data capture and implementing ethical AI, npj Digital Medicine (2024). DOI: 10.1038/s41746-024-01050-7


https://medicalxpress.com/news/2024-05-ai-experts-explore-ethical-video.html

Neuroscientists: integrity of white brain matter in superagers does not deteriorate, explains sharp memory

 A team of neuroscientists from Universidad Politécnica de Madrid and Queen Sofia Foundation Alzheimer Center, both in Spain, has found that so-called superagers maintain memory as they grow older because they do not experience a decline in the integrity of their white brain matter.

In their study, published in The Journal of Neuroscience, the group conducted multiple tests with 100 octogenarian volunteers over a 10-year span.

Prior research and anecdotal evidence suggest that as people grow older, they tend to lose neurological function—thinking skills decline, as does memory retention and retrieval. But people known as superagers remain cognitively sharp and their memory skills do not deteriorate.

For this new study, the team in Spain evaluated the brains of these people and compared them with non-superagers to find out what was behind such differences.

The researchers recruited 64 superager volunteers and 55 non-superagers who periodically received brain scans and blood draws, took memory tests and completed multiple types of questionnaires over 10-year periods. The tests were designed to learn more about their lifestyles, behavior and how well their brains were holding up as they grew older.

The researchers found differences in the integrity of white brain matter. For superagers, there was little to no loss. More specifically, they found little loss in the mass of white brain matter in the  and hippocampus, two parts of the brain that are heavily involved in  processing and retention. They also found few signs of Alzheimer's disease.

Unfortunately, the research team found no evidence that could explain why some people are superagers, though they did note some minor differences in lifestyle choices—people in better health overall tended to have , as well.

The team also noted that superagers did not smoke or drink less, eat better, or exercise or sleep more. They also were no smarter or less intelligent than average and did not do any better or worse in their professional life prior to the onset of old age.

More information: Marta Garo-Pascual et al, Superagers resist typical age-related white matter structural changes, The Journal of Neuroscience (2024). DOI: 10.1523/JNEUROSCI.2059-23.2024


https://medicalxpress.com/news/2024-04-neuroscientists-white-brain-superagers-deteriorate.html