A study published in JAMA Internal Medicine detailed the best available tools to assess severity of diagnosed delirium in hospitalized persons, reports Medical Xpress . The researchers mined databases including 9,409 articles that addressed measurement of delirium severity, identifying six final high-quality instruments. The cited tools were the Confusion Assessment Method, Confusional State Examination, Delirium-O-Meter, Delirium Observation Scale, Delirium Rating Scale, and Memorial Delirium Assessment Scale. These measures will facilitate accurate quantification of delirium severity to improve clinical care, with the goal of encouraging greater usage. "The time is right to advance measurement of delirium severity: measurement is important, impactful, and efforts to stratify risk, target treatment, and monitor for outcomes are already possible and feasible with existing approaches," noted Harvard Medical School Professor Sharon K. Inouye. Meanwhile, Brown University's Richard N. Jones said, "Measurements of delirium severity should play an important role in the advancement of clinical care and research for persons with delirium."

U.S. District Judge Reed O'Connor of Texas ruled on Friday that the entirety of the Affordable Care Act (ACA) is unconstitutional because of a recent change in federal tax law, reports the Washington Post . The ruling upheld a lawsuit initiated by Texas Attorney General Ken Paxton; the plaintiffs' contention that the ACA is invalid stems from the Supreme Court's 2012 ruling in which Chief Justice John G. Roberts Jr. wrote for the majority that the penalty the law created for Americans who do not carry health insurance is constitutional because Congress "does have the power to impose a tax on those without health insurance." Congressional Republicans pushed through a change in which that penalty will be eliminated, starting in January, as part of the tax overhaul earlier this year. The lawsuit argues that, with the enforcement of the insurance requirement stripped, there is no longer a tax so the law no longer is constitutional. If the ruling stands, it would create widespread disruption across the U.S. healthcare system. The White House released a statement concerning the ruling, saying, "We expect this ruling will be appealed to the Supreme Court. Pending the appeal process, the law remains in place." Congressional Democrats decried O'Connor's ruling, as did major healthcare industry segments. America's Health Insurance Plans promised consumers that their health coverage would remain "strong and stable" while the ruling is appealed.

The three most male-dominated sectors and the three fastest-growing sectors since December 2016 are mining, construction, and transportation and utilities, but in the same period, women's employment in these sectors rose more than 10 percent, reports the New York Times . A faster rate of employment growth for women was focused in sectors that are at least 66 percent male, where women's employment rose 5 percent, compared to 3 percent for men. However, only 11 percent of women currently work in male-dominated fields, and experts expect female-dominated occupations like healthcare will grow fastest over the long term. "In a tight labor market, firms give workers a chance they would not otherwise consider," says Harvard University's Lawrence Katz. "But the tight labor market could facilitate longer-term change if it demonstrates to firms that they should be more open to women in previously male-dominated areas." In male-dominated industries, the fastest growth for women has been at building sites and on the factory floor, instead of in the accounting office; women's employment rate climbed 6.9 percent, versus 2.3 percent for men. Meanwhile, in mixed- and female-dominated jobs within male-dominated industries, men's employment grew 4.3 percent to women's 3.8 percent. The expansion of women in male-dominated jobs might last only as long as the labor market remains tight.

The Labor Department estimates that private-sector workers' average hourly compensation, including both pay and benefits, increased 2.9 percent from a year earlier in the third quarter, reports the Wall Street Journal . The yearly gain in base pay for U.S. workers was a slight increase from the prior quarter, led by a 3 percent increase in wages and salaries. It was the first period since mid-2016 that base pay rose at a faster rate than benefits. Another Labor Department measure of hourly wages climbed 3.1 percent in November from a year earlier, matching the best annual increase in nine years. The improvement in wages comes with the unemployment rate holding steady at 3.7 percent since September, the lowest point in 49 years. "It's about time that workers are being compensated. We've been waiting to see these base pay increases for the longest time," notes Robert Half's Paul McDonald. Benefit costs — including health coverage, retirement benefits, and paid leave — increased 2.7 percent from a year earlier in the quarter ended in September. The data suggests tax cut-related bonuses did not rise in the third quarter, while the share of compensation from nonproduction bonuses remained the same as in the third quarter from the previous two periods.

The Centers for Disease Control and Prevention (CDC) reported last Friday that the number of children and adolescents vaccinated for flu in mid-November was up nearly 7 percentage points over last year at that time and coverage among adults was up 6.4 percentage points, according to Stat . This does not suggest whether more people will be vaccinated overall this winter, or that the previous flu season is changing behavior this winter. The gain could indicate that more people were inspired to get their flu shot sooner this year. The CDC concedes that it is difficult to say for sure what is fueling the increase, but its working theory is that more people are receiving vaccinations because last winter reminded them that flu can be dangerous. The agency estimated that 80,000 Americans in total were killed by the flu last year, and the chief strain was the influenza A virus H3N2, which is associated with seasons of greater severity. The CDC analysis noted that experience from previous flu seasons demonstrates that people continue to get vaccinated through the winter and even into spring, with end-of-season rates in children 19 percentage points higher than the early season rates, and 8 percentage points higher in adults.

A study was conducted by Lancaster University to characterize U.K. seniors' loneliness and social isolation over the winter holidays and what technological solutions can help remedy it, reports The Conversation . The researchers determined older people believe meeting face-to-face is especially meaningful versus telephone and online interactions. A majority of older adults learned about social events through printed ads in public places such as libraries, through talking to people, or through the Internet. Since the information was spread across different sources and in different formats, it made finding out about social events challenging for seniors. Limitations with public transit often made social events inaccessible, and the charity Age UK South Lakeland suggested only 17 percent of their clients currently have online access. The Lancaster researchers devised an app that taps open data about events and volunteering opportunities nearby. Seniors can establish user profiles to set their preferences for events according to cost and location; they can then review transport options and routes to the event on a map featuring the location of bus stops and car parks as well as nearby toilets and benches. If they choose an event they want to attend, it is recorded in a calendar. The app also can be accessed by family, friends, or caregivers who can search and plan on their behalf; this allows for the app to be beneficial to older adults who lack Internet access.

A poll from the National Aging and Disability Transportation Center (NADTC) found 86 percent of caregivers are concerned about how well their older loved one drives and believe the time is coming or even has passed when driving is unsafe, reports Deseret News . Over one in five older adults do not drive, and 600,000 stop driving every year. Obstructions to transportation include lack of a "go-to" single source to learn about alternative transportation options, as well as the cost of such options, assuming they are available. Eighty percent of older respondents do drive, while 58 percent ride with family and friends and 54 percent walk "sometimes or often." Only 15 percent use public transit, and 10 percent use a cab service; no more than 33 percent older adults said they know about community transportation options and 41 percent said they lack "good alternative transportation options" if they cannot drive. NADTC has launched an "Every Ride Counts" campaign to highlight local transportation options for vulnerable adults who need help with transportation. Easter Seals' Nancy Goguen says the campaign's seeks to improve and ensure people's awareness about accessibility options. Much of the program involves technical assistance, such as providing images and ads to which local programs can add their contact, for example.

A multi-state coalition of 43 attorneys general have submitted a letter calling for the prioritization of updates to the Social Security Administration's (SSA) electronic databases and verification methods, so financial institutions can instantly check for and flag synthetic identity theft, reports SCVNews . The law requires banks and their service providers to pay fees to cover the cost of developing and operating the SSA system, but delays in the verification process gives criminals an opportunity to use stolen identities before an incident is identified. "It's time to move the SSA's verification technologies into the 21st century to keep up with identity thieves who are exploiting our vulnerabilities," argues California Attorney General Becerra. "We urge the SSA to prioritize making its systems as nimble and strong as possible, when the funding is available from banks and others that will use the system, to combat this growing problem." The current system does not permit institutions real-time identity checks, and miscreants target the most vulnerable, especially children and recent immigrants with no credit histories. The letter's signatories recommend the SSA deploy electronic signatures or other verification methods, so institutions can confirm identity and flag theft in real time.

A request for information (RFI) from the U.S. Department of Health and Human Services and its Office for Civil Rights (OCR) suggests it has extensive plans for revamping privacy elements of the Health Insurance Portability and Accountability Act (HIPAA), reports Politico Pro . The RFI concentrates on improving care coordination, with questions covering access to health information, sharing with social service agencies, expanding data clearinghouses' access, and beneficiary health data. One question asks whether doctors should have latitude to share information with other healthcare providers or social agencies without recipient authorization in cases where they deem it in the best interest of the recipient. Also covered by the RFI are issues such as the "accounting for disclosures" rule, which allows recipients to understand to whom their data had been disclosed. OCR has been unable to meet that requirement, with an earlier attempt defeated after negative public feedback. The request revives the issue by seeking basic information, like how frequently covered entities receive requests for an accounting of disclosures. OCR Director Roger Severino has vowed to rethink HIPAA requirements for an time when more care coordination — and thus more data-sharing — is needed, while also promising "big, juicy enforcement" actions against certain HIPAA violators.

A new forecast from eMarketer says Americans 55 and older are the fastest-growing group of electronic wearable users in the United States, mainly thanks to the devices' enhanced health features. Next year, 8.2 million Americans age 55 and older are expected to use a wearable device, up more than 15 percent this year. "Wearables like smartwatches are now coming equipped with additional health features, which are especially appealing to older Americans," says eMarketer analyst Cindy Liu. "The Apple Watch Series 4 is outfitted with some major enhancements, including ECG electrocardiography readings and fall-detection features." Next year, more than one in five Internet users are projected to be using a wearable device. "Continuous improvements in design and functionality are key drivers of smartwatch adoption," Liu notes. "Specifically, LTE connectivity will be a huge driver, as it allows smartwatch users to stay connected while leaving their phones behind. Other improvements, like longer battery life, larger screens, and new health features, will be sure to attract new users."