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Medical College of Wisconsin CEO on science, academic medicine during COVID

Dr. John Raymond Sr. has served as president and CEO of the Milwaukee-based Medical College of Wisconsin since July 2010. It’s the nation’s third-largest private medical school, and its more than 1,600 faculty physicians constitute one of the largest medical groups in a state where COVID-19 cases have surged in recent weeks. Raymond talked with Assistant Managing Editor David May about lessons learned during the pandemic and priorities for the months ahead. The following is an edited transcript.

MH: Can you talk about Wisconsin’s COVID-19 caseload? It’s recently been one of the nation’s hot spots for surges in new cases.

Raymond: Like many parts of the Midwest, Wisconsin is experiencing rapid community spread of COVID-19, especially in the north central and northeastern regions of the state. In addition to a surge of new cases, the positivity rates and the reproductive numbers and measures of contagiousness are very unfavorable. So this indicates a large and growing burden of disease. Data posted (on Sept. 30) by the Wisconsin Department of Health Services showed that every county of the state had either a high or very high burden of disease. And more than half of the counties had a trajectory that was unfavorable.

And this has also been exacerbated by the need to quarantine healthcare staff, who either have active infections or who have confirmed exposure. In many cases, especially in rural parts of states, the staff is the bottleneck. You can create surge capacity for ventilators, ICU beds and hospital beds, but if you don’t have enough staff to take care of the patients, that’s a real problem.

MH: Initial reporting was that the universities were a part the problem, but what about the rural areas? Is there a general theory about what’s happening?

Raymond: We had well over 100,000 students, returning to school; most of the universities in Wisconsin had some form of in-person classroom activity that began in early September and late August. So for the first week in September, when the surge really was beginning to be apparent in Wisconsin, most of the cases were associated with young people in the 18-24 range. There was a very, very significant spike in cases. What was interesting though, is the spike wasn’t limited just to counties that had a large university; we were seeing community spread in addition to the return of thousands of students. And we believe that was in part due to long-term (pandemic) fatigue, some skepticism about the utility of wearing a masks and a lot of gatherings and relaxation of social distancing around the Labor Day holidays.

MH: Given all that’s transpired, what have your doctors and affiliated hospitals learned during this pandemic?

Raymond: Like other parts of the country, we now know much better how to triage and provide supportive care for patients with COVID-19. And there are some moderately effective therapeutics that we can strategically deploy to help us. Just the level of comfort in taking care of novel coronavirus has increased significantly.

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Rising Temperatures Undermine Academic Success and Equity

Hotter daytimes are thwarting students’ academic progress and exacerbating long-standing educational inequities for people of color, according to researchers who examined the issue in more than 50 countries.

The report, published yesterday in the journal Nature Human Behavior, used two major datasets to track the relationship between students’ exposure to soaring temperatures and their learning outcomes. The data revealed that additional days above 80 degrees Fahrenheit inhibit students’ performance on standardized tests that are meant to measure educational achievement and cognitive ability.

“Temperature has been shown to affect working memory, stamina and cognitive performance, and to lead individuals to reduce time spent engaging in labour activities,” the researchers wrote. “This suggests that, in addition to the channels above, heat may directly affect students’ capacity to learn or teachers’ ability and willingness to teach.”

Co-author Joshua Goodman, a professor of education and economics at Boston University, said the findings have major implications for students who attend classes in buildings that lack proper ventilation and air conditioning. Both in the United States and abroad, he underscored, those schools disproportionately serve low-income families and people of color.

So while it’s already important to ensure school facilities are safe and comfortable, as climate impacts intensify, it will only become more important that older facilities are updated or replaced altogether.

“The returns of doing that,” Goodman said, “are going to get higher over time.”

The researchers worked with two datasets to study academic achievement and temperature across a range of age groups, economies and international borders.

The first dataset examined the test scores of more than 144 million students in nearly 60 countries who took a standardized international exam between 2000 and 2015. The test at issue is administered every three years by the Programme for International Student Assessment and aims to provide comparative, international data on 15-year-olds’ academic performance in reading, math and science.

The second analysis, meanwhile, comprised more than 270 million exam scores of U.S. students between the third and eighth grades. The researchers pulled the exam results from the Stanford Education Data Archive, which standardizes different states’ required annual exams to provide national comparability.

The research revealed that students who went to school during years with additional hot days demonstrated “reduced learning”—and lower test scores. Of particular importance to Goodman was that in the United States, “basically all of the impact of heat on these test score outcomes was driven by Black and Hispanic students, and not by white students. Similarly, by low-income school districts and not by high-income school districts.”

In this way, the two datasets yielded the same conclusion, Goodman said. The learning damage associated with hotter temperatures appear to be larger for low-income populations around the world. That likely means that heat exposure—which is intensifying in step with global warming—will have a more direct and persistent impact on economic growth and development than previously anticipated.

“There are countries where students [already] experience 200 days a year where the temperature is over 80 degrees Fahrenheit,” said Goodman.