To increase the window of time that a drug exposure can be detected, researchers from Florida International University have developed an innovative, sensitive, and specific method to detect drug exposure, which is fundamentally different from traditional toxicological drug testing. The research team developed and validated the procedure (or assay) to detect and measure drug exposure based on modifications to blood proteins caused by the body’s reaction to a drug. The researchers examined the following commonly abused drugs: methamphetamine, MDMA, Δ9-THC, oxycodone, cocaine, and diazepam. The novel blood protein modification assay has some advantages over currently available methods for detecting drug exposure. First, the assay is highly sensitive and specific, meaning that it can detect drug exposure even in cases where the drug is no longer detectable in blood or urine samples. Second, the assay is based on modifications to blood proteins rather than the drug itself or its metabolites. This means that it can detect exposure to a wider range of drugs and can potentially identify obscured or disguised drug exposure. The assay has important implications for forensic investigations, particularly in cases where drug use is relevant but difficult to detect. For example, investigators could use the assay to retrospectively detect drug use in cases involving impaired driving, workplace accidents, or criminal investigations, such as drug-facilitated sexual assaults. Substance abuse treatment programs could also use the assay to help monitor individuals. Researchers anticipate that this novel approach will significantly benefit criminal justice research by providing an additional tool to detect and quantify important agents of forensic interest over longer periods of time.

This report presents data on U.S. residents age 16 or older who reported that they had been victims of identity theft in the 2021 Identity Theft Supplement to the National Crime Victimization Survey (NCVS). Data include types of identity theft, demographics of the victims and the ways they discovered the theft, financial losses incurred, and steps taken after the theft. The report found that in 2021, about 23.9 million people (9% of U.S. residents age 16 or older) had been victims of identity theft during the prior 12 months. For 76% of identity-theft victims in 2021, the most recent incident involved the misuse of only one type of existing account, such as a credit card or bank account. About 59% of identity-theft victims had financial losses of $1 or more that totaled $16.4 billion in 2021. Additionally, in 2021, about 2% of persons age 16 or older experienced the misuse of an existing email or social media account.

This study evaluates the implementation of the Supporting Education and Employment Development (SEED) program between May 2021 and June 2023. The SEED program is a 13-month pre-plea deferred-prosecution program, which aims to serve adultsaged 18-26, charged with delivery or intent to deliver (drugs) in Cook County, Illinois. Overall, results of the evaluation show that despite some operational challenges, SEED was implemented smoothly. However, interviewees did indicate there were opportunities for program refinement and additional evaluation. The study made four key recommendations for continued implementation: (1) continuously evaluate program dosage and participant needs and adjust SEED services when possible based on participant needs; (2) balance virtual and in-person services; (3) ensure appropriate funding and staffing; and (4) conduct future evaluations.

This report reviews standardized testing practices in the Department of Defense's school system. The Department of Defense Education Activity (DODEA) operates a school system that primarily serves military-connected families. Like traditional public school districts, the system uses standardized tests—tests administered and scored in a preset, standard manner—to assess academic progress of students over time. According to the Government Accountability Office’s analysis, DODEA students spent more time on standardized tests throughout a student's K–12 education, compared to students in nine selected public school districts. Specifically, DODEA students averaged about 24 school days while students in the nine districts averaged about 16 school days across grades K–12. In 2021, DODEA convened a working group made up of agency leadership, school principals, teachers, and other instructional staff to review and recommend changes to testing policies and procedures. However, the plan does not follow several leading project management practices, such as how progress will be tracked and reviewed, or explain how stakeholders would be involved in decision-making and execution. The U.S. Government Accountability Office recommends that DODEA's implementation plan for the recommendations from its working group comport with leading project management practices by including information about how progress will be tracked and reviewed, and how stakeholders will be involved.

Community colleges and broad-access universities (those with minimally selective admissions policies) provide an opportunity for students across the United States to attain post-secondary degrees and economic mobility. However, graduation rates from such colleges are often low and there are many obstacles that can be difficult to overcome, especially for students who must balance work or family responsibilities, older students, students from low-income backgrounds, and students of color who face additional systemic barriers. Furthermore, the COVID-19 pandemic introduced unprecedented challenges for college students, making the pursuit of higher education even more difficult. Starting in 2019, 13 colleges across five states (California, Indiana, Minnesota, New Jersey, and Ohio), along with their state higher education agencies, have worked with MDRC to customize and launch Scaling Up College Completion Efforts for Student Success (SUCCESS). The program is a multifaceted student support program designed to effectively pro¬mote student success and be financially sustainable. Eleven of the 13 colleges are participating in the randomized controlled trial. A previous brief presenting early findings from the first study cohort illustrated that the SUCCESS program in the 2020–2021 academic year, as adapted for the context of the pandemic, had no discernible effect on students’ academic progress. This report provides updated insight into the SUCCESS program after one year of participation for the first three evaluation student cohorts, covering fall 2020 through summer 2022. The main implementation finding from that time period is that the program implementation varied by college and term, and did not fully align with the SUCCESS model, largely due to the adaptations implemented during the COVID-19 pandemic. However, students who were offered SUCCESS had a different college experience from students in the control group—they were more likely to be told about the importance of full-time enrollment and, on average, they had substantially more contact with their advisors or coaches.

In this research, the authors conduct a statewide examination of elementary schools in North Carolina and a quasi-experimental analysis of an urban district that recently changed its elementary start times. The authors find that earlier start times predict less sleep for students. Regarding academic outcomes, the resulting estimates are small in magnitude and suggest that earlier elementary start times have near-zero effects. Earlier start times predict a slight increase in absences and modestly higher math scores, especially for traditionally disadvantaged students. However, the analyses suggest that elementary school students are absent more often when their school switches to an earlier start time. The authors conclude that in districts that need to stagger start times, it may be advisable for elementary schools to start earlier to accommodate later secondary school start times.

To examine whether U.S. homes are prepared for an aging population, this report uses data from the 2019 American Housing Survey to show the number of housing units with select aging-accessible features. It examines the number of households with older adults who have difficulty using some feature of their home and how their demographic and economic characteristics differ from those who report no difficulty. The report also looks at older adults’ beliefs and expectations about aging in place. Of the 37 million households with older adults in the United States, nearly 11% reported difficulty living in or using their home. Among the oldest households, this figure was doubled (about 24%). One conclusion of this report is that older households face different housing accessibility needs across geographic areas of the United States. These accessibility needs differed significantly by division, as well as by age and housing tenure. These relationships likely reflected a combination of geographic differences in older, inadequate housing, and older adults’ poor health. Most older households said that their home met their accessibility needs very well, even though most homes in the United States lacked some basic aging-ready elements (i.e., a step-free entryway and a bedroom and full bathroom on the first floor). Similarly, relatively few older homeowners had renovation plans to improve the home’s aging-accessibility, even though 1 in 10 reported difficulties living in or using their home. The disconnect may have stemmed from a variety of factors such as a lack of resources to renovate, a belief that the home’s existing layout was good enough, or for renters, a lack of control over changing their home’s layout. The need for aging-ready homes is likely to grow over the next few decades, as baby boomers age and the size of the older population expands.

Decades of nuclear energy research and weapons development created radioactive waste at sites in the Midwest and Northeast U.S.—leading to environmental risks for nearby communities. The U.S. Army Corps of Engineers (Corps) reported $2.6 billion in environmental liabilities in fiscal year 2022 for the estimated future costs to investigate and clean up contamination under its Formerly Utilized Sites Remedial Action Program (FUSRAP). Of the 19 active sites in the program, four sites with complicated cleanup remedies or large amounts of contamination make up about three-quarters of this estimate. However, Corps officials said that FUSRAP's environmental liability has the potential to be affected by uncertainties, such as the discovery of additional contamination after completing a cost estimate for remediation. Since 2016, FUSRAP's environmental liability has risen by nearly $1 billion, an increase that officials attribute to uncertainties, along with inflation. The Government Accountability Office’s (GAO) review of FUSRAP documents found that the Corps minimally met selected leading practices for program management related to risk management and cost estimating, among other things. For example, the Corps does not have a documented program-level risk management process for FUSRAP. Additionally, Corps officials said that they consider FUSRAP's environmental liability estimate to be the program's life cycle cost estimate. However, the environmental liability estimate does not include all costs and does not track costs from previous years. The GAO made five recommendations, including that the Corps update the FUSRAP Program Management Plan; create a program management roadmap; conduct risk management; develop a life cycle cost estimate for FUSRAP; and include the specific needs of FUSRAP communities in outreach strategies.

In this report, the authors create benchmarks for comparison with the Department of the Air Force’s accession cohorts by estimating the fraction of the eligible (and propensed or having a propensity to serve) population, using ten mutually exclusive categories of gender and race and ethnicity. The benchmarks provide a measure of progress on diversity and inclusion in the force and a comparison to clearly identify whether a demographic's overrepresentation or underrepresentation can be attributed to specific eligibility standards or propensity to serve, or both. The report found that body mass index, height, and education and aptitude requirements are the most important barriers to both enlisted and officer eligibility, but these requirements affect the eligibility of gender and racial and ethnic groups differently. Eligibility requirements limit racial and ethnic minority representation, but propensity to serve offsets barriers to eligibility for these minorities. Additionally, eligibility requirements favor representation of women, but propensity to serve is a key barrier to accessions for women. Considering gender and race and ethnicity jointly, no minority group meets the demographic benchmarks of the U.S. population that is both eligible and has a propensity to serve across the three accession sources (enlisted, the U.S. Air Force Academy, and Reserve Officers' Training Corps or Officer Training School).

Non-fatal injuries are major causes of emergency department visits in the United States. The National Center for Injury Prevention and Control estimated that, in 2020, 22.9 million emergency department visits related to nonfatal injuries occurred. Visits for assault (excluding sexual assault) represented 5.8% of these visits. This report uses the most recent data from the National Hospital Ambulatory Medical Care Survey to present assault-related emergency department visit (excluding sexual assault) rates by selected demographic and hospital characteristics. Key findings from the report include that during 2019–2021, the overall emergency department visit rate for assault was 4.5 visits per 1,000 people per year.Emergency department visit rates for assault were highest for people ages 18–24 (9.2) and 25–44 (7.7), and then declined with age. The emergency department visit rate for assault was highest for Black non-Hispanic people compared with all other race and ethnicity groups. Medicaid, Children’s Health Insurance Program, or other state-based program was the most common primary expected source of payment among emergency department visits for people injured by assault. The emergency department visit rate for assault was higher for people who visited hospitals in metropolitan statistical areas (4.9) compared with nonmetropolitan statistical areas (2.0).

The U.S. is confronting an urgent and worsening shortage of psychiatric beds. For example, in Massachusetts, hundreds of patients have been wait-listed for acute inpatient psychiatric beds. In California, well over a thousand individuals deemed mentally incompetent to stand trial have been housed in county jails, awaiting placement at psychiatric facilities. The COVID-19 pandemic has exacerbated this dynamic, creating an epidemic within the broader pandemic. The percentage of the U.S. populace reporting serious psychological distress—a marker of need for inpatient psychiatric services—has risen from 4% in 2018 to 13% in 2020. Meanwhile, psychiatric facilities have experienced disrupted continuity of operations and reduced bed capacity—for example, by converting double-occupancy rooms to single-occupancy rooms to reduce viral spread. While the COVID-19 pandemic has shed light on the shortcomings of psychiatric bed infrastructure, the decline in bed capacity has progressed steadily for more than 50 years. This progression was driven, in part, by declining lengths of stays at psychiatric facilities, as well as the promise of community-based care that appropriately and humanely responded to patient needs. In practice, however, availability of community mental health services has remained lacking. Currently, there are no standardized approaches or best practices for determining psychiatric bed need, as not all psychiatric beds are alike; some individuals with certain backgrounds are difficult to place in psychiatric beds; and demand may be a weak proxy for need. The authors propose a three-stage approach to estimation. In stage 1, states should generate an inventory of current bed occupancy rates, average length of stay, wait list volume, transfer requests to higher and lower levels of care, and the types of patients that facilities are unable to place. Stage 2 should focus on accumulating epidemiologic and demographic data to recalibrate information from stage 1. The final stage is to convene experts, including epidemiologists, methodologists, and clinicians, to deliberate evidence and theoretical considerations.

In this brief, the authors examine the spending of the four types of post-acute care (PAC) providers, their payments in relation to cost, and proposals to reduce Medicare spending for PAC. Medicare enrollees who need recuperation and rehabilitation services after an acute inpatient hospital stay can receive PAC in skilled nursing facilities, inpatient rehabilitation facilities, long-term care hospitals, or at home through the home health care benefit. Under rules that vary by PAC setting, enrollees may also be admitted into PAC directly from the community, which is common for home health. To provide more context for weighing these proposals, the authors examine which traditional Medicare enrollees use PAC (by age and income) and how their total program spending is allocated across payers (Medicare, out-of-pocket, Medicaid, or supplemental plan). The authors found that moving payments by Part A for home health services to Part B would be an expedient way to deal with the hospital insurance deficit, but it would do nothing to address Medicare spending as a whole and could lead to increased Part B premiums. Additionally, policies that would aim to generate program savings by increasing cost-sharing obligations for users of PAC would add to already high financial burdens for beneficiaries lacking supplemental or Medicaid coverage unless increased cost sharing for PAC were accompanied by policies that would reduce beneficiaries’ overall exposure to high out-of-pocket costs.