Heart Walk to Save Lives
By Michael Vybiral American Heart Association
Autumn in Central Texas is the perfect time to get outside and enjoy the cooler temperatures, watch the annual bird migrations, and walk to save lives with the American Heart Association. This year’s Austin Heart Walk, slated for Sunday, Oct. 27 at Moody Amphitheater at Waterloo Park, invites members of the community and local businesses alike to combat the leading cause of death in Austin, heart disease.
The impact of the Austin Heart Walk extends beyond the day of the event. Participants will play a crucial role in the American Heart Association’s Nation of Lifesavers™ initiative, a national effort aimed at doubling cardiac arrest survival rates by 2030. For more than 60 years, the American Heart Association has been a global leader in resuscitation science, education, and training, and the official publisher of CPR guidelines. CPR education will be a critical element of the Austin Heart Walk, with Hands-Only CPR demonstrations available to participants. Through the Nation of Lifesavers initiative, the Association is committed to empowering individuals everywhere to act in the event of a cardiac emergency, making sure that no one is left without the help they need when seconds count.
“My family believes that people with brain injuries can regain their independence, and I am honored to carry on that legacy to help other patients and families transform tragedy into triumph,” said Dr. Ashley. “As the 2024 Austin Heart Walk Chair, I look forward to connecting, learning and spreading important resources
Over 90% of people who suffer out-of-hospital cardiac arrests die, but CPR can double or even triple a cardiac arrest victim’s chance of survival. Since over 70% of out-of-hospital cardiac arrests take place in homes, you could be the difference to save the life of a loved one. There are two steps to save a life:
I look forward to ...spreading important resources to improve the overall health of our community and remind everyone that heart health is brain health — Dr. Ashley
This year’s Austin Heart Walk Chairperson is Dr. Matthew Ashley, the Chief Medical Officer of Centre for Neuro Skills. Dr. Ashley has dedicated his career to bringing awareness to the importance of heart disease and stroke prevention.
to improve the overall health of our community and remind everyone that heart health is brain health.”
In a medical emergency like cardiac arrest, every second counts. Survival depends on immediately receiving CPR from someone nearby.
1. Call 911. Let them know that you suspect somebody is experiencing a cardiac arrest and provide them with your precise location. EMS will be dispatched to your location, but in the meantime:
2. Push hard and fast. With one hand atop another, push hard and fast in the center of the chest to the beat of a familiar song that has 100-120 beats per minute, like “Too Sweet” by Hozier, “Pink Pony Club” by Chappell Roan or “Stayin’ Alive” by the Bee Gees.
Susan G Komen Fight for Quality
Legal Matters
The Fifth Circuit Confirms the DOL’s Authority to Use Salary Basis Test for FLSA Overtime Exemptions
By Derek A. McKee, J.D. Polsinelli, PC
The U.S. Court of Appeals for the Fifth Circuit recently confirmed that the United States Department of Labor (“DOL”) has the authority to use a salary basis to define its white-collar overtime exemptions. This is a big win for the DOL as it is presently defending its latest increase to the minimum salary thresholds for executive, administrative, and professional exemptions under the Fair Labor Standards Act (“FLSA”), also known as the FLSA’s “white-collar exemptions”, in the Eastern and Northern Districts of Texas.
For medical practice admin-
istrators and medical practitioners alike, this news should strongly encourage you to seek counsel about the compensation of your exempt employees to ensure you are prepared to comply with the new salary thresholds announced by the DOL earlier this year.
The Mayfield Decision
In Mayfield v. U.S. Department of Labor, a unanimous three-judge panel of the Fifth Circuit provided that the DOL has the authority to “define and delimit” an exemption from overtime pay under the FLSA. In so ruling, the Court affirmed the dismissal of a lawsuit initiated by a Texas fast-food operator, Robert Mayfield, who claimed Congress never authorized the DOL to use salaries as a test for whether workers have managerial duties.
The Court rejected Mayfield’s argument. In response, the Fifth Circuit wrote that “[d]istinctions based on salary level are ... consistent with
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the FLSA’s broader structure, which sets out a series of salary protections for workers that common sense indicates are unnecessary for highly paid employees.” Upon issuing the Mayfield decision, the 5th Circuit joined the four other federal appeals courts who have considered this issue previously (including the D.C. Circuit, the 2nd Circuit, the 6th Circuit, and the 10th Circuit).
2024 DOL Rule
The 2024 DOL rule effectively focused on three main points. First, it raised the minimum weekly salary to qualify for the FLSA’s white-collar exemptions from $684 per week to
$844 per week (equivalent to a $43,888 annual salary) on July 1, 2024. Second, it called for another increase of the minimum weekly salary to $1,128 per week (equivalent of a $58,656 annual salary), on January 1, 2025. Third, under the 2024 DOL rule, the above salary threshold would increase every three years based on recent wage data. As mentioned above, the Mayfield decision comes at a time when the DOL is defending its recent 2024 rule increasing the salary thresholds for white-collar exemptions
see Legal Matters ...page 13
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Oncology Research
Breast Cancer Is on The Rise Among Millennials –Do You Know Your Risk?
By Moya Griffin, M.D., FACS Texas Breast Specialists
Austin
North
Breast cancer affects one in eight women, and incidence rates are on the rise for those in their late 20s, 30s, and early 40s. While there is no surefire way to prevent breast cancer, understanding your risk and taking proactive steps today can make all the difference tomorrow. Remember that having one risk factor, or even several, does not mean you will have breast cancer, and women with no risk factors can still develop breast cancer.
Genetic and Biological Risk Factors
Certain factors that cannot be changed, such as your family history, can increase the likelihood of developing breast cancer. Women younger than
45 may be at higher risk if they have one or more of the following genetic or biological factors:
• Close relatives who were diagnosed with breast cancer before age 45, especially if more than one relative was diagnosed or a male relative had breast cancer.
• Personal or family history of ovarian cancer.
• Changes in certain breast cancer genes (BRCA1 and BRCA2) or close relatives with these changes.
• Ashkenazi Jewish heritage.
• Radiation therapy to the breast or chest during childhood or early adulthood.
• Previous breast cancer diagnosis or certain other breast health issues, such as lobular carcinoma in situ (LCIS), ductal carcinoma in situ (DCIS), atypical ductal hyperplasia, or atypical lobular hyperplasia.
• Dense breasts as seen on a mammogram.
• Reproductive history resulting in increased exposure to estrogen such as starting menstruation before age 12 or menopause after age 55, having your first child after age 30, or never having children.
• Exposure to medications that use hormones, such as certain types of birth control or hormone replacement therapy.
Learning about your family history, undergoing genetic risk evaluation and testing, and going to your annual physical can help you understand which genetic or biological risk factors may affect you. Other Risk Factors
Environmental or non-genetic risk factors, such as diet and physical activity, are linked to 40% of cancer cases and almost half of all cancer deaths in the U.S. Speak with your physician about what changes you can make to reduce your risk.
• A diet high in foods like red meat or ultra-processed food can increase breast cancer risk among premenopausal women. However, substituting legumes for one serving of meat per day can lower
see Oncology ...page 14
Mental Health Are You a
Helicopter Parent?
By Baylor College Of Medicine
Overprotective parents are often referred to as helicopter parents. While they have their child’s best interest and safety in mind, they might be overbearing at times. A Baylor College of Medicine child and adolescent psychiatrist explains the motive behind helicopter parents and emphasizes the importance of sympathizing with them.
“A helicopter parent is often fueled by anxiety, and that anxiety can come in different flavors: anxiety for their child to be safe, successful or not to be emotionally harmed, as well as anxiety to keep up with the Joneses or what their family or culture expects,” said Dr. Laurel Williams, professor in the Menninger Department of Psychiatry & Behavioral Sciences at Baylor.
A helicopter parent is one who does not allow for their child
to do things that most would consider to be developmentally appropriate on their own with less direct intervention by the parent. Demonstrating sympathy and empathy as well as understanding these parents is crucial as they typically act this way as a desire to be helpful. Williams does not recommend telling these parents that their behavior is harmful but suggests asking questions about why they act this way.
“Don’t tell someone they’re a helicopter parent, but instead, approach them in a way to not make them feel judged,” she said.
“Support them first and see if they’re willing to concede: ‘I notice you often step in when there’s a disagreement on the soccer field, can you help me understand why?’ They might have a good reason, or they might be willing to listen to why their behavior shouldn’t continue.”
Helicopter parents try to
make the pathway easier for the child, but if they insert themselves in their child’s issues too often, the child might not learn how to handle failure and disappointment. Parents need to model how their kids should handle these feelings, such as not making a sports team or getting a bad grade on a test.
“Be helpful in planning on how this doesn’t happen again, but if you don’t let them handle it on their own, you can delay their development,” Williams said.
While it might be difficult
to let your child do tasks alone without adult supervision, it is important to identify the right time for them to do these tasks independently, like walking to school or going to the mall. If your child demonstrates that they can be responsible and follow multi-step commands over time without losing track, they might be prepared for more independence. If they cannot fulfill these duties on their own, it might not be
Mental Health ...page 14
Games, Puzzles and Reading Can Slow Cognitive Decline In The Elderly—Even In Those With Mild Cognitive Impairment
By Ann Kellett, PhD
School of Public Health researcher recommends engaging in these activities at least three to four times a week
The high-level participation group consistently exhibited higher cognitive function levels during the study period.
The aging process can lead to diminished cognitive functioning for older adults. In addition, about 10 percent of people previously diagnosed with mild cognitive impairment develop Alzheimer’s disease or other forms of dementia every year.
Although a few studies have found that activities such as putting together jigsaw puzzles can protect against cognitive aging, the benefits of these activities in preventing or
associate professor of health behavior at Texas A&M. “We sought to help fill the gap in our understanding of cognitive decline.”
For the study, published in the Journal of Cognitive Enhancement, Kim, along with researchers from the University of Southern Mississippi and Indiana University, analyzed data on 5,932 people who were at least 50 years old in 2012, had mild cognitive impairment and were part of the Health and Retirement Study (HRS) from 2012 to 2020.
The HRS collects data through self-reported paper-and-pencil surveys and in-depth phone interviews. For this study, the researchers analyzed the answers to seven questions about how often participants engaged in cognitively stimulating activities such as reading, game playing and hobbies. Next, they
postponing cognitive decline are still largely unknown.
Now, findings from a new study from the Texas A&M University School of Public Health suggest that older people with mild cognitive impairment who engage in high levels of activities such as word games and hobbies have better memory, working memory, attention and processing speed than those who do not.
divided the participation levels in the categories of low, mid and high based on criteria used in previous studies and conducted repeated-measured multivariate analysis of covariance.
“In short, the high-level participation group consistently exhibited higher cognitive function levels during the study period and maintained a similar level of cognitive functions compared to the other groups,” Kim said.
Those in the high-level category had higher levels of memory, working
“Today, nearly six million people in the United States have dementia, and this number is projected to grow to about 14 million by 2060—with minority populations affected the most,” said Junhyoung “Paul” Kim, PhD, an see Cognitive Decline...page 13
Join 250,000+ professionals who get free Continuing Medical Education (CME) with Texas Health Steps Online Provider Education. Choose from over 50 CME courses developed by trusted Texas experts, for experts like you. Quick courses and case studies on topics such as Medicaid guidelines, ethics and mental health, and more are all available 24/7.
St. David’s Healthcare Facilities Receive National Recognition for Cardiovascular And Stroke Care
St. David’s Health Care facilities recently earned the American Heart Association/ American Stroke Association Get With The Guidelines® achievement awards for demonstrating commitment to following up-to-date, research-based guidelines for the treatment of heart disease and stroke, ultimately leading to more lives saved and fewer readmissions to the hospital.
“We are honored to be recognized by the American Heart Association and American Stroke Association for our dedication to helping patients achieve the best possible outcomes after a heart attack or stroke,” Ken Mitchell, M.D., chief medical officer of St. David’s HealthCare, said.
“Our physicians, nurses and staff are committed to providing exceptional care to the Austin community, and we are incredibly proud of their work.”
Heart disease and stroke are the No. 1 and No. 5 causes of death in the United States, respectively. Each year, they claim more lives in the U.S. than all forms of cancer. Studies show patients can recover better when providers consistently follow treatment guidelines. Get With The GuidelinesCoronary Artery Disease
St. David’s South Austin Medical Center and St. David’s Round Rock Medical Center received the Get With The Guidelines - Coronary Artery Disease STEMI Receiving Center Gold Plus award for the treatment of ST elevation myocardial
Digestive Health First in Central Texas to Offer Minimally Invasive GI Procedure to Remove Cancerous Tissue
Endoscopic Submucosal Dissection Removes Precancerous and Cancerous Tissue from The Gastrointestinal Tract Without Surgery
Digestive Health, a clinical partnership between Ascension Seton and UT Health Austin, is the first in Central Texas to offer Endoscopic Submucosal Dissection (ESD), a minimally invasive procedure that removes precancerous and cancerous tissue from the gastrointestinal (GI) tract without surgery.
The ESD procedure entails the use of a flexible tube called an endoscope to target tumors
located under the lining of the GI tract. This process can be used to examine and remove growths, stage early cancers, rule out cancer in suspicious growths, and treat certain types of benign (non-cancerous) polyps.
Procedures take place at Dell Seton Medical Center at The University of Texas. UT Health Austin is the clinical practice of Dell Medical School at The University of Texas at Austin.
infarction (STEMI) heart attack patients, while St. David’s North Austin Medical Center received Get With The GuidelinesCoronary Artery Disease STEMI Receiving Center Gold award.
A STEMI heart attack is caused by a blockage of blood flow to the heart, and it requires timely treatment. To prevent death, it’s critical to restore blood flow as quickly as possible, either by mechanically opening the blocked vessel or by providing clot-busting medication.
St. David’s Medical Center and St. David’s North Austin Medical Center received the Get With The Guidelines® - Coronary Artery Disease NSTEMI Gold award for the treatment of non-STEMI heart attack patients.
During the ESD procedure, patients are put under general anesthesia and the endoscope is inserted through the mouth or anus to the tumor’s location. Doctors then mark the tumor’s borders and inject fluid beneath it to separate it from the muscle wall. A surgical knife is then used to carefully cut the diseased tissue from the wall. After the tissue is removed, a device may be placed to ensure the site closes.
“We are proud to be the first clinic in Austin, and Central Texas, to offer this innovative, minimally-invasive procedure to patients with GI tract concerns,” said Dr. Zhouwen “David” Tang, who was recruited out of private practice in Houston to join Digestive Health as a gastroenterologist and hepatologist. “Patients who are candidates for ESD can now receive quality care close to home,
Get With The GuidelinesStroke
St. David’s Medical Center, St. David’s North Austin Medical Center, St. David’s South Austin Medical Center and St. David’s Round Rock Medical Center received the Get With The Guidelines - Stroke Gold Plus quality achievement award for
see St. David’s ...page 13
and avoid travel to San Antonio, Houston or Dallas,” said Tang who is also an Assistant Professor in the Department of Internal Medicine at Dell Med.
To date, Tang and his team have completed 10 ESD procedures at Dell Seton. Additional benefits of ESD include:
• Shorter hospital stays
• Faster recovery time
• Reduced pain
• Lower recurrence rate
• More accurate histopathologic evaluation and staging
Digestive Health
Digestive Health is bolstered by advanced diagnostics, nutritional services, and clinical social work all in a single clinic, led by specialists focused on patient outcomes, cutting-edge research, and teaching the next generation of physicians.
Drug Trial for Rare Fetal Blood Disease Shows Promise for Less Invasive Approach
By The University of Texas at Austin Dell Medical School
Data from a new investigational drug that could alter the standard treatment for a rare blood disease suggests it has the potential to delay or prevent anemia and the need for intrauterine blood transfusions in babies who are at high risk for the condition, known as Hemolytic Disease of the Fetus and Newborn (HDFN). Results of the Phase 2 clinical trial of the drug nipocalimab were published today in The New England Journal of Medicine.
HDFN is a serious condition in which the blood types of the mother and her fetus do not match, potentially causing life-threatening anemia in the baby. The current standard for treating HDFN requires an average of four ultrasound-guided intrauterine blood transfusions during the pregnancy. Complications with transfusion include fetal death, premature rupture of membranes and preterm birth.
“If further studies support using
nipocalimab to treat HDFN, it will make treating the fetus in these pregnancies safer and easier for pregnant moms,” said maternal fetal medicine specialist and lead study investigator Kenneth Moise Jr., M.D. Moise is a professor in the Department of Women’s Health at Dell Medical School at The University of Texas at Austin and co-director of the Comprehensive Fetal Care Center, a clinical partnership between Dell Children’s Medical Center and UT Health Austin, the clinical practice of Dell Med.
Called the UNITY study, the research involved following 13 pregnant women who had either experienced a fetal loss or needed early intrauterine transfusions during a previous pregnancy due to HDFN. DNA tests indicated their current fetus was at high risk of also having HDFN. Participants received intravenous nipocalimab between 14 and 35 weeks of gestation during pregnancy.
More than half the participants in the study (54%) had a live birth at
or after 32 weeks without needing a transfusion. Some did not need a transfusion even after birth. None of the babies developed a dangerous HDFN condition called fetal hydrops, a condition linked to a lower survival rate for babies wherein large amounts of fluid collect inside the fetus.
For HDFN, nipocalimab works by halting the transfer of antibodies across the placenta, preventing the attack on the fetus’s red blood cells and lowering the amount of antibodies in the mother’s bloodstream.
“Nipocalimab is the only drug in development with the potential to treat a variety of alloimmune diseases that affect the fetus such as fetal/neonatal alloimmune thrombocytopenia and immune-mediated congenital heart block,” Moise said. Nipocalimab also has
the potential to treat a wide spectrum of autoantibody diseases such rheumatoid arthritis and myasthenia gravis, he said.
In late 2023, Johnson & Johnson, the sponsor of the UNITY Phase 2 study, initiated a Phase 3 pivotal trial of nipocalimab in HDFN called AZALEA. Researchers began enrolling pregnant individuals earlier this year who are at risk for severe HDFN and have experienced the condition in a prior pregnancy to further assess the efficacy and safety of nipocalimab. The AZALEA trial is a randomized controlled trial that is being conducted in maternal fetal centers around the world. Moise is the lead investigator of the Phase 3 trial in Central Texas.
Alleviating the Burden: Susan G. Komen’s Fight for Quality Breast Cancer Care
By Susan G Komen
People across the country struggle to access and afford high-quality care. This is especially true following a breast cancer diagnosis. But even before that diagnosis many face financial and administrative barriers to needed breast imaging. Government action is critical for making broad, systemic and lasting changes that will end deaths from breast cancer forever. Despite major public policy wins in state legislatures and in Congress, disparities in healthcare access, patient treatment, and breast cancer outcomes persist.
To address these inequities and improve health outcomes for all patients, Susan G. Komen’s Center for Public Policy focuses our efforts on three key policy areas. Komen is advocating for policies that ensure healthcare is accessible and affordable, regardless of where someone lives, so
that the most vulnerable populations receive the lifesaving care they need.
The three key areas are accelerating research, ensuring access and alleviating patient burden, and were selected with the input of the breast cancer community who believe these are three primary areas where significant, long-term changes can be made. While these issues apply broadly to all of our public policy work, Komen’s Center for Public Policy has worked and continues to work on critical policy right here in Texas.
Accelerating research
Komen advocates for increased support for biomedical research to drive the discovery of new, more effective treatments. As a founding member of the coalition supporting the Cancer Prevention and Research Institute of Texas, Komen advocated for its’ creation and continues to fight for the biennial appropriation of
$600 million ensuring that continued operations of this groundbreaking institute.
Ensuring access
Komen advocates for access to affordable, high-quality care for all patients. This includes robust funding for the Texas Breast and Cervical Cancer Services Program (BCCS), housed within the Department of Health and Human Services (HHS).
Since our initial work in 2007 for the first state appropriation for BCCS, Komen has continued to advocate for funding to ensure low-income, uninsured and underinsured women have access to breast cancer screening and diagnostic services. Alleviating patient burden
Komen advocates for robust polices that recognize both the financial toxicity of treating breast cancer and the systemic hurdles patients must pass through to access their care. Komen worked with legislative champions in Texas to introduce and pass legislation eliminating a patient’s out of pocket costs for diagnostic breast imaging and prohibiting “fail-first” policies for metastatic cancer patient’s treatments. Additionally, Komen has supported efforts to expand insurance coverage of biomarker testing, fertility preservation services, and banning copay accumulator programssee Fight...page 13
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UTSW Research: Alcohol-Associated Liver Disease, Depression Treatment, And More
Studies Investigate ALD Racial Disparities, Esketamine Promise for TRD Patients, COVID-19’s Employment Impact, And Suicidal Ideation Biomarker Testing
By UT Southwestern
How alcohol-associated liver disease differs among races
Researchers have long known that outcomes for alcohol-associated liver disease (ALD) aren’t equal among all races and ethnicities in the U.S., but differences among these groups have been less clear. To investigate, researchers from the U.S., Spain, and Chile, including Thomas Cotter, M.D., Assistant Professor of Internal Medicine in the Division of Digestive and Liver Diseases at UT Southwestern Medical Center, searched three nationally representative databases covering 2011 to 2018 for racial and ethnic disparities in the natural history of ALD.
Their findings, published in Liver International, showed that Hispanic and Asian people had a higher rate of ALD at younger ages compared with non-Hispanic white individuals, despite lower overall alcohol consumption. Black people had comparatively lower rates of ALD and a reduced risk of death during hospitalization due to ALD. Hispanic and female Asian individuals had the lowest probability of liver transplantation if wait-listed. Future
research should focus on determining the reasons for these differences, Dr. Cotter and his colleagues reported. Esketamine shows promise for treatment-resistant depression
An estimated one-third of patients with major depressive disorder have treatment-resistant depression (TRD), characterized by an inadequate response to two or more oral antidepressants (OADs). Three international clinical trials have shown that esketamine (an intranasally delivered, specialized form of the anesthetic and antidepressant ketamine) can improve depression symptoms in patients with TRD when taken with a newly initiated OAD. However, whether these effects persisted in patient-reported measures was unknown.
To answer this question, researchers led by Madhukar Trivedi, M.D., Professor of Psychiatry and Director of the Center for Depression Research and Clinical Care in the Peter O’Donnell Jr. Brain Institute at UT Southwestern, analyzed data from the clinical trials. Results, published in CNS Spectrums, showed a significant improvement in symptoms for those taking a new OAD with esketamine compared with a placebo nasal spray
based on responses to the nine-item Patient Health Questionnaire, a validated measure of depression severity. Participants were also significantly more likely to achieve remission from TRD with esketamine than with the placebo. These results show a strong correlation between patient- and physician-reported measures and the promise of esketamine treatment for TRD.
COVID-19’s effects on individual employment
COVID-19’s unprecedented impact on the U.S. labor market has been well established, but its effects on individual employment and the ability to work have not. Ahamed Idris, M.D., Professor of Emergency Medicine and Internal Medicine at UT Southwestern, and researchers from several institutions studied data from 2,939 adults enrolled in the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE). There were eight INSPIRE study sites, including UTSW.
The researchers’ national study, published in PLOS ONE, compared long-term symptoms and outcomes among patients with COVID-like symptoms between December 2020 and August 2022. Each was employed
before the pandemic and tested positive for COVID-19. Three months after infection, 7.2% reported missing 10 or more workdays and 13.9% reported not returning to work after infection. The chances of these events were significantly higher for the nearly 10% of participants who had five or more COVID-19 symptoms.
The research findings suggest that despite the end of the federal Public Health Emergency for COVID-19, the clinical and economic long-term implications of the pandemic on employment status and work absenteeism are important factors for policymakers to consider. EEG testing shows possible biomarker for suicidal ideation Understanding the neurobiological underpinnings of suicidal ideation and identifying biomarkers could help doctors identify those at risk and researchers develop effective interventions. Although studies using functional MRI (fMRI) have connected suicidal ideation with dysfunction in neuronal networks in the brain, the high cost of fMRI prevents it from being used as a clinical tool for assessing suicide risk.
Age Well, Live Well
Raise Awareness About Financial Exploitation This October
By Texas Health and Human Services’ Office of Aging Services Coordination
Financial Exploitation Awareness Month is observed in October to help build awareness of financial fraud and scams and reduce the stigma of those affected by these types of exploitation.
Financial exploitation is when a caretaker, family member or other person with an ongoing relationship
with an adult improperly uses or attempts to improperly use their financial resources. Older adults and people with disabilities are at a higher risk of financial exploitation.
Texas ranks third in the U.S. in losses to elder fraud with over $278 million in losses reported in 2023, according to the FBI.
Being aware of the signs of financial exploitation can help. The U.S. Department of Justice lists some
examples: sudden changes made to a person’s bank account or legal documents, unexplained credit card charges, or an unexplained disappearance of valuables.
The Consumer Financial Protection Bureau shares four important steps to intervene in a fraud or scam:
1. Prevent the abuse by raising awareness.
2. Recognize the exploitation.
3. Record your observations in detail.
4. Report to the appropriate authorities.
In early 2024, state and community partners formed the Texas Elder Justice Coalition with the goal of ending financial exploitation of older Texans through education, accountability and collaboration. The coalition’s campaign slogan, “Stop the Stigma,” encourages supporting older adults in reporting financial exploitation.
The coalition website offers steps you can take to report financial abuse and other resources to safeguard older Texans.
Texans can report financial exploitation by calling the Texas Abuse Hotline at 1-800-252-5400.
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Legal Matters
Continued from page 3
in both the Eastern and Northern Districts of Texas. Indeed, the Mayfield decision could not have come at a more opportune time for the DOL because it supplies these Texas federal judges with new direction from the Fifth Circuit to consider when making their rulings.
Cognitive Decline
Continued from page 6
memory, and attention and processing speed than those in the mid- and low-level groups. In addition, those in the mid-level category had higher levels of working memory and attention and
St. David’s
Continued from page 8
their commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines. St. David’s North Austin Medical Center, St. David’s
Digestive Health
Continued from page 8
“More than 60 million Americans are affected by digestive diseases, and the available diagnostic and treatment options are increasing in number and complexity,” said Dr. Deepak Agrawal, medical director
What Does this Mean for Medical Practices and Medical Practitioners?
The Mayfield decision bolsters the DOL in its bid to set and increase the minimum salary requirements for its white-collar overtime exemptions, which will certainly pose challenges for employers in creating compliant employee compensation structures. If the 2024 DOL rule goes into effect, employers will need to substantially raise their exempt employees’ salaries
processing speed than those in the low-level participation group.
“We also found significant differences in all three cognitive functions between years with a declining slope, but the differences between 2014 and the other years of the data set that were examined were not significant,” Kim said.
Kim and the others are hopeful
to ensure they remain properly exempt from the overtime provisions of the FLSA. Because medical practice compensation models often have exempt, salaried employees within their ranks, now is the time to talk to an employment attorney regarding compliance with the DOL’s salary threshold. Failure to be prepared on these increases could jeopardize your employee’s exempt status under the FLSA, which can greatly increase the
that these findings will lead health care providers to recommend that older people with mild cognitive impairment play games, read or engage in similarly stimulating activities at least three to four times a week.
“In addition, we hope that barriers to doing this, such as inadequate caregiver support and financial constraints, could be overcome through stronger public
likelihood of costly unpaid wage claims and/or overtime claims. Take it from someone who regularly works on wage and hour matters—sticking our metaphorical heads in the sand is not the best course of action in defending employment-related claims, particularly those regarding something as concrete as a salary threshold.
care services and community support networks,” Kim said.
Continued from page 10
ensuring all payments made by or on behalf of a patient counts towards their annual deductible.
With over 120,000 volunteer advocates, Komen amplifies our collective voice to fight for policies at the state and federal levels that alleviate financial burdens and ensure equitable access to quality care. This year, we introduced legislation in 34
South Austin Medical Center and St. David’s Round Rock Medical Center also received the Target: Type 2 DiabetesTM Honor Roll award by ensuring patients with type 2 diabetes who might be at higher risk for complications receive the most up-to-date evidence-based care when hospitalized due to stroke.
of Digestive Health and Associate Professor in the Department of Internal Medicine at Dell Med.
Additionally, St. David’s Medical Center, St. David’s South Austin Medical Center and St. David’s Round Rock Medical Center received the Target: StrokeSM Elite Plus award, while St. David’s North Austin Medical Center and St. David’s Georgetown Hospital received the Target: StrokeSM Elite award. To qualify, hospitals must meet specific criteria to reduce the time between an eligible patient’s arrival at the hospital and treatment with thrombolytic therapy.
“Digestive Health also offers advanced care for inflammatory bowel disease, liver, pancreas, colon and esophagus, working closely with surgeons, dieticians, social workers, and others to help patients find the right treatment options for their needs.”
Digestive Health offers comprehensive digestive care for general gastroenterology, including preventive screening and:
• Achalasia
• Barrett’s esophagus
• Colorectal cancer
• Crohn’s disease
• Colitis
states, backed by grassroots support, to provide key patient protections and remove barriers to needed care. By mobilizing our community, we advocate for policies that protect patients, prioritize research, and drive systemic changes for better outcomes. Proceeds from Komen events, like the Austin MORE THAN PINK Walk, fund critical patient care services, groundbreaking research, and key initiatives in public policy and advocacy. These efforts are aimed at improving access to care
and supporting those diagnosed with breast cancer. By coming together at the Susan G. Komen Austin MORE THAN PINK Walk, we move closer to a future where no mother, sister, or friend will ever have to hear the words, “You have breast cancer.”
Ending breast cancer needs compassion, research and care. Ending breast cancer needs all of us. Join us on Sunday, October 27 for the Austin MORE THAN PINK Walk. When we come together for an event like this one, we get one step closer
• Eosinophilic esophagitis
• Esophageal cancer
• Fatty liver disease
• Gastroesophageal reflux disease
• Heartburn
• Hepatitis
• Hiatal and paraesophageal hernias
• Inflammatory bowel disease
to a future where no mother, sister or friend will hear the words, “You have breast cancer.”
For more information on the Austin MORE THAN PINK Walk, and how you can help support Komen’s Financial Assistance programs, please visit komen.org.
Heart Walk
Continued from page 1
Continue providing CPR until EMS arrives and takes over.
By learning Hands-Only CPR and joining the Nation of Lifesavers, you can help to make sure that no one is left without the help they need when seconds count. You can learn more about Hands-Only CPR and the Nation of Lifesavers at the Austin Heart Walk on Sunday, Oct. 27. Sign up today at
Oncology
Continued from page 4
• breast cancer risk by 19% among premenopausal women.
• Growing research suggests being physically active helps reduce risk.
• Similar to other cancer types, your risk of breast cancer may rise as your alcohol consumption increases.
• Being overweight or obese can raise breast cancer risk as well as the risk of breast cancer recurrence among women who have had the disease.
• Emerging research suggests exposure to high levels of air pollution or other chemical pollutants may increase risk of certain breast cancer types, such as estrogen-receptor positive breast cancer.
Work with your physician to complete breast cancer risk assessments to evaluate your personal risk based on your overall health, number of childbirths and age at those births, and
Mental Health
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time to let them do things out of your sight. Williams recommends doing dry runs: ask your child to remember to do things at certain times when you still have oversight so if does not go well, you can intervene.
“If this goes well, do further dry runs where you do the activity with them, but you don’t tell them what to do and simply walk alongside them to see if they follow the steps you’ve discussed, like getting to school on their own,” she said.
Williams also suggests asking your child about the things that worry you to see if you feel comfortable in their response. Let
previous benign breast disease, among other factors.
You Know Your Breast Cancer Risk. Now What?
Once you have met with your healthcare provider to determine your breast cancer risk, it’s time to decide your next steps, which might include:
• Screenings: Early detection of breast cancer can greatly affect treatment options and outcomes. Depending on your age and risk level, your healthcare provider may recommend certain screening tests, such as breast self-exams, clinical breast exams, mammograms, ultrasounds, and MRI screenings, or a combination.
• Lifestyle changes: Your healthcare provider can provide personalized recommendations for maintaining a healthy lifestyle to reduce cancer risk.
• Preventive measures: For women at high risk of breast cancer,
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your child show you that they can manage the task on their own.
Some older teenage children might argue that their parents are overbearing compared to their peers’ parents. If a child lays out these concerns, listen to them and explain why you created these rules. Parents can use this opportunity to see if the child can handle a mature conversation. Instead of telling the child they can have something or gain a new privilege, ask the child to give reasons as to why this situation should change, which teaches them how to negotiate and have a clear understanding of the risks and benefits.
prophylactic surgery (also called preventive or risk-reducing surgery) may be appropriate.
• Staying updated and informed: Your breast cancer risk can change over time. Keeping up with any changes in your family history of breast cancer and learning more about breast cancer risk and prevention can help you have ongoing, informed conversations with your physician.
The more you know about your breast cancer risk, the better equipped you’ll be to take steps toward prevention and peace of mind. Talk to your healthcare provider today about your breast cancer risk to develop a personalized plan for early detection and risk reduction.
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“It doesn’t have to be an emotional decision where you give in right away, so make sure to have the conversation at the appropriate time so you can sit down and talk with your child. This will teach the child patience and delayed gratification,” Williams said.
Listen to your child and have a family meeting with all parents present before making changes to the rules.
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Strategies for Dementia Care
What you need to know as a primary care provider.
Earn free online Continuing Medical Education (CME) credits developed by the Texas Department of State Health Services and physician experts on Alzheimer’s disease and related dementias. These courses will keep you up to date on the latest validated assessment and screening tools, help you direct patients to community resources, and reinforce your role in helping patients and their families manage symptoms throughout the disease process.
Learn more at dshs.texas.gov/alzheimers-disease/provider