MIAMI - Florida's beaches and tropical weather may make the state an appealing vacation destination, but its thoroughfares are gaining a dubious reputation for pedestrians and bicyclists.

Last week, a 51-year-old rider was killed and another seriously injured by a drunk driver on one of Miami's most infamous roadways, the Rickenbacker Causeway. It's the fourth cyclist death on that stretch of road in the past nine years.

Miami architect Bernard Zyscovich is proposing a plan to convert part of the causeway to a park, freeing up space for riders and walkers. He also is working up similar safety redesigns for other parts of the city.

"This could become a really bike-centric city," he said, "if we could all get organized to create safe and protected pathways, like Portland (Ore.) and Seattle and some other model cities have run, where you just feel totally safe in being able to do that."

An average of more than 100 riders are killed each year, according to the Florida Department of Highway Safety and Motor Vehicles, and nearly 5,000 are injured in Florida accidents. Nearly one in six of the nation's fatal bicycle accidents occurs in the state.

According to the National Complete Streets Coalition's yearly Pedestrian Danger Index, in 2014, Orlando, Tampa, Jacksonville and Miami ranked as the top four most unsafe cities in the country for walkers. Many Florida roads simply weren't built with foot travel in mind, with small sidewalks and little or no room for bikes.

The state's large older population also is a factor, and Zyscovich said international drivers combine to make conditions especially treacherous in Miami.

"I think that part of what happens with that," he said, "is that you end up with many people who are new to this environment that are driving with different habits and different histories."

Miami-Dade County Mayor Carlos Gimenez has called the safety of cyclists and pedestrians a "top transportation priority," and is pledging to work with fellow leaders to prevent more tragedies.


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North Dakota officials are urging people receiving health coverage through a key public program to stay on top of their renewal if they are still eligible. It follows the end of pandemic rules for Medicaid. At the start of the COVID crisis, Congress paved the way for states to keep people continuously enrolled in Medicaid. But with the public health emergency over, states such as North Dakota are unwinding the provision.

Krista Fremming, interim medical services division director of the North Dakota Department of Health and Human Services explained when they recently sent out renewal notices, only one in three people returned them. She pointed out it is possible that some people found other options, but her team suspects many who still need help did not take the necessary steps to secure it.

"For the forms that were returned, about seven in ten people still qualified," she added. "So, that gives a good indication that many of the unreturned forms are for people who would still qualify. And we want to continue their coverage, if they do. "

She said more than 4,000 people were disenrolled last Wednesday. The state carried out a media campaign, as well as outreach with providers, in hopes of ensuring recipients knew the forms were mailed to them. Fremming said the state is exploring other ways to connect with members. Those who were disenrolled have 90 days to return the forms to receive back-dated Medicaid coverage if they still qualify.

Fremming added they are especially worried about households with children losing coverage.

"We know that getting vaccinations and having access to dental care and behavioral health services are so important to laying a strong foundation for children as they grow up," she continued.

North Dakota has an auto-renewal process to make it easier for staff to verify if an individual still qualifies for coverage. But Fremming said it is still new and limited, and added it does not include people who have self-employment income, or who are subject to asset tests. Meanwhile, renewal forms are mailed out around the 20th of each month and are due within 30 days.


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Nevada has received an overall score of 43 in the nation for the health and well-being of its seniors in the state. According to the United Health Foundation's 2023 Senior Report, the Silver State's older adults fare well when it comes to lower rates of obesity, drinking and inactivity. The state is facing challenges related to high suicide and high poverty rates, as well as low flu vaccination rates among older Nevadans.

Dr. Rhonda Randall, Chief medical officer for United Healthcare, said when it comes to suicide, they are noticing more prevalence in some groups over others.

"We see that it disproportionately affects white men, and older white men because they have a tendency to choose more lethal means with suicide attempts," she explained. "They're more successful, and that's what we see in the trend here. It has been persistent for quite some time."

Randall added the report consists of 52 different measures of senior health across five different categories, including socioeconomic factors, the physical environment where seniors live, the clinical care they receive, behaviors and other health outcomes.

Nevada saw a 15% drop from just over 30 aides per 1,000 adults ages 65 and above in 2018 to 26 per 1,000 adults in 2021. The state also saw an 8% increase in early deaths among older adults. Randall said opioid overdoses led to an increase in premature deaths, and added that reflects "the same troubling trend" prevalent in other populations in the United States; seniors are not untouched.

"Why I highlight that as a geriatrician is, I think, a lot of people don't think that seniors are as affected by substance-use disorders and opioid-use disorder - but they are," she said.

Randall added it is concerning that as a country, many of the gains made in recent years related to longevity and an increase in life expectancy have started to reverse. Her group is calling for greater connectivity and community engagement among seniors in Nevada and across the country.

Longer sentences handed out for major crimes in Michigan and other states over the past few decades mean a larger portion of people in state and federal prisons are older adults. However, research from the Gerontology Department at Wayne State University finds senior inmates with special health needs are not getting the care they need. The study finds that half of all people in prison have at least one chronic health condition, such as hypertension, diabetes, heart disease or arthritis.

Roscinda Sneed, an associate professor at Wayne State University, said without intervention these conditions will worsen as the prison population ages.

"What you'll see in most correctional systems is that they have programming focused on mental health, they have programming focused on substance abuse, but there really isn't a lot of deliberate attention to chronic disease," Sneed explained.

Sneed will use those funds to study the effectiveness of an existing program called the Chronic Disease Self-Management Program, which she explained is used primarily in community settings and has improved health care communications, reduced ER visits and hospitalizations, and decreased health-care spending.

The National Institutes of Health grant is $600,000 over five years, and Sneed said she is applying for an additional grant to scale up the program for widespread use in state prisons in Michigan and other states to maximize its effectiveness. She said she is particularly interested in how prisons adapt chronic disease management programs to reflect the unique constraints of incarceration.

"What we want to do is talk to them about their experiences in implementing this program such that we can develop a scalability plan, so a plan for how we would actually implement this program on a large scale." she continued. "And that's what we would test in a future study."

Sneed added incarceration is already expensive. In 2013, the Federal Bureau of Prisons spent $881 million dollars to care for older prisoners, an amount that continues to rise exponentially.

"I think prisons are under-resourced in general, and so they try and do the best that they can in terms of managing health-care issues, but there's always an opportunity to do better," she said.