Whitney Howell

Healthcare. Politics. Family.

Brittany Stresing, Owner, LimBonics

Published in the May 2015 Durham Magazine

By Whitney L.J. Howell

At 14, Brittany Stresing received news that both changed her life and planned her future. She was diagnosed with scoliosis and spina bifida, and she learned one leg was shorter than the other. As a result, she was fitted with orthotic braces.

The experience solidified her belief that patient care should be personal and launched her down a path to improve the healthcare process for others.

“I was handed this profession through dealing with surgery and orthotic intervention with braces,” said Stresing, 28. “I received bad care followed by good care. I realized it’s better to treat people as individuals rather than numbers.”

Today, she’s a certified prosthetist and orthotist, as well as the owner of LimBionics, a prosthetic/orthotic company in Durham. She is secretary for the N.C. Orthotics and Prosthetics Trade Association, and she is also president-elect of the N.C. Chapter of the Academy of Orthotists and Prosthetists – the first woman to hold this position. In addition, she was the first woman spotlighted for the Ossur Women’s Leadership Initiative, an organization helping promote women in leadership roles.

Her goal, she said, is to maintain open communication with patients and give them a sense of security around their treatment and therapy. She provides those services in rehabilitation facilities, hospitals, nursing homes, or doctor’s offices. Patients also come to her from across the state.

“Whenever someone works with us, they’re always going to the same person who knows them and what they’re going through,” she said. “We take the time to find a therapy that will work with their wants and lifestyle – not just a textbook approach.”

Reaching this point wasn’t always easy, though. She was accepted to a 15-person prosthetics program at the University of Texas Southwestern Medical Center in Dallas and completed a rigorous residency at the University of North Carolina at Chapel Hill. But, she was still one of few women in a heavily male-dominated field.

She fought against the stereotype that female prosthetists were more suited for a practice’s administrative work than building prosthetics or orthotics. Now, she consistently designs and builds some of the most technologically-advanced patient care devices available, including prosthetics that replace missing body parts and braces that strengthen feet, ankles, knees, or hips.

Every step, she said, is devoted to working with the patient to identify their needs and to design a treatment plan all parties – patients, physicians, and Stresing’s colleagues – can agree upon.

“With every patient, we evaluate how they walk, how the use their arms, or whatever body part is affected,” she said. “We work to reduce their pain and make that body part functional again.”

To read the profile at its original location: http://issuu.com/shannonmedia/docs/binderdmmay/79?e=13657385/12589504 pg. 56

June 28, 2015 Posted by | Profiles | , , , | Leave a comment

Dr. Brenda Armstrong, Dean of Admissions, Duke University School of Medicine

Published in the May 2015 Durham Magazine

By Whitney L.J. Howell

As a student in a segregated Rocky Mount, N.C., high school, Brenda Armstrong, M.D., knew she wanted to be a scientist of some sort. But, she didn’t know far her determination and the support of her family and friends would take her.

But, now, Armstrong points to events and people in her life that positioned her to use her gifts to help others.

“My life, and whatever roles I’ve been fortunate enough to find, has been about giving back,” she said. “I have wonderful gifts that no dollar amount could bring.”

Today, Armstrong, 66, has been the Duke University School of Medicine Dean of Admissions for nearly 20 years. (She’s also an associated dean for medical education, a professor of pediatrics, and a pediatric cardiologist for children, adolescents, and adults with congenital heart disease — a woman who wears many hats!) She’s changed the School’s demographic make-up to better reflect the Durham community, more than doubling the number of black applicants in her first few years and continuing to enhance diversity.

It’s an accomplishment close to her heart. While at St. Louis University School of Medicine, Armstrong was the only black woman student for three out of her four years of training. She recruited the second black woman who joined her for her final year.

Her road to steering medical school admissions was a winding one, though. It was a teaching job right out of Duke undergraduate that revealed Armstrong’s future career.

For four years, she taught science and math to the same students as they progressed through school. With her, the students rose from “C” and “D” achievers to the honor roll. That experience prompted her to pursue medical school so she could heal and teach others about their well-being.

She even had the opportunity to hone her teaching skills in medical school – this time with a support network. The custodial staff frequently asked her about her work as she studied late at night.

“When I studied by myself, the folks cleaning up would ask me what I was doing,” she said. “It was great to have someone who looked like me care about my work. They were my study aids, and they knew it.”

Because the community bolstered her, she works to give back. For more than 30 years, she’s served as the physician for the Durham Striders, a local youth track association.

“Being of the community and in the community makes me a better person,” she said. “The community has kept me grounded, has given me values, and has allowed me to use whatever gifts I have to make my community better.”

To read the profile at its original location: http://issuu.com/shannonmedia/docs/binderdmmay?e=13657385/12589504 pg. 38

June 28, 2015 Posted by | Profiles | , | Leave a comment

Federal Regulations and Radiology

Published on the June 11, 2015 DiagnosticImaging.com website

By Whitney L.J. Howell

Editor’s Note: It’s no longer enough for radiologists to be imaging experts. Health care is becoming big business and radiologists need to understand how to navigate the system. Diagnostic Imaging’s Business of Radiology series provides radiologists with the business education they need to succeed. 

Few things can impact radiology as directly or significantly as changes to health care regulations and policies. They’re initiatives that require you to change your workflow, to adopt new strategies, and even abandon long-used systems.

From the Affordable Care Act to coding overhauls to new value-based payment systems, industry experts are watching the next set of regulatory efforts to determine the impact on your daily practice.

“In many cases, you take the approach of preparing for the worst and hoping for the best,” said Tom Dickerson, MD, chief executive officer of Illinois-based Clinical Radiologists, SC.

The coming changes will build upon an uneven playing field for radiologists and the patients who need imaging services.

Despite long-standing fears that radiology volumes were lagging, the past four years have actually seen a nationwide bump of 8%. According to Sarah Mountford, client services manager with billing services company Zotec Partners, this boost can be attributed to the expansion of Medicaid services in some states, as well as the growth of health information exchanges and a recovering economy.

In fact, thanks to the Medicaid expansion, the percentage of uninsured patients using radiology services dropped from 7.5% to 6.5% between 2012 and 2014, respectively. On the flipside, states that didn’t expand Medicaid are seeing increases in uninsured patients accessing imaging services. That’s an uptick from 9% in 2012 to 12% in 2014 – more than 4 million patients.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/federal-regulations-and-radiology

June 17, 2015 Posted by | Healthcare, Politics | , , , , , , , , , , , , | Leave a comment

Harmful Or Harmless? New Studies Light Up Debate on E-cigarettes

Published on the June 8, 2015, N.C. Health News website

Even as more people use e-cigarettes, questions arise about their safety and whether they actually do help smokers kick the habit.

By Whitney L.J. Howell

When e-cigarettes hit the market in 2007, they were embraced as an effective and safe strategy for smokers to break their addiction to traditional cigarettes. Since then, they’ve grown in popularity among all age groups. But research has revealed mixed success in helping to quit.

And now North Carolina researcher are questioning their safety.

Some of the e-cigarette liquids for sale in N.C. today. Flavors, from left to right: watermelon, Irish cream and appletini. Photo credit: Rose Hoban

Some of the e-cigarette liquids for sale in N.C. today. Flavors, from left to right: watermelon, Irish cream and appletini. Photo credit: Rose Hoban

A new study from Research Triangle Park-based RTI International points to many e-cigarette characteristics that could pose intrinsic, and yet unidentified, health dangers. The research comes on the heels of reports that e-cigarette use is on the rise.

In North Carolina, according to the North Carolina Youth Tobacco Study, e-cigarette use sky-rocketed 325 percent among high school students from 2011 to 2013. A full 10 percent of students are now considering using e-cigarettes.

Other research, including a March 2014 Journal of the American Medical Association Internal Medicine study, showed e-cigarette use among Americans leaped from 2 percent of U.S. smokers in 2010 to more than 30 percent in 2012.

Whether e-cigarettes are helping smokers quit has been the subject of pretty fierce debate in the research world. A May 2014 study published in Addiction showed the alternative cigarettes helped 60 percent of aspiring quitters reach their goal. Other studies suggest that e-cigarette users quit smoking but keep using the e-cigarette as a way to get nicotine.

Many of those former cigarette smokers argue the newer devices are safer.

But to date, said Jonathan Thornburg, RTI’s director of exposure and aerosol technology and lead study author, there’s been no way to prove e-cigarettes are any safer than traditional cigarettes. And, it turns out, he said, they may be just as dangerous.

“The visible smoke from e-cigarettes dissipates just after exhale, but those particles are still there – there’s still a high potential that the public will breathe them in,” Thornburg said. “Other research has found that second-hand nicotine exposure from e-cigarettes is similar to that of conventional cigarettes.”

Current use

Traditional cigarette use is falling among American high school students, but, based on Centers for Disease Control and Prevention data, e-cigarettes are the popular substitute. An April CDC report, based on the National Youth Tobacco

N.C. tobacco users by gender. Data source: N.C. Youth Tobacco Survey, 2013

N.C. tobacco users by gender. Data source: N.C. Youth Tobacco Survey, 2013

Survey, revealed e-cigarette use has tripled among American teenagers.

From 2011 to 2014, e-cigarette use nationwide among middle-schoolers rose from 1.1 percent to 3.9 percent and from 4.5 percent to 13.4 percent among high-schoolers. Those rates translate to approximately 450,000 middle school students and 2 million high school students.

E-cigarette dangers

Although the Food and Drug Administration has deemed many e-cigarette ingredients safe for consumption, that categorization doesn’t necessarily mean they’re safe to inhale. That’s where the safety of e-cigarettes becomes ambiguous, Thornburg said.

A man “vapes” an e-cigarette. Often the devices are made to look like traditional cigarettes. Photo by Taylor Dahlin, flickr creative commons

A man “vapes” an e-cigarette. Often the devices are made to look like traditional cigarettes. Photo by Taylor Dahlin, flickr creative commons

E-cigarette vapor particles are small – only slightly larger than a bacteria, at a width of 100 to 800 nanometers. But, even at that size, they pose a threat, he said. Nearly half of all inhaled e-cigarette particles remain in the lungs to grow in the respiratory system, and the remaining exhaled particles can be as dangerous as second-hand smoke.

“People need to know the potential for significant second-hand smoke with e-cigarette vapors,” Thornburg said. “Danger doesn’t just come from inhaling the nicotine, but from the other chemical vapors too.”

Lighting an e-cigarette also presents a risk. E-cigarettes don’t ignite like traditional ones, so there’s no carcinogen from combustion, but starting one produces a slightly altered form of formaldehyde, a disinfectant and embalming fluid. That form has a greater potential for getting stuck in lung tissue.

In addition, little is understood about what happens when other e-cigarette ingredients get into lungs. The glycerin, propylene glycol (a syrupy liquid added to food, cosmetics and some medicines to help them absorb water and stay moist), food preservatives and artificial flavorings could be dangerous to breathe in.

In fact, it’s already well known, Thornburg said, that inhaling artificial butter flavoring, one of the popular flavors in the liquid used in e-cigarettes, is dangerous.

He said that while there could be a level of preservatives and flavors that’s safe to breathe in, “we don’t know what that is yet.”

To answer that question, Thornburg’s team is conducting a study to determine if e-cigarette second-hand exposure to the nicotine and other ingredients is high enough to warrant concern. The goal is to inform public policy on how and when e-cigarettes should be regulated.

But until that data exists, he said, cities and towns can’t create any ordinances addressing e-cigarette use.

Social risks

Determining the actual health risks associated with e-cigarettes goes beyond giving teeth to public health regulations. It’s also critical to combating advertising and marketing efforts that present these products as completely safe alternatives to traditional cigarettes, said Annice Kim, a social scientist in RTI’s public health policy research program.

From 2011 to 2014, money spent on publicizing e-cigarettes ballooned from $6.4 million to more than $100 million, reaching

In this commercial, actress Jenny McCarthy says, “I get to have a blu without the guilt, because there’s only vapor, not tobacco smoke.” Image via youtube screen shot

In this commercial, actress Jenny McCarthy says, “I get to have a blu without the guilt, because there’s only vapor, not tobacco smoke.” Image via youtube screen shot

approximately 24 million youths.

“It’s a big public health concern because these ads might make e-cigarettes appealing to young people,” Kim said. “It’s alarming from a social, medicine and public-science perspective that these ads feature celebrities espousing the benefits of e-cigarettes when their safety has not been established.”

Despite heavy advertising and lack of safety data, some states are already implementing measures to curb e-cigarette use. In most states, including North Carolina, e-cigarettes cannot be sold to anyone under age 18. North Carolina also taxes the sale of e-cigarettes.

Other states have implemented e-cigarette bans on school property, and several states, also including North Carolina, specifically prohibit the use of e-cigarettes in 100 percent smoke-free sites.

Additional research

Alongside the RTI study, research is starting to reveal that e-cigarettes carry their own health hazards. A recent study out of UNC-Chapel Hill showed that five of 13 liquid flavors – including hot cinnamon candies, banana pudding and menthol tobacco – are toxic in high doses and can change cell life, cell reproduction and cell communication in the lungs.

Work out of the University of Alabama School of Medicine discovered that the temperature of the e-cigarette coil is directly associated with the production of harmful chemicals, such as acrolein (used in herbicides), acetaldehyde (a toxic irritant) and formaldehyde. And inhaling the vapor suppresses one’s ability to cough.

Albert Einstein University researchers found that after 30 e-cigarette puffs in 15 minutes, users were far less sensitive to capsaicin, a component of chili peppers that can induce coughing. A reduced ability to cough can be dangerous because coughing can prevent choking and it removes infectious agents from the lungs.

New research with mice from Indiana University found that just the nicotine in e-cigarettes is enough to negatively impact lung function. The effects are greater with higher doses, but nicotine inhalation causes acute lung inflammation, decreased lung cell growth and a change in lungs’ ability to act as a barrier to outside insult.

Even substances found in nicotine-free e-cigarettes attacked the molecules that hold together the endothelial cells that line the lungs and protect from infection.

The hope, Kim said, is this current and future research will continue to highlight the yet-unknown dangers of e-cigarettes both to the user and those in the vicinity. Data that reveals the potential negative impacts, she said, could be the best arrow in the quiver to fight against marketing efforts that support e-cigarette use.

“If we don’t make an effort to educate people, we’re only going to be flooded by counter messages that e-cigarettes are perfectly safe,” Kim said. “Perceptions, correct or not, will be spread by word of mouth and on social media.”

To read the story at its original location: http://www.northcarolinahealthnews.org/2015/06/08/harmful-or-harmless-new-studies-light-up-debate-on-e-cigarettes/

June 8, 2015 Posted by | Healthcare, Science | , , , , , , , , , , , , , , , , | Leave a comment

When Testing Becomes Overtesting

Published on the May 15, 2015 DiagnosticImaging.com website

By Whitney L.J. Howell

On April 1, Mark Cuban, billionaire entrepreneur, NBA team owner, and actor, took to Twitter, sharing his philosophy on how patients can best be engaged with their health care. In a series of tweets, he advocated – among those who can afford it – for having a quarterly blood test in an effort to establish an individualized health baseline.

Not only would this strategy give patients and their children more knowledge about their health care over time, he said, but it would also allow patients to be more proactive about their medical treatment. No more waiting to get sick – patients could, potentially, identify problems early and ask for intervention.

The wake of those tweets has been filled with mixed responses from the medical community. Within radiology, a specialty constantly concerned with the specter of overtesting, providers are in heated disagreement over whether Cuban’s advice is reckless or revolutionary for health care.

To determine the pros and cons of a quarterly blood-test strategy, Diagnostic Imaging interviewed two industry experts. Saurabh Jha, MD, MS, assistant professor of radiology at the Hospital of the University of Pennsylvania, and Stephen Hunt, MD, PhD, an interventional radiologist and co-director of the Penn Image-Guided Interventions Laboratory shared their thoughts.

To read the debate at its original location: http://www.diagnosticimaging.com/practice-management/when-testing-becomes-overtesting?GUID=EF943FEE-BD0C-44C7-A1BC-C82F32210979&XGUID=&rememberme=1&ts=15052015

May 15, 2015 Posted by | Healthcare | , , , , , , | Leave a comment

New Research Points to Feeding Peanuts Early to Avoid Allergy

Published on the May 5, 2015, North Carolina Health News Network website

New findings about peanut allergies is turning the advice pediatricians give to parents of young children on its head. Scientists from North Carolina are in the thick of this new research.

By Whitney L.J. Howell

As a 15-month-old, Brayden Baylor touched his first peanut butter cracker. Within minutes, his face turned red, he broke out in hives and he began rubbing his eyes until they were swollen shut.

It was a classic peanut-allergy reaction. But, because he hadn’t actually eaten the cracker, or the peanut butter on it, his parents didn’t realize what was happening – until a second reaction erupted within hours.

“We had given him a dose of Benadryl, and, at the time, we still didn’t really know what caused the problem. There’s no history of food allergies in either of our families,” said Karrie Baylor, Brayden’s mother and a Charlotte resident. “But when it happened a second time, he was sitting in my lap and suddenly turned red and swollen. That’s when we took him to the emergency room.”

After a blood test, a local allergist diagnosed Brayden with a peanut allergy – a potentially deadly immune response affecting between three million and six million Americans, the majority of whom are children. According to a 2001 Archives of Internal Medicine study on food allergies, peanut allergies rank worst, accounting for more than 50 percent of the 200 annual food allergy-related deaths nationwide.

Peanuts are one of North Carolina’s most significant agricultural products, yielding about 8 percent of the U.S. total annual production. Much of the research on peanut allergy has also been done in N.C. Image courtesy USDA

Peanuts are one of North Carolina’s most significant agricultural products, yielding about 8 percent of the U.S. total annual production. Much of the research on peanut allergy has also been done in N.C. Image courtesy USDA

In fact, the fear of peanut allergy and its potentially fatal outcomes prompted the American Academy of Pediatrics, in 2000, to issue guidelines recommending children consume no peanut protein before age 3. The hope was that delayed exposure would give a child’s immune system time to strengthen and prevent peanut allergies.

But that hasn’t happened. Between 1997 and 2010, peanut-allergy prevalence among American children has skyrocketed 50 percent, according to the Centers for Disease Control and Prevention. And, based on existing data, occurrence within North Carolina mimics the national population.

This meteoric rise has baffled allergy and immunology researchers and sparked many investigations into the body’s response to peanut protein and how it can be calmed. Now there’s a watershed study, funded by the National Institutes of Health, that experts say conclusively proves the existing approach to combating peanut allergies has been wrong.

In short, the AAP guidelines meant to safeguard children like Brayden are actually causing more allergy cases to break out.

“This study is definitive. That’s unusual in this business,” said Herman Mitchell, vice president for Rho, the Chapel Hill-based contract research organization that handled the study’s statistical and data coordination. “We usually see trends, but this is a whopping finding that is very clear. It’s a reason to completely change the recommendations about avoiding peanuts at an early age.”

Problem peanuts?

While peanut-allergy rates are high in the United States and United Kingdom, that’s not the case everywhere. A 2008 Journal of Allergy and Clinical Immunology study revealed British children were 10 times more likely to have a peanut allergy than Israeli children.

Those nation’s health care systems are roughly equivalent, but there’s a significant cultural difference. Israeli families introduce children to peanut products far earlier. A snack called Bamba – a peanut butter-flavored corn puff – is present in 90 percent of Israeli homes and helps transition infants to solid food.

As part of the NIH’s Immune Tolerance Network, Gideon Lack, pediatric allergy professor at King’s College London, launched a study to investigate whether eating peanut-protein products, such as Bamba, early has a protective effect, Mitchell said.

Lack’s five-year study enrolled 600 4-to-11-month-old children who were at risk for developing a peanut allergy.

They either had another existing food allergy, a family history of peanut allergy or eczema. Half of the children were introduced to Bamba, while the other half followed the existing guidelines that prohibit exposure. The children who received Bamba ate it three times a week for five years.

The study ended with a food challenge that escalated the peanut-protein amount participants ate over several hours.

The results, published in a February New England Journal of Medicine issue, showed children who ate Bamba were 81 percent less likely to develop peanut allergy. Among non-consumption participants, 13.7 percent developed a peanut allergy, while only 1.9 percent of the Bamba group did.

According to Wesley Burks, chair of pediatrics at the UNC-Chapel Hill School of Medicine, Lack’s study will change how doctors advise parents about peanuts.

Burks leads a long-standing peanut-allergy study designed to help children with existing peanut allergies, including Brayden, develop a tolerance to peanut protein.

“These studies will change the paradigm with respect to feeding in the first six months of life for kids with allergic diseases. The guidelines for introducing peanut protein will change within the next year,” he said. “That will be the easy part; but medical guidelines take years to be disseminated.”

It will take between five and 10 years, he said, for pediatricians to abandon the current guidelines and begin advising parents based on these new findings.

Testing the idea

While the results of Lack’s study seem to indicate that preventing peanut allergy before it occurs is possible, it’s not yet clear whether that’s the case, Mitchell said. The effect could be desensitization, meaning participants who exhibit no current allergic responses could have reactions to peanut protein later in life.

To answer that question, several Bamba group participants agreed to avoid peanut protein for a year and then complete another food challenge. This new group will also include 40 children who don’t have peanut-allergy risk factors but had a positive allergy skin test. Results of this new study will also help doctors treat children with peanut allergies.

“It would be ideal if we could understand exactly who’s at risk,” he said. “Then pediatricians could measure a child’s risk and could recommend early [peanut-protein] exposure.”

Mitchell advised that parents have their child evaluated by an allergist if any peanut-allergy risk factor exists. An allergist can provide guidance on how to introduce peanut protein into the diet.

Slow buildup

These study results and new guidelines will help prevent peanut allergies in

Karrie and 6-year-old Brayden Baylor share a Reese’s Peanut Butter Cup three years after Brayden started treatment for his peanut allergies. Photo courtesy Karrie Baylor.

Karrie and 6-year-old Brayden Baylor share a Reese’s Peanut Butter Cup three years after Brayden started treatment for his peanut allergies. Photo courtesy Karrie Baylor.

infants and newborns, but it can’t help the children who already live with peanut intolerance.

That’s where Burks’ work comes in. For more than 25 years, he has worked toward treatments that help children – most of whom are over age 2 – develop a peanut-protein tolerance that reduces the severity of allergic reaction. The therapy is considered a success if a child can ingest a peanut or peanut protein without being thrown into a debilitating or potentially fatal immune response.

To date, Burks, who is also physician in chief at North Carolina Children’s Hospital, and his team have developed three treatment forms, all of which culminate with a food challenge similar to Lack’s study. In some cases, participants drip peanut protein-infused liquid under their tongue, while others wear patches impregnated with peanut protein. The most effective strategy though has been mixing peanut-protein powder with other well-tolerated foods, such as applesauce or ice cream.

“When the protein powder is introduced regularly – and in increasing quantities – it can make changes to the immune system,” Burks said.

Based on Rho’s data, Burks said he will begin to enroll and treat younger children in a continued effort to reduce peanut-allergy impact.

In the meantime though, he will continue to treat children Brayden’s age and younger, helping them overcome their peanut allergies. Brayden’s therapy has already been declared a success after three years: He passed his final food challenge without exhibiting any signs of allergic reaction.

His celebratory feast? His first-ever Reese’s Peanut Butter Cup.

To read this story at its original location: http://www.northcarolinahealthnews.org/2015/05/05/new-research-points-to-feeding-peanuts-early-to-avoid-allergy/

May 5, 2015 Posted by | Healthcare, Science | , , , , , , , , , , , , , , , | Leave a comment

Accounting Advice for Radiology Practices

Published on the April 23, 2015, DiagnosticImaging.com website

By Whitney L.J. Howell

Editor’s Note: It’s no longer enough for radiologists to be imaging experts. Health care is becoming big business and radiologists need to understand how to navigate the system. Diagnostic Imaging’s Business of Radiology series provides radiologists with the business education they need to succeed.

Throughout radiology, there’s no shortage of hand-wringing about slashed reimbursements and shrinking bottom lines. New requirements and regulations on the horizon could further endanger your balance sheet.

But, according to industry experts, proactive, thorough accounting strategies and choices can help keep your group or practice afloat.

“Accounting procedures are important because profit margins are declining every year due to Medicare cuts and strategies that payers are employing,” said David Yousem, MD, neuroradiology director, program development vice chairman, and radiology professor at Johns Hopkins Medical Institution. “Mind your Ps and Qs or else you won’t have a profit margin.”

Studying your expenditures and income might frequently take a back seat to your concerns over patient care and quality, but it isn’t something you can ignore, he said. Knowing how to categorize your financial activities and your business model, as well as taking a close look at your daily activities can make the difference in your practice’s monetary health and growth.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/accounting-advice-radiology-practices?GUID=EF943FEE-BD0C-44C7-A1BC-C82F32210979&XGUID=&rememberme=1&ts=24042015

April 30, 2015 Posted by | Healthcare | , , , , , , , , , , , , | Leave a comment

The Ethical Radiologist

Published on the March 18, 2015 DiagnosticImaging.com website

Editor’s Note: It’s no longer enough for radiologists to be imaging experts. Health care is becoming big business and radiologists need to understand how to navigate the system. Diagnostic Imaging’s Business of Radiology series provides radiologists with the business education they need to succeed.

By Whitney L.J. Howell

he bedrock code of being a physician and provider is to first, do no harm. Implied in that statement, industry experts said, is a requirement to always act in an ethical manner. It’s one of the easiest ways to safeguard patient safety and present the best quality care.

In radiology, abiding by the highest level of ethical behavior is a sure-fire way to show your colleagues and the health care community that they can have confidence in your work product.

“If you really care about the patient, really care about your colleagues and community, it will shine through,” said Richard Gunderman, MD, an Indiana-based radiologist who has written and published about radiology ethics. “We have an ethical responsibility to put the best interest of the patient above the hospital or health care system that might happen to employ us.”

The American College of Radiology (ACR) Ethics Committee serves as the industry’s highest ethical authority, and it routinely publishes guidelines and policies to help you navigate ethical situations. But, remembering and monitoring ethics at a more local, day-to-day level is also important.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/ethical-radiologist

March 20, 2015 Posted by | Uncategorized | , , , , , , , , | Leave a comment

Exploring the Waves for New Medical Knowledge

Published on the March, 16, 2015 North Carolina Health News website

Researchers in eastern North Carolina are culling the waters of the coast to find ingredients for new drugs and treatments for disease.

By Whitney L.J. Howell

Think about the ocean, and visions of whales, shellfish and the occasional starfish might pop to mind, not medical therapeutics and advancements in drug delivery. But with new research, the waves that crash on North Carolina’s coast are bringing innovative strategies and tools for improving health.

Together, researchers from the University of North Carolina-Wilmington and East Carolina University’s Brody School of Medicine are investigating how microorganisms found in ocean waters could improve the performance of existing medications, such as drugs for diabetes, cancer and heart disease.

“There’s a new class of compounds based on marine life that can get inside cells and show the cell’s permeability,” said David Brown, an ECU cardiac physiologist and associate physiology professor involved in the partnership.

Brown said UNCW researchers know the ocean side of the equation, whereas his group has studied compounds that can potentially be used to create designer medicines that get into cells and function better.

“Where UNCW’s expertise stops … is where we pick up,” he said.

The partnership, which still awaits final funding approval, formed in response to a call from the University of North Carolina Board of Governors for game-changing research between UNC system institutions that could spawn new approaches to treating disease.

Sharing work & benefits

Any research successes borne from North Carolina’s 300 miles of coastline and estuaries would likely be further supported by the UNCW-based Marine Biotechnology in North Carolina program and the nonprofit Wilmington-based Marine Bio-Technologies Center of Innovation. The Bio-Technologies Center, bolstered by a $2.5 million grant from the N.C. Biotechnology Center, is charged with helping shepherd discoveries into products and processes.

The marine life component of this collaboration comes from the lab work of UNCW Center for Marine Science director Dan Baden, who has studied red tide, the algae bloom known for killing large

UNCW Center for Marine Science director Dan Baden with some of the more than 750 cloned samples from more than 500 microorganisms collected from the waters off North Carolina’s coast. Photo courtesy UNC-Wilmington/Jamie Moncrief

UNCW Center for Marine Science director Dan Baden with some of the more than 750 cloned samples from more than 500 microorganisms collected from the waters off North Carolina’s coast. Photo courtesy UNC-Wilmington/Jamie Moncrief

fish populations by paralyzing their central nervous systems.

Baden’s team identified a microorganism capable of crossing a cell’s outer protective layer – the membrane that acts as a gatekeeper, only letting select substances in and out of cells.

His team dubbed these microorganisms “escortins” because they can escort materials through that natural cellular fence, depositing them at a specific target. Escortin™ is already on the market as a cancer-drug delivery tool. Test results showed it delivers cancer medications to cells within minutes, compared to other drug-delivery systems that can take up to a day to be effective.

Work is underway for additional safety and efficacy trials, as well as clinical trials, to test whether Escortin can be used in other ways, Baden said.

Escortin could be given alongside other drugs, said Baden, who is also a UNCW marine sciences professor.

“If we can bind the escortins to a drug of interest at ECU, then we have the potential

to develop a pairing where our molecules carry medications across the membrane efficiently,” he explained. He called escortin “a molecular carrier that could potentially have ubiquitous importance well past the end of all our careers.”

Delivering a guarantee

At ECU, Brown’s research has focused on mitochondria, the structures in cells that convert food into energy. He calls mitochondria the key to medication success.

Brown has focused on the mitochondria inside heart cells, how they affect heart disease and irregular heartbeats and how they repair other malfunctioning mitochondria. When cells are diseased, he said, mitochondria don’t work well.

Because of the cell’s outer membrane, there hasn’t yet been a definitive way to get drugs to the mitochondria in order for them to heal and return to normal functioning.

“Many times, there’s no guarantee a medicine will get into the cell that can benefit from it,” Brown said. “There’s no way to be absolutely sure [a medicine] gets to the right place.”

Escortins create that guarantee for mitochondria, Baden said, taking medications through the cell’s outer membrane.

North Carolina waters bring healing

That targeted drug delivery could have a significant impact on adults living near both institutions.

According to 2010 data from the North Carolina State Center for Health Statistics, nearly 13 percent of adults in eastern North Carolina – the highest rate in the state – live with Type 2 diabetes. Data from the Eat Smart Move More NC initiative also revealed between 63 and 68 percent of adults in the same area are overweight or obese.

Parts of cells being measured out for testing in the UNCW Center for Marine Science. Investigators use methods that involve physics and biology to learn more about the cells’ function and structure at the molecular level. Photo courtesy UNC-Wilmington/Jamie Moncrief

Parts of cells being measured out for testing in the UNCW Center for Marine Science. Investigators use methods that involve physics and biology to learn more about the cells’ function and structure at the molecular level. Photo courtesy UNC-Wilmington/Jamie Moncrief

“Mitochondria in diabetics aren’t good at burning fuel for many reasons,” ECU’s Brown said. “If we can use the ocean to help design treatments, then there’s huge potential for treating the disproportionately high population of diabetics and people with metabolic illness.”

The escortin-medication relationship could also improve the efficacy of heart medications, Baden said. Being able to deliver heart medications to patients who’ve had a heart attack or stroke in a timely manner can potentially decrease avoidable deaths, an important goal in eastern North Carolina, a region known as the “buckle” of the “stroke belt.”

Economic impact

The state’s 300-mile coastline presents the universities with a wealth of discovery opportunities, said Deb Mosca, the Bio-Technologies Center’s chief executive and a microbial geneticist who studies the genetics of microorganisms.

UNCW researchers are already deeply involved in culling the ocean for plants and animals that could benefit human health. Once they find a new organism with intriguing characteristics, they clone it, eliminating the need to harvest more and potentially disrupt the ocean’s ecosystem.

In doing so, Baden said, investigators are looking for new aspects of genetics and chemistry that haven’t been seen before.

“If you combine ECU’s drugs with our molecules, we’ve created new intellectual property that can extend the life of patents and add new value. It’s a scaffold for us to build upon,” UNCW’s Baden said. “Translational science – applying research in a real-world way – earns money from tax dollars and gives back to the American people.”

The process can also work in reverse, he said. If researchers know there’s a need for a certain type of medication that functions in a particular way, they can work toward finding a marine biotechnology solution to the problem. And that could create greater economic stability in the region by bringing new tools, collaborations and science jobs to eastern North Carolina, fueling further economic development.

UNCW is already on that path with its new translational science building, funded by the U.S. Department of Commerce and National Institute of Standards and Technology. The 69,000-square-foot space is the first of its type in the region, and it brings together, under one roof, researchers from a variety of scientific fields, making professional cooperations even easier.

“It’s a resource for North Carolina biotechnology, the UNC system and the state that goes beyond just the faculty and institutions working together – it includes students,” Baden said. “It’s about coming into a multidisciplinary, collaborative environment and developing relationships through big science, business and working with the right people to combine expertise and experiences to do things that weren’t possible before.“

To read the story at its original location: http://www.northcarolinahealthnews.org/2015/03/16/11680/

March 20, 2015 Posted by | Healthcare, Science | , , , , , , , , , , , | Leave a comment

Catching Emotional and Developmental Problems in Homeless Children

Published on the March 2, 2015, North Carolina Health News website

A new study shows children experiencing homelessness are at more risk of mental health and developmental problems.

By Whitney L.J. Howell

Four-year-old Aiden and his mother came to a Raleigh Salvation Army Women & Children’s Shelter for the 30-day overnight program in October. They had no car and had shuttled between the homes of friends and family in Raleigh and Durham, but Aiden’s mother was determined to find the services her son needed.

Aiden, whose name is changed for his privacy, screamed and cried frequently, couldn’t focus and couldn’t sit still. He had language delays, couldn’t convey his needs and wants and couldn’t interact in age-appropriate ways.

Unfortunately, Aiden isn’t alone. A look inside the state’s homeless shelters quickly reveals a sobering fact – many residents are children. And a substantial number of those kids need mental health services they’re not getting.

Luckily for Aiden, a Community Action Targeting Children who are Homeless (CATCH) case manager got involved, screening his developmental and social-emotional status. Aiden scored extremely low, completed additional testing and was diagnosed with autism. The CATCH case manager referred him to Child Find, an exceptional-needs children’s initiative, where he entered a half-day program.

“The Child Find office works closely with CATCH and understands the barriers unique to homelessness. It was extremely helpful to the mom, as the half-day program lets her seek employment and stable housing,” said Jennifer Tisdale, a Project CATCH coordinator who works with Aiden’s case manager.

“Without CATCH case management, it’s entirely possible this child would’ve never been identified and wouldn’t have received the services and placement in an appropriate setting beneficial to them both,” she said.

According to a new NC State University and Salvation Army-funded study, 25 percent of homeless children – from infants to early-elementary school age – need mental health services to avoid developmental delays.

“In North Carolina, the fastest growing homeless population is families, not individuals. It’s really important to see how this situation impacts them, especially young children,” said Jenna Armstrong, an NCSU doctoral student and study co-author. “We found there’s a significantly higher proportion of homeless children experiencing developmental and social-emotional delays than those who aren’t homeless.”

The situation in North Carolina

Nationally, there are 2.5 million homeless children. According to the 2014 National Center on Family Homelessness report, North Carolina falls in the bottom half, at 29th, in addressing this issue. Statewide, there are more than 55,000 homeless children, making North Carolina one of the 15 worst nationwide.

North Carolina has 650 emergency shelters and nearly 1,900 additional transitional or supportive housing spaces for homeless families. A newly formed interagency group on homelessness also exists. But few existing intervention programs focus on young children.

The NCFH report also revealed that North Carolina’s homeless children fall below national averages in academic performance. Only 22 and 29 percent of fourth-graders meet educational standards in reading and math, respectively. By eighth grade, those numbers decline to 19 and 23 percent.

What are the risks?

The NCSU/CATCH study evaluated 328 children, aged two months to six years, in 11 Wake County homeless shelters. They observed children and conducted 20-minute assessments with their parents. Most homeless children adapt and function well, but researchers found a quarter of the group suffer negative effects.

“Many homeless children have experienced prolonged poverty, exposure to family and neighborhood violence, separation from parents due to child protective-services involvement and inadequate parenting,” said Mary Haskett, an NCSU psychology professor and lead study author. “Residing in shelters adds the stress of living in a chaotic, crowded, often unsafe environment, and access to services is extremely limited for young children who are homeless.”

Based on CATCH-conducted assessments, homeless children have greater communication and language development delays – in fact, existing research shows 60 percent have significant communication delays. In this study, toddlers had particularly low communication development scores.

Learning to read is harder for children who don’t hit milestones on time, Haskett said, placing them at higher academic failure risk.

The team assessed physical development in babies, Armstrong said, by whether infants could sit up unsupported, which happens at about 4 to 7 months, and when they began babbling and talking not long afterwards. Investigators also examined social-emotional development by observing whether older children threw tantrums and how well they handled their emotions. By comparing a child’s behavior to large, national pediatric behavioral studies, the team concluded many homeless children, such as Aiden, fell outside normal behavioral development ranges.

These delays could emerge at any age, Haskett said. Boys appeared to be at greater risk than girls for delayed social-emotional development, based on parental reports. Parents of 28 percent of at-risk boys and 21 percent of at-risk girls expressed concerns about their child’s social-emotional development.

But determining the extent of the difference and why it exists requires more research, she said.

What can be done?

Older school-age children receive some mental health services, Haskett said, through the federal McKinney-Vento Homeless Assistance Act. The law requires that schools have an education liaison to help students enroll in school and coordinate transportation for the student to attend. It also mandates other needed services, such as vocational or technical training, free or reduced school meals and before-and-after-school care.

But services for younger children are rare, she said.

“When these children arrive at a shelter, the priorities are housing and other basic needs of families,” Haskett said. “If children’s developmental and mental health needs are severe and obvious to shelter staff, a referral for appropriate services might be made. But if the delays are subtle, it’s unlikely. Untreated minor delays and mental health concerns tend to simmer and worsen over time.”

That’s why screening children, like Aiden, is vital, she said. Early identification can increase their access to existing beneficial programs, such as Early Head Start, a free child-development program for low-income families. The program teaches parents activities to bolster their children’s learning and offers day care center-based learning programs that help kids meet developmental and social-emotional milestones.

Other programs, such as the Nurse-Family Partnership, Incredible Years and the Triple P-Positive Parents Program, also give at-risk children support for improved growth and future academic performance, she said.

Through the Nurse-Family Partnership, maternal and child health nurses work with at-risk and low-income first-time parents, teaching them healthy habits and skills to support their infant’s early development. Incredible Years focuses on ensuring children’s healthy social and emotional development. Triple-P also strives to teach parents effective coping strategies to shepherd their child’s emotional development.

A Child’s Place, a school for homeless children in Charlotte, exemplifies early-intervention success. Ninety-two percent of the homeless children with whom they work read at grade level, compared to 48 percent nationally.

Having early-intervention service representatives participate in screening homeless children could make early assessments more effective, Haskett said. They could help determine whether a child is eligible for targeted programs.

“But the workforce must have competencies in young children’s mental health and development to serve this group,” she said. “Unfortunately, most communities lack mental health providers who can service children ages birth to 5.”

However, the NCFH recently made policy recommendations for promoting development and mental health functioning in homeless children. The hope, Armstrong said, is that this research will support those recommendations, as well as prompt legislators to advocate for expanding assessment screenings and create more support services.

Too often, Armstrong said, children like Aiden fly below the radar.

“They’re not paid attention to in shelters and they’re not noticeable in the school system,” she said. “We’re lucky to be at the forefront of this problem, to advocate for making these invisible children more visible to policymakers who have the power, through money, to remediate the problem.”

To read the article at its original location: http://www.northcarolinahealthnews.org/2015/03/02/catching-emotional-and-developmental-problem-in-homeless-children/

March 2, 2015 Posted by | Healthcare | , , , , , , , , , , , , , , , , | Leave a comment


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