Whitney Palmer

Healthcare. Politics. Family.

Right From the Start

Published in the Spring 2016 University of North Carolina Greensboro Research Magazine

By Whitney L.J. Howell

The best foot forward. It’s what we all want for our children in those first few years. But, the question is — how do we get there?

Nationally and locally, debates rage. It’s difficult to find consensus on the best way to educate our children or even prepare them to be educated. One thing we can be sure of? It’s no simple task. It will require a lot of work and collaboration to get it right.

UNCG is leading the way. Here, researchers have investigated — sometimes for years — what it takes to make sure children are healthy and ready to learn. And, now, investigators are combining their knowledge, resources, and networks to meet these challenges directly.

Faculty and staff, from the UNCG Department of Human Development and Family Studies to the UNCG Center for Youth, Family, and Community Partnerships, conduct basic research, translate research into evidence-based practice, and help create local, state, and national educational policy. As they reach out to families, help towns and cities identify and intervene with struggling children, and teach professionals vital skills for the classroom, these investigators have one goal in mind — giving every child the right start.

“We take what we glean from research and teaching and put it together to make a difference. That knowledge shouldn’t remain in the academy,” says Dr. Chris Payne, director of the Center for Youth, Family, and Community Partnerships. “It’s our mission to work for the greater good of our community.”

The Importance of Early Social & Emotional Development

For children to maximize their educational experiences, it’s critical they come into the classroom ready to learn. That makes the first five years invaluable to healthy growth, Payne says. During that time, approximately 90 percent of brain structures develop, establishing the foundation for how a child learns and processes information.

The healthiest growth occurs, explains Payne, when children have secure relationships with their caregivers and feel free to express emotions, including fear, anger, and happiness.

Emotion Regulation

Although school carries an inherent focus on grades, academic ability isn’t the only factor determining whether a child is actually classroom-ready. Another key indicator is whether he or she can appropriately regulate emotions, says Dr. Susan Calkins. “The more structured preschool and school environments present a unique set of challenges to children — challenges that require emotional readiness.”

If you visit the Human Development and Family Studies (HDFS) professor’s lab while her team collects data, you’ll observe children singing, counting, or playing games. Others might be crying and flailing fists. They’re expressing a wide range of emotional abilities, dependent on their age and experiences.

While some children control their impulses by employing various learned strategies, others lack these skills and have trouble delaying gratification or managing frustrating tasks. Their negative emotional responses indicate immature emotional readiness.

“Being able to manage emotions is critical for academic achievement, school readiness, and mental health,” Calkins explains. Without emotion regulation skills, children can’t establish positive student-teacher and peer-to-peer relationships. If they can’t express themselves or manage their feelings in ageappropriate ways, they also risk social rejection. “If children don’t master emotional regulation, they face challenges for years to come.”

To help children reach appropriate levels of emotional maturity, adults must recognize their natural responses and know how to handle them, Calkins says. To find the tools parents and caregivers need, she and her team have recruited children from more than 450 families to participate in the RIGHT Track study.

Although we can begin to understand emotion regulation by observing the behavior of and collecting information from children and their caregivers, collecting data at the physiological level also provides a key piece of the puzzle in understanding not only how emotional regulation develops but also the degree to which it impacts various areas of the child development.

In one component of the study, Calkins team attaches heart rate electrodes to each child to measure their physiological arousal and then presents them with a frustrating task. Two-year-olds are asked to open a cookie jar that was glued shut or wait to open a present, while 5-yearolds are tasked with unlocking a box using a set of keys that does not actually include the correct key.

The team watches both the child’s actions as well as the caregiver’s responses. Did the children quit or did they stick with the task? Did the parent offer guidance or withdraw from the situation? Children and parents returned to the lab for more advanced tests as they aged.

“So far, we’ve seen that children who get extremely frustrated with these tasks also experience behavior problems,” Calkins says. “These kids who lack skills to control their emotions and cope are also more likely to experience depression and academic and health issues and to engage in substance abuse and risky sexual behavior later in life.”

There are many ways children can rein in overwhelming feelings. Distractions, such as singing songs, diverting concentration, or engaging in self-soothing behaviors, can effectively control emotions.

Knowing how to implement these behaviors helps a child navigate social and academic environments, says Calkins. They also help children stay focused on tasks and enhance their autonomy. When children have these skills, they can approach difficult situations without adult intervention.

Calkins’ findings are important not just for parents but for educators too. Early development of a positive teacher-student relationship can help children sidestep many of the aforementioned problems. “This is critical knowledge, especially in today’s kindergarten climate where we’re getting young children ready for a series of tasks and tests.”

Parent-Child Relationships

Healthy emotion regulation is imperative for children to achieve school readiness, but of course they can’t do it alone. Parents must be involved, points out HDFS professor Esther Leerkes. And, at every step, parents must provide age-appropriate guidance or children won’t internalize the correct skills.

“The quality of parenting matters. We know that how parents respond when a child is upset can help children learn to regulate their emotions — which in turn affects their early cognitive development and school readiness,” she says. “We also know if children struggle emotionally, they are more likely to struggle academically.”

Inside Leerkes’ lab, parents and young children are completing a treasure hunt. They must find the best route for a bear to cross a body of water and reach a prize on an island. While the child’s goal is getting to the treasure, the research team’s objective is to determine how differing parenting styles affect a child’s emotional and cognitive abilities and early readiness for school.

The kids and adults are participants in the School Transition and Academic Readiness (STAR) project. With over $6 million in funding over the last decade from the National Institute of Child Health and Human Development, Leerkes and her collaborators are following over 500 children from age 4 to the first grade.

It matters, she says, whether parents engage children in stimulating ways. The adults can choose to withdraw from the game, take it over, or engage the child and guide him or her through the process, helping them understand and make decisions.

The most successful children, she says, have emotionally supportive parents. They were involved in play and offered age-appropriate guidance, praise, and encouragement. Children faltered when parents took charge, became frustrated, or didn’t participate at all. Children were also more likely to lose interest, appear bored, or withdraw when parents pushed too hard or became negative.

Leerkes’ team also assesses the children’s physiological and neural activity as they problem solve.

For example, the team puts each child through a Stroop test. These tests tax participants by requiring them to inhibit their initial responses — a child might be required to say the word “night” when they see a picture of the sun. The researchers observe which regions of the brain are active, and they record how many picture presentations the children get right.

They’re looking to see, Leerkes says, what types of brain activity correlate to high performance levels. One day, their findings could help predict a child’s level of academic performance and perhaps even help identify children who need early interventions.

In another study with infants and toddlers, the team monitors both parents and children as children are presented with frightening or frustrating situations. Leerkes’ team has found that a younger child’s emotional control is strongly linked to the caregiver’s behavior and emotions. If parents exhibit frustration, irritation, or anxiety — identified by elevated heart rates accompanied by poor regulation — children aren’t as able to control their emotions and behavior. To minimize a child’s exposure to negativity, Leerkes suggests that parents pay attention to their own emotions while interacting with their children. Imagine your child’s perspective, she advises, and calm yourself by pausing to take deep breaths and relax when you can feel your own strong emotions rising.

When parent-child interaction is positive, everyone benefits, Leerkes says. Children develop better emotional control, and they use that skill to maintain their attention and manage their frustration, both critical for adaptive peer relationships and active engagement in school. And parents proudly watch their children succeed in school transitions.

Child Care Program Quality and Teacher Support

In laying the foundation for school readiness and a lifetime of success, we know that quality of parent-child interactions and the home environment is critical. But quality in other child care environments, including preschools and child care centers, is just as crucial.

It’s important for parents to know what an early childhood program offers, how effective their teachers are, and where the curricula are strong. In 1999, HDFS faculty Dr. Deb Cassidy, Dr. Linda Hestenes, Dr. Sharon Mims, and Dr. Steve Hestenes began collaborating with the N.C. Division of Child Development and Early Education to help parents make these important choices.

Their long-running N.C. Rated License Assessment project, which has received over $50 million in funding, rates child care programs throughout the state — currently over 7,000 programs. Of these, 45 percent of child care centers and approximately 11 percent of home-based programs have earned the top, five-star rating.

The N.C. Rated License Assessment project is just one of many ways UNCG is helping improve the overall quality of child care and education statewide. Another example? In conjunction with the N.C. Department of Public Instruction, HDFS Associate Professor Catherine Scott-Little is providing technical support for a new North Carolina K-3 assessment system. The system collects data on students from kindergarten through third grade, to help individualize their teaching and learning. Teachers, support staff, and families provide information for the assessment from observations, conversations, work samples, and more.

Teachers are better prepared and can better personalize teaching strategies when they understand how children learn. The K-3 Assessment system will arm teachers with a more complete picture of each of their students, improving their instruction and helping to meet their individual needs. With the information from the assessment Scott-Little is helping to design, teachers can more effectively target and teach to areas where high-need children need the most help.

A well-educated, prepared teaching staff is the biggest factor in achieving a five-star rating in the current N.C. Rated License guidelines. But finding the best qualified teachers to choose from can be difficult in the current environment of student loan debts and low teacher wages statewide. UNCG is taking steps to help grow our pool of highly educated teachers and to make sure they are supported and paid a living wage to keep them in the field.

HDFS Professor Deborah Cassidy has led the charge in preparing North Carolina teachers for more than two decades. Her latest focus is the EQuIPD (Education Quality Improvement & Professional Development) program. Funded by a Smart Start grant from the Guilford County Partnership for Children, EQuIPD is bringing professional development directly to existing early childhood professionals in Guilford County.

“Traditionally, early childhood professionals struggle to find the time and resources to get the continuing education and professional development they need,” says Cassidy. “Through this program, our staff brings interconnected services, such as peer coaching and training, directly to teachers and directors in early childhood settings. Together, we are implementing strategies we know have a direct impact on increasing the quality of early care and education.”

Another example of efforts in this area, says Cassidy, is UNCG’s mentoring program, which pairs teachers working in higher-quality programs with those working in lower-quality programs over a four month period. Mentors — who receive a stipend — meet regularly with mentees to discuss problems, strategies, and tactics. These conversations help identify opportunities for reaching children, as well as actions that might hamper a child’s academic progress. The connections are designed to give teachers a safe, reliable sounding board to analyze problems.

“The relationships that develop are more important than the content discussed. Being an early-education teacher can be isolating,” Cassidy says. “Having someone to discuss issues with can be invaluable.”

It’s also important, Cassidy says, for teachers to feel comfortable instructing students on complicated subject matters. To foster that confidence, UNCG supports community-training events that raise awareness of early-education topics through keynote speakers and workshops. For example, a recent session offered guidance for teaching science and math in age-appropriate ways. The hope, she said, is these sessions will enhance teachers’ abilities to create strong curricula that reach children of all readiness levels.

But having high-quality teachers who know how to reach students and who have targeted curricula that teach to every student’s needs means nothing if those teachers don’t make it into or stay in the classroom. There’s only one way to ensure high quality teachers are available, Cassidy says. Current and future educators must receive salaries that accurately reflect the time and effort that goes into the job.

To highlight this dire need, HDFS hosts Worthy Wage Day, an event that invites community leaders and politicians to work a child-care job for two hours, earning a teacher’s hourly pay — $10.97. They’re presented an honorary check during a press conference and are given the opportunity to discuss their experience.

Not only does Worthy Wage Day give community leaders a first-hand view of what teaching and caring for young children actually requires, but it also highlights the dire income insecurity experienced by many of North Carolina’s early-education teachers. Up to 45 percent receive income support. In fact, many can’t afford to enroll their own children where they work. Until this inequality is sufficiently addressed, Cassidy says, the state will continue to struggle to maintain a well-educated, dedicated, quality teacher workforce.

To read the article at its original location: http://research.uncg.edu/wp-content/uploads/2016/04/onlineUNCGResearchSpring016.pdf

 

May 25, 2016 Posted by | Education, Politics | , , , , , , , , , , , , , , , , , | 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

Surviving ACA: A Guide for Rheumatologists

Published on the Dec. 19, 2013 Rheumatology Network website

By Whitney L.J. Howell

Healthcare reform implementation is in full swing. How will it affect rheumatologists? Questions remain, but industry experts say that much of the impact lies with rheumatologists themselves.

The specialty has already faced one healthcare delivery re-design: In the 1990s, health maintenance organizations (HMOs) proved disastrous for providers and facilities. Now, in similarly-designed accountable care organizations (ACO) touted under the Affordable Care Act, providers are assigned to share responsibility and payments for patient care.

For some, ACOs may conjure the ghosts of failed collaborative-care efforts under HMOs. But experts say that rheumatology’s response has been largely positive.

“Rheumatologists are more hopeful now,” said Rod Hochman MD, president and CEO of Providence Health & Services in Seattle. “There are lessons learned from the HMO experience. We know rheumatologists must ensure the healthcare system knows what they do and how they affect change.”

In fact, according to the 2013 Medscape Rheumatologist Compensation Report, 23%  of rheumatologists have participated in ACOs.

Preparing For Success

While positive attitudes will help during this transition, Hochman’s biggest concern is whether rheumatologists can educate their physician-colleagues about the impact of rheumatology services. Succeeding, he said, means demonstrating how rheumatology simultaneously improves patient care and controls costs.

“Rheumatologists must position themselves as musculoskeletal managers,” he said. “They’re uniquely situated to understand what’s needed or not and what therapies are possible, particularly with joint and back pain, before going for surgery.”

It’s crucial for rheumatologists to assume this role because musculoskeletal services often rank among a facility’s top five service lines, accounting for significant expenditures.

For example, rheumatologists can increase collaborations with orthopedists and neurosurgeons to determine whether a patient needs surgery. Or they can partner with primary clinicians to diagnose many causes of joint pain without extensive and expensive imaging studies.

Job Security

With cost control as a bedrock ACO principle, concerns exist within rheumatology that hospital-provider relationships could shrink. Instead of partnering with practices, some providers fear, facilities will opt for a single part-time rheumatologist to treat patients. Some evidence supports this concern – more than 80% rheumatologist providers spend fewer than four hours weekly treating inpatients, according to the Medscape report.

But Hochman believes relatively low numbers and skill-set specificity will protect rheumatologists.

“There will be few rheumatologists nationwide, so there shouldn’t be a big worry about being out of work. The focus should be maximizing abilities and relevance,” he said. “Understanding inflammatory disease is invaluable, so it isn’t a question of not working. It’s of getting reimbursed for work they do.”

Gathering Reimbursement

Recouping adequate payment in ACOs could prove difficult because rheumatologist-managed conditions, including joint pain or knee and hip replacements, face bundling.

“It’s going to be tricky as we go to bundled-episode payments from fee-for-service,” Hochman said. “Under fee-for-service, rheumatology has been predominantly outpatient, so things can’t get worse. They can only get better.”

He recommended that providers closely monitor reimbursement for biologic agents used to treat rheumatoid arthritis and other autoimmune conditions, as well as infusion therapy payments.

The American College of Rheumatology (ACR) is more wary of bundled payments, however. In a Nov. 12 letter to the U.S. Senate Finance Ways & Means Committee, the ACR expressed concern over the potential long-term impact.

“Bundled payments under one label or another will drive providers to identify patients with the best margins,” the ACR wrote. “This will result overall in less value and even worse access for the patients.”

Consequently, Hochman said, providers should discuss with payers how they’ll handle reimbursement and care management in ACOs. Based on Medscape report data, nearly 40% of rheumatologists would drop poorly-reimbursing payers.

Healthcare attorney Stephen M. Harris, a member of the Knapp, Petersen, Clarke firm in Glendale CA,  advised rheumatologists to determine whether participating in a Medicare ACO – which often uses primary services for patient assignment – prevents them from participating in others.

There are two ways to avoid this problem, he said:

  • Bill under a separate federal tax ID number (TIN): Provide some services under professional services or employee leasing agreements with facilities billing under their TIN. Or form a separate group that retains and bills for physicians or lets providers work part-time elsewhere. Physicians could also bill under their Social Security numbers.
  • Code differently: Select codes not categorized with primary care services. For example, code office visits as part of a global procedure fee. Beware, though: This method could limit reimbursement.

Ultimately, Hochman said, rheumatologists must integrate into care management in a way that avoids being seen as part of primary care.

“Rheumatologists will be teachers and managers of patient populations in ACOs,” Hochman said. “If I formed an ACO, I would ensure leadership had a couple of rheumatologists to manage the system and work with primary doctors.”

To read this article at its original location: http://www.rheumatologynetwork.com/articles/surviving-aca-guide-rheumatologists

 

December 20, 2013 Posted by | Healthcare, Politics | , , , , , , , , , , , | Leave a comment

Radiologists Should Worry About Medical Device Tax, Too

Published on the Jan. 10, 2013, DiagnosticImaging.com website

By Whitney L.J. Howell

On January 1, the long-debated and much-opposed medical device tax went into effect. To date, medical device manufacturers have clearly stated their opposition, but industry leaders portend practicing radiologists also have reason to be concerned.

Barely a week old, this measure levies a 2.3 percent tax on all medical devices. The law calls for manufacturers to pay for the tax added to the sale price of the device, but many worry the cost will not only trickle down to providers, but will also, ultimately, stymy the progression of patient care by hindering research and development efforts.

“As radiologists, most of us chose the specialty because it’s a field that incentivizes technological innovation that can make enormous differences in patient care,” said Geraldine McGinty, MD, chair of the American College of Radiology (ACR) Economics Commission. “Payment or health care policies that would, in any way, negatively impact innovation are things that make us feel uncomfortable.”

The device tax will inevitably impact practitioners’ bottom lines, she said. The actual dollar amount is yet unknown, but manufacturers will be forced to pass some of the tax increase on to their customers. The price hike will likely be an unwelcome addition to existing imaging reimbursement cuts and the difficulties radiologists already face with collecting payments from patients. Equipment purchasing decisions could become more complicated or could be postponed, she said.

In addition to individual monetary concerns, radiologists should also worry about what the medical device tax could mean for their ability to provide the most up-to-date patient care. According to the Medical Imaging and Technological Alliance (MITA), this initiative is a job-killer because it makes outsourcing jobs overseas more attractive. But research and development efforts will also be a casualty, said MITA Executive Director Gail Rodriguez.

According to a recent MITA survey, 29 percent of manufacturers anticipate slicing into their research and development budgets as a way to cover the anticipated $287 million associated with the device tax. This change could leave providers without new technological innovations for treating patients, MITA said.

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2122393

January 14, 2013 Posted by | Healthcare, Politics | , , , , , , , , , | Leave a comment

Proposed Cuts Lead to Radiology Practice Self-Analysis

Published on the Nov. 14, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

When CMS released its 2013 proposed Medicare payment cuts this month, no one in radiology was particularly surprised. Industry experts knew radiology settings and providers faced slashed reimbursement rates, and it’s now time for practices to assess just how affected they might be.

In the fee schedule, set for Jan. 1, 2013, implementation, CMS retained its proposed multiple procedure payment reduction (MPPR) of 25 percent to the professional component (PC) for CT, MRI, and ultrasound imaging conducted by one or more providers in the same practice on the same patient, during the same session, on the same day. The Medicare proposed cuts will also decrease overall payments to radiation therapy centers by 9 percent and reduce payments to radiation oncology providers by 7 percent.

Overall reaction, said Maurine S. Dennis, senior director of economics and health policy at the American College of Radiology, is that these proposed reductions are both arbitrary and complicated. The MPPR cut is creating significant angst, she said.

“It’s a cut — a cut to the professional component, so it’s real money out of our providers’ pockets,” she said. “The proposal deals a lot with subspecialists, and it’s complex. It’s going to take time to figure out how everything will shake out.”

The looming 25 percent MPPR cut isn’t the only problem, however, said Mike Mabry, executive director of the Radiology Business Management Association. CMS has also yet to publish any information or guidance about the new coding modifier it plans to implement for same-day, same-provider services. Currently, your coders use the -59 modifier to identify procedures done on the same day that are distinct from all others performed.

In addition, the agency has not released a definition for what it considers to be same-session, leaving practices to determine for themselves how best to process this type of claim. The best course of action, Mabry said, is for practices to conduct a self-assessment of how at-risk they are for MPPR PC payment cuts.

Practices that provide a higher level of tertiary care or other advanced diagnostic imaging services should conduct the most involved analyses of their same-day, same-session services. These settings, he said, will be the most vulnerable to the MPPR PC reduction and will feel the greatest impact on their bottom line.

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2114454

November 14, 2012 Posted by | Healthcare, Politics | , , , , , , , , , , , , , | Leave a comment

Influencing policy – Changing the way things are done

Published in the Fall 2012 Carolina Public Health Magazine

By Whitney L.J. Howell

UNC Gillings School of Global Public Health faculty members and alumni lead state, national and international programs, making an impact upon health outcomes including disease reduction, food choice improvement and enhancement of services for domestic violence victims.

Leah Devlin, DDS, MPH, Gillings Professor of the Practice in health policy and management, secures economic safety and health for North Carolina’s children through her appointment to the policy group Action for Children. Currently, she tackles smoking and obesity prevention.

As North Carolina’s state health director and public health division director from 2001 to 2009, Devlin accomplished a great deal, including policy changes for public schools. Under her leadership, the health department developed comprehensive school health programs, placed nurses in schools, mandated regular physical activity and required nutritious lunches. During her tenure, mental health and injury prevention services also were introduced.

“You cannot separate health and education from outcomes,” Devlin says. “Children must be healthy to learn. If a person doesn’t graduate from high school, he or she is less able to earn a decent wage and therefore less able to live in healthy environments or purchase healthy foods. The impact of poverty, lack of education and housing issues shapes health policy.”

Although 2009 alumna Kristal Chichlowska, PhD, MPH, concentrates on social indicators driving California’s health disparities, her work is important to North Carolina. As director of the California Tribal Epidemiology Center at the California Rural Indian Health Board (www.crihb.org), she serves 109 American Indian tribes routinely
underrepresented in epidemiologic data.

Physicians often misclassify American Indian and Alaska Native patients’ ethnicities, masking the groups’ childhood and
chronic disease burdens. Without accurate data, health programs cannot secure funding to meet community needs.

“For instance, we found California’s American Indians were misclassified in state health databases up to 60 percent for
some health outcomes,” Chichlowska says. “Now, we advocate for oversampling, pushing the state capital and federal agencies for data improvement.”

Since 2010, the epidemiology center has surveyed these communities about diseases and published data online, she says. This information bolsters CRIHB’s outreach effort to enhance policies.

Sandra Martin, PhD, maternal and child health professor, evaluates the performance of policies and strategies. As a Governor’s Crime Commission member, she and her co-members analyze domestic violence and sexual assault programs and helped develop a standardized, statewide reporting system.

The question, she says, is whether these programs can use the system to provide care.

“We’re surveying all programs about their capacity for using the new system, and we’ll offer necessary training,” she says. “We’re also looking at how well programs address substance abuse. It’s a sensitive topic people often ignore because they’re uncomfortable talking about it.”

Martin’s research revealed four components vital to understanding the efficacy of domestic violence and sexual assault services – the victim’s satisfaction with the services, victim’s progress toward goals, changes to violence victims experienced and changes in victims’ knowledge about services.

Martin also has studied child maltreatment in military families. She found abuse occurs more frequently when one parent –
frequently the father – is deployed. Congress used these findings to increase family support services during deployments.

The School’s dean, Barbara K. Rimer, DrPH, is chair of the President’s Cancer Panel, the group charged with monitoring the nation’s cancer effort.

The panel has organized a series of four workshops to develop strategies to accelerate cancer prevention by increasing the proportion of age-eligible individuals who are vaccinated against human papillomavirus (HPV) infections. Noel Brewer, PhD, associate professor of health behavior, co-chaired the second workshop, titled “Achieving widespread vaccine uptake.”

Increasing vaccine access is critical to eliminating avoidable disease, Rimer says.

“A vaccine to prevent cancer is the Holy Grail of cancer control. Yet, only about 30 percent of girls and less than 2 percent of boys have been vaccinated,” Rimer says. “If we identify promising strategies to increase HPV vaccine use, then, indirectly at least, we’d contribute to preventing cancers. That’s why I’m doing this.”

While the advisory panel cannot mandate action, Rimer wants health organizations to help implement proposed policies and recommendations. Cervical Cancer Free NC (www.ccfnc.org), based at the School and led by Brewer, is one such effort, aiming to reduce or eliminate cervical cancer in North Carolina by advocating for vaccination, screening and treatment.

HPV causes more than 560,000 new, worldwide cases of cervical, oropharyngeal and other cancers annually. For Brenda Edwards, PhD, who received her biostatistics degree at the School in 1975, the goal is reducing all cancers – her objective
at the National Cancer Institute (NCI) since the 1990s. Now, she is senior adviser to NCI’s Surveillance, Epidemiology and End Results (SEER) database – a registry from 15 major cities, totaling roughly 28 percent of the U.S. population. The data include patient demographics, primary tumor site and morphology, stage-at-diagnosis, first-treatment course and follow-up.

“These data look beyond clinical trial results for a better picture of how to use and apply outcomes to impact total populations,” Edwards says. “Studies and modeling groups can analyze SEER data to see who gets cancer, mortality rates, data changes over time, risk factors and how to minimize risk.”

The Food and Drug Administration uses the statistics to determine orphan drug status (an orphan drug is developed specifically to treat a rare medical condition). The statistics also help NCI extrapolate the number of new diagnoses annually. Such estimates inform Medicare and Medicaid policy decisions, Edwards says.

For many patients, health care is obtained at rural, critical-access hospitals (CAHs), which often don’t monitor their financial status. To help these vital facilities track expenditures, George Pink, PhD, Humana Distinguished Professor of Health Policy and Management, and Mark Holmes, PhD, health policy and management assistant professor, developed the Critical Access Hospital Financial Indicators Report, based on data from 300 CAHs.

Using 21 financial ratios, the report identifies hospital financial strengths and weaknesses. Thus, facility and state program
administrators can pinpoint institutions that could benefit from grant funding or consultant guidance, Pink says.

“The hope is that these data will help hospital managers think strategically and strengthen their system to adapt and survive when federal reimbursement rules change,” Holmes says. “It’s something they might not have been able to do prior to getting these reports.”

In 2009, President Obama appointed David B. Richardson, PhD, associate professor of epidemiology at the School, to the White House Advisory Board on Radiation and Worker Health.

Two years later, Japanese citizen groups and public health researchers called upon Richardson’s expertise in radiation after a national disaster. When a horrific earthquake and tsunami damaged a nuclear energy facility, Richardson advised about the development of policies that would keep the Japanese people safe and about long-term strategies to understand health effects of the disaster.

Richardson’s research investigates occupational and environmental causes of disease, with a particular focus on ionizing
radiation. He has served in various capacities at UNC since 1996 when he began as a postdoctoral researcher.

He has led a number of studies of workers at U.S. Department of Energy facilities focused on occupational health and radiation exposures. Previously, he worked at the World Health Organization’s International Agency for Research on Cancer in Lyon, France, and at the Radiation Effects Research Foundation in Hiroshima, Japan.

Barry Popkin, PhD, W.R. Kenan Jr. Distinguished Professor of nutrition, improves global food choices by helping countries establish proper nutrition labeling guidelines. Currently, only The Netherlands has national labeling policies. This dearth of guidance troubled Popkin.

“I had to get involved when I saw the food industry – global and stateside – creating labeling systems to allow enormous amounts of sugary, salty and fatty foods to be labeled as healthy,” Popkin says. “I knew it was essential for a scientist to create an appropriate, science-based system.”

Based on World Health Organization and U.S. standards, these labeling policies reduce added sugars and sodium, lower trans and saturated fats, and increase whole grains, legumes, fruits and vegetables. Seven additional countries are considering a national labeling policy, Popkin says, to control obesity, diabetes and other diet-related ailments.

To read the article at its original location: http://www.sph.unc.edu/images/stories/news/cph_2012_fall/documents/influencing_policy.pdf

November 13, 2012 Posted by | Education, Healthcare, Politics | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Connecticut’s Dense Breast Legislation Three Years Later

Published on the Oct. 23, 2012, Diagnostic Imaging website

By Whitney L.J. Howell

Connecticut launched its law mandating providers alert women if they have dense breasts and offer supplemental ultrasound screenings three years ago. The road has been rocky — radiologists initially resisted it, the density legislation confused many patients, and few women seemed interested in the secondary scans. But new research shows the law has resulted in more cancers found.

Much discussion surrounded Connecticut’s dense breast tissue law when it passed in 2009, requiring referring physicians to inform women with dense breast tissue that they could benefit from supplemental ultrasound screening. A recent study revealed the law had a slow, but effective, start.

In research published in the October issue of Radiology, investigators from Yale University determined less than 20 percent of women with dense breast tissue opted to have an ultrasound screening after receiving abnormal mammogram results. The retrospective review analyzed the ultrasound results for nearly 1,000 women who underwent the procedure.

Although fewer women than anticipated opted for ultrasound screenings after the law took effect, lead study author Regina Hooley, MD, assistant professor of diagnostic radiology, said giving patients the option of supplemental ultrasound screening after a mammogram was useful. Based on data pulled from the legislation’s first year, her team found additional 3.2 cancers per 1,000 women were discovered using ultrasound.

“These findings are right in the ballpark for the amount of cancers we identify with mammogram,” Hooley said. “Although mammography is the only test with data to show it reduces breast cancer-related mortality, it’s clear, with this study, that ultrasound provides an acceptable cancer detection rate at an acceptable cost.”

In January, Texas enacted its own version of the law, known as Henda’s Law. And, the American College of Radiology anticipated 13 additional states introducing some type of similar legislation during 2012.

According to the study’s cost analysis, each cancer identified via ultrasound cost approximately $60,000. That figure equals roughly $200 per patient, Hooley said. It’s also important to note that Connecticut insurance companies are required, under law, to cover these supplemental ultrasound screenings.

Connecticut radiologist Jean Weigert, MD, who serves as treasurer for the Radiological Society of Connecticut, also tracked supplemental ultrasound screenings in her practice. Her results, she said, are exactly the same as Hooley’s.

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/womens-imaging/content/article/113619/2110186

October 23, 2012 Posted by | Healthcare, Politics | , , , , , , , , , , , , | Leave a comment

Former NASA historian says agency’s future lies with unmanned projects

Published in the Sept. 17, 2012 Raleigh News & Observer and Charlotte Observer

By Whitney L.J. Howell

We asked Alex Roland, professor emeritus of history at Duke University, to put the current Mars Curiosity mission in a perspective. Roland is a former NASA historian.

Q: What are the benefits of unmanned space exploration, such as the Mars Curiosity?

One question has driven all current space exploration: Was there ever, or is there now, life on Mars? It’s likely if there were, it’s disappeared, but we might find evidence. That would have enormous implications for the space program and for the human race and condition. It would suggest we’re not unique in the universe.

Such a discovery would increase NASA’s emphasis on getting the country to agree to a manned Mars mission. NASA sees itself as having had a golden age with the Apollo program. Ever since, it has tried to find something else to capture public imagination to justify a large increase in our space activity spending. Curiosity plays an interesting role because if it finds evidence, NASA can increase its manned mission push. But Curiosity is such a capable exploration vehicle, and it’s so much cheaper and less dangerous than a manned mission, that many of us believe we should invest in more Curiosities.

Q: What’s the advantage of unmanned missions?

Whenever you send people to space, the expedition’s purpose changes. To explore Mars, we can send up as many remotely controlled vehicles as necessary. They’re uniquely designed for exploration. A manned mission must get people there and back safely. That trumps all else, and it limits exploration. Humans can only do safe exploration. Their exploration time is limited because they must return to Earth soon. It also limits the equipment sent up because astronauts need a lot of life support. For exploration, we’re better off sending custom-designed, remotely controlled, automated spacecraft. There’s nothing humans can do on Mars that a machine can’t. Sending people increases risk and diverts the mission’s goal.

Q: Are there potential technological gains from the Curiosity mission?

Investing in science and technology, especially research and development,

This panorama image of Curiosity’s lower front and underbelly combines nine images taken by the rover’s Mars Hand Lens Imager on Sept. 9. Fine-grain Martian dust can be seen adhering to the wheels, which are about 16 inches wide and 20 inches in diameter. The bottom of the rover is about 26 inches above the ground. On the horizon at the right is a portion of Mount Sharp, with dark dunes at its base. The imaging by MAHLI was part of a week-long set of activities for characterizing the movement of the arm in Mars conditions.

always produces spinoff. Second-order consequences and unanticipated technological applications can be useful in other fields. But that comes from any R&D. NASA’s spinoff record isn’t great. It has claimed the dollars it has invested produced more spinoff technology, but that mostly isn’t true. There’s nothing specific NASA does that makes R&D any more productive.

Q: Could this Mars mission be seen as a relaunch of space exploration?

Whenever I hear of manned Mars missions, my first question is, “Why?” What will we do? Will it be like Apollo where we send humans there and bring them home safely, and that’s the end?

NASA maintains manned Mars missions will be part of a permanent space colonization program. That begs the question of why colonize Mars? Sending humans there to take pictures, scoop soil, and return safely will cost hundreds of billions of dollars. An initial colonization mission would cost probably around $1 trillion just to get started.

So, it’s reasonable to ask the purpose and benefit of having people on Mars. A good comparison is the International Space Station. We paid more than $100 billion to put it up there and never found a good use for it. Within a decade, we’ll likely abandon it, let it decay in orbit, and burn up in the atmosphere. If we can’t find a good use for the space station that’s comparatively close and safe – even though we’ve lost two space shuttles and crews going there and back – how do we think we’ll find a good use for humans on Mars?

Q: What continues to drive NASA toward manned exploration? Are we still searching for our place or role in the universe?

That’s exactly it. When NASA sent the first crew to the space station, it stressed this reflected both the agency’s and our country’s place in history. It emphasized this was the beginning of permanent human space habitation. It believed from then on humans would be in space and people would look back and remember America, NASA, and the space program.

But there’s no commitment to fund the space station very far into the future. It’s too expensive to maintain, and it’s not doing anything useful.

NASA will argue strenuously to maintain a space presence. We all love NASA. We love what they do and think they’re good and capable. But the public has a right to ask what we’re getting for our investments, especially when budgets are stressed.

Q: In the last decade, space exploration has shifted from government-funded enterprise to the private sector. Will this continue?

I’ve long been skeptical that private companies without government subsidy can make money flying in space. There isn’t that much money to be made. It’s a big business, but it’s not what most private venture firms are motivated by. Often, it’s idealistic, very wealthy people with lots of money to invest.

They grew up in the space age. They want the same permanent space presence NASA wants, and they’re going to help make it happen. I think we’re seeing evidence they can build launch vehicles and operate them more cheaply than NASA. But do they have a business model for sustainable programs and making money?

None will reveal how much they’ve spent, and without long-term, sustainable business models, venture capital isn’t attracted. It’s unclear how many companies will make money.

NASA’s trying to help them because if companies assume routine activities, like launching satellites or resupplying the space station, then NASA can divert funding to futuristic enterprise, including manned Mars missions. Perhaps NASA has enough business to keep them going for a while, but not enough for long-term profit. One strange peculiarity of modern technology is the satellites we launch now are so big and powerful we don’t need as many of them as we used to.

Q: What can NASA do to reignite or reinvent itself?

What many at NASA only say privately is the public often doesn’t appreciate NASA’s unmanned spacecraft magnificence. It has transformed how we understand the universe and presented research possibilities, but NASA’s believed its public and congressional support and budget depend on manned space exploration.

NASA has believed people don’t care about space science, communication and weather satellites. But these technologies give us today’s world. Manned space flight has been little more than circus or stunt. Astronauts go up, float around, and return without accomplishing much.

Curiosity exemplifies how exciting unmanned space activity is, and how interested the public can be if NASA educates them.

To read the Q&A at its original Raleigh News & Observer location: http://www.newsobserver.com/2012/09/16/2346665/what-will-follow-curiosity.html#dsq-content

To read the Q&A at its original Charlotte Observer location: http://www.charlotteobserver.com/2012/09/16/3534401/what-will-follow-curiosity.html#storylink=misearch

September 17, 2012 Posted by | Education, Politics, Science | , , , , , , , , , , , , , , , | Leave a comment

Meaningful Use Stage 2 Rule Offers Radiologists Some Clarity

Published on the Sept. 6, 2012 DiagnosticImaging.com website

By Whitney L.J. Howell

The final rule for Stage 2 of the Meaningful Use (MU) program, released last month, clarifies a few sticking points for the radiology industry, but some questions remain, say industry experts who are still digging through the specifics of the rule.

Still considered to be a move toward standards-based health information exchanges, the final rules for Stage 2 — released by CMS and the Office of the National Coordinator (ONC) set to take effect in 2014 —provide some additional clarity for how radiologists and hospitals should approach MU. But they’re little changed from the proposed versions. The similarities, some said, are surprising.

“It’s interesting that CMS’ final rule resembled the proposed rule as much as it did,” said Michael Peters, legislative and regulatory affairs director for the American College of Radiology (ACR), noting the short time between the publication of the proposed and final rules. “This was probably the result of an extremely quick rule-making that spent less time addressing stakeholders’ concerns.”

Individual providers and practices shouldn’t change their daily workflow and activities just yet, Peters said. The final rule, its requirements, and menu items, have not yet been completely analyzed.

However, it’s clear so far that the final rules offered additional guidance in three main areas: imaging accessibility, computerized physician order entry (CPOE), and hardship exemptions for meeting MU requirements. These areas have also been points of concern for the ACR.

According to Keith Dreyer, DO, chair of the ACR IT and Informatics Committee-Government Relations Subcommittee and radiology vice chair at Massachusetts General Hospital, the final rule guidance should make MU compliance easier for practicing radiologists. It combines certification criteria for eligible hospitals and eligible providers (EPs) in hospital settings with certified electronic health record (EHR) technology. The rule also impacts clinical quality measures.

“The clinical quality measures are better aligned with other quality incentive programs, making the overall process simple to achieve,” he said.

Fortunately, the final rule doesn’t require providers to store imaging results in an EHR with the ONC abandoning its proposal that images be available for download and transfer to third parties. Instead, they can offer a link to study results. In addition, CMS is only requiring 10 percent of images to be accessible this way instead of the 40 percent suggested in the proposed rule.

This change is a double-edge sword, Dreyer said. While it does relieve some of the pressure EPs felt regarding image accessibility, it also affects patients.

“It was disappointing to see the removal of the portion of the proposed MU objective requiring the ability for patients to view, download, and transmit their medical image data,” he said. “This was a common request of patients.”

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/meaningful-use/content/article/113619/2101122

September 10, 2012 Posted by | Healthcare, Politics | , , , , , , , , , , , , , , , , , , , , | Leave a comment

Public Service A Lifestyle for Knoxville Mayor Rogero

Published in the Summer 2012 Furman University Alumni Magazine

By Whitney L.J Howell

TAKE A LOOK around Furman’s campus and it’s clear there’s no “typical Furman student.” The student body is a mish-mash of ages, interests, ethnicities, accomplishments and goals.

But even among such a diversified group, Madeline Rogero was unique as a senior in 1979.

“I was a bit of an older student. I had one child already, and one was on the way,” she says. “My second child was just about
three weeks old when I graduated.”

That wasn’t the only thing that made Rogero stand out. She had transferred to Furman after a year at Temple University and two years as a political science major at Ohio State. Before her senior year, however, she felt called to help California’s farm aides — which led to a four-year hiatus from higher education, during which she worked with Cesar Chavez to help farm workers improve their living and working conditions.

Today, as mayor of Knoxville — the first woman to serve as mayor of any of Tennessee’s four largest cities (including Memphis, Nashville and Chattanooga) — Rogero says those kinds of experiences shaped her view not only of public service, but of what it means to be a contributing member of a community. She jumped head-first into improving Knoxville as soon as she moved there more than 30 years ago.

“I got my start in politics as a county commissioner. I cared about neighborhood issues,” she says. “I ran for mayor because I wanted to continue the work that I had been doing — dealing with blighted properties, strengthening our communities, and actively supporting sustainability issues.”

During the past three decades Rogero has served on numerous boards, including the Knoxville Transportation Authority, Partnership for Neighborhood Improvement, and the Mental Health Association of Knox County. Her efforts have earned her many accolades, including the 2003 Knoxvillian of the Year award.

Rogero has a long history of working to revitalize areas that have fallen into disrepair. After losing a close mayoral race in 2003 to Bill Haslam — now the state’s governor — Rogero joined his administration as community development director. The Office of Neighborhoods, launched under her leadership, was instrumental in completing a $25.6 million program that helped secure tax credits, grants and bonds for businesses in economically depressed parts of the city.

Rogero and her staff also spent countless hours on commercial redevelopment, historic preservation, property redemption, and services that enhanced the community’s economy. She spearheaded a five-county collaboration that garnered a $4.3 million grant to support sustainable community planning.

Even before taking the job with the city, though, Rogero pushed to improve her community. Among other responsibilities, she consulted with Capital One Financial Corporation’s community affairs office and was executive director of Knoxville’s Promise, an organization devoted to giving youths the resources they need to become successful adults.

As mayor, Rogero is focused on redeveloping Knoxville’s south waterfront and working with a local foundation to support 10 city parks, as well as hiking and biking trails.

Although she spent only a year at Furman, she credits her time there with helping her learn to translate her real-world, outside-the-box experiences into effective civic endeavors. She points to classes with professors Jim Guth and Don Aiesi as forums where she came to understand the value of her work with Chavez.

“I remember they would often call on me during political science and constitutional law discussions because I had a lot of real and practical experience to bring to those conversations,” she said. “They knew I had a different point of view.”

From a young age, Rogero says, she felt she would become involved in causes greater than herself.

“The nuns and priests [in her Catholic schools] challenged us to be involved,” she says. “A lot of different things were happening in the ’60s — the civil rights movement, the Vietnam War. That education opened my mind beyond my personal experiences and really
instilled in me a sense of working for the world to be more equitable, inclusive and diverse.”

Rogero also learned firsthand the importance of helping others during her childhood in Florida. At any given time, foster children or other family members lived in her house. Seeing her parents open their lives to those in need taught her to reach out to others whenever she could.

That time with family also nurtured Rogero’s love of nature. Her father, she says, loved to hunt and fish, and they spent a great deal of time at the beach or on the river.

Her affinity for the outdoors has never faded. Rogero and her husband, Gene Monaco, often bike around Knoxville’s greenways or use their flatwater kayaks to paddle down the Tennessee River. Her greatest outdoor adventure, however, is being a beekeeper.

“As a family, we suit up in the gear with the veil and the gloves, and we share the honey the bees make with friends and family,” says Rogero, a mother and grandmother of two and stepmother of three. “It’s a really amazing thing to get into when you realize that
one-third of the things we eat depend on honeybees for pollination. It’s really helped me to learn about and appreciate the ecosystem we live in.”

To read the article online at its original location (p. 33): http://www2.furman.edu/sites/fumag/Documents/FM12%20SUMMER%20low%20res%20spreads.pdf

September 10, 2012 Posted by | Education, Politics, Profiles | , , , , , , , , , , , , , , , , | Leave a comment

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