Category Archives: Voices from the Field

Apr 16 2014
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A Behind the Scenes Look at a Documentary Series on Climate Change

Sabrina McCormick, PhD, is a sociologist, filmmaker, and an associate professor of environmental and occupational health for the Milken Institute School of Public Health at the George Washington University. She is an alumna of the Robert Wood Johnson Foundation Health & Society Scholars program.

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The first episode of Years of Living Dangerously, a new documentary series exploring the human impact of climate change, aired last Sunday on Showtime. I worked on the series as associate producer and producer, but I am also a scientist who has been studying the impact of climate change on human health for almost a decade. In all that time, I’d developed a good grasp of what climate change looks like from a scientific point of view. But working on the series made me learn a lot more about what climate change looks like, not just here in the United States but worldwide.

This documentary television series consists of nine episodes featuring star correspondents as they meet experts and visit ordinary people who have lived through extreme weather events triggered by climate change. James Cameron, Jerry Weintraub, and Arnold Schwarzenegger served as executive producers of the series, along with former 60 Minutes producers Joel Bach and David Gelber. I worked with Matt Damon on an upcoming segment about heat waves and with Michael C. Hall on another story focusing on Bangladesh, a nation already vulnerable to extreme weather.

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Apr 15 2014
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Media Exposure and Acute Stress Following the Boston Marathon Bombings

E. Alison Holman, PhD, FNP, is an associate professor in nursing science at the University of California, Irvine and a Robert Wood Johnson Foundation Nurse Faculty Scholar.

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A year ago today, on April 15, 2013, in the first major terror attack on U.S. soil since September 11, 2001, Dzhokhar and Tamerlan Tsarnaev planted two pressure cooker bombs near the finish line of the Boston Marathon. Three people died and more than 260 were injured. For a week authorities searched for the perpetrators, shootouts occurred, and Boston was locked down. As reporters and spectators filmed the mayhem, graphic images were shown repeatedly in both traditional and social media around the world. Like the September 11, 2001 (9/11) terrorist attacks, the population of the United States was the terrorists’ intended psychological target. Yet most research on reactions to such events focuses on individuals directly affected, leaving the public health consequences for populations living outside the immediate community largely unexplored.

Tens of thousands of individuals directly witnessed 9/11, but millions more viewed the attacks and their aftermath via the media. In our three-year study following 9/11, my colleagues and I found that people who watched more than one hour of daily 9/11-related TV in the week following the attacks experienced increases in post-traumatic stress (PTS) symptoms (e.g., flashbacks, feeling on edge and hyper vigilant, and avoidance of trauma reminders) and physical ailments over the next three years (Silver, Holman et al., 2013).

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Apr 8 2014
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Preventing Youth Violence May Cost Less Than You Think…

Adam L. Sharp, MD, MS is an emergency physician and recent University of Michigan Robert Wood Johnson Foundation Clinical Scholar (2011-2013). He works for Kaiser Permanente Southern California in the Research and Evaluation Department performing acute care health services and implementation research.

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Violence is a leading cause of death and injury in adolescents. Recent studies show effective interventions can prevent violent behavior in youth seen in the Emergency Department (ED). Adoption of this type of preventive care has not been broadly implemented in EDs, however, and cost concerns frequently create barriers to utilization of these types of best practices. Understanding the costs associated with preventive services will allow for wise stewardship over limited health care resources. In a recent publication in Pediatrics, "Cost Analysis of Youth Violence Prevention," colleagues and I predict that it costs just $17.06 to prevent an incident of youth violence.

The violence prevention intervention is a computer-assisted program using motivational interviewing techniques delivered by a trained social worker. The intervention takes about 30 minutes to perform and was evaluated within an urban ED for youth who screened positive for past year violence and alcohol abuse. The outcomes assessed were violence consequences (i.e., trouble at school because of fighting, family/friends suggested you stop fighting, arguments with family/friends because of fighting, felt cannot control fighting, trouble getting along with family/friends because of your fighting), peer victimization (i.e., hit or punched by someone, had a knife/gun used against them), and severe peer aggression (i.e., hit or punched someone, used a knife/gun against someone).

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Apr 4 2014
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RWJF Nurse Fellow Builds a Culture of Health Through the Community Health Center Movement

Linnea Windel, MSN, RN, president and CEO of VNA Health Care in Aurora, Ill., received the Illinois Primary Health Care Association’s Danny K. Davis Award last fall for her leadership of and service to the community health center movement. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2008-2011).

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Human Capital Blog: Congratulations on your award!  What does this mean for you and for your organization’s work?

Linnea Windel: The community health center movement (and the work that we do) reaches thousands of uninsured and underinsured people who, in most cases, wouldn’t have access to primary health care services otherwise. The award highlights the purpose of our work and the work of many.

HCB: The award is named for Danny K. Davis, a member of the U.S. House of Representatives and a champion of the community health center movement. How is VNA Health Care carrying out his mission?

Windel: When we became a federally qualified health center (FQHC) 12 years ago, we were serving 6,000 patients; this year we are on track to serve 60,000 patients. In the space of 12 years, we’ve expanded our service area and now have nine health centers in suburban Chicago. We live out the purpose of the community health center movement and the purpose of the award through the provision of care in communities with significant need.

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Mar 28 2014
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Merging Social Media with Art to Improve Cardiovascular Health

Raina Merchant, MD, MSHP, is a Robert Wood Johnson Foundation (RWJF) Clinical Scholars program alumna and an assistant professor at the University of Pennsylvania Department of Emergency Medicine. She recently launched a venture that challenges citizen designers to make automated external defibrillators (AEDs) more visible.

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Human Capital Blog: Congratulations on the launch of your new research venture at the University of Pennsylvania. Can you describe it?

Raina Merchant: In June, 2013, we launched the Social Media and Health Innovation Lab. It’s a multidisciplinary group of physicians, computer scientists, demographers, communications specialists, policy scientists, designers, and more.

The group has expertise in crowdsourcing, app development, Twitter analyses, Facebook analyses, Foursquare engagement, Gigwalk analyses, Yelp analyses, and gaming. The Lab disseminates multidisciplinary research at the intersection of social media, mobile technology, and health—and uses digital tools to improve individual and population health behaviors and outcomes. One of the Lab’s recent projects merges social media with art to improve cardiovascular health.

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HCB: How does your current project build off of your previous one, which located and digitally mapped AEDs in Philadelphia?

Merchant: Our initial project, the MyHeartMap Challenge, used crowdsourcing and social media to locate life-saving AEDs in Philadelphia. Through this project we located and documented more than 1,400 AEDs in Philadelphia and created an AED map. Through this effort we learned how difficult it is for AEDs to be identified when they are suddenly needed. AEDs are often hidden in plain sight.

To explore ways to make AEDs more visible, we launched the Defibrillator Design Challenge. Specifically, it’s an online crowdsourcing contest for individuals to create designs around the space of AEDs so they are more noticeable. We’ve allotted more than $1,000 for the winner with the most votes and social media “shares.”

Through this work we hope to accomplish two things: First, we want to make AEDs more visible so that people will know where they are when needed; and second, we want to empower people to look for AEDs in public places and notice them.

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Mar 21 2014
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The Lucky One

Vanessa Grubbs, MD, MPH, is an assistant professor at the University of California, San Francisco, School of Medicine, and a scholar with the RWJF Harold Amos Medical Faculty Development Program. She is writing a book about what she calls the “sometimes irrational use of dialysis in America,” which will include a version of this narrative essay.

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It is a Monday afternoon like any other and time to make my weekly rounds at the San Francisco General Hospital outpatient dialysis center. I push my cart of medical charts down the long aisle of our L-shaped dialysis unit and see Mr. Rojas, my dialysis patient for over a year now. He is in his mid-40s and slender, sitting in the burgundy-colored vinyl recliner. His blue-jeaned legs and sneakered feet are propped up on the extended leg rest. The top of his head shines through thinning salt and pepper hair. White earbud headphones peek through gray sideburns. He is looking intently at his Kindle, rarely glancing up at the activity around him.

I roll my cart up to his recliner, catching his eye. His right hand removes the earbuds as the left pauses his movie. He looks up at me, smiling. “Hola, Doctora. How are you?” he says with emphasis on the “are.”

“I am good. How are you doing?” I smile back at him as I grab his chart from the rack. I write down his blood pressure and pulse—both normal—and the excellent blood flow displayed on the dialysis machine. My eyes shift to his fistula, the surgically thickened vein robustly coursing halfway up his left forearm like a slithering garden snake. It is beautiful to me. Through it, Mr. Rojas is connected to the dialysis machine.

“I am good, Doctora. No problems. I feel healthy. Strong.” His brown eyes glint.

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Mar 18 2014
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RWJF Scholar Recognized for Research to Protect Preemies from Hypothermia

Robin Knobel, PhD, RN, is an associate professor at the Duke University School of Nursing and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2010-2013). The University of Carolina at Chapel Hill (UNC-CH) School of Nursing recently recognized her with its Distinguished Alumna award.

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Human Capital Blog: Congratulations on the award! What does it mean for you and for your research?

Robin Knobel: I was truly honored to receive this award from UNC-CH because it recognizes my achievement thus far in my career in my area of research around improving thermal stability with premature infants. I was given great support as a doctoral student at UNC-CH through mentorship in research from faculty who are leaders as nurse scientists. To be recognized by alumni and faculty of the UNC-CH School of Nursing is a tremendous honor.

HCB: You received the award for your research into physiologic processes related to thermoregulation and perfusion in extremely premature infants. Can you explain what this means in lay terms?

Knobel: Yes. Premature infants are born too early to be able to keep themselves warm through the normal methods of heat production. Normally, infants up to one year of age do this through a metabolic production of heat, instead of shivering. Premature infants lack necessary components to accomplish efficient production of heat and consequently can become very cold if exposed to cold air after birth and through stabilization in the neonatal unit. They often experience hypothermic body temperatures during the early weeks after birth, which can lead to instability and possible lasting insults such as brain hemorrhage, infection, or even death. My research is studying the mechanisms around thermal stability in premature infants and ways to prevent bad outcomes from hypothermia.

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Mar 11 2014
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Challenges Facing the Nation’s Emergency Care System: From Everyday Care to Disaster Preparedness

An interview with Nicole Lurie, MD, MSPH, the assistant secretary for preparedness and response at the U.S. Department of Health and Human Services, and an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program. She is the co-author of “The U.S. Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready for Disasters,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. The interview is part of a series of posts featuring RWJF Scholars who authored articles in the issue.

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Human Capital Blog: You write that the nation’s emergency care system is in trouble. What are the challenges facing emergency departments (EDs)?

Nicole Lurie: We’ve understood for at least a decade that the emergency system is in trouble.   We ask a lot of this system, and as a result we have EDs that are really crowded and with long wait times, boarding times and throughput times. It’s become a de facto access point for many people who lack access to primary care or insurance, which wasn’t what it was originally set up for. Now, EDs have evolved to be more than places to treat life and limb threats and serve as default diagnostic and therapeutic entry points. But many people who end up in an emergency department may be willing to be treated in a different kind of environment. It is really up to us to build a system that accommodates their needs and ensure our emergency care system can do its important work.

And remember: We changed the way we deliver care in the U.S. from a hospital-based focus to an outpatient focus over the last few decades, but we never really built the infrastructure for it. Outpatient providers have had their visits shortened and group practice environments have changed the relationship between patients and their primary care providers. We hear about the shortage of primary care providers and the crisis of crowding and boarding in emergency departments, but we don’t always connect the dots to understand how we got here. It is a good time to start to have this conversation as payment models are encouraging us to recognize that generating health for our patients is a team effort.

HCB: How do you see the emergency care system evolving, particularly with respect to disaster preparedness?

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Mar 10 2014
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The Changing Role of the Emergency Department

An interview with Renee Hsia, MD, a Robert Wood Johnson Foundation Physician Faculty Scholars program alumna and associate professor of emergency medicine at the University of California, San Francisco. She is the co-author of “Emergency Care: Then, Now and Next,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. The interview is part of a series of posts featuring RWJF Scholars who authored articles in the issue.

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Human Capital Blog: Other than the obvious changes in technology, how are emergency departments (EDs) different today than they were 50 years ago?

Renee Hsia: We’ve had a dramatic transition since the 1950s, in terms of what emergency departments do, and the patient outcomes we expect. We mention in the article, for example, that years ago many emergency departments used funeral hearses to transport patients to the ED. Now transport is usually in vehicles with all sorts of life-saving equipment on board. That’s one reason the mortality rate is a lot lower now than it was then; death is much rarer in the emergency room today.

Another dramatic transition has been the rise of the specialist in emergency medicine. It used to be more common to have physicians trained in other specialties taking turns in the emergency room. You still see that in some rural areas, but it’s far less common. There’s been a gradual movement toward the understanding that we need people who are masters in the acute presentation of illness.

We’ve also seen the beginnings of a system transition, with a growing focus on regionalization. We have to account for the reality that not all community EDs and hospitals are equipped with the same technology as tertiary hospitals, such as a cardiac catheterization lab, for example. We need to be sure that we can get patients “the right care in the right place at the right time,” and that requires close coordination within the larger health care system.

HCB: You discuss the relationship between ED crowding and changes in primary care practice. Could you tell us about that?

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Mar 5 2014
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The Affordable Care Act Bolsters Disaster Readiness

Nicole Lurie, MD, MSPH, is the assistant secretary for preparedness and response at the U.S. Department of Health and Human Services (HHS), and Kacey Wulff, MPH, is special assistant to the assistant secretary, at HHS. An alumna of the Robert Wood Johnson Foundation Clinical Scholars program, Lurie is the co-author of “The U.S. Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready for Disasters,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. This is part of a series of posts  featuring RWJF Scholars who authored articles in the issue.

Nicole Lurie, MD, MSPH Nicole Lurie

As we approach the Affordable Care Act’s March 31 enrollment deadline, data is starting to emerge about how these reforms are making care more accessible, cost less, and, ultimately, Americans healthier. As these reforms take effect, and make our day-to-day health care system stronger, they also result in strengthening communities across the country to become more resilient and disaster-ready.

The gaps that inspired and propelled health reform like untreated chronic conditions and mental illness, and health disparities plague our health care system every single day. During a crisis, like a hurricane, earthquake, or attack, these issues can become magnified. As a result, the ability for individuals and communities to prepare, respond, and recover successfully is intrinsically linked to the strength of the underlying health care system.

Kacey Wulff, MPH Kacey Wulff

The Affordable Care Act expands mental health and substance use disorder benefits and federal parity protections for 60 million Americans. As a result, many Americans who previously have not had coverage for mental health care will have greater access to this and other important aspects of health care. This will help to make the tools that support recovery from injuries sustained during disasters, whether illness, injury, or trauma, more accessible.

This boost in preparedness is important for responding to disasters big and small: the biggest indicator of how a person or community will fare during a disaster is how they were doing before the crisis struck. While health insurance doesn’t guarantee that you will be healthier, it does make health much more likely. 

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