February 14, 2017
Giving children a strong start in their first five years doesn’t just help children and their families. The benefits of their success radiate throughout their communities – as do the consequences when they struggle. But the many fields that help shape what happens for young children and their families during these critical years don’t always work together. Collaborating across disciplines related to early childhood development and learning was one of the challenges posed to over 100 scholars, policy makers, advocates, philanthropists and practitioners who gathered in Orlando for the University of Florida’s Early Childhood National Summit Feb. 8-10. In the first five minutes, UF President Kent Fuchs made it clear that the summit was focused on creating actionable ideas and steps to move the field forward. “It is crucial that our work on behalf of children is tangible, that it is scalable, and that it reaches the children who need it,” Fuchs said. The summit, also attended by UF Provost Joseph Glover, professors from six UF colleges and the deans of UF’s College of Education, Levin College of Law, College of Medicine, and College of Public Health and Health Professions, brought together early-childhood leaders from around the country. University of Kansas special-education professor Judith Carta, the interim director of early childhood research at KU’s Juniper Gardens Children’s Project and one of the summit’s expert panelists, lauded UF for recognizing the importance of the issue and taking action. “We’re using the University of Florida as an example of what universities can do if they just get behind the right issues,” she said. After a welcome from philanthropist and InterTech Group CEO Anita Zucker, a UF alumna who created the Anita Zucker Center for Excellence in Early Childhood Studies at her alma mater, the group heard from keynote speaker Jacqueline Jones of the Foundation for Child Development. After her speech, Jones, who served as the U.S. Department of Education’s first deputy assistant secretary for policy and early learning, stressed the importance of working to retain bipartisan support for early childhood initiatives. “Where is the common ground, and how do we get to it and hold on to it?” Jones said. “We have to do that, or we’ve failed the children and families we work for.” Before summit attendees broke out into workgroups, panelists with expertise in psychiatry, pediatrics, psychology, law, education and advocacy shared perspectives to inform the discussions. Their presentations illustrated just how high the stakes are during early childhood, detailing chronic medical conditions with roots in early childhood and factors that influence children’s potential before they’re even born. Then the workgroups got down to the business of the summit: creating recommendations and actions on how to move forward. By the afternoon, each workgroup had addressed three themes – discovering the keys to opening young minds, influencing the influencers to unlock children’s potential, and inspiring new initiatives for the next generation – drawing on the diverse backgrounds and expertise of participants such as New York University pediatrics professor Dr. Benard Dreyer, immediate past president of the American Academy of Pediatrics. The summit’s multidisciplinary approach “is absolutely the only way we’ll make progress,” Dreyer said. The day closed with talks by Glover, Zucker and early childhood advocate David Lawrence Jr., a UF alum, president of the Early Childhood Initiative Foundation and chair of the Children’s Movement of Florida. The next morning, Anita Zucker Center director Patricia Snyder, UF’s David Lawrence Jr. Endowed Chair in Early Childhood Studies, presented each workgroup’s recommendations for feedback and further development. “The recommendations and action steps will compel us to continue to be a convener of early childhood activities and will help elevate this work to a broader level,” Snyder said. After final input from the summit attendees and facilitators, the recommendations and action steps will be shared with the policy makers, practitioners and scholars who will shape the future of early childhood. As Anita Zucker Center co-director Maureen Conroy put it: “We really want this summit to be the beginning, not the end.”
February 10, 2017
The news was bad. Mimi, a woman in her early 80s, had been undergoing treatment for lymphoma. Her husband was being treated for bladder cancer. Recently, she developed chest pain, and a biopsy showed that she had developed a secondary tumor of the pleura, the space around one of her lungs. Her oncology team’s mission was to share this bad news. Mimi’s case was far from unique. Each year in the U.S., over 1.6 million patients receive hospice care, a number that has been increasing rapidly over the past few years. What made Mimi’s case remarkable was not the grimness of her prognosis but her reaction to it. When the members of the team walked into Mimi’s hospital room, she was lying in bed holding hands with her husband, who was perched beside her on his motorized wheelchair. The attending oncologist gulped, took a deep breath, and began to break the news as gently as he could. Expecting to meet a flood of tears, he finished by expressing how sorry he was. To the team’s surprise, however, no tears flowed. Instead Mimi looked over at her husband with a broad smile and said, “Do you know what day this is?” Somewhat perplexed, the oncologist had to admit that he did not. “Today is very is special,” said Mimi, “because it was 60 years ago this very day that my Jim and I were married.” The team members reacted to Mimi with astonishment. How could an elderly woman with an ailing husband who had just been told that she had a second, lethal cancer respond with a smile? Compounding the team’s amazement, she then went on to share how grateful she felt for the life she and her husband had shared. Mimi thanked the attending oncologist and the members of the team for their care, remarking how difficult it must be to deliver bad news to very sick patients. Instead of feeling sorry for herself, Mimi was expressing sympathy for the people caring for her, exhibiting a remarkable generosity of spirit in the face of a grim disease. The members of the team walked out of Mimi’s room shaking their heads in amazement. Once they reached the hallway, the attending physician turned and addressed the group: “Mimi isn’t the only person in that room with cancer, but she is surely the sickest. And yet,” he continued, to nods all around, “she is also the healthiest of any of us.” “Be thine own palace, or the world’s thy jail.” - John Donne Disease need not define us Mimi’s reaction highlights a distinction between disease and illness, the importance of which is becoming increasingly apparent. Simply put, a body has a disease, but only a person can have an illness. Different people can respond very differently to the same diagnosis, and those differences sometimes correspond to demographic categories, such as male or female. Mimi is a beautiful example of the ability to respond with joy and gratitude in the face of even life’s seemingly darkest moments. Consider another very different patient the cancer team met with shortly after Mimi. Ron, a man in his 40s who had been cured of lymphoma, arrived in the oncology clinic expecting the attending oncologist to sign a form stating that he could not work and therefore qualified for disability payments. So far as the attending knew, there was no reason Ron couldn’t hold a job. Ron’s experience of disease was very different from Mimi’s, a phenomenon familiar to cancer physicians. Despite a dire prognosis, Mimi was full of gratitude. Ron, by contrast, though cured of his disease and apparently completely healthy, looked at his life with resentment, even anger. He felt deeply wronged by his bout with cancer and operated with a sense that others should do what they could to help make it up to him. Mimi was dying but content with her life. Ron was healthy but filled with bitterness. Both patients had the same diagnosis – cancer - but the two human beings differed dramatically, and so too did their illness experiences. Mimi felt blessed by 60 years of a good marriage, while Ron saw in his cancer just one more example of how unfair life had been to him. “Death be not proud, though some have called thee Mighty and dreadful, for thou art not so…” - John Donne The real meaning of health When the members of the cancer team agreed that Mimi was the healthiest person in the room, they were thinking of health in terms of wholeness or integrity. In fact, the word health shares the same source as the word whole, implying completeness or fullness. Ron felt repeatedly slighted, but Mimi looked at life from a perspective of abundance. A full life is not necessarily marked by material wealth, power over others, or fame. Many people who live richly do so modestly and quietly, never amassing fortunes, commanding legions, or seeing their picture in the newspaper. What enriches their lives is not success in the conventional sense but the knowledge that they have done their best to remain focused on what really matters. Mimi easily called to mind many moments when she and those she cared about shared their company and their love. Any sense of regret or sorrow over what might have been quickly gave way to a sense of gratitude for what really was, still is, and will be. Her outlook on life was shaped by a deep conviction that it had a meaning that would transcend her own death. Couple enjoying the snow. Via Shutterstock. From www.shutterstock.com When someone has built up a life ledger full of meaningful experiences, the prospect of serious illness and death often do not seem so threatening. For Mimi, who had lived most of her days with a keen awareness that they would not go on forever, death’s meaning had been transformed from “Life is pointless” to “Make every day count.” Mimi regarded the prospect of dying as a lens through which to view the meaning of life. She saw her illness as another adventure through which she and Jim would pass. Death would separate them, but it would also draw them closer together, enabling them to see more clearly than ever how much their love meant to them. From Mimi’s point of view, death is not a contaminant, fatally introduced to life at its final stage. Instead death is a fire that burns away all that is not essential, purifying a person’s vision of what is most real and most worth caring about. Though not happy to be ill, Mimi was in a profound sense grateful for death. Her sentiments echo those of the poet John Donne: “One short sleep past and we wake eternally: And death shall be no more; death, thou shalt die.” This article was originally published on The Conversation. Read the original article.
February 9, 2017
The University of Florida’s bat house — and the bat barn that was built to accompany it in 2010 — shelters one of the world’s largest urban bat populations. The story of its success begins with a conflagration and ends with a tourist attraction, with ridicule, public protest and the intervention of two Florida governors along the way. This month, the bat village grew with the addition of another bat barn. With the original house crumbling, officials hope the resident bats will move from the original house into the new barn, a longer-lasting design that builds on what they’ve learned over the years. But as they learned from the first bat house, bats don’t always take a hint.
February 9, 2017
Politicians and policymakers are discussing what parts of the Affordable Care Act to change and what to keep. While most of us have little control over those discussions, there is one health care topic that we can control: what we talk about with our doctor. The Institute of Medicine (IOM) released the landmark publication Crossing the Quality Chasm 15 years ago. The report proposed six aims for improvement in the U.S. health system, identifying that health care should be patient-centered, safe, effective, timely, efficient and equitable. The idea that health care should be patient-centered sounds obvious, but what does that mean? The IOM defines it as care that is “respectful of and responsive to individual patient preferences, needs, and values” and that ensures “patient values guide all clinical decisions.” For this to truly happen, doctors’ appointments need to cover more topics than how one is feeling and what can be done. Does your doctor know your values? If you answered no, you’re not alone. Fewer than half of people report that their physician or other health care provider asks about their goals and concerns for their health and health care. Your doctor can discuss medical tests and treatments without knowing your life goals, but sharing your values and needs with your doctor makes discussions and decisions more personalized – and may lead to better health. How does patient-centered care happen? In order for your health care to center around you, your doctor needs to know your values, preferences and needs. Everyone is different. Your values and needs may also vary from one appointment to the next. From www.shutterstock.com As a neurologist, when I’m working with a 76-year-old widow whose main goal is to remain independent in her home, we frame her care in that context. We weigh benefits of medications versus the complexity of adding one more drug to her crowded pill box. We discuss how a walker helps her be more independent rather than less, as she can move around her home more safely. When a stressed college student comes to my office for a bothersome tremor, his preference is to avoid medications that he might forget to take or that might harm his school performance. This guides our discussion of the pros and cons of different options, including using medications but also doing nothing, an option that almost half of patients feel strongly should always be discussed. A year from now after graduation, we’ll revisit the conversation, as his goals and needs may be different. In sharing their values and goals with me, these individuals enabled a health care approach that respected their needs and also responded to their life circumstances. Values and shared decision-making Incorporating your values alongside what we know from medical research is the basis of shared decision-making, described as the pinnacle of patient centered care. Shared decision-making is a partnership between you and your physician. If you involve someone else like a spouse in decision-making, they can be engaged in shared decision-making, too. Shared decision-making is not just relevant when deciding whether or not to start a treatment, but also when deciding whether to undergo screening (e.g., mammography) or get testing to tease out a diagnosis. The key element of shared decision-making is incorporating your values and preferences alongside the best available evidence. To do this, your physician should explain the medical information associated with each of the different options – the research, the anticipated benefits and how likely they are, the risks and how often complications or side effects happen, the costs, etc. Your physician should also discuss your values and preferences as they relate to these options. For example, when partnering with a person with chronic daily headache and a high-stress job, I’ll help him or her reflect on the potential benefits of fewer headaches on work productivity but also the potential impact of the side effect of morning grogginess. With so many options and so much uncertainty in medicine, individualized care is critical. That happens most effectively if you and your doctor are on the same page about your goals and needs. Tools for navigating shared decision-making There are three-step and five-step outlines for shared decision-making, which are primarily aimed at helping physicians be intentional about this process. These models frame the steps of medical discussions slightly differently, but both emphasize that patients and health care professionals need to be engaged – it’s a partnership. Alternatives are compared, values discussed and a decision made. Reassessment is also an important part of shared decision-making, as alternatives and values can change over time. For common decisions, different health care organizations have created decision aids to help physicians and patients talk through the scientific evidence, pros and cons, and values that are likely to impact the specific decisions to be made. The Agency for Healthcare Research and Quality has decision aids on topics including lung cancer screening, nonsurgical treatment options for women with incontinence and treatments for men with localized prostate cancer. The Mayo Clinic Shared Decision Making National Resource Center has decision aids for common topics such as choosing the right medicine for depression and deciding whether you should treat osteoporosis (and if so, what treatment makes the most sense). Decision aids are not designed for patients to make decisions on their own. They are created to enhance your partnership with your doctor, providing a structured way for you to talk through a decision by reviewing the evidence and your preferences. What you can do While busy lives can hinder introspection, it is helpful for you to know your own goals and needs. Are you focused on working two more years until retirement? Do you want to explore physical therapy or diet changes before considering medications? Are you walking your daughter down the wedding aisle in two months and want something to hide the tremor that never really bothered you before? If you know your values and your goals for the coming months or years, it’s easier to share them with your doctor. Shared decision-making also requires you to be an active participant. Listen to the options, the pros and cons. Ask questions. Think through how each option relates to your personal values and preferences. Take time if you need it. And then with your doctor, decide what’s best for you. This article was originally published on The Conversation. Read the original article.
February 6, 2017
On a battlefield in the not-too-distant future, a soldier whose leg was shattered by a roadside bomb could have a brighter future. The injured soldier’s bone may ultimately be replaced with a biomanufactured version that could perform as well as the original and – most importantly – would not be rejected by the body. This is one of the goals of the Department of Defense (DoD), which has tapped the University of Florida (UF) to lead efforts in the Southeastern United States in biofabrication – the manufacturing of tissues and living implants for numerous applications. UF is the Southeastern node of a new public-private Manufacturing USA initiative, the Advanced Regenerative Manufacturing Institute (ARMI). Headquartered in Manchester, New Hampshire, ARMI is the 12th Manufacturing USA Institute. It brings together nearly 100 partner organizations from industry, government, academia and the non-profit sector to develop next-generation biomanufacturing processes and biotechnologies. Approximately $80 million from the federal government will be combined with more than $200 million in cost share to support the development of tissue and organ manufacturing capabilities. As a part of continuing efforts to help revitalize American manufacturing and incentivize companies to invest in new technology development in the United States, ARMI will lead the Advanced Tissue Biofabrication (ATB) Manufacturing USA Institute on behalf of the Department of Defense. The need is as real and as urgent as today’s headlines. “The Department of Defense has a significant number of warfighters who experience horrific injuries.” Blast injuries, for example, often involve burns and the loss of bone. “The Department of Defense has tackled this because they believe – and I too believe – that we can make a difference,” said Greg Sawyer, a Mechanical and Aerospace Engineering professor in UF’s Herbert Wertheim College of Engineering. Sawyer, who is directing UF’s research efforts said, “One of our goals is to develop bone that can be implanted in people and won’t be rejected, but will be incorporated into their existing bone and skeleton.” UF’s research spans multiple areas in biofabrication including 3D biosystems for drug screening, organ life support systems, and implantable living tissues. One of UF’s key contributions is its Soft Matter Engineering Center, which has developed technologies for 3D printing of soft materials. These printing techniques pioneered by Sawyer’s colleague, professor Tommy Angelini, enable the precise placement and support of cells, tissues, and materials in 3D. Direct printing of these materials into a “Liquid-Like Solid” medium provides continuous support and stability in an aqueous environment that contains nutrients and drugs needed for development. Prior to Angelini’s discovery, printing an extremely soft object in three dimensions was impossible because, by its nature, most 3D printing methods require an object to solidify layer by layer, with the printing tip depositing a material such as a plastic or metal, which hardens to provide its own support. One of the first areas that Sawyer believes UF can make an impact is in the development and fabrication of microtissues – essentially making miniature pieces of liver, for instance, or small precise tumors, and use them to test treatments for disease. “We’ve already demonstrated the ability to do this,” Sawyer said. Other UF researchers involved in the project and critical to its success include David Hahn, professor and chair of the Department of Mechanical and Aerospace Engineering; Dr. Parker Gibbs, a professor of Orthopedic Surgery and Chief Medical Officer for UF Health Shands; and Steve Ghivizzani, a professor in the Department of Orthopedics and Rehabilitation in the UF College of Medicine. Under the umbrella of Manufacturing USA, a public-private network that invests in the development of world-leading manufacturing technologies, ARMI will work to integrate and organize the fragmented collection of industry practices and domestic capabilities in tissue biofabrication technology in order to better position the USA relative to global competition. ARMI will also focus on accelerating regenerative tissue research and creating state-of-the-art manufacturing innovations in biomaterial and cell processing for critical Department of Defense and civilian needs. “We need to develop 21st century tools for engineered tissue manufacturing that will allow these innovations to be widely available – similar to how a 15th century tool (the printing press) allowed knowledge to spread widely during the Renaissance,” said inventor Dean Kamen, ARMI’s chairman. ARMI’s efforts are supported by forty-seven industrial partners, twenty-six academic and academically affiliated partners, and fourteen government and non-profit partners. The ARMI partnership continues to grow. About ARMI:The Advanced Regenerative Manufacturing Institute (ARMI), headquartered in Manchester, New Hampshire, is the 12th Manufacturing USA Institute. It brings together a consortium of nearly 100 partners from across industry, government, academia and the non-profit sector to develop next-generation manufacturing processes and technologies for cells, tissues and organs. ARMI will work to organize the current fragmented domestic capabilities in tissue biofabrication technology to better position the USA relative to global competition. For more information on ARMI, please visit www.ARMIUSA.org.
WEEKLY NEWS: February 23, 2017