Milwaukee Center Research Articles

Increase in traumatic injury burden amidst COVID-19 was disproportionately shouldered by racial and ethnic minority patients: An urban case study

Background When the COVID-19 pandemic intersected with the longstanding global pandemic of traumatic injury, it exacerbated racial and ethnic disparities in injury burden. As Milwaukee, Wisconsin is a racially diverse yet segregated urban city due to historic and ongoing systemic efforts, this populace provided an opportunity to further characterize injury disparities. Method We analyzed trauma registry data from the only adult Level 1 trauma center in Milwaukee, WI before and during the COVID-19 pandemic ( N = 19,908 patients from 2015–2021). We retrospectively fit seasonal ARIMA models to monthly injury counts to determine baseline injury burden pre-COVID-19 (Jan 2015–Mar 2020). This baseline data was used to forecast injury by race and ethnicity from April 2020 to December 2021 and was compared to actual injury counts. Results For all mechanisms of injury (MOI), counts during the pandemic were significantly higher than forecasted for Black or African American (mean absolute percentage error, MAPE = 23.17) and Hispanic or Latino (MAPE = 26.67) but not White patients (MAPE = 12.72). Increased injury for Black or African American patients was driven by increases in motor vehicle crashes (MVCs) and firearm-related injury; increased injury for Hispanic or Latino patients was driven by falls and MVCs. Conclusions The exacerbation of injury burden disparities during COVID-19, particularly in specific MOI, underscores the need for primary injury prevention within specific overburdened communities. Injury prevention requires intervention through social determinants of health, including addressing the impact of structural racism, as primary drivers of injury burden disparities.

Newborn blood spot screening – knowledge of genetic testing among mothers

Introduction and aim. Newborn blood spot screening (NBS) uses genetic technology to screen for selected genetic, endocrine, and metabolic disorders. The purpose of the study was to assess the knowledge of newborn blood spot genetic screening among expectant mothers. Material and methods. Between October 2015 and January 2016, a 20 question, multiple-choice questionnaire was administered to expectant mothers presenting for a pre-natal ultrasound at the Maternal Fetal Care Center in Milwaukee, Wisconsin Froedtert Hospital. Statistical analysis used Chi-Square or Fisher’s exact test for categorical variables. Results. 103 women completed the survey; 34% believed that education regarding screening is incomplete and 39% believed that it needs improvement. 27% knew the purpose of newborn screening. Conclusion. Many mothers lack general and specific knowledge about NBS and the diseases screened for. Health education that provides accurate and complete information on the newborn blood spot screening should be provided to all parents prior to the administering of any genetic testing. Key areas that should be targeted include: purpose of NBS, screened diseases and how to interpret the results of the test.

Hypertriglyceridemia during hospitalization independently associates with mortality in patients with COVID-19

BackgroundAlteration in blood triglyceride levels have been found in patients with coronavirus disease 2019 (COVID-19). However, the association between hypertriglyceridemia and mortality in COVID-19 patients is unknown.ObjectiveTo investigate the association between alteration in triglyceride level and mortality in hospitalized COVID-19 patients.MethodsWe conducted a retrospective study of 600 hospitalized patients with COVID-19 diagnosis (ICD10CM:U07.1) and/or SARS-CoV-2 positive testing results between March 1, 2020 and December 21, 2020 at a tertiary academic medical center in Milwaukee, Wisconsin. De-identified data, including demographics, medical history, and blood triglyceride levels were collected and analyzed. Of the 600 patients, 109 patients died. The triglyceride value on admission was considered the baseline and the peak was defined as the highest level reported during the entire period of hospitalization. Hypertriglyceridemia was defined as greater than 150 mg/dl. Logistic regression analyses were performed to evaluate the association between hypertriglyceridemia and mortality.ResultsThere was no significant difference in baseline triglyceride levels between non-survivors (n = 109) and survivors (n = 491) [Median 127 vs. 113 mg/dl, p = 0.213]. However, the non-survivors had significantly higher peak triglyceride levels during hospitalization [Median 179 vs. 134 mg/dl, p < 0.001]. Importantly, hypertriglyceridemia independently associated with mortality [odds ratio=2.3 (95% CI: 1.4–3.7, p = 0.001)], after adjusting for age, gender, obesity, history of hypertension and diabetes, high CRP, high leukocyte count and glucocorticoid treatment in a multivariable logistic regression model.ConclusionsHypertriglyceridemia during hospitalization is independently associated with 2.3 times higher mortality in COVID-19 patients. Prospective studies are needed to independently validate this retrospective analysis.

Abstract WP215: Residential Greenspace Protects Against Stroke

Introduction: Greenspace, both residential and public, is associated with improved outcomes for a variety of medical conditions. Its effect on stroke incidence is not as well established. In this study, we sought answers to three questions: Does an increase in residential greenspace, as measured by the Normalized Difference in Vegetation Index (NDVI), lessen the odds of stroke? Is socioeconomic status (SES), as measured by the Area Deprivation Index (ADI), correlated with NDVI? Is proximity to a public park a risk factor for stroke? Methods: This is a matched (1:4) case-controlled study. The cohort was adult patients admitted to Aurora St Luke’s Medical Center in Milwaukee, WI between 2016 and 2018. Non-stroke controls (N=328,868) were matched to stroke cases (N=2336) on known cardiovascular risk factors after excluding patients with prior stroke, addresses outside of Milwaukee County, and residences within 250 meters of a water feature. The matched study sample included 5870 patients (stroke cases=1174 and non-stroke controls = 4696). The mean NDVI within a 250 meter radius around the patients’ residence and distance to a public park were calculated using satellite imagery and geographical information systems (GIS) software. State decile and national percentile ADI were obtained from the Neighborhood Atlas. A Spearman’s rank-order correlation determined the relationship between the NDVI, state and national ADI, and proximity to parks. Conditional logistic regression was used to examine the relationship between a stroke event and NDVI, ADI, and proximity to public parks. Results: We found a protective association between higher NDVI values and stroke (OR = 0.33, 95% CI = 0.111-0.975, p = 0.045). There was a negative correlation between NDVI and national (rs(5870) = -.548, p &lt; .001) and state (rs(5870) = -.550, p &lt; .001) ADI, both statistically significant. There was no association between proximity to parks and stroke (OR = 1.00, 95% CI = 1.000 – 1.000, p = 0.456). Conclusion: An increase in residential NDVI significantly decreases the odds of stroke. Distance to a public park did not impact the odds of stroke. These findings have implications for city planning and mitigation of social disparities in health.

Patient Barriers for Weight Management Among African American Women.

The primary aim of this study was to assess the perceptions of local African American women who are overweight or obese using semi-structured focus groups to identify barriers to weight management and factors that support strategy success. The secondary aim of this study was to determine recommendations for patient-centered weight management interventions established specifically for African American women in the Milwaukee-area community. Three semi-structured focus groups to explore barriers to weight management were performed among women patients. Participants (N=41) were recruited via email, postal mail, and phone as available from an academic medical center in Milwaukee, Wisconsin. Focus group discussions were transcribed verbatim, reviewed by the study team, and coded based on recurring themes within and across interviews. Responses were analyzed by frequency of occurrence using qualitative computer software. Five primary barriers to weight management were identified from focus groups: food choices, lifestyle changes, social support, locus of control, and health education. Based on participant reports, improvements to present practice and health literacy for patients may be merited. There was expressed interest by patients for being involved in future research and development of patient-centered interventions. This study provides support for the use of a community-based participatory research approach in determining appropriate considerations for weight management interventions suitable for this patient population. Future research should include stakeholders not included in this study, such as community organization leaders, and primary care physicians to develop a refined intervention targeting the primary barriers to weight management.

Health care access and quality for persons with disability: Patient and provider recommendations

BackgroundSignificant disparities in health care access and quality persist between persons with disabilities (PWD) and persons without disabilities (PWOD). Little research has examined recommendations of patients and providers to improve health care for PWD. ObjectiveWe sought to explore patient and health care provider recommendations to improve health care access and quality for PWD through focus groups in the physical world in a community center and in the virtual world in an online community. MethodsIn all, 17 PWD, 4 PWOD, and 6 health care providers participated in 1 of 5 focus groups. Focus groups were conducted in the virtual world in Second Life® with Virtual Ability, an online community, and in the physical world at Agape Community Center in Milwaukee, WI. Focus group data were analyzed using a grounded theory methodology. ResultsThemes that emerged in focus groups among PWD and PWOD as well as health care providers to improve health care access and quality for PWD were: promoting advocacy, increasing awareness and knowledge, improving communication, addressing assumptions, as well as modifying and creating policy. Many participants discussed political empowerment and engagement as central to health care reform. ConclusionsBoth PWD and PWOD as well as health care providers identified common themes potentially important for improving health care for PWD. Patient and health care provider recommendations highlight a need for modification of current paradigms, practices, and approaches to improve the quality of health care provision for PWD. Participants emphasized the need for greater advocacy and political engagement.

Promoting independence among children with disabilities at the Milwaukee Center for Independence (MCFI)

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) [1] formally and explicitly recognizes the importance of how to achieve independence for individuals with a disability. This encompasses individual autonomy, the opportunity to be actively involved in decision-making processes, and the opportunity to access the physical, social, economic and cultural environment [1]. To ensure independence is achieved, it is crucial that individuals have access to a range of opportunities and resources so that they can make meaningful choices and decisions about the management of their life and environment [2]. The Milwaukee Center for Independence (MCFI) is a nonprofit agency assisting individuals with a disability to live and work successfully in their communities. At MCFI, the concept of independence is reflected throughout the agencies many evidence-based programs and services. The purpose of this article is to describe how independence is fostered in children attending the School for Early Development and Achievement (SEDA), an affiliate of MCFI. Founded in 2002, SEDA provides early intervention services to at-risk children from grades K4 through 2nd, with a particular focus on children with early developmental disabilities. SEDA is a free public school chartered through the University of Wisconsin-Milwaukee. The intended audience for this article includes parents and families of children with early developmental disabilities, teachers, special educators, speech, occupational and physical therapists, donors and potential donors of non-profit organizations.

Promoting Independence among Children with Disabilities at the Milwaukee Center for Independence (MCFI)

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) [1] formally and explicitly recognizes the importance of how to achieve independence for individuals with a disability. This encompasses individual autonomy, the opportunity to be actively involved in decision-making processes, and the opportunity to access the physical, social, economic and cultural environment [1]. To ensure independence is achieved, it is crucial that individuals have access to a range of opportunities and resources so that they can make meaningful choices and decisions about the management of their life and environment [2]. The Milwaukee Center for Independence (MCFI) is a nonprofit agency assisting individuals with a disability to live and work successfully in their communities. At MCFI, the concept of independence is reflected throughout the agencies many evidence-based programs and services. The purpose of this article is to describe how independence is fostered in children attending the School for Early Development and Achievement (SEDA), an affiliate of MCFI. Founded in 2002, SEDA provides early intervention services to at-risk children from grades K4 through 2nd, with a particular focus on children with early developmental disabilities. SEDA is a free public school chartered through the University of Wisconsin-Milwaukee. The intended audience for this article includes parents and families of children with early developmental disabilities, teachers, special educators, speech, occupational and physical therapists, donors and potential donors of non-profit organizations.

Shoulder Symptoms and Function in Geriatric Patients

Musculoskeletal problems, including shoulder pain, are common in the general population and are often cited as reasons for physician visits. Although many risk factors for shoulder pain are postulated, the effects of shoulder pain on functional level and perceived quality of life are poorly characterized in older adults. In this study, we set out to determine the prevalence and impact of shoulder symptoms and dysfunction in an older adult veteran population. A chart review, cross-sectional survey, and examination were performed. A sample of 93 individuals, aged 60 years or older, was recruited from a primary clinic outpatient waiting room at the Clement J. Zablocki VA Medical Center in Milwaukee, Wisconsin. Patients were asked about shoulder symptoms and self-assessed health and completed the Stanford Modified Health Assessment Questionnaire. A series of 3 shoulder maneuvers was used to assess shoulder mobility and pain. The presence of diabetes and statin use was documented. A more thorough chart review was performed on individuals who reported shoulder pain and disability. Severe shoulder pain was common in the study group, reported by 31% of all participants. Functional limitation measured by the Modified Health Assessment Questionnaire and answering "yes" to greater difficulty performing daily tasks was associated with reduced internal rotation, which was present in almost 36% of all participants. Symptoms were often bilateral. No statistically significant risk factors emerged in this small sample, but suggestive trends were apparent. Interestingly, few patients reported discussing these problems with their providers, and shoulder-related problems were documented in only 10% of corresponding problem lists of symptomatic patients. With an aging population, the high prevalence of shoulder pain may have considerable impact on public health. It will become increasingly important to define risk factors, delineate etiologies, and devise new management strategies for patients with symptomatic shoulder disease.

Assessment of Self-Perceived End-of-Life Care Competencies of Intensive Care Unit Providers

The need for improved (end-of-life) EOL care in the intensive care unit (ICU) has gained attention in the medical literature over the last 10 years. The purpose of this study is to describe ICU health care providers' self-perceived knowledge, attitudes, and behaviors related to the provision of EOL care as a first step in planning educational interventions for ICU staff. One hundred eighty-five ICU staff members of an academic affiliated tertiary medical center in Milwaukee, Wisconsin received the survey, the Scale of End-of-Life Care in the ICU (EOLC-ICU), a new questionnaire developed for this study. The response rate was 50.3%. We found that having previous EOL care education was common among ICU staff. However, several deficiencies in self-perceived EOL competencies were identified among staff, particularly in the areas of communication, continuity of care, and decision-making process. Nursing and medical staff also had different perceptions on how certain EOL behaviors were carried out in the ICU. Educational interventions will be implemented in our ICU in an effort to improve staff preparedness for the provision of quality EOL care.

The Challenges of PAH in Pregnancy

PAH patients who become pregnant– certainly against medical advice– or whose disease is diagnosed while pregnant present myriad challenges. On October 17, 2011, a group of physicians who have dealt with these complicated issues met by telephone to discuss their approaches and thoughts on dealing with these unique patients. Co-guest editor Deborah Jo Levine facilitated the discussion among Drs Ron Oudiz, Director of the Pulmonary Hypertension Center at Los Angeles County Harbor-UCLA Medical Center; Irene Lang, cardiologist at the Medical University of Vienna; Evelyn Horn, Director of the Heart Failure, Mechanical Circulatory Support, Pulmonary Hypertension Program at Cornell and adjunct professor at Columbia; and Dianne Zwicke, Medical Director of the Pulmonary Hypertension Clinic at Aurora St. Luke's Medical Center in Milwaukee, University of Wisconsin School of Medicine.

Free Health Clinic Links College, Church, and Community

Granville Neighborhood Health Center (GNHC) in Milwaukee, Wisconsin, was conceived out of community need and the vision of Risen Savior Lutheran Church, Wisconsin Lutheran College (WLC), and community leaders. GNHC offers free healthcare services monthly to the uninsured and a service-learning and clinical site for nursing and other students at the college.

Effects of a Culturally Tailored Intervention on Changes in Body Mass Index and Health-Related Quality of Life of Latino Children and Their Parents

To evaluate the effects of a multicomponent, family-based, culturally tailored intervention for overweight Latino children and their parents. One group pretest/posttest with clinic comparison group. Community health center in Milwaukee, Wisconsin. 54 Spanish-speaking, Latino families with children 8 to 11 years of age at enrollment and a body mass index (BMI) > 85th percentile. Thirty-one completed the 12-month follow-up. Measures. BMI, fitness measures, self-reported eating patterns, sedentary behaviors, and quality of life scales. Index child and one (index) parent participated in interactive sessions and physical activity reinforced by family goal-setting, staff support, and supplemental activities. Small but statistically significant changes in child BMI z score (Δ = .13 SD, p < .001) and parent fitness (Δ = .74, p < .04) were documented by paired t-test. Quality of life increased significantly for children (combined Pediatric Quality of Life Inventory score Δ = 10.7, p < .001) and parents (Short Form Health Survey12 mental composite score Δ = 8, p < .022; Wilcoxon rank sum test). BMI z score for clinic comparison children (n = 31) increased significantly during the same time period (Δ = .23 SD, paired t = 4.32, p < .0002). A culturally tailored program for Latino families reduced BMI for enrolled children and significantly enhanced quality of life for children and parents. Intervention approaches that integrate cultural and social circumstances and emphasize goal setting and life style changes may be fruitful for this population of at-risk children.

“It's Kind of Fun to Do the Impossible”: The Story of Milwaukee's Urban Ecology Center

The Urban Ecology Center in Milwaukee, Wisconsin, offers an innovative model for urban environmental education. From its humble beginnings as a neighborhood effort to save a park from crime, it has grown into a one-of-a-kind environmental community center serving tens of thousands of visitors a year. The secret to its success is its replicable Neighborhood Environmental Education Project, which provides neighborhood children and youth with experiences in the natural world. This is coupled with a community program that fosters cross-generational mentor relationships as a means to develop a strong environmental ethic. The Center's experience holds useful lessons for communities elsewhere.

The Use of Expectation in Solution-Focused Formula Tasks

Solution-focused therapy, developed by de Shazer and others at the Brief Therapy Family Center in Milwaukee, Wisconsin, has been a major force in the field of psychotherapy over the last twenty years. It is a directive, action-oriented approach that quickly gets clients focused on their own resources. Solution-focused therapists use several tasks to assist in the change process. This paper will explore how the theme running through the effectiveness of these tasks is that of expectation. The paper will begin with a discussion of expectancy in psychotherapy and how this creates an ambiance for difference. Then, the history of Solution-Focused Formula Tasks (SFFTs) will be presented. Finally, a discussion of the primary principles of SFFTs will be presented where the utilization of expectancy to prime the client for change will be highlighted as the main conduit of change.

'Vent: Woodland Pattern's 25th Anniversary Celebration

Just before Thanksgiving, Anne Kingsbury and Karl Gartung, founders of Woodland Pattern Book Center in Milwaukee, invited everyone passionate or curious about contemporary innovative writing and art to mark the occasion of their twenty-fifth birthday. Anne and Karl established the non-profit arts center in 1980 with a vision, as Karl then wrote, "to prove the living artist." Since then, their original stock of fewer than one thousand titles has grown to over 27,000 and includes an incredible array of small and fine press poetry books and broadsides. Because Anne and Karl remain dedicated to pursuing their original mission, artists working outside the mainstream continue to find a resource and space to share their work. In its inimitable way, Woodland Pattern called on poets, an essayist, fiction writers, a filmmaker, and musicians to sing them into their twenty-sixth year. Celebrations began Friday night with a reading and film screening, bringing together local talent and nationally known writers. Peggy Hong read work filled with movement and anatomy and was a perfect choice for the opening reader, bringing a tone of intimacy and celebration that endured throughout^ the weekend. Terri Kapsalis then read essays haunted with other voices: the] two main pieces, "Bound" and "Most Beautiful Experiment," were excerptsj from a larger project on the history of hysteria. "Bound," particularly arresting , examines the possession ofnuns in a French convent in the 1630s. Lisa Jarnot was the final reader of the evening, and her frequently funny, sound-based poems were enchanting. The sound repetitions seemed, with their sly shiftings, to extend indefinitely while remaining oddly self-contained. The effect was labyrinth-like. Friday concluded with Jennifer Montgomery's film Notes on the Death of Kodachrome documenting her cross-country trek to collect Super 8 film equipment loaned to various friends years earlier. The highpoint of the film is its final sequence, when, having recovered all ofher equipment, Montgomery uses Super 8 to recreate a dream both hilarious in its portrayal ofherself as a megalomaniacal filmmaker and lovely in its surface lushness. Celebrations reconvened Saturday evening with KikiAnderson and Roberto Harrison as the opening acts for Keith and Rosmarie Waldrop. Anderson's poetry can be terse and edgy, and what seemed to me her most successful works were those that read through other texts. "The Cook," one in a series ofpoems drawn from endnotes to Balzac's Père Goriot (1834), was especially well crafted. • Harrison read from two forthcoming manuscripts, Counter Daemons and "Bicycle," a sequence from Os. Working with computer concepts, Harrison writes incantatory poems rife with anaphora that seem far more rooted in a natural world than in one of drives and gigs. '*While each of the events was lovely in its own right, the Waldrops were for me the highlight ofthe weekend. Both Rosmarie and Keith have enormous presence and graceful delivery. Rosmarie read from her newest ':books, Love, Like Pronouns (2003) and Blindsight (2003). More than anything, these poems convey an earnest mindfulness: how it is to think through language and to make language think. The musings of Jacob Delafon, the character ofKeith's latest book, The Real Subject * ' (2004), had the audience in high spirits by the end of the evening. ,. ' ' When the Waldrops read from one of their collaborative pieces, it was perhaps my favorite part of the entire weekend. Picking up ,^^0/Lthe last line of the other's previous stanza and writing/reading ^TÉ^·fromthatpoint, the work sustainedanevocativerecursiveness. 11^CtAs if that weren't enough, the night ended with turkey and 'memm. · - homemade pudding back at Anne and Karl's. lip : " The final events on Sunday included readings by Martha Bergland and Wanda Coleman, and an evening concert. * * Bergland read a wonderfully humorous and touching account of her childhood memories of farm life. Although Coleman was under the weather, she managed to make the hair on my arms stand up. Her voice, like an instrument, slid - from whispered hisses to full, reverberating chords as she read about her mother and deceased sister. To bring the celebration to a close, a group of twelve musicians, including Hal Rammel and Steve Nelson-Raney, played the twenty-fifth Anniversary Waltz without the waltz—two hours...

Heavy Call Schedule Has Alcohol-Like Effect

Back to table of contents Previous article Next article Education & TrainingFull AccessHeavy Call Schedule Has Alcohol-Like EffectLynne LambergLynne LambergSearch for more papers by this authorPublished Online:4 Nov 2005https://doi.org/10.1176/pn.40.21.0017After a month on a heavy night-call schedule, resident physicians perform neurobehavioral tests as poorly as they do after consuming three to four alcoholic drinks when better rested, researchers at Brown University Medical School have found.Thirty-four pediatric residents, 18 women and 16 men in their late 20s, participated in the prospective study, reported in the September 7 JAMA.J. Todd Arnedt, Ph.D., now a clinical assistant professor of psychiatry at the University of Michigan School of Medicine, and colleagues at Brown University assessed the residents' attention, vigilance, and driving skills at the end of two four-week rotations under four conditions: light call, light call with alcohol use, heavy call, and heavy call with placebo.The study was conducted between October 2001 and August 2003. On the light-call schedule, residents averaged 44 hours of work a week in daytime clinics with night call only if the on-call resident became ill. On the heavy-call schedule, they averaged 90 hours a week (80 hours after nationwide resident work hour limits went into effect July 1, 2003) in neonatal intensive care, pediatric intensive care, or wards, with mandated call every fourth or fifth night.The week before the testing, residents on the heavy-call rotation averaged five hours and 20 minutes of sleep a night, and residents on the light-call rotation, six hours and 38 minutes a night, or 78 minutes more.Residents on the heavy-call rotation spent the night before the testing on call, averaging just over three hours' sleep. Residents on the light-call rotation slept their usual amount.After arriving for test sessions at 3 p.m., residents completed self-report sleepiness assessments. They then took a 60-minute standard battery of attention and performance tests, plus a driving-simulation test, and assessed their own performance and effort.Next, they consumed either alcohol (light call) or a nonalcoholic placebo (heavy call) and repeated all tests and self-evaluations.The alcohol consisted of vodka mixed with tonic, adjusted to body weight, to produce equivalent peak blood alcohol concentrations (BAC) of 0.04-0.05 g% per 100 mL of blood. The placebo consisted of an equal volume of chilled tonic water, dispensed from vodka and tonic bottles. In both heavy-call and alcohol conditions, residents received rides home after taking tests.After consuming alcohol following light call, and before and after consuming placebo following heavy call, residents' reaction times were 7 percent to 10 percent slower and their error rates 40 percent higher than they were after light call alone. “Decrements of that magnitude are potentially significant in the patient-care setting,” Arnedt said.In both heavy-call conditions and after light call with alcohol, residents failed to maintain consistent speed and lane position and drove off the road more frequently on the driving test than they did after light call alone. They showed only limited ability to judge the extent of their own sleepiness and impairment, however.This is the first study to compare impairment related to heavy night call directly with that resulting from alcohol ingestion, Arnedt said. The observed post-call deficits, he said, reflect both acute sleep loss and superimposed chronic partial sleep deprivation common in residency training.In another report in the same issue of JAMA, Kathlyn Fletcher, M.D., of the Clement J. Zablocki Veterans Affairs Medical Center in Milwaukee, Wis., and colleagues reviewed 54 studies assessing effects of interventions to reduce work hours on residents' education and quality of life.Psychiatry residents surveyed in one study reported that use of a night float benefited their well-being, education, and clinical duties. Residents in various disciplines felt reduced hours generally aided quality of life, but did not always improve their patient care or educational experience.“Despite the intuitive appeal of restricting working hours, it is important to consider potential negative ramifications,” said sleep and chronobiology specialists Drew Dawson, Ph.D., of the University of South Australia in Adelaide, South Australia, and Phyllis Zee, M.D., Ph.D., of Northwestern University in Chicago, in an editorial in the same issue of JAMA.Reducing work hours may increase patient risks in some situations. Taking a broad systems-based approach to safety management, which might include altering standard procedures, they said, also might help defend against fatigue-related errors.An abstract of “Neurobehavioral Performance of Residents After Heavy Night Call vs. After Alcohol Ingestion” is posted at<http://jama.ama-assn.org/cgi/content/abstract/294/9/1025>. Abstracts of the accompanying articles, “Effects of Work Hour Reduction on Residents' Lives: A Systematic Review” and “Work Hours and Reducing Fatigue-Related Risk: Good Research vs. Good Policy,” are posted at<http://jama.ama-assn.org/cgi/content/abstract/294/9/1088> and<http://jama.ama-assn.org/cgi/content/extract/294/9/1104>, respectively. ▪ JAMA 2005 294 1025 JAMA 2005 294 1088 JAMA 2005 294 1104 ISSUES NewArchived

A Center of a Different Stripe

What do tiny black-and-white-striped zebrafish have in common with human beings? As it turns out, quite a lot. The zebrafish and other aquatic model organisms are helping researchers to better understand complex biomedical questions including how humans develop and are affected by toxic exposures. This work is the focus of the and Freshwater Biomedical Sciences Center (MFBSC) at the University of Wisconsin (UW) –Milwaukee, an NIEHS environmental health sciences center. “Most investigators who work with living systems use mammalian species as model systems,” says director David Petering, a professor of chemistry at UW–Milwaukee. “So, up until recently, general toxicologists wondered what in the world aquatic organisms could contribute to the study of environmental health and toxicology. It turns out that, historically, aquatic organisms have been enormously important in the development of biomedical research.” Petering notes, for example, that most of the basic understanding of how nerve impulses are conducted arose from studies of the large nerve axon of the squid. The MFBSC is one of four aquatic research centers funded by the NIEHS. It is located in the Wisconsin Aquatic Technology and Environmental Research (WATER) Institute at UW–Milwaukee. (In addition to UW–Milwaukee faculty, the center draws researchers from several other Wisconsin institutions, including Marquette University, the Medical College of Wisconsin, and UW–Madison.) The center’s genesis dates to the late 1970s, when former NIEHS director David Rall promoted the use of aquatic systems to study human and environmental health issues. The Milwaukee center was the first MFBSC to form. It has since evolved into an advanced aquatic animal facility with laboratories supporting four core research areas: signal transduction and endocrine disruption, metals toxicology and neurotoxicology, the use of zebrafish as a model organism for developmental toxicology, and behavioral toxicology. Additionally, the MFSBC supports a pilot project program, which offers researchers an opportunity to explore the utility of aquatic models in environmental health research and to further develop methods that are already in use.

Logic modeling: a tool for improving educational programs.

Palliative care education programs must be systematically designed and accurately evaluated in order to account for their impact on learners and learning communities. Logic modeling is a framework for designing educational programs and monitoring their influence. We applied a logic modeling process to a Palliative Care Educational Program (PCEP), embedded within a required month-long geriatrics rotation for third-year general internal medicine residents at the VA Medical Center in Milwaukee, Wisconsin. Each of four main categories of a logic model and the process for applying the steps to the PCEP are described. The four logic model categories that form the basis of the analysis are: (1) inputs, the raw resources consumed by the program (human resources, money, and space); (2) outputs, program activities and the number and types of actual participants; (3) outcomes, what the program will achieve in the short term (knowledge, attitudes and behavior change); and (4) impact, the results that are of ultimate interest to program stakeholders, such as placement in medically underserved areas, improved health or more efficient care. The application of logic modeling to the PCEP exposed achievements (e.g., resident knowledge gains) and gaps (no evidence of long-term impact) in each of the model categories and has resulted in the design team's reassessment of each program component. Palliative care educators can improve their programs by using the logic model categories and process steps to explicitly define and assess the links between key program components.

Weinhous Is AAPM’s President-Elect

The American Association of Physicists in Medicine has a new president-elect: Martin S. Weinhous, chief of the medical physics section in the department of radiation oncology at the Cleveland Clinic Foundation in Cleveland, Ohio. Weinhous will begin his term as president-elect on 1 January 2002, succeeding Robert G. Gould. He will become president in 2003 and chairman of the board in 2004.A goal for AAPM, says Weinhous, is “to work toward assuring that the AAPM remains one of the world’s premier scientific associations for medical physicists while working in partnership with related societies to further the interests of all.”Weinhous also plans “to increase efforts to educate the lay community regarding physicist participation in their health care and to continue efforts to make our association and profession known to our national political leaders.”Weinhous received a BS in physics from Rensselaer Polytechnic Institute in 1966, then earned MS and PhD degrees in physics from the University of New Hampshire in 1970 and 1974. After postdoctoral training in radiation oncology physics at Yale University, he worked at several institutions before joining the Cleveland Clinic in 1994. His research interests include radiation therapy physics. Four new at-large members of AAPM’s board of directors will also take office on 1 January 2002 for three-year terms. They are J. Daniel Bourland, an associate professor and head of the physics section in the department of radiation oncology at Wake Forest University School of Medicine in Winston-Salem, North Carolina; Sherry Connors, a senior medical physicist at the Cross Cancer Institute in Edmonton, Alberta, Canada; Douglas J. Simpkin, senior medical physicist at St. Luke’s Medical Center in Milwaukee, Wisconsin; and Andrew Wu, director of the medical physics division at the University of Pittsburgh Cancer Center in Pennsylvania. Weinhous PPT|High resolution© 2001 American Institute of Physics.