It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Thursday, August 18, 2022
New University of Rochester study shows promising alternative to opioids for pain after dental extractions
As the opioid epidemic rages on during the COVID-19 pandemic, a study by the University of Rochester Medical Center’s Eastman Institute for Oral Health (EIOH) shows promise for a non-opioid alternative for acute dental pain.
Prescription opioid-involved death rates increased more than 16% from 2019 to 2020, and among all the opioid overdose deaths, prescription opioids represent nearly 18 percent, according to the Centers for Disease Control and Prevention.
Published today in JAMA Network Open, the study compares two large groups of patients representing an equal number of men and women ages 18-93 who had dental extractions at the Institute’s Howitt Urgent Dental Care clinic in Rochester, New York.
“We hypothesized that using a combination of the non-opioid pain medications and adding gabapentin to the mix for pain would be an effective strategy to minimize or eliminate opioids for dental pain,” said Yanfang Ren, DDS, PhD, MPH, professor and clinical chief, Howitt Urgent Dental Care.
For the 3,300 patients in the first group in 2012, those with mild pain were treated with ibuprofen or acetaminophen. For moderate to severe pain, patients were prescribed higher doses of ibuprofen or opioid combinations including hydrocodone, oxycodone or codeine.
But the second group of nearly 3,800 people who had extractions from March 2021 through February 2022, received no opioids whatsoever.
Similarly, for mild pain, the second group was prescribed acetaminophen or ibuprofen. For moderate to severe pain, higher doses of ibuprofen or an ibuprofen and acetaminophen combination were prescribed.
For the segment of patients who were unable to take ibuprofen or acetaminophen due to health issues or potential interactions with existing medications, they were often prescribed an opioid combination in year 2012, but a gabapentin combination was used
instead in 2022 to use as a non-opioid alternative. The results were promising when the effectiveness was evaluated using a real-word measure of proportion of patients returning for additional pain treatment after receiving the prescribed analgesics.
“Although the American Dental Association recommends nonsteroidal anti-inflammatory drugs for managing pain,” Dr. Ren said, “dentists frequently prescribe opioids for dental pain and contribute substantially to new and persistent opioid use. This may partly be explained by the lack of alternatives to opioids, especially when the ibuprofen or acetaminophen are ineffective or can’t be tolerated.”
“This study represents continued efforts by our team and other dentists to minimize the use of opioids for dental pain,” said Eli Eliav, DDS, PhD, the director of EIOH and a pain expert. “Additional studies, preferably randomized controlled clinical trials, are needed to confirm the safety and effectiveness of this approach. It is our duty to continuously seek safe and effective treatment for our patients in pain.”
Other authors on the study include Qirong Huang, DDS, MS, Linda Rasubala, DDS, PhD, Richard H. Gracely, PhD, Junad Khan, BDS, MSD, MPH, PhD, and Eli Eliav, DMD, PhD.
Comparison of Analgesic Prescriptions for Dental Pain and Patient Pain Outcomes Before vs After an Opioid Reduction Initiative
ARTICLE PUBLICATION DATE
17-Aug-2022
A new neuromorphic chip for AI on the edge, at a small fraction of the energy and size of today’s compute platforms
The NeuRRAM chip is the first compute-in-memory chip to demonstrate a wide range of AI applications at a fraction of the energy consumed by other platforms while maintaining equivalent accuracy
IMAGE: A TEAM OF INTERNATIONAL RESEARCHERS DESIGNED, MANUFACTURED AND TESTED THE NEURRAM CHIP.view more
CREDIT: DAVID BAILLOT/UNIVERSITY OF CALIFORNIA SAN DIEGO
An international team of researchers has designed and built a chip that runs computations directly in memory and can run a wide variety of AI applications–all at a fraction of the energy consumed by computing platforms for general-purpose AI computing.
The NeuRRAM neuromorphic chip brings AI a step closer to running on a broad range of edge devices, disconnected from the cloud, where they can perform sophisticated cognitive tasks anywhere and anytime without relying on a network connection to a centralized server. Applications abound in every corner of the world and every facet of our lives, and range from smart watches, to VR headsets, smart earbuds, smart sensors in factories and rovers for space exploration.
The NeuRRAM chip is not only twice as energy efficient as the state-of-the-art “compute-in-memory” chips, an innovative class of hybrid chips that runs computations in memory, it also delivers results that are just as accurate as conventional digital chips. Conventional AI platforms are a lot bulkier and typically are constrained to using large data servers operating in the cloud.
In addition, the NeuRRAM chip is highly versatile and supports many different neural network models and architectures. As a result, the chip can be used for many different applications, including image recognition and reconstruction as well as voice recognition.
“The conventional wisdom is that the higher efficiency of compute-in-memory is at the cost of versatility, but our NeuRRAM chip obtains efficiency while not sacrificing versatility,” said Weier Wan, the paper’s first corresponding author and a recent Ph.D. graduate of Stanford University who worked on the chip while at UC San Diego, where he was co-advised by Gert Cauwenberghs in the Department of Bioengineering.
The research team, co-led by bioengineers at the University of California San Diego, presents their results in the Aug. 17 issue of Nature.
Currently, AI computing is both power hungry and computationally expensive. Most AI applications on edge devices involve moving data from the devices to the cloud, where the AI processes and analyzes it. Then the results are moved back to the device. That’s because most edge devices are battery-powered and as a result only have a limited amount of power that can be dedicated to computing.
By reducing power consumption needed for AI inference at the edge, this NeuRRAM chip could lead to more robust, smarter and accessible edge devices and smarter manufacturing. It could also lead to better data privacy as the transfer of data from devices to the cloud comes with increased security risks.
On AI chips, moving data from memory to computing units is one major bottleneck.
“It’s the equivalent of doing an eight-hour commute for a two-hour work day,” Wan said.
To solve this data transfer issue, researchers used what is known as resistive random-access memory, a type of non-volatile memory that allows for computation directly within memory rather than in separate computing units. RRAM and other emerging memory technologies used as synapse arrays for neuromorphic computing were pioneered in the lab of Philip Wong, Wan’s advisor at Stanford and a main contributor to this work. Computation with RRAM chips is not necessarily new, but generally it leads to a decrease in the accuracy of the computations performed on the chip and a lack of flexibility in the chip’s architecture.
"Compute-in-memory has been common practice in neuromorphic engineering since it was introduced more than 30 years ago,” Cauwenberghs said. “What is new with NeuRRAM is that the extreme efficiency now goes together with great flexibility for diverse AI applications with almost no loss in accuracy over standard digital general-purpose compute platforms."
A carefully crafted methodology was key to the work with multiple levels of “co-optimization” across the abstraction layers of hardware and software, from the design of the chip to its configuration to run various AI tasks. In addition, the team made sure to account for various constraints that span from memory device physics to circuits and network architecture.
“This chip now provides us with a platform to address these problems across the stack from devices and circuits to algorithms,” said Siddharth Joshi, an assistant professor of computer science and engineering at the University of Notre Dame , who started working on the project as a Ph.D. student and postdoctoral researcher in Cauwenberghs lab at UC San Diego.
Chip performance
Researchers measured the chip’s energy efficiency by a measure known as energy-delay product, or EDP. EDP combines both the amount of energy consumed for every operation and the amount of times it takes to complete the operation. By this measure, the NeuRRAM chip achieves 1.6 to 2.3 times lower EDP (lower is better) and 7 to 13 times higher computational density than state-of-the-art chips.
Researchers ran various AI tasks on the chip. It achieved 99% accuracy on a handwritten digit recognition task; 85.7% on an image classification task; and 84.7% on a Google speech command recognition task. In addition, the chip also achieved a 70% reduction in image-reconstruction error on an image-recovery task. These results are comparable to existing digital chips that perform computation under the same bit-precision, but with drastic savings in energy.
Researchers point out that one key contribution of the paper is that all the results featured are obtained directly on the hardware. In many previous works of compute-in-memory chips, AI benchmark results were often obtained partially by software simulation.
Next steps include improving architectures and circuits and scaling the design to more advanced technology nodes. Researchers also plan to tackle other applications, such as spiking neural networks.
“We can do better at the device level, improve circuit design to implement additional features and address diverse applications with our dynamic NeuRRAM platform,” said Rajkumar Kubendran, an assistant professor for the University of Pittsburgh, who started work on the project while a Ph.D. student in Cauwenberghs’ research group at UC San Diego.
In addition, Wan is a founding member of a startup that works on productizing the compute-in-memory technology. “As a researcher and an engineer, my ambition is to bring research innovations from labs into practical use,” Wan said.
New architecture
The key to NeuRRAM’s energy efficiency is an innovative method to sense output in memory. Conventional approaches use voltage as input and measure current as the result. But this leads to the need for more complex and more power hungry circuits. In NeuRRAM, the team engineered a neuron circuit that senses voltage and performs analog-to-digital conversion in an energy efficient manner. This voltage-mode sensing can activate all the rows and all the columns of an RRAM array in a single computing cycle, allowing higher parallelism.
In the NeuRRAM architecture, CMOS neuron circuits are physically interleaved with RRAM weights. It differs from conventional designs where CMOS circuits are typically on the peripheral of RRAM weights.The neuron’s connections with the RRAM array can be configured to serve as either input or output of the neuron. This allows neural network inference in various data flow directions without incurring overheads in area or power consumption. This in turn makes the architecture easier to reconfigure.
To make sure that accuracy of the AI computations can be preserved across various neural network architectures, researchers developed a set of hardware algorithm co-optimization techniques. The techniques were verified on various neural networks including convolutional neural networks, long short-term memory, and restricted Boltzmann machines.
As a neuromorphic AI chip, NeuroRRAM performs parallel distributed processing across 48 neurosynaptic cores. To simultaneously achieve high versatility and high efficiency, NeuRRAM supports data-parallelism by mapping a layer in the neural network model onto multiple cores for parallel inference on multiple data. Also, NeuRRAM offers model-parallelism by mapping different layers of a model onto different cores and performing inference in a pipelined fashion.
An international research team
The work is the result of an international team of researchers.
The UC San Diego team designed the CMOS circuits that implement the neural functions interfacing with the RRAM arrays to support the synaptic functions in the chip’s architecture, for high efficiency and versatility. Wan, working closely with the entire team, implemented the design; characterized the chip; trained the AI models; and executed the experiments. Wan also developed a software toolchain that maps AI applications onto the chip.
The RRAM synapse array and its operating conditions were extensively characterized and optimized at Stanford University.
The RRAM array was fabricated and integrated onto CMOS at Tsinghua University.
The Team at Notre Dame contributed to both the design and architecture of the chip and the subsequent machine learning model design and training.
The research started as part of the National Science Foundation funded Expeditions in Computing project on Visual Cortex on Silicon at Penn State University, with continued funding support from the Office of Naval Research Science of AI program, the Semiconductor Research Corporation and DARPA JUMP program, and Western Digital Corporation.
A compute-in-memory chip based on resistive random-access memory
Weier Wan, Rajkumar Kubendran, Stephen Deiss, Siddharth Joshi, Gert Cauwenberghs, University of California San Diego
Weier Wan, S. Burc Eryilmaz, Priyanka Raina, H-S Philip Wong, Stanford University
Clemens Schaefer, Siddharth Joshi, University of Notre Dame
Rajkumar Kubendran, University of Pittsburgh
Wenqiang Zhang, Dabin Wu, He Qian, Bin Gao, Huaqiang Wu, Tsinghua University
Corresponding authors: Wan, Gao, Joshi, Wu, Wong and Cauwenberghs
CAPTION
A close up of the NeuRRAM chip
CREDIT
David Baillot/University of California San Diego
CAPTION
The NeuRRAM chip uses an innovative architecture that has been co-optimized across the stack.
CREDIT
David Baillot/University of California San Diego
JOURNAL
Nature
METHOD OF RESEARCH
Experimental study
SUBJECT OF RESEARCH
Not applicable
ARTICLE TITLE
A compute-in-memory chip based on resistive random-access memory
ARTICLE PUBLICATION DATE
17-Aug-2022
How environmental changes affect the shapes of RNA in living cells
IMAGE: NEW TECHNOLOGY WHICH IS CAPABLE OF PROFILING RNA STRUCTURE AT THE RESOLUTION OF A SINGLE MOLECULE IN LIVE CELLSview more
CREDIT: JOHN INNES CENTRE
The impact of environmental conditions on the dynamic structures of RNAs in living cells has been revealed by innovative technology developed by researchers at the John Innes Centre.
The research, the result of a collaboration between the groups of Professor Dame Caroline Dean FRS and Dr Yiliang Ding, increases our understanding of what happens at cellular level in response to environmental signals. This raises the possibility that we may use this knowledge to fine-tune crops or develop RNA-based therapies for diseases such as COVID-19 (SARS-COV-2.)
Previous research by these groups showed that two important genetic elements COOLAIR and FLC interplay to regulate plant molecular responses to warm and cold.
But it was unclear how the RNA structure of COOLAIR contributes to the regulation of FLC - a genetic brake on flowering in plants.
Researchers in the Ding group developed a new technology which is capable of profiling RNA structure at the resolution of a single molecule in live cells.
Using this technique allowed them to observe RNA structural changes. In warm conditions COOLAIR RNA adopts three predominant structures and these shapes and proportions changed after the plants were exposed to cold temperatures.
They noticed that changes in RNA conformations in one hyper-variable region of COOLAIR changed FLC expression.
By introducing mutations into the sequence of this RNA region, the researchers were able to alter the flowering time of the plants.
Dr Ding said: “Our work has shown that RNAs can adopt different conformations, or structures. These diverse conformations dynamically change in response to external conditions. In this study by tuning the RNA structure, we altered the flowering time of the plant.”
The understanding of how RNA structure affects RNA function and the ability to engineer plant genomes at the RNA cellular level, increases the possibility of designing crop types with more desirable agronomic and nutritional traits.
The group says that the technology can also be applied to human cells where RNA structures could serve as a guide for designing RNA-based therapies.
First author Dr Pan Zhu said: “Every RNA is likely to have its own RNA structure landscapes and conformational diversities. Our technology will allow us to explore the pervasive functional importance of RNA structures in the RNAs of interest such as SARS-COV-2.”
The group will now look to share their new technology with RNA-based industrial or academic collaborators.
During the process of gene expression DNA is transcribed into RNA which is then used to make proteins. RNA is often referred to as the “skinny molecule” because it is single stranded, but recent work has highlighted its structural diversity and how these structures affect gene regulation and protein synthesis.
In plants FLC acts as a brake on flowering, a key part of a molecular mechanism which ensures the plant only flowers when it has reached a required level of cold exposure. COOLAIR is antisense to FLC, binding to it and blocking it from being transcribed after cold exposure. Knowledge of these mechanisms will be key to understanding the consequences of climate change.
Recently published research out of VCU Massey Cancer Center demonstrated that cancer patients who live in rural areas experience higher mortality rates than nonrural cancer patients, among those receiving radiation treatment. Patients living in rural areas were also more likely to miss their radiation appointments, especially at the beginning of their treatment.
Unfortunately, patients who live in rural areas have a higher mortality rate than those living in nonrural areas. Given that cancer treatment nonadherence is associated with higher rates of cancer recurrence and survival, a team of cancer researchers — led by Bonny Morris, Ph.D., RN, — set out to see if geographic differences in nonadherence could be contributing to the higher cancer mortality rate observed among rural residents. Nonadherence is classified as missing a treatment appointment. The researchers examined medical records data from 3,000 cancer patients to assess how nonadherence to radiation treatment and overall survival were impacted by characteristics like where a person lives, their age, race and other social and clinical factors.
The study found that rural residence was associated with both radiation treatment nonadherence and poorer overall survival. Rural patients with a treatment delay had the lowest overall survival, compared to both nonrural survivors and rural survivors without delay.
“Not receiving the prescribed radiation treatment plan impacted patients’ chance of survival, especially for patients living in rural areas who miss treatments at the beginning of their treatment course,” Morris said. “The two-year survival rate was 76% for nonrural residents who did not experience a treatment delay versus 27% for rural residents who experienced a treatment delay. The health care system can play an important role, and I would say has an ethical responsibility, to reduce, and better yet, eliminate these disparities through targeted support programs like patient navigation.”
Study co-author Bernard Fuemmeler, Ph.D., M.P.H., associate director for population sciences and Gordon D. Ginder, M.D., Chair in Cancer Research at VCU Massey Cancer Center, said the findings reinforce the cancer center’s mission to promote health equity by understanding the gaps in cancer care and care delivery to better serve the community. Massey’s catchment area consists of 66 counties and cities, spanning a variety of rural and nonrural communities in the eastern, central and southern portions of Virginia.
“Our data stress the importance for cancer centers across the country with similar catchment areas to identify and attend to the needs of the rural populations they serve,” Fuemmeler said.
Along with rural residents, the research showed that widowed patients, advanced stage cancer patients and lung cancer patients were more likely to be nonadherent to radiation therapy. The study authors suggest that radiation treatment programs should consider implementing nonadherence risk assessments to understand access barriers for each patient based on a multitude of factors, including geographic residence, marital and employment status, cancer type, disease stage and treatment delay. Additionally, they suggest that services such as patient navigation and referrals to social work or financial counselors should be routinely offered to support treatment adherence, particularly for rural patients who are delayed in starting radiation.
Morris reports that her background as someone who grew up in a rural area as well as her clinical background as an oncology nurse helped her to design this study. While a doctoral student at the VCU School of Medicine, she was awarded an F99/K00 fellow award through the National Cancer Institute (F99CA245799), which is a predoctoral-postdoctoral transition award that funded the present study. She is now a postdoctoral fellow at Wake Forest University School of Medicine and in the K00 phase of this award, which will allow her to further her research on how to improve adherence among rural patient populations (K00.
Collaborators on this study include Emma Fields, M.D., and Roy Sabo, Ph.D., members of the Developmental Therapeutics research program at Massey; and Ryan Hughes, M.D., radiation oncologist, and Kathryn Weaver, Ph.D., in the Department of Social Sciences and Health Policy at Wake Forest University School of Medicine. This study was also supported by the VCU Massey Cancer Center Biostatistical Shared Resource, and, in part, with funding from NIH-NCI Cancer Center Support Grant (P30 CA016059).
JOURNAL
International Journal of Radiation Oncology*Biology*Physics
Sociodemographic and Clinical Factors Associated with Radiation Treatment Nonadherence and Survival among Rural and Nonrural Cancer Patients
FOR PROFIT HEALTHCARE U$A
Current insurer calculation of qualified payment amount for out-of-network (OON) care may violate No Surprises Act
Skewing data when calculating key rate for OON care weakens community anesthesiology, emergency and radiology practices, and can be used to narrow provider networks and reduce patient access to care
CHICAGO – In possible violation of the No Surprises Act, health insurance company calculations of Qualified Payment Amounts (QPA) for anesthesiology, emergency medicine and radiology services (and possibly other specialty services) likely include rates from primary care provider (PCP) contracts. A new study conducted by Avalere Health and commissioned by three national physician organizations examined a subpopulation of PCPs and determined that contracting practices may directly impact the QPA.
Despite the law’s directive that QPA calculation be based on payment data from the “same or similar specialty” in the same geographic region, insurers may be calculating median in-network rates for specialty services using PCP contracted rates for services that were never negotiated, may never be provided by those physicians and may never be paid. This method may violate the law and produce insurer-calculated QPAs that do not represent typical payments for these services.
Insurers have already attempted to use the new law to raise profits by artificially lowering the QPA. Further, they have cancelled contracts of providers who declined large reimbursement cuts. Using such erroneous data in QPA calculation may further narrow medical networks, deny patients their choice of providers and could delay diagnosis and treatment of illness and injury.
“This new research raises significant questions about the accuracy of insurer calculated QPAs,” said American Society of Anesthesiologists (ASA) President Randall M. Clark, M.D., FASA. “We have received reports of extremely low QPAs that bear absolutely no resemblance to actual in-network rates in the geographic area; yet these same rates are being used by insurers as their initial payment.”
In the study, 75 primary care practice employees who have a role in contracting with insurers were surveyed regarding whether they contract with insurers for services they rarely or never provide, as well as negotiation practices related to these services. The survey found that 68% of respondents had services that they rarely provide (fewer than twice a year) included in their contracts, and 57% of respondents had services that they never provide included in their contract.
Congress debated including a benchmark for determining payment rates for out-of-network providers in the No Surprises Act but decided not to dictate a specific rate. Such a rate, Congress argued, could not adequately reflect the different specialties and regions care is provided in across the country. Instead, the law directed insurance companies to calculate their own QPAs and directed independent arbiters to take these QPAs into consideration when settling payment disputes. The QPA is intended to reflect a health insurer’s median contracted rate to providers based on the region in which they practice and for providers in the “same or similar specialty.”
Unfortunately, insurance companies may be incorporating contracted rates for services like those included in the PCP contracts that will never be provided by those physicians and for which insurers will never pay. Additionally, the inclusion of rates not actively negotiated by such providers will likely artificially lower the QPA, effectively reducing payments for the anesthesiologists, emergency physicians and radiologists, who actually do provide those services.
“On behalf of our all our members, the American College of Emergency Physicians (ACEP), the American College of Radiology® (ACR®) and ASA call on policymakers to eliminate the QPA as the sole/primary factor in arbitration and ensure the integrity of the QPA, by insisting they be calculated based on “same or similar specialty” in network rates, thus mitigating the unintended consequences of relying on health insurers’ median in-network rates based partially on data from providers who don’t actively negotiate those rates,” said Gillian Schmitz, M.D., FACEP, president of ACEP. “Physicians rely on fair reimbursement to keep their doors open and continue providing lifesaving medical care to their patients.”
“This study demonstrates yet another reason why policymakers cannot make the QPA the primary factor in such arbitration nor base important regulations solely on insurer-produced and defined data,” said Jacqueline Bello, M.D., FACR, Chair of the American College of Radiology Board of Chancellors. “Decisionmakers should work with healthcare providers and insurers to consider relevant and verifiable data, ensure that patients have adequate provider networks, and protect access to care by ensuring sensible, sustainable reimbursement.”
About the American Society of Anesthesiologists Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 55,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.
For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/madeforthismoment. Like ASA on Facebook and follow ASALifeline on Twitter.
About the American College of Emergency Physicians The American College of Emergency Physicians (ACEP) is the national medical society representing emergency medicine. Through continuing education, research, public education, and advocacy, ACEP advances emergency care on behalf of its 40,000 emergency physician members, and the more than 150 million Americans they treat on an annual basis. For more information, visit http://www.acep.org and www.emergencyphysicians.org.
About the American College of Radiology The American College of Radiology (ACR), founded in 1924, is a professional medical society dedicated to serving patients and society by empowering radiology professionals to advance the practice, science and professions of radiological care.
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MY BREAKFAST FOR THIRTY YEARS
Coffee and cigarettes: Research sheds new light on nicotine and morning brew
For some smokers, the first cigarette of the day is just not as satisfying without a cup of coffee. That could be more than just a morning habit: Chemical compounds in roasted coffee beans may help lighten the effects of morning nicotine cravings, University of Florida researchers have found.
In a cell-based study, the researchers identified two compounds in coffee that directly affect certain high-sensitivity nicotine receptors in the brain. In smokers, these brain receptors can be hypersensitive after a night of nicotine withdrawal.
The recently published findings have yet to be tested in humans but are an important step toward better understanding how coffee and cigarettes affect nicotine receptors in the brain, said Roger L. Papke, Ph.D., a pharmacology professor in the UF College of Medicine. Caffeine is coffee’s feel-good ingredient for most people but smokers may get another kind of boost.
“Many people like caffeine in the morning but there are other molecules in coffee that may explain why cigarette smokers want their coffee,” Papke said.
The researchers applied a dark-roasted coffee solution to cells that express a particular human nicotine receptor. An organic chemical compound in coffee may help restore the nicotine receptor dysfunction that leads to nicotine cravings in smokers, the researchers concluded.
The findings have led Papke to a broader hypothesis: One of the compounds in brewed coffee, known as n-MP, may help to quell morning nicotine cravings.
Papke said he was intrigued by the idea that nicotine-dependent smokers associate tobacco use with coffee in the morning and alcohol in the evening. While alcohol’s effect on nicotine receptors in the brain has been thoroughly researched, the receptors’ interaction with coffee has been studied less.
“Many people look for coffee in the morning because of the caffeine. But was the coffee doing anything else to smokers? We wanted to know if there were other things in coffee that were affecting the brain’s nicotine receptors,” Papke said.
The findings, he said, provide a good foundation for behavioral scientists who could further study nicotine withdrawal in animal models.
Funding for the research was provided by the National Institutes of Health.
While volunteering at an Indian orphanage in 1984, Dr. David Buck found his passion for helping those most in need during an encounter with the greatest humanitarian in human history – Mother Teresa. That unforgettable experience put him on a decades-long path to reshaping how communities care for the underserved.
“Mother Teresa asked us ‘Who among you wants to change the world?’” recalled Buck. “Internally I was screaming ‘Me, I do!’”
But Buck, now a professor and associate dean for community health at the University of Houston Tilman J. Fertitta Family College of Medicine, didn’t raise his hand.
“She said ‘For all of you who want to do that, there’s the door. Our task is much greater. Our task is to love one person at a time,’” he said. “So, I came back to the U.S. and knew I wanted to make a difference here at home.”
Buck recently reflected on his nearly 40 years of tackling the homelessness epidemic, repairing a fragmented aid industry, and challenging the status quo in medicine in a first-person account published in the Journal of Social Distress and Homelessness.
Early in his career, just after returning from that life-changing experience with Mother Teresa, Buck volunteered with Houston Catholic Worker House where he learned the biggest problem facing the homeless was access to health care. Not long after, he established two free health clinics and a dental clinic, but soon realized the root problem wasn’t just access. Instead, it was a lack of integration of all the services they needed.
“There was no system of care, from primary care to subspecialty care, health care to housing, food, even identification cards to transportation. Homelessness is like a prison of these catastrophic failures at every level. Education, employment, the judicial system. It goes on and on,” said Buck, noting that there are hundreds of non-profits but no financial incentives for one service industry to work with others like housing, transportation or employment.
Recognizing what he calls a “profound lack of leadership,” Buck founded Healthcare for the Homeless Houston in 1999 to promote health, hope and dignity for those affected by homelessness through accessible and comprehensive quality care. His vision was to provide pathways for moving beyond the cycle of homelessness through integrated care and collaborative partnerships and eliminate those obstructive service silos.
“You have to go to the place that does housing, but you don’t have transportation,” he said. “You have to get I.D., but that’s a different Texas agency. You have psychiatry here, but not at your primary care doctor, and then you have to go somewhere else for your meds. It’s this endless cycle.”
To further the mission, Buck founded another non-profit, the Patient Care Intervention Center (PCIC), and partnered with United Way, among others, to build a coordinated health safety-net where stakeholders share and integrate social and medical data to help make better decisions.
In the journal article, Buck suggests three strategies that need to be adopted across the health care system to more effectively treat homeless individuals and improve health outcomes:
Challenge funders at all levels
Philanthropic institutions, the private sector, local, national, and international public grant agencies must implement financing strategies that incentivize and reward collaboration among service organizations.
Resist the temptation to add new non-profits
Further proliferation of non-profit organizations will only serve to further fragment care. Instead, regardless of whether the financial incentives are there or not, reach across the aisle and build meaningful coalitions with existing players.
Change starts from within
Reform professional culture to reward practices that are proven to improve key outcomes.
When asked how it’s possible to build a primary care system that is responsive to the needs of the homeless, Buck suggested providing care based on values rather than problems. It’s a strategy based on cognitive behavioral therapy that can lead to health behavior changes.
“Imagine your typical doctor’s appointment: “Hi Mr. Patient, nice to see you today for your hypertension, obesity, substance use, your mental illness, oh and did I mention your obesity?” As I go on with that statement, you become less and less motivated for the behavior change that could improve your health. Now compare that to a values-based approach. Who and what is most important to you? And then you derive goals from that,” he said in the journal interview with article authors Nicholas Peoples and Mary Fang, both medical students at Baylor College of Medicine.
Buck said challenging the status quo is what brought him into academic administration. The Fertitta Family College of Medicine was founded in 2019 on a distinct social mission to improve health and health care in underserved urban and rural communities where poor health outcomes are often more prevalent. Buck is part of the team educating medical students on how to provide compassionate, high-value care (high quality at reasonable cost), with a focus on primary care and other needed physician specialties.
In September, Fertitta Family College of Medicine students for the first time will join students from Baylor and UT medical schools in working at the HOMES (Houston Outreach Medicine, Education and Social Services) Clinic at Healthcare for the Homeless, one of the first student-run medical clinics in the country and the only one in Houston, and the first one at a Federally Qualified Health Center (FQHC).
“We know what’s wrong, and now we have the tools to fix it,” he said.
His vision goes back to that day nearly 40 years ago when Mother Teresa gave him the inspiration for what has become his life’s work. But that work is far from finished, and now he’s hoping that inspiration is passed along to his students.
“We need the next generation of doctors to implement new approaches to improve the quality of care, and that’s part of our focus at UH.”
Healing the homelessness, fixing a broken aid industry, and challenging the status quo: perspectives of a physician-activist
Attitudes toward mandatory COVID-19 vaccination in Germany
DEUTSCHES AERZTEBLATT INTERNATIONAL
COLOGNE. It has become obvious that sufficiently high immunity to COVID-19 cannot be achieved in Germany through voluntary vaccination alone. On this background, Thomas Rieger and Carsten Schröder from the German Institute for Economic Research, Berlin, together with Christoph Schmidt-Petri from the Karlsruhe Institute of Technology, investigated the acceptance of a policy of general mandatory vaccination against COVID-19. The scientists also investigated the questions of which population groups are supportive of such a measure, which ones are opposed, and what their reasons are, respectively (Rieger T, Schmidt-Petri C, Schröder C: Attitudes toward mandatory COVID-19 vaccination in Germany—a representative analysis of data from the Socio-Economic Panel for the year 2021. Dtsch Arztebl Int 2022; 119: 335–41).
The authors used for their analysis representative data from the Socio-Economic Panel (SOEP). The SOEP consists of a random sample from the population resident in Germany, whose members participate in annual surveys. Because of the far-reaching consequences of the COVID-19 pandemic, the SOEP 2021 was enhanced by including a new COVID-19 survey module. In the time period from January through December 2021, 17,132 participants were interviewed regarding their attitudes regarding a policy of general mandatory vaccination against COVID-19. Furthermore, data were collected on participants’ sociodemographic characteristics, health, political attitudes, and trust in the legal and political systems. The authors used univariate, bivariate, and multivariate statistical analyses to evaluate these data.
They found that a slight majority of survey participants were supportive of mandatory general vaccination against COVID-19. The primary reason given was the attitude that otherwise, not enough people would undergo vaccination. The most important reason given by those opposed to mandatory vaccination was the desire for individual freedom of choice. The group of supporters were older, fewer of them had received tertiary education, they were less healthy, tended to have no children, had centrist political orientations, and had more trust in politics. These differences were, however, not terribly pronounced compared with the group of opponents of mandatory vaccination. The biggest difference actually consisted in the fact that notably more supporters were vaccinated against COVID-19 than opponents (90% versus 60%).
In the authors’ view, future analyses should investigate the question of how attitudes towards mandatory COVID-19 vaccination change over time and can be influenced. In this context, in addition to whether or not mandatory vaccination is introduced in Germany, it is likely to play a role how this would be implemented in detail.
