OPINION
Health Record Systems Affects Care
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Synapse The UCSF Student Newspaper
Thursday, Feburary 27, 2014
synapse.ucsf.edu
Volume 58, Number 21
NEWS
All Smiles at Give Kids a Smile Day By Edmundo Abasolo Contributing Writer
By Jordan Mar Contributing Writer
C
Photo by Triet Vuong/D3 Second-year dental student Christie Duong works with a young patient.
Goodman (D3) and Emily Wineland (D3). This year’s coordinators worked hard to ensure that children not only received necessary dental care, but also took away oral health awareness and preventative care measures, all in a fun and engaging environment.
In addition to dental goodie bags, youngsters received toys and prizes for partaking in educational games. Perhaps a major highlight for kids were the balloon sculptures handcrafted by local balloon artists. This event was cru-
SMILE DAY » PAGE 7
OPINION
A Letter From the New Interim GSA President
D
MIND Your Career UCSF's new plan for building a better biomedical workforce
D
espite the rain, it was all smiles at UCSF Dentistry’s jungle-themed Give Kids a Smile Day 2014. Through the efforts of our volunteers, which included student dentists, pre-dental students, faculty and staff, children from all over the Bay Area received dental care and oral health education free of charge. The annual event attracted 121 children from San Francisco and the surrounding area. Services provided by volunteers included oral health screenings, prophylaxis/coronal polishing, sealant placement and fluoride varnish. The Division of Pediatric Dentistry residents, faculty and alumni helped student providers perform exams, formulate treatment plans and provide care throughout the day. These services would not have been possible without the generous donations of dental supplies from Henry Schein, Patterson Dental, GSK, Crest, Oral-B and Colgate, among others. Additionally, a range of other health screenings and nutrition/lifestyle activities were provided by the Schweitzer Fellows from Bay Area health professions programs, including UCSF Dentistry’s Jolie
NEWS
ear Graduate Students’ Association (GSA) members, At the February 2014 GSA Board Meeting, your GSA representatives, consisting of graduate, nursing and physical therapy students, approved my appointment as interim president of GSA, taking over for Joseph Foy, who stepped down as president due to taking a leave of absence from UCSF. I believe my multi-year experience in GSA and my experiences as a DDS/PhD student will help me in my new role as interim GSA president, a role where I aim to continue the work of my predecessor for the current academic year. By now, you should be aware that GSA is in a transitional phase, due to the approval of the New Student Government Referendum by the UCSF student body in January 2014 (visit gpsa.ucsf.edu for more information). As a result, the responsibilities entrusted to GSA by graduate, nursing and physical therapy students will now be redistributed throughout a new structure that aims to better serve you. My main goal is to work with the student leaders of Associated Students of UCSF (ASUC) to ensure that the aspects that made GSA strong will continue within the new Graduate and Professional Students’ Association (GPSA), and the academic student governments of Associated Students of Graduate Division, Associated Students of School of Nursing (formerly Nursing Student Council), and Associated Students of Physical Therapy. Although establishing the new student government structure is a large endeavor, it is not the only thing GSA has been working on this academic year:
Housing – working with the Graduate Division to provide a student-moderated listServ that students can use to find housing opportunities. Insurance Premiums – working with Student Health to minimize increases in premiums and provide resources about how the Affordable Care Act affects UCSF students going forward now that the insurance exchanges are available. Conference Travel – developing a fair solution to maximize the number of awards we can provide to our members to attend conferences that might otherwise be cost prohibitive. Community Building – partnering with ASUC to host monthly events, such as the All School Formal and Game Nights, as well as partnering with Registered Campus Organizations (RCOs) to build camaraderie throughout the student body. While these are just a few of the issues, I will make sure these and any other active issues GSA is working on will not be lost during the transition to the new student government structure. In closing, I encourage all graduate, nursing and physical therapy students to attend the monthly GSA meetings to learn more about the issues and provide your input. If you are unable to make the meetings, please visit gsa.ucsf.edu to learn more about GSA, or to contact us with any issues or opinions you may have. Sincerely, Michael Le Graduate Students’ Association Interim President
areer development. It’s a phrase that is slowly gaining mass in the realm of biomedical sciences. Prior to the summer of 2012, when the NIH released its report on the biomedical workforce, the concept of career development whispered through the halls of UCSF; frequently heard by some, rarely listened to by many. It is still common to hear graduate students and postdocs lamenting their vague future, unsure where they’ll be after their training is complete. Recent reports by both the NIH and the Graduate Division at UCSF found that nearly half of all biomedical graduate students leave academia after completing their training. Only half of those remaining in academia obtain tenure track positions. This supports the fact that a growing number of PhDs are pursuing careers other than that of academic research, but how are these PhDs finding these career paths? In a system built to develop great thinkers, assumed to fill the ranks of academic research, where can one find the necessary time, resources and support to become informed about these (no longer) “alternative” career options? At UCSF, a new program aimed at changing the culture of career development at both an individual and institutional level is on the horizon. Last year, UCSF received a grant from the NIH Broadening Experiences in Scientific Training for their proposal “Motivating Informed Decisions (MIND): Careers For The Future Biomedical Workforce.” This proposal, authored by Dr. Keith Yamamoto, Dr. Theresa O’Brien, Bill Lindstaedt and Dr. Jennie Dorman, hopes to improve the career development of trainees by increasing individual awareness and knowledge of the variety of careers available, helping trainees develop the skills and network they need to pursue their chosen career, and building an environment at UCSF that is supportive of all career paths. In general, most trainees are aware of their
MIND YOUR CAREER » PAGE 5
2 | February 27, 2014 | synapse.ucsf.edu
EVENTS MISSION BAY EVENTS FOOD TRUCK THURSDAYS AT MISSION BAY
Thursday, Feb. 27, 11 a.m.-2 p.m., 4th Street & Nelson Rising Lane, Mission Bay Join the food truck lunch party every Thursday at Mission Bay and explore the tasty culinary options to break up your routine. Each week will feature two different vendors, so there will always be something new. Grab some friends, get some food, and take your lunch experience up a notch.
TAX WORKSHOP FOR STUDENTS AND SCHOLARS ON STIPENDS
Thursday, Feb. 27, 3-4 p.m., Genentech Hall, N114, Mission Bay John Barrett, tax manager for the UC Office of the President, and a member of his staff will provide tax-related information specifically for postdocs and students who are paid a stipend. Because no taxes are withheld from stipends, postdoc fellows and postdoc paiddirects may be particularly interested in this workshop; however, all postdocs and students are welcome to participate. Sponsors: Graduate Division and Postdoc Office.
SYNAPSE NEWSPAPER
Friday, Feb. 28, noon-1 p.m., Graduate Division, CC-310, Mission Bay Synapse is looking for student writers, bloggers, photographers and designers. Come to the lunch meeting, share your story ideas and enjoy a free lunch. For more information, email synapse@ucsf.edu.
MUSLIM FRIDAY PRAYER SERVICES
Friday, Feb. 28, 1-2 p.m., Byers Hall, 211, Mission Bay The Muslim Community at UCSF holds regular Friday prayer services (Jum’a) for the UCSF Muslim community every week. Come join your fellow brothers and sisters for prayer, lunch and socializing. All are welcome.
MISSION BAY RIPS
Friday, Feb. 28, 4-5 p.m., Genentech Hall Auditorium, Mission Bay Research In Progress Seminar is a seminar series at which one student and one postdoc present their current research. Talks are 15 minutes in length and are preceded by a 20-minute social. Snacks and beverages are provided.
BAGEL TUESDAY
Tuesday, March 4, 8:30 a.m., Student Lounge, Genentech Hall, Mission Bay Come enjoy some free bagels, pastries and coffee. Learn about campus services and events and build a community at Mission Bay. Open to Students and Postdocs.
UCSF CAMPUS STORE ONSITE SALE
Wednesday, March 5, 11 a.m.-2 p.m., Genentech Hall Atrium, Mission Bay Take advantage of the convenience of shopping in person at the pop-up stores. The UCSF Online Campus Store comes to Parnassus and Mission Bay. Get your hands on the clothing, accessories, mugs, and other UCSF collectible items. campuslifeservices. ucsf.edu/retail/21/the_campus_store_ comes_to_you#sthash.u6edV8pg.dpuf.
VOCAL CHORDS A CAPPELLA SPRING CONCERT Wednesday, March 5, 7:30-9 p.m.,
Genentech Hall Auditorium, Mission Bay Join Vocal Chords for an exciting evening of UCSF's a cappella group singing jazz and contemporary pop hits, with opening acts by the Chamber Music Society. Free food and drinks. Sponsors: UCSF Arts & Events and Performing Arts Fund.
PARNASSUS EVENTS PROJECT HEALTHY HEART LUNCH TALK
Thursday, Feb. 27, noon-1 p.m., Health Sciences West, 303, Parnassus Project Healthy Heart will be hosting a lunch talk to raise awareness for heart health during the American Heart Month of February. Dr. Rebecca Leon will give a presentation on the detection, management and prevention of heart attack and stroke. Dr. Leon is an assistant clinical professor at UCSF and a clinical pharmacist at Kaiser Permanente.
BLACK HISTORY MONTH CELEBRATION
Thursday, Feb. 27, 6-8 p.m., Cole Hall, Parnassus The Black Student Health Alliance and the Student National Medical Association will celebrate black history and culture with performances and guest speakers. Light refreshments will be provided.
PET A PUP AT DOG DAY FRIDAYS
Friday, Feb. 28, noon-2 p.m., Millberry Union, 111W, Parnassus There will be a pup every Friday in February, so don’t miss out. Take time to de-stress with Gilligan, a Pitbull Lab, from Animal Assisted Therapy of SPCA. Enjoy some tea or hot chocolate, and leave your stress at the door.
MUSLIM FRIDAY PRAYER SERVICES
Friday, Feb. 28, 12:30-1 p.m., Medical Sciences, 168, Parnassus The Muslim Community at UCSF holds regular Friday prayer services (Jum’a) for the UCSF Muslim community every week. Come join your fellow brothers and sisters for prayer, lunch and socializing.
CAMPUS EVANGELISTIC FELLOWSHIP
Friday, Feb. 28, 7-10:30 p.m., Nursing, 517, Parnassus Join the Campus Evangelistic Fellowship for its weekly meeting, with Bible study, hymn singing and fellowship.
ASUC MEETING: DENTISTRY, MEDICINE & PHARMACY STUDENTS
Monday, March 3, 5:30 p.m., Library, CL221, Parnassus Meet your executive board members at the monthly ASUC meeting and be a part of the discussion on topics relating to student priorities. Visit the ASUC website for more details and to RSVP. http://bit.ly/ ASUCwebsite
UCSF CAMPUS STORE ONSITE SALE
Tuesday, March 4, 11 a.m.-2 p.m., Nursing Café, Parnassus Take advantage of the convenience of shopping in person at the pop-up stores. The UCSF Online Campus Store comes to Parnassus and Mission Bay. Get your hands on the clothing, accessories, mugs, and other UCSF collectible items. campuslifeservices. ucsf.edu/retail/21/the_campus_store_ comes_to_you#sthash.u6edV8pg.dpuf.
7TH ANNUAL CHANCELLOR'S LEADERSHIP PANEL ON DIVERSITY & INCLUSION
Tuesday, March 4, noon-1:30 p.m., Cole Hall, Parnassus An opportunity for the MedCenter and campus community to hear from key senior leadership on diversity initiatives at UCSF. The Panel will be livestreamed. lecture.ucsf. edu/special-events/diversity-panel-2014/.
BAGEL WEDNESDAY
Wednesday, March 5, 9:45 a.m., Nursing Mezzanine, Parnassus Come enjoy some free bagels, pastries and coffee. Learn about campus services and events and build a community at Parnassus.
PARNASSUS FARMERS’ MARKET
Wednesday, March 5, 10 a.m.-3 p.m., ACC, 400 Parnassus Ave. Shop the Farmers’ Markets on Wednesdays to pick up locally grown produce and more. Sponsor: Pacific Coast Farmers’ Market Association.
SYNAPSE NEWSPAPER
Wednesday, March 5, noon-1 p.m., Millberry Union 123W, Parnassus Synapse is looking for Mission Bay and Parnassus writers, bloggers, photographers and designers. Come to the lunch meeting, share your story ideas and enjoy a free lunch. Email for more information and to RSVP: synapse@ucsf.edu.
IMN MIDWEEK MEDITATION HOUR
Wednesday, March 5, 5:30-6:30 p.m., Library, CL 211, Parnassus The Integrative Medicine Network invites everyone in the UCSF community to experience a weekly guided meditation. All are welcome, whether you are looking to combat day-to-day stress using meditation or you'd like to uncover subtle layers of your self by diving deep. No experience in meditation is necessary. Both regular meditators as well as amateurs are welcome.
UCSF RUN CLUB
Wednesday, March 5, 5:30-6:30 p.m., Millberry Union Central Desk, Parnassus Please drop by and join UCSF Fit & Rec for a run. Each Wednesday night, the Run Club runs various distances (from 3-6 miles) at 9 to 11 minutes per mile.
ENGLISH CORNER
Wednesday, March 5, 6-8:30 p.m., Clinical Sciences, 130, Parnassus English Corner is an informal conversational English class given as a free community service and provided on a voluntary basis by both people born and raised in the United States as well as many people who have, at one time in their lives, experienced life as a new immigrant to the United States.
OFF-CAMPUS OFF THE GRID: UPPER HAIGHT
Thursday, Feb. 27, 5-9 p.m., Stanyan and Waller Streets, SF Off the Grid is a roaming mobile food extravaganza that travels to different locations daily to serve delicious food, with a free side of amazing music, craft and soul.
CALIFORNIA ACADEMY OF SCIENCES: DARK UNIVERSE NIGHTLIFE
Thursday, Feb. 27, 6-10 p.m., Cal Academy, Golden Gate Park Celebrate what we don’t yet know about our ever-expanding Universe. In the planetarium, catch Dark Universe, a cosmic voyage that explores the mysteries of dark energy and dark matter. Join SETI Institute senior astronomer Seth Shostak as he breaks down the astronomical world of unknowns
and hear how the concept of the unknown influences the groundbreaking work of interdisciplinary artist and Guggenheim Fellow Charles Lindsay, SETI’s first Artistin-Residence. At the Project Lab, learn about the Academy’s efforts to explore little-known hotspots around the world—from the deep sea to the sweltering badlands of Africa, and remote places in between.
ANNOUNCEMENTS UCSF INTRAMURALS LEAGUE REGISTRATION MARCH 1-14, 2014
Open Registration for UCSF Intramurals begin on March 1. League begins the week of March 31. Leagues are included in RecPass. www.recsports.ucsf.edu
CORPORATIONS, CONSUMPTIONS, AND PROTECTING PUBLIC HEALTH
Wednesday, March 19, 4-6 p.m., 3333 California St, 263, Laurel Heights The UCSF School of Nursing invites you to a panel discussion and to celebrate the book release of Lethal but Legal by Nicholas Freudenberg, Professor of Public Health at City University of New York (CUNY). Panel includes Dr. Ruth Malone, UCSF, Michele Simon, EatDrinkPolitics, Dr. Lori Dorfman, Berkeley Media Studies Group, and Nicholas Freudenberg, CUNY. Space is limited. RSVP mike.henseler@nursing.ucsf.edu.
UCSF SOFTBALL TOURNAMENT: REGISTRATION DEADLINE MARCH 14
Saturday, April 12, 11 a.m.-5 p.m., Moscone Playground, SF Spend a weekend playing softball with friends and others from the UCSF community during this two-day softball tournament. Equipment such as softballs, bats and helmets are provided. www.recsports.ucsf.edu
PITCH COUNSELOR SUMMER OPPORTUNITY – STIPEND AVAILABLE
No summer plans and love working with high school students? Apply to be a PITCH Counselor and expose high school students to healthcare careers and create hands-on clinical skills activities and GET PAID! Must be able to commit to entire summer program: July 7-25, Monday-Friday, 8:30 a.m.-4 p.m. at Parnassus. Email resume and completed application to: Anthea K. Lim, EAOP and PITCH (anthea.lim@ucsf.edu). Learn more at https://cep.ucsf.edu/student-programs/ career-exploration-education-healthsciences/pitch.
DIRECTING CHANGE STUDENT VIDEO CONTEST: SUBMISSION DEADLINE MARCH 1
Submit a 60-second video addressing Suicide Prevention or Ending the Silence of Mental Illness. Winner will receive $500. This contest is part of statewide efforts to prevent suicide, reduce stigma and discrimination related to mental illness, and to promote the mental health and wellness of students. For more info, go here: http://bit.ly/1dQJcyJ.
UCSA STUDENT LOBBY CONFERENCE
April 5-7, Sacramento, CA Join fellow UC students in speaking with state legislators at the State Capitol about legislation related to higher education issues. Never done it before? No problem! The weekend is full of workshops devoted to showing you how. All reasonable costs will be reimbursed by ASUC & GSA. Learn more: ucsa.org/our-work/ucsa-conferences/ slc/. Registration is required, so please sign up in advance with Christoph Hanssmann. Register: Christoph.Hanssmann@ucsf.edu.
synapse.ucsf.edu | February 27, 2014 | 3
OPINION
Health Record Systems Affect Patient Care By Akshay Govind Associate Editor
I
started a rotation at San Francisco General Hospital at the beginning of February—my first one there since the summer of 2011. I had been avoiding the county hospital mostly because of the inconvenience of commuting to Potrero Hill from my home in the Outer Sunset, but maybe there was a part of me that had been eluding SFGH because of the constant feeling of inadequacy that comes from trying to provide quality care from within a clumsy healthcare system that seems so implausible in the year 2014. To summarize record keeping there, progress notes and consultations are done either on paper or are dictated and transcribed a day or two later. Some people put new paper notes at the front of a chart, some at the back. Penmanship varies. The chart itself may be on its appropriate rack or it may be floating around with someone on the floor. The emergency department, the intensive care unit, standard hospital wings and radiology images are all on different computer systems that don’t share log in information, and there are a host of other special sheets that may or may not need to be filled out depending on whether an order originated from the computer entry system or a printed out set of orders during a patient transfer. I find the five short beeps setting on my pagers to be the least annoying setting I can count on to wake me up. At 12:42 a.m. I find out the acute care ward is not able to administer insulin to my diabetic patient because I had initialed to continue the insulin order from when she was in the intensive care unit, rather than rewriting the order from scratch. If you were planning on getting to the hospital by 6 a.m., would you drive in right now to fix the order? Would that depend on the nurse’s description of how the patient was doing clinically? Should it? Our oral surgery clinic functions on a collection of loose-leaf papers stuffed into a folder. Each page has the patient’s information and a date on it, and one copy will eventually be added to their full medical record in chronological order. In real time however, in this patient population that is already com-
Synapse
With many patients seeking care both at UCSF and at SFGH, it only makes sense that they should be on the same health record system, argues the author.
plicated for medical and/or social reasons, the arduous process of combing through the pages to find out what patients actually need has almost certainly contributed to errors occurring. Add to this the fact that just a couple clinicians and a handful of students are treating dozens of patients, the vast majority of whom are miserable and moaning from their pain, and it can be difficult to keep one’s head on straight every moment of the day. The hospital has tried to address the error-prone processes, but this often is done by adding forms and protocols to an already piecemeal system, perhaps addressing one problem but often creating another. At UCSF’s Parnassus campus, the rollout of Epic/APEX (a unified electronic health record) was not without complication. It took me over two hours to discharge my first patient in the summer of 2012. I’m sure there have been more logistical hang-ups than I could ever know, but I support the dedication to the concept that a hospital should use a single system that is complex enough to meet the needs of its various users and intuitive enough to facilitate its use. I know I’m much more likely to look through everyone’s daily notes, scroll through
500 Parnassus Ave. Millberry Union 108W San Francisco, CA 94143 tel: (415) 476-2211 | fax: (415) 502-4537 synapse@ucsf.edu
The UCSF Student Newspaper synapse.ucsf.edu STAFF
Yi Lu | EDITOR Jenny Qi | EXECUTIVE EDITOR Angela Castanieto | ASSOCIATE EDITOR Akshay Govind | ASSOCIATE EDITOR Steven Chin | MANAGING EDITOR
About
Synapse is the UCSF student-run weekly newspaper, which runs on Thursdays during the academic year and monthly during the summer. Synapse seeks to serve as a forum for the campus community. Articles and columns represent the views of the authors and not necessarily those of the Board of Publications or the University of California.
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Announcements and letters should be submitted six days before publication. All submissions can be either emailed or mailed. All material is subject to editing. Letters to the Editor must be signed by the author.
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Paid advertisements do not necessarily reflect the views of Synapse. Synapse and its editorial board reserve the right to decline advertisements promoting false or misleading claims, known health risks, or content deemed by the editors to be antithetical to the interests of UCSF students or the UCSF community. Synapse does not accept advertisements from tobacco or alcohol manufacturers, or sexually oriented personal ads. Synapse reserves the right to run any ad with a disclaimer.
every image, and think harder about what I write when it’s all in the same place. Further, as many patients seek care both at UCSF and at SFGH, it only makes sense that they should be on the same system. So what has held us back? I challenge anyone to say it has been anything other than the cost of the upgrade. Someone crunching some numbers has done an analysis that shows that the errors made in the clumsy system are able to be cleaned up for less additional money than the cost of changing everything to the system that would lead to fewer errors in the first place. The hardworking clinicians and staff at SFGH toil furiously to provide appropriate care to the patients in front of them, but as long as they avoid disasters, a diligent bean counter doing his/her job properly would never be able to justify buying the new system. I hope that during my training here at UCSF, the intrinsic value of smoother care will be quantified in such a way as to help SFGH make the technological leap into the 21st century that the rest of UCSF hospitals have made successfully.
Akshay Govind is a third-year resident in the Department of Oral and Maxillofacial Surgery.
NEWS
Health Forum Promotes Better Healthcare for LGBTQI Community By Brian Shaw Staff Writer
T
hrough lively discussions and films, moving speeches and patient panels, the UCSF LGBTQI Health Forum gave participants a deeper understanding of the health needs of LGBTQI patients and strategies to meet those needs. Now in its sixth year, the annual UCSF LGBTQI Health Forum offered concrete training and important first-person perspectives on working with the LGBTQI community. More than 200 people attended the Health Forum on February 22, making it the largest such gathering in the country to educate students on LGBTQI health needs. Breakout sessions stimulated lively discussion around topics such as the basics of health for men who have sex with men to coming out as a health professional. At a panel on “Kink Health,” students and providers were asked to examine the difficult situation of a “kinky” patient who has bruises,
HEALTH FORUM » PAGE 4
NEWS BRIEFS
Samsung, UCSF Partner to Accelerate Innovations in Preventive Health Technology
Samsung Electronics Co., Ltd., and UCSF have announced a partnership to accelerate validation and commercialization of promising new sensors, algorithms and digital health technologies for preventive health solutions. The two organizations will jointly establish the UCSF-Samsung Digital Health Innovation Lab, a new space located in UCSF’s Mission Bay campus, where some of the world’s leading researchers and technologists will be able to develop and run trials to validate exciting new mobile health technologies. The joint innovation lab will be a first-ofits-kind test bed where entrepreneurs and innovators will be able to validate their technologies and accelerate the adoption of new preventive health solutions. "Harnessing new preventative health technologies to help people live healthier lives is the next great opportunity of our generation,” said Young Sohn, president and chief strategy officer of Samsung Electronics.
Access to Guns Increases Risk of Suicide, Homicide Someone with access to firearms is three times more likely to commit suicide and nearly twice as likely to be the victim of a homicide as someone who does not have access, according to a comprehensive review of the scientific literature conducted by researchers at UCSF. The meta-analysis, published online Jan. 20 in Annals of Internal Medicine, pools results from 15 investigations, slightly more than half of which were done after a 1996 federal law prohibited the U.S. Department of Health and Human Services from funding research that could be seen as promoting gun control. The review excluded studies that relied on survey data to estimate gun ownership and focused instead on studies that included more specific information about whether victims had access to guns. “Our analysis shows that having access to firearms is a significant risk factor for men committing suicide and for women being victims of homicide,” said Andrew Anglemyer, PhD, MPH, an expert in study design and data analytics in Clinical Pharmacy and Global Health Sciences at UCSF, who is also a U.S. Army veteran.
Marijuana-Derived Epilepsy Drug in Clinical Trial for Children with Uncontrolled Seizures A new international, multi-center study led by researchers from UCSF Benioff Children’s Hospital is the first to evaluate whether purified cannabinoid is effective in treating severe forms of childhood epilepsy that do not respond to standard antiepileptic drugs. “Better treatment for children with uncontrolled seizures is desperately needed,” said Maria Roberta Cilio, MD, PhD, principal investigator for the multi-center study and director of research at the UCSF Pediatric Epilepsy Center. “It’s important to get seizure control at any age, but in children, uncontrolled seizures may impact brain and neurocognitive development, which can have an extraordinary effect on quality of life and contribute to progressive cognitive impairment.” The drug, called Epidiolex, is a purified cannabinoid that comes in a liquid form containing no tetrahydrocannabinol (THC), the psychotropic component in cannabis. Produced by the biopharmaceutical company GW Pharmaceuticals, Epidiolex is considered a schedule 1 substance by the U.S. Food and Drug Administration (FDA).
4 | February 27, 2014 | synapse.ucsf.edu
BOOK REVIEW
Shedding Light on Grief and Healing Tell Me Again (Poetry and Prose from The Healing Art of Writing, 2012) By Jenny Qi Executive Editor
W
hat do you get when you invite a group of like-minded writers to spend a week on an idyllic campus, immersed in creative writing and focused on the subject of healing? A powerful collection of poetry and prose that springs from the deepest black wells of human experience. Tell Me Again, published by UC Medical Humanities Press this month, is the result of the weeklong Healing Art of Writing Conference that took place at Dominican University in July 2012. “Being cured of a disease is not the same as being healed, and…expressive writing promotes both spiritual and physical healing,” according to conference organizers Dr. David Watts, clinical professor of Medicine at UCSF, and his wife Dr. Joan Baranow, associate professor of English at Dominican University. Wary of the dehumanizing sterility that can plague the medical practice, they “sought to strengthen compassionate understanding between healthcare providers and [patients].” Conference participants included health professionals, students and patients. They retreated from their hectic lives to each produce and revise dozens of pages of writing over the course of the week. It was an opportunity for all of the participants to share their diverse perspectives on healthcare and healing.
Medical practitioners remember their most memorable patients, patients write defiantly in the face of trauma and disease, parents mourn their lost children and children mourn their lost parents. This anthology includes the finest of these writings. Joanne Clarkson’s “The Oldest Sense” is one of many haunting reflections on the life of a terminally ill patient. Similarly, in “Two Deaths and a Lesson,” medical student Adam Luxenberg crafts a sometimes-humorous, moving profile of an elderly patient. “I Press My Finger to Your Palm” is Marissa Bois’ tender elegy for an aging grandfather. As a whole, Tell Me Again is by turns painfully honest, sardonically funny, breathtaking and unpredictable. Reading through this collection, I am struck by the fierce universality of grief—grief for lost loved ones, lost patients, lost body parts. But even more striking is the strength with which the speakers overcome these losses. “Words, that can so often fail us like so many wet matches, also have the potential to light on fire—to light my life, light up the life of others,” writes John Fox in his essay “Letting The Light In.” Light—this is what this anthology does—it sheds light on some of the most painful parts of human life, and in doing so, it lets the light penetrate the darkness. To place an order, please email brian. dolan@ucsf.edu.
Jenny Qi is a third-year BMS student.
Health Forum » FROM PAGE 3
but states that the way in which they were inflicted was consensual. Panelists who are part of the kink community said that they want the provider, as a mandated reporter, to investigate these claim, but to ultimately defer to the judgment of the patient. In the introductory course “So…How Do I Ask That?” led by UCSF Faculty Dr. Michell Lunn, MD and Dr. Juno Obedin-Maliver, MD, MPH, the forum brought together students from all of the UCSF professional schools, as well as students from Stanford, Davis, UCLA and local service providers. Drs. Lunn and Obedin-Maliver highlighted some of the great disparities within the LGBTQI community—increased obesity among lesbian, higher HIV rates among transgender folks and more discrimination in the healthcare setting in the LGBTQI community. Despite these challenges, Lunn and Obedin-Maliver noted that all practitioners can work to end these disparities through communicating more and assuming less. As the day progressed, attendees were afforded the unique opportunity to hear directly from members of the LGBTQI community about their experiences with the health system. The panelists shared gripping stories about the struggles they faced and highlighted the need for all working in health services, no matter their title, to respect the essential dignity of their patients and treat all people humanely. Over lunch, participants watched the film Transgender Tuesdays: A Clinic in the Tenderloin, featuring the storied Tom Waddell clinic. The film highlighted one of the earliest attempts at healthcare for trans people in San Francisco and the positive experiences of the patients who went to the clinics.
After the screening, individuals involved in the making of the film discussed the importance of transgender health. Included on the panel was Cecilia Chung, a transgender woman who battled discrimination for many years and now serves as a Health Commissioner for the City of San Francisco and was recently appointed to the Presidential Advisory Council on HIV/AIDS. The event closed with a keynote speech by Eric Sawyer, co-founder of the AIDS Coalition to Unleash Power, ACT UP and current director of Civil Society Partnerships at UNAIDS, New York. Sawyer outlined the history of ACT UP and its impact on the perceptions of both HIV/AIDS and the gay community in the United States. His moving stories about how ACT UP organized individuals in the gay community to assert their right to health care and, in the absence of government support, create their own systems of care reminded attendees of the continual need to fill gaps in care. In order to fulfill the healthcare needs of the LGBTQI community, there is much to be done. But, after the Health Forum, there are two hundred more people who are committed and able to do the work. The event was organized by: Rand Dadasovich (Joint Medical Program), Mark Jeng (Graduate Division), Nicole Copti, Raad Shebib (School of Physical Therapy), Hannan Braun, Sai-Wing Chan, Colette DeJong, Mark Dela Cruz, Elaine Lee, Michael Liu, Jon Phuong, Brandon Perkovich, David Ramierez, Tess Veuthey and Greg Zahner (School of Medicine) with the support of Marcus Ferrone, PharmD, Larry Lariosa (LGBT Resource Center) and Sarah Steer (LGBT Resource Center).
Brain Shaw is a first-year medical student.
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synapse.ucsf.edu | February 27, 2014 | 5
UCSF JOURNAL CLUB
MIND Your Career » FROM HOME PAGE
career options in broad terms, but becoming educated in the structure of every career path and the skill sets required of each is difficult. Furthermore, once the necessary knowledge is gained, arriving at a decision for one’s future may be even more daunting. To overcome these challenges, the MIND program aims to direct participants towards proper resources for researching career paths and assist in the decision process by coaching participants to utilize universal skills gained during graduate and post-doctoral training: critical thinking and problem solving. Framing career decisions as a research project, rather than a complex life decision, and providing the means to address each question within that project will allow trainees to view career issues more appropriately and comfortably arrive at their career path of choice. Once a career path is chosen though, it can be tough to fully immerse one’s mindset into the field of choice. Many trainees may experience career “identity” crises, feeling like they’re leaving (or even quitting) academia for a new, unfamiliar field while failing to identify with either. To overcome this, the MIND program plans to ease participants into the professional network of their chosen career path. With over 40 external partners constituting a variety of professions, including industry research, business development, entrepreneurship, intellectual property law and science policy, participants will have the opportunity to make numerous meaningful connections with professionals in their field of choice via informational interviews, shortterm internships, job shadowing and simulation exercises and more. The authors of the MIND program believe that when trainees have both a thorough un-
derstanding of the demands of a given career path and the beginnings of a professional network in that area, they will embrace their new career identities and confidently embark on the training necessary to find future success. Cultivating acceptance of different career paths does not stop at the individual level, though. Creating a supportive environment that promotes many different career options is key to producing trainees that ultimately thrive in their chosen careers. The MIND program hopes to build such an environment by first assessing the strengths and shortcomings, both real and perceived, of the career development culture at UCSF. After establishing a baseline, strategies potentially including improved mentorship training, a seminar series about different careers, and even modifications to graduate program coursework will be developed to improve the baseline culture. If successful, this aspect of the MIND program could radically change the concept of both graduate and post-doctoral training, better preparing the future biomedical workforce for the bevy of career option available to them. The MIND program for UCSF graduate students and postdocs will launch in Fall 2014, starting with an inaugural class of approximately 32 trainees and expanding to upwards of 124 trainees by year four. It is a one of the many steps UCSF is taking to address career development challenges in post-graduate training.
Jordan Mar is a fourth-year BMS graduate student and sub-leader of the Science Policy Group at UCSF.
Recent research by UCSF scientists By Taylor LaFlam Staff Writer
REPRODUCTIVE BIOLOGY: Mammalian Fused is essential for sperm head shaping and periaxonemal structure formation during spermatogenesis. Nozawa, I., et al. (Chuang). Dev Biol. 2014 Feb. 10. Epub ahead of print. As depicted in many middle school sexual education videos, sperm rely on their vigorously beating tail to propel themselves on their long journey to the egg. The development of this flagellum is part of the final phase of spermatogenesis. Although the sequence of events occurring during this final metamorphosis is well described, the precise mechanism remains poorly understood. In this paper, Nozawa and colleagues have demonstrated an essential role for the protein Fused in this process. They find that germ cell-specific deletion of Fused rendered male mice infertile. They further showed that Fused localizes to microtubule-organizing structures. In the absence of Fused, the axoneme, the core flagellar structure, is present but problems in the bordering periaxonemal structure lead to poor motility. IMMUNOLOGY: PKCδ promotes transitional B cell negative selection and limits proximal BCR signaling to enforce tolerance. Limnander, A., et al. (Roose). Mol Cell Biol. 2014 Feb. 10. Epub ahead of print. As B cells develop, genetic recombination produces highly variable B cell receptors. This diversity results in being ready to produce antibodies against a nearly limitless range of potential targets, but also invariably includes receptors that recognize components of the human body. Several mechanisms normally act to eliminate or control these self-reactive B cells. Disruptions in these checks can result in severe autoimmunity, as is seen in rare patients with mutations in the signaling cascade kinase PKCδ. In this article, the authors investigated how loss of PKCδ leads to autoimmunity. They showed that this protein is necessary for activation of a signaling cascade that results in the death of self-reactive B cells. They also found that it normally dampens signaling from the B cell receptor, so loss of its function makes the B cells aberrantly easy to activate. NEUROSCIENCE: Olig1 function is required to repress dlx1/2 and interneuron production in mammalian brain. Silbereis, J.C., et al. (Rowitch). Neuron. 2014. 81(3):574-87. The healthy cerebral cortex requires a balance between excitatory and stimulatory signals— too much of either has been associated with neural disorders such as epilepsy. The appropriate relative numbers of excitatory pyramidal neurons and inhibitory interneurons are established during embryonic development in a carefully regulated process. Previous research has shown that normal development of inhibitory interneurons requires the action of the transcription factors Dlx1/2, but the detailed mechanism has remained unclear. The authors here addressed this question by examining the role of the transcription factor Olig1. They found that deletion of Olig1 in mice results in a 30 percent increase in cortical interneurons because Olig1 usually represses the transcription factor Dlx1/2. The researchers suggested that Olig1 merits investigation as a potential therapeutic target. GENOME ENGINEERING: Isolation of single-base genome-edited human iPS cells without antibiotic selection. Miyaoka, Y., et al. (Conklin). Nat Methods. 2014 Feb. 9. Epub ahead of print. Many human genetic disorders are due to point mutations, in which only a single amino acid is altered. When introducing these mutations into cells for study, scientists usually use antibiotics to select for successfully altered cells, which requires genomic changes in addition to the point mutation. In this paper, the authors described a method for efficiently identifying rare mutations, making antibiotic selection unnecessary, and demonstrated it by introducing specific point mutations into five different genes. The method relies on highly sensitive detection of mutants and progressive enrichments. Cells are plated into multiple wells, some of which will by chance have a higher proportion of cells with the desired mutation. The most enriched well can be plated again into several wells, the most enriched of these selected, and so forth. After several rounds, the researchers isolated clones initially present at a frequency of only one in two thousand.
Taylor LaFlam is a fifth-year MSTP student.
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FOOD 6 | February 27, 2014 | synapse.ucsf.edu
A Charming Pizzaria Opens Near Kezar By Angela Castanieto Associate Editor
S
itting near Kezar Stadium at the intersection of several park-side neighborhoods, the location of Kezar Pizzetta might be considered by some to be no-man’s land. The only restaurant on the block, it’s evident the owners rolled the dice when selecting this location, formerly New Ganges, to open a restaurant last year. Kezar Pizzetta is full of character, from the original art on the walls to the throw pillows lining the back benches. It’s a homey, neigh-
Kezar Pizzetta 775 Frederick St (between Willard St & Lincoln Way) San Francisco, CA 94117 (415) 665-7700 Mon-Sun 11 a.m.-9:45 p.m. www.kezarpizzetta.com borhood restaurant — perfect for groups of students to gather for weekday happy hours ($1 off draft beers from 4-7 p.m.). Kezar Pizzetta offers eight beers on tap, including several from Speakeasy and Deschutes breweries, but the restuarant specializes, of course, in pizzettas—smaller,
personal-sized pies that can be customized with an array of toppings. Patrons can order pies with simple layers of cheese and margherita sauce, or choose from the daily selection of gourmet meats and cheeses. The menu also has a few appetizers, including eggplant parmigiana and broccolini mixed with diced pancetta. These are no-frills appetizers. We ordered the eggplant parmisana starter, which was a straightforward example of this rustic dish done right—at least to this non-connoisseur of Italian food. Thinly sliced and piled below a generous layer of melted mozzarella and marinara, the eggplant lacked the bitterness that I’ve often found when trying the dish at other places. From the pizza menu we selected the Potato Medley, which promised an enticing combination of potatoes, brussel sprouts, prosciutto and homemade mozzarella. While the pizza that arrived at our table had all of these elements, it was rather sloppily put together. The generous shavings of prosciutto were piled mostly on one side, while the beautifully cooked potatoes and brussel sprouts were sparse and left me wanting more. However, a rich roasted garlic flavor was present in each bite, as was the crisp, light texture of the crust. For dessert we returned to the basics with
Photo by Angela Castanieto/Tetrad5 Kezar Pizzetta specializes in pizzettas—smaller, personal-sized pies that can be customized with an array of toppings.
their apple galette. While it tasted like a decent apple pie, it offered nothing special despite being recommended by the server. It was bizarrely garnished with sliced kiwi and a sweet red sauce. Overall, the food at Kezar Pizzetta was not disappointing, but for the price point it’s a bit overpriced for the average UCSF student—$15 for the rather small pizza, $7-8 for
everything else. Their lunch special—a salad and pizza— is priced at $20. However, because of the inviting interior and beer selection, I’m planning on dragging my lab members out here soon for its happy hour.
Angela Castanieto is a fifth-year Tetrad student.
synapse.ucsf.edu | February 27, 2014 | 7
PUZZLES The Weekly Crossword
ACROSS 1 Witty ones 6 Teen malady 10 Allergy symptom 14 Puccini work 15 Pressing need? 16 Skedaddle! 17 Place for fishing 18 Pork fat 19 Go soft, in a way 20 Like doors or gates 22 Full of oneself 24 Serling or Stewart 25 Quite a few 26 Nun's beads 28 Freudian topic 29 Before, to Byron 30 Small drink 31 Arctic rodent 33 Cockpit datum 36 7th of March, e.g. 37 Big Easy festival 40 Fraternal fellow 43 Equestrian event 47 Plaintive, as in poetry 50 Make a scene? 51 Hair product 52 Fizzled firecracker 53 Puzzling problem 55 Go for the gold 56 Outback bird 57 Kind of wolf 58 For now, for short
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Smoking, e.g. Roman date Hopping mad From the top Arboreal abode Gown material Part of TLC Deuce taker Put in office
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Conventional Stick it out Doctrinal suffix Legalese adverb 12 Chanel offering 13 Ballpark snacks 21 Less damp 23 Acrobatic athlete of column DOWNWeek of 2/24/14 27 Kind - 3/2/14 1 Inner ear part 30 Droopy-eared 2 Derived by logic dog 3 Come back in 32 Sphagnum, for 4 Bottom of the one barrel 34 Urban woe 5 Sushi go-with 35 Pulled off 6 Suffer illness 38 Metric weight 7 Bad-mannered
39 Summarize 40 Chopper to the ER 41 Oxide used in sandpaper 42 Casanova, for one 44 Stir up 45 Hereditary 46 Sulfur or silicon 48 Sanctify with oil 49 Fiery fleck 54 Hunted birds 55 Aesop's ending 59 Animated film, "____ of the Guardians" 61 Barnyard female 63 Slob's apartment
Edited by Margie E. Burke
THE STRENGTH TO HEAL
starts with our scholarship.
Capt. Ana Morgan, M.D., HPSP Medical Recipient Brooke Army Medical Center, Texas
Difficulty : Medium
HOW TO SOLVE:
You can begin training for the career you’ve always dreamed of with financial assistance from the U.S. Army. Through the Health Professions Scholarship Program (HPSP)*, you could be eligible to receive a full tuition scholarship for an accredited medical program. The HPSP provides reimbursement for books, laboratory equipment and academic fees. You’ll also receive a sign-on bonus of $20,000 and a monthly stipend of $2,157. During breaks, you’ll have the opportunity to train alongside other members of our health care organization. To learn more, call (650)347-3967 or visit San Mateo Medical Recruiting Center 400 S. El Camino Real, STE 450 San Mateo, CA 94402 Email: usarmy.knox.usarec.list.9e3j@mail.mil www.goarmy.com/amedd.html
(Answer appears elsewhere in this issue) *Certain requirements and eligibility criteria apply. ©2013. Paid for by the United States Army. All rights reserved. Information subject to change.
Copyright 2014 by The Puzzle Syndicate
Piled Higher and Deeper by Jorge Cham
Solution to Sudoku
www.phdcomics.com
Smile Day » FROM HOME PAGE cial for many who attended because a large proportion of the children suffer from early childhood decay, lack dental insurance and many have never seen a dentist before. For those with children entering grade school, these services also satisfy the California mandated K-1 oral health assessment. Given the feedback received from parents, we are sure that this event was a success for all. When asked to reflect on the day, parents rated the event as excellent. One parent left a comment, stating “Thank you for making dentistry a fun day. My kids and I learned so much. Please have this event every year!”
title: "It's time." - originally published 1/22/2014
Edmundo Abasolo is a third-year dental student.
8 | February 27, 2014 | synapse.ucsf.edu
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