July 10, 2015
MEDICAL UNIVERSITY of SOUTH CAROLINA
Oil spill study raises ‘red flag’ about compound By Dawn Brazell
Inside Humanitas
Public Relations
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hat good could come from a devastating oil spill may seem odd. “We learn from our mistakes, but we’re learning more than we even expected to,” said Demetri Spyropoulos, Ph.D., a researcher and senior author of a study released July 2 in the journal Environmental Health Perspectives, which is published by the National Institute of Environmental Health Sciences. The study had two “home runs,” he said. One was that researchers found a commonly-used chemical known as DOSS (dioctyl sodium sulfosuccinate), an ingredient in the dispersant used to clean up the Deepwater Horizon oil spill, is likely an obesogen. An obesogen is a compound that potentially contributes to obesity in people and wildlife. The second major finding was how commonly used this compound is, including in laxatives, some flavored soft and fruit drinks, homogenized milk and many personal care products. “We were expecting this to be like looking for a needle in a haystack, but instead we
Dr. Spyropoulos joins Ph.D. student Alexis Temkin and Dr. Rob Bowers.
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Dr. Demetri Spyropooulos points to a vial of COREXIT, a dispersant used in the Deepwater Horizon oil spill. His team studied this, oil mixed with dispersant and saline (middle) and Deepwater Horizon crude ‘source’ oil. were able to zero in on a single component in this complex mix of oil and dispersant,” said Spyropoulos, who is an associate professor in the Department of Pathology and Laboratory Medicine. Funded by the Gulf of Mexico Research Initiative (GoMRI), scientists were investigating the environmental contamination resulting from the Deepwater Horizon oil spill. The spill began April 20, 2010, in the Gulf of Mexico and was capped 87 days later. An estimated 200 million gallons of oil impacted about 500 miles of the Gulf’s shoreline and about two million gallons of dispersant were used in the cleanup. A major component of the COREXIT dispersants used to clean up the spill is DOSS. The oil, saline and dispersant mixture is a complicated brew of compounds that scientists were examining to see if any parts of the mixture had biologically active agents that act as endocrine disruptors. The disruptors belong to a class of chemicals that change the body’s hormone systems by mimicking or blocking normal processes. The study showed DOSS binds to a protein that changes the expression of a suite of genes involved in making new fat cells and
other related functions. “One possible effect of that orchestration is to drive stem cells toward fat cells," Spyropoulos said. “With the obesity epidemic, not only is it about what you eat and how hard you exercise, but that there are chemicals in the environment that might tell your body to behave differently than it normally would, such as make more fat cells or change your metabolism to increase your appetite or slow your metabolism.” A GRAS (generally recognized as safe) notice on DOSS was submitted to the Food and Drug Administration in 1998, which means manufacturers of food and personal care products can put it into products and not mention that it is in there. Since it’s used in laxatives such as Colace that are prescribed to some pregnant women, and might be in so many commonly–used products, it’s important for researchers to look at its possible impacts on human health, he said. “We’re at a point where we have put up a red flag, and we can say on a cellular level this likely contributes to fat cell differentiation. We don’t know yet if this compound DOSS will be obesogenic in
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2 The CaTalysT, July 10, 2015
Dental WHite COat CeremOny marks start Of CliniCal years
photos by Anne Thompson, Digital Imaging
Seventy-four third-year dental students from the James B. Edwards College of Dental Medicine gathered at The Citadel’s Summerall Chapel June 19 to recite the Dentist’s Pledge and receive their white coats. The celebration recognizes the student’s transition from didactic and preclinical course work into clinical practice.
Spring and Fishburne road project continues Work will continue at Fishburne and President as well as on Sheppard St. Both the intersection at Fishburne and President (including part of Fishburne) and Sheppard streets from the Crosstown to Rutledge are expected to remain closed. The detour route around the intersection at Fishburne and President streets may shift a little so please be alert
Editorial of fice MUSC Office of Public Relations 135 Cannon Street, Suite 403C, Charleston, SC 29425. 843-792-4107 Fax: 843-792-6723
Editor: Cindy Abole catalyst@musc.edu Catalyst staff: Mikie Hayes, hayesmi@musc.edu Dawn Brazell, brazell@musc.edu J. Ryne Danielson, daniejer@musc.edu Helen Adams, adamshel@musc.edu Sarah Pack, packsa@musc.edu Jeff Watkins, watkinsj@musc.edu
for changes. Work includes: water relocations and installation of stormwater infrastructure at Fishburne and President streets and other construction. Starting July 7, Bogard Street will close from the Crosstown to President Street affecting traffic around President and Fishburne streets. For project information, visit www. SeptimaClarkProject.com. The Catalyst is published once a week. Paid adver tisements, which do not represent an endorsement by MUSC or the State of South Carolina, are handled by Island Publications Inc., Moultrie News, 134 Columbus St., Charleston, S.C., 843-849-1778 or 843-958-7490. E-mail: sales@moultrienews.com.
Left: Student Laura Wysocki is presented her white coat by Dental Associate Dean Dr. Mark Barry.
The CaTalysT, July 10, 2015 3
MUSC leaders ‘ecstatic’ over state funding for new hospital, telehealth Staff Report Leaders at MUSC are using the words “ecstatic” and "thrilled” following the governor’s decision not to veto funding for key MUSC items in the state budget. The budget includes $25 million for the new MUSC Shawn Jenkins Children’s Hospital and $16 million for telehealth at MUSC. MUSC President David Cole, M.D., FACS, said Gov. Nikki Haley and the General Assembly showed health care leadership in approving the funding. The money for the children’s hospital comes at a critical time, he said. “The $25 million investment will allow us to continue to move forward with the planned construction of the MUSC Shawn Jenkins Children's Hospital. Now, with the combined support of private philanthropy, state support and HUD financing, we look forward to continuing this mission in this new facility.” HUD is the U.S. Department of Housing and Urban Development. The new $350 million children’s
hospital and women’s pavilion is expected to open in 2019, replacing the current 28-year-old MUSC Children’s Hospital. Cole said it will provide the best in specialized pediatric and maternal-fetal care. “This occurs in collaboration with all of the pediatric care facilities and hospitals in the state,” Cole said. “I am very appreciative of the steadfast legislative leadership that understands our mission and shares our vision to transform the health of our children as we move forward.” Through a combination of state funding and philanthropy, the university so far has secured almost $68 million for the new children’s hospital and women's pavilion, a level that will help MUSC close on a federal loan and maintain the project's timeline. The state’s commitment will likely spur additional philanthropic support for the project, said Jim Fisher, vice president for development and alumni affairs at MUSC. “From a fundraising standpoint, this
print provided
An artist’s rendering of the MUSC Shawn Jenkins Children’s Hospital. is tremendously exciting news,” Fisher said. “The fact that the state legislature and governor came together to make this investment sends a powerful message that our children’s hospital is an invaluable health care resource for the entire state. It validates what we’ve been sharing with the community since day one of this fundraising campaign, and it will be very helpful to us as we continue
SC ETV program to debut July 15 Staff Report The latest made-for-television dialogue co–produced by MUSC’s Public Information and Community Outreach Initiative (PICO) and South Carolina Educational Television (SC ETV) is ready for broadcast and national distribution. “Climate Change: A Global Reality” will debut on SC ETV, Wednesday, July 15, at 9 p.m. Moderated by CNN Chief National Correspondent John King and featuring six expert panelists, the program examines the wide-ranging impacts of climate change and suggests constructive steps to reduce those impacts. “For more than 20 years, the Medical University and SC ETV have partnered to produce programs on complex environmental health issues,” said David Rivers, DHL, PICO director and executive producer of the program. “Climate change, with all of its human health, environmental, economic and public policy implications, presents a tremendous challenge to our nation. How we respond will impact Americans’ quality of life for generations to come.” Rivers cited the U.S. Department of Energy for its support of the program, which includes questionand-answer segments, pre-produced video packages illustrating the challenges presented by climate change, and studio audience participation.
Program panelists include: Holly Bamford, Ph.D., assistant secretary for conservation and management in the U.S. Department of Commerce, National Oceanic and Atmospheric Administration; Milton Bluehouse, Jr., Esq., a Navajo tribal member from Ganado, Arizona; Cynthia L. Cory, director of environmental affairs for the California Farm Bureau Federation; Mark Mitchell, M.D., an environmental health physician from Hartford, Connecticut; Jack Moyer, Carolinas/ Tennessee Water Security and Preparedness sector leader for AECOM in Raleigh, North Carolina; and LaVerne E. Ragster, Ph.D., president emerita of the University of the Virgin Islands. Following its debut, on July 18, the National Educational Telecommunications Association (NETA) will distribute the program by satellite to its public and educational television affiliates nationwide.
“Climate Change” to air “Climate Change: A Global Reality,” will air statewide on SC ETV at 9 p.m., Wednesday, June 15.The program is moderated by John King, CNN chief national correspondent.
to raise money for this project.” The other key state budget item involving MUSC provides $16 million for telehealth. The money will be distributed across South Carolina to other connected hospitals, urban and rural, as MUSC ramps up the South Carolina Telehealth Alliance. Telehealth
See funding on page 11
4 The CaTalysT, July 10, 2015
Overheard at MUSC By J. ryne Danielson Public Relations
WHO Robert Sade, M.D., distinguished university professor of surgery and director of the Institute of Human Values in Health Care at MUSC, has written several hundred articles, book chapters and books on clinical surgery, medical education, biomedical ethics and health policy. He currently chairs the Ethics Committee of the American Association for Thoracic Surgery, a body on which he has served for nearly 20 years, and also co-chairs the Ethics Forum, which he co-founded. What Published by Oxford University Press, Sade’s new book, “The Ethics of Surgery: Conflicts and Controversies,” is an important resource for surgeons, as well as anyone interested in the ethics of medicine in the 21st Century. Sade’s book tackles dilemmas surgeons may face on a daily basis: everything from the morality of deceiving insurance companies for the patient’s benefit, to dealing with noncompliant patients and even whether sleepdeprived surgeons have the responsibility to inform their patients before performing surgery. Sade did not shy from controversial topics. In fact, he sought them out. Consider the chapter he co-wrote with Benjamin Hippen, M.D., a nephrologist at Baylor College of Medicine, and Lainie Friedman Ross, M.D., Ph.D., professor of clinical medical ethics at the University of Chicago Medicine. He argues that financial incentives—cash payments—should be used to increase organ donation. “Ever since organ donation became clinically feasible,” he writes,” there have not been enough organs to go around.” Sade calls for the freedom for donors to donate organs for financial benefit. Despite the risk of inequitable care and the possible exploitation of the poor, he
photos provided
Dr. Robert Sade, who chairs the Ethics Committee of the American Association for Thoracic Surgery, wrote a book on the ethics of medicine in the 21st Century.
argues that financial incentives would increase the supply of donated organs and that “saving lives is more important than abstract moral concerns.” Totaling 28 chapters, Sade’s book is divided into seven thematic sections: The Problem of Surgical Ethics; Professional Integrity; Relationships with Patients—Autonomy and Consent; Innovation and Uses of Technology; Organ Donation and Transplantation; Conflicts of Interest in Surgery; and Ethical Issues in Healthcare Policy. Why “Surgical culture is steeped in ethics, and surgeons confront and resolve ethical dilemmas as much or more than most other professionals,” Sade writes, “although they often may not recognize the situations they resolve are problems in ethics—they are just part of the daily routine.” Nonetheless, he adds, “ethics discussions have historically taken place far less frequently in the surgical literature than in the medical literature.”
To address this gap in the literature, without glossing over the broad diversity of viewpoints of surgeons in the field, Sade chose a format primarily composed of point-counterpoint discussions with a few free-standing editorials. Serving as both editor and moderator, Sade either authors or co-authors each article included in the collection. “This book has two goals,” Sade writes. “The first is to provide educational materials in surgical ethics for the enjoyment and enlightenment of practicing surgeons and other physicians, surgical residents, and medical students. The second is to make surgeons aware that ethics is not a static, stable discipline; rather, it is a dynamic field that is animated by varying perspectives on important controversies, perspectives that arise from diverse training backgrounds, from differences in personal value systems, and sometimes from fundamentally differing worldviews. If these goals are achieved, I believe that surgical practice will be better for it, to the ultimate benefit of the patients we treat.”
The CaTalysT, July 10, 2015 5
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6 The CaTalysT, July 10, 2015
Writing gives med student something he’s been missing By J. ryne Danielson Public Relations “For most jobs, the payment was directly proportional to the paranoia.” John Minner is a third–year medical student at MUSC, and that’s how his submission to the 2015 issue of Humanitas begins. Set in the near future, “Jakarta Express” follows a courier who specializes in illicit goods; he has just accepted a job that may be too big for him to handle. “I thought of this story a couple years ago when Bitcoin was just becoming a big thing. People were talking about how to transport millions of dollars just sitting on a hard drive somewhere and someone suggested hiring a tracked courier. The idea seemed ridiculous over a series of ones and zeroes on a hard drive. So, I was stewing on that idea while reading “Neuromancer” and some other cyberpunk when I decided to sit down and write this one afternoon.” Minner didn’t think Humanitas, MUSC’s literary journal, would publish his story, since genre fiction is something most literary journals shy away from. Not
HUMANITAS 2015
4-Speed Chromatic by Matt Ewald, College of Medicine
only did they publish it, they awarded it a 2015 Award for Creative Excellence in prose. Minner has been writing since middle school but said that Humanitas gave him a good excuse to write more. “It gets you motivated to set a deadline and produce a piece,” he said. Minner’s passion to become a doctor began with an interest in science. “I realized I wanted to use science in public service,” he said. He wants to go into psychiatry to serve patients who are often stigmatized in ways patients with purely physical illnesses are not. “A lot of these diseases are ignored or looked down upon, cast out of those populations — that’s what I’m interested in treating. That kind of idea — of treating the underserved — is why I started having an interest in medicine to begin with.” Many think of science and art, medicine and creative writing, as opposites, but Minner disagrees. In fact, he says, that’s an idea Humanitas was created to challenge. “There’s a relatively long-standing tradition of the physician–intellectual. There are still a few great physician–
Peace by Dee Norton, College of Medicine writers. Michael Crichton comes to mind; he finished med school and decided what he wanted to do was write. Sam Shem was a psychiatrist–writer. I think a lot of people, because medicine is so fact–based, need a creative outlet. “There’s a club on campus,” he continued, “the Student Medical History Club. And they will often have discussions of physicians in the early 1900s that had very diverse interests. They were physicians, but they also studied botany. And they were publishing papers in these alternate fields on the side. I don’t know if that’s possible today, you have to have more focus in your field. But, I think it’s important to have diverse interests. That’s an important part of Humanitas. It reminds you that you can still have other interests. I don’t know that it helps anyone become a better doctor, but it helps to keep you sane and helps you to become a more well–rounded person.” Minner believes fiction is also useful for carrying out thought experiments and addressing counter–factual theories that are otherwise beyond the scope of
HUMANITAS 2015
science. “Medicine sometimes feels confining, but fiction gives one the opportunity to create the truth rather than just react to it,” he said. “In medicine, you’re working within a set of rules to determine what’s going to be best for the patient. You’re
See ARTon page 7
WHat is Humanitas? HUMANITAS is a yearly literary journal of MUSC showcasing the artistic talents of employees, faculty, students and staff. It is a journal of prose, poetry, visual arts (art and photography) and musical compositions from the ranks of MUSC. Each year, cash prizes are awarded for the top submission in each of the four categories. To view the 2015 Humanitas journal online or for more information, visit http://academicdepartments.musc.edu/ humanities/humanitas.htm.
The CaTalysT, July 10, 2015 7
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Continued from Page Six
trying to figure out something that you may never have the complete answer to. If a patient dies, you don’t necessarily know if you could have done anything differently.” That’s a frustrating thing to deal with, Minner said, but fiction creates an opportunity to search and explore avenues otherwise unavailable to the physician. Is writing just an escape? Minner doesn’t think so. “All writing has to be rooted in human emotion and, especially for psychiatry, it’s another way to connect to the human element. In psychiatry, you’re trying to understand the thought process and the mind of your patient. Writing is another opportunity for that.” Minner said world building is his favorite aspect of writing. “That you get to design the setting in which your characters exist is fun. It allows you to borrow different elements from works you admire to create something new.” One whose work Minner has drawn from is William Gibson, the science fiction author who coined the term “cyberspace” and helped create the genre of cyberpunk, which focuses on the social upheaval that radical breakthroughs in technology can bring about. “I like the idea of the misimagined future — how right he was but also how wrong. Gibson, he gets the idea that information and the Internet will be everywhere, but he thinks the largest programs are going to fit on 64 MB.” Minner was also inspired by avant-garde horror writer
Hungry Hungry Hippos by Katie Boland, College of Medicine Mark Z. Danielewski, whose “House of Leaves,” he said, “opened up a world of different tools for storytelling.” Videogames such as “Battletech,” “Mechwarrior” and Sid Meier’s “Alpha Centauri,” that he remembers playing as a child, also left their mark, shaping the atmosphere he wanted to create. “It wasn’t unusual for videogames to tell their story in intermittent pages of text back then,” he said. But how does one find the time to write in med
Third-Year medical student John Minner is one of several MUSC students who contributed to the 2015 Humanitas. HUMANITAS 2015
Left: Two Sisters Diptych by Christian Hicks, College of Medicine
HUMANITAS 2015
school? “A lot of times, you don’t,” Minner said. “I wrote the first draft of this story — I just had a free moment in the hospital, and I started scribbling down notes on a sheet of paper I had with me. It’s tough to make the time, but when you get a good idea, you find an hour or two to work on it, then keep coming back whenever you have a moment. When writing gives you something that you’ve been missing, you tend to make the time.”
8 The CaTalysT, July 10, 2015
APTR presents top award to AHEC executive director David Garr honored for a career of significant achievements in preventive medicine By Mikie hayes Public Relations
W
ith the midday sun shining through the window blinds, the silver bowl sitting high atop its pedestal glistened over the dozen or so other awards arranged about the table. For David Garr, M.D., this lifetime achievement award signified the pinnacle of a dedicated career. “This award is special,” he said. “Basically, I’ve devoted my career to trying to do as good a job as I possibly can in preventing problems and improving the health of populations. And that goes back to my days in rural practice.” The Duncan Clark Award was presented to Garr by the Association for Prevention Teaching and Research at this year’s annual meeting. A national organization, located in Washington, D.C., for which Garr served as president from 2004 through 2006, APTR advocates for more substantial integration of population health into the nation’s health care delivery systems. The organization’s topmost award honors the work of a senior-level professional whose distinguished record of achievement in the areas of teaching, research or advocacy in the areas of public health and preventive medicine have left a special mark on these fields.
First presented in 1974, the Duncan Clark Award, named for a founder of the association, has been awarded 29 times in the organization’s 41-year history. Garr said he feels privileged to be in the same ranks as past recipients. “The people who received this award since it was established have been some of the people I have the most enormous respect for. To be part of that group, and listed along with them, is just very gratifying.” The annual meeting, titled “Teaching Prevention 2015: Connect. Motivate. Educate. Transform,” was held in Charleston in March and brought together health professions faculty from around the country to network and advance population health education. MUSC Vice President for Academic Affairs and Provost, Mark Sothmann, Ph.D., kicked off the meeting, welcoming guests to Charleston during the Monday opening plenary session, which highlighted prevention initiatives underway in South Carolina and led to a dynamic discussion around what types of partnerships can improve health outcomes. Sothmann said it was through respect for Garr's leadership in prevention teaching and research nationally that Charleston was chosen as the host city for this year's APTR annual meeting.
See Award on page 9
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“I can think of no individual more deserving than Dr. David Garr to receive the Duncan Clark Award for lifetime achievement,” he added. “His contributions have been seminal, and now the nation's health care reform agenda is beginning to focus on what David has been advocating for decades.” Big CHanges in HealtH Care As academic health centers (AHCs) like MUSC have more recently begun to concentrate their attention on the requirements of the Affordable Care Act, such as focusing on population health and developing patient-centered medical homes, it is clear Garr’s work beginning in the early 2000s was significantly ahead of the curve, and those labors have paid off. Population health has in the last few years become a buzzword used by clinicians, researchers and health care and public health policymakers to refer to opportunities for AHCs, health care delivery systems, public health agencies, and community–based organizations to work together to improve health outcomes in the communities they serve. Likewise, the patient-centered medical home is considered to be among the most promising approaches to delivering higher–quality, cost–effective primary care, as patients have close contact with a clinician (physician, physician assistant or nurse practitioner) who coordinates their ongoing care. Prevention is the cornerstone of the ACA. But even before there was an ACA, Garr was thinking about prevention, population health, the PCMH concept and how to best educate tomorrow’s providers to meet the new demands that the nation would be experiencing. “When we developed the first plan in 2002, we were working
photo provided
APTR presenters including Dr. Andrew Maccabe, from left, Dr. John Vena, Dr. David Garr and Stephanie MilesRichardson of Morehouse College at the national meeting. toward these approaches. The reality is, not until the ACA were there real incentives and rewards for looking at the health of populations. The health care system in the past was built around taking care of people one at a time. With access to electronic medical records, we now have the ability to examine the health of populations of patients being served and introduce approaches designed to improve their health outcomes and decrease the ever–increasing costs of care.” The ACA is changing things. It provides incentives for people who adopt these new approaches. For example, those who don’t install EMRs and don’t show evidence of addressing the health of their populations, won’t receive the highest level of reimbursement for the care they provide. “Now, new programs are being developed in practices and communities to look at population health needs and to serve the needs of and care for these populations,” Garr said. “For example, PCMHs are now sending reminders for appointments and tests. So we’re seeing a change in the mentality of how we approach health care. It’s not happening quickly, but it’s going to be
happening more and more.” Concerning the prevalence of largely preventable diseases such as diabetes, cancer and heart disease increasing in the United States, Garr said, “Improving population health through research, education, and prevention could be the turning point in our health care delivery system. By transforming it from one where we treat sickness to one where we concentrate on preventing disease and promoting health and wellness, we can make a dramatic difference in reducing disease, increasing patient satisfaction and lowering costs. “By way of reference,” Garr continued, “in our health care system now, we do a great job of taking care of problems downstream — when problems develop, we try do our best to address those health issues. We’re interested in moving upstream and preventing problems from developing. The analogy is we’re doing a great job pulling people out of the river, but we want to go upstream and find out why people are falling into the river. If we can do a better job with integrating prevention and population health, we can reduce our health care costs. That’s what we’re ultimately
trying to achieve.” It has been predominantly through Garr’s work with the APTR that he and his colleagues have been able to effect such essential change in this forward–thinking area. Since 2002, he has chaired the Healthy People Curriculum Task Force, an interprofessional group that includes representatives from across the spectrum of health care, including nursing, medicine, dental medicine, pharmacy and physician assistants, as well as allied health and public health experts. Garr said it has been a tremendous group effort. The task force has met twice a year since 2002 with a goal of changing health professions education. To that end, they developed a framework for what all health professionals should learn. The product of their work resulted in the Clinical Prevention and Population Health Curriculum Framework, which was first published in 2004, then revised and republished in 2009, and again in early 2015. This report is recognized for remaining the quintessential framework that provides a common core of knowledge for clinical health professions about individual and population– oriented prevention and health promotion efforts. The future of health care, Garr believes, is tomorrow’s health care providers. “In order for us to be really successful at getting more prevention and population health into educational programs, we really needed to bring together the leaders of those organizations and to come forward with recommendations about what should be included in the education of our future health work force.” Garr thinks MUSC has been responsive in terms of including prevention in the curriculum of its six colleges and promoting interprofessionalism. “MUSC is doing a very good job with
interprofessional initiatives. I also think there is a fair amount of prevention that is incorporated into the curriculum of our colleges. What I would like to see is our students working together in teams to really address some of these preventable problems that we’re seeing both on our campus and in communities across the state. That is where I see the frontier of medicine — really harnessing the team in the health care delivery system and in the community to really make the kind of difference I think we can in the coming years.” small tOWn DOC It’s been 30 years since Garr joined the MUSC faculty. In 2003, while a professor in the Department of Family Medicine and assistant dean for community medicine in the College of Medicine, Garr was named executive director of the South Carolina Area Health Education Consortium, or AHEC. South Carolina AHEC, Garr shared, “exists to connect students to health careers, health professionals to communities and communities to better health. Specifically, our goal is to increase the number of young people who aspire to become health care professionals with a special emphasis on the underrepresented ethnic minorities and economically disadvantaged. We have built strong relationships throughout the state, and we are able to place health professions students in rural and underserved areas for clinical rotations, and finally, we work to increase the health care workforce through programs aimed at recruiting and retaining primary care providers.” No small job. Even with such a time– consuming leadership position,
See Award on page 11
10 The CaTalysT, July 10, 2015
Take the Mindful Challenge and enjoy a good night’s sleep A recent survey found that more people are sleeping less than six hours a night, and sleep difficulties visit 75 percent of us at least a few nights per week. An occasional bout of insomnia is generally nothing to worry about. However, chronic sleep loss should be addressed as it can be the cause or effect of other health issues. For example, sleep disorders can lead to other medical conditions, such as high Susan Johnson blood pressure, diabetes, and low sex drive, and having an undiagnosed sleep disorder can make it more difficult for your body to recover from illness. According to the American Academy of Sleep Medicine, chronic insomnia, which affects as many as 10 percent of adults, involves ongoing difficulty falling asleep or staying asleep — or regularly waking up earlier than desired — despite an adequate opportunity for sleep.
Health at work
HealtH Care WOrkers Medical professionals are at increased risk for developing sleep issues. Whether it’s long shifts on call, being delayed at work due to medical emergencies or simply not being able to switch the brain off after a stressful day at work, going to bed at the same time every night and getting adequate sleep can be difficult. Shift work sleep disorder (SWSD) affects people who frequently rotate shifts or work at night, causing a constant or recurrent pattern of sleep interruption, resulting in insomnia or excessive sleepiness during waking hours. Health care workers, nurses in particular who work the night shift, are more likely to have poor sleep habits, a practice that can increase the likelihood of committing serious errors that can put the safety of themselves as well as their patients at risk, according to a study published by the American Academy of Sleep Medicine. effeCts Of sHift WOrk sleep DisOrDer Sleep deprivation can cause a significant reduction in performance and alertness. Reducing nighttime sleep by as little as one and a half hours for just one night could result in a reduction of daytime alertness by as much as 32 percent. Decreased alertness and excessive daytime sleepiness impair memory and cognitive ability and also contribute to a higher risk of sustaining an occupational injury. Research suggests that lack of sleep can increase risk for serious health problems such as high blood pressure, heart attack, heart failure, stroke, obesity, diabetes and psychiatric problems including depression. symptOms The following are common symptoms when shift
worker disorder is present: q Difficulty concentrating q Headaches q Lack of energy q Excessive sleepiness q Throat muscles or tongue relaxes more than normal during sleep q Increased accidents & work-related errors q Sick leave needed q Irritability and mood problems imprOving sleep HaBits Everyone can benefit by following guidelines for good sleep hygiene, especially the need to sleep in a dark, quiet room. Proper sleep hygiene includes keeping the room temperature cool and comfortable and having a regular bedtime routine. Shift workers may also be helped by using “white noise” (produced by tuning a radio to the far end of the dial or by running a fan) to block out external noise. Turning off the phone (an answering machine can be used if necessary) and disconnecting the doorbell or putting up a “Do Not Disturb” sign can also help. Relaxation techniques such as reading, meditation, gentle yoga, progressive muscle relaxation or imagery can also set the stage for a good night (or day) of sleep. You can avoid sleep problems by: q Maintaining a healthy body weight by exercising and eating a balanced diet. q Going to bed and waking up at the same times every day. q Sleeping in a quiet, dark environment by turning off the TV, computer, and cell phones.
Employee Wellness
q July Monthly Mindful Challenge — Make sleep a priority. Begin by taking the challenge’s first survey at http://tinyurl.com/qgv5dfk. A link to the final survey will be sent at month’s end to those who take the first survey. q Employee Finess Series — 12:15 to 12:45 p.m. Exercise Bands: Take 30 minutes during lunch to learn how a 10-minute exercise band workout can lead to better health and fitness. Class is led by fitness expert Katie Blaylock of the Human Performance Lab. Free day pass to the MUSC Wellness Center for participants. Participants should check in at the membership desk for directions to the free class and receive their pass. Email musc-empwell@musc.edu to register. q Worksite Screening — Thursday, July 30, Clinical Sciences Building, Room HE628h; This screening, valued at about $350, is availble to employees with the State Health Plan (including MUSC Health Plan) at no charge for the basic test. Employees and spouses without this insurance can participate for $46. Go to musc.edu/employeewellness/2015WorksiteScreening. To register, click on link provided. q Chair massages — Free massages are offered
to employees from 11:30 a.m. to 1:30 p.m. on Wednesdays. Check broadcast messages for locations and times. q Farmers Markets — Fresh fruits and vegetables are available from local farmers on Fridays from 7 a.m. to 3:30 p.m. at the Horseshoe. Look for returning vendors King of Pops and Angel Blends.
MUSC Wellness Center
q HITS (High Intensity Training System) — Make yourself faster, stronger and more agile through this sixweek program. Sign up at the membership desk. Visit www.musc.edu/hsc or 792-5757. q Adventure Out is a yearlong outdoor fitness campaign to encourage residents to visit city parks for exercise. Free fitness classes with the purchase of an Adventure Out T-shirt or tank ($10/$15) for the entire year. T-shirts purchased from previous years are valid. Classes are designed for all ages and fitness levels. For information, visit www.musc.edu/adventureout.
MUSC Urban Farm
q Early Bird Maintenance — 7:30 to 8:30 a.m., Wednesdays q Sunset Work and Learn — 4 to 5 p.m., Thursday q Saturday Work and Learn — 9 to 11 a.m., July 11 and July 18
The CaTalysT, July 10, 2015 11
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involves using technology to connect experts with patients who are too far away or otherwise unable to visit medical specialists in person. James McElligott, M.D., medical director of MUSC’s Center for Telehealth, said the program is already paying off. “It’s allowing 96 percent of the population of South Carolina to be within an hour drive of life-saving stroke care. School–based telehealth is increasing access to primary care in both urban and rural underserved settings,” McElligott said. “Emergency room consultation from pediatric specialists is allowing child– specific expertise to be available in its greatest time of need, an effort that will soon be deployed across the state in partnership with all four children’s hospitals. Primary care practices are expanding their ability to care for their population through in–office telehealth services such as specialty consultation, mental health treatment, nutrition counseling and weight management.” That patients can monitor chronic health conditions from their homes is a big advantage, he said, citing as one example a diabetic home monitoring program underway as a partnership between MUSC and Abbeville. “Tele–CU co–management efforts
photo by Dawn Brazell, Public Relations
Georgetown’s Dr. Paul Hletko examines a patient with help from MUSC pediatrician Dr. James McElligott (on video monitor). have reduced the time patients need to be in the ICU and hospitals in South Carolina, simultaneously improving care while reducing costs,” he said. Cole agreed about the health benefits. “Telemedicine is an innovation that will transform how we provide health care in the future, and specifically enable better health access for patients in rural areas of our state,” Cole said. “We embrace having the opportunity to take a leadership role in facilitating the development of the South Carolina Telehealth Alliance and this technology.”
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continuing to see patients remained a priority for him. He still does one day a week. “A lot of people in administrative positions have given up practice,” he said. “I felt that was not what I wanted to do. Clinical practice keeps me grounded in who I am and what all that training was about.” In addition, he stays in touch with patients by email and enjoys the connection he has with them. He feels the practice of family medicine is special; it has allowed him to build and maintain relationships with families across generations. In fact, Garr and his wife have always had that in common. Deborah Williamson, DHA, an associate professor in the College of Nursing, has been a nurse midwife for 27 years. Garr met Williamson when they both attended Duke: He was a medical student, and she, a nursing student. Both were doing volunteer work at a free medical clinic in inner–city Durham when they met. “And now, lo and behold,” he said, “here we are approaching our 40th wedding anniversary.” Together they moved, in 1975, to the rural town of Tooele, Utah, where he was the town doctor and she was the nurse midwife. “We delivered babies together in rural Utah,” he said, adding that his wife was the first woman to deliver babies in that community since women rode sidesaddle more than 100 years before. Fast forward 40 years and, while both wear many hats serving in leadership positions at MUSC, it’s still common for them to work together for the good of the community. Williamson coordinates the Office of Hispanic Health Initiatives in the College of Nursing. She also
photo provided
Dr. David Garr addresses fellow members of the APTR. helped establish the nurse practitionerrun Partners in Health Care clinical practice at the East Cooper Community Outreach facility in Mt. Pleasant. Garr has worked with her to offer opportunities for interprofessional teams of students interested in primary care to work with the nurse practitioners while they are providing care to the uninsured patient population they are serving. The work Garr has accomplished has been truly gratifying. “It’s been fun to reflect back on what we’ve been trying to do. It’s been a fun road. I’ve had an opportunity to work with really great people throughout my career, and it has been a privilege to be a member of the excellent MUSC faculty, serving students and patients for more than 30 years. It is gratifying to work with people every day who are involved and committed to making a difference in the lives of those we serve.”
12 The CaTalysT, July 10, 2015
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humans, though, and if so, at what dosages that effect would be achieved and which populations would be most susceptible.” What researchers can say is that other dispersants may be safer. Collaborating with other GoMRI members who are developing alternative dispersants, MUSC researchers are testing the endocrine activities of the new dispersants. “They sent us an effective two–component dispersant mix. We did the tests we performed on COREXIT and found that it has much lower activity in our tests.” They also are preparing the next generation of scientists who will study how to better protect human health from compounds that act as endocrine disruptors. Alexis Temkin, a marine biomedicine and environmental sciences Ph.D. student at MUSC and a GoMRI Scholar, along with Robert Bowers, Ph.D., are first authors on the study. It’s this kind of research that brought Temkin to MUSC and the Hollings Marine Laboratory, which also was involved in the study.
“I knew I wanted to study environmental health on a molecular level and explore the connection between environmental health and public health,” she said. “The Marine Biomedicine Program directed by Lou Guillette was really a perfect fit, and Demetri’s newly funded project studying the long-term health impacts of the DWH oil spill was a great opportunity for me.” Temkin said their research involved using a cell reporter system to see if certain chemical mixtures interact with proteins involved in cell processes that guide metabolic functions such as fat differentiation. Because cellular processes are microscopic and complex, they engineered the cells to light up if a chemical caused that specific change in the cell. “We then use other experiments like cell differentiation or in vivo model studies to follow up on and further investigate these hits,” she said. “We were definitely surprised by the results. My original hypothesis was that one or more components of oil could be potential obesogens. When we narrowed it down to a component of COREXIT and then down further to a
single chemical, DOSS, I was even more surprised. Investigating the use of DOSS other than its use in COREXIT has been a really eye–opening experience, too, given its broad use as a chemical.” Temkin said she loves being a GoMRI scholar and that the funding agency places a high value on student work and the collaborative potential between different researchers and projects. “It’s been a wonderful and supportive environment to pursue a Ph.D.” It's also fertile ground for future research. Spyropoulos said they are particularly interested in what happens during fetal exposure. There’s a hypothesis that speculates that what the fetus is exposed to during pregnancy can have a profound impact on its health trajectory throughout life. There is a transfer of some of the compounds that the mother is exposed to that goes to the fetus. The cells in a fetus begin with pluripotent stem cells that have the potential to differentiate into any cell in the body. “In one model of obesity, there is a mesenchymal stem cell that can produce bone, cartilage, fat and muscle cell types. What our work
suggests is that DOSS — if it gets into a mesenchymal stem cell lineage — will affect differentiation that will make it more likely to become a fat cell.” Spyropoulos said that just because a compound is used at a level lower than what would kill cells in the body doesn’t mean it’s necessarily harmless. The oral laxative used by some pregnant women can be prescribed at up to 1/10th the dosage used in their study, which signifies this is an area that warrants further investigation. “We need to think more holistically. This chemical helps disperse oil, but is that the only thing it does? This chemical helps a woman who is pregnant with constipation, but what else is it doing? And is it interacting with other chemicals so its impact is stronger?” More research is needed to study compounds that may alter the behavior of cells and hormonal balances in the body that can contribute to disease, he said. “We now need to take a second look at anything we put on our bodies, in our bodies and in the environment. If some major culprits are identified, that could lead to significant health improvements.”
ITALY DISCOVERED
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THE TOUR FOR PEOPLE WHO DON’T WANT TO DO TOURS Chef Massimiliano Sarrocchi and wife Natasha Herron have been running small private tours to Italy for the past 13 years. Our formula is small group (max 13). No hotel hopping every night, authentic, good food, wine and culture, great fun! Now we have added the colonial jewel, San Miguel de Allende, Mexico, Mexico, the reigning Conde Naste’s number one city and Unesco world heritage sight.
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For 9 days your home away will be a lovely villa in the heart of the city. We are running this tour over the famous ‘Day of the Dead’ festival, festival, a fantastic time to explore the cobbled streets, art galleries and markets, enjoy a cooking class, (painting /photography optional) visit pyramids, the city of Guanajato- home of Diego Rivera, much more.
✮ Oct 30 - Nov 7 ✮
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2015
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