Austin Medial Times

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Volume 5 | Issue 8

Inside This Issue

August Edition 2022

Shift Work Increases the Severity of Strokes Later In Life Research finds living against our internal body clocks can damage our long-term health by altering gut and brain interactions By Lindsey Hendrix

Dell Medical School, Austin Community College Team Up to Support Mental Health Needs See pg. 10

INDEX Legal Matters....................... pg.3 Oncology Research......... pg.4 Mental Health...................... pg.6 Healthy Heart....................... pg.8

UT Southwestern Researchers Capture First Images Of Antibody Attacking Neuron Receptor See pg. 11

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s most Americans wind down for bed, 15 million people are just clocking into work. These hospital workers, emergency responders, factory operators and others are among the 20 percent of the world’s population who do shift work. Their different sleep-wake cycle elevates their risk for numerous health disorders, including diabetes, heart attacks, cancer and strokes. Now, new research, published in Neurobiology of Sleep and Circadian Rhythms, shows the adverse effects of shift work can be long-lasting, even after returning to a normal schedule. “Shift work, especially rotating shift work, confuses our body clocks and that has important ramifications in terms of our health and well-being and connection to human disease,” said David Earnest, PhD, professor in the Department of Neuroscience and Experimental Therapeutics at the Texas A&M University College of Medicine. “When our internal body clocks are synchronized properly, they coordinate all our biological processes to occur at the right time of day or night. When our body clocks are misaligned, whether through shift work or other disruptions, that provides for changes in physiology, biochemical processes and various behaviors.” A previous study done by Earnest and colleagues found that animal models on rotating shift work schedules had more severe stroke outcomes, in terms of both brain damage and functional deficits, than those on regular 24-hour cycles of day and night. Males were distinguished by worse outcomes in which mortality

rates were much higher. This new study took a different approach. Rather than examining immediate effects of shift work on strokes, the researchers returned all subjects to regular 24-hour cycles and waited until their midlife equivalent— when humans are most likely to experience a stroke—to evaluate stroke severity and outcomes. “What was already born out in epidemiological studies is that most people only experience shift work for five to eight years and then presumably go back to normal work schedules,” Earnest said. “We wanted to determine, is that enough to erase any problems that these circadian rhythm disruptions have, or do these effects carry over even after returning to normal work schedules?” They found that the health impacts of shift work do, indeed, persist over time. The sleep-wake cycles of subjects on shift work schedules never truly returned to normal, even after subsequent exposure to a regular schedule. Compared to controls maintained on a regular day-night cycle throughout the study, they displayed persistent alterations of their sleep-wake rhythms, with periods of abnormal activity when sleep would

have normally occurred. When they suffered strokes, their outcomes were again much worse than the control group, except females had more severe functional deficits and higher mortality than the males. “The data from this study take on added health-related significance, especially in females, because stroke is a risk factor for dementia and disproportionately affects older women,” said Farida Sohrabji, PhD, also a professor in the Department of Neuroscience and Experimental Therapeutics and director of the Women’s Health in Neuroscience Program. Interestingly, the researchers also observed increased levels of inflammatory mediators from the gut in subjects exposed to a shift work schedule. “We now think that part of the underlying mechanism for what we’re seeing in terms of circadian rhythm disruption causing more severe strokes may involve altered interactions between the brain and gut,” Earnest said. The results of this study could eventually lead to the development of interventions that block adverse see Shift Work...page 14

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Legal Matters HHS OCR Issues New, Post-Dobbs Guidance

By Iliana L. Peters, J.D. and Abby E. Bonjean, J.D. Polsinelli, PC

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he United States Supreme Court recently issued its long-anticipated ruling in Dobbs v. Jackson Women’s Health Organization. In Dobbs, the Supreme Court upheld Mississippi’s abortion restrictions making most abortion procedures illegal after 15 weeks of pregnancy, and, in the process, overturned Roe v. Wade and Planned Parenthood v. Casey, which established a federal constitutional right to abortion. Although the Dobbs decision itself did not outlaw the procedure, several states have “trigger laws,” designed to go into effect upon Roe’s and Casey’s reversal, or pre-Roe

laws that outlaw or limit abortions. Other states are expected to implement additional restrictions and bans in the coming months. These state laws may have dramatic implications on patient privacy. In the wake of the Dobbs decision, the Department of Health and Human Services (HHS), Office for Civil Rights (OCR) issued new guidance regarding the privacy of patients seeking reproductive health care. The guidance addresses two issues: (1) how federal law and regulations protect patients’ medical information relating to reproductive health care, and (2) the extent to which private medical information is protected on personal devices and how consumers can protect the privacy of their health information when using period trackers and other health-related apps. I. Protecting the Privacy of Patients’ Information in Health Care Settings The guidance affirms that federal rules to protect individuals’ protected health information (PHI) are already

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in place under the Health Insurance Portability and Accountability Act (HIPAA). Specifically, the guidance emphasizes that HIPAA covered entity health care providers, health plans, and health care clearinghouses can use or disclose PHI, without an individual’s signed authorization, only as expressly permitted or required by the HIPAA Privacy Rule. HHS OCR clarifies that disclosures for purposes not directly related to the provision of health care to an individual—such as disclosures to law enforcement officials or to avert a serious threat to health or safety of a pregnant patient—are permitted only in specific circumstances and if certain requirements are met. HIPAA covered entities and business associates should ensure that they have robust policies and procedures in place to address requests for information from law enforcement officials, disclosures to prevent or lessen a serious and imminent threat to the health or safety of a pregnant patient or the public, and disclosures that are otherwise required by law. Examples: • “An individual goes to a hospital emergency department while

experiencing complications related to a miscarriage during the tenth week of pregnancy. A hospital workforce member suspects the individual of having taken medication to end their pregnancy. State or other law prohibits abortion after six weeks of pregnancy but does not require the hospital to report individuals to law enforcement. Where state law does not expressly require such reporting, the Privacy Rule would not permit a disclosure to law enforcement under the “required by law” permission. Therefore, such a disclosure would be impermissible and constitute a breach of unsecured PHI requiring notification to HHS and the individual affected.” An entity making a disclosure in this see Legal Matters...page 14

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Oncology Research What Is The ‘Pet Effect’ and Can It Help Cancer Patients? By Travis Cox, M.D., Texas Oncology– Harker Heights, Marble Falls, and Round Rock North

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hink about how you feel around your pet. Do you feel content, happy, or loved? Since the pandemic, the emotional value of pets has become even more apparent. This special bond, known as the “pet effect,” is the beneficial relationship between people and animals that positively impacts the health and well-being of both. In a recent survey of pet owners worldwide, 95 percent consider their pets to be a part of the family. The same survey revealed there is a strong link between pet ownership and improved human health. In fact, 87 percent of surveyed pet owners say they have experienced a mental or physical health benefit from bonding with their pet.

Pets offer companionship, motivation to stay physically active, and positive encouragement during challenging times, especially for people with cancer. How pets impact your mental health According to the American Psychological Association, pet owners tend to have increased self-esteem and a more positive mood. A study on the impact of pets and mental health conducted during the COVID-19 pandemic found that pets can increase uplifting emotions and enhance coping skills when connection to others is diminished or not possible. The emotional toll of coping with cancer is significant for patients and can lead to periods of depression and anxiety. The potential mental health benefits for cancer patients who own a pet include: • Easing anxiety and elevating negative or depressed moods • Boosting patients’ self-esteem and giving a sense of purpose • Offering company, companionship,

and comfort, and lessening feelings of isolation or loneliness • Providing a distraction from pain, stress, and boredom The physical benefits of the ‘pet effect’ Pet ownership has also been linked to improving people’s physical health. Research shows that pets can help lower a patient’s blood pressure and heart rate, reduce stress levels, and even alleviate pain. Studies have found that social interaction between people and animals can increase levels of the “feel-good” hormone oxytocin, while others may experience a feeling of calm or relaxation from petting or snuggling with a cuddly pet, due to lowering levels of the stress hormone cortisol. Doctors often emphasize the importance of exercise for cancer patients. Another valuable benefit of having a pet—and an easy way for “pet parents” to get exercise—is to simply take their pet for a walk. Considerations of having a pet when going through cancer treatment Even with these benefits, having

a pet is not ideal for everyone, and patients may want to consult their medical team for recommendations, based on their circumstances. Pet ownership carries a great responsibility and patients need to ensure they can care for their pet at home while undergoing treatment. Having a plan for assistance with tasks like feeding or walking your pet should be established early. Additionally, pets are not an appropriate surprise gift.

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Mental Health Keeping Mental Health Crises Out of the Criminal Justice System Travis County Leaders, Dell Medical School Working Together to Transform Behavioral Health Care Among the Incarcerated

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cross the nation and within Travis County, a disproportionate number of people living with mental health and substance use disorders end up in jail instead of getting the mental health treatment and support they need. Mental health experts at Dell Medical School at The University of Texas at Austin are

“This planning effort brings innovators, experts and advocates together to understand the challenges and the opportunities, and to help us achieve a coordinated system of mental health care in Travis County for people who have been stuck in or are cycling pointlessly through jail,” said County Judge Andy Brown. Based on a Proven Model “To address the complexities around the criminal, legal and mental health system intersection, we have to step back and work

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joining forces with the Travis County Commissioners Court and a wide range of community partners to address this problem by rethinking – and ultimately redesigning – the local intersection of criminal, legal and behavioral health systems. The goal of the effort, known as the Travis County Forensic Mental Health Project, is to establish solutions rooted in person-centered and evidence-based care for people stuck at or repeatedly cycling through this intersection. About 2 million people with serious mental illness are incarcerated annually in the U.S. One in 5 U.S. adults will experience a mental illness within a given year. In Travis County, 37% of people incarcerated in October 2021 were receiving mental health care in jail. By May 2022, the rate had increased to 42%.

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collaboratively across both systems,” said Steve Strakowski, M.D., associate vice president for regional mental health and professor in the Department of Psychiatry and Behavioral Sciences at Dell Med. “It will take a ‘people first’ approach to find actionable solutions to this mental health crisis, with health equity as a guiding principle.” This approach is based on a proven model, Strakowski said. Since 2016, Dell Med has collaborated with the Texas Health and Human Services Commission, along with other partners, to develop an innovative model for a continuum of mental health care at the Austin State Hospital (ASH). The state-funded project includes a new 240-bed hospital facility to support a new see Mental Health...page 13


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Healthy Heart

FEEL GOOD AGAIN

American Heart Association Adds Sleep to Cardiovascular Health Checklist By American Heart Association Presidential Advisory

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leep duration is now considered an essential component for ideal heart and brain health. Life’s Essential 8™ cardiovascular health score replaces Life’s Simple 7™, according to a new Presidential Advisory. “The new metric of sleep duration reflects the latest research findings: sleep impacts overall health, and people who have healthier sleep patterns manage health factors such as weight, blood pressure or risk for Type 2 diabetes more effectively,” said American Heart Association President Donald M. Lloyd-Jones,

level is 150 minutes of moderate physical activity or more per week or 75 minutes per week of vigorous-intensity physical activity for adults. • Nicotine exposure: Use of inhaled nicotine-delivery systems, which includes e-cigarettes or vaping devices is added. Life’s Essential 8™ also includes second-hand smoke exposure for children and adults. • Sleep duration: Measured by average hours of sleep per night, the ideal level is 7-9 hours daily for adults. Ideal daily sleep ranges for children are 10-16 hours for ages

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M.D., Sc.M., FAHA, who led the advisory writing group. The Life’s Essential 8™ components of optimal cardiovascular health are divided into two major areas – health behaviors and health factors. Health behaviors include diet, physical activity, nicotine exposure and sleep. Health factors are body mass index, cholesterol levels, blood sugar and blood pressure. Life’s Essential 8™ includes: • Diet: The Dietary Approaches to Stop Hypertension (DASH)-style diet score has eight components: high intake of fruits, vegetables, nuts and legumes, whole grains, low-fat dairy, and low intake of sodium, red and processed meats, and sweetened drinks. • Physical activity: The optimal

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5 and younger; 9-12 hours for ages 6-12 years; and 8-10 hours for ages 13-18 years. • Body mass index: The writing group acknowledges that body mass index (BMI) is an imperfect metric, yet it is easily calculated and widely available; therefore, BMI continues as a reasonable gauge to assess weight categories that may lead to health problems. • Blood lipids: The metric for blood lipids is updated to use non-HDL cholesterol as the preferred number to monitor, rather than total cholesterol. • Blood glucose: This metric is expanded to include the option of hemoglobin A1c readings or blood glucose levels. see Healthy Heart ...page 13


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Dell Medical School, Austin Community College Team Up to Support Mental Health Needs

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uggling school, work, relationships and newfound independence can make young adulthood a particularly challenging time. The years between ages 16 and 25 are also the period when many begin to experience mental health symptoms for the first time, yet the symptoms often go undiagnosed. To provide early intervention for young adults struggling to access mental health support in Central Texas, the Center for Youth Mental Health at Dell Medical School at The University of Texas at Austin has teamed up with Austin Community College District (ACC) to launch a new mental health pilot called the Amplify Center. Set to open this fall as part

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“Young adulthood doesn’t fit well into our existing mental health care systems,” said Deborah Cohen, Ph.D., a Dell Med assistant professor and Amplify Center executive director. “Our current mental health system was created to support adults who are already living with chronic mental illness. A young adult usually can’t access those services unless they are in crisis or have a run-in with the police. We need better solutions for this age group than what’s currently in place,” said Cohen. Students identified as having more acute mental health care needs will be referred to Integral Care, Travis County’s public mental health care provider and an Amplify Center collaborator.

of a two-year pilot program, the Amplify Center will focus its first year on mental health services for at least 200 ACC students ages 18-29 at their Eastview Campus, located in a medically underserved part of Travis County. In collaboration with ACC’s Student Services team, students will receive mental health screenings and diagnostic assessments by mental health professionals and will have access to services such as individual counseling, peer support and resource navigation for connection to other community services. Eventually, the center aims to expand to include additional services at more ACC locations and other community locations in Travis County.

The Center for Youth Mental Health within Dell Med’s Department of Psychiatry and Behavioral Sciences envisions a mental health system that truly meets the developmental needs and goals of adolescents and young adults. It was established through a grant from the Michael & Susan Dell Foundation. The Amplify Center is the result of nearly five years of community brainstorming to implement a model to fill a significant gap in care. “The Center for Youth Mental Health has collaboratively worked

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Austin Medical Times

UT Southwestern Researchers Capture First Images of Antibody Attacking Neuron Receptor Findings Provide Mechanism to Diagnose and Treat Autoimmune Diseases

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sing U T Southwestern’s Cryo-Electron Microscopy Facility, researchers for the first time have captured images of an autoantibody bound to a nerve cell surface receptor, revealing the physical mechanism behind a neurological autoimmune disease. The findings, published in Cell, could lead to new ways to diagnose and treat autoimmune conditions, the study authors said. “We’re entering a new era of understanding how autoimmune disease works in the central nervous system,” said Colleen M. Noviello, Ph.D., Assistant Professor of Neuroscience at UTSW who

specializes in obtaining cryo-electron microscopy (cryo-EM) images down to an atomic level of resolution. Dr. Noviello co-led the study with Ryan Hibbs, Ph.D., Associate Professor of Neuroscience and Biophysics, an Effie Marie Cain Scholar in Medical Research, and an Investigator in the Peter O’Donnell Jr. Brain Institute and Harald Prüss of Universitätsmedizin Berlin. Researchers have studied autoimmune diseases – a class of conditions in which the immune system attacks healthy parts of the body – for decades. However, the first autoimmune disease targeting a neuronal receptor protein was

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discovered just 15 years ago, Dr. Noviello explained. Since then, researchers have reported the existence of a handful of other diseases that fall into this category. These include autoimmune e n c e p h a l it i s , a condition characterized by the sudden onset of severe symptoms including psychosis, seizures, movement disorders, impaired consciousness, and problems with the autonomic nervous system, which controls involuntary bodily functions. Researchers in Germany recently identified a patient, then 8 years old, whose autoimmune encephalitis appeared to be caused by antibodies that attack

Autoimmune encephalitis occurs when antibodies or T-cells go rogue and attack the brain. In this study, UTSW researchers and colleagues from Berlin used cryo-electron microscopy to determine the atomic structures of autoantibodies bound to the GABAA receptor. That receptor is an important protein in the brain and a target in autoimmune encephalitis.

see UT ...page 13

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Age Well, Live Well Regular Vaccinations for Aging Well By Olivia Burns HHS Aging Texas Well Coordinator

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eceiving regular vaccinations is important for everyone’s health, especially older adults who are at risk for more complications from the seasonal flu and shingles. Vaccines can help build and maintain immunity from contracting a variety of diseases and viruses, including influenza, pneumonia and COVID-19. If you contract one of these viruses, having a vaccine can prevent or lower your risk of developing serious symptoms that may require

hospitalization or even lead to death. According to the National Center for Health Statistics, influenza and pneumonia are estimated to be the cause of death for 50–60,000 people each year. The Centers for Disease Control and Prevention reports that just over 1 million people have died from COVID-19 in the U.S. As we age, our immune system doesn’t work as effectively and previous immunity we may have built up can weaken. Older adults are more likely to experience serious complications from viruses and diseases, so it is important that older adults receive

regular vaccinations. The following are common recommended vaccines for older adults: • Seasonal flu vaccine: It is recommended that everyone age 6 months and older receive a yearly flu vaccine. Older adults are recommended to get the high-dose flu vaccine, which is specifically designed for adults age 65 and older. • Pneumococcus vaccines: Pneumonia is often a secondary condition caused by viruses like the flu and COVID-19. Experts recommend getting this vaccine if you have a chronic disease, have a weakened immune system or are age 65 or older. • ● Shingles (Herpes Zoster) vaccine: Shingles and chickenpox are caused by the same virus. While chickenpox is often considered something mainly children get, the virus can become active again as you get older and lead to shingles, a painful skin rash. To prevent this, experts recommend getting the two-dose vaccine if you’re age 50 or older. • Tetanus, diphtheria and

pertussis (TDAP) vaccines: TDAP is recommended for everyone, especially if you are regularly around babies or young children. These vaccines help prevent contracting whooping cough, tetanus, pertussis and diphtheria. • COVID-19 vaccines and booster shots: Vaccines and boosters for COVID-19 are important for preventing or reducing serious symptoms. They help your immune system build better protection against the virus, including its variants. To learn more about recommended frequency for receiving these vaccines, view the Adult Immunization Schedule. Medicare, Medicaid and private health insurance plans typically cover the cost of receiving many of these vaccines. If you don’t have insurance, you might be eligible for assistance. To learn more and find a vaccine provider, visit the Texas Department of State Health Services Adult Safety Net Program website or call 800-252-9152. For more information about programs and services for older adults, visit the Health and Human Services Age Well Live Well webpage or call 2-1-1. 

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Mental Health Continued from page 6 way of treating mental health issues. Construction of the new ASH is expected to be completed in late 2023. The ASH Brain Health Redesign model’s use of a steering committee of community stakeholders from all backgrounds and expertise cascading into a series of work groups supports a true collaboration across a complex system. By using a similar model for Travis County, it engages more people than usually possible to support and provide insights for the best solutions for Travis County residents. “For far too long, we have overlooked the most valuable perspective when designing the intersection where criminal justice involvement meets mental

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health care: the perspective of people receiving services,” said Parker LaCombe, director of peer support services at Austin State Hospital. “We have seen throughout the redesign of the new ASH how valuable the input of people with lived experience truly is, and by using ‘people first’ as our guiding principle for both the work of the Travis County Forensic Mental Health Project and the ASH redesign, we are able to ensure a person-centered approach rooted in the belief that recovery is possible for all people experiencing mental health and/ or substance use challenges,” said LaCombe. The steering committee includes more than 15 experts and organizations spanning academia, law enforcement, the judicial system, health care systems, advocacy groups, substance use experts, and people with lived

experience and their families, among others. Applying a Health Equity Lens to Find Transformative Solutions The Travis County Forensic Mental Health Project will apply a health equity lens in its quest for transformative solutions, striving to address and correct longstanding sociodemographic inequities, Strakowski said. Already underway since May, the project is currently evaluating existing systems, has formed a steering committee and will establish working groups to perform an environmental scan and data analytics to produce actionable recommendations. By February 2023, the group plans to provide actionable and fundable recommendations to the county commissioners. “The lack of adequate behavioral health care for people

experiencing mental health crises in the criminal justice system has forced jails into being among the largest mental health care providers in the state,” said Travis County Sheriff Sally Hernandez. “Jails were never designed to function in this manner. It’s a travesty that causes needless suffering and seriously depletes resources. This is a program that’s desperately needed.” The project may result in expanding existing programs or creating new programs or services, a central building space for services, as well as other innovative and communitydistributed components, said Strakowski, who leads the steering committee. Ultimately the group hopes to form a scalable, replicable model of care for the nation’s mental health system. 

Each component of Life’s Essential 8™, which is assessed by the My Life Check tool, has an updated scoring system ranging from 0 to 100 points. The overall cardiovascular health score is the average of the scores for each of the eight health

measures. Overall scores below 50 indicate “poor” cardiovascular health, 50-79 is considered “moderate” and scores of 80 and above indicate “high” cardiovascular health. “Life’s Essential 8™ is a major step forward in our ability to identify

when cardiovascular health can be preserved and when it is sub-optimal. It should energize efforts to improve cardiovascular health for all people and at every life stage,” Lloyd-Jones concluded.

antibody bound to the receptor. UTSW’s cryo-EM facility, opened in 2016 with support from the Cancer Prevention and Research Institute of Texas (CPRIT), provides 3D images of biological molecules up to atomic resolution. The images show that, both together and separately, the antibodies prevent the GABAA receptor from inhibiting neuronal signaling, causing neurons to become too electrically excited and leading to brain inflammation, cell death, and seizures characteristic of autoimmune encephalitis. Screening for these antibodies could lead to better diagnosis of this condition,

said Dr. Noviello; likewise, finding ways to block the interaction between these antibodies and their target could lead to better ways to treat it. As understanding of autoimmune nervous system diseases is still in its infancy, Dr. Hibbs said that he, Dr. Noviello, and their colleagues plan to make the study of these disorders using cryo-EM a focus of the Hibbs lab’s research into the future. The team is already collaborating with Steven Vernino, M.D., Ph.D., Professor of Neurology, Vice Chair for Education and Faculty Affairs, and Distinguished Teaching Professor; and Nancy

Monson, Ph.D., Associate Professor of Neurology and Immunology, to study more autoimmune conditions that affect the central nervous system. Dr. Vernino holds the Rex Griswold Distinguished Professorship in Multiple System Atrophy and the Dr. Bob and Jean Smith Foundation Distinguished Chair in Neuromuscular Disease Research.

Healthy Heart Continued from page 8 • Blood pressure: Blood pressure levels less than 120/80 mm Hg is optimal, and hypertension is defined as 130-139 mm Hg systolic pressure (the top number in a reading) or 80-89 mm Hg diastolic pressure (bottom number).

UT Continued from page 11 the GABAA receptor, a protein that sits on the surface of synapses – specialized structures that connect brain cells. This receptor’s role is to inhibit neuronal firing, balancing the electrical signals prompted by excitatory receptors to maintain healthy signaling between nerve cells. After confirming that two kinds of antibodies derived from this young patient’s immune cells readily bound to the GABAA receptor, Drs. Noviello, Hibbs, and their colleagues in the Hibbs lab performed cryo-EM – a technique that freezes proteins in place to get high-resolution microscopic images – for each

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Shift Work

Continued from page 1 effects of disrupted circadian rhythms. In the meantime, shift workers can improve care of their internal body clocks by trying to maintain a regular schedule as much as possible and avoiding a diet high in fat, which can cause inflammation and also alter the timing of circadian rhythms. This research has clear implications for shift workers, but it

Legal Matters Continued from page 3

circumstance could be subject to up to more than $1.9 million in civil money penalties for making a single disclosure of information about the patient to law enforcement. “A law enforcement official goes to a reproductive health care clinic and requests records of abortions performed at the clinic. If the request is not accompanied by a court order or other mandate enforceable in a court of law, the Privacy Rule would not permit the clinic to disclose PHI in response to the request. Therefore, such a disclosure would be impermissible and constitute a breach of unsecured PHI requiring notification to

Oncology Continued from page 4 It is important to first establish with the patient and their household that

Austin Medical Times could extend to many other people who keep schedules that differ greatly from day to day. “Because of the computer age, many more of us are no longer working from nine to five. We take our work home and sometimes work late at night,” Earnest said. “Even those of us who do work regular schedules have a tendency to stay up late on the weekends, producing what is known as ‘social jet lag,’ which similarly unwinds our body clocks so they no longer keep accurate time. All this can lead to the

same effects on human health as shift work.” To avoid some of these health hazards, Earnest says the best approach is to maintain a regular schedule of awake time, sleep time and mealtimes that doesn’t vary drastically from day to day. In addition, avoid the usual cardiovascular risk behaviors like eating a high-fat diet, not getting enough physical activity, drinking too much alcohol and smoking.

HHS and the individual affected.” An entity making disclosures of multiple patients’ information to law enforcement without a court order requiring such disclosures under penalty of law could be subject to up to more than $1.9 million in civil money penalties for each individual whose information the entity disclosed. II. Protecting Consumers’ Health Information When Using Personal Devices Because HIPAA only applies to health information when it is maintained and transmitted by covered entities and business associates, the guidance clarifies that the HIPAA Privacy Rule generally does not protect the privacy or security of personal health information when it is saved or accessed through an individual’s

personal phone or tablet. HHS OCR provides suggestions for consumers on how to protect the privacy of their health information stored on personal devices, including how to select more secure apps, delete stored data and turn off location services permissions on Apple and Android devices. HHS OCR reiterated that the best way for individuals to protect their health and personal information from being collected and shared on their personal cell phones or tablets without their knowledge is to limit what personal information they send and store on or through devices. HHS OCR recommended that individuals leave the devices at home, if they are concerned about tracking of their activities through geolocation. 

they are able and willing to provide all needed care. The importance of support systems for cancer patients is well-known. In appropriate situations, pets and animal interactions can be a boost to your spirits, bringing a smile

to your face and creating a welcome distraction from the daily trials of cancer. 

additional donors to expand the number of individuals served through this initiative. According to data from the U.S. Surgeon General, in December 2021 the nation saw approximately 6,600 deaths by suicide among 10to 24-year-olds. It’s the second most likely cause of death, and young adults are at the greatest risk. “These numbers are startling and disturbing, and the pandemic hasn’t helped. Students are having a

harder time finding help and quality care,” said Shasta Buchanan, Ed.D., ACC vice chancellor of student affairs. “Our goal is to get more individuals the right care and when they need it — when their symptoms are in their infancy.” 

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August 2022

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Dell with community providers to propose a creative solution to address the gap in the care continuum for young adults,” said Kathleen Casey, Ph.D., a senior director of clinical innovation and development at Integral Care. “We hope this pilot is able to expand and fulfill unmet needs in our community.” Love, Tito’s, and Twin Liquors also donated funds to initiate this pilot. The Center for Youth Mental Health is actively exploring

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