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UCSF Medical Center, John Muir Health affiliate

Relationship to serve as cornerstone of Bay Area network to provide more integrated care.

By Karin Rush-Monroe, UC San Francisco

UCSF Medical Center and John Muir Health have finalized an agreement that will serve as the foundation for a Bay Area health care network intended to provide patients with high quality care at an affordable price.

The two health systems also have formed a new development company that will enable them to collaborate on building new medical facilities, increase the number of physicians in the health care network, and provide physicians and patients new tools to improve coordination of care, with the ultimate goal of an enhanced patient experience.

Under the agreements, both organizations remain independent. Together, UCSF Medical Center and John Muir Health:

  • Have invested in a collaborative effort, called the Bay Area Accountable Care Network, to form a regional health care network. Establishing a Bay Area-wide network will provide patients from throughout the Bay Area and Northern California with a competitively priced option to access, close to where they live or work, many of the Bay Area’s most trusted and respected hospitals, health systems and physician organizations.
  • Will equally own and operate a new development company. The formal affiliation will enable both organizations to build on their strengths and work together to develop joint initiatives and a shared services organization to support programs and initiatives focused on better health care, at lower costs, for Bay Area patients.

“UCSF Medical Center, and John Muir Health are leading the development of a comprehensive Bay Area network of providers who share a common commitment to providing safe, high quality, patient centered care at an affordable price. We intend to offer this network to health plans who serve patients throughout the Bay Area,” said Mark R. Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospitals. “We look forward to working not just with each other, but with other health organizations throughout the Greater Bay Area, in order to provide an exceptional health care experience for patients.”

The two organizations will apply for a restricted Knox-Keene license effective in the Greater Bay Area. This license, which is issued by the California Department of Managed Health Care, would enable the Bay Area Accountable Care Network to contract directly with health plans to develop an insurance product that provides access to high-quality care at an affordable price.

As a next step, UCSF Medical Center and John Muir Health will coordinate their Epic electronic medical record systems and patient communication portals to enable better physician and patient communications. UCSF Medical Center and John Muir Health also anticipate, with other provider partners, building enhanced physician practice management services to create alternatives for physicians throughout the Bay Area who wish to be participating providers in the Bay Area Accountable Care Network.

“Our affiliation brings together two forward-thinking organizations that share a vision for how health care will be delivered in the future,” said Cal Knight, president and CEO of John Muir Health. “We’re pleased to have finalized our affiliation so we can further our joint initiatives and efforts to develop a Bay Area Accountable Care Network. We’re focused on meeting the needs of patients by providing better access to high-quality and affordable care throughout the Bay Area from trusted and respected physicians, hospitals, outpatient facilities and health systems.”

Both John Muir Health and UCSF Medical Center already have experience in successful care models developed under the Affordable Care Act, such as accountable care organizations (ACOs), that have demonstrated lower health care costs and improved health care quality. These experiences, as well as those of other organizations that choose to be part of the provider network, will be translated into the Bay Area Accountable Care Network. The goal is to provide the right care at the right time and in the most appropriate setting, whether that is the primary care physician’s office, an outpatient center or a hospital. When better coordination of care results in lower costs, the savings achieved are passed along to consumers in the form of lower health care benefit premiums.

By working more closely, the two organizations also will offer more convenient access to care for patients in Northern California. For example, an outpatient clinic for liver transplant services will be established at the John Muir Health’s Walnut Creek Outpatient Center. This will allow patients who are waiting for transplants, or have recently received transplants, at UCSF Medical Center, which is nationally recognized for the quality of its program, to receive clinical services such as blood testing and monitoring at the new location. John Muir Health’s Physician Network is a comprehensive network of primary care and specialist physicians, covering virtually all conditions except transplants.

In addition, both organizations are widely recognized for the quality of care they provide. U.S. News & World Report recently ranked UCSF Medical Center, John Muir Medical Center, Walnut Creek and John Muir Medical Center, Concord as the top three hospitals in the San Francisco-Oakland area. In addition, the John Muir Physician Network recently received the highest possible “elite” ranking from the California Association of Physician Groups.

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UC researchers awarded stem cell grants

Funding to develop treatments for Huntington’s, spina bifida, chronic diabetic wounds.

Roslyn Rivkah Isseroff, UC Davis

University of California researchers from two campuses received three grants totaling more than $12 million in funding from the state’s stem cell agency to develop stem cell treatments for Huntington’s disease, spina bifida and chronic diabetic wounds.

The funding was part of $25.2 million in Preclinical Development Awards targeting seven deadly or disabling disorders – what the California Institute for Regenerative Medicine considers “the most promising” research leading up to human clinical trials using stem cells to treat disease and injury.

UC Davis researchers were awarded a pair of grants totaling more than $7 million to develop stem cell therapies for spina bifida ($2.2 million) and chronic diabetic wounds ($5 million).

Diana Farmer, professor and chair of surgery at UC Davis Medical Center, is developing a placental stem cell therapy for spina bifida, the common and devastating birth defect that causes lifelong paralysis as well as bladder and bowel incontinence. She and her team are working on a unique treatment that can be applied in utero – before a baby is born — in order to reverse spinal cord damage.

Diana Farmer, UC Davis

Roslyn Rivkah Isseroff, a UC Davis professor of dermatology, and Jan Nolta, professor of internal medicine and director of the university’s Stem Cell Program, are developing a wound dressing containing stem cells that could be applied to chronic wounds and be a catalyst for rapid healing. This is Isseroff’s second CIRM grant, and it will help move her research closer to having a product approved by the U.S. Food and Drug Administration that specifically targets diabetic foot ulcers, a condition affecting more than 6 million people in the country.

Also, Leslie Thompson of the Sue & Bill Gross Stem Cell Research Center at UC Irvine has been awarded $5 million to continue her CIRM-funded effort to develop stem cell treatments for Huntington’s disease. The grant supports her next step: identifying and testing stem cell-based treatments for HD, an inherited, incurable and fatal neurodegenerative disorder. In this project, Thompson and her colleagues will create an HD therapy employing human embryonic stem cells that can be evaluated in clinical trials.

Leslie Thompson, UC Irvine

CIRM’s governing board also approved an application for the Tools and Technology Award that had been deferred from the January meeting. UCLA’s Carla Koehler will now get $1.3 million for research on a small molecule tool for reducing the malignant potential in reprogramming human induced pluripotent stem cells and embryonic stem cells.

Overall, CIRM’s governing board has awarded nearly $1.9 billion in stem cell grants, with half of the total going to the University of California or UC-affiliated institutions.

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UC Global Health Institute hosts policy briefing

Institute prepares for UC Global Health Day, second policy briefing, April 18 at UCLA.

Policy briefing presenters and UC Global Health Institute leadership (from left): Christopher Paige, Haile Debas, Joel Diringer, Marc Schenker, Yissel Barajas, Gil Ojeda and Thomas Coates.

The UC Global Health Institute hosted its first policy briefing March 17 with a focus on the health status of California’s largely immigrant, agricultural workforce.

The institute also is gearing up for UC Global Health Day, April 18 at UCLA, which will include a second policy briefing with a focus on undocumented workers and their families.

Farmworkers are a vulnerable population facing disparities in health and access to care, among many others. More than 80 people attended this policy briefing at UC Center Sacramento, which highlighted strategies on how to improve the health of this population. (View the briefing, courtesy of The California Channel.)

Speakers included Gil Ojeda, director of the California Program on Access to Care at the UC Berkeley School of Public Health; Tom Coates, director of UCLA’s Center for World Health and co-director of the UC Global Health Institute; and UC Davis public health sciences professor Marc Schenker, co-director of the Center of Expertise on Migration and Health within the UC Global Health Institute.

Schenker was lead author on the corresponding white paper. The paper included 11 policy recommendations to expand health insurance/access, improve public health infrastructure, increase the number of health workers and occupational safety employees, establish fairness across industry, improve living conditions, and promote agricultural safety and health education.

A panel including representatives from a nonprofit, social services organization; a farmworker advisory group; and a major California berry grower provided responses to the presentation.

The event launched the first of two policy papers from the UC Global Health Institute this year – with the second paper to focus on state-level policy and legislative changes to benefit undocumented workers and their families.

The second policy paper will be the topic of a special plenary session during UC Global Health Day, April 18 at UCLA. A diverse panel will engage in a dynamic discussion of a forthcoming white paper on this timely issue. The brief is sponsored by the UC Global Health Institute, with support from the UCLA Center for Health Policy Research.

Presented by the UC Global Health Institute, UC Global Health Day is an annual conference that showcases the research, training and outreach in global health being undertaken across the University of California.

It’s a chance for UC students, fellows, faculty, staff and visiting scholars to share their current work in global health. The day will feature plenary sessions, posters and concurrent breakout sessions covering a broad range of global health topics. The keynote speaker will be Patrick Soon-Shiong, founder and CEO of NantHealth, chairman of the Chan Soon-Shiong Family Foundation, and chairman and CEO of the Chan Soon-Shiong Institute of Molecular Medicine. Registration costs $75 for general admission and $50 for students. To register online by April 14, visit: https://www.eventbrite.com/e/uc-global-health-day-2015-tickets-15838746116.

For questions, email ucghi@globalhealth.ucsf.edu.

About the UC Global Health Institute
The UC Global Health Institute advances the mission of the 10-campus University of California system to improve the lives of people in California and around the world. By stimulating education, research and partnerships, the institute leverages the diverse intellectual resources across the university to train the next generation of global health leaders and accelerate the discovery and implementation of transformative global health solutions.

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UCSF to study benefits of personal approach to breast cancer screening

Five-year study will be a UC Health systemwide effort involving all five UC medical centers.

Breast cancer researcher Laura Esserman consults with a patient at UCSF. Esserman is leading a new study that will compare a personalized approach to breast cancer screening with annual mammograms. (Photo by Susan Merrell, UC San Francisco)

By Elizabeth Fernandez, UC San Francisco

A research team at UC San Francisco has won a five-year award of $14.1 million from the Patient-Centered Outcomes Research Institute (PCORI) to investigate whether a personalized approach to breast cancer screening is as safe and effective as annual mammograms.

The project, called the WISDOM study, will be led by breast cancer researcher Laura Esserman, M.D., M.B.A., professor of surgery and director of the Carol Franc Buck Breast Care Center at the UCSF Helen Diller Family Comprehensive Cancer Center.

“The controversy surrounding breast cancer screening has left women and their providers frustrated and confused,” said Esserman. “The time has come to put the controversy to rest.”

The five-year study – a UC Health systemwide effort with participation from all five UC medical centers – will involve approximately 100,000 women 40 to 80 years old. It will test a more targeted approach to breast cancer screening: Those at higher risk are screened more often and those at lower risk are screened less often. Annual screening will be weighed against a personalized schedule of screening based on each woman’s individual risk.

“This pragmatic trial will allow us to learn who is at risk for what type of breast cancer, and to continue to refine our approach to screening, potentially leading to less screening for those at very low risk and more for those at greater risk,” Esserman said. “It will enable us to focus on prevention as well. If our study is successful, fewer women will suffer from the anxiety of false-positive mammograms and unnecessary biopsies, and more women will gain a realistic understanding of their personal risk of breast cancer, which may reduce general worry about breast cancer.”

Women will be invited to be randomized (assigned by chance) to either the personalized or the annual screening arm. The two strategies will be compared to determine whether personalized screening is as safe as annual screening and whether it will reduce false-positive results and over-diagnosis.

Investigators also will determine whether women will readily accept personalized screening and whether knowledge of their own risks — and the reasons for their personalized screening regimen — will reduce, or at least not increase, anxiety about breast cancer. Additionally, the researchers will determine whether the personalized approach will lead to more of the highest-risk women deciding to use strategies that may prevent breast cancer.

Participants in the personalized screening arm will receive a risk assessment that will evaluate family and medical history, breast density, and tests for genes linked to the development of breast cancer.

Those with the highest personal risk of developing breast cancer or cancers that grow more quickly will receive recommendations to begin screening at an earlier age, receive mammograms more often, and continue screening until they are older. Those with the lowest personal risk will begin screening later, screen less frequently, and stop screening earlier. No woman will be screened less often than is recommended by the U.S. Preventive Services Task Force guidelines.

“We will learn from each woman who participates, and each woman will be equipped equally with more informed options to better personalize her medical care,” said Alan Ashworth, Ph.D., FRS, president of the UCSF Helen Diller Family Comprehensive Cancer Center and senior vice president for cancer services of UCSF Health. “This is a significant rethinking of breast cancer risk assessment and is a great example of how the UCSF cancer center is working to fully integrate cancer care with research for patient benefit.”

Participants in the breast cancer study will be drawn from the Athena Breast Health Network, a collaboration of the five University of California medical centers to drive innovation in breast cancer prevention, screening and treatment.

All eligible women from participating health plans who receive breast cancer screening at a UC medical center will be able to participate. The first health plan to participate is UC Care, a self-insured PPO plan for UC employees and retirees that offers care provided by UC’s medical centers. The first insurer to participate is Blue Shield of California, which has created a policy that will allow reimbursement for study-related services for members who are enrolled in the WISDOM trial while data are still being gathered about the safety and efficacy of personalized breast cancer screening. Discussions are underway with additional health plans and insurers.

“Blue Shield of California is pleased to support this important work to improve breast cancer screening and prevention,” said Marcus Thygeson, M.D., M.P.H., chief health officer at Blue Shield of California. “The current ‘one size fits all’ screening approach doesn’t do enough to reduce breast cancer deaths while also causing women to undergo unnecessary testing and treatment that harms their quality of life. This study promises to help find a better approach to breast cancer prevent and treatment, which will benefit our entire community.”

UC’s systemwide Center for Health Quality and Innovation will partner with Athena on the project to help provide value-based care.

“This project is a paradigm shift for preventive screening, harnessing UC’s systemwide strengths to advance care for Californians,” said John Stobo, M.D., executive vice president of UC Health. “We’re thrilled to be able to offer this screening trial to UC employees and the broader public.”

The breast cancer study is one of five projects selected for PCORI funding totaling $64.1 million. The award was approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract to UCSF.

“This project was selected for PCORI funding not only for its scientific merit and commitment to engaging patients and other health care stakeholders in a major study conducted in real-world settings, but also for its potential to answer an important question about breast cancer screening and fill a crucial evidence gap,” said PCORI Executive Director Joe Selby, M.D., M.P.H. “We look forward to following the study’s progress and working with UCSF to share its results.”

PCORI is an independent non-profit research institution. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions. For more information about PCORI’s funding awards, visit the Research and Results page on www.pcori.org.

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UCLA’s Clinical Informatics Fellowship Program among first to be accredited

Prospective applicants are urged to apply by April 1.

By Roxanne Moster, UCLA

UCLA’s Clinical Informatics Fellowship Program has been approved by the Accreditation Council for Graduate Medical Education, providing the innovative subspecialty with key support as it earns broader recognition. In receiving accreditation, UCLA becomes one of only seven programs nationwide to earn approval from that important sanctioning body to date.

“We’re fortunate to be among the programs that will pioneer clinical informatics training, helping to establish the new subspecialty’s role in transforming health care,” said Dr. Douglas Bell, professor of medicine at UCLA and program director of the new fellowship.

Clinical informatics involves the application of both biomedical knowledge and information management to improve health care. Physicians who practice this growing scientific discipline strive to improve and transform health care by analyzing, designing, implementing and evaluating information and communication systems that enhance individual and population health outcomes, improve patient care, and strengthen the patient/clinician relationship.

“The UCLA fellowship program received accreditation just a year after planning and development began,” said Kevin Baldwin, specialist in IT engagement and quality improvement for UCLA Health and the program administrator.

Baldwin added that accreditation elevates UCLA to the vanguard of clinical informatics training.

“This program puts us at the forefront of informatics nationally, and we’re excited to continue building our leadership in the field,” he said.

The field of clinical informatics came into sharp focus in 2011 when the American Board of Medical Specialties approved it as a new, board-eligible subspecialty. Beginning in 2018, board eligibility in clinical informatics will require completion of a fellowship program that is accredited by the ACGME. Currently, fewer than 800 physicians around the country are board-certified in clinical informatics.

With accreditation now complete, UCLA Health and the David Geffen School of Medicine at UCLA have begun seeking candidates for two clinical informatics fellowship positions. Physicians from around the country are expected to apply, and fellows will be chosen in April. The two-year fellowship positions, both of them open to graduates of residency programs in any medical specialty, will begin in July 2015.

“It is exciting and humbling for UCLA Health to be part of the initial group of programs around the country that will offer this innovative and impactful fellowship in clinical informatics,” said Dr. Michael Pfeffer, chief medical informatics officer and acting chief information officer for UCLA Health. “We have a diverse, board-certified clinical informatics faculty ready to train the country’s future leaders in informatics.”

The goal of UCLA’s fellowship program is to train physicians in the principles and practice of clinical informatics, preparing them to lead the way in implementing health information technology systems as well as in research that advances the discipline.

“Clinical informatics is the scientific discipline focused on how we can deliver knowledge and information precisely where it’s needed in health care,” said Bell. “By learning to conduct rigorous research as well as to manage health IT systems, our fellows will close the gap between informatics research and practice by conducting research that’s embedded in and that directly informs clinical informatics practice.”

As they investigate how health care IT systems impact the delivery of care, fellows will focus on real-world problems such as the fatigue that physicians and nurses face as more and more devices capable of tracking patient data bombard them with information.

Fellows will complete a training program that includes:

• Clinical rotations, which involve four-week assignments to working units of the UCLA Health Information Services and Solutions Department. The department was responsible for UCLA Health being named among the nation’s “most wired” by Hospitals and Health Networks magazine.
• Didactics, including case studies and course work presented by expert faculty and covering a challenging core curriculum.
• An individualized, mentored research project based upon personal career objectives and informatics challenges that fellows identify during clinical rotations.
• Dedicated time to practice in the fellow’s specialty.

“As much as possible, we incorporated practical experience into this program in order to equip the fellows with the skills necessary to flourish in the physician workforce immediately after certification in this specialized field.” Baldwin said. “These early fellows are innovators. I see them going out and having a big impact nationally across the health system.”

At least some graduates are expected to fill the role of chief medical information officer within health care delivery organizations, serving as a bridge between the physician team and IT workforce to ensure that IT systems are implemented appropriately.

“Clinical informatics is critical to the success of technology in health care, whether it involves electronic health records, imaging informatics or shaping policy on how technology is used,” Pfeffer said. “As board-certified physicians in the specialty of their choosing, and as active clinicians using technologies in real time, they will be able to apply their knowledge from the fellowship to develop new and user-friendly ways for technology to help clinicians take better care of patients.”

Prospective applicants are urged to complete an online application at www.uclahealth.org/ClinicalInformaticsFellowship by April 1. Questions should be emailed to: CIFellowship@mednet.ucla.edu.

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UC Irvine names dean of medicine

Georgetown Executive Vice President and Dean Howard Federoff will start July 1.

“I am quite excited to be joining UCI, which has a highly regarded history of medical care, education and research. I plan to bring a fresh perspective to this new position and guide our medical school and healthcare enterprise to new heights," Dr. Howard Federoff said. (Photo by Georgetown University Medical Center)

By Tom Vasich, UC Irvine

Dr. Howard Federoff – a nationally renowned clinical and research leader at Georgetown University and a groundbreaking investigator for neurological disorders – will join UC Irvine as vice chancellor for health affairs and dean of the School of Medicine.

In this position, Federoff will oversee and guide the development of UC Irvine Health. In addition to leading the School of Medicine, he will provide strategic direction for the clinical programs of UC Irvine Medical Center and all affiliated patient care centers and will ensure the alignment of the clinical enterprise and the physicians’ practice plan with the university’s academic and research missions. He also will provide guidance on the development and integration of UCI’s health-related academic programs in nursing science, public health and pharmaceutical sciences. He will begin July 1.

At Georgetown, Federoff is the executive vice president for health sciences and executive dean of the School of Medicine. He is responsible for advancing the educational and research missions of Georgetown University Medical Center and working effectively with the leadership of MedStar Health, its clinical partner. GUMC is a $274 million biomedical research and educational organization that accounts for more than 85 percent of the university’s sponsored research funding.

“Howard brings unique and exceptional abilities to this position during an important moment in UCI’s distinguished story,” said UCI Chancellor Howard Gillman. “UCI is one of America’s leading research universities, and UC Irvine Health is Orange County’s only academic medical center. Howard’s background, experience and leadership skills will ensure that UCI accelerates its contributions to human health and provides the people of this region with world-class patient care.”

“I am quite excited to be joining UCI, which has a highly regarded history of medical care, education and research,” Federoff said. “I plan to bring a fresh perspective to this new position and guide our medical school and healthcare enterprise to new heights.”

After earning master’s, doctoral and medical degrees from the Albert Einstein College of Medicine in New York City, Federoff held clinical and academic positions at Einstein and the University of Rochester before joining Georgetown in 2007. Board-certified in internal medicine and endocrinology & metabolism, he also has advanced research in the areas of gene therapy and neurodegenerative disorders such as Parkinson’s, Alzheimer’s and prion diseases. He holds a number of medical patents, with several other patents pending.

Federoff was lead author of a 2014 study – which included UCI researchers – that discovered and validated a predictive blood test for those at risk for Alzheimer’s.

“We reviewed many excellent candidates over several months, and the search committee was unanimous in its enthusiasm and support for Howard. His unique combination of leadership and experience in research, education, the clinical enterprise and philanthropy ensures that UC Irvine Health will continue to grow in national stature and impact. We are delighted that he has chosen to join our team,” said Bruce Tromberg, professor and director of the Beckman Laser Institute & Medical Clinic, who chaired the search committee.

“Dr. Federoff has demonstrable experience at one of the signature medical centers in the United States,” said Terry Belmont, CEO of UC Irvine Medical Center. “He is well-suited to assuming an important health care leadership position in Orange County, the region and the country.”

Federoff also will play a key role advancing philanthropic activities and community and industry partnerships for UC Irvine Health. He believes that patient-centered prevention, wellness and care delivery will be powered by the most compelling science.

“The current environment demands that we develop and translate our discoveries to promote wellness and deliver value-based medicine,” he said. “The health sciences, when effectively intertwined, enable providers to collaborate, ensuring that every patient receives the most compassionate and individualized care.”

“With his noteworthy accomplishments, Dr. Federoff will continue to enhance UCI’s growing achievements in advancing clinical and research breakthroughs that will improve and protect health, both in our community and around the globe,” said James Mazzo, chairman and CEO of AcuFocus and a UC Irvine Foundation trustee.

Federoff will replace Dr. Roger Steinert, the Irving H. Leopold Chair in Ophthalmology and director of the Gavin Herbert Eye Institute, who has served as interim dean of the School of Medicine since Dr. Ralph Clayman retired from the positon in July 2014.

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Health Sciences and Services changes name to UC Health

Reflects role providing leadership to UC’s five med centers, 17 health professional schools.

The University of California Office of the President’s Division of Health Sciences and Services has changed its name to UC Health to reflect its role providing leadership and strategic direction for UC’s five academic medical centers and 17 health professional schools.

UC President Janet Napolitano approved the name change and promoted the head of UC Health, Dr. John Stobo, to executive vice president from senior vice president.

“UC’s campuses and medical centers are leaders in health education, research and patient care,” Stobo said. “Our new name recognizes our mission to bring together UC’s medical centers and health professional schools to create something where the whole is greater than the sum of its parts. Our central office at UC Health is small but mighty, providing leadership and strategic direction to advance health in California and beyond.”

UC’s five academic medical centers – Davis, Irvine, Los Angeles, San Diego and San Francisco – rank among the nation’s best hospitals, not only providing care but also training tomorrow’s leaders and tackling health’s toughest challenges.

Meanwhile, UC has the largest health sciences instructional program in the nation. Its 17 health professional schools on seven campuses – Berkeley, Davis, Irvine, Los Angeles, Riverside, San Diego and San Francisco – rank among the nation’s best graduate schools.

According to U.S. News & World Report’s 2016 Best Graduate Schools rankings released today (March 10), five UC medical schools ranked in the top 50 nationally for research and four placed in the top 20 nationally for primary care rankings. Three UC nursing schools ranked in the top 50, including No. 2 UCSF, while UC Davis had the nation’s top veterinary school and in public health UC Berkeley ranked ninth and UCLA was 10th. In the most recent assessment (2012), UCSF ranked first in pharmacy. The surveys do not rank dental or optometry schools.

UC Health also provides oversight on the business and financial activities of the clinical enterprise and supports operational initiatives at individual UC campuses and development of systemwide initiatives. For example, the Leveraging Scale for Value initiative launched last year to collaborate as a system to reduce costs at UC medical centers. In addition, UC Health has shared responsibility for overseeing UC student health centers and self-insured plans for UC students and for UC employees.

For more information, visit UC Health.

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University of California Office of the President
(510) 987-9200

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Curing cancer, one tax return at a time

Check a box and fund two UC-administered cancer research projects.

California taxpayers fund a number of health programs — some administered by UC — by designating a portion of their tax refund.

By Kate Rix, UC Newsroom

Those contribution lines on your 540 State Income Tax Return where you can fill in donation amounts for nearly 30 different California-based funds? Those are just nickel-and-dime funds without much impact, right?

Wrong.

Last year California taxpayers contributed more than $4 million to an inspiring range of worthy health, environmental and educational funds. Among the funds that get an important boost around tax time are the California Breast Cancer Research Program and the California Cancer Research Fund. Both funds are administered by the University of California, which distributes the money as direct grants to California researchers working on the cutting edge.

In other words, those contributions have a tangible impact in the fight against cancer, supporting work that ranges from personalized support for young cancer survivors to new low-radiation screening tools.

Protecting fertility for young cancer survivors

As treatments for breast cancer improve, the number of young women surviving the disease has grown. Of the 2.8 million cancer survivors in the U.S., 10 percent are under 45 at diagnosis. After enduring cancer therapies and one of the most frightening experiences of their lives, survivors often find themselves faced with a variety of worrisome long-term health issues.

During chemotherapy, menstrual periods often stop, and it is not uncommon for women — even very young women — to experience the symptoms of menopause, including hot flashes and vaginal dryness. Cancer fears become compounded by worries that they may never be able to have children and that their bodies will never be the same.

“Young breast cancer survivors and their health care providers want to learn about how to manage reproductive health after cancer,” said Dr. Irene Su, an assistant professor in the Division of Reproductive Endocrinology and Infertility at the UC San Diego School of Medicine.

Closing the knowledge gap

“There hasn’t been an emphasis on providing reproductive health information to young survivors,” Su said. Also, because many health care providers may not see that many young women with cancer, they may face knowledge gaps on providing reproductive health care for this population.

“Right now, there is a dearth of resources for disseminating reproductive health care information to patients and providers.”

Su is leading a project, funded by the California Breast Cancer Research Program, to help women and their medical providers — no matter where they are located — have access to up-to-date, evidence-based information to treat estrogen deprivation symptoms, improve sexual function and monitor fertility potential after cancer. CBCRP received nearly $400,000 through the tax check-off program last year.

With a grant of more than $750,000 over three years, the project will generate the Reproductive Survivorship Care Plan (SCP-R), a Web-based tool that offers the best current research on managing hot flashes, sexual problems, fertility concerns and contraception to young breast cancer patients and their providers. Information can be tailored to the patient, and focuses on specific issues. The SCP-R will be tested in a randomized controlled trial that launches this summer.

The resource is being developed with the participation of patients and caregivers recruited across the country and with the oversight of a stakeholder panel of clinicians, researchers and breast cancer survivors.

Young women who survive breast cancer often have questions about fertility. It isn’t unusual, for example, for a young woman’s periods to stop when she undergoes chemotherapy. Women who have not completed their families may worry that not menstruating means that they are infertile. “The SCP-R will provide relevant information on the natural course of ovarian recovery, when survivors usually get their periods back, types of blood tests that can help monitor ovarian function, and, equally importantly, what tests are not recommended and what we still don’t know,” Su said.

Women who have completed their families will need to consider effective contraception. In the United States, birth control pills are the most common reversible form of contraception. For a cancer survivor, however, it is crucial to keep estrogen levels low.

“The copper IUD is a great form of reversible birth control, because it is non-hormonal and highly effective,” said Su. “It would be great if a family practice physician or oncology provider had knowledge of how effective different birth controls are and what are recommended methods for breast cancer survivors.”

Lung cancer screenings as safe as chest X-rays

Lung cancer is the most deadly form of cancer in the U.S. While patients with other forms of cancer are living longer than before, the five-year survival rate for lung cancers hasn’t improved much in recent decades. More people die from lung cancer than from the next four cancers combined (including breast and prostate cancer). And while smoking is a leading cause of lung cancer, up to 15 percent of lung cancers have no relation to smoking; even smokers who quit smoking up to 15 years previously are still at risk of lung cancer.

One obstacle has been the lack of any screening test to detect lung cancer at an early stage. While imaging technology held some promise, it was unproven and there were some risks associated with being screened. But just a few years ago, a national lung screening trial found that at-risk patients who were screened using low-dose CT scanning technology had a 15-20 percent lower chance of dying of lung cancer than those who received a standard chest X-ray.

These results showed promise for a new tool, with dramatically reduced radiation, to detect the most deadly form of cancer.

With funding from the California Cancer Research Fund (administered by UC’s Tobacco-Related Disease Research Program), a team at UCLA is working to bring the level of radiation in an ultra-low-dose CT scan even lower. The TRDRP received nearly $445,000 through the tax check-off program last year.

“We know how to do the screening and the technology is pretty good,” said Michael McNitt-Gray, a professor of radiology at the UCLA School of Medicine. “We want to push that dose even lower. We’d like to get the same level as a single chest X-ray.”

Shorter times, improved images

Several aspects of CT scanning technology have improved dramatically. While low-dose CT screenings have been possible for nearly 20 years, technical limits have made them difficult to use effectively.

For example, an accurate image used to take up to 60 seconds to capture. Patients had to hold their breath during that entire time, something that most smokers can’t do.

The improvements being made at UCLA make the process faster — the actual scan takes just 5 seconds — and can allow finer detail in the image, showing suspicious objects in the lung as small as 5 mm.

The timing of the UCLA project couldn’t be better. Last year, private insurers began covering the cost of ultra-low-dose CT scans. In February, Medicare announced that it also would cover the screening, making the early detection tool available to the elderly and disabled who may be at risk of developing lung cancer.

“The test itself is very quick,” says McNitt-Gray. “The patient lies down, puts their arms above their head, and does some practice breathing. Based upon a planning view, the scanner adjusts to the patient’s anatomy so that just enough of the radiation dose is used to provide the necessary image quality to detect anything suspicious in the lungs.”

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Stop blaming the moon, says UCLA scientists

Study highlights flaws in earlier research on hospital admissions and the lunar cycle.

Jean-Luc Margot identified several flaws in a 2004 article that claimed hospital admissions increased when there was a full moon. (Photo by Sean Brenner, UCLA)

By Stuart Wolpert, UCLA

“It must be a full moon” is a common refrain when things appear more hectic than usual.

The moon is even blamed when things get crazy at hospital emergency rooms or birth wards. “Some nurses ascribe the apparent chaos to the moon, but dozens of studies show that the belief is unfounded,” said Jean-Luc Margot, a UCLA professor of planetary astronomy.

Of course, the moon does not influence the timing of human births or hospital admissions, according to new research by Margot that confirms what scientists have known for decades. The study illustrates how intelligent and otherwise reasonable people develop strong beliefs that, to put it politely, are not aligned with reality.

The absence of a lunar influence on human affairs has been demonstrated in the areas of automobile accidents, hospital admissions, surgery outcomes, cancer survival rates, menstruation, births, birth complications, depression, violent behavior, and even criminal activity, Margot writes. His study was published online by the journal Nursing Research.

Even though a 40-year-old UCLA study demonstrated that the timing of births does not correlate in any way with the lunar cycle, the belief in a lunar effect has persisted. A 2004 study in a nursing journal, for example, suggested that the full moon influenced the number of hospital admissions in a medical unit in Barcelona, Spain.

But Margot identified multiple flaws in the data collection and analysis of the 2004 research. By re-analyzing the data, he showed that the number of admissions was unrelated to the lunar cycle.

“The moon is innocent,” Margot said.

So why do the erroneous beliefs live on in spite of the evidence?

Margot cited what scientists refer to as the “confirmation bias” — people’s tendency to interpret information in a way that confirms their beliefs and ignore data that contradict them. When life is hectic on the day of a full moon, many people remember the association because it confirms their belief. But hectic days that do not correspond with a full moon are promptly ignored and forgotten because they do not reinforce the belief.

Margot said the societal costs of flawed beliefs can be enormous.

In just one current example, the recent measles outbreak appears to have been triggered by parents’ questionable beliefs about the safety of the measles vaccine.

“Vaccines are widely and correctly regarded as one of the greatest public health achievements, yet vaccine-preventable diseases are killing people because of beliefs that are out of step with scientific facts,” Margot said.

A willingness to engage in evidence-based reasoning and admit that one’s beliefs may be incorrect will produce a more accurate view of the world and result in better decision-making, Margot said.

“Perhaps we can start by correcting our delusions about the moon, and work from there,” he said.

► For more about how cognitive biases influence our beliefs, Margot recommends Thomas Gilovich’s “How We Know What Isn’t So” (1991).

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Qualcomm Institute launches industry innovation space at UC San Diego

Half of the initial tenants are startup ventures led by UC San Diego faculty, staff or students.

The second floor of Atkinson Hall will house the new Qualcomm Institute Innovation Space, initially with seven tenants and more on the way.

By Doug Ramsey, UC San Diego

Working closely with other campus entities to translate ideas from the lab into products and companies in the marketplace, the Qualcomm Institute has launched an Innovation Space where qualified faculty startups, industry partners or national laboratories can lease office or lab space inside the research institute’s headquarters building on the UC San Diego campus.

“The Qualcomm Institute Innovation Space is an important new addition to the university’s growing ecosystem supporting entrepreneurship and technology transfer,” said UC San Diego Chancellor Pradeep K. Khosla. “The facility will complement existing campus units that include venture-capital accelerators, incubators, tech transfer and entrepreneurism centers to promote commercialization of research findings.” Those units include the Triton Fund and the recently created UC Ventures fund, EvoNexus (open to campus startups), the university’s Technology Transfer Office, as well as the Moxie Center for Student Entrepreneurship, The von Liebig Entrepreneurism Center, and The Basement, a combined incubator/accelerator program for student entrepreneurs launched in February.

The Qualcomm Institute is the UC San Diego division of the California Institute for Telecommunications and Information Technology (Calit2), whose original mandate included close engagement with industry. Consistent with that mandate, the Qualcomm Institute Innovation Space (QIIS) has carved out roughly 6,000 square feet of space on the second floor of Atkinson Hall. Most of the available space has already been committed to the first half-dozen applicants that were accepted into the program.

“Tenants in the Innovation Space lease space and avail themselves of our technical services at external user’s rates,” said Qualcomm Institute Director Ramesh Rao. “Our goal is to nurture these companies by helping them leverage the state’s investments in science and innovation and help with California’s economic development when they move off campus.”

QIIS tenants must go through a rigorous selection process to lease space for a maximum of two years, after which they are expected to exit the facility to make room for newcomers.

Among the earliest tenants, Comhear Inc. recognized the importance of being close to the institute’s researchers after signing a multi-million-dollar deal in 2014 to develop products jointly with the Qualcomm Institute’s Sonic Arts R&D group, led by Peter Otto. “We are building a line of new products based on an exclusive license to audio beamforming technology originally developed by Peter Otto’s group,” said Comhear CEO Randy Granovetter. “In our collaboration with the Qualcomm Institute, Comhear has now developed a suite of innovative audio software, products and services for spatial conferencing in unified communications, gaming, music and streaming video. We continue to work closely with his team, but our business is expanding so we had to locate some of our people outside of the Innovation Space close to the university, while leaving a few who work most intensively with their university counterparts.”

Another established company and newcomer to the QIIS facility is Technosylva, which has offices in Spain and California. The company develops advanced GIS-enabled software solutions for wildfire protection planning, operational response as well as firefighter and public safety. Products include software models and programs for fuels mapping, fire behavior analysis, simulation modeling and wildfire risk assessment. Technosylva has worked closely with Qualcomm Institute researchers on the WIFIRE project and recognized the value of setting up shop just an elevator-ride away from the WIFIRE team.

“Our expertise in predictive modeling and field emergency-response technology is a perfect complement to QI’s expertise in communications, sensors, and visualization technologies,” said Technosylva President Joaquin Ramirez, who was a visiting scholar at the Qualcomm Institute in summer 2013. “By having the opportunity to co-locate, we have a tremendous opportunity to incubate disruptive technologies to change the way real-time wildland fire modeling, mitigation and response is done.”

RAM Photonics LLC has worked closely with the Qualcomm Institute’s Photonic Systems Lab over the past three years, and currently licenses technology from UC San Diego.

“Having an office located in the QI Innovation Space will facilitate more rapid development from university research results into commercialized products,” said RAM Photonics President John Marciante. “Closer interaction with UCSD researchers in photonics and electronics is invaluable to transitioning that technology, and hopefully future technologies, to the marketplace.”

The company has three target markets for its specialty, high-performance fiber systems: telecommunications, data communications and medical imaging.

Startups

While the Innovation Space is open to outside companies such as Technosylva, RAM Photonics and Comhear that benefit from proximity to university collaborators, half of the initial tenants are startup ventures led by UC San Diego faculty, staff or students. Those ventures include VirBELA, Sinopia Biosciences and STEAM Engine.

VirBELA was incubated at UC San Diego’s Rady School of Management with a $1.7 million grant from the Graduate Management Admission Council. VirBELA used that grant to develop and demonstrate an immersive, 3-D virtual-reality campus environment that hosted a global business-simulation competition for management students at top universities on three continents.

“We have several ongoing customers for our virtual campus technology, but we are also expanding into other 3-D virtual worlds and games for learning and development,” said VirBELA CEO Alex Howland, who was program director of VirBELA prior to its spinout from the Rady School last December. “Having space in the QIIS facility will allow us to stay close to the large community of developers on campus, while we also expand our efforts to find new customers as well as financial support from the venture-capital community.”

STEAM Engine Inc. is an education technology startup co-founded by Qualcomm Institute research scientist/explorer Albert Yu-Min Lin; chief creative officer Vijay Lakshman, a master game designer behind such titles as “Lord of the Rings Online,” the “Elder Scrolls” series, and “Animal Jam”; and former National Geographic president and STEAM Engine chief executive officer, Tim Kelly, based in Washington, D.C. The STEAM Engine team at QIIS will be part of developing the first game-based immersive learning platform focused on science, technology, engineering, arts and math.

“We are excited to have offices in the Qualcomm Institute Innovation Space and to be part of this cutting-edge research community,” Kelly said. “We intend to collaborate closely with several of the research groups in QIIS, including Albert’s labs and the UC San Diego Design Lab, among others.”

Sinopia Biosciences is a startup spun out of UC San Diego bioengineering professor Bernhard Palsson’s Systems Biology Research Group. Co-founder Aarash Bordbar is a recent graduate (B.S. ’08, Ph.D.’14) and former president of the Bioengineering Graduate Society at UC San Diego. Sinopia applies systems biology and bioinformatics to hematology and pharmacology.

“We are developing a computational platform that is comprised of statistical and mechanistic models for analyzing large, high-throughput data sets for a couple of biomedical problems,” said Bordbar. “Our predictive platform attempts to use such high-powered computation for transfusion medicine applications and for understanding the mechanisms of how pharmaceuticals cause side effects. We believe these computational approaches uniquely position us to quickly develop novel experimental and clinical strategies that would have been daunting to devise otherwise.”

Palsson and Bordbar gave talks discussing Sinopia’s platform at the 2014 annual meeting of the American Association of Blood Banks and the 2015 annual meeting of the American Society for Clinical Pharmacology and Therapeutics. Last year, Sinopia received a Phase 1 Small Business Innovation Research (SBIR) grant from the NIH National Heart, Lung and Blood Institute.

Nonprofit

Not all occupants of the Qualcomm Institute Innovation Space are for-profit enterprises. A team of UC San Diego researchers is helping to make universal education a reality through the Foundation for Learning Equality (FLE). As its website proclaims, FLE is “bridging the global digital divide by bringing the online learning revolution offline.”

“It’s estimated that one in three children worldwide lacks access to a quality basic education,” said Jamie Alexandre, a recent UC San Diego alumnus in cognitive science (Ph.D. ’14) who interned at Khan Academy before forming FLE along with a group of other UCSD students. “Sixty percent of the global population lacks the connectivity needed to access online education, so we have been developing an offline version of Khan Academy. Since being launched in December of 2012, the open-source platform, KA Lite, has now been installed in more than 140 countries and is used by thousands of schools, orphanages, community centers, refugee camps and prisons.” The offline server can be downloaded and run on a basic device such as a Raspberry Pi or on aging Windows PCs, then other devices nearby can connect to that server to access the Khan Academy videos, do exercises and track their progress. A teacher with a single server can provide a classroom of 35 students with simultaneous access to KA Lite, and track their progress using teacher dashboard tools to enable them to most effectively intervene and help students who are struggling.

Single point of engagement

The Qualcomm Institute provides a single point of engagement to enable all campus transactions ahead of occupancy. The approved lease is executed through the campus Real Estate Office. If any service agreement is involved, it is processed through the university’s Procurement Office, while any IP arrangements or material transfer agreements are secured through the Tech Transfer Office. On-campus parking permits are also available for purchase by QIIS occupants.

Limited square footage is still available for leasing in the Innovation Space. Interested parties can download the application for admission online and email the completed application to innovation@calit2.net. Applications are reviewed by the institute’s Executive Council and, subject to formal approval, tenants must agree to Atkinson Hall building occupancy rules by signing a facility use agreement.

Factors affecting the selection process include: letters of support from other UC San Diego, regional or national organizations (e.g., CONNECT, BIOCOM, EvoNexus, von Liebig Center); relevance to the strategic plans of UC San Diego and the Qualcomm Institute; depth and breadth of collaborations with the institute and/or other campus units; and commitment to community education through the use of interns, entrepreneur education via community outreach, and mentor programs.

The Qualcomm Institute Innovation Space also will help foster collaborative creation of intellectual property (IP) involving University of California and non-UC personnel – thereby extending the prevailing base of engagement built on IP entirely generated by UC personnel and licensed to other parties.

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Scientists link unexplained childhood paralysis to eneterovirus D68

UCSF-led team rules out other pathogens with comprehensive sequencing.

By Laura Kurtzman, UC San Francisco

A research team led by UC San Francisco scientists has found the genetic signature of enterovirus D68 (EV-D68) in half of the California and Colorado children diagnosed with acute flaccid myelitis – sudden, unexplained muscle weakness and paralysis – between 2012 and 2014, with most cases occurring during a nationwide outbreak of severe respiratory illness from EV-D68 last fall.

The finding strengthens the association between EV-D68 infection and acute flaccid myelitis, which developed in only a small fraction of those who got sick. The scientists could not find any other pathogen capable of causing these symptoms, even after checking the cerebrospinal fluid for every known infectious agent.

Researchers analyzed the genetic sequences of EV-D68 in children with acute flaccid myelitis and discovered that they all corresponded to a new strain of the virus, designated strain B1, which emerged about four years ago and had mutations similar to those found in poliovirus and another closely related nerve-damaging virus, EV-D70. The B1 strain was the predominant circulating strain detected during the 2014 EV-D68 respiratory outbreak, and the researchers found it both in respiratory secretions and – for the first time – in a blood sample from one child as his acute paralytic illness was worsening.

The study also included a pair of siblings, both of whom were infected with genetically identical EV-D68 virus, yet only one of whom developed acute flaccid myelitis.

“This suggests that it’s not only the virus, but also patients’ individual biology that determines what disease they may present with” said Charles Chiu, M.D., Ph.D., an associate professor of Laboratory Medicine and director of UCSF-Abbott Viral Diagnostics and Discovery Center. “Given that none of the children have fully recovered, we urgently need to continue investigating this new strain of EV-D68 and its potential to cause acute flaccid myelitis.”

Among the 25 patients with acute flaccid myelitis in the study, 16 were from California and nine were from Colorado. Eleven were part of geographic clusters of children in Los Angeles and in Aurora, Colorado, who became symptomatic at the same time, and EV-D68 was detected in seven of these patients.

Although the researchers found EV-D68 in the children’s respiratory secretions and in the blood from one case, they did not find it in cerebrospinal fluid. The researchers said this may not be surprising given that other nerve-damaging viruses, like polio, are also extremely difficult to detect in cerebrospinal fluid.

Eighty percent of the children reported having an upper respiratory illness about six days, on average, before their acute flaccid myelitis symptoms began. Slightly more reported having a fever, including all of the cases from the clusters in California and Colorado.

Samples were collected more than a week after the children began showing symptoms of an upper respiratory infection, and this likely made it much harder to find EV-D68. There may also be other reasons to explain why the virus was not found in cerebrospinal fluid in children with neurological symptoms.

“The lack of detectable virus in CSF could also mean that the neurological symptoms are coming from an aberrant immune response to recent EV-D68 infection and not because the virus is directly invading neurons,” said Chiu, senior author on the paper published today (March 30) in The Lancet Infectious Diseases.

This study was supported by grants from the National Institutes of Health, a University of California Discovery Award, an Abbott Viral Discovery Award and the Centers for Disease Control and Prevention Emerging Infections Program.

Other authors include Alexander Greninger, M.D., Ph.D., Samia Naccache, Ph.D., Guixia Yu, B.S., Sneha Somasekar, B.S., Scot Federman, B.A., and Doug Stryke, B.S., of UCSF; Kevin Messacar, M.D., and Samuel Dominguez, M.D., Ph.D., of Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora; Anna Clayton, B.S., M.P.H., Christopher Anderson, B.S., Shigeo Yagi, Ph.D., Sharon Messenger, Ph.D., Debra Wadford, Ph.D., Dongxiang Xia, M.D., Ph.D., and Carol Glaser, D.V.M., M.D., of the California Department of Public Health; Keith Van Haren, M.D., of Lucile Packard Children’s Hospital at Stanford University; and Grace Aldrovandi, M.D., of Children’s Hospital Los Angeles and University of Southern California.

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Triathlete, actor share stories of recovery from traumatic brain injury

UCLA’s Brain Injury Research Center hosts symposium.

Greg Parks and Kathleen Pullen-Norris, a nurse at the Ronald Reagan UCLA Medical Center, were married for less than a year before Parks was in a bike accident and sustained a life-changing brain injury. (Photo courtesy of Greg Parks and Kathleen Pullen-Norris)

By Elaine Schmidt, UCLA

Triathlete Greg Parks never recalled the cause of the accident that left him lying unconscious in the road, still straddling the bicycle he’d been riding in Santa Clarita. But he will never forget what followed: four weeks of hospitalization and grueling rehabilitation. Then came another four months before he was able to resume his life as a newlywed husband and rocket-test engineer.

Actor Larry Miller was also able to pick up his life as the father of two after suffering a life-threatening head injury in 2012 and being on life support for a month. Well-known for the memorable characters he played in more than 100 films and TV shows, Miller also started back to work after his recovery.

Parks and Miller recently shared their experience of coming back from a life-changing brain injury at a public symposium hosted by the neurosurgery department’s Brain Injury Research Center at the Ronald Reagan UCLA Medical Center. Both men, as well as those who care for patients with traumatic brain injuries (TBI), talked about how to advocate for loved ones and how caregivers must also take time to tend to themselves.

“My accident was the best thing that could have happened to me,” said Miller, who has advocated for TBI patients before the California Senate. He opted to see the brighter side of his situation. “A brain injury wakes you up and makes you appreciate all that you have. Everything became funnier in my life.”

From her perspective as the wife of a patient, Kathleen Pullen-Norris, Parks’ wife, described the challenges she faced in obtaining proper treatment for her husband at the hospital where he was first taken and how she coped during his journey to recovery.

“Being the spouse of a TBI patient can be one of the world’s darkest places,” admitted Pullen-Norris, who happened to be a nurse at the Reagan UCLA Medical Center’s neuro-ICU unit, where her husband was eventually hospitalized. “You are not the injured, but you are the aching. Greg describes TBI as a fog. Being a TBI wife is like being a lighthouse — the best and brightest lighthouse I can muster.”

She emphasized the need for personal self-care. “Without the caregiver, the patient is lost,” she stressed. “That means taking time for yourself.”

Parks encouraged therapists to push their patients to recapture their mental and physical fitness. “My toughest therapist was my beautiful wife, Kathleen,” said Parks, who had married Pullen-Norris less than a year before his accident and raced in New Zealand’s Ironman competition together on their honeymoon.

“I am grateful to her for making fitness a priority and am living proof that a good support system is essential for surviving a brain injury,” Parks said.

Each year, an estimated 2.4 million Americans suffer a blow to the head that results in a traumatic brain injury, according to Dr. Paul Vespa, director of neurocritical care at the Reagan UCLA Medical Center and a professor of neurosurgery and neurology at the David Geffen School of Medicine.

“Swift treatment can prevent death and permanent brain damage, but not every hospital offers the trained specialists and sophisticated equipment required to treat TBIs effectively,” Vespa pointed out.  “As a result, tens of thousands of people die needlessly each year, and more than 5.3 million Americans live with a lifelong disability.”

Pullen-Norris echoed Vespa’s message. “Greg and I are deeply grateful to his UCLA physicians and nurses. Without their expertise and diligence, our work would be for nothing. They saved Greg and, in turn, saved me.”

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