UC Health is enhancing care through a first-of-its-kind program.
UC Davis' medication management program is but one way the university's medical centers are improving medical care through the Delivery System Reform Incentive Program. (Photo by Charles Casey, UC Davis)
How do you make a renowned health system even better?
From improving medication management to providing a medical home for HIV patients, the University of California is enhancing care across its medical centers through a first-of-its-kind program.
UC and California’s other designated public hospitals are participating in the Delivery System Reform Incentive Program (DSRIP), a pay-for-performance initiative that aims to expand access to care, enhance quality and improve population health.
UC San Diego Dr. Amy Sitapati (left) directs the Owen Clinic, which has become a model medical home for HIV patients.
The program, effective from 2010-15, was created as part of California’s Medicaid Section 1115 Waiver, which supports California public hospitals and academic medical centers, recognizing their provision of health services for a “disproportionate share” of low-income patients compared to other hospitals.
California’s DSRIP provides a potential $3.3 billion in funding over five years for participating public hospitals based upon achieving specific milestones related to innovations in care delivery and improved outcomes. Collectively, UC medical centers set 733 milestones across 60 projects to capture up to $500 million in at-risk funding over five years. The program aligns with national health reform goals of increasing access to quality, affordable care. Since its inception, other states have launched similar programs.
UCLA Dr. Michelle Bholat (right) gives a lesson on electronic medical records to international medical graduates (from left) Hendry Perez Pascual, Marcus Medina and Gloria Monsalve.
UC’s DSRIP efforts show the university’s commitment to meeting the goals of health reform. UC medical centers are working locally on their campuses and together across the system to improve the outcomes and experience of patients. For example, a project to improve response time to patients with severe sepsis and septic shock has resulted in improvements that were previously not thought possible. As a result, sepsis mortality rates are declining at all UC medical centers.
This series of stories exemplifies ways that UC medical centers are making innovative improvements:
Berkeley Lab’s Ashok Gadgil puts engineering to work for humanity.
Ashok Gadgil demonstrates use of the Darfur stove to Mary Robinson, former president of Ireland and former UN High Commissioner for Human Rights. (Photo by Roy Kaltschmidt, Berkeley Lab)
By Kate Rix
When Ashok Gadgil arrived in Washington this spring to be inducted into the National Inventors Hall of Fame, a quote on the back of the event program spoke directly to his own personal philosophy.
It was from Abraham Lincoln: “The patent system added the fuel of interest to the fire of genius.”
“This is the first time the body made a decision not just to recognize patents which have led to improvements in the developed world, but also began to say, what do invention and patent do for the bottom 3 billion people?” Gadgil says of his induction, seated in his office above the UC Berkeley campus. “It signals to those of us who work on problems not because they’ll lead to corporate profit or a better weapons system, that this is another important role of creativity.”
Gadgil was one of 15 inventors admitted into the Hall of Fame this year. He was inducted specifically for UV Waterworks, a disinfecting device that uses ultra violet light to generate the electricity needed to kill pathogens in water. The technology provides safe drinking water for 5 million people every day in deep rural communities of India, the Philippines and Ghana.
Gadgil (pronounced GOD-gill) directs the Energy and Environmental Technologies Division at Lawrence Berkeley National Laboratory. His other inventions include a fuel-efficient cookstove and a method to remove arsenic from groundwater. Overall, his body of work has helped millions of others, in the spirit of what Lincoln called “the fuel of interest” combined with humanitarianism.
Safe water for mere pennies
UV Waterworks systems provide safe drinking water a cost of about 2 cents for 12 liters.
“My goal was to see what people could pay if they make $1 or $2 a day,” Gadgil says. “We are asking for 2 cents for 10 liters, so they can avoid getting diarrhea several times a year.”
UV Waterworks has saved an estimated 1,000 children’s lives, Gadgil said. “That’s not too bad, though the number could be 10 or 50 times larger.”
While Gadgil invented the system, the UC Regents hold the patent and the publicly traded corporation WaterHealth International lined up investors, including Johnson & Johnson and Dow Chemical.
Fuel-efficient stove lessens women’s risks
Also making an impact is the Berkeley Darfur Stove, which replaces the traditional “three stone” cooking fire for Darfuri refugees in western Sudan. The old method of cooking required women to walk — for up to seven hours, five times a week — outside the safety of the camps to collect wood. Encounters with armed militia during those treks almost certainly result in rape.
In 2005 Gadgil led a fact-finding mission to Darfur, interviewing women and observing how they cook. He realized he could design a stove that uses 75 percent less fuel to cook the same amount of food in the same pot, reducing the number of firewood collection trips.
The stoves were designed at Lawrence Berkeley Lab but are manufactured in a factory in Darfur and sold for $20 each, generating income for factory workers. Some 15,000 cookstoves are in use in Darfuri camps, plus additional stoves modified for use in Ethiopia.
Gadgil’s team continues to refine the cookstove technology, in pursuit of even cleaner ways to use biomass fuel. Another project, however, hearkens back to clean drinking water. Gadgil and his lab developed a method to remove naturally occurring arsenic from groundwater in Bangladesh and India, binding iron to microscopic arsenic molecules so they become large enough to be captured by a filter. The technology recently was licensed to an Indian business with a plan to install filtration plants in villages where the water will be sold.
The existence of a business model is core to Gadgil’s guiding principles as an inventor. While some of his colleagues in science turn their nose at the idea of making a profit from research, Gadgil — who applied to business school before engineering graduate studies — sees sustainability and potential in financial gain.
‘A model where everybody prospers’
“You cannot go to scale and help a billion or 2 billion people without everybody along the way making a dime,” he says. “Charity is critical to filling cracks in the system, but there is not enough charity to go around. If you want to lift people from an existence we consider beneath human dignity, you have to have a model where everybody prospers.”
Gadgil was not always so focused on using his skills to help people in the developing world. As a student at the Indian Institute of Technology Kanpur he worked hard, did well in school and that was enough.
In 1971 Gadgil had an acceptance letter from every university to which he had applied, except Berkeley. He was about to start courses at CalTech when the letter came from Berkeley to say that they had secured funding to offer him a spot in the graduate civil engineering program.
“A friend of mine told me that Berkeley is a deep and vast ocean and that I would not experience the intellectual depth anywhere else,” he recalls. “He was right. I took courses in everything under the sun. I could sit in the back of the room and take classes in political economy of development.”
He recalls a lesson from one of his professor, former Cal physicist Arthur Rosenfeld: A good scientist takes in the bigger picture of how the real world works.
“I was just very, very good at physics,” he says. “Being here doing my Ph.D. changed my thinking. I credit that to the Berkeley experience.”
All five UC medical centers ranked nationally by U.S. News & World Report.
The University of California has two of the nation’s top 10 hospitals and all five of its medical centers rank among the nation’s best hospitals, according to U.S. News & World Report’s annual survey.
U.S. News also ranked UC medical centers No. 1 in their metropolitan areas – UCLA Health System in Los Angeles, UCSF Medical Center in San Francisco, UC San Diego Health System in San Diego and UC Davis Medical Center in Sacramento. UC Irvine Medical Center ranked best in Orange County and fourth in the Los Angeles region.
“The U.S. News rankings reflect the excellence throughout the UC Health system,” said Dr. John Stobo, UC Health senior vice president. “Our academic medical centers are dedicated to providing the best possible patient care, training tomorrow’s leaders and tackling health’s toughest challenges.”
For the 2014-15 America’s Best Hospitals survey, U.S. News evaluated about 4,700 hospitals nationwide in 16 adult specialties, reviewing patient safety, reputation and other factors, with just 144 ranking nationally in even one specialty. UCLA and UCSF were among two of only 17 hospitals that entered the Best Hospitals Honor Roll by scoring high in at least six specialties.
“The data tell the story – a hospital that emerged from our analysis as one of the best has much to be proud of,” says Avery Comarow, the health rankings editor at U.S. News. “A Best Hospital has demonstrated its expertise in treating the most challenging patients.”
UCLA Health System’s hospitals in Westwood and Santa Monica ranked fifth nationally and best in the western United States and California. UCLA ranked among the top 50 hospitals nationally in 15 of the 16 specialties: cancer (9); cardiology and heart surgery (12); diabetes and endocrinology (9); ear, nose and throat (11); gastroenterology and GI surgery (5); geriatrics (3); gynecology (11); nephrology (8); neurology and neurosurgery (7); ophthalmology (5); orthopedics (11); psychiatry (8); pulmonology (16); rheumatology (8); and urology (4).
UCSF Medical Center ranked eighth nationally. UCSF placed among the top 50 hospitals nationally in 11 specialties: cancer (8); diabetes and endocrinology (5); ear, nose and throat (8); gasteroenterology and GI surgery (25); geriatrics (12); gynecology (6); nephrology (4); neurology and neurosurgery (5);
orthopedics (14); rheumatology (10); and urology (6).
UC San Diego Health System ranked among the top 50 hospitals nationally in 11 specialties: cancer (25); cardiology and heart surgery (23); diabetes and endocrinology (32); ear, nose and throat (22); gastroenterology and GI surgery (38); geriatrics (19); nephrology (15); neurology and neurosurgery (25); orthopedics (44); pulmonology (6); and urology (16).
UC Davis Medical Center ranked nationally in 10 specialties: cancer (34); cardiology and heart surgery (24); ear, nose and throat (31); geriatrics (25); gynecology (35); nephrology (19); neurology and neurosurgery (42); orthopedics (26); pulmonology (15); and urology (48).
UC Irvine Medical Center, which made the Best Hospitals list for the 14th consecutive year, ranked nationally in three specialties: ear, nose and throat (33); geriatrics (39); and nephrology (50).
Survey results are available online at http://health.usnews.com/best-hospitals. Overall, the Mayo Clinic in Rochester, Minnesota, ranked first; Massachusetts General Hospital in Boston was second; Johns Hopkins Hospital in Baltimore was third; and the Cleveland Clinic was fourth.
UC system united in effort to help put world on path to sustainably, nutritiously feed itself.
UC President Janet Napolitano plants oregano with Matt Orke in the student-run community garden at UCLA. (Photo by Reed Hutchinson, UCLA)
By Alec Rosenberg
University of California President Janet Napolitano and chancellors from all 10 campuses are joining forces on an audacious and far-reaching goal: harnessing the collective power of UC to help put the world on a path to sustainably and nutritiously feed itself.
President Napolitano unveiled the UC Global Food Initiative today (July 1) over the course of three events, starting at the Edible Schoolyard in Berkeley, followed by a presentation to the California State Board of Food and Agriculture in Sacramento, and finally at the UCLA community garden in the Sunset Canyon Recreation Center.
The initiative brings together the university’s research, outreach and campus operations in an effort to develop and export solutions throughout California, the United States and the world for food security, health and sustainability, Napolitano said during the morning briefing.
“It is a commitment to apply a laser focus on what UC can do as a public research university — in one of the most robust agricultural regions in the world — to take on one of the world’s most pressing issues,” Napolitano said.
The Edible Schoolyard is a 1-acre garden and kitchen classroom at the Martin Luther King Jr. Middle School, founded by Chez Panisse chef and owner Alice Waters. It has become a model for teaching children how to grow and eat a healthy, sustainable diet. It features vegetables, herbs, vines, berries, flowers, fruit trees and chickens.
UC President Janet Napolitano (right) tours the Edible Schoolyard at Berkeley’s Martin Luther King Jr. Middle School with founder and restaurateur Alice Waters. (Photo by Robert Durell)
Waters gave Napolitano a tour of the garden and then at a press conference gave her a basket of eggs from the garden’s chickens, quipping that she was “putting all her eggs” in Napolitano’s basket.
“I’m extremely excited and very hopeful because I know that she believes as I do that public education is the best way to solve the problems of the world,” said Waters, a UC Berkeley alumna.
Vision and leadership
Napolitano received an equally warm reception from state agricultural leaders.
“There is no better time to launch this initiative than today,” said board President Craig McNamara. “Count on us at the State Board of Food and Agriculture. We are your partners.”
The initiative will harness UC’s leadership in the fields of agriculture, medicine, nutrition, climate science, public policy, social science, biological science, humanities, arts and law, among others.
It comes at a crucial time, Napolitano said. A billion people — most of them in the developing world — suffer from chronic hunger or serious nutritional deficiencies. More than half a billion — primarily in the industrialized nations of the world — are obese. Against this backdrop, climate change and population growth fuel additional uncertainty and urgency about how to sustainably feed the world.
“This initiative shows great vision and leadership from President Napolitano and the University of California,” said Karen Ross, secretary of the California Department of Food and Agriculture. “Climate change and population growth will greatly strain our ability to provide healthy food to people here and around the world.
“President Napolitano’s proposal to leverage the strategic assets of the entire UC organization makes it a valuable partner in addressing the significant challenges and opportunities for our production agriculture and food system.”
Napolitano said that she and campus chancellors decided to launch the Global Food Initiative after recognizing that the university system is uniquely positioned to play a leading role in addressing the related challenges of nutrition and sustainability.
Playing to strengths
Henry Brady, dean of UC Berkeley’s Goldman School of Public Policy, was among a half dozen UC leaders and members of the university’s Food Initiative Working Group to join Napolitano at the Edible Schoolyard. Also in attendance were UC Santa Cruz professor Daniel Press, executive director of the Center for Agroecology & Sustainable Food Systems at that campus, and Ann Thrupp, executive director of the Berkeley Food Institute at UC Berkeley.
Brady said that the initiative’s strength comes from the depth of work and research across the 10-campus system. Each location brings its own area of expertise, he noted.
“We at the Berkeley Food Institute are trying to see how we can transform the food system to be more sustainable and we want to do it through good science, good policy, good thinking,” Brady said.
Press echoed Napolitano’s sentiment that UC’s involvement comes at a crucial moment.
He said that UC Santa Cruz had long been the “mothership” of organic agriculture in California and the U.S.
“We feel a lot of what people are talking about with sustainable agriculture and justice in the food system — these are things we’ve been working on for 40 years,” Press said. “Now the world is much more receptive.”
Helene Dillard, dean of the College of Agriculture and Environmental Sciences at UC Davis, talks with reporters in Sacramento. (Photo by Robert Durell)
Helene Dillard, dean of the College of Agricultural and Environmental Sciences at UC Davis, who joined Napolitano at the meeting with the state board, said that people at UC Davis are particularly excited about the initiative because it aligns so well with work already under way at the campus.
UC Davis last year launched the World Food Center to focus on transformative research at the intersection of food, agriculture, health and public policy.
“We’re already the No.1 agricultural school in the nation and the world,” Dillard said. “Having the UC system focusing on this really plays to our strengths.”
At UCLA, Napolitano was joined by UCLA Executive Vice Chancellor and Provost Scott Waugh; Wendy Slusser, associate vice provost for the UCLA Healthy Campus Initiative; students who manage the garden; and Los Angeles and Riverside school district officials.
UCLA’s initiative is an integrated effort aimed at making the campus the healthiest university in the country, promoting health and wellness of students, faculty and staff, and helping other communities achieve the same objectives. The Healthy Campus Initiative was envisioned and supported by philanthropists Jane and Terry Semel. Jane Semel was present for the announcement.
Napolitano toured the garden with members of the student group DigUCLA. She also planted an oregano plant and learned about gardening basics from the students.
Slusser said that she was excited to learn that the Healthy Campus Initiative served as a starting point for what has grown into a larger and stronger UC-wide effort. “On a personal note, the initiative is bringing me back to my roots since food has been the driving force in my medical and academic career, and also my father is a fourth-generation California rancher. So thank you, President Napolitano, and thank you to all our UCLA and community partners for working so hard in making us stronger together to promote health, wellness and happiness through food.”
UC is California’s land-grant university and has played a key part in helping California become the nation’s leading agricultural state. UC’s Division of Agriculture and Natural Resources has experts in every county in California, helping farmers, ranchers and others cope with tough issues like drought.
But UC’s leadership goes beyond agriculture. Students, faculty and staff have turned UC’s campuses into living laboratories for sustainable food practices. UC also is on the frontlines of addressing issues of food inequality and health, from developing flood- and drought-resistant crops to developing a highly efficient cookstove that addresses food security issues posed by displaced persons in Darfur.
Napolitano noted that the Berkeley Food Institute is studying the relationship between pest control, conservation and food safety on Central Coast farms; the World Food Center at UC Davis stands with 26 other centers dedicated to food and agriculture on that campus; students and faculty at UC Santa Cruz are transforming the field of agroecology; and the cutting-edge Healthy Campus initiative at UCLA taps all members of the campus community.
“We do much,” Napolitano said, “but, together, we can do more.”
Examples of projects that will be undertaken in the first phase of the UC Global Food Initiative include:
Expanding experiential learning, including demonstration gardens;
Creating a course catalogue of all food-related courses available on UC campuses;
Leveraging food purchasing power to encourage sustainable farming practices to serve nutritious fare in dining halls and cafeterias;
Data mining of existing information to help develop insights and action plans for agriculture and responses to climate change;
Organizing food pantries, so that food reaches hungry mouths instead of going to waste; and
Developing policies to better enable small growers to become suppliers.
Supporting student involvement
To support student engagement, Napolitano also announced the creation of the President’s Global Food Initiative Student Fellowship Program. The Office of the President will provide $7,500 to each UC campus to be used for three fellowships of $2,500 each. At the campuses’ discretion, these fellowships will go to undergraduates or graduate students, to fund student-generated research, related projects or internships that focus on food issues.
Keith Gilless, dean of UC Berkeley’s College of Natural Resources, said he was excited to see the system collaborate on such an important goal.
“I’ve been working my whole career to see how does the UC system as a whole come together so the sum is greater than its parts,” Gilless said. “The time is right to mobilize the university’s resources both to advance science and practices and to raise public consciousness about food issues broadly.”
UC San Diego's Ralph Greenspan (center) is helping lead the Cal-BRAIN initiative.
The California budget signed by Gov. Jerry Brown today (June 20) creates a statewide research grants program called Cal-BRAIN, an initiative led by UC San Diego. With an initial allocation of $2 million, Cal-BRAIN – short for California Blueprint for Research to Advance Innovations in Neuroscience – is a state complement to the federal BRAIN Initiative announced by President Barack Obama in April 2013. It aims to “accelerate the development of brain mapping techniques, including the development of new technologies.”
UC San Diego played a significant role in the national initiative and will now lead the state effort to revolutionize our understanding of the brain and the diagnosis and treatment of brain disorders of all kinds. By improving our ability to see what goes on in the brain in much greater detail and at a much faster timescale, we aim to make discoveries around autism, Alzheimer’s, PTSD and other behavioral health issues and injuries that affect everyone from our children to our homeless veterans.
In this leadership role, UC San Diego will guide the collaboration among the UC campuses and is currently discussing a significant financial investment of non-state, university resources in Cal-BRAIN.
Ralph Greenspan, director of UC San Diego’s Center for Brain Activity Mapping, established at the university in May 2013, is co-author with Paul Alivisatos, director of the Lawrence Berkeley National Laboratory, of a proposal to the University of California Office of the President and to the state Legislature that served as a blueprint for the bill just signed into law.
The proposal calls for organizational hubs in Southern and Northern California, at UC San Diego and Berkeley Lab, to coordinate research activities, facilitate communication and seek additional funds from private and industry partners.
Both Cal-BRAIN and the national initiative are expected to spur not only a new academic discipline but also a new industry cluster of “neurotechnology.” And the tools and inventions needed for mapping the brain will also likely have broad applications to a range of disease monitoring beyond the brain and even to fields beyond health.
“UC San Diego’s leadership role in Cal-BRAIN is of vital importance — not only to the university and the San Diego region but for the state as a whole,” said UC San Diego Chancellor Pradeep K. Khosla. “We will be developing the next technology cluster in ‘neurotech’ just as we did in high-tech, clean-tech and more, creating high paying jobs and world renowned results. I am confident that, with our strengths in neuroscience and biotechnology in San Diego, we will be producing ground-breaking research with significant social impacts.”
Since helping state Senate Majority Leader Ellen Corbett to convene the first hearing on California’s possible role in the BRAIN Initiative at UC San Diego in October 2013, Greenspan and other representatives from the university have traveled numerous times to Sacramento, presenting the case for Cal-BRAIN before members of the state Senate and state Assembly.
Senate President Pro Tem Darrell Steinberg (D-Sacramento) and state Sen. Marty Block (D-San Diego) were early champions. Assembly Speaker Toni Atkins (D-San Diego) also supported the bill.
“UC San Diego is a world leader in the biosciences, and it is a perfect fit to have UC San Diego serve as the Southern California hub of Cal-BRAIN,” Atkins said. “Cal-BRAIN will help develop brain mapping technologies and has the potential to make significant advances in treating conditions such as Alzheimer’s and Parkinson’s. I am proud San Diego will be at the forefront of this important effort.”
Greenspan – who is also associate director of the Kavli Institute for Brain and Mind at UC San Diego and professor in residence of neurobiology and cognitive science – is one of the original writers, as was Alivisatos of LBNL, of the white paper that sparked the national BRAIN Initiative.
“Our vision was for Cal-BRAIN to serve as a driver for trying out different possible technologies and converging on a unified approach for doing effective brain mapping, in which UC San Diego will play a key role,” Greenspan said. “Cal-BRAIN is a great start to realizing the ultimate goal: mapping the brain’s trillions of connections in real time.”
Behind the scenes at UC San Diego Health System’s trauma center.
Dr. Raul Coimbra (left) helps lead UC San Diego Health System's Level-1 Trauma Center. (Photo by Erik Jepsen, UC San Diego)
It’s 10 o’clock on a Tuesday morning and the UC San Diego Health System Level-1 Trauma Center is quiet. The only sounds are beeps and tones from machines monitoring the health and status of a handful of patients, the subdued bustle of staff tending to their work and family members visiting their sick or injured loved ones in the adjacent Surgical Intensive Care Unit.
Then, suddenly, a page sounds: A new trauma patient is en route. With trained, almost automatic response, trauma nurses, residents, fellows and surgeons move into position at the trauma resuscitation bay unit. When paramedics arrive with the patient, every second will count.
Seven trauma team members stand around a steel table, all with specific roles. With advanced technology and verbal communication with paramedics on scene, the trauma team is prepared and ready to execute a treatment plan before the patient is even in the hospital.
“We are always in a state of readiness,” said Dr. Raul Coimbra, new surgeon in chief at UC San Diego Medical Center – Hillcrest and chief of the division of Trauma, Burn, Surgical Critical Care and Acute Care Surgery at UC San Diego Health System. “Each second we effectively save with one patient, will be used to treat the next, making for a stronger workflow and collaboration with trauma surgeons and achieving the ultimate goal of improved patient care and survival rates.” The doors open. Paramedics roll the patient into the trauma resuscitation area. Trauma team members take over. If you are envisioning a chaotic scene from the television show “Grey’s Anatomy,” think again. The team calmly and efficiently assesses the patient, a male who fell and severely injured himself while vacationing in Mexico.
More than 3,200 patients are admitted to the trauma center each year. Trauma surgeons treat injuries that include not just injuries from falls, but the consequences of motor vehicle accidents, assaults, gunshot and stab wounds and burns.
UC San Diego Health System’s trauma center is one of only four in the nation where trauma patients are treated in a free-standing trauma center not located within the emergency room, as trauma patients require a highly specialized medical team with a unique skill set.
“Trauma patients come directly to the trauma center for the most critical care, bypassing the emergency department,” said Coimbra. “There is a dedicated trauma team that cares for this population from the time they are admitted until discharge from the hospital.”
Stanley Prusiner among UC participants at New York Times health conference.
New York Times correspondent Elisabeth Rosenthal and Nobel laureate Stanley Prusiner discuss developments in Alzheimer's research at the Health for Tomorrow conference at UCSF Mission Bay. (Photos by Susan Merrell, UC San Francisco)
By Alec Rosenberg
Nobel Prize winner Stanley Prusiner is not resting on his laurels.
Instead, the 72-year-old UC San Francisco neurologist has set his sights on solving one of the biggest challenges facing health care today: Alzheimer’s disease.
Prusiner made a passionate plea for tackling Alzheimer’s and other neurodegenerative diseases Thursday (May 29) at the New York Times Health for Tomorrow conference at UCSF Mission Bay Conference Center. The conference, which featured experts from the University of California and across the country, addressed the changing landscape of health care.
Alzheimer’s already has a large impact on health care: It’s the sixth-leading cause of death in the U.S. — more than breast cancer and prostate cancer combined — and nearly half of people age 85 and older have the disease, Prusiner said. Without action, it will get worse — the prevalence of the disease is projected to triple by 2050 to as many as 16 million Americans.
“This is a huge, huge problem, and we’re not doing nearly enough,” said Prusiner, a UC San Francisco professor of neurology and director of the Institute for Neurodegenerative Diseases. “This is such an important area. There is no substitute for research. That’s going to really make a difference.”
Stanley Prusiner, UC San Francisco
Filling the pipeline
The National Institutes of Health provides only $500 million in research funding for Alzheimer’s, compared with more than $5 billion for cancer research, even though each costs society about $200 billion a year, Prusiner noted.
While many drugs treat cancer and hundreds more are in the pipeline, no single drug today halts or slows neurodegenerative diseases, he said. Prusiner, who just wrote a memoir, “Madness and Memory,” about his Nobel Prize-winning discovery of prions — infectious proteins that could be at the root of neurodegenerative diseases such as Alzheimer’s and Parkinson’s — aims to change that.
In April, UCSF formed a new collaboration with Japan-based pharmaceutical company Daiichi Sankyo Co. Ltd. This joint venture, capitalizing on Prusiner’s research, is focusing on developing drugs and molecular diagnostics for multiple neurodegenerative diseases, including Alzheimer’s and Parkinson’s.
“I’m very optimistic now that we are going to get there,” Prusiner said. “This is a huge step forward. We need 10 more of these around the world.”
UC President Janet Napolitano
UC is conducting research on health’s most pressing problems, teaching the next generation of health professionals and working to improve health care quality, access and affordability, said UC President Janet Napolitano, who delivered welcoming remarks at the conference.
“There are no quick fixes, but I think working together we can make steady progress,” Napolitano said.
Indeed, research is being conducted throughout UC on Alzheimer’s and many other health issues. Napolitano noted that UC San Francisco leads a team that was just awarded a $26 million federal grant — part of President Obama’s Brain Initiative — to create an implantable device that will retrain the brain to recover from mental illness. She also pointed to research by conference speakers David Kilgore of UC Irvine and Michael Fischbach of UC San Francisco.
David Kilgore, UC Irvine
Kilgore, a clinical professor of family medicine, talked about the problem of “diabesity”: Diabetes rates have tripled in the last 20 years, while more than two-thirds of adults are considered to be overweight or obese. Among Kilgore’s patients at a UC Irvine clinic, 70 percent have diabetes, often in combination with other chronic diseases.
“The challenge of chronic disease has completely changed what it’s like to be a primary care physician,” Kilgore said.
More prevention is needed, Kilgore said. He started group medical visits for patients with diabetes. They receive extra information about nutrition, exercise and receive a healthy cooking lesson.
“They love it,” Kilgore said.
UC San Francisco's Michael Fischbach and Stanford's Justin Sonnenburg discuss research into gut bacteria.
Going with the gut
Fischbach, a UC San Francisco assistant professor of bioengineering and therapeutic sciences, discussed his research on the gut with collaborator Justin Sonnenburg, a Stanford University microbiologist who has a bachelor’s degree from UC Davis and a doctorate from UC San Diego. They are studying gut bacteria and how it could help reveal the causes and new treatments for Crohn’s disease and obesity.
“The beauty of being in basic research is you don’t know where you’re going to end up,” Fischbach said after their panel presentation. “It’s nice to be on a journey where you don’t know where the ship lands. I hope it’s going to improve human health.”
The Health for Tomorrow conference addressed issues ranging from the impacts of the Affordable Care Act to rethinking how to deliver care in the 21st century to issues of access, affordability and applying technology. Speakers included Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services; Diana Dooley, secretary of the California Health and Human Services Agency; New York Times correspondent Elisabeth Rosenthal; CEOs Toby Cosgrove of the Cleveland Clinic and Bernard Tyson of Kaiser Permanente; and several with UC ties.
As part of the conference, five entrepreneurs were invited to give short talks about their health-related startup companies. Three of them studied at UC:
Erik Douglas, CEO of CellScope, has a doctorate degree from UC Berkeley and UC San Francisco. The company’s first product, CellScope Oto, turns a smartphone into a digitally connected otoscope, enabling remote care for ear infections, the leading reason for pediatric visits.
Anupam Pathak, Lift Labs founder and CEO, has B.S. and M.S. degrees from UC Berkeley. Lift Labs makes active stabilization tools for people living with tremor. Its pocket-sized Liftware, which has a spoon and other attachments, is a “Swiss Army knife for people with tremors.”
Joanna Strober, founder and CEO of Kurbo Health, has a J.D. from UCLA. She founded Kurbo after becoming concerned about the consequences of her middle son being overweight. Kurbo has developed a mobile app designed for children and their families to help them lose weight and live healthier lives.
Julea Vlassakis from UC Berkeley leads a demonstration in the breakout session entitled, "Innovation and Infrastructure for Slum Health: Advancing Technology to Work in Low-Resource Settings." (Photo by Robert Durell)
Videos of the keynote presentations from the fourth annual University of California Global Health Day are now available for streaming on UCTV.
More than 400 people attended the 2014 UC Global Health Day at UC Davis on April 26. The event was sponsored by the UC Global Health Institute, with support from UC Davis’ Office of the Chancellor, School of Veterinary Medicine and School of Medicine.
The event featured presentations from faculty and students across the 10-campus UC system on topics ranging from global health diplomacy, maternal and child health, animal health, emerging infectious diseases, economics, migrant health, and more. Keynote presenters included UC President Janet Napolitano, UC Davis Chancellor Linda Katehi, USC Institute for Global Health Director Jonathan Samet, and UC Davis professors Jonna Mazet and Andrew Hargadon.
“As I’m pursuing my dreams, I’m helping others to pursue theirs,” said the 31-year-old. “This is why I needed to be here and discover another purpose in my life.”
UC President Janet Napolitano presented awards to Rodriguez-Torres of Elk Grove and a UCLA student wellness campaign at a meeting of the UC Board of Regents in Sacramento May 14.
Her impact across UC
“The work of these bright students has a tremendous impact not only on their home campuses but across the UC system and out in their communities,” said Napolitano. “I’m pleased to have a chance to recognize their efforts and dedication to tackling tough issues that affect us all.”
More than 7,500 attend the conference, and more than 80 percent of participants are high school, community college and UC students who are underrepresented in the field of medicine.
For the October 2013 conference, Rodriguez-Torres was responsible for the medical programming that brought to the conference about 50 of 700 speakers, including leaders of national organizations.
Helping with students’ struggles
Earlier, she met one of her own mentors through the conference and is committed to providing such opportunities for other students. “I’ve seen the struggles students go through. I can see I can do something about it,” said Rodriguez-Torres, who continues to serve on the conference’s organizing board as director of medical programming.
In nominating Rodriguez-Torres for the award, Adela de la Torre, vice chancellor of student affairs at UC Davis, wrote that her saga exemplifies a “tenacity of spirit that propels her social justice action.”
Rodriguez-Torres completed three years of medical school in Colombia before obtaining political asylum in the United States, where she cleaned houses, served fast food, and provided child care to help support her family and save for her education. As her English proficiency grew, she worked as an immigration consultant and a tax preparer for people with limited English.
Three associate degrees
Because her medical school credits from Colombia were not transferable, she studied at American River College — where she earned three associate degrees — before transferring to UC Davis.
Drawn to the university by the opportunity to work at the student-run Clinica Tepati in Sacramento, she has helped provide free care for the underserved, mostly Latino patients.
As a winner of a $10,000 Donald A. Strauss Public Service Scholarship, she established a prevention-focused diabetes education class that extended the clinic’s work. Her project provides monthly classes in nutrition and diabetes prevention as well as Zumba fitness classes at All Hallows Parish in Sacramento.
After graduating in June, Rodriguez-Torres plans to pursue a master’s degree in public health at UC Davis and then a medical degree on her way to becoming an internist focusing on diabetes prevention.
Breakthrough technologies creating public benefit, improving health.
A system for removing arsenic from groundwater, developed at Berkeley Lab, is helping to provide safe drinking water for people in India and Bangladesh.
By Carolyn McMillan
Lawrence Berkeley Laboratory scientist Ashok Gadgil has developed an inexpensive and easily maintained system for removing arsenic from groundwater.
It’s a breakthrough technology that could protect millions of people around the world from arsenic poisoning, a silent killer that is especially prevalent in the rural villages of India and Bangladesh.
Across the bay, a UC San Francisco orthopedic surgeon has tackled a different sort of epidemic — the thousands of young athletes who tear knee ligaments every year while playing soccer.
Dr. Jeffrey Lotz has developed a faster, better and cheaper way to assess whether an athlete is at risk for lower extremity injuries. His 3-D movement analysis system lets physical therapists and trainers assess an athlete’s body mechanics in order to prescribe the right exercises to avoid injury.
The products of research
These two innovations are just a fraction of the commercially viable discoveries and inventions to emerge recently from the University of California — and part of what makes UC such a powerhouse of economic growth for the state.
UC researchers reported more than 1,700 new inventions last year, according to the recently released Technology Commercialization Report. UC inventions led to 71 new start-up companies and produced roughly $106 million royalty and fee income for the university.
UC President Janet Napolitano, speaking at the university’s annual Technology Commercialization Forum on May 8, said that UC is committed to doing even more to help faculty, researchers and students bring their discoveries to the marketplace.
“Steering UC’s cutting-edge discoveries through our labs and into the world economy is central to our mission as a public university,” Napolitano said. “We are committed to supporting our faculty and students with a strong, nimble infrastructure that will help them pursue patents and develop start-up companies, and we will continue to develop partnerships with industry and investors.”
Gadgil and Lotz were among 20 UC inventors to showcase their innovative research at the forum. The work spanned a huge array of fields and came from eight UC campuses and Lawrence Berkeley National Laboratory.
Improving life and environment
At UC San Diego, a clinical trial is under way to test an oxygen delivery system for people with chronic pulmonary obstructive disorder (COPD), a respiratory ailment. The system automatically responds in real time to a patient’s changing oxygen needs, delivering the right amount of oxygen with each breath.
“Our goal is to increase the autonomy and mobility for people with COPD,” said Dr. Xaxier Soler, associate director of UC San Diego’s pulmonary rehabilitation program. “We want to extend their quality of life.”
The technology was developed by co-inventors Stephen Roberts and David Lischer — the latter a COPD patient who was frustrated that current oxygen devices limited his activity levels. Lischer has tested a prototype of the new device since 2010, and it works well enough that he now goes skiing, Soler said.
At UC Davis, Basam Younis has developed the next generation of water disinfection systems using UV light, rather than chlorine, to eliminate pathogens. Younis’ system achieves a higher level of water purification than earlier UV systems — and does it at a lower cost.
Better yet: His system has proven to be particularly effective at eliminating what Younis referred to as “emerging contaminants” — things like pharmaceuticals, flame retardants, human hormones and care products — which increasingly are found in water supplies.
Steven Beckwith, UC’s vice president for research and graduate studies, said that the breadth and depth of innovation is a reflection that UC has created an “ecosystem of discovery” across its campuses and labs.
“This is the largest, and without a doubt, the most prestigious university in the world,” Beckwith said. “Our researchers tackle complex issues and look to answer some of the biggest questions that society has. And ultimately, we are looking to create a benefit for the public.”
The University of California has taken great strides toward increasing quality and decreasing costs across its medical centers, from reducing blood clots to preventing falls to decreasing hospital readmissions.
To thrive as a system in this dynamic environment, UC Health will need to ramp up such collaborations, speakers said at the UC Center for Health Quality and Innovation’s third annual colloquium, May 2 at the Oakland Marriott City Center.
About 320 people attended the colloquium, whose talks can be viewed on UCTV. Speakers included innovation center leaders, grant recipients and collaborators as well as the head of a leading health care software company and the chair of the state Senate Health Committee. More UC innovators will be participating May 28-29 at the New York Times Health for Tomorrow conference at UCSF Mission Bay Conference Center (view the webcast live at www.nythealthfortomorrow.com).
The colloquium highlighted UC efforts to expand innovations across the system, build partnerships and break down silos amid trends that reinforce the urgency of working together to transform health care.
With 17 professional schools and five academic medical centers (Davis, Irvine, UCLA, San Diego and San Francisco) that have combined revenue of $7.5 billion a year, UC has significant scale as a health system. To leverage that scale, UC’s medical centers have increasingly been working together as a system, from contracting to reducing expenses to improving clinical performance, said Dr. John Stobo, UC Health senior vice president.
UC Health wants to “do the right thing for the patients we serve” and build on the strengths of its nationally ranked medical centers to be known for providing more affordable, more accessible, safe, quality health care, Stobo said.
Tackling the ‘triple aim’
UC’s innovation center, launched in 2010, has funded about 50 grant and fellow projects from throughout UC Health and convened systemwide collaborations from fetal treatment to heart surgery. The center supports innovations at UC medical center campuses and hospitals that seek to achieve the “triple aim” of better patient care and better population health while better controlling costs of care.
“UC Health is leading efforts to reduce variations, reduce costs and produce better outcomes,” said Karyn DiGiorgio, interim director of the innovation center.
Take, for example, the UC Cardiac Surgery Consortium, which has focused on four major areas, compared data and worked to develop evidence-based best practices.
“We were already providing very good care, and we’ve been able to improve upon that,” said Dr. Michael Madani, UC San Diego chief of cardiovascular and thoracic surgery.
“Coming together has made a real difference,” added Dr. Jeffrey Milliken, UC Irvine chief of cardiothoracic surgery. “Each of us got better.”
Working together can be challenging. UC campuses have different priorities, different structures and serve different populations.
“Change is never easy,” said Terry Leach, the innovation center’s past executive director. “But you can learn from the innovators before you, and they’re eager to share what they’ve learned.”
Indeed, obstacles can be overcome, grantees said. Keys include building relationships, forming multidisciplinary teams and gaining leadership support.
“The leadership has to buy in,” said Catherine Walsh of UCLA, who leads an innovation center-funded project that has reduced hospital falls at UCLA and is working to expand it to other UC medical centers.
UC San Francisco’s Dr. Rebecca Smith-Bindman leads the UC DOSE project to optimize and standardize computed tomography radiation doses for patients across UC medical centers. She organized a two-day retreat last month to bring together radiology decision-makers from each of the five UC medical centers. The retreat helped build trust, as participants could see the data showing variation in radiation doses and discuss low-dose protocols, she said.
“My concern is quality,” Smith-Bindman said. “The issue is very important to our patients.”
UC Davis’ Dr. Elisa Tong leads the UC Tobacco Cessation Network, an innovation center-funded project that targets tobacco use and exposure — the No. 1 cause of preventable death. UC medical centers see about 125,000 smokers a year, and the network aims to reduce that number by using electronic medical records to address tobacco use and exposure at every clinical encounter, she said.
“This is something that can improve efficiency, patient care, quality, outcomes and it will improve return on investment,” Tong said.
Speaker Carl Dvorak, president of electronic health records vendor Epic Systems Corp., said the next frontier of health care innovation is mobile phones. It’s important for health providers to make things as convenient as possible for patients, such as offering mobile billing, payments, appointment scheduling and prescription refills, he said.
“Patients will wonder what’s wrong with you if you don’t offer these in five years,” Dvorak said. “It’s going to be the price of admission.”
Another key issue is implementation of the Affordable Care Act. As of April 17, nearly 1.4 million Californians had signed up for health plans through the Covered California exchange while 1.9 million people newly enrolled in Medi-Cal. UC Health has partnered with Anthem Blue Cross to offer Californians access to UC’s medical centers and physicians for in-network health care on the exchange.
“California has done an incredible job with health care reform implementation,” said state Sen. Ed Hernandez, an optometrist who chairs the Senate Health Committee. “But if we are going to be successful, we have to ensure there is cost control.”
Hernandez said he plans to hold hearings on how to contain health care costs.
UC Health has been focusing on ways to reduce costs. In March, UC announced that its five medical centers will collaborate as a system to save in the range of $100 million to $150 million a year. The “Leveraging Scale for Value” project will focus initially on three areas: supply chain, revenue cycle and clinical laboratories, Stobo said.
Early detection is key to diagnosis potential tooth decay.
Mora Braggs dons a tooth costume to help promote the UCSF free dental screening at the San Francisco's Cesar Chavez Festival.
The Cesar Chavez holiday is a time to remember the late civil rights leader by promoting community service.
This year, UC San Francisco faculty and students answered the call to action by volunteering their time to provide free dental screenings at the city’s Cesar Chavez Festival in the Mission District on April 12.
Dozens of people, including 60 children, participated in the screenings and received fluoride varnishes to prevent cavities. Dental school residents also provided free oral health education and made referrals to the UCSF Dental Center for cases that needed follow-up.
During the festival, at least 15 people were recommended for follow-up with a dentist at the Dental Center and three were found to have serious dental problems.
Early detection is key to diagnosing potential tooth decay, which remains one of the most common diseases. By age 17, more than 7 percent of children have lost a permanent tooth to decay.
The UCSF School of Dentistry offers free screenings throughout the year at locations throughout San Francisco. Its next event will be on Sunday, May 4, at Third & Newcomb at the Bayview Sunday Streets. Download the event flier, or visit the UCSF Community and Government Relations page for more information.