TAG: "Patient care"

UCSF receives $100M gift to advance health sciences mission


Landmark gift cements Chuck Feeney’s role as UC system’s top philanthropist.

Chuck Feeney

By Jennifer O’Brien, UC San Francisco

UC San Francisco has received a $100 million gift from visionary philanthropist Charles F. “Chuck” Feeney to support its new Mission Bay hospitals, world-class faculty and students, and research programs focused on the neurosciences and aging.

This donation brings the longtime supporter’s total UCSF giving to more than $394 million, making Feeney the single largest contributor to the University of California system.

“I get my gratification from knowing that my investments in medical research, education, and the delivery of health care at UCSF will provide lifelong benefits to millions of people not only in the Bay Area but also around the world,” said Feeney, who, despite his global presence as a successful entrepreneur and discerning philanthropist, prefers remaining out of the limelight. “I can’t imagine a more effective way to distribute my undeserved wealth.”

Reflecting on Feeney’s contributions, UCSF Chancellor Sam Hawgood, M.B.B.S., said, “As we celebrate UCSF’s 150th anniversary this year, it is only fitting that we acknowledge the unique role Chuck has played in our history. While his impact has been felt most profoundly during this past decade, his generosity will carry on forever at our university, in the San Francisco community, throughout the Bay Area and globally, as our faculty and students advance knowledge and provide the finest clinical care. We are honored that he has decided to invest again in UCSF.”

Feeney’s gifts to UCSF are most visible at the university’s Mission Bay campus, where he has provided indispensable support to create advanced facilities and foster the environment for the biomedical research and patient care that goes on within them.

Before the latest funding, Feeney’s most recent gift to the campus was to UCSF Global Health Sciences, enabling the October 2014 opening of Mission Hall, which houses global health researchers, scientists and students under the same roof for the first time. Feeney, who coined the term “giving while living,” also generously supported the building of the Smith Cardiovascular Research Building and the Helen Diller Family Cancer Research Building.

“Chuck Feeney has been our partner at Mission Bay for more than 10 years,” added Hawgood. “He immediately embraced the Mission Bay concept, and he has enthusiastically helped us shape a larger vision for the campus and finance its development because he knew that our research and clinical programs could not flourish without state-of-the-art buildings.”

Gift to support four primary areas

The Campaign for the UCSF Medical Center at Mission Bay
Funds will support the $600 million philanthropy goal of the $1.5 billion hospitals project. The latest donation builds upon the transformative $125 million matching gift Feeney made to support the hospitals complex and its programs in 2009, the largest gift received toward the campaign.

The opening of the 289-bed hospital complex – which includes UCSF Benioff Children’s Hospital San Francisco, UCSF Betty Irene Moore Women’s Hospital, UCSF Bakar Cancer Hospital, and the UCSF Ron Conway Family Gateway Medical Building – was the culmination of more than 10 years of planning and construction. Strategically located adjacent to UCSF’s renowned Mission Bay biomedical research campus, the new medical center places UCSF physicians in close proximity to UCSF researchers and nearby bioscience companies who are working to understand and treat a range of diseases, from cancer to neurological disorders.

“It’s been thrilling to see the reactions of our patients and their families as they encounter the amazing care offered at our new UCSF Mission Bay hospitals,” said Mark Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospitals. “This world-class experience would never have been possible without the support of Chuck Feeney who, as the largest contributor to the project, helped us create the hospitals of our dreams. Every patient cured, every breakthrough discovered at Mission Bay, will be thanks in part to Chuck. His legacy is unparalleled.”

Neuroscience and aging
The gift also supports UCSF’s pre-eminent neuroscience enterprise, including its Sandler Neurosciences Center and neurology programs at Mission Bay.

The center, a five-story, 237,000-square-foot building that opened in 2012, brings under one roof several of the world’s leading clinical and basic research programs in a collaborative environment. UCSF’s neurology and aging efforts are focused on finding new diagnostics, treatments, and cures for a number of intractable disorders, including Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, stroke, migraine, epilepsy and autism. The programs also seek to integrate neuroscience and clinical disciplines with public health initiatives in order to disseminate and implement novel findings from research centers of excellence, as well as conduct community outreach to raise awareness about the diseases of aging.

“Chuck Feeney has taken a keen interest in the challenges of aging,” said Hawgood. “In turn, he has recognized UCSF’s extraordinary talent in the neurosciences, among both basic researchers and those who translate research into clinical care and public policy. This gift will build on UCSF’s strengths while encouraging strong partnerships at other research institutions around the world where Chuck also has made important investments.”

Student scholarships and housing
Even with its extraordinary academic firepower, UCSF has extremely limited funds to support scholarships for professional students in its schools of dentistry, medicine, nursing and pharmacy. Part of the gift will provide scholarship support, bolstering UCSF’s ability to recruit the best and brightest students, regardless of their financial circumstances.

Recent decreases in state funding led to tuition increases and higher demand for scholarships. This, in turn, increased student debt. Combined with Bay Area housing prices that are among the highest in the nation – from 2011 to 2013, the median rent increased by 24 percent – the prospect of overwhelming debt can deter economically vulnerable students as well as those from middle-class backgrounds from attending UCSF. By minimizing debt upon graduation, the scholarships will help ensure that a UCSF education remains in reach for students from underserved populations, as well as for those students who choose to become health care leaders in underserved communities.

“Scholarships give our students the gift of freedom: to make career choices based on purpose and passion, rather than the price of education; to use time to study, explore science, and volunteer to help others, rather than working to make ends meet; and to succeed because someone who never met them saw enough potential to invest in their dreams,” said Catherine Lucey, M.D., vice dean for education at UCSF’s School of Medicine. “These scholarships catalyze our schools’ ability to find, recruit, educate and nurture the workforce our country needs: talented professionals whose life experiences enable them to provide compassionate care to today’s diverse communities and advance science to improve the health of future communities.”

Faculty recruitment
The donation also will help UCSF recruit the next generation of promising faculty in an increasingly competitive marketplace.

New funding will attract junior faculty – who frequently find it more challenging to secure research funding – and provide initial startup funds as they launch their research careers and clinical practices. With decreasing federal support for young investigators, this gift will underwrite a new generation of brilliant upcoming faculty.

“While Chuck’s unprecedented generosity has been focused primarily on Mission Bay, he understands the power of the entire UCSF enterprise, from our cutting-edge stem cell research at Parnassus to our innovative cancer programs at Mount Zion,” Hawgood said. “We’re thrilled that Chuck has inspired other philanthropists to join him in creating one of the most vibrant life science communities in the world, where progress will ripple far beyond Mission Bay and the campus for generations to come.”

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UCSF Medical Center at Mission Bay opens


Large-scale transport completed with support of city of San Francisco agencies.

More than 130 patients were carefully transported from Parnassus and Mount Zion campuses to the new UCSF Medical Center at Mission Bay on Feb. 1. (Photo by Noah Berger)

>>Related: UCSF Medical Center at Parnassus and Mount Zion to expand care

>>Related: President Bill Clinton tours new UCSF hospitals

By Karin Rush-Monroe, UC San Francisco

With 40 ambulances, approximately 300 UCSF staff and faculty, as well as 100 emergency medical services personnel, UCSF Medical Center on Sunday, Feb. 1,  safely transported 131 patients to the new UCSF Medical Center at Mission Bay from its Parnassus and Mount Zion campuses.

The move day started at 7 a.m. on the UCSF Parnassus campus; later in the day patients also were transported from the UCSF Mount Zion campus. The last patient to be moved arrived at UCSF Medical Center at Mission Bay at 3:33 p.m. The new medical center also greeted the first baby born at the new hospitals, a healthy boy who entered the world at a little more than seven pounds.

The opening of the new hospitals was the culmination of more than 10 years of planning and construction of the complex, which includes UCSF Benioff Children’s Hospital San Francisco, UCSF Betty Irene Moore Women’s Hospital, UCSF Bakar Cancer Hospital and the UCSF Ron Conway Family Gateway Medical Building.

The move day, itself, reflected significant planning. “Patient safety was our top priority during the patient move, along with minimizing disruption to our neighbors. We achieved both goals, thanks to the superb work of our medical center faculty and staff as well as our partners in the City of San Francisco,” said Mark R. Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospitals. “We have been looking forward to this day for some time, and the opportunity to start providing care in our new location at UCSF Mission Bay.”

The majority of patients who made the trip on Sunday were children, as UCSF Benioff Children’s Hospital San Francisco moved from Parnassus to its new home at UCSF Mission Bay.

Strategically located on UCSF’s world renowned UCSF Mission Bay biomedical research campus, the new medical center puts UCSF physicians in close proximity to UCSF researchers and nearby biotechnology and pharmaceutical companies in Mission Bay and beyond who are working to understand and treat diseases ranging from cancer to cardiovascular disease to neurological conditions.

“Placing the hospitals on our Mission Bay campus underscores our commitment to driving discoveries toward patient care, ensuring that our world-class researchers are working in close proximity to our leading clinical researchers and physicians in the hospitals,“ said Sam Hawgood, M.B.B.S., chancellor of UC San Francisco.  “They also will provide invaluable training for our medical students, the next generation of clinicians who will take care of patients at health care facilities across California and nationally.

“Significantly, the move also frees up space on our Parnassus and Mount Zion campuses, which will allow us to enrich our medical programs for adult patients there. With the opening of the hospitals at Mission Bay, we now have integrated clinical care and research programs on all of our campuses, the critical factor that has contributed to UCSF’s local, regional and global impact.”

The UCSF Parnassus campus will be restructured to provide more specialized clinical services, such as transplants, and the UCSF Mount Zion campus will become a world-class hub for outpatient care.

“UCSF Medical Center’s new $1.5 billion, state-of-the-art campus in our city’s Mission Bay neighborhood will help improve the health of children, women and cancer patients,” said San Francisco Mayor Ed Lee. “This is not just a milestone for UCSF; this is a milestone for our city and our city’s health care industry, which is at the heart of our economy providing good jobs for our residents.

“Right before our eyes, we have seen the transformation of this underutilized railyard in Mission Bay into an epicenter where new discoveries and innovation in medicine are saving lives around the world. By working together with our great partner UCSF, and the many generous philanthropists that helped build these new hospitals, we will continue to ensure our residents get the highest quality of health care.”

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Newly named Shiley Eye Institute projects bigger, bolder vision


UC San Diego emerges as regional hub for eye care, research, education, community service.

By Scott LaFee, UC San Diego

Reflecting its emergence as a regional hub for unparalleled clinical care, research, education and community service, the UC San Diego Shiley Eye Center has been renamed the UC San Diego Donald P. and Darlene V. Shiley Eye Institute, encompassing the Shiley Eye Center, the Anne F. and Abraham Ratner Children’s Eye Center, the Hamilton Glaucoma Center and the Joan and Irwin Jacobs Retina Center.

“The new name more accurately captures the fullness of the work being done at Shiley,” said Pradeep Khosla, chancellor of the University of California, San Diego. “The institute and Department of Ophthalmology, working hand-in-hand with the School of Medicine and other programs across campus, will leverage every possible tool and expertise, from genetics, bioengineering and pharmacy to pathology, neurosciences and stem cell research, to improve the treatment of eye diseases, find new cures and hasten the day when blindness is entirely preventable.”

Robert N. Weinreb, M.D., chair and Distinguished Professor of Ophthalmology and director of the Shiley Eye Institute, said the institute’s emphasis would remain focused upon achieving excellence – in the clinic and in the laboratory. “The department will continue to partner with groups in San Diego and throughout the world to translate research into better vision. We also will continue to nurture and grow our programs for community outreach and continuing medical education for physicians.”

The Shiley Eye Institute, part of UC San Diego Health System, employs 227 faculty and staff. In 2014, there were 106,470 patient visits and 4,862 surgeries. The Shiley Eye Mobile conducted 12,238 vision screenings, 2,011 eye exams, dispensed 1,288 pairs of free glasses and referred numerous children for more serious follow up care.

“It was always very clear that my late husband had a special place in his heart for the Shiley Eye Center,” said Darlene Shiley, a staunch supporter of the center since it was founded in 1991. “I will never forget how moved he was by (former director and department chair) Dr. Stuart Brown’s description of the work being done and the work that still needed to be addressed.  And now, decades later, Dr. Robert Weinreb is focused on patient-centric care excellence and leading the Shiley into new areas of eye research and treatment.  Successful past, bright future – how lucky we all are to have such dedicated physicians, researchers, staff and eager volunteers.”

Doctors and researchers at Shiley have made measurable progress in addressing some of the primary diseases of vision, such as macular degeneration, glaucoma, diabetic retinopathy, corneal and retinal disorders and cataracts. Patients range in age from 1 day to 105 years old.

Shiley physician-scientists are actively involved in diverse research and scholarship, from defining all of the cell types and synaptic connections that link the eyes to the brain, part of President Obama’s BRAIN Initiative, developing biosensors and an artificial retina, even exploring the possibilities of whole eye transplants. In 2013, Shiley Eye Center was ranked fourth in the nation in funding to departments of ophthalmology from the National Institutes of Health. Last year, the Department of Ophthalmology was awarded a prestigious K12 grant from the NIH to train clinician scientists, one of just a few such grants in the country. In 2014, Shiley researchers published 205 peer-reviewed studies and conducted 29 clinical trials.

The institute will include the new Richard C. Atkinson Laboratory for Regenerative Ophthalmology, created last year with an anonymous $6.5 million gift from a grateful patient. The new lab will investigate cell replacement therapies, tissue engineering and other biomedical advances to reverse vision loss and blindness. Researchers will explore novel stem cell approaches and work closely with the Sanford Clinical Stem Cell Center at UC San Diego Health System, which was established in 2013.

A new Vision Research Center is in the early stages of planning along with the creation of a framework to fund the project. The center is envisioned to accelerate the translation of new research into treatments for patient with blinding ophthalmic diseases.

“The center is intended to help bridge the gap between laboratory and clinic by bringing together brilliant minds and diverse talents in a shared facility,” said Weinreb. “This integrated approach will speed the transformation of discoveries into clinical applications that can be tested through clinical trials.”

The new Shiley Eye Institute embraces the larger mission of UC San Diego, its schools and programs and the UC San Diego Health System, said David Brenner, M.D., vice chancellor of health sciences and dean of the School of Medicine. “Our goal is unprecedented collaboration across all disciplines, moving basic science to real-world applications as quickly and as effectively as possible and doing so in a way that truly improves patient care and lives. I think people will see that vision come to life in the institute.”

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UC Irvine first in Orange County to use remote heart failure monitoring system


Implanted CardioMEMS sensor helps reduce heart failure-related hospital readmissions.

Pranav Patel, UC Irvine

UC Irvine Health is the first medical center in Orange County to offer heart failure patients a wireless system that allows cardiologists to remotely monitor their pulmonary artery pressure and heart rate measurements.

Real-time access to this data enables doctors to proactively manage a patient’s condition, helping to reduce the rate of hospital readmission related to heart failure, the leading cause of hospitalization among adults 65 and older in the U.S., according to the American College of Cardiologists.

Heart failure refers to the progressive weakening of the heart muscle until it no longer pumps enough blood to meet the body’s needs. Advances in treatment allow more patients to survive hospitalization for heart failure, but more than 50 percent of them experience a new onset of symptoms and end up being readmitted within six months. Cardiologists hope the CardioMEMS Heart Failure System will help break this cycle.

Dr. Pranav Patel, chief of the UC Irvine Health Division of Cardiology, implanted the sensor in an 84-year-old male patient on Feb. 6.

“This technology will help change the way we manage heart failure patients,” said Patel. “Once the patient returns home, they must pay careful attention to changes in weight, ankle or abdominal swelling and shortness of breath. CardioMEMS monitors their heart rate and artery pressure daily, and transmits that information to a secure database at the hospital or clinic for review by a physician or a nurse. We can identify early warning signals before the patient feels any symptoms.”

The implantable sensor is about the size the size of a dime, with thin loops at each end, and is placed in the pulmonary artery during a right heart catheterization procedure. Once implanted, the patient cannot feel the sensor, and it does not interfere with other devices such as a pacemaker or defibrillator. The system wirelessly captures and transmits the patient’s data to a secure database for analysis.

CardioMEMS received FDA approval in May 2014 and is designed for use with patients who have been hospitalized the previous year with New York Heart Association Class III heart failure. The American Heart Association uses this classification system, which is based on how much a patient’s physical activity is limited by their heart condition.

“If the patient is experiencing rising pressure or any deterioration of their heart failure condition, we can immediately make changes to their medication, diet and daily activities,” Patel said. “Early detection is the key to preventing more serious complications, avoiding another emergency room visit or hospital stay, and enhancing the patient’s overall well-being.

The UC Irvine Health Heart Failure Program uses state-of-the-science equipment and technologies to identify the cause of heart failure, or cardiomyopathy. A multidisciplinary team then works with patients to stabilize their condition and develops a comprehensive treatment plan.

In each of the last four years, the program has received the American Heart Association’s Get With The Guidelines – Heart Failure Gold Plus Quality Achievement Award. The recognition signifies that UC Irvine Health has achieved the goal of treating heart failure patients according to prevention guidelines recommended by the American Heart Association/American College of Cardiology.

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Stein, Doheny eye institutes join forces


Affiliation expands UCLA faculty, adds new clinics to UCLA Health, improves patient access.

Doris and Jules Stein (Photo from Stein Eye Institute archives)

By Elaine Schmidt, UCLA

Two of the nation’s top eye institutes have united in an affiliation that will improve patients’ access to leading vision specialists.

UCLA’s Stein Eye Institute and the Doheny Eye Institute — both created by families whose legacies helped shape Los Angeles — have joined forces to offer the best in patient care, vision research and training for future eye specialists. The affiliation adds 14 clinicians and researchers from Doheny, formerly associated with the University of Southern California, to the ophthalmology faculty at the David Geffen School of Medicine at UCLA.

“The Stein–Doheny affiliation is a beautiful fit,” said Dr. Bartly Mondino, director of the Stein Eye Institute and chair of ophthalmology at the David Geffen School of Medicine at UCLA. “We share similar missions and have a long history of collaboration. This partnership expands UCLA’s footprint tremendously by providing patients with greater access to the top doctors in cornea, retina, glaucoma, neuroophthalmology and oculoplastics.”

As part of the agreement, Doheny’s clinics will join the UCLA Health network. Two Doheny Eye Center UCLA sites will expand community access to specialty care in newly renovated offices in Arcadia and Fountain Valley. A third clinic, in a new medical–surgical suite in Pasadena, will act as Doheny Eye Center UCLA’s primary hub.

Each organization will preserve its identity while combining clinical and teaching operations. Both institutes have earned international recognition for the quality of their patient care and research. U.S. News and World Report’s 2015 “Best Hospitals” survey ranked the combined Stein Eye and Doheny Eye institutes as the No. 5 center for ophthalmology based on feedback from specialists in the field.

“Since our establishment in 1947, the Doheny Eye Institute has worked to become the premier vision research and education eye institute in the world through the discovery of new knowledge, innovative eye-care therapies and the education of the leaders of ophthalmology and vision science,” said Ed Landry, chair of the Doheny Eye Institute board of directors. “UCLA and the Stein Eye Institute share our values and high standards for education, patient care and research. We expect that the combination of our two leading programs will result in even greater recognition and accomplishments.”

“We are honored to work with the Doheny Eye Institute to improve patient care throughout Southern California, while simultaneously extending the Stein Eye Institute’s research and educational outreach, which hold immense value for the nation and world,” said Dr. David Feinberg, president of the UCLA Health System, CEO of the UCLA Hospital System and associate vice chancellor of the Geffen School of Medicine. “We appreciate this rare and unique opportunity to strengthen relationships with our distinguished colleagues at Doheny, many of whom have long collaborated with us in serving the Los Angeles community.”

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MRI technique developed for nonalcoholic fatty liver disease in children


UC San Diego study makes strides toward noninvasive diagnostic for pediatric liver disease.

By Heather Buschman, UC San Diego

Between 5 and 8 million children in the United States have nonalcoholic fatty liver disease (NAFLD), yet most cases go undiagnosed. To help address this issue, researchers at UC San Diego School of Medicine have developed a new magnetic resonance imaging (MRI)-based technique to help clinicians and researchers better detect and evaluate NAFLD in children. The study is published today (Feb. 5) in Hepatology.

“Currently, diagnosis of NAFLD requires a liver biopsy, which is not always available or performed. This leads to both misdiagnosis and missed diagnoses, hampering patient care and progress in clinical research,” said Jeffrey B. Schwimmer, M.D., professor of clinical pediatrics at UC San Diego, director of the Fatty Liver Clinic at Rady Children’s Hospital-San Diego and the first author of the study. “Thus, a noninvasive method for diagnosing and/or evaluating NAFLD has the potential to impact millions of children.”

NAFLD is characterized by large droplets of fat in at least 5 percent of a child’s liver cells. Obesity and diabetes are risk factors for NAFLD. Doctors are concerned about NAFLD in children because it can lead to hepatitis, liver scarring, cirrhosis and liver cancer.

Traditionally, NAFLD is diagnosed by a gastroenterologist in consultation with a pathologist, who examines the patient’s biopsied liver tissue under a microscope. The presence and severity of liver fat is graded by the pathologist as none, mild, moderate or severe, based on the percentage of liver cells that contain fat droplets.

In an effort known as the MRI Rosetta Stone Project, Schwimmer and colleagues used a special MRI technique known as magnitude-based MRI, which was previously developed by researchers in the UC San Diego Liver Imaging Group, to estimate liver proton density fat fraction (PDFF), a biomarker of liver fat content.

“Existing techniques for measuring liver fat are dependent upon the individual scanner and the center at which the measurements were made, so they cannot be compared directly,” said Claude B. Sirlin, M.D., professor of radiology at UC San Diego and senior author of the study. “By comparison, PDFF is a standardized marker that is reproducible on different scanners and at different imaging centers. Thus, the results of the current study can be generalized to the broader population.”

In this study, the researchers compared the new MRI technique to the standard liver biopsy method of assessing fat in the liver. To do this, the team enrolled 174 children who were having liver biopsies for clinical care. For each patient, the team performed both MRI-estimated PDFF and compared the results to the standard pathology method of measuring fat on a liver biopsy.

The team found a strong correlation between the amount of liver fat as measured by the new MRI technique and the grade of liver fat determined by pathology. This is an important step towards being able to use this technology for patients. Notably, the correlation was influenced by both the patient’s gender and the amount of scar tissue in the liver. The correlation between the two techniques was strongest in females and in children with minimal scar tissue.

Depending on how the new MRI technology is used, it could correctly classify between 65 and 90 percent of children as having or not having fatty liver tissue.

“Advanced magnitude MRI can be used to estimate PDFF in children, which correlates well with standard analysis of liver biopsies,” Schwimmer said. “We are especially excited about the promise of the technology for following children with NAFLD over time. However, further refinements will be needed before this or any other MRI technique can be used to diagnose NAFLD in an individual child.”

Study co-authors include Michael S. Middleton, Cynthia Behling, Kimberly P. Newton, Hannah I. Awai, Melissa N. Paiz, Jessica Lam, Jonathan C. Hooker, Gavin Hamilton and John Fontanesi, all at UC San Diego.

This research was funded, in part, by the National Institutes of Health (grants UL1RR031980, DK088925-02S1 and R56-DK090350-01A1) and the National Science Foundation (grant 414916).

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Paramedics may be best first lineof defense in treating stroke patients


First-of-its-kind study, led by UCLA, offers hope for faster, more effective care.

By Kim Irwin, UCLA

A consortium led by UCLA physicians has found that paramedics can safely start providing people with medication in the first minutes after the onset of a stroke instead of waiting for them to receive treatment at a hospital.

Although the drug tested, magnesium sulfate, did not improve patient outcomes, the research points to a new method for treating stroke patients quickly.

For people who have suffered a stroke, immediate treatment is key — the more time that passes before the restoration of blood flow, the higher the likelihood that stroke victims will suffer irreversible brain damage.

The study findings indicate that paramedics can give intravenous medications to stroke patients within the “golden hour,” the window during which treatments are most likely to help patients survive and avoid debilitating, long-term neurological damage. That finding is a game-changer, said Dr. Jeffrey Saver, the study’s co-principal investigator and director of the UCLA Stroke Center.

“The trial succeeded in its goal of devising a means to deliver promising drugs to stroke patients in the first minutes, when there’s the greatest amount of brain to save. We have opened a new therapeutic window that is now being used to test other compounds and deliver clot-busting drugs to patients in the field,” said Saver, who also is a professor of neurology at the David Geffen School of Medicine at UCLA. “Stroke is a true emergency condition. Time lost is brain lost — for every minute that goes by without restoration of blood flow, 2 million nerve cells are lost.”

The study appears in today’s (Feb. 5) issue of the New England Journal of Medicine.

The phase 3 Field Administration of Stroke Therapy–Magnesium (FAST–MAG) clinical trial involved collaboration among 315 ambulances, 40 emergency medical service agencies, 60 receiving hospitals, 715 emergency physicians, 210 neurologists, 26 neurosurgeons and 2,988 paramedics in Los Angeles and Orange counties. In the study, half of the 1,700 patients had the study drug administered within 45 minutes, while 74 percent were treated within the golden hour.

“This study involved an unprecedented cooperative effort of paramedics in the field and emergency physicians serving as investigators,” said Dr. Sidney Starkman, co-principal investigator and co-director of the UCLA Stroke Center.

“Through this study we were able to instill permanently in everyone’s mind the idea that ‘time is brain.’ We believe this represents a paradigm shift in the treatment of stroke and potentially numerous other neurological conditions,” said Starkman, who also is professor of emergency medicine and neurology at the Geffen School. “We demonstrated that paramedics not only are eager to provide the best possible patient care, but also are capable of being invaluable partners in an intense, time-dependent clinical trial.”

Today, the only ways to treat strokes caused by blocked blood vessels are to reopen the arteries with tissue plasminogen activator, a clot-busting drug, or to use catheters to remove the clot. But, in general, neither can be done until the patient arrives at the hospital and undergoes a CT scan to rule out bleeding in the brain. Additional treatments can only be offered after that, by which time substantial brain injury may already have occurred.

The FAST–MAG trial used magnesium because in animal studies it dilated blood vessels and increased blood flow in the brain. Magnesium also countered the damaging calcium buildup that occurs when cells are deprived of oxygen. It had been already approved for use in humans, it had a good safety profile and paramedics were familiar with it.

“Now we are tasked with finding a different agent or combination of agents that can improve stroke outcomes within that golden hour,” Saver said. “The ambulance treatment platform can be used around the world to test promising agents.”

Dr. Bill Koenig, medical director of the Los Angeles County Emergency Medical Service Agency, worked closely with Saver and Starkman on the FAST-MAG study.

“To assist paramedic recognition of stroke victims, the nationally recognized Los Angeles Pre-hospital Stroke Screen was developed,” Koenig said. “FAST-MAG also served as an impetus to create the Los Angeles County System of Stroke Hospitals, which every year treats over 10,000 stroke victims. When the day comes that a medication can successfully treat stroke in its early stages, this novel system in Los Angeles will be well positioned to immediately apply the treatment to our patients. I am confident that with the dedicated investigators, along with a finely tuned EMS system, that discovery will be sooner rather than later.”

Dr. Walter Koroshetz, acting director of the National Institute of Neurological Disorders and Stroke, said this study shows that it is possible to get treatments to stroke patients even before they arrive at a hospital.

“Because a blocked blood vessel causes brain damage over minutes to hours, this pre-hospital approach to treatment is sure to be adopted and refined in clinical research studies,” Koroshetz said. “Ultra-early brain salvage in stroke patients will someday surely reduce the tremendous burden of disability and death due to stroke.”

Saver said clinical trials currently being conducted in the U.S., Canada and England are testing new compounds using the early treatment infrastructure created by the FAST–MAG study.

Stroke is the fifth leading cause of death in the U.S. and is a major cause of adult disability. About 800,000 people in the U.S. have strokes each year, and one person dies from a stroke every four minutes, on average.

The study was funded by the National Institute of Neurological Disorders and Stroke at the National Institutes of Health.

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Motorcycle crash survivor meets blood donors who helped save his life


UCLA patient received 20 times the average person’s blood volume.

Brandon Levine and some of the more than 200 blood donors whose blood he received at Ronald Reagan UCLA Medical Center after a horrific motorcycle accident last April. (Photo by Reed Hutchinson, UCLA)

By Elaine Schmidt, UCLA

Due to confidentiality laws, most blood donors and recipients never meet. But on Friday, a rare event organized by the UCLA Blood and Platelet Center brought together a man who survived a horrific motorcycle crash with some of the 196 blood donors who helped save his life.

“Donating blood is one of the most selfless and gracious gifts you could ever give anyone,” Internet executive Brandon Levine told a packed room of blood donors and news reporters at the UCLA Faculty Center. “A part of you is inside me. I have no way to repay you, except to say thank you so much for my life.”

Levine, 40, has no memory of the accident that happened on his first solo ride last April. The force hurled him chest-first into a guardrail, severing his aorta and vena cava, the primary vein that transports blood to the heart.

Levine arrived by ambulance at Ronald Reagan UCLA Medical Center bleeding from multiple wounds, including internally. He had shattered his jaw, eye socket, arm and hip; damaged his kidneys, lungs and liver; and knocked out his teeth. To reconstruct his face, doctors had to use 140 plates.

As the ER team rushed Levine into the OR for emergency heart surgery, he grabbed the arm of anesthesiologist Dr. Barbara Van de Wiele. “Please help me,” he pleaded.

“I heard those three words in my head for the next eight hours as we transfused 100 units of blood into his veins and struggled to save his life,” recalled Van de Wiele. “Brandon would not be here but for the generosity of those who hear the ‘Please help me’ of strangers in desperate need of precious blood.”

She thanked his donors for saving “a wonderful person who survived the unsurvivable.”

In total, Levine was transfused with 207 units of blood, plasma and platelets — about 20 times the average person’s blood volume. During his first night in the hospital, his heart stopped twice, forcing nurses to resuscitate him. Doctors gave him only a 5 percent chance of survival.

He was hospitalized for two months — the first in a coma — in the intensive-care unit at Reagan UCLA Medical Center. Three grueling weeks of daily physical therapy followed in UCLA’s inpatient neurological rehabilitation unit, which Levine joked, was “like boot camp for handicapped people.”

Despite losing 50 pounds of muscle, enduring more than 10 surgeries and having to relearn how to swallow, sit up, walk and run, Levine’s will to recapture his life never flagged. Judging from his comments, neither did his sense of humor.

“When I first saw my legs, I started to cry, because they looked like toothpicks,” he remembered.  “But the great thing about losing 50 pounds is you get to put it back on. I ate nonstop, and calories didn’t count. It was like living in heaven.”

Levine was accompanied by his girlfriend, Leah Horwitz, whom he started dating nine months before the crash, and his mother, Betsy Sachs, who flew in from his hometown of Baltimore, Maryland. Neither left his side during the first three months of his recovery.

Ranging in age from mid-teens to mid-70s, Levine’s donors hailed from throughout the Los Angeles region and spanned the spectrum demographically. Many had given platelets and blood dozens of times, with one man donating platelets on 194 separate occasions.

The group included UCLA students, staff members, a physician, a large group of Glendale High School students who held a school blood drive the week before Levine’s accident, and good Samaritans who drove from as far as Riverside to donate at UCLA.

“Now I have a face to go with every bag of blood I received,” Levine said with emotion to his donors.

In a classic example of life coming full circle, Levine and Horwitz will lead the pace car for the 2015 City of Angels Fun Ride, a cycling event that raises money for the UCLA Blood and Platelet Center. This year, the ride, which will start at Royce Hall, is set for April 26, one year to the day of Levine’s accident.

To learn about donating blood or platelets at UCLA, see www.gotblood.ucla.edu, call (310) 825-0888 or email  gotblood@ucla.edu.

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Caring for the child’s brain


Pediatric Brain Center provides holistic care for patients’ full range of brain-related needs.

Audrey Price

By Kathleen Masterson, UC San Francisco

Fifteen-year-old Audrey Price slowly reaches for an orange plastic cup sitting on the counter. In a concerted effort, her fingers close around it, and she lifts it to chest height, shaking ever so slightly.

For Audrey, this simple act marks a tremendous journey from diagnosis to brain surgery to therapy and slow healing.

Just 11 months ago, she was living a typical middle-schooler’s life in a Bay Area suburb, hanging out with friends, playing tennis and obsessing over the British boy band, One Direction.

Then Audrey began developing weakness in her right side. After a series of doctor’s appointments, she ended up visiting a neurologist, who ordered scans of her brain that showed an aneurysm the size of a golf ball pressing on her brain stem.

That’s when her neurologist called UC San Francisco.

Audrey was brought into the newly formed Pediatric Brain Center at the UCSF Benioff Children’s Hospital San Francisco, which integrates neurology, neurosurgery, physical and occupational therapy, speech, social work and neuro-psychology to provide seamless holistic care for patients’ full range of brain-related needs. It’s one of just a few specialized pediatric brain centers in the U.S.

The center’s unique structure and specializations ended up being an ideal match for Audrey’s rare and complex condition.

Heather Fullerton and Nalin Gupta lead UC San Francisco's Pediatric Brain Center, which opens a new, centralized location at the new UCSF Benioff Children's Hospital at Mission Bay on Feb. 1. (Photo by Cindy Chew)

Bringing the doctors to the patient

The Pediatric Brain Center was founded about two years ago, spearheaded by Heather Fullerton, M.D., and Nalin Gupta, M.D. The center brings together a diverse range of UCSF experts from across multiple departments to treat patients together, as a team.

Rather than the typical experience in which a patient may see one doctor and then be referred to another specialist, and then another, chasing multiple appointments over weeks, at the Pediatric Brain Center the physicians, nurses and other key staff coordinate the care around the patient. One coordinator books all the patient’s appointments, from check-ups to arranging tests to surgery, and each patient is treated by a team assembled specifically to meet his or her unique medical needs.

“The goal was to make not only the patient experience, but also the problem solving and treatment, more rational. We wanted to be able to design our care around the patient’s medical issue, as opposed to simply following the organizational structure of the institution,” said Gupta.

Initially the center existed mainly as an organization change, with all the experts still located in separate offices at Parnassus. With the Feb. 1 opening of the UCSF Medical Center at Mission Bay, the Pediatric Brain Center will soon have it’s own central location to further streamline the patient experience.

“It’s so much easier for the family to have one place to go for all their child’s care, all the way from the initial treatment to rehabilitation,” said Fullerton.

Unique expertise in research and care

Having a centralized space will help make the patient experience smoother, but the crux of the Pediatric Brain Center is its network of highly specialized researchers, clinicians and surgeons.

“Having clinicians and researchers together helps inform what we study,” said Fullerton, a practicing neurologist who also researches pediatric strokes. “So many of our clinicians are also researchers, so when a question comes up in clinic, we can use our own local expertise to start the search for an answer. For example if I keep seeing this strange-looking blood vessel, I can turn around and start a study to investigate what’s happening.”

That’s a distinct advantage of an academic medical center. Private practices couldn’t afford the freedom to develop deep expertise in narrow areas, said Gupta. Furthermore, a child’s brain isn’t like the adult brain; treating a growing brain requires specialized neurology expertise.

“With the Pediatric Brain Center, we’re explicitly trying to leverage the strengths of the institution,” said Gupta. “We have people that have lot of expertise in narrow areas, and by definition those are often rare things.”

Building a specialized team

The Pediatric Brain Center brings all these diverse experts together, forming a unique treatment team made up of specialists relevant to each patient’s needs.

That’s vital for patients like Audrey, said Gupta.

“What Audrey had was very rare and complex. She’s an example of type of patient that there isn’t a list of 500 patients like that,” he said. “It’s not like other conditions where we could simply look to see what did we do for last 500.”

So Audrey’s doctors assembled a team of neurologists and neurosurgeons to develop a plan to remove the brain aneurysm.

“Audrey’s surgical team in consultation was so calm, they really explained things really well in terms we understood,” said her mother, Barbara Price. “We left there feeling very relieved this was treatable, that we were not in emergency situation and we had one of best surgical teams in the world that would treat her.”

Audrey’s surgery went well, and the team was able to remove the brain aneurism safely.

However, when she came out of surgery, she could hardly move the right side of her body. Her doctors quickly called in another team member, Jonathan Bixby, M.D., who specializes in physical rehabilitation.

“Unlike some other aspects of medicine, rehabilitation is dependent on how much effort the patient puts in,” said Bixby.

“Audrey was great. With any patient dealing with significant changes to the body, there can be issues adjusting. Audrey adjusted quickly, and was very willing to work with a therapist.”

Ongoing team care

Audrey is continuing to get stronger every day. She does her physical therapy daily at home, has learned to do nearly everything with her left hand and was able to start high school last fall.

She got there after spending six weeks living at the hospital after her surgery; she practiced physical therapy six hours a day, six days a week. It’s exhausting work, but her therapists strived to incorporate Audrey’s interests into her exercises to make it more fun, including using therapy dogs and playing One Direction’s music during sessions.

“The hardest part is not knowing when my body is going to be back to the way it was,” she said. “The doctors said, ‘all brains are different,’ and that was the most frustrating part.”

Throughout her hospital stay, her bed was covered in a fleece blanket with the One Direction’s faces on it, including her favorite singer, Niall.

Barbara Price recalled that one day Audrey came back to her room to find a note atop her One Direction blanket that read something like: “‘Dear Audrey, I’m really proud of all the hard work you’re doing’ then the note quoted lyrics from one of the songs. It was signed,  ‘Love, Niall,” she said with a laugh. One of the doctors had scripted this joking note of encouragement.

“The team was so funny and thoughtful, so we had a lot of laughs that got us through some tough times.”

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UC Davis burn center receives Beacon Award for Excellence


Caregivers recognized for improving patient outcomes, meeting high standards.

Members of the Burn Unit at UC Davis Medical Center

By David Ong, UC Davis

The American Association of Critical-Care Nurses (AACN) recently conferred a bronze-level Beacon Award for Excellence on the Firefighters Burn Institute Regional Burn Center at UC Davis Medical Center.

The Beacon Award for Excellence — a significant milestone on the path to exceptional patient care and healthy work environments — recognizes unit caregivers who successfully improve patient outcomes and align practices with AACN’s six Healthy Work Environment Standards. Units that earn this three-year, three-level award with a gold, silver or bronze designation meet national criteria consistent with Magnet Recognition, the Malcolm Baldrige National Quality Award and the National Quality Healthcare Award.

AACN President Vicki Good praised the commitment of the caregivers at the Firefighters Burn Institute Regional Burn Center for working together to meet and exceed the high standards set forth by the Beacon Award for Excellence.

“These dedicated health care professionals join other members of the exceptional community of nurses who set the standard for optimal patient care,” Good said. “The Beacon Award for Excellence recognizes caregivers in stellar units whose consistent and systematic approach to evidence-based care optimizes patient outcomes. Units that receive this national recognition serve as role models to others on their journey to excellent patient and family care.”

The bronze-level Beacon Award for Excellence earned by the Firefighters Burn Institute Regional Burn Center signifies success in developing, deploying and integrating unit-based performance criteria for optimal outcomes.

The Burn Center earned a bronze award by meeting the following evidence-based Beacon Award for Excellence criteria:

  • Leadership Structures and Systems
  • Appropriate Staffing and Staff Engagement
  • Effective Communication, Knowledge Management, Learning and Development
  • Evidence-Based Practice and Processes
  • Outcome Measurement

Other Beacon Award designations include silver and gold. Recipients who earn a silver-level award demonstrate continuous learning and effective systems to achieve optimal patient care; gold-level awardees demonstrate excellent and sustained unit performance and patient outcomes.

The Burn Center’s Beacon Award for Excellence recipients will be published in AACN Bold Voices, the monthly award-winning member magazine distributed to more than 100,000 acute and critical care nurses nationwide. AACN also honors awardees at the National Teaching Institute & Critical Care Exposition, the world’s largest educational conference and trade show for nurses who care for acutely and critically ill patients and their families.

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UC San Diego to host region’s first camp for stroke survivors, caregivers


Therapeutic retreat offers support, education and a bit of fun.

Alexander Khalessi, UC San Diego

By Jackie Carr, UC San Diego

On Jan. 23-25, more than 15 stroke survivors and their caregivers will go on a mini-vacation in La Jolla as part of a therapeutic retreat for those whose lives have been affected – sometimes turned upside down – by stroke. The 50s-themed stroke camp is being co-hosted by UC San Diego Health System, which has one of the nation’s first certified Comprehensive Stroke Centers.

“Stroke camp is part of UC San Diego’s larger commitment to the care of neurovascular patients and their families,” said Alexander Khalessi, M.D., director of endovascular neurosurgery and surgical director of neurocritical care at UC San Diego Health System. “Beyond receiving the best possible neurological care or developing new therapies, we support patients through their recovery and get them back to their lives.”

The camp will be the first Refresh & Retreat Stroke Camp in California, with the flare of an American Bandstand theme, complete with an invitation to bring “your letter sweaters, poodle skirts and dancing shoes.” The event is sponsored with Covidien, a global health care leader.

Stroke care has advanced rapidly in recent years, but strokes still involve some permanent loss of healthy brain tissue due to either a lack of blood flow or bleeding within the brain itself. As a result, many stroke survivors require significant time to recover and rehabilitate. During this healing process, it is the caregivers – often a spouse or family member – who may suddenly find themselves overwhelmed and socially isolated by their new responsibilities.

“Stroke camp is about pampering the caregivers and recognizing the toll strokes take on them,” said Julie Jurf, R.N., stroke care coordinator, UC San Diego Health System. “The camp’s aim is to bring fun, respite and renewal to stroke survivors, their families and caregivers.”

Jurf will volunteer at the retreat to assist caregivers.

“I will be pushing a wheelchair, standing in line for food, or doing whatever needs to be done so that my caregiver can go for a swim or relax,” she said. “Even just a two-day break can go a long way to bring renewal to people’s life.”

Khalessi added that stroke camp provides patients with support and encouragement, offers a welcome rest for their caregivers, and provides an opportunity to bond with other stroke survivors.

Over three days, attendees will be invited to participate in a variety of camp-like activities, including drum circles, craft-time and 50’s bingo, as well as survivor and caregiver break-out discussion sessions that allow attendees to vent, share and console as needed.

In addition, Khalessi, a national expert in catheter-based and open cranial neurosurgeries for stroke, aneurysms and other blood vessel disorders of the brain, will lead a tour of the Center for the Future of Surgery at the UC San Diego School of Medicine. This facility is a national destination for developing and refining new life-saving stroke treatments, now transforming the standard of care for stroke patients.

“Stroke is a disease that had no solutions 30 years ago. It is now a treatable medical and neurosurgical emergency. Even five years ago, stroke care involved a single drug and supporting patients through their new disabilities,” Khalessi said. “We now have catheter-based procedures and devices that allow for rapid and safe restoration of blood flow in the most severe forms of stroke, involving large vessels of the brain,” a procedure known as stent thrombectomy that in a recent study published in the New England Journal of Medicine greatly improved stroke patients’ prognoses.

“We have phenomenal new treatments for hemorrhagic stroke, or bleeds within the brain, due to cerebral aneurysms or high blood pressure, using minimally invasive surgical or catheter-based techniques,” he said. “These strokes are no less devastating and were a death sentence a decade ago.”

The designation of a Comprehensive Stroke Center at UC San Diego Health System is formal recognition of its ability to receive and treat the most complex stroke cases around the clock, every day of the year, with a multidisciplinary team of neurologists, neurosurgeons, cardiologists and rehabilitation specialists.

Approximately 680,000 American’s each year survive a stroke, making stroke the nation’s leading cause of disability. A patient’s ability to benefit from the latest in stroke-care technologies hinges upon a third party recognizing stroke and ensuring that the patient is brought to a hospital where comprehensive stroke care can be provided.

About Retreat & Refresh Stroke Camp
Retreat & Refresh Stroke Camp is a nonprofit based in Peoria, Illinois. It has sponsored 105 stroke camps nationwide since 2004. The nonprofit’s founder and executive director, Marylee Nunley, is caregiver to her husband John, who had a stroke in 2001. For more information, visit http://strokecamp.org.

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New report ID’s transparency as a means to improve patient safety


Open communication the ‘magic pill’ needed to improve many issues related to safety.

Robert Wachter, UC San Francisco

Open communication and a free flow of information represent the “magic pill” needed to improve many of the issues in health care related to safety, according to a new report released by the National Patient Safety Foundation’s Lucian Leape Institute. “Shining a Light: Safer Health Care Through Transparency” defines transparency as “the free, uninhibited flow of information that is open to the scrutiny of others,” and calls for sweeping action within and across organizations, between clinicians and patients, and in public reporting.

“We hope this report will help convince people that transparency is not only the right thing to do, but that it will lead to improved outcomes, fewer errors, more satisfied patients and reduced costs of care,” said UC San Francisco’s Robert M. Wachter, M.D., associate chair of the Department of Medicine. He and Gary Kaplan, M.D., F.A.C.M.P.E., chief executive officer, Virginia Mason Health System, both members of the NPSF Lucian Leape Institute, served as co-chairs of this initiative.

The report addresses four distinct yet overlapping domains where the open exchange of information is necessary to improve safety:

  • Between clinicians and patients to ensure patients are well informed at all stages of their care
  • Among clinicians to ensure the practices of high performers are shared with their peers
  • Between organizations to allow greater collaboration on safety protocols and events
  • With the public through meaningful measures and data that is understandable and useful to health care consumers

The authors provide specific recommendations relevant to each domain and to the areas of measurement and leadership. In all, more than three dozen recommendations are outlined in the report addressing issues such as disclosure of conflicts of interest, shared decision making with patients, and development of core competencies for communicating about medical errors and quality measures to patients, families, other medical professionals and the public.

“Transparency has been largely overlooked as a patient safety tool, in part because it requires a foundation of a safety culture and strong organizational leadership,” said Kaplan. “The barriers are not necessarily easy to overcome, but we will never truly achieve safe patient care without improvements in transparency in each of the domains we cite.”

Increased transparency, the report says, will yield broad benefits by promoting accountability; catalyzing improvements in quality and safety; promoting trust and ethical behavior; and facilitating patient choice. The result of two roundtable meetings that included participants with a broad range of expertise, the report also includes case studies of how transparency is applied in practice.

“We are grateful to our roundtable participants for the time and expertise they contributed to this report,” said Tejal K. Gandhi, M.D., M.P.H., C.P.P.S., president and CEO of NPSF and president of the Lucian Leape Institute. “This is a complex issue, and it is not going to happen overnight, but we believe advances in transparency will significantly improve patient safety.”

This is the fifth in a series of reports about issues that the NPSF Lucian Leape Institute has identified as transforming concepts to improve patient safety. The first, “Unmet Needs: Teaching Physicians to Provide Safe Patient Care” (2010), addresses the need for teaching quality and safety principles in medical education. In 2012, the Institute published “Order from Chaos: Accelerating Care Integration,” which looks at the problem of fragmented care and possible solutions. “Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care” (2013), details the profound problem of physical and psychological risks to the health care workforce. “Safety Is Personal: Partnering with Patients and Families for the Safest Care” (2014) looks at patient and family engagement in health care. All Institute reports are available for download on the website.

In addition to Drs. Leape, Gandhi, Kaplan and Wachter, current members of the NPSF Lucian Leape Institute include Janet Corrigan, Ph.D., M.B.A., distinguished fellow, Dartmouth Institute for Health Policy and Clinical Practice; Susan Edgman-Levitan, P.A., executive director, John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital; Gerald B. Hickson, M.D., senior vice president for quality, safety and risk prevention, Joseph C. Ross Chair in Medical Education & Administration, assistant vice chancellor for health affairs, Vanderbilt University Medical Center; Julianne Morath, R.N., M.S., president and CEO, Hospital Quality Institute of California; Paul O’Neill, former chairman and CEO, Alcoa, and 72nd secretary of the U.S. Treasury; and Dennis S. O’Leary, M.D., president emeritus, The Joint Commission.

Members of the institute’s Roundtable on Transparency will discuss the new report in a live webinar on Feb. 12 from 9-10 a.m. Pacific Time. Registration is free of charge and open to all. Details are available at http://bit.ly/LLItransparency.

For more information about the report or the NPSF Lucian Leape Institute, visit www.npsf.org/lli.

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