SAVE THE DATES! Collaborative Care Model (CoCM) Skill Building Trainings
SAVE THE DATES! Collaborative Care Model (CoCM) Skill Building Trainings
Please mark your calendars for the following CoCM Skill Building Trainings on a variety of topics. Trainings are from 8 a.m. - 5:15 p.m. unless otherwise noted. Registration details coming soon!
Wednesday, May 28, 2025
CoCM Skills Building Training: Adult Behavioral Activation and Motivational Interviewing
Location: Southern Regional AHEC 1601 Owen Drive | Fayetteville, NC 28304
Thursday, May 29, 2025
CoCM Skills Building Training: Child and Adolescents -- Exposure Therapy and Behavioral Activation
Location: Southern Regional AHEC 1601 Owen Drive | Fayetteville, NC 28304
Tuesday, June 3, 2025 - 8 a.m. - 12:30 p.m.
CoCM Skills Building Training: Adult Motivational Interviewing
Location: The Conference Center at GTCC, 7908 Leabourne Road | Colfax, NC 27235
Wednesday, June 4, 2025
CoCM Skills Building Training: Child and Adolescents -- Exposure Therapy and Behavioral Activation
Location: The Conference Center at GTCC, 7908 Leabourne Road | Colfax, NC 27235
REMINDER! 2nd Annual CoCM Behavioral Health Care Manager Summit
May 16, 2025 from 9 a.m. - 3:45 p.m.
The Conference Center at GTCC
7908 Leabourne Road | Colfax, NC 27235
Register now for the 2nd Annual Collaborative Care Model (CoCM) Behavioral Health Care Manager (BHCM) Summit, presented jointly by NC AHEC and Southern Regional AHEC!
This year's summit will provide an update on CoCM in North Carolina and cover essential topics such as effective documentation and written exposure therapy. These sessions are designed to enhance the unique clinical skills required for BHCMs practicing in primary care and other healthcare settings.
Primary care providers, behavioral health professionals (including college/graduate students) who are interested in learning more about the role and responsibilities of the CoCM BHCM and primary care practices interested in hiring CoCM BHCMs are encouraged to attend.
Don't miss out on this invaluable training opportunity! Click on the blue button below to view more details and to register. We look forward to seeing you there!
How YOU Can Help Reduce Inequities In Diabetes Prevention
How YOU Can Help Reduce Inequities In Diabetes Prevention
(AMA, Andis Robeznieks) – Black women are 2.3 times as likely and Hispanic women 1.4 times more likely to die of diabetes as non-Hispanic white women, according to the U.S. Department of Health and Human Services Office of Minority Health.
One approach to addressing these health inequities in Black and Hispanic women is promoting diabetes prevention within the health care setting. Research shows focusing on efforts to minimize gaps in care can dramatically boost the referral rates to National Diabetes Prevention Program (National DPP) lifestyle-change programs which are effective in preventing or delaying progression to type 2 diabetes for those at risk. Referral rates for these groups more than doubled expectations at three health care organizations—significantly eclipsing the anticipated 25% referral rate.
As part of a 5-year Centers for Disease Control and Prevention cooperative agreement, the AMA in collaboration with the American College of Preventive Medicine and the Black Women's Health worked on a pilot with an aim to build organizational capacity to screen, test, refer and enroll Black and Hispanic women—two population groups that have been disproportionately affected by diabetes—to National DPP sites.
This work formed the foundation of two studies published in AJPM Focus, a journal of the Association for Prevention Teaching and Research and the American College of Preventive Medicine. One study outlined the cascade model developed by the AMA Improving Health Outcomes group and tested at the pilot sites, and the other was an executive summary of lessons learned.
“We were able to create the theoretical model, and test that model at these sites,” said Tamkeen Khan, PhD, the AMA’s lead economist for outcomes analytics and the lead author of the AJPM Focus study.
“The end goal was to get the most eligible patients enrolled in a diabetes prevention program as possible,” Khan added. “Awareness is huge—If patients don't know what's going on with them, they're not going to do anything about it.”
The participating health care organizations provided quarterly and annual data on patients, such as screenings, referrals and enrollments over a 36-month period from July 2019 to July 2022. In addition, they reported on barriers and facilitators to enrollment in the National DPPs.
The structured, National DPP lifestyle-change program has been proven effective at preventing or delaying progression to type 2 diabetes for people at risk.
The AMA’s Diabetes Prevention Guide supports physicians and health care organizations in defining and implementing evidence-based diabetes prevention strategies.
This comprehensive and customized approach helps clinical practices and health care organizations identify patients with prediabetes and manage their risk of developing type 2 diabetes, including referring patients at risk to a National DPP lifestyle-change program based on their individual needs.
Taking it to the next level
Health care organizations “play a critical role in advancing equity at every stage of the diabetes prevention cascade,” Khan and her colleagues wrote. “Leadership support and systematic changes were key to advance and sustain equitable diabetes prevention processes in reducing the burden on inequities in chronic disease management.”
The cascade model is a stepwise framework that can reveal gaps in the continuum of care and provides areas of opportunity for improvements.
“Screening is level one, ordering the labs is level two,” Khan explained. “If they are not ordering the labs after screening, then that is a gap.”
The next step was patient awareness followed by referral to a lifestyle-change program if patients were at risk for prediabetes. The final level in the cascade model concludes with patient enrollment in a National DPP.
“The data helped us to identify the gaps, or the leakage points,” Khan said. “What can we work on together to help fill in these leakage points and help the most patients using the cascade model?”
Pilot sites added clinical decision-support alerts to identify patients eligible for screening, the study says. They also screened for, and worked to address, social determinants.
Black patients received nutrition examples specific to African American or Southern diets, the executive summary says. Citizen advisory boards were convened to develop a sense of community ownership, and program sessions were held in churches and other community centers that helped build trust.
Programs for Hispanic patients were offered in Spanish, according to the summary. Peer educators helped engage patients as did cooking demonstrations and an emphasis on family support.
A newly revamped AMA STEPS Forward® toolkit, “Team-Based Care of Type 2 Diabetes and Prediabetes,” can improve physicians’ capacity to help patients reach their glycemic goals through such an approach. The toolkit also pinpoints opportunities to improve the health of patients with prediabetes and diabetes while saving time for the care team.
Physician champions enable success
The role of physicians as “program champions” was highlighted in the executive summary.
“Health care organizations reduce disparities and advance health equity for disproportionately affected populations by cultivating program champions, engaging in community outreach, and advocating for systemic changes to increase accessibility,” the summary says.
Last October, Khan and colleagues from the AMA and the North Carolina Medical Society examined the role of physician champions in a study published in the Journal of Public Health Management and Practice.
“The champion’s responsibilities included supporting diabetes prevention awareness efforts and disseminating clinical content,” Khan wrote.
“Successes reported by the physician champions include increased awareness of prediabetes through outreach and clinical education,” she added. “It also enabled collaborations with community-based organizations, adopting shared learnings and best practices, and availability of statewide referral platforms that aided champions in engaging peers.”
Not only do physician program champions get things done, but they are also more likely to ensure that those things “get done well with better outcomes,” Khan said.
New Report: Emergency Care Becoming Increasingly Vulnerable In The United States
New Report: Emergency Care Becoming Increasingly Vulnerable In The United States
(HealthDay News) — The viability of hospital-based emergency care in the United States is at risk, according to a RAND report released April 7.
Mahshid Abir, M.D., from RAND in Santa Monica, California, and colleagues conducted focus groups, a survey, and literature review to assess the current value of emergency care, evaluate challenges to sustaining emergency care, measure trends in emergency care payment, and identify alternate funding strategies for emergency care.
The authors found that emergency departments remain the safety net of the U.S. health system. Top challenges include the following: a consistent increase in visit numbers from 2020 to 2024; increased patient complexity (both complex medical and social needs); increased patient acuity; and insufficient capacity, which can lead to crowding, longer wait times, and violence toward emergency department staff. Additionally, payment to physicians per emergency department visit is falling. The authors of the report recommend policies allocating local funds to emergency departments, greater investment in primary care, and protections for those needing care without the ability to pay as well as protections for health care workers.
“Urgent action is needed to sustain hospital emergency departments, which act as a safeguard for patients who use the services and communities that rely on them during a crisis,” Abir said in a statement. “Unless these challenges are addressed, there is an increasing risk that emergency departments will close, more doctors and nurses will leave emergency medicine, and patients will face even longer waits for care.”
Leading With Heart: Creating Healthy Work Environments
Leading With Heart: Creating Healthy Work Environments
(Novant Health, Page Leggett) – In the next 30 minutes, around 60 Americans are going to die of heart disease. And most were preventable. Most people know about the importance of diet and exercise in maintaining a healthy heart, but there are other factors that contribute to heart disease that are seldom talked about – especially in the workplace. And many are within your control.
This was the topic of discussion during a recent Well-Being Exchange webinar for business leaders presented by Novant Health Employer Solutions. Two physician leaders, cardiologist Dr. Jonathan Fisher and Dr. Chan Badger, president of Novant Health Primary Care, discussed the role executives can play in their employees’ well-being. There’s a lot more to it than offering health insurance.
Workplace stress, for one. Fisher cited the generational change taking place in the workforce. Younger employees expect more than a paycheck. “They want satisfaction and a sense of purpose,” he said.
Badger and Fisher showed attendees how they can make changes designed to benefit their employees’ health and promote a workplace culture that prioritizes emotional well-being. There are important lessons everyone can take from the conversation. Here are some highlights.
When it comes to work hours, less is more.
Not everyone has a choice about how many hours they put in at work. For those who do, it’s healthier for your heart and your overall well-being to stick to a 40- to 50-hour workweek.
“Autonomy is the sense that I have some control over my workday and a sense of pride in … the work I do,” Fisher explained. “If the boss dictates everything about a worker’s day – from when they start work to how many minutes they can spend on each task to when they’re allowed to take breaks, that’s not giving the employee any freedom.
“But if we build flexibility into their daily schedule, if we allow people to spend 10% to 20% of their workday on tasks that light them up, that can double or even triple productivity.”
Not having autonomy leads to anxiety. “The research in organizational psychology going back almost 50 years shows there’s a simple formula to predict stress level at work,” Fisher said. “It looks at the demands on the worker versus their sense of control.” The more demanding the job – and the more your boss is looking over your shoulder – the greater the stress.
If your workplace doesn’t allow you any autonomy, it’s even more important to spend your off-hours doing what you love.
Everyone deserves to feel safe – in every sense – at work.
Fisher recalled working for leaders early in his career who made him feel unsafe – and actually at risk – about sharing his opinion.
Fostering a sense of safety at work isn’t just the right thing for a manager to do. There’s a business reason behind it. “The factor that can increase a team’s effectiveness by 300% is psychological safety,” he said.
Do you feel psychologically safe at work? Are you free to express your opinions to your boss? Employees deserve that.
Don’t dismiss ‘soft skills.’
“We use the term ‘soft skills’ to describe psychological safety and emotional intelligence,” Fisher said. “The so-called hard skills of leadership include finance, delegation and project management. But the hardest part of being a leader isn’t balancing a spreadsheet. It’s inspiring other people … and to do that, we can't just leave emotional intelligence for some psychology team to take care of.”
Fisher encourages those in leadership roles to value and cultivate emotional intelligence. We all need to.
Connect with people; develop relationships.
“Research shows us that people cannot fully flourish in their lives – and work is a big part of our lives – unless they feel like they belong to a group that's larger than themselves with a mission larger than themselves,” Fisher said. Among the questions he asks every patient: Do you feel connected to other people? “If they don't, they have a 27% increased risk of having a heart attack,” he said. “[Isolation] is just as bad as smoking cigarettes or having diabetes.”
Badger thinks “one of the hallmarks of a good leader is one who develops relationships – not superficial ones, but true personal connections. I want my team to understand that I don't have all the answers, and I don't claim to. But I promise that I'll roll up my sleeves, have conversations and work to figure out the answer together.”
Be a whole-hearted leader.
Many people assume the heart sends all its blood outward to the body, but in fact, the very first branches of the aorta — the coronary arteries — deliver oxygen-rich blood back to the heart itself. The heart gives itself oxygen first. If you are a leader in your organization, change begins with you. “Add a commitment to nurture and nourish your own heart so you can show up for others as a whole-hearted leader,” Fisher said.
Be willing to listen. And then, act.
“Be open to hearing team members give feedback and then actually acting on that feedback,” Badger said. “Part of that is understanding that they have some input and that you’ll listen to that, incorporate that and use that to affect some change.” It’s not enough to just listen, Badger clarified. The second part of acting and incorporating the input is key.
Seek professional help.
What can workplace leaders do during a time of serious grief, such as the death of an employee?
Badger called this “a real opportunity to bring in outside resources to help support the team.” Fisher reiterated the importance of asking for professional help: “When someone is at risk, it's important to not go it alone.”
Make connections.
Fisher shared how emotional connection plays a vital role in healing. “Patients will say to me, ‘Dr. Fisher, I love you.’ That's not something I ever expected as a medical student. And I say it back because I really feel that this other dimension – whether it's eliminating loneliness, creating a sense of belonging – it creates physical changes in the patient's heart. It slows the heart rate down, lowers the blood pressure. I use it as a medicine.”
Set an example of well-being.
Fisher and Badger emphasized that leaders need to model healthy behaviors. You shouldn’t lecture your employees about the importance of a work-life balance if you’re always at work. Fisher suggested establishing boundaries such as no calls, emails or texts on the weekends or after, say, 8 p.m. If you suddenly think of something, at midnight, that you need to tell a colleague, make a note to yourself about it rather than texting that late. The colleague, especially if junior to you, may feel compelled to respond right away.
That’s good advice for all of us.
NCMS Advanced Healthcare Leadership Program Faculty Member Featured in Voyage Magazine!
NCMS Advanced Healthcare Leadership Program Faculty Member Featured in Voyage Magazine!
(Voyage Raleigh) – Today we’d like to introduce you to Amna Shabbir, MD, NBC-HWC, CPC
Hi Amna, it’s an honor to have you on the platform. Thanks for taking the time to share your story with us – to start maybe you can share some of your backstory with our readers?
From my teenage years, I’ve been passionate about empowering others to heal and thrive—whether through positive psychology, behavioral neuroscience, or medicine. This drive led me to a career in medicine, with training in Internal Medicine at the Cleveland Clinic. After residency, I moved to Raleigh and worked as a full-time primary care physician.
Like many in healthcare, I eventually faced the dual challenges of burnout and moral injury. During that difficult time, I reflected on what brought me joy in medicine: caring for older adults. This realization led me to complete a Geriatrics fellowship at Duke University. Now dual board-certified in Internal Medicine and Geriatrics, I balance part-time clinical practice with my passion for helping high-achievers thrive.
Coaching psychology, a natural extension of my focus on life optimization, became a powerful tool in supporting others. I earned my Wellness Coaching Certification from Duke Integrative Medicine and became a National Board-Certified Health and Wellness Coach, later deepening my expertise as a Master Certified Life Coach. These skills empower me to guide clients in overcoming obstacles and embracing life with confidence, calm, and clarity. As a professional speaker, I deliver workshops, keynotes, and boot camps that help attendees create tangible results.
My journey has inspired two ventures: Amna Shabbir Wellness Coaching and the Early Career Physicians Institute®, where I support physicians and high-achievers in navigating challenges.
Fiercely advocating for mental health is a cornerstone of my work. I’m proud to serve as an Ambassador for the Dr. Lorna Breen Heroes’ Foundation, which works to destigmatize mental health access for healthcare workers. Additionally, I actively contribute to the North Carolina Medical Society, the North Carolina Clinician and Physician Retention and Well-being Consortium, and the American College of Physicians North Carolina Chapter’s Well-being Committee.
I also cherish my other roles in life that complete me, including being the wife of a busy solar entrepreneur dedicated to serving the Triangle community and being the Super Mom to two young girls.
Through every step, my mission remains the same: to empower others to heal, grow, and shine.
Alright, so let’s dig a little deeper into the story – has it been an easy path overall and if not, what were the challenges you’ve had to overcome?
As we look around, we often see people who appear to have it all together, but the reality is often far more complex. My own journey has been no exception. Behind the outward accomplishments lies a journey of physical and mental health challenges, and moments of profound vulnerability.
Like many healthcare workers, I faced burnout and moral injury early in my career. The demands of a full-time primary care practice, combined with physical health challenges, tested my resilience in unexpected ways. I also experienced postpartum depression twice, navigating the complex emotions of motherhood while striving to meet the high expectations of being a physician. I felt isolated and my self-doubt was deafening, even as I appeared to “have it all together.”
Career pivots added their own set of hurdles. Whether it was stepping back into medical training after years of practice or transitioning into entrepreneurship, these shifts required me to embrace uncertainty, relinquish perfectionism, and redefine success. Even entrepreneurship is rewarding but often isolating, especially when creating something from scratch while juggling multiple roles such as motherhood. I had to learn to take bold risks, ask for help, and trust my instincts—all while staying true to my purpose of helping others thrive. The road hasn’t been smooth, but it has been transformative. One of my favorite quotes by Erin Hansen comes to mind here:
“There is freedom waiting for you,
On the breezes of the sky,
And you ask “What if I fall?”
Oh but my darling,
What if you fly?”
Thanks for sharing that. So, maybe next you can tell us a bit more about your business?
I am deeply passionate about my work serving high achievers, particularly those in healthcare, because I know how it feels to hide under a blanket of perfectionism while being simultaneously crushed from every direction.
The reality is that our time on this planet is finite, and the moment we truly recognize this and start living with intentionality, everything shifts. In all the experiences I offer—whether through coaching, workshops, or speaking engagements—my goal is to help turn abstract desires into tangible goals that leave you taking bold, meaningful action.
I work with both individuals and organizations, providing:
🎤 Speaking Engagements
📈 Well-being & Leadership Programs
🤝 Corporate Wellness Workshops
🤝 1:1 and Group Coaching
I collaborate with Learner+ to offer clinician-centric continuing medical education (CME) and continuing education (CE) credits for all my offerings.
The proud results my clients have experienced include:
– Confidence Creation (working through impostor syndrome and people-pleasing)
– Setting Tangible Boundaries
– Time & Energy Management
– Self-Advocacy
– Interpersonal Communication
– Stress Management Techniques
– Burnout Recovery and Prevention
– Cultivating a Life Outside of Work
– Achieving Physical Fitness Goals
What sets me apart is my unique approach, combining multiple evidence-based techniques rooted in the neuroscience of behavior change, coaching, and positive psychology, alongside my lived experience as a physician, mother, and entrepreneur.
Is there a quality that you most attribute to your success?
Grit- I attribute all my success to my ability to be gritty.
Duke Biologist: Honey, I Shrunk The Proteins!
Duke Biologist: Honey, I Shrunk The Proteins!
(Duke School of Medicine, Angela Spivey) – In August 2024, Duke University School of Medicine computational biologist Rohit Singh, PhD, posted on the social media platform X, “Introducing Raygun, a new approach to protein design.”
He was talking about an artificial intelligence tool his team created to help biologists “shrink” or “expand” existing proteins. The X post got nearly 200,000 views and nearly 1,000 likes. He also posted a link to a draft paper on bioRxiv, a “preprint” website where scientists share work ahead of formal publication.
Across the country, at University of California San Diego, biophysics PhD student Young Su Ko was intrigued. He doesn’t usually have time to try out any of the “cool projects” he reads about. But this one was different. “Rohit is a big guy in the field. I was a fan of his research,” Ko said.
Ko decided to use Raygun to compete in a protein design competition. To his surprise, the tool helped him design two new proteins that may show promise as chemotherapies, and he won top 10 placement in the contest.
Raygun is just one of several tools that Singh, an assistant professor of biostatistics & bioinformatics and cell biology, has built to help scientists work both faster and smarter to understand disease and ultimately develop better therapies. Most of them he makes widely available for further development.
Singh isn’t allergic to making money, having previously applied AI to the financial world, including founding a startup company that used deep learning to help small businesses assess risk and get credit. He has worked with Duke’s Office of Translation and Commercialization to file a provisional patent on CoNCISE, a tool that can scan a catalog of billions of chemical compounds in seconds. And for commercial uses of RayGun, he would aim to patent that too.
But he sees value in making tools accessible to other scientists early on. “You need to make it easy for people to build on top of it and try things out,” he said. “Science is better for sharing.”
Translating the Language of Proteins
While other computational biologists (including 2024 Nobel Prize winner David Baker, PhD, of the University of Washington) have created tools that can design an entirely new protein from scratch, Singh’s team developed Raygun to improve upon existing proteins by adding or deleting amino acids. That is, by “shrinking” or “enlarging” them.
Singh and postdoctoral fellow Kapil Devkota, PhD, named it Raygun in homage to movies like “Honey I Shrunk the Kids,” in which a scientist invents a “shrinkray” that blasts a laser to miniaturize objects. “Kapil and I and the other co-authors are all sci-fi fans, and there is this trope of a laser gun that can shrink or expand things,” Singh said. “And we thought, wouldn’t it be cool to have something like that in real life.”
Unlike its movie counterpart, Raygun isn’t a contraption that uses lasers; it’s a machine- learning framework (a computer program that runs two different algorithms).
Raygun is based on protein language models, which work on the same principle as large language models, which are the basis of chatbots that many people use every day. There is a “language” that governs how a protein’s amino acid sequence leads to its shape and function, Singh said, but scientists don’t fully understand it. Protein language models analyze patterns between sequence and function in millions of proteins, acting as a “translator,” Singh said.
“The catch here is that the translation gets more and more unreliable the further you get from the original protein,” he said. “But in some cases, we can actually shrink a protein by 50% while keeping the overall behavior the same.”
Better Sensors
A case in point: Singh’s team used Raygun to “shrink” two proteins that are commonly used as fluorescent reporters (eGFP and mCherry). Then Scott Soderling, PhD, professor and chair of cell biology at Duke, had the DNA encoding the redesigned proteins synthesized by a company, then conducted cell-based imaging experiments with the proteins to show that they still maintained their fluorescent properties.
This shows that Raygun may be useful for creating more accurate biological sensors. “So much of biology is about imaging now,” Singh said.
Scientists will fuse a protein with fluorescent properties onto a particular gene or protein of interest so that the protein will glow when it’s expressed. But that very process can cause unintended changes.
“It’s actually pretty risky in terms of being able to measure what you want to measure,” Singh said. “It’s like you have a car that gives you 30 miles to the gallon, and then you attach a big trailer to it, and then your whole mileage is off. You want the trailer to be as aerodynamic as possible.”
Singh, Devkota, and team are computer scientists, so they spend much of their time “writing tons and tons of code.” But they do this tucked outside a cell biology wet lab on the fourth floor of the Sands basic sciences building, embedded with the scientists who can benefit from their tools.
In this model for “discovery AI” at Duke, the computer scientists are “a vital part of the ecosystem of basic science in which biologists and computer scientists work together,” Soderling said.
A Surprising Success
Raygun is good at enlarging proteins, too, as Ko’s success in the protein design competition showed. Contestants were asked to design new proteins that would be relevant to chemotherapy, specifically proteins that would bind to epidermal growth factor receptor, (EGFR) which is involved in several types of cancers, including breast cancer.
Ko instructed Raygun to enlarge the protein epidermal growth factor but still preserve its function. “My thought was if we can miniaturize an existing binder or enlarge an existing binder to the EGFR, maybe that can improve the binding in some way,” he said.
To use Raygun, all Ko needed was the preprint, as well as the computer code and files that Singh had posted on file-sharing site GitHub.
“They basically shared the recipe for how you use Raygun,” Ko said.
The program suggested 10 candidate proteins that Ko submitted to the contest. Entries were narrowed down using computer analysis, and for the top 200 entries, scientists in a wet lab synthesized and tested the new proteins.
Four of Ko’s candidate proteins made it to the wet-lab step. In experimental testing, two of them bound to the epidermal growth factor receptor. “Fifty percent is a pretty high success rate for designing and making a protein that actually binds to the desired structure. That was already very exciting,” Ko said.
One of those two proteins bound better to EGFR than EGF itself. This result won Ko his top 10 placement.
Surprisingly, the new protein that bound most tightly to EFGR was the one that was the least like the original protein. So, these modifications would not have been obvious to a scientist. “The Raygun model has a deeper understanding of which amino acids can be changed to actually improve the binding,” Ko said.
Ko posted about the win on X, but he never expected Singh to see it. “I have less than 100 followers,” he said.
But Singh did see it, and he reached out to Ko. They’re now collaborating, adding Ko’s results to a paper the team has submitted for journal publication, with Devkota as first author. Ko and Devkota met up to talk science when he visited San Diego for a conference.
“It's one of those cool things,” Singh said. “We built something that we think of as a fundamental innovation, then people took it in directions we didn’t imagine.”
Advanced Healthcare Leaders New Co-Chair
Advanced Healthcare Leaders New Co-Chair
The NC Medical Society's Advanced Healthcare Leaders program welcomes Dr. Michaux Kilpatrick, MD, PhD, as a new Co-Chair. Dr. Kilpatrick is a neurological surgeon with Novant Health Brain and Spine Surgery.
Dr. Kilpatrick also holds an adjunct faculty position at the UNC School of Medicine Charlotte campus. She graduated from the University of North Carolina School of Medicine in Chapel Hill and completed her Neurosurgery residency at UNC Hospitals, at which time she received the House Officer of the Year Award. She is active in many civic, educational, and community organizations. Dr. Kilpatrick looks forward to bringing her experience and expertise to the Scholars in the Medical Society's leadership programs.
To learn more about the Advanced Healthcare Leaders program which will start recruiting for 2026 later this year, click here - https://ncmedsoc.org/
Diagnosed With 'Dense Breasts'? You May Need More Than A Mammogram
Diagnosed With 'Dense Breasts'? You May Need More Than A Mammogram
(NPR, Yuki Noguchi) – Joy, a 46-year-old in Pittsburgh, recalls being the same age as her teenage boys, when her own mother diligently got cancer screenings. "She had her mammograms every year," Joy says.
But, Joy thinks her mother likely had "dense breasts," as she does. That means more concentrated clusters of glands and tissue, as opposed to fat. So the 2D, black-and-white images of a typical mammogram x-ray likely didn't catch the tumor her mom had until it had grown big enough to feel.
"She was diagnosed at age 43 and by 48 she was gone," says Joy, who asked that NPR use only her first name as she hasn't shared her health information widely with friends and family.
When Joy herself turned 43, she enrolled in a breast-imaging study, which gave her a mammogram that came back showing nothing of concern. But then, after researchers followed up with more high-contrast imaging, Joy got a call back: "We think we see something."
About 40% of women fall into the categories ranging from dense to extremely dense breasts — putting them at higher risk of developing cancer, which is also harder to detect on 2D or even newer 3D mammograms.
New information, but still a tough question
As of September 2024, federal regulations began requiring all mammogram reports to include information about breast density, including language saying, "in some people with dense tissue, other imaging tests in addition to a mammogram may help find cancers."
But with 40% of women falling under these dense breast categories, when is magnetic resonance imaging, known as MRI, or other follow-up imaging a good idea?
It is a tough question to answer, and there is not a one-size fits all approach.
The U.S. Preventive Services Taskforce is the expert body that makes recommendations for primary care doctors and sets which screening tests should be fully covered by insurance. It says evidence is "insufficient to assess the balance of benefits and harms of supplemental screening for breast cancer," including ultrasounds and MRIs, for women with dense breasts. Harms of additional screening could include subsequent testing such as biopsies and exposure to more radiation, if follow up x-rays are ordered.
Cost is a barrier
Joy's second image caught a tumor early enough to remove it completely. So she wishes follow-up MRIs were more routine and readily available. "I think it should be more automatic," says Joy.
But in fact, the vast majority of eligible women currently do not get the follow up screening. MRI machines are in short supply around the country, and sometimes hard for patients to get to, making it hard to get appointments.
But "cost is the biggest barrier, and most of the supplemental imaging is not covered by insurance," with out-of-pocket costs for an MRI about $1,000, says Krissa Smith, vice president of education at Susan G. Komen Breast Cancer Foundation.
Smith says there are questionnaires and online tools — including on Komen's Web site — to help women gauge their personal cancer risks. Still, she says, assessing whether a followup MRI is recommended is not a simple question to answer, because family history, genetics, weight, and lifestyle can all factor into one's risk, so she recommends starting with a doctor.
"It really has to be a conversation with your doctor, because if you have other risk factors, [like] a family history of breast cancer, that's going to be a more targeted conversation for you and what you need," she says.
Dr. Wendie Berg did that, a decade ago.
"I had put in my own risk factors into the risk models and determined that I, in fact, was high risk, and I knew I had dense breasts," says Berg, a radiology professor at the University of Pittsburgh, who researches breast imaging. But her doctor wasn't familiar with the latest science: "I contacted my doctor and I said I would like to get a screening MRI. And he said, 'Well, remind me why you want to do that?'"
Berg says the lack of physician education about breast density remains a problem today.
MRIs find more cancers
According to Berg's own findings, mammograms detect, on average, five cancers out of 1,000 patient scans. Ultrasounds catch a couple additional. "We added a screening MRI and found another 15 cancers per thousand, even after the mammogram and ultrasound," she says, meaning it detected far more cancers at earlier stages.
Unlike a CT scan, MRIs do not expose patients to radiation.
Yet — for various reasons, cost, complexity, or lack of awareness — Berg says fewer than a tenth of those eligible for the follow-up MRIs, get them. Often, she says, doctors don't have the time to go through each patient's risk assessments to help determine whether they should pursue an additional MRI.
Berg shares some of the relevant information on an educational Web site, densebreast-info.org, where she is chief scientific officer.
Berg benefitted from her own self-advocacy with the MRI she pushed her doctor for 10 years ago. "As luck would have it, that MRI showed a small, invasive cancer that is not visible on my mammogram," she says. That early detection enabled her to remove the tumor entirely, and she remains cancer free.
Berg says right now the onus is on women to take charge and advocate for themselves, with doctors and, if possible, for insurance coverage. "It remains incumbent on the woman herself to look at her risk factors, to talk to her doctor and say, 'Hey, I'd like to get an MRI,'" she says. "Don't wait for them to recommend it to you."
Advocates For Black Maternal Health Press NC General Assembly To Approve ‘MOMnibus’ Legislation
Advocates For Black Maternal Health Press NC General Assembly To Approve ‘MOMnibus’ Legislation
(NC Newsline, Clayton Henkel) – On the week that North Carolina senators were busy rolling out a $32.6B spending plan, it was difficult to gain attention for legislation that some consider a longshot this session. But Senator Natalie Murdock (D-Chatham, Durham) refused to allow budget week to shift her focus from what she sees as the critical need to pass a bill crafted to improve Black maternal health outcomes.
The United States has the highest maternal mortality rate in the developed world. And Black women in the U.S. are three times more likely to die from pregnancy-related health problems than white women.
Murdock has repeated those sobering facts for more than three years now, as she tries to get the Republican-controlled Senate to advance the MOMnibus 3.0 Act.
Battling perceptions and negative stereotypes
Gabriel Scott, an MPA with the North Carolina Coalition of the National Council of Negro Women, joined Murdock last week in advocating for Senate Bill 571/House Bill 725.
Scott said when she went into labor at 25 weeks, doctors were dismissive.
“I needed pain medication, I needed help, I needed something. They did not listen.”
After she delivered her twins, complications with the placenta and an excessive loss of blood, left her husband terrified she might need a blood transfusion.
“They finally had an anesthesiologist come to give me medication. My husband said, can you at least tell me what the medication is? And the anesthesiologist laughed and said, ‘Oh, this is typically medicine we give to war vets who have had limbs blown off,’” Scott recounted. “They took it as a joke. The doctor continued to shove his arm in me.”
Hours later in recovery, a white female doctor came to her room acknowledging the difficulty of the delivery.
“And she said, there are things that we know we do well at the hospital and then there are things that we know we don’t do well, and one of those things is our treatment of African-American women and childbirth.”
The same doctor suggested both she and her husband might seek mental health help.
Scott gives thanks to God that her twin girls are healthy. But she’s been dealing with pelvic pain for over four years and the trauma of doctors who didn’t listen to her.
Dr. Charity Watkins, an assistant professor of social work at North Carolina Central University and a maternal health researcher at Duke University, shared her own terrifying story of pregnancy-related heart failure.
“I always feel it is important for me to introduce myself using my professional roles. Maybe my doctoral degree will save me from the daily mistreatment I experienced because of my dark complexion. Maybe leaning into the perceived prestige of being a professor will protect me from poor perceptions and negative stereotypes associated with being a Black woman,” Watkins told a room of reporters on Wednesday.
After her pregnancy, Watkins presented with classic heart failure symptoms, a family history of heart disease, and a recent cesarean delivery followed by hemorrhaging.
She was told by a doctor that maybe it was the flu.
“What could have led to me receiving quality health care without having to prove I’m worthy of being treated as a human being?”
MOMnibus 3.0
Watkins believes the MOMnibus 3.0 Act would have changed her birth story, with doctors who would not have dismissed her as being over-dramatic or “just another Black woman exaggerating her pain levels.”
The legislation would direct the NC Department of Health and Human Services to establish and operate a maternal mortality prevention grant initiative that would establish or expand programs for the prevention of maternal mortality and severe maternal morbidity among Black women.
“It’s time for us to provide Black mothers with more confidence in their care before, during, and after childbirth,” said Watkins.
The legislation would also require NCDHHS, in collaboration with community-based organizations led by Black women and a historically Black college and universities (HBCUs) that primarily serves minority populations to create evidence-based implicit bias training program for health care professionals.
Patients receiving care at a perinatal care facility would also receive a list of their rights including being informed of continuing health care requirements following discharge.
The bill would also earmark $3 million for each year of the 2025-27 biennium for the UNC Board of Governors for recruiting, training, and retaining a diverse workforce of lactation consultants in North Carolina.
Reps. Zack Hawkins (D-Durham) and Julie von Haefen (D-Wake) are advocating for HB 725, the companion bill in the state House.
Hawkins said his two sisters and his wife had their own stories in which doctors were not “listening appropriately” to their pain, and the fact that they knew their own bodies.
Von Haefen said while it may not seem like her place to speak on Black health, she also knew she could not turn away.
“This should not be something that’s put solely on Black women. White women need to be allies in this fight, because we are all mothers.”
In North Carolina Black women are 1.8 times more likely to die from childbirth, two-thirds of these deaths are preventable, according to Murdock.
NCDHHS: ‘Be on Alert’: Mpox Detected in Sewage Samples in NC
NCDHHS: ‘Be on Alert’: Mpox Detected in Sewage Samples in NC
(WYFF, Stephanie Moore) — The North Carolina Department of Health and Human Services is asking people and providers to be on alert for mpox cases following the detection of mpox particles in multiple sewage samples found through routine wastewater testing.
Health officials said there have been two cases of mpox, formerly known as monkeypox, in North Carolina and the new wastewater detections were determined to be another type, clade I, not previously found in North Carolina. These detections indicate potential undiagnosed or unreported cases. At this time, the risk to the public remains low.
Below is the information provided by health officials:
"The mpox virus is primarily spread by prolonged close contact, typically skin-to-skin, often during sexual activity. There are two genetic types of the virus, known as clade I and clade II. The viral particles found in wastewater were determined to be clade I. To date, only four clade I cases have been reported in the U.S. Clade I mpox is responsible for a large outbreak in Central and Eastern Africa, which appears to be spreading mostly through heterosexual contact with some spread to household members, including children.
"North Carolina’s detections were found in wastewater samples collected on March 25, March 28 and April 8 from a treatment plant in Greenville, NC. No clade I cases have been reported to date; however, these detections mean there was possibly at least one person with an undiagnosed or unreported clade I mpox infection present or traveling through the Greenville area around the time of these detections.
'The detection of clade I mpox virus in wastewater surveillance tells us the virus is potentially here in our state, even though no cases have been reported and confirmed,' said NC Health and Human Services Secretary Dev Sangvai. 'We encourage health care providers to be on the lookout for mpox cases and we encourage people who are at higher risk to protect themselves by getting vaccinated.'
"NCDHHS requests that all North Carolina health care providers consider mpox in patients with compatible symptoms and ask about any recent international travel. Providers who are treating patients with mpox infections should contact their local health department or the NCDHHS Division of Public Health’s 24/7 epidemiologist on-call number: 919-733-3419.
"These recent results were found by the North Carolina Wastewater Monitoring Network, which launched in 2021 to better understand the spread of certain viruses in communities across North Carolina. This network is a collaboration between NCDHHS, the University of North Carolina at Chapel Hill, wastewater utilities and local health departments. Samples are collected routinely from 35 wastewater treatment plants across the state and tested for specific viruses, including SARS-CoV-2 (the virus that causes COVID-19), influenza and respiratory syncytial virus (RSV). People with these viruses shed viral particles in their stool even if they don’t have symptoms. These virus particles are no longer infectious but can still be detected through lab testing.
"While wastewater surveillance has become a valuable tool for tracking and responding to viruses, the program is now at risk due to proposed federal funding cuts. Wastewater surveillance funding allows North Carolina to have a crucial early warning system for levels of infections that can help public health officials and health care providers make decisions, such as providing guidance on how to prevent infections.
"NC Wastewater Monitoring Network results are routinely shared on the NCDHHS wastewater monitoring dashboard. Testing for mpox is done on samples from 18 of the participating sites and results are shared on the CDC Mpox wastewater dashboard.
"If you think you have mpox or have had close contact with someone who has mpox, visit your health care provider or contact your local health department. Symptoms include a rash on any part of the body, like the genitals, hands, feet, chest, face or mouth. The rash can initially look like pimples or blisters and may be painful or itchy. The rash will go through several stages, including scabs, before healing. Some people experience flu-like symptoms before the rash, while others get a rash first followed by other symptoms. In some cases, a rash is the only symptom experienced.
"Vaccines are available to protect against mpox infection from both clade types and can reduce the severity of illness if infection does occur. Information about vaccine recommendations and where to find vaccine is available on the NCDHHS mpox page."
Cyberattack Aftermath - Loan Repayment Pressure from Optum - Are You Impacted?
Cyberattack Aftermath - Loan Repayment Pressure from Optum - Are You Impacted?
In February 2024, Change Healthcare, the medical claims clearinghouse and payment processor of the UnitedHealth Group, experienced a cyberattack. As a result, many physicians and practices experienced a disruption in claims payment which resulted in a serious cashflow dilemma for many.
In response to the ransomware attack and the resulting revenue cycle impact, UnitedHealth Group, via their subsidiary Optum, initiated a temporary financial assistance program whereby no-interest loans were offered to help physicians and practices survive the resulting cashflow challenges. The basic terms of the loan agreement were that repayment would be expected 45 days following the claims processing system being restored with deadline flexibility for practices finding it difficult to return to financial stability.
It has come to our attention that Optum is applying pressure on those with outstanding loans to make repayment while they are still dealing with unresolved claims from the cyberattack disruption. We are aware that some practices have received notices from Optum threatening to recover outstanding loan balances through recoupments.
Are you among the practices that have received these notices? Through collaboration with the American Medical Association, we are trying gauge the impact of the Optum’s aggressive loan recovery effort and would ask that you respond to share your experience if have received such notification. Please use the link below to respond.
https://www.surveymonkey.com/r/HQNQTMC
Thank you for responding.
A New Consensus On Substance Use Disorders And Healthcare
A New Consensus On Substance Use Disorders And Healthcare
(NC Newsline, Sara Harington and Jana Burson) – New polling from the Legal Action Center shows North Carolinians nearly universally (98%) view substance use disorders (SUD) as a problem deserving of attention. More than two-thirds know someone impacted by SUD, and the data shows robust support – across political and demographic lines – for a health-first approach to the issue. North Carolinians support expanding access to the full spectrum of evidence-based SUD treatment, including medications and eliminating SUD-based discrimination.
Leaders in North Carolina’s executive and legislative branches can take heart in this emerging consensus of support for their efforts to combat the state’s overdose epidemic. Fortunately, Governor Josh Stein and First Lady Anna Stein both support access to evidence-based treatment and ending the stigma that interferes with the delivery of treatment.
Additionally, State Representative Timothy Reeder and State Senator Jim Burgin recently held a press conference with the Addiction Professionals of NC (APNC) to announce the NC Treatment Connection website, aimed at ensuring all SUD treatment providers in the state use evidence-based models.
These efforts are essential since the Centers for Disease Control and Prevention (CDC) ranks North Carolina in the top 15 states with the highest fatal overdose rates. According to the state’s Department of Health and Human Services, 2023 (the most current year of data) marks NC’s highest rate of fatal overdose since 2010, with an estimated 4,442 deaths. That’s 12 deaths per day, more than double the rate of fatalities from vehicle crashes that year.
For opioid use disorder, the most evidence-based form of treatment uses either methadone or buprenorphine, two of the three medications approved by the FDA for treatment of this disorder. The third, naltrexone, has much less robust evidence of efficacy.
Buprenorphine and methadone are effective at treating opioid withdrawal and cravings for opioids. These two medications for opioid disorder (MOUD), in repeated studies, show a reduction in overdose death rates of at least two-fold.
If a medication showed such a reduction in death when used to treat any other chronic condition, failing to provide that medication would be malpractice. Yet MOUD is often prohibited in settings such as drug courts, skilled nursing facilities, and even in residential SUD treatment programs. These stigmatizing practices lead to unnecessary deaths.
We must eliminate MOUD- and SUD- based discrimination in all settings, especially healthcare settings. The stigma some medical professionals hold towards people with SUD can lead to dangerous results. Studies have shown clinicians can miss important diagnoses or deny care when they harbor preconceived ideas about patients.
Inadequate treatment of withdrawal symptoms causes patients to leave against medical advice or avoid medical care completely. Verbal and nonverbal communication of disdain or judgment from medical providers intensifies the shame already felt by patients with SUD and harms the therapeutic relationship. Even at facilities treating SUD, some providers carry negative attitudes towards life-saving buprenorphine and methadone.
The people of North Carolina also have reasons for optimism. In 2024, North Carolina experienced a five-year low of 12,447 emergency department visits due to overdose. The availability of naloxone, now free at many jails, health departments, and harm reduction sites, and the use of mobile OUD treatment clinics to reach people in areas that previously lacked access has contributed to this positive trend.
Clearly, there’s much more work to be done. North Carolina’s widespread support for strategies that prioritize treatment over punishment signals a prime opportunity for action. NC leaders should build on their efforts in three key ways:
- Ensure emergency departments, primary care providers, jails, recovery courts, and SUD treatment programs all provide – or act as conduits to – evidence-based treatment.
- Expand the SUD treatment workforce
- Ensure public funds, including opioid settlement money, only support programs that provide access to evidence-based treatment.
Overwhelming public support for a health-first approach, the leadership of policymakers committed to change, and the availability of lifesaving interventions bring the overdose crisis within our reach for positive change.
By investing in treatment, harm reduction, and policies that promote recovery and combat discrimination, North Carolina can save lives and create a robust healthcare system that treats all people with dignity and respect. There is consensus, and the path forward is clear.
Let us act with urgency.
Look! Up in the Sky! Get Ready to See The Lyrid Meteor Shower
Look! Up in the Sky! Get Ready to See The Lyrid Meteor Shower
(CNN, Kameryn Griesser and Ashley Strickland) – After months without a meteor shower, sky-gazers now have a reason to keep their chins up — the Lyrids are here to kick off the season.
The Lyrids have graced the sky since April 17 and will hang around until Saturday, with the densest concentration of meteors flying by Monday night into Tuesday, according to the American Meteor Society. In a perfectly dark sky, onlookers can typically spot up to 18 meteors per hour during the Lyrid shower’s peak. This year, however, light from the waning crescent moon will make it somewhat harder to see the celestial show.
Still, local weather conditions allowing, careful observers in the Northern Hemisphere can expect around five streaking lights per hour appearing between 10 p.m. local time Monday and 4:30 a.m. Tuesday, said Dr. Bill Cooke, lead for NASA’s Meteoroid Environment Office.
“Most meteors you see (during a Lyrid shower) are not brilliant fireballs — they are faint little streaks — and the more moonlight there is, it tends to wash out those faint little streaks,” Cooke said. “Meteor observing is one of those things where you’re going to take your time.”
For the optimal viewing experience, Cooke recommends lying down somewhere outside with minimal light pollution and giving your eyes about 30 minutes to adjust to the darkness.
“The other important thing is: Don’t look at your cell phone, because that bright screen destroys your night vision,” Cooke said. “And it takes your eyes off the sky.”
More about the Lyrids
Regular meteor showers occur throughout the year as the Earth passes through a field of debris left by comets and asteroids, said Shannon Schmoll, director of Abrams Planetarium at Michigan State University.
The Lyrids originate from the parent comet C/1861 G1 (Thatcher), which is about halfway through its roughly 415-year orbit around the sun. While Comet Thatcher was discovered in 1861, the Lyrids have been observed for 2,700 years, making them one of the oldest known meteor showers, according to NASA.
The best time to view the Lyrids is when Lyra, the Northern Hemisphere constellation from which the meteors appear to radiate, is above the horizon, according to EarthSky.
What happens during a meteor shower?
As the comet travels, it leaves a trail of ice and dust moving thousands of miles per hour in its wake, astronomer Dean Regas said.
“The meteors hit the (Earth’s) atmosphere and slow down, and that transmits heat. That’s the flash you see,” Regas said. “Most of the material from meter showers, the comet pieces, will burn up before they hit the ground, and a lot of them are about the size of a grain of sand. So it’s really impressive to see something so small light up like that.”
While the Lyrids tend to be relatively predictable each year, occasionally they exceed expectations.
Outbursts of 100 meteors per hour occur unpredictably, averaging about every 60 years. The next outburst is expected around 2042, according to the American Meteor Society. It is not entirely known what causes these outbursts, but other planets and objects are thought to affect the density of the debris as they cross paths, Schmoll said.
Other meteor showers to come
If you miss the peak of the Lyrid shower, there’s still a chance to catch some shooting stars this year.
Here are peak dates for upcoming meteor showers in 2025, according to the American Meteor Society and EarthSky.
● Eta Aquariids: May 5–6
● Southern Delta Aquariids: July 29–30
● Alpha Capricornids: July 29–30
● Perseids: August 12–13
● Draconids: October 8–9
● Orionids: October 22–23
● Southern Taurids: November 3–4
● Northern Taurids: November 8–9
● Leonids: November 16–17
● Geminids: December 12–13
● Ursids: December 21–22
Full moons to watch for
Following the recent pink moon event, there are eight more full moons to look out for this year, with supermoons occurring in October, November and December.
Here’s the list of full moons remaining in 2025, according to the Farmers’ Almanac:
● May 12: Flower moon
● June 11: Strawberry moon
● July 10: Buck moon
● August 9: Sturgeon moon
● September 7: Corn moon
● October 6: Harvest moon
● November 5: Beaver moon
● December 4: Cold moon
Lunar and solar eclipses in 2025
In the lead-up to the fall season, two eclipse events will grace the sky.
A total lunar eclipse will be most visible from Europe, Africa, Asia, Australia, parts of eastern South America, Alaska and Antarctica on September 7 and 8. A lunar eclipse, which causes the moon to look dark or dimmed, occurs when Earth is between the sun and moon and the three celestial objects line up in a row so that the moon passes into our planet’s shadow.
When the moon is within the darkest part of Earth’s shadow, called the umbra, it takes on a reddish hue, which has led to the nickname “blood moon” for a lunar eclipse, according to NASA. That shadow isn’t perfect, so sunbeams sneak around the shadow’s edges, bathing the moon in warm hues.
A partial solar eclipse will occur on September 21 as the moon moves between the sun and Earth but the celestial bodies aren’t perfectly aligned, according to NASA. In this type of event, the moon only blocks part of the sun’s face, creating a crescent shape in which it appears the moon is taking a “bite” out of the sun. This event will be visible to parts of Australia, Antarctica and the Pacific Ocean.
Cancer Death Rates Declining, New Report Says, But Diagnosis Rates Are On The Rise For Women
Cancer Death Rates Declining, New Report Says, But Diagnosis Rates Are On The Rise For Women
(CNN, Katherine Dillinger) – A new report on cancer in the US shows a steady decline in overall deaths from 2001 through 2022. The rate of diagnoses among men fell from 2001 through 2013 and then stabilized through 2021 but these incidence rates among women increased slightly every year between 2003 and 2021.
Those trends were interrupted in 2020, when cancer incidence rates fell significantly, the report shows, possibly because of disruptions in medical care related to the Covid-19 pandemic. After 2020, they returned to expected levels. “Because fewer cancers were diagnosed in 2020, especially through screening, we may see a larger percentage of cancers diagnosed at a late stage in future years,” the report says.
The 2024 Annual Report to the Nation on the Status of Cancer was published Monday in the journal Cancer. It’s based on data from cancer registries funded by the US Centers for Disease Control and Prevention and the US National Institutes of Health’s National Cancer Institute, and it’s released by those institutions, the American Cancer Society and the North American Association of Central Cancer Registries.
“Overall, cancer incidence and death rates continue to decline, representing changes in risk factors, increases in screening utilization, and advances in treatment,” the researchers write. “However, sustained disparities by race and ethnicity emphasize the need to fully understand the factors that create these differences so that they can be mitigated.”
Fewer people in the US are using tobacco, helping lower incidence and death rates for smoking-related cancers like lung, bladder and larynx, the report says. And these sustained declines in lung cancer have been a major contributor to the overall improvements in cancer death.
However, incidence rates are on the rise for several other cancers, including those linked with excess weight, such as pancreas and kidney cancers; uterine, breast and liver cancers among women; and colon and rectal cancers among adolescents and young adults.
Previously published research has shown that cancer diagnoses are shifting from older to younger adults and from men to women. Middle‐age women now have a slightly higher cancer risk than their male counterparts, and young women are nearly twice as likely to be diagnosed with the disease as young men, according to an American Cancer Society report published earlier this year.
The new report shows that incidence rates among women have risen 0.3% each year. The largest observed increase among women was for stomach cancer, which the researchers say may be largely due to a change in the classification of tumors by the World Health Organization.
Rates of breast cancer diagnoses are also gradually increasing, driven mostly by types of cancer that have been associated with factors like obesity, alcohol use and age when someone gives birth for the first time.
The data continues to show large racial disparities. For example, Black women have a 40% higher rate of death from breast cancer than White women, and their rate of death from uterine cancer is double that of White women.
Differences in access to care and less use of diagnostic procedures and treatment may account for some of the difference, the researchers say. “One additional potential risk factor disproportionately affecting Black women is the use of chemical hair relaxers, which may be associated with an increased risk of uterine cancer among postmenopausal women.”
Changing habits such as stopping tobacco use, staying at a healthy weight, eating a healthy diet with fruits and vegetables, avoiding alcohol and protecting skin can all reduce risk of cancer. Screening can help find and treat cancers early, before they spread. Screenings are available and recommended for certain people for breast cancer, colon and rectal cancer, cervical cancer, endometrial cancer, lung cancer and prostate cancer.
What Doctors Wish Patients Knew About Becoming A Living Kidney Donor
What Doctors Wish Patients Knew About Becoming A Living Kidney Donor
(AMA, Sara Berg, MS) – The decision to donate a kidney is not just an act of generosity; it’s a lifesaving act that provides hope for someone in need. Every year, thousands of people wait anxiously for a lifesaving transplant, their futures uncertain as they cling to the possibility of finding a match. But amid the statistics and the struggles, there are everyday heroes—people who step forward to share the gift of life, often with a stranger.
Kidney transplants are the most common organ transplant in the U.S. Of the over 120,000 people awaiting a life-saving transplant, over 90,000 are waiting for a kidney. Last year, about 28,000 kidney transplants were performed, 6,000 of which were from living donors.
The AMA’s What Doctors Wish Patients Knew™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines.
In this installment, Jennifer R. George, MD, a general and abdominal transplant surgeon at HCA Healthcare’s Las Palmas Medical Center in El Paso, Texas, took the time to discuss becoming a living kidney donor. As a leader in living donor kidney transplants, HCA Healthcare performed 351 living kidney donor transplants in 2024, which was 5.5% of living kidney donor transplants performed nationally.
HCA Healthcare is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Why kidney donation matters
When on the waitlist for a kidney donation, most people wait three to five years for a deceased donor kidney, but a living donor transplant can be scheduled within months if one is available. Dialysis can sometimes also be avoided altogether. A living donor kidney can last between 15 and 20 years, while a deceased donor kidney lasts about eight to 12 years.
“Kidney donation saves lives. Remaining on dialysis leads to cardiovascular health complications,” said Dr. George. “Kidney donation is essential in helping those with kidney disease avoid developing those health complications, allowing them to live longer and healthier lives.”
Whether you are donating a kidney to a loved one, friend, acquaintance or stranger, it is a transformative, lifesaving act. It is the ultimate gift you can give someone.
Being healthy is key for donors
"The most important thing to keep in mind is you shouldn’t rule yourself out from being a donor if it’s something you’re interested in,” said Dr. George. “Don’t hesitate to submit an application to your transplant center because they’re going to do all the workup that’s necessary to make sure that you’re healthy and that you are not going to have any issues after you donate a kidney. Let us do all of the workup to make sure that everything looks good.”
Additionally, some studies have found that living donors live longer than the average person because the workup ensures that donors are very healthy people. You can continue to do the same activities you could before donating. It will not alter your lifestyle.
Most donors are healthy and don’t require changes to their lifestyle afterward. “There's actually a group of donors who go out to climb mountains together, run marathons and do a lot of extreme sports, which is definitely your decision to do,” said Dr. George.
A living donor advocate will help
“You’re going to meet a living-donor advocate who is separate from the transplant team,” Dr. George said. “Their only interest is making sure that you are staying safe as a donor and that you don’t feel pressured and that your interests are being protected.”
This is to make sure that “the donor doesn’t feel pressured and that you have the support you need after you donate,” she added.
The AMA Code of Medical Ethics says that “enabling individuals to donate nonvital organs is in keeping with the goals of treating illness and relieving suffering so long as the benefits to both donor and recipient outweigh the risks to both.” Learn more with the AMA about transplantation of organs from living donors.
Compatibility testing is the first step
“Once a transplant center receives your application, their living donor coordinator will reach out to you and give you some educational materials,” Dr. George explained. This helps to ensure “you’re more familiar with the process.”
Then, “the first thing that most centers in the country will do is blood work to make sure that you’re a match for the person you want to donate to,” she said. “If you’re not a match, there are other options that you can consider to help your recipient get a kidney, even if it’s not your own.”
There is kidney paired donation
“People want to donate to a friend or family member or someone they know, but sometimes they are not a match for them, and if that is the case, you can do something called a kidney paired donation,” said Dr. George. “A paired donation is when we find another pair and their donor doesn’t match to their recipient, but that other donor matches to your recipient.”
“So, everyone ends up with a living-donor kidney. It may not be the person who you initially intended to donate the kidney to, but you’re still helping your loved one get a living donor kidney,” she added. “It’s a really good way to help someone get a very good kidney and to get them off dialysis faster.”
Other testing is completed too
More laboratory testing is done to ensure “there are no concerns for any medical issues that you were not aware of before,” Dr. George said. For example, “we do some urine studies to be sure that the kidneys are working the way that we want them to.”
Additionally, “we do some imaging studies to make sure that there’s nothing abnormal in the anatomy and that’s when you meet the surgeon and a kidney specialist,” she said.
There is a review committee
“Our No. 1 concern is you, as a donor, and making sure you stay healthy, so we’re going to make sure that everything looks good and that you’re safe to be a donor,” Dr. George said.
Once the application is submitted and tests completed, “that’s all reviewed by a committee, and that committee is made up of the surgeon, nephrologist and all of the coordinators who work in the transplant center,” she explained. “Then the case is discussed, and if everything looks good medically and from a social standpoint, you’re going to be approved to be a donor.”
You don’t have to be related
“One of the common misconceptions is that the donors have to be related to each other. Donors don’t have to be related. In fact, it could be a complete stranger,” Dr. George said. “Once in a while, we do have donors who are called nondirected donors. They are people who just feel moved to donate a kidney and they don’t know anyone who is on dialysis, but they just want to donate a kidney to anyone who may be on the list around where they live.”
“So, you can actually submit an application to be a donor, and you don’t have to have someone who you want to donate to,” she said. “There are about 90,000 people who are waiting for a kidney in the country, and you can help one of those people who are on the list waiting for a kidney even if you don’t know them.”
“Being a donor is an incredibly selfless and amazing thing to do in general, but to provide this kind of gift to someone who you’ve never met is especially amazing,” Dr. George emphasized.
Surgery is minimally invasive
“Once that whole process is done and you're approved, then we talk about scheduling a surgery,” Dr. George said. “And that's usually done based around the timeline that is requested by the recipient and the donor.”
“This is an elective surgery, so it can be scheduled whenever the donor and the recipient feel comfortable with doing it,” she said, noting that the surgery is and typically done “laparoscopically or robotically with very small incisions and a camera.”
“You're usually in the hospital 24 hours, maybe 48 hours if you require a little bit more time for recovery,” Dr. George added.
Short-term risks are related to surgery
“The short-term risks are surgically related. So, just as with any surgery, someone who donates the kidney is going to have some discomfort at their incisions, which is normal for anyone who has any kind of surgery,” said Dr. George, adding that “things like getting a hernia after the surgery—which have a very small likelihood—are possible short-term risks.”
Many donors will see a slight rise in their creatinine level, an indicator of kidney function. However, “it’s normal to see your kidney number go up a little bit after donation, but that doesn’t mean that the kidney that is remaining isn’t working appropriately,” she said.
Long-term risks are minimal
“The long-term risks are also very small. The thing that people worry about the most is: If I donate a kidney, am I going to need to be on dialysis in the future?” Dr. George noted. Being a living kidney donor “doesn’t significantly increase your risk of having problems with your one remaining kidney in the long term.”
“Most patients who are donating a kidney will not face a lot of long-term risks after they donate,” she added, noting that some risks, although small, include slightly higher blood pressure and diabetes. There is also a less than 1% risk of living donors developing kidney failure after donation. If you do end up needing a kidney transplant after donating, you will be given higher priority on the waitlist.
There is an increased risk of developing certain kidney-related health issues in Black and Hispanic populations, according to the National Kidney Foundation. Living donation is especially important in these populations that are significantly impacted by the complications of kidney disease.
Recovery will vary
“The recovery for everyone is different. Some people feel comfortable going back to work after a week and some people take six weeks off,” Dr. George said. “But in general, we tell people: No heavy lifting and to take it a little easier for at least the first six weeks. And then after that, back to normal activities.”
"No matter what surgery you have, you’re going to get these recommendations,” she said. “The reasons we say that is ... because it takes about six weeks for those muscles to heal completely, and then after that, there are no restrictions.”
Remember to stay hydrated
“We’re going to recommend that you just stay really well hydrated because even though you can live a nice, long, healthy life with one kidney—especially in the beginning—the body is getting used to filtering everything through that one kidney,” said Dr. George. “So, we want to make sure that you avoid getting dehydrated.
That means “drinking at least 64 ounces of water” a day, she added.
Have your support team ready
“Another really important thing is that you are going to have a surgery and you're going to need some help after surgery,” Dr. George said. “Anyone who has surgery will need a little bit of support.”
“So, make sure that you have your support team ready for the recovery after the donation process,” she added. “That's one of the most important things for preparation.”
This is a big decision
While “it is a very safe surgery, it’s still a surgery, so you need to be mentally and physically prepared because it is stressful having surgery for anything,” Dr. George said. “It’s something that you need to make sure you’re prepared for, make sure you have the support that you need during that recovery period.”
“The other thing is it’s OK to change your mind about being a donor. This is a really big decision to make, and it’s great that someone makes this decision,” she said. “But for different reasons, someone might decide they were ready to be a donor and maybe it’s not right for them right now.”
“It’s important to know that no matter what, up until the time that you go back for your donor surgery, you have the right to say you’re not ready to be a donor, and your privacy will always be protected,” Dr. George said. “If you feel unsure about being a donor, you can tell this to your physician and to your living-donor advocate, and we provide a medical out.”
“If you don’t feel comfortable at that time, but later on things have changed and you feel good about it, you can be considered to be a donor in the future,” she said. “We won’t disclose the reason why you can’t donate or the reason why we’re not proceeding because we want to protect you and your privacy.
“It’s OK if you change your mind because we want to make sure that you’re safe and that your interests are being respected,” Dr. George added.
US Women Physicians Have Higher Risk of Suicide Compared With General Population
US Women Physicians Have Higher Risk of Suicide Compared With General Population
(Clinical Pain Advisor, Ron Goldberg) – Women physicians in the United States vs women who are not physicians have a higher rate of suicide, according to study findings published in JAMA Psychiatry.
Since 2007, there have been inconclusive reports of comparative suicide incidence among US physicians vs nonphysicians regardless of sex. In the current study, researchers aimed to estimate this difference and analyze associated factors.
The researchers used data from the National Violent Death Reporting System to conduct a retrospective cohort study in the US from January 2017 through December 2021. Data used was from 30 US states and Washington, DC.
Across the study period, suicides were identified among 448 physicians (mean [SD] age, 60 [16] years; 21% women, 79% men). Comparatively, 97,467 general population suicides were identified (51 [17], years; 21% women, 79% men). Physician decedents vs nonphysicians were more likely married or in a domestic partnership (53% vs 34% [data from all US jurisdictions]).
"Comprehensive and multimodal suicide prevention strategies remain warranted for physicians, with proactive consideration for those experiencing mental health issues, job problems, legal issues, and diversion investigations."
Physician women vs nonphysicians had higher rates of suicide in 2017 (incident rate ratio [IRR], 1.88; 95% CI, 1.19-2.83) and in 2019 (IRR, 1.75; 95% CI, 1.09-2.65), and an overall higher suicide risk from 2017 to 2021 (IRR, 1.53; 95% CI, 1.23-1.87), though this was not a statistically significant finding (P=0.80). During COVID-19 (2020 to 2021) suicide rates were more comparable (IRR, 1.34; 95% CI, 0.92-1.90), although higher by percentage among the general population vs women physicians.
Conversely, in men, physicians vs nonphysicians had lower suicide risk from 2017 to 2021 (IRR, 0.84; 95% CI, 0.75-0.93, P=0.20). Physician men also had a lower risk of suicide during the COVID-19 period (IRR, 0.88; 95% CI, 0.77-1.00).
Overall, compared to the general population, physicians had higher odds of depressed mood (adjusted odds ratio [aOR], 1.35; 95% CI, 1.14-1.61; P <.001). Higher odds of problems preceding suicide were more common among physicians vs general population for legal issues (aOR, 1.40; 95% CI, 1.06-1.84; P=.02), job concerns (aOR, 2.66; 95% CI, 2.11-3.35; P <.001), and mental health (aOR, 1.66; 95% CI, 1.39-1.97; P <.001), as was use of poisoning (aOR, 1.85; 95% CI, 1.50-2.30; P <.001) and use of sharp instruments (aOR, 4.58; 95% CI, 3.47-6.06; P <.001).
Higher odds of positive toxicology were also noted among physicians compared to the general population for cardiovascular agents; caffeine; benzodiazepines; poison; anxiolytics, nonbenzodiazepines, or hypnotics; and drugs not prescribed for home use.
The study authors wrote, “Comprehensive and multimodal suicide prevention strategies remain warranted for physicians, with proactive consideration for those experiencing mental health issues, job problems, legal issues, and diversion investigations.”
Study limitations include possible lack of US national representation, and the retrospective design lacks causality between possible precipitating factors and suicide.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Brisk Walking Lowers Risk of Potentially Deadly Heart Rhythm Issues, Study Finds: Here’s the Ideal Speed
Brisk Walking Lowers Risk of Potentially Deadly Heart Rhythm Issues, Study Finds: Here’s the Ideal Speed
(Nice News, Stephen Beech) – The next time you’re out for your daily walk, add a little extra pep in your step — your heart will thank you. A U.K. study found that brisk walking may lower the risk of potentially deadly heart rhythm issues like atrial fibrillation, tachycardia, and bradycardia, and is particularly beneficial for women and people under the age of 60. And according to the research, the ideal speed for gleaning these benefits is 4 mph or over.
This study “is the first to explore the pathways underpinning the association between walking pace and arrhythmias, and to provide evidence that metabolic and inflammatory factors may have a role. Walking faster decreased the risk of obesity and inflammation, which, in turn, reduced the risk of arrhythmia,” said Jill Pell, a University of Glasgow professor who led the research.
The findings, published online by the journal BMJ Heart, were strongest in women, people under 60, those who weren’t obese, and those with preexisting long-term conditions. The results were independent of known cardiovascular risk factors.
Heart rhythm abnormalities, or arrhythmias, are common with atrial fibrillation, a disorder that causes an irregular heartbeat. Over the last 30 years, they’ve doubled to reach nearly 60 million cases worldwide in 2019. Abnormalities like these are associated with heightened risks of a potentially fatal heart attack or stroke.
Yet while walking pace is associated with lower risks of cardiovascular disease and death, few previous studies had evaluated its potential impact on heart rhythm abnormalities.
So the research team looked at the impact of different walking speeds while exploring the potential role of risk factors like age, obesity, smoking, and alcohol intake. To do so, they analyzed data from questionnaires gathered from 420,925 U.K. participants with an average age of 55, a pool made up of 55% women. The amount of time spent walking at different paces, garnered from activity tracker readings, was available for 81,956 of them.
The researchers defined a slow pace as walking at less than 3 mph, a steady or average pace as 3-4 mph, and a brisk pace as more than 4 mph. The findings? Just over 6.5% reported a slow walking pace, 53% shared an average walking pace, and 41% a brisk walking pace. During an average tracking period of 13 years, 36,574 of the participants (9%) developed heart rhythm abnormalities, with atrial fibrillation the most common.
Participants reporting a faster walking pace were more likely to be men, tended to live in less deprived areas, and had healthier lifestyles. They also had smaller waists, weighed less, had better grip strength, and showed lower levels of metabolic risk factors, including blood fats and fasting glucose, as well as lower levels of inflammatory activity, and fewer long-term conditions.
After accounting for potentially influential background demographic and lifestyle factors, an average or brisk walking pace was associated with “significantly lower” risks of all heart rhythm abnormalities — at 35% and 43%, respectively — compared with a slow walking pace.
Average and brisk walking speeds were also associated with lower risks of atrial fibrillation (38% and 46%, respectively); and other cardiac arrhythmias (21% and 39%, respectively) compared with those who reported a slow pace.
The researchers said that while the amount of time spent walking at a slow pace wasn’t linked to the risk of developing heart rhythm abnormalities, more time spent walking at an average or brisk pace was associated with a 27% lower risk. Overall, just over a third (36%) of the association between walking pace and all heart rhythm abnormalities was influenced by metabolic and inflammatory factors.
Said Pell: “This finding is biologically plausible because cumulative epidemiological studies have shown that walking pace is inversely associated with metabolic factors, such as obesity, fasting glucose, diabetes, and high blood pressure which, in turn, are associated with the risk of arrhythmias.”
Stem Cells To Treat Parkinson's? 2 New Studies Hint At Success.
Stem Cells To Treat Parkinson's? 2 New Studies Hint At Success
(NPR, Jon Hamilton) — Patients suffering from Parkinson's disease may soon benefit from a powerful treatment option: stem-cell transplants.
In a pair of small studies designed primarily to test safety, two teams of researchers found that stem cells transplanted into the brains of Parkinson's patients began producing the chemical messenger dopamine and appeared to ease symptoms like tremor, researchers reported in the journal Nature.
The results indicate that "now we have the potential to really, really halt this disease in its tracks," says Dr. Mya Schiess, a neurology professor at UTHealth Houston who was not involved in either study.
The Food and Drug Administration has cleared one of the stem-cell treatments for a Phase 3 study, the last hurdle before approval.
About 1 million people in the United States are living with Parkinson's, a brain disease that attacks neurons that make dopamine. As those neurons die, patients can develop a range of disabling symptoms, including tremor, rigidity, fatigue, difficulty walking and cognitive problems.
Stem cells are immature cells that can develop into many different cell types — including neurons that make dopamine.
Positive results
One of the new studies involved 12 people in the U.S. and Canada living with Parkinson's.
Surgeons administered either a low or high dose of a stem-cell product from BlueRock Therapeutics, a subsidiary of biotech and pharmaceutical giant Bayer. The treatment was derived from human embryonic stem cells, which researchers had coaxed into becoming immature brain cells called neuron progenitors.
During surgery, these cells were injected into a structure on each side of the brain that's involved in movement.
"The idea is to place these neuron progenitors right where you need them to connect with other neurons in the brain," says Dr. Viviane Tabar, a stem-cell scientist and chair of neurosurgery at Memorial Sloan Kettering Cancer Center.
Tabar is also a founding investigator at BlueRock.
PET scans taken 18 months later showed that the transplanted cells were producing dopamine. An assessment using a standard rating scale of Parkinson's progression suggested the treatment was also easing symptoms.
For a typical Parkinson's patient, "you would expect every year to get two to three points worse," says Dr. Lorenz Studer, who directs the Center for Stem Cell Biology at the Sloan Kettering Institute in New York and is a scientific adviser to BlueRock.
Participants in Studer's study had a very different experience: "The high-dose group, they got about 20 points better."
The low-dose group also appeared to benefit, but not as much.
A second study by researchers in Kyoto, Japan, used induced pluripotent stem cells, which are derived from a patient's own cells, rather than an embryo.
Seven patients had the cells injected into both sides of their brains. As in the U.S. and Canadian study, the transplanted cells produced dopamine and the patients appeared to see their symptoms decrease.
No patient in either study experienced a serious adverse event.
Long time coming
The apparent success comes after decades of frustration trying to replace the brain cells killed off by Parkinson's.
Starting in the 1980s, scientists began transplanting fetal tissue into people with Parkinson's. But the efforts produced uneven results and sometimes troubling side effects like uncontrolled movement.
Stem cells promised better results. But the technology evolved slowly.
Studer's team, for example, began looking at stem cells to treat brain diseases more than 25 years ago.
"For us, it's quite an exciting time," he says, "finally seeing some of the fruit of that work."
One reason it's taken so long, Studer says, is that stem cells have the potential to become so many different kinds of cells. It takes just the right mix of chemicals at just the right time to produce a neuron that makes dopamine, he says.
"It took us nearly 10 years to figure out the recipe, how to make specifically those dopamine cells," he says. "It took us another 10 years to have the product that we would dare to put into patients."
Another challenge was creating and packaging large numbers of stem cells that could be easily delivered to surgeons. So researchers developed techniques that allowed them to freeze stem cells until they were needed.
"You just thaw them and suspend them in an approved medium" before surgery, Tabar says.
Now that many of the technical hurdles have been cleared, stem cells appear poised to offer a new treatment option for Parkinson's, and perhaps other brain diseases like epilepsy or Alzheimer's.
"If we're missing neurons, we're able to replace them," Tabar says. "And the full expectation is that these cells are not going to function as cells that just release [a substance like] dopamine. They're going to rebuild circuitry."
There still may be risks though, which means scientists will need to continue monitoring the stem cells they transplant into a patient's brain.
"They're going to be there for a long, long time," Schiess says. "So you have to follow up and see if there is tumor formation or something of that nature."
Schiess also notes that stem cells don't cure an underlying disease like Parkinson's. So the new neurons may eventually succumb to the same disease process.
Even so, she thinks they could offer new hope to many patients, including those who are no longer responding to drug treatment.
Study Highlights Cancer Risk From Millions Of CT Scans Performed Annually
Study Highlights Cancer Risk From Millions Of CT Scans Performed Annually
(NPR, Ronnie Cohen) – CT scans diagnose afflictions from tumors to kidney stones to life-threatening diseases and injuries, such as aneurysms and blood clots leading to stroke.
But the radiation emitted by this essential diagnostic tool may cause more harm than previously known and could eventually be responsible for roughly 5% of all cancers diagnosed in the U.S. in a single year, a new study finds.
"Medical imaging has potential benefits," said radiologist Dr. Rebecca Smith-Bindman, an epidemiology professor at the University of California, San Francisco, and lead author of the study published Monday in JAMA Internal Medicine. "It has potential harms as well, and it's really important to balance them."
Scientists long ago established that ionizing radiation emitted by computed tomography, or CT, scans increases cancer risk. But, since 2007, use of the imaging technique has surged 35%, the study says, due in part to growth in what Smith-Bindman and her colleagues call "low-value, potentially unnecessary imaging."
Their new research, based on projections from hospitals in 20 U.S. states, estimates that 103,000 cancer diagnoses, or 5% of all cancers, could result from 93 million scans performed in the U.S. in 2023 alone.
"There's nothing you can do about radiation that you've been exposed to already. But you want to limit future exposure to cases when you really need it," Smith-Bindman said.
Some scans might add no diagnostic value, she said. Moreover, the amount of radiation a scan emits fluctuates widely and can be far higher than necessary with the operator, not the machine, making the difference, she said. The dose at one scanning facility can be 50 times stronger than at another.
Dr. Dana Smetherman, chief executive officer of the American College of Radiologists, praised the study for bringing awareness to the question of radiation risk. Some people are unaware, for example, that ultrasounds and MRIs do not emit radiation and that CT scans do, she said.
"As radiologists, we always want patients to be informed and feel comfortable asking the questions, 'tell me more about this test, what's involved, what's it going to show you?' " said Smetherman, who was not involved with the research.
Echoing a statement from the American College of Radiology after the study's release, she stressed that the study's projection of cancer diagnoses from CT scans was based on statistical modeling, not actual patient outcomes.
There are no published studies directly linking CT scans to cancer, the statement says. "Americans should not forgo necessary, life-saving medical imaging and continue to discuss the benefits and risks of these exams with their healthcare providers," it continues.
CT scans use ionizing radiation to create cross-sectional pictures inside the body. The scans can reveal more detail than conventional X-rays and are accurate, quick and relatively inexpensive.
Full body scans miss the mark when it comes to improving U.S. disease prevention
Nationally, the new cancer projections from CT scans put them on par with other well-known, population-wide risk factors for cancers, like alcohol and obesity, an editor's note accompanying the study points out. Cigarette smoking remains the leading contributor to U.S. cancers, causing 19% of them, followed by excess body weight at 7.6% and alcohol consumption at 5%, Smith-Bindman said.
To curtail radiation exposure, authors of the study and the editorial urge changes to current practices.
The surest way to eliminate exposure to radiation from CT scans is to stop doing the low-value ones. Yet efforts to restrict them, including an initiative from the American Board of Internal Medicine Foundation called Choosing Wisely that launched in 2012, have fallen short, Smith-Bindman said.
She believes the greatest opportunity to reduce risk from CT scans is to optimize the dose used in each scan.
"We can absolutely try to reduce all those excessive doses," she said. "We need buy-in from physicians and hospitals."
She says patients can try to reduce their cancer risk by discussing with their doctors how important it is to get any particular scan and how they might receive as small a dose of radiation from a scan as necessary.
The University of California, San Francisco, hosts a website called Know Your Dose in an effort to empower patients to ask questions about how much radiation they're getting from scans.
A brain scan, the website shows, can emit as little radiation as 200 dental X-rays or as much as 1,600. The radiation dose from an abdominal scan for a suspected kidney stone can be as low as 100 dental X-rays or as high as 8,000. Kidney stones also sometimes can be diagnosed with ultrasound, which does not emit radiation, the website notes.
One of the reasons for the striking differences in radiation emissions is that sometimes patients are scanned just once, and other times they're scanned multiple times. Multiple images often are unnecessary, Smith-Bindman said.
Though she and others have been pushing for federal standards for dosages, there are none.
Under a Medicare measurement tool released in January, hospitals and imaging facilities share information about how much radiation their scanners emit. Based upon the information, Smith-Bindman and her colleagues are developing a quality measure for CT scanning. So far, she said, one-third of scans exceed the targets in their testing.
"We need patients to ask their doctors, 'Can you use low dose when you scan me?' " Smith-Bindman said. "It's crazy that patients have to ask for it, but it's actually really successful."
ECU Health’s Roanoke Rapids ICR program, The First Of Its Kind In Eastern North Carolina
ECU Health’s Roanoke Rapids ICR program, The First Of Its Kind In Eastern North Carolina
((ECU Health) — On Jan. 6, the ECU Health Cardiac Rehabilitation – Roanoke Rapids clinic, partnered with Pritikin Intensive Cardiac Rehabilitation (ICR), opened its doors to the community. It’s the first program of its kind in eastern North Carolina, and its first cohort of patients is preparing to graduate from the program.
Pritikin ICR is based on the Pritikin Program, which has been taught for nearly 50 years at the Pritikin Longevity Center in Miami, Florida. More than 150,000 people have attended the program, and more than 100 peer-reviewed, published studies performed by the University of California in Los Angeles (UCLA) medical researchers have established the program’s proven health benefits. Recently, ECU Health’s cardiac rehabilitation clinic in Roanoke Rapids partnered with the program to bring its cutting-edge methods to eastern North Carolina.
To participate in the program, patients must have experienced a qualifying heart condition, including stable angina, heart attack within the last 12 months, coronary artery bypass surgery, heart valve repair or replacement, coronary angioplasty or stent placement, heart transplant or heart/lung transplant and chronic heart failure.
The program’s comprehensive, lifestyle-change curriculum is based on three pillars: safe, effective regular exercise, heart-healthy nutrition and a healthy mindset that fosters healthy behaviors. This programming is one aspect that differentiates ICR from conventional cardiac rehabilitation. Additionally, the program includes 72 sessions – 36 exercise and 36 educational – as opposed to the 36 maximum sessions of traditional cardiac rehabilitation. The goal is to provide patients with the tools and knowledge they need to succeed both during rehabilitation and long after.
Markus Melvin, the program manager for cardiovascular and pulmonary rehab, detailed a typical day for participants. “Patients come three days a week and do about an hour of exercise followed by an hour of education. Every patient has a guidebook with exercise tips, recipes and other information that they bring with them to each session” he explained. “It’s like they’re in school. They take notes and ask questions.” Overall, he said, patients enjoy the experience and are engaged in the curriculum. “We teach them about medications, exercise, balance training, healthy mindset like communication skills and setting goals, tobacco cessation – it’s great to see that lightbulb switch on when they get it.”
The resounding patient feedback to this approach has been positive. Robin Joyner joined the program after having a series of heart attacks, a defibrillator placement and recovery after an infection. “They suggested I do ICR, and I said any type of therapy to get my heart strong again was okay with me,” she said. “It gets me out of the house, I can socialize and I work out.” James Moseley, who found ICR after having open heart surgery four months ago, agreed. “They are making my heart work,” he said. “They’re giving me a second chance. I enjoy going.”
One of the favorite parts of the program happens on Wednesdays when the staff dietitian prepares heart-healthy meals the patients can then eat. “I love it,” Robin shared. “One day she made an apple turnover with fajita bread, and another day she made white bean chili. Her food has taste to it.” While he didn’t always like the recipes the dietitian made, James said the experience helped him to be a more mindful eater. “The cooking makes you think about what you can and can’t do, and I think about everything I eat now,” he said. “That’s a blessing.”
Another benefit for patients is the ability to socialize and connect with others going through a similar experience. Markus said it was common for patients to talk with each other and share their knowledge and background. “You see that camaraderie in class, and they make friends,” he said. “They discuss their personal events and someone says, ‘Oh, I went through something similar.’ They teach each other things and it makes the classes fun.” Robin agreed: “We all get together and talk,” she said. “We all share what happened to us. Everyone is nice to each other and it’s a happy place.”
Of course, a centerpiece of the program is the exercise, which Robin admitted was intense. “Markus doesn’t play,” she laughed. “He’s so nice and kind, and he makes it fun, but he never lets us take the easy way out.” Markus called attention to the tailored exercise plans for each patient, as well as the careful monitoring they undergo during each visit. “We’re the touch points between doctor visits for these patients, so we can spot things that are happening with regards to medications or new signs or symptoms,” he said. “And we help the patients learn exercises and how to progress them, whether they have never exercised in their life or used to exercise in the past.”
Robin and James agreed that it was beneficial to have this program close by, so they don’t have to travel long distances to attend. “I was previously in regular cardiac rehabilitation in Rocky Mount,” Robin said, noting the challenges of an increased travel time. James said he wouldn’t have been able to participate had the program been in Greenville. “The main thing I hear about this program is that it’s local,” Markus said. “It’s the first rehab program in the area for quite some time, so the fact that it’s within a short drive is a big selling point,” he said. And clearly, the program is in demand. “We started with three patients and now have 20, and we do have a waitlist because we have more and more patients being referred to us,” Markus said. “There’s definitely a need for it here, and it shows an increased awareness of the importance of cardiac health.”
Robin and James are approaching their graduation date, at which time a new cohort will be ushered in. They both emphatically agreed that ICR is beneficial and worth the time. “I am feeling pretty good now,” James said. “I was walking slowly at first, but I’ve gone up on speed and incline on the treadmill and the bike. I think about my kids, my grandkids and my girlfriend and I want to be here for them. The doctors did their part, and now we have to do ours.” Robin said that while she exercised daily prior to this program – and still walks regularly now – she feels a lot better for having participated in ICR. “I have more energy when I go to class, and I can’t wait to go again. Everyone with a heart problem should have therapy because it really does work, and with this group, you’re dealing with the best.”
To learn more about the ECU Health – Roanoke Rapids ICR program, visit ECUHealth.org.
Medicaid Expanded NC Health-Care Access. This Fix Could Make It Run Smoother
Medicaid Expanded NC Health-Care Access. This Fix Could Make It Run Smoother
(The Carolina Journal, Craig Richardson and Erik Randolph) – Two years ago, many low-income households in North Carolina had an unsettling fear: getting a pay raise or a promotion. In some cases, it might trigger the sudden loss of health insurance for adult family members if they were on Medicaid. This scenario was termed a “benefits cliff.”
Between a rock and a hard place, families often went without health insurance, or even turned down pay raises or better jobs. Ironically, they made too much for Medicaid and too little to qualify for government-subsidized insurance offered through the Affordable Care Act (ACA).
In December 2023, Gov. Roy Cooper signed bipartisan legislation to eliminate that insurance gap, helping more than 600,000 North Carolina adults by expanding Medicaid eligibility to higher income levels. That closed the health-insurance gap with opportunities to later gain health insurance through the ACA marketplace.
That’s better for these 600,000 adults. For those already on Medicaid, it extends their income range and allows them to earn more without fear of losing their Medicaid benefits, despite the program having poor health outcomes when compared to other types of coverage. And it helped others who were uninsured, because having Medicaid should be better than no coverage at all. It also helps employers retain their workers, although now the government is picking up more of the cost at taxpayers’ expense.
But there is still an unsolved problem: When the income rises too high to qualify for Medicaid, the transition is a far cry from, say, switching cell phone providers.
Getting health care from NC Medicaid is simple. Present your Medicaid card to the health-care provider, and treatment is usually free or at most a $4 co-pay. There are no monthly premiums either.
When Medicaid gets dropped after a pay raise, out-of-pocket expenses will increase, whether it is employer-based insurance or the ACA Marketplace. Employer-based insurance will most certainly cost more with deductibles, premium shares, and other out-of-pocket expenses. At least for most lower income earners, ACA Marketplace subsidies make it a better deal. To participate in the government-run Marketplace, an individual cannot be offered adequate and affordable health coverage from their employer. For all others, the entry into the ACA Marketplace can be daunting. There are Gold, Silver, and Bronze plans with different monthly premiums, deductibles, and co-pays to contend with.
Understanding these new terms and implications on a family budget can be overwhelming, especially for those with limited English or digital proficiency. One way the state of North Carolina’s Department of Health and Human Services helps is by collaborating with NC Navigators Consortium to assist individuals, using trained and certified counselors.
Not only is there a new grab-bag of terms and payments to understand, but families also face something different than a Medicaid benefits cliff. ACA insurance gets more expensive every time the worker gets a raise, since the subsidies decrease. Despite the added expense, workers only lose a portion of their raise — keeping the lion’s share. It’s a slope rather than a cliff.
However, these changes can be difficult to anticipate for those who don’t understand how the system works. And that fear of change can translate into folks sticking with lower-paying jobs just to avoid the complicated and often unknown consequences when losing Medicaid.
Take the example of Joe, who is the married head of household for his family with two children, earning $40,000 a year. He, his wife, and his children will qualify for full Medicaid benefits.
With salary raises, there is a bit of a bumpy road ahead that the family may or may not foresee.
For example, if annual family income jumps to $50,000, Joe and his wife lose Medicaid eligibility but now qualify for ACA health insurance. In a bit of a quirk of health policy, the family’s children get to retain Medicaid, because of their eligibility at a higher income level than the adults.
The true market cost for the couple’s ACA insurance is $9,322, but the federal and state government subsidy is $8,982, so that leaves a modest annual premium of $340 for the couple to pay but total out-of-pocket costs can rise to an unaffordable $6,300 limit.
If the family’s income rises to $60,000, the couples’ annual ACA premium rises in turn to $1,200 for the couple, with the children still on Medicaid.
But at $70,000, the family faces more complexity. The children will now lose eligibility for Medicaid. The family now needs an ACA plan that covers everyone. The market cost of that family plan jumps to $15,476, but the subsidy rises as well to $13,152, leaving a new annual premium of $2,324 with a new and increased out-of-pocket cost limit of $15,100.
In other words, a $10,000 raise resulted in a near doubling of the family’s health insurance premium, but 85% of the total healthcare premium is still borne by the federal and state government.
The ACA marketplace still saves taxpayers a lot of money. When the entire family was on Medicaid, the cost to state and federal taxpayers was $21,488 annually.
The ACA family plan, on the other hand, only costs $15,476 to provide. With taxpayers chipping in, say, a $2,374 annual premium at a family income of $70,000, the taxpayer cost drops even further, to $13,152. That’s a 39% savings compared to providing Medicaid to the family but with more potential expenses if a family member gets sick.
Certainly, the new system is better than families falling into a health-insurance gap. But families getting ACA benefits still face challenges the rest of us don’t, including not always understanding or anticipating how changes in employment and income affect health coverage.
As North Carolina continues its journey with Medicaid expansion, we have an opportunity — and an obligation — to address the challenges of individuals transitioning to the ACA Marketplace or employer coverage. By minimizing stress points and work disincentives, we can ensure that all North Carolinians have access to the healthcare coverage they need to thrive.
To help, our research teams at Winston-Salem State University and the Georgia Center for Opportunity are reimagining how the state of North Carolina can improve Medicaid, transitioning off Medicaid, and healthcare insurance coverage in ways that improve work incentives and strengthen the state economy. We look forward to sharing that over the next two weeks with forthcoming articles. More information on how North Carolina can reform Medicaid and health insurance will be made available with the third and last article in this series.
Two UNC Health hospitals Named To Newsweek’s “Best Maternity Hospitals 2025” List
Two UNC Health hospitals Named To Newsweek’s “Best Maternity Hospitals 2025” List
(UNC Health) — Two UNC Health Hospitals have been named to Newsweek’s “America’s Best Maternity Hospitals 2025” list:
- UNC Hospitals (Chapel Hill, NC)
- UNC Health Rex (Raleigh, NC)
Only 20 hospitals in North Carolina are included in America’s Best Maternity Hospitals 2025. Both UNC Hospitals in Chapel Hill and UNC Health Rex in Raleigh were awarded the highest ranking with 5 ribbons each. Both have also earned this award for four years in a row.
Additionally, both have also been recognized for America’s Best In-State Hospitals 2025, ranked 2nd and 3rd for the State of North Carolina and in the Top 100 for World’s Best Hospital Awarded by Newsweek.
UNC Hospitals has also been awarded the following by Newsweek:
- World’s Best Specialized Hospitals 2025 – Cardiology – Ranked 87
- World’s Best Specialized Hospitals 2025 – Endocrinology – Ranked 84
- World’s Best Specialized Hospitals 2025 – Obstetrics & Gynecology – Ranked 21
- World’s Best Specialized Hospitals 2025 – Oncology – Ranked 165
- World’s Best Specialized Hospitals 2025 – Orthopedics- Ranked 90
- World’s Best Specialized Hospitals 2025 – Pediatrics- Ranked 68
Newsweek partnered with data and business intelligence portal Statista for the fourth annual ranking of America’s Best Maternity Hospitals. The list recognizes the 404 leading maternity hospitals in the U.S.
The ranking is based on a nationwide online survey of hospital managers and medical professionals (regarding areas like perinatal care and operative obstetrics) as well as publicly available data from hospital surveys addressing the patient experience (including topics such as cleanliness and communication about medication).
Data on hospital quality metrics—like the number of elective deliveries and level of personnel vaccination—was provided from several sources, including nonprofit hospital accreditation organization The Joint Commission, the Centers for Medicare and Medicaid Services, and the Health Resources and Services Administration.
Geriatric Wellness For Primary Care
Geriatric Wellness For Primary Care
(Piedmont AHEC) – This educational program is specifically designed for physicians and healthcare professionals who work with geriatric patients in primary care settings. By participating, you will gain invaluable insights into effectively managing depression and addressing ageism within this vulnerable population. You'll learn essential strategies for prescribing medications wisely and promoting mobility, which are crucial for enhancing the quality of life for your patients. Don’t miss this opportunity to deepen your expertise and make a meaningful impact on the lives of older adults. Join us in transforming geriatric care and ensuring that your patients receive the compassionate, informed care they deserve.
Speaker bios:
Dr. Julie Williams an experienced community-based physician educator with immersive training in clinical research who specializes in the care of complex older adults. She is currently Assistant Professor at the Cone Health Internal Medicine Residency Program where she shares her enthusiasm for providing excellent care to our older patients on the wards and in the clinic. Dr. Williams is certified in both Internal Medicine and Geriatrics.
Dr. McClester Brown is an Associate Professor at the UNC School of Medicine Department of Family Medicine where she serves as the Vice Chair of Education. She is certified in both Family Medicine and Geriatric Medicine. Her predominant clinical focus is caring for adults sixty-five and older in the community and in long term care.
Agenda:
12:55-1:00 Check in
1:00-1:05 Announcements/Into
1:05-1:55 Medication Management and Mobility in Older Adults: The Pearls and Pitfalls of Prescribing - Julie Williams, MD
1:55-2:45 Mood and Matters Most: Caring for Depression in Older Adult and Combatting Ageism to Support Well Being -
Mallory McClester Brown, MD
2:45-3:00 Q&A
This educational activity did not receive commercial support.
Disclosure:
Piedmont AHEC adheres to the ACCME, ACPE, and ANCC Standards regarding industry support of continuing education. Disclosure of the planning committee and faculty's commercial relationships, if any, will be made known at the time of the activity. Speakers will also state when off-label or experimental use of drugs or devices is incorporated in their presentation.
Accreditation:
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Southern States CME Collaborative (SSCC) through the joint providership of Piedmont AHEC and Cone Health. The Piedmont AHEC is accredited by the SSCC to provide continuing medical education for physicians.
Physician Credit: The Piedmont AHEC designates this live activity for a maximum of 2.0 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Piedmont Area Health Education Center is approved as a provider of nursing continuing professional development by the North Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. It has been approved for 2.0 Nursing Contact hours.
Objectives
- Appreciate the potential individual and system-level harm of adverse medication events
- Understand how the physiologic changes associated with aging alter how medications are tolerated
- Identify the risks of polypharmacy
- Recognize common potentially harmful medications, med-med interactions, and med-disease interactions
- Learn how to deprescribe through shared decision-making toward goals of safety and well-being
- Become familiar with strategies to enhance adherence
- List the diagnostic criteria for depression in older adults
- Choose the appropriate treatment options for older adults with depression
- Identify mechanisms of action and side effects of medications for treatment of mood disorders in older adults
- Identify mechanisms of action and side effects of medications for treatment of mood disorders in older adults
- Identify strategies to combat ageism, in turn leading to better health for older adults.
Speakers
- Mallory McClester-Brown, MD, Associate Program Director
- Julie Williams, MD, Assistant Professor
Audience
Duke Students Bridge Healthcare Gaps In North Carolina’s Rural Communities
Duke Students Bridge Healthcare Gaps In North Carolina’s Rural Communities
(The Chronicle, Madera Longstreet-Lipson) – Multiple times a year, a group of Duke undergraduates pack their bags and make an early morning road trip to remote areas across North Carolina. Over the two-day periods, the students work alongside medical practitioners to provide services to medically under-resourced communities, ranging from customized eyeglass fittings to dental cleanings.
Even without medical degrees, students in Duke Remote Area Medical still serve a critical role in helping source free and accessible health care across the state.
“The patients are always such a pleasure to interact [with] and talk to,” said Dental Recruitment Director Priyanka Patel, a sophomore. “They are really grateful for the service we are offering them. They aren’t, unfortunately, able to get these services anywhere else.”
Many patients RAM serves have various medical needs and come from a range of individual circumstances. While some face dental issues, for instance, they may lack dental insurance, resulting in quickly resolvable issues worsening over time. Other patients may seek out eye care, including access to prescription lenses.
In order to provide care for remote communities, the Duke team — an arm of the national RAM organization — operates across two branches. Its General Executive team organizes trips for volunteers, while the Community Host Group operates a clinic in Henderson, N.C.
For Patel, this means reaching out to a number of local health care providers who would potentially be interested in volunteering their services to RAM. Those willing to contribute can help hundreds of patients receive the care they need.
At its March pop-up clinic in Henderson, the club’s efforts resulted in 195 patients receiving prescription eyeglasses, 84 adults receiving general medical exams and 90 tooth extractions, among other assistance, including cleanings, eye exams and dental X-rays. Of those RAM served, 38% were Black, 30% were Hispanic, 14% were Asian and 9% were white.
Patel shared that in comparison to last year, when roughly 20 dentists from East Carolina University volunteered at the clinic, RAM was also able to recruit dental students from the University of North Carolina at Chapel Hill, which she described as a “big win.”
According to sophomore Albert Liu, a clinic coordination officer and member of the general executive team, around three times a year, Duke RAM sends students to clinics across the state. He characterized the trips as an opportunity for the students to broaden their understanding of communities beyond Durham.
“It’s a really good experience for … volunteers to go experience a different demographic — somewhere that’s not just the Duke student body,” he said.
Media and Promotions Officer Grace Wang, a junior, shared the importance of building trust with community members and partners to encourage them to seek RAM’s services.
She shared how collaborating with newspapers and radio stations in those areas to spread the word is key. Moreover, creating partnerships with Henderson-area schools, daycares and libraries has helped foster trust between local organizations in potentially vulnerable populations and Duke RAM.
Wang further described the process of reaching out to local partners as “eye-opening,” allowing her to consider “the struggles that people who live in very faraway areas — who maybe don't have internet or don't have all these things that we take for granted — [have].”
She also pointed to the high cost of medical care, noting that “little things, like surprise bills or small accidents, can actually have a really catastrophic, avalanche effect … show[ing] just how many gaps there are in our health care system.”
Recognizing these challenges, she noted that there are still more ways to extend RAM’s impact — specifically mentioning efforts to increase the number of providers working at the clinics.
Part of their work involves increasing advocacy beyond those areas — particularly on Duke’s campus.
Senior Sahith Kudaravalli, a member of the advocacy team, works alongside others in the organization to make health care policies “more digestible” for Duke students.
The team hosts meetings to discuss legislation and give students the opportunity to write letters backing or opposing policies, while even proposing policies themselves that they think would positively impact the health care arena. Recently, this included a policy aiming to expand the definition of a health care volunteer provider to increase patient care access.
These efforts, Kudaravalli said, aligns with his view that health care goes beyond prescribing medications and providing clinical treatment.
“It's also about addressing all these different barriers that they might face from a social and political system and how that can have as much of an impact on their care,” he said.
New ECU Research Unveils Insights On Carbon-Fiber Shoes And Foot Health
New ECU Research Unveils Insights On Carbon-Fiber Shoes And Foot Health
(ECU , Benjamin Abel) – The sports world is built on finding the next advantage to win the big game, break the finish line tape and win a medal. For runners, advantages are usually incremental, at best.
Until the advent of the carbon-fiber revolution, giving elite runners a fractional, but measurable, leg up on races. While technology is increasingly giving the general running public the same advantages as world-class athletes, little is known about what is happening with the runner’s foot inside the shoes.
Until now.
East Carolina University’s Ankur Padhye, a doctoral student in the College of Allied Health Sciences’ Department of Physical Therapy, is using cutting edge technology, and cutting up very expensive shoes, to get an understanding of what is happening with the bones, muscles and ligaments of those wearing carbon-fiber kicks.
A Born Scientist
Padhye grew up measuring things.
His father, a zoologist who studied frogs near their home on India’s west coast near M
umbai, roped Ankur into his research.
“I went on field trips collecting frogs, measuring their feet and everything. I guess trying to find answers with the data on graphs was always my thing,” Padhye said.
In high school, he considered medical training but knew a doctor’s work-life balance could be harsh. During his undergraduate education he represented his university playing badminton and cricket, never great at anything, Padhye said, but “decent at everything.” The mix of medicine and knowing the need for injury prevention treatment and research made physical therapy a natural fit for his graduate education.
After graduating with a master’s degree in physical therapy from the University of Indianapolis, Padhye took a job at a clinic in Kinston. The work was rewarding, but the spark he got early in life from fundamental science — learning new things for the first time — was missing. When he was accepted at ECU as one of the physical therapy department’s doctoral students, he was able to pursue pure science while working with patients, a perfect blend of his interests.
Why the Research?
Padhye knew early that the central focus of his research would be injury prevention, but he noticed during his time working with patients that the basic science findings from physical therapy research labs lagged too much. Findings that could prevent injury or speed recovery were getting hung up.
Could he find a way to evaluate emerging science and quickly bring those findings to practitioners in clinics and hospitals?
The question was where to begin.
Most research on stress loads has been limited to studying cadaver feet or using sensitive mats that register how bare feet land on the ground.
“But that’s not really how most people do our tasks like running. Not many people run barefoot in a marathon,” Padhye said.
After consultation with his mentors in the physical therapy department, Drs. John Willson and Stacy Meardon, Padhye was intrigued by the possibilities in a niche research area of forefoot mechanics. The foot had been studied, of course, but the hard part was knowing what was happening with the bones, tendons and other parts when a person is wearing a shoe.
“I found out there’s not much going on research-wise because it’s complicated to come up with simple yet effective solutions to get answers to what’s exactly happening at the joint,” Padhye said.
Research has been done around how carbon-fiber shoes running shoes increase performance —VO2 max and exertion levels — but what actually happens under the skin, where bones meet and tendons hold everything together, was still something of a mystery. Almost nothing was known.
How do you “see” inside of a shoe, particularly when it is being worn?
A common technique for studying how the body moves is to affix reflective markers to points of the body that special cameras can detect and replicate in a digital environment. For Padhye to get at the joints he needed to image, he had to strategically cut holes in the upper material of both the carbon fiber and control shoes to adhere the markers to participants’ feet.
Add some incredibly sensitive insoles connected to computers to an array of motion-capture technology like that used to create Hollywood sci-fi blockbuster characters, and Padhye and his team were off the races.
How the Shoes Work
A New York Times article on carbon fiber shoes discusses the technology’s development and use by elite runners as well as those looking for a leg up on race day. In short, the shoes offer a small, but not insignificant, advantage in terms of energy expenditure.
Traditionally, running shoe companies have played at the margins of technology to help runners gain an advantage: different foams for soles, air pockets in the heel, thick soles or barely any cushioning at all.
Carbon fiber is different. Manufacturers have incorporated a carbon-fiber plate into the sole of seemingly normal shoes. The plates make the shoes rigid, very difficult to bend in half by hand, but they give when worn. While running, the flexing process requires energy, which then creates a spring-like function when the carbon plate resumes its normal shape.
Carbon-fiber shoes have been shown to give wearers up to 4% increase in efficiency, meaning runners use less energy and can run faster. The first sub-two hour marathon was run in carbon fiber shoes, which has fueled considerable controversy since, but shoe manufacturers have gone all in on marketing carbon-fiber shoes to the general public.
“Previous studies were based on gas exchange. With these carbon-fiber shoes the amount of oxygen a runner inhaled, and carbon dioxide exhaled was X,” Padhye said. “And then without the shoes it was 4% more, something like that. So, the previous researchers said, ‘OK, these shoes help with energetics.’”
There is little doubt that the shoes increase performance, but Padhye wanted to know if the shoes prevent injury.
Dr. John Willson, a professor in the PT department and one of Padhye’s advisors, said at the heart of the study is learning the mechanics of wearing the new technology. Do the toes push off differently? Does the stability the carbon-fiber provides the foot insulate it from injury from repetitive stress? Or do the muscles work differently to propel the foot forward?
“There may be some real applications for people with foot and ankle injuries, and possibly even knee injuries,” Willson said. “Previous studies have just looked at the whole foot as a unit. What is causing the increase or decrease in propulsion forces? We’ll be able to separate those influences.”
Padhye and his team recruited a handful of local runners to their basement lab in the health sciences building, a cavernous space with a long wall lined with a showroom’s worth of treadmills. At one end is Padhye’s treadmill, ringed overhead with cameras and lights that record every step the runners in the study take.
One participant, 2007 ECU College of Nursing graduate Marina White, has been a neonatal intensive care nurse for nearly two decades. She started running several years ago and became enamored with seeing her personal improvements.
White said she’s a “nerd for science” and thought participating in the study could be a cool experience, plus learning about — and experiencing — the carbon-fiber technology without investing several hundred dollars was enticing.
On the morning of her evaluation, White was measured in slew of ways — height, weight, bone length, flexibility — before testing her calf endurance. After reflective markers were attached, she strapped on a backpack full of computer sensors and slipped her hot pink socked feet into a pair of modified shoes.
Once on the treadmill, Padhye and a fellow student began logging data coming from the pressure insoles in White’s shoes and the dots placed on the major joints in her body that showed in real time on a huge television screen on the wall.
After finishing her first run on the treadmill, White said she immediately felt the difference in the carbon-fiber technology.
“It was way easier this time. It was different; interesting that the shoe made such a difference. Running with the shoe felt springy, where before it felt flat, if that makes sense,” White said.
How Does This Impact the Public?
The hypothesis that Padhye is working from is that in addition to making runners faster, the carbon fiber shoes might also reduce loads on forefoot bones and joints.
Padhye said carbon-fiber shoes are currently not designed for everyday running.
“All the big manufacturers say that the foam and plate interaction, especially the foam side, only has a maximum potential of 100 miles. So even if someone is using these as training
shoes, they are probably not at their best efficiency after 100 miles,” Padhye said. “Plus, these are really high-end shoes that are very expensive, upwards of $200, so as of now, I don’t see these as a regular training shoe for everybody.”
But maybe the technology could be used for middle distance runners to reduce injury from the stress on the feet and legs of runners training for longer races. If runners are going to try these shoes for increased performance and potential injury prevention, Padhye cautions that they should train with them as the carbon-fiber shoes force a slightly different running style, which poses its own risk for injury.
“These shoes encourage a more rocking style so if someone wants to train to use these shoes, I think they should keep that in mind,” Padhye said.
Willson said research like Padhye’s is important to extend the foundational understanding of how the body works, but it is equally important for the future of teaching physical therapy students. While most PT students graduate and treat patients for the rest of their careers, Willson said he and fellow faculty members will one day age out of the classroom and will need to be replaced by skilled researchers.
“There’s a real need in the in the academic space for physical therapists who have their Ph.D. There are accreditation standards that dictate the composition of the faculty who teach in physical therapy programs and a certain percentage of faculty need to have a terminal academic degree,” Willson said.
New Study: Technology Use May Be Associated With A Lower Risk For Dementia
New Study: Technology Use May Be Associated With A Lower Risk For Dementia
(CNN, Kristen Rogers) – With the first generation of people exposed widely to technology now approaching old age, how has its use affected their risk of cognitive decline?
That’s a question researchers from two Texas universities sought to answer in a new meta-analysis study, a review of previous studies, published Monday in the journal Nature Human Behavior. The query investigates the “digital dementia hypothesis,” which argues that lifetime use may increase reliance on technology and weaken cognitive abilities over time.
“We say a really active brain in youth and midlife is a brain that is more resilient later,” said Dr. Amit Sachdev, medical director of the department of neurology and ophthalmology at Michigan State University, who wasn’t involved in the study.
But the authors discovered that the digital dementia hypothesis may not bear out: Their analysis of 57 studies totaling 411,430 older adults found technology use was associated with a 42% lower risk of cognitive impairment, which was defined as a diagnosis of mild cognitive impairment or dementia, or as subpar performance on cognitive tests.
Forms of technology included computers, smartphones, internet, email, social media or “mixed/multiple uses,” according to the new study.
“That these effects were found in studies even when factors like education, income, and other lifestyle factors were adjusted was also encouraging: the effect doesn’t seem just due to other brain health factors,” co-lead study author Dr. Jared Benge, associate professor in the department of neurology at the University of Texas at Austin’s Dell Medical School, said via email.
The authors searched eight databases for studies published through 2024, and the 57 chosen for their main analysis included 20 studies that followed participants for about six years on average and 37 cross-sectional studies, which measure health data and outcomes at one point in time. The adults were age 68 on average at the beginning of the studies.
While technology use was generally linked with a lower risk of cognitive decline, the findings for social media use were inconsistent, the authors said.
None of the 136 studies the authors reviewed overall reported an increased risk of cognitive impairment correlated with technology use — a consistency that is “really quite rare,” said co-lead study author Dr. Michael Scullin, professor of psychology and neuroscience at Baylor University, via email.
The research is “a really well-organized and -executed meta-analysis of essentially the entire field over the last 18 years or 20 years,” said Dr. Christopher Anderson, chief of the division of stroke and cerebrovascular diseases at Brigham and Women’s Hospital in Boston. Anderson wasn’t involved in the study.
But if you’re thinking the study’s findings mean you’re free to use technology to your heart’s content since your brain will be fine anyway — not so fast.
“Our findings are not a blanket endorsement of mindless scrolling,” Benge, who is also a clinical neuropsychologist at UT Health Austin’s Comprehensive Memory Center, said. “They are instead a hint that the generation that gave us the internet has found ways to get some net positive benefits from these tools to the brain.”
And despite the study’s significance, there are still many uncertainties about the relationships between various aspects of technology use and brain health.
Technology use and the brain
One of the study’s limitations is that it doesn’t have details on how people were using technological devices, experts said. As a result, it’s unclear whether participants were using computers or phones in ways that meaningfully exercised their brains, or what specific way may be most associated with cognitive protection.
Lacking information on the amount of time technology was used means it’s also unknown whether there is harmful threshold or if only a little time is needed for cognitive benefits, Anderson said.
These questions are difficult “to try to answer, because the sheer volume of technology exposures that we have to navigate is so high,” Sachdev said. “To isolate one technology exposure and its effect is difficult, and to measure just a whole ecosystem of technology exposures and … their aggregate effect is also a challenge.”
Additionally, “the amount that we can extrapolate from this study towards future generations is very unclear, given the ubiquity of technology today that people are exposed to and have been exposed to from their birth,” Anderson said.
“When you think about the kind of technology that this cohort would’ve been interacting with earlier in their lives, it’s a time when you had to really work to use technology,” Anderson added.
Their brains were also already well formed, Benge said.
The study may support the alternative to the digital dementia hypothesis, which is the cognitive reserve theory. The theory “contends that exposure to complex mental activities leads to better cognitive well-being in older age,” even in the face of age-related brain changes, according to the study.
That technology may reduce risk of cognitive decline by helping us be more neurologically active is possible, Sachdev said. Technology use can also foster social connection in some instances, and social isolation has been linked with greater odds of developing dementia.
It’s also possible that older adults who are using technology may already have more active and resilient brains, explaining their engagement with technology.
Managing your technology use
Inferences on best practices for technology use in consideration of cognitive health can’t be drawn from the study since it didn’t have specifics on participants’ use habits, experts said.
But “it does support that a healthy mix of activities is likely to be the most beneficial, and that fits with other literature on the topic as well,” Anderson said. “What this probably does more than anything else is provide some reassurance that there’s no association between at least moderate use of technology and cognitive decline.”
Engaging in moderation is best, Sachdev said. And that should largely bring joy, genuine connection, creativity and intellectual stimulation to your life, experts said.
“It should be productive in some way,” he added, and entertaining yourself can sometimes meet that requirement. But if you’re experiencing eye or neck strain from sitting in front of a screen, that’s a sign you’re using technology too much.
“Too much of anything can be a bad thing,” Sachdev said. “Identifying the purpose and the duration and then executing along those lines is how we would advise for most topics.”
Some older adults have avoided technology use, thinking it’s too difficult to learn. But Scullin and others have found even people with mild dementia can be trained to use such devices, he said. Though sometimes frustrating, the difficulty “is a reflection of the mental stimulation afforded through learning the device,” Scullin added.
Formula Dilution Is On The Rise, What Your Patients Should Know About The Risks
Formula Dilution Is On The Rise, What Your Patients Should Know About The Risks
(WKBW, Pheben Kassahn) – As families across the country deal with trying to make ends meet, doctors are seeing some parents turning to dangerous methods to stretch their dollars including watering down baby formula.
Pediatricians and emergency physicians are sounding the alarm, warning that improper formula preparation can have permanent consequences.
Dr. Meghan Martin is an emergency medicine physician who trained at Women and Children's Hospital of Buffalo. She recently treated an infant who experienced seizures due to diluted formula.
"Recently, I had a young patient present with seizure activity; we were able to get medication to get the seizure to stop," Dr. Martin said. "When we did lab work, we saw the sodium levels were low. So we asked the parents about what the baby had been eating and drinking and the baby had been breastfed, but mom had to go back to work after six weeks. She wasn't able to pump enough at work, so they had to start introducing formula. The formula wasn't mixed properly. The ratio of scoops to water was off. The baby had been getting too much water and ended up with water intoxication."
Infants under one year old have underdeveloped kidneys, which makes them more susceptible to water intoxication. Most baby formulas require one scoop of formula for every two ounces of water. Doctors stress the importance of following this exact ratio.
Dr. Stephen Turkovich, President of Oishei Children's Hospital, emphasized that improperly mixing baby formula can lower a baby's sodium levels, leading to seizures, brain swelling, or even permanent brain damage.
"One of the things that can happen is the dilute formula can cause their sodium, or their salt content in their blood, to drop to dangerous levels," Dr. Turkovich said. "That can cause some seizures. We call it water intoxication, so it's really important that when you make your formula, you put the water in there first and then you make the scoops."
While the condition is treatable if caught early, Dr. Turkovich said you can prevent this from happening by not giving plain water to babies under three months old and limiting water intake between six and 12 months.
For families struggling to afford baby formula, he recommended contacting a pediatrician or utilizing available community resources.
"There's many ways you can get formula," Dr. Turkovich said. "WIC is one of those great organizations that can help you get formula and also food for you if you are a breastfeeding mom and for the rest of your family." 
Another resource is FeedMore WNY, which said it supported about 4,000 infants last year through its food bank distribution network.
"These items can often be expensive," said Public Relations Manager Catherine Shick. "For many families who may have limited resources, they may be in a very impossible decision in terms of what resources you can allocate; Do I purchase baby formula? Do I purchase groceries?"
FeedMore WNY provides formula and food assistance and can be contacted through their website at feedmorewny.org or by calling (716) 822-2002.
Two From UNC Health Named In TBJ Health Care Leadership Awards
Two From UNC Health Named In TBJ Health Care Leadership Awards
(UNC Health News Team) – UNC Health is proud to announce that two physician-researchers were honored by the Triangle Business Journal as recipients of 2025 Health Care Leadership Awards.
The TBJ published a brief profile of each award recipient on April 10.
Those from UNC Health who were selected, and the category in which they were honored, are:
Dr. Edwin Kim, UNC School of Medicine – Innovator/Researcher
Edwin Kim, MD, MS, associate professor of medicine in the Division of Rheumatology, Allergy, and Immunology at the UNC School of Medicine, division chief of UNC Pediatric Allergy & Immunology and member of the UNC Children’s Research Institute, leads the Food Allergy Initiative at UNC-Chapel Hill, and he has been researching food allergies for over a decade. He treats children and adults living with a range of food allergies including milk, egg, wheat, soy, peanuts and tree nuts, as well as fish and shellfish. Dr. Kim also has three children of his own with nut and legume allergy. He knows first-hand how difficult living with food allergies can be for babies, toddlers, adolescents and families. He has dedicated his career to pushing clinical research forward to help kids like his and around the world overcome allergies.
One of Dr. Kim’s biggest professional achievement’s last year included results from the OUtMATCH clinical trial, published in the New England Journal of Medicine, showing that a monoclonal antibody, omalizumab, increased the amount of peanut, tree nuts, egg, milk and wheat that multi-food allergic children as young as age one could consume without an allergic reaction. His work was recently highlighted in National Geographic’s, “7 Medical Breakthroughs that Changed Medicine in 2024.” A food allergy reaction can occur within minutes or hours after eating an allergic food, and symptoms can range from mild to life-threatening. However, anti-IgE therapy like omalizumab is a breakthrough defense in treating severe allergic reactions. Omalizumab can significantly reduce the risk of food allergy to peanuts and other foods after about four months of treatment – a relief to many families.
Dr. Stephanie Duggins Davis, UNC Children’s Hospital – Doctor of the Year
Dr. Davis is a nationally known expert in cystic fibrosis and other rare lung diseases. In 2023, Davis was designated as a world expert from Expertscape on ciliary motility disorders, dextrocardia, Kartagener Syndrome, respiratory system abnormalities, and situs inversus. During the past 25 years, she has led or been part of teams that were funded by over $40 million of grants from the National Institute of Health or foundations to understand and find treatments for rare, life-threatening diseases such as cystic fibrosis and primary ciliary dyskinesia.
She has over 200 peer-reviewed publications on these topics that are frequently cited across the globe. She has been selected to lead numerous national professional organizations over the past five years, including serving as the Chair of the American Board of Pediatrics Board of Directors, the American Thoracic Society Pediatric Assembly, and the Society of Pediatric Research.
In late 2023, UNC Health announced its plans for the new N.C. Children’s Hospital. The new hospital will transform the care of children across the state and ensure a healthier future for North Carolina’s children through the highest level of comprehensive care.
Dr. Davis has been incredibly busy over the past year, working closely with the chairperson and other leaders at Duke Children’s. Together, they have sought ways for the two children’s specialty hospitals to work together, emphasized cooperation instead of competition. In part due to her work, executives at both institutions recently announced an affiliation to form the new, free-standing North Carolina Children’s Hospital together.
Congratulations to Dr. Kim and Dr. Davis for this well-earned recognition!
Capitol Chronicle: Karen Smith, MD, Lends Her Voice To Medicare Payment Advocacy
Capitol Chronicle: Karen Smith, MD Lends Her Voice To Medicare Payment Advocacy
The North Carolina Medical Society has been intensely engaged with our offices on Capitol Hill to stress the urgency of fixing the current Medicare Physician Payment dilemma. 2025 is the fifth year in a row that physicians have had to absorb a Medicare pay cut and access to care for our state’s Medicare patients hangs in the balance. Medicare payment has declined by 33% over the past 23 years, when adjusted for inflation, while practice costs have increased by nearly 50%. Practice viability is increasing under threat as a result of this trend.
Dr. Karen Smith, family physician in Raeford, NC and member of the North Carolina Medical Society board of directors has put an exclamation point on the Medical Society’s messaging to Congress in her recent column in the Fayetteville Observer.
Join Dr. Smith in her advocacy by reaching out to your members of the US Senate and US House of Representatives to add your voice to the effort to fix Medicare payment. They need to hear from constituents about how Medicare payment cuts are having an impact on your patients and your practice. Below are links for making calls and sending emails. If you need assistance in contacting these offices, please let us know.
U.S. Senate
| Sen. Ted Budd | Call |
| Sen. Thom Tillis | Call |
U.S. House of Representatives
School-Based Telehealth Expands In North Carolina
School-Based Telehealth Expands In North Carolina
In a small room at Hillcrest Elementary School in Burlington, students can now meet with a doctor during the school day — virtually.
The school joins a growing network across North Carolina where students don’t have to leave school to be seen for physical or behavioral health needs.
Health advocates say that school-based telehealth care cuts down on absenteeism, ensures that students receive routine care that they might not otherwise be able to get, and can even boost test scores.
At Hillcrest Elementary, one student’s recent visit for a stomach ache turned out to be an underlying dental issue — an abscessed tooth.
“They could have been out of school for two or three weeks, but we were able to figure out what was wrong and get him the proper care,” said Kristy Davis, chief student services officer for Alamance-Burlington School System.
Enhancing access
The COVID-19 pandemic “propelled the adoption of telehealth in school settings,” according to the authors of a 2023 review of more than 30 studies on school-based telehealth.
“The perceived benefits derived from these interventions were substantial, augmenting traditional approaches, enhancing clinical care, and fostering collaborative efforts within families,” the authors wrote. “The implications underscored the enhancement of healthcare access, early anomaly detection, and the elevation of nursing leadership within the telehealth domain.”
Yet telehealth services in North Carolina schools came long before the COVID-19 pandemic, driven in large part by difficulties in accessing care in far-flung rural communities.
In North Carolina, Health-e-Schools began providing telehealth services to schoolsin the western part of the state in 2011. The program, an initiative of the Center for Rural Health Innovation, started with a handful of schools in two districts. Today, it serves more than 90 schools in seven western North Carolina counties and partners with 40 schools in four southeast counties.
In Guilford County, Cone Health launched its first telehealth clinic in 2021 at Bessemer Elementary in Greensboro through a partnership with Guilford County Schools and the Guilford Education Alliance. By spring of 2024, 14 low-income schools in the district were participating. Another 12 schools have been added this academic year.
In fall 2024, Cone added Moss Street Elementary in Rockingham County Schools, followed by Hillcrest Elementary in the Alamance-Burlington School System earlier this year.
Davis is already eyeing expansion in Alamance-Burlington.
“It is something that we want to put in more schools,” she said.
Working together
The Carolina School-Based Telehealth Learning Collaborative, which includes the western North Carolina and Cone Health programs, held its spring meeting in Greensboro on April 4.
About 50 people, including several virtual participants, gathered at Union Square Campus to talk about growing school-based telehealth programs. The collaborative is made up of 17 partners — hospital systems, university programs and health agencies — from North Carolina, South Carolina and Virginia.
They shared what’s working or not working, and what they have coming up.
The programs use different models to provide care.
Cone Health uses a certified medical assistant as a “telepresenter” who is based in the school. Their program also involves parents in the visit, usually by sending them a link to their smartphone so they can participate.
The medical assistant/telepresenter gets about four weeks of additional training. They work full time, so they can act as a part of the school health team, said John Jenkins, medical director of Cone Health School-Based Care.
Families must sign a consent form before students can be seen at the clinic. A provider, such as a pediatric nurse practitioner or a pediatrician, gets pulled in for cases such as an earache, upset stomach, injuries and colds, for example.
That provider can assess the child using special equipment handled by the certified medical assistant, “just as if they were in their own office,” Jenkins said. The Bluetooth-powered equipment allows the remote provider to visualize the ears, throat, heart and lungs of the patient and send a prescription to the pharmacy, if necessary. There are also some medications in the clinic that can be sent home with the child if prescribed.
“The vast majority, about 90 percent of the time, we would return children to class the same day,” Jenkins said.
In Guilford County Schools, 42% of students at the schools with clinics signed consent forms to participate, district data shows. That year, there were 3,174 clinic visits, which led to 1,440 virtual telehealth visits with a doctor or nurse practitioner.
Guilford County Schools officials have seen improved attendance at all of the participating schools, according to data shared at the telehealth conference. Two-thirds of the schools experienced a decrease in office discipline referrals on average for students participating in the clinic compared with those who were not. In addition, students who signed up for the clinics at many of the schools did better on end-of-grade reading and math tests than their peers.
‘Showing improvement’
The latest area of growth for the school-based telehealth collaborative has been in telepsychiatry for behavioral health issues.
The Improving Adolescent Child health Through Telepsychiatry in NC has been providing therapy and psychiatry telehealth care in schools for about two years. The program operates out of the Department of Psychiatry in the School of Medicine at UNC Chapel Hill.
Early data shows that 70 percent of patients reported improvement with depression, 86 percent improvement for anxiety issues and 69% improvement for children with attention deficit hyperactivity disorder, said Charissa Gray, program director of virtual care and integrated behavioral health at UNC Chapel Hill.
“Definitely people are showing improvement, so we want to continue to see these numbers grow,” she said.
Their program is continuing to evolve.
They’ve looked at enhancements such as rotating session times so a student isn’t missing the same class each week, or having someone available to speak Spanish, said Stephanie Brennan, a pediatrician and child and adolescent psychiatrist who works with the UNC Chapel Hill program.
They’ve also been flexible with who helps the student connect to the session. In some schools, that’s the school nurse or school social worker. In others, they give the school the money to hire a contractor to be there.
“And that’s been really working out beautifully. That person is part of the school culture,” said Alison Burke, a clinical instructor with the program. “They also make sure the technology is working well. And they’re also there outside the door in case we need them, in case there’s a crisis or anything like that.”
Charlotte-based Atrium Health also recently added school-based telepsychiatry, which is now available in 57 schools throughout the southern Piedmont.
A real “pain point” has been juggling the various schedules for schools, including early release days and teacher work days and other days off, said Donnie Mitchem, director of Atrium Health’s Behavioral Health School-Based Teletherapy.
She said in some participating schools the Atrium program will only see the commercial payers because they have somebody in house who sees Medicaid patients. In some schools, it’s the opposite.
Cone Health is in the process of adding behavioral health to its school-based telehealth clinics. They’ll pilot the program in a few schools first before expanding it, Jenkins said.
Community care
At the Greensboro conference, the keynote speaker encouraged members of the school-based telehealth collaborative to expand telehealth to the community.
Schools are often natural gathering places for communities, they have spaces to allow for private conversations, and they have the reliable technology access that many homes may not have, said Kathy Wibberly, director of the Mid-Atlantic Telehealth Resource Center. The federally funded center serves North Carolina, seven other states and the District of Columbia.
Expanding telehealth services to the community could include everything from helping families deal with nutrition education or mental health issues or abuse issues that are going on in the home, she said.
“Because if the students are healthy, but the family is unhealthy, the students aren’t going to stay healthy for very long,” Wibberly said.
Several of the North Carolina collaborative members said they are already expanding their services.
The UNC Chapel Hill telepsychiatry program will be offering therapy over the summer to school staff.
Jenkins said Cone Health’s program plans to partner with the hospital system’s virtual urgent care program to give teachers an opportunity to be treated while at school, so they don’t have to leave for routine issues.
Davis, a former teacher, knows how beneficial that will be.
“That teacher that takes a half a day to go get their blood pressure checked, that’s a lot of instructional time missed as well,” she said. “If it’s something that they can go get it checked by the telehealth presenter and stay at work and just be gone for 10 minutes, that’s a win … for everyone.”
ACL Injuries: How Shape Of Knees Matter
ACL Injuries: How Shape Of Knees Matter
ACL (anterior cruciate ligament) injuries are a big problem, especially for athletes who jump, pivot, and change direction quickly. Female athletes are more likely to suffer from ACL injuries. Many things can increase the risk, but one important factor is the shape of the tibial plateau, the top part of the shinbone where the knee joint sits. The way the knee is shaped, and the forces applied to it, can affect how much stress is put on the ACL. Understanding these risk factors can help prevent injuries, especially for female athletes.
How knee shape affects ACL injuries
The inside of the knee is extremely smooth, almost like an ice-skating rink. The front of the knee slopes upward, while the back slopes downward. Imagine trying to land from a jump or change direction on a surface that is both slippery and angled. This puts extra stress directly on the ACL.
Comparing injured and uninjured knees
A group of researchers studied 104 people, 55 of whom had never had an ACL injury (33 women and 22 men) and 49 who had torn their ACL (27 women and 22 men). They measured different parts of the tibial plateau, including the slopes and depth of the bone.
Here’s what they found:
Women with ACL injuries had a steeper lateral tibial slope (a higher angle) and a shallower medial tibial depth compared to women without injuries.
Men with ACL injuries had a steeper lateral and medial tibial slope and a shallower medial tibial depth than men without injuries.
Overall, medial tibial depth was the biggest risk factor, followed by lateral tibial slope.
What this means for preventing injuries
This study shows that the shape of the tibial plateau plays a big role in ACL injuries. Injury prevention programs should consider individual differences in knee anatomy. While strengthening muscles and improving movement patterns are still important, personalized approaches based on knee structure may help reduce injuries. The findings also suggest that men and women have different risk factors, meaning prevention strategies should be tailored for each group.
Conclusion
By understanding how knee shape affects ACL injuries, we can improve prevention and treatment. Future research should continue to explore these factors so that athletes can get personalized training and support. By combining knowledge of knee anatomy with traditional training, we can take big steps toward reducing ACL injuries for athletes everywhere.
Dr. James Slauterbeck is an orthopedic surgeon whose special interests include sports medicine, adolescent sports medicine, female sports medicine, and high school and college athletic injuries. He is affiliated with UNC Health Orthopedics at Southeastern Health Park and UNC Health Southeastern. To learn more, call 910-738-1065 or visit https://www.unchealth.org/care-services/doctors/s/james-r-slauterbeck-md.a
Durham Man With Stage 4 Lung Cancer Sees Promising Results From NIH-Funded Trial At Duke
Durham Man With Stage 4 Lung Cancer Sees Promising Results from NIH-Funded Trial At Duke
(WNCN, Maggie Newland) — A Durham man with stage four lung cancer credits a Duke clinical trial for giving him his life back. The trial is funded by the National Institutes of Health and based on research also funded by the NIH.
The federal agency funds tens of billions of dollars of research yearly, but with cuts impacting the health agency, doctors across the country are concerned that future medical research could be at risk.
Alfonzo Grafton is looking toward the future. “I’m very hopeful,” he said.
He hasn’t always felt so optimistic, though. Nearly two years ago, he was diagnosed with lung cancer. His initial treatment didn’t work, and the cancer spread.
“It was discouraging because I said, ‘Oh, Lord. My time is coming to an end. I mean, it’s like you got stage 4. You can’t get no worse, so where do I go from here?”
Grafton ended up in a clinical trial at Duke with Dr. Eziafa Oduah, a medical oncologist.
“What I’m trying to do is really to overcome immunotherapy resistance. Immunotherapy resistance is a huge problem for many lung cancer patients,” Dr. Oduah explained.
Research, also conducted at Duke, found that a certain protein, called PCSK9, can decrease an immune cell’s ability to kill cancer cells, thereby making immune therapy ineffective in many patients.
The current trial looks at combining immunotherapy with a monoclonal antibody that inhibits that particular protein to see if tumors have a better response. The NIH provided funding for both the initial research and the trial.
In some patients, including Grafton, it is showing promise.
“He’s been on this treatment now for — coming close to — two years now,” noted Oduah.
That’s pretty significant given his initial prognosis.
“They gave me two years to live. Most people just don’t live past two years,” Grafton said. “I’m about to come up on that two years. I’m good.”
Doctors hope to do more research based on their findings.
“Since we have these results, some of the preliminary results that we are seeing, we’re actually hoping to have this trial open to a broader population of patients,” Oduah explained.
But doctors aren’t sure what impact federal cuts may have on NIH-funded research.
We are designing other studies that will require NIH funding based on the results that we have seen, and so that is where I see that we might have potential problems and limitations, if we do not have enough funding,” she added. “NIH funds both basic and clinical research and so it is really core to what we do as physicians and to patients’ ability to get to get the best care.”
Dr. Oduah hopes that future studies can benefit more patients. Grafton does too. He wants others to feel the same sense of hope that he now has.
“I’m just blessed and I’m still here,” he said. ” I still put my faith in God and I just keep it moving.”
What To Do When You Feel Like An Imposter In Residency Training
What To Do When You Feel Like An Imposter In Residency Training
(AMA, Brendan Murphy) — You’ve earned your white coat. You’ve studied, trained and matched with a program. But some resident physicians—even as they have graduated and earned the title of “doctor”—may still feel as though they don’t belong.
Imposter phenomenon, often called imposter syndrome, is “the internal experience of feeling like a fraud and doubting the validity of one’s own achievements,” according to a study published in BMC Medical Education. Rates of imposter phenomenon among resident physicians range between 33% and 44%, says the study.
If you experience this phenomenon during internship or later on during residency, here is how you can cope with it.
It can creep up on you
One area in which impostor phenomenon can manifest, the study found, is during role changes. That could be during the transition from medical school to residency or fellowship.
A third-year psychiatry resident in Oklahoma, Brady Iba, DO, didn’t experience impostor phenomenon until his second year of residency during a shift on which he was moonlighting.
Dr. Iba was covering a 55-bed hospital on his own that night. A patient came in expressing suicidal thoughts—something he’d managed countless times during residency. The clinical decision to admit was straightforward. But this time, the responsibility felt heavier.
“It was just me,” said Dr. Iba, an AMA member. “There was no attending to back me up, no co-resident to run it by. It was a decision I’d made a hundred times—but now it was my decision. Solely mine. And I started doubting it.”
Realizing that he was feeling different about the experience, Dr. Iba spoke with the nurse working on triage that night.
“We walked through it,” he said. “This was the first time I made a decision that was wholly my own and not defended by other attendings or residents.”
That brief exchange helped him understand the root of his self-doubt: it wasn’t about clinical competence—it was about transitioning into independence.
The AMA Thriving in Residency series has guidance and resources on navigating the fast-paced demands of training, maintaining health and well-being, and handling medical school student loan debt along with other essential tips about succeeding in graduate medical training.
Living with uncertainty
There’s a difference between not belonging and not knowing something. As a resident still in training you won’t have all the answers, yet acknowledging that can be difficult.
“We need to be able to say, ‘I’m not sure,’” said Dr. Iba. “Admitting uncertainty isn’t weakness. It’s being responsible.
“No decision is small. Every choice you make matters to your patients. You’ve earned the right to make those choices,” he added.
Dive deeper:
- Feel like an impostor physician? It won’t stop when residency’s over
- What I wish I knew in residency about becoming chief resident
- These 8 traits make great doctors, and residents can develop them
- Nervous about your intern year? 3 resident physicians offer insight
- 5 tips to help resident physicians shift from intern to PGY-2
Talk it out
In Dr. Iba’s program, psychiatry residents meet weekly in a formal “process group” led by an outside therapist. It’s a space where they reflect on the emotional weight of their work, including those nagging feelings of not being enough.
“We had an intern say, ‘I don’t feel like I deserve to make these decisions. I don’t belong in this role,’” Dr. Iba said. “And everyone in the room could say, ‘Yeah, I’ve felt that too.’”
“We’re trained to suppress our emotions. But in psych, and honestly in any field, reflecting on your feelings helps you grow. You realize this isn’t just happening to you—it’s part of becoming a doctor.”
It takes time
Over time, the moonlighting shifts got easier, and for Dr. Iba the title “physician” started to feel less like an act and more like a reality.
“I settled in. I reminded myself: ‘I’ve done this before. I know what I’m doing. I’m good at my job.’ That’s why we’re here.”
When impostor phenomenon does take hold, Dr. Iba said it’s important to acknowledge that feeling.
“It’s normal to doubt yourself,” Dr. Iba said. “Even over small things. But don’t ignore it. Work through it. You’re trained for this. You belong here.”
Division Of Services For The Blind Open House On April 22 In Greenville
Division Of Services For The Blind Open House On April 22 In Greenville
(NCDHHS) – Join NCDHHS' Division of Services for the Blind at an open house celebrating their new location on April 22 from 10 a.m. to 2 p.m. at 1029 W.H. Smith Blvd in Greenville.
The open house is a great opportunity to learn about services available for people who are blind, visually impaired or deafblind to help them reach their goals of independence and employment. For questions, please reach out to area supervisor Lylaya Lennon at 252-999-7423.
NCDHHS Urges North Carolinians To "Fight The Bite" To Prevent Tick- And Mosquito-Borne Diseases
NCDHHS Urges North Carolinians To "Fight The Bite" To Prevent Tick- And Mosquito-Borne Diseases
(NCDHHS) – As warmer weather approaches, the North Carolina Department of Health and Human Services is urging North Carolinians to "Fight the Bite" by taking measures to reduce their risk of tick- and mosquito-borne diseases. In 2024, more than 900 cases of tick- and mosquito-borne illnesses were reported statewide.
April is Tick and Mosquito Awareness Month and NCDHHS is announcing the return of the "Fight the Bite" campaign to increase awareness about the dangers of vector-borne diseases. Students in grades K-12 were invited to submit educational posters for the annual campaign contest. NCDHHS, local health departments and K-12 schools will use these illustrations to educate residents about measures they can take to protect themselves. Winners will be announced at the end of April on the NCDHHS "Fight the Bite" webpage.
"Vector-borne diseases are on the rise in North Carolina," said Emily Herring, Public Health Veterinarian. "We encourage all North Carolinians to protect themselves from tick and mosquito bites by wearing long sleeves and pants, using EPA-approved repellents, and checking for ticks after spending time outdoors."
Rocky Mountain spotted fever, Lyme disease and other tick-borne diseases can cause fever, headache, rashes, flu-like illness and other symptoms that can be severe. Lyme disease accounted for 33% of all tick-borne diseases reported last year. Ehrlichiosis, which can cause symptoms similar to Lyme disease, accounted for 38% of all tick-borne diseases in 2024. These diseases are treatable with antibiotics, and early treatment can prevent severe illness from developing. If you feel ill after you have been bitten by a tick, it is important to see your health care provider as soon as possible.
Ticks live in wooded, grassy and brushy areas, and frequenting these areas can put you in contact with ticks and increase your potential exposure to vector-borne diseases. To reduce exposure to ticks:
- Use an EPA-approved repellent, such as those containing DEET or picaridin, on exposed skin and treat clothing with a pesticide called permethrin (0.5%). Use caution when applying insect repellent to children.
- Check yourself and your children for ticks if you have been in a tick habitat and remove them promptly.
- Reduce tick habitats around your house with selective landscaping techniques such as pruning shrubs and bushes, removing leaf litter and keeping grass cut short.
The mosquito-borne diseases most often acquired in North Carolina are West Nile virus, eastern equine encephalitis and La Crosse encephalitis. Nationally, North Carolina was second to only Ohio in reported cases of infections from La Crosse virus between 2003 and 2023. Most reported mosquito-borne diseases — including cases of malaria, dengue, chikungunya and Zika — are acquired while traveling outside the continental United States. To reduce exposure to mosquitoes:
- Use an EPA-approved mosquito repellent, such as those containing DEET or picaridin, when outside. Use caution when applying to children.
- Consider treating clothing and gear (such as boots, pants, socks and tents) with 0.5% permethrin.
- Install or repair screens on windows and doors and use air conditioning if possible.
- "Tip and Toss" to reduce mosquito breeding: empty standing water from flowerpots, gutters, buckets, pool covers, pet water dishes, discarded tires and birdbaths at least once a week.
- Talk with your primary care provider or local health department if you plan to travel to an area where exotic mosquito-borne diseases occur and always check your destination to identify appropriate prevention methods, including vaccines.
For more information on tick- and mosquito-borne diseases in North Carolina, please visit the NCDHHS Vector-Borne Diseases webpage.
North Carolina Ranks #41 In Children's Health Care, Find Out Why
North Carolina Ranks #41 In Children's Health Care, Find Out Why
(WFMY, Teyah Glenn) — When moving with kids, there’s a lot to think about—from school district rankings to the proximity of the nearest hospital or pediatrician.
On the health front, a recent study by WalletHub reveals that North Carolina ranks behind 39 other states (plus Washington, D.C.) when it comes to children's health care.
North Carolina ranks #41
“The quality of children’s health care should be a top priority for parents when choosing where to live,” said WalletHub analyst Chip Lupo. “Early access to quality pediatric and dental care, nutritious food, and safe spaces for recreation can significantly improve a child’s chances of growing up healthy and developing lifelong positive habits.”
WalletHub’s study evaluated each state using key indicators to determine the best and worst for children’s health care. These included:
- Overall health and access to care
- Nutrition, physical activity, and obesity rates
- Oral health
Massachusetts took the top spot for child health care, ranking #2 in health and access, #1 in nutrition and activity, and #20 in oral health. Also earning top marks were Rhode Island, New Jersey, Pennsylvania, and Vermont.
North Carolina, however, ranked near the bottom at #41 overall. Contributing to its low score were below-average rankings across all three categories:
- #35 for health and access
- #35 for nutrition, activity, and obesity
- #41 for oral health
The study also broke down state rankings in more specific health-related categories, such as infant mortality rates and the percentage of uninsured children. North Carolina showed up in one of these bottom-tier lists, ranking among the five worst states for the percentage of children with “excellent or very good” teeth.
In this category, North Carolina placed 47th nationwide—surpassed only by Missouri, Nevada, Mississippi, and Oklahoma.
Duke Researchers: Therapy Combination Carries Risk For Cancer Patients With Brain Metastases
Duke Researchers: Therapy Combination Carries Risk For Cancer Patients With Brain Metastases
(Duke Health, Sarah Avery) – Therapies that unleash the immune system to fight tumors have greatly extended the lives of people with many types of cancer.
But there are reports that patients with melanoma and lung cancer whose disease has spread to the brain may experience serious inflammatory reactions after receiving immunotherapy drugs concurrently with radiation.
In a study appearing April 9 in JAMA Network Open, researchers at the Duke Center for Brain and Spine Metastasis report a nearly two-fold increase in the risk of symptomatic brain inflammation, termed radiation necrosis, among patients with brain metastases receiving the immunotherapies within four weeks of a form of targeted radiation therapy called radiosurgery.
“Our findings reveal a previously unreported risk of brain tissue damage in patients who receive dual immune-checkpoint blockade therapies within four weeks of radiosurgery,” said senior author Zachary J. Reitman, M.D., Ph.D., assistant professor in the departments of Radiation Oncology, Neurosurgery and Pathology at Duke University School of Medicine. “Identifying this risk can potentially lead to more effective use of these therapies to maximize tumor control and reduce adverse effects.”
Reitman and colleagues in the Duke Cancer Institute -- including lead author Eugene J. Vaios, M.D., assistant professor of Radiation Oncology – analyzed outcomes from 288 melanoma and lung cancer patients at Duke. Eighty-two patients were treated with dual immune-checkpoint blockade of ipilimumab plus nivolumab; 129 received only a single immunotherapy drug; and 77 received no immunotherapy. All underwent radiosurgery.
Of the patients who received the dual immune-checkpoint blockade concurrently with radiosurgery, 25.9% developed symptomatic inflammation and damage to tissue in their brains. In contrast, 12.3% of patients who received only one immunotherapy and radiosurgery, and 13.7% of patients who received no immunotherapy, experienced similar injury.
Vaios said the researchers also found that the rates of symptomatic inflammation were significantly reduced when the interval between radiosurgery and dual immune-checkpoint blockade exceeded four weeks (e.g., sequential therapy). With sequential therapy, this risk became comparable to treatment with one immunotherapy or no immunotherapy.
That could improve the odds of survival after radiosurgery.
“We found that patients who developed symptomatic brain tissue damage within 12 months of radiosurgery had significantly worse survival,” Vaios said. “In future studies, we hope to identify a way to reduce tissue damage, perhaps by better sequencing therapies and by developing predictive algorithms to better quantify risk, guide treatment selection, and appropriately counsel patients.”
In addition to Vaios and Reitman, study authors include Rachel F. Shenker, Peter G. Hendrickson, Zihan Wan, Donna Niedzwiecki, David Carpenter, Warren Floyd, Sebastian Winter, Helen A. Shih, Jorg Dietrich, Chunhao Wang, April K.S. Salama, Jeffrey M. Clarke, Karen Allen, Paul Sperduto, Trey Mullikin, John P. Kirkpatrick, and Scott Floyd.
The study received funding support from the National Cancer Institute, which is part of the National Institutes of Health (5R38-CA245204, 1K38CA292995-01, K08-CA2560450).
The Melatonin-ification of Childhood Bedtimes
The Melatonin-ification of Childhood Bedtimes
(UNDARK, Michael Schulson) — Two years ago, at a Stop & Shop in Rhode Island, the Danish neuroscientist and physician Henriette Edemann-Callesen visited an aisle stocked with sleep aids containing melatonin. She looked around in amazement. Then she took out her phone and snapped a photo to send to colleagues back home.
“It was really pretty astonishing,” she recalled recently.
In Denmark, as in many countries, the hormone melatonin is a prescription drug for treating sleep problems, mostly in adults. Doctors are supposed to prescribe it to children only if they have certain developmental disorders that make it difficult to sleep — and only after the family has tried other methods to address the problem.
But at the Rhode Island Stop & Shop, melatonin was available over the counter, as a dietary supplement, meaning it receives slightly less regulatory scrutiny, in some respects, than a package of Skittles. Many of the products were marketed for children, in colorful bottles filled with liquid drops and chewable tablets and bright gummies that look and taste like candy.
A quiet but profound shift is underway in American parenting, as more and more caregivers turn to pharmacological solutions to help children sleep. What makes that shift unusual is that it’s largely taking place outside the traditional boundaries of health care. Instead, it’s driven by the country’s sprawling dietary supplements industry, which critics have long said has little regulatory oversight — and which may get a boost from Secretary of Health and Human Services Robert F. Kennedy Jr., who is widely seen as an ally to supplement makers.
Thirty years ago, few people were giving melatonin to children, outside of a handful of controlled experiments. Even as melatonin supplements grew in popularity among adults in the late 1990s in the United States and Canada, some of those products carried strict warnings not to give them to younger people. But with time, the age floor dropped, and by the mid-2000s, news reports and academic surveys suggest some early adopters were doing just that. (Try it for ages 11-and-up only, one CNN report warned at the time.) By 2013, according to a Wall Street Journal article, a handful of companies were marketing melatonin products specifically for kids.
And today? “It’s almost like a vitamin now,” said Judith Owens, a pediatric sleep specialist at Harvard Medical School. Usage is growing, including among children who are barely out of diapers. Academic surveys suggest that as many as one in five preteens in the U.S. now take melatonin at least occasionally, and that some younger children consume it multiple times per week.
On social media, parenting influencers film themselves dancing with bottles of melatonin gummies or cut to shots of their snoozing kids. In the toxicology literature, a series of reports suggest a rise in melatonin misuse — and indicate that some caregivers are even giving doses to infants. And according to multiple studies, some brands may contain substantially higher doses of the hormone than product labels indicate.
The trend has unsettled many childhood sleep researchers. “It is a hormone that you are giving to young children. And there’s just very little research on the long-term effects of this,” said Lauren Hartstein, a childhood sleep researcher at the University of Arizona.
In a 2021 journal article, David Kennaway, a professor of physiology at the University of Adelaide in Australia, noted that melatonin can bind to receptors in the pancreas, the heart, fat tissue, and reproductive organs. (Kennaway once held a patent on a veterinary drug that uses melatonin to boost the fertility of ewes.) Distributing the hormone over the counter to American children, he has argued, is akin to a vast, uncontrolled medical experiment.
“It is a hormone that you are giving to young children. And there’s just very little research on the long-term effects of this.”
To others, that kind of language might seem alarmist — especially considering that melatonin appears to have mild side effects, and that sleep problems themselves can have consequences for both child and parental health. Many caregivers report melatonin is helpful for their children, and it’s been given for years to children with autism and ADHD, who often struggle to sleep. Beth Malow, a neurologist and sleep medicine expert at Vanderbilt University Medical Center who has consulted for a pharmaceutical company that manufactures melatonin products, raised concerns about a tendency to highlight “the evils of melatonin” without noting that “it’s actually very safe, and it can be very helpful.” Focusing just on the negatives, she added, “is to throw the baby out with the bathwater.”
All of this leaves parents navigating a lightly regulated marketplace while receiving conflicting medical advice. “We know that not getting enough sleep in early childhood has a lot of bad effects on health and attention and cognition and emotions, et cetera,” said Hartstein. Meanwhile, she added, “melatonin is safe and well-tolerated in the short term. So there’s a big question of, well, what’s worse, my kid not sleeping, or my kid taking melatonin once a week?”
As for the answer to that question, she said: “We don’t know.”
The urge — the desperate, frantic, all-consuming urge — to get a child to fall sleep is familiar to many parents. So is the impulse to satisfy that urge through drugs. Into the early 20th century, parents sometimes administered an opiate called laudanum to help young children sleep, even though it could be fatal. Decades later, when over-the-counter antihistamines like Benadryl became popular, some parents began using them, off-label, as a sleep aid.
“Most people are pretty happy to resort to over-the-counter medication if their kids are not sleeping,” one mother of two small kids told a team of Australian researchers for a 2004 study. “It really saves the children’s lives,” she added, because “it stops mums from throwing them against the wall.”
Compared to other sleep aids, melatonin supplements have obvious advantages. Chief among them is that they mimic a natural hormone: The body secretes melatonin from a pea-sized gland nestled in the brain, typically starting in the early evening. Levels peak after midnight, and drop off a few hours before sunrise.
Artificially boosting melatonin helps many people fall sleep earlier or more easily.
“There’s a big question of, well, what’s worse, my kid not sleeping, or my kid taking melatonin once a week?”
When a child takes a 1 milligram dose of melatonin, the hormone quickly enters their bloodstream, signaling to the brain that it’s time for sleep. Melatonin reaches levels in the blood that can be more than 10 times higher than natural peak concentrations. Soon, many children begin to feel drowsy.
Children can generally tolerate melatonin. Known side effects appear to be mild, and, compared to antihistamines, people taking low doses of melatonin are less likely to wake up feeling groggy the next morning.
As early as 1991, some researchers began administering small doses of the hormone to children with autism, who sometimes have extreme difficulty falling and staying asleep. A series of trials conducted in the Netherlands in the 2000s found that melatonin could also have modest benefits for non-autistic children experiencing insomnia, and it seemed to be safe in the short-term — although the long-term consequences of regularly taking the hormone were unclear.
The timing of the research coincided with a move in the U.S. to loosen regulations on dietary supplements, led by Sen. Orrin Hatch of Utah, a supplement-industry hub.
News reports suggest that, by the late 2000s, some parents were trying melatonin for older children.
It’s hard to know for sure who first decided to market melatonin specifically to children, but a key player seems to be Zak Zarbock, a Utah pediatrician and father of four boys who, in 2008, began selling a drug-free, honey-based cough syrup. In 2011, his company, Zarbee’s, introduced a version of its children’s cough remedy that contained melatonin. Soon after, Zarbee’s launched a line of melatonin supplements tailored to children. In a 2014 press release, Zarbock stressed that “a child shouldn’t need to take something to fall asleep every night.” But melatonin, he said, could act like “a reset button for your bedtime routine” when things got out-of-whack. (Zarbock did not respond to interview requests.)
More products followed, and usage rates have climbed. One possible reason for that is that American children are having more difficulty falling asleep. Some experts think screen use is causing sleep problems, and rising rates of anxiety and depression among children may also be affecting slumber. Clinicians report treating families that use melatonin to counteract the stimulating effects of caffeine.
Another possibility — and they’re not mutually exclusive — is that supplement makers sensed a market opportunity and seized it. Gummies have made melatonin more palatable to children; supplement makers now market widely to parents online. At least one company seems to have made overtures to parents via a pediatrics organization: Vicks ZzzQuil, a popular line of children’s melatonin products, sponsored a 2020 webinar on sleep hosted by the American Academy of Pediatrics.
Read more about melatonin trends here.
UNC School of Medicine Launches New 9-Month Biomedical Master’s Degree
UNC School of Medicine Launches New 9-Month Biomedical Master’s Degree
(UNC School of Medicine, Tiffany Garbutt) – Some students want to chase their scientific curiosity or bolster their experience before exploring career options. The new nine-month biomedical, non-thesis Master of Science in cell biology and physiology in the UNC School of Medicine will help them do that.
“This is the kind of program that I would have really benefited from as an undergraduate graduating from UNC with a biology degree and not certain of my career path,” said Emily Moorefield, an associate professor in the medical school’s cell biology and physiology department. Moorefield leads the committee of faculty and administrative personnel developing the new program.
Other master’s degree programs in the School of Medicine are designed for students interested in entering specific health professions such as nursing or dentistry. Some biomedical sciences departments also offer opportunities to laboratory technicians to earn a master’s degree on a case-by-case basis. The new MS program, launched in collaboration with The Graduate School, is the first at Carolina to offer a full generalized biomedical sciences curriculum to a cohort of incoming students.
“This program is for students who are questioning their career path, need a bit more time and information as to what career options are available, or didn’t get the opportunity to do research as an undergrad,” said Kristen Scherrer, an assistant professor in the cell biology and physiology department and director of graduate studies for the master’s program.
The program provides students the unique opportunity to gain hands-on experience in translational research laboratories without requiring a final thesis project. “We have an interdisciplinary department with access to 90 different research labs,” Scherrer said.
Students have options other than research, though, and will preview various biomedical career options in professional development classes.
“We want to inspire our students to chase their scientific curiosity and, after graduation, boost the economic and societal benefits of the biomedical research industry,” said Kathleen Caron, department chair.
The biopharmaceutical industry in North Carolina grew by 43% in just three years and will require an estimated 8,000 new workers by the end of 2026. “Our goal is to train the next generation of scientists to meet the many needs of N.C.’s rapidly expanding biomedical industry,” Caron said.
The program prepares students for medical and other health professional schools, doctoral programs and academic and industry careers. Faculty will support and advise students on how to achieve their unique career goals in the biomedical workforce.
The strength of the program is its educators. “We’re real people who were once in their shoes trying to figure out what to do after undergrad. We care and genuinely want students to succeed,” Moorefield said.
The program lasts just nine months, long enough for students to gain new skills and prepare for their future career goals without taking too much time. “Of course, they will get a great education,” Scherrer said. “But the exciting piece is watching what they do next, and hopefully we help influence that.”
Apply for the Master of Science in cell biology and physiology by May 15.
Over 500 Flu-Related Deaths Reported In North Carolina This Season; Vaccination, Preventative Measures Encouraged
Over 500 Flu-Related Deaths Reported In North Carolina This Season; Vaccination, Preventative Measures Encouraged
(WNCN, Greg Funderburg, Keaton Eberly) — Vesenta Watson spends most of his days working with Child Fund International and says he got sick a few months ago.
“Back in December, I came down terribly with the flu, and I was bedridden for several days,” he said.
The North Carolina Department of Health and Human Services announced the reported flu deaths for the 2024-25 season on Wednesday, saying more than 500 people diagnosed with flu died across North Carolina this past respiratory virus season. This marks the highest number of flu-related deaths since 2009, state health officials said, a fact that has left many, including Samalia Idris, in a state of shock.
Idris, who contracted COVID-19 a few years ago and had a brief hospital stay, now gets a flu shot every year. Her experience has taught her the importance of vaccination and she now takes her flu shot without fail, along with other preventive measures like wearing a mask.
Dr. David Weber with UNC Medical Center Chapel Hill says wearing a mask is one way to protect yourself because the numbers are higher than usual.
“We have seen high numbers this season, and here at our medical center, we have seen 12 deaths from influenza. They have been all adults so far this year,” he said.
Contact Your Legislators; Ask Them to Oppose the SAVE Act
Contact Your Legislators; Ask Them to Oppose the SAVE Act
The SAVE Act was introduced Tuesday. This will allow Advance Practice Registered Nurses (APRNs), including nurse anesthetists, to practice without physician involvement.
We ask you to email your state Senator and House member TODAY asking them to oppose the SAVE Act. Specifically, request that they do not co-sponsor the legislation. You can find your legislators here.
Talking points to consider including in your emails to legislators:
• I am a physician or PA practicing in...
• The SAVE Act will eliminate physician involvement from patient care.
• The SAVE Act could impact patient safety and increase health care costs.
• Please do not co-sponsor the SAVE Act.
Thank you for your engagement. If you have questions or feedback in the meantime, do not hesitate to reach out to your NCMS team.
Tracking Measles Cases in the United States
Measles Outbreak are Raising Alarm Among Public Health Experts
(CNN, , , and Recent outbreaks of measles in the United States are driving up case counts and raising alarm among public health experts, especially as vaccination rates among children lag.
The concern this year comes after the first reported death in the US since 2015 and following a significant increase in the number of cases in 2024. CNN is monitoring these cases and updating this page each week as new national data is collected and released from state health departments by the US Centers for Disease Control and Prevention.
Cumulative measles cases in the United States. As of March 20, there have been more cases than there were by the same week last year.
A large outbreak in West Texas is largely responsible for the spike in the national cases so far in 2025.
Measles is a highly contagious airborne disease. It can cause serious health consequences or death, especially for young and unvaccinated children. Most of the cases involve people younger than age 20.
General symptoms may include fever, cough, runny nose, watery eyes and a rash of red spots. About 1 in 5 unvaccinated people in the US who get measles will be hospitalized, according to the CDC.
About 1 in every 20 children will develop pneumonia, and others may develop a dangerous swelling in the brain called encephalitis. Up to 3 of every 1,000 children who become infected with measles may die from respiratory and neurologic complications.
National data compiled by the CDC lags behind reports collected by state health agencies. Here’s the latest national snapshot of which states have reported cases so far.
Measles is preventable, thanks to a highly effective vaccine. Experts recommend that children get the measles, mumps and rubella, or MMR, vaccine in two doses: the first between 12 months and 15 months of age, and a second between 4 and 6 years old. One dose is about 93% effective at preventing measles infection; two doses are about 97% effective.
The current outbreak “is absolutely being driven and started by unvaccinated individuals,” said Dr. Michael Mina, chief scientific officer of the telehealth company eMed and an expert in the epidemiology, immunology and spread of infectious disease.
The increased concern about measles cases can be attributed to falling vaccination rates and to increased travel, which can result in unvaccinated people acquiring measles abroad and bringing it back to the US, according to the CDC, which occurred in 2019.
Here’s how the cases this year compare to the past.
Measles was eliminated in the US in 2000. Imported cases are expected, but when vaccination rates are high, the risk remains low and outbreaks are rare. Outbreaks in 2019, particularly two in underimmunized Orthodox Jewish communities in New York, threatened measles elimination status in the US.
“If a measles outbreak continues for a year or more, the United States could lose its measles elimination status,” according to the CDC.
Because measles is so contagious, a high level of vaccination coverage is key to minimizing spread. The US has set a target vaccination rate of 95%, but coverage among kindergarteners has dipped below that in recent years.
MMR vaccine series completion among kindergarteners decreased from 95.2% during the 2019–2020 school year to 92.7% in the 2023–2024 school year, leaving about 280,000 at risk, according to the CDC.
Coverage varies widely by state.
“If a measles outbreak continues for a year or more, the United States could lose its measles elimination status,” according to the CDC.
Because measles is so contagious, a high level of vaccination coverage is key to minimizing spread. The US has set a target vaccination rate of 95%, but coverage among kindergarteners has dipped below that in recent years.
MMR vaccine series completion among kindergarteners decreased from 95.2% during the 2019–2020 school year to 92.7% in the 2023–2024 school year, leaving about 280,000 at risk, according to the CDC.
Coverage varies widely by state.