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Heart attack and stroke patients without medical insurance face “devastating” health care costs that can bankrupt them, research from UT Southwestern and other centers shows. “Many patients with large medical bills may have had to declare bankruptcy, sell their home, and be hounded by medical bill collectors as they struggled to juggle rent or mortgage payments while paying for utilities and food,” said cardiologist Dr. Rohan Khera, an Internal Medicine fellow at UT Southwestern Medical Center and co-first author of the paper, “Medical expenses are the leading cause of bankruptcy in the United States.” For uninsured patients hospitalized with acute myocardial infarction (heart attack), the median cost for their stay totaled $53,384 in 2012, according to the research. Uninsured stroke patients had a median bill of $31,218. Recent UTSW findings: Calcium in arteries influences heart attack risk Patients without calcium buildup in the coronary arteries had significantly lower risk of future heart attack or stroke despite other high risk factors such as diabetes, high blood pressure, or bad cholesterol levels. Even small weight gain is bad for the heart Modest weight gains – even among those who aren’t overweight – can cause dangerous changes to the heart, but small amounts of weight loss can improve the condition. Based on the likely annual incomes of the uninsured patients, which were modeled on the median incomes of their residential zip codes, the researchers estimated that 85 percent of the heart attack patients and 75 percent of the stroke patients faced hospital bills greater than 40 percent of the income they had left after buying food. About 60 percent of the uninsured heart attack patients had bills higher than their annual income, after allowing for the purchase of food, according to the paper. “The potentially devastating financial impact of these events on the uninsured is considerable,” according to the paper, which pointed out that more than 1 in 8 of heart attack and stroke patients were without insurance before the Affordable Care Act (ACA). The research, published in the journal Circulation, looked at thousands of patients hospitalized for acute myocardial infarction (heart attack) or stroke between 2008 and 2012, the year before Americans began signing up for subsidized insurance on exchanges created under the federal Affordable Care Act (ACA). The patients studied ranged from age 18 to 64 (federal Medicare insurance is available to those 65 and older). More than 39,000 hospitalizations for heart attack and more than 29,000 hospitalizations for stroke were analyzed. Information for the paper came from the National Inpatient Sample, a large database developed by the federal Agency for Healthcare Research and Quality. Collaborators included cardiologist Dr. James de Lemos, Professor of Internal Medicine and holder of the Sweetheart Ballā€Kern Wildenthal, M.D., Ph.D. Distinguished Chair in Cardiology and Medical Director for the Dallas Heart Study, and researchers were from Baptist Health South Florida, Johns Hopkins Bloomberg School of Public Health, Florida International University, Michael E. DeBakey VA Medical Center, Brigham and Women’s Hospital, and Yale New Haven Hospital. About UT Southwestern Medical Center UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty has received six Nobel Prizes, and includes 22 members of the National Academy of Sciences, 18 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The faculty of more than 2,700 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in about 80 specialties to more than 100,000 hospitalized patients, 600,000 emergency room cases, and oversee approximately 2.2 million outpatient visits a year.
A new treatment program that combines the power of technology with tried and true methods to help cancer patients overcome their addiction to tobacco is ready to enroll its first patients at Penn Medicine’s Abramson Cancer Center. As part of the program, doctors are alerted about a patient’s tobacco use through the electronic medical record. At that point, an automated referral is made for the patient to Penn’s Tobacco Use Treatment Service (TUTS), which then directly provides patients with state-of-the-science tobacco use treatment in an effort to get them to quit for good and assist with their medical treatment and recovery. Nearly 10 percent of survivors continue to smoke cigarettes, according to the American Cancer Society. More than 80 percent of those survivors smoke every day. And, importantly, the most recent United States Surgeon General’s report concluded that, based on the existing scientific evidence, quitting smoking improves the prognosis of cancer patients. “We wanted to develop the infrastructure to ensure that all cancer patients are screened for tobacco dependence and contacted by a trained tobacco treatment specialist who can help them quit,” said the project’s co-leader Robert A. Schnoll, PhD, an associate professor in the Department of Psychiatry, the co-leader of Penn’s Tobacco and Environmental Carcinogenesis Program, the program leader and director of the Center for Interdisciplinary Research on Nicotine Addiction, and a member of Penn’s Abramson Cancer Center. Once doctors get an electronic alert about a patient’s tobacco use, that patient is screened for available smoking cessation clinical trials or for a smoking cessation program. Certified Tobacco Treatment Specialists then provide behavioral counseling and recommend medication, and each patient is provided with an individualized treatment plan. This can also include referral to the free PA Quit-line cessation service, navigation to find medication, and hands-on, individualized in-person or phone smoking cessation counseling.  The initial focus of the program is the Department of Radiation Oncology, which Schnoll says they chose because it “provides a nexus point for many cancer patients, so we can ensure substantial access to Penn patients.” “Our oncologists are dedicated to addressing tobacco dependence among our patients, and we as a department are committed to expanded training and education,” said James Metz, MD, chair of Radiation Oncology. “Being part of an academic institution like Penn gives us the chance to work with outside departments to further these sorts of important initiatives to improve patient care, and we’re always pleased to take advantage of opportunities like this.” “Building this program in such a focused population will allow us to understand what works best and what needs to be refined,” said the project’s co-leader Frank T. Leone, MD, MS, an associate professor of Medicine. “In the long term, we hope to bring this program to the rest of the Abramson Cancer Center and possibly other specialties throughout the health system.” Initial support for the program came from a $100,000 grant from the CVS Health Foundation. Penn was also awarded a $500,000 grant as part of the National Cancer Institute’s Cancer Centers Cessation Initiative – known as C3I and part of the Cancer Moonshot initiative – to further develop and then expand this program across the cancer center. ### Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $6.7 billion enterprise. The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2016 fiscal year. The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine. Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2016, Penn Medicine provided $393 million to benefit our community.
Patients diagnosed and treated for a long-term potentially fatal diseases such as cancer, can accumulate distressing and traumatic experiences along the way. A new study from the Marcus Institute of Integrative Health at Thomas Jefferson University examines how the brain is activated when the Neuro Emotional Technique (NET) is used to help cancer patients process traumatic memories. The research, published in the Journal of Cancer Survivorship, also adds to the basic understanding of the pathophysiology of traumatic stress in general and the underlying mechanisms involved with resolving it. “The results of this study are a breakthrough in understanding how an intervention like NET works, particularly in regard to the cerebellum’s role in the regulation of emotional experiences. We now understand that the cerebellum does much more than coordinate motor activity,” said principal investigator Daniel Monti, MD, MBA, Director of the Marcus Institute of Integrative Health who is also a member of the Sidney Kimmel Cancer Center at Jefferson. The intervention, Neuro Emotional Technique (NET), is unique in allowing the practitioner to not only gauge the patient’s subjective distress but also how the nervous system is reacting to that stress, using biofeedback tools. This provides information that is not usually part of standard interventions, and is what potentially makes NET an especially efficient and efficacious therapeutic solution for traumatic stress. By showing the link between the cerebellum, limbic (emotional) centers, and autonomic nervous system, the present study expands current understanding of traumatic memories and how and intervention like NET can significantly alleviate the suffering associated with them. “This is the first study that offers a demonstrable solution for cancer patients with traumatic stress symptoms. It also expands our understanding of the importance of the cerebellum in coordinating traumatic emotions, and the body’s response to them,” said Dr. Monti. This new data suggests that a brief therapeutic course of the NET intervention substantially alters the brain’s response to traumatic memories, and it elucidates the potential importance of the cerebellum in regulating the brain and body’s response to traumatic stress. (Previous research from the Marcus Institute demonstrated the efficacy of the NET intervention for relieving stress in cancer patients.) “Just four to five brief NET sessions result in significantly less emotional and physical distress, and these improvements are associated with connectivity changes throughout the brain,” said Dr. Monti. “Patients, even those who were skeptical at first, have reported the NET intervention as ‘diffusing a bomb’ on ‘the worst anxiety ever.’” The study was funded by the One Research Foundation. Authors declare no conflicts of interest.
The U.S. officially entered the Great War – known more commonly as World War I – 100 years ago in April 1917 and remained active through the war’s end in November 1918. Many historians view WWI as a turning point for the rest of the 20th century, and DePaul University faculty are available to speak on the war’s relevance in modern times. Experts can discuss WWI technologies that changed how war is waged, how colonial building led to war, and how the war influenced a young Adolf Hitler’s beliefs about power and architecture. Available experts include: Eugene Beiriger, Associate Professor of History, Peace, Justice and Conflict Studies, College of Liberal Arts and Social Sciences. Beiriger is an expert on 19th and 20th century British and European political and diplomatic history. He has written and presented on the First World War, and can speak on the importance of the war in today’s world. “We cannot understand the issues of today — European politics and union, Russian assertiveness under Putin, Turkish political strife, and the politics and divisions of the Middle East, South and East Asia, as well as the growth of U.S. economic and military power — without confronting the important legacies of the First World War,” said Beiriger. “At the time, it was ‘the war to make the world safe for democracy,’ ‘the war to end all wars,’ and ‘the Great War.’ All these phrases were used to describe the First World War until Europe experienced the rise of dictatorships of the right and the left in the 1920s and 1930s, and a second world war occurred which was greater in magnitude and destruction. In the U.S. today, the Second World War and the Cold War have long been seen as the most important in the trilogy of 20th century conflicts. Most historians, however, have focused on the First World War as perhaps the most significant event of the 20th century. To them, the First World War remains one of the most bloody, transitional and significant conflicts in human history. The war was the ultimate ‘cataclysm,’ the ‘apocalypse,’ and ‘Armageddon’ itself. It ushered in the ‘age of extremes’ and the ‘century of violence,’” Beiriger said. Beiriger can be reached at 773-325-7454 or eugene.beiriger@depaul.edu. Robert Garfield, Associate Professor of History, College of Liberal Arts and Social Sciences. Garfield is an expert on the history of European expansion, the history of science and technology, and African history. He can speak on the military technology that changed WWI and future wars. “WWI was the first war fought in three dimensions, with airplanes above and submarines below. Airplanes ended the idea that a nation was some sort of giant fortress with walls around it that an enemy had to breach. Now you could just fly over them. That contributes to the idea that there was no longer such thing as the battlefront and the warfront. Now everybody was at war and at risk. Military technology changed the sociology of war as well as its actual fighting,” said Garfield. “WWI was also the first real mechanical war,” he noted. “Even before the war began, there was the automobile and the airplane. The war also saw the beginnings of the tank and self-propelled artillery pieces. In a sense, warfare was taken over by the internal combustion engine, which meant horses and men simply were not as important as they were before, although they still died in enormous numbers. The ability to build and use things, rather than simply have mass armies, is something that WWI changes very much.” Garfield can be reached at 773-325-1556 or rgarfiel@depaul.edu. Paul Jaskot, Professor of History of Art and Architecture, College of Liberal Arts and Social Sciences. Jaskot is an expert on post-war German art and architecture. He can speak on colonial building leading up to WWI; Hitler’s vision of architecture during his rise to power; how the conflict of WWI and its conclusion in the Treaty of Versailles contributed to the rise of Hitler; and how the Nazi Party used the memory of WWI as a constant point of reference in their regime. “Germany colonized very late, especially compared to France or Britain, and we know that that conflict helped lead to WWI. Architecture was becoming more and more international; Germany was using architectural innovation to build settlements more quickly. Therefore, this type of conflation with international competition and expansion of architectural technology was part and parcel to the war beginning,” said Jaskot. “Hitler's ‘Mein Kampf’ was written in the shadow of WWI in 1925,” he added. “There's a cultural chapter in the book in which Hitler talks about how great nations, ones that are powerful in economics, social, military, are ones that build. He makes an analogy between strong countries and what he thinks is good architecture, like traditional forms Classicism, Gothic and Egyptian. So, he wasn't really challenging architectural form, but he really talked about architecture as an expression of power, and he never wavered in that position from 1924 until he died in 1945.” Jaskot can be reached at 773-325-2567 or pjaskot@depaul.edu.
Highlights In white patients with chronic kidney disease, those with depressive symptoms had a higher risk of early death than those without depressive symptoms. This risk was much lower after accounting for use of anti-depressants, however. In black patients, the presence of depressive symptoms was not linked to risk of death. Results from the study will be presented at ASN Kidney Week 2017 October 31–November 5 at the Ernest N. Morial Convention Center in New Orleans, LA. Treatment of depressive symptoms may help lower the risk of early death in individuals with chronic kidney disease, but racial/ethnic differences may exist. The findings come from a study that will be presented at ASN Kidney Week 2017 October 31­–November 5 at the Ernest N. Morial Convention Center in New Orleans, LA. Depression is common, under-recognized, and undertreated among patients with chronic kidney disease, especially among racial/ethnic minorities. Delphine Tuot, MD (University of California, San Francisco) and her colleagues assessed the presence of depressive symptoms among 3725 participants in the Chronic Renal Insufficient Cohort (CRIC). The team found that 23.3% of participants had depressive symptoms at the start of the study, with 17.0% prevalence of anti-depressant use. The rate of death was 3.37 per 100 person-years during a median of 6.7 years of follow-up. (A person-year is the number of years of follow-up multiplied by the number of people in the study.) In white individuals, those who experienced depressive symptoms had a 1.5-fold higher risk of death than those without depressive symptoms, even when taking into consideration socioeconomic factors, severity of kidney disease, and burden of other chronic conditions. This risk was much lower when the researchers accounted for use of anti-depressants, however. In black individuals, the presence of depressive symptoms was not linked to risk of death. The findings suggest that depressive symptoms may be differentially associated with the risk of early death among white and black individuals with CKD. “This study confirms prior research that depressive symptoms are common among individuals with CKD and suggests that there are potential long-term mortality benefits of treating depression among patients with mild to moderate kidney disease. More research is needed to understand differences in mortality risk among racial/ethnic subgroups,” said Dr. Tuot. Study: “Treatment of depression symptoms is associated with attenuated risk of all-cause mortality” (Abstract 2763107) ASN Kidney Week 2017, the largest nephrology meeting of its kind, will provide a forum for more than 13,000 professionals to discuss the latest findings in kidney health research and engage in educational sessions related to advances in the care of patients with kidney and related disorders. Kidney Week 2017 will take place October 31–November 5, 2017 in New Orleans, LA. Since 1966, the American Society of Nephrology (ASN) has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has nearly 17,000 members representing 112 countries. For more information, please visit www.asn-online.org or contact us at 202-640-4660.
When people thank veterans for their service, they often are thinking of the commitment they made when they enlisted. They are less aware of the unique challenges veterans face transitioning from military service to civilian life. In 2016, there were 20.9 million veterans in the United States. Out of those, approximately 453,000 were unemployed, according to the Bureau of Labor Statistics. Returning veterans often find they have to reconnect and re-establish their roles with their families. They also struggle to obtain health care and navigate benefits. Vets4Warriors – a confidential, 24/7 peer support network for service members, veterans and their families operated out of Rutgers University Behavioral Health Care – helps ease this transition by providing solutions to physical, mental or social challenges before they turn into crises. Staffed by veterans trained in behavioral health, the network is available via phone (855-838-8255), live chat or text. Rutgers Today spoke to Maj. General (ret.) Mark Graham, Director of Vets4Warriors, about what the public should know about the challenges that veterans face – and how they can make the transition easier.   What are the main reasons people call Vets4Warriors? Our peer support specialists make over 1,100 contacts each week with veterans, those on active duty and family members for reasons ranging from anxiety, loneliness, depression and post-traumatic stress disorder to financial and relationship issues. Often, callers just want to talk. Although we focus on peer support, we also connect callers to organizations that provide resources to help them get services such as health care, insurance, employment, housing and benefits. Our peers continue to follow up with callers for as long they need; we build relationships.   How are veterans uniquely positioned to help other veterans in need? The military has a culture and structure that is different than the civilian world. There is a strong camaraderie and bond that forms in the military – whether a person has been deployed or not. When you’re in the military, your unit becomes your second family. That bond is severed when people leave the service; our peer support specialists fill that role, providing an empathetic ear that can only be given by someone who has “been there.” Many veterans – whether they just retired from service or have been out for decades –have a difficult time disclosing that they are struggling because they do not want to appear “weak.” However, when they call Vets4Warriors, they reach a peer who understands the culture and the connections made in the military. Since our conversations are confidential, outside of the military chain of command and answered immediately by a fellow veteran, we are able to establish an immediate trust. Peers don’t judge or share what they are told; it all stays in the vault. Whenever possible, we try to match callers to peers of the same gender and military branch. We also have military family members who can provide peer support to spouses and parents who are struggling with the demands that come with having a loved one who is serving or has just returned home. Vets4Warriors is based on the Reciprocal Peer Support model, which was developed at Rutgers University Behavioral Health Care Call Center. The idea is that by helping callers, the peer support specialists likewise receive support back. They reinforce each other.   What challenges do veterans face when securing employment? How can civilians help? Many veterans have never applied to civilian jobs; they must learn a whole new skill set – in short order. Creating a resume can be difficult. They don’t know how to translate their military experience into civilian terms. They also are not used to listing their individual accomplishments; in the military, it’s never “I,” it’s “we.” Civilians can help by reviewing veterans’ resumes to ensure they are presenting their skills effectively and in a way that can be understood. Companies can be more attuned to how a veteran’s experiences translate to the workforce. For example, the military builds leadership skills. A lot of responsibility is given to young men and women, which increases as they progress through the ranks. These leadership qualities as well as veterans’ ability to be flexible and agile are skills that are important in the civilian workforce. Also, veterans have been trained to seek solutions from a variety of perspectives – another valuable skill. How can the public help ease the transition of returning veterans? Although veterans appreciate when people acknowledge their service, what they really want is to be given opportunities in the civilian world. Accept and welcome them into your community – where you live, work, worship and volunteer. Look for ways to engage them in your organizations; you’ll find they are great teammates.
Retired Lieutenant General and 21st U.S. Air Force Surgeon General Dr. Thomas W. Travis will be the featured speaker at the University of Texas Southwestern Medical Center Third Annual Tribute to Veterans, Nov. 7. Travis, the Senior Vice President for the Uniformed Services University of the Health Sciences’ Southern Region in San Antonio, Texas, will share a personal story about an Air Force medic who was severely wounded by an IED attack in Afghanistan, representative of the sacrifices made by Veterans and the medical advances seen in the current long war.  “Veterans Day provides us with a wonderful opportunity to recognize our fellow UT Southwestern employees who are veterans of the U.S. Armed Forces and thank them for their dedication and service to our country.  UT Southwestern Medical Center is committed to ensure a diverse workforce - one that fosters an environment of inclusiveness and respect. Welcoming veterans is part of that commitment,” said Ivan Thompson, UT Southwestern vice president for Human Resources. The event is being hosted by the UT Southwestern Office of Diversity & Inclusion and Equal Opportunity, along with the Veterans Business Resource Group.  It starts at 11 a.m. in the Eugene McDermott Plaza, D1.600 Lecture Hall on South Campus. “We are honored to have General Travis as our keynote speaker for the University of Texas Southwestern Medical Center’s 2017 Veterans Day event,” said Kim Siniscalchi, Vice President for Strategic Initiatives and Executive Sponsor for the Veterans Business Resource Group.  “In 2015, UT Southwestern held their inaugural Veterans Day event, and it was a huge success!  Based on the positive feedback from our veterans, Dr. Podolsky [the university president] decided to make it an annual event honoring our veterans, families, and Health Professions Scholarship Program [medical] students.  This year we have a unique opportunity to hear from the 21st Surgeon General of the U.S Air Force.  And, not only is he a former surgeon general, he is also an experienced fighter pilot, and he has a great story to tell.”    Travis served in the U.S. Air Force from 1976 until 2015.  He entered the service as an ROTC program distinguished graduate from Virginia Polytechnic Institute and State University, and went on to become an F-4 pilot and aircraft commander prior to attending medical school at USU.  He held a number of prestigious career assignments, including chief of medical operations for the Human Systems Program Office at Brooks Air Force Base in San Antonio, director of Operational Health Support and chief of the Aerospace Medicine division for the Air Force Medical Operations Agency in Washington, DC.  He later became deputy Surgeon General of the U.S. Force, followed by Surgeon General, overseeing a $6.6 billion, 44,000-person integrated health care delivery system serving 2.6 million beneficiaries at 75 military treatment facilities worldwide.  “When I was asked to speak to the UT Southwestern Medical Center as they honor Veterans this year, I immediately said yes.  I have had the amazing opportunity to work closely with all of our uniformed services for many years,” said Travis.  “I am very grateful to be able to recognize and thank the UT Southwestern veterans for their service, and hopefully provide some insights and inspiration to this important audience.”  The Uniformed Services University of the Health Sciences (USU), founded by an act of Congress in 1972, is the academic heart of the Military Health System. USU students are primarily active-duty uniformed officers in the Army, Navy, Air Force and Public Health Service who receive specialized education in tropical and infectious diseases, TBI and PTSD, disaster response and humanitarian assistance, global health, and acute trauma care. A large percentage of the university’s more than 5,800 physician and 900 advanced practice nursing alumni are supporting operations around the work, offering their leadership and experience. USU’s graduate programs in biomedical sciences and public health are committed to excellence in research and oral biology. The university’s research program covers a wide range of clinical and basic science important to both the military and public health.  For more information, visit www.usuhs.edu.
As a combat engineer in the Army, Stephen Bettini helped train soldiers to navigate and overcome obstacles. To fulfill an important objective, sometimes it meant building bridges. Other times, it meant removing them.  Now, Bettini is building bridges of a different kind: Earlier this year, he was hired as Cedars-Sinai’s first full-time military veteran recruiter, a new position to help veterans establish and maintain careers in the health system. Bettini is trumpeting the message that Cedars-Sinai is veteran friendly — whether that means recruiting candidates at job fairs, assisting spouses in gaining employment or keeping veterans informed about available state and federal benefits. Cedars-Sinai already employs approximately 265 veterans and has made hiring more former service members a priority. “I’m excited to help bring in more veterans who are wonderfully talented men and women,” Bettini said. “They have a great set of skills we want to tap, and they are focused on mission. That’s who we need here.” Bettini said veterans not only possess the knowledge and experience to perform specific jobs, but they also have an abundance of what employers refer to as “soft skills”— personal traits that enable them to excel in the workplace. “Their soft skills are just off the scale,” Bettini said. “They are trained to work within diverse teams, to deal with adversity and to lead. They are very dedicated. Basically, they have everything the military instills in its people.” Creating and filling Bettini’s position was a top agenda item for Andy Ortiz, senior vice president of Human Resources and Organization Development. Ortiz, who joined Cedars-Sinai last year, grew up in a household that had the highest respect for veterans. His father served in the Vietnam War. “We have to have the best, most capable people to deliver on our mission as an organization, and from my perspective, vets fit that bill,” Ortiz said. “Hiring them is good to do for the community, and it is part of our talent strategy. It’s the right thing to do.” Hiring Bettini is the latest effort by Cedars-Sinai to support veterans and their spouses. In October, the organization was accepted into the Military Spouse Employment Partnership Program, a Department of Defense initiative that helps spouses of active duty military members land jobs in the private sector by pairing the military with leading businesses, including Amazon, Comcast, Southwest Airlines and Hyatt Hotels. In February, Cedars-Sinai was recognized by the Department of Defense for supporting employees in the National Guard and Reserve. Once on the job, Bettini quickly found that Cedars-Sinai enjoys strong name recognition and a stellar reputation. But like other large Southern California employers, some prospective employees weren’t sure they wanted to deal with the region’s high cost of living and congested roadways. “Commute times can be a barrier,” Bettini said. “But people also know we are among the best at what we do and they want to be part of that.” This is not the first time Bettini has acted as a recruiter. He formerly served as a nurse recruiter for Kaiser Permanente, and he worked as a recruiter toward the end of his Army hitch in several places, including Reseda and Glendale. Attitudes about veterans have dramatically changed since 1975 when Bettini enlisted in the Army. With the national trauma of the Vietnam War still fresh, Bettini remembers going to a bar and being insulted because he was in uniform. “The anti-military sentiment was pretty strong back then,” he said. The military was not Bettini’s original career plan. He wanted to be a baseball player and had a scholarship to play at the collegiate level, but a car accident left him with an injured leg. He lost his scholarship and eventually joined the Army. Bettini was stationed in Germany before the Berlin Wall was torn down. At the time, tourists from the west could take short trips into East Berlin. His brief look behind the Iron Curtain with its onerous state controls and flagging economy gave him a new appreciation for the sacrifices made to keep western Europe free. “It really made me feel proud of what the soldiers before had done and what I was doing there,” he said. He has a similar feeling about working at Cedars-Sinai. “I love being here,” Bettini said. “I want every organization to know Cedars-Sinai is here and that we are serious about hiring veterans.” 
Since 9/11, more than 2 million men and women have deployed to Iraq, Afghanistan and other conflict zones as part of the war on terror. With up to 20 percent now reporting symptoms of post-traumatic stress disorder, both they -- and their families – must cope with the invisible wounds of war. Symptoms of PTSD can include irritability, isolation, agitation, jumpiness, nightmares, sleep disturbances and substance abuse. All of these can take a toll not just on the person with PTSD, but on their loved ones as well. Dr. Jo Sornborger, director of psychologic health for the UCLA Health Operation Mend program, specializes in the unique mental health needs of veterans and their families. Operation Mend provides advanced surgical and medical treatment, as well as comprehensive psychological support, for post 9/11 service members, veterans and their families. Too often, Sornborgor says, families tend to continuously focus the majority of their physical, emotional and mental resources into taking care of the family member with PTSD, inadvertently creating an imbalance that can both constrain the veteran’s healing and further stress the family. Sornborger points out, however, that a psychological injury such as post-traumatic stress does not mean a person is incapable of contributing to the family’s ability to function as a unit. “It might seem easier to avoid including the injured vet into the daily routines of household, but this strategy comes at a significant cost to the whole family in the long run. It often leaves them drained of internal resources, resentful and can erode the self-worth of the injured veteran,” says the licensed clinical psychologist. “If the family recalibrates the resource distribution, the household will run more efficiently, be more cohesive and everyone will feel like they belong and have a purpose.” To interview Dr.Sornborgor, please contact Amy Albin, UCLA Health Sciences Media Relations, at (310) 267-7095 or aalbin@mednet.ucla.edu. ** UCLA Health Operation Mend (www.operationmend.ucla.edu) provides advanced surgical and medical treatment as well as comprehensive psychological support for post 9/11 service members, veterans and their families. It also offer an intensive, six-week outpatient treatment program for PTSD and TBI in a collaboration between Wounded Warrior Project® and three other  academic medical centers, including Emory Healthcare, Massachusetts General Hospital and Rush University Medical Center, in cooperation with the U.S. Department of Veterans Affairs.
The severity of symptoms can be reduced for individuals with emerging post-traumatic stress disorder through the use of smart phone apps, according to a new study published in the August edition of the journal Cyberpsychology, Behavior, and Social Networking by researchers at the Uniformed Services University (USU).About 10 to 20 percent of U.S. service members returning from Iraq and Afghanistan are believed to have post-traumatic stress disorder (PTSD), associated with impaired physical and mental health, as well as overall functional status.  Sub-threshold PTSD, defined by an insufficient number of symptoms or severity to meet the full criteria of PTSD, is even more common than PTSD. Sub-threshold PTSD also has a 25 percent progression rate to the full disorder, which underscores the importance of early intervention. Considering prior studies have shown it may be more beneficial to address sub-threshold PTSD with lower intensity treatment, researchers at USU’s Center for Neuroscience and Regenerative Medicine (CNRM), in collaboration with the National Intrepid Center of Excellence at the Walter Reed National Military Medical Center, sought to test the feasibility and effectiveness of using not-so-intense smart phone apps to help reduce sub-threshold PTSD symptoms. The researchers provided apps to 144 service members and military family members identified as having sub-threshold PTSD.  The apps were designed to foster engagement in social activities, while promoting relaxation, psychoeducation, and controlled breathing and meditation – approaches that have been linked with enhanced resilience and reduced likelihood of mental health conditions.  Participants were divided into a randomized group and a control group, a majority of which were men and service members, and about half had been deployed to Iraq or Afghanistan. Every day for six weeks, the researchers sent text messages to the randomized group as reminders to use the apps on a daily basis. Meanwhile, the control group received daily texts with inspirational quotes, but weren’t directed to use the apps. Participants in both groups, regardless of whether they were directed to use the apps, reported reduced symptoms of PTSD, anxiety, and depression during the six-week period. However, the group receiving daily texts prompting them to use the apps, did report using the apps more.Participants used a variety of apps, including Tactical Breather, created by the National Center for Telehealth and Technology, a component of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.  This app was designed to teach service members how to use breathing to control their stress, emotions, and physiological responses to stress. Other apps featured techniques to help with relaxation and positive thinking via mindfulness exercises, inspirational quotes, and coping statements.  Both groups of participants reported their reduced symptoms were sustained after three months, but after around six to 12 months, some showed a partial relapse. The researchers suggest evidence of relapse in general is not unexpected since PTSD, depression and anxiety are often more chronic than acute conditions. “Smartphone apps are easy to use anywhere, anytime, so military personnel could even use them just before, or during, deployment to help cope with the stress of deployment,” said Dr. Michael J. Roy, professor of medicine at USU and a retired Army colonel.  Dr. Roy was lead author on the study, funded by CNRM. The researchers also suggest this app-based approach, on a long-term basis, could be beneficial in continuing to reduce sub-threshold PTSD symptoms over time, though further studies will need to be conducted. Automatic alerts could be set up on an individual’s phone, the researchers said, to help promote use of these apps on a long-term basis, or they could be promoted in follow-up visits to their primary or behavioral health care providers.Roy’s study co-authors include Dr. Michelle Costanzo, with USU’s Center for Neuroscience and Regenerative Medicine, Dr. Krista Highland, with USU’s Department of Military and Emergency Medicine, and Dr. Cara Olsen, with USU’s Department of Preventive Medicine and Biostatistics.