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Saturday, May 20, 2017

Rural Doctors’ Training May Be in Jeopardy

 Editor's note: This story has been updated to provide correct information about the amount of money dispensed to the Teaching Health Center Graduate Medical Education program. The information the Health Resources and Services Administration initially provided to Stateline was incorrect.

In nearly two years as a medical resident in Meridian, Mississippi, Dr. John Thames has treated car-wreck victims, people with chest pains and malnourished infants. Patients have arrived with lacerations, with burns, or in a disoriented fog after discontinuing their psychiatric medications.

Thames, a small-town Mississippi native, said the East Central Mississippi HealthNet Rural Family Medicine Residency Program has been “exactly what I was looking for.”

Unlike the vast majority of doctors, Thames sought a residency in a rural clinic instead of in a teaching hospital because his ambition is to practice in the sort of place where he grew up, where doctors are scarce. He wants to be able to handle anything that comes through the door, from infections to gunshot wounds to a woman who might deliver a baby any second.

But budget decisions in faraway Washington, D.C., may make it more difficult for Thames and other doctors who want to practice in small towns or underserved cities.

Under the Teaching Health Center Graduate Medical Education program, which is part of the Affordable Care Act, the federal government dispenses grants to community health centers to train medical residents. The goal of the program is to address the shortage of primary care physicians in rural and poor urban areas.

But under current law, the federal government will stop funding the program, which serves nearly 750 primary care residents in 27 states and Washington, D.C., at the end of September. Without congressional action, it might be shut down. 

“The program is absolutely doing what it is designed to do, which is to put doctors in underserved areas like ours,” said Darrick Nelson, the director of Hidalgo Medical Services’ teaching health center program, which is training six residents in Lordsburg, New Mexico.

The teaching health centers have received bipartisan support in the past. But supporters worry that because the program is new, relatively small, and not as well-known as other federally funded doctor training programs, it might fall through the federal budgetary cracks.

“The greatest threat to the teaching health centers is the dysfunction in Washington,” said Dan Hawkins, a vice president at the National Association of Community Health Centers, a research and advocacy group.
Earlier Cuts
Bipartisan support didn’t protect the program from earlier cuts. In 2010, Congress allocated $230 million over five years. When it approved a two-year extension in 2015, it provided $60 million a year which, because of growth in the program, resulted in a reduction in the level of support per resident. That reduction was enough to cause some of the teaching health centers to train fewer residents. Some have closed.

Studies have found that most physicians end up practicing close to where they did their residencies. But most teaching hospitals are located in urban centers, far from rural regions with acute doctor shortages. Poor urban neighborhoods also have difficulty attracting physicians.

The American Association of Teaching Health Centers, a nonprofit advocacy group, said the ACA residency program is having the intended result. According to the organization, 55 percent of teaching health center graduates practice in underserved areas, compared to 26 percent of those who graduate from hospital-based residencies.

“The program is doing exactly what we wanted it to do,” said John Sealey, director of medical education for Authority Health in Detroit. More than 60 percent of residents who graduated from teaching health centers in Detroit go on to practice in medically underserved areas, many of them in Michigan, he said.

Progress in Montana
RiverStone Health, a health care provider in Billings, Montana, was a teaching health center even before the federal program began. RiverStone started training residents in 1998, after partnering with two local hospitals.

“The state was completely reliant on recruiting from other areas, which was clearly not working as well as it should,” said Roxanne Fahrenwald, a RiverStone vice president. Fifty-one out of 56 Montana counties have shortages of primary care doctors, according to the federal government.

With the federal money awarded to it under the ACA, RiverStone has been able to add one medical resident a year to its program, bringing its number of residents to 24. About 70 percent of RiverStone graduates have remained in the state.

Supporters also argue that teaching health centers expose residents to the types of ailments and health disparities, such as higher rates of obesity, diabetes and heart disease, that they are likely to encounter if they practice primary care in underserved areas.
“In a community health center, most of the patients are going to present with conditions or ailments more common to a primary care practice, whereas those in the hospital will be sicker, with more acute needs,” said Shawn Martin, a vice president at the American Academy of Family Physicians.

The residents in teaching health centers do spend some of their time training in hospitals. They must complete hospital rotations in surgery, inpatient care, obstetrics and gynecology.

But health center residents also see what many hospital residents never do. In Washington, D.C., for example, medical residents at Unity Health Care Inc. often work in jails, homeless shelters and HIV/AIDS clinics.

Those receiving care at such sites would bear the brunt of the impact if federal money for the health center residency program disappears.

“I’m very nervous,” said Eleni O’Donovan, director of the teaching health center program at Unity. “The program is not sustainable without that funding.” 

Wednesday, November 30, 2016

Can You Hear The Corn Grow? Yes!

 Spoiler alert: The sound corn emits while growing is surprisingly similar to the sound of breaking corn, and one possible reason behind it may radically change the way we think about plant growth

Newswise, November 30, 2016 -- There’s an old farmer’s tale that says, “On a quiet night you can hear the corn grow.” It may seem funny, but Douglas Cook at New York University and colleagues Roger Elmore and Justin McMechan, at the University of Nebraska, were able to use contact microphones to directly record the sounds of corn growing.

Corn is the leading grain crop in the U.S. with more than 350 million metric tons harvested yearly. But a lack of understanding about the mechanics involved in wind-induced corn stalk failure has hindered further improvements in corn production. Crop scientists have been working on this problem for more than 100 years, albeit with only marginal success.

Now, by applying mechanical engineering tools and techniques, a group of engineers and plant scientists led by Cook are making headway addressing this problem as well as discovering other issues related to plant growth and development.

During the 172nd Meeting of the Acoustical Society of America and the 5th Joint Meeting with Acoustical Society of Japan, being held Nov. 28-Dec. 2, 2016, in Honolulu, Hawaii, Cook will describe his work using acoustic emissions techniques to explore corn stalk growth and breakage.

“Material breakage is a lot like a microscopic earthquake: the sudden release of internal stresses sends sound waves radiating in every direction,” Cook explained.

“We’re using special sensors called piezoelectric contact microphones to monitor the sounds emitted by corn stalks just before failure. This helps us understand the failure process more clearly.”

So what does it sound like? “Surprisingly, it sounds remarkably similar to the sounds made when corn breaks,” Cook said.

“We now think that plant growth involves millions of tiny breakage events, and that these breakage events trigger the plant to rush to ‘repair’ the broken regions. By continuously breaking and repairing, the plant is able to grow taller and taller.”

While the researchers haven’t yet determined whether this is true for all plants, Cook suggested that it may be a mechanism similar to that involved in muscle development: Lifting weights imparts tiny micro-tears in the muscle and, as these are repaired, the muscle is strengthened.

This intriguing finding is the result of the fusion of two seemingly unrelated disciplines: plant science and mechanical engineering.

“Many crops are lost each year due to wind damage,” Cook said. “Engineers know a lot about how to prevent structural failure, and by using natural breeding techniques plant scientists can improve virtually any feature of the plant that they can measure. So you can imagine that a great deal of progress in plant structural integrity can be achieved by these two disciplines working together.”

In terms of applications, “this is a very young field of research, so most of our work is still quite fundamental in nature,” Cook said. “We’re learning about plant growth and breakage, which could be useful to breeders when developing optimally designed plants.”

For example, they’ve learned that the leaves of corn plants actually provide the majority of structural support during periods of rapid growth. That’s quite amazing according to Cook -- and not a role a leaf is typically expected to play. So it should help plant scientists start developing new varieties with tougher leaves that are less susceptible to failure during the growth phase.

Cook’s background is in human biomechanics, so he and colleagues are currently using computerized tomography (CT) technology to obtain 3-D images of plants.

“We also plan to use magnetic resonance imaging (MRI) technology to visualize corn growth and development,” Cook added. “We’d like to learn more about stalk failure -- with a goal of identifying the ‘weakest link’ within the stalk failure process. Once it’s identified, plant scientists can try to improve stalk strength and resilience.”

Monday, November 7, 2016

Can the Arts Help Save Rural America?

 (Pew Charitable Trust, Stateline)

Will Performing Arts help save Rural America

Hayes Carll performing at the 2016 Red Ants Pants Music Festival in White Sulphur Springs, Montana. Some small towns are looking to the arts as a way of attracting money and people.
© Tony Demin

IOWA CITY, Iowa, November 7, 2016 — Ten years ago, Sarah Calhoun became a 21st century pioneer, staking a claim in a town far from her Connecticut roots: White Sulphur Springs, Montana, population 939, located in what was then the poorest county in the nation.

The logging industry had dried up in the mountain town, but Calhoun saw potential. So she launched Red Ants Pants, manufacturing work wear for women.

She started an online business and opened a brick and mortar store, and then a music festival with big-name talent like Lyle Lovett and Wynonna Judd.

The festival brought thousands of music fans to White Sulphur Springs and generated money to help finance rural enterprises. Today, the once ramshackle downtown has been revitalized as other businesses have popped up.

Which is why Calhoun was at a conference in Iowa City last week, standing before a crowd of other rural denizens, business leaders, artists and policymakers, preaching about the role the arts can play in bringing timeworn towns back to life.

“I want to make rural America sexy again,” Calhoun said. And the arts, she said, are a way to help do just that.

As post-recession, rural America continues to struggle, some rural leaders, using private and public funding, are experimenting with the arts as a tool to fuel economic and community development like they did for White Sulfur Springs.

The National Endowment for the Arts is helping by giving $125,000 in seed money to fund a “Next Generation” initiative to help build arts hubs in rural America.

The idea is to connect artists, arts groups, civic leaders and philanthropists and encourage them to create sustainable cultural scenes in rural communities to help spur economic development and entice new, young residents. Iowa, Kentucky and Minnesota participated this year. Other states seek to join next year.

“You need arts in rural America so that the next generation wants to come there and live,” said Charles Fluharty, president and CEO of the Rural Policy Research Institute, a public policy institute located at the University of Iowa College of Public Health.

“If you do not build vibrant, inclusive, diverse places for young people, they’re not going to raise their families there. They’re simply not. And those communities will wither away,” Fluharty said.

Around the nation, arts are helping a handful of rural communities make a go of it. Marfa, a remote desert town in Texas with a population of 1,765, has become an international arts mecca among fashionistas.

Every summer for the last 45 years, 12,000 people swarm Winfield, Kansas, pitching their tents at the town’s annual bluegrass music festival and temporarily doubling the city’s population.

Business leaders and city administrators say it’s almost impossible to pin a dollar figure on the amount of revenue arts and entertainment can bring to a rural community. In 2013, arts and cultural production contributed $704 billion to the U.S. economy and supported 4.7 million jobs.

Community leaders say the arts can foster community pride and create jobs, even on a modest scale. To be successful, they say, a rural community must figure out what makes it unique — a gorgeous natural landscape that can serve as the backdrop for a writers’ retreat, an old opera house, or a tradition of local storytelling — and capitalize on that.

“People say, ‘I’m going to Winfield.’ They don’t say, ‘I’m going to the Walnut Valley Festival.’ The festival is giving us this name recognition. You could never pay for that type of recognition,” said Warren Porter, Winfield’s city manager.

Tourists flock to Lanesboro, Minnesota, population 754, a historic town known for its Victorian architecture and scenic river bikeway, to take in theater, art galleries, museums, film festivals and live music. 

Smithsonian magazine named it one of its “20 Best Small Towns to Visit.” (Minnesota has an arts and heritage fund paid for with revenue from state sales taxes.)

There, the entire town was declared an arts campus two years ago. And with $1.3 million in local, state and federal funding, the town has been renovating facilities, helping artists relocate there and developing an artist residency center, said John Davis, executive director of Lanesboro Arts, a coordinating organization. In the meantime, 10 businesses have opened in town.

Owensboro, a small city in western Kentucky located on the Ohio River, has invested $260 million of public and private money to revamp its downtown riverfront and convention center and build a new building for its International Bluegrass Music Museum.

The city was known for its museum, which opened in 1991 and “set the tone for creating a brand for arts and culture,” said Joe Berry, vice president of entrepreneurship for the Greater Owensboro Economic Development Corporation. The town also has a symphony and a pre-professional ballet company.

“We’ve watched our state government send money to everywhere but Owensboro,” Berry said. “We decided we’re not going to wait for our state government to help us. We’re going to roll up our sleeves and figure out how to do it ourselves.”

Remaking Small Town America

At the “Next Generation” summit in Iowa City, artists and policy wonks from 35 states crammed in conference rooms to talk strategy, breaking every now and then to take in a performance from a storyteller or folk singer.

They toss around the term “creative placemaking,” an earnest shorthand for building economically viable arts hubs.

The bit of jargon belies the urgency that many rural communities face, said Bob Reeder, program director of Rural LISC (the rural component of the Local Initiatives Support Corporation), a Washington, D.C.-based nonprofit that works with rural communities to stimulate economic development.

In nearly half of the country’s rural counties, more people have moved out than have moved in during every decade since the 1950s. Many rural communities are blighted, with vacant buildings and crumbling infrastructure. Rural unemployment has eased up since the recession, but creating jobs remains a challenge.

“There are many rural communities that are threatened with becoming a ghost town,” Reeder said. “Can the arts save rural America? I would never call it a panacea, but it’s another strategy that we have in our toolkit.”

Metropolitan areas receive community development block grants from the U.S. Department of Housing and Urban Development, which give them the flexibility to do long-term strategic planning.

In contrast, rural communities have to compete for funding. They can apply for a federal HUD grant. And they receive competitive grants from their governor’s office, which are typically meted out every few years. By the time that funding comes around, it usually goes to obtaining, say, a new fire truck, rather than creating an arts scene.

“That’s a massive disadvantage to community development,” Fluharty said.

Escaping the Big City

Zachary Mannheimer, a former New Yorker who moved to Iowa nine years ago, travels his adopted state consulting with small towns on how to convert their abandoned hospitals and hotels into multiuse facilities that incorporate rental housing for young professionals, restaurants and community arts centers.

The idea is to make a town attractive to young people, said Mannheimer of the Iowa Business Growth Company, a for-profit economic development group that uses federal and state loans and tax credits to fund small business startups in towns across the state.

Increasingly, Mannheimer said, young creative types are being forced out of big cities and are looking for less expensive places to live. And many people eventually tire of metropolis living and seek a less hectic existence.

A recent study by the Center for Rural Entrepreneurship found that half of the young people from rural communities said that they would love to stay in their hometowns if there were real career opportunities available for them. That means small town America needs to prepare to welcome them back.

“Towns have to be prepared for 30 years from now. It’s all about figuring out what does your town have that no other town on the planet has,” Mannheimer said.

Rural communities should think small in starting to revitalize themselves, said Reeder of Rural LISC.

Trying to woo back manufacturing in today’s service-driven economy is not realistic, he said. All too often, big corporations swoop into a rural community but don’t end up hiring many locals.

And they rarely stick around, he said, leaving carcasses of abandoned industrial parks.

“Don’t be trying to get a Wal-Mart,” Reeder said. For every dollar spent in these stores, 90 cents goes outside the community, he said. “For every dollar spent in a local food mart, just the opposite happens.”

‘Capital of Quirkiness’

Sometimes becoming a tourist mecca has its downside, especially if a town doesn’t have the infrastructure to support the boom.

In Marfa, for example, there’s no room to grow, said James Mustard, the city administrator. The town is landlocked, bordered by ranches that have been owned by a handful of families for years.

In the 1970s, the artist Donald Judd left New York for Marfa. He bought a chunk of land, and with foundation money, populated Marfa with all kinds of art installations. CBS’s “60 Minutes” dubbed the town “the capital of quirkiness.”

Over the years, hipsters from New York and Los Angeles gobbled up the housing stock to use as second homes. As a result, appraised housing values skyrocketed, and some locals complained about a jump in their property taxes. Part-timers rented out their homes on Airbnb. Affordable housing shrank.

“We have few vacant lots,” Mustard said. “You can’t build a subdivision. You can’t build 20 new houses.”

But as Calhoun of the Red Ants Pants Music Festival in White Sulphur Springs sees it, with careful planning, a community can take advantage of tourism dollars.

The proceeds from the annual music fest go to a foundation that funds leadership programs for women, and provides grants to improve rural communities and support family farms and ranches.

Her county is no longer the poorest in the nation. White Sulphur Springs has a new Main Street, sporting goods store, brewery and bakery — and new sidewalks and streetlights. It soon will have a new school and library.

But Calhoun is not interested in seeing White Sulphur Springs become a boom town. There’s a reason why she moved to the middle of nowhere.

“Getting bigger isn’t the solution. Getting better is. If you design it for the tourists, you’re making a mistake,” said Calhoun, who represented Montana last year at the White House’s Small Business Leadership Summit. “Design it for your community. Then the others will come.” 

Wednesday, October 26, 2016

As Rural America Ages, Volunteers Give a Hand

© The Pew Charitable Trusts

Volunteers help aging Rural America
Dave Brown, 75, a volunteer for the Harpswell Aging at Home team, insulates the floor under a house in coastal Maine. Volunteers in the graying state are helping seniors remain in their homes.
HARPSWELL, Maine, October 26, 2016 — Dianna Haller loved her small, one-story home in this coastal fishing town, but it didn’t love her back. The living room floor was sagging. Snakes and mice were wriggling in through a gap under the front door. And mold was seeping in through a crawl space full of standing water.

Haller, a 65-year-old widow with chronic obstructive pulmonary disease who uses an oxygen generator, was rushed to the emergency room several times this year because of breathing problems her doctors said were exacerbated by the mold. She badly needed help, but couldn’t afford the repairs.

Last month, the Harpswell Aging at Home team came to Haller’s rescue. The group of volunteers in their 60s and 70s, dubbed the Dream Team, went to work insulating and shoring up the floor, sealing the foundation, rebuilding the front door, installing rain gutters and storm windows, replacing ceiling lights that were fire hazards, and doing other work — all for free.

Across Maine, volunteers are stepping up to help rural seniors like Haller who want to remain in their homes as they age. Some work with local governments or nonprofits. Others have simply gotten together to offer a hand. Many of them are seniors themselves.

And what they are doing can be emulated by the rest of the nation, as the number of people 65 and over is projected to explode from 48 million to 77 million between now and 2035.

Maine’s rural population is older than that of most other states. Demographers project that a third of the state’s population will be 65 and over by 2032.

And the challenges confronting Maine as it deals with an aging population are turning up elsewhere. Rural America is aging faster than its urban counterparts, as fewer children are born and younger, working-age adults are moving away.

John Cromartie, a U.S. Department of Agriculture geographer, said the problems would be particularly severe in New England, the Great Plains and Midwest farming states.

“The rural areas are the canary in the coal mine,” he said. “In lots of cases, older people don’t have the means to leave, even if they wanted to. And many want to stay because it’s where they were born or settled down and raised a family.”

Local governments cannot afford to pay for all the services needed to help seniors stay in their homes.

State governments face the same dilemma. And retrofitting a house for aging people can be expensive. It can cost $800 to $1,200 to widen a doorway to accommodate a wheelchair, $1,600 to $3,200 for a ramp, and up to $12,000 for a stair lift.

That’s what makes Maine’s growing volunteer network so valuable.

“There isn’t enough money in Maine to deal with this problem,” said Jess Maurer, executive director of the Maine Association of Area Agencies on Aging. “It’s going to have to be community by community, using volunteers and public and private resources.”

Already, more than 60 communities throughout the state have started or are in the process of starting programs to help seniors age in their homes, Maurer said.

Some volunteers offer rides. Others grow and donate fresh fruit and vegetables. Some offer respite to caregivers. And many, like the Harpswell Aging at Home team, perform home maintenance or do chores that residents can’t do themselves.

Sandy Markwood, CEO of the National Association of Area Agencies on Aging, called what’s going on in Maine a model for other states.

“These are really small communities doing incremental changes that make a huge difference to the people who live there. They’re doing it with existing resources and the human capital they have there.”

As in other rural areas, many of Maine’s seniors live in multilevel homes without a bathroom or bedroom on the first floor.

When they can no longer drive, there’s little, if any, public transportation available, and grocery stores, pharmacies and doctors can be far away. Experts say older adults who stay in their homes often do less maintenance as the years go by, so their houses often deteriorate.

“The challenges in rural areas are probably the most severe,” said Susan Reinhard, a senior vice president at the AARP Public Policy Institute. “Isolation is a serious problem. Depression goes up. Physical health declines.”

For Haller, the Dream Team not only improved her house but improved her health. She is breathing better and hasn’t been to the hospital since they did the work. “You used to smell the mold all the time,” she told volunteers who arrived to make more repairs this month. “Now I can smell the salt air.”

At the Forefront of a Trend

In Maine, people 65 and over made up 19 percent of the state’s population last year, up from 16 percent in 2010. And many state officials and advocates foresaw the coming trend.

In 2013, the Maine Council on Aging and House Speaker Mark Eves held a series of roundtable discussions about the issue with leaders of business, finance, housing, philanthropy and state and local government.

That provided a framework for a summit on aging that drew 400 people in 2014, and resulted in the Maine Aging Initiative, in which groups across the state try to come up with ways to tackle the challenges posed by an older population.

Among the Initiative’s recommendations: Urging communities to help the elderly remain in their homes.

Advocates for seniors in Maine, New Hampshire and Vermont also share information about ways to help keep seniors in their homes and beef up efforts to make communities more age-friendly. The partnership is now working with more than a hundred communities in the three states.

And in 2015, Eves, a Democrat, and state Sen. David Burns, a Republican, created a legislative caucus on aging. Since then, the Legislature has passed or funded 16 measures to help older adults, including more funding for home-delivered meals and in-home care workers and expanded property tax relief for seniors.

“One of our goals wasn’t just to pass legislation, but to elevate the profile of these issues affecting our aging population so people can take the initiative,” Eves said. “If you fast-forward 10 years, I think Maine will have some lessons for other states, particularly rural ones, about how to do it well.”

Lending a Hand

Many of the lessons in Maine are to be found in the volunteer and civic groups that have sprung up or stepped in to help seniors continue to live at home.

The Dream Team in Harpswell was modeled after another home modification team, The Regulars, a group of retiree Habitat for Humanity volunteers who have been helping seniors in mid-coast Maine since 2014.

Last year, the John T. Gorman Foundation gave Bath Housing, a regional housing authority, a $156,000 grant to help seniors make home modifications. The agency used $69,000 from the grant to contract with Habitat to expand The Regulars’ work.

Like the Dream Team, The Regulars are an eclectic group of retirees, including a lawyer, an engineer, an FBI agent and an English professor, who volunteer for Habitat.
They work twice a week, rain or shine or snow — which is why they’re called The Regulars. They have taken on 60 jobs throughout the area.

They’ve done everything from widening doors and fixing gutters to replacing floors to installing ramps. Habitat pays for materials, trains the volunteers, and provides liability insurance, staff support and a van with tools.

Many seniors who’ve gotten help from The Regulars live in substandard housing or mobile homes, which often are not insulated and can be freezing during long, cold Maine winters.

“One guy who had five bypass operations had no heat. We got the furnace working,” said George Shaw, 76, a volunteer. “We’re these people’s peers. We make them feel like they’re being helped by their own community.”

Kathy Smith, development director for Habitat for Humanity-7 Rivers Maine, said it’s not just rural seniors living in modest homes or trailers who need help. The group has assisted people who live in larger houses that are worth more, but don’t have the income to maintain them.

The Village Lodge Handy Brigade, run by a team of Masonic lodge brothers whose ages range from 19 to the mid-70s, assists seniors in the small farming town of Bowdoinham and in two other towns with everything from changing lightbulbs and installing smoke detectors to replacing storm windows and making minor carpentry fixes.

“This program helps people maintain their independence and keeps their property from deteriorating,” said Peter Warner, 60, the Masons’ lodge master.

Warner said that since his team, whose motto is “One light bulb at a time,” organized in February, it has helped about 30 seniors. On a recent fall day, two team volunteers visited the home of a grateful 76-year-old woman and her disabled sons to replace ceiling tiles in a bathroom ruined by a plumbing leak.

“Older folks don’t want to be seen as needing help, but with the Handy Brigade, they know of them and may even have someone in their family who was a Mason,” said Patricia Oh, who coordinates senior services for Bowdoinham and works with the team.
‘Life Experience to Share’

Cumberland is another Maine town committed to helping seniors remain in their homes. It budgets about $50,000 a year for an aging in place initiative that includes a program that sends trained volunteers to spend time with seniors who feel lonely or who live with a caregiver who needs a break.
Susan Gold, the town’s Aging in Place coordinator, said the program offers social and psychological support, and isn’t income-based. “Providing a friend isn’t something you can buy, even if you have a million bucks,” she said.

For Brian and Judy Hathaway, both 76, a weekly visit from volunteer Heidi Kleban makes a big difference.

Judy Hathaway suffered a stroke nearly 10 years ago. She has difficulty communicating and often gets frustrated. Her caregiver husband said he desperately needs some time away, and when Kleban visits he can take off and know his wife is having a good time playing cards or taking walks. “Heidi comes in and Judy just melts. She loves her,” he said.

Kleban, 46, said she volunteers because she enjoys the company of older people. “They have a whole life experience to share,” she said. “And besides, who else would have taught me gin rummy?”

Monday, October 24, 2016

Study Suggests Farm Traffic Vehicle Accidents Could Be Reduced By More Than Half

Cutting Farm accidentsState policies that increase lighting and reflecting recommendations for farmers can significantly reduce accidents involving tractors and other farm vehicles

Newswise, October 24, 2016 — A new study from the University of Iowa College of Public Health has found that traffic accidents involving farm vehicles in the Midwest would decrease by more than 50 percent if state policies required more lighting and reflection on those vehicles.

The study by the college’s Great Plains Center for Agricultural Health (GPCAH) compared rates of farm equipment–related crashes in nine Midwestern states in the context of the states’ policies on lighting and marking vehicles.

Those states report an average of more than 1,100 farm vehicle-related crashes each year, often causing severe or fatal injuries.

The American Society of Agricultural and Biological Engineers (ASABE) has issued standards on lighting and marking farm vehicles to promote safety among all roadway users.

The standards suggest certain numbers of headlights, taillights, turn signals, and other exterior lighting visible to other drivers, as well as the number and size of reflective markers.

The organization’s standards are not all required by state laws, but many of the nine states in the study have adopted some of them or have their own policies that address the same issues.

The researchers found fewer crashes in states with more stringent lighting and marking policies, in particular those that adhered to ASABE’s standards.

States with greater compliance with ASABE standards had 11 percent fewer farm equipment road crashes than states with lesser compliance. Illinois law and policies were most compliant with the standards, whereas Missouri's were the least.

Using data from 2005 to 2010, researchers estimate the number of accidents annually would be cut 60 percent, from 972 to 385, if states implemented policies that increased compliance with ASABE standards by 25 percent over current policies.

In Iowa, the study estimates crashes would decrease from an annual average of 164 to 65, or by 60 percent
Marizen Ramirez, UI professor of occupational and environmental health and lead investigator on the study, says most farm vehicle–passenger vehicle collisions occur because most passenger vehicle drivers are not familiar with farm vehicles and cannot correctly gauge the speed at which they are moving. This often leads to vehicles approaching too quickly and attempting to pass in unsafe conditions, which can result in a crash.

She says the likelihood of a crash is greater in October and November, when more farm vehicles are on the road for the harvest and the sun sets earlier.

“We know that farmers spend a lot of time on the roads, especially during planting and harvest,” she says. “Our research shows that lighting and marking—like reflectors, slow-moving vehicle emblems, and taillights—can help farm vehicles stand out on roadways so passenger vehicle operators are more likely to see them. It helps to do all that you can to increase your visibility on the road, especially when farmers may be driving during and after dawn or dusk.”

Thursday, August 11, 2016

Program Will Train Mental Health Providers, Improve Health Care in Rural Missouri

Missouri program to boost Rural Communities
August 11, 2016--According to the U.S. Census, 37 percent of Missourians live in rural communities and have limited access to health care, particularly mental health care.

A new graduate education program at the University of Missouri has received nearly $700,000 from the Health Resources and Services Administration (HRSA) in the U.S. Department of Health and Human Services to train psychology doctoral candidates in integrated, primary health care settings, in an effort to improve health care for underserved populations with mental health and physical disorders.

“Placing psychology doctoral candidates within primary health care agencies will enhance the current infrastructure in Missouri’s communities and improve comprehensive care for patients,” said Laura Schopp, professor of health psychology and co-principal investigator for the training program.

“For example, a patient with diabetes may need psychological help to address mental barriers that could be preventing them from changing their behavior. Having psychologists working side-by-side with primary care providers should result in better patient outcomes and savings to the state in Medicaid dollars.”

The funding will support several training partnerships and placements throughout Missouri including:
• Missouri Department of Mental Health and Community Mental Health Centers
• Missouri Division of Vocational Rehabilitation
• Family and Community Medicine Clinics in the MU School of Medicine
• MU Thompson Center for Autism and Neurodevelopmental Disorders
• Harry S Truman VA Medical Center
• Fort Leonard Wood Army Post

“Previous research has indicated the need for a comprehensive approach to health care,” Schopp said. “If we treat the whole person—mind and body—patients will have significantly better health outcomes. This new training program will allow people to help patients that do not have access to the psychological care that they need.”

The HRSA Graduate Psychology Education program at MU is being led by Brick Johnstone, professor of health psychology in the MU School of Health Professions. Along with Schopp, the program is being assisted by Eric Hart, associate clinical professor of health psychology and training director; Renee Stucky, professor at the Comprehensive Pain Management Center in the MU School of Medicine; Nikole Cronk, associate teaching professor of family and community medicine in the MU School of Medicine; and psychologists from the MU department of health psychology.

This project is supported by HRSA of the U.S. Department of Health and Human Services under grant number 1D40HP29827-01-00 for $699,772 over a three-year period. As required by the grant, MU provides some benefits to graduate students who contribute to this work. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 

Wednesday, August 3, 2016

Sweet Potato Crop Shows Promise as Feed and Fuel

Newswise, August 3, 2016 --As some Florida growers try to find new crops and the demand for biofuel stock increases globally, University of Florida Institute of Food and Agricultural Sciences researchers have found that sweet potato vines, usually thrown out during harvest, can serve well as livestock feed while the roots are an ideal source for biofuel.

This could be a key finding for the agriculture industry in Florida and to biofuel needs worldwide, said post-doctoral researcher Wendy Mussoline.

“The agriculture industry in Florida is looking to find new, viable crops to replace the citrus groves that have been diminished by the greening disease,” Mussoline said.

“Potato farmers are also trying to find new crops that offer both biofuel alternatives as well as food and/or animal feed opportunities. They are conducting field trials on several varieties of sweet potatoes to determine if they are an economically viable crop that they can market.”

According to a newly published study by professor Ann Wilkie and Mussoline, an industrial sweet potato variety (CX-1) may do the trick.

Currently, 99 percent of the ethanol produced in the United States comes from corn or sorghum, the study says. But scientists and business interests are considering highly productive alternatives such as sweet potatoes for biofuel. Although China produces 81 percent of the world’s sweet potatoes, U.S. sweet potato production reached a record high of 3.2 billion pounds in 2014, according to the U.S. Department of Agriculture.

Wilkie and Mussoline, both researchers in the UF/IFAS soil and water sciences department, found that CX-1 is a superior choice as a dual-purpose crop than the so-called “table” varieties – which people would normally eat -- known as Beauregard and Hernandez.

They determined this by putting CX-1, Beauregard and Hernandez, through multiple tests in the field and laboratory in Gainesville.

“The CX-1 roots have higher starch content and thus higher potential for fuel ethanol yields than the table varieties,” Mussoline said.

The study demonstrated CX-1’s value as animal feed and promotes the industrial sweet potato crop as a dual-purpose crop that could be used for both fuel ethanol -- from the starchy roots -- and nutritious animal feed -- from the vines.

“Although this would be a ‘new’ feedstock for biofuels in the U.S., sweet potato is currently used in other countries; for example, China and Brazil, use it as a biofuel feedstock,” Mussoline said.

“The sweet potato is a high-yielding crop suited to tropical and subtropical climates that requires minimal fertilization and irrigation, and the CX-1 industrial cultivar offers superior potential for feed and fuel,” Wilkie said.

The research was sponsored by the Florida Department of Agriculture and Consumer Services Office of Energy.

The new study is published online in the Journal of the Science of Food and Agriculture,