Category: Health

Art and Healing Intersect at 11th Street Health Center with Mural Arts Porch Light Initiative

Originally posted on DrexelNow.

Can creating art heal a person, connect a family, or even strengthen a whole neighborhood? Members of the community served by Drexel’s 11th Street Family Health Services (11th Street) center in North Philadelphia are participating in a transformative neighborhood art project that aims to answer those questions.

The Porch Light Initiative, a project of the Mural Arts Program and the City of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services, situates art and human connection at the heart of recovery and healing in distressed Philadelphia neighborhoods. In fall 2012, Drexel’s community-based, nurse-run health center became a participating site for Porch Light’s third year.

Under the guidance of an artist, a creative arts therapist and Mural Arts Porch Light Initiative staff, 11th Street is hosting weekly workshops for referred behavioral health patients, monthly open studios for the entire community and other events for public participation and project feedback. These activities will culminate with the creation of works of public art in the neighborhood in the spring of 2013 and a dedication event in the fall.

The Porch Light Initiative is based on the premise that art can play a critical role in healing, resilience and wellness. It is designed to help all participants– individuals who are healing, artists, community members, service providers and city government – create a connection to each other through the creation of participatory community-driven art. Porch Light’s organizers and participants hope these connections will be powerful forces as all work to make the community vibrant, healthy and strong.

Artwork of the concept of home by a participant in the Porch Light Initiative at 11th Street Family Health ServicesPorch Light participants at 11th Street have reported early benefits from their participation in these activities:

“Being a part of Porch Light has helped me take care of me better.  It helps me relax and puts me in control,” said Sherman, a participant who chose not to use his last name for privacy.

“Porch Light makes me feel good about my neighborhood and I’m excited about the entire city being able to notice my neighborhood in a positive light with the new murals,” said another participant, Bridgette.

“It’s incredible to me that a group of 11th Street patients are convening every week for nine months to further create meaning in their own lives, and simultaneously represent the community by discussing historic meaning that Richard Allen [local public housing] residents would appreciate seeing in the murals,” said Lindsay Meeks, 11th Street’s director of Creative Arts Therapies. “Although the murals will be the culminating product shared with all, this process of building trusting relationships, and generating communal stewardship, could be the longest lasting product.”

A Holistic Approach to Healthy Living

Drexel’s 11th Street Family Health Services is an interdisciplinary community-based health center run by the College of Nursing and Health Professions in collaboration with the Family Practice and Counseling Network to meet the needs of a historically underserved population. Patients at 11th Street see a core care team that includes a nurse practitioner, behavioral health specialist and social worker. In addition, based on the needs of the community, the center offers a wide array of health and wellness services including nutritional support and education, dental services, physical therapy, creative arts therapies and mindfulness meditation. The center has been cited as a model by the Agency for Healthcare Research and Quality of the U.S. Department of Health & Human Services, and by the Robert Wood Johnson Foundation.

“We’re thrilled that 11th Street has joined as a partner in Porch Light’s third year,” said Dr. Arthur C. Evans, commissioner of the City of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services. “As an integrated, holistic behavioral health and physical health center, 11th Street is willing to step outside the traditional medical treatment box in innovative ways to improve individual and community health. Their approach is entirely consistent with the values and methods that the Department of Behavioral Health and Intellectual disAbility Services is taking in its public health approach to improving the population’s behavioral health.”

“The Porch Light program has added another dimension to the wide range of services offered at the center,” said Dr. Patricia Gerrity, director of 11th Street and a professor and associate dean for community programs in Drexel’s College of Nursing and Health Professions. “The extraordinary aspect of the program is its design and success in bringing patients, staff and the community together to improve their collective understanding and sensitivity to behavioral health through the creation of public art.”

Artwork of the concept of home, by a participant in the Porch Light Initiative at 11th StreetThe holistic approach to health at 11th Street sets it apart from other Porch Light sites, according to Sara Ansell, program manager of the Porch Light Initiative. She said it was easy to integrate Porch Light’s guided art activities with a group of patients who are accustomed to attending health promotion classes, such as cooking and yoga, at the center.

In addition, Ansell said, “11th Street has pushed us in a good way to broaden our language to make it applicable to any participants enrolled at all three sites this year.” Several of the other sites participating in Porch Light now and in the previous two years are centers focusing on treatment for substance abuse and specific behavioral health issues, Ansell said. “Now we talk about ‘healing’, rather than ‘recovery’; ‘therapeutic activity’, rather than treatment.’”

The Science of Healing through Art

A broader approach to healing through art could reap further benefits for health providers and artists who can implement art programs based on Porch Light’s model in the future. Ansell said that the Porch Light Initiative is developing guidelines to replicate its program at other sites around the country.

The program’s deep integration of measurement and evaluation into the program’s design will help shape that future planning. Researchers from Yale University’s School of Medicine are conducting a comprehensive scientific evaluation of Porch Light and its impact on health at the individual and neighborhood level.

At 11th Street and other Porch Light sites, researchers are conducting interviews with individual participants over time as well as in-depth case studies to assess the impact of Porch Light’s creative and therapeutic activities on individual well-being. In addition, researchers are measuring community outcomes to determine the potential impact of public art on the revitalization of the neighborhood. These measures include residents’ perceptions of neighborhood safety and reduction of neighborhood blight.

A participant in the Porch Light Initiative draws with colorful markers.The preliminary results from Yale’s study, based on data collected last year, are expected to be released in early Spring 2013.

“This is a true intersection of art and science,” Ansell said. “Measuring Porch Light in this way will help us better understand the impact of the work and shed light on what we can do better moving forward.”

For ongoing updates about the Porch Light Initiative and 11th Street’s participation, follow 11th Street and Porch Light on Facebook: http://www.facebook.com/eleventhstreethealthservices and http://www.facebook.com/PorchLightInitiative.

About the Mural Arts Program: For 28 years, the Mural Arts Program has united artists and communities through a collaborative process, rooted in the traditions of mural-making, to create art that transforms public spaces and individual lives.  At the heart of its work are the 50 to 100 mural and other public art projects it leads each year.  These projects range in scale and purpose, but all include a diversity of stakeholders in the creation of the artwork, and working with partners to align projects to existing strategies.  This deeply collaborative approach to creating public art builds social capital, inspires a sense of communal ownership over public space, and empowers people to continue to work for positive change in their communities.  The murals also create unique project-based learning opportunities for thousands of marginalized youth and adults in Art Education for Youth, Restorative Justice, and Behavioral Health programs.

– See more at: http://drexel.edu/now/archive/2013/January/11th-Street-Health-Center-Mural-Arts-Porch-Light/

Researchers Describe the Physical Forces Underlying Sickle Cell Disease

An oxygenated red blood cell (left) is disc-shaped and flexible. A red blood cell in a sickle disease patient, when not carrying oxygen, forms a larger, rigid sickle shape (right).

Originally posted on DrexelNow.

Researchers at Drexel University have identified the physical forces in red blood cells and blood vessels underlying the painful symptoms of sickle cell disease. Their experiment, the first to answer a scientific question about sickle cell disease using microfluidics engineering methods, may help future researchers better determine who is at greatest risk of harm from the disease. They report their findings in Cell Press’s Biophysical Journal today.

Capillary Blockage Conundrum

Like many scientific questions, this discovery began with a mystery. Normal, healthy red blood cells are extremely flexible, squeezing and slipping through blood vessels with ease, even passing through the smallest capillaries that are narrower than the red blood cells themselves. But in sickle cell disease, red blood cells are prone to deforming and turning rigid while flowing through the body. A seemingly logical explanation for sickle cell disease was that its symptoms – painful episodes and organ damage caused by oxygen deprivation – resulted from the rigid sickle cells forming inside narrow capillaries and then getting stuck there.

In fact, sickle cells do not get stuck inside capillaries. The symptoms of sickle cell disease come from partial obstructions in slightly wider blood vessels farther downstream—vessels wide enough that sickle cells should be wide enough to flow through. The mystery, then, was why? How do wide, rigid cells regularly pass through the narrowest channels without getting stuck?

To find out, the Drexel researchers developed an experimental setup to test flow through a model blood vessel.

“We created a channel, using microfluidic methods, that would be comparable in size to a human capillary,” explained Dr. Frank Ferrone, a professor of physics in Drexel’s College of Arts and Sciences and senior associate vice provost for Research, who was the study’s senior author.

Ferrone and colleagues took advantage of the fact that, for as long as they are carrying oxygen, red blood cells in sickle disease patients remain as squishy as healthy red blood cells. “They are the functional equivalent of a beanbag,” Ferrone said.

It is only after delivering their cargo to the body that hemoglobin molecules become prone to an internal reaction that turns the squishy “beanbag” cells rigid.

To test why the rigid cells do not get stuck in narrow capillaries, the researchers parked a red blood cell from a sickle patient at the center of their artificial narrow channel while the cell was still in its flexible state. Then, using a laser method, they induced the cell’s hemoglobin to begin the polymerization reaction that leads to sickling. Then they gradually raised the pressure at one end of the channel. They repeated this experiment multiple times with multiple different red blood cells. The amount of pressure required to dislodge the cells reached its maximum near 100 pascal.

“On the scale of pressures between arteries and veins, that’s not a whole lot,” Ferrone said. The pressure required to dislodge a rigid cell from inside a capillary is within the range of typical pressures in these blood vessels.

Uncooked Spaghetti in the Beanbag

Based on this experiment, Ferrone said, “we understand these processes in fundamental physical terms – we know how the stiffness of sickle cell arises, in other words – and so we have a more complete picture.”

That picture, Ferrone explained, describes what happens inside sickling cells as they turn from beanbag-like flexibility while carrying oxygen to rigid inflexibility.

Inside sickle cells, hemoglobin molecules remain separate when carrying oxygen (left). The molecules combine to form long, rigid polymer chains (right) when not carrying oxygen.
Inside sickle cells, hemoglobin molecules remain separate when carrying oxygen (left). The molecules combine to form long, rigid polymer chains (right) when not carrying oxygen.

Once the hemoglobin releases its oxygen, in sickle disease there is an ensuing molecular chain reaction between hemoglobin molecules to form long polymer chains that are rigid – a bit like uncooked spaghetti, according to Ferrone. As the spaghetti chains begin to grow inside the beanbag, the cell becomes less and less flexible.

However, if the cell is restrained inside a narrow channel when this reaction begins, its shape is physically restrained from growing outward. The rigid-spaghetti polymer chains inside the cell are blocked from growing beyond a certain length across its radial axis. They exert pressure outward on the cell membrane, thereby causing resistance. As observed in the experiment, that slight resistance requires a small amount of external pressure to dislodge cells from the capillary.

The researchers also found a relationship in their experiment that bolsters this explanation: the higher the concentration of hemoglobin in the cell, the greater the pressure required to dislodge the cell. This makes sense, Ferrone explained, because more hemoglobin would create more polymer chains pushing outward on the cell membrane.

Danger at Intermediate Speeds

Ferrone said these findings also indicate that the timing of polymerization inside sickle cells may be important to understanding patients’ susceptibility to symptoms.

The researchers described three potential scenarios for red blood cells turning rigid as they circulate in the bodies of sickle disease patients.

In the best-case scenario, the polymerization reaction is so slow that red blood cells remain flexible until they return to the lungs to pick up more oxygen.

The next-best scenario, which Ferrone said was somewhat surprising, is for hemoglobin to polymerize relatively quickly. If the cells begin to grow rigid while in a narrow capillary – the real-life equivalent of their experimental setup – then they will be forced into a skinny sausage shape. After passing through the capillary, rigid cells in that relatively thin shape can continue slipping through narrower spaces in wider vessels where partial obstructions have begun to form.

But intermediate-speed sickling is potentially most dangerous, according to the research team. If red blood cells flow past capillaries while still flexible, but later begin to grow rigid in a wider space, they are more likely to become both rigid when larger in size – making them susceptible to getting trapped in a vessel where previous sickle cells have already caused partial obstructions.

Ferrone suggested that this intermediate-speed danger may be a pitfall that investigators should avoid when developing therapies aimed at slowing the cell-sickling process.

Other authors of the paper with Ferrone were Dr. Alexey Aprelev, an assistant teaching professor of physics in Drexel’s College of Arts and Sciences, William Stephenson, a recent Drexel graduate who conducted work on this project for his undergraduate senior project in physics, Hongseok (Moses) Noh, an associate professor in the College of Engineering and Maureen Meier, a nurse at St. Christopher’s Hospital for Children.

– See more at: http://drexel.edu/now/archive/2012/October/Physics-of-Sickle-Cell-Disease/

Autism Outreach on Wheels: Students Design Mobile Clinics for A.J. Drexel Autism Institute

Originally posted on DrexelNow.

The newly established A.J. Drexel Autism Institute at Drexel University is hitting the road with design assistance from students in the Antoinette Westphal College of Media Arts & Design.

Students are developing designs for the interior and exterior of a vehicle that will be used as a mobile clinic, the first mobile unit for autism in the Philadelphia region. Researchers and outreach staff from the Institute will use the vehicle to conduct clinical testing as part of autism research studies. It will also support community-level interventions that promote early diagnosis and effective interventions, especially in underserved communities. The vehicle will also be used to raise awareness of the A.J. Drexel Autism Institute, the nation’s first autism center focused on public health science.

“With the A.J. Drexel Autism Institute’s particular focus on public health, we wanted to be able to bring the best ideas from research to diverse communities – rolling out these vehicles will help promote engagement with diverse communities,” said Dr. Craig Newschaffer, director of the Institute and a professor in Drexel’s School of Public Health.

The vehicle design challenge is part of a six-week summer interior design course taught by Diana Nicholas, a professor in the Department of Architecture + Interiors. The undergraduate and graduate students participating include interior design majors Blanca Arzayus, Hattan Bakhit, Stephanie L. Heucke, Fay E. Leff, Maureen P. McMenamin, Christine Montemarno, Shannon N. Pruztman, Alexis Siriani, Yoshie Takeo and Lauren M. Young; graphic design majors Grace Lam and Ilana A. McLean; and architecture major Miguel A. Vargas.

Exterior design concept of a mobile clinic inspired by paper cranesThe 13 students are working in groups to develop their designs with input from faculty members and experts in autism spectrum disorders. Each group has chosen a theme drawn from assigned readings about autism and from the members’ own personal experiences with the disorder. The students have also reviewed video examples of the types of activities that will occur in the mobile clinics.

The mobile clinic will be used by clinical assessment teams making site visits to evaluate children taking part in research studies and participating in model programs. Visits will happen both at families’ homes and on-site at community service providers such as schools and health centers. For example, periodic home visits are a regular part of the Early Autism Risk Longitudinal Investigation (EARLI), a major national study directed by Newschaffer involving families with a child on the autism spectrum. The study looks at mothers of autistic children during a subsequent pregnancy and for three years after the birth of the new baby. The EARLI study is intended to help identify the complex causes of autism spectrum disorders. EARLI investigators collect biological and environmental samples from members of participating families and from their homes, and the children also receive behavioral and developmental assessments for autism spectrum disorders.

Design sketch for a comfortable interior for a mobile autism assessment unitTo create a mobile clinic that researchers can use for a variety of purposes, students face a number of unique design challenges. Expert advisors encouraged the students to equip the vehicle’s interior as an optimal environment for one-on-one interaction for behavioral assessments while providing accommodations for children with specific sensory needs, such as dimmable lights, neutral tones and textures and minimization of outside sounds. Other interior recommendations included movable seating, a video monitor, a two-way mirror for observation of assessments, power outlets and storage compartments.

The vehicle’s exterior design presents different challenges: For research, a flexible design is essential. Any mention of “autism” on the exterior of the vehicle must be removable to protect the privacy of families and individuals involved in research studies. However, on other occasions the vehicles will be used for outreach and awareness at community and public events, where recognizing the connection to the A.J. Drexel Autism Institute is a desirable factor. The Institute’s advisors told students that the mobile assessment units should be approachable if parked in a community and have the ability to be branded in multiple languages for outreach to underserved, ethnically diverse communities.

Overall, the design concepts must present a vehicle that is safe, navigable, inviting and secure.

The designs will be judged by a panel of local community members with autism expertise. The groups with the winning designs will receive a financial award.  The best aspects of all the designs will be incorporated into the custom-outfitted vehicle that will be ordered this fall.

The mission of the A. J. Drexel Autism Institute is to discover, develop and disseminate population-level and community-based approaches that will prevent morbidity and disability associated with autism; and to address the needs of, and improve the quality of life for, individuals with autism of all ages and their families. Autism is believed to affect one in 88 U.S. children and perhaps up to 4 million U.S. adults, many of whom are undiagnosed.

– See more at: http://drexel.edu/now/archive/2012/July/Autism-Outreach-on-Wheels-Mobile-Clinic-Design/

Zombie Uprising Helps Nurse Educators’ BRAINS

Originally posted on DrexelNow.

They came from beyond the grave… and gave 24 nursing educators an unforgettable lesson they’ll take with them as they train the next generation of health professionals across the continent.

Monday morning, 24 nursing education professionals from across the U.S. and Canada gathered at Drexel for the first day of a week-long certificate program in clinical simulation at the College of Nursing and Health Professions – where they will learn to manage simulation labs for training health professionals at their home institutions. They expected a classroom workshop in the use of manikins and standardized patients (actors tasked with portraying a patient to aid hands-on and interpersonal training for students). Little did they know, something more sinister was lurking in body bags in the very next room.

An hour into the morning session, program organizer Carol Okupniak and simulation coordinator John Cornele interrupted with news of a breaking emergency: An outbreak of the highly infectious viral agent Ataxic Neurodegenerative Satiety Deficiency Syndrome (as described by the CDC) had taken hold in Philadelphia. All the health professionals at Drexel that day, including the simulation program participants, were being called in to attend to victims of the virus. Okupniak is the director of the Center for Interdisciplinary Clinical Simulation and Practice (CICSP) at Drexel, and a lead organizer of the week’s events.

The first twelve participants rushed in to attend to the “ill and wounded” manikins. (Ten rushed in, while two stopped to don gowns and masks before exposing themselves to an infectious agent.) They checked vital signs and attempted to assess their patients.

A few minutes later, the remaining twelve participants followed. Their assignment: Visit the morgue area and identify the five dead bodies. But these were no ordinary dead people. The instant they were touched, the dead (actors) rose, grunting, stumbling, and uttering a low but urgent groan of “Braaaaaaains.” They lurched toward the manikin patients in their beds, reaching for the sweet nectar resting on their pillows. (That is, brains, made of Jell-o and gummi worms.)

The participants tasked with identifying the dead rallied to contain their “patients” in the morgue area, while those responsible for manikins stood guard over their precious brains. As the room nevertheless grew increasingly chaotic, Okupniak called in reinforcements in the form of additional staff who had already been infected with the virus.

And so the third wave of zombies – CICSP and Drexel staff members Angie DeRamus, Shenna Hines, Fabien Pampaloni, and Nick Mazzuca – stumbled in. Instead of helping as intended, they fought for their share of the tasty, precious brains.

After ten minutes of growing chaos and confusion, a voice over the intercom called the scenario to an end. As the stunned participants filed out of the simulation room, headed to a debriefing session, Michael Jackson’s “Thriller” began playing over the speakers, and the actors broke out of zombie character and began to dance.

Lessons Learned

In the debriefing session, conference participants discussed their feelings about the simulation exercise. Okupniak and Dr. Leland “Rocky” Rockstraw, who led the debriefing, emphasized that their goal was to give the participants the experience of their students’ perspective on simulation scenarios, by throwing them directly into one. When participants noted that they felt underprepared to handle this emergency – having no idea what they were in for with Ataxic Neurodegenerative Satiety Deficiency Syndrome – that became a learning point, that preparing students prior to clinical simulation is key.

In the debriefing, Okupniak also demonstrated the importance of a Zombie Apocalypse Survival Kit, as described by the CDC – useful for all kinds of emergencies, including some that have affected the region recently, such as floods.

Drexel’s Zombies Will Rise Again

While all clinical simulation scenarios in Drexel’s CICSP are recorded on digital video for educational review, this week’s events were recorded with several additional cameras. The CICSP staff plan to produce a video for the Zombie Apocalypse Emergency Preparedness video contest to be announced later this month by the CDC.

More Photos and Behind the Scenes

For additional photos and behind-the-scenes views of preparing the zombie uprising at Drexel, view the Flickr photoset.

Additional coverage of the event on Newsworks.org: Zombies attack in Center City — but it’s for a good cause.

– See more at: http://drexel.edu/now/archive/2011/August/Zombie-Uprising-Helps-Nurse-Educators-BRAINS/