Monday, April 20, 2015

Learning the Principles of Social Network Analysis (SNA) to Better Understand Mexican Migration

By Jacqueline Olvera 

When the Center for Health Innovation (CHI) announced its Summer Scholar Program in 2014, I jumped at the opportunity to apply. CHI made it possible for AU faculty to enroll in a variety of summer skill building courses and seminars offered at the Mailman School of Public Health at Columbia University.  Since I had been working on a project on Mexican migration, I was particularly interested in the Social Network Analysis (SNA) course. I had conducted in-depth interviews with migrants from Tlaxcala, Mexico with funding from the Russell Sage Foundation and was interested in finding out if network analysis would enrich my study. Based on preliminary analysis of these interviews, the data revealed that relationships between migrants were meaningful structures. That is, I was finding that social ties are how migrants find housing, jobs, and information about community resources. And equally as important, the formalized structures of these relationships seemed to be the basis for inclusion and exclusion when forming community. Given my interests in social relationships, I was delighted when I found out that I would indeed be able to enroll in the SNA course. 
The course I participated in provided an excellent introduction to the conceptual and computational principles of SNA. On our first day, we covered what Social Network Analysis is and is not, what counts as network data, and how to collect it.  We spent time using R, a language and platform for statistical computing and graphing in order to manipulate network matrices and visualize network data.  Thereafter, we quickly moved on to a discussion of ego-networks and the meaning of distance, density, and balance within an individual’s networks.  By day three, we covered higher-order network structures: the group and entire networks. All the while, we focused on important network structural features such as equivalence, clustering, centrality, and cohesion.  For example, in a migrant network computing centrality indices might tell us which individual in a network is the most central or popular.  
The fourth day of the course was by the best part – we put our knowledge to work by focusing on applications of SNA.  We explored examples from epidemiological research such as the transmission of AIDS, the structure of adolescent romantic and sexual networks, and the dynamics of smoking in large networks.  Each of these empirically motivated problems gave us a glimpse into how network analysis is applied.  More specifically, we focused on three network processes: Search, Diffusion, and Influence.  And, we replicated analyses of classic studies that examine how network ties facilitate the exchange of employment information as well as the efficiency of job search strategies in networks.

On the final day of the course, we covered statistical models and worked through tutorials in R.  The instructor introduced network autocorrelation and stochastic actor oriented (SIENA) models. Since I had experience with spatial analytic techniques, the network autocorrelation model was familiar. In a recently published paper, I used neighborhood-level data to estimate spatial lag models that follow similar autocorrelation properties.
After completing the course, I have spent much time thinking more about how I might use the insights of network analysis to ask, what network practices in the small migrant community I have been studying might tell us something about the raising and blurring ethnic boundaries? My hope is that by integrating social network analysis into my research I will make new inroads into the ways in which migrant communities come to make sense of the places they live and work in.

A New Approach to Mental Healthcare

by Bonnie Eissner

For too many people with mental illness, crisis medical care has become the norm—a trend that has a great personal and financial toll. In 2013, hospitalizations for Nassau County residents who received Medicaid mental health services cost the agency more than $35 million. The fact that many patients are rehospitalized within 30 days of discharge calls into question the effectiveness of this crisis approach to mental healthcare.

To address this issue, New York State is now working with physicians and health clinics to provide health homes for Medicaid recipients who suffer from chronic mental and physical illness. The health home concept is to offer an integrated system of care in which a patient’s needs—from scheduling medical appointments to providing transportation to those appointments to setting up social services—are coordinated by a small interdisciplinary team or an individual care manager.  

Central Nassau Guidance & Counseling Services, Inc., based in Hicksville, New York, is one agency that offers health home services. Last year, with funds from a New York State Innovation Fund grant, the agency established its Stability at Home pilot program to help Medicaid recipients with serious mental health conditions transition from hospitalization or haphazard community care into a more stable health home system of care.

Chrisann Newransky, Ph.D., an assistant professor at Adelphi’s School of Social Work, explained that a primary goal of this new approach is to facilitate the many healthcare responsibilities and tasks that seem routine to the rest of us. “If people stay connected to the system—they don’t drop out of the system—then they’re less likely in general to use emergency care, which we know is completely expensive and not all [that] effective,” she said.

After consulting with Adelphi’s Center for Nonprofit Leadership and its faculty director, Peter Chernack, Ph.D., Central Nassau Guidance & Counseling tapped Dr. Newransky, whose primary research interests are disease prevention and health disparities, to be the external evaluator of Stability at Home.

Dr. Newransky is advising on the best sources of data and approaches to data collection for evaluating the program’s effectiveness for the nearly 150 participants and their families. She is also conducting independent follow-up research with the participants and families.

“What’s unique about the [program] design is that different organizations are coming together,” she said, noting that the Long Island Crisis Center and Options for Community Living, Inc. are also involved in the project. This coming summer, Dr. Newransky plans to interview the leaders of the three organizations in order to document this model of interagency collaboration and understand what worked well and what improvements can be made.

This article appeared in the Spring 2015 edition of Erudition

Monday, April 13, 2015

Advancing the Science of Addiction and Trauma Recovery

by Bonnie Eissner

What is the relationship between early-life trauma and addiction? What treatments are most effective for people, particularly poor women and families who are struggling with these often-linked challenges? How can these treatments be implemented in community clinics?

These are questions that Denise Hien, Ph.D., a professor at the Gordon F. Derner Institute of Advanced Psychological Studies, has been seeking to answer throughout her career. A researcher, clinician and teacher, her overarching aim is to “understand how early-childhood abuse evolves over the course of life and intersects with substance use and other kinds of problems.”
Dr. Hien has noted that “as many as 80 percent of women seeking treatment for drug abuse report lifetime histories of sexual and/or physical assault.” Through her clinical work with women and families in New York City’s Harlem, Morningside Heights and Washington Heights neighborhoods, as well as her national research, Dr. Hien works to improve treatment outcomes for patients who struggle with trauma and substance abuse. 

Since 2002, Dr. Hien has been a co-principal investigator with the National Institute on Drug Abuse (NIDA) Clinical Trials Network Greater New York Node. The network is a federal initiative to link researchers and community-based treatment centers to allow real-world studies of drug treatments. In a recent NIDA-sponsored study, for example, Dr. Hien and her team examined what happened when an antidepressant medication was added to a cognitive behavioral therapy treatment for PTSD and alcohol use disorders. The researchers found that the drug combined with the therapy, known as Seeking Safety, was significantly more effective at treating PTSD and alcohol abuse than therapy alone.

“You might think, ‘Well isn’t that obvious? That’s what people do, they give [patients] medication and they give them therapy,” Dr. Hien said. “But nobody really knows if it works. So here’s a trial that showed that it really works.”

In another NIDA-sponsored project, Dr. Hien and her colleagues worked with drug counselors across the country to see if they could safely and effectively conduct trauma treatment groups with their clients. “The answer was yes they could, so it provided support for being able to translate treatment into the real world,” Dr. Hien said.

Having conducted numerous clinical trials, Dr. Hien is intimately familiar with their advantages as well as their shortcomings. “It’s hard to show big effects with relatively small sample sizes,” she pointed out, adding, “And then there’s the problem of ending up testing what amount to short-term treatments for long-term problems.”

How can these challenges be overcome? For Dr. Hien, the short answer is big data. She is now applying for a grant to create a large data set from more than 20 clinical trials that tested the efficacy of medication and psychotherapy in treating PTSD and substance use disorders. Dr. Hien explained that with information on thousands of patients, “you can ask questions that are more nuanced when it comes to trying to advance the science of treatment.”

Dr. Hien teaches master’s- and doctorate-level psychology courses at Adelphi and says that her work in the field amplifies what she can offer students in the classroom.

“My clinical work and my research inform my teaching because they’re what I’m passionate about, and usually I’m teaching things that link up to these topics,” she said. 

This article is from the spring 2015 issue of Erudition. 

Monday, April 6, 2015

CHI Rapid Response: Sports Concussion Symposium

by Sophia Conti

On Monday, March 30 Adelphi University’s Center for Health Innovation and Winthrop University Hospital hosted a Sports Concussion Symposium, a rapid response event designed to react to emergent health issues on Long Island. The event featured a variety of speakers and panelists, providing an overview of concussions and the importance of recognizing its symptoms.

Concussions are defined as a trauma-induced alteration in a person’s mental state, with physical, cognitive, emotional, or sleep-related symptoms. While higher-grade concussions tend to involve a loss of consciousness, not every concussion does. A single concussion can take weeks, months, or even years to heal completely.

“Every concussion is different,” said Dr. Kevin Curley, an attending physician at Winthrop University Hospital. “Each concussion can have varying combinations of symptoms.”

Multiple concussions can lead to detrimental long-term health problems, such as chronic traumatic encephalopathy (CTE) and traumatic brain injury. A concussion occurring before a previous one has completely healed can lead to second impact syndrome, a fatal brain herniation.

Among the panelists was Pat LaFontaine, National Hockey League Hall of Fame member, who attested to the severity of concussion symptoms. “All those symptoms are for real,” LaFontaine said. “I was lucky my brain found its way back and plugged itself back in.”

Several states, including New York, have legislated the return-to-play criteria for concussed athletes, which often prohibit students from playing on the same day as their head injury. Even the international community has created guidelines for a standardized concussion assessment.

Baseline testing for athletes in balance, cognition, and emotion is extremely important. After a hit to the head, the same tests can be conducted to more easily diagnose a concussion. Coaches, parents, and teachers are also crucial to concussion diagnosis, as they are most familiar with student athletes and may be able to more easily identify changes in behavior than a physician.  

“Sports provide many positive benefits to our children and young adults,” said Don Gronachan, vice president of physical medicine sales at Biodex Medical Systems, Inc. “But we are concerned about the short- and long-term safety of these young athletes.”

The CHI Rapid Response: Sports Concussion Symposium consisted of Emilia Zarco, Robert Otto, John Wygand, and John Petrizzo in the Ruth S. Ammon School of Education, Department of Exercise Science, Health Studies, Physical Education and Sport Management; and Daniel McCabe and Michael Gavagan in the Department of Athletics. 

Speakers and panelists at the CHI Sports Concussion Symposium
First row (from left): Michael Kennedy ’81, DO, MBA, director, Expert Medical Care; Elizabeth Gross Cohn, Ph.D., RN, director, Adelphi University Center for Health Innovation; Gayle Insler, Ph.D., provost and senior vice president of academic affairs, Adelphi University; Emilia Zarco, MD, MEd, chair of the Department of Exercise Science, Health Studies, Physical Education, and Sports Management, Adelphi University; Ann Cornell-Bell, Ph.D., vice president of administration, Perseus Science Group LLC; Don Gronachan, MA ’83, vice president of physical medicine sales, Biodex Medical Systems, Inc. Second row (from left): Kevin Curley, MD, Winthrop University Hospital; Rupi Johal, MD, Winthrop Orthopaedic Associates; Mark Grossman, MD, team physician for Adelphi Athletics; Pat LaFontaine, NHL Hall of Fame and founder, Companions in Courage Foundation; Javan Esfaniari, M.Sc., chief scientist and technology officer, Chembio Diagnostic Systems, Inc. 

Monday, March 30, 2015

Avoiding Athletic Injury: Tips for Athletes and Dancers

By Cecil Harris

Injuries such as concussions or torn ligaments can be detrimental to young athletes and dancers. These tips from Adelphi alumni provide guidance for athletes, dancers, and their parents on how to avoid these injuries. 

For Athletes and Their Parents 
from Chris Armas ’94 and Mike Gavagan, M.S. ’03

Prepare properly. Eat right and sleep.
Set aside time to rest and recover. Many teens play three or four sports and their bodies break down before they get to college.
Don’t overdo it. Athletes are more susceptible to injury when they practice or play too long.
Listen to your body. If your body tells you that you’re tired, rest.
Get proper footwear. Foot injuries can be prevented this way. Some kids play so much that they burn through the footwear they have and are running on nothing.

For Dancers and Their Parents 
from Linda Hamilton, Ph.D. ’89

More is not necessarily better. Many injuries occur after the fourth class or fourth hour of dancing in a day.
Be careful of the teacher. Don’t work with a teacher who is demeaning or harshly critical of dancers. Dance should be fun. (Dr. Hamilton danced for the legendary George Balanchine in the New York City Ballet. Instead of calling out a dancer by name for making a mistake, he used pop culture references to make his point. When Dr. Hamilton erred during one rehearsal, he said, “More Parks sausages, Mom. Please!”)
Rest. It’s important to get eight hours of sleep each day.
Let kids be kids. There’s hardly any downtime for dancers. Kids need time to do other fun things.
Be sensitive to your perfectionism. Accept it. That’s an essential part of why you became a dancer.

Excerpted from the spring 2015 issue of AU VU.

Friday, March 20, 2015

Starbucks Conversations?

By Ronald Gross
Conversations New York

A barista at the Spring Street Starbucks  in lower Manhattan yesterday afternoon  slapped a sticker on my cup that read: RACE TOGETHER. 

He was following the suggestion of Starbucks president Howard Shultz, who had announced the nation-wide campaign earlier in the week.  Starbucks  wants staff and customers at its  7,000 shops across to U.S. to invite in-store conversations about "issues of race, prejudice, and lack of economic opportunity."

As I settled into a corner sofa, I asked the woman next to me: "What do you think about talking about these issues in Starbucks?" 

"Not my cup of tea, frankly," she replied with lower Manhattan coolness.   "I come here to calm down, or to take out.   Wrong time, wrong place."

But the couple who sat down on the other side of me was interested.  "It's naive, sure -- but it's a start," said Larry, a software developer.   And his co-worker, Russell, added: "We've talked about this at our shop, but it's actually easier with people with whom you don't have a lot of baggage.  We've had some good talks with other customers, and with one of the baristas."

The three of  us talked  for 15 minutes.  It was the longest conversation I'd had with African Americans in over a month.

I spent the rest of the afternoon and evening stopping into 7 more Starbucks stores  in a variety of neighborhoods in Manhattan, getting as far uptown as the one on 168th Street and Broadway.   (That's 6 more stores than were visited by Times reporter Sydney Ember for the  article  on 3/19, p. B1.)

Total results: 6 illuminating conversations, 2 brush-offs.   At two of the stores, the people involved were talking seriously about continuing the discussion beyond this encounter.

This Starbucks campaign is taking its lumps in the blogosphere, where it's being accused of everything from grandiosity and condescension, to manipulation and hypocrisy; some of the points -- about Starbucks sourcing, corporate staffing, and HR policies -- are telling. 

But from my totally unscientific sampling of 0.1 percent of Starbucks stores nationwide,  I'm giving two cheers for this experiment in civic discourse.   Time was when coffee houses were hotbeds of citizen-to-citizen conversations about issues that mattered -- such as in 18th century Britain and America, where they made governments quake.   It's heartening  to get even this slight  whiff of that amidst the white foam.

Monday, March 16, 2015

Bringing Innovation to Nursing Education

Nexus Hospital Room
by Clementine Tousey
As the place where the College of Nursing and Public Health faculty’s decades of experience combine with state-of-the-art facilities to train the nursing leaders of tomorrow, the Nexus Building and Welcome Center will bring innovation to nursing education.
Starting in Fall 2015, when the new building will be open, the ultramodern simulation labs and exam room will feature closed-circuit TV so professors can observe student performance. These facilities will increase the quality of Adelphi nursing students’ education and give  them better preparation as they enter the workforce, according to three faculty members who are among the most frequent users of the current sim labs—Maryann Forbes, Ph.D. ’99, associate professor and chair of the College’s Department of Adult Health; Deborah Ambrosio-Mawhirter ’81, M.S. ’95, Ed.D., assistant professor and chair of the Department of Nursing Foundations; and Terry Mascitti, clinical assistant professor and faculty member teaching nurse practitioner students.
Dr. Forbes said that high-fidelity simulations (the ones now utilized in Alumnae Hall) enable a high-tech patient mannequin to model patient-care situations. These have proven to be effective in increasing student confidence, while providing a safe environment for students to practice and improve critical nursing skills, she said. Students, for example, can practice delivering medication, administering IVs, taking blood pressure and inserting catheters on the SimMan, she explained.
In addition to the sim labs, the new facilities will include examination rooms for “standardized patients,” trained actors who will mimic a health condition by portraying a set of symptoms. (The actors are actual people who will come in, possibly from theperforming arts program at Adelphi, but nothing is confirmed yet, Dr. Forbes said.) Thus, Dr. Forbes said, the new labs and exam rooms will give students hands-on practice treating patients and communicating with other healthcare professionals in a realistic patient-care environment.
The Nexus facilities represent a quantum leap from the three simulation labs now available in Alumnae Hall. There will be a whole suite in Nexus, resembling that of a hospital unit. Dr. Ambrosio-Mawhirter said these new facilities will foster active learning, allowing students to bridge theory with practice and gain confidence as novice nurses. The new technology will allow faculty to move beyond the traditional classroom instruction to a state-of-the-art nursing education, she added.
Mascitti agreed that the new facilities will be a tremendous asset to both undergraduates and graduates because students will now have the ability to use more simulation. She maintained that simulation is the wave of the future and that it’s key in the absence of live patients. It allows nursing students to perform various exams and develop treatment plans in a supervised environment. She believes that Nexus signifies Adelphi’s investment in future nurses and nurse practitioners.