Can hospitals prevent gun violence? This ‘universal screening’ study will find out.
Gun violence is a public health crisis that is notoriously difficult to study because of politics. Finally, a new research initiative has the green light to collect life-saving data.
Stephen Johnson is a St. Louis-based writer whose work has been published by outlets including PBS Digital Studios, HuffPost, MSN, U.S. News & World Report, Eleven Magazine and The Missourian.
- New York's Northwell Health system recently received a $1.4 million grant for a new study on gun violence prevention.
- The study tasks doctors with asking all patients about their access and exposure to guns, and recommending interventions and safety tips as needed.
- The goal is to destigmatize doctor-patient conversations about guns, and reframe gun violence as a public health issue.
Doctors often ask patients about the health risks in their daily lives, such as sugar intake or tobacco use. After all, doctors can use that information to design better treatments. And on a larger scale, health professionals can use anonymized medical data on substances like sugar and tobacco to learn more about diseases like diabetes and lung cancer.
So, what if doctors began asking similar questions about guns, which are involved in more than 100 deaths in the U.S. every day? Could patients and researchers benefit in similar ways?
A new study from Northwell Health, the largest health system in New York State, aims to find out. In the "We Ask Everyone. Firearm Safety is a Health Issue" study, which began in September, doctors will ask every patient who visits an emergency department at three Northwell Health facilities about their access and exposure to firearms, with questions like:
- Do you have a gun at home?
- Do you have access to guns outside your home?
- Have you had a gun pulled on you over the last six months?
The answers will become part of a large, anonymized data pool that will help researchers better understand the underlying factors behind gun violence. Northwell Health will also offer interventions to at-risk patients.
"This will be the first research study to universally screen all patients who come into the emergency department for firearm access, and gun violence risk, and then intervene as needed, with gun safety counseling, gun locks, community resources, and medical referrals," said Dr. Chethan Sathya, director of Northwell's Center for Gun Violence Prevention. "If you look at any other public health issue, it starts with this universal type of approach."
In the study, all conversations about firearm access and exposure will be confidential. The goal is to encourage firearm safety, educate at-risk patients on violence-prevention resources, and normalize doctor-patient conversations about guns—not stigmatize gun ownership or infringe upon individual rights.
The collected data will help health professionals develop better models for predicting who's most at risk of gun violence. Northwell Health isn't quite sure what that data will reveal. That's why universal screening is the first step.
"The bottom line is, we don't know the answers yet," said Dr. Sathya. "So, how can we target screening if we don't even know the basic elements of a public health approach?"
When we reframe [gun violence] as a public health issue, then we're able to use the same strategies that we've used to decrease car-crash deaths, decrease infections and deaths from HIV, and reduce injuries and deaths from a host of other problems.
Reframing conversations on gun violence
One major goal of the study is to reframe how health professionals and patients discuss gun violence—an issue that's often couched only in political terms.
"Our big push is to consider gun violence as a public health issue," said Dr. Sathya. "For decades, we've tried to get doctors to try to ask [patients about firearms access and exposure]. They won't, because it's not considered part of the usual care."
Dr. Megan Ranney, an emergency physician and Chief Research Officer for the American Foundation for Firearm Injury Reduction in Medicine, said talking about guns from a different angle can lead to meaningful reductions in injuries and deaths.
"When we reframe [gun violence] as a public health issue, then we're able to use the same strategies that we've used to decrease car-crash deaths, decrease infections and deaths from HIV, and reduce injuries and deaths from a host of other problems," said Dr. Ranney. "We don't waste our time arguing while death rates go up. Instead, we actually do something that we as individual Americans can take on."
Moving forward on gun violence research
Mortality rate vs funding for 30 leading causes of death in the United States.
Credit: Stark et. al. / JAMA
Over the past couple of decades, researchers have conducted many studies on gun violence. But hardly any received federal funding. To put it in perspective, a 2017 study found that the federal government spends about $63 on firearms research for every life lost to gun violence in the U.S. Compare that to $182,668 in funding for every life lost to HIV.
The funding freeze stems largely from the Dickey Amendment, which Congress passed in 1996 to ensure that "none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention (CDC) may be used to advocate or promote gun control."
"It comes from a perception that research was done with an agenda of legislative change, which it isn't," said Dr. Ranney. "Research is done in order to advance health, and it ideally happens from a perspective that is independent of personal belief."
Focused on public health instead of politics, the new study aims to broaden the scope of firearms research.
"The studies that have been conducted with respect to firearms have been so limited," said Dr. Sathya, noting as an example how doctors might ask about firearms only if a patient is suicidal. "Because there has been no funding, we're starting from scratch in many ways."
Hospitals and gun violence prevention
Dr. Sathya and Mr. Dowling are spearheading Northwell's gun-violence prevention efforts, including the "We Ask Everyone. Firearm Safety is a Health Issue" research study.
Credit: Northwell Health
One reason health professionals are uniquely suited to play a lead role in preventing gun violence is that they're often the first point of institutional contact for at-risk people. By normalizing doctor-patient conversations about guns, health professionals would be able to intervene early.
For example, they could connect at-risk patients with violence-prevention resources like the New York City Mayor's Office to Prevent Gun Violence, which curbs gun violence through strategies like "violence interrupters," liaisons between communities and public officials, and funding for community-based activities to make neighborhoods safer.
Northwell Health president and CEO Michael Dowling also noted that about 40,000 people die from guns every year in the U.S., while thousands more are injured. For the health professionals that treat the victims, these statistics aren't abstract.
"Gun violence is a public health problem, period," said Dowling. "As guardians of public health, it is our responsibility to address this scourge on our communities, and the clinicians who are knee-deep in the carnage."
In 2021, Northwell Health plans to begin sharing and discussing the results of its multi-year study with other health systems as part of its Gun Violence Prevention Learning Collaborative.
"We hope that it serves as a blueprint for other hospitals and health systems as to how to institute this universal approach so that doctors can start asking the question more and more, and so it isn't an awkward topic to talk about," said Dr. Sathya.
A unique exoplanet without clouds or haze was found by astrophysicists from Harvard and Smithsonian.
- Astronomers from Harvard and Smithsonian find a very rare "hot Jupiter" exoplanet without clouds or haze.
- Such planets were formed differently from others and offer unique research opportunities.
- Only one other such exoplanet was found previously.
Munazza Alam – a graduate student at the Center for Astrophysics | Harvard & Smithsonian.
Credit: Jackie Faherty
Jupiter's Colorful Cloud Bands Studied by Spacecraft<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="8a72dfe5b407b584cf867852c36211dc"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/GzUzCesfVuw?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>
People often make a killing in stocks, but what else do people buy in hopes of selling for a fortune?
- Outside of stocks and bonds, some people make money investing in collectibles and make a fair amount on them.
- One stamp even sold for a billion times its face value.
- The extreme dependence on future collectability limits the potential of most of these opportunities.
Pokémon Cards<iframe width="730" height="430" src="https://www.youtube.com/embed/hVUmTaSoB5Y" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> For those who weren't content to catch them all in a video game came a trading card game where you could collect them all. Some classic cards have gained tremendous stature among collectors and Pokéfanatics and sell for extremely high prices. </p><p> An older card featuring Charizard, a fire breathing dragon, regularly sells for thousands <a href="https://www.lifesuccessfully.com/gaming-articles/the-most-wanted-pokemon-cards-charizard#/" target="_blank" rel="noopener noreferrer">online</a>. Given that the card could be purchased for a couple of dollars in 1999, this is quite the return. A particular pack of the cards, which cost $5 in 2003, now sells for $650, one hundred and thirty times the original asking <a href="https://adamrybko.medium.com/stocks-or-pokemon-cards-an-introduction-to-alternative-investing-32fe499083c4" target="_blank" rel="noopener noreferrer">price</a>. </p><p> Of course, not every card will fetch these high prices. Buying cards as an investment is tricky. You have to essentially guess at which cards will be considered highly valuable at a later date and will be unable to collect any dividend before selling them.</p><p> Furthermore, you have to presume that people will be collecting the cards years after buying them. While Pokémon has remained popular, it is a bit of an outlier in terms of enduring success.</p>
Shoes<p> People from all walks of life, from skateboarders to the First Lady of the <a href="https://www.rappler.com/newsbreak/in-depth/imelda-marcos-shoes-mixed-legacy" target="_blank" rel="noopener noreferrer">Philippines</a>, enjoy collecting shoes. An entire subculture exists for people interested in collecting sneakers, and some people make quite a profit in it.</p><p> The Nike SB Dunk Low Reese Forbes Denims, priced initially at $65 in 2002, are commonly valued in the thousands of dollars now. The Nike Air Jordan 1 Retro High x Off White "Chicago" shoe sold for $190 a mere four years ago, but now sells for $4000 a <a href="https://sixfiguresneakerhead.com/sneaker-model-return-alternative-investment-stock-x-reseller/" target="_blank" rel="noopener noreferrer">pair</a>. </p><p> A <a href="https://www.huffpost.com/entry/sneakers-good-investment_n_5bd1f5ebe4b0d38b588143ee?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAALOu0F9zs5DBHHOIjMgHOZR6K88W3rZkyD3ftBMz2nzlHfoxD4MS2Iz1vF3H-a4_xzOWIIrsJyv76Gj6xwUXaRIRdjq7M2m7I6-lxihWIcEfs7F9PgOwnx82JXPfXmWL7-RQlNUufOyvd8V6TCzMEYrEjzMXVU77IWk9MjOEtsln" target="_blank" rel="noopener noreferrer">Huffington Post</a> article points out that most of these shoes offered better returns than gold over the same period. The same article quotes YouTube personality <a href="https://www.youtube.com/user/mrFOAMERSIMPSON" target="_blank" rel="noopener noreferrer">Mr. Foamer Simpson</a> and his explanation of the difficulties of making money on shoes:</p><p style="margin-left: 20px;"> "There's a guessing game or element of unpredictability that makes it exciting for some collectors. With sneakers, you kind of never know. Sure, you know what sneakers are more limited or which ones were harder to get, but even with that, it fluctuates a lot. A sneaker that was very valuable two years ago might all of a sudden crash and no longer be valuable."</p>
Toys of all kinds<iframe width="730" height="430" src="https://www.youtube.com/embed/0uYnj1i1EQw" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> If there's one thing everybody loves, it's what they loved when they were children. That often translates into old and rare toys fetching insane prices at auction.</p><p> Beanie Babies, those little stuffed animals from the 90s, once sold at a price of thousands of dollars <a href="https://www.thefiscaltimes.com/2015/03/02/How-Great-Beanie-Baby-Bubble-Went-Bust" target="_blank" rel="noopener noreferrer">online</a>, not bad considering they sold for $5. Lego sets, particularly those featuring well-known franchises like Star Wars, can sell for hundreds of dollars <a href="https://finance.yahoo.com/news/20-geeky-collectibles-could-millions-201624881.html" target="_blank" rel="noopener noreferrer">online</a>. </p><p> As with Pokémon cards, the success stories are dependent on what people are interested in collecting long after most people forgot the toy existed.<strong> </strong>While some collectors have ideas on how to gauge what might or might not end up being valuable later, there seems to be a considerable amount of luck involved.</p>
Stamps<p> The hobby of kings has occasionally made some people as rich as one, with rare stamps and extensive collections fetching high prices at auction.</p><p> One of the famous "Inverted Jenny," stamps, a rare misprint showing an upside-down airplane, sold for $1,593,000 at <a href="https://www.linns.com/news/us-stamps-postal-history/2018/november/nov-15-jenny-invert-sale-record.html" target="_blank" rel="noopener noreferrer">auction</a>. The most valuable stamp in the world, the British Guiana 1c magenta, last sold for $9,480,000, a billion times its face <a href="http://www.sothebys.com/en/auctions/2014/magenta-n09154.html" target="_blank" rel="noopener noreferrer">value</a>. For those interested in a shorter-term investment, the USA Forever stamp has gained a face value of 75% since its introduction and can still be used to send a letter.</p>
Coins<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTUxNjY2Ny9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzMjUwNzk3OX0.HMBXb1mbiL0D-JbFcD7pBWNZ8TcOB4mzcJ6ri2aCNOg/img.jpg?width=1245&coordinates=0%2C1%2C0%2C1&height=700" id="41fe2" class="rm-shortcode" data-rm-shortcode-id="57f1ae74688caf29e150c4ce2f7c5b41" data-rm-shortcode-name="rebelmouse-image" data-width="1245" data-height="700" />
- Charles Darwin speculated that wingless insects thrived on windy islands so they wouldn't be blown off the land.
- While the reasoning was slightly faulty, researchers have now proved Darwin's 165-year-old "wind hypothesis."
- This finding is yet another example of how environments shape the animals that inhabit them.
Photo: Christian / Adobe Stock<p>Monash researchers looked at three decades of data on various insect species living in Antarctica and 28 Southern Ocean islands—including Svalbard, Jan Mayen, Ellef Ringnes, Bathurst, and St. Matthew—and discovered a trend: wind (as well as low air pressure and freezing temperatures) made flight nearly impossible to resident insects. They simply didn't have the energetic resources needed to take to the sky. Better to crawl around and scavenge.</p><p>Darwin wasn't completely right. He thought the evolutionary adaptations were due purely to wind throwing insects off the island. But nutrition matters too. Flight consumes a ton of energy. The windier it is, the harder insects have to work. Battling a gale requires an inordinate amount of calories. As the team writes, </p><p style="margin-left: 20px;">"Strong winds can also inhibit normal insect flight activity, thereby increasing the energetic costs of flying or maintaining flight structures. This energy trade-off is more complex than Darwin's single-step displacement mechanism because it requires genetic linkage between traits associated with flight ability, flight propensity, and fecundity or survival." </p><p>Still, you have to hand it to the man. During a time when most humans assumed animals were all the result of metaphysical tinkering, Darwin gazed out into nature and connected the dots. His mind has inspired over a century-and-a-half of scientific progress as we continue to build on—and, as this study shows, prove—his theories. </p><p>Darwin knew that every animal is the product of its environment, and therefore must respect both its boons and its boundaries. Talk about a lesson we need today. Environments are known to become very hostile to foreign invaders when pushed too hard. Right now, we're courting disaster. Hopefully, we won't wait for evolution to ground our ambitions. </p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a> and <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank" rel="noopener noreferrer">Facebook</a>. His most recent book is</em> "<em><a href="https://www.amazon.com/gp/product/B08KRVMP2M?pf_rd_r=MDJW43337675SZ0X00FH&pf_rd_p=edaba0ee-c2fe-4124-9f5d-b31d6b1bfbee" target="_blank" rel="noopener noreferrer">Hero's Dose: The Case For Psychedelics in Ritual and Therapy</a>."</em></p>
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