Tag: University of Vermont

Bob Pepperman Taylor’s fifth floor office in the Old Mill looks out over the shoulders of Waterman Hall to Burlington, Lake Champlain, and the Adirondacks beyond. Near at hand on his desk is a neat stack of papers that represents the nearly final manuscript of his latest book Lessons from Walden: Thoreau and the Crisis of American Democracy recently published by the University of Notre Dame Press.

“I had never intended to be a Thoreau scholar—it just seemed to happen that way,” said Taylor whose previous books include The Routledge Guidebook to Thoreau’s Civil Disobedience and America’s Bachelor Uncle: Henry Thoreau and the American Polity.

“In my first book on environmental ethics, Thoreau represented one of the traditions I was identifying in the American discourse about environment. Then I wrote a book about Thoreau’s political ideas.”

For a scholar who specializes in political theory, the history of American political thought and environmental ethics, perhaps it’s not surprising that Taylor’s scholarship often leads back to Thoreau, one of America’s original environmentalists and political thinkers. 

The theme for his new book developed during a sabbatical several years ago. 

“One of things I’m interested in is how democratic thinkers propose to protect democracy from its own vices,” Taylor said. “My proposal was to write a book on nature, religion, education, and populism, and how all of these have been promoted in various ways in the American tradition as protections from democracy’s pathologies. When I wrote the first chapter it became its own book about the lessons Walden gives us, the way these lessons resonate through present time in the U.S, and whether or not those lessons are useful.”

The book addresses two crises that have become especially urgent in the Trump era: threats to democratic norms and political institutions, and dangers to the environment driven by climate change.

Taylor grapples with a particular problem of democracy dating as far back as antiquity. Plato was concerned that citizens in a democracy wouldn’t have the knowledge or character for responsible self-government. The American founding fathers, Taylor says, shared the fear of the “mischief of factions.” 

“Their solution was to form a republic so no one branch of government could take over,” Taylor explains. “The language of the founders portrayed a political machine that would ‘go of itself’—they were animated by the idea that we can’t reform human beings, so we need to design a political machine to correct human imperfections.”

But Taylor notes that in Thoreau’s time, the turbulent Jacksonian period, the machine was insufficient in controlling factions, which led prominent Whigs and reformers like Horace Mann to call for comprehensive public education to insure that Americans could act and vote as disciplined, judicious citizens.

“He (Mann) wasn’t alone—the idea began to emerge that public schooling was critical for democracy,” Taylor said. “Along with the Scouting movement and the Pledge of Allegiance, a little later on, we see leaders trying to promote civil virtue in a society that wasn’t very virtuous. It reflected the degree of anxiety about leaving government in the hands of citizens.”

What would Thoreau say about the latest rise of populism and threats to the environment? Taylor notes that Thoreau, the ultimate individualist who was always distrustful of political movements and parties, wouldn’t be the loudest voice in the room.

“One of the points I make is that Walden doesn’t provide prescriptions for political crisis,” he said. “Thoreau isn’t really good for helping us think about crisis management. His contribution helps us think beyond the immediate crisis, to how we can each live as more responsible citizens.”

 

Bob Pepperman Taylor is the Elliott A. Brown Green and Gold Professor of Law, Politics and Political Behavior at UVM. His other books include The Routledge Guidebook to Thoreau’s “Civil Disobedience” (Routledge, 2015); Horace Mann’s Troubling Legacy: The Education of Democratic Citizens (University of Kansas Press, 2010); Citizenship and Democratic Doubt: The Legacy of Progressive Thought (University of  Kansas Press, 2004); America’s Bachelor Uncle: Henry Thoreau and the American Polity (University Press of Kansas, 1996) and Our Limits Transgressed: Environmental Political Thought in America (University Press of Kansas, 1992). He received the George V. Kidder Outstanding Faculty Alumni Award in 2016.

Source: UVM News

Sadly, it’s “a very busy time” to be a mathematical epidemiologist, says Laurent Hébert-Dufresne —professor of computer science at UVM and, yes, an expert on the mathematical modeling of epidemics. 

And at the top of his to-do list he’s been speaking to reporters and other scientists—because he wants people to understand why it’s so important, during the Covid-19 epidemic, to close schools, shut restaurants, cancel concerts and empty cruise ships.

“A lot of people wonder if it’s necessary, if it’s reasonable,” he says, “and the answer is yes.”

Not all diseases are like this, but the novel coronavirus appears to “live at the mesoscale,” Hébert-Dufresne says—the scale of universities, hospitals, churches and other medium-sized gatherings of people. Therefore, attacking it at this scale is a more powerful and efficient way to stop the spread than simply relying on individuals to wash their hands and keep their distance.

The show must not go on

On March 9, Pearl Jam received global press attention when the band announced it was postponing their North American tour. Many people wondered if it was an overreaction. A few days later, Hébert-Dufresne and three of his colleagues posted a pre-print edition of a new scientific study explaining why these kinds of event closures were critically important. It didn’t get quite as much attention as Pearl Jam, so here’s the gist:

Standard models assume that diseases simply move by diffusion through a pattern of random mixing. One-person-to-the-next-interactions are, of course, at a basic level, how the virus is spread. But Hébert-Dufresne’s work shows that more sophisticated models, that have “higher-order structures” built in, can identify how hotspots can build, say, within one school. In short, our real lives are not a web of random contacts but are organized around social institutions.

When an epidemic localizes around one of these kinds of structures, it could be that the odds of catching the virus “on the street,” Hébert-Dufresne says, would be 1 in 10,000, but in that school it might jump to 1 in 10. “So it makes sense to focus our interventions on these larger structures,” he says, at least as much as on individual behaviors, like hygiene. If an individual reduces their social contacts by 10% “we’re going to do roughly 10% better,” HD says. “It’s a linear return.” 

But since our contacts happen within the larger structures we’re part of—like schools and Pearl Jam crowds—interventions to stop large gatherings “means there’s actually an increasing return,” he says. “The more we intervene at this scale, the better. The second 10% is more useful than the first. The third 10% is more useful than the first two.”

And with a vigorous effort to close enough schools and cancel large gatherings, the “math makes it clear,” he says, that, at certain moments, an epidemic “can suddenly collapse.”

Source: UVM News

On National Doctor’s Day, March 30, Forbes published “15 Heroic Firsthand Stories From the Coronavirus Front Lines.” Physicians featured included UVM alumna Dr. Lynn Black, a medical director of the Respiratory Illness Clinic at Massachusetts General Hospital. Previously, she did disaster response in Haiti after the Haiti earthquake and Hurricane Matthew and in Liberia during the Ebola epidemic. A graduate of UVM’s school of nursing, Black is on the College of Nursing and Health Sciences Advisory Board. 

Since March 11, I’ve been working on expanding our ability to care for patients with possible COVID-19. We had a small clinic, the Medical Walk-In, at the start, then about a week after we expanded to a unit in what had previously been the women’s health outpatient clinic. Then the following week we opened up in a larger off-site sports medicine clinic. It’s been a continuous evolution of finding larger and more appropriate areas to take care of sick and contagious people. Our exam rooms have been completely stripped down. There are no pillows or paper on the tables. There are no chairs. There is one stethoscope that stays in the room, because once a patient is seen in there, the entire room, along with equipment, needs to be cleaned. This is usually done by the physician in the room to lessen the need for another person needing personal protective equipment. 

Other disaster settings, such as Haiti and Liberia, have been low-resource settings. That’s a very different infrastructure. I have learned in those settings how to manage a disaster situation, how to keep a team together, and how to move quickly. There needs to be a very clear chain of command on how to get things done. My biggest worry is that there are not going to be enough restrictions to make sure that we can stop this virus, and that people won’t pay serious attention to the need for social distancing and isolation. But I am choosing to be hopeful. I think that everyone is taking this seriously now and working hard. The world has experienced Spanish flu, polio and other infectious illnesses, and I do think that we’ll come out the other side of this. 

Read a story from 2018 on Dr. Black’s disaster relief work.

Source: UVM News

Months before the coronavirus outbreak became international news, nurse practitioner Jennifer Allaire, G ‘12, and nursing graduate student Erin Leighton, Doctor of Nursing Practice ’20, began developing a telemedicine protocol for patients of Appletree Bay Primary Care in Burlington. Their trial project aimed to serve patients who miss in-clinic appointments due to mobility and transportation challenges, and to limit visits by patients who don’t need to be seen in person.

Now, with social distancing and stay-at-home orders in place around the world to curb COVID-19, primary care by video chat is everyone’s new normal.

Appletree Bay Primary Care, part of the College of Nursing and Health Sciences, is an outpatient clinic that serves as a teaching site for undergraduate and graduate students. The students work side-by-side with nurse practitioners and nurses who are UVM faculty. The Appletree Bay telehealth trial, began in 2018, was Leighton’s graduate project for the Doctor of Nursing Practice (DNP) program, which provides opportunities for students to identify and apply evidence related to issues of importance to nursing.

With a telemedicine system ready when the COVID-19 pandemic began unfolding, Appletree Bay quickly converted to clinic-wide remote primary care. This helps prevent potentially sick patients from spreading coronavirus, and keeps medical professionals healthy so that they can continue to do their jobs. 

“It was an amazing mobilization. Having the technology and systems in place allowed Appletree Bay Primary Care to nimbly move to telehealth during a quickly evolving pandemic,” Allaire says. “Students witnessed the clinic transition to video visits and participate in virtual patient care.” 

Almost all Appletree Bay patient visits now take place by phone or Zoom, an internet videoconferencing platform. NPs and nurses evaluate, diagnose and treat patients, answer questions about symptoms and medications and provide triage for patients unsure of what to do or where to go for help.

For routine blood tests that must be performed in person, such as blood clotting tests for patients taking blood-thinners, medical assistants wearing masks and gloves meet patients in the parking lot to do finger pricks, as patients remain in their cars.

“We have hardly any patients coming into the clinic for any reason,” says Ellen Watson, a nursing instructor and family nurse practitioner. “The technology is very manageable, and it feels like all staff and our patients are working together to make a difficult and potentially very stressful situation as good as it can be.”

Source: UVM News

A message from President Suresh Garimella to the UVM Community:

Without a doubt, these are challenging and unusual times. But I continue to be very impressed—and proud—of the strength, understanding, and connection that define our university.

Please take a few moments to view this video, and thank you for the many ways you keep UVM strong.

 

Warm wishes,
Suresh Garimella

 

See the latest information and updates surrounding UVM’s response to COVID-19.

Source: UVM News

For the nearly 36 million Americans who experience panic attacks, the coronavirus pandemic is a potentially significant new trigger, a recent story in the Washington Post reported.

For panic attack sufferers facing these new anxieties, there is little recourse. Medication is minimally effective and has side effects. Cognitive behavioral therapy doesn’t work for nearly two-thirds of panic sufferers. And bio-feedback, which has shown promise, is cumbersome and impractical to use outside a laboratory or clinical setting.

A new app developed by faculty at the University of Vermont, PanicMechanic, may be part of a solution. The app adapts biofeedback-like monitoring so it can be used on a mobile phone. The app can work at any time and in any location, the first technology to do so for panic.

PanicMechanic is meant to be used as a supplement to professional clinical care.

“The challenge with panic attacks is that they’re episodic,” said one of the app’s developers, Ellen McGinnis, an assistant professor at the University of Vermont’s Center for Children, Youth and Families at the University of Vermont and a trained clinical psychologist.

“That means they’re not only difficult to treat in a traditional therapy setting, because a panic attack is hard to induce, but also that the one intervention that does seem to work for people—biofeedback—isn’t available when it’s needed.”

PanicMechanic uses the camera on a cell phone to measure the body’s panic response, using an approach similar to photoplethysmography

“Activating the app, then holding your finger against the flash can give you an objective measure of your reaction to stress,” said Ryan McGinnis, assistant professor of Electrical and Biomedical Engineering at the University of Vermont, and a co-developer of the app.

The concept for the app is grounded both in decades of research showing that enabling panic sufferers to observe their body’s reaction to stress reduces panic, and in the clinical practice of Ellen McGinnis.

“I’ve used a low tech version of this technique with a dozen patients,” she said. ‘The panic attack sufferer used just a pen, paper and timer to take their own heart rate and plot it on paper during the panic attack. It was very effective in helping patients manage, take control of and overcome their panic.”        

The explanation? Intervening with objective information targets a driving dynamic of panic, she says. 

“Panic takes hold and you feel like you’re out of control of your body. By showing someone their patterns of physiological arousal, it helps them gain a sense of mastery over their panic response.”

The app also works because it gives the panic sufferer something to do during an episode.

“One of the worst aspects of a panic attack is that you feel helpless,” Ellen McGinnis said.

In addition to displaying an objective measure of the body’s panic response, the app also asks, in a sequence of screens, “how much sleep and exercise you’ve had, what you ate, what your anxiety level is, and if you’ve consumed drugs or alcohol,” she said.

The screens both occupy the panic sufferer and serve a useful purpose, providing data on behaviors and triggers associated with the attack that could be avoided in the future.

The app also predicts how long the panic attack will last, based on past attacks.

That’s key, Ellen McGinnis said, because one of the most frightening aspects of a panic attack is that “it seems like it will never end.”

PanicMechanic employs machine learning to make sure the data gathered by the user on heart is accurate. 

“Our beta testing showed that people can’t always put their finger on their cell phone in free living settings and get an accurate reading of their heart rate,” Ryan McGinnis said. The machine learning functionality corrects for faulty finger placement. In a study that will be published later this year, Ellen and Ryan McGinnis and their collaborators demonstrate that data obtained by the app was as accurate as that obtained in a lab setting.

“PanicMechanic helps panic attack sufferers learn to understand their panic attacks,” Ellen McGinnis said. “When they do that, working in partnership with their therapist, they’ve gone a long way toward stopping them.” 

The team that developed PanicMechanic includes Steve DiCristofaro of Synbrix Software, LLC., in addition to Ellen and Ryan McGinnis.

The PanicMechanic app is available at the Apple App store.

 

 

Source: UVM News

Late Friday afternoon of spring break, the Center for Teaching and Learning (CTL) team realized they needed a new plan for the faculty trainings that were slated to start the following Monday morning. 

Barely a week before, CTL acting director, Professor Annie Murray-Close, and the rest of UVM’s faculty received notice that a shift to remote learning was possible, given the growing threat of the coronavirus. Charged with supporting faculty in the use of instructional technology, CTL focused on developing a resources portal to support faculty and to provide the trainings, mentors, and helpline assistance that would make this quick pivot to remote instruction not only possible, but successful.

The collaborations that ensued underscore the all-hands-on-deck moment that CTL—and the full university teaching and support community—were called to.

Many faculty sidelined their spring break plans to spend the week learning to migrate their classes online. Continuing and Distance Education stepped in to assist with CTL’s email inquiries, Enterprise Technology Services joined CTL in responding to faculty requests for help and served as technological support during the now-remote CTL workshops, and the UVM Tech Team stood at the ready to assist faculty and students with technical difficulties. Writing in the Disciplines director Susanmarie Harrington joined forces with the CTL team to develop a full suite of workshops. And faculty from across disciplines with experience in online teaching volunteered at the CTL help-desk to assist their colleagues. 

“What continues to be impressive in such a challenging time is watching people who are already strained by moving their own classes online volunteering to help us assist their colleagues all across campus,” says Murray-Close. 

That Friday of spring break—in the now routine end-of-afternoon CTL meeting to discuss questions that came up that day—it became apparent that continuing to work on campus would push CTL past the university’s 25-person gathering limit many times during the day. In a move now familiar across the workplace, the CTL team made an immediate pivot to fully online programs. CTL staff spent the weekend redesigning the Monday workshops, developing remote learning materials for online teaching using Screencast-O-Matic, Blackboard, and Microsoft Teams, and answering the steady stream of individual support requests.

It was a busy weekend for spring break, but a productive one. That first suite of workshops for effectively migrating to online teaching has now morphed into an ongoing series of trainings. More importantly, they created space for faculty to discuss emerging issues, like how to best support students with flexibility and compassion. While the university community looks forward to the eventual return to residential learning, the UVM spirit remains in full force behind the student academic experience, whether on campus or online. 

Source: UVM News

Jim Gildea ’92 began his work as town administrator in Westfield, N.J., two months before September 11, 2001. A community of 31,000 just a 20-mile drive from the twin towers of the World Trade Center, Westfield lost twelve citizens that day. In his leadership role, Gildea has also helped the community cope and move forward in other times of crisis, from the economic freefall of 2008 to Hurricane Sandy. 

Today, Westfield is in the thick of the coronavirus pandemic’s Metro New York red zone. Speaking to the challenge of the current situation, Gildea says, “In reality, this is almost a combination of all of those things we dealt with in the past. But with those previous events, you knew that in a number of days it would be solved. Roads would be cleared, the power would be back on after the storm. But with this, the main difference is there is no clear end in sight.” 

Gildea’s roots run deep in Westfield, his hometown where his parents still live. His first job for the city was as a lifeguard in high school. After college at UVM, he returned to first work in recreation, then move into the town administrator role. (His roots also run deep at the University of Vermont, where he majored in small business management in the College of Agriculture and Life Sciences. His sisters Katie ’03 and Cristin ’95 are also graduates, and he admits to hoping his daughter, a junior in high school, might become a next-generation Catamount.) 

The police chief, fire chief, and town health officer are among the unit heads who report to Gildea. He praises their heroic efforts on the front lines, mentioning with pride that Westfield assisted in establishing the first coronavirus testing site serving the 21 towns in Union County. Gildea continues to work from the town’s city hall daily. Offices such as the town clerk and tax collector have employees working solo in shifts to protect their health. “We’re making sure the gears of government can still work,” Gildea says. “During times like this we need the government to work better than ever.”

Before the pandemic hit, Gildea was poised to present the town budget, approximately $50 million, for the next fiscal year. But as civic revenue streams shut down, it’s a shifting outlook. Gildea is reassessing, considering next steps and hard decisions to help the town emerge strong on the other side of the pandemic. Those Westfield roots keep him focused and positive. “One of the benefits of serving in the town where you live is you get to see and make changes where you live, in the places you care about,” Gildea says. “Together with the people I work with, that’s what keeps me going every day.” 

Source: UVM News

The COVID-19 crisis has put the spotlight on the courageous doctors and nurses battling the disease at the front lines.

But behind the scenes, another group of medical professionals is fighting its own battle with the virus, readying the equipment and outfitting the spaces medical staff need to be effective.

Nearly 39 clinical engineers and biomedical technicians in Technical Services Partnership, or TSP, a unit in UVM’s Instrumentation and Technical Services division, have fanned out around the state at hospitals large and small to do this preparatory work. 

Their focus? Helping healthcare facilities expand their inventory of intensive care rooms and isolation space for Covid-19 positive patients.

“Like ventilators and testing kits, ICU rooms are in short supply,” said Mike Lane, director of Instrumentation and Technical Services, “and they’re going to be needed.”

To meet the demand they anticipate, hospitals are creating new ICU spaces and re-purposing existing rooms. With the help of the TSP biomedical team, UVM MC just expanded  a 17-bed  medical-surgical ICU and added a 10-bed space to the emergency room.

All the rooms need the sophisticated monitoring systems medical staff rely on to treat gravely ill patients, which track vital signs like body temperature, blood pressure, pulse rate and respiratory rate. For COVID-19 patients experiencing respiratory distress, they must also measure the amount of oxygen and carbon dioxide  in the blood stream.

Installing this complex equipment, integrating it into a hospital’s electronic health record system and making sure it is in working order is a critical mission for TSP right now.

 While TSP specializes in technology — it currently oversees 70,000+ devices in 35 hospitals — it also helps hospitals with procurement, and not all of its contributions are technical.

“I talked with a customer yesterday, and one of the big issues is beds, which are also in short supply,” Lane said. Adding more hours to an already long day, Lane got on the phone with TSP’s vendors and suppliers and tracked down the beds — at a reasonable price. 

But TSP’s emphasis now is on technology. In addition to the monitoring equipment, the group is also helping the Vermont Healthcare Emergency Planning Coalition, a collaborative of hospitals and other facilities in the state that plans for disasters, acquire ventilators.

In March and April, TSP’s clinical engineers tracked down and ordered nearly 250, which they will assemble, test and ready for deployment around the state.

 

Source: UVM News

Over the last three weeks, a team of scientists, engineers and doctors at the University of Vermont have developed a new design—and built a working model—for a simple, inexpensive ventilator.

“We think these could be rolled out very quickly and be effective on an emergency basis,” says University of Vermont lung expert Jason Bates who is leading the new effort in response to the burgeoning global coronavirus epidemic—and the huge shortage of ventilators that may be needed to treat people.

Affectionately called the “Vermontilator,” preliminary calculations suggest the UVM Ventilator “can be produced quickly and in large numbers for a few hundred dollars per unit in parts and materials,” Bates says.

Alternative approach

Unlike other improvised emergency ventilator designs, now being worked on around the world, the UVM team’s approach uses an alternative mode of helping critically ill patients breathe. It’s called “airway pressure release ventilation” or APRV.

This APRV approach may be particularly useful for patients suffering with the new virus. “One of the main complications from COVID-19 is called acute respiratory distress syndrome, a disease where the lungs fill up with an inflammatory fluid,” explains Dr. Anne Dixon, director of pulmonary disease and critical care medicine at the University of Vermont Medical Center and Larner College of Medicine. “Many of these patients end up being dependent on a ventilator for fairly prolonged periods.”

The new ventilator could help these patients by inflating their lungs using long inspirations of air, which are held inflated at a constant and relatively high pressure, Bates explains. Then “at regular intervals, short expirations are allowed during which the lungs expel carbon dioxide,” he says.

This APRV approach is the opposite of a normal breathing pattern—and may allow patients with COVID-19 to avoid, or reduce, the lung damage associated with the disease and with extended periods on a ventilator.

For more than fifteen years, Jason Bates— a professor in both UVM’s Larner College of Medicine and College of Engineering and Mathematical Sciences—has been researching the kind of lung damage that occurs during illnesses like doctors are now seeing in COVID-19 patients. A traditional fear is that a ventilator can cause injury from overinflation of the lungs. But Bates’ research is part of a growing body of evidence showing nearly the opposite: that the major risk to many patients comes when regions of the lung collapse. Then, the damaged and delicate lining of the lung comes together, sticks, and then is peeled apart—over and over.

“This peeling apart process is extremely injurious to the lining itself and can damage it to the point of allowing fluid to leak into the lungs from the capillaries that course through it,” Bates says. “Once this starts happening, the damage from peeling becomes worse, causing ventilator-induced lung injury to progress in a way that is difficult to reverse.”

APRV may avoid this trouble. “This mode of ventilation is thought to be particularly safe and non-injurious for patients with acute respiratory distress,” says Dr. Dixon who has been supporting the project.

A peak approaches

The APRV approach is also helpful to the engineers designing the new ventilator. Using this simpler breathing pattern allowed the team at UVM’s IMF Labs to build the prototype Vermontilator with a simple mechanism. Unlike a traditional ventilator—a very complex piece of equipment that can cost more that $25,000—the Vermont-built machine was quickly assembled out of a commercially available motor that drives a rotating disk, conventional medical hoses, and other relatively simple parts. The team’s prototype was built using a 3-D printer and machining equipment, with pieces that could be easily milled or cast, and assembled.  Bates credits the extraordinary skill of UVM engineers Jake Kittel, Mike Lane, Carl Silver and Guy Kennedy as being critical to the project’s rapid progress.

“We’ve diverted resources from our other projects to work on this and the guys are working all weekend,” says Lane, the director of UVM’s IMF Labs. “We know we have a very limited window to be successful, maybe just weeks before this [epidemic] peaks in Vermont.”

Dr. Dixon agrees. “They’re facing a catastrophic shortage of ventilators in New York. We’re hearing from our colleagues there that they’re trying to use machines we use for patients with obstructive sleep apnea and trying to ventilate people by hooking two patients up to one ventilator. Just crazy stuff that I’ve never heard of in my lifetime,” she says. “This new ventilator has amazing potential to help quickly. It’s not just simple—it’s innovative and elegant.”

The design is about to be submitted to the FDA for emergency review, and the team is working with the Vermont Manufacturing Extension Center, UVM Health Network, UVM Foundation, the state of Vermont, and other partners to secure funding, and engage qualified manufacturers. They’re also collaborating with UVM Innovations to develop an intellectual property strategy and business model to produce a large number of the devices.

Source: UVM News