More than a Fitness Center: The Veteran Wellness Center's Holistic Approach to Suicide Prevention - 2/10/21
New fitness center system could provide global 24/7 access - 8//2/22
Why We Need Single Sex Fitness Center Options
Myths About Selective Mutism - en espanol
Chatbot Beat Doctors on Clinical Reasoning

More than a Fitness Center: The Veteran Wellness Center's Holistic Approach to Suicide Prevention - 2/10/21

Suicide prevention is more than mental health care. Here’s how San Antonio’s new Veteran Wellness Center is providing a more holistic approach.

When it comes to suicide prevention, so many programs, solutions, and approaches focus on one singular thing: improving mental health.

However, I believe that suicide prevention goes so much deeper, farther, and wider than just mental health. There are so many other aspects that make up the wholeness of someone’s health and overall quality of life.

I can give someone counseling all day long, but if they struggle to pay both medical and other bills, have gained weight, lost their job, and are not financially secure, then suicide prevention means supporting all of these needs in addition to supporting any behavioral health needs that come with these challenges.

Understanding this was the catalyst for Endeavors’ new Veteran Wellness Center, and it’s why we are focused on expanding the gamut of services for Veterans in the name of suicide prevention.

More Than A Fitness Center

The overall desire and vision of the wellness center is to decrease suicide. The way we’re doing that is from a quality of life perspective. We’d like to provide people with the ability to choose wellness from any angle they need to without shame or stigma.

Wellness comes to us in lots of different forms. It could be learning something new, making a healthy meal, learning how to meditate, exercising, moving more, connecting with others, or receiving mental health support or family counseling.

This is why the Veteran Wellness Center will offer comprehensive services to support the daily wellness choices of each client. We built this combination of services to help with the overall balance of a person’s wellness rather than just focusing on one aspect of their lives. To do this, we used six pillars of wellness to create our programs: Mind-Body, Connectedness, Spiritual, Environmental, Economic, and Knowledge.

Pillar #1: Mind-Body

The pillar of mind-body connects physical fitness with medical care, holistic treatments, and mental health care under one principle. Besides a free gym equipped with the latest gear, we will offer fitness classes, including Tai Chi, Yoga, Zumba, and walking and/or running groups. Holistic care such as acupuncture and massage will be available as options for treatment of various conditions and non-chemical treatments of chronic pain and anxiety. We will provide access to mental health services for any era Veteran and their family members. Primary medical care and dental services will also be provided as a way to round out the mind-body wellness experience.

Pillar #2: Connectedness

Connectedness is all about providing the basic human function of people being together with a targeted focus to decrease isolation. We’ve really used that as our guiding force when creating our facility. We purposefully built a connectedness area with plenty of seating and light, connected to the lobby and a cafe. We want people to come in and feel like they can have lunch, grab a coffee, sit and work on their laptop, or whatever else they need. We really see it as a community hub. You don’t have to be a part of our client population to come to the wellness center.

Pillar #3: Spiritual

Spiritual health is incredibly important as well, no matter what religion or practice you adhere to. Spiritual services will be offered with meditation and mindfulness moment opportunities in the forms of readings and informational offerings that will be provided in the common areas, purposeful focus on multiple forms of spiritual expressions with the display and availability of art, quotes, and readings from diverse sources. Practices such as Thai Chi, Yoga, and meditative journaling will be taught thus fostering a sense of wellbeing, wholeness, and connectedness in all the wellness center’s offerings is a key component to the wellness principle of spirituality.

Pillar #4: Environmental

The environmental principle is founded on the idea that the space you spend your time in should be beautiful. We purposefully built the facility to capture a natural aesthetic so visitors can feel connected to the environment and with what is around us— rocks and trees and the beauty of nature. We utilized wood, stone, an abundance of light, and transparency to allow for the services being offered to be encouraged and from a posture of a positive embrace of a healthy life. We encourage natural beauty to be focused on daily in your own environment.

Pillar #5: Economic

Economic wellness is a significant factor in the six principles of wellness due to the significant role economic status plays in the client’s social determinants of health and their long-term medical outcomes. The wellness center will offer direct access to homelessness prevention to eligible Veterans and their families, rapid re-housing, and other financial crises. Financial wellness moments will be offered as either self-directed learning or in-person case management support and learning. Policy and advocacy work will also be offered and supported at the wellness center to encourage global changes to increase positive economic policies that directly impact social determinants of health.

Pillar #6: Knowledge

Knowledge is a common thread through everything. This is what enhances, strengthens, and supports overall health. This is why knowledge options will be provided through guest speaker series, psychoeducational classes, access to information via Wi-Fi, and suggested readings. We have a 2,000-square-foot community center where we plan on hosting events related to educating people.

A Personal Connection

Suicide prevention is not just mental health care. Suicide prevention is appropriate housing, access to medical care, access to fitness outlets, outlets to connectedness with people, and way more.

For me, this work is personal. Besides being a veteran myself, I come from a family of Veterans and active duty folks. Over my adult life, I watched my father (who was a Vietnam Veteran) struggle in silence with PTSD for decades. To cope, he would try and find community anywhere he could find it— at the gym, at a coffee shop, etc. There was no way he was going to go to counseling; and to be honest, that wasn’t what he needed. He needed a loving, caring community and access to multiple resources in various spheres of health.

I truly believe that our siloed approach to care and the stigmatization and shame that is prevalent in our society related to seeking mental health care is problematic. This shame continues the incorrect idea that mental health is a weakness. The truth is we all have mental health, we all need support, we all need a well-rounded approach to our emotional life.

I believe this well-rounded approach to suicide prevention is going to save lives. services. For more information, please visit www.endeavors.or

New fitness center system could provide global 24/7 access - 8//2/22

Staff Sgt. Anthony Davis innovation rodeo graphicPHOTO DETAILS / DOWNLOAD HI-RESJOINT BASE SAN ANTONIO-LACKLAND, Texas – Removing roadblocks from achieving fitness goals is at the heart of the idea submitted by Staff Sgt. Anthony Davis to the 2022 Air Force Installation and Mission Support Center Innovation Rodeo. The shift leader for the 6th Force Support Squadron at MacDill Air Force Base, Florida, wants to streamline the process of granting fitness center access to service members and civilians in transit between duty stations.

Originally from Arlington, Texas, Davis is proposing an innovation that will modernize the gain and loss process for fitness centers across the enterprise and help the Air Force remain fit-to-fight. He’s among eight finalists for the 2022 Innovation Rodeo and will pitch his idea to a panel of AFIMSC leaders Aug. 19 in San Antonio.

Davis shared the backstory for his idea and his thoughts about coming to the Alamo City for the annual innovation event.

Q: What is the name of your idea?

Universal 24

Q: What is the problem you’re solving?

When service members or civilians permanently or temporarily change duty stations, 24/7 fitness center access is not automatically established. For example, if someone reports after the fitness center closes for normal staff business hours, they will not be able to maintain their respective fitness schedule until they can check in with staff and are granted access. Additionally, fitness center staffs don’t know when customers change duty stations. This leads to the system getting backlogged with names of people who haven’t scanned in for months, and it can cause the system to go down or delay access for active customers.

Q: What is your solution to that problem?

Create a web site that fitness staff can update when a customer changes duty stations. Regardless of their arrival time or fitness schedule, customers can maintain their fitness routine without having to wait for fitness staff to manually grant access.

Q: How did you come up with the idea?

At MacDill AFB, we have 24/7 capabilities. But when military or civilian personnel arrive at our base, customers must come to the fitness center to get 24/7 access because we have to manually add their information into the system. With the web site, customers would be transferred ahead of time. For example, if a customer is traveling from Altus AFB, Oklahoma, to MacDill, all the patrons would need to do is notify the Altus fitness center staff of their change ahead of time so they can update the system through the web site. Then all they have to do it scan their ID at the front desk of the MacDill fitness center for access, thus, leaving fitness center staff to tend to the other customers in a timely manner.

Q. How will your idea help the Air Force deliver installation and mission support capabilities, improve installations or support families in a better way?

It will uplift the mission because customers will always have access to the fitness center so they can stay fit-to-fight. It would also cater to busy families who can’t make it to the fitness center during business hours.

Q. How does it feel to be selected as a finalist for the 2022 Innovation Rodeo?

It feels breathtaking to say the least! I had a small spark of hope to be involved with this, so just the experience is rewarding.

Q. You’ll be spending a week in San Antonio, learning from leading innovators, collaborating with industry partners and networking with peers, senior leaders and innovation teams. What are you hoping to gain from that experience?

I’m looking for inspiration, guidance, networking and the chance to see what’s possible.

Q: Why do you think innovation and a culture change that empowers Airmen and Guardians is important in today’s Air and Space Forces?

Things like this give people motivation to speak out about things they may have otherwise reserved due to lack of confidence. Opportunities like this pave the way for bold, innovative leaders for our future.

Q: Is there anything you would like to add?

Thank you for selecting me. I look forward to this experience and I’m eager to see how everything works.

Why We Need Single Sex Fitness Center Options

Myths About Selective Mutism

Clarifying the facts on a poorly understood disorder

Selective mutism (SM) is a relatively rare anxiety disorder in which children who are talkative at home are unable to speak in more public settings, including school. Their behavior is often misinterpreted as an inability to speak at all, or as a willful refusal to speak. Here are some of the most common myths aboutSM.

Selectively mute children have been traumatized or abused.

This is an unfortunate myth because it may prevent parents from seeking help for a child for fear of being suspected of abuse. There is no evidence linking selective mutism to trauma; children who are selectively mute are comfortable speaking at home but overcome by anxiety in social situations. Experts believe the condition is familial and possiblygenetic.

SM is just shyness. Kids with SM will grow out of it.

SM is a type of social anxiety that is much more extreme than ordinary shyness; it’s a paralyzing inability to speak which interferes with a child’s life and development. While some children do eventually overcome SM without treatment, they may endure years of suffering and miss out on age-appropriate activities and development.

Kids with SM have speech problems.

While some children with SM do have a speech delay, the two conditions are unrelated and many selectively mute children have no speech or language learning problems. When children cannot speak to unfamiliar adults, their verbal skills may be underestimated.

Children with SM are oppositional or manipulative.

The idea that children “choose” selective mutism was such a popular idea that for a while SM was known as “elective mutism,” and it was attributed to poor parenting. The truth is that SM stems from social anxiety and inhibition, not anger or a desire to control; the children experience it as an inability to speak.

Children with SM can speak if adults make clearer demands.

Pressure to speak is precisely what children with SM find most paralyzing. What they need are interventions to reduce anxiety and encourage efforts to speak with positive reinforcement. Being careful to give a child 5 seconds extra time to respond to a question can also increase the chance that she will find her voice.

SM is a form of autism.

Children with SM, when they are feeling anxious, often react with lack of eye contact, a blank expression, and other behaviors that may look like an autism spectrum disorder. However, SM is fundamentally different from autism; while children with autism lack social and communication skills, children with SM are severely inhibited in speaking in certain situations.


Chatbot Beat Doctors on Clinical Reasoning - 4/1/24

GPT-4 earned higher clinical reasoning scores than residents and attendings

When evaluating simulated clinical cases, Open AI's GPT-4 chatbot outperformed physicians in clinical reasoning, a cross-sectional study showed.

Median R-IDEA scores -- an assessment of clinical reasoning -- were 10 for the chatbot, 9 for attending physicians, and 8 for internal medicine residents, Adam Rodman, MD, of Beth Israel Deaconess Medical Center in Boston, and colleagues reported in a research letter in JAMA Internal Medicine

In logistic regression analysis, GPT-4 had the highest estimated probability of achieving high R-IDEA scores (0.99, 95% CI 0.98-1.00) followed by attendings (0.76, 95% CI 0.51-1.00) and residents (0.56, 95% CI 0.23-0.90), with the chatbot being significantly higher than both attendings (P=0.002) and residents (P<0.001), they reported.

Rodman told MedPage Today that medicine has been searching for ways to improve clinical decision-making, given that research has suggested misdiagnosis can result in up to 800,000 deaths each year in the U.S. He said large language models (LLMs) like GPT-4 "are one of the most exciting interventions in 50 years" for the clinical reasoning field.

One advantage of AI in this context is that it "doesn't have the cognitive biases humans do," he said. "It's able to second-guess itself and, because of that, can have a more robust differential."

Nonetheless, he said doctors who use GPT-4 today for assistance in diagnosis should be aware of its limitations.

"The justification for physicians using it right now is for experienced physicians who are aware that they could be missing something to de-bias themselves," he said. "You have to have a lot of domain knowledge because otherwise if it tells you something wrong, you might not know."

While GPT-4 distinguished itself on R-IDEAS scores in the study, it had similar outcomes to attendings and residents on diagnostic accuracy and cannot-miss diagnoses, the researchers reported. Median inclusion rate of cannot-miss diagnoses in initial differentials were 66.7% for GPT-4, 50% for attendings, and 66.7% for residents.

However, GPT-4 had more frequent instances of incorrect clinical reasoning than residents (13.8% vs 2.8%, P=0.04), but not attendings (12.5%), they reported.

"This observation underscores the importance of multifaceted evaluations of LLM capabilities preceding their integration into the clinical workflow," the researchers wrote.

For their analysis, Rodman and colleagues recruited internal medicine residents and attending physicians from two academic medical centers from July to August 2023. For the reasoning assessment, they used 20 clinical cases from NEJM Healer, an educational tool that uses virtual patients to assess clinical reasoning. Each case had four sections: triage presentation; review of systems; physical examination; and diagnostic testing.

Each physician took on one case, writing up a differential diagnosis for each of the four sections, and GPT-4 completed all 20 cases on August 17-18, 2023.

The study was limited by the fact that it was based on clinical data from simulated cases, so it's "unclear how the chatbot would perform in clinical scenarios." Also, they noted that they used a "zero-shot approach" to prompt the chatbot, so iterative training may be able to boost the AI's performance.

"Future research should assess clinical reasoning of the LLM-physician interaction, as LLMs will more likely augment, not replace, the human reasoning process," they concluded.