Duke University Alumni Magazine


GUNSHOT INJURIES
COST TAXPAYERS



Illustration by Harrison Haynes

n 1994, more than 38,000 people in the United States died from gunshots; nearly another 100,000 people were injured. These statistics represent the "enormous human toll of gun violence," and cost U.S. taxpayers more than $1 billion in lifetime medical costs, says a new study in an August issue of The Journal of the American Medical Association (JAMA).

The estimated medical costs of treating fatal and non-fatal gunshot injuries in the United States in 1994 was $2.3 billion, of which $1.1 billion was paid for by taxpayers through government programs, the JAMA article states. The article's authors--Philip Cook of Duke, Bruce Lawrence and Ted Miller of the National Public Services Research Institute, and Jens Ludwig of Georgetown University--used hospital discharge figures from Maryland and New York, emergency department records from South Carolina, and information from a number of other sources, including the National Spinal Cord Injury Statistical Center, to calculate their findings. The researchers say they primarily used 1994 figures for their study because these data were the most up-to-date and comprehensive available.

The researchers calculated that the mean medical cost per injury was about $17,000, of which 49 percent was paid by taxpayers, 18 percent by private insurance, and 33 percent by other sources. "While medical costs are a relatively small component of the total burden imposed on society by gun violence, they represent a substantial cost to the medical system," according to the article.

Cook, a professor of public policy studies and director of the Terry Sanford Institute, says that many people see gun violence as someone else's problem, believing that it has nothing to do with them or their circumstances. "But if they are taxpayers, they should be concerned about it, if for no other reason than so much of the cost is shared through government programs and insurance. In that respect, we all share in the pain."

The researchers note in their article that this "study presents what we feel are the first nationally representative estimates for the sources of payments for medical costs that are specific to gunshot injuries." They add, "While measuring medical costs is not as straightforward as counting the number of victims, valid cost estimates are important for at least two reasons. First, such estimates are relevant to evaluating gun violence-reduction programs. Second, reliable estimates for the financial burden that gun violence imposes on the medical-care system may help guide reimbursement policies."

To calculate lifetime medical costs, they measured acute-care hospital costs and follow-up charges that included prescriptions, medical supplies (such as crutches), home health care, and follow-up physician visits. While the mean medical cost per injury ran about $17,000 for the 134,445 fatal and non-fatal gunshot injuries in 1994, the non-fatal gunshot injuries that required hospitalization resulted in more than $35,000 per case in lifetime medical costs.

The researchers also determined that:

  • Gunshot injuries due to assaults accounted for 74 percent of the total medical costs.

  • Government programs are the primary payers for 40 percent to 50 percent of hospitalized gunshot injury cases. These same programs are the primary payers for 62.5 percent of spinal injury cases due to gunshots and 88.6 percent of spinal injury cases after initial hospitalization.

  • Non-fatal self-inflicted gunshot injuries have higher lifetime costs that unintentional injuries or assaults.

  • For non-fatal gunshot injury victims, the majority of medical treatment costs come after the patient has been discharged from the hospital.

"We see our estimates as being the lower bound," says Cook. "There are some costs we were not able to include but which nonetheless add to the [total] cost, such as the cost of treatment for psychological injuries associated with the shooting. We also were not able to take into full account the follow-up costs for brain injuries."

The research was supported by a grant from the Joyce Foundation in Chicago.


SPEEDY DATA
DELIVERY


omputer science researchers at Duke have developed a system for Internet communications at speeds higher than one billion bits--one gigabit--per second in a local area network (LAN) of desktop computers. This system essentially doubles the current speed at which data can be transferred over the fastest LANs with TCP/IP, the communications standard used for the Internet and the World Wide Web. It is 20,000 times faster than communication through a telephone modem.

The system uses a special high-speed Myrinet LAN operating at Duke's computer science department. Duke's Myrinet system was supplied by Myricom Inc. of Arcadia, California, as part of an experimental project funded by the National Science Foundation to develop new techniques for high-speed communications. This Myrinet network is itself rated at more than 1 gigabit. But system bottlenecks limit the rate at which data can move between the network and the computers connected to it, says Jeff Chase, Duke assistant computer science professor.

Using the fastest LANs now on the market, "you'll get about a half a gigabit per second through TCP," Chase says. By using the latest newly released Myrinet network cards together with their own modifications, the Duke team achieved speeds of 1.147 billion bits a second by mid-May, notes Andrew Gallatin, a senior systems programmer in Duke's computer science department who works with Chase. Other members of the Duke group include computer science graduate student Kenneth Yocum and Alvin Lebeck, also an assistant computer science professor.

"It's the first demonstration on public record of TCP/IP running faster than a gigabit per second, end-to-end, one host [network workstation] to another," Chase says. "What we have done is provide the software support that's needed to allow others to achieve similar speeds on other networks that will arrive in the future."

Details can be found at the Duke department of computer science website at www.cs.duke. edu/ari/trapeze.

LANs are groups of computers that are wired together to allow them to exchange messages and data. They range in speed and complexity from commonplace office networks to the array of high-end Digital Alpha workstations currently connected by Myrinet in a glassed-in "fishbowl lab" in Chase's department. Those machines and associated equipment are part of a larger Duke computer science testbed cluster funded by grants from the National Science Foundation, Myricom, and Intel Corp.

While the Myricom LAN is experimental and operates within a small space, the techniques developed there could eventually help computer users obtain more efficient access to larger scale networks, including a future version of the Internet, Chase says.

It might also mean that standard TCP/IP type software could be used for such cutting-edge applications as wiring together individual desktop computers into a massively parallel supercomputer. "What we've done is narrow the gap between standard TCP/IP communications that everybody loves and knows how to use and has the software to use and these more cutting-edge technologies that are harder to use and difficult for people to program," he says.


BIG BOOSTS
FOR ATHLETICS


wo gifts to Duke athletics--a bequest of more than $5 million from the estate of Tobias C. "Zollie" Sherrill '51, and a $2.5-million trust established by John Koskinen '61 and his wife, Pat--will support scholarships for student athletes, renovations and improvements to the soccer/lacrosse stadium, and the construction and maintenance of new recreational facilities on West Campus.

Sherrill, who died in 1996, was president of the T.A. Sherrill Construction Co., a grading and paving company in Charlotte. He was a football letterman at Duke and a charter member of the Iron Dukes, the organization largely responsible for funding athletic scholarships. His endowment will support as many as eight additional scholarships annually.

Duke currently offers 201 athletic scholarships in fifteen of its twenty-six varsity sports; before this gift, only thirty-six were supported by an endowment. Each scholarship costs approximately $33,000 annually and covers tuition, room and board, and other expenses. (Because Duke is a private institution, it does not have access to state support, which reduces the annual cost of an athletic scholarship at state universities in the Atlantic Coast Conference.)

In the next few years, the university plans to add another thirty-four new scholarships, for which fund raising is under way as part of the athletic department's portion of the Campaign for Duke.

In recognition of the gift--the largest ever for athletic scholarships at Duke--the men's basketball office area in the Schwartz-Butters Building adjacent to Cameron Indoor Stadium will bear his name. Slated for completion late in the fall, the Schwartz-Butters Building is a six-story addition to Cameron that will house an academic center for student athletes, men's and women's basketball offices and facilities, and a new sports hall of fame. The building will anchor the northwest end of Duke's West Campus recreational-athletic complex, which includes Card Gym and the Taischoff Aquatic Center; the new Wilson Center, a student recreational facility that opened with the start of classes; and the indoor Sheffield Tennis Center under construction, as well as the outdoor courts.

The Koskinens established a $2.5-million charitable lead trust, which, over a twenty-year period, is expected to generate $300,000 for the soccer/lacrosse stadium, $1 million to support West Campus recreational facilities, and more than $1 million to establish the John and Patricia Koskinen Scholarship Endowment fund to support female student athletes. In honor of their generosity, the refurbished soccer facility was named the John and Patricia Koskinen Stadium in a September ceremony.

Koskinen, who chairs President Clinton's Council on 2000 Conversion and is a former deputy director of the White House Office of Management and Budget, is a past chair of Duke's board of trustees, a former president of the Duke Alumni Association, and current chair of the newly created Athletics Advisory Board. In 1997, he was recognized as the top trustee in America by the Association of Governing Boards. He also was instrumental in bringing World Cup soccer to the U.S. He earned his bachelor's in physics at Duke and a law degree from Yale University. The Koskinens have two children; their son, Jeffrey, graduated from Duke in 1995.

Improvements to the stadium, which hosts Duke's men's and women's soccer and lacrosse programs, will be made in stages, beginning with a new scoreboard. Other enhancements include new restrooms, a press box, and a meeting room. The Koskinens' gift will endow two new annual scholarships for Duke student athletes.

In just its fourth year of existence, Duke's women's lacrosse team advanced to its first Final Four in the 1999 NCAA Championships. The men's lacrosse team made its sixth NCAA appearance and earned its first ever NCAA Tournament first-round bye in 1999. The men's soccer team concluded its 1998 season with an 18-4 overall record and a spot in the NCAA Tournament. The women's soccer team enters its twelfth season this year with seven NCAA Tournament appearances, including an appearance in the 1992 national championship game.


NEW TRUSTEES
NAMED


physician, a businesswoman, an aspiring technology consultant, a researcher, and an attorney have been elected to Duke's board of trustees. Edward G. Bowen M.D. '59 of Atlanta, Nancy A. Nasher J.D. '79 of Dallas, Brandon H. Busteed '99 of Boston, G. Clark Smith of Durham, and Gwynne A. Young '71 of Tampa have been elected to their first terms as members of the thirty-seven-person board.

Bowen, an obstetrician/gynecologist, is also an assistant clinical professor at Emory University School of Medicine. A past president of the medical staff of Northside Hospital in Atlanta, he currently chairs its board of trustees. He is also on the board of Fidelity National Bank and a former member of the boards of the Atlanta Opera and Atlanta Meals on Wheels. He enrolled in Duke's Trinity College in 1953, withdrawing in 1955 to enter Duke Medical School. He has been a member of the medical center's board of visitors since 1992 and is a past president of the Medical Alumni Council. In 1990, he received the Charles A. Dukes Award for Outstanding Volunteer Service to Duke. Bowen is married to Mary Martin Davis Bowen A.M. '59 and they have three grown children.

Nasher, a Princeton graduate, is an experienced lawyer and businesswoman who, since 1992, has been the owner of NorthPark Center, one of the premier shopping centers in the United States; president and chief executive officer of the NorthPark Development Company; and vice president of NorthPark Management Company. She had been an associate at a law firm; general counsel and director of leasing, marketing, and retail operations of The Nasher Company; and chairman of the board and chief executive officer of Northcorp Realty Advisors Inc. She has served on the boards of the Duke University Museum of Art, the Princeton University Museum of Art, and the University of North Texas School of Visual Arts. A lifetime member of the Duke law school's board of visitors, Nasher is a member of the law school's campaign planning committee and the university's campaign steering committee. She is also a member of the board of directors of the Dallas Museum of Art, Dallas Symphony Orchestra Association, Dallas Business Committee for the Arts, North Texas Public Broadcasting-KERA 13, Zale Lipshy University Hospital at Southwestern Medical Center, and Children's Cancer Fund of Dallas. She is the daughter of Duke trustee emeritus Raymond D. Nasher '43.

Busteed, who graduated in May with a bachelor's degree in public policy studies, has been elected to serve as the "young trustee" on the Duke board. He will spend the first year of his three-year term as a non-voting observer. He works for the Yankee Group, an information-technology market research and consulting firm in Boston. During his senior year at Duke, he was a student member of the trustee Business and Finance Committee. As an undergraduate, he was class president his junior year; was founder and chair of the Campus Social Board, which was formed to plan events for the entire campus; and worked on long-term initiatives for the betterment of social life, including the establishment of an alcohol-free dorm at Duke. He also was one of three founders of a national nonprofit organization, CIRCLe Network (College Initiatives to Reinvent Campus Life), which held a national leadership conference at Duke in March for student leaders and administrators. As a senior, he received the William J. Griffith Community Service Award and the Badge Award from the Duke police for his efforts to encourage safe social opportunities on campus.

Smith, a graduate research assistant in the Center for Applied Control at Duke since October 1994, is a Ph.D. candidate in mechanical engineering and is doing research on active control of noise and vibration. He plans to open a small start-up company with other students from Duke's Fuqua School of Business. He was nominated by the university's Graduate and Professional Student Council for his three-year term as a "young trustee." Besides serving on several councils, judicial boards, and committees, Smith initiated and developed an online resource for community members in need of child care in the Durham area. In 1999, he received three honors for his volunteer work: the Young Adult Volunteer of the Year Award from the Volunteer Center of Greater Durham and The Herald-Sun; the H.C. Jr. and Lois Cranford Volunteer Award from the Triangle United Way; and the William J. Griffith Award. He earned his bachelor's at Rensselaer Polytechnic Institute, where he received the Clarence E. Davis Award as the outstanding senior in mechanical engineering, and a master's degree from Virginia Polytechnic Institute and State University.

As president of the Duke Alumni Association, Young--who was a trustee of the University of Tampa and of the Tampa Preparatory School--will be an observer on the board of trustees during 1999-2000. She will be a voting member the following year. Young practices general civil litigation at the Tampa law firm Carlton Fields. After earning her J.D. at the University of Florida in 1974, she was an instructor at the University of Florida College of Law and an assistant state attorney for the Thirteenth Judicial Circuit in Florida. Young is a founder of the Child Abuse Council Inc., and serves on its advisory board. A member of the Tampa Chamber of Commerce, she is a former director of the Tampa Metropolitan YMCA, a former president of the Junior League of Tampa, and a former director of the Association of Junior Leagues International.


IN BRIEF

Pelham Wilder Jr., after marking a half-century of service to Duke--most conspicuously as university marshal and chief of protocol, his role since 1977--will be handing over his ceremonial mace after commencement ceremonies in May. He earned his bachelor's and a master's at Emory University, and a master's and doctorate at Harvard University. After serving in the Navy and then as a teaching fellow at Harvard, he joined Duke's chemistry department as an instructor in 1949. One of the first scientists to conduct research on the nature of cigarette smoke, he was named chemistry professor in 1962, pharmacology professor in 1967, and a distinguished professor in 1987. He directed undergraduate studies in chemistry for eighteen years. In 1971, he was one of the first faculty members to receive the alumni award for distinguished undergraduate teaching. After retiring from the faculty in 1990, he continued to teach in the chemistry department and at the medical school. In 1993, he was awarded the University Medal for Distinguished Meritorious Service.

Donna Zapf is the new director of the Master of Arts in Liberal Studies Program. In 1994, she began teaching in the Graduate Liberal Studies Program at Simon Fraser University in Vancouver, Canada; she became the program's director in 1997. Her teaching interests are interdisciplinary theories and histories of the arts, with an emphasis on modernism and contemporary practices and cultural theory and history. Zapf succeeds Diane Sasson, who was director of the interdisciplinary degree program for adult learners for twelve years. MALS has the largest enrollment of any Duke graduate program.

Joseph M. Corless Ph.D. '71, M.D. '72, a researcher, physician, and honored teacher, has been named vice dean for faculty and academic affairs at Duke Medical Center. In this newly created position, Corless will develop a broad initiative involving "mentoring" medical school faculty, placing special emphasis on female and under-represented minority faculty members as well as new teaching staff. He will also oversee the institutional review board, the international office, and policies related to conflict of interest and misconduct in science. In 1996, he was named director of appointments, promotions, tenure, and faculty development; two years later, he was promoted to assistant vice chancellor for academic affairs

Arts and Sciences Dean William Chafe has been named to the additional position of vice provost for undergraduate education. Chafe, who will retain the title and duties of dean of the faculty of arts and sciences, assumes responsibility for policy leadership in academic matters pertaining to Trinity College as well as in the areas of admissions and financial aid for undergraduates in arts and sciences and the School of Engineering. The Alice Mary Baldwin Professor of history was appointed dean of the faculty of arts and sciences in 1995. He had chaired the history department. He came to Duke in 1971 as an assistant professor of history, was promoted to full professor in 1979, and was named to a distinguished chair in 1988. He received the university's distinguished teaching award in 1973-74. In 1998-1999, Chafe was president of the Organization of American Historians.

Robert J. Thompson Jr., who was dean of undergraduate education, is now dean of Trinity College. Karla Holloway, William Rand Kenan Professor of English and African American literature, is dean of the humanities and social sciences; and Berndt Mueller, James B. Duke Professor of Physics, is dean of the natural sciences. The last two positions are new. Thompson's research has centered on clinical child psychology, and he has played a major role in promoting reform in the curriculum and in leading efforts to transform the University Writing Program and the Center for Teaching, Learning, and Writing. Holloway, who joined Duke in 1992, focuses on African-American literature from the perspectives of linguistics and cultural studies. Mueller's expertise is theoretical physics.

Kenneth C. Morris is chief financial officer of Duke University Health System. The former senior vice president of finance for Mission+St. Joseph's Health System in Asheville will be responsible for financial management for Duke's system, including financial strategy, budgeting and financial control, and overall financial performance. He earned his master's of public administration at the University of Colorado and worked at Tulane University in New Orleans before becoming vice president for finance and treasurer at Loyola University Medical Center in Chicago.




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