Nelleke C. van Wouwe, Ph.D., M.Sc., joined the research faculty at the University of Louisville School of Medicine as assistant professor in the Department of Neurological Surgery on June 1.

At UofL, van Wouwe will be working on research to understand the function of the basal ganglia in patients with Parkinson’s disease, Huntington’s disease, Tourette syndrome and other conditions. The basal ganglia are located at the base of the forebrain and are associated with control of voluntary movements, cognition, emotion and other functions. She will be working with Joseph Neimat, M.D., chair of the Department of Neurological Surgery, on experiments conducted in the operating room during deep brain stimulation surgeries. Her NIH-funded research will investigate how the basal ganglia affect cognitive functions crucial to navigating daily life situations, such as the ability to stop or change action.

“For example, patients with Parkinson’s disease may find it difficult to stop and control voluntary actions. The ability to stop an action can also depend on whether a positive or negative outcome is expected,” van Wouwe said. “Generally, dopaminergic medication and deep brain stimulation restore the ability to control actions, but some patients develop impulse control disorders. A better understanding of failures in adaptive behavior in neurologic or neuropsychiatric disorders with altered frontal basal-ganglia circuitry could ultimately help tailor treatment to individual needs.”

Since 2012, van Wouwe has been researching cognition and movement disorders at Vanderbilt Medical Center in Nashville. She was educated at Leiden University in the Netherlands and conducted research at the Netherlands Organization for Applied Scientific Research in Soesterberg before moving to the United States.

Van Wouwe’s research uses cognitive behavioral tasks, neurophysiological measurements, neuropsychological instruments and interventions such as medication withdrawal and deep brain stimulation to identify changes in action control and action-outcome learning resulting from neurodegenerative diseases. She is investigating the role of the subthalamic nucleus in action control and action-valence learning by means of cognitive testing, deep brain stimulation and intraoperative recording studies.

June 4, 2018

When a patient comes into the emergency room at University of Louisville Hospital with symptoms of a stroke, they benefit from a team of specially trained nurses dedicated to ensuring they receive the appropriate care quickly. In cases of stroke, time is brain!

As the state’s first Certified Comprehensive Stroke Center, UofL Hospital meets the highest standards of stroke care, and continually raises the bar. Prompt treatment with intravenous Alteplase (IV t-PA) is associated with better outcomes, lower mortality and shorter length of stay for patients with ischemic stroke. One of the key stroke treatment guidelines established by the American Heart Association and American Stroke Association is the administration of IV t-PA within 60 minutes of arrival at the hospital for patients with ischemic stroke. The staff at UofL Hospital continually works to improve this time, aiming to deliver IV t-PA to eligible patients within 45 minutes.  

Deidra Gottbrath, R.N., B.S.N., leads a team of specialized stroke clinical resource nurses on staff at UofL Hospital to help ensure that eligible stroke patients receive IV-tPA as quickly as possible. It can be challenging to determine whether a patient’s symptoms are due to a stroke or another condition. Gottbrath, who is certified in critical care and stroke care, provides the added resource to help expedite this process.

“From the moment we start participating in care, the ultimate focus becomes treating the stroke. That sounds simple, but there are a lot of complex cases that involve stroke symptoms,” Gottbrath said. “We don’t wait until we are sure it is a stroke before we apply that urgency. We focus on treating every case with stroke symptoms as though it is a stroke until we firmly rule out a stroke and let go of that urgency.”

Paula Gisler, R.N., Ph.D., is director of the UofL Hospital Stroke Program and helped define the stroke clinical resource nurses’ role. “These nurses are a resource to patients and physicians to drive care for all stroke patients. They do whatever it takes to get stroke patients appropriate care to achieve the best outcomes.”

The stroke clinical resource nurse supports emergency room nurses to assess potential stroke patients, facilitate scans, get IV-tPA medication prepared, and work with family members. They keep lines of communication flowing among emergency room nurses, doctors, the stroke team, the radiology staff and other providers.

“We are the string that ties the story together so it makes a complete circle, rather than leaving threads that might be woven together later,” Gottbrath said. “Because we focus solely on that one patient and situation, because that is our priority, we can offer the resource of locating family members to get the full story to get the patient treatment.”

Gottbrath and the other stroke clinical resource nurses follow patients beyond the emergency room, advocating for patients and keeping the lines of communication open throughout their stay. They provide education for patients and their families, as well as bedside nurses who care for stroke patients outside of the stroke unit.

“We are involved in the daily discussions of what type of rehab is appropriate for a patient and communicating that back to the families,” Gottbrath said. “We are there from the scariest moment to looking forward to going home or to rehab. We see the full circle of care.”

Kerri Remmel, M.D., Ph.D., director of the UofL Hospital Stroke Center and chair of the UofL Department of Neurology, says Gottbrath and her colleagues are invaluable assets to stroke care.

“Deidra and the other stroke clinical resource nurses provide an exceptional service to our patients,” Remmel said. “They are vital in keeping the focus on stroke care for those patients and making the connections that have led to even more improvements in the care we provide.”

Gottbrath and Tina Walsh, R.N., B.S.N., another stroke clinical resource nurse at UofL Hospital, compiled research data showing that since the introduction of stroke clinical operations nurses in 2016, door-to-needle times at UofL Hospital have shortened by an average of 2.5 minutes for eligible patients receiving IV t-PA at the hospital. In addition, eligible patients receiving IV t-PA within 45 minutes of arrival increased from 37 to 49 percent. Gottbrath presented the data at the International Stroke Conference earlier this year.

Although the UofL program does not yet have stroke nurses on duty around the clock, having these nurses in the hospital has led to faster door-to-needle times even when a stroke nurse is not in the building.

“This position has encouraged and educated the staff so that even when we are not physically present, stroke care is fresh on people’s minds – they remember the urgency of it,” Gottbrath said.

Gisler expects UofL Hospital will have a stroke clinical resource nurses on duty around the clock by the end of 2018.

A native of southern Indiana, Gottbrath originally planned to become a physician, but she did not  feel as engaged in that career path as she expected. She followed her sister’s suggestion to try nursing and discovered it gave her the interaction with patients that she enjoyed.

“As I delved into it, I felt more connected to nursing,” she said. “The minute I started nursing school I thought, ‘This is what I’ve been missing. This is the connection to medicine I always wanted.’”

“Every day is so different and so challenging but so rewarding. Now I can’t image doing something different."

More about stroke

A stroke occurs when a blood vessel in the brain is either blocked (ischemic) or ruptures (hemorrhagic), causing a loss of blood flow to the brain. In cases of ischemic stroke, the “clot-busting” drug, Alteplase (t-PA), delivered intravenously within hours of the stroke, can provide brain-saving relief, which can prevent death or result in improved recovery for the patient.

To learn more about recognizing stroke and stroke treatment guidelines, visit the American Stroke Association.

 May 23, 2018

Students, faculty, staff, patients and visitors to facilities within the University of Louisville Health Sciences Center now have a marked one-mile path to foster wellness through walking.

The HSC Medical Mile walking path was dedicated at a ribbon-cutting on Tuesday, May 23. Louisville Mayor Greg Fischer joined UofL School of Medicine Dean Toni Ganzel, M.D., to open the new path.

The Medical Mile follows a 1-mile path from the HSC Plaza north to East Muhammad Ali Boulevard, east to South Hancock Street, south to East Chestnut Street, west to South Floyd Street, north to East Muhammad Ali again, and finishing up by going south on South Preston back to the starting point.

The mile is marked along the way with the Medical Mile graphic image and with one-fourth, one-half and three-quarter mile markers as well.

The creation of the Medical Mile was part of the School of Medicine’s SMART Wellness Task Force and the Being Well Initiative, said Chief of Staff Karan Chavis, and is the product of the work of the committee under the leadership of former co-chair Miranda Sloan and current co-chair Tamara Iacono.

“We know that walking is great physical activity that virtually anyone can do, and with the sidewalks we have surrounding our buildings, we have a ready-made way to create a dedicated walking space for people,” Chavis said. “Through the spring and summer, we are encouraging people to create ‘walking trains,’ picking up people along the way and walking together.”

Photos of the ribbon-cutting are available here.

The University of Louisville Board of Trustees today approved a name change of an existing institute that will contribute to expanding the university’s scope in evaluating the influence of the environment on health and wellness 

The Board okayed the changing of the name of the Kentucky Institute for the Environment and Sustainable Development (KIESD), created in 1992, to the Envirome Institute. Like KIESD, the institute will support research and applied scholarship, teaching and educational outreach activities, but with greater emphasis on community engagement and health.

Aruni Bhatnagar, Ph.D., professor and the Smith and Lucille Gibson Chair in Medicine in the UofL School of Medicine, is tapped to lead the institute, which will have a more focused emphasis on the health effects of the environment, not as separate domains but as an integrated whole. An envirome is the total set of environmental factors, both present and past that affect the state and disease susceptibility of individuals. 

“Over the past decade, new expertise in the area of environmental health research has emerged,” Bhatnagar said. “To fully meet the needs of our state and nation in environmental health, it is critical for UofL to expand the scope of the KIESD and to recruit new leading scholars with broad backgrounds in health sciences, environmental research and community engagement.”

The Board also approved the creation of the Center for Healthy Air, Water, and Soil (CHAWS), a part of the Envirome Institute. CHAWS will support outreach activities to promote collaborations and interactions with the community for information exchange, partnership in scientific studies, dissemination of environmental information to the community and consultation by the community on issues relevant to the environment and health.

University of Louisville School of Medicine Dean Toni Ganzel, M.D., has appointed Kimberly Boland, M.D., to serve as interim chair of the Department of Pediatrics. The appointment is effective July 1, 2018.

Boland has served as assistant dean of resident education and work environment in the Office of Graduate Medical Education at the UofL medical school since August 2016. Additionally, she holds the positions of executive vice chair of pediatrics, associate director of pediatric residency training and professor in the UofL Department of Pediatrics. Board-certified in pediatrics, Boland is a pediatric hospitalist with UofL Physicians – Pediatric Hospital Medicine and Norton Children’s Hospital.

“Kim Boland is an outstanding clinician educator, scholar and leader,” Ganzel said. “She is well positioned to lead the Department of Pediatrics now and into the future.”

In addition to overseeing the pediatric residency program for nine years as program director, Boland oversaw nine pediatric fellowship programs at UofL. She assisted in the creation of the department’s Development and Behavioral Fellowship, Pediatric Child Abuse Fellowship, Pediatric Pulmonary Fellowship, Pediatric Endocrinology Fellowship and Pediatric Hematology-Oncology Fellowship. She also serves the university on the Promotion Appointment and Tenure Committee and the School of Medicine Wellness Committee.

She is a past recipient of the Paul Weber Award, the School of Medicine Master Educator Award and Dean’s Educator Award for Distinguished Teaching along with five clinical teaching awards and seven faculty peer-mentoring awards.

Boland was named a fellow of the Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program’s 2017-18 class. ELAM is a yearlong fellowship for women faculty in schools of medicine, dentistry and public health and provides training and experiential learning to help expand the national pool of qualified women candidates for executive positions in the academic health sciences.

She also is immediate past chair of the Association of Pediatric Program Directors’ Mid-America Region and a member of its Curriculum Task Force and a past president of both the Kentucky Pediatric Foundation and the Kentucky Chapter of the American Academy of Pediatrics.

A Louisville native, Boland earned her undergraduate degree from Notre Dame University and her medical degree from UofL. She completed her residency and chief residency in pediatrics and a fellowship in pediatric critical care at St. Louis Children’s Hospital at Washington University in St. Louis.

Boland succeeds Charles Woods, M.D., who has been named pediatrics chair at the University of Tennessee-Chattanooga and Children’s Hospital at Erlanger after serving at UofL for 12 years. “We thank Dr. Woods for his many years of service and leadership at the School of Medicine and wish him well in his new position,” Ganzel said.

Tickets are now available for Louisville Magazine’sBest of Louisville® award celebration recognizing people and companies who make Louisville a great city.

The James Graham Brown Cancer Center at the University of Louisville has been named the “Charity of Choice” of the event, scheduled for 6:30-10 p.m., Thursday, July 12, at the C2 Event Venue, 225 E. Breckinridge St.

Funds raised for the cancer center from the Best of Louisville event will specifically go to the UofL Brown Cancer Center’s M. Krista Loyd Resource Center, a place for patients and families to receive much-needed resources such as transportation and lodging assistance; wigs, scarves and prosthetics; and a variety of therapies, education and support.

Early bird tickets throughout May are $35 per person when using the code ENDCANCER at checkout. Beginning June 1, early bird tickets will be $45 with the code. Regular-price tickets purchased without the code are $50 per person.

Tickets are available at UofLBrownCancerCenter.org by clicking on the “Best of Louisville” link. All sales with the promo code ENDCANCER go directly to the cancer center.

Admission includesfood and drink tastings, cash bar and a complimentary copy of Louisville Magazine's July "Best of Louisville" issue. The magazine created the city’s first reader-voted awards 33 years ago.

Sponsors of the event are UofL Hospital, Korbel California Champagne, DJX 99.7 All the Hits, Four Roses Bourbon and Universal Linen Service/Every Piece Counts.

For information, contact Elea Fox, executive director of advancement for the Brown Cancer Center, 502-852-3380 or elea.fox@louisville.edu.

In addition to general urology, Choi has special interest in pelvic reconstructive surgery, including vaginal repair of prolapse and robotic surgery for female prolapse conditions. She offers treatments for voiding dysfunction using botox injections to the bladder and sacral neuromodulation.

“I practice a multidisciplinary approach in treating various urinary complaints, and use minimally invasive techniques to achieve maximum results,” Choi said. “I work closely with pelvic floor physical therapists for conservative treatment options. When medication and other more conservative therapies do not achieve desired results, we can consider a bladder pacemaker or other more novel approaches.”

For survivors of prostate and other cancers or severe urinary trauma, Choi performs specialized reconstructive procedures including urethroplasty, in which she uses tissue from inside the patient’s cheek to reconstruct the urethra. She also implants artificial urinary sphincters (AUS) for the treatment of urinary incontinence, male bladder slings and penile prosthesis, and provides other treatments for erectile dysfunction.

“Dr. Choi’s expertise is a great asset for patients throughout Kentuckiana,” said Murali Ankem, M.D., M.B.A., chair of the UofL Department of Urology. “She already has gained the attention and respect of the entire department and patients she has served.”

Choi graduated from the Texas College of Osteopathic Medicine after receiving her bachelor’s degree from Texas A&M University. Following her urology residency at Charleston Area Medical Center in W.Va., she completed a fellowship in female urology, neurology and pelvic floor reconstruction at Metropolitan Urologic Specialists in Minneapolis.

Choi is a member of the American Urology Association, Society of Urodynamics Female Pelvic Medicine & Urogenital Reconstruction, and American College of Osteopathic Surgeons.

May 8, 2018

The Department of Psychiatry and Behavioral Sciences at the University of Louisville School of Medicine has partnered with a community mental health center to bring telepsychiatry to rural residents, most of whom would otherwise have difficulty obtaining care.

The department and The Adanta Group this month received an honorable mention from the Mid-Atlantic Telehealth Resource Center’s Breaking Barriers through Telehealth awards for bridging gaps to mental health care in rural Kentucky and providing an innovative way to train resident physicians.

The collaboration began in 2015, transplanting the well-established model for teaching residents in a clinical setting to a video teleconferencing platform that connects patients at a rural mental health care facility to UofL psychiatrists. Through the partnership, UofL provides telepsychiatry primarily in Casey and Taylor Counties.

“Telepsychiatry often means the difference between care and no care for some rural patients,” said Robert Caudill, M.D., UofL Physicians – Psychiatry, residency training director and associate professor of the UofL Department of Psychiatry and Behavioral Sciences. “These patients can go long periods of time between appointments because they have to travel far from home for care or available slots are filled. Rural health facilities have a difficult time recruiting and maintaining medical staff.”

UofL has helped maintain Adanta’s staffing level without having to rely on temporary doctors who are typically expensive to employ. In turn, Adanta increased the length of appointments to allow residents time to learn under faculty supervision.

“We provide university-based physicians who are working with the clinics consistently and Adanta didn’t have to hire us at 40 hours a week,” Caudill said. “I could be there for four hours an afternoon in an isolated clinic, and with the click of a mouse, treat patients in a different clinic without having to drive somewhere. The logistics are persuasive.”

Telepsychiatry has other benefits to the patient. Stigma surrounding mental health treatment is reduced because the process of going to appointments is more private. It’s also less intimidating to patients who have experienced trauma to meet with a physician through a video monitor, Caudill said.

As mental health services transition from relying on traditional office visits, UofL psychiatry residency graduates are prepared to integrate technology into their clinical practice.

Timothy Bickel, telehealth director at the UofL School of Medicine, said training resident physicians in telemedicine should expand beyond psychiatry.

“Medical students and residents get attention from prospective employers for being involved in telehealth,” Bickel said. “Students should at least have the opportunity to be exposed to telehealth.”

Kentucky Justice Secretary John Tilley, the University of Kentucky and the University of Louisville announced a new partnership today that will strengthen the state Medical Examiner’s Office, a vital step amid the deadly opioid epidemic and a national shortage of forensic doctors.

Under the agreement, the Justice Cabinet will contract with the universities for forensic pathology services, combining resources for both autopsies and medical education. The move is expected to boost salaries for doctors, helping improve recruitment and retention, and it will help the cabinet avoid charging counties a fee for autopsies.

“The opioid crisis has placed tremendous strains on our state, and we must take every opportunity to innovate and find efficiencies,” Secretary Tilley said. “By partnering with universities, we can improve the pay and size of our forensics team while also ensuring that families, coroners and police get the answers they need when tragedy strikes.”

The agreement also will help UK and UofL maximize training opportunities for medical students and residents in pathology.

“Our collaboration with the Justice Cabinet and their Medical Examiner’s Office illustrates the University of Kentucky’s desire to take a comprehensive, ‘all hands on deck’ approach to addressing Kentucky’s opioid crisis,” said Dr. Darrell Jennings, chair of the UK Department of Pathology and Laboratory Medicine. “This opportunity will provide our medical students in Lexington, Bowling Green and Northern Kentucky, along with our residents and fellows, with unparalleled training on the front lines, harnessing the power of compassion and commitment to transform the future.”

“Through this strengthened relationship with the state Medical Examiner’s Office, we will broaden the educational and training opportunities for our students, residents and fellows,” said Dr. Eyas Hattab, chair of the Department of Pathology and Laboratory Sciences at UofL. “Our trainees will have access to the number and variety of cases that are invaluable as they prepare for the next steps in their careers.”

UofL will provide up to six pathologists in state medical examiner offices; UK will provide up to four. The cabinet will pay the universities for any services performed by these doctors on a scale similar to current costs. The cabinet and universities will also collaborate on strategies that could possibly lower the overall cost of the program in the long run.

The Medical Examiner’s Office currently employs nine doctors – six in Louisville, two in Frankfort and one in Madisonville. The partnership is expected to provide a net increase of one forensic pathologist immediately with opportunities to add an additional doctor, possibly within two years, thanks to recruitment assistance from the universities.

All doctors have an opportunity to transition into university positions, and those who do are expected to receive a salary increase depending on the individual contracts between doctors and universities. Added salary will compensate for additional responsibilities such as teaching, researching, writing, consulting or other contributions that doctors are interested in pursuing.

While the exact terms of employment will depend on the individual contracts, the higher pay scale is expected to make Kentucky more effective at hiring and keeping new doctors.
Kentucky, like many other states, has struggled to recruit forensic pathologists in recent years due to a national shortage. Only about 500 forensic doctors are currently practicing across the country. At the same time, overdose deaths have continued to climb over the past decade, driving up demand for autopsies and toxicology tests. More than 1,400 Kentuckians died from an overdose in 2016.

In response, enhancing the Medical Examiners’ Office has remained a high priority under the current administration.

In 2016, the office resumed services in Madisonville (following a two-year hiatus), helping coroners and law enforcement agencies across Western Kentucky reduce travel costs and obtain evidence at a faster pace.

Secretary Tilley said he plans to continue looking for ways to improve the office. For instance, the cabinet is aggressively seeking grant funds to expand capacity, reduce caseloads, expand toxicology analysis and enhance data collection.

“We want to consider every option to enhance services while avoiding fees for counties,” he said. “UK and UofL have been excellent partners in this process, and we look forward to continuing our work with coroners to ensure their needs are met.”

Due to anticipated inclement weather on Tuesday, April 24, the ribbon-cutting event for the new Medical Mile walking path at the University of Louisville Health Sciences Center campus has been postponed.

The event will be rescheduled for a later date.

Please contact Jill Scoggins at 502-852-7461 or jill.scoggins@louisville.edu if you have any questions.

About the Medical Mile:

The creation of the Medical Mile walking path is part of the School of Medicine’s SMART Wellness Task Force and the Being Well Initiative. The Medical Mile follows a 1-mile path on the University of Louisville Health Sciences Center campus. A map of the path can be found here.The mile is marked along the way with the Medical Mile graphic image and with one-fourth, one-half and three-quarter mile markers.

It is well-established that the community of organisms inside our bodies perform vital roles in digestion, production of critical metabolites, controlling the immune system and even affecting the brain.

To further understand these associations linking the microbiome - bacteria, yeasts, fungi, viruses and protozoans - with inflammation and disease, the University of Louisville has received an $11.2 million federal grant over five years to establish an interdisciplinary research program.

The grant, awarded through the National Institute of General Medical Sciences, establishes a Center of Biomedical Research Excellence (COBRE) and pairs well-funded scientists with junior faculty in the Schools of Dentistry, Medicine and Engineering. This arrangement facilitates the career development of junior faculty, and aims to advance the study of the interface between microbiome, inflammation and disease development.

“Although the microbiome contributes to many beneficial aspects of our physiology, when these communities are out of balance, or dysbiotic, they are implicated in an array of diseases such as inflammatory bowel disease, periodontitis, vaginosis, colorectal cancer, and distant sites like rheumatoid arthritis, even neurological disorders like Parkinson’s disease and autism spectrum,” said Richard Lamont, Ph.D., chair of the School of Dentistry’s Department of Oral Immunology and Infectious Diseases and principal investigator for the grant.

Furthermore, Lamont said, inflammation is a process that provides the mechanism connecting the microbiome and disease.

“The interplay of the pro and anti-inflammatory components of the immune system with microbes often dictates whether a person remains healthy or develops a disease, as well as controls aspects of recovery, chronic infection and the level of tissue destruction,” he said.

Microbiology and Immunology in the School of Medicine is the other primary department participating in the COBRE. Researchers in the J.B. Speed School of Engineering’s bioengineering department will provide expertise as possible new discoveries show potential for new therapeutic technology against disease.

“This program will synergize with, and augment, existing research priorities at UofL centered around microbial community-associated diseases,” said Greg Postel, M.D., interim UofL president. “We are confident that establishing a critical mass of investigators with unique complementary expertise will propel UofL to a position of preeminence in this important field.”

“We are thrilled to add this COBRE multidisciplinary program in research, education and mentoring to facilitate and accelerate the transition of junior faculty to independent extramural funded status, advancing our overall research enterprise,” said T. Gerard Bradley, B.D.S., M.S., Dr.Med.Dent., dean of the School of Dentistry.

The grant will support five junior faculty and their specific research focused on the mouth, GI tract, arthropod (flea) vector environments, vagina and lungs:

• Juhi Bagaitkar, Ph.D., will study how oxidants change neutrophil, or white blood cell, responses in the mouth. She is focused on inflammatory pathways regulated by Reactive Oxygen Species essential in host responses to oral bacteria. She hopes to provide insights into neutrophil biology, and enhance the understanding of immune pathways related to inflammation of the gums and the interface with microbes.
• Venkatakrishna Jala, Ph.D., will investigate the beneficial effects of the microbial metabolite, uronlithin A (UroA) and its structural analogue UAS03 in inflammatory bowel disorders. He will examine their impact on both immune responses and maintenance of the epithelial barrier in the gastrointestinal mucosal membrane.
• Matthew Lawrenz, Ph.D., will study the pathogenic mechanisms of Y. pestis, a bacterium that causes bubonic plague. Humans can become sick after being bitten by a rodent flea. Lawrenz will further investigate several mechanisms, including how Y. pestis evades macrophages, a kind of white blood cell first on the scene of infection. As the project develops, Lawrenz also hopes to explore the relationship of Y.pestis and microbial communities of the flea, which may impact colonization and transmission.

• Jill Steinbach-Rankins, Ph.D., will investigate a new nanotherapeutic approach to treat bacterial vaginosis (BV), a dysbiotic condition where vaginal microbial communities are disrupted. With expertise in materials science engineering and biomedical engineering, Steinbach-Rankins aims to develop targeted community engineering to restore the balance between the microbiome and host to prevent the manifestation of disease.

• Jonathan Warawa, Ph.D., will investigate Burkholderia pseudomallei (Bp), the bacterium responsible for respiratory melioidosis, an inflammatory disease of the lungs that progresses into a fatal systemic disease involving major organs. This project drills down into innate immune responses contributing either to protection and resolution of diseases or to increased morbidity. Through greater understanding of immune responses, therapeutic intervention is possible.

The COBRE also helps establish a functional microbiomics core research facility at UofL. The facility will provide germ free animal facilities, oxygen-free culture capability, microbiome sequencing and bioinformatics, assessment of inflammatory markers and pathology services. 

Students, faculty, staff, patients and visitors to facilities within the University of Louisville Health Sciences Center now have a marked one-mile path to foster wellness through walking.

The HSC Medical Mile walking path will be dedicated at a ribbon-cutting on Tuesday, April 24, at 11:30 A.M. Louisville Mayor Greg Fischer will join UofL School of Medicine Dean Toni Ganzel, M.D., to open the new path.

The event will be held at the Medical Mile’s starting point, on the sidewalk next to the Health Sciences Center Plaza near Kornhauser Library, 500 S. Preston St.

The Medical Mile follows a 1-mile path from the HSC Plaza north to East Muhammad Ali Boulevard, east to South Hancock Street, south to East Chestnut Street, west to South Floyd Street, north to East Muhammad Ali again, and finishing up by going south on South Preston back to the starting point.

The mile is marked along the way with the Medical Mile graphic image and with one-fourth, one-half and three-quarter mile markers as well.

The creation of the Medical Mile was part of the School of Medicine’s SMART Wellness Task Force and the Being Well Initiative, said Chief of Staff Karan Chavis, and is the product of the work of the committee under the leadership of former co-chair Miranda Sloan and current co-chair Tamara Iacono.

“We know that walking is great physical activity that virtually anyone can do, and with the sidewalks we have surrounding our buildings, we have a ready-made way to create a dedicated walking space for people,” Chavis said. “Through the spring and summer, we are encouraging people to create ‘walking trains,’ picking up people along the way and walking together.”

The path of the HSC Medical Mile is shown on the map below:

Staying up-to-date on the latest developments in medical research and clinical care is part of every physician’s duty to provide the best care for patients.

The quality and integrity of courses offered through the University of Louisville Office of Continuing Medical Education and Professional Development have been affirmed by the Accreditation Council for Continuing Medical Education (ACCME). In March, the ACCME awarded the school Accreditation with Commendation for a six-year accreditation period.

“We were thrilled to receive the notice that we have been reaccredited to continue offering lifelong learning programming for our physicians and physicians all over the U.S.,” said Daniel Cogan, Ed.D., assistant dean for CME and professional development at the UofL School of Medicine.

UofL’s CME office offers continuing education for physicians not only in Louisville, but throughout Kentucky and across the United States. The ACCME Commendation recognized the office’s effectiveness in addressing local and community issues such as the medical needs of diverse groups, including LGBTQ patients and other underserved populations.

“Continuing education for physicians in the community contributes to improved health care and a healthier population in Kentucky as well as throughout the region and the world,” said Toni Ganzel, M.D., M.B.A., dean of the UofL School of Medicine. “The exceptional services provided by this office are a credit to the leadership and dedication of Dr. Cogan and his staff.”

The office provides programming approved by the American Medical Association, AMA PRA Category 1 credit, for more than 40 major CME courses each year, as well as more than 50 regularly scheduled series programs such as Grand Rounds in UofL departments and divisions. The office provides services for local and regional partners, including Jewish Hospital, the Robley Rex Veterans Administration Medical Center, Ireland Army Community Hospital at Fort Knox, and Area Health Education Centers in the western half of Kentucky. They also provide administrative services for third-party CME providers.

“We work with joint providers to offer multi-day courses in many parts of the country and as far away as Hawai’i and the Caribbean,” Cogan said. “We also provide course development services for our partners in India. In 2017, our programs provided CME credit for more than 23,000 practicing physicians, from primary care to the most specialized practitioner, and another 20,000 non-physician health-care providers.”

April 17, 2018

“Odds are that at some point in your flying career, you will have to respond to an overhead page:  ‘Is there any doctor on board the flight,’” Raymond Orthober, M.D., assistant professor of emergency medicine at the University of Louisville, told 35 second- and third-year medical students.

Orthober, the students and additional instructors were aboard a Delta aircraft, engaged in a training event for treating passengers who have medical issues during a commercial flight. Although the aircraft remained at the gate, the space created a realistic environment for learning to provide medical care in the air.

“One day that’s going to be me who can stand up and say, ‘I’m here.’ This is a chance to have a little background in what to do in those scenarios and to get comfortable managing those things in an airplane setting,” said Matthew Wilson, a third-year UofL medical student who took part in the training.

See a video about in-flight emergency training.

In-flight emergencies are just one of the scenarios Wilson and other medical students experience as part of the Disaster Medicine Certificate Series (DMCS), a program at the UofL School of Medicine that prepares them for a wide variety of emergency situations. More than 65 second- and third-year students have participated in DMCS training events, including mass casualty triage and handling hazardous materials, since the extracurricular program began at UofL last fall. Organizers believe it is the only program in the nation that exposes medical students to this type of training on an ongoing basis.

The DMCS grew out of third-year medical student Madison Kommor’s own desire to help in case of an emergency.

“I hope I never have to respond to a disaster situation, but I was tired of sitting in a library waiting for someone to teach me what to do if something happens,” Kommor said.

DMCS is designed to prepare future physicians in every specialty to put their skills to work in case of natural or man-made disasters such as a flood, hurricane or mass shooting.

“A lot of students got excited about it. They want to be useful, but they need to be trained,” said Bethany Hodge, M.D., M.P.H., assistant professor of pediatrics at UofL and a faculty advisor for DMCS.

The program’s training sessions, which take place during the students’ free time, familiarize students with emergency response systems and prepare them to provide medical assistance outside of a hospital or clinical environment. During the in-flight emergency training, instructors shared stories of their own experiences with in-flight emergencies, described medical supplies typically found on commercial aircraft, and explained laws and best practices for helping passengers in distress and the use of ground-based medical support. Students then rotated among seven training stations, where they treated simulated in-flight emergencies such as cardiac arrest, drug overdose, turbulence injuries and choking.

“The disaster medicine training provides the opportunity to get hands-on in real-world settings that we really don’t get elsewhere in medical training,” Wilson said.

In addition to the flight emergency experience, the students have received mass casualty training from the United States Army, instruction in medical countermeasures from the Louisville Metro Department of Health & Wellness, and learned about trauma management in a wilderness setting. Once students have accumulated sufficient training points within a two-year period, they will receive a certificate of program completion.

Although the students will not be licensed physicians for a few more years, they are putting their training to work for the community immediately. Program participants are required to enlist in the Medical Reserve Corps (MRC), a national network of volunteers organized for emergency response under the U.S. Department of Health & Human Services. Some of the students have participated with the MRC in response to the Hepatitis A outbreak, assisting the Louisville Department of Health & Wellness with vaccination drives. Other students have joined the Norton Children’s Special Response Team, formed to handle hazardous material decontamination situations at Norton Children’s Hospital.

“I think the real world experience is valuable and you are not just waiting to give back, which is another thing that motivates the students,” Hodge said. “Being able to do something now is really positive.”

The opportunity for immediate application and the ongoing nature of the program, as opposed to a one-time event, give Hodge confidence that the students will retain their involvement in disaster preparedness throughout their careers.

“My hope is that we have people with the mindset for disaster preparedness,” Hodge said. “No matter what type of physician they become, they are able to support the systems that deal with natural and man-made disasters.”

April 16, 2018

We have been bombarded with the notion that bacteria are bad for us. You probably also have heard that germs are becoming more and more resistant to antibiotics, leaving us vulnerable to diseases that we thought were conquered. As scientists develop ever-more-powerful medications to fight bacterial infections, the bacteria are fighting back, and sometimes seem to be winning.

Will we eventually enter a post-antibiotic era where simple infections can kill us?

Deborah Yoder-Himes, Ph.D., assistant professor in the Department of Biology at the University of Louisville, assures us we are not yet doomed, but we do need to have a battle plan.

“If we take steps now to combat the rising rates of antibiotic resistance, develop new antibiotics and secure these medicines for future use, we can win the war against these bugs,” Yoder-Himes said.

How do we do this?

At the next Beer with a Scientist, Yoder-Himes will discuss how most bacteria are actually good for us, how pathogenic bacteria evolve to resist our most potent medications and how science can preserve our ability to fight illness-causing infections.

The talk begins at 8 p.m. on  Wednesday, Apr. 18, at Against the Grain Brewery, 401 E. Main St. in Louisville. A 30-minute presentation will be followed by an informal Q&A session.

Admission is free. Purchase of beer, other beverages or menu items is not required but is encouraged.

Organizers add that they also encourage Beer with a Scientist patrons to drink responsibly.

UofL cancer researcher Levi Beverly, Ph.D., created the Beer with a Scientist program in 2014 as a way to bring science to the public in an informal setting. Once a month, the public is invited to enjoy exactly what the title promises:  beer and science.

Watch for info on the next Beer with a Scientist, scheduled for May 16.

Julia Semple spent 10 years trying to figure out what was wrong.

“It started with my head sort of twitching back and forth, like when you shake your head ‘no.’ It was completely involuntary,” Semple explained. “It progressed to other areas of my body over time. You know when you relax and you have a little twitch? Imagine that except a hundred times bigger and over and over again so you could never fall asleep. It was horrible.”

The symptoms interfered with Semple’s sleep as well as her work as a massage therapist and dancer. Unable to detect a physical cause for the symptoms, numerous physicians and other health providers in her home state of Delaware told her they likely were caused by stress. Finally, in 2016, a neurologist gave her condition a name:  functional movement disorder.

Internet research led Semple to Kathrin LaFaver, M.D. a neurologist at the University of Louisville and director of the Parkinson’s Disease and Movement Disorders Clinic at UofL Physicians. LaFaver developed the Motor Retraining program (MoRe), one of only a few such programs in existence for the treatment of FMD. MoRe was modeled after a program at Mayo Clinic and combines neurological treatment, psychological counseling, and physical and occupational therapy during a week-long inpatient therapy at Frazier Rehab Institute, a part of KentuckyOne Health. The program aims to improve patients’ motor symptoms, help them regain control over abnormal movements and develop better coping skills.

Functional Movement Disorders (FMD) are common conditions involving abnormal movements – jerking, tremor or issues with gait or speech. The problems are due to miscommunications in the central nervous system. Patients often complain of fatigue and difficulties with concentration and thinking.

“Functional disorders are in the borderland between neurology and psychiatry, and there is a lack of treatment programs for the conditions. Diagnostic tests do not reveal a cause for the FMD, so patients experiencing symptoms often are told by neurologists that ‘nothing is wrong,’ and may be referred to a psychiatrist,” LaFaver said.

FMD can be triggered by psychological or physical stress or trauma, or may have no obvious trigger. Although it is not revealed in traditional imaging or other diagnostics, the condition is potentially reversible through multidisciplinary therapy. Patients from 25 states have undergone week-long inpatient therapy for FMD in the MoRe program at UofL. More than 85 percent of patients undergoing the MoRe program have shown improvement in their symptoms after one week of treatment, and 69 percent report the improvement of symptoms was maintained after six months.

Semple experienced significant improvement during her week of intensive therapy tailored to her individual needs and symptoms.

“After a decade of people telling me ‘take a vacation,’ or ‘there is nothing wrong with you,’ the care at UofL and Frazier was the best ever. Everyone – whatever their part was – they really cared,” Semple said.

“All of my life was wrapped up in trying to manage these symptoms. The treatment literally gave me my life back.”

International FND Awareness Day, April 13, 2018

FNDHOPE.ORG provides information on functional neurological disorders (including FMD), along with links to resources such as the UofL Physicians MoRe program. Patients, providers and family members are invited to support International FND Awareness Day on April 13 by taking the #LetsTalkFND pledge and share information to increase awareness of the conditions.

To recognize International FND Awareness Day in Louisville, Kathrin LaFaver, M.D., neurologist with UofL Physicians, will host a Lunch & Learn on Friday, April 13, to share some of the latest research on functional movement disorders. The free event is open to patients affected by functional movement disorders and their care partners.

To attend the luncheon, held at Frazier Rehab Institute in the Bill Collins Resource Center, 220 Abraham Flexner Way, call 502-852-7654 or email Alexandra.jacob@louisville.edu by April 11.

April 9, 2018

A researcher whose work has substantially advanced the understanding of metals toxicology, John Pierce Wise, Sr., Ph.D., University Scholar and professor in the Department of Pharmacology and Toxicology, has received the Career Achievement Award from the Society of Toxicology (SOT) Metals Specialty Section.

The award, presented at the SOT’s annual meeting held last month in San Antonio, recognizes the outstanding achievement of a researcher, mentor and leader in the field of toxicology.

Wise was nominated by Max Costa, Ph.D., professor and chair of the Department of Environmental Medicine at NYU School of Medicine.

Costa says Wise’s influence in the education, training and mentorship of young scientists in the field of metals toxicology is “unequivocal.”

Wise has served as primary mentor for more than 40 doctoral and masters level students, while guiding nearly 90 undergraduate and  60 high school students in the field of biomedical and environmental research. He received the SOT Education award in 2016.

His research focuses on mechanistic toxicology with an emphasis on metal carcinogenesis and the “One Health” concept that human health, animal health and ecosystem health are intertwined and interdependent.

“Dr. Wise’s work has led to important advances in metal-induced genotoxicity, DNA repair and chromosome instability,” Costa said. “He is leading the effort to understand how metals can induce DNA breaks while suppressing their repair. In addition, he is a pioneer in the effort to understand how metals impact centrosome biology.”

The breadth of Wise’s work is exemplified through research in human cells as well as cells from other species including fish, whales, sea turtles and sea lions. In addition to bench science, Wise has lead field efforts to study the impact of the Gulf of Mexico oil crisis on resident whale species, the impact of metals on whales in the Gulf of Maine, and the conservation of sea turtles in Vieques, Puerto Rico.

The Society of Toxicology (SOT) is a professional and scholarly organization of more than 7,800 scientists from academic institutions, government and industry in the U.S. and abroad. The Metals Specialty Section is one of the organization’s 28 subgroups.

April 9, 2018

For the first time, resident physicians from the University of Louisville earned a top-10 finish in the American Psychiatric Association’s MindGames National Residency Team Competition.

UofL residents Laura Romer, M.D., Svetlana Famina, M.D., and Melissa Sullivan, M.D., finished fourth out of more than 100 psychiatry programs across the United States that took the hour-long online exam testing knowledge of patient care, medicine and psychiatric history.

The physicians took a no-anxiety, no-expectation approach to the competition, a test similar to the Psychiatry Resident-In-Training Examination (PRITE) that residents take annually, said Romer, a fourth-year resident. They reviewed old PRITE questions, but couldn’t find time in their hectic schedules to prepare as a group.

The strategy worked.

“This is our passion,” Famina said. “All the knowledge we’ve accumulated from daily clinical practice and working with our attending physicians stays with us.”

This was the best finish in the competition of any UofL-sponsored team, said Robert Campbell, M.D., the team's coach and assistant professor of the Department of Psychiatry and Behavioral Sciences in the UofL School of Medicine.

“With more than 200 programs in the country, our residents showed themselves to be true scholars in the field of psychiatry,” Campbell said.

Sullivan, a third-year resident, said the team’s finish is a testament to the quality of the residency program.

“We have so many clinical sites that we go to. We see so many different types of patients. We learn from many researchers. UofL has a lot to offer its residents,” Sullivan said.

Patients with severe spinal cord injury (SCI) often experience chronically low blood pressure that negatively affects their health, their quality of life and their ability to engage in rehabilitative therapy.

“People with severe spinal cord injury – especially when it occurs in a higher level in the spine – have problems with blood pressure regulation to the point that it becomes the main factor affecting quality of life for them,” said Glenn Hirsch, M.D., professor of cardiology at the University of Louisville (UofL). “Some cannot even sit up without passing out. They are forced to use medications, compression stockings or abdominal binders to maintain an adequate blood pressure.”

Working with human research participants, Hirsch and researchers at the Kentucky Spinal Cord injury Research Center (KSCIRC) at UofL, have found that spinal cord epidural stimulation can safely and effectively elevate blood pressure in individuals with SCI along with chronic hypotension. The research was reported this month in Frontiers in Human Neuroscience (Normalization of Blood Pressure with Spinal Cord Epidural Stimulation After Severe Spinal Cord Injury).

Led by Susan Harkema, Ph.D., associate director of KSCIRC and professor of neurosurgery, the research included four research participants with chronic, motor complete, cervical SCI who suffered from persistent low resting blood pressure. The participants were implanted with an electrode array for epidural stimulation, and individual configurations for stimulation were identified for each participant. During five two-hour sessions, the participants’ blood pressure was elevated to normal ranges. Their blood pressure returned to low levels when stimulation ceased, and was again elevated to normal ranges with stimulation.

Stefanie Putnam was one of the research participants. Following a severe spinal cord injury in 2009, Putnam’s blood pressure was so low she was unable to engage in the simplest of activities without losing consciousness.

“It prevented me from participating in activities, from talking on the phone, from sitting at a table and eating food. I had trouble breathing, trouble swallowing, trouble carrying on a conversation,” Putnam said. “I was passing out periodically – six or more times a day. Then I would have to tilt back in the chair for two hours.”

To help sustain her blood pressure, Putnam took medication, wore an extremely tight corset and drank a large amount of caffeine.

“I would still pass out,” she said.

With epidural stimulation, Putnam said she immediately felt the effects.

“I went from feeling like I was glued to the floor to elevated – as though gravity was not weighing me down. I feel alive!” she said.

Because of the undesirable side effects of pharmaceutical and non-pharmaceutical interventions, Hirsch said epidural stimulation for chronic low blood pressure in SCI could have significant benefits.

“People with severe SCI who have problems with resting hypotension have limited options. This intervention appears to reliably and reproducibly maintain blood pressure,” Hirsch said.

This work builds on previous research at KSCIRC showing benefits of spinal cord epidural stimulation, along with activity-based training, in which individuals with SCI have achieved voluntary movement, standing and stepping, and improved bladder, bowel and sexual function.

Harkema, the publication’s first author, said the blood-pressure research is promising, but must be tested over time and with a larger cohort of study participants.

“We need to see if it will have an impact over months or years,” Harkema said. “It will be very important to determine if these results are sustainable.”

To that end, UofL is screening participants for a six-year study that will further explore the life-enhancing effects of epidural stimulation on people with spinal cord injury (SCI). That study will measure the extent to which epidural stimulation will improve cardiovascular function as well as facilitate the ability to stand and voluntarily control leg movements below the injury level in 36 participants with chronic, complete spinal cord injuries. Individuals interested in being considered for this study can add their information to the university’s Victory Over Paralysis database: victoryoverparalysis.org/participate-in-research.  

The published research is supported by the Craig H. Neilsen Foundation, The Leona M. and Harry B. Helmsley Charitable Trust, University of Louisville Hospital, Christopher & Dana Reeve Foundation and Medtronic Plc.

March 19, 2018

"Heeeeere's Johnny!" That lead-in, followed by a big-band trumpet blast, was the hallmark of late-night television for three decades. “Johnny” was Johnny Carson, the announcer was Ed McMahon and the bandleader was Doc Severinsen. Beginning in 1962, “The Tonight Show” with Johnny Carson ruled the night airwaves for 30 years.

A Louisville audience will have the chance to hear Severinsen’s iconic big band sound next month. UofL’s Department of Ophthalmology and Jazz Studies Program will present “Jazz-4-Sight” featuring Severinsen performing with the UofL Jazz Ensemble at 8 p.m. April 7 at the School of Music’s Comstock Hall, 105 W. Brandeis Ave. Concert tickets are $50 a person, with all proceeds benefiting the Kentucky Lions Eye Center and UofL jazz students.

Doc Severinsen and His Big Band hit the road in 1992, following the final telecast of Carson’s show, and hasn’t stopped touring since. Audiences enjoy Severinsen’s shows not only because he shared their living rooms for so many years but also because of the Big Band repertoire, which includes Duke Ellington and Count Basie standards, pop, jazz, ballads, big band classics and, of course, “The Tonight Show” theme.

Severinsen, 90, can still play hard and hit all the high notes, a result of his continued commitment to studio practice and the refinement of his craft. The trumpeter also surrounds himself with the best in the business and enjoys sharing the spotlight. 

The public also is invited to a 6 p.m. gala that includes dinner and a silent auction at the University Club, 200 E. Brandeis Ave. 

Click http://bit.ly/UofLJazz4Sight to purchase tickets for the concert or gala. For questions or more information, contact the School of Music at 502-852-6907.