In recognition of her support, the University of Louisville will rename its most recently created institute to The Christina Lee Brown Envirome Institute. The UofL Board of Trustees voted on the name change today.

“I cannot think of a better way to honor Christie for her tremendous generosity that has allowed the institute to become a reality and to get off to such a strong start,” said UofL President Neeli Bendapudi.

In May, Brown committed $5 million in support of the institute, which takes a holistic approach to researching how the human-environment interrelationship impacts peoples’ lives. In addition to building on the pioneering work of Aruni Bhatnagar, Ph.D., that established the field of environmental cardiology, UofL will incorporate community engagement and citizen science to introduce a singular, new approach to the study of health. Bhatnagar is the institute’s director, as well as the Smith and Lucille Gibson Chair in Medicine.

The Christina Lee Brown Envirome Institute develops new infrastructure for transdisciplinary knowledge, bridging academic research with community engagement it transforms the city of Louisville into an urban laboratory and establishes the university as a repository of knowledge about the envirome. The Christina Lee Brown Envirome Institute offers global leadership in developing new models of living by making decisions through the lens of health.

The Kentucky Cancer Program at the University of Louisville James Graham Brown Cancer Center is teaming up with the Bullitt County Health Department to honor breast cancer survivors in October.

The “Think Pink” event will be held beginning at 5 p.m., Tuesday, Oct. 23, at the Paroquet Springs Conference Centre, 395 Paroquet Springs Dr., Shepherdsville.

Former Kentucky First Lady Judy Patton and breast cancer survivor Tabitha Spencer, RT,, R(M), of Baptist Health Louisville, will speak. Health information booths also will be set up on a variety of topics related to breast cancer.

The event is free but RSVPs are required by calling the Bullitt County Health Department at 502-955-5355.

For more information, contact Pam Temple of the Kentucky Cancer Program at 502-852-6318 or pam.templejennings@louisville.edu.

The majority of older adults take at least one prescription medication daily, and according to 2016 data from the Substance Abuse and Mental Health Services Administration, more than 500-thousand Medicare Part D beneficiaries take opioids, with the average dose far exceeding the recommended amount. This can lead to health risks such as breathing complications, confusion, drug interaction problems and increased risk of falls.

To help tackle the issue of opioid misuse in older adults, the Institute for Sustainable Health & Optimal Aging at the University of Louisville has been working with individuals in rural Kentucky who are involved in the institute’s Flourish Program, which is designed to deliver interdisciplinary care coordination to those with chronic conditions.

Of the 154 patients who have received services, medication management issues related to opioid prescriptions and interactions with other medications were a factor with more than 90 patients. Medication safety also proved to be a problem, with family members or caregivers taking opioids from patients in at least 10-percent of cases.

The institute recently received supplemental federal funding to their Geriatrics Workforce Enhancement Program grant, specifically to expand work in Bullitt, Henry, Oldham, Shelby, Spencer and Trimble counties related to opioids and older adults. This effort also will be offered in Jefferson, Barren, Metcalf and Hart counties.

“This additional funding will allow us to dramatically increase our ability to screen for potential opioid misuse and to educate patients, students and practitioners on best practices for pain management for older adults,” said Anna Faul, Ph.D., the institute’s executive director.

Joe D’Ambrosio, Ph.D., the institute’s director of health innovation & sustainability and assistant professor at the UofL School of Medicine will lead an interdisciplinary clinical team of faculty from nursing, social work and counseling psychology to serve as mental health clinicians for the project.

He said the institute is developing a new program to train students and clinicians on how to identify and treat opioid-related substance abuse among older adults. The programming also will be offered to community mental health partners including Centerstone, the region’s largest mental health care provider.

A team of researchers at the University of Louisville has garnered $16.4 million from the National Institutes of Health to explore several angles related to how different aspects of our environment contribute to the development or health impacts of diabetes and obesity.

“More than 90 million adults in the United States are obese and more than 30 million adults suffer from diabetes. Our faculty, staff and students work every day to understand the causes and impacts of both so that we can develop the next generation of preventions, cures and treatments,” said UofL President Neeli Bendapudi, Ph.D. “This group of dynamic researchers now is looking at how our environment, in the broadest sense of the word, plays a role. This understanding has the potential to change not just people in Louisville, but literally the world. This is some of what makes UofL a great place to learn, work and invest.”

Aruni Bhatnagar, Ph.D., director of the UofL Diabetes and Obesity Center and the recently created Envirome Institute, which houses the Diabetes and Obesity Center, earned a competitive renewal grant that provides funding for essential core programs for all researchers in the center. Additionally, the center grant helps set the director of the research with an emphasis on metabolic and inflammatory mechanisms leading to diabetes, obesity and insulin resistance; stem cell biology; and environmental determinants of cardiometabolic disease. This marks the second successful five-year renewal that Bhatnagar has earned.

Petra Haberzettl, Ph.D., assistant professor of medicine, and Bradford Hill, Ph.D., associate professor of medicine, received funding to examine the effects of air pollution on stem cell health.

Jason Hellman, Ph.D., assistant professor of medicine, received funding to explore how exercise can reduce inflammation. His previous work has shown previously uncovered new mechanisms of sustained inflammation in atherosclerotic lesions in diet-induced obesity.

Matt Nystoriak, Ph.D., assistant professor of medicine, is examining how the heart talks to blood vessels to increase blood flow during exercise.

Timothy O’Toole, Ph.D., assistant professor of medicine, received support to study how the molecule carnosine can be activated in protecting humans against airborne particulate matter.

Kentucky has an abundant supply of water – sometimes too much. So it may seem like we need not worry about our water use as much as people living in drier areas such as California or Arizona.

That is not necessarily the case.

At the next Beer with a Scientist, Robert Bates, a water expert and nearly 30-year employee at Louisville Metro Sewer District, will explain that, while it is plentiful here in Kentucky, water still is a precious commodity and recycling it makes sense. He will discuss water recycling in the United States, the “Louisville water cycle” and how some local organizations are recycling water to make beer.

Now an operations specialist with GRW, an engineering consulting firm based in Lexington, Bates was in operations management for more than 10 years at MSD’s Morris Forman Water Quality Treatment Center, the largest wastewater treatment facility in Kentucky. He also is a past president of the Water Environment Association of Kentucky/Tennessee (WEAKT) and has co-authored several peer-reviewed scientific publications on wastewater.

“There is no new water, so the more we can do to protect this most vital resource, the better,” Bates said. “Plus, no water, no beer!”

His talk begins at 7 p.m. on Wednesday, Oct. 17, at Holsopple Brewing, 8023 Catherine Ln., Louisville. A 30-minute presentation will be followed by an informal Q&A session.

Enjoy this popular event, organized by Louisville Underground Science, at its earlier time and new location. Admission is free. Purchase of beer, other beverages or menu items is not required but is encouraged.

Organizers continue to 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. At these events, the public is invited to enjoy exactly what the title promises:  beer and science.

For the first time in years, Dionte Foster played tennis on two legs.

The Special Olympics gold medalist traveled to Louisville last week from his native St. Kitts in the Caribbean to receive pro bono clinical care from University of Louisville Physicians and a sports prosthesis from Louisville Prosthetics that would retail for about $61,000.

While training for the 2015 Special Olympics World Summer Games in Los Angeles, Foster was diagnosed with osteosarcoma, a type of bone cancer, which required his left leg to be amputated above the knee.

“It was devastating because tennis is my world. It almost felt like it was the end of life,” Foster said. “But, I became determined to not give up. I’ve been living life to the fullest ever since and trying to be strong for me and my mom.”

Foster, 24, not only lost his leg, but the cancer had spread to his lungs, requiring surgery and chemotherapy, which he received in New York because adequate treatment was not available in the Caribbean.

He continued to play tennis, albeit with great difficulty, on one leg. Special Olympics officials started raising money to get Foster a prosthetic leg and news of the effort reached Matt Holder, MD, MBA, chief executive officer of the Lee Specialty Clinic in Louisville, who also serves as the global medical adviser for Special Olympics.

Seeking help, Holder contacted Priya Chandan, MD, MPH, assistant professor in the Division of Physical Medicine & Rehabilitation in UofL’s Department of Neurological Surgery and a Special Olympics Kentucky board member. Through the UofL connection, Matthew Adamkin, MD, UofL Physicians-Physical Medicine & Rehabilitation, was tapped to provide care at no cost to Foster. Adamkin prescribed the prosthetic and worked closely with licensed prosthetist and pedorthotist Wayne Luckett of Louisville Prosthetics to ensure it would meet Foster’s needs. Luckett obtained specialized components for the prosthetic through donations from Freedom Innovations, Martin-Martin Bionics, Endolite North America and American Prosthetics.

Foster must learn to trust his prosthetic, placing more weight on it in order to improve his movement.

“It’s hard work to wear a prosthetic,” Luckett said. “It requires 100-percent more energy to move compared to able-bodied people. He’s already an athlete and in good shape, but we’re going to get him in better shape so he can return to the tennis courts and be competitive again.”

Also during his time in Louisville, Foster underwent a CT scan of his chest with support from the Mary Jane Gift Quality of Life Fund through the UofL James Graham Brown Cancer Center. The fund was established by Tommy and Alex Gift to honor their mother after she lost her life to cancer.

Foster received good news; his CT scan showed no evidence of cancer. Megan Nelson, MD, UofL-Physicians-Physical Medicine & Rehabilitation, who specializes in cancer rehabilitation, helped organize the CT scan and arranged for Foster to meet with a sarcoma support group.

After a couple days of physical therapy, Foster trained on the tennis court with Rex Ecarma, UofL men’s tennis head coach, and Jeff Bourns, an amputee and Adapted Touring tennis player who holds a Top 5 World Rank (Category A) on the TAP World Tour.

The effort by multiple organizations to improve Foster’s mobility and help him return to competitive tennis was extraordinary, Adamkin said.

“I’ve never been a part of anything like this,” Adamkin said. “Dionte’s strides have been remarkable. With every day, he will get more confident and secure with the prosthesis.”
Foster said he is determined to make his story an example that inspires others to overcome adversity.

“It’s a game changer,” Foster said of receiving his new leg. “This has been an honor and I’m really thankful. It’s amazing to know I have a leg to go back home with and put my crutches aside.”

At age 96, Seymour “Sy” Slavin is still active speaking to groups in the community. A professor emeritus of the University of Louisville Kent School of Social Work, Slavin recently was recognized as one of 15 awardees of the 2018 Gold Standard Awards for Optimal Aging.

Now in its seventh year, UofL’s Institute for Sustainable Health and Optimal Aging hosted the awards this month, honoring Slavin in the educator category.

After teaching more than 30 years, Slavin went on to create and serve as the first director of the Kentucky Labor Institute. He lectures on topics ranging from Einstein’s views on the relationship of science and religion to the role of the administrative state in a democracy.

The Gold Standard awards honor individuals age 85 and older who lead flourishing lives, said Anna Faul, Ph.D., executive director of the institute.

“We do not have to be free of aging-related challenges to age optimally. It is our ability to flourish and live our best lives every day in the face of these challenges. This year’s outstanding cohort of awardees and nominees are true inspirations,” she said.

Fifteen awardees along with 58 other nominees were recognized at a luncheon on Sept. 7 sponsored by Hosparus Health. The event corresponds with Optimal Aging Month – an effort dedicated to promoting the positive view that aging is an opportunity, not a disease.

“The award winners demonstrate that while aging optimally looks different for every person, we can all strive to continue living our best lives at every stage,” said Christian Furman, M.D., medical director of the institute.

“Hosparus Health applauds the institute for recognizing that aging is a part of life. As an organization dedicated to improving the quality of life, we are honored to be a part of this event,” said Phil Marshall, president and CEO of Hosparus Health.

The complete list of 2018 category award winners include:

• Elmer Lucille Allen, Category: Outstanding Individual, Age: 86
• Mary Atherton, Category: Years of Wisdom, Age: 100
• Elizabeth Bealmear, Category: Years of Wisdom, Age: 91
• Les Brooks, Category: Never too Late, Age: 86
• Thomas Cork, Sr., Category: Outstanding Individual, Age: 92
• Don & Patsy Hall, Category: Outstanding Couple, Age: 87 & 87
• Father Simon Herbers, Category: Compassion, Age: 97
• Beatrice Huff, Category: Kentucky, Age: 89
• Margot Kling, Category: Social Justice, Age: 92
• Margaret Martel, Category: Years of Wisdom, Age: 106
• Emma Patria Pedroso Iglesias, Category: New Beginnings, Age: 85
• Dorothy Roehrig, Category: Years of Wisdom, Age: 100
• William T. Shumake, Category: Leadership, Age: 92
• Dr. Seymour Slavin, Category: Educator, Age: 96

Of four research participants living with traumatic, motor complete spinal cord injury, two are able to walk over ground with epidural stimulation following epidural stimulation paired with daily locomotor training. In addition, all four participants achieved independent standing and trunk stability when using the stimulation and maintaining their mental focus. The study was conducted at the Kentucky Spinal Cord Injury Research Center at the University of Louisville (UofL) and was published online early, and will appear in the Sept. 27 issue of New England Journal of Medicine. The study was funded by the Leona M. and Harry B. Helmsley Charitable Trust, University of Louisville Hospital and Medtronic plc.

See video story

This ground-breaking progress is the newest development in a string of outcomes at UofL, all pointing to the potential of technology in improving quality of life – and even recovery – following spinal cord injury. This latest study builds on initial research published in The Lancet in 2011 that documented the success of the first epidural stimulation participant, Rob Summers, who recovered a number of motor functions as a result of the intervention. Three years later, a study published in the medical journal Brain discussed how epidural stimulation of the spinal cord allowed Summers and three other young men who had been paralyzed for years to move their legs. Later research from UofL demonstrated this technology improved blood pressure regulation.

“This research demonstrates that some brain-to-spine connectivity may be restored years after a spinal cord injury as these participants living with motor complete paralysis were able to walk, stand, regain trunk mobility and recover a number of motor functions without physical assistance when using the epidural stimulator and maintaining focus to take steps,” said author Susan Harkema, Ph.D., professor and associate director of the Kentucky Spinal Cord Injury Research Center at the University of Louisville. “We must expand this research – hopefully, with improved stimulator technology – to more participants to realize the full potential of the progress we’re seeing in the lab, as the potential this provides for the 1.2 million people living with paralysis from a spinal cord injury is tremendous.”

Progress for Individuals Living with Paralysis

The American Spinal Injury Association Impairment Scale (AIS) was used to classify the spinal cord injuries of each of the four participants. When the four participants joined the study, they were at least 2.5 years post injury. They were unable to stand, walk or voluntarily move their legs. Eight to nine weeks prior to the implantation of an epidural stimulator, they started daily locomotor training – manual facilitation of stepping on a treadmill – five days per week for two hours each day. Although there were no changes to their locomotor abilities prior to the implant, following the epidural stimulation participants were able to step when the stimulator was on and the individual intended to walk. Participants 3 and 4 were able to achieve walking over ground – in addition to on a treadmill – with assistive devices, such as a walker and horizontal poles for balance while the stimulator was on.

“Being a participant in this study truly changed my life, as it has provided me with a hope that I didn’t think was possible after my car accident,” said Kelly Thomas, a 23-year-old from Florida, also referred to as Participant 4. “The first day I took steps on my own was an emotional milestone in my recovery that I’ll never forget as one minute I was walking with the trainer’s assistance and, while they stopped, I continued walking on my own. It’s amazing what the human body can accomplish with help from research and technology.”

Jeff Marquis, a 35-year-old Wisconsin native who now lives in Louisville, was the first participant in this study to attain bilateral steps. “The first steps after my mountain biking accident were such a surprise, and I am thrilled to have progressed by continuing to take more steps each day. In addition, my endurance has improved, as I’ve regained strength and the independence to do things I used to take for granted like cooking and cleaning,” said Marquis, who is participant 3 in New England Journal of Medicine study. “My main priority is to be a participant in this research and further the findings, as what the University of Louisville team does each day is instrumental for the millions of individuals living with paralysis from a spinal cord injury.”

“While more clinical research must be done with larger cohorts, these findings confirm that the spinal cord has the capacity to recover the ability to walk with the right combination of epidural stimulation, daily training and the intent to step independently with each footstep,” said Claudia Angeli, Ph.D., senior researcher, Human Locomotor Research Center at Frazier Rehab Institute, and assistant professor, University of Louisville’s Kentucky Spinal Cord Injury Research Center.

Advancements for Spinal Cord Injury Community

This research is based on two distinct treatments:  epidural stimulation of the spinal cord and locomotor training. Epidural stimulation is the application of continuous electrical current at varying frequencies and intensities to specific locations on the lumbosacral spinal cord. This location corresponds to the dense neural networks that largely control movement of the hips, knees, ankles and toes. Locomotor training aims to ultimately retrain the spinal cord to “remember” the pattern of walking by repetitively practicing standing and stepping. In a locomotor training therapy session, the participant’s body weight is supported in a harness while specially trained staff move his or her legs to simulate walking while on a treadmill.

“We are seeing increasing interest in the use of neuromodulation procedures and technologies such as epidural stimulation in the treatment of spinal cord injury and restoration of locomotor, cardiovascular and urodynamic functions,” said Maxwell Boakye, M.D., M.P.H., M.B.A., chief of spinal neurosurgery at the University of Louisville and clinical director of the Kentucky Spinal Cord Injury Research Center. “Epidural stimulation is likely to become a standard treatment with several improvements in design of the device to target more specific neurological circuits.”  

For more information on epidural stimulation research, visit Victoryoverparalysis.org.

September 24, 2018

When she was in 8^th grade, Breathitt County native Sunshine Smoot decided she wanted to be a pediatrician. As a Governor’s Scholar after her junior year in high school, she happened to overhear one of the instructors talking with another student about GEMS, a program that provides gifted high school students with Guaranteed Entrance to Medical School (GEMS) at the University of Louisville even before they start college.

“I remember her explaining what a one-of-a-kind program GEMS was, how those selected had unique opportunities in undergrad that others would not have until much later in their medical careers and how the GEMS were a close-knit group seen around campus together,” Smoot said. “Overhearing that one conversation affected my whole life.”

For 30 years, GEMS has provided mentoring and support for nearly 300 academically talented youth from across Kentucky interested in becoming physicians by providing a clear path to complete college and enter medical school. Each academic year, about 10 students are admitted to the program as freshmen entering UofL.

Established in 1988, GEMS paves the way for the students selected for the program as they enter UofL as undergraduates knowing they will have automatic admission to the UofL School of Medicine as long as they maintain certain academic standards. In addition, GEMS students have the opportunity to shadow practicing physicians and faculty, participate in seminars, serve the Louisville community and build relationships with other students who have the goal of becoming a physician.

The students retain their automatic admission to the UofL School of Medicine as long as they have maintained a 3.4 cumulative and science grade point average in undergraduate work, scored at or above the national mean on each section of the Medical College Admissions Test (MCAT), and participated fully in program activities.

Kevin Trice, M.D., M.B.A., now a director of sleep medicine at Baptist Hospital in Madisonville, Ky., said GEMS gave him the confidence and freedom to pursue medicine.

“It completely changed my trajectory. I was interested in medicine, but planned to pursue engineering since it was easier and I had a better chance,” Trice said. “Once I was accepted, it relieved me of the anxiety and stress common in undergraduate pre-med students.”

James Frazier, M.D., was a member of the 1990 GEMS class and graduated from the UofL School of Medicine in 1998. Now the vice president of medical affairs at Norton Healthcare, Frazier said the GEMS program was life changing.

“I owe everything to GEMS. They took a chance on me right out of high school. It took a lot of pressure off that I saw my future classmates going through,” Frazier said. “You would see those who were trying to get in, how stressed they were about MCAT and maintaining their GPA. It definitely gave me an advantage not having to worry about maintaining perfect grades.”

Frazier said the freedom from stress allowed him to broaden his undergraduate education.

“Because of that reduced stress, I got to take more well-rounded classes – history, economics, finance – than if I had to maintain a 4.0 GPA. It helped me when I started private practice to have a little knowledge about the business world and how to run practice,” Frazier said.

Scott Sullivan, M.D., a member of the 1989 GEMS class and 1996 alumnus of the UofL School of Medicine, credits the program with providing resources he needed to enter medicine.

“I doubt I would be in medicine without the program. Living in a rural area and never having much exposure to medicine, I lacked mentors and direction. The program provided both, which proved to be invaluable,” said Sullivan, who is from Ballardsville, Ky.

Now an ob/gyn and specialist in maternal-fetal medicine, Sullivan is a professor at Medical University of South Carolina in Charleston, S.C.

“Having access to dedicated and experienced mentors at the age of 18 was incredibly helpful,” Sullivan said. “They got me on the right track very quickly. They gave mentorship not only about how to become a physician, but how to be interested in public health, education and community involvement.”

Another advantage for students who have participated in the program is the relationships they built with colleagues and mentors that enrich their college and medical school experience, including physicians, researchers and faculty in the School of Medicine.

“The most valuable part is the people you meet and you are with for four years in undergrad and medical school. For those eight years you are extremely tight. I am still in close contact with all the people in GEMS with fair regularity,” Frazier said. “We have a 20^th reunion coming up and I am looking forward to seeing them. Having that network of people here in town is invaluable.”

“The program was very forward thinking at the time as a way to keep Kentucky physicians in the state, and I believe they have done a pretty good job,” Frazier said. “It was a very progressive thing for UofL to have done 30 years ago, and I’m happy the school has supported it for so long.”

Smoot was admitted to the GEMS program in 1997 and graduated from UofL School of Medicine in 2006. She now is a pediatrician at Juniper Health in Campton, Ky.

“I often wonder if I had not happened to overhear a chance conversation, being from Eastern Ky., would I have gone to UofL for my undergraduate years, and then on to UofL medical school?” Smoot said. “Looking back now, I can’t imagine a different past, and I certainly would regret missing out on the friendships I made at UofL 20 years ago that still mean the world to me.”

GEMS BY THE NUMBERS

Number of students participating in GEMS 1988-2018:     290

Number of GEMS students who have graduated from UofL School of Medicine:   148

Number of GEMS students currently enrolled in UofL School of Medicine:  27

Number of GEMS students enrolled or graduated from another school of medicine:  19

Number of GEMS students currently enrolled in UofL as undergraduates:  39

Number of GEMS students who were Kentucky Derby Festival princesses:  5 (1 Queen)

Number of Kentucky counties represented by GEMS students:  49

Number of GEMS students who have completed or are enrolled in MD/PhD programs:  6

September 20, 2018

A new assessment tool developed by the University of Louisville’s Institute for Sustainable Health & Optimal Aging aims to measure functionality and quality of life for older adults with multiple chronic conditions (MCC).

The Flourish Index is a set of evidence-based, quality of care indicators across six determinants of health: biological, psychological, health behaviors, health services, environmental and social. Some specific factors include preventive care, medication management, process of care measures, promotion of health behaviors, transportation, isolation, income challenges and food access.

The index resulted from the institute’s research associated with the Geriatric Workforce Enhancement Program (GWEP).

Executive Director of the institute, Anna Faul, Ph.D., said the need for a broader assessment tool was clear.

“The majority of other indicators are disease and setting-specific and don’t fully account for the functional and quality of life factors affecting older adults with MCC,” she said. “Other scales and measures often do not capture a patient’s life satisfaction but focus solely on medical improvement.”

The federal Health Resources and Services Administration (HRSA) has awarded UofL’s institute with grant funding to lead the two-day training Sept. 20 – 21 for other GWEP programs at the University of Iowa, Rush University, University of Utah and Indiana University.

The workshop will focus on the customization of the Flourish Index - specifically, how to align it with the Medicare Annual Wellness Visit, how the index can be used to facilitate primary care transformation and how it can be implemented by the health care workforce in collaboration with community-based services. Central to the conversation will be the index’s role in demonstrating the sustainability of comprehensive care coordination.

“We are honored by the recognition from HRSA to teach other GWEP programs about our Flourish Index,” Faul said. “The GWEP programs attending the workshop are united in our interest to develop new measures that fully capture the holistic health and well-being of patients. Being selected to host this workshop demonstrates that people are recognizing the exciting and transformative potential of our Flourish Index,” she said.

This workshop is part of the institute’s annual effort to celebrate Optimal Aging Month. Learn more about events happening in September.

For the first time since 2009, Stefanie Putnam is able to prepare – and eat – meals for herself, put the vest on her service dog, Kaz, and drive herself to activities with her horse without losing consciousness or gasping for breath.

“My whole life has opened up for me again!” Putnam said.

A C4 spinal cord injury in 2009 left Putnam paralyzed from the neck down and suffering from chronic low blood pressure. She relied on medication and tight corsets to maintain her blood pressure, but she still passed out five or six times a day.

Her new lease on life is the result of spinal cord epidural stimulation (scES) she received as a participant in research at the University of Louisville’s Kentucky Spinal Cord injury Research Center (KSCIRC) to aid recovery for individuals with spinal cord injury. Research published today in JAMA Neurology describes the improvements Putnam and three other research participants experienced in blood pressure and heart rate regulation during and after scES. All four participants had chronic, complete cervical spinal cord injury, persistent low resting blood pressure and blood pressure decrease when sitting up prior to receiving scES.

[Video story on Youtube]

“From a quality of life perspective, orthostatic hypotension, or low blood pressure when sitting up, is truly life limiting,” said Glenn A. Hirsch, M.D., a cardiologist with the UofL School of Medicine and co-author of the study.

Spinal cord epidural stimulation uses an implanted electrode array to deliver electrical signals to the lumbar spine. For this study, research participants received stimulation using specific configurations selected to target cardiovascular function, monitoring blood pressure and cardiovascular function throughout, for an average of 89 daily, two-hour sessions. Earlier research showed the benefits of scES in controlling cardiovascular function during stimulation, but this data reveals participants’ blood pressure and heart rate remained stabilized between sessions, showing an enduring effect.

“What was most surprising was that only having it on for a few hours a day, we were noticing participants having normal blood pressure through longer periods of each day,” Hirsch said. “We are noticing it now across the research participants who had that problem, that there is a prolonged stabilizing effect even after the stimulator is turned off.”

Since receiving scES for her cardiovascular symptoms, Putnam said she enjoys increased independence and alertness, and she no longer needs medication to increase her blood pressure.

“I am an active member in my own life instead of merely existing. I am really living! I can prepare and cook my own meals. I can feed myself and carry on a conversation. Without the disruption of passing out or gasping for breaths in the middle of a task or having to stop and be back in my chair for two hours at a time, I can accomplish so much more. Now I can live my best life with energy to focus on my future.” Putnam said.

Research at UofL using scES, led by Susan Harkema, Ph.D., associate director of KSCIRC and professor of neurosurgery at UofL, began with the goal of restoring motor function. However, researchers and participants soon noticed stimulation led to improvements in cardiovascular and autonomic systems as well.

“In our motor system studies, we observed that we could actually regulate blood pressure without activating the motor system. That launched us into another area of research,” Harkema said. “Many people don’t realize that walking in many cases is not really the aspect that makes their daily lives most difficult because they have cardiovascular dysfunction and problems with respiratory, bowel, bladder, and sexual function. All of those things are disrupted so every day is incredibly difficult for people with spinal cord injury.”

In ongoing research to explore further the life-enhancing effects of epidural stimulation, the UofL researchers are conducting a six-year study with 36 participants with chronic, complete spinal cord injuries.

To learn more about supporting and participating in spinal cord injury research at UofL, visit the university’s Victory Over Paralysis website:  victoryoverparalysis.org. 

Today’s published research, “Epidural Spinal Cord Stimulation Training and Sustained Recovery of Cardiovascular Function in Individuals with Chronic Cervical Spinal Cord Injury,” was 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.

September 17, 2018

JoAnn Joule’s father, William Marvin Petty, M.D., suffered from diabetes for many years. A 1952 graduate of the University of Louisville School of Medicine, Petty served as Jefferson County Coroner from 1962 to 1974 and was a family physician in Fern Creek for 43 years.

Joule’s son lives with type 1 diabetes.

To honor her late father and help improve the lives of those with type 1 diabetes, Joule has given $500,000 to the University of Louisville Foundation to establish the William Marvin Petty, M.D., Research Fund. The fund is designated to support type 1 diabetes research at the UofL School of Medicine.

“I saw the toll diabetes took on my dad, and now my son is faced with the same disease,” Joule said. “I was not happy that medical research has not come up with anything new in the 40 years my son has been suffering. I am putting my assets behind the UofL research team.” 

That research team includes Haval Shirwan, Ph.D., and Esma Yolcu, Ph.D., of the UofL Department of Microbiology and Immunology, who are working to develop techniques to prevent and treat type 1 diabetes with particular focus on transplantation of islet cells.

Type 1 diabetes is a chronic autoimmune disease in which the pancreas does not produces enough insulin, a hormone required to convert glucose to energy in the body. There is no cure for type 1 diabetes, and standard treatment involves regular injections of insulin, which is far from keeping blood sugar in balance.

Insulin is produced in the pancreas by a type of cells called islet cells. Individuals with type 1 diabetes have too few or altogether lack the type of islet cells that produce insulin to keep glucose at the proper level. In recent years, physicians have developed a treatment in which they transplant the needed islet cells into a patient. However, the patient’s immune system often rejects the transplanted islet cells over time, attacking and killing them. To keep the transplanted cells alive, patients must take immunosuppression medications, which have a number of undesirable side effects.

At UofL, Shirwan and Yolcu have pioneered a process to create a manufactured protein known as Fas ligand (FasL), to protect the islet cells from destruction by the patient’s immune system. This process, patented by the UofL Office of Technology Transfer, is called ProtEx^TM technology. ProtEx is used to create FasL, which is then applied to islet cells to protect them from destruction by the immune system once they are transplanted into the patient.

Preclinical research has shown that FasL is highly effective in protecting islet cells in small animal models. However, additional testing is necessary before the therapy can be used in humans.

“Ms. Joule’s contribution will enable us to achieve an important milestone for further development of the technology towards clinical translation by performing efficacy and safety studies. We are very grateful for that support,” Shirwan said.

Greg Postel, M.D., executive vice president for health affairs at UofL, said the university is grateful for the contribution to research by and in honor of members of the Louisville community.

“We are extremely pleased that Ms. Joule has elected to support this very promising research at the University of Louisville,” Postel said “We believe her donation will allow this research to improve the lives of type 1 diabetic patients sooner rather than later.”

September 10, 2018

When did you last travel overseas? Do you remember how long it took for your sleep cycle to return to normal?

That feeling of jet lag signals a disruption to your naturally occurring circadian, or daily, biological rhythms. Circadian rhythms help our bodies know when to eat, when to sleep and when to be active. They also control the life cycle of every cell in the body.

“When our circadian rhythms become disrupted, humans and animals are at greater risk for the rise and spread of cancer,” said Liz Cash, Ph.D., a clinical health psychologist and director of research for the Department of Otolaryngology Head and Neck Surgery and Communicative Disorders at the University of Louisville. She also holds adjunct positions in the Departments of Psychological and Brain Sciences, and Family and Geriatric Medicine.

At the next Beer with a Scientist, Cash will deliver, “Tick-tock:  How disrupting your body clock and sleep cycle gives rise to cancer … and what you can do about it.” Her talk will include evidence of how circadian disruption contributes to cancer incidence and progression, as well as some simple, effective strategies to maintain or regain good circadian rhythms. 

The talk begins at 8 p.m. on Wednesday, Sept. 12, 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. At these events, the public is invited to enjoy exactly what the title promises:  beer and science. 

Owensboro Health and the University of Louisville School of Medicine are partnering to create Owensboro’s first family medicine residency program. The program will be located at Owensboro Health’s Parrish Medical Building and is scheduled to open on July 1, 2020.

“By establishing a family residency program in Owensboro, we hope to improve the health of our region for years to come,” said Greg Strahan, president and CEO of Owensboro Health. “This program gives Owensboro Health a pivotal role in educating the next generation of physicians and will help meet an important need for more primary care in our area.”

The three-year program is expected to open with a class of six resident physicians and admit an additional six physicians each year. Residents will undertake a robust curriculum of classroom studies and clinical rotations, working alongside expert instructors and practicing physicians from a variety of specialties. They also will provide primary care at Owensboro Health’s family medicine location on Parrish Avenue, which means expanded health care access for area patients.

“Part of our vision for this program is that some physicians will want to continue practicing in Western Kentucky after they have completed their residency,” said Steve Johnson, vice president of government and community affairs for Owensboro Health. “For our system to be working toward that vision, with a valuable partner like UofL, is an exciting development for this region.”

The agreement between the two health care systems establishes UofL School of Medicine as the program’s academic sponsor, a key step toward obtaining approval and accreditation by the Accreditation Council for Graduate Medical Education. Under the affiliation agreement, UofL will provide a program director and faculty and also lend its expertise to help the program achieve and maintain accreditation.

“UofL has achieved success with its family medicine residency program in Glasgow, Ky., in terms of building relationships in the community and improving primary care,” said Brent Wright, M.D., UofL School of Medicine associate dean for rural health innovation, and vice chair for rural health and professor in the Department of Family and Geriatric Medicine at UofL. “We plan to achieve the same success in Owensboro.”

Rural-based graduate medical education programs are important to physician distribution since physicians tend to practice within a 100-mile radius of where they did their residency training, Wright said.

The establishment of the residency program is also another positive step in the redevelopment of the Parrish Avenue campus, which was home to Owensboro Health Regional Hospital until 2013, when the system opened a new hospital on Owensboro’s east side. Since then, Owensboro Health has remodeled the Parrish campus, keeping or expanding key services including outpatient cancer treatment, family medicine and several specialty clinics.

“The residency program helps fulfill the promise we made to the community: that the Parrish campus would continue to provide access to care, support the regional economy and become an educational facility,” Strahan said. “We are especially grateful for the efforts of State Sen. Joe Bowen, who helped the project gain support in the Kentucky legislature. Now these dreams are becoming reality.”

The University of Louisville Hospital – Comprehensive Stroke Center is piloting a new effort to provide follow-up care for stroke patients after they leave the hospital. UofL Hospital’s U Care is designed to support continued recovery for patients following their inpatient stay.

“We want to ensure that patients have all they need when they leave the hospital to successfully continue their recovery at home – education, medications and a phone number to call if there are any problems,” said Paula Gisler, administrative director of the UofL Hospital Stroke Center.

U Care was developed in partnership with Lacuna Health, a subsidiary of Kindred Healthcare, to follow up with patients after they leave the hospital. Registered nurses with U Care reach out to patients by phone on a regular schedule to monitor the patients’ recovery progress, check their medications, ensure they have made appropriate follow-up appointments and answer any questions or health concerns that arise. The nurses have access to the patients’ health records and can escalate any concerns to hospital staff or physicians if a patient requires further clarification or intervention. The program pilot, which began in June, will follow 250 stroke patients for 45 days after discharge, whether they went home or to a rehab facility for recovery.

Patients and their families also may call the nurses at U Care if they have questions or concerns related to their stroke. In addition, the program will record levels of patient satisfaction at the rehab centers.

“At UofL Hospital, we continually strive for excellence in the acute treatment of stroke patients,” said Kerri Remmel, M.D., Ph.D., medical director of the UofL Hospital Stroke Center and chair of the UofL Department of Neurology. “U Care adds the vital step of thoroughly programmed follow-up with stroke patients to ensure they continue recovery, avoid unnecessary readmission to the hospital and prevent a second stroke.”

Lacuna Health administers U Care for the hospital, and is monitoring its success to make further improvements and to adapt the program to other patient populations.

“We are thrilled to support the University of Louisville Hospital – Comprehensive Stroke Center’s U Care program with our RN-led clinical AfterCare model. Patients and their caregivers need more resources and ongoing support when managing the transition from a hospitalization to another setting or home. We look forward to implementing this model and future programs to help UofL Hospital provide a differentiated patient experience for the communities it serves,” said Brian Holzer, M.D., M.B.A., C.E.O. of Lacuna Health.

U Care is yet another innovation in quality stroke care by the staff at the UofL Hospital, the first hospital designated as a comprehensive stroke center in Kentucky by the Joint Commission. In addition, UofL Hospital once again has been awarded the top level of distinction by the American Heart Association/American Stroke Association with the Get With The Guidelines® Target:  Stroke Elite Plus, Gold Plus award. The award recognizes the hospital’s success in providing the most appropriate stroke treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence. Hospitals must achieve 85 percent or higher adherence to all Get With The Guidelines-Stroke achievement indicators for two or more consecutive 12-month periods and achieve 75 percent or higher compliance with five of eight Get With The Guidelines-Stroke Quality measures to receive the Gold Plus Quality Achievement Award.

UofL Hospital has achieved the highest recognitions for stroke care for 12 years.

About stroke

Stroke is the fifth leading cause of death and a leading cause of adult disability in the United States. On average, someone in the United States suffers a stroke every 40 seconds, someone dies of a stroke every four minutes, and nearly 800,000 people suffer a new or recurrent stroke each year.

When someone is having symptoms of a stroke – slurred speech, sudden leg or arm weakness, facial drooping, loss of balance or visual changes – getting them to the hospital quickly can mean the difference between recovery and permanent disability. One of the best treatments for ischemic stroke is treatment with the clot-busting drug, intravenous tissue plasminogen activator, or IV tPA. If given in the first three hours after the start of stroke symptoms, IV tPA has been shown to significantly reduce the effects of stroke and lessen the chance of permanent disability. UofL Hospital Stroke Center staff strive to deliver IV tPA to appropriate patients within 45 minutes to one hour from the time they arrive at the hospital.

The UofL Hospital Stroke Center also offers clot removal procedures that can limit or reverse stroke symptoms in patients whose symptoms began up to 24 hours prior to arrival at UofL Hospital. For both clot removal and IV tPA, “time is brain.”  The more quickly a patient can receive either treatment, the better the patient outcome.

August 23, 2018

Three new surgeons have joined the University of Louisville Department of Neurological Surgery this summer. Each of these physicians brings highly specialized clinical skills that will benefit patients in Louisville and throughout the region through University of Louisville Physicians – Neurosurgery, as well as provide advanced training and conduct research at the UofL School of Medicine. They will perform surgeries at UofL Hospital and Jewish Hospital, a part of Kentucky One Health.

“I am excited to have these three highly skilled neurosurgeons join our already exceptional group in the Department of Neurological Surgery and at UofL Physicians. The added expertise they bring with them will benefit our patients greatly as well as our community here in Louisville,” said Joseph S. Neimat, M.D., chair of the UofL Department of Neurological Surgery.

Norberto Andaluz, M.D., is director of skull base surgery and professor of neurosurgery in the UofL Department of Neurological Surgery. His areas of clinical interest include pituitary tumors, aneurysms, brain tumors, arteriovenous malformations, intracerebral hemorrhage, carotid artery disease, Moyamoya disease, skull base surgery, endoscopic brain surgery and minimally invasive crania and spinal surgery.

Andaluz completed his medical education and residency at the Universidad Nacional de Rosario and at Instituto de Neurología y Neurocirugía, Sanatorio Parque, in Rosario, Argentina. He completed fellowships in neurosurgery at Cincinnati Veterans Affairs Medical Center and in cerebrovascular surgery at the University of Cincinnati Department of Neurosurgery.

Dale Ding, M.D., assistant professor in the UofL Department of Neurological Surgery, cares for patients with cerebrovascular disorders, including all causes of hemorrhagic and ischemic stroke, using both neurosurgical and endovascular approaches. He has clinical expertise in surgically treating brain aneurysms, brain and spinal vascular malformations, intracranial and extracranial atherosclerosis, carotid stenosis, acute ischemic stroke, Moyamoya disease and idiopathic intracranial hypertension.

Ding graduated from the Duke University School of Medicine, completed residency at the University of Virginia, and completed fellowships in cerebrovascular and skull base surgery at Auckland City Hospital, New Zealand, and endovascular surgical neuroradiology at Barrow Neurological Institute in Phoenix. His research interests include the role of inflammation in stroke, computational modeling of blood flow in cerebrovascular disorders, clinical outcomes of patients with cerebrovascular disease and exploring the roles of new endovascular devices and surgical technologies.

Emily Payne Sieg, M.D., is assistant professor and director of neurotrauma in the UofL Department of Neurological Surgery. She will provide neurosurgical care for traumatic cranial and spinal cord injuries, neurocritical care and advanced neuromonitoring, and minimally invasive and complex spine surgery.

Sieg earned her medical degree at Penn State College of Medicine and completed her residency at Penn State Health Milton S. Hershey Medical Center. She also completed fellowships in neurocritical care and complex spine surgery at Penn State. Her research interests include clinical and translational research in neurotrauma and critical care, including spinal cord injury, brain trauma and peripheral nerve injury.

These and other physician faculty members in the UofL School of Medicine provide patient care through the multispecialty group practice, UofL Physicians.

August 15, 2018

Beth Riley, M.D., oncologist and deputy director for clinical affairs, and Liz Wilson, nurse navigator, at the James Graham Brown Cancer Center, will be among 10 Cure Champions honored Sept. 22 by the American Cancer Society at the 2018 Hope Gala.

The society annually selects Cure Champions for their contributions to the Louisville community, 2018 Hope Gala Chair Kevin Wardell said. “Our Cure Champions are truly the stars of the evening. They shine a light on the good works going on the community.”

“The Hope Gala not only raises funds for the American Cancer Society’s vital mission; it also elevates the community as a whole,” Jan Walther, American Cancer Society executive director, said. “The Cure Champions remind us all how we can do our part to be activists in the cause.”

The event will be held from 6 to 11:30 p.m. in the Omni Hotel Commonwealth Ballroom, 400 S. Second St. Festivities begin with a VIP Rooftop Cocktail Hour, a celebration of the Cure Champion honorees, a live auction and a live performance from Louisville’s own Linkin’ Bridge.

Tickets are $150 per person, $1,500 for a table of 10 or $2,500 for a table of 10 and recognition as a Bronze Sponsor. To purchase and for more information, go to the 2018 Hope Gala website.

Louisvillians who love sports and want to support the University of Louisville’s James Graham Brown Cancer Center can do both on Saturday, Aug. 11, 2018.

They can head on over to Louisville Slugger Field, 401 E. Main St and see the Louisville Bats take on the Lehigh Valley IronPigs of Allentown, Penn., on MARVEL Super Hero Night No. 2. Doors open at 5 p.m. and the game starts at 6:30 p.m.

The event will support the M. Krista Loyd Resource Center at the Brown Cancer Center, said Elea Fox, executive director of development for the cancer center. “This is a great opportunity for baseball fans to support the region’s only comprehensive cancer center,” Fox said. “It gives supporters the chance to take take part in a fun evening while giving back to the Brown Cancer Center.”

In addition to fund-raising, representatives from the M. Krista Loyd Resource Center and the Kentucky Cancer Program at UofLwill be at the game providing cancer screenings and educational materials. Located on the first floor of the Brown Cancer Center, 529 S. Jackson St., the center is named for a former patient and her family who generously support the programs and services offered to the patients and to the community.

From coffee to counseling, the resource center provides a peaceful environment for cancer patients to learn, relax and heal emotionally. The goal of the M. Krista Loyd Resource Center is to help connect patients and family members with the services that go beyond medical treatment to achieve the best possible experience.

Educational materials, videos and Internet access to cancer-related websites are offered to patients, and the staff provides information patients need to cope with their condition and its treatment. Patients are connected with support groups and other free services that can help in the healing process.

About Louisville Bats’ MARVEL Super Hero Night No. 2

Coming off the success of MARVEL Super Hero Night No. 1 on June 23, the second MARVEL Super Hero Night on Aug. 11 will feature the Hulk with giveaways and promotions. Fans should be on the lookout for character meet-and-greet opportunities, special super hero-themed jerseys worn by the players and additional super hero merchandise, sights and sounds. Plus, the first 2,000 fans through the gates will receive a special edition MARVEL Hulk bobblehead.

An added feature will come the following week: The hero-themed jerseys worn by players will be auctioned off online, also benefitting the resource center.

A pre-game party with band will open the evening, and Raymond Loyd – whose family donated funding to create the M. Krista Loyd Resource Center – will throw out the first pitch. He will be joined on the field with other members of the Loyd family, including Krista’s children.

Cancer heroes and survivors will be honored throughout the evening, and resource center staff will be on hand with cancer awareness and education materials. An added feature will come the following week: The hero-themed jerseys worn by players will be auctioned off online, also benefitting the resource center. For details and ticket options, go to the Louisville Bats’ MARVEL Super Hero Night website.

Besides shade and beauty, can trees and shrubs actually help make people healthier? In a first-of-its-kind study, researchers from the University of Louisville Envirome Institute are working with a neighborhood in South Louisville to answer that question.

Today, UofL announced a five-year, $3 million grant from the National Institute of Environmental Health Sciences of the National Institutes of Health to help fund the Green Heart project. The university also announced a $2 million grant from The Nature Conservancy to support the endeavor.

The Green Heart study will look at the connections between a green environment and human health. The institute will study air quality, innovative landscape design, the qualities of a friendly, healthy neighborhood and human health.

“The Green Heart project is the epitome of collaboration,” said UofL President Neeli Bendapudi, Ph.D. “Dr. Aruni Bhatnagar and his team are bringing together people from not only all of the university, but throughout Louisville and beyond to create a new paradigm for population research that truly has international implications.

“His creative thinking is leading to innovative public-private partnerships that eventually will lead to healthier communities.”

“People appreciate trees and they’re good and they’re aesthetically pleasing, but whether they actually have specific quantifiable health-promoting effects by removing pollutants from air has never been rigorously tested,” said Bhatnagar, director of the Envirome Institute and the Smith and Lucille Gibson Chair in Medicine. “Through the Green Heart project, we are changing that.”

More than half the world’s population resides in urban areas, which have higher than average levels of air pollution. Air pollution is a significant contributor to cardiovascular disease and is linked to 7 million premature deaths worldwide annually, 200,000 in the United States alone.

Bhatnagar and his team will include 16 low-vegetation neighborhood clusters in Louisville to examine the impact of urban greenery on their health. The researchers are recruiting 700 community participants within these 16 clusters for the study. The team will examine blood, urine and hair samples to assess cardiovascular health.

In eight of the clusters, the team and their partners will plant as many as 8,000 native trees of all sizes. Additionally, they will plant shrubbery and grasses to further optimize the ability to filter pollutants from the air.

Two years later, the researchers again will collect samples from the volunteers and analyze the differences. They also will compare the results to those from the participants in the eight neighborhood clusters that did not live in the areas that had the plantings.

“We believe that the greening of the neighborhoods will positively impact not only the air quality, but also the health of the people who live in those areas,” Bhatnagar said. “If we are correct, we may be able to create new strategies for the prevention of cardiovascular disease.

“The results of this project also will provide new insights into the effects of urban vegetation on community environment. These findings will be relevant to the development of new public health polices and the optimization of ongoing planting efforts in cities around the world to enhance public health.

The Green Heart Project is a collaborative initiative of the University of Louisville with Washington University in St. Louis; Cornell University, The Nature Conservancy, Hyphae Design Laboratory, the United States Forest Service and other partners. The grant from the National Institutes supports health evaluation of community participants, whereas the greening efforts are supported by the grant from The Nature Conservancy.

Rural areas in the United States face a shortage of behavioral health practitioners. As CNN recently reported, a new study in the American Journal of Preventive Medicine found that 47-percent of non-metropolitan counties don’t have access to a psychologist. The shortage extends to psychiatrists, nurse practitioners and a cadre of behavioral health resources including shelters, hospitals and community support groups.

The Institute for Sustainable Health & Optimal Aging at the University of Louisville is working to meet this need in rural Kentucky. This fall, the institute will place 38 students specializing in behavioral health into a dozen rural health care sites across 10 rural and underserved communities.

“Older adults are particularly affected by the lack of behavioral health practitioners,” said Anna Faul, Ph.D., the institute’s executive director. “Isolation and depression are common issues for older adults, with 20-percent of rural older adults diagnosed with depression. Not having access to behavioral health care can severely worsen conditions and lead to physical decline. Furthermore, mobility limitations can make it difficult for older adults to drive long distances to get the care they need.”

Locations where the students will be placed include:

• Kentucky River Medical Practice (Henry County)
• Kentucky One Health Primary Care Associates (Shelby County)
• T.J. Samson Family Medicine Center (covering Barren, Hart, and Metcalfe Counties)
• Exceptional Senior Living (Oldham County)
• Multi-purpose Community Action Agency (Bullitt and Shelby Counties)
• Tri-County Community Action Agency (Oldham and Trimble Counties)

Several practices, while in Jefferson County, serve older adults in rural areas:

• Family Community Clinic (Jefferson County)
• University of Louisville AIM Clinic (Jefferson County)
• University of Louisville Family & Geriatric Practice (Jefferson County)
• University of Louisville PNES Clinic (Jefferson County)
• Park DuValle Community Health Center (Jefferson County)
• Presbyterian Homes and Services of Kentucky (Jefferson County)

A primary goal of this program is to increase the geriatrics behavioral health workforce in rural communities. Both undergraduate and graduate students across multiple disciplines are involved. Many of the masters and doctoral-level students are participating in the institute’s Flourish Behavioral Health Graduate Internship. The internship, funded by a four-year federal grant, is part of the institute’s Flourish Network, a program focused on team-based care coordination for older adults.