A University of Louisville study will evaluate how health care, public health and social services organizations are working together to improve the health and well-being of individuals served through Freedom House programs in Louisville and Manchester, Ky.

Freedom House, operated by Volunteers of America Mid-States (VOAMID), is a residential treatment program for alcohol and/or drug dependent pregnant women and women with young children.

The research will examine Freedom House and its recent expansion into eastern Kentucky, determining how well and in what ways the urban and rural partners align in terms of purpose, data sharing, financing and governance.

Aligning Systems for Health Program, led by the Georgia Health Policy Center and supported by the Robert Wood Johnson Foundation, has awarded UofL more than $290,000 to fund the two-year study. UofL is one of seven institutions to receive the competitive funding. 

UofL researchers Liza M. Creel, Ph.D., MPH, assistant professor, School of Public Health and Information Sciences, and co-director, Commonwealth Institute of Kentucky, and Deborah Winders Davis, Ph.D., director, Child and Adolescent Health Research Design and Support Unit, Division of Clinical and Translational Research in the Department of Pediatrics, will lead the study. 

“We’ll focus on health equity and investigate similarities and differences between settings as it relates to program implementation and success of clients in the Freedom House program. We look forward to sharing data-driven insights around how organizations across sectors can work together to improve outcomes for the people and the communities they serve,” Creel said. 

“We are so pleased to collaborate with UofL on this study that will ultimately help pregnant and parenting moms in our Freedom House programs have even better recovery outcomes in both our urban and rural communities,” said Jennifer Hancock, president and chief executive officer of Volunteers of America Mid-States. 

VOAMID operates three evidence-based residential, licensed clinical treatment programs in Louisville. The Freedom House programs treat mothers’ substance use disorder, promote the birth of healthy babies, reunite families and reinforce positive behavior changes. Annually, the Louisville programs serve approximately 170 women, and more than 200 babies and children. 

Earlier this year, the organization expanded into eastern Kentucky with a new site in Clay County, a rural area hit hard by opioid use, with high rates of Neonatal Abstinence Syndrome and out-of-home foster care placements much higher than Kentucky’s overall rate (91 vs. 43 per 1,000 children). This location can serve more than 60 women, 30 newborns, and 50 minor children each year.

Polypharmacy is an underappreciated factor in undesirable patient outcomes. In older adults, polypharmacy is considered a syndrome of harm and presents a challenge to primary care providers. The United States has one of the highest medication use rates per capita in the world.
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0095454317300532?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0095454317300532%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.ncbi.nlm.nih.gov%2F

Physician burnout is an emerging condition that can adversely affect the performance of modern-day medicine. Chronic overwork, constant stressors, and a poor work environment cause emotional exhaustion, depersonalization, and a reduced sense of personal achievement.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6682395/

 A searchable database of accredited continuing education (CE) activities and additional resources that can help the CE provider and clinician community respond to the novel coronavirus (COVID-19) public health emergency.
https://accme.org/resources-category/novel-coronavirus-education

The COVID-19 pandemic has led to the expansion of telemedicine, and as part of that expansion, faculty at the University of Louisville are piloting new smart glasses for advanced delivery of health care.

“There is both an urgent and widespread need to not only treat patients but deliver expertise and training remotely and safely to both professionals and medical learners,” said R. Brent Wright, M.D., associate dean for rural health innovation at the UofL School of Medicine, who has been working with various companies to explore a smart glasses solution for telemedicine since 2014.

Long-term care (LTC) facilities and emergency departments represent two of the areas with greatest need for the glasses for direct physician care during the pandemic. The UofL Trager Institute, emergency medicine and psychiatry are part of a feasibility study to test the Vuzix M400 smart glasses.

“It is imperative that we find solutions for health care to continue for the vulnerable nursing home population in Kentucky,” said Anna Faul, Ph.D., executive director and professor, UofL Trager Institute. “The use of smart glasses to provide real-time, expert geriatric care to residents of long-term care facilities is a huge step in increasing access to care, particularly during COVID-19. Each nursing home in our study will receive smart glasses that will allow for remote video consults with specialized medical providers and behavioral health experts without the need for the providers to enter the facilities and expose themselves and other patients to COVID-19.”

The concept is fairly straightforward. An advanced practice nurse practitioner or other health care professional working at a LTC facility will put on the web-connected glasses and dial-in with an attending physician through the Zoom conference platform. A camera and microphone are attached to the glasses, and the technology has the potential to display and obtain information for the physician to access remotely. The physician can see and interact directly with the LTC resident, providing immediate consultation and evaluation.

The glasses allow for ease of mobility and hands-free interaction for the on-site provider, an advantage over current standard telehealth delivery which requires computers and monitors to be transported from bed-to-bed on large carts. Additionally, data can be input into medical records hands-free, and can be controlled by voice-commands.

Smart glasses will support health care workers at five LTC facilities and one emergency department in Kentucky. UofL researchers will conduct a brief feasibility study related to the use of these six pairs of smart glasses. If the data is promising, the study will be extended. Once the pandemic has subsided, researchers hope to investigate the utility of usage for medical education.

“This technology holds great promise. UofL faculty are exploring how to transform health care and this is part of an innovative solution as we provide care and educate the next generation of physicians,” said Toni Ganzel, M.D., dean of the UofL School of Medicine, and vice president for academic medical affairs.

“The pandemic has served as the catalyst for changing delivery of care. When you have to do things so rapidly and emergently there is a call to be creative and innovative. Telemedicine allows us to share expertise while keeping a safe distance, and the smart glasses are very high-fidelity.

“The timing had to be right for this technology to become more accepted. It will be big part of health care moving forward, even after this swell with the COVID-19 pandemic, and it will be exciting to see some of our current medical residents incorporate telemedicine into their future practices,” Wright said.

Several years ago, Guillermo Rougier, Ph.D., professor in the Department of Anatomical Sciences and Neurobiology at the University of Louisville, was approached by David Krause, Ph.D., curator at the Denver Museum of Nature & Science, to help identify a complete, 3-D fossil he had discovered on Madagascar.

“When Dr. Krause showed it to me in a scientific meeting and asked me for my opinion, I said I had never seen anything like this,” Rougier recalled. “This mammal has teeth for which we have no parallel.”

Krause and a team of paleontologists discovered the fossil during an expedition in Madagascar and spent more than a decade working to determine where it falls in the long history of mammalian evolution and what it tells us about geography and changes in global fauna over time.

Rougier, a paleontologist who specializes in the study of the skull and teeth of ancient mammals, was intrigued and joined the international team of researchers to thoroughly analyze the fossil. Their analysis was published today in the journal Nature.

The fossil is remarkably complete, an extremely rare find for ancient mammals that lived alongside the dinosaurs. Rougier described the creature as very roughly resembling a beaver or a small capybara.

“First, it is surprising how complete it is,” Rougier said. “Second, this fossil is preserved in three dimensions. When you have an animal that dies and is preserved in the rocks, the weight of the rocks on top of it flattens it out. Often it looks like a steam roller ran over it. So you might have a complete skeleton but it will be the thickness of a piece of paper – all splat out. This animal was preserved in 3-D so this gives us a wealth of detail that we very rarely have in other specimens.”

The research team named the creature Adalatherium, which is translated from the Malagasy and Greek languages and means “crazy beast,” a nod to its bizarre characteristics. They placed it among gondwanatherians, a poorly known group of mammals found in various locations in the Southern Hemisphere. Rougier used the teeth and skull of the animal to figure out how to relate it to other mammals that were living at the time and afterward.

“Teeth in mammals reflect their ancestry, diet and environment. In the case of Adalatherium, the morphology is so peculiar that it is hard to use the characters we normally use to establish family relationships,” Rougier said. “Mammalian systematics and evolution rest heavily on dental morphology, so when you do not have teeth – or they are so strange that you do not know what to do with them (think of anteaters, whales, armadillos and pangolins) – we have a problem.”

Rougier was part of the expeditions in which the first gondwanatherians were discovered in his native Argentina in the 1980s, but relatively few specimens of the group have been found since then. That makes this unusually complete discovery in Madgascar exceptionally useful in forming a more accurate picture of the enigmatic group.

Madagascar, an island off the coast of Africa, is known for unique animal species that developed in isolation over millions of years. The island broke off from India and over a period of 100 million years moved toward Africa, yet never quite arrived, allowing the animals to evolve distinctly from the larger continents.

“Adalatherium is a product of this time of isolation when Madagascar was an island, detached from India and shifting towards Africa, but before there was any African influence. So it was basically an experiment, an example of what we call island biogeography or island evolution,” Rougier explained.

“Long isolated places produce very unique results in biology,” Rougier said. “These fossils keep reminding us of the unexpected forms and shapes that evolution can take over long periods of time in an isolated place. Adalatherium is an animal for which we don’t have any real parallels.”

Although the discovery of Adalatherium is a breakthrough in understanding the gondwanatherians, there still is a great deal the scientists do not know about the animals of this time and place.

“Adalatherium is just one piece, but an important piece, in a very large puzzle on early mammalian evolution in the Southern Hemisphere,” Krause said. “Unfortunately, most of the pieces are still missing.” 

Sophie Sears, a pharmacology and toxicology program PhD candidate in the laboratory of Dr. Leah Siskind has been awarded an individual NIH F31 predoctoral fellowship from the NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES.  Her dissertation project is "Role of macrophages in cisplatin-induced kidney injury and progression to chronic kidney disease"

Health care workers and first responders put their own health at risk every time they come face-to-face with someone who has – or may have – COVID-19. Often, the only thing between these workers and the virus is an N95 respirator. But a critical short supply of the masks could leave front-line workers unprotected, placing them, their families and other patients at risk of transmitting the virus.

The University of Louisville is offering a program to decontaminate used N95 respirators, boosting the supply of masks for local health care providers, first responders and community organizations such as nursing homes at no charge.

The N95 Decontamination Program, announced April 11 by Louisville Mayor Greg Fischer, will begin next  week, sterilizing up to 7,000 N95 masks per day using vaporized hydrogen peroxide (VHP). This process has been validated by Battelle Memorial Institute as a way to allow the masks to be reused safely by health care workers.

The respirators, which protect health care workers from up to 95 percent of small particles, including viruses, normally are discarded after a single use. However, the critical shortage of N95 masks amid the global COVID-19 pandemic has forced some health care workers to use masks longer than recommended or use other, less effective masks. Given the shortage, the CDC is not objecting to reuse of masks that have been decontaminated under the emergency circumstances, using processes that have been proven to be effective.

In her efforts to ensure a supply of personal protective equipment for the university, Cheri Hildreth, M.B.A., director of the UofL Department of Environmental Health and Safety, was investigating reports on various decontamination processes for N95 respirators. She heard about other institutions that were using VHP successfully.

“Clearly, VHP was looking like the real deal. I checked with Leslie Sherwood, as I thought she had a VHP generator for the university’s gnotobiotic laboratory,” Hildreth said. “When I started seeing the data on VHP, I said we need to activate on this.”

Leslie Sherwood, D.V.M., assistant vice president for research services and director of Research Resources Facilities at UofL, confirmed they did have the device, one of fewer than 100 in use across the country. The device vaporizes hydrogen peroxide that destroys bacteria and viruses in the air and on surfaces, and is used to decontaminate the contents of an entire room.

“We use the Bioquell VHP generator to disinfect rooms in the vivarium to keep our facilities and equipment very clean for our animals,” said Sherwood, who has orchestrated the decontamination project. “We also have used it for other decontamination needs that pop up. This has popped up.”

Sherwood and Hildreth assembled a team and set the project in motion in a matter of just a few days. They modeled the UofL decontamination process on one developed by Battelle using a Bioquell VHP generator following the 2014 Ebola outbreak and took cues from colleagues who developed a similar program at Duke University. Bioquell and Duke both have applied for Emergency Use Authorizations (EUA) from the U.S. Food and Drug Administration for the process. Battelle already has received an EUA from the FDA for the process.

So far, more than 30 organizations and facilities in Louisville, southern Indiana, Lexington and northern Kentucky have expressed interest in participating or applied on the project’s website.

“The ability to extend the life of our PPE eases the strain on access to a limited supply worldwide,” said Bob Van Burskirk, director of supply chain at UofL Health. “While our days-on-hand stock of PPE remains adequate, the safe reuse of select items ensures another level of safety for our front-line physicians and nurses.”

Participating facilities will be provided site-specific, dedicated collection containers for the used N95 respirators. Once filled, the containers are sealed, decontaminated, picked up by UofL staff members and brought to the Kosair Charities Clinical and Translational Research building on UofL’s Health Sciences Center campus. There, they are placed in a negative pressure air flow room in the lab with wire shelving strung with paper clips, each room holding 3,500 – 4,000 masks. The negative pressure air flow ensures that any air in the room is filtered and exhausted out of the building, not back into the hallway.

The used masks are hung and laid on wire shelves, arranged so that every surface is fully exposed to air, and the entire room is treated with VHP for 1-2 hours. The VHP is then allowed to dissipate, which takes another 4-5 hours.

After treatment with VHP, the masks are inspected for damage, staining or deformities, given a tally mark on the strap to indicate they have been decontaminated, and boxed to be returned to the same facility from which they were collected. Once the masks have 20 tally marks, they are discarded.

“When they are clean, we go through the quality assurance checks to make sure the elastic is not broken and there is no wear and tear,” said Steven Davison, D.V.M., assistant professor in Research Resources Facilities. “We have three rooms, so we can rotate groups of masks in each room, moving the VHP generator from one room to another.”

Each time a room full of masks is treated, biological indicators placed in the room are tested to ensure the VHP levels were sufficient to kill the virus, a step requiring an additional 24 hours. The entire process will take about 48 hours.

Davison said the staff members and UofL administrators have dedicated their own time to set up the rooms, test the process and provide administrative support to create the program.

“Our staff has been essential and very willing to help. They have the expertise in using the equipment. We couldn’t have gotten to this point without our staff, much less moving forward,” he said. “However, to keep it going, we will rely on a group of paid UofL employees who choose to participate and health sciences professional student volunteers.”

The program requires individuals to transport the used masks, perform the decontamination process and quality assurance checks and repackage and redistribute clean masks to health care providers. UofL employees who have training in biomedical safety procedures have chosen to participate, and protective equipment and safeguards are in place to protect them. In addition, UofL professional students in the Schools of Dentistry, Medicine, Nursing and Public Health and Information Sciences are eligible to volunteer to deliver the decontaminated N95 respirators to participating facilities. A sufficient number of staff and volunteers have signed up to help and are being trained to launch the program. If demand grows, more staff will be needed.

Sherwood said many individuals and departments throughout the university have come together to create the program in just a few weeks, including the School of Medicine, Speed School of Engineering, which provided logistics, the Department of Environmental Health and Safety, led by Hildreth, and the Executive Vice President for Research and Innovation's office. In that office, Kevyn Merten, Ph.D., associate vice president for research and innovation, has navigated the legal, fundraising and participant details needed to get the program up and running.

“This is just one more example of the many members of the UofL community who have responded to urgent needs, working together and using our advanced research expertise and infrastructure to solve problems during this crisis,” said Kevin Gardner, Ph.D., executive vice president for research and innovation at UofL.

“Everyone that is involved in this really just wants to help the front-line health care providers,” Sherwood said.

The N95 Decontamination Program has been awarded a $50,000 grant from the One Louisville: COVID-19 Response Fund that will support operational costs of the program. However, since there is no charge to the hospitals and other participating organizations, donations are gratefully accepted to help further defray the costs of equipment and supplies.

April 23, 2020

During the COVID-19 crisis, many of us have found ourselves suddenly working from home. This new remote work experience – new routines, new people in our work space and new ways of understanding productivity – is anything but business as usual.

“Traditionally, work had defined boundaries, meal times had defined boundaries and socializing had defined boundaries. Those boundaries are gone,” said Brad Shuck, Ed.D., associate professor in the University of Louisville’s Department of Educational Leadership, Evaluation and Organizational Development. “If your productivity has slipped in the last few weeks and you are feeling a tad more irritable or just defeated, there is a scientific reason why.”

Shuck and Charley Miller, founder of Unitonomy, a Louisville-based company that designs software to increase remote working efficiency, will help all of us new work-at-homers cope in a virtual presentation of the next Beer with a Scientist. Distraction – whether it is trying to learn and explain third-grade math, bombardment of Slack messages or the lure of just one more episode on Netflix – cost more than just a diversion from activity. It costs mental space and time to refocus. Using the behavioral economic principle of capacity, Shuck and Miller will explain how decision science can help us understand why we feel distracted, why we might get more easily frustrated, and what we can do about it.

Shuck and Miller will speak via Facebook Live from Holsopple Brewing beginning at 7 p.m. on Wednesday, April 22. As in the in-person versions of Beer with a Scientist, their 30-minute presentation will be followed by an informal Q&A session using Facebook comments.

To participate in the event, visit the Louisville Underground Science Facebook page just before 7 p.m.:  https://www.facebook.com/LouisvilleUndergroundScience/

The presentation also will be aired live on the Holsopple Brewing Facebook page:  https://www.facebook.com/holsopplebrewing/

Under circumstances not requiring social distancing, Beer with a Scientist is held at Holsopple Brewing, 8023 Catherine Lane. If you would like one of their beverages to enjoy during the event, Holsopple’s drive-up dock is open Tuesday-Saturday from 2-6 p.m. Organizers encourage Beer with a Scientist guests to drink responsibly, even if they are participating from home.

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.

After four Louisville coal-fired power plants either retired coal as their energy source or installed stricter emissions controls, local residents’ asthma symptoms and asthma-related hospitalizations and emergency department (ED) visits dropped dramatically, according to research published in Nature Energy this week. Among the authors for this work were researchers from the University of Louisville Christina Lee Brown Envirome Institute, Louisville Metro Department of Public Health and Wellness, Louisville Metro Office of Civic Innovation and Technology, Family Allergy & Asthma, Columbia University Mailman School of Public Health, Propeller Health, University of California Berkeley, Harvard TH Chan School of Public Health, University of Texas at Austin and Colorado State University.

Coal-fired power plants are known to emit pollutants associated with adverse health effects, including increased asthma attacks, asthma-related ED visits and hospitalizations. In 2014, coal-fired power plants accounted for 63 percent of economy-wide emissions of sulfur dioxide (SO₂) in the United States. Historically, Kentucky has ranked among the top five states in the U.S. for emissions from power generation.

Starting with a pilot in 2012, the city of Louisville embarked on a project called AIR Louisville, which aimed to use data from digital inhaler sensors to gain insights into the impact of local air quality on the burden of respiratory disease in the community. More than 1,200 Louisville residents with asthma and COPD were equipped with sensors produced by Propeller Health, which attach to patients’ existing inhalers and deliver insights on medication use, symptoms and environmental factors to an app on their smartphone.

Between 2013 and 2016, one coal-fired power plant in the Louisville area retired coal as an energy source and three others installed stricter emission controls to comply with regulations from the U.S. Environmental Protection Agency. Researchers took advantage of these circumstances to analyze the impact of the coal-fired power plant energy transitions on residents’ respiratory health, using data from Propeller and local hospitals to assess how asthma-related symptoms, ED visits and hospitalizations changed over time.

The study looked at the frequency of the total number of asthma-related ED visits and hospitalizations per ZIP code in Jefferson County, where Louisville is located, as well as the frequency of asthma rescue medication use among 207 people. Data on rescue medication use for asthma was used as a proxy for patients’ symptoms, as patients use their rescue medication for acute relief from symptoms such as coughing and shortness of breath.

Ted Smith, Ph.D., director of the Center for Healthy Air, Water and Soil in the UofL Envirome Institute and co-author of the study, said the work confirms important connections between environment and health.

“At the Envirome Institute and the UofL Division of Environmental Medicine, we are pioneering an approach that puts a focus on place in medicine – the places where people live and how their location affects clinical outcomes,” Smith said. “This research is a great example of the impact of environmental factors on people’s health. Air pollution first affects the lungs, but we know that when people breathe pollutants, it also affects other organs, including the heart.”

The study spanned 2012 to 2017, when four coal-fired power plants in Jefferson County either retired coal or installed stricter SO₂ controls. The researchers found that energy transitions in the spring of 2015 resulted in three fewer hospitalizations and ED visits per ZIP code per quarter in the following year, when comparing areas that had high coal-fired power plant emission exposure prior to the transition to those with lower levels. This translates into nearly 400 avoided hospitalizations and ED visits each year across Jefferson County.

At the individual level, the Mill Creek SO₂ scrubber installed in June 2016 was associated with a 17 percent immediate reduction in rescue medication use, which was maintained thereafter. The study also found the odds of having high rescue use throughout a month (on average more than four puffs per day) was reduced by 32 percent following the June 2016 energy transition.

“AIR Louisville brought together local government, public and private partners and residents for a common mission: To leverage local data to help push for safer and healthier air,” said Louisville Mayor Greg Fischer. “This study demonstrates the public health impact of retiring coal as an energy source or further controlling coal-fired emissions.”

“This study was unique in its ability to measure asthma morbidity based on both hospitalizations and daily symptoms, and to leverage an abrupt change in environmental exposure to more directly attribute changes in asthma exacerbation to changes in coal-fired power plant emissions,” said Joan Casey, Ph.D., lead author of the paper and assistant professor of environmental health sciences at Columbia University Mailman School of Public Health.

The main funding for the project was provided by the Robert Wood Johnson Foundation. Support also was provided by the Foundation for a Healthy Kentucky, Norton Healthcare Foundation, Owsley Brown Charitable Foundation, the American Lung Association, the National Institute of Environmental Health Sciences and the U.S. Environmental Protection Agency. The contents of the research and related materials are solely the responsibility of the grantee and do not necessarily represent the official views of the USEPA or the Robert Wood Johnson Foundation.

April 17, 2020

Innovation at the University of Louisville involving multiple departments at the university has led to a promising solution for the shortage of swabs in COVID-19 test kits. In response to a request from the Commonwealth of Kentucky, UofL’s Additive Manufacturing Institute of Science & Technology (AMIST), along with faculty and students in the Schools of Dentistry, Engineering and Medicine have created a 3D printed swab made of a pliable resin material. 

“This effort adds to the list of our response during the pandemic, including 3D printed face shields, respirators and ventilators being manufactured through the expertise of our institute. We hope our work will provide the necessary tools for Kentucky, as well as our local health care facilities,” said Ed Tackett, director of workforce development at AMIST, which is part of the J.B. Speed School of Engineering. 

The School of Dentistry operates a 3D print lab used in prosthodontic fabrication of dental implants, crowns and even jaw bones. 

Gerald “Jerry” T. Grant, DMD, MS, is interim assistant dean of Advanced Technologies and Innovation at the School of Dentistry, and associate director at AMIST. He collaborated with business partners Envisiontech on a resin to meet the material requirements for the swab, and NewPro3D to help develop a faster printing time. Grant’s goal is to print 385 swabs in less than an hour, and then to make the manufacturing processes available to companies within the state for large-scale production. 

Grant brings a wealth of knowledge from his military experience where he developed the 3-D Medical Applications Center at Walter Reed National Medical Center, Bethesda, providing support to medical and dental commands in digital design and 3D printing in patient custom reconstruction and devices.  

He compares the urgent need for items like face shields and swabs to the issues he faced in the military. 

“The number of injuries could not be addressed with the conventional methods of fabrication and we had to develop a digital solution to design, and eventually a direct printing solution to fabricate. 

“3D printing can provide an unique opportunity to address urgent needs – this is the reason I came to UofL to work with teams of engineers, physicians, dentists, artists and others to address situations much like we have now,” Grant said. 

Grant said students and prosthodontic residents have been significant contributors to the project’s success. 

Justin Gillham, J.B.Speed School of Engineering undergraduate mechanical engineering student and member of the AMIST co-op, worked closely with Tackett and Grant on the design. 

“Once I had a design complete, I sent it to Ed Tackett and Dr. Grant to print. With their feedback, I could change my design within minutes and have a new swab ready to be tested. In just a few days, we went through many designs that we could then test and change almost immediately,” Gillham said. 

George Pantalos, PhD, professor, Department of Cardiovascular and Thoracic Surgery, and professor, Department of Biomedical Engineering, sterilized and tested the swabs at the UofL Cardiovascular Innovation Institute, ensuring they could absorb enough solution material to be viable. 

Bioengineering students Sienna Shacklette and Clara Jones are working under the direction of Pantalos to assemble COVID-19 test kits. Just last week they compiled more than 700 kits which included biohazard specimen bags, labels, sample vials filled with viral transport media, and commercially available swabs that are in short supply. The kits were immediately sent throughout Kentucky to test individuals for COVID-19. 

Shacklette and Jones also have prepared test kits with 3D printed swabs that will be used in a validation clinical trial to be conducted in collaboration with Forest Arnold, DO,  MSc, associate professor, Division of Infectious Diseases, and UofL Health – UofL Hospital epidemiologist. 

“Although we are limited by the number of swabs available, we are not limited by the enthusiastic effort of our students,” Pantalos said. 

Grant said he is amazed at the responsiveness of everyone involved in the project. 

“We have been able to move a project in just over a week to possible patient trials, something that would normally have been a much longer process. The development of this swab will benefit the people of Kentucky as the supply access to commercial swabs remains inadequate, and a solution to allow for more timely testing becomes imperative,” he said.   

Clinical trials of the 3D printed swabs are expected to begin by the end of this week. With favorable results, it is anticipated they will be ready for use widely as early as the beginning of May.

The Commonwealth of Kentucky, in collaboration with the University of Louisville Christina Lee Brown Envirome Institute and the Louisville Healthcare CEO Council, is launching a groundbreaking initiative with three large Kentucky hospital systems; Baptist Health, Norton Healthcare and UofL Health. The purpose is to help its health care workers understand whether they were unknowingly exposed to COVID-19, to determine how much immunity was generated by such exposure, and to identify those with the best immune responses as donors of high-quality plasma for rescue treatment of patients with advanced COVID-19. In addition, these data will be informative as scientists worldwide are working to determine whether quantitative antibody measurements can be used to predict immunity in the overall workforce. This program represents a unique alliance between government and otherwise competing private groups in order to address an unprecedented crisis.

Testing will begin with high-risk personnel in Kentucky, starting with the health care workforce. As the process is scaled up it will be made available to other essential workers. There will be three steps of testing. First, a point-of-care test will provide a yes or no answer on the presence of antibodies. In a second step, positive blood will then be assayed for the amount of antibodies present in the blood. Finally, in patients with high amounts, the neutralizing power of the antibodies will be evaluated.

The University of Louisville Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases (CPM), has established a high-throughput real-time assay for SARS-CoV-2 antibodies that will be utilized and CPM will use their renowned Bio Safety Level 3 facility to test for the neutralizing activity of the antibodies.

“The University of Louisville is committed to addressing all forms of health,” said Neeli Bendapudi, President of the University of Louisville. “We are uniquely positioned to play a key role in this effort because of our talented researchers at CPM and our UofL Regional Biocontainment Laboratory which allows us to establish the very best donors of plasma for patients.”

This unprecedented collaboration of the public and private sector has already secured private donations of $1.75 million in the form of a challenge grant to build community-wide coalition of philanthropic support, which will allow the program to scale more quickly and save more lives. (Click here for more details on how you can help.)

“America and Louisville need more and advanced COVID-19 testing now. I am excited about this ambitious project and its potential to provide useful data for the recovery of our community. Louisville's team of cutting-edge scientists represents the best of who we are as Louisvillians, compassionate, smart and entrepreneurial,” said Louisville Mayor Greg Fischer.

“This is exactly the kind of collaboration that Kentucky is poised to enable,” said Dr. Cedric Francois, CEO of Apellis Pharmaceuticals and LHCC board member. “We have the infrastructure in our commonwealth to quickly bring this revolutionary technology together by leveraging the great work already being done with the health care stakeholders, such as Norton Healthcare’s convalescent plasma program and the extensive work that had already been done to start their antibody serology testing, to improve Kentucky’s response and recovery to the COVID-19 pandemic and be a model for the rest of the nation.”

“This model for testing is exciting and it is our hope that antibody measurements can be used to predict immunity,” said Gov. Andy Beshear. “If so, it will be a critical tool in the reopening of Kentucky’s economy.”

Learn more about the program, named the Co-Immunity Project, here.

Microbiologists at the University of Louisville have found that Legionella pneumophila usesa “tool” that allows it to thrive in an amoeba host and in human lung cells, but with very different results. In the amoeba, considered the bacterium’s natural host, it results in coexistence, making the amoeba host a suitable, safe home for the bacteria’s proliferation. In the human, however, it leads to a deadly form of pneumonia and a paradoxical inflammatory response in the lungs.

In an article published last week in Cell Host & Microbe, Yousef Abu Kwaik, Ph.D., professor, and Chris Price, Ph.D., senior research scientist, both of the Department of Microbiology and Immunology, and other researchers at the University of Louisville, explain that L. pneumophila uses the same mechanism or virulence determinant in both amoeba and the accidental human host, but with different results. A virulence determinant is a gene or protein that plays a key role in disease development.

Legionnaire’s disease is a type of pneumonia caused by the bacterium L. pneumonphila. Legionnaire’s disease, named for one of the first documented outbreaks of the infection at an American Legion convention in Philadelphia in 1976, accounts for approximately 15 percent of pneumonia cases worldwide and has a mortality rate of 20 to 50 percent. L. pneumophila evolved as an environmental bacteria that lives in water, surviving and proliferating in several species of amoeba as its natural hosts. It is the only bacterial pathogen for which amoeba are the natural hosts and humans are accidental hosts.

The bacteria are transmitted to humans who accidentally inhale them in water particles that have been aerosolized by man-made devices such as cooling towers, whirlpools, fountains or misters such as those used in grocery stores or in water parks. These devices distribute the water particles into the air along with bacteria that may be present in the water.

When L. pneumophila enters its natural amoeba host, it injects a protein into the single-celled organism that prevents the amoeba from destroying the bacteria and provides a safe home in which the bacteria may grow and spread. When L. pneumophila enters human lungs, it injects the same protein into alveolar macrophages. Contrary to the outcomes in the amoeba, the bacterial protein stimulates an inflammatory response in human macrophages that contributes to pneumonia. This effect is counterproductive to the bacteria as it stimulates the human host to restrict the invading bacteria. The effect of the injected protein in human cells also contradicts evolutionary co-existence of the pathogen with the human host, which is considered an accidental host. The injected bacterial protein has evolved in Legionella to interfere with a specific process in the amoeba host that does not exist in the more evolved human cells, where a paradoxical effect is mounted in response. 

“Our findings show for the first time that a bacterial ‘tool’ has evolved exclusively to manipulate an amoeba host-specific process, but it has a paradoxical effect on the human host,” Abu Kwaik said.

This knowledge may lead to methods that help reduce the bacteria’s ability to survive in amoeba in water sources, limiting the transmission of Legionnaire’s disease.

“Since the bacteria are not transmitted from one person to another, we have the opportunity to prevent transmission by targeting the bacterial protein with small molecule inhibitors,” Abu Kwaik said. “That would enable the amoeba to restrict and degrade the bacteria, blocking their amplification in the water system and, in turn, abolishing accidental droplet transmission to humans.”

April 14, 2020

Li has been conducting research funded by the National Cancer Institute for the past five years which led him to the connection between activity of a protein expressed in fatty tissue and an increase in breast cancer development. Li and colleagues shared the theory in an invited forum in Trends in Molecular Medicine, a Cell Press journal, published online last week. The article describes Li’s theory that adipose fatty acid binding protein (FABP4), expressed in fatty tissue, is responsible for fueling breast cancer tumor growth.

“Many types of cancer are related to obesity, not only breast cancer. More than 13 types of cancer are clearly associated with obesity and I think the list will go on and on once we have more data,” Li said. “In our research, we found the fatty acid binding protein family, especially one member, FABP4, plays a very critical role in the association of obesity and cancer, most specifically breast cancer. We theorize that FABP4 is responsible for the underlying molecular mechanism which promotes obesity-associated breast cancer development.”

Adipose tissue in the body produces FABP4 within fat cells, where it processes and distributes water-insoluble long-chain fatty acids. A certain amount of FABP4 enters the bloodstream under normal conditions. However, as a higher volume of fat tissue is accumulated, more FABP4 is secreted into circulation.

“When we get obese, this protein is secreted out much more into the circulatory system,” Li said. “Normally these molecules are inside the cells, but when people are obese, the molecules are outside.”

Li’s theory offers two ways in which FABP4 may stimulate growth in breast cancer tumors.

First, within the cells, FABP4 increases in certain tumor-associated macrophages, which accumulate in tumors to promote tumor growth. Li’s research also revealed that when FABP4 is inhibited, tumor growth is reduced in animal models even though the adipose tissue remained.

Second, when elevated levels of FABP4 circulate outside the fat cells in obesity, the protein promotes breast cancer development through direct interaction with breast cancer cells. In animal research, mammary tumor development and growth were reduced in obese animals in which FABP4 was controlled.

In addition, FABP4 in the bloodstream appears to work in multiple mechanisms to fuel interactions between tumor components and fat cells, thereby promoting cancer development.

Moreover, Li’s research group recently published findings in Cancer Research showing that different types of high-fat diets have different effects on tumor development. High-fat diets of either cocoa butter or fish oil both result in fat-induced obesity. However, the cocoa butter diet results in increased mammary tumor growth, while the fish oil diet does not. This study not only confirms the critical role of FABP4 in obesity-associated cancer, but reveals that not all obesity promotes the development of tumors.

Li and his team believe a better understanding of how FABP4 works both within macrophages and in circulation could provide opportunities to prevent certain breast cancers from progressing. It may also lead to the development of treatment methods that target FABP4 with drugs or specific antibodies.

“Now we are trying to generate some antibodies for this protein, which could be a very effective therapy strategy for obesity-associated cancer,” Li said.

April 13, 2020

Physical isolation and social distancing have become the new normal amid the COVID-19 pandemic, and strengthening psychological coping is as important as staying physically well. 

“One of the big challenges I see in my clients is the inability to deal with uncertainty. The lack of control over this disease has confronted so many with what little power we have over our lives,” said University of Louisville Trager Institute and Republic Bank Foundation Optimal Aging Clinic Director of Wellness Joseph G. D’Ambrosio, PhD, JD, LMFT, CSW.

D’Ambrosio, who also is an assistant professor in the UofL School of Medicine, says having an understanding of the disease is needed in order to protect ourselves and others, but it also is important to remember “this, too, shall pass, and we will be stronger because of it. Past generations have risen up and used crisis situations to improve the world, and we can do the same.”

He points out that a crisis can present an opportunity to stop and re-evaluate life.

“I find that in times like this, it is important to look introspectively at who we are and how we want to truly live. So many of us live a life that was prescribed by either family, society or our own beliefs about what we should do to be successful – but it may not be allowing us to be as happy or as prosperous as we could, if we were doing what we really wanted,” he said.

He gives advice on jump-starting mental strength that can lead individuals to the future life they truly want:

• Start a mindfulness practice. Begin by committing to five minutes in the morning and five minutes at night to silence and contemplation. Increase the time commitment daily so that you are doing at least 20 minutes twice a day. It will help situate you in the world where you can be your best self. There are many free apps such as Insight Timer or Calm that can help. 

• Now is a good time to begin to live a healthy lifestyle. For many that means changing diet to include more fruits and vegetables, and eating less meat and dairy. Work hard to make your body as immune proof as it can be, D’Ambrosio said. 

• Most importantly, have compassion for yourself and those around you. “We forget what a little bit of shared love can do to change ourselves and the world,” D’Ambrosio said.

Parents: Routines give children a sense of safety and security

Children are among those most affected by the new normal, D’Ambrosio said, and when a child experiences uncertainty it increases stress and feeling of helplessness. 

“A young child’s brain undergoes constant development as they grow. Routines help the part of a young child’s brain that is able to plan ahead and make predictions about the future. Having routines in place give children the space to feel good about themselves as they know what is coming, and understand that they can accomplish the tasks presented,” he said.

D’Ambrosio encourages parents not to be too rigid if they go off schedule, just confirm that tomorrow you are back on schedule. 

“Be kind to yourself and your children. These are stressful times and flexibility may be your biggest ally,” he said. 

He offers some important tips for making day-to-day life at home more enjoyable and manageable for both children and parents:

• Plan a specific time to awake and go to bed, do schoolwork, perform house chores, play, eat, exercise and have family time.
• Develop a specific time for children to spend by themselves either drawing or reading.
• Create a bedtime ritual, if you don’t already have one.
• Work with your children to make pictures or signs for each activity that they can see and count on happening.
• Be sure to let children know when the next routine is going to happen so that they can be prepared. For example, “we have 15 minutes left of study time so that we can take an exercise break.”
• Use a dry-erase board or poster to post a daily agenda that includes reading time, playtime, naps, etc.
• Assign chores to your children. Even children as young as 3 years old enjoy sharing adult responsibilities.
• When preparing meals, include children in the preparation even if it is something small.
• Encourage video-chatting with family and friends. Two children drawing together while on a video-chat can be fun and give the children a chance to connect.
• Help your children to become artists by using old magazines, wrapping paper and mail advertisements to make collages.
• Encourage independent childhood play time. Parents don’t have to be with kids 24/7,   and the separation is a great way to help children differentiate from their parents. That is a skill they will need to get through the rest of their lives, D’Ambrosio said.

Read a Q&A with D’Ambrosio on mental health insights during the COVID-19 pandemic on the UofL Trager Institute blog.

Dr. Matt Cave (UofL GI; Hepatobiology & Toxicology COBRE Core Leader) does cutting edge research on Exploring the Role of Environmental Chemicals in Liver Disease. His research is featured on the NIEHS website: https://www.niehs.nih.gov/research/supported/success/2020/cave/index.cfm.

UofL has been a leader in the area of environmental hepatology since the 1970s.

The novel coronavirus may have K-12 students in Kentucky’s school districts learning at home, but researchers at the University of Louisville are using the computing power of thousands of computers in classrooms across the state to identify drugs to treat COVID-19. The desktop computers are part of the DataseamGrid, a network of computers housed in classrooms of 48 Kentucky school districts as part of a partnership designed to support research, education and workforce development.

John Trent, Ph.D., deputy director of basic and translational research at the UofL Health - James Graham Brown Cancer Center and Wendell Cherry Endowed Chair for Cancer Translational Research, conducts virtual screening to discover new cancer drugs using the DataseamGrid for high-volume computations. Today, he has the computers at work 24/7 to identify the most promising drugs and compounds to fight SARS-CoV-2 and its disease, COVID-19.

“In these unprecedented times, we had a resource where we could potentially make an impact quickly and switch over from some of our cancer targets to SARS-CoV-2 targets,” Trent said. “We have been very successful in doing this in cancer for 15 years. We are using the same approach in targeting the coronavirus, just targeting a different protein.”

Established in 2003, Dataseam is funded by the Kentucky General Assembly to provide computing infrastructure, workforce development and educational opportunities for students and staff in Kentucky school districts. Available computing power in those units is put to work performing computer modeling calculations to screen anti-cancer drugs for Trent’s team and collaborators at UofL.

“Like a lot of industries, we have shifted our skills and infrastructure to address this issue,” said Brian Gupton, CEO of Dataseam. “We are always going to have cancer, but at least for the time being, we are glad the DataseamGrid is here for Dr. Trent to screen those drugs.”

In mid-March, Trent and his team entered new data onto the DataseamGrid, along with UofL’s dedicated research computers, in a two-pronged approach to match three-dimensional models of proteins in SARS-CoV-2 to drugs and compounds that could help in treating or preventing COVID-19. The DataseamGrid provides up to 80 percent of the computational power for these projects.

The first approach is to test about 2,000 drugs already on the market and another 9,000 investigational drugs and nutraceuticals that have been tested for toxicity to isolate those most likely to be effective against the virus.

“For the immediate approach, we are testing drugs that already are approved by the FDA or have been tested in humans. If we find activity with those drugs, we could get them into patient trials a lot quicker,” Trent said. “However, these drugs obviously were designed for something else and they may not have the same efficacy of a very selective drug.”

To find that selective drug, Trent’s second prong of research includes computational models to screen 37 million small molecules and compounds against the target proteins in SARS-CoV-2. These molecules could be used to develop a new drug specifically to treat the virus. That process would take more time, however, to obtain FDA approval.

“That initial discovery of a new, more-selective agent is more long term. You are looking at 12 to 18 months before you would even think about testing those in a patient,” Trent said. “But time is of essence at the moment, so we are doing both things at the same time.”

Using the DataseamGrid and UofL research computers, Trent and his team are screening the drugs and small molecules against 3-D structures of four proteins in the virus to see which compounds might bind with the proteins. A drug that interferes with the activity of any of these proteins would reduce the virus’s ability to spread.

Trent began the research with the first two proteins described for SARS-CoV-2: the main protease, an essential enzyme used by the virus to break down viral proteins and make new virus particles, and spike proteins, the triangular “knobs” the virus uses to attach itself to host cells. These spikes are the knobs commonly seen in graphic images on the surface of the virus. Trent now also is testing drugs against two additional target proteins that were described very recently.

So far, the process has identified about 30 drugs as potentially effective against SARS-CoV-2. Trent recommended these for biological testing by other UofL researchers in the UofL Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases (CPM). Directed by Kenneth Palmer, Ph.D., the CPM is one of only a few labs in the United States capable of testing the drugs against the virus. That testing is expected to begin in mid-April.

If the CPM researchers find the drugs to be effective against SARS-CoV-2 in the lab, they could be moved to the next phase of testing in animal models, testing that also may be conducted at CPM.

“This computer modeling is an excellent way to identify the best potential candidates for laboratory testing rapidly, and this strategy could lead to relief sooner rather than later for patients suffering from COVID-19,” Palmer said.

Gupton says it is good to know the DataseamGrid continues to support urgent medical research even though students are working from home.

“Ironically, we hope to return to cancer research as soon as possible,” Gupton said. “Even though the students are not in classrooms, Kentucky school districts are providing them with instruction, technology, internet access and even meals. The districts’ Dataseam systems engineers are supporting both the university’s work and K-12 efforts. We all are proud to be ‘digital first responders’ in Kentucky’s part of the global fight.”

As part of the Dataseam partnership, UofL provides academic scholarships annually for students from participating school districts who come to the university to pursue a degree in science, technology, engineering or math.

April 9, 2020

The University of Louisville and UofL Health have announced significant leadership appointments.

Toni Ganzel, M.D., dean of the UofL School of Medicine, has received an additional appointment as vice president for academic medical affairs. Reporting to President Neeli Bendapudi and Provost Beth A. Boehm, Ganzel will oversee research activity at the Health Sciences Center, including the centers and institutes. In addition, she will oversee areas including diversity and inclusion, faculty development and student health.

She will work closely with UofL Health CEO Tom Miller to ensure successful teaching and research at the recently expanded UofL Health network.

“Dr. Ganzel has done an excellent job as dean of the School of Medicine,” said UofL President Neeli Bendapudi. “I value her expertise and her leadership and look forward to continuing to work with her in this new role. She and Tom Miller are a great team to lead medical education, research and care in our community.”

Bendapudi and Ganzel will join nine other individuals from a variety of disciplines on the newly formed UofL Health Board of Directors. The board members from the university are:

• Neeli Bendapudi, UofL president
• Toni Ganzel, dean, School of Medicine, and vice president for academic medical affairs
• Kelly McMasters, chair, Department of Surgery
• Diane Medley, member, UofL Board of Trustees
• Fred Williams, physician, UofL Health

Community members include:

• Pat Mulloy, of counsel, Wyatt, Tarrant and Combs
• Ben Breier, CEO, Kindred Health care
• Heidi Margulis, retired chief corporate affairs officer, Humana
• Junior Bridgeman, CEO, Bridgeman Hospitality
• William Ballard, attorney and former health care executive
• T. Richard Riney, former executive vice president, CAO of Ventas

“These board members understand the complexities of today’s health care climate and will deliver a vision for the future,” Bendapudi said. “The foundation for UofL Health is strong. This board, along with the continued support of our elected officials in Frankfort, ensures our ability to deliver excellence, innovation and compassionate care for all in the Commonwealth.”

A decade ago, when the National Institutes of Health needed to place a high-security biocontainment laboratory in Kentucky, capable of safely studying dangerous and emerging infectious diseases, they turned to the University of Louisville.

Over the past decade, the laboratory has responded to national emergencies, studying highly infectious diseases such as SARS and others. Today it is being called upon in research efforts focusing on the novel coronavirus, SARS-CoV-2, and the disease it causes, COVID-19. And in that lab, researchers are exploring compounds that hold promise as therapeutic agents against the disease and could be grown quickly in host tobacco plants.

That’s right, tobacco.

A strain of the reviled plant that has caused fatal diseases for centuries could be the key to quickly mass-producing a preventive agent, treatment or vaccine for COVID-19.

“A protein in the university’s own proprietary portfolio and other compounds from industry sources may be useful against SARS-CoV-2,” said Kenneth Palmer, Ph.D., director of UofL’s Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases (CPM).  “We are currently conducting laboratory research with these compounds that could eventually lead to a therapeutic agent against COVID-19.”

UofL’s Regional Biocontainment Laboratory (RBL) is housed in the CPM and is part of a network of 12 regional and two national labs nationwide that were established with support from the NIH to conduct research with infectious agents. The national labs are located at Boston University and at the University of Texas Medical Branch at Galveston. Regional labs are located at the University of Chicago, Duke University, Boston University and other universities throughout the U.S. The RBL network stands ready in response to public health emergencies and emerging diseases such as the novel coronavirus.

The UofL RBL includes Biosafety Level 3 facilities built to the most exacting federal safety and security standards. The stringently secure facilities protect researchers and the public from exposure to the pathogens being investigated. As part of the RBL network, the UofL RBL is able to respond to needs of researchers, federal agencies and pharmaceutical companies nationwide to conduct research with infectious agents.

Palmer and his research team received samples of SARS-CoV-2 last month and are researching it only in the highly secure confines of the RBL. Covered head to toe in personal protective equipment to prevent self-infection, the researchers now are testing the therapeutic candidates against the disease in cell cultures.

The UofL compound is known as Q-Griffithsin and is co-owned by the university with the National Cancer Institute and the University of Pittsburgh. It is a potent anti-viral protein that possesses microbicidal capabilities. The other compounds are proprietary to their respective companies.

The research goal is to identify the best potential treatment option that could eventually be tested in humans, first at UofL to gauge its safety and efficacy and then later at the University of Pittsburgh and other clinical trial sites to continue to test its effectiveness. Although there are no guarantees, “we believe we could move into human clinical trials by the end of the year,” Palmer said.

That’s where the tobacco plants come in. A large amount of the ultimate therapeutic will be needed for human trials. Kentucky’s historical cash crop is a perfect host to produce the quantities needed.

“The unique quality about studying these compounds in Kentucky is that we can rapidly scale up production of tobacco plants to produce the large amounts of the agent we will need for human testing,” Palmer said. “As people already know, tobacco grows very well in Kentucky.”

Some of the compounds are already showing promise in the laboratory. While the end of the year seems far off in the current coronavirus climate, it is realistic because “SARS-CoV-2 may be with us for a couple of winter seasons. We’d like to have a product that could be tested if the infection comes back in the cold season like influenza does,” Palmer said.

If it does, Palmer and his team will be ready. “We think we will be able to deliver the drug as a nasal spray and hope we can use it as a preventive, pre-exposure treatment before a vaccine could be developed. This will be important for the public and especially for those who are at risk because of their age or pre-existing health conditions or because they work in health care.”

UofL Health is launching an immediate expansion of its telehealth program to improve patient access with more than 600 of our providers, while maintaining social distancing, during the ongoing COVID-19 pandemic.

On March 25, Kentucky Gov. Andy Beshear emphasized the importance of using this technology, especially in our current environment.

“This is something that had been on track for a launch later this year,” said Wade Mitzel, Chief Operating Officer, UofL Physicians. “But given the current need to reduce contact and increase precaution, we fast tracked the launch in order to give our patients peace of mind, with a convenient and safe way to access their provider.”

UofL Health – Telehealth will be available to established and qualifying new patients by calling our primary care access line: 502-588-4343. A scheduling specialist will help determine whether a telehealth or in-person visit would best serve the need.

Our telehealh appointment is like an in-person appointment with a provider. During the visit you’ll talk about your current health concerns and learn what to do.

• Your visit can take place from a location that is the most convenient for you.
• Your provider will use a video-based application to talk with you by phone, tablet or computer.
• Our telemedicine platform is secure and HIPAA compliant.
• Your photo and voice will not be recorded or stored.
• Your privacy and rights will be respected and ensured.

If a telehealth appointment is appropriate, the scheduler will provide further instructions on downloading the application, verify an email address and confirm that you have a webcam or built-in camera for your desktop, laptop, phone, tablet or other compatible device. When it is time for your appointment to begin, you’ll click on a link to be connected with a provider.

Through UofL Health – Telehealth our providers can provide an initial assessment of symptoms related to COVID-19, plus treat common conditions like colds and flu, sore throats, rashes, allergies, bladder infections and more. Providers may prescribe medications, if appropriate, recommend an over-the-counter medication or provide home care options. If needed, the provider may refer patients to an appropriate UofL Physicians - Primary Care office location, specialist or to an emergency department.