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.

Sixteen members of the University of Louisville School of Medicine faculty have completed a 10-month training program aimed at developing effective future leaders in academic medicine. Leadership and Innovation in Academic Medicine (LIAM) was designed to develop innovative thinking skills in early to mid-career faculty who are motivated to be leaders in medical education.

“Leadership is more important than ever as the university prepares to deal with changes in our health-care world. Our leaders need to have the resilience and creativity and the ability to be innovative and problem solve as challenges keep coming,” said Gerard Rabalais, M.D., M.H.A., associate dean of faculty development, who created the program along with Staci Saner, M.Ed., program manager for faculty development.

“We need to deepen our bench here at the university,” said Tracy Eells, Ph.D., M.B.A., vice provost for faculty affairs, at the program’s final event on July 17. “We need to have a deep set of leaders that we can turn to because there are a lot of leadership positions at the university.”

The participants attended monthly meetings organized to introduce innovation and design thinking through understanding how to lead oneself, how to lead others and how to lead the organization.

Jeremy Clark, M.D., assistant professor in the Department of Ophthalmology and Visual Sciences, most values the connections he made with other participants.

“The single most impactful aspect of LIAM is the relationships I built with each of my peers and with our physician leaders in the School of Medicine.  I now have 15 other young leaders that I can go to and ask for advice and counsel when I am struggling with leadership problems,” Clark said.

Hugh Shoff, M.D., assistant professor in the Department of Emergency Medicine, expected the program to help him acquire tools for becoming a better leader and innovator in medicine. He was surprised by the value of the self-reflection aspect.

“We spent lot of time in the beginning learning to analyze yourself and make sure you as a person are in the right place to become a better leader. I didn’t expect to spend as much time on that, but I am glad we did,” Shoff said.

Eells said self-leadership is a critical aspect of the program’s three-stage approach.

“It has to start with yourself, with emotional intelligence, knowing how to keep your cool when you are in a tense situation since you are serving as a role model to many others around you when you are serving in a leadership capacity,” Eells said.

The self-reflection portion will be expanded for the second LIAM cohort, which will increase from 16 to 24 members.

At the program’s final meeting, teams of four participants presented projects to improve the school or health care in general and presented them to a panel of judges, leaders from the UofL School of Medicine, and members of the 2018-2019 cohort were announced.

2018-19 LIAM second cohort

Pascale Alard, Ph.D.                                Microbiology and Immunology
Thomas Altstadt, M.D.                           Neurosurgery
Laura Bishop, M.D.                                  Medicine
Eric Burton, M.D.                                      Neurology
Camilo Castillo, M.D.                              Neurosurgery
Priya Chandan, M.D., M.P.H.               Neurosurgery
Brittany Chapman, M.D.                        Neurology
Lynzee Cornell, Ph.D.                              Otolaryngology and Communicative Disorders
Russell Farmer, M.D.                              Surgery
Shahab Ghafghazi, M.D.                        Medicine
Josephine Gomes, M.D.                        Family and Geriatric Medicine
Sushil Gupta, M.D.                                   Pediatrics
Ahmed Haddad, M.D., Ph.D.                Urology
Jennifer Hamm, M.D.                             Obstetrics, Gynecology and Women's Health
David Haustein, M.D.                              Neurosurgery
Bridget Hittepole, M.D.                         Medicine
Deborah Kozik, M.D.                               Cardiovascular and Thoracic Surgery
Rana Latif, M.D.                                        Anesthesiology
Jennifer Le, M.D.                                      Pediatrics
M. Eli Pendleton, M.D.                          Family and Geriatric Medicine
Melissa Potts, M.D.                                 Radiology
Vikas Singh, M.D.                                     Medicine
Abigail Stocker, M.D.                              Medicine
Christina Terrell, M.D.                            Psychiatry

2017-2018 LIAM class projects

Increasing the Value of Academic Teaching 

Academic teaching is a core mission for UofL School of Medicine faculty that is difficult to quantify in terms of scholarly recognition. The definition and documentation of good teaching is lacking. Our project proposes a structured way of accounting for teaching in an easily accessible system, and ideas for a culture shift towards recognition of teaching excellence as a critical mission for the university.
Team members:  Alexander Ovechkin, M.D., Ph.D., Christine Brady, Ph.D., Elizabeth Cash, Ph.D., Kathrin LaFaver, M.D.

A Better PICC Line

The project focuses on the creation of a PICC line that is tamper-evident for use in patients who have a history of IV drug use and require long-term antibiotic therapy for conditions such as bacterial endocarditis. The hope is that use of this PICC line will allow these patients to transition home for IV antibiotics in lieu of prolonged hospital stays to complete the antibiotics course.
Team members:  Farid Kehdy, M.D., Hugh Shoff, M.D., Laura Workman, M.D., Luz Fernandez, M.D.

Mind the Gap:  Using Generational Strengths to Create Faculty-Student Teaching Partnerships
Many University of Louisville Health Sciences Center faculty struggle to adapt their teaching to include new educational pedagogies due to lack of time, variable prioritization of teaching and difficulty using new technology. We propose the creation of student-faculty partnerships where the faculty – our content experts – can use the technical savvy and availability of students to modify and improve their teaching. We plan to pilot this initiative as part of the Medical Students as Teachers elective for fourth year medical students and measure change in course evaluations, student satisfaction and faculty well-being.
Team members:  Leah Siskind, Ph.D., Sara Multerer, M.D., Sara Petruska, M.D., Tyler Sharpe, M.D.

Financial Empowerment
Leaders in academic medicine are frequently ill prepared to make the financial decisions that are a necessary part of their jobs. There is currently a gap between finance officers at senior levels and leaders at lower levels who lead clinical, research or education teams. Our proposed innovation is to empower leaders across the University of Louisville School of Medicine to make financial decisions by providing local, focused financial training to leaders.
Team members:  Carolyn Roberson, Ph.D., Adrienne Jordan, M.D., Brian Holland, M.D., Jeremy Clark, M.D.

July 25, 2018

The Northeast Kentucky Area Health Education Center (NE KY AHEC) has received the Center of Excellence Award in Distribution at the National AHEC Organization’s biennial conference held July 8-11 in Arlington, Va.

“The work of David Gross and the Northeast AHEC exemplifies the incredible work performed by all of our statewide AHEC programs. We are so fortunate to have this effort recognized on a national level as we seek to close the health care gap in our rural areas,” said R. Brent Wright, M.D., acting statewide program director for Kentucky AHEC and associate dean for rural health innovation, UofL School of Medicine.

The regional center received the honor for its STEPS program. STEPS, or Successfully Training and Educating Pre -medical Students, was created in 2013 to level the playing field for local students interested in applying to medical school. Appalachian Kentucky, including most of the NE KY AHEC’s service region, has a long-standing shortage of physicians.

Studies have shown shortages are partially attributable to factors including Appalachian students’ inadequate academic preparation, limited exposure to health care occupations, low self-confidence and financial considerations. STEPS helps northeast Kentucky students overcome these barriers by providing participants with Medical College Admission Test (MCAT) preparatory courses as well as mock interviews, application process and personal statement tutorials, physician shadowing and other activities aimed at better preparing them for the process of applying to medical school.

“It’s quite an honor to be chosen by our peers for one of only three Center of Excellence awards among the nation’s nearly 250 regional AHECs,” said David Gross, director of the NE KY AHEC. “The purpose of STEPS is to produce not just more, but more competitive, medical school applicants from our region. In part because of this program, we continue to see meaningful increases in the number of local students applying to and being accepted by in-state medical schools.”

Since its creation, three cohorts of students have completed STEPS and the subsequent medical school application/ interview/matriculation cycle. Of the 25 students who met all program requirements, 22 matriculated to medical school.

The NE KY AHEC recently entered into a two-year contract with the Kentucky Primary Care Office to replicate STEPS among the other seven Kentucky AHECs.

About AHEC

AHEC is a collaborative effort of the University of Louisville Health Sciences Center, the University of Kentucky Medical Center and eight regional centers. The goal of the Kentucky AHEC program is to improve the recruitment, distribution and retention of health care professionals (particularly in primary care) in medically underserved areas throughout the state.

Each regional AHEC center serves a specific geographic area of the state, and is responsible for certain counties in their area.

The University of Louisville serves as the central office for all eight regional centers.

In the simulation center at the University of Louisville School of Dentistry, several dozen undergraduate students are sampling some of the skills they would learn in dental school. The students, part of the Summer Health Professions Education Program (SHPEP), are getting a glimpse of what life is like in health professions school.

“This was really cool to do. We made impressions of our fingers like they do when they put braces on and mold your teeth,” explained Whitney McKee, a college sophomore from Birmingham, Ala.

McKee is one of 59 undergraduates from around the United States who are spending six weeks at UofL this summer to boost their academic skills, network with health professions students and faculty, and learn about health-care career options. The students, from as far away as California, New York and Puerto Rico, all are interested in pursuing health professional careers after college such as medicine, dentistry, pharmacy, nursing or other advanced degrees.

Although she is a pre-med student, McKee is still refining her career plans. In SHPEP, she is learning about areas of health care she had not considered before.

“I’m open to anything because I don’t know what specialty I want to do,” McKee said. “I’m looking into dentistry and pharmacy and nursing. It’s given me more information about public health, because we don’t have that kind of program at my school.”

This is the 13th year for the program at UofL, one of 13 campuses across the United States hosting students in SHPEP in partnership with the Robert Wood Johnson Foundation and with direction from the Association of American Medical Colleges and the American Dental Education Association. The goal of SHPEP is to strengthen academic proficiency and career development skills of students underrepresented in the health professions. Many of the students identify as African American/Black, American Indian and Alaska Native and Hispanic/Latino, or come from communities of socioeconomic and educational disadvantage.

“This program really allows the participants to get a bird’s eye view of what professional school will be like,” said Sharon Gordon, M.S., coordinator of the SHPEP program at UofL. “The students are given the opportunity to study a few of the basic science concepts they will need to master in professional school and are taught by professors at the UofL Health Sciences Center. They also interact with other health-care professionals as well as current students during their time here.”

The students stay in dorms on Belknap Campus and are introduced to the UofL schools of medicine, nursing, dentistry and public health, as well as the Sullivan University College of Pharmacy. Along the way, they learn about programs offered at UofL. McKee was surprised to learn UofL offers a Distinction in Global Health Track to students in the School of Medicine.

“You get the opportunity to learn about global health. I never knew that was an option and I’d really like to do that. I’ll definitely be applying [to UofL] but I am an out of state student, so we will see,” McKee said.

Meeting health professionals, potential mentors and like-minded peers is an important benefit for sophomore Alexandria Danielle Lee of the University of South Alabama. She plans to become a certified registered nurse anesthetist.

“Yesterday, I got to meet an anesthesiologist. Since I’m interested in anesthesia, that was very helpful for me. She said I can come shadow her,” Lee said.

In addition to engaging in rotations in health-care settings and simulations like the one in the School of Dentistry, the students receive academic enrichment in basic sciences, as well as development of study skills, communication, financial literacy, interprofessional education, health equity and health policy.

“In the program, participants learn what they need to do to be prepared for the rigors of professional school,” Gordon said. “Typically, the semester after they leave the program is one of their best based on the academic enrichment they receive through SHPEP.”

Jarvez Ellis, a freshman student from Chowan University in North Carolina, said participation in SHPEP has given him tools to achieve his goal of becoming a physician.

“This program has allowed me to become more focused, clear and confident in my goals and what will be required to get into medical school,” Ellis said.

Lee believes her participation in the program will pay off when she applies to advanced health programs.

“Not everybody wants to spend six weeks of their summer here at a program taking classes,” Lee said. “This program really helps you stand out from other applicants.”

July 19, 2018

A new initiative seeks to empower individuals to take control of their own health and positively influence the health of others.

The Institute for Sustainable Health & Optimal Aging  at the University of Louisville has launched a health education effort in Kentucky called the Microclinic Program, created by Microclinic International.

The microclinics are designed to empower individuals to lead healthier lives and manage chronic disease. Participants learn how to decipher nutrition labels, cook healthy meals, take part in group fitness activities and reach health goals.    

The institute recently held a facilitator training for community and health care industry workers. They will lead small group microclinics with patients, friends and family at community centers, workplaces, churches, senior seniors, hospitals, health clinics, extension offices and schools. 

The facilitators are members of the Kentucky Coalition for Healthy Communities, a community coalition supported by the institute’s Geriatrics Workforce Enhancement Program grant and other community organizations. The first cohort of trainees includes representatives of UofL, Aetna, Area Agencies on Aging, Care Source and Anthem, along with Bullitt, Henry, Jefferson, Trimble, and Franklin counties in Kentucky.

The institute plans to offer additional trainings for individuals in counties surrounding Jefferson County and those near the Barren River area.

To schedule a microclinic or facilitator class, and to learn more about the program, contact Mona Huff at 503-845-6849 or rjhuff01@louisville.edu . Learn more about the Institute for Sustainable Health & Optimal Aging at www.OptimalAgingInstitute.org.

Spine surgeons and researchers at the University of Louisville, concerned about potential opioid misuse resulting from pain management related to surgery, have discovered positive news in a study of back surgery patients. The study, conducted by researchers in the UofL Department of Neurological Surgery, concludes that patients undergoing surgery for degenerative spondylolisthesis are less likely to be dependent on opioids after than before the surgery.

The national opioid epidemic affects millions of Americans. Overdoses claimed more than 42,000 lives in 2016, according to the Centers for Disease Control and Prevention, up from 33,000 in 2015, and Kentucky has the fifth highest rate of overdose deaths of any state, at 33.5 per 100,000 population. Unfortunately, many people who abuse opioids were introduced to the drugs through a physician’s prescription to control pain.

“Spine surgery patients deal with an immense amount of pain both before and after surgery. Opioids are used to manage that pain,” said Mayur Sharma, M.D., M.Ch., a resident in the UofL Department of Neurological Surgery who led the study. “Patients have been abusively using opioids for pain resulting in the recently declared national opioid crisis. Our work indicates that surgery for degenerative spondylolisthesis is associated with a reduced risk of opioid dependence.”

In the research, published last week in Journal of Neurosurgery: Spine, the authors analyzed records for 10,708 patients who had surgery between 2000 and 2012 for degenerative spondylolisthesis, a condition in which one vertebra slips over another one, compressing the nerves in the spinal column, most often occurring in the lower back. The researchers found that 14.85 percent of the patients were opioid dependent within one year prior to the surgery, and 9.9 percent were opioid dependent 3 to 15 months after the surgery. Most of the patients received decompression and fusion surgery for the condition. The authors concluded that overall, opioid dependence was reduced by nearly 5 percent following surgery for degenerative spondylolisthesis.

In addition to the reduction in dependency, analysis of the records showed that younger age and prior opioid dependence were associated with a higher risk for post-surgery opioid dependence. This information may guide physicians in predicting which patients are at higher risk for opioid dependence following surgery.

“It is important to note that 10 percent of patients who come for surgery for degenerative spondylolisthesis will be opioid dependent after surgery. These patients require special attention. Our paper discusses some of the predictive factors to consider,” Sharma said.

“Factors predicting opioid dependence in patients undergoing surgery for degenerative spondylolisthesis: analysis from the MarketScan databases,” was coauthored by Sharma, Maxwell Boakye, M.D., chief of spinal neurosurgery, Beatrice Ugiliweneza, Ph.D., M.S.P.H., assistant professor, and Zaid Aljuboori, M.D., of UofL, and colleagues at University of California, Davis and Swedish Medical Center in Seattle. 

June 26, 2018

TheUniversity of Louisville today announced the first multimillion dollar gift of President Neeli Bendapudi’s tenure to establish the Envirome Institute at the School of Medicine.The gift, $5 million, fromthe Owsley Brown II Family Foundation, supports the first institute dedicated to the study of the human envirome. Taking a holistic approach to researching how the human-environment interrelationship impacts peoples’ lives, the institute will build on the pioneering work of Aruni Bhatnagar, Ph.D., the institute’s director, in the field of environmental cardiology. The institute will incorporate community engagement and citizen science to introduce a singular, new approach to the study of health.

Twenty-five years ago, the Human Genome Project completed the first map of our genetic code, revealing how our genes relate to our health, and potentially our susceptibility to disease. Built on a new vision of health, the Envirome Institute pioneers actionable knowledge about all forms of health and how they are affected by the environment beyond genomics. This gift from Brown catalyzes existing resources and adds new capabilities toward the ambitious, long-term mission of studying the human envirome with the same precision and rigor applied to decoding the human genome.

“All of us at the University of Louisville are grateful to Christina Lee Brown for the trust she has put in us to tackle such a large and complex idea as how our broad environment impacts our lives,” Bendapudi said. “Her generosity will enable our group of researchers, staff and students to explore new concepts associated with exploring the elements of a single person’s overall environment and determine how that affects their lives. The impact this will have will be felt well beyond Louisville.”

“This isn’t just the University of Louisville’s Human Envirome Institute. It is Louisville’s Human Envirome Institute,” Brown said, “Each of us, individually, must put health, broadly understood, in the center of all of our public and private efforts. And we are encouraged by the will and determination of the new president, Neeli Bendapudi, to immediately step in and support the Institute’s efforts and importance to both the city of Louisville and the university.”

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity — the University of Louisville serves as the perfect home for this new unique, holistic, interdisciplinary, educational model. It is truly a world-class organization,” Bhatnagar said.

The institute will open a door to a healthier future in Louisville and across the globe. The research of Bhatnagar and colleagues has pioneered the field of environmental cardiology and begun to uncover the important influence of the environment on heart disease. The institute, by studying the relationship of our health to the natural and the social world around us, will amplify the potential of this broad and promising territory.

Humans live in complex, variable and diverse environments that are fashioned by their unique mix of history, culture and social organization. Until recently, we lacked the material and conceptual tools required for studying the health effects of the natural, social, cultural and economic dimensions of the human environment as a whole. As in the graphic Circle of Harmony and Health (below), health should be understood holistically as psychological, intellectual, spiritual, cultural, nutritional, economic and environmental health.

This institute serves as a unifying capstone organization over several existing centers including the Diabetes and Obesity Center, the Superfund Research Center and the Tobacco Regulation and Addiction Center. Together these centers have successfully attracted more than $100 million in extramural funds over the past decade. This new interdisciplinary, connected institute creates new potential to expand those resources significantly. Additionally, a Center for Healthy Air, Water and Soil will be established within the Envirome Institute to advance the work that the Louisville community began five years ago.

The Envirome Institute also introduces a more public science and opens a welcoming door for the residents of Louisville. Enviromics can involve the participation of whole communities in the process of data collection as well as in the benefits from health initiatives that may be free or subsidized. As part of a medical institution, the institute is committed to healing and helping turn discovery into actionable change, with Louisville as a living, urban laboratory.

#WeAreUofL

More about Aruni Bhatnagar, Ph.D.

The newly appointed director of the Envirome Institute, Bhatnagar is the Smith and Lucille Gibson Chair in Medicine. He also is director of two University of Louisville centers, which now fall under his leadership within the Envirome Institute – the Diabetes and Obesity Center and the American Heart Association Tobacco Research and Addiction Center.

Bhatnagar’s work has led to the creation of the new field of environmental cardiology. His studies show how pollution affects the heart and blood vessels and how exposure to polluted air affects the risk of obesity and diabetes. His research, supported by several grants from the National Institutes of Health, has led to the publication of more than 250 research papers and 20 book chapters. He has mentored 55 students, fellows and trainees.

More about Christina Lee Brown, Activist & Philanthropist

Christy Brown is a global leader in creating new ways to empower “citizen scientists” to lead healthier lives by advocating for a culture of health using nature as the standard and encouraging all decisions to be made through the lens of health. She believes passionately in the potential of urban and rural communities to effect positive change by working together, at the same time celebrating their commonalities and differences.

Having a strong passion for community led Christy to become a co-founding board member of the Berry Center. Its mission is to accept no permanent damage to the ecosphere, taking the human health of local communities into consideration.

Understanding that healthy air, water and soil are the keys to the health of all life, Christy founded the Institute for Healthy Air, Water & Soil in 2014. As the institute began to lean into its work, a bigger mission began to occur all around, attracting both local and national ambassadors. The work of the Institute for Healthy Air, Water & Soil will transition into the newly founded Center for Healthy Air, Water & Soil. 

Located across Belknap Campus and the Health Sciences Center, the Envirome Institute will provide an umbrella for the following centers:

• Diabetes and Obesity Center
• Center for Integrated Environmental Health Sciences
• American Heart Association Tobacco Regulation and Addiction Center
• Superfund Research Center
• Center for Healthy Air, Water and Soil
• Center for Environmental Policy and Management
• Center for Environmental and Occupational Health Sciences

June 19, 2018 [Updated centers list 8/30/2019]

Cigarettes continue to make a killing in Kentucky. That’s because quitting is incredibly hard – even downright impossible – for many smokers.

Brad Rodu, D.D.S., professor at the University of Louisville School of Medicine, says smokers can reduce health consequences of smoking tobacco by switching to smoke-free alternatives, including dip and chew products, and e-cigarettes.

“These smoke-free tobacco products provide tobacco pleasure and satisfaction. More importantly, decades of research document that smoke-free tobacco is vastly safer than cigarettes,” Rodu said.

For more than 20 years, Rodu has worked to educate smokers and non-smokers on safer alternatives to smoking tobacco, authoring more than 60 tobacco research articles for medical and scientific journals. He has been in the forefront of policy development in this field, and in 2011, he launched Switch and Quit Owensboro, the first-ever community cessation program based on switching to smoke-free alternatives.

At the next Beer with a Scientist, Rodu will discuss, “Harm Reduction:  What You Don’t Know About Tobacco and Health.”

The talk begins at 8 p.m. onWednesday, June 20, at Against the Grain Brewery, 401 E. Main St. in Louisville. A 30-minute presentation will be followed by an informal Q&A session.

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

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

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