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.

Amblyopia, commonly known as “lazy eye,” is a visual disorder common in children. The symptoms often are low acuity in the affected or “lazy” eye and impaired depth perception. Researchers have long believed that the impaired vision by one eye is a consequence of exaggerated eye dominance that favors the fellow or “good” eye.

Amblyopia typically is treated by patching the fellow eye to strengthen the affected eye with the goal of restoring normal eye dominance. If correction is not achieved prior to the closing of a “critical period” that ends in early adolescence, visual impairments are more difficult to treat, if not permanent.

Research published today, led by Aaron W. McGee, Ph.D., assistant professor in the University of Louisville Department of Anatomical Sciences and Neurobiology, may lead to changes in how amblyopia is treated, particularly in adults. The research shows that eye dominance and visual acuity are controlled by different areas of the brain, and that one can be corrected without correcting the other.

“We unexpectedly discovered that they aren’t related. They’re independent,” McGee said. “It may not be necessary to instill normal eye dominance to correct visual acuity.”

Previously, McGee and fellow researchers identified a gene called ngr1 as essential in closing the critical period. He found that deleting ngr1 in animal models permits the critical period to remain open or to re-open, facilitating recovery of normal eye dominance and visual acuity. However, the relationship between the improved visual acuity and eye dominance was not clear.

Today’s research reports that recovery of eye dominance alone is not sufficient to promote recovery of acuity, and recovery of acuity can occur even if eye dominance remains impaired. McGee and his colleagues found that eye dominance is regulated by the brain’s primary visual cortex, while visual acuity is governed by another area of the brain, the thalamus.

McGee is the senior author on the article, published in Current Biology, (Distinct Circuits for Recovery of Eye Dominance and Acuity in Murine Amblyopia). Co-authors include Céleste-Élise Stephany Ph.D., a graduate student at the University of Southern California at the time of the research and now a postdoctoral fellow at Harvard Medical School, Shenfeng Qiu, Ph.D., assistant professor of the University of Arizona, and others.

The researchers applied tools to selectively delete the ngr1 gene in different areas of the brain. When ngr1 was deleted from the primary visual cortex, normal eye dominance was recovered but acuity remained impaired. When ngr1 was deleted from the thalamus, eye dominance was impaired, but visual acuity recovered to normal.

“Genes that are limiting recovery from amblyopia are working in parts of brain circuitry that previously were not recognized to have a role in improving visual acuity,” McGee said. “This could allow researchers to address acuity directly, without having to restore normal eye dominance.”

June 7, 2018

Unraveling  the complexities of cancer continues as the next generation of scientists pick up the baton and blaze new trails of discovery. Influencing students to pursue cancer research careers is at the heart of the University of Louisville’s National Cancer Institute-funded Cancer Education Program, now in its seventh year.

A new class of more than 40 undergraduate and medical students representing 13 institutions including Stanford University and MIT, began the 10-week program in May.

Sarah Mudra completed the program in 2014. Inspired by her experience in Louisville, she’ll start medical school at UofL this summer.

Mudra, who plans to pursue the School of Medicine’s Distinction in Research Track, will conduct research in collaboration with Beth Riley, M.D., F.A.C.P., associate professor of medicine and deputy director of clinical affairs at the James Graham Brown Cancer Center.

Riley was Mudra’s primary mentor in the Cancer Education Program.

“I witnessed the multi-faceted nature of medicine as Dr. Riley balanced relational care with scientific inquiry and ethical decision-making – I became fascinated with the field of oncology,” Mudra said. “Dr. Riley became a steadfast encourager and mentor, prompting me to ask complex research questions and examine new bodies of literature.”

Throughout the 10 weeks, Mudra worked with Riley to analyze data from individuals who were diagnosed with breast cancer through testing on the cancer center’s mammography van. They engaged in conversations about patient care and population-based research, including the utility of mobile mammography for reducing health disparities.

Mudra said it was her participation in the Cancer Education Program that laid the foundation for continued scientific exploration as a post-baccalaureate research fellow at the National Institutes of Health in Bethesda, Md. During the two-year fellowship, she worked to refine her research techniques and develop a novel protocol for human microbiome analysis.

“It is remarkable how the Cancer Education Program molded my professional and scientific development, serving as my foundation,” Mudra said. “I would advise all students interested in scientific growth to pursue a dedicated period of research in a field of interest. Be inquisitive and curious. Exercise a willingness to learn any aspect of a project, and uphold a tireless work ethic. Above all, demonstrate gratitude for the opportunity to be shaped through a mentor’s guidance.”

The directors of the program, David Hein, Ph.D., Peter K. Knoefel Endowed Chair of Pharmacology and chair of the Department of Pharmacology & Toxicology, and La Creis Kidd, Ph.D., Our Highest Potential Endowed Chair in Cancer Research and associate professor in the Department of Pharmacology and Toxicology, outlined the success of UofL’s program in an article published in the Journal of Cancer Education.

Since 2011, 188 students have completed UofL’s program.

May 31, 2018

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

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

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

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

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

June 4, 2018

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More about stroke

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

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

 May 23, 2018

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

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

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

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

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

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

Photos of the ribbon-cutting are available here.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

May 8, 2018

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The event will be rescheduled for a later date.

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

About the Medical Mile:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

April 17, 2018

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

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

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

See a video about in-flight emergency training.

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

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

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

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

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

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

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

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

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

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

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

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

April 16, 2018

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

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

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

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

How do we do this?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

International FND Awareness Day, April 13, 2018

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

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

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

April 9, 2018