School of Medicine Celebrates its URM Graduates

School of Medicine Celebrates its URM Graduates

Faculty members and trainees from the School of Medicine gathered to celebrate the accomplishments and achievements of the University of Louisville’s graduating minoritized House Staff trainees and Doctoral students. The inaugural event, hosted by the Office of Faculty Affairs and Advancement, the Office of Graduate Medical Education and the HSC Office of Diversity and Inclusion, celebrated 26 URM trainees and six PhD graduates. 

“The medical school accrediting bodies have asked medical schools, nationwide, to focus on increasing the faculty recruitment and retention of underrepresented minoritized (URM) faculty,” said Chris Seals, PhD, assistant dean of faculty affairs and advancement. “The Dean and leadership, at our School of Medicine, are committed to doing so and realize that the pursuit of this goal starts with creating an inclusive cultural environment that celebrates the accomplishments of our own URM faculty, staff, and students. While URM medical students have been recognized and celebrated, this celebratory event honors an additional group that we want to celebrate: residents, fellows, PhD students, and postdoctoral fellows.”

The graduating honorees were each gifted items from the Office of Graduate Medical Education and the Office of Faculty Affairs and Advancement.

“We are proud of the success of each of our graduates and take great joy in celebrating their accomplishments. This group of scholars are on the trajectory to becoming faculty members and building a culture that embraces their success might encourage them to return to UofL and join our Cardinal family as faculty members,” said Toni Ganzel, MD, dean of the School of Medicine.

The School of Medicine has witnessed a slow but steady growth of minority faculty in recent years. At count, seven of the honoree graduates will be staying in the area and four of which will add to the school’s minority faculty members.

Seals summed up perfectly the reason for the event: “This event is just one small step toward building a culture of inclusivity which embraces and celebrates diversity and belongingness for residents, fellows and PhD graduates who are of marginalized identity groups.”

The graduate honorees included:

  • Andrew Selk, Department of Emergency Medicine
  • Aaron Kuzel, Department of Emergency Medicine
  • Phillip Giddings, Department of Emergency Medicine
  • Monica Chamorro, Department of Family and Geriatric Medicine
  • Lauren Miller, Department of Family and Geriatric Medicine
  • Diana Otero Mostacero, Department of Medicine
  • Samantha Sears, Department of Medicine
  • Mohamed Eisa, Department of Medicine
  • Cristian Rios, Department of Medicine
  • Chanelle Benjamin, Department of Medicine
  • Armando Bosch, Department of Medicine
  • Laura Sims, Department of Medicine
  • Cristina Salmon, Department of Medicine
  • Meena Vessell, Department of Neurosurgery
  • Zebulun Cope, Department of Obstetrics, Gynecology, & Women’s Health
  • Tawana Coates, Department of Obstetrics, Gynecology, & Women’s Health
  • Terri Mason, Department of Pathology & Laboratory Medicine
  • Stephanie Battistini, Department of Pediatrics
  • Dominique Elmore, Department of Pediatrics
  • Mobolanle Elder, Department of Pediatrics
  • Caroline Jackson, Department of Pediatrics
  • Lauren Hernandez, Department of Pediatrics
  • Mara Harris, Department of Physical Medicine & Rehabilitation
  • Raymond McDermott, Department of Radiology
  • Christina Warner, Department of Surgery
  • Michael Keyes, Department of Surgery
  • Andre Richardson, PhD Candidate
  • Sabryna Robbins, Pediatrics
  • Luis Alvarado, Anatomical Sciences and Neurobiology
  • Timothy Audam, Biochemistry and Molecular Genetics
  • Henry Nabeta, Microbiology and Immunology
  • Hazel Ozuna, Microbiology and Immunology
  • Samiyyah Sledge, Physiology

In first in-human use, UofL & Norton physicians implant tiny pacemaker, saving infant’s life

Patient born at 28 weeks with slow heart rate and congenital heart disease receives never before used pacemaker implant
In first in-human use, UofL & Norton physicians implant tiny pacemaker, saving infant’s life

X-ray shows the chest cavity of a patient too small for traditional care, driving the UofL-Norton team to perform the first known U.S. human implantation of a novel-designed tiny pacemaker in a premature infant.

A multidisciplinary team within Norton Children’s Heart Institute, affiliated with the UofL School of Medicine, worked together to save the life of an infant born with congenital structural heart defects and complete atrioventricular block (CCAVB) that led to a slow heart rate. The patient was too small for the traditional path of care, driving the innovative team to perform the first known human implantation of a novel-designed tiny pacemaker in a premature infant.

“It is remarkable how our team of pediatric specialists came together with the device company to offer a resolution for such a small patient weighing less than three pounds at the time of implant,” said Soham Dasgupta, M.D., pediatric electrophysiologist, Norton Children’s Heart Institute, and UofL assistant professor of pediatric cardiology. “This case is unlike any other and we are so pleased to see this patient thriving as a result of the innovative approach.”

Approximately 1 in 22,000 infants are born with CCAVB. Untreated, the condition has a high incidence of prolonged illness or death. The usual treatment involves implantation of a pacemaker once the patient meets a minimum body size, typically 4 1/2 to 5 1/2 pounds, to accommodate the implantable device. Taking time for the baby to grow while being otherwise treated is strongly preferred for this situation. With this patient, however, the traditional plan was not working.

“In this instance, the patient was not of the optimal size and medical/conservative management was unsuccessful, so a specially modified pediatric-sized pacemaker also known as an implantable pulse generator (IPG) created by Medtronic was used,” Dasgupta said.

Dasgupta and his colleague, Christopher L. Johnsrude, M.D., director of pediatric and adult congenital electrophysiology at Norton and UofL associate professor of pediatric cardiology, reviewed the relevant preclinical data from a procedure where a similar tiny pediatric IPG had been implanted in an adult Yucatan miniature pig, an animal with a heart that resembles a child’s heart.

Once it was determined the pediatric IPG was potentially compatible with the patient at Norton Children’s, Dasgupta worked with Norton Children’s Research Institute, affiliated with the UofL School of Medicine, and the manufacturer, to obtain local Institutional Review Board approval and emergency authorization from the U.S. Food and Drug Administration. 

The procedure to place the implant was completed over the course of a two-hour open-heart surgery. The tiny device measures 1.16 by 0.65 by 0.38 inches and weighs 0.18 ounces.

“While the operative steps might be comparable to the usual pacemaker implantation surgery, this surgery was especially delicate due to the very small size of the baby,” said Bahaaldin Alsoufi, M.D., chief of pediatric cardiothoracic surgery, co-director of Norton Children’s Heart Institute, and UofL professor of cardiothoracic surgery. “This tiny pacemaker generator was positioned in the abdominal wall on the right side and was connected to the usual leads that were attached to the heart.

"This novel device will provide the necessary support that the baby currently needs. At time of repair of the patient’s congenital heart defect in the future, we will be able to utilize these same leads and likely connect them then to a traditional larger pacemaker generator.”

To date, the patient is doing well and continues to be cared for by cardiac and neonatal specialists across Norton Children’s Heart Institute.

UofL to create New Vision of Health Campus for pioneering work to increase health equity

New downtown Louisville location will house research to advance knowledge of environmental factors affecting health
UofL to create New Vision of Health Campus for pioneering work to increase health equity

Rendering of the New Vision of Health Campus.

The University of Louisville is creating a new campus in downtown Louisville to be known as the UofL Christina Lee Brown Envirome Institute - New Vision of Health Campus, where study will focus on health as a shared community resource, incorporating environmental and cultural factors. The campus will be both a world-class research center and a nexus for community engagement, spawning citizen scientists and making health equity everyone’s pursuit. It will consist of two historic buildings on West Muhammad Ali Boulevard totaling 133,000 square feet and an adjacent garden space.

The launch of the New Vision of Health Campus is made possible by a commitment from health advocate Christina Lee Brown of Louisville valued at $47 million by the university. Brown is providing $30 million over 20 years to support the UofL Christina Lee Brown Envirome Institute and is giving rent-free use of the buildings to the university, equating to a $17-million in-kind donation. In a special meeting earlier today, the UofL Board of Trustees approved a lease granting UofL use of the property, which is owned by Brown. The university plans to seek additional partnerships and financial support for the campus and its mission.

“We are incredibly grateful to Mrs. Brown for this generous gift of support and this special space in the heart of the city,” said Lori Stewart Gonzalez, interim president of UofL. “On this new campus, UofL researchers will increase our understanding of the many aspects of our environment that contribute to optimum health for everyone, here and beyond. It embodies our commitment to health equity.”

“To grow from our past and promote long, fulfilling lives, we shouldn’t chase any single cause. We live in a complex, interdependent world where history is our shared legacy and health is our shared aspiration,” Brown said. “By honestly recognizing our common stories, we can frame a new vision of health which unifies us. It can inspire healthier lives, healthier communities and a healthier world.”

The New Vision of Health Campus will include specially designed laboratories and offices for the UofL Christina Lee Brown Envirome Institute that will engage researchers and community members to learn how natural, cultural and personal environments impact health. Institute researchers work with community partners to discover how to build healthier cities, creating insights and models to improve health in Louisville and around the world.

The research will be directed by Aruni Bhatnagar, director of the UofL Envirome Institute, professor of medicine and chief of the UofL Division of Environmental Medicine.

“Our quest is to pursue the new vision that health is a resource that needs to be cultivated through conducive physical and environmental conditions,” Bhatnagar said. “Health is more than the absence of disease. Health is a resilience that helps individuals withstand all forms of stress. We want to move the discussion of health away from disease and instead focus on actively promoting health before disease occurs.”

The UofL Christina Lee Brown Envirome Institute was created in 2018 with a $5-million gift from Brown that charged UofL researchers to take a holistic, multidisciplinary approach to understanding how the human-environment interrelationship affects peoples’ lives and to convert that knowledge to actionable steps to promote human health. This research and the new funding announced today support the university’s grand challenge strategic research priority of “Advancing Our Health,” an initiative to lead a transformative shift in how we understand, promote and recover health through all stages of life.

Research highlights from the Envirome Institute include the Green Heart Project, documenting the health impacts of living among greater levels of vegetation, the Co-Immunity Project, tracking the presence and spread of COVID-19 in the community through testing of individuals and wastewater, and research to document the effects of smoking and vaping on health. Bhatnagar is co-director of the American Heart Association’s Tobacco Center for Regulatory Science, and the center’s research was employed as key evidence for ending the sale of flavored vaping products in California. The institute also houses the only NIH Superfund Research Center devoted to studying the effects of superfund chemicals on cardiovascular health, diabetes and obesity.

“This is UofL research that could transform the way we promote well-being by revealing and decoding the factors that affect it,” said Kevin Gardner, UofL’s executive vice president for research and innovation. “We are proud to work with Christina Lee Brown and appreciate her continued support to further this important effort in advancing our health. Together, we will help people here in Louisville and around the world live lives that are not just longer, but healthier and more resilient.”

The gift announced today is the single largest philanthropic gift in the university’s history.

UofL alumnus wins Kentucky Oaks with home-bred Secret Oath

UofL alumnus wins Kentucky Oaks with home-bred Secret Oath

Secret Oath as foal on Briland Farm, owned by Robert and Stacy Mitchell

Growing up in Frankfort, Robert O. Mitchell never dreamed of owning racehorses. Riding his pony on his grandparents’ farm was as close as the UofL School of Medicine alumnus came to the horse business until after graduating from medical school and training at UofL in general and cardiovascular surgery.

“Drs. Hiram Polk and J. David Richardson always took the fifth-year general surgery residents to Churchill Downs,” Mitchell said. “That was my first trip to Churchill Downs. Even if you had asked me then, I would never have thought I would own a horse or have a Kentucky Oaks winner that was born on my farm.”

Yet on May 6, Secret Oath, a filly that Mitchell and his wife Stacy raised on their farm, out of a mare that they also raised, won the Kentucky Oaks. While many high-performing racehorses are owned by groups of investors, having a home-bred horse win the prestigious Oaks is a bit unusual.

“I live on the farm. We have never put a horse on the racetrack that wasn’t born here,” Mitchell said. “I have never bought a racehorse.”

In 2002, the Mitchells purchased Briland Farm in Lexington, where he practices as a heart surgeon. They bought a mare for $1 and began a small-scale Thoroughbred breeding operation.

“I’m not a typical doctor type. I don’t play golf. I get my relaxation by driving the tractor and delivering foals. We had one born 48 hours ago,” Mitchell said. “We mostly breed horses and sell them, but in the breeding business you tend to get in the racing business by default if horses don’t sell.”

Such was the case with Secret Oath. When buyers showed little interest in her as a yearling, the Mitchells withdrew her from the Keeneland sale and put her in training with a successful Thoroughbred trainer, D. Wayne Lukas. The move paid off as Secret Oath proved her ability with four wins leading up to the Oaks.

Although he was introduced to Churchill Downs by Hiram Polk and J. David Richardson, chair and vice chair of surgery at UofL at the time, Mitchell said that for him, horses and medicine are very distinct endeavors. Nevertheless, both are knowledge-based and involve a lot of data – and both are serious business.

“You have to be very objective when you’re in the horse business. It’s easy to fall in love with these animals and think of them as pets. It is easy for the emotions to take over and for you to lose your objectivity,” Mitchell said. “And you have to be objective and analytical to be a heart surgeon.”

Mitchell, who strategically plotted the best match for Secret Oath’s dam, Absinthe Minded, said he enjoys the analytical aspect of breeding.

“I like trying to find the breedings and the matings and the genetics. It’s like trying to play chess with Mother Nature. Every now and then, Mother Nature lets you win.”

Secret Oath followed her Oaks win with a fourth-place finish in the Preakness Stakes on May 21.

Medicine and miles: UofL med student celebrates mini-marathon success

Medicine and miles: UofL med student celebrates mini-marathon success

Caroline Gosser, second-year medical student

As if being a medical student isn’t enough of a challenge, second-year student Caroline Gosser recently became the first female to finish the 2022 Mini-Marathon. She began running competitively during her freshman year of high school.

“I didn’t know anyone in my class, so my parents signed me up for summer camps,” said Gosser, “Little did they know, this would lead to them driving overnight to meets in other states as I competed for the University of Louisville.”

Gosser now meets with various running clubs throughout the week as a part of her training regimen. “Making plans to meet someone for a run when the weather is awful or you feel unmotivated is a good trick for getting the run in, anyways,” said Gosser, “There’s a fine line between productive training and overtraining. Most of the time, the extra five miles to get a certain weekly mileage isn’t worth it, but the extra rest is beneficial.” Gosser found that in medical school, 70 miles a week is all she can handle both mentally and physically.

“Some days it does feel very overwhelming to balance school, research, projects, running, and being a good friend or family member,” Gosser mentioned, “Getting enough sleep definitely helps. I also always take Saturday afternoons and evenings off to do something fun that is not running or school related.” She says seven and a half hours of sleep per night helps her stay on track.

We are so proud of Caroline for her dedication to her training both inside the classroom and out. She’s currently preparing for Step One and will be taking some time to relax before her third year begins. When asked what her future running aspirations were, she said, “I am saving the marathon debut for a few years down the road.”

UofL med students run KDF races for kids in a tougher race

UofL med students run KDF races for kids in a tougher race

Seth Walsh, who received a Kentucky Derby Festival miniMartahon medal from med student David Means as part of the Medals4Mettle program.

For the first time in three years, University of Louisville medical, dental and other students who ran the Kentucky Derby Festival miniMarathon or Marathon on April 30 were able to present their race medals in person to their race buddies, children battling a critical illness.

This year marks the 15th UofL Medals4Mettle event, which pairs the UofL students with children battling critical illness who are patients of Norton Children’s Cancer Institute, affiliated with the UofL School of Medicine. The students presented medals they earned for running the 13.1-mile mini marathon or 26.2-mile marathon earlier in the day to the kids at a socially distanced, outdoor party at the Health Sciences Center Courtyard.

This was the third time that fourth-year medical student David Means has run the KDF miniMarathon in honor of Seth Walsh, a 7-year-old battling leukemia.

“I’ve gotten to see Seth grow year by year,” Means said. “I’ve actually seen him at a UofL game and we’ve done a few other events. Just to meet him and his family and see what a cool family they have – so much support for this little man.”

Walsh has his collection of the medals hanging on his bedpost, said his mother, Michelle.

“It’s a great way for the students to learn what these children are going through, but fun for the children to realize that people are there for them,” she said.

The UofL Medals4Mettle event is part of an Indianapolis-based nonprofit organization that links athletes and critically ill individuals. The pandemic prevented the traditional in-person medal ceremony for the last two years, so students running in 2020 and 2021 sent their medals to the kids with a personal note, connecting virtually over Facetime or Zoom when possible.

This was the third Medals4Mettle run for Madi Harley, a third-year medical student who plans to practice pediatrics. While her buddy was unable to attend Saturday’s medal exchange, she enjoyed the smiling faces of the kids who were there.

“I hope we are able to serve as a bright light for each kid, reminding them they are rockstars and we are rooting for them,” she said.

Big hats are more than a Derby fashion statement

Big hats are more than a Derby fashion statement

Jeffrey Callen, M.D., and chief of division of Dermatology

It’s officially Derby week in Louisville, which means the sun shines bright on our Kentucky home. Big hats and fascinators will crowd Churchill Downs as spectators gather to watch the 148th running of the Kentucky Derby. Regardless of your outfit choice, the School of Medicine wants to remind you that your Derby hat is more than a fashion statement: it’s a chance to protect yourself from the sun’s harmful rays. Jeffrey Callen, M.D., and chief of our division of Dermatology weighed in with his suggestions for sun protection this Derby season.

Q. In terms of sun protection, what is the general rule of thumb in terms of exposure and sunscreen application?

A. Sunscreens are imperfect in their protective effects for several reasons. First, is that as their name suggests they are a screen. Think of a screen door, depending on the weave of the metal used to make the door, a person might see through the door relatively unimpeded or if the weave is really tight, it might be impossible to see much. Sunscreens are tested and given a number indicating their Sun Protective Factor (SPF), the higher the number, the higher the protection. However, an SPF 60 does not represent double the protection of an SPF 30 sunscreen. The second issue is adequacy of application which in many clinical settings is inadequate and thus the sunscreen might not function as its SPF suggests. Thirdly, the SPF only measures the effect of Ultraviolet B (UVB) light and Ultraviolet A (UVA) is not measured by this designation. Although in general UVA does not cause sunburn, it enhances the effects of UVB. The fourth issue is the length of time that an individual is exposed to UV light. During day-long events like the Derby it becomes necessary for reapplication of sunscreen to have continued benefit, and this is less frequently applied in the necessary amount than the first application.

Bottom line - don't depend on sunscreens as a sole method of protection. Use good sense in avoiding direct exposure by staying in shaded areas, as well as wearing clothing that protects against the sun including hats with a wide brim.

Q. What is the best sunscreen I can purchase from a drug store?

A. There is no single "best" sunscreen. Look for products that are labeled with an SPF of 30 or more, are broad spectrum and are water resistant.

Q. Scenario: It’s too late. I didn’t apply sunscreen in time, and I’ve burned myself. Now what?

A. Burns from sun come in degrees. For mild redness, only symptomatic treatment is needed including cool compresses, topical emollients, and an oral nonsteroidal anti-inflammatory drug (e.g., naproxen or ibuprofen). If the sunburn is severe, which would be indicated by blistering and systemic symptoms, (e.g., fever, nausea, vomiting, etc.) you might need to be hospitalized.

Severe blistering sunburns have been linked to an increased risk of melanoma. If you have had such a burn, you should see a physician (preferably a dermatologist) with some regularity (depends on your skin type, how many burns you have had and your age among other factors). 

Q. Any other sun safety tips?

A. Limit your exposure to direct or reflected sunlight. You can get adequate levels of Vitamin D through diet and supplements.

He leaves us with this last statement of wisdom: “An ounce of prevention is worth a pound of treatment.” Bet wisely on your health this Derby weekend and best of luck at the races!

Not just a horse race: UofL Physician offers tips for KDF Marathon runners

Not just a horse race: UofL Physician offers tips for KDF Marathon runners

Jonathan Newsom, MD, CAQSM

It’s Derby season in Louisville, which means it’s time for the annual Kentucky Derby Festival Mini/Marathon. The race will begin at 7:00 a.m. on April 30, passing through both Belknap and Health Sciences Campuses at the University of Louisville. After an in-person hiatus due to the pandemic the race will be returning to normal activity. The School of Medicine asked Jonathan Newsom, M.D., and faculty member of our Sports Medicine Fellowship for some preparation tips for our runners.

Q. What tips do you have for a first-time marathon runner to prepare for the race?

A. First and foremost, enjoy yourself! Marathon training is a very taxing and time-consuming endeavor. You absolutely want to enjoy training and when race day comes, trust that you have put in the work necessary to finish. You’ll need to trust your body and start slow. If this is your first marathon, give yourself time to find your stride and pace so you can get yourself to the finish line. It’s also very important that you fuel your body properly during training as well as race day. Marathon running requires a great deal of energy from the body, and this will need to be available through food and energy stores.

Q. How can runners best avoid injury pre- and post-race?

A. Be sure to listen to your body. If something is hurting, take a rest day. If the pain is persistent, see a physician or physical therapist to be evaluated. One solid strategy to avoid injury is to incorporate cross training into your race preparation. It’s a great way to increase overall fitness and use other muscle groups to avoid overtraining. It’s also a good idea for you to have rest or recovery days built into your training plan and using those days to allow the body to recover. Lastly, be sure to stretch regularly and use different recovery modalities such as a foam roller or massage gun.

Q. How would you recommend runners prepare the night before?

A. Eat a good carbohydrate-rich meal the evening before and focus on hydrating your body if you haven’t already. Pack your gear and get everything ready for the morning so you have one less thing to worry about on race day. Then, get plenty of rest! You’ve done the work, now it’s time to perform.

Q. Okay, the race is finished. What tips would you share for someone to help recover after the race and the days following?

A. Eat something. After a marathon, your body is depleted of its energy stores, and a key part of recovery is replenishing these stores. If you have the energy, try to do an easy cool down like a jog or walk. Also, be sure to stretch and re-hydrate! Ensuring you are properly hydrated will speed your healing process. Your muscles will be sore, but getting a head start on recovery with stretching will help you down the road.  Finally, get off your feet and relax. YOU DID IT!

UofL Health expands family medicine services in south Louisville

UofL Health expands family medicine services in south Louisville

Cutting the ribbon on the new UofL Health - Family Medicine facility are, left to right, Toni Ganzel, Jonathan A. Becker, Luz Fernandez, Donna Roberts, Mariam Traore, Ashley Iles, Melisa Adkins, Wade Mitzel, Tanya Keen, Tom Miller and Shane FItzgerald.

UofL Health and the University of Louisville are increasing access to family medicine in south Louisville on the Mary & Elizabeth Hospital campus.

On April 21, UofL Health announced that three primary care providers who are UofL School of Medicine faculty along with eight first-year resident physicians are opening a new office in Medical Plaza 1, Suite 306, 4402 Churchman Ave.

The new office becomes a second location of UofL Physicians – Family Medicine at Cardinal Station on Central Avenue. 

“This is a great opportunity to increase access and health services to an underserved population,” said Jonathan Becker, chair of the Department of Family and Geriatric Medicine at the UofL School of Medicine. “The immediate benefit is to south Louisville, but long term, the impact is much larger as our future physicians share best practices developed here with other communities and the state.”

“Expanding the School of Medicine’s Family Medicine Residency Program is good for UofL and UofL Health and mostly, good for the people served by Mary & Elizabeth Hospital,” said Toni Ganzel, dean of the UofL medical school and vice president for academic medical affairs at UofL. “In 2019, with the help of the Commonwealth of Kentucky, UofL and UofL Health took on a struggling health care system and promised that it would not close but would, in fact, grow.

“This expansion is another example in that continued growth and represents our ongoing commitment to providing high quality care to the people of Louisville today as we educate and train the health care workforce for tomorrow.”

“Mary & Elizabeth Hospital provides services for a population that has tremendous need for accessible primary care,” said Melisa Adkins, chief executive officer at UofL Health – Mary & Elizabeth Hospital. “The community we serve has above-average rates of obesity, high blood pressure, diabetes and heart disease. The opening of this clinic with 11 new family medicine providers will have immediate positive impact on the health care of our south Louisville community.”

Current patients can move their care to the Mary & Elizabeth Hospital location or continue to receive health care services from other providers at the Cardinal Station location, Suite 100, 215 Central Avenue.

UofL researchers share new understanding of origins and types of astroblastoma brain tumors

UofL researchers share new understanding of origins and types of astroblastoma brain tumors

Image of brain MRI scans by Cottonbro via Pexels

A team of researchers led by a University of Louisville experimental neuropathologist has discovered important characteristics of certain types of brain tumors that may lead to novel options to treat them and better understanding of how they and other brain tumors arise.

Norman Lehman, UofL professor of pathology and biochemistry and molecular genetics, led the study of the origins of uncommon brain tumors called astroblastomas that most often affect children and young adults.

“This research gives us a new understanding of how childhood brain tumors with origins in early embryonic development arise,” Lehman said. “It could lead to detection very early in the formation of these types of tumors, new treatments or potentially even strategies to prevent their formation.”

The research, published this week in Nature Communications, revealed two distinct subtypes of these tumors, one that develops in early childhood, the other developing later in life.

The type of astroblastoma that occurs in young children is derived from radial glia that arise very early in the embryonic brain and are biologically related to tumors known as ependymomas. The other type of astroblastoma, typically occurring in young adults, is derived from later neural stem cells called outer radial glia and are biologically related to astrocytomas.

The research also has implications in understanding differences in tumor occurrence based on sex.

“The early-development astroblastoma tumor appears to occur exclusively in females, which may give us a better understanding of why certain types of tumors not involving the reproductive system are found more frequently in males or females,” Lehman said.

Lehman also said the tumors’ mechanisms likely involve alterations in DNA methylation that could possibly be exploited to detect tumor development early on or mitigate their development, but also are associated with other types of neural conditions.

“The altered genes that are associated with the development of these tumors are genes that also are associated with developmental neurocognitive disorders such as autism spectrum disorder, attention deficit hyperactivity disorder and schizophrenia,” he said.

Contributors to the work included Brian Williams and Akshitkumar Mistry, both assistant professors in the UofL Department of Neurological Surgery and neurosurgeons with UofL Health, UofL biochemistry and molecular genetics graduate student Müge Sak and former UofL pathology resident Khaled Alkhateeb.

“We have very few treatments for brain tumors,” Mistry said. “If we can get to the bottom of this very rare brain tumor in terms of its biological origins or its biological behavior, then that knowledge could be applied to some of the other aggressive brain cancers. The question is, how does this sort of research apply to other tumors that are not well understood, and can we gain insight into those other tumors to hopefully figure out how they’re behaving?”

Other important contributors included developmental biologist Nathalie Spassky of the Institut de Biologie de l’École Normale Supérieure in Paris and Kenneth Aldape of the National Cancer Institute Center for Cancer Research. 

Central High School goes Cardinal Red

Central High School went red on Monday, April 18, as part of a UofL Takeover where 11th graders  gathered in-person  to speak with members of the UofL community about programs offered at the university and to how to succeed long-term. The event offered students the opportunity to engage with a panel of UofL speakers as well as participate in a college fair expo. In addition to the School of Medicine, the event was attended by the UofL Admissions, SPEED School, Nursing and other programs.

“The UofL Day at Central High School provides students with a face-to-face opportunity to gain insight about internships, co-ops, research, and shadowing experiences available to them,” said Dwayne Compton, Chief Diversity Officer for UofL School of Medicine. “Early exposure to career pathway initiatives offered by UofL assist with closing the opportunity gaps we know exist. Now more than ever, it is vital that UofL collaborate with JCPS schools like Central to assist students with becoming college and career ready.”

Panelists of the event included representatives from Dentistry, Nursing, Public Health, Admissions, and Medicine. The ULSOM panelists answered a variety of questions from the audience, including scholarship opportunities and challenges they faced during their careers. ULSOM asked panelists why the UofL day at Central is so important to high school students.

“I think it’s important to learn in the beginning what the trajectory is to go into medicine,” said Bill Ngha, Pediatrics Resident Physician, “They’ll need to know what courses they’ll have to take and how to invest in yourself early on.”

Central high school has six magnet programs in which students can elect to participate in beginning their freshman year. Dennis Mostiller and Emmanuel Edwards are two students participating in the Pre-Medicine program that is a part of the Medical/Health Services magnet. Motivated by television shows such as Grey’s Anatomy and the hands-on activities, they’re confident Medicine is the program for them.

The Pre-Medicine Program at Central High School is led by Shantel Reed, pre-medicine magnet teacher. She works to  capitalize on her student’s interests to increase engagement and success. “On Fridays, our classes watch an episode of Grey’s Anatomy as an assignment,” said Reed, “They pair medical terms from the show with their coursework to make connections.”

The importance of the Pre-Medicine program at Central High School was affirmed by UofL Pediatrics Attending, Jennifer Porter. “We know that we need diversity in medicine; patients do better with physicians who look like them. It’s important that we invest here in Kentucky to recruit people to stay here, too.”

The UofL Day at Central is part of a collaborative partnership that began in 2018 between the University of Louisville Office of Diversity and Community Engagement and Central High School. Each year more than 120 students from Central participate in the magnet programs and are introduced to UofL programming that support diversity in medicine and other concentration areas. The Pre-Medicine program traditionally graduates 33 students each year.

“The School of Medicine has a vested interest in the success of our area high school students. Our partnership with Central High School and other magnet programs is vital to our success in caring for our community through a diverse future workforce,” said Toni Ganzel, dean of the School of Medicine.

View photos from the event here. 


UofL Envirome Institute launches podcast on how natural forces affect human health

UofL Envirome Institute launches podcast on how natural forces affect human health

“Elements of Nature” podcast, hosted by UofL’s Aruni Bhatnagar, explores the impact of natural forces on human health.

The University of Louisville Christina Lee Brown Envirome Institute has launched a monthly podcast, “Elements of Nature,” to increase listeners’ understanding of the connections between nature and health.

In each episode, Aruni Bhatnagar, director of the Envirome Institute and chief of the UofL Division of Environmental Medicine, hosts an expert to discuss how natural forces – water, air, fire and space – affect human health and wellness. Bhatnagar and his guests discuss topics such as how sleep and sunlight regulate our mood and fitness, how air pollution impairs health and increases the risk of chronic disease or how greenspaces and vegetation affect attention and immunity.

“This podcast, ’Elements of Nature,’ is a monthly series about how natural forces shape and influence us and, if we pay attention, how we can live a more gratifying, healthy and harmonious life,” Bhatnagar said. “We’ve talked with renowned scientists, professors, authors and thought leaders about our relationship with elements of nature and how it impacts our health and resilience.”

In the first episode of “Elements of Nature,” Bhatnagar and guest Russell Foster, a professor of circadian neuroscience at the University of Oxford, discuss how circadian rhythms, light and sleep affect our wellbeing and performance. Future topics on “Elements of Nature” consider health effects of air pollution, the level of greenness in residential areas and the importance of the sun.

“Elements of Nature” is available on Apple, Google, Spotify, Stitcher and other podcast platforms.


 Upcoming episodes of “Elements of Nature”:

#2 Dr. Arden Pope – Air (April)

C. Arden Pope III, PhD, is an American professor of economics at Brigham Young University and one of the world's foremost experts in environmental science.

#3 Gay Browne – Green (May)

Gay Browne is an environmental advocate and humanitarian, the founder of Greenopia, a comprehensive guide to help consumers positively impact their personal health, and author of “Living with a Green Heart.”

#4 Dr. Michael Holick – Sun (June)

Michael F. Holick, PhD, MD, is professor of medicine, physiology and biophysics, director of the General Clinical Research Unit, director of the Bone Health Care Clinic and director of the Heliotherapy, Light and Skin Research Center at Boston University Medical Center.

#5 Richard Louv – Nature (July)

Richard Louv is an American non-fiction author and journalist best known for his seventh book, “Last Child in the Woods: Saving Our Children from Nature-Deficit Disorder,” which investigates the relationship of children and the natural world in current and historical contexts.

Dean's Staff Excellence Awards returns to in-person celebration

Staff members from the University of Louisville School of Medicine were recognized for their creativity and dedication at the 6th annual Dean’s Staff Excellence Awards on March 31.

The event, hosted by Dean Toni Ganzel, honored School of Medicine Staff nominated by their colleagues for their outstanding excellence exhibited over the last 12 months.

“Our staff lean in during periods of plenty and during periods of challenge, and let’s face it: we see a little more periods of challenge than we do periods of plenty, especially the last two years,” said Dean Ganzel, speaking during the event. “You are sometimes sung, sometimes unsung heroes in just the way that you quietly and daily carry out exemplary work.”

Over 30 staff members were nominated for seven different award categories. The awards were presented to:

  • Shelly Matthis and Rhonda Pugh, co-awardees for Performance Excellence in an Administrative Office
  • Jason Xu, for Performance Excellence in a Clinical Department
  • Phyllis Harris, for Heart of the School
  • Shorye Durrett, for the Anti-Racism, Diversity, Equity, and Inclusion Award
  • Medical Student Affairs, for Team of the Year
  • Mandy Ryan, for Employee of the Year
  • Ashlee Melendez, for the Dean’s Lifetime Achievement Award

This was the first in-person award ceremony in two years due to the COVID-19 pandemic.

“It was so nice to see everybody face-to-face and in person,” said Dean Ganzel, “I wish we could have these monthly.”

View photos from the event here.

New UofL program offers support for students of color interested in the medical profession

Lack of mentorship and exposure to the medical field is often a barrier for Black and Brown students interested in becoming doctors, but UofL is working to change that through the Porter Scholars in Medicine Program.

“The road to becoming a doctor is a long and often bumpy one for everyone. Having a community to support a student and provide guidance can make the difference between wearing a white coat and giving up on that dream,” said Brit Anderson, a physician in UofL’s Department of Pediatrics. “Students who do not have family and friends in the medical field may miss out on this supportive medical community.”

Anderson, along with V. Faye Jones, associate vice president for health affairs – diversity initiatives at the Health Sciences Center and vice chair of inclusive excellence in the Department of Pediatrics, teamed up with Leondra Gully, advisor for the Woodford R. Porter Scholarship Program, to create the new initiative.

The program is aimed at UofL’s Porter Scholars, a scholarship program for exceptional undergraduate students of color from Kentucky and neighboring Indiana counties. First-year students through seniors interested in health care go through an application process to take part in the niche Porter Scholars in Medicine Program, now in its second year.  

Students receive mentoring and shadowing experiences from UofL physicians, and are also able to participate in clinical experiences including simulation and ultrasound. They learn about the medical school application process and entrance exam, gain insight related to the history of medical disparities in underrepresented communities and connect with students in UofL’s chapter of the Student National Medical Association. The program also hosts book clubs and discussions.

“I don’t think people realize the value of this program; there were no specific programs for Black and Brown students wanting to go into medicine. This a welcome space, and a different feeling of support – it’s what we need,” said Hayley Benson, a biology major and one of 17 students participating in this year’s Porter Scholars in Medicine program.

Diversifying the medical field

Gully says the program not only supports students interested in becoming physicians, but the ultimate outcome is far reaching – to diversify the medical field.

“We know from life experiences and the literature more diverse doctors are needed,” she said. “Diversity in the medical field has been proven to impact health disparities for marginalized communities and goes a long way in helping those communities receive equitable health care and improve patient outcomes.”

Senior Diane Appiasie can relate. She says her interest in medicine stems from the impact of health care providers throughout her life, and the aspiration to provide the same quality of care for others.

“I have been further driven to pursue a career in the medical field by a desire to continue advocating for health equity as a health care professional,” says Appiasie, who hopes to focus on a career in emergency medicine and neurology.

One future goal of the program is to engage students in off-campus experiences. Gully and her team are working to coordinate an opportunity this fall for Porter Scholars to see a live surgery through the Kentucky Science Center Pulse of Surgery program. Organizers also hope to explore ways to eventually secure funding for students who want to attend medical school.

“We know this program can be impactful, and we’re excited to see it grow,” Anderson said. “It is such an honor to work with this team and meet these wonderful students as we strive to advance health equity in our community.”

New tablet controller improves home use of epidural stimulation for individuals with spinal cord injury

Enhanced user interface and expanded capabilities are highlights of new controller in development by UofL, Kessler Foundation, and Medtronic for managing spinal cord injury
New tablet controller improves home use of epidural stimulation for individuals with spinal cord injury

Keith Smith, UofL spinal cord research participant, with trainer Kristin Benton, working with the new tablet interface to control his Medtronic epidural stimulator

When Keith Smith recently got a new tablet, it wasn’t for watching videos or scanning social media.

Instead, this tablet allows Smith, who has tetraplegia, more independent control of an implanted Medtronic Intellis™ neurostimulator, allowing him to better take advantage of the stimulator’s benefits for the disabling effects of a spinal cord injury.

Smith received the stimulator two years ago while participating in a study involving individuals paralyzed by spinal cord injuries at the University of Louisville’s Kentucky Spinal Cord Injury Research Center (KSCIRC). The stimulator has provided Smith benefits such as voluntary movement, increased trunk control and improved blood pressure regulation. 

“The stimulator has restored my health in a big way. I don’t feel sick all the time anymore. I’m not passing out; I’m not dizzy,” he said. “I am enjoying my life again. It gives me something I can use to fight for my recovery.”

To fully take advantage of the stimulator’s benefits, the stimulator must be adjusted periodically throughout the day to regulate his blood pressure and other functions, each of which requires distinct stimulator settings. Smith, who has limited use of his hands due to a C4-level spinal cord injury, previously had to rely on a caregiver to change the settings due to the small size of the buttons on the standard stimulator controller device.

But now, thanks to the new tablet controller with a larger, touch-screen interface designed with his needs in mind, Smith can adjust settings himself.

“Previously, the remote was controlled by my caregiver. I couldn’t do it because I don’t have [full use of] my hands. Now that we have this new technology, I can control it on my own,” Smith said. “I am going to be able to use many more functions and be able to control it and adjust it in a much more significant manner on my own. It’s a big benefit to my life.”

In addition to a more accessible interface, the updated controller has the capacity to store more setting configurations for immediate use and provides smoother transitions between configurations that allow the person with spinal cord injury to change positions such as from sitting to standing.

Over the last few months, the new tablet controllers have been provided to 16 participants in the spinal cord epidural stimulation research program at UofL. Additional participants will receive the new tablet controllers in the coming months, as well as any new participants receiving epidural stimulators.

Epidural stimulation, an experimental therapy for spinal cord injury recovery, involves implanting an electrode on the lower spinal cord, along with a neurostimulator under the patient’s skin, which delivers mild electrical impulses to the spine. When electrical pulses are delivered in different configurations, research at UofL and other centers has shown they help paralyzed individuals like Smith achieve voluntary movement, blood pressure regulation, the ability to stand, improvements in bowel, bladder and sexual function and other benefits, particularly when combined with activity-based therapy. Some participants even have been able to take steps.

UofL first used Medtronic epidural stimulators for spinal cord injury research in 2009 under an FDA Investigational Device Exemption. The research, led by Susan Harkema, professor of neurological surgery and associate director for KSCIRC, has resulted in multiple health benefits and function recovery for paralyzed individuals. While epidural stimulators, also known as spinal cord stimulators, have been proven to provide effective relief for chronic pain and are commercially available for this application, their use for individuals with spinal cord injury remains experimental.

The new controller, known as Stim X Release 1, also offers added benefits for the researchers by precisely recording stimulation use by the participants outside the lab.

“This is Release 1 and we expect future releases to continue to improve the technology,” said Claudia Angeli, assistant professor of bioengineering at UofL’s J.B. Speed School of Engineering and director of the Epidural Stimulation Program at KSCIRC. “Additional improvements are planned with feedback from the participants and the development of wireless sensors to monitor the user’s condition and adjust stimulator settings as needed. In a closed-loop or human-in-the-loop system, the controller could alert the user or adjust the stimulation based on a change in blood pressure, for example.”

UofL, Kessler Foundation, Medtronic, Johns Hopkins Applied Physics Laboratory and multiple funders are working together to fast-track technology improvements that allow individuals with spinal cord injury to realize the benefits of epidural stimulation in their homes and communities, not just in the research setting.

“This is the sort of innovation a Carnegie Research-1 university can and ought to be doing,” said Kevin Gardner, UofL’s executive vice president for research and innovation. “This is innovation with real, human impact – work that advances health and helps people live lives that are healthier, more resilient and more fully empowered.”

This work is funded through the NIH BRAIN Initiative by the National Institute of Neurological Disorders and Stroke, the National Institutes of Health SPARC Common Fund Program, Kessler Foundation and the University of Louisville.

New Kentucky 3RNET Consortium to connect health care professionals, employers to better address rural workforce shortages

A new consortium of four Kentucky health care organizations, led by the University of Louisville School of Medicine, is working to connect a wide range of health care professionals and employers to better address workforce shortages in rural and underserved parts of the Commonwealth.

The Kentucky 3RNET Consortium — which also includes the Kentucky Office of Rural Health (KORH), the Kentucky Primary Care Association (KPCA) and the Kentucky Rural Health Association (KRHA) — will maintain and promote Kentucky-specific health care job postings on The National Rural Recruitment and Retention Network (3RNET), a nonprofit online portal that helps job candidates more easily find health care openings in rural and underserved communities and helps community health centers, critical access hospitals and rural health clinics recruit candidates for open positions.

Consortium members will jointly manage Kentucky’s presence on the 3RNET site to expand the types of jobs posted and increase the use of the service throughout the Commonwealth among both employers and candidates seeking jobs. This is the first time that a state’s postings at the 3RNET site will be monitored and maintained by a group of partners.

“Our Commonwealth faces significant health care personnel challenges. This new consortium leverages the unique perspective and expertise of each organization to engage with job seekers and employers,” said Brent Wright, associate dean for rural health innovation at the University of Louisville School of Medicine and the brainchild behind the consortium. “If we can fill vacancies in multiple health disciplines, we will improve access to health care services throughout the state.”

KORH Director Ernie Scott said bringing the four organizations together to collectively address health care workforce shortages in Kentucky communities makes perfect sense.

“Workforce shortages cannot be singlehandedly addressed by just one organization in Kentucky or any other state. Instead, we’ve got to take a ‘village’ approach — we’ve got to come together as a unified team with a unified purpose,” he said. “Working together, this consortium will allow us to have a greater impact than any of our organizations could have individually.”

Ashley Gibson, KPCA’s workforce program director, called the collaboration between organizations “essential” for the recruitment and retention of employees.

“Workforce shortages in our state are making it harder for people in many communities to access care,” she said. “This collaboration hopes to reverse that trend and actually expand access to health care services.”

KRHA Executive Director Tina McCormick said her organization is always looking for ways to support its members and partner with organizations that have a similar mission.

“Access to care is vital and without the workforce to support that care, our rural areas get left out again,” she said. “We hope with this partnership we will build strong bonds across the state to provide job seekers access to open positions and provide employers a mechanism to locate prospective employees for their vacancies.”

3RNET, which works at the national level to improve rural and underserved communities’ access to quality health care through the recruitment of physicians and other health care professionals, allows health care facilities to post their open positions online at and lets health care professionals conduct free searches of those job openings. State-specific pages on the website — which contain information about communities, available job opportunities and loan repayment programs — are maintained by 3RNET members, including the newly formed Kentucky 3RNET Consortium.

Leading cardiologist, health equity expert named chair of UofL Department of Medicine

Leading cardiologist, health equity expert named chair of UofL Department of Medicine

A nationally renowned cardiologist and health equity expert has been selected to head the University of Louisville Department of Medicine. Kim Williams Sr. will serve as chair of the department beginning July 1.

As chair, Williams will lead the scientific, clinical and educational programs of the UofL School of Medicine’s largest department, which includes more than 200 faculty and 150 staff in 10 divisions. He will build collaborations within the School of Medicine and with its partners. He also will be responsible for the planning and guidance of clinical efforts within the UofL Health system as well as developing and implementing a vision for the department that integrates clinical, educational and research missions, while fostering a culture of collaboration, equity and inclusion.

“We are excited for Dr. Williams to be joining our team,” said School of Medicine Dean Toni Ganzel. “He brings a wealth of expertise in cardiology and health equity. His academic background, clinical experience and leadership skills will be strong assets to the department, the institution and our community. His work will enhance and augment our work with strategic partners in health equity.”

A Chicago native, Williams has over 40 years of experience as an educator, researcher, and clinician focused on advocacy for nutrition, national and international health care disparities, health care delivery and advanced access to cardiac imaging. He currently is chief of the Division of Cardiology at Rush University and associate dean for faculty diversity, equity and inclusion. He specializes in cardiology, cardio-nutrition, cardio-rheumatology, cardio-nephrology, preventive cardiology and cardiovascular radiology. A past president of the American College of Cardiology and the American Society of Nuclear Cardiology, he is former chairman of the board of directors of the Association of Black Cardiologists.

He also is the founder of the Urban Cardiology Initiative in Detroit, a program that works to reduce ethnic heart care disparities. Williams continues community-based efforts in Chicago at Rush, including leading the H.E.A.R.T. program (Helping Everyone Assess Risk Today), screening for heart disease and intervening with education, nutrition and lifestyle changes.

Williams earned his medical degree from the University of Chicago Pritzker School of Medicine. He completed his internship and residency at Emory University Department of Medicine and a fellowship in cardiology at the University of Chicago.

“Building and leading Rush cardiology has been challenging and fulfilling, yet I was drawn to the UofL Department of Medicine by the leaders, the faculty and the fundamentals already in place, as well as the potential that I see for growth and impact in the areas of prevention and health equity,” Williams said. “We have leadership with vision, and we have some existing programs that will be enhanced – and some robust opportunities to develop – aiming to expand health care access in Louisville, maintain our high level of clinical quality and patient experience, deliver cost efficient care and keep provider wellness at the forefront.”

Computer assisted therapy opens doors to depression relief for many

Computer assisted therapy opens doors to depression relief for many

Jesse Wright, M.D., Ph.D., professor of psychiatry at the University of Louisville and director of the UofL Depression Center

Cognitive behavioral therapy is a highly effective treatment for depression. A number of factors can prevent patients from receiving successful therapy, however. The need for frequent visits – often more than once per week – taking time off work, transportation, the cost of visits or even access to providers trained in this therapy can prevent patients from getting treatment for their depression.

A newly published clinical trial led by University of Louisville physicians has shown that a computer-assisted therapy can overcome these barriers while providing effective treatment for depression.

Jesse Wright, professor of psychiatry at UofL and director of the UofL Depression Center, documented treatment results for a diverse group of 175 adults for depression. The study, published in JAMA Network Open in February, showed that patients in a primary care setting who participated in CCBT reported significantly greater improvement in their depressive symptoms than those receiving treatment as usual.

“With modest amounts of telephone support from a clinician, CCBT was associated with greater improvement in depression, anxiety and quality of life than usual treatment in a diverse group of primary care patients. We were pleased to see that CCBT had more than double the remission and response rates as usual treatment,” Wright said.

“There has been a historical lack of effective care for depression in the primary care setting,” he said “Because this study population included people with lower income and lack of internet access, results suggest that this form of treatment can be acceptable and useful in diverse primary care settings.”

Rather than requiring frequent office visits, patients can engage in CCBT online whenever their schedule allows and from the comfort of their home. A primary care provider can monitor and support the patient's progress, helping patients who may not desire or be able to see a psychologist or psychiatrist for their therapy.

“Particularly during the COVID pandemic, we have seen how limited appointments are for mental health services and the rise of telemedicine has led to increasing comfort with utilizing technology to support health, which makes computer-assisted cognitive behavioral therapy a great option,” said Laura Bishop, an associate professor and internal medicine-pediatrics physician at UofL and a co-author of the study.

In the study, CCBT participants used the nine-lesson computer program “Good Days Ahead,” along with as many as 12 weekly telephone support sessions with a master’s level therapist, along with the treatment usually provided by the primary care sites.

“I think this is a preferable option for younger patients who often are more comfortable with self-reflection and working through the CCBT on a computer rather than meeting face-to-face with a provider,” Bishop said. “We've seen more and more familiarity with wellness and meditation apps over the past few years that have paved the way for CCBT to be widely accepted.”

Wright began work on computer-assisted therapy in the 1990s and led the initial development of Good Days Ahead. In addition to depression, Wright said CCBT also could be adapted to treatment for obsessive-compulsive disorder (OCD), anxiety, eating disorders or other conditions.

Patients in the Louisville area can request use of Good Days Ahead through the UofL Depression Center.

Good Days Ahead is being reviewed by the U.S. Food and Drug Administration under a new protocol for certification of therapeutic computer programs.

Wright retains an equity interest in MindStreet, Inc., the company that now manages Good Days Ahead.

UofL professor aims to improve gender equity among physicians

UofL professor aims to improve gender equity among physicians

Jennifer Koch, MD

A professor of medicine and director of the internal medicine residency program in the UofL School of Medicine, Dr. Jennifer Koch is a member of the Gender Equity in Medicine (GEM) research group, a collaboration of medical educators from multiple universities working together to better understand the impact of gender bias in medical training.

In September, the American Medical Association, the AMA Women Physicians Section (WPS) and the AMA Foundation awarded a $10,000 grant to the group as part of the 2021 Joan F. Giambalvo Fund for the Advancement of Women research grants program.

The group received the grant for a multi-site longitudinal study aimed at understanding the combined impact of race, ethnicity and gender on women’s experiences in graduate medical education, also known as medical residency. UofL News talked to Koch about why this work is important and how it will help ensure quality medical care for all.

UofL News: What have you and the group learned in your study of gender bias in graduate medical education?

Jennifer Koch: We have learned that there are differences based on gender in the assessment of learners (resident doctors) in internal medicine residency. Whereas residents who are men tend to receive performance scores that increase throughout their training as they gain experience, women residents are more likely to see a plateau in the performance scores they receive when they reach the halfway point in residency.

There is evidence that women doctors who are out in practice have better patient outcomes, which suggests that it is highly unlikely that the differences in assessment scores during residency represent a true difference in their performance during training. Therefore, this difference likely indicates the presence of gender bias in the educational experience of women residents.

ULN: What might the implications be on health care?

Koch: A diverse health care workforce is essential to delivering excellent patient care to a diverse population. Working to mitigate bias in the training of physicians is an important step toward promoting a diverse physician workforce.

ULN: How might this bias be reduced?

Koch: This requires more study. Some ways we might accomplish this include implicit bias training and raising awareness amongst faculty evaluators and revamping assessment tools which may inadvertently promote bias.

ULN: What inspired you to dig deeper into this issue?

Koch: I drew on my own experiences as a woman in medicine, as well as my desire to provide an excellent training experience for the physicians in my internal medicine residency training program.

I have a very specific memory as a resident when I was attempting a difficult procedure and the situation was a critical one. My attending barked at me to allow the male resident to step in to do the procedure instead. I said, ‘No, I’ve got this!’ – and I did. I successfully completed the procedure. 

This is an example of how bias can affect patient care. In the middle of a critical situation where I was trying to fully focus on the patient, I had to remove my focus from the patient and make a split-second decision about whether to stand up for myself. Most examples are, thankfully, not this dramatic. But every experience a trainee has helps to shape them into their future self as a physician.

ULN: Regarding the new funding, what do you hope to learn about gender and ethnicity or race in assessments of residents?

Koch: We hope to quantitate the degree to which race-based bias is present in assessment of these learners and examine whether it exists in synergy with gender bias for those trainees who are both women and underrepresented in medicine. Quantifying its extent is a first step toward better defining the potential problem and then working toward its mitigation.

ULN: What have you learned from this research that you have applied at UofL to increase equity for female residents?

Koch: We have created a Women In Medicine Networking group (WIMN) in the UofL internal medicine residency program. The group holds educational sessions and discussions about issues experienced by women in the field of medicine and as COVID allows, holds social events to encourage networking and mentorship amongst women residents and faculty.

UofL researchers used trained immunity to reduce tumor activity in pancreatic cancer

UofL researchers used trained immunity to reduce tumor activity in pancreatic cancer

Study authors Anne Geller, left, and Jun Yan

Pancreatic cancer is one of the most deadly cancers. The five-year survival rate is just 10% for patients diagnosed with pancreatic ductal adenocarcinoma (PDAC), the most common type of pancreatic cancer. Further, one promising area of cancer treatment, immunotherapy, has not provided benefit for pancreatic cancer patients.

University of Louisville researchers recently have shown that beta-glucan, a natural carbohydrate, can generate enhanced immune responses to cancer in the pancreas and may lead to improved efficacy of immunotherapy for pancreatic cancer.

Jun Yan, chief of the Division of Immunotherapy in the Department of Surgery at UofL, said one of challenges for pancreatic cancer is that natural immune cells are unable to enter the pancreas to combat the growth of tumors, creating an immune desert.

“These tumors lack quality effector immune cells that can kill them,” Yan said. “In addition, pancreatic cancer has a unique tumor microenvironment that prevents the influx of anti-tumor immune cells.”

In new research published this month in Nature Communications, Anne Geller, an MD/PhD student, and a research team at UofL led by Yan demonstrate that a type of beta-glucan derived from yeast can alter the environment within the pancreas to promote anti-cancer immune cell migration to the site of the cancer. Beta-glucan, a naturally occurring carbohydrate found in plants, bacteria and fungi, is known to induce trained immunity, stimulating an immune response to a specific stimulus, such as pancreatic tumor cells.

Trained immunity is a new concept in the field of immunology and is the idea that innate immune cells possess a form of “memory,” which typically only has been considered to be a feature of adaptive immune cells such as T-cells. Using animal models, Yan and his team found that when they injected particulate beta-glucan into the peritoneal area, it accumulated in the pancreas and promoted anti-cancer immune cell migration to the area. These immune cells were found to have a trained immunity phenotype and effectively inhibited pancreatic cancer growth.

“This research demonstrates that a natural compound can stimulate trained immunity in pancreas,” Yan said.

The researchers also found that beta-glucan-stimulated trained immunity can enhance PD-1 antibody therapy in pancreatic cancer. Anti-PD-1 immunotherapy has been approved to treat many types of cancer including melanoma and lung cancer. However, this therapy has failed in treating pancreatic cancer. This research could be a breakthrough in successfully applying immunotherapy to pancreatic cancer.

“This research has a great potential for clinical translation as it elucidates a strategy for delivering therapeutics directly to the pancreas, identifies a mechanism of enhancing anti-tumor immune responses against pancreatic tumors and provides insight into ways of unleashing the awesome power of immunotherapies against PDAC,” Geller said. “This could be a breakthrough in treating the deadly cancer that has evaded so many other forms of treatment.”

Yan, director of the Immuno-Oncology Program at UofL Health - Brown Cancer Center and study coauthor, and surgical oncologist Robert C.G. Martin II are conducting a clinical trial using beta-glucan in pancreatc cancer patients as a proof-of-concept study.

“This publication demonstrates that a simple yeast-derived beta-glucan supplement has the potential to enhance a patient’s immune system and then respond more effectively to therapies in pancreatic cancer. The concept that patients’ immune systems can be ‘trained’ to see their pancreatic cancer as abnormal or foreign could be a crucial step in enhancing a patients’ overall survival and thus quality of life,” said Martin, professor and director of the UofL Division of Surgical Oncology and a co-author on the study.

According to the American Cancer Society, more than 60,000 adults are expected to be diagnosed with pancreatic cancer in the U.S. in 2022 and nearly 50,000 patients will die from the disease. Alex Trebek, long-time host of the game show “Jeopardy!” shared his pancreatic cancer diagnosis and treatment journey beginning in 2019. Trebek died in 2020, just over 18 months after announcing his diagnosis.

“UofL is committed to solving big, global challenges through research,” said Kevin Gardner, UofL’s executive vice president for research and innovation. “This work, leveraging the power of the immune system to better treat pancreatic cancer, could have a big impact in helping people live lives that are not just longer, but healthier and more resilient.”


Funders: NIH/NCI R01CA213990 and the Endowment in translational research

DOI:  10.1038/s41467-022-28407-4