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Motor Retraining therapy provides hope for functional movement disorders

Patients find answers through unique, specialized program at UofL Physicians
Motor Retraining therapy provides hope for functional movement disorders

Julia Semple in therapy for functional movement disorders

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

Society of Toxicology recognizes lifetime achievement of John Pierce Wise, Sr.

Society of Toxicology recognizes lifetime achievement of John Pierce Wise, Sr.

John Pierce Wise, Sr., Ph.D., receives the Career Achievement Award

A researcher whose work has substantially advanced the understanding of metals toxicology, John Pierce Wise, Sr., Ph.D., University Scholar and professor in the Department of Pharmacology and Toxicology, has received the Career Achievement Award from the Society of Toxicology (SOT) Metals Specialty Section.

The award, presented at the SOT’s annual meeting held last month in San Antonio, recognizes the outstanding achievement of a researcher, mentor and leader in the field of toxicology.

Wise was nominated by Max Costa, Ph.D., professor and chair of the Department of Environmental Medicine at NYU School of Medicine.

Costa says Wise’s influence in the education, training and mentorship of young scientists in the field of metals toxicology is “unequivocal.”

Wise has served as primary mentor for more than 40 doctoral and masters level students, while guiding nearly 90 undergraduate and  60 high school students in the field of biomedical and environmental research. He received the SOT Education award in 2016.

His research focuses on mechanistic toxicology with an emphasis on metal carcinogenesis and the “One Health” concept that human health, animal health and ecosystem health are intertwined and interdependent.

“Dr. Wise’s work has led to important advances in metal-induced genotoxicity, DNA repair and chromosome instability,” Costa said. “He is leading the effort to understand how metals can induce DNA breaks while suppressing their repair. In addition, he is a pioneer in the effort to understand how metals impact centrosome biology.”

The breadth of Wise’s work is exemplified through research in human cells as well as cells from other species including fish, whales, sea turtles and sea lions. In addition to bench science, Wise has lead field efforts to study the impact of the Gulf of Mexico oil crisis on resident whale species, the impact of metals on whales in the Gulf of Maine, and the conservation of sea turtles in Vieques, Puerto Rico.

 

The Society of Toxicology (SOT) is a professional and scholarly organization of more than 7,800 scientists from academic institutions, government and industry in the U.S. and abroad. The Metals Specialty Section is one of the organization’s 28 subgroups.

April 9, 2018

Psychiatry residents place 4th in national MindGames competition

Psychiatry residents place 4th in national MindGames competition

Psychiatry resident physicians (from left) Svetlana Famina, Laura Romer and Melissa Sullivan placed fourth in the American Psychiatric Association’s MindGames National Residency Team Competition.

For the first time, resident physicians from the University of Louisville earned a top-10 finish in the American Psychiatric Association’s MindGames National Residency Team Competition.

UofL residents Laura Romer, M.D., Svetlana Famina, M.D., and Melissa Sullivan, M.D., finished fourth out of more than 100 psychiatry programs across the United States that took the hour-long online exam testing knowledge of patient care, medicine and psychiatric history.

The physicians took a no-anxiety, no-expectation approach to the competition, a test similar to the Psychiatry Resident-In-Training Examination (PRITE) that residents take annually, said Romer, a fourth-year resident. They reviewed old PRITE questions, but couldn’t find time in their hectic schedules to prepare as a group.

The strategy worked.

“This is our passion,” Famina said. “All the knowledge we’ve accumulated from daily clinical practice and working with our attending physicians stays with us.”

This was the best finish in the competition of any UofL-sponsored team, said Robert Campbell, M.D., the team's coach and assistant professor of the Department of Psychiatry and Behavioral Sciences in the UofL School of Medicine.

“With more than 200 programs in the country, our residents showed themselves to be true scholars in the field of psychiatry,” Campbell said.

Sullivan, a third-year resident, said the team’s finish is a testament to the quality of the residency program.

“We have so many clinical sites that we go to. We see so many different types of patients. We learn from many researchers. UofL has a lot to offer its residents,” Sullivan said.

Epidural stimulation shown to normalize blood pressure following spinal cord injury

UofL research supports future study of beneficial effects of stimulation
Epidural stimulation shown to normalize blood pressure following spinal cord injury

Susan Harkema, Ph.D., Glenn Hirsch, M.D.

Patients with severe spinal cord injury (SCI) often experience chronically low blood pressure that negatively affects their health, their quality of life and their ability to engage in rehabilitative therapy.

“People with severe spinal cord injury – especially when it occurs in a higher level in the spine – have problems with blood pressure regulation to the point that it becomes the main factor affecting quality of life for them,” said Glenn Hirsch, M.D., professor of cardiology at the University of Louisville (UofL). “Some cannot even sit up without passing out. They are forced to use medications, compression stockings or abdominal binders to maintain an adequate blood pressure.”

Working with human research participants, Hirsch and researchers at the Kentucky Spinal Cord injury Research Center (KSCIRC) at UofL, have found that spinal cord epidural stimulation can safely and effectively elevate blood pressure in individuals with SCI along with chronic hypotension. The research was reported this month in Frontiers in Human Neuroscience (Normalization of Blood Pressure with Spinal Cord Epidural Stimulation After Severe Spinal Cord Injury).

Led by Susan Harkema, Ph.D., associate director of KSCIRC and professor of neurosurgery, the research included four research participants with chronic, motor complete, cervical SCI who suffered from persistent low resting blood pressure. The participants were implanted with an electrode array for epidural stimulation, and individual configurations for stimulation were identified for each participant. During five two-hour sessions, the participants’ blood pressure was elevated to normal ranges. Their blood pressure returned to low levels when stimulation ceased, and was again elevated to normal ranges with stimulation.

Stefanie Putnam was one of the research participants. Following a severe spinal cord injury in 2009, Putnam’s blood pressure was so low she was unable to engage in the simplest of activities without losing consciousness.

“It prevented me from participating in activities, from talking on the phone, from sitting at a table and eating food. I had trouble breathing, trouble swallowing, trouble carrying on a conversation,” Putnam said. “I was passing out periodically – six or more times a day. Then I would have to tilt back in the chair for two hours.”

To help sustain her blood pressure, Putnam took medication, wore an extremely tight corset and drank a large amount of caffeine.

“I would still pass out,” she said.

With epidural stimulation, Putnam said she immediately felt the effects.

“I went from feeling like I was glued to the floor to elevated – as though gravity was not weighing me down. I feel alive!” she said.

Because of the undesirable side effects of pharmaceutical and non-pharmaceutical interventions, Hirsch said epidural stimulation for chronic low blood pressure in SCI could have significant benefits.

“People with severe SCI who have problems with resting hypotension have limited options. This intervention appears to reliably and reproducibly maintain blood pressure,” Hirsch said.

This work builds on previous research at KSCIRC showing benefits of spinal cord epidural stimulation, along with activity-based training, in which individuals with SCI have achieved voluntary movement, standing and stepping, and improved bladder, bowel and sexual function.

Harkema, the publication’s first author, said the blood-pressure research is promising, but must be tested over time and with a larger cohort of study participants.

“We need to see if it will have an impact over months or years,” Harkema said. “It will be very important to determine if these results are sustainable.”

To that end, UofL is screening participants for a six-year study that will further explore the life-enhancing effects of epidural stimulation on people with spinal cord injury (SCI). That study will measure the extent to which epidural stimulation will improve cardiovascular function as well as facilitate the ability to stand and voluntarily control leg movements below the injury level in 36 participants with chronic, complete spinal cord injuries. Individuals interested in being considered for this study can add their information to the university’s Victory Over Paralysis database: victoryoverparalysis.org/participate-in-research.  

The published research is supported by the Craig H. Neilsen Foundation, The Leona M. and Harry B. Helmsley Charitable Trust, University of Louisville Hospital, Christopher & Dana Reeve Foundation and Medtronic Plc.

 

 

March 19, 2018

 

UofL hosts famed trumpeter Doc Severinsen for benefit concert Apr. 7

Concert and gala to benefit Kentucky Lions Eye Center and UofL Jazz students
UofL hosts famed trumpeter Doc Severinsen for benefit concert Apr. 7

Doc Severinsen

"Heeeeere's Johnny!" That lead-in, followed by a big-band trumpet blast, was the hallmark of late-night television for three decades. “Johnny” was Johnny Carson, the announcer was Ed McMahon and the bandleader was Doc Severinsen. Beginning in 1962, “The Tonight Show” with Johnny Carson ruled the night airwaves for 30 years.

A Louisville audience will have the chance to hear Severinsen’s iconic big band sound next month. UofL’s Department of Ophthalmology and Jazz Studies Program will present “Jazz-4-Sight” featuring Severinsen performing with the UofL Jazz Ensemble at 8 p.m. April 7 at the School of Music’s Comstock Hall, 105 W. Brandeis Ave. Concert tickets are $50 a person, with all proceeds benefiting the Kentucky Lions Eye Center and UofL jazz students.

Doc Severinsen and His Big Band hit the road in 1992, following the final telecast of Carson’s show, and hasn’t stopped touring since. Audiences enjoy Severinsen’s shows not only because he shared their living rooms for so many years but also because of the Big Band repertoire, which includes Duke Ellington and Count Basie standards, pop, jazz, ballads, big band classics and, of course, “The Tonight Show” theme.

Severinsen, 90, can still play hard and hit all the high notes, a result of his continued commitment to studio practice and the refinement of his craft. The trumpeter also surrounds himself with the best in the business and enjoys sharing the spotlight. 

The public also is invited to a 6 p.m. gala that includes dinner and a silent auction at the University Club, 200 E. Brandeis Ave. 

Click http://bit.ly/UofLJazz4Sight to purchase tickets for the concert or gala. For questions or more information, contact the School of Music at 502-852-6907. 

Ravenous Race honors friend, benefits Brown Cancer Center

Save the date: Sept. 22 in Bowling Green, Ky.
Ravenous Race honors friend, benefits Brown Cancer Center

When the husband of a friend and co-worker of Morgan Baer died in January, she wanted to both honor his life and help vanquish the killer that took it.

That’s the inspiration behind the Ravenous Race, a 5K race and 1-mile walk scheduled for Saturday, Sept. 22, in Bowling Green, Ky.

Both events kick off at 6 a.m. with day-of registration followed by packet and bib pick-up. The starter’s gun will fire for both events at 7:30 a.m. The race start and end points are Chaney’s Dairy Barn, 9191 Nashville Rd. in Bowling Green.

Pre-event registration is available on raceroster.com.

Proceeds from the event go to support research carried out by the University of Louisville’s James Graham Brown Cancer Center where Baer’s friend Dean Valentini was treated. Diagnosed with a rare form of cancer, internal melanoma, Valentini traveled from his home in Bowling Green to Louisville to obtain the specialized care he needed from staff at the Brown Cancer Center.

Valentini lost his fight when he died Jan. 7, but Baer and Valentini’s wife Deana were inspired to do something to honor Dean who was a dedicated marathon runner himself.

“Deana and I are passionate about the research, particularly in melanoma, going on at the James Graham Brown Cancer Center,” Baer said. “I wanted to do something in Dean’s memory, and this race seemed most appropriate.”

The event name reflects another of Dean’s obsessions: A Baltimore native, he was a lifelong fan of the Baltimore Ravens.

Baer is currently signing up race sponsors in several categories to support the event. For details, phone 270-839-1029 or email morgan.foster@topper.wku.edu.

Can increasing green space improve our health?

Learn about research into the effects of foliage on health at Beer with a Scientist Mar. 14
Can increasing green space improve our health?

In neighborhoods with poor air quality and many busy streets, residents have a higher risk of heart disease. Researchers at the University of Louisville are studying air quality, innovative landscape design and human health to determine, scientifically, whether planting more trees and adding greenspaces in a neighborhood could increase the health of its residents.

Aruni Bhatnagar, Ph.D., director of the Diabetes and Obesity Center at UofL, will discuss the research, the Green Heart Project, at the next Beer with a Scientist event.

“No one knows whether and to what extent trees and neighborhood greenery affect human health and why,” Bhatnagar said. “This work will tell us how to design a neighborhood that supports human health and whether an increase in the urban greenspaces and vegetation could enhance physical and mental health by decreasing the levels of ambient air pollution.”

The Green Heart Project is a collaboration of UofL, The Nature Conservancy, Hyphae Design Laboratory, the Institute for Healthy Air Water and Soil, the U.S. Forest Service and the City of Louisville. The goal of the project is to assess how residential greenness and neighborhood greenspaces affect the health of our communities by decreasing the levels of pollution and promoting physical activity and social cohesion.

The talk begins at 8 p.m. onWednesday, Mar. 14, 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. For more information and to suggest future Beer with a Scientist topics, follow Louisville Underground Science on Facebook.

At the next Beer with a Scientist, Apr. 18, Deborah Yoder-Himes, Ph.D., will discuss super bacteria, antibiotic resistance and why everything is labeled "anti-bacterial."

Age-Friendly Louisville asks community members to give input for more age-inclusive city

Age-Friendly Louisville asks community members to give input for more age-inclusive city

Older adults involved in a discussion.

Creating solutions for affordable, safe housing as Louisvillians age, along with discussion on improving transportation are elements of conversations at workshops taking place throughout the city this spring.

As a part of Age-Friendly Louisville, the University of Louisville’s Institute for Sustainable Health and Optimal Aging joins AARP, the City of Louisville and the Kentuckiana Regional Planning and Development Agency to host workshops on what makes the community a better place for people to live, work and play at every stage of life. The events will include small group discussions on housing, mobility, respect and social inclusion, and community support and health services.

Workshop dates are March 7, 14, 21, 28, and April 4, 7, 17 and 24. More information, including times and locations, is available online

Information received from these conversations will help guide an action plan to drive the implementation of age-friendly practices. In October 2016, the City of Louisville became a member of the AARP Network of Age-Friendly Communities, an institutional affiliate of the WHO’s Global Network of Age-Friendly Cities & Communities®.

KIPDA and UofL’s Institute for Sustainable Health and Optimal Aging also are teaming up to host World Café events this month in Jefferson, Bullitt, Shelby and Trimble counties. These events include discussion about the results of the most recent regional needs assessment and how to work together to ensure support for the area’s aging population. More information is available online

Delivering depression treatment through technology

Delivering depression treatment through technology

Jesse Wright, M.D., Ph.D.

Computer-assisted cognitive behavioral therapy effectively treats depression, showing potential to improve access to the treatment and reduce its cost, according to researchers at the University of Louisville and University of Pennsylvania.

Patients experienced a positive and robust response to online cognitive behavioral therapy (CBT), equaling a traditional in-person CBT treatment course with three times more therapist contact, according to the study, which published in the March issue of the American Journal of Psychiatry.

While one of the most effective non-pharmacological treatments for depression, traditional in-person CBT poses barriers to those who need treatment.

“Traditional CBT takes a fair amount of time, money and resources, and there aren’t enough cognitive behavioral therapists,” said Jesse Wright, M.D., Ph.D., director of the UofL Depression Center, Gottfried and Gisela Kolb Endowed Chair in Outpatient Psychiatry in the UofL School of Medicine, and an author of the study. “The technology delivers treatment more efficiently and reduces cost by allowing many more people to be treated by the same therapist.”

For the study, more than 150 medication-free patients with major depressive disorder were randomly assigned to 16 weeks of either traditional CBT, which entails up to 20 sessions of 50 minutes each, or computer-assisted CBT using the Good Days Ahead program and 12 abbreviated therapy sessions.

The program, which Wright helped develop, consists of nine Internet-based modules that use video, psychoeducation, mood graphs to measure progress and interactive skill-building exercises that help users apply CBT methods in daily life. A dashboard allows clinicians to assess progress and coordinate aspects of treatment.

Both treatment groups experienced significant improvements and similar rates of symptom reduction across the 16 weeks of treatment. Patients with chronic and severe depression benefitted from both treatment courses.

The research was funded by grants totaling more than $2.5 million from the National Institute of Mental Health, the lead federal agency for research on mental disorders and part of the National Institutes of Health.

Authors of the study are Wright, Michael E. Thase, M.D., Tracy D. Eells, Ph.D., M.B.A., Marna S. Barrett, Ph.D., Stephen R. Wisniewski, Ph.D., G.K. Balasubramani, Ph.D., Paul McCrone, Ph.D., and Gregory K. Brown, Ph.D.

Older adults in rural Ky. to benefit from more behavioral health services

UofL Institute for Sustainable Health & Optimal Aging receives nearly $2 million from HRSA
Older adults in rural Ky. to benefit from more behavioral health services

Older adult couple talking with a health care provider

Older adults are often burdened with a variety of health conditions, sometimes coupled with loneliness, anxiety and depression. A strategy to engage primary care practitioners in meeting behavioral health needs of older adults is at the heart of a new federal grant awarded to the University of Louisville Institute for Sustainable Health & Optimal Aging (ISHOA).

Nearly $2 million in funding from the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, will provide stipends each year over a four-year period to 13 master level social work students, five counseling psychology students, and four doctoral level psychiatric nursing students for a total of 88 students. These students will be part of the Rural Geriatric Integrated Behavioral Health (BH) and Primary Care (PC) Training Network and will complete behavioral health practicums in primary care settings throughout Bullitt, Henry, Oldham, Shelby, Spencer and Trimble counties. They also commit to seek employment in those areas upon graduation.

“Isolation and transportation are big issues for older adults. Often there are limited behavioral health clinicians in rural areas, and it is the perfect marriage to incorporate behavioral health services within the primary care offices where older adults are already seeking care,” said Anna Faul, Ph.D., executive director of ISHOA and associate dean of academic affairs at the
UofL Kent School of Social Work.

Christian Furman, M.D., the institute’s medical director and a professor of geriatric and palliative medicine, said the combination of multiple health conditions like diabetes, high blood pressure, heart failure and hearing or vision loss can be overwhelming for older adults.

“The mind-body connection is so important,” Furman said. “Physicians can write prescriptions but unless a person understands why they have a disease and receives the proper training on how to be resilient, people can feel helpless in their situation. We see a lot of alcohol and drug-abuse, and now the opioid epidemic.”

As the result of a $2.55 million HRSA grant awarded to the institute in 2015 for the creation of the Kentucky Rural & Underserved Geriatric Interprofessional Program, older adults in rural areas already are seeing the benefits of coordinated care.

Former Henry County resident Lynn Retzlaff, 66, has been living with a degenerative bone disease most of his life, resulting in a number of health complications leading to such factors as poor nutrition, reliance on opioids, isolation and despair.

Through meeting with one of the institute’s community health organizers, Retzlaff was able to get connected with multiple services for older adults, including a nutritionist, a student counselor and transportation services. He also learned new techniques for managing pain.

“I am no longer on opioids,” Retzlaff said. “I now use meditation tapes and have found they help me more than the pain medication. Before, I would cycle between relief and suffering.”

Retzlaff says he now eats more balanced meals and is in an overall better mental state.

“Many older people feel they can’t cope – they feel helpless. Without the help of the institute and community health organizers I would have deteriorated and life would be very gray.”

The newest HRSA grant also aims to bring enhanced training to both students and primary care providers. Utilizing the institute’s already established Interdisciplinary Curriculum for the Care of Older Adults, along with development of a curriculum for the Professional Certificate in Rural Geriatric Interdisciplinary Integrated BH-PC and continuing education courses for health care professionals, the initiative hopes to build capacity for the mind-body approach to care for seniors.

“We are thrilled to receive this grant award,” Faul said. “With this funding, we will improve the health outcomes of vulnerable older adults in our rural counties. We also will dramatically increase the interdisciplinary approach to health care education and service delivery, infuse behavioral health into rural primary care, and provide students with increased employment possibilities.”

Furman, who practices geriatric medicine with UofL Physicians, says both older adults and their care-givers stand to benefit from the grant.

“When you look at a disease like dementia, patients deal with many behavioral disorders like paranoia or agitation, and there can be a lot of anxiety on how to problem-solve around those factors. This grant is important in not only getting behavioral health specialists into rural areas but also in opening up opportunities for physicians and nurse practitioners to coordinate with behavioral specialists to improve patient outcomes from a social support stand-point.”

Watch a video about the institute’s work to benefit older adults in Kentucky.

UofL leading nationwide efforts to improve lifelong care for people with intellectual/developmental disabilities

Partnership between UofL and Special Olympics aims to increase physicians’ comfort in treating adult patients with IDD
UofL leading nationwide efforts to improve lifelong care for people with intellectual/developmental disabilities

SOKY Athlete Ambassador Morgan Turner talks with medical students

At one time, people with intellectual/developmental disabilities (IDD) were mostly children. Thanks to medical advances and the deinstitutionalization movement, the number of adults living in the community with IDD has grown dramatically. These individuals require the same health-care services as any adult, but their care may come with added challenges. Most physicians in adult medical specialties have not been trained to work with these patients, and may not be comfortable with the communication challenges or other unique needs they may have.

Priya Chandan, M.D., M.P.H., assistant professor in the UofL School of Medicine and in the School of Public Health and Information Sciences, is leading nationwide efforts to help future physicians become more knowledgeable about caring for patients with IDD throughout their lives. Chandan, who has an older brother with Down syndrome, has a personal understanding of the need for physicians who can provide equitable care for people with IDD.

“This patient population is not just a pediatric population. All physicians need to be comfortable serving patients with IDD,” Chandan said.

To achieve that goal, Chandan is leading the National Curriculum Initiative in Developmental Medicine (NCIDM), a partnership between Special Olympics International (SOI) and the American Academy of Developmental Medicine and Dentistry (AADMD) to ensure future physicians receive training to care for individuals with IDD across their lifespan. Over four years, 12 medical school partners will design and implement their own curriculum enhancements. UofL is part of the first cohort for this training, along with Baylor College of Medicine and the University of Colorado. The second cohort includes Ohio State, Case Western Reserve and Georgetown Universities.

Chandan also is working with Amy Holthouser, M.D., senior associate dean of medical education, to develop the educational programs at UofL. One program is an elective rotation for fourth-year students at Lee Specialty Clinic, an interdisciplinary clinic that focuses on caring for people with IDD that is funded by the Commonwealth of Kentucky. Through working with the patients and staff at Lee Specialty Clinic, the students will become more comfortable treating these patients.

In addition, second-year medical students at UofL are participating in small group discussions led by Special Olympics Kentucky (SOKY) athletes in the Athlete Leadership Program. The goal of these discussions is to help the students better understand the needs of IDD patients by hearing their story and having the athletes express their needs.

Morgan Turner, a SOKY Athlete Ambassador who has met with the second-year students, said the most important message he wants to convey to the students is to include him in communication.

“When working with someone with a disability, be patient and ask questions to the patient and the parent. Don’t just talk to the parent,” Turner said.

“Communication is a big part of it,” Chandan said. “While this is a medical education project, we also see this as a way for people with intellectual and developmental disabilities to be self-advocates. Having them speak directly to medical providers about what it is like to be a patient and what they need from us is powerful.”

Chandan recently received two additional grants to expand her work. The first, an SOI Inclusive Health Innovation Grant, aims to improve education for resident and attending physicians regarding care for people with IDD. Chandan will be working with the American Academy of Physical Medicine & Rehabilitation (AAPM&R), leading efforts to educate resident and attending physicians regarding physiatrists’ role in the care of patients with IDD. Darryl Kaelin, M.D., chief, professor and residency director of the UofL Division of Physical Medicine and Rehabilitation and president of AAPM&R, also is working on the project.

The second grant is from the Working for Inclusive and Transformative Healthcare (WITH) Foundation to collaborate with the University of Kentucky’s Human Development Institute to develop a tool to aid with informed consent discussions. The tool will have the look of a graphic novel and will help facilitate conversations between health-care providers, patients with IDD and supporters.

“I went to medical school with the intention of being a physician who serves patients with IDD,” Chandan said. “Along the way, I realized that we have work to do in terms of health education and health-care delivery. My goal with these efforts is to improve care for these patients.”

 

 

 

February 21, 2018

Kentucky Cancer Program teams up with UofL Women's Basketball for 'Play4Kay Pink Out' Thursday

Kentucky Cancer Program teams up with UofL Women's Basketball for 'Play4Kay Pink Out' Thursday

UofL fans will get to see the Horses and Hope pink Mustang and Mobile Screening Unit as the Kentucky Cancer Program teams up with Louisville Women's Basketball this Thursday.

The UofL Women Basketball Cards, ranked fourth in the nation, will offer some health awareness along with the team’s matchup with the University of Virginia, Thursday, Feb. 22, at the KFC Yum! Center. Tip-off is at 7 p.m.

The Play4Kay Pink Out honors the late Kay Yow, a former NC State coach who died from cancer. The Kay Yow Cancer Fund is celebrating its 10th anniversary of providing funding and support for cancer research.

The Kentucky Cancer Program at the UofL James Graham Brown Cancer Center will be on hand at the game with giveaways and educational materials on the importance of early screening and detection of breast cancer. Louisville Women’s Basketball also will recognize breast cancer survivors on the court during halftime.

Fans are encouraged to wear pink, and representatives of Tom Drexler Plumbing and Remodeling will accept $5 donations for a breast cancer awareness t-shirt in the main concourse of the KFC Yum! Center. Proceeds will benefit Gilda's Club of Louisville.

Fans also will get to check out the Horses and Hope Mustang and Mobile Screening Unit, vehicles that are projects of Horses and Hope, an organization that brings cancer screening, detection and treatment services to workers in the equine industry in Kentucky.

Breast cancer survivors are eligible to receive one free ticket and a discounted ticket for $3 for all guests. Call the Louisville Cardinals' Ticket office for this offer at 502-852-5151. Other fans can receive discounted tickets for $3 by visiting My Cardinal Account and using promo code PLAY4KAY.

 

 

Supporting future professionals

Minority Pre-Health Symposium provides guidance for high school and undergraduate students interested in health professions
Supporting future professionals

Students at the 2018 Minority Pre-Health Symposium

Kyle Castaneda knows the value of mentors and connections for applying to medical school. A University of Louisville senior majoring in biochemistry, he credits the networking and advice he gained at events such as the Minority Pre-Health Symposium with helping him achieve admission to the UofL School of Medicine, where he will enroll this fall.

“I was from a very rural county. I was not prepared when I got to college to become a successful applicant for medical school,” Castaneda said. “I didn’t know a lot about when to shadow, when to volunteer or when to apply to medical school.”

High school and undergraduate students interested in health professions visited the UofL Health Sciences Center (HSC) campus Feb. 10 to learn about career and educational opportunities, tour the Schools of Dentistry, Medicine, Nursing and Public Health & Information Sciences, and meet with advisors and potential mentors. Representatives from the four HSC schools were on hand to discuss with students the skills needed to navigate the road to higher education in the health sciences.

Hannah Granholm, a high school sophomore from Louisville, attended the symposium to learn more about becoming a nurse practitioner. “I learned that a nurse practitioner does more than just give people shots and medicine. They do a lot more, and it takes a lot of work to do it,” Granholm said.

Glenda Granholm, Hannah’s mother, encouraged Hannah to attend. “I thought she could get exposure to different fields and could talk to people who know the field. That way she’ll be more comfortable asking questions.”

Vivian Doyle, a second-year UofL medical student, took a group of the students on a tour of the School of Medicine. She said a mentor provides essential support for students aspiring to careers in medicine, dentistry or graduate studies.

“It’s definitely important to find mentors – a physician, a medical student or an upper classman. That way, if you do get nervous or you have your doubts, you can go to your mentor and ask advice,” Doyle said.

Barbara Ekeh, another second year medical student, said the event also provided an opportunity to learn about the lesser-known careers in health-care, such as public health, graduate studies or dentistry.

“There are so many avenues in medicine and some are more visible than others. One student was asking, ‘What is public health?’ I didn’t know what that was until I was in college. Sometimes it can be a little overwhelming.” Ekeh said. “This is an avenue where they can meet other students to try and figure out what they are interested in doing.”

The event also allowed the students to connect with advisors and faculty members who could help them along in the process. Ashley O’Neil, a program coordinator in the UofL HSC Office of Diversity and Inclusion, helps students determine the best fit and guides them through the application process.

“There are people like me who will help you figure out your path and what it is going to take for you to succeed. I’m here to help in your journey with shadowing, clinical work, understanding the MCAT and its whole process, and the application itself,” O’Neil said.

Alona Pack, M.S.N., M.A., R.N., assistant professor in the UofL School of Nursing, said student organizations also can be important resources for the students.

“We have support systems for minority students here, particularly the Black Student Nurses Association. They provide mentorship and academic support to the students. They also do community outreach and develop leadership skills. It’s a good network for the students.”

The Student National Medical Association, Student National Dental Association, Health and Social Justice Scholars, Black Student Nurses Association, and the UofL Health Sciences Center Office of Diversity and Inclusion hosted the program, attended by 85 high school and undergraduate college students. The event was funded by the UofL Student Government Association Club Programming Committee (CPC) and the UofL Commission of Diversity and Racial Equality (CODRE).

Castaneda said events such as the symposium can help students connect with other programs and student organizations, which he found helpful. Castaneda attended the Professional Education Preparation Program (PEPP) prior to college, and joined the Multicultural Association of Pre-Medical Students (MAPS) once he arrived on campus.

“PEPP particularly got me up to speed and it made me feel a lot more comfortable when I got to college. I just kept doing the programs. They give you more exposure to the field. They let you meet great people and they help you along the process.”

See a photo gallery from the event here.

For more information on mentoring programs, visit the UofL HSC Office of Diversity and Inclusion website.

From black hat to white hat: Findings tip assumptions about TAK1 in muscle growth

Research published today reveals molecule’s critical role in maintaining muscle health
From black hat to white hat:  Findings tip assumptions about TAK1 in muscle growth

Control and TAK-1 inactivated tibialis anterior muscle

Among researchers exploring the mechanisms of muscle growth and health, there have been certain conceptions about the role of the signaling protein, transforming growth factor-ß-activated kinase 1 (TAK1). Convention was that TAK1 is detrimental to muscle health since it activates pathways associated with muscle wasting.

“TAK1 is a very important molecule in the body and it is involved in the regulation of almost all cell types. It is implicated in many signaling processes and many physiological roles in the body,” said Ashok Kumar, Ph.D., a professor and distinguished university scholar in the University of Louisville Department of Anatomical Sciences and Neurobiology. “But the role of TAK1 in skeletal muscle was not known at all.”

Kumar and Sajedah M. Hindi, Ph.D., a postdoctoral fellow in the department, hypothesized that by removing TAK1, they could mitigate the negative effects of two downstream pathways associated with muscle wasting with a single action. They and other members of the research team devised a series of cell culture and animal model experiments to determine if removal of TAK1 would preserve muscle mass and strength.

Their first clue to the significance of TAK1 was that mice genetically modified to remove TAK1 in skeletal muscle all died shortly after birth. Shifting their strategy, the researchers began working with adult mice. They found that in mature mice, instead of increasing muscle mass, reducing TAK1 resulted in severe muscle wasting, along with abnormalities in mitochondria and oxidative stress. These changes are consistent with those witnessed in muscle of individuals with amyotrophic lateral sclerosis (ALS), type II diabetes, cancer and aging.

“It did the opposite of what we were hoping it would do,” Hindi said. “In other tissues, having too much TAK1 has a bad effect. Knocking it down is actually positive. But in mature skeletal muscle, knocking TAK1 down had a negative effect.”

The research is detailed in TAK1 regulates skeletal muscle mass and mitochondrial function, published today in the journal JCI Insight, authored by Hindi, Kumar, Shizuka Uchida, Ph.D., associate professor and researcher in the UofL Cardiovascular Innovation Institute, Bradford Hill, Ph.D., associate professor and researcher in the UofL Diabetes and Obesity Center, and others at UofL.

This research reveals the essential role of TAK1 for the health of mature skeletal muscle, and adds to work by Kumar, Yuji Ogura, Ph.D., now of Japan, and Hindi, published in 2015 in Nature Communications, revealing that TAK1 is required for adult muscle cell proliferation and survival and for the regeneration of adult skeletal muscle upon injury. That research showed that when TAK1 is reduced, satellite stem cells do not vigorously self-renew and many eventually die. Alternately, when TAK1-regulated signaling is increased, the satellite cells prosper.

Kumar believes this understanding of the essential role of TAK1 in muscle health could lead to the development of therapies to preserve muscle mass in the elderly and in individuals with muscle wasting diseases such as muscular dystrophy, cancer, type II diabetes and ALS.

“This is a very fundamental discovery that people had a misconception about this pathway. This protein is very important for muscle maintenance,” Kumar said. “The next question is whether this is a mechanism for loss of muscle mass in all these conditions. We have approaches now to put this protein back into the body. If we put it back in the muscle or we have some drugs that activate this molecule, can we improve the muscle mass, can we preserve the muscle mass?”

Physicians familiar with stresses facing transgender youth better equipped to provide care

LGBT Healthcare Summit sponsored by Humana at UofL to focus on mental health
Physicians familiar with stresses facing transgender youth better equipped to provide care

Christine Brady, Ph.D.

Research shows that transgender youth experience higher rates of depression and are more likely to attempt suicide. Health-care providers are better equipped to care for these young patients and their families if they are familiar with their needs and struggles.

“As a mental health professional specializing in working with transgender and gender non-conforming youth, I am keenly aware of the prejudice, discrimination, rejection and bullying these youth face on a day-to-day basis,” said Christine Brady, Ph.D., a clinical psychologist with UofL Physicians’ Bingham Clinic and assistant professor in the University of Louisville Department of Pediatrics, Division of Child & Adolescent Psychiatry & Psychology.

“Rejection often comes out of fear, fear of the unknown. If I can reduce the fear of one person and facilitate that person approaching a transgender youth with more acceptance and compassion, I'll consider the summit a huge success.”

Brady will provide insight for health-care providers and the community as part of the LGBT Healthcare Summit at UofL, sponsored by Humana. Her talk, “Transgender and gender creative youth:  Mental health and evidence-based treatments,” will help familiarize participants with common terms and vocabulary used within the transgender community, communicate the prevalence of mental health issues and health disparities among transgender youth, and learn about both effective and potentially harmful mental health treatments across early, middle and late childhood development. Register for Brady’s talk, scheduled for noon at the UofL HSC Auditorium on Feb. 16, at http://www.summit_brady.eventbrite.com.

The LGBT Healthcare Summit also will feature "Substance use disorder treatment responsiveness for LGBT clients" by Brian Hurley, M.D., M.B.A. Hurley is an addiction psychiatrist and medical director for Substance Use Related Care Integration at the Los Angeles County Health Agency and assistant professor of addiction medicine at U.C.L.A. The presentation will include a panel of community members speaking to the challenges and successes around this issue in Louisville, including Jennifer Hancock, president of Volunteers of America Mid-States. Register for Hurley’s 9 a.m. presentation at http://www.summit_hurley.eventbrite.com.

The LGBT Healthcare Summit sponsored by Humana will be held Friday, Feb. 16 at the UofL Health Sciences Center Auditorium, 500 S. Preston St., Louisville, Ky. 40202.

Spinal cord injury research: Bonus benefit to activity-based training

UofL researchers report activity-based training improves urinary function after spinal cord injury, investigate effects of epidural stimulation
Spinal cord injury research:  Bonus benefit to activity-based training

Charles Hubscher, Ph.D.

Activity-based training has resulted in unexpected benefits for individuals with severe spinal cord injury (SCI). Researchers in the Kentucky Spinal Cord Injury Research Center (KSCIRC) at the University of Louisville have discovered that the training, designed to help individuals with SCI improve motor function, also leads to improved bladder and bowel function and increased sexual desire.

Research participants receiving activity-based training conducted by KSCIRC at Frazier Rehab Institute initially reported improvements in bladder, bowel and sexual function anecdotally. Charles Hubscher, Ph.D., professor and researcher at KSCIRC, has documented those changes in research published today in the journal PLOS ONE.

For individuals with severe spinal cord injury, bladder and bowel dysfunction are among the most detrimental factors to their quality of life, even more than the loss of independent mobility.

“Patients with spinal cord injury say they are most concerned by the problems associated with bladder function,” Hubscher said. “These issues contribute heavily to a decline in their quality of life and impacts overall health.”

Bladder dysfunction associated with SCI results in numerous health complications, requiring lifelong management and urological care in the form of catheterization, drug and surgical interventions, peripheral electrical stimulation and urethral stents. All of these therapies bring with them serious side effects and none substantially improves the basic functions.

To document changes in bladder, bowel and sexual function resulting from activity-based therapy, Hubscher and his colleagues performed urological testing (urodynamics) and asked research participants with severe spinal cord injury (SCI) to complete surveys about their bladder and other functions. Eight of the participants received activity-based training, which includes locomotor training, stepping on a treadmill with their body weight supported, and stand training in a specially designed frame. Four participants did not receive training.

The active participants’ functions following training were compared with their own condition prior to training and with individuals not receiving training. Following 80 daily sessions of locomotor training with or without stand training, the active individuals were found to store significantly more urine at safer pressures, reported fewer incidents of nighttime voiding and reduced general incontinence, as well as improved bowel functioning and increased sexual desire.

“Today’s published research indicates that activity-based training strengthens the neural circuits that control urogenital and bowel functions,” Hubscher said. “We hope to further validate those findings by determining if the improvements can lead to elimination of related medications and/or long-term reduction in the number of daily catheterizations. In addition, we are evaluating the effects of spinal cord epidural stimulation on those circuitries.”

Susan Harkema, Ph.D., professor and associate director of KSCIRC and an author of the study, said the publication highlights the value of the research collaborations at UofL.

“This work showcases the exceptional environment for research at UofL, with basic scientists working in parallel with clinicians in rehabilitation and neurosurgery,” Harkema said. “There are relatively few researchers addressing bladder, bowel and sexual function both in animals and humans in chronic spinal cord injury. Dr. Hubscher’s work adds a unique and valuable aspect to our research.”

Epidural Stimulation Research

Researchers at KSCIRC are investigating the use of spinal cord epidural stimulation (scES) to facilitate the ability of SCI patients to stand, voluntarily control leg movements, and improve other functions. Spinal cord epidural stimulation involves the delivery of electrical signals to motor neurons in the spine by an implanted device.

In concert with this research, Hubscher is investigating the effects of scES on bladder, bowel and sexual function in SCI patients. Funded by a $3.5 million grant from the National Institutes of Health, Hubscher has begun work to map the lumbosacral spinal cord for multiple aspects of bladder function. This work will identify locations on the spine and device configurations for using scES to improve bladder storage and voiding efficiency.

The funding is through the NIH Common Fund program Stimulating Peripheral Activity to Relieve Conditions (SPARC), which aims to increase the understanding of nerve-organ interactions and neuromodulation to advance treatment of diseases and conditions for which conventional therapies fall short.

Hubscher’s SPARC project has a three-year timeline and includes concurrent investigations in both animals and humans. His team will enlist six human research participants who have received scES devices and have completed the initial epidural stimulation study to assist with the development of device parameters, then test those parameters at home.

For the estimated 1,275,000 people in the United States who live with paralysis from SCI, therapies resulting from this research have the potential to increase their quality of life as well as reduce health-care costs.

#WeAreUofL

About the Kentucky Spinal Cord Injury Research Center at the University of Louisville

The Kentucky Spinal Cord Injury Research Center (KSCIRC), opened in 2001, provides the opportunity for basic scientists, physicians, neurosurgeons and physical therapists to work collaboratively with the common goal of curing paralysis. Through close association with clinical colleagues in the UofL Department of Neurological Surgery, KSCIRC is in a unique position to conduct research designed to ultimately lead to effective treatments for spinal cord injury. This continuum of research has facilitated a “bench-to-bedside” and “bedside-to-bench” approach, where basic science questions are examined from a translational perspective and findings in the clinical setting enlighten or guide future basic scientific studies.

Research supported by NICHHD grant no. R01HD080205, the Leona M. and Harry B. Helmsley Charitable Trust, the Christopher & Dana Reeve Foundation, and the Craig H. Neilsen Foundation. KSCIRC Neuroscience Core facilities supported by NIH/NCRR P30 grant no. 8P30GM103507. NIH:  Functional Mapping with Lumbosacral Epidural Stimulation for Restoration of Bladder Function After Spinal Cord Injury, grant no. 1OT2OD024898-01.

Research shows elite defenders have ‘steely focus’

UofL scientist reveals how football players excel at the mental game
Research shows elite defenders have ‘steely focus’

Brandon Ally, Ph.D.

The millions of viewers watching the Super Bowl on Feb. 4 will no doubt witness exceptional physical abilities of the athletes as they execute precise passes, acrobatic catches and lightning-fast runs. However, research at the University of Louisville into the neurocognitive abilities of these players is revealing specific skills that allow them to excel at the mental game as well.

Brandon Ally, Ph.D., and researchers at the UofL Center for Sports Cognition have demonstrated that elite college and professional football defensive players have a greater ability to show steely focus, shielding their actions against interfering information on the field. Ally, an assistant professor in the Department of Neurological Surgery, has looked at the speed with which elite defensive players read a play and close on offensive threats.

In research recently accepted in Frontiers in Psychology: Movement Science and Sport Psychology, Ally and his colleagues compared reaction times in NCAA football players with non-athletes. The athletes and non-athletes show similar reaction times to simple stimuli. In an experimental task requiring the subjects to respond in the same direction as a series of five arrows, again there was no difference between NCAA football players and non-athlete controls.

However, when the center arrow is pointed in the opposite direction of the four other arrows (which were all moving in the same direction), the NCAA football players respond to the direction of the center arrow much more quickly than the non-athletes. 

“This means that football players are more proficient at shielding motor response execution speed from the interfering effects of distraction than non-athletes,” Ally said. “On the field, this will translate to the ability to more quickly spot key movements amidst the visual chaos of the offense and respond with decisive action.”

 

Putting cancer detection, prevention on the road

Brown Cancer Center screening unit meets people where they are
Putting cancer detection, prevention on the road

The same cancer screening services available at the University of Louisville’s James Graham Brown Cancer Center can be brought to workplaces, churches, schools or other organizations, with just a phone call to schedule.

The cancer center’s Mobile Screening Unit provides prevention and early detection services for breast and other types of cancers. People with private health insurance, Medicare or Medicaid will incur no additional charges for mobile services, and the cancer center will bill providers on behalf of the patients. Some co-pays may apply.

Services provided by the Mobile Screening Unit are furnished by staff at the cancer center and the Kentucky Cancer Program, the statewide cancer prevention and control program mandated by the Kentucky General Assembly.

For more than 25 years, the mobile unit has reached people at their place of business, church, school or community, first focusing on the provision of mammograms for breast cancer and later adding screening services for other types of cancer.

Business and organizational leaders who want to schedule the unit should contact Vera Hobbs at 502-562-4361, extension 4.

 

 

UofL oncology nurse recognized for compassionate care

Heather Hibbard, B.S.N., R.N., to be honored at luncheon, Feb. 28
UofL oncology nurse recognized for compassionate care

Heather Hibbard BSN, RN

Heather Hibbard, B.S.N., R.N., manager of the medical oncology and infusion center at the University of Louisville James Graham Brown Cancer Center, is being honored for making a difference in the lives of cancer patients. Hibbard is one of seven health-care providers who will be in the spotlight at the Third Annual Commitment to Compassion Luncheon, sponsored by Passport Health Plan, Insider Louisville and the Compassionate Louisville Healthcare Constellation. The event is scheduled for Wednesday, Feb. 28, at the Muhammad Ali Center.

Hibbard uses her training as well as her personal experience to make life a little easier for cancer patients. Her father and grandfather were diagnosed with lung cancer within one month of each other, and passed away one month apart in 2013. Although it was a painful time for her, that experience helps her understand how to improve care provided to the patients at the Brown Cancer Center.

Hibbard says she wants to provide the kind of care for patients and families that she would want to receive. To help make things easier, she developed a lab and line room where patients can have their vitals and lab work done before seeing the physician. This reduced patient wait times by two thirds.

“Cancer does not have to be a death sentence, but the patients need top-notch, nurturing and individualized care,” Hibbard said. “My one goal in life is to make a difference in cancer care – to give others hope that we are doing everything we can as an oncology center. I have a great group of people who want better care for their patients and I help them in reaching that goal.”

It is often little things that make a difference for patients.

“You don’t ever hear, ‘thank you for accessing my port,’” Hibbard said. “But you do hear ‘thank you for being gentle with me,’ ‘thank you for listening,’ ‘thank you for calling home health and getting things set up so my life is a little easier.’”

The Commitment to Compassion luncheon, emceed by television health and science reporter Jean West, will include recognition of the compassionate care honorees, a performance by the West Louisville Boys Choir and a panel discussion on “Innovative and compassionate care in West Louisville.” Reservations are available online.

Physician leader at UofL School of Medicine’s Madisonville campus honored by Kentucky Academy of Family Physicians

Physician leader at UofL School of Medicine’s Madisonville campus honored by Kentucky Academy of Family Physicians

William J. Crump, M.D.

The Kentucky Academy of Family Physicians (KAFP) has recognized the work of William J. Crump, M.D., associate dean, University of Louisville School of Medicine Trover Campus. The organization recently awarded Crump the Distinguished Service Award, an award given to a family physician who has served in leadership roles with the KAFP and has advanced the specialty of family medicine.

Nominated by William Thornbury, M.D., Crump of Madisonville, Ky., is praised for his leadership and tireless effort promoting evidence-based medicine through the publication of scholarly work. Crump, who served as editor of the Kentucky Academy of Family Physicians Journal from 2006-2017, helped transform the journal into a peer-reviewed publication for the scholastic contributions of the Commonwealth’s family medicine community.

“Perhaps the most enjoyable part of my role was getting students, residents and young faculty through their first manuscript effort, from bright idea to published product. They are our future,” Crump said.

Not only has Crump led the academy in his role of bolstering the scholarship for health improvement of Kentuckians, as an educator-physician Crump teaches medical students at the  UofL School of Medicine Trover Campus in Madisonville. Preclinical students have the opportunity to spend two three-week summer sessions at the campus, working with primary care preceptors. Up to 12 students are selected to spend their third and fourth years of training in Madisonville where they help meet health care needs of rural Kentuckians.