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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.

 

UofL Physicians – Family Medicine Cardinal Station accepting new patients at renovated facility

UofL Physicians – Family Medicine Cardinal Station accepting new patients at renovated facility

UofL Physicians – Family Medicine Cardinal Station

January is a great time to start anew and take a health inventory. Luz Fernandez, M.D., medical director of UofL Physicians - Family Medicine Cardinal Station, encourages individuals to make yearly check ups a priority.

“Developing a lasting, trusted relationship with a primary care provider is important, regardless of a person’s age,” Fernandez said.

During an annual visit, a provider asks the patient about health habits, the health of close relatives and overall lifestyle. The information will determine risks of common medical conditions and whether further testing is needed. The check up, says Fernandez, is a good way to screen for and possibly detect medical conditions such as diabetes and high cholesterol so they can be treated at an early stage, minimizing risks of serious complications in the future.

A primary health care provider also can partner with patients in setting healthy habits. Fernandez hopes to inspire SMART goals:

  • S: Specific, significant 
  • M: Measurable
  • A: Achievable
  • R: Realistic and Results-oriented 
  • T: Time based and Trackable

“You are much more likely to stick to an exercise plan if you commit to a 30 minute walk or jog three days a week instead of saying ‘I will exercise more,’ ” Fernandez said.

She says it is best to be as specific as possible and to make sure the goal is attainable, adding that accountability is important to success.

“Discuss your plans with a primary care provider, and rely on trusted family and friends for support,” she said. “Technology resources like the app, myfitnesspal can track food intake, exercise and weight loss; seeing a graph of progress may work to keep you motivated.”

New patients accepted at renovated facility

UofL Physicians – Family Medicine Cardinal Station, located at 215 Central Ave., Suite 100, recently updated its facility and is welcoming new patients for check ups and other health related purposes, including acute illness.

With 25 patient rooms, the practice offers a full spectrum of on-site services including:

  • Well care visits, immunizations
  • X-rays
  • Lab work
  • Spirometry
  • EKG
  • Toenail removal
  • Mole removal
  • Birth control placements
  • Vision screenings
  • Cancer screenings

Most insurance plans accepted. Free parking available on the surface lot in front of the office. For an appointment or more information, call 502-588-8720.

UofL resident physician to deliver research at national ophthalmology conference

UofL resident physician to deliver research at national ophthalmology conference

Joshua C. Gross, M.D.

Joshua C. Gross, M.D., a first-year resident in training with the UofL Department of Ophthalmology and Visual Sciences, will present his research at the annual meeting of the Association of University Professors of Ophthalmology (AUPO) on Jan. 26 in Austin, Tex. At the RPB/AUPO Resident and Fellow Research Forum. Gross has conducted research into the association between blood flow in the retina and the progression of open-angle glaucoma and diabetes mellitus.

Working with colleagues at Indiana University School of Medicine and in Italy, Gross found that patients who had reduced retinal blood flow and optic nerve damage consistent with glaucoma who also had diabetes experienced faster visual deterioration than patients with similar characteristics but who did not have diabetes.

Open-angle glaucoma, the most common form of glaucoma, accounts for at least 90 percent of all glaucoma cases, affecting about 3 million Americans. It is caused by the slow clogging of the drainage canals, resulting in increased eye pressure. 



January 25, 2018

UofL research finds depressive symptoms linked to shorter survival in patients with head and neck cancer

UofL research finds depressive symptoms linked to shorter survival in patients with head and neck cancer

Liz Cash, Ph.D.

In a study of patients with head and neck cancer, even mild depressive symptoms were associated with poorer overall survival. Published early online today in CANCER, a peer-reviewed journal of the American Cancer Society, the findings indicate that patients should be screened and treated for depressive symptoms at the time of diagnosis. In addition, studies should examine parallel biological pathways linking depression to cancer survival.

Many patients diagnosed with head and neck cancer experience symptoms of depression, which can make it difficult for them to manage treatment side effects, quit smoking, or maintain adequate nutrition or sleep habits. A team led by Elizabeth Cash, Ph.D., of the University of Louisville School of Medicine, was interested to see if depressive symptoms might also affect patients’ health outcomes.

The researchers studied 134 patients with head and neck cancers being treated at the UofL James Graham Brown Cancer Center multidisciplinary head and neck clinic from October 2012 to October 2013 who reported depressive symptoms during the planning of their treatment. In this group, 67.2 percent expressed measureable depressive symptoms. When the investigators examined the patients’ clinical data over the following two years, they found that patients with greater depressive symptoms had shorter survival, higher rates of chemo-radiation interruption, and poorer treatment response.

“We observed that head and neck cancer patients who reported more depressive symptoms at their initial appointment were more likely to miss scheduled treatment appointments and were more likely to have tumors that persisted after medical treatment,” said Cash, who serves as the director of research for the Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders at UofL. “We also observed that patients with depressive symptoms suffered greater two-year overall mortality rates, and this was especially true for those who did not achieve optimal response to medical treatment.”

Poorer treatment response partially explained the depression-survival relationship; however, there were no significant effects from factors commonly used to determine cancer prognosis—such as the patient’s age, the stage of tumor advancement or extent of smoking history.

“This suggests that depressive symptoms may be as powerful as the clinical features that physicians typically use to determine the prognosis of patients with head and neck cancer,” Cash said.

She also noted that most patients in the study did not meet criteria for diagnosis of major depressive disorder, suggesting that even mild symptoms of depression may interfere with head and neck cancer treatment outcomes. She said that while the findings need to be replicated in a larger study, they do suggest that depressive symptoms may affect head and neck cancer patients’ survival through mechanisms that potentially coincide with the activities of their tumor.

“We want patients to know that it is normal to get depressed when they are diagnosed, but it is important to seek help for any depression symptoms because (not doing so) may lead to poorer outcomes related to their cancer treatment,” Cash said.

She and her colleagues are hopeful that this information can facilitate discussions between patients and psycho-oncologists or behavioral oncology specialists to expedite the development of targeted behavioral interventions, which may have high potential to complement medical treatment efficacy.

 

Can technology be used to treat eating disorders? Beer with a Scientist, Jan. 17

Can technology be used to treat eating disorders? Beer with a Scientist, Jan. 17

Cheri Levinson, Ph.D.

Eating disorders affect about 8 million people in the United States at any one time. Although a large majority is young women, anorexia nervosa, bulimia nervosa and other types of eating disorders can affect men and people of any age. Cheri Levinson, Ph.D., assistant professor in the Department of Psychological and Brain Sciences and director of the Eating Anxiety Treatment Laboratory at the University of Louisville, will share some of her research in the treatment of eating disorders at the next Beer with a Scientist event, Wednesday, Jan. 17.

Levinson will discuss the lab’s research on the association between eating disorders and anxiety. In addition, she will describe therapies that incorporate technological innovations.

“The most common treatments for eating disorders only work for about 50 percent of individuals,” Levinson said. “In the Eating Anxiety Treatment Lab, we are working on developing novel treatments personalized to the individual,” Levinson said. “Many of our treatments use technology to help improve treatment and reach more people.”

Levinson’s talk begins at 8 p.m. onWednesday, Jan. 17, 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.

Upcoming Beer with a Scientist dates:  Mar. 14, Apr. 18.

 

 

 

January 9, 2018

Robert Friedland proposes new term for the role of microbiota in neurodegeneration: Mapranosis

Robert Friedland proposes new term for the role of microbiota in neurodegeneration:  Mapranosis

Possible routes for microbial amyloid to influence the CNS

Research in the past two decades has revealed that microbial organisms in the gut influence health and disease in many ways, particularly related to immune function, metabolism and resistance to infection. Recent studies have shown that gut microbes also may cause or worsen Parkinson’s disease, Alzheimer’s disease and other neurodegenerative conditions.

University of Louisville neurology professor Robert P. Friedland, M.D., and Matthew R. Chapman, Ph.D., professor at the University of Michigan, have proposed a new term to describe an interaction between gut microbiota and the brain in an article released today in PLOS Pathogens.

Friedland and Chapman propose the term “mapranosis” for the process by which amyloid proteins produced by microbes (bacteria, fungi and others) alter the structure of proteins (proteopathy) and enhance inflammation in the nervous system, thereby initiating or augmenting brain disease. The term is derived from Microbiota Associated Protepathy And Neuroinflammation + osis (a process).

Friedland hopes that giving the process a name will facilitate awareness of the process, as well as research leading to therapeutic opportunities.

“It is critical to define the ways in which gut bacteria and other organisms interact with the host to create disease, as there are many ways in which the microbiota may be altered to influence health,” Friedland said.

Research into the multitude of microbes that inhabit the human body has expanded considerably in recent years. Genomic analysis has begun to reveal the full diversity of bacteria, viruses, fungi, archaea and parasites living in and on the body, the majority of them in the gut. Even more recently, researchers have begun to explore how the proteins and other metabolites produced by microbes inhabiting the gut influence functions in other parts of the body, including the brain. However, we do not yet have a full understanding of how these systems work. The relationship between the microbiota and the brain has been called the “gut-brain axis.”

It is understood that the clumping of misfolded amyloid proteins, structures produced by neurons in the brain, are associated with neurodegeneration and conditions such as Alzheimer’s disease, Parkinson’s disease and amyotrophic lateral sclerosis (ALS).

“It is well known that patterns of amyloid misfolding of neuronal proteins are involved in age-related brain diseases. Recent studies suggest that similar protein structures produced by gut bacteria, referred to as bacterial amyloid, may be involved in the initiation of neurodegenerative processes in the brain,” Friedland said. “Bacterial amyloids are produced by a wide range of microbes that inhabit the GI tract, including the mouth.”

In research published in 2016 in Scientific Reports, Friedland and colleagues showed that when E. coli microbes in the gut of rats and worms (nematodes) produced misfolded amyloids, the amyloids produced in the animals’ brains and intestines also misfolded, a process called cross-seeding.

“Our work suggests that our commensal microbial partners make functional extracellular amyloid proteins, which interact with host proteins through cross-seeding of amyloid misfolding and trigger neuroinflammation in the brain,” Friedland said.

In today’s article, Friedland and Chapman also address other factors related to the microbiota and its products and how they influence neurodegenerative disorders.

  1. The microbiota modulates (enhances) immune processes throughout the body, including the central nervous system.
  2. The microbiota may induce oxidative toxicity (free radicals) and related inflammation that contributes to neurodegeneration.
  3. Metabolites produced by the microbiota may be either beneficial (health sustaining) or damaging (pathogenic).
  4. Host genetics influence microbiota populations, illustrating that the gut-brain axis is bidirectional.

Friedland believes further research in this area may lead to therapies for these neurodegenerative diseases, which are increasing in frequency and for which there are few effective treatments.

Chapman’s research is supported by the National Institutes of Health. Friedland’s work has been supported by The Michael J. Fox Foundation.

 

December 21, 2017

Medical residents’ toy drive collects nearly 900 gifts for local kids

Medical residents’ toy drive collects nearly 900 gifts for local kids

The UofL House Staff Council collected nearly 900 toys for its Toys for Tots campaign this month. Resident physicians pictured are, clockwise from lower left, Svetlana Famina, M.D., Jason Messinger, M.D., Jamie Morris, M.D. and Paul Parackal, M.B.B.S.

Nearly 900 toys swamped a Christmas tree in the University of Louisville Health Sciences Center administration building, ready to be delivered to local children who would otherwise go without presents this year.

For the third year, the UofL School of Medicine House Staff Council, the representative body for resident and fellow physicians, led a weeklong collection for Toys for Tots. Donations were received from individual residents and fellows as well as School of Medicine faculty, staff and students.

“Unfortunately, there are so many families in Louisville who cannot afford toys for their children,” said Svetlana Famina, M.D., a third-year psychiatry resident. “We work with these families a lot on a daily basis, so we know how much things like this are appreciated by children and their parents.”

Stock Yards Bank & Trust will provide a luncheon and plaque to the three residency programs that donated the most toys.

The winning program for the third straight year, the Department of Psychiatry and Behavioral Sciences, collected about 430 toys. Aside from gathering donated toys, psychiatry residents raised about $1,000 to buy additional gifts, Famina said.

The Department of Obstetrics, Gynecology and Women’s Health donated the second-most number of toys and the Department of Radiology finished third.

Jamie Morris, M.D., a radiology resident, said the annual toy drive has become an important way for UofL medical residents to give back to the community, especially children.

“It’s important to share what we have,” Morris said. “The residency program is a strong coalition and we have a lot to give the Louisville community.”

Staff members of the Office of Graduate Medical Education sorted and packed the toys in donation boxes, which were picked up by a Toys for Tots volunteer on Dec. 11.

The U.S. Marine Corps Reserve Toys for Tots Program collects new, unwrapped toys during October, November and December each year, and distributes those toys as Christmas gifts to underprivileged children in the community in which a campaign is conducted.

Survey for older adults designed to assess social service needs

Survey for older adults designed to assess social service needs

ISHOA and KIPDA

Senior citizens who live in Jefferson and surrounding Kentucky counties are encouraged to take a brief survey online or over the phone to help analyze social service needs for older adults and individuals with disabilities.

For the second year, the University of Louisville Institute for Sustainable Health and Optimal Aging will conduct a community needs assessment on behalf of the Kentuckiana Regional Planning & Development Agency (KIPDA).

Led by the institute’s Executive Director, Anna Faul, Ph.D., and Director of Health Innovation and Sustainability, Joe D’Ambrosio, Ph.D., the 2018 KIPDA needs assessment surveys people across the seven KIPDA counties – Bullitt, Henry, Oldham, Shelby, Spencer, Trimble and Jefferson. It looks at each county in regards to housing, outdoor spaces and buildings, transportation and streets, health and wellness, social participation, inclusion and education opportunities, volunteering and civic engagement and job opportunities.

The survey results, together with an analysis of current community services and gaps, will allow the institute to make specific and strategic recommendations to KIPDA. If adopted, these recommendations are designed to ensure that older adults and individuals with disabilities have their immediate social service needs met while more broadly enabling them to lead lives of dignity and independence.

Anyone living in the designated counties is invited to complete the Community Needs Assessment Survey. The more people that participate, the more likely service gaps can be addressed. Older adults, caregivers, and persons with disabilities are especially encouraged to participate in this research study. Survey participants do not have to be recipients of KIPDA services.

The assessment can be found online or by calling 502-852-8953. The institute can provide a paper copy upon request or at senior centers within the seven counties. The deadline to complete the assessment is Feb. 1, 2018.

For more information, visit www.optimalaginginstitute.org/kipda or contact Dr. D’Ambrosio at joe.dambrosio@louisville.edu or 502-852-7811.

UofL Hospital opens new center to treat hepatitis C

Kentucky has highest infection rate in country; disease can now be cured
UofL Hospital opens new center to treat hepatitis C

The new UofL Hospital Hep C Center opened on Wednesday.

University of Louisville Hospital opened a new center today to treat hepatitis C, a particular problem in Kentucky, which has the highest infection rate in the country.

A ribbon-cutting and open house marked the UofL Hospital Hep C Center’s official opening Wednesday morning, with the first patients scheduled later in the day.

“While Kentucky has the highest rate of new hep C cases in the U.S., few places exist here for treatment,” said Barbra Cave, a family nurse practitioner specializing in gastroenterology and hepatology who leads the center. “This is a much-needed service in the community.”

In the past, treating hepatitis C was difficult. It involved a triple therapy with interferons that lasted almost a year, with multiple side effects. Not everyone was a candidate for treatment. Doctors found it challenging, and some patients opted to not get treated at all.

“Many patients were scared off by treatment, knowing it was going to be hard,” Cave said. “Maybe they saw a friend go through it. But we want them to know it’s not hard anymore. We can help so many people.”

Today, treatment is one pill, once a day, for 8-12 weeks – with minimal side effects, said Ashutosh Barve, M.D., Ph.D., the center’s medical director and a gastroenterologist with the hospital and UofL Physicians. The center also uses FibroScan, which allows staff to perform a non-invasive assessment of the liver without a biopsy.

“This is truly a success story of modern medicine,” he said. “We went from discovering the basic science of the disease in the late ‘80s, early ‘90s, to finding a cure in 2014.”

Up to half of patients who have it may not know they are infected, Cave said. The U.S. Centers for Disease Control and Prevention has recommended screening for all baby boomers.

“People may carry the disease for decades before they have symptoms,” she said.

Hepatitis C is a blood-borne illness. It may have been contracted from a blood transfusion prior to 1992, contaminated tattoo equipment or IV drug use. Older veterans are particularly at risk due to the use of the old “jet gun” vaccinators by the military and combat injuries, Cave said.

Contaminated dental equipment can also spread hepatitis C, and the disease can be passed from mother to baby.

“The virus can live on a surface for weeks, if not sterilized properly,” Cave said.

Though hepatitis C is now easily curable with proper treatment, the disease can cause major complications if left untreated. It can cause cirrhosis of the liver or liver cancer. Barve, who also directs the Liver Cancer Program at the UofL School of Medicine, said hepatitis C is a leading cause of liver transplant.

Hepatitis C may predispose those infected to diabetes and depression, and it has an association with joint pain, regardless of the amount of liver damage.

The new center will see patients every weekday, and the hospital is expecting 2,000 patient visits per year, with space to expand as volume grows.