On the Cover
Coping with the influx of information that accompanies
a diagnosis can be overwhelming and frustrating for
patients. But how well health-care providers foster
understanding and build communication with their
patients is crucial. Solutions vary from expert to expert,
but researchers across the HSC are working toward ways
to improve health literacy and patient communication.
Illustrations by Anney Doucette.
Table of Contents
SEducation: Black history
SPatient care: Dance fever
Patient care: NICU for horses
SPatient care: Patients in need
SResearch: Fighting HIV/AIDS
SGifts: Donation for cochlear implants
SExtraordinary person: Supriya Dass
Cover story: Health literacy
SResearch: The science of pain
SResearch: Program for addicted doctors
Jacksonville: Dr. Simulator
SProfile: Linda Hayward
S* ** ** ** **** ** SS SS ** ** ** ** SS SS SS S S ** ** ** ** ******** SS * ** ** ** ** ** ** SS SSS****
In search of ...
This month, a search committee will interview seven finalists in line to
replace Senior Vice President for Health Affairs Douglas Barrett, M.D,
who announced his plan to step down last year. The committee, led by
Win Phillips, UF's vice president for research, will meet March 18-19 with the
following candidates: Cam Enarson, M.D., M.P.H., a visiting scholar at the
University of North Carolina at Chapel Hill; David Guzick, M.D., Ph.D., dean of
the University of Rochester School of Medicine and Dentistry; Eric G. Neilson,
M.D., chair of the department of medicine at the Vanderbilt University School
of Medicine; John R. Raymond, M.D., provost and vice president for academic
affairs at the Medical University of South Carolina; Robert C. Robbins, M.D., a
professor and the chair of cardiothoracic surgery at the Stanford University
School of Medicine; Martin P. Sandler, M.D., associate vice chancellor for
hospital affairs at Vanderbilt University Medical Center; and David Jonathon
Shulkin, M.D., president and chief executive officer of Beth Israel Medical
Center. For more information, visit www.health.ufl.edu.
-April Frawley Birdwell
Dr. Doug Barrett, UF's senior vice president for health affairs, announced
his intentions to step down from his position last year. This month, seven
candidates will interview on campus for the job.
12 j Ji iji http: news.health.ufl.edu
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JUST KICKING' IT
Spring is a time for new beginnings, and what better wayto start the season than by spending time in
the great outdoors for a good cause? Hosted by the the UF Student Occupational Therapy
Association and Horses Helping People Inc.,the Giddy Up Gators 5K Run/Walkwill be held from 8
a.m.to 11 a.m. March 21 atWestside Park. Proceeds will provide equine-assisted therapy to
individuals with disabilities. For more information, e-mail Elle Woertz at firstname.lastname@example.org. The Health
Administration Student Association will host the Kickin' itforthe Kids kickball tournamentfrom 9 a.m.
to 5 p.m. March 29 atthe T.B. McPherson Recreation Center ballfieldsto benefitAlachua County
Little League and promote healthier lifestyles for children. The tournament is open to the public. For
more information, e-mail Amber Frye at email@example.com.
Visit us online @ http://news.health.ufl.edu for the Ictest news Und HSC events 3
.. ............ ....'
By Jessica Metzger
frican-Americans have contributed much to the medical field
during the past few centuries, including many medical firsts.
neers like James Durham, Solomon down the stereotypes in television and the media.
ller and Charles Drew are not well- I'm hoping for more (changes) now with a president
lid Donna Parker, M.D., an assistant dean who looks different."
ity affairs for the UF College of Medicine, The cost of medical education and the
ecture on the history of African- expectation for African-Americans to finish college
is in medicine Feb. 12. Durham was the and help support their families, as well as a lack of
Physician to practice in the United scholastic preparation and community examples,
miller, who studied neurodegenerative have led fewer black students to pursue careers in
, was one of five scientists selected to work medicine, Parker said.
s Alzheimer. Drew founded and directed Racism is still a factor, too, said Parker, citing an
ican Red Cross blood bank. incident in 2000 at UF when police asked two black
the progress made in the past century, medical students to leave after finding them on
percent of medical students and doctors campus studying late one night. It was not until a
can-American in 2006, compared with 2.5 white classmate vouched for them that they were
S1910, according to a report in the Journal permitted to stay, Parker said.
rican Medical Association. But Parker said She also shared some of her own experiences of
eful that change is on the horizon, discrimination during her time as a medical
ve made great strides, but we have much student at UF.
row," Parker said. "We need to break
Parker remembered answering a question
correctly and being ignored by the professor, only
to have a white classmate give the same answer and
be praised for it. While a student at the Malcom
Randall Veterans Affairs Medical Center, she
recalled following her patient into the operating
room and being ignored when gloves were passed
to the others in the room.
Though not obvious signs of discrimination,
these omissions were hurtful, Parker said.
Annie Song, 21, a first-year medical student,
said many of Parker's points surprised her,
especially how the first black physician practiced
during slavery and how recently UF integrated.
UF's first black student was accepted into the
College of Law in 1958. The first African-
American physicians Reuben Brigety, M.D.,
and Earl Cotman, M.D. graduated from the UF
College of Medicine in 1970.
Parker said she thought the lecture was well-
"I hope it will stimulate people to think
differently and realize the many contributions
made by blacks," she said. 0
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Dancing class helps Parkinson's
patients rediscover movement
By Laura Mize
In her car outside UF's Orthopaedics and
Sports Medicine Institute, Judy Whitmore
was frozen. Unable to walk inside,
Whitmore was in danger of missing her
weekly dance class the one that helps her
defy the Parkinson's disease she has battled
for more than a decade.
"When my meds kick in I can talk and walk and dance like
anybody else," Whitmore explained. "At this point of the disease,
sometimes you don't know when they will kick in. Kelly and the
girls from the class came out with an office chair and wheeled me
into the building."
Once inside, Whitmore joined the circle of other Parkinson's
patients and their partners, raising their arms above their heads and
breathing deeply in and out. After a few minutes the quaking in her
arms had ceased. She grasped the armrests of her chair and pushed
herself up. Judy Whitmore the dancer was emerging.
Halfway through the hourlong class, Whitmore was following
classmate Larry Baird as he taught the group a line dance called the
Canadian Stroll. She said the breathing exercises and movement
helped her medication to take effect.
Whitmore and her husband Don have attended the Dance for Life
class designed for Parkinson's patients since it began in January.
They've been married for 38 years and dancing together for 45.
"The passion with the music, I think, is probably the thing (about
the class) that's most beneficial to everybody," she said.
Led by Kelly Drummond Cawthon, an associate professor in the
College of Fine Arts, students of a UF Dance Teaching Methods
course assist the Parkinson's patients and their partners during
class, teaching them dance steps and steadying them as they move
about the room.
"You see, quite often, when the patients come in at the beginning,
there are tremors and then you can see it quieting down," Drummond
Cawthon explained. "The joy relieves the symptoms. With the
rhythm and the movement ... dancing can't take (the disease) away
completely, but it can offer somewhere else (for them) to be."
Hubert Fernandez, M.D., says the class helps Parkinson's patients
largely by increasing their coordination.
"In Parkinson's patients, they're actually not very weak, but they
have a problem with stiffness and coordination," said Fernandez, an
associate professor in the College of Medicine department of neurology
and co-director of the UF Movement Disorders Center. Fernandez
also co-directs the Dance for Life class for Parkinson's patients.
The new Dance for Life program is a result of research that
indicates dancing can reduce symptoms and improve
quality of life of Parkinson's disease patients.
Doctors often instruct Parkinson's patients "to listen to music and
just march (with) the beat of the music, or sometimes we give them a
metronome and then they take their steps with the metronome."
Fernandez said exercise slows the advance of the disease and
dancing can help people with Parkinson's overcome bouts of
frozenness like the one Whitmore experienced. The class dance
steps and curriculum, he said, were designed to address specific
needs of Parkinson's patients.
"Music is part of us and it makes it now effortless when they
remember their dance step or they remember the music and then
just walk to it," Fernandez said. "It becomes second nature."
The class meets each Monday through April 29. Another session
will begin sometime after that. Fernandez said future classes will be
the basis of research on how dancing affects things like quality of
life, gait, fitness, depression and anxiety in Parkinson's patients
Whitmore is evidence that the benefits of the class are more than
just physical. For her, the youthful dancers beside her provide a lift
to the spirits.
"To see those young bodies move with such agility," she said, "it
just inspires us to get with it." 0
Visit us online @ http://news.health.ufl.edu for the Ictest news Und HSC events 5
A baby story
UF's equine NICU nurses foals (and their moms) back to health
By Sarah Carey
When Ocala resident Irene Bryan's
Appaloosa mare Skippa Secret
gave birth to a premature foal
last year, both mother and baby needed
immediate medical care. Thanks to
veterinarians at the UF Hofmann Neonatal
Intensive Care Unit, both horses survived.
"Our personal veterinarian, Dr. Andy Bennett, responded to
my call in the middle of the night," Bryan said. "Based on what
he saw after coming out and performing X-rays on site, he
recommended that we get both horses to the foal unit at UF as
soon as possible."
When Bryan arrived with her horses at UF's large animal
hospital, veterinary emergency team members were waiting for
them outside the facility with a gurney.
The foal was treated for eight days with antimicrobials and
supportive care for prematurity and sepsis. In addition, Skippa
Secret was successfully treated for a retained placenta. UF
veterinarians continue to monitor the pair's progress, although
both animals are successfully recuperating at home.
UF's equine neonatal intensive care unit, commonly referred
to as the "foal unit," was established in the early 1980s and was
the result of a unique partnership between veterinary specialists
and human neonatologists at the UF Health Science Center.
Neonatology research at UF has been funded by the Morris
Animal Foundation, Florida's Pari-Mutuel Trust Fund and the
Florida Thoroughbred Breeders & Owners Association.
The facility is staffed by board-certified specialists who can
provide immediate medical attention and handle any level of care
quickly. The foal unit is Florida's only equine neonatal ICU with
board-certified internists who provide round-the-clock care for
critically ill foals and their dams.
"We've (always) got the crash cart ready to go," said Dana
Zimmel, D.V.M., a board-certified internist specializing in
equine medicine and an assistant professor of large animal
medicine at UF.
Most foals treated at UF's foal unit are born prematurely or
are under a month old. Among the most common ailments
treated at the unit are bacterial infections, which can produce
clinical signs within the first 24 hours after birth or during the
first month of life.
The vast majority of cases seen at UF's foal unit are considered
"Primarily, we see foals with sepsis, or bacterial infections in
their bloodstream; foals that have diarrhea; or foals that have
problems because they suffer from hypoxic-ischemic
encephalopathy, or a lack of oxygen around the time of birth,"
Zimmel said. "Those foals, known as dummy foals, appear normal
at first and then within the first 48 hours of life they lose the
ability to nurse. They also lose their affinity for the mare and
often progress to not being able to stand and even experience
Many foals that have been treated for "dummy foal syndrome"
have gone on to become outstanding athletes, Zimmel said. Strike
the Gold, the 1991 Kentucky Derby winner, is just one example.
Thoroughbred breeding season takes place between Jan. 1 and
June 30, but occasionally foals will be admitted to UF in the fall
months, Zimmel said. The unit will accept patients from
referring veterinarians as well as from individual clients who
would like to bring their foals directly to UF's large animal
For Bryan's granddaughter, who witnessed much of the horses'
ordeal, the trip to the foal unit left quite an impression, too. The
9-year-old has decided she wants to become a veterinarian.
"The foal was a gift to my granddaughter so that she could
show her in halter competitions through 4-H," Bryan said. "She's
now spending a lot of time with the foal and hopes to learn more
about veterinary medicine because of this experience."
Anyone seeking more information about the foal unit should
call the large animal hospital front desk at 352-392-2229. O
UF's equine neonatal
intensive care unit
offers care to foals
suffering from a
variety of ailments.
I I ~- ~I~~r iiiii iiiiiiiii;iiiiiiiiiiiiiiiiii;,iiiiiiiiii I
The animals of
UF researcher speaks at conference
celebrating veterinary institute's history
By Sarah Carey
U F infectious disease specialist Tony Barbet has attended many professional
meetings in his 30-year career, but never anything quite like the
Onderstepoort Centenary Pan African Veterinary Conference and
Celebration, held Oct. 6-9 in South Africa.
The Onderstepoort Veterinary Institute's 100 years of existence was a big
enough deal that South Africa issued a special postage stamp in honor of it. Even
the country's president showed up as guest of honor.
"When South Africa was being settled, they needed animals for several reasons,
including transport in the region," said Barbet, a professor in the UF College of
Veterinary Medicine's department of infectious diseases and pathology who was
one of only two United States scientists invited to speak at the conference.
"As settlements began moving northward, all kinds of animal diseases were
discovered," he said. Many people who were moving northward lost a lot of their
animals; rinderpest wiped out most of the cattle in the country and African horse
sickness wiped out most of the horses."
Onderstepoort's first director, Sir Arnold Theiler, is known as the father of
veterinary science in South Africa. A veterinary bacteriologist who also was a
researcher, a teacher and an administrator, Theiler created a vaccine to combat
the dreaded disease of rinderpest in 1896. As a direct result of his efforts, the
disease was controlled in South Africa. Under Theiler's leadership, many local
diseases were researched and vaccines developed at Onderstepoort, which remains
an important part of South African academic and professional culture.
Among the guests at the conference were several of Theiler's descendants,
including his granddaughter, Elizabeth Theiler-Martin, daughter of Max Theiler,
College of Veterinary
Medicine professors Dr.
John Harvey (from left), Dr.
Dan Lewis, Dr. Antonio
Pozzi and Dean Glen
Hoffsis gather in the
laboratory dedicated to
the memory of Rob Parker,
a former faculty member
who died last year.
who won the Nobel Prize for developing a vaccine for yellow fever.
Barbet said he and Theiler-Martin struck up an interesting conversation. He
told her the West Nile virus vaccine for horses developed by UF researcher
Maureen Long, Ph.D., D.V.M., actually involves the insertion of West Nile virus
genes into her father's yellow fever virus vaccine.
"You can actually trace the origin of her West Nile vaccine back to Max
Theiler's vaccine since it is a combination of both viruses," Barbet said. "Ms.
Theiler-Martin did not know about this, and I'll bet Max wouldn't have thought
his vaccine would wind up being used in a vaccine that helped the United States
combat a different disease."
Barbet, whose research interest is in defining molecular mechanisms of
pathogenesis in tropical and emerging diseases, developing recombinant vaccines
and improving diagnostics, presented an abstract on "Persistence Mechanisms in
He hopes to cultivate future relationships with South African scientists,
hopefully through collaborations with the UF veterinary college.
"They actually have quite a need to train up some of their scientists in some of
the interests we have here at UF," Barbet said. 0
New orthopedics lab dedicated
to former faculty member
By Sarah Carey
n the first formal recognition of a collaboration that
has spanned more than 30 years, UF doctors who
treat both humans and animals came together on
campus recently to dedicate the new Comparative
Orthopaedics and Biomechanics Laboratory in memory
of the late Dr. Rob Parker, a former UF small animal
orthopedic surgeon who was killed in a car accident
The UF College of Medicine's department of
orthopaedics and rehabilitation's biomechanics
laboratory, formerly housed in the UF Health Science
Center, has been renamed to reflect the physician/
veterinarian collaboration and is now located in the UF
College of Veterinary Medicine's academic building.
More than 60 people from both colleges gathered to
hear brief presentations about the benefits of the
intercollegiate collaboration and tour the new lab.
Administrators from both colleges all said one key
advantage of the formal collaboration will be the ability
to submit stronger grant proposals.
"Many funding organizations clearly like to see
translational research across a university and this new
laboratory will clearly align the researchers from both
colleges to be better positioned to apply for certain
grants," Horodyski said.
Parker, whose name is on the plaque hanging outside
of the laboratory, had been a charter member of the
veterinary college faculty when the college opened its
doors in 1977.
"For 20 years, the name Rob Parker was synonymous
with small animal orthopedics in the state of Florida,"
said Dan Lewis, D.V.M., a professor of small animal
surgery at UF and longtime friend and colleague of
Parker's. "It only seemed fitting as we brought this joint
venture together that we dedicate the new lab in his
Visit us online @ http://news.health.ufl.edu for the Ictest news ind HSC events
Dental students teach migrant
workers about oral health
There is a group of hard-working
individuals about an hour outside of
Gainesville Hispanic migrant workers
who travel around Florida in a nomadic
existence, following the harvest crops and
wages, which are hardly enough to live on.
Because of their situation, these workers are essentially isolated from
the medical system. To help, Lucia Shaddox, D.D.S., Ph.D., an assistant
professor of periodontics, and a group of students from the Hispanic
Student Dental Association traveled in January to the Smith Farm
Migrant Camp in Spuds, Fla., where they performed free dental
screenings on uninsured migrant workers.
The St. Johns Migrant Information and Service Fair provides free
education and medical screenings to a group of about 80 Hispanic
migrant workers who spend the winter season in St. Johns County each
year. Many are uneducated and speak no English. The fair brings
together Spanish speakers, social workers and medical volunteers to
bring donated goods and supplies and to teach these people about basic
health and wellness. Other organizations at the event provide health
services such as free HIV screenings, blood pressure checks and
blood-glucose tests to screen for diabetes.
Barbara Llanes, a second-year dental student, first attended the fair
last year. She and fellow HSDA member Diley Perez distributed
toothbrushes and information to earn community service hours. They
wanted to do more and involve the rest of the club, so this year they
brought along two more members and enlisted the help of Shaddox,
their faculty adviser, to perform oral exams.
Of the patients they examined, 11 showed signs of periodontal
disease and three needed urgent care. The group had limited tools and
resources and weren't able to perform more complicated procedures
such as extractions and deep cleaning. Llanes said untreated conditions
like inflammation and gingivitis can be dangerous for the workers
because they could eventually affect their general health.
The workers have toothbrushes and many of them attend this
informational session each year, but they have no access to proper
medical care on a regular basis. The nearest dental facilities are more
than an hour away at UF, and none of the workers have the money or
insurance necessary for regular dental visits.
"I'm Hispanic, and I've gone through all of that, not being able to get
proper medical care and not having insurance," Llanes said.
Llanes was born in Cuba and moved to Spain with her family when
Dr. Lucia Shaddox (center) and Hispanic Student Dental Association members
(from left) Sophia Resposo, Diley Perez, Barbara Llanes and Carla Kontax
performed free dental screenings for uninsured migrant workers at the Smith
Farm Migrant Camp in January.
she was 9. When she first moved to the U.S. in 2000 she didn't have
medical insurance. She said she is glad she has the opportunity to help
and raise awareness about this population.
"To me it's more about giving back," she said. "That's where I came
from; I know what they're going through. That's what the club is about,
trying to help."
Although College of Dentistry students and faculty travel to
impoverished countries such as Mexico and the Dominican Republic to
help people each year, Shaddox said she thinks it also would help to
focus more efforts closer to home.
"Sometimes we forget that we have people living in the same
situation right next to us, and we need to do something about that,"
The next step for the club and the college is to arrange some way for
the workers to receive more extensive dental care. Shaddox plans to
speak with the college's administration about finding ways to serve this
population by either bringing them to another facility or sending the
school's mobile dental unit to this area.
"Right now this was just the first step, just the beginning of a long
road we have ahead to try to fix and help this population," she said. 0
18 ( lll i...ji;;;i,.;Il http: news.health.ufl.edu
Donation to boost
Jerry and Judith Davis donated $21 million
to UF Shands Cancer Center
By Karen Dooley
Eleven years ago Jerry and Judith Davis helped jump-start the UF cancer
program with a $5 million donation. On March 2, the university
announced that the Jacksonville couple has strengthened its commitment
in the fight against cancer with an additional $21 million gift to the UF Shands
The Davises gave $20 million to the College of Medicine to create the Jerry W.
and Judith S. Davis Cancer Endowment. The gift is the largest single donation
made to the College of Medicine, and it will be used to support teaching, research
and programs in cancer, with special emphasis on research in lymphoma, breast
cancer, bone marrow and gastrointestinal cancer.
Shands HealthCare also received $1 million for its Raising Hope Campaign to
support construction of the $388 million Shands at
UF Cancer Hospital.
S"Anyone who has been touched by cancer knows
that when it strikes, it affects not just the
individual, but everyone around that person," said
Jerry Davis, who has survived several bouts with
cancer and whose wife, Judith, is a breast cancer
survivor. "We are blessed to have some of the best
physicians in academic medicine today at the
University of Florida, and we want to retain those
outstanding physicians and attract more."
The couple's recent gift is expected to speed the
JERRYW. DAVISclinical translation of novel research findings into
developing new therapies and diagnostic tools.
Dr. Joseph V. Simone, director of the UFSCC,
said the "enormous" gift from the Davises will help
ensure that the Cancer Center has the resources
necessary for discovering better tools for treating
"All future patients will owe them a heartfelt
debt of gratitude," Simone said.
Jerry Davis, a private investor and 1968 graduate
of UF's College of Journalism and
Communications, has served on the Shands
HealthCare board of directors since 2001. He and
JUDITH S.D S his wife serve as co-chairs of the Shands Cancer
JUDITH S. DAVIS
Hospital fundraising effort.
The 500,000-square-foot Shands at UF Cancer
Hospital will house 192 private inpatient beds for a variety of patients and will
also include a critical care center for emergency- and trauma-related services.
One of every seven adults hospitalized at Shands at UF each year is treated for
cancer or cancer-related ailments. According to the American Cancer Society,
Florida is second only to California in cancer occurrence.
"It may not be in my lifetime, but I think in my children's or grandchildren's
lifetime cancer will not be the disease it is today," Jerry Davis said. "In 10 years it
should be much more controllable.
"I think the University of Florida will have a role in making that happen." 0
Dr. Jay Levy (left) said UF can play a role in addressing the HIV/AIDS
crisis in Latin America and the Caribbean. Here, Levy speaks with UF
professor John Dame.
Leading the charge
Distinguished researcher says UF poised
to help address HIV/AIDS in the region
By Czerne M. Reid
U F, with its scientific expertise and physical proximity to Latin America
and the Caribbean, is well-poised to help fight the spread of HIV/
AIDS in those regions, according to Jay Levy, M.D., one of the
discoverers of HIV, the virus that causes AIDS.
Levy visited UF during the annual meeting of the Florida Center for AIDS
Research, which is led by Maureen Goodenow, Ph.D., the Stephany W.
Holloway university chair for AIDS research at UF's College of Medicine.
The Caribbean has the second highest rate after sub-Saharan Africa of
people living with HIV/AIDS. In Latin America, one in 200 adults is infected.
Levy, whose group was the first to demonstrate that condoms reduce HIV
transmission, also discussed his work on a white blood cell product that can
block HIV replication.
HIV is the fourth leading cause of death globally and the leading cause of
infectious disease deaths. Thirty-three million people globally are infected
with HIV, and 2.7 million are newly infected each year, according to the
Kaiser Family Foundation.
"This is becoming and has now become the worst epidemic to hit
humankind," Levy said.
Levy's research involves determining why some people infected with HIV
survive for long periods without progressing to AIDS. Levy in 1986
discovered that a type of immune cell called CD8+ produced a protein that
suppresses viral activity. That research could fuel development of new
"I think it's going to be very important for HIV, but also for other chronic
viruses such as hepatitis C," said UF virologist James Maruniak, Ph.D.
Levy is collaborating with College of Veterinary Medicine professor Janet
Yamamoto, Ph.D., who co-discovered the feline AIDS virus and discovered
the feline AIDS vaccine.
Such UF advances could, in time, have a direct impact on HIV infection
rates in nearby countries, faculty scientists say.
"We're positioned geographically, and if we position ourselves professionally
to pursue that, we could have an impact on the epidemic in a part of the world
we have access to," said John Dame, Ph.D., chair of the department of
infectious diseases and pathology in the College of Veterinary Medicine. 0
Visit us online @ http://news.health.ufl.edu for the Ictest news 9
UF Audiology, foundation give the gift of hearing
The James W. Pickle Charitable Foundation donated money to the UF
College of Public Health and Health Professions audiology program to
provide cochlear implant upgrades for children and adults. Leslie Merian
(from left) said she would not have been able to get the upgrades for her
children Leah, Nick and Brooke Stanfield without it.
before receiving a cochlear implant at the
age of 3, Leah Stanfield would not talk,
remembers her mother, Leslie Merian.
Leah, now 14, her sister Brooke, 16, and brother Nick, 12, all have cochlear
implants and can now communicate with friends and family and hear noises
most people take for granted, like police sirens wailing and toilets flushing.
Thanks to cochlear implant upgrades the siblings received through a donation
the James W. Pickle Charitable Foundation made to UF's audiology program,
they can listen to iPods, talk on the telephone and hear video games, too. Nick
now attends a mainstream school with an interpreter instead of a specialized
school for children who are deaf.
The foundation donated $69,650 in 2007 to the UF audiology program,
providing cochlear implant upgrades for 14 children and adults, said Larry
Sacks, the foundation's executive director. The foundation's additional donation
of $45,000 in 2008 allowed for more new hearing devices.
"Our mission is to give grants for life-altering medical devices," Sacks said.
"We've found that the hearing department, and working with Dr. Holmes, has been
very responsive to finding us candidates who can benefit from our foundation."
A cochlear implant is a small device surgically implanted in the cochlea, the
part of the inner ear where sounds are translated into signals, said Alice Holmes,
Ph.D., a professor of audiology in the department of communicative disorders at
the College of Public Health and Health Professions. A microcomputer
processor worn outside the body picks up sound and converts it into an electrical
signal. That signal is sent through the skin into a receiver and then to the brain,
effectively creating sound.
"I've seen what cochlear implants can do to literally change the lives of adults
and children with severe to profound hearing loss," Holmes said. "Cochlear
implants can be a tool to allow a child who is born deaf to acquire speech and
language so that they can attend public school."
Cochlear implants open a new world of knowledge to children, said Lori
Lazarus, a speech pathologist at C.W. Norton Elementary who works with some
of the children who benefited from the donation.
"It's not that the kids are brighter, they have always been bright," Lazarus
said. "But now they have access to sound information."
Hearing helps children with reading because most words are easier to learn
phonetically, added Tina Kercheval, a teacher who works with deaf children at
C.W. Norton Elementary.
Upgrades are almost as important as the device itself, allowing the wearer to
hear more channels and levels of noise. Recent upgrades improvements made
to the external processor include a better signal for perceiving sound and
more cosmetic changes such as a smaller external pack and losing the cord that
runs from the ear to the processor.
Lazarus said students with these upgrades can now hear multiple channels of
noise, allowing them to overhear other conversations and effectively pick up
However, getting these upgrades was difficult. Upgrades are costly, about
$6,000 for one individual, an expense many families and those on Medicaid
cannot afford, Holmes said.
Lazarus and Kercheval wrote letters to Medicaid and the state asking for
funding to help their students get the upgrades but were told Medicaid and state
agencies could not cover the cost unless the children's devices were damaged
beyond repair, Kercheval said.
The children could not understand why they were denied the upgrades and
wrote letters to Tallahassee explaining their frustration, Lazarus says.
Kercheval and Lazarus knew the limitations of that option and were ecstatic
when presented with another choice.
"We chatted with the audiology department and found out about the Pickle
Foundation," Lazarus said. "They were touched by how much the kids wanted
Two of Lazarus and Kercheval's current students and two former students were
added to the upgrade list and received the upgrades around Christmas of 2007.
"It was the best Christmas present ever," Lazarus said.
Merian said her children are doing great both at home and in the classroom
since they received the upgrades.
"It's made their social lives and their self-esteem better," Merian said.
"They're more comfortable wearing it. They're not standing out in public like
they did before (with the cords). For the girls, that's a big thing."
Staff and students participating in the cochlear implant program include
surgeon Patrick Antonelli, M.D., and audiologists Holmes, Kristin Letlow,
Au.D., and Katherine Lingus-Gray, Au.D., as well as several speech pathologists
and about 40 doctor of audiology students who work in the program.
Merian said she is especially thankful.
"If it wasn't for UF Audiology and the foundation, (my children) wouldn't
have the upgrades," Merian said. "I could never have done it without them." 0
,1,I II t L"J
How a childhood tragedy
led this PHHP student to
By Laura Mize
upriya Dass knows what it's like to be burned.
A native of India, Dass was riding in a van in her hometown with her
classmates when a fire broke out. When she and the other girls managed
to escape the vehicle, bystanders hit them with coats to put out the fire. There
were no fire extinguishers, fire trucks or ambulances to come to their rescue.
Dass suffered third-degree burns and 15 of her classmates were burned.
"My hair was burned off completely," Dass said. "My face was burned to the
side. I had my legs burned and my hands."
She was 11 years old.
Dass spent two months recovering in the hospital, undergoing multiple skin
grafts and enduring an infection. She had to wear tight pressure garments for
about eight months to minimize scarring. She also required surgery to recover
some motion in her right pinky finger.
Today, Dass is a junior in UF's pre-occupational therapy program. She credits
the work of her two physical therapists, one of whom worked with her for eight
months at her parents' home in India to help her regain motion and strength, for
her astonishing recovery.
"I was able to go back to school and play sports and run and play basketball,"
Dass explained. "That's stuff... that I was afraid I wouldn't be able to do after
my accident, you know."
Spurred by her accident and recovery and inspired by the help she received in
therapy, she decided to pursue a career in health care. Dass moved with her
family from India to Chicago as a junior in high school four years ago, then soon
moved to Ocala. That's where she learned about UF and decided she wanted to
be a Gator. She began her college career planning to be a physical therapist.
But when Dass learned about occupational therapy in one of her introductory
classes, she loved the emphasis the field places on helping patients become as
autonomous as possible.
"Physical therapy's cool. You get back your range of motion and stuff like that,
but OT is more specific to living on your own and adapting and learning and
being independent. And I guess that aspect of it really, like, connected with me."
Dass sometimes observes occupational therapists working with children at
ACG Therapy Center.
Jill McCarthy, a therapist who works there, said Dass' own experiences as a
patient will be helpful in her future career.
"Supriya has shown great qualities of a health-care professional, as she is
inquisitive, enthusiastic and caring toward all staff members and clients,"
McCarthy said. "Supriya has openly shared her experience of being involved in
an accident in which she received burns to her body. In my opinion, Supriya's
personal experience of the rehabilitation process will be inspiring and
comforting to many of her future co-workers, clients and families."
This summer, Dass is hoping to land an internship at the Shriners Hospital for
Children in Tampa.
Ultimately, she wants to help people overcome the same challenges she did.
"Working with burn patients is definitely where my heart's at," she said.
"Patients will connect with you when you know what they're going through.
When you understand, there's that comfort level."
After she finishes her bachelor of health science degree she wants to earn a
master's degree in occupational therapy. Dass plans to apply to the program at
UF. She is currently a member of the university's Health Science Student
Organization and the Student Occupational Therapy Association.
Dass also has set several other goals for herself: to work in the United States
for a few years as an occupational therapist and then go back to work in India for
a while. She says she wants to open a nonprofit occupational therapy clinic in
India. Eventually, she wants to participate in a travel program for occupational
therapists, spending a bit of time working in many different countries. 0
Visit us online @ http://news.health.ufl.edu for the latest news Und HSC events
h health liteiacj mattej
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But since that Friday, when doctors detected a tumor just wider than
a quarter in her husband's brain, words like glioblastoma, radiation
and chemotherapy have become integral parts of her everyday
"At first, it felt like being punched in the stomach, you can't quite
catch your breath," remembers Stokes, a Citrus County middle school
guidance counselor who spends her weekdays in Gainesville while her
husband undergoes radiation therapy at the UF Shands Cancer Center.
"That weekend, I just started looking up brain tumors in general on
the Internet. I found some really good sites, informative without being
By the time she and her husband, Joseph "Cliff" Stokes, arrived in
Gainesville for his biopsy, Stokes had a good grasp of what was wrong.
Even still, there were questions the couple didn't know to ask when UF
neuro-oncologist Erin Dunbar, M.D., explained his condition and
discussed the options for treatment.
It doesn't matter whether a patient has a Ph.D. in chemistry or an
eighth-grade education, coping with the influx of information that
I2 l ,12,M l http: news.health.ufl.edu
accompanies a diagnosis like cancer can be overwhelming and
frustrating. To the lay person, the language of health care can be as
confusing as trying to comprehend how derivatives and securities
messed up the economy. The emotions and stress of health problems
don't make comprehension any easier. But how well health-care
providers foster this understanding and build communication with
their patients is crucial, experts say.
According to the Institute of Medicine, about 90 million adults in
the United States have what's considered limited health literacy,
meaning about half of the population lacks some of the skills or
background knowledge needed to navigate the health-care system and
make choices. Why does this matter? Studies show that patients with
low health literacy rack up more stays in the emergency room and
accrue more health-care costs than other patients.
Beyond that, the flow of communication and information between
provider and patient is key to empowering people to make their own
health-care decisions, says Jeffrey Goldhagen, M.D., a UF associate
professor of community pediatrics at the College of Medicine-
"This is so much more than just do they understand 'I am supposed
to take pills today,'" said Goldhagen, who studies children's rights in
health care. "In order to participate in generating health, an
individual needs to have access to information, has to have a voice,
has to be listened to and play a role in their own health development."
A variety of issues affect how patients obtain information, and the
traditional aspects of literacy, such as reading and writing, are just
minor facets of the problem.
Not all health-care providers take the time to build relationships
with their patients. Health settings can be intimidating. Because of
the Internet, information (some of it suspect) is ubiquitous, and news
reports about health care and research can lead patients to conflicting
conclusions. And because many people don't like to admit when they
don't understand something, people often avoid asking questions.
Solutions seem to vary from expert to expert, but researchers across
multiple UF colleges are working toward ways to improve health
literacy and patient communication.
"We can't leave people behind," said Elizabeth Shenkman, Ph.D.,
chair of the department of epidemiology and health policy research in
the College of Medicine. "It's a huge problem in this country. Frankly,
when I saw the statistic I was surprised. I never would have thought 90
million people (would struggle) with understanding health materials."
This concept of better understanding the needs of patients isn't
new, says Goldhagen, who describes health literacy as part of an
evolution in medicine that's been occurring over the past few decades.
Ensuring that patients understand their health care and are active
participants in decision-making is actually a patients' rights issue, he
says. In the past, doctors prescribed, patients obeyed. Now, the goal is
for patients to partner with providers and take charge of their own
care, from eating right to remembering to follow up on tests.
"We're in this together," says Sharon Bradley, M.S.N., a clinical
assistant professor of nursing. "It's not the health-care provider
telling the patient what to do, it's really a relationship. There is some
give and take."
In the month since Tracie Stokes' husband was diagnosed with
cancer, the gray folder has become one of her most valued possessions.
The folder, which Dunbar gave them, is stuffed with information on
her husband's medication, blood tests he needs, potential side effects
and symptoms as well as maps and other handouts.
But the folder is just a fragment of what Dunbar has done to
educate the couple and guide them through all of the decisions they
have had to make, Stokes says.
"She told us about clinical trials available all over the country,"
Stokes says. "We never felt pressured that we had to stay with her. She
helped us think through the whole thing ... and provided all this
information without making us feel like we didn't know anything."
Because of the complexity of her patients' cases and the vast
amount of information they need to make decisions about treatment
and clinical trials, Dunbar says she could spend a minimum of 20
hours with the typical family just getting them up-to-speed.
"You have to be able to explain to them not only what you think
will be in their best interest, but also about the alternatives and the
pros and cons of those alternatives," she says.
But as crucial as the task of arming patients with information is,
it's also difficult for an individual to manage alone, especially in a
health-care system where providers are increasingly asked to do more
"The era of a single provider being able to provide this information
in an office visit is over," she says. "We need a new model to get these
patients and caregivers ready."
Dunbar thinks a new type of team is necessary to meet patients'
information needs. She has partnered with Beth Layton of the HSC
Libraries and Gwen Lombard, director of the neurosurgery residency
program, to establish a pilot program that will embed a librarian in
neurosurgery to help doctors provide more personalized, in-depth
information to patients and resident physicians.
The goal of the project is to have the librarian, whose salary will be
funded by a Sewell Foundation grant, become a part of the health-
care team, working directly with doctors, trainees and patients in the
hospital, Layton says. They hope to have a push-cart with a laptop the
librarian can use in the hospital to help patients and residents get
more information on a case-by-case basis. Aside from helping doctors
unearth research and information for patients at the bedside, the
librarian will collect and compile reliable information in a Web site
HSC librarians are already developing.
"It's silly for each physician to be reinventing the wheel around the
College of Medicine," Dunbar says. "The library is by far the best
trained. They absolutely have the perfect situation to provide true,
high-quality information across the board. They are such an
Building a trusted Web site that can be a clearinghouse for
information is key, Lombard says, because often patients and family
members don't think of questions they want to ask until the middle of
the night. The group plans to study the project and the effects it has
on improving access to health information. If it works well, it could
be implemented in other departments.
"People aren't made with cookie cutters," Lombard says. "People
Visit us online @ http://news.health.ufl.edu for the latest news ind HSC events 13
have overlying conditions. You have to tailor a search for the patient, get
them the information when they want it."
Although health literacy is an issue for many patients in general, several
UF researchers are focusing on how communication and understanding
affect specific populations of patients, particularly those dealing with
chronic diseases such as diabetes and cystic fibrosis.
Jamie Pomeranz, Ph.D., an assistant professor of rehabilitation
counseling in the College of Public Health and Health Professions, is
working on a grant to assess the health literacy of parents whose children
are newly diagnosed with cystic fibrosis.
"You have new parents who have a child and find out that child has CF,"
he says. "They're thinking the worst and just trying to adapt to having a
child. When someone is talking to them, are they even listening?
"From a counseling perspective, we want to empower them. We try to
empower our consumers (so they) make their own decisions."
Another population UF is focusing on is cancer survivors, who must be
monitored not only for recurrence of their cancer, but also for effects of
their treatment that can occur years into remission, says pediatric
oncologist Patricia Shearer, M.D., an associate professor of pediatric
oncology and founding director of the university's new Cancer
Although the program includes all cancer survivors who have completed
treatment and have been cancer-free for at least two years, one of its
primary goals is to help young adults, who often have limited access to
care. About 80 percent of young adults become long-term survivors, but
transitioning from pediatric care to adult care can be a struggle. They also
face barriers such as obtaining insurance, paying for care and
understanding their own role in maintaining their health.
"It's crucial for the young adult cancer survivor to understand the type
of cancer and treatment they had and what the follow-up needs to be,"
Shearer says. "You would think survivors would know what they had, but
(often) they just don't. That's why the health literacy is so important."
To help develop more effective chronic care programs for these patients,
Shearer and Shenkman are planning a pilot project to gather data about
young adult cancer survivors' health literacy, coupled with other aspects of
"Cancer care is on a trajectory; it's very important to get a handle on
this," Shearer says. "We need to empower these young cancer survivors to
manage their medical and psychological issues that emerge once cancer
therapy is finished." 0
1I .141 I Ihttp: news.health.ufl.edu
Consumer medication information falls short,
By Laura Mize
ext time you pick up a prescription, take a
look at the pamphlet of information the
pharmacist hands you with your medication.
Is it easy to understand? How big is the
font? Can you distinguish the really
important information from the less
essential? All these factors affect the quality
and accessibility of the instructions and
other information consumers need to safely
take their prescription medicines.
The information comes from private
companies who collect and format the data
for pharmacies to distribute. According to a
recent study by Carole Kimberlin, Ph.D.,
and Almut Winterstein, Ph.D., UF College
of Pharmacy faculty members, much of this
information does not comply with U.S. Food
and Drug Administration guidelines for its
formatting and content.
The FDA does not have regulatory
authority over such information, so the way
it is presented varies from one pharmacy to
the next even for the same medications.
"In the late '90s, the FDA was on the
verge of implementing regulations that they
had generated to, well, to regulate the
content and the format of consumer
medication information that was given to
patients when they got prescriptions filled,"
Kimberlin explained. "Congress stopped
that regulation from going into effect and
said that they would leave it to the private
sector efforts but charge the FDA with
evaluating how well the private sector
In 2001, the FDA funded a study
conducted by University of Wisconsin
researchers that sent trained shoppers to
pharmacies across the country to fill
prescriptions for specific medications.
Pamphlets of information handed out with
the drugs were then evaluated by a group of
experts according to FDA standards for
things such as the comprehensiveness of the
information and its format. Non-experts also
evaluated the documents for consumer
Kimberlin, a professor of pharmaceutical
outcomes and policy, and Winterstein, an
assistant professor of pharmaceutical
outcomes and policy, conducted a similar
study in 2008, also with FDA funding, and
compared the results of the two studies. The
researchers presented their findings
Feb. 26-27 at a public hearing before the
FDA's Risk Communication Advisory
Committee in Washington, D.C.
"What we found was that there was more
content, more pieces of information included
in most of the information leaflets that were
given to patients," said Kimberlin, "but that
the formatting, the reading level, the font
size, how easy it is to read in terms of the
spacing between lines all of the
formatting that would make it more readable
and interpretable did not improve at all."
Even with the increase in information
present, some pamphlets did not include all
the vital content recommended by the FDA.
In addition, Winterstein said the increase
in information included is not necessarily
useful to patients or easily understood, and it
may actually hinder comprehension in the
long run. For some patients, she emphasized,
knowing how to properly use their
medications can be a matter of life or death.
"I think this is more a philosophical issue
of, you know, how much do you want the
government to regulate certain things?"
Winterstein said. "A private company will
only put as much effort financially into this
as requested or required. I mean some of
these leaflets are really bad, to say the least."
She said she hopes the research will
prompt policy change on the issue.
"The reality is our research shows that
after this has been in the private domain for
a decade now, it really is not up to what is
needed," she said. "So from that perspective,
I think the FDA has a good chance right
now that people will agree that having a
more prescriptive system would probably
Visit us online @ http://news.health.ufl.edu for the latest news ind HSC events 15
By Jessica Metzger
p ain is an epidemic in our world today, according
to Robert Yezierski, and the ways of treating pain
leave much to be desired.
As director of the Comprehensive Center for Pain Research at UF, Yezierski, Ph.D.,
coordinates activities that help create new research and training opportunities in the
pain research field, both locally and internationally.
S. ... The ultimate goal of the center's efforts is to find a way to better translate information
into more effective treatments for managing pain, said Yezierski, a professor in the
College of Dentistry department of orthodontics.
Yezierski recently received three grant awards for different areas of pain research in
his laboratory. The first, from the International Association for the Study of Pain,
provides $40,000 to Yezierski and a colleague in Denmark for their study on chronic
pain associated with spinal cord injury.
This grant allowed a student from Denmark to visit UF for two months, during which
time the researchers developed a new animal model for studying pain. The resulting research has provided a working theory about
how certain pathological factors contribute to the onset of chronic pain after spinal injury.
The preliminary findings from this research seem to indicate that spinal cord compression is a major contributor to the
development of chronic pain, Yezierski said. He hopes continued research in the area will give them a better understanding of the
physical factors that play a key role in the development of chronic pain after injury.
"In order to study different consequences associated with spinal injury, we need a model that simulates the clinical condition,"
Yezierski said. "We then study the anatomy, neurochemistry and the physiology of animals to see what kind of changes have taken
place and how these changes correlate with behavioral changes. It's a relatively simple paradigm but one that requires a lot of effort
to obtain results that we hope will have a significant clinical impact."
The second grant of $50,000 was awarded to both Yezierski and St. Charles Pharmaceuticals. The grant is being used to develop
new pain models and pain assessment strategies to test new drug formulas for treating chronic pain conditions.
The third grant, $275,000 from the National Institute on Aging, is being used to study the effects of age on pain sensitivity.
"It occurred to me when analyzing the demographic data that the segment of our population over the age of 50 is the fastest-
growing segment of our population," Yezierski said. "This, combined with the fact that the No. 1 cause of disability in the elderly
is pain in muscles and joints, made it clear that pain in the elderly was an area with many exciting challenges and opportunities
Yezierski said his lab's initial research investigated questions about increased sensitivity to temperature changes as one ages, the
relationship between aging, injuries and pain, as well as age-related differences in pain sensitivity between male and female rats.
"There are many questions we have to deal with clinically in the management of chronic pain in the elderly that we really don't
have answers to," Yezierski said. "We are all getting older and facing a lot of health-care challenges. Here at UF, we have a lot of
expertise related to the study of aging. Faculty at the Institute on Aging are helping us understand the aging process and in turn, we
are sharing with them our understanding of pain."
Yezierski said these grants are extremely vital to the continuation of research on pain, and he hopes for more support in the future.
"When you are successful in the competition for grant support, it allows you to expand the work you're doing and ask more
questions," Yezierski said. "More importantly, it allows you to bring in more people to work in the lab. The more people you have,
the more creative the research environment, which translates to more experiments and increased productivity. The grants we have
received will enable us to ask more questions that will hopefully allow us to get closer to identifying therapeutic targets that can be
used in the development of more effective treatment strategies for chronic pain conditions." 0
16 .l I,,Ml http: news.health.ufl.edu
Now hear this
Vitamins could offer daily
dose of hearing protection
Vitamin supplements can prevent hearing loss in laboratory animals,
according to two new studies, bringing investigators one step closer to the
development of a pill that could stave off noise-induced and perhaps even
age-related hearing loss in humans.
UF researcher and senior author Colleen Le Prell, Ph.D., reported the findings
Feb. 18 at the Association for Research in Otolaryngology's annual conference in
The supplements used in the research studies are composed of antioxidants -
beta carotene and vitamins C and E and the mineral magnesium. When
administered prior to exposure to loud noise, the supplements prevented both
temporary and permanent hearing loss in test animals.
"What is appealing about this vitamin 'cocktail' is that previous studies in
humans, including those demonstrating successful use of these supplements in
protecting eye health, have shown that supplements of these particular vitamins
are safe for long-term use," said Le Prell, an associate professor in the UF College
of Public Health and Health Professions' department of communicative disorders.
About 26 million Americans have noise-induced hearing loss, according to the
National Institute on Deafness and Other Communication Disorders, the agency
that funded the studies.
In the first study, UF, University of Michigan and OtoMedicine scientists gave
guinea pigs the vitamin supplements prior to a four-hour exposure to noise
similar to levels reached at a loud concert. Researchers assessed the animals'
hearing by measuring sound-evoked neural activity and found that the treatment
prevented temporary hearing loss in the animals.
In humans, temporary noise-induced hearing loss, often accompanied by
ringing in the ears, typically goes away after a few hours or days as the cells in the
inner ear heal. Because repeated temporary hearing loss can lead to permanent
hearing loss, the scientists speculate that prevention of temporary changes may
ultimately prevent permanent changes.
In a second study in mice, UF, Washington University in St. Louis and
OtoMedicine researchers showed the supplements prevented permanent noise-
induced hearing loss that occurs after a single loud sound exposure.
"Ear protection, such as ear plugs, is always the best practice for the prevention
of noise-induced hearing loss," Le Prell said. "But in those populations who don't
or can't wear hearing protection, for people in which mechanical devices just
aren't enough, and for people who may experience unexpected noise insult, these
supplements could provide an opportunity for additional protection." 0
Genetic tests may improve dosing of
widely used anti-clotting drug
information to more accurately
prescribe doses of a commonly used
blood-thinning drug whose potency and side
effects vary greatly from one person to the next,
reports an international team of medical
scientists including UF researchers.
Writing in the Feb. 19 issue of The New
England Journal of Medicine, researchers describe
how they developed a way to use information
about a patient's genetic makeup to determine
optimal doses of the anticoagulant warfarin, JULIE A. JOHNSON, PHARM.D
commonly referred to as a blood thinner.
An estimated 2 million new patients with heart conditions or other risk
factors begin warfarin treatment annually in the United States, making
warfarin one of the most widely prescribed drugs in the world. It is used to
prevent blood clots, which can lead to heart attacks, strokes or death.
"In this study, we used data from the largest, most diverse group of
patients to date to develop a method for using genetic information in
combination with other patient information to determine the dosage of a
very commonly used drug," said Julie A. Johnson, Pharm.D, who directs the
UF Center for Pharmacogenomics and is a member of the UF Genetics
Institute. "This is one of the top five drugs that cause hospitalizations for
adverse effects. The real value will be to patients getting warfarin therapy
prescribed for the first time."
On the basis of the findings, the National Institutes of Health announced
it will soon launch the largest multicenter, randomized clinical trial in the
United States to test whether a gene-based strategy for prescribing the initial
warfarin dose will improve patient outcomes. UF will be one of 12 centers
participating in this trial.
"Warfarin is a complicated drug to use because of its very narrow
therapeutic window," said Johnson, a professor and chairwoman of UF's
department of pharmacy practice. "It's a matter of balance. At one end there
is a clotting risk, at the other is a bleeding risk, and in the middle is where
we get the desired benefits from the drug. Finding the right dosage for a
patient can be very tricky."
The first of 1,200 anticipated participants in the clinical trial will begin
enrolling in March, according to the NIH. O
Visit us online @ http://news.health.ufl.edu for the latest news ind HSC events 17
Road to recovery
Special programs help doctors battle drug addiction
By Czerne M. Reid
Doctors who become addicted to alcohol and other drugs can be
treated successfully and returned to medical practice with the
help of special programs that couple referral to treatment and
monitoring with rapid responses to noncompliance, UF researchers report.
The study is the
analysis of such
confirms they are
to simply punishing
doctors. The findings
are published in the
March issue of the
Journal of Substance MARK GOLD, M
More than three-quarters of doctors enrolled in
state programs stayed drug-free over a five-year
monitoring period. The results were the same
regardless of whether the doctor's drug of choice
was alcohol, crack cocaine, prescription drugs or
"Treatment works," said Mark Gold, M.D., chair
of psychiatry at the UF College of Medicine and the
McKnight Brain Institute. "It has been shown now
to be safe and effective and cost-effective.
"It should be a model for treatment of anyone
with these diagnoses," said Gold, who with UF
colleagues pioneered evaluation and treatment for
In general, rates of illicit drug use are lower
among physicians than the general public, but rates
of prescription misuse are five times higher among
physicians, according to a 2008 review Gold
co-authored in the Harvard Review of Psychiatry.
Gold and others conclude that drug problems in
doctors are related to ease of access, stress, lack of
early detection and specialties that put them in
regular contact with drugs of addiction. Addiction
also appears linked to physician-suicide.
Physician Health Programs are not addiction
treatment programs, however. Instead, they provide
intensive, long-term case management and
monitoring. Doctors sign contracts agreeing to
abstain from drugs or face intensified treatment,
being reported to their medical licensing boards or
losing their license.
The programs aim to save the lives and careers of
addicted physicians and to protect the public by
addressing substance use among doctors. They are
also an effective way to remove noncompliant
doctors from the practice of medicine.
"This isn't to cover it up, it's quite the opposite,"
said David Baron, D.O., chair of Temple
University's psychiatry department. "It allows for
quality treatment and to make sure that we're still
ensuring the safety of the public." Baron, who
oversees Pennsylvania's program, was not involved
in the current study.
Program measures include group and individual
therapy, residential and outpatient programs,
surprise workplace visits from monitors and links
to 12-step programs of Alcoholics Anonymous and
Narcotics Anonymous. Doctor-patients get care not
only for drug problems, but also for accompanying
medical or psychiatric disorders. They pay for their
treatment, drug tests and follow-up care.
The research, funded by the Robert Wood
Johnson Foundation, evaluated 904 physicians
admitted to 16 state-run Physician Health
Programs from 1995 to 2001. Collaborators
included founding National Institute of Drug
Abuse Director and former drug czar Robert
Dupont, M.D., A. Thomas McLellan, Ph.D., of the
University of Pennsylvania, and Lisa Merlo, Ph.D.,
Previous studies have shown that in individual
states, and on a small scale, the programs are
effective. The current study, first reported at the
Betty Ford Institute, has the largest sample of
physicians ever followed and over the longest period.
Doctors in the programs had to abstain from
alcohol or other drugs and were tested frequently
for five or more years. If tests revealed they had
returned to substance abuse, swift action was taken
- doctors were reported to the medical board,
which could lead to loss of their licenses.
"It's the idea of a carrot and a stick," said Scott
Teitelbaum, M.D., director of the UF-run Florida
Recovery Center, which treats addicted physicians
referred from around the country. "There's always a
level of resistance people never feel they need the
level of care that's recommended. Someone might
not agree with you, but if they want to practice
medicine they have to comply."
Often, with the support of peers and growing
realization that treatment is working, physician-
patients' motivations change from simply wanting
to obey the rules to wanting to change their lives,
One-fifth of doctors were reported to their board
during treatment and monitoring some more
than once with multiple disciplinary actions taken.
But 78 percent of doctors in the programs had no
positive drug tests during five years of monitoring.
Five to seven years after starting treatment, 72
percent were actively practicing medicine, without
drug abuse or malpractice. O
1 1... I81 ,,.I http: news.health.ufl.edu
means longer life for
By Czerne M. Reid
transplant could depend on where he or
she signs up to get the surgery, new UF
The shorter the waiting time at a transplant
center, the longer patients are likely to live. A
combination of center-related factors could
mean up to a four-year difference in life
expectancy for candidates.
The UF study is the first to analyze overall
survival chances for people waiting for a kidneyE E S ,
transplant, rather than for people who had
already received a transplant.
"Patients want to know their survival long term, not just if they happen to
make it to surgery," said lead researcher Jesse Schold, Ph.D., of UF's College of
The findings are published in the February issue of the journal Medical Care.
Kidney transplantation doubles life expectancy compared with dialysis
treatment. On average, wait time nationally for a deceased-donor kidney is four
to five years, but in some states it is more than seven.
In 2007, at least 70,000 patients were on waiting lists for kidney transplants
at one of 240 centers around the country, according to the Organ Procurement
and Transplantation Network. Patients are prioritized by blood type, immune
system activity and other factors. The longer a person waits, the more dialysis
he or she gets, and the poorer the life expectancy.
Long waiting times for donor organs have led many people to seek
alternatives, some of which have raised ethics questions. One example in the
United States is a members-only organ-sharing "club" in which people who
pledge to donate organs get preferred access to donations from other members.
Internationally, there have been reports of people buying organs from live
The UF research evaluated data from almost 109,000 patients from a
national transplant database, using characteristics thought to have the greatest
impact on patient survival: waiting time, past performance of a center in terms
of patient death rates, proportion of non-ideal donors and number of deceased-
donor transplants a center does a year.
Waiting time had the strongest effect on survival once a patient got on a
transplant list. At centers with the longest wait times, patients' risk of death
was a third higher than at those with the shortest waits. 0
Hodgkin's disease survivors face
Shining increased breast cancer risk
By Czerne M. Reid
omen who as children got radiation
treatment for Hodgkin's disease are
almost 40 times more likely than others
to develop breast cancer, according to findings from
five institutions, including UF.
The higher the radiation dose, the higher the risk,
researchers report. These women are also likely to
develop cancer in both breasts.
"Our first priority is always to get rid of the ?
cancer. Our second priority is to do so in a way that "
preserves the best possible quality of life," said NANCY MENDENHALL, M.D.
researcher Nancy Mendenhall, M.D., an oncologist
with UF's College of Medicine who co-authored a
paper detailing the results in the September issue of the International
Journal of Radiation Oncology Biology Physics. "These findings tell us we're
moving in the right direction with recent changes in treatment that lower
In the past, children with Hodgkin's disease were treated with
radiation alone, in relatively high doses to large volumes of the body.
Today, doses are half the levels used 20 years ago, smaller portions of the
body are treated, and, in many cases, radiation has been replaced by
Hodgkin's disease is a cancer of unknown cause that affects tissue in
the lymph nodes, spleen, liver and bone marrow. In 2005, there were
almost 76,000 women in the United States who had a history of
Hodgkin's disease, according to the National Cancer Institute.
Death rates from Hodgkin's disease have plummeted by more than 70
percent in the last 40 years in the United States, and researchers now
focus on reducing the so-called "late effects" of treatment that show up
In the current study, 398 women younger than 19 who were treated for
Hodgkin's were evaluated from 1960 until 1990. They had been seen at
UF, the Rochester Medical Center, Boston Children's Hospital and
Dana-Farber Cancer Institute, St. Jude Children's Research Hospital or
the Sidney Kimmel Cancer Center at Johns Hopkins University.
Researchers found that women who had been treated for childhood
Hodgkin's disease were 37 times more likely than others to develop breast
On average, it took 19 years after treatment for cancer to develop.
Guidelines call for Hodgkin's survivors to start being monitored for
breast cancer 10 years after treatment or at age 30 whichever comes
Visit us online @ http://news.health.ufl.edu for the latest news and HSC events 19
UF physician leading the way
in simulation education
Dr. Steven Godwin is the medical
director of simulation education
at the UF College of
By Kandra Albury
They breathe, speak, bleed and even give
birth no, they're not real patients, but
lifelike mannequins known as simulators used
to train residents, nurses and other health-care
workers at the UF Center for Simulation Education
and Safety Research at the Jacksonville campus.
The center was formed in 1999 as a collaborative effort between the UF
College of Medicine-Jacksonville and Shands Jacksonville. A Department of
Defense grant was used to purchase the campus's first simulator. As the center
grew, simulation was incorporated into the resident education curriculum to
teach trainees how to treat important medical conditions.
Steven Godwin, M.D., a UF College of Medicine-Jacksonville associate
professor and associate chair of emergency medicine, oversees the high-tech
operation. As assistant dean and medical director of simulation education, he
was instrumental in bringing the center to the campus.
More than 70 simulators are housed in the 24,000-square-foot center on the
Shands Jacksonville campus, making it one of the largest simulation centers in
the country. With skin that can be pierced for injections or surgery, these
simulators mimic almost every type of illness or injury. Rooms are armed with
standard hospital equipment beds, electronic monitors and medical supplies
completing the sense of realism. The center also includes an operating room
and a disaster simulation area.
Godwin said what appeals most to many academic physicians about simulation
is the ability to train for specific conditions on demand and the ability to teach
less-used yet life-saving procedures. Using the simulation center also allows for
group learning, interaction and assessment.
"If I want to give a demonstration on the treatment of atrial fibrillation (a
disorder of the heart rhythm) but don't have a patient with that condition, I can
create that in the simulation center," Godwin said.
The center is primarily used by UF resident physicians training in emergency
medicine, internal medicine, obstetrics and gynecology, orthopedics, pediatrics
20 j "~ iii.J .ii.!'ii;":,I;:.I[
and surgery. The space is designed to merge the classroom experience with
simulated patient encounters, allowing residents to gain valuable hands-on
experience and exposing them to procedural training, crisis management and
diverse clinical situations.
Other health-care providers also receive training in the center. Nurses receive
simulation education on treating wounds, taking vital signs, locating veins and
administering intravenous medications. Paramedics train for mass-casualty and
disaster scenarios. The center also offers military combat medics and soldiers
training for low-trauma emergency, cases that they might see at supporting
civilian hospitals in a war zone.
Godwin received his medical degree from the Medical University of South
Carolina in Charleston, S.C. He came to the UF College of Medicine-Jacksonville
in 1994 for a residency in emergency medicine. When he finished, he was
recruited to join the faculty.
Constance Haan, M.D., a UF associate professor of surgery and senior
associate dean of educational affairs, said Godwin has led the journey into
simulation education and application of technology-enhanced learning at the
campus. She said he continues to be an innovative educator and an
"Dr. Godwin has a keen eye for identifying simulation opportunities to build
better team functioning and communication skills to deal with the challenging
interactions that occur in the face of a patient and family under stress from
injury or illness," Haan said. "Dr. Godwin is a leader in collaboration for
multidisciplinary teams on campus and for institutions and organizations that
wish to utilize simulation education. We are fortunate and proud to have him as
one of our education leaders."
Godwin's goals for the center are to meet the educational needs of university
programs. He envisions the center as a leader in curricular development for
medical education of residents as well as for continuing medical education for
practicing physicians and nurses.
Because of the highly developed training offered by the simulation center,
patients are the true beneficiaries, Godwin said.
"It is very rewarding to see our physicians and nurses trained using these
advanced simulators and to know that because of this technology, our patients
receive some of the best care in the region," he said. 0
I I ~- ~I~~r iiiii iiiiiiiii;iiiiiiiiiiiiiiiiii;,iiiiiiiiii I
Society selects UF faculty as leaders
/snley E. Doorn
By Kandra Albury
ix College of Medicine-Jacksonville physicians have new roles with
the Duval County Medical Society. At the society's annual meeting
Jan. 15, three faculty members were appointed to the board of
directors while three others were elected as officers.
The new officers include John W. Kilkenny III, M.D., an associate
professor in the department of surgery, who was elected president of the
society. Ashley E. Booth, M.D., an assistant professor and associate
program director for the emergency medicine residency program, was
elected vice president. Malcolm T. Foster Jr., M.D., an adjunct professor
in the department of medicine, was elected treasurer.
Appointed to the board were Daniel Kantor, M.D., a UF assistant
professor of neurology and director of the Shands Jacksonville
Mobeen Rathore David Wood
Comprehensive Multiple Sclerosis Program; Mobeen Rathore, M.B.B.S.,
a UF professor of pediatrics and associate chair of the department of
pediatrics; and David Wood, M.D., a UF associate professor of pediatrics
and medical director of Jacksonville Health and Transition Services.
Each physician will serve a one-year term.
During the same meeting, Kantor was appointed as an alternate
delegate to the Florida Medical Association, and he will serve on the
Northeast Florida Legislative Committee of the Duval County Medical
The society is a professional association of nearly 2,000 physicians
dedicated to ethical and high-quality medical care for the community. It
serves as an advocate for physician members and their patients. O
A company that cares
Magazine honors Jacksonville pediatrics department
| By Kandra Albury
Tnhe department of pediatrics at the UF College of Medicine-Jacksonville was chosen as one of
Northeast Florida's most community-minded companies by Jacksonville Magazine as part of its
Annual Companies That Care feature.
This is the second time the department of pediatrics has received this honor, having done so
previously in 2005.
j iii. [The department of pediatrics was honored at an awards luncheon held Jan. 29 at the Omni Jacksonville
V -2 hotel and was one of 30 companies featured in Jacksonville Magazine's January issue. Other companies
S_. honored include CSX, Publix Super Markets, Bank of America, Blue Cross Blue Shield of Florida and
According to the magazine, the department was selected because of its myriad community activities,
from carnivals to health screenings as well as its involvement in programs such as Patrons of the Hearts,
which helps children from across the world come to Jacksonville for surgery. UF faculty members donate
SI their time and services to help these children.
Thomas W. Chiu, M.D., chair of the department of pediatrics at the College of Medicine-Jacksonville,
said it was an honor to receive this award for his department's contributions to the community.
"This is an award that all University of Florida faculty, staff and students should be proud of," Chiu
said. "In competition with larger companies in our community, we may be 'small' but through our
dedication to children's services, we are able to provide much to Jacksonville. I am very proud of this
award and thank my faculty and staff for the well-deserved recognition." 0
Visit us orline @ http://news.health.ufl.edu for the latest news crd HSC evets 21
COLLEGE OF DENTISTRY
ANDREW JAKYMIW, Ph.D., a
research assistant professor in
the oral biology department,
recently received two grants
to fund research aimed at
developing RNA intereference-
based therapies for the
treatment of oral cancer. In July
2008, he was awarded a three- AndrewJakymiw
year, $375,000 new investigator
research grant from the Bankhead-Coley Cancer
Research Program at the Florida Department of
Health. In September 2008, Jakymiw received a
National Institutes of Health and National Institute
of Dental and Craniofacial Research award that
provides one to two years of mentored support at
$97,200 a year, followed by up to three years of
independent support contingent on employment.
SHANNON M. WALLET,
Ph.D., an assistant professor,
recently received a two-year,
$402,875 grant from the
National Institutes of Health to
fund a study on the regulatory
mechanisms of cyto/chemokine
expression that directly and
indirectly contribute to tissue
destruction and periodontal Shannon M. Wallet
disease progression. In November, she received a
$75,000 contract from Palmolive Corp. In 2007,
she received a three-year, $414,000 grant from
the American Diabetes Association to investigate
the role of gingival epithelial cells in innate
immunity of type 1 and type 2 diabetes.
Better than an apple ...
College of Dentistry
students recently selected
L. Jeannine Brady,
Ph.D., and Matthew
J. Dennis, D.D.S., as
the college's teachers
of the year, recognizing
L. Jeannine Brady excellence, innovation and
effectiveness in teaching the
dental sciences. Brady, an
associate professor in oral
biology, was selected as the
Basic Sciences Teacher of
the Year. Dennis, a clinical
associate professor oral
and maxillofacial surgery
and diagnostic sciences,
was selected as the Clinical
Matthew J. Dennis
Teacher of the Year. The
awards will be presented during the annual
American Student Dental Association banquet
April 25, and the winners' names will be
added to a plaque in Room D3-3. Later this
spring, Brady and Dennis will be honored as
part of a campuswide event.
Junior faculty receive -p
cancer research grant
Three junior faculty members from the College
of Medicine have been selected to receive
the American Cancer Society Chris DiMarco
Institutional Research Grant. Jacqueline A.
Hobbs, M.D., Ph.D., an assistant professor Jacqueline A. Hobbs Daniel J. Indelicato Li Zh
Hobbs, M.D., Ph.D., an assistant professor
of psychiatry and molecular genetics and microbiology; Daniel J. Indelicato, M.D., an assistant
professor of radiation oncology with the UF Proton Therapy Institute; and Li Zhong, M.D., an assistant
professor of pediatric cellular and molecular therapy, were awarded $30,000 in seed money for their cancer
research projects. The grant, directed byW. Stratford May, M.D., Ph.D., has been awarded three times
since 2000. The one-year grant funds cancer research projects in several areas, including basic science,
epidemiology, health policy research and clinical care, among others.
DANIEL KANTOR, M.D., an
assistant professor of neurology,
has been named president-
elect of the Florida Society of
Neurology. Kantor will serve a
two-year appointment starting
Sept. 11, followed by a second
two-year term as president. The
society's mission is to advance Daniel
the art and science of neurology
and promote the best possible care for patients
with neurological disorders.
MOBEEN H. RATHORE, M.D.,
a professor and associate chair
of pediatrics, has been appointed
vice president of the Florida
Pediatric Society, the Florida
chapter of the American Academy
of Pediatrics. The mission of the
Florida Pediatric Society is to
promote the health and welfare of Mobeen H. R
Florida's children and to support the
pediatricians and pediatric specialists who provide
their health care.
Pediatrics residents NAMITA
SHARMA, M.D. and
BHATIA, D.O., each received
a scholarship from the American
Academy of Pediatrics Friends
of Children Fund to attend
the 2009 Resident Advocacy Nia
Day Feb. 18 in Washington, Namita S
D.C. This year's event focused
on health-care reform. The
residents received advocacy
training and met with
congressional officers to discuss
legislative issues related to
COLLEGE OF MEDICINE Shimona Raikuma
LUCIA NOTTERPEK, Ph.D.,
has been appointed chair of the
department of neuroscience,
joining the growing ranks
of women who lead basic
science departments at major
university medical centers. A
UF neuroscientist since 1999,
Notterpek has established
a track record of scientific
discoveries that may impact future therapies
for brain diseases, especially those involving
the peripheral nervous system the vast
communications network that transmits information
from the brain and spinal cord to every other part
of the body. "Dr. Notterpek brings experience and
passion to lead the department of neuroscience
ahead in its mission to hasten the discovery
of treatments and cures for chronic and acute
disorders of the nervous system," said Dr. Michael
L. Good, interim dean of the college.
M. BRENT SEAGLE, M.D., an
associate professor and chief
of the division of plastic and
reconstructive surgery, was
elected president of the Florida
Association in January. This
marks the second time he
will serve as the association's M. Brent Seagle
president. The Florida Cleft
Palate-Craniofacial Association is a statewide
group of health-care specialists and parents who
welcome opportunities to help children with facial
anomalies. Seagle, who has been with the UF
department of surgery since 1986, also serves as
co-director of the UF Craniofacial Center.
PUBLIC HEALTH AND HEALTH PROFESSIONS
STEVEN GEORGE, Ph.D. P.T.,
an assistant professor in the
department of physical therapy,
received the John C. Liebeskind
Early Career Scholar Award
from the American Pain Society.
The award recognizes early
career achievements that have
made outstanding contributions Steven George
to pain scholarship. George will
receive the award in May at the society's annual
scientific meeting in San Diego.
ANNESHA LOVETT, Pharm.D.,
M.S., a student in the health
services research doctoral
program, received a fellowship
in health outcomes research
from the Pharmaceutical
Research and Manufacturers
of America Foundation. The
fellowship includes a $20,000
stipend to support her research
on a comparison of prescription drug plans offered
by Medicare Part D and the Federal Employees
Health Benefits Program.
Nicotine, sleep, SIDS, blood pressure ... for Linda Hayward,
it's just another day in the lab
By Laura Mize
Linda Hayward, Ph.D., is an associate
professor of cardiovascular physiology in
the UF College of Veterinary Medicine,
but the goal of her research is to help people.
Hayward's research focuses mostly on blood pressure and how it is
regulated by different body systems.
Her interest in physiology began with a focus on muscle and exercise
physiology, which stemmed from her years playing tennis in high school
and college. Hayward says she wanted to understand "how to become a
"For tennis, what is the difference in someone like (an) elite athlete
(such as) Roger Federer and an excellent player that doesn't make it to
that level? Some of it is related to brain interaction with sensory input
and muscle control," Hayward said.
One of her recent projects examines how exposure to nicotine in the
womb affects the body's management of blood pressure and the
Hayward says the research, which she has conducted with the help of
graduate student Carie Reynolds and David Fuller, Ph.D., from the
College of Public Health and Health Professions, shows that nicotine
exposure in the womb can affect a person for the rest of his or her life.
"It changes brain function," she said. "A lot of those changes are
Another result, she explained, is that body systems develop
differently. This seems to be linked to sudden infant death
"Our data suggest that the sleep system develops out of phase
with all the other systems," Hayward explained, "and that
probably contributes to the inability of these kids to arouse in
response to a physiological stimulus."
Not all children exposed to nicotine in the womb die of SIDS,
of course, but Hayward said such children may develop a different
set of problems as they grow.
"Instead of sudden infant death syndrome, (the) child is
thought to not awaken in response to low oxygen, and so they
sleep really well," she said. "And then it turns out, as they grow
older, the system regulating sleep has been chronically changed,
and it looks like when they become adolescents and adults that
they don't sleep well enough anymore."
Hayward says a lot of medical literature links poor sleep with
cardiovascular disease and that rats exposed to nicotine in the
womb "have a slightly higher blood pressure than the average rat
or a control rat."
This supports the idea that a malfunction in the sleep control
system, which controls other body systems, may cause changes in
blood pressure regulation. The next step in the research is to see
if moms with hypertension who smoke during pregnancy have
babies with blood pressure even higher than their own.
Together with Mohan Raizada, Ph.D., from the College of
Medicine, and Michael Katovich, Ph.D., from the College of
Pharmacy, Hayward has received a grant from the university's
Division of Sponsored Research to begin the work.
"We've started those studies and it looks like it indeed is true,"
she said. "So the question is: Is that a function of the interaction
between what the nicotine model changes and this hypertensive
situation, which involves this renin angiotensin system and
changes in the brain?"
Hayward also has supervised the work of Joslyn Ahlgren, a
Ph.D. student in physiology at the veterinary school, on how
exercise affects the body's response to blood loss. Hayward and
Ahlgren designed the study together.
Though Ahlgren is still compiling the data, findings so far
show that rats that exercise maintain a higher blood pressure after
losing blood than those that don't. They also return to a normal
blood pressure sooner than rats that have not been exercising, and
do not go into as severe a state of shock after blood loss.
Hayward said this research is important to help understand if
treatments for humans deemed to be effective in sedentary rats
would also work well for people who get a lot of exercise.
Ahlgren, who is in the final year of the program, said working
with Hayward has helped her develop better research skills.
"She is an excellent mentor for several reasons. She is highly
organized. I have definitely learned prioritizing and time
management within a research design. She's just very good at it." 0
Visit us online @ http://news.health.ufl.edu for the latest news ind HSC events23
Third-year medical student Jenn Johnson helped raise money at Buddha
Belly restaurant for UF's international trip to Chiang Rai, Thailand.
HealthNet held an open
house Feb. 11, offering an
opportunity to meet the staff
and try Cisco internet-based
phones. The HealthNet team
includes (from left) Rob
Snively, Jaime Iludain, Marie
Walker, Tom Livoti, Jason
Deleon, Stephanie Nunez,
Linda Sheets Hoffman and
College of Pharmacy students pose for a picture on their last day of pharmacotherapy class.
UF Health Science Center
Office of News & Communications
Senior Vice President,
Douglas J. Barrett, M.D.
News & Communications
Melanie Fridl Ross
April Frawley Birdwell
Melanie Fridl Ross, John Pastor
Kandra Albury, April Frawley Birdwell,
Jennifer Brindise, Tracy Brown Wright,
Sarah Carey, Karen Dooley, Linda
Homewood, John Pastor, Jill Pease,
Czerne M. Reid, Karen Rhodenizer,
Melanie Fridl Ross, Priscilla Santos,
Jessica Brandi, Jessica Metzger,
Cassandra Jackson, Beth Powers,
The POST is the monthly internal
newsletter for the University of
Florida Health Science Center, the
most comprehensive academic
health center in the Southeast,
with campuses in Gainesville
and Jacksonville and affiliations
throughout Florida. Articles feature
news of interest for and about
HSC faculty, staff and students.
Content may be reprinted with
appropriate credit. Ideas for stories
are welcome. The deadline for
submitting items to be considered
for each month's issue is the 15th
of the previous month. Submit
to the editor at afrawley@ufl.
edu or deliver to the Office of
News & Communications in the
Communicore Building, Room
UF Health Science Center
UNIVERSITY of FLORIDA