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Front Cover | |
Match Day 2005 | |
Parking decals | |
Dental clinic for special kids | |
Acupuncture for animals | |
Manatees' brittle bones | |
Oral bacteria found in arterie... | |
New drugs for bad bugs | |
Herbal drug interactions | |
Sex differences in health | |
Research | |
Education | |
Distinctions | |
Environmental health | |
Stem cell research | |
Small animal vet helps big... | |
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Front Cover
Page 1 Match Day 2005 Page 2 Parking decals Page 3 Dental clinic for special kids Page 4 Acupuncture for animals Page 5 Manatees' brittle bones Page 6 Oral bacteria found in arteries Page 7 New drugs for bad bugs Page 8 Herbal drug interactions Page 9 Sex differences in health Page 10 Page 11 Page 12 Research Page 13 Education Page 14 Page 15 Distinctions Page 16 Environmental health Page 17 Stem cell research Page 18 Small animal vet helps big time Page 19 Back Cover Page 20 |
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Sex Differences in Medicine10 UF Health Science CENTER IC E N T E R Deta clni Ne drg Mate ***ucator UP FRONT TABLE OF CONTENTS SPOST IT Parking Decals SPATIENT CARE Dental Clinic for Special Kids O PATIENT CARE Acupuncture for Animals RESEARCH Manatees' Brittle Bones Q RESEARCH Oral Bacteria Found in Arteries O RESEARCH New Drugs for Bad Bugs RESEARCH Herbal Drug Interactions 0 COVER FEATURE Sex Differences In Health ^15) EDUCATION Pharmacy College in St. Pete SDISTINCTIONS Genetics Home is Topping Out SADMINISTRATION Environmental Health @ PROFILE Small Animal Vet Helps Big Time TVLbch t6y 2005 UF senior medical student Amanda Aulls salutes St. Patrick's Day with the wearing' o' th' green as she takes aim at Gainesville in an annual College of Medicine tradition the Match Day pinnin' o' the map. Match Day, which coincidentally fell on St. Patrick's Day this year, celebrates a turning point in the fourth-year students' lives, as they learn where they'll spend the next several years of their medical training. Aulls, who will pursue residency in internal medicine and diagnostic radiology, is one of 99 graduating seniors and among the 34 who will train at Shands at UF in Gainesville. As part of the ceremony, held at Emerson Hall, each student placed a pushpin in a map of the United States to identify his or her destination. C2 POST IT What's Your View? f The American Cancer Society's Relay For Life will take place ELAY April 15 16 at the Stephen C. FOR LIFE O'Connell Center. SThe Society's signature- fundraising event involves teams of 10-15 people who take turns walking around a track for 18 hours to celebrate life and honor cancer survivors while raising money for medical research. Other events include games, food, fun, music and activities including a luminaria ceremony to honor survivors and those who are no longer with us. To participate you can: Form your own Relay for Life team by gathering 10 to 15 of your favorite people to have fun and make a difference. Donate Online -go to www.cancer.org/relayonline and select the UF event. You can donate to a team, individual, or even light a luminaria. Sponsor the event. Sponsorship opportunities are available for your organization or company starting at just $250 with great marketing opportunities. Volunteer to help with the needs at the site itself on the day of the event. Register as a Survivor If you are a cancer survivor, you can participate in kicking off the event and a reception. The Relay for life takes place in more the 4,200 locations nationwide. It raised $265 million in 2003. Going on 50 Get ready to celebrate. The big 5-0 is right around the corner. This autumn will mark the beginning of the colleges of Medicine's and Nursing's 50th anniversary celebrations. When these colleges opened in the fall of 1956, they were part of a well-orchestrated and farsighted plan that was unusual for the time: the creation of an academic health science center with six colleges, a common health sciences library and a central administration, now the Office of the Senior Vice President for Health Affairs. The events marking the 50th will include creation of a time capsule, special research day events, exhibits, and banquets, fairs and luncheons honoring alumni, faculty, donors, administrators, students and staff. The high point of these activities will occur March 9-11, 2006. Look for future updates on these activities in the POST and a soon-to-be-unveiled 50th anniversary Web site. The HSC has many pleasing views. This one is from a common area on the 4th-floor of the Public Health and Health Professions/Nursing/Pharmacy Complex. Send photos of your favorite HSC views to baltozer@ufl.edu. Soon to expire: your wheel clearance All UF parking decals will expire on May 1. Reorder by April 15 to receive a new decal in time to avoid those nasty parking tickets. You have three ways to reorder: Online at www.parking.ufl.edu where you can pay with a payroll deduction. By mail and make payment with a check. Trek on down to pay in person at the Transportation and Parking Services office. Find it at Gale Lemerand Drive (formerly North South Drive) and Mowry Road, Monday through Friday, 8 a.m. to 4:30 p.m. For additional information, please contact Transportation and Parking Services at 392-8048. 3 PATIENT CARE Dental clinic serves a rising tide of Medicaid kids By Adrianna Rodriguez arbara Sheets, a grandmother and medical foster mother, said she called more than 20 offices in Jacksonville trying to find a dentist to treat her grandson, Teddy, 10, a Medicaid patient who has Down's syndrome and asthma. "It isn't easy," said Sheets of the search for a dentist who would sedate Teddy for dental treatment. The College of Dentistry's department of pediatric dentistry, as part of North Florida's dental safety net, works especially hard to provide dental care for children on Medicaid, including to those who must be sedated during dental procedures. For children from low-income families, Medicaid's low reimbursement fees are a difficult hurdle to overcome in finding dental treatment. For parents with children with special needs, the search for treatment can be even more laborious. UF's College of Dentistry provides low-cost dental care to many of these children at college-operated clinics in Gainesville, Jacksonville, Hialeah and St. Aleigha Odom, 10, eagerly waits in the Pediatric Dental Clinic to receive dental sealants. "I love the dentist," said Aleigha. Petersburg, and through rotations in 13 community- based clinic partnerships. Through this Statewide Network for Community Oral Health, the college provides approximately 10 percent of all dental care to the state's low-income residents. Between the college's Gainesville campus clinic and the Eastside clinic alone, the university saw more than 7,200 children enrolled in Medicaid in 2003-04, about 13 percent of all its Gainesville patients. As options for treatment elsewhere dwindle, the demand at the clinics increases. "We are proud of what we have and the service we provide to the community," said Marcio Guelmann, D.D.S., an assistant professor and interim chairman of pediatric dentistry at UF. "We try to do our best to give response to the demand that we have." Because of his disability and fear of being in the dental chair, Teddy usually must be sedated before dental treatment can proceed. At the UF clinic, residents found a way to make Teddy comfortable enough to treat him without sedation, Sheets said. "He did an excellent job working with Teddy," said Sheets of Miguel Argumosa, D.M.D., the first-year resident who treated her grandson. "They truly know how to treat special needs kids." Many of the children who come to the clinic have been referred by private dentists because the patients might be jittery or have a disability that makes them difficult to treat without sedation. Sedations are complicated anesthesia procedures many doctors are either unable or unwilling to perform, opting instead to refer these patients to the university, Guelmann said. Despite the college's strong network of Kristiar clinics throughout Florida, UF struggles for Mi( to meet the growing demand for dental latest v care from underserved and low-income patients on Medicaid. At 8 a.m. on the third Friday of each month, Maureen Travers, the UF pediatric dentistry clinic's office assistant, opens the appointment book during "new patient call day." For two hours she schedules new patients for appointments up to two months in advance. She alternates between taking telephone callers and those parents or guardians waiting in line. Demand is so great that all the 250 to 300 new patient appointments available are booked by 10 a.m. Shirley Martin drove more than an hour from Live Oak and waited in line an hour and a half on the third Friday of November to make an initial appointment for her granddaughter, Aleigha Odom, 10, to be seen in January. Martin said she had not found any dentist closer to her who would see Aleigha, who is a Medicaid recipient. In fact, there are many other children in need of dental treatment who don't receive it at all. The U.S. Census Bureau estimated that in 2002 only about 21 percent of all Medicaid-eligible children in Florida actually received dental treatment. This low percentage is influenced by a dearth of n Lee Lajoie, 9, had no trouble sitting perfectly still guel Argumosa, D.M.D., a first-year resident, on his 'isit to the clinic for spacers. private dentists participating in the Medicaid program, according to Boyd Robinson, D.D.S., director of the Division of Community Based Programs at the dental college. "The access to care issue is really a resource issue," said Robinson. "We are not meeting the demand. The state of Florida is not meeting the demand. We are helping, but we are not meeting the demand." With Medicaid in Florida paying 35 percent of usual and customary fees, most dentists in private practice see few, if any, of these patients, Robinson said. The university's clinics are often the only place for them to seek treatment. To respond to the lack of participating dentists, the college is working to instill in its students and residents a sense of responsibility to improve access to care issues, said Guelmann. "We motivate our residents when they finish the program here to take Medicaid reimbursement, to see Medicaid patients, to respond to the access to care, not to say no to Medicaid, (but to) try to participate and help those kids that don't have other ways of getting treatments," Guelmann said. "If everyone does a little bit it will be much easier." Q4 PATIENT CARE Dr. Xie, center, with acupuncture interns Drs. Inbar Israeli and Tiffany Rimar, perform an electro- acupuncture procedure on Cheyenne. Acupuncture growing in popularity for treatment of horses, small animals By Sarah Carey Cheyenne, a mustang mare owned by Lana Haven, has a condition known as heaves, causing her breathing to become labored and rapid as the horse seeks to obtain more air. But since Haven began using UF's veterinary acupuncturist Dr. Huisheng Xie to treat Cheyenne last year, the mare's quality of life has improved, Haven said. "Traditional medicine has been challenged to control her symptoms, and the side effects of steroids can also cause debilitating problems such as laminitis and Cushing's syndrome," Haven said. Acupuncture has lessened the frequency of Cheyenne's breathing difficulties and allowed Haven to decrease the steroid use and its debilitating side effects. The growing popularity of acupuncture as a treatment for both horses and small animals is reflected in the rate at which the UF acupuncture service's caseload has increased about 20 percent per year since the service began with Xie's hiring in 1999. "I think this is because of more veterinary referrals, word of mouth due to great clinical results, and because pet owners love their animals so much and have been given no other options except the acupuncture approach," Xie said, adding that he sees, on average, 10 horses and 10 small animal cases per week. He sees his patients in the clinics at UF's Veterinary Medical Teaching Hospital on Mondays and Tuesday and he makes farm calls on Wednesdays. Occasionally, Xie has seen other cases besides companion animals and horses, including a rabbit, a bird, an elephant and a llama. Xie said acupuncture is used for three common problems in horses: lameness and musculoskeletal conditions; neurologic conditions; and diseases that do not respond well to conventional medicines, such as heaves, chronic diarrhea and skin problems. Small animals most commonly are treated for geriatric conditions such as osteoarthritis and tumors; endocrine conditions; and diseases such as skin problems, inflammatory bowel disease, congestive heart failure and chronic renal failure, all of which do not respond well to conventional medical treatment. "I believe that the best medicine is to integrate traditional western medicine and Chinese medicine," Xie said. "The traditional Western medicine is good at diagnostic and emergency. Chinese medicine is good at chronic conditions and prevention." Occasionally, Xie does encounter veterinarians who are skeptical about the benefits of acupuncture. "I smile, and go away," he said. Meanwhile, Haven is a definite fan. "I highly recommend Dr. Xie," she said. "It is an expensive venture to treat a horse with a diagnosis of heaves with acupuncture and herbal medicine, but we made the decision to try and give my mare as much quality of life as possible, so acupuncture and herbal medicine were the only routes left. Traditional Western medicine alone was not working." 0 Community Rounds delivers health education, services to area residents By Tom Nordlie Alachua County residents may find UF health screenings and information as close as their neighborhood or workplace, thanks to a new interdisciplinary service-learning program that teams UF student and faculty volunteers with private-sector professionals. Known as Community Rounds, the one-year pilot project presents monthly health fairs at local civic organizations, where participants can get blood pressure and vision screenings, dental exams and even advice on social services and legal matters, said Richard Davidson, M.D., M.P.H., a UF alumni distinguished teaching professor of medicine and one of the group's advisers and co- founders. "We hope to have done six to nine fairs by the end of spring," Davidson said. "We've had really positive response from the community agencies to hosting these sessions." One recent session took Community Rounds to The ARC of Alachua County, an agency serving developmentally disabled citizens. Others have occurred at health clinics and the St. Francis House homeless shelter. There is no charge to participants or hosting organizations. About 15 students from UF's colleges of Dentistry, Law, Liberal Arts and Sciences, Medicine, Nursing, and Public Health and Health Professions help lead the organization, making key decisions about scheduling and logistics for the health fairs, said Rhondda Waddell, M.S.W., an adviser and co-founder. In total, about 30 volunteers are active in Community Rounds, which holds monthly meetings at UF's Health Science Center. The program is funded primarily by HSC's Program for Interdisciplinary Education, part of the Office of the Senior Vice President for Health Affairs. Efforts are under way to make Community Rounds a more permanent feature of UF, Davidson said. He directs the Program for Interdisciplinary Education; Waddell is co- director. "We've had a great response from both the community and the students, and we're pleased to offer these kinds of services to our community partners," Waddell said. For more information, visit http://families.health.ufl.edu. iaineduJ " '''-- RESEARCH Manatee bone studies may influence public policy debate on boat speeds By Sarah Carey or the manatees who call Florida's coastal tributaries home, speeding boaters are like charging bulls in an underwater china shop. UF researchers have discovered that despite the placid sea cows' huge size, their bones are actually as brittle as some porcelain plates. That may make them even more vulnerable than anyone thought to suffering life-threatening injuries in a collision. Manatees like this one have brittle bones that increase their risk of injury. Boat strikes are the leading cause of manatee deaths in Florida, but until now scientists haven't understood the mechanics of what happens to the endangered marine mammals when these deadly accidents occur. The surprising finding could ultimately change public policy for the management of Florida's waterways, said Roger Reep, Ph.D., a professor in the College of Veterinary Medicine's physiological sciences department. "When you pick up "When you pick up a manatee rib, it's much denser than a cow bone or a denser than a cow human bone," Reep said. "Most people would think these ribs would be really Most people would strong, as they're so heavy. But in fact they behave like a ceramic material. We be really strong, as feel this information will contribute fact they behave lit significantly to our understanding of manatee-boat interactions, and will be critical in establishing boat speed zones adequate to minimize the chance of fatal impacts." Manatee bones have no marrow cavity, which is why their bones are so dense. That density makes manatee bones fragile and more likely to break than most other types, with fractures occurring more or less along straight lines as opposed to being dispersed within the bone, Reep said. The typical manatee rib weighs a mc bone think they e ac about 2 pounds and has a higher mineral content than other types of bone, researchers also found up to 70 percent compared with 65 percent. While the difference seems small, it apparently translates into large changes in mechanical properties, they said. Additional findings from the ongoing project, which mingles veterinary physiology and engineering expertise in a first-ever effort to describe the biomechanics of impact injuries, will be published in an upcoming issue of the Journal ofBiomechanics. UF scientists will also discuss the study April 9 at the UF-sponsored Marine Mammal Medicine conference in Gainesville. Using an air gun to hurl a 2-by-4-inch board toward a manatee bone target, and strain gauges to measure load at the moment of impact, the researchers are able to reconstruct the way various forces are distributed through the bone. "You can actually measure the amount of energy that was propagated through the bone just by looking at the geometry. What we're doing is getting an idea of the amount of energy it takes to break a bone," said Reep, who has teamed with Jack Mecholsky, the study's other principal investigator and a professor and associate chairman of the department of materials science and engineering at the College of Engineering. They are working on the project with UF graduate student Kari Clifton, who began the study as part of her dissertation research in 1998 with funding from UF's Marine Mammal Medicine Program. The force applied by a boat to a manatee during impact depends primarily on boat speed, but also on variables such as the size of the boat, researchers said. "One thing we're not sure about yet is how much of the force of the boat actually reaches the ribs, since manatees don't get hit directly on the ribs, but rather on the soft tissue covering the ribs," Reep said. "This is an unanswered question." Manatees, listed as an endangered species by the federal government since 1967, are large, slow-swimming, gentle mammals that are entirely aquatic. natee rib, it's much Only about 3,000 manatees remain in the wild. Most are concentrated in SOr a human bone. Florida, but can be found in summer months as far west as Texas and as far these ribs would north as Virginia. West Indian Smanatees can also be found in the 're so heavy. But in coastal and inland waterways of Central ceramic material." America and on the northern coast of South America. Roger Reep. Ph.D. Human activities are the major threat to their survival through boat-related injuries and deaths, habitat loss or degradation, and, in some countries, hunting, according to the U.S. Geological Survey's Sirenia Project. Officials have documented 5,329 manatee deaths in Florida from 1974 to 2004, of which 1,164 were attributed to watercraft collision, according to the Florida Fish and Wildlife Conservation Commission. 0 C6 RESEARCH Live oral bacteria found in arterial plaque By Lindy McCollum-Brounley um disease has been linked to hardening of the arteries for nearly a decade, and scientists have long fingered a gang of oral bacteria as the obvious suspects behind many cases of the vessel-clogging killer. Now UF researchers have cornered the bacterial ringleaders of gum disease inside human artery-clogging plaque the first concrete evidence to place the pathogens at the heart of the circulatory crime scene. Their report appears in the current issue of Atherosclerosis, Thrombosis and Vascular Biology. "Our finding is important because it has proved there are live periodontal bacteria in human atherosclerotic tissue," said study investigator Ann Progulske- Fox, Ph.D., a professor of oral biology at the College of Dentistry. "Now we can begin to understand how these bacteria contribute to the disease process." The oral bacteria UF researchers found in the plaque, Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans, are two of the most aggressive offenders in periodontal disease, the leading cause of adult tooth loss. Because of the strong association between periodontal and cardiovascular diseases, scientists have postulated for years that oral pathogens contribute to arterial damage that leads to heart attack or stroke, which kill nearly a million Americans a year. In fact, a recent study conducted elsewhere found a direct correlation between the amount of periodontal bacteria in the mouth and the formation of blockages in the carotid artery in the neck. To reach the circulatory system, the bacteria have to breach the barrier between tissues in the mouth and the bloodstream, Progulske-Fox said. For patients with periodontal disease, whose gums are inflamed and bleed easily, bristles from even the softest toothbrush can tear tiny blood vessels in the compromised gum tissues, leaving the door wide open for bacteria to enter. But could the bacteria elude the body's protective immune response once within the bloodstream? Researchers worldwide have sought to empirically nab oral bacteria dead or alive in atherosclerotic tissues. They have found remnants of bacterial DNA in arteries, signaling that bacteria had entered the bloodstream. Yet scientists have never been able to grow periodontal bacteria isolated from arterial plaque in Petri dishes, even though the same species of bacteria swabbed from oral plaque can be cultured that way. Therefore, researchers could not be sure the DNA was from bacterial trespassers destroyed by the immune system in the bloodstream, or if live bacteria were actually directly involved in plaque formation within the vessel walls. Progulske-Fox and her team found the endothelial cells were infected with both P. gingivalis and A. actinomycetemcomitans, proving live bacteria had been present in the atherosclerotic plaque. "This report certainly provides a smoking gun that live bacteria have become seeded from the oral cavity to become inhabitants of the vessel wall," said Steve Offenbacher, D.D.S., Ph.D., distinguished professor of periodontology at the University of North Carolina at Chapel Hill School of Dentistry. "The exciting implications focus on the known ability of these bacteria to destroy connective tissue in the mouth, suggesting that when infecting the vessel wall they may contribute to the instability of the atherosclerotic plaque leading to acute events such as heart attack or stroke." Progulske-Fox plans to study atherosclerotic tissue samples from 50 to 60 more patients to better understand how bacteria infect arterial cells. She suspects some strains of the bacteria may be more successful in breaching the barriers separating oral tissues from the bloodstream. These bad bugs would become "most wanted" in the fight against periodontal and cardiovascular disease. "More study samples will show us which strains are implicated in the disease process, so we can design simple diagnostic technology that could be used in a dental office to identify specific bacteria the patient is carrying and whether that bacteria is known to cause atherosclerotic disease," said Progulske-Fox. She envisions those diagnostic tests would be the first step in the war against periodontal and cardiovascular diseases, eventually leading to the development of a vaccine that would prevent oral bacteria from ever gaining a stronghold in the mouth. Antibiotic or antimicrobial treatments that could kill the bacteria after they have entered the circulatory system might also someday be possible. For now, however, she advises people to practice good oral hygiene. "It is important for these patients to have very good dental hygiene," said Progulske-Fox, "because losing a tooth may not be a big deal to some people, but it can become a life-threatening situation." 0 Ann Progulske-Fox demonstrates the culture method used to find oral "'t pathogens in ai teral plaque Diseased artery tissue was liquified and placed in a culture flask with healthy artery cells and culture media, seen here as the clear pink liquid within the flask After a 24-hour incubation period. the cells in the broth were found to be infected with bacterial ,pathogens P gingivalis and A .--actinornyceterncornitans K "n m 7 la tb RESEARCH New drugs for bad bugs: UF approach could bolster antibiotic arsenal By Melanie Fridl Ross Call it a chemical crystal ball. A new approach to predict whether a drug in development is likely to work and which dose is best could get antibiotics to market faster and more cheaply, say UF researchers. In recent years, scientists worldwide have sounded the alarm: There simply aren't enough drugs to combat bad bugs. Bacteria are increasingly adept at outwitting the traditional antibiotic arsenal. Yet designing and testing new antibiotics can be a maddeningly slow and costly process if pharmaceutical companies even bother, says Hartmut Derendorf, Ph.D., chairman of the department of pharmaceutics at the College of Pharmacy. Many would rather invest in compounds aimed at patients with chronic conditions such as high cholesterol or diabetes, not in drugs designed to be used for a week or two and then stopped once an infection clears, he said. Now UF researchers have devised a patent-pending method that combines testing of various drug concentrations "About one new anti at the site of infection with a series of laboratory analyses and mathematical approved. That's cert models designed to streamline drug development. The method helps better determine which drugs are worth studying in people and at which dose, avoiding the typically lengthy and expensive trial-and-error approach that can take years. "About one new antibiotic a year is approved," said Derendorf, who discussed the technique March 5 at the annual meeting of the American Society for Clinical Pharmacology and Therapeutics in Orlando. "That's certainly not enough. Even more worrisome, there are very few in the pipeline right now. Meanwhile, the requirements are getting longer and longer, and this is a huge dilemma with the recent discussion about Vioxx. That's created some doubt in the approval procedure. I think we have to come to a reasonable expectation here in terms of the balance between benefits and potential harm. The worries I have right now are because of these unrealistic expectations, the requirements are going to be even higher and it's going to be harder and even more expensive to bring a new drug to market." About 70 percent of bacteria found in hospitals resist at least one of the drugs commonly used to treat the infections they cause, according to the Food and Drug Administration. The agency warns that unless problems are detected early and swift action taken to find substitute drugs, previously treatable diseases could again emerge in more virulent forms. Public health officials cite antibiotic resistance as a growing problem for a host of diseases, from childhood ear infections to malaria. Last year, the FDA published a report calling attention to inefficiencies in the drug and medical product development process, urging changes to make the process "more predictable and less costly." The latest estimates put the cost of bringing a new product to market at $1.6 billion to $1.8 billion. UF researchers are working on an approach known as PK/PD, which combines principles of pharmacokinetics, or an analysis of drug concentrations in the body, and pharmacodynamics, their effect on bacteria or how a drug kills bacteria. "In the past, blood samples were taken and the serum concentration of the drug was measured and that number was used to make dosing decisions," said Derendorf, whose work is primarily funded by the pharmaceutical companies Pfizer and Sankyo. "That may not always be the right place to look. Most infections are not in the blood but in other sites of the body. Some of the recommendations we have may not be the optimal doses." UF researchers have developed a patent-pending technique called microdialysis that uses a small needle probe to measure how much of a drug actually ends up in the fluid surrounding the bacteria at sites of infection and are among the first in the country to test the method in people. These concentrations can differ widely from those found in the bloodstream. In the past, microbiologists would expose bacteria to certain concentrations of an antibiotic and then determine the minimum concentration that prevents bacterial growth. That number was taken and compared with concentrations of the drug in the blood, and from those two numbers a dosing decision is made. But the )io ai tic a year is approach doesn't reveal how quickly bacteria are killed. nly not enough." So UF scientists developed a system of pumps they can use to expose bacteria to Hartmut Derendorf, Ph.D. changing concentrations of an antibiotic, mimicking the concentration profile present in a patient at the actual site of an infection. They then measure how quickly the bacteria are killed or see if they regrow, and use mathematical modeling to estimate the optimal dose. "Based on the results in the lab, then you can do I q , a clinical study of what you think is going to work best," Derendorf said, "and you'd find the best dose much faster than just by going by trial and error or by using some of the traditional ways." i Dr. Hartmut Derendorf is a ., distinguished professor and chairman of the - department of pharmaceutics. Q8 i. RESEARCH Type 2 diabetes patients warned to avoid herbal supplement By Linda Homewood Patients taking the prescription drug Avandia to control type 2 diabetes ,h..h ild not take the herbal supplement St. John's wort. That was the take- h..me message at the annual meeting of the American Society for Clinical I'harmacology and Therapeutics. At the March meeting in Orlando, Reginald Frye, Ph.D., an associate professor at the College of Pharmacy, presented his research findings that St. John's wort caused 9 the popular drug to be metabolized 35 percent faster, which means there is less of the drug in the body to control blood sugar levels. v 11 ^ A new class of prescription drug rosiglitazone known by the Is 'woo trade name Avandia-on the market since 1999 has quickly Become a preferred drug treatment for type 2 diabetes, listed among Sthe top 60 of all drugs prescribed in the United States, said Frye. "Many patients with diabetes turn to alternative therapies such as herbal products," said Frye. "They may not be aware of the Ed supplement's effect on their prescribed medicine." The study, conducted with 27 non-diabetic subjects taking rosiglitazone together with St. John's wort, focused on four out of seven known genotypes. The other three genotypes are not very common, said Frye, who is the associate director for the UF Center of Pharmacogenomics. Blood samples taken periodically over a 24-hour period showed consistent results in each of the genotypes studied. In all cases, there was a 26 percent reduction of the prescribed drug concentration in the subject's blood. The American Diabetes Association reports that more than 18 million people in the United States, or roughly six percent of the population, have diabetes. The type 2 variety accounts for 90 percent of all diabetes. O Gene analysis to help trauma patients on the horizon A genetic tool with the potential to identify which trauma and burn patients are most likely to become seriously ill has worked consistently in a wide range of experimental clinical settings an important hurdle to overcome before the method is routinely used in emergency rooms and intensive care units. In a report published in the Proceedings of the National Academy of Sciences, researchers from eight institutions, including UF, describe how they were able to consistently analyze which genes are active in patients with serious infections or traumatic injuries. Researchers want to understand the genetic features that enhance a patient's recovery as well as the elements that cause people to die sometimes weeks after an injury occurs. Identifying those factors could help physicians choose the best treatment, a decision that could mean the difference between life and death, according to UF Genetics Institute scientists. "The vast majority of patients who experience severe trauma or burn injuries actually do well," said Lyle Moldawer, a surgery professor in the College of Medicine. "They're resuscitated at the scene, taken to the hospital, have an uneventful recovery and they're discharged. But there's a certain fraction who go on to develop complications that lead to organ failure and death, which is the most common cause of death after traumatic injury sepsis and multisystem organ failure. So the goal is to use functional genomics as a tool to identify those patients who, after severe trauma and burn injury, will go on to manifest this multisystem organ failure. It's a way to better characterize the nature of the immuno-inflammatory response to trauma." Traumatic injuries claim hundreds of thousands of lives each year in the United States. In addition, millions of patients are hospitalized, at an annual cost to society of more than $200 billion. Patients may face a long and difficult recovery period riddled with many potentially fatal complications along the way. Genomic analyses took place at UF, the Stanford Genome Technology Center and Washington University in St. Louis. Overall data analysis was based at Massachusetts General Hospital at Harvard Medical School. John Pastor Effian1ji 9 MKX--- Police checks chill alcohol sales to minors Carloads of young people have been slipping on flip-flops, icing down the beer and heading to warmer climes for the annual ritual of alcohol-fueled partying known as Spring Break. The participants include many college and high school students under the drinking age who all too often are able to purchase alcoholic beverages illegally. Now new research shows law enforcement authorities trying to shut off the tap might be wise to step up the patrols year-round, not just during Spring Break, report UF and University of Minnesota researchers in a recent issue of the journal Addiction. Findings from their five-year national study reveal that police checks of establishments that sell alcohol strongly deter sales to minors, and are even more effective when repeated as often as every three months. The researchers also found that these checks, in which an underage buyer attempts to purchase alcohol without showing identification and violators are cited, work far better than programs that train staff at bars and restaurants to identify and refuse service to minors. "We found that enforcement has significant effects, but just like enforcement against any offense, you can't just do it once and think it solves everything," said Alexander C. Wagenaar, Ph.D., a professor of epidemiology and health policy research at the College of Medicine. "We have to create an ongoing perception on the part of the managers and owners of these establishments that they have a decent chance of getting caught if they sell to teenagers." Tom Fortner COVER STORY THE X-FACTOR: Sex differences in medicine By Denise Trunk At least once a year Layla Skelton, 77, pulls up a chair to an inch-thick packet of forms and sets to work. She isn't trying to meet an IRS deadline, but the documents are every bit as important to her. She painstakingly answers questions about her diet, fitness and responses to medical treatments something Skelton has done every year for the past 10 years as a participant in the Women's Health Initiative. The health of the next generation of women depends, to an extent, on Skelton and thousands of others like her. Until recently, women have largely been viewed through a prism defined by middle-aged white males and their ailments. But in the past 10 years, medical professionals have intensified efforts to understand how biological differences between the sexes are revealed in disease symptoms, diagnosis and treatment. "This is the first time for such a long-term study for women," Skelton said. "I'm all for it. This might help future generations. I think it is wonderful." THERE IS A DIFFERENCE Leading killers such as heart disease and cancer act differently in women than in men. In fact, scientists have found dramatic to subtle health differences between the sexes in everything from the progression of HIV to AIDS to the perception of pain and response to pain medication. UF researchers from many fields, many of whom are affiliated with the Women's Health Research Center, are studying sex differences to find clues to the mechanisms underlying disease states. The ultimate goal: to attain new preventive, diagnostic and therapeutic practices for the benefit of women as well as men. "It is clear the issue cuts across medical disciplines," IF Dr. Marian Limacher said Mary Ann Burg, Ph.D., director of the WHRC and an associate professor in family health. "Areas of c - focus here at UF are in the differences in women's disease outcomes and in the way women utilize the health-care system as compared to men, and also in illnesses involving the i j autoimmune and cardiovascular systems." While researchers While resarcerLayla Skelton and her nie acknowledge reproductive sex hormones play a key role in these sex differences, they say genetic, environmental and experiential differences also contribute. Doctors believed heart disease to be one medical condition against which women were protected by their hormones. In 1993, a now-historic long-term study of postmenopausal women, established by the National Institutes of Health and the National Heart, Lung and Blood Institute, began at medical facilities across the nation, in part to test the supposition. The Women's Health Initiative consists of a set of clinical trials and an observational study of more than 161,000 women who reside throughout the United States. These trials were the first prospective randomized studies to examine the effects of hormone replacement therapy, diet modification and calcium and vitamin D supplements on heart disease, bone fractures and breast and colorectal cancer. "The participants are amazing for their dedication to finding answers for future generations. They have willingly been a part of a research study that would likely not directly help them," said Marian Limacher, M.D., a professor of medicine who serves as the principal investigator for the UF Clinical Center for the Women's Health Initiative. Limacher said prior to the WHI study, medical doctors acted on a long-held assumption that estrogen and progesterone protect women from heart disease and stroke. The assumption has its genesis in the white male model of health, which does not account for sex differences. As it turns out, heart disease affects women 10 years later than men, increasing the occurrence of disease after the age of menopause. Many doctors ce at the Women's Health Initiative Participant Appreciation Event at UF. assumed women were left unprotected by the age-related drop in hormones. "I thought that the question of hormones and coronary disease needed an appropriate clinical investigation, and that's why I was eager to get involved," said Limacher, a cardiologist. "In the early 1990s, many doctors were recommending long-term hormone treatment based on no trial data." The WHI hormone trial had two studies: an estrogen- plus-progestin study of women who had a uterus and the estrogen-alone study of women without a uterus. When preliminary data rolled in, the estrogen plus progestin portion of the trial was shut down early because of potential increased health risks to participants. The data shattered assumptions of the protective nature of estrogen, instead showing that women on hormone replacement therapy had a small - but real increased risk of developing heart disease, breast cancer and stroke compared with those not taking hormones. In 2004, the estrogen-alone study was also stopped early due to persistent increased risk of stroke, but no overall risk or benefit for heart disease or breast cancer was detected. The diet and vitamin branches of the study are complete, with results due in the fall, and through a five- year extension study researchers will continue to track participants via questionnaires. In the meantime, the study has dramatically changed the way doctors consider and prescribe hormone replacement therapy "Working with WHI has been interesting, rewarding and complex," Limacher said. "It is nice to actually be part of a study that can change clinical practice." io HEART DISEASE AND HIV As recently as 10 years ago, a Gallup survey revealed 88 percent of doctors failed to realize there were sex differences in the symptoms for diagnosing heart disease. According to the National Coalition for Women with Heart Disease and the American Heart Association, about half a million women die of heart disease and stroke each year, nearly twice as many as die from cancer. Although that figure is higher in women than in men, women receive only 36 percent of open heart surgeries and 33 percent of angioplasties. In addition, most sudden cardiac deaths occur in women, but only 20 percent of all cardiac defibrillators are placed in women. "For years physicians gained the notion that women were really spared this disease, so much so they believe that estrogens protected them, and they tried to give them estrogens to protect them, which we know now is really wishful thinking," said Carl Pepine, M.D., chief of cardiovascular medicine at the College of Medicine. In fact, the No. 1 killer of women was and is heart disease, but it affects women differently in older age brackets, so medical doctors were missing it because symptoms of the illness did not fit the "classic" model. "The other thing that becomes apparent, if you believe that men and women are equal and make comparisons by trying to adjust for age, body weight and Dr. Carl Pepine cholesterol, you will always come out with the notion that women do better than men, but the caveat is that this disease presents about 10 years later in women as it does in men. So any adjustment has to take that into consideration. That is another thing that clouded our vision over the past years," Pepine said. Risk factors for cardiovascular disease in both men and women include high cholesterol and blood pressure, smoking, not exercising, obesity, stress and a family history of heart disease and stroke. But Pepine said an evolving number of conditions unique to women can make their blood vessels perform in an abnormal way, leaving them vulnerable to disease. Conditions that can occur in pregnant women, such as hypertensive disorders, were once thought to clear up after the baby's birth. But the disease is now known to cause a permanent increased risk of heart disease. "The research shows that once they get this it alters their vasculature for life. Their blood vessels respond abnormally," Pepine said. "So this is a condition that we knew existed but we just didn't know its implications for heart disease." Once men and women are matched for body weight, it turns out women's coronary arteries are smaller than men's, Pepine said. "Transplant literature shows recently, if you transplant a heart from a female to a male and study the size of the coronary arteries, within the first year the size of the coronary arteries expand," Pepine said. "And if you transplant from female to female they don't change size. Finally, if you transplant a heart from male to female, coronary arteries get smaller." And the typical symptoms of heart attacks differ between the sexes. Men having heart attacks experience crushing chest pain, cold sweats and pain radiating in the shoulder, neck and back, Pepine said. Women's symptoms are more subtle, less predictable and include weakness, body aches, an overall feeling of illness and pain or discomfort above the waist. The problem is women's symptoms can be overlooked because they don't fit the white-male model, Pepine said. "Women get dismissed from medical care, they utilize more medical resources, outcomes aren't that good," Pepine said. "The case I'm try to make is that there are differences." Maureen Goodenow, Ph.D., a professor of pathology and the Stephanie W. Holloway university chair in AIDS research, said the HIV virus also seems to behave differently in men than in women. "[Biological] gender issues should be Dr. Maureen Goodenow considered in HIV and AIDS studies," Goodenow said. "A lot of women weren't being classified with AIDS. The way the disease progresses, displays symptoms and is treated is different in men and women and studies need to be done on these differences. Certainly women contract HIV at a higher rate than men." HIV viral loads formerly were used as an indicator to predict when HIV would turn into full-blown AIDS. Drugs were prescribed once the virus reaches a certain level in the blood. Those guidelines were recently changed as new research discovered women who initially carry a lower level of virus in the body can still develop full-blown AIDS as quickly as men who carry higher viral loads. "Absolutely there is a need for clinical trials to examine viral load and the subsequent speed of development of the virus," Goodenow said. PERCEPTION OF PAIN Part of the difficulty in diagnosing ailments such as heart attack in women may rest in the way they perceive pain. Pain is a subjective experience, and studies have shown that women feel and report more pain than men do. Fibromyalgia, a chronic pain condition, affects nine women for every one man, said Roland Staud, M.D., an associate professor of medicine. Some of the established sex differences in health Depression Women are two to three times more likely than men to suffer from depression. One reason is women do not produce as much of the neurotransmitter serotonin as men do. Heart health Women who undergo heart bypass surgery for heart blockages are nearly twice as likely as men to die afterward. Health care -While women and men get colon cancer at about the same rate, it is perceived to be a male illness and more men get a preventive screening exam. Lung cancer Now the leading cause of death by cancer in women. Women smokers are 70 percent more likely than men who smoke to develop lung cancer. Women metabolize tobacco's carcinogens differently than men. Female smokers are more likely to develop two more fatal types of lung cancer. Immune systems Almost all autoimmune diseases disproportionately affect women compared with men, and women are 75 percent more likely than men to suffer from rheumatoid arthritis, multiple sclerosis and lupus. Woman are also twice as likely to contract a sexually transmitted disease and are 10 times more likely to contract HIV during unprotected sex with an infected partner. Pain medications Kappa opiate pain medications are far less effective in relieving postoperative pain in men than in women, while ibuprofen is more effective in men than in women. Drug differences- Women come out of anaesthesia faster than men. Alcohol absorption -When women drink they carry higher levels of alcohol in their blood than size-matched men, partly because women produce significantly less of the enzyme that breaks down alcohol. Bone health One in four men will have an osteoporosis-related bone fracture in his lifetime; one in two women will. Statistics from the National Center on Health Statistics, the U.S. Centers for Disease Control and Prevention, and the American Heart Association. differences continued on 12 I 1 0 011 differences continued from 11 The pain of osteoarthritis, rheumatoid arthritis and systemic lupus erythematosus occurs mostly in women, he said. "In many of these syndromes, women are more affected by disease-related pathologic mechanisms, like, for example, in osteoarthritis or in rheumatoid arthritis," Staud said. "But nevertheless, even amongst these populations, women have more pain compared to men. And so they represent a major part of the general population that we are currently focusing on because they are the most affected." Even small differences may be important. In an as-yet unpublished study, Staud found there was no sex effect for a certain fibromyalgia medication. "I want to emphasize that the testing was very specific for measuring central sensitization in patients this was not a pain study per se," Staud said. "We found that neither men nor women were differently affected by this medication. Generally, where pain sensitivity is concerned, sex differences are interesting but small and likely not clinically relevant." Social and cultural factors defining male and female gender roles, not biological or sex differences, are deciding factors of the difference in pain perception, said UF psychologist Michael Robinson, Ph.D., who Dr. Roland Staud directs UF's Center for Pain Research and Behavioral Health, part of the College of Public Health and Health Professions. Robinson's studies found that women report pain sooner and report greater pain primarily because men are trained to be "strong" and resist admitting their pain. He set up an experiment in which women, before they were tested, were told the amount of time the average woman could keep their hand in a cold bath. Each male subject was told an average time for men, which was the same as that of the female participants. At the end of the study the women had withstood a longer period in the bath. "It completely erased the sex differences," Robinson said. Another aspect of his research involved asking participants to rate the pain of others based on videotaped images of men and women's descriptions of pain. Women rated the person's pain closely to what it actually was, whereas men consistently underrated the pain experience for both men and women. "This has implications for how male and female doctors treat their patients," Robinson said. "Some research has shown that women are more frequently prescribed anti-anxiety medication than anti-pain medications compared to men. These prescribing differences may be associated with gender stereotypes about how men and women are 'supposed' to express pain. Women's expressiveness may be misinterpreted as an emotional problem, rather than a pain problem. "Your stereotypes may be partly formed by differences in pain processing, but it's clear your pain processing can be altered by your belief systems and your expectations and your stereotyped behavior," Robinson said. "It's possible we're not treating people optimally because we're not recognizing the sex differences we should, and we're inappropriately recognizing sex differences that we shouldn't." Cultural factors can't be dismissed when it comes to assessing pain in men and women, but don't be quick to discount basic biology the body does play a role, said Roger Fillingim, Ph.D., an associate professor at the College of Dentistry and a researcher in the UF Comprehensive Center for Pain Research, a partnership between the College of Dentistry and UF's McKnight Brain Institute. "It is not possible to separate the body from the mind," Fillingim said. "There is a desire for a biological measure of pain, but the definition of pain is subjective and is based on the reporting of the experience of pain." Still, he said, "All the evidence suggests women bear a greater burden of pain throughout their lives. Prevalence of pain and severity of pain seem to be greater in women." Fillingim's collaborating researchers in Canada have found sex differences in the way study animals react to pain. "It isn't entirely or mostly social, because mice and rats don't the have same social influences," Fillingim said. "One would assume most of their socialization is due to their biology." The fundamental factors that contribute to pain differences between women and men are important qualitative measures that are necessary to study, Fillingim said. One's experience of pain is influenced by past experience, anxiety, cultural conditioning and biological and psychological makeup. Fillingim studies the factors that lead to pain to see how they differ. The psychological experience is one of those factors, Fillingim said. For example, anxiety is much more strongly related to pain in men than in women. "Men who have high anxiety have higher reports of pain and may respond better to treatment," he said. And don't forget the importance of genes. Fillingim and his colleagues recently examined sex differences in responses to pain-relieving medicines and discovered a potent painkiller appears to work better in women who carry a gene associated with red hair and fair skin. "The ultimate goal would be to do a blood test on somebody, look at their genetic makeup as well as other chemical, biological and psychological characteristics, plug all that information into a computer, and the computer would print out a sheet that says, 'Okay, this drug, at this dose, is going to provide this patient the best relief from pain'," Fillingim said. GENDER AND GENESIS One thing most scientists who study sex differences can agree on is the divergence, whether it is social or biological, starts with human genesis. Scientists have only just unveiled the mysteries of the X chromosome, recently decoding its genetic sequence. Women have two copies of the powerful, gene-packed X chromosome; men only have one. Therefore, if a copy of one of a woman's genes has a mutation, the other can fill in. Not so for men. For example, the complete X chromosome sequencing confirms that a high number of its genes code for proteins important for brain function. Many types of mental retardation have been linked to defects in genes on the X chromosome, and historically more males suffer from mental retardation, because they lack a back-up gene. As study of medical treatments continues, more and more researchers will turn to our genes for answers, making the questions of sex and ethnic differences relative only to what treatments work best for our gene type. "We are just beginning to explore the full range of differences between men and women and between individuals of different ethnicities or races," Limacher said. "The characterization of the biologic differences is far from perfect. They tend to be characteristic of a group response, but what is needed is better understanding of the genetic basis for responses. Between men and women there are the obvious differences, but there are subtleties between all members of groups. "I think it will all come down to genomics and proteomics," she continued. "So instead of guessing at a possible therapeutic effect we may one day be able to target the right therapies based on genetic makeup. I don't think this is unrealistic, just a ways off in the future determining an individual's genetic markers in order to select an appropriate medication seems a tall order but so did sequencing the human genome, and that has already been done." 0 Jiiw RESEARCH Cure no quick fix for cancer survivors on long road to recovery By Melanie Fridl Ross Patients who hear the dreaded words "you have cancer" invariably look forward to the day the doctor tells them "you're cured." But UF researchers say survival often comes at its own price the mind may need mending even after the body heals. A national study of cancer patients who underwent bone marrow transplantation reveals cancer diagnosis and treatment has a Profound and lasting emotional and physical impact that can persist for decades. Many cancer survivors report lingering sleep and sexual problems, pain, cognitive problems and generally poor physical well- being relative to their healthy peers, said John Wingard, M.D., director of the blood and marrow transplant program and deputy director of the UF Shands Cancer Center for the Gainesville campus. The study was the Dr. John Wingard largest to date to assess long-term quality of life issues among these patients. "A cure is not necessarily synonymous with total resumption of good health," Wingard said. Many patients suffer physical complications, such as infections or toxicity from intensive chemotherapy and radiation treatment, he said. And both the patient and the family must often travel to specialized tertiary care centers distant from the home, requiring them to establish a temporary residence for a number of weeks or even months. Their work is disrupted, and they frequently face financial challenges and high health-care costs. "All of this occurs in the setting of a considerable amount of anxiety about whether the transplant is going to be successful, whether the cancer is going to be controlled, and whether potentially lethal complications will occur during therapy," Wingard said. "The individual and the family are subjected to a pressure cooker of emotions and challenges they need to face." The findings, published in the Journal of Clinical Oncology, highlight the need for doctors to help their patients cope with the often traumatic experience of fighting cancer and the stresses they live with in its aftermath, Wingard said. Each year, an estimated 30,000 Americans undergo a bone marrow or peripheral blood stem cell transplant, typically a procedures of last resort. Both types of transplantation aim to restore patients' blood stem cell counts after their own stem cells have been wiped out by high-dose chemotherapy or radiation therapy used to treat cancer. After they are infused into the bloodstream, stem cells take up residence in the bone marrow, where they give rise to the immune system's infection-fighting white blood cells, red blood cells or platelets. Worldwide, about 100,000 people who have undergone a successful transplant are alive, and the number of long-term survivors grows daily. The study involved 662 patients treated at 40 transplant centers who had breast cancer, acute or chronic leukemia, or lymphoma among the most common indications for transplantation. Researchers at UF, Northwestern University, the University of Kentucky and the Medical College of Wisconsin interviewed participants by telephone and asked them to describe their quality of life. The patients also completed a series of standardized questionnaires that evaluated their physical health, whether they were depressed or anxious or had other mental health problems, the quality of the support they received from friends and family, and whether they had pain, sleep or sexual problems, fatigue or other ailments. They also were asked about their perceived spiritual well-being. A comparison group of 158 healthy peers completed a similar battery of questionnaires and telephone interviews. "A cure is not necessarily synonymous with total resumption of good health." John Wingard, M.D. The bottom line? "Cure is not the end of the journey," Wingard said. "Survivors continue to travel down the road revisiting some of the experiences they had perhaps months, even years, later. It's important for all of us as family members and friends to be aware of that and to be supportive of individuals who have undergone very traumatic experiences involving their health. Long after a cure is achieved, there may be issues, including stress and depression, that may linger and that still require medical attention." 0 A patient with breast cancer undergoes hours of conventional radiotherapy treatment in a linear accelerator machine. __j 1 13 EDUCATION Master educator fellowship program enhances teaching and education scholarship By Tom Nordlie L-EI P people who've never tried teaching may not realize it is truly a discipline unto itself, involving planning, communications and motivational skills. That's why UF is fortunate to be one of the nation's few universities to boast a certificate program to assist its Health Science Center faculty in improving their teaching abilities, the Master Educator Fellowship. The program's basic premise is that students benefit when teachers reach their full potential. "There's a myth that good teachers are born," said Kyle E. Rarey, Ph.D., a UF professor of anatomy and cell biology and of otolaryngology, and the program's director. "We believe that with appropriate resources, a teacher can become more effective." The 18-month program began training its third cohort of participants in January, with groups operating simultaneously on the Gainesville and Jacksonville HSC campuses. Classroom sessions, held every other week, use teleconferencing to link both groups in real time. "We have 20 faculty participating, 13 from Gainesville and seven from Jacksonville," said Rarey, who also is the College of Medicine's associate dean for program and faculty development. "One of the important benefits of the Visiting speaker Boyd F. Richards, Ph.D., is a professor of pediatrics and director of the Office of Curriculum at Baylor College of Medicine in Houston. He spoke to the master educator's class about developing and evaluating clinical performance examinations, problem- .- based learning g."" _. curricula, active 'o.. learning strategies and faculty development. program is it provides an opportunity for faculty to interact with others from outside their disciplines and from the other campus." The program emphasizes three areas methods of instruction and evaluation, mentoring and educational research. Besides text readings, the curriculum includes classroom discussions, presentations by nationally recognized guest lecturers and training in Vista, an online course management system. One of the key components of the program is a scholarly project in medical education research, which each participant also must plan, execute and present, said Caridad Hernandez, M.D., the College of Medicine's associate they'll be appearing at actual scientific meetings, applying for grants and hopefully publishing their work." Founded by the College of Medicine in 2000, the program recently was opened to faculty from all six colleges in the Health Science Center. The current cohort includes two College of Dentistry faculty members, and that's only the beginning, Rarey said. "I envision this cutting across all the colleges," Rarey said. "What we talk about is creating optimal learning environments for the learner." To provide constructive criticism, the program includes teaching evaluations every six months, he said. Each evaluation involves a self-assessment, a peer assessment conducted by other participants and a critique by members of the Society of Teaching Scholars, the College of Medicine's elite teaching honorary. "We also have feedback exercises in the Harrell Professional Development & Assessment Center, where they'll interact with standardized students," Rarey said. Similar in concept to the standardized patients used in medical education, standardized students are actors and actresses who portray students in prearranged scenarios, he said. The scenarios are videotaped for review, providing a unique opportunity for the participants to compare multiple approaches to the same situation. The Master Educator Fellowship is funded by the College of Medicine, one of the few medical "There's a myth that good teachers are born. We believe that with appropriate resources, a teacher can become more effective." director for faculty development and the program's associate director. "We want to give faculty the tools to be productive in medical education research," Hernandez said. "So as part of the research project Kyle E. Rarey, Ph.D. schools nationwide that have established such programs, Rarey said. He credits support from Dean Craig Tisher, M.D., and Senior Associate Dean for Educational Affairs Robert Watson, M.D., as key components of the program's success. "Few schools have deans who are willing to actively support these kinds of projects," Rarey said. "This shows how much Dr. Tisher values education." 0 For more information about the Master Educators Fellowship, visit www.med.ufl.edu/oea/opfd/faculty/master_educator.htm 14 ~ EDUCATION Third-year students Jennifer Konaszewski and Gina Hanna at work in the College of Pharmacy's new dispensing lab in St. Petersburg College. UF is 'Springing Up' at St. Petersburg College By Linda Homewood The College of Pharmacy will showcase its newest facility April 15-16 at St. Petersburg College with a combined building dedication and National Advisory Board meeting. Adding to the whirlwind of activities, the UF College of Dentistry simultaneously has new construction under way for its 14,000-square-foot sister facility. The CVS Education Center of the UF College of Pharmacy at St. Petersburg College was opened to returning pharmacy students in the spring 2005 semester. More than classrooms, the 8,500-square-foot facility offers a new skills laboratory that is a smaller version of the lab used in the new Gainesville pharmacy building. It also features a model pharmacy and stations for compounding a growing area in pharmacy practice, said College of Pharmacy Dean and Associate Provost of Distance Education William Riffee, Ph.D. "This is an exciting time as our distance campus programs continue to grow and mature," Riffee said, "We will be admitting our fourth class this fall to complete the buildout of the St. Petersburg, Orlando and Jacksonville campuses." Speakers for the Friday morning dedication ceremony will represent institutions with varied interests, but whose leaders share a common vision in education. The speaker lineup for the event includes a representative of CVS Corp., in recognition of the $1.1 million building gift when it acquired Eckerd Corp. in Florida; UF College of Pharmacy representatives Riffee and the student council president; a member of UF's board of trustees; and representatives of St. Petersburg College and its University Partnership Center. Teresa Dolan, D.D.S, M.P.H., dean of the College of Dentistry, will also speak in support of the joint UF initiative at the campus in Seminole. "This collaboration with St. Petersburg College is an outstanding example of how the University of Florida can partner with educational institutions at the local level to provide expanded educational opportunities to Florida's residents," Dolan said. An open house and tours of the new pharmacy education facilities will follow the dedication ceremony. The College of Pharmacy National Advisory Board will convene in the afternoon at the CVS Education Center to begin their semi-annual meeting. The board will continue its meeting Saturday morning, ending with a look at "student life at a distance campus," and then will join students and their families at a Family Day luncheon. O Scheduling the end Commencement time is here and the HSC Colleges will hold ceremonies at the following places and times: COLLEGE OF DENTISTRY When: Friday, May 27 at 3:30 p.m. Where: Center for the Performing Arts Speaker: Sam Low, D.D.S., M.S., M.Ed., a UF professor of periodontics, associate dean of faculty practice, continuing education and allied health, and president of the Florida Dental Association COLLEGE OF MEDICINE When: Saturday, May 21 at 9 a.m. Where: Center for the Performing Arts Speaker: Bruce Dan, M.D., the managing editor and executive director of The Patient Channel. An infectious diseases specialist, Dan has won two Emmy awards for his work in television journalism COLLEGE OF NURSING When: Friday, April 29 at 2 p.m. Where: Center for Performing Arts Speaker: Chris Machen, B.S.N., UF's First Lady and retired neonatal nurse COLLEGE OF PHARMACY When: Saturday, April 30 at 2:00 p.m. Where: Center for the Performing Arts Speaker: Harold O'Steen, College of Pharmacy alumnus, Class of '54; member of the College of Pharmacy National Advisory Board; and pharmacy owner Reception: Immediately following at the Hilton UF Hotel and Conference Center COLLEGE OF PUBLIC HEALTH AND HEALTH PROFESSIONS When: Thursday, April 28 at 6:30 p.m. Where: Stephen C. O'Connell Center Reception: Immediately following at Emerson Alumni Hall COLLEGE OF VETERINARY MEDICINE When: Saturday, May 28, at 2 p.m. Where: Center for the Performing Arts Speaker: UF president Bernie Machen Reception: Immediately following at the Touchdown Terrace Club, Ben Hill Griffin Stadium 15 " '''-- DISTINCTIONS JACKSONVI LLE STUART L. KLEIN, M.A. has joined the College of Medicine as executive director of the University of Florida Proton U H Beam Institute in Jacksonville. He is currently working from Gainesville on the operational plans for the multi-million dollar institute set to open in the summer of 2006. For the last 14 years, Klein was administrative director of the Department of Radiation Oncology for the University of Pennsylvania Health System in Philadelphia, Pa. He was responsible for 210 employees at eight practice locations around the city. The 43-member faculty group also conducted $6.5 million in sponsored research. MEDICINE ERNEST L. MAZZAFERRI, M.D., is the 2005 recipient of the Distinguished Educator Award presented by the Endocrine Society. The award is presented annually in recognition of exceptional achievement as an educator in the discipline of endocrinology and metabolism. Mazzaferri will receive the award in June at the society's 87th annual meeting in San Diego. An expert in thyroid disease, Mazzaferri is also president-elect of the American Thyroid Association. SATYA NARAYAN, Ph.D., an associate professor of anatomy and cell biology at the UF Shands Cancer Center, has been named to the American Society for Biochemistry and Molecular Biology. The Bethesda, Md.-based nonprofit scientific and educa- tional organization seeks to ad- vance the science of biochemistry and molecular biology in part through advocacy for funding of basic research and education, support of science education and promotion of diversity in the scien- tific workforce. NURSING NANCY MENZEL, Ph.D., R.N., an assistant professor, recently won the 2005 Golden Pen Award from Slack Inc., the publisher of the American Association of Occupational Health Nurses Journal. The Golden Pen Award is an annual award recognizing excellence in writing. Menzel was honored for her 2004 article "Back Pain Prevalence in Nursing Personnel." The article described the increasing number of workplace injuries in nursing personnel, primarily musculoskeletal disorders, and offered solutions to obtain more accurate information on this persistent problem. PHHP TODD FRASER, an office manager in the department of occupational therapy, received a $500 bonus from the UF Incentive Efficiency Program, which honors ideas that improve university effectiveness and efficiency. As a result of Fraser's suggestion, staff can now verify the education of new faculty members who are UF graduates through the university computing network, rather than calling the registrar's office. JESSE SCHOLD, a doctoral student in the department of health services research, management and policy, and a research coordinator in the College of Medicine, received a Young Investigator award from the American Transplant Congress. The award covers travel costs associated with attending the group's annual meeting in May in Seattle. Schold is the senior author of three abstracts that have been accepted for presentation at the meeting. J J Genetics, cancer researchers 'raise the roof' An $85 million building at the Health Science Center intended to help scientists achieve breakthroughs in genetics and cancer research is more than half finished. University leaders joined construction workers for lunch and a topping-out celebration in March, marking the raising of the roof of the Cancer and Genetics Research Building at Gale Lemerand Drive and Mowry Road. The H-shaped structure will house some of UF's top scientists in an effort to propel genetic discoveries and advances in cancer research. It will house employees working with the UF Genetics Institute, the UF Shands Cancer Research Center, the Interdisciplinary Center for Biotechnology Research and the C.A. Pound Human Identification Laboratory. In terms of bricks and mortar, the structure represents an 8.5 percent increase in research space at the Health Science Center. When it's finished in spring 2006, the 280,000 square foot building will push the Health Science Center campus over the 3 million mark in terms of gross square footage for research facilities. Clinical and health psychology graduate students KAREN CHUNG, ADAM HIRSH and ERIN O'BRIEN each received a Young Investigator Travel Award from the American Pain Society. The grants covered travel costs associated with attending the society's annual meeting in March in Boston. But beyond the physical facility, this project represents an intellectual focus that will bring researchers together from the six HSC colleges, the Institute of Food and Agricultural Sciences, the College of Liberal Arts and Sciences and beyond. Displaying commemorative shirts at the construction milestone were (from left) John Wingard, M.D., director of the blood and marrow transplant program and deputy director of the UF Shands Cancer Center for the Gainesville campus; Thomas Yang, Ph.D., program director of the Center for Mammalian Genetics; W. Stratford May Jr., M.D., Ph.D., director of the UF Shands Cancer Center; Kenneth Berns, M.D., Ph.D., director of the UF Genetics Institute; Roland Herzog, Ph.D., an associate professor of cellular and molecular therapy; Terence R. Flotte, M.D., the Nemours eminent scholar and chairman of the department of pediatrics; Frank Javaheri, facilities planning & construction; and Arun Srivastava, Ph.D., chief of the division of cellular and molecular therapy. John Pastor 16 II~ ADMINISTRATION Environmental health: New faculty member links public health and veterinary medicine By Sarah Carey Abs a graduate student, Natalie Freeman, Ph.D., studied rats, cats and wolves. But her use of stuffed birds to conduct research may be a first. Veterinary medicine has always played a key role in public health, and never more than now at UF. The growing field of environmental health is partly what attracted Freeman to her present position at UF's Health Science Center. She recently joined the faculty as an environmental health specialist, a joint position in the College of Public Health and Health Professions and the College of Veterinary Medicine. "We use stuffed toys to evaluate pesticide accumulation in household products," said Freeman. "Since children tend to sleep with stuffed toys, and at young ages chew on them, understanding the pesticide load in these toys is important for understanding all the routes of exposure that are important for children. Freeman's research focuses on health risks to children and the role vet med plays in public health. Conditions that affect humans also affect other species, and the means of improving health in one species can also help in others, Freeman said. ...dft "I think the linkage between vet med and public health is a natural one," she added. She said she was intrigued by the challenges associated with developing o a new environmental health program within a relatively new college of public health. "A good environmental health program requires good toxicologists, risk assessors, environmental engineers, analytical chemists and statisticians, as well as exposure assessors," she said. "UF has the foundation for that program, with superb individuals in all these disciplines." Freeman's department chairman in the veterinary college's department of physiological sciences, Dr. John Harvey, said Freeman's work is important in identifying sources of contaminants and determining how . much is consumed by children from their home environment. "For little kids, it's not just food, house dust and soil exposures that are important when we evaluate pesticides," Freeman said. "From an instructional point of view, we use the toys as graphic examples of the range of things kids come in contact with that may be contaminated." A self-described "Jersey girl," Freeman became a Floridian and a Gator in October after serving 12 years as an adjunct faculty member at Robert Wood Johnson Medical School and the School of Public Health, which are branches of the University of Medicine and Dentistry of New Jersey and the graduate program in environmental science at Rutgers University. "Part of my research came about because of an intrinsic interest I have in animals, and part was because it is sometimes easier to gain insights into the human condition by studying animal models," Freeman said, adding that veterinarians have long known that animal studies frequently Dr. Natalie Freeman with some of her "tools of the trade" examples of guide studies of human health issues. children's toys she uses to demonstrate ways in which children might come into Robert Frank, Ph.D., dean of the College of Public Health and Health contact with contaminated items. Freeman is associated with the College of Professions, welcomes Freeman to the new position. Public Health and Health Professions and the College of Veterinary Medicine. "Dr. Freeman's work, and her presence at UF, are exciting steps in our efforts to build environmental health and link the colleges of Veterinary Medicine and Public Health and Health Professions," he said. O =WXV~ FIVE QUESTIONS Stem cell research: science fiction and science fact Pushed into the spotlight by political disagreements, debate in Congress and even the deaths of Ronald Reagan and Christopher Reeve, the subject of stem cell research has jumped from the orderly pages of scientific journals into a tumultuous world. The POST asked Edward Scott, Ph.D., an associate professor of molecular genetics at the UF Shands Cancer Center and director of the Program in Stem Cell Biology and Regenerative, d.il, Ii. at the College of Medicine, to lend a bit of perspective. What is it about stem cell research that has people so fascinated? Stem cells represent the potential for true regeneration of things that are broken, such as o brain cells, spinal cords, livers, eyeballs or hearts. Right now we're in early stages of research, so it's hard to tell how much of this is science fiction and how much is science fact. But the potential is there. Because stem cells can theoretically repair the body, they have captured the imagination of a number of people who have debilitating diseases. Why the controversy surrounding the research? Current politics have redefined stem cells to mean embryonic stem cells stem cells taken from human embryos. The reality is a stem cell can generate new tissue no matter where you get it from our program focuses on stem cells taken from adults. Folks may want to look at adult stem cells as a counter balance to the ethical obstacles presented by using embryonic stem cells. Adult stem cells can be harvested from you or me with a simple needlestick. What is happening at UF's Program for Stem Cell Biology and Regenerative Medicine? What we're doing is taking an interdisciplinary approach to regenerative medicine, combining stem cell biology with gene therapy, nanotechnology, biomedical engineering, physics and many other fields to rebuild not just cells, but entire organs. The idea is to take our stem cells, which we know can do all kinds of wonderful things, and get them to build a new liver, for example. Californians strongly supported a bond measure that will bankroll $3 billion worth of stem cell research. Other states are expected to follow suit. Is this a good thing, or can it create a "brain drain" in states that don't take similar action? Anytime more money and resources are put toward solving health problems, it's a good thing. But it will be interesting to see what percentage of stem cell biologists wind up leaving their current states to go to places like California. It will also be interesting to see what happens when a scientist working with stem cells in California applies for a National Institutes of Health grant. Does the NIH tell them to get the money from their state, or will it review the grant normally? What should Florida be doing? That's a question for the citizens and voters. It would be beneficial to have public discussions to determine if Florida residents are interested in supporting targeted research. The reality is that it takes a lot of money to do science. O =WX1 PROFILE Burrows' contributions to veterinary medicine are extensive, at home and abroad By Sarah Carey If you had told Colin Burrows, B.Vet.Med., Ph.D., in his younger years in the United Kingdom that he'd be a department chairman and a meeting planner in Florida, he'd have said you were crazy. "I was going to be an English country vet," said Burrows, who chairs the department of small animal clinical sciences and serves as chief of staff of the Small Animal Hospital at UF's College of Veterinary Medicine. "When I went to vet school, it was with the intention of learning how to treat sick cows and horses and the occasional dog and cat," Burrows said. "How I ended up as a 'dog diarrhea doctor' in Florida is a long story." Burrows also is executive director of the North American Veterinary Conference, one of the world's leading continuing education vehicles for the veterinary profession. He has received numerous awards for his contributions to small animal internal medicine and comparative gastroenterology, and this year was honored with the prestigious Royal Canin Award by the American Animal Hospital Association for his contributions to international veterinary medicine. "Veterinary medicine has been very good to me," he said. "I've traveled the world. My wife teases me that I must be over the hill, as I'm only asked to speak in Third World countries now, but to me that is so gratifying. I'd rather help educate practitioners in Paraguay who lack even some basic knowledge and are starving for continuing education than, say, practitioners in Portland who already know so much." On UF's faculty since August 1980, Burrows was hired as an associate professor of small animal medicine to teach gastroenterology and internal medicine to veterinary students and see patients in the Small Animal Hospital. He has been a department chairman since 1996. "While I'm still a sometime-gastroenterologist, I am now a full-time administrator thinking more about budgets and human resources than I do about patients, and that's not good," he said. "I miss my patients and client interaction and love it when I can get back into the clinic on occasion to help out." Much has changed in the quarter century Burrows has worked at UF. "When I first came here, you could count the veterinary specialists in the rest of Florida on the fingers of one hand," Burrows said. "There's been an explosive growth of specialty practices all over the state that has impacted us significantly in many ways. We've trained our own competition, but the competition has forced us to become much more reactive and responsive to the needs of the referring veterinarian." The college also has experienced declining state support and has had to rely more and more on the hospital as a source of revenue to support its teaching enterprise, Burrows said. Currently, Burrows is active in the campaign to raise funds for a new Small Animal Hospital and is proud of the development of new oncology, behavior and cardiology services that has occurred under his leadership. "Colin's ability to understand where the profession is, where it needs to go, and how we need to respond is key to many successful new activities the department and the veterinary teaching hospital have embarked on as a result of his exceptional leadership," said college Dean Joseph A. DiPietro. Every year in January, the North American Veterinary Conference is held in Dr. Colin Burrows examines a dog at UF's Small Animal Hospital. Orlando for veterinarians, veterinary technicians, practice managers and industry representatives who sell their wares in a massive exhibit hall. It's Burrows who keeps things running as smoothly as they do. "We are now the world's premier continuing education event for veterinary professionals," he said, adding that NAVC's growth also has helped the UF veterinary school in many ways, by providing additional income for many of staff and faculty members, as well as exposure on the world stage. "Few if any can plan more successful educational programs for veterinarians, technicians or owners than Colin," DiPietro said. "His effective leadership and know-how are key to the success the NAVC enjoys worldwide. We appreciate his efforts to keep the college heavily involved in the NAVC, which is not only one of the largest but one of the very best veterinary meetings in the world." O EjiTj19 -- ----- LOOKING' AT YOU Veterinary dermatologists adopt, treat dachshund to save from euthanasia In early February the owner of a dachshund named Baby contacted the Veterinary Medical Teaching Hospital's dermatology service, because the dog's difficult and costly skin condition required her to give up the dog. "As a group effort, especially through Dr. Millie Rosales, we are treating Baby," said Dr. Lisa Akucewich, a clinical assistant professor of dermatology with the College of Veterinary Medicine. The UF dermatology team decided to treat Baby's demodex mites with milbemycin, which she takes every day along with antibiotics. Rosales said in just three weeks, there has been dramatic improvement in Baby's condition, and in up to six months her skin should improve. Baby has been adopted by Rosales' sister, Maria. -Sarah Carey Dr. Lisa Akucewich, left, and Dr. Millie Rosales with Baby, who shows improvement after less than a month of treatment by UF's veterinary dermatology team. Published by UF Health Science Center Office of News & Communications Senior Vice President for Health Affairs Douglas J. Barrett, M.D. Director, News & Communications Tom Fortner Editor Denise Trunk Senior Editors Melanie Fridl Ross, John Pastor Art Director Lisa Baltozer Staff Writers Tracy Brown, Sarah Carey, Tom Fortner, Linda Homewood, Lindy McCollum-Brounley, Patricia McGhee, Tom Nordlie, John Pastor, Jill Pease, Melanie Fridl Ross, Denise Trunk Support Staff Cassandra Jackson, Beth Powers, Kim Smith Intern Leah Cochran 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 dtrunk@ufl.edu or deliver to the Office of News & Communications in the Communicore Building, Room C3-025. www.news.health.ufl.edu UF Health Science CENTER |