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

	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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