A P U B L I CAT I O N O F N O R T H E A S T O H I O M E D I CA L U N I V E R S I T Y â€¢ V O L 2 0 .1 S P R I N G 2 019
THE BASICS TO A QUALITY LIFE
e’ve all heard it several times over — people are living nearly two times longer than their ancestors were at the beginning of the 20th century. Of course, there are a number of reasons why one rarely made it past 50 in the early 1900s — infectious diseases were among the top. And we all know that medical and public health education have largely been responsible for many people now living beyond the age of 80. But as people live longer with diseases such as those of the heart and cells — the dominant causes of death today — it is gratifying to see the increased acknowledgement of the role that basic science plays in the understanding of how such diseases behave and the development of novel therapies for them. That’s why Akron Children’s Hospital is collaborating with NEOMED and its basic science researchers: to help develop a broader research agenda to advance the wellness of the more than half a million children and adults that it serves. Anita Jeyakumar, M.D., the hospital’s director of pediatric otolaryngology, sums it up, “They’re (NEOMED) doing a lot of state-of-the-art work already … (and) we have a lot of patients.” The hospital is working with Jeff Wenstrup, Ph.D., director of NEOMED’s Hearing Research Focus Area, to develop a collaborative center for hearing loss that would be both research- and clinically-based – and that’s just one area in which the scientists and clinicians are partnering. When the average person learns that someone has diabetes, they often think it’s simply about consuming too much sugar; when they hear obesity, they think it’s all about lifestyle; and when they hear that someone has liver disease, they think alcohol abuse. The basic science conducted by Dr. Yanqiao Zhang and his team in the newly established Diabetes, Obesity and Metabolism Research Focus Area dispels many myths, expands understanding, and offers approaches for treatment and mechanisms for prevention that take us all beyond the basics. And much as assumptions are misplaced on those who suffer from liver disease, people with serious mental illness are often criminalized by our justice systems. Natalie Bonfine, Ph.D., an assistant professor in our Department of Psychiatry at NEOMED, is part of a research team that is examining how to lower the rate of recidivism (currently 15 percent higher than the national average) in people with serious mental illness. She works with community organizations that use the evidence-based practice of cognitive behavioral therapy to help divert those with mental illness from returning to jail or becoming criminally involved. Disease impacts us socially as much as it does biologically. The studies of basic science researchers are having an impact not only on our life expectancy, but also on the quality of the lives that we live.
Jay A. Gershen President
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T H E PA S S I O N O F P H Y S I C I A N S , P H A R M A C I S T S A N D H E A LT H C A R E R E S E A R C H E R S
VOL 20.1 SPRING 2019 Northeast Ohio Medical University is a communitybased, public medical university with a mission to improve the health, economy and quality of life in Northeast Ohio through the medicine, pharmacy and health science interprofessional education of students and practitioners at all levels. The University embraces diversity, equity and inclusion and fosters a working and learning environment that celebrates differences and prepares students for patient-centered, teamand population-based care. Ignite magazine (Spring 2019, Volume 20, No. 1) is published twice a year by the Office of Marketing and Communications, 4209 St. Rt. 44, P.O. Box 95, Rootstown, OH 44272-0095 Email: firstname.lastname@example.org Jay A. Gershen, D.D.S., Ph.D., President NEOMED Board of Trustees Robert J. Klonk, Chair Paul R. Bishop, J.D., Vice Chair E. Douglas Beach, Ph.D. Sharlene Ramos Chesnes Joseph R. Halter Jr. Chander M. Kohli, M.D. Richard B. McQueen Phillip L. Trueblood Susan Tave Zelman, Ph.D. Student Trustees Carl A. Allamby David J. Johnson Editor: Elaine Guregian Contributing Editors: Samantha Hickey, Roderick L. Ingram Sr., Liam Martin (intern) Jared F. Slanina Publication Design: Scott J. Rutan Illustrations: Cover: Elise Radzialowski, senior at University of Akron Myers School of Art; pages 4 and 8, Emily Wolchko, University of Akron Myers School of Art (’18); page 12, Malieka Gurrera, University of Akron Myers School of Art (’18); page 16, Hui-Chu Ying, professor, University of Akron Myers School of Art. Photography: Chris Smanto, Lew Stamp As a health sciences university, we constantly seek ways to improve the health, economy and quality of life in Northeast Ohio. The Accent Opaque paper used for this magazine has earned a Forest Stewardship Council (FSC) and a Sustainable Forestry Initiative (SFI) certification. Strict guidelines have been followed so that forests are renewed, natural resources are preserved and wildlife is protected. Ignite was printed by Printing Concepts in Stow, Ohio, using soy inks. No part of this publication may be reproduced without prior permission of the editors. Copyright 2018 by Northeast Ohio Medical University, Rootstown, Ohio 44272.
DEPARTMENTS 22 INTERPROFESSIONAL EDUCATION
31 HUMANITIES IN MEDICINE
25 HUMANITIES IN MEDICINE
34 WHALE WATCHING
26 IN THE REDIZONE 28 CLASS NOTES
33 DONOR SPOTLIGHT 35 FINAL LOOK
04 THE KETOGENIC DIET, DEMYSTIFIED A scientist’s research perspective on the popular diet.
08 STRESSFUL HOME, HARDER HEARING Environmental stress early in life may have lasting adverse effects on hearing.
12 TAKING CONTROL OF STINKIN’ THINKIN’ Connecting people with serious mental illness with tools that help.
15 DIABETES, OBESITY AND METABOLISM RESEARCH A new team looks for novel approaches.
16 THE HEART VALVE REPLACEMENT DILEMMA Surgery viewed through the lens of medical ethics. About the cover: Artist Elise Radzialowski is a senior at the Myers School of Art of the University of Akron, a NEOMED partner school.
Ignite magazine was honored by the Council for Advancement and Support of Education in its District V (Great Lakes region) competition in 2018. In the category of Best Alumni/Institution Magazine, 2,999 FTE or fewer, Ignite magazine’s Fall 2017 and Spring 2018 issues won a bronze award. In the category of Best Cover (Magazine, Tabloid, or Brochure), open to institutions of all sizes, Fall 2017 Ignite won honorable mention.
18 RESEARCHER, MEET CLINICIAN A hospital-university collaboration is taking off.
For web extras, visit www.neomed.edu/ignite The magazine won four American Advertising Awards from the Akron (Ohio) chapter of the American Advertising Federation in 2019. The Spring 2018 and Fall 2018 issues each won in the category of Entire Magazine Design. Ignite also won awards for its cover and inside spreads for the Spring 2018 and Fall 2018 issues.
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THE KETOGENIC DIET, DEMYSTIFIED BY DENISE INMAN, Ph.D.
eto this, keto that: The products have been flooding store shelves and the ads are impossible to miss. What’s all the fuss about? The ketogenic diet is one in which a person limits carbohydrate consumption to less than 50g/day and eats primarily fat (90 percent) and protein (6 percent). The diet was first developed as a means to reduce seizures in pediatric patients who were unresponsive to epilepsy drugs. By providing the body with fat as a primary source of fuel, the body was forced to break down the fat to fatty acids and use those fatty acids instead of sugar. It is still not entirely known why a ketogenic diet would have such an impact on pediatric epilepsy patients. It’s true that specific groups have found the ketogenic diet helpful because restricting your intake of carbohydrates can benIllustration: Emily Wolchko
efit blood sugar control. For example, people with diabetes (both Type 1 and Type 2) can often keep their blood glucose levels in better control with a ketogenic diet because they are severely limiting their intake of the dietary sources of sugar — carbohydrates. My own interest in the diet is from a researcher’s perspective: I’m studying its potential benefits for people with glaucoma. Who else would benefit from a ketogenic diet? That’s a question for each person to answer in consultation with a physician, but fair warning: This diet is very challenging to maintain. Imagine finding 90 percent of one’s calories from fat! In the laboratory, when we provide experimental animals with the ketogenic diet, it looks like we are feeding them lard. In a way, we are. That doesn’t sound very appealing to most people. So why has the
ketogenic diet become a major diet fad?
NOT ALL KETO DIETS ARE CREATED ALIKE Normally, the body looks first to sugar (technically, glucose) for its energy source. If glucose is not available, the body can use fat or protein instead. Fat is broken down in the liver into fatty acids, then chemicals called ketones. The first thing that has enabled the popularization of the diet is the fact that many popularizers are misusing the ketogenic label by significantly modifying the diet from the original fat and protein composition. There are at least half a dozen variations on the ketogenic diet, all of them designed to make it more appealing and easier to follow than the original version. However, none of these diets would be worth following (or provide the potenNORTHEAST OHIO MEDIC AL UNIVERSITY
tial benefits) if the diet did not keep a person in a state called ketosis (see sidebar). Nutritional ketosis is when the concentration of ketones in the blood is 0.5 to 3mM. At this level, the body is primed and able to use fatty acids for fuel. The ketogenic diet works by helping the body maintain ketosis. Individuals on a Western diet, which tends to be high carbohydrate, high fat, and too much protein, are eating too many carbohydrates to ever prompt their body to use the fats they ingest as fuel. That means most of the fat they eat is just added to their fat stores all over the body. In order to get the body to burn fat, one can either engage in long bouts of intense exercise or train the body to use fat for fuel by entering ketosis. If you fast long enough, eventually you will enter ketosis — as do individuals following a ketogenic diet. One challenge of the diet is identifying vegetables that do not contain enough starch to affect carbohydrate levels yet still provide important micronutrients and fiber. The recipe provided in this issue (published by diethood.com) is an example of how ketogenic diet recipes often use good fats from foods such as avocado, nuts and healthy oils. These stuffed avocados are a good example of a vegetable-based dish for someone following a ketogenic diet. But I’ll say it again; determining whether following the full keto diet regimen is right for you is a question for you to discuss with your physician. One final note: Fat is your friend on the ketogenic diet! Whole milk, full-fat yogurt and cheeses are high on the ketogenic diet list of must-haves.
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THE KETOGENIC DIET AND GLAUCOMA
esearch by a team led by Denise Inman, Ph.D., on how a ketogenic diet could potentially benefit people with glaucoma has been published in The Journal of Neuroscience. Dr. Inman explains what her team has found so far.
WHAT IS THE PROBLEM YOU ARE TRYING TO SOLVE? More than 2.7 million people in the U.S. live with glaucoma, according to the National Eye Institute of the National Institutes of Health. Glaucoma can have a devastating impact on quality of life for older people: Consider an elderly person who relies on reading to connect them to other people and to what’s going on in the world. What happens when they lose that connection? The risks of not being able to see well are serious, too, especially for people of an age who are already more likely to fall. In 2016, the Centers for Disease Control and Prevention said that falls were the number one cause of fatal and nonfatal injuries among adults over 65. As a member of the Neurodegenerative Disease and Aging focus area at NEOMED, my work has an emphasis on the neurodegen-
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Illustration: Emily Wolchko
erative aspects of glaucoma. My research team and I sought out the ketogenic diet as a means to an end. In our research, we have shown that there is a metabolic vulnerability in aged mice with glaucoma. We found that this vulnerability was accompanied by decreased levels of a transporter that moves ketones and lactate from the bloodstream to the optic nerve — the bundle of axons that transmits the visual signal to the brain from the eye. The ketogenic diet was our method of trying to reverse the decrease of those transporters, and it worked. The diet increased transporter levels, probably as a result of the increased levels of ketones. The ketogenic diet was also meant to stress the mitochondria in the optic nerve by forcing them to process those ketones. If the mitochondria were dysfunctional, as
some research has suggested, then making the mitochondria work overtime should have been catastrophic to optic nerve function. Making a bad part work harder usually just yields a bad outcome. However, the mitochondria handled the increased work just fine, and the optic nerve functioned better for mice on the diet. Without seeming to state the obvious, I would emphasize that mice are not people. It’s too early to tell if the diet is appropriate for glaucoma patients, despite its positive effect in mice. You can’t rush research, but we are learning more every day.
IN THE MEANTIME? The biggest risk factors for glaucoma are age and high intraocular pressure. There is not much that you can do about the former, but I encourage everyone to go to your optometrist for regular eye exams to monitor the latter.
DEVILED AVOCADOS reprinted from diethood.com Ingredients
3 avocados, halved, pits removed, flesh scooped out, reserve shells
1. Place avocado flesh in a large mixing bowl; set aside.
Fresh lime juice 3 hard-boiled eggs, diced 4 slices turkey bacon, cooked to a crisp and crumbled 2 green onions, thinly sliced, white parts only (reserve green parts for garnish) ½ cup crumbled feta cheese Salt and fresh ground pepper, to taste ⅓ cup plain yogurt Chopped fresh parsley, for garnish
2. Squeeze lime juice inside of the scooped-out avocado shells and set aside. 3. Add diced eggs, crumbled bacon, sliced green onions, feta cheese, salt and pepper to the mixing bowl. 4. Using the back of a fork or a potato masher, start mashing and folding the salad until a thick mixture forms. 5. Stir in the yogurt; taste for seasonings and adjust accordingly. 6. Add prepared avocado filling to scooped avocado shells. Pile it high. 7. Garnish with green onions, chopped bacon, and parsley. 8. Serve.
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STRESSFUL HOME, HARDER HEARING BY ELAINE GUREGIAN
he mother was frantic. yngology at Akron Children’s Hospital in been a sense of urgency around the care. Her baby had recently been Ohio, recalling the case from her previous Now, Dr. Jeyakumar is considering another reason for urgency: the hypothesis of treated for bacterial meningitis, position in another state. but soon after bringing her home from “I said, ‘We have to see her right away.’ NEOMED researcher Merri Rosen, the hospital to the home she shared with A hearing test showed that the baby Ph.D., that experiencing serious stress at home during a temporary hearing loss her own parents, she and her mother no- was profoundly deaf in both ears. ticed that the baby wasn’t turning as much “We moved quickly to get her imaging could have a detrimental effect on a child’s to sound. done, because her cochlea was starting to hearing later in life. “Just get a hearing test when things ossify, which would make a cochlear imStress in homes can take many forms, settle down,” they had been told. plant surgery impossible. Within two from a child’s parents arguing over monThe child was otherwise healthy, and weeks we had her implanted. Now she’s ey to a child helplessly observing emoshe had been immunized. tional or physical abuse. But things seemed scariHere’s an example that NOW, DR. JEYAKUMAR IS CONSIDERING ly worse, and now the happened recently and is ANOTHER REASON FOR URGENCY: mother was on the phone quite common, says Dr. with the office of Anita Jeyakumar: The father THE HYPOTHESIS OF NEOMED Jeyakumar, M.D., an ear, came to her clinic with RESEARCHER MERRI ROSEN, PH.D., THAT nose and throat specialist the patient. The mother EXPERIENCING SERIOUS STRESS AT HOME who snapped to attention followed up to schedule when she overheard her surgery. The day before DURING A TEMPORARY HEARING LOSS administrator saying the surgery, the dad COULD HAVE A DETRIMENTAL EFFECT something about “mencalled, saying things were ON A CHILD’S HEARING LATER IN LIFE. ingitis” and “the baby better — he and the child’s mother were getisn’t responding.” “The thing about bacterial meningitis two years old, speaking in two-word sen- ting separated — and canceled the suris, the organ of hearing called the cochlea tences. She’s doing amazing,’’ reports the gery. Next, the mother called, irate that can ossify. It’s like a snail shell, with fluid physician, who is also an associate profes- surgery had been canceled, stating that inside of it, and the entire fluid part grows sor at NEOMED. she is the child’s legal guardian. bone. If it ossifies, there’s nothing we can “Finally, we recommended delaying do technologically to bring the hearing Early hearing loss — or conversely, the surgery and re-evaluating the child with back. That can happen within weeks after knowledge and resources to prevent it both parents present, unless legal docuthe bacterial meningitis,’’ said Dr. Jeyaku- — can make a huge difference in a child’s ments were provided instructing us to do mar, now the director of pediatric otolar- future. Because of that, there has always otherwise,’’ says Dr. Jeyakumar. Illustration: Emily Wolchko
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AN EAR INFECTION GETS WORSE Dr. Rosen’s research looks at a situation that begins with something that parents dread: when children with ear infections develop otitis media with effusion — sticky fluid in the middle ear, a condition that often produces temporary hearing loss. “During critical developmental periods in childhood, even temporary hearing loss can result in later difficulty with speech perception, especially in challenging listening environments, like fast speech or background noise,” explains Dr. Rosen. She currently studies animal models to understand how this early hearing loss changes brain circuitry, causing later problems with speech processing. Ignite talked with Dr. Rosen about her study, which arose from work supported by a grant from the National Institutes of Health. What led you to the idea that there might be a correlation between stress and hearing problems in children? I discovered it accidentally while testing our animals. When young pups were separated from their mothers during development for behavioral testing, I took them at different ages, one hour every few days, and tested them. Then I waited until they were adults and re-tested them, two months later. My team found that this early separation was enough to change their ability as adults to detect certain hard-to-hear sounds — those that change quickly over time and are important for speech. We realized that what was changing was not just in the ear but in the brain. This was similar to what we were already seeing in animals with early hearing loss, but it had never been described before for early stress. It’s known that children from low socioeconomic households can have worse
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HOW DR. ROSEN’S STUDY WORKS “The first stage is to contact parents whose kids had ear tubes inserted because of persistent ear infections and fluid. We’ll have them complete surveys that can tell us about stress levels at home, such as specific stressful scenarios, food insecurity, and household income. Kelly Cichy, Ph.D., who has expertise in family stressors through her work in human development and family studies at KSU, will be helping with the surveys. “Akron Children’s has a diverse patient population, which should help us compare kids growing up with different amounts of stress. Parents can bring their kids in for psychoacoustical testing with Julia Huyck, Ph.D., so we can determine what types of auditory and cognitive processing are affected by early stress and early hearing loss together. The kids will be older and recovered from ear infections by the time we contact the families, so we won’t have perfect early information about these kids. “The second stage of the project will be for kids who are coming in now. Dr. Jeyakumar at Akron Children’s will put protocols in place that mesh with clinical care, so we can keep track of their hearing loss and ask about their stress regularly along the way. We’ll bring them in every 6-12 months to test their auditory, speech, and cognitive skills, and can follow them up for several years. This will tell us how their brain activity has been impacted by their early experiences — leaving a residual decline in the ability to process language. This study will have a lot more power, because we’ll be able to directly relate the age and severity of early hearing loss and early stress with functional outcomes.” – Merri Rosen, Ph.D. outcomes than more privileged kids after early hearing loss, but nobody has directly tested why or how. So, we then examined what happened in our animals with a combination of early stress and early hearing loss. It turns out that the two interact — the combination was much worse than either one alone. What kinds of stressors in the home might play a role? Certainly, low socioeconomic status will contribute — food insecurity, worries about money and resources, concerns about safety, etc. If there’s stress, it gets passed around. Kids pick up on the emotions around them. If the general environment is challenging, if the kids don’t get enough attention, that can be a big deal. Early life stress is a whole field unto
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itself. People who study it try to mimic the lack of supportive environments that kids experience. Extreme examples are children in the foster care system or orphanages. Others are situations where kids don’t get parental support and don’t have as much interaction and language exposure with the adults around them — and not as much feedback. For example, in a grocery store, where parents with more time would carry on a conversation with their child as they shopped, saying something like “Oh, look at those red and green apples, which kind should we buy?’’ Yes. For people without much time, there’s nothing like that with their children. If the parents are stressed out, this can affect their children. If there are lots
of kids in residence, there may not be as much attention available. There could also be individual stressful events that even people with good resources can have in their environments — like a sick family member who’s taking up a lot of attention. What do researchers already know about early life stressors? Researchers know that early life stress can cause cognitive problems, such as with memory and attention. They’ve shown changes in brain regions involved in those functions. The new thing that’s suggested by our results is that these cognitive problems may be partly because the auditory information that’s sent to the cognitive regions is already compromised — poorly encoded by auditory brain circuits. With animal models, researchers can mimic the early life stressors that humans experience, but under controlled conditions. Separating pups from their mothers mimics neglectful environments. And unpredictable stressors are much more stressful than predictable stressors — which I confirmed with my experiments. I started by separating the pups from their mothers at the same time each day, which had a small effect. Then I decided ok, let’s mix it up and do it randomly. That changed everything. That made it a much more stressful experience, and the animals’ auditory perception became worse. How about with humans? When you’re researching stress in humans, it’s not as controlled as with animal models. So, it’s inevitably more challenging to figure out which elements of stress contribute to poor outcomes later. You have to use questionnaires to measure stress, and relate that to kids’ ability to process speech, including detecting sounds that change rapidly over time.
What’s your timeline for this project? First, my lab is using animal models to determine exactly what changes occur in the auditory parts of the brain during early life stress, and how they affect sound perception. Then we’re doing the same for the interaction of stress and hearing loss. Finally, we’re testing whether auditory training that involves exposure to specific sounds can improve animals’ sound perception. This will help us understand the best approach to help kids with ear infections in stressful environments. I’ve recently applied to the NIH to renew my current grant, which looks at an animal model of hearing loss, in order to study stress and hearing loss together. At the same time, we’re moving forward on the collaboration with Akron Children’s, with my colleague Julia Huyck, Ph.D. She is an assistant professor in speech pathology and audiology at Kent State University, who studies auditory development in kids and teenagers. Dr. Huyck is an expert on using behavior on listening tasks to evaluate hearing in kids. This project will determine how early hearing loss and early life stress interact.
What would be the best possible outcome of your research? We’re expecting to find that early hearing loss and stress together cause problems with speech perception that emerge later on — and to identify at what ages kids are most susceptible. Dr. Jeyakumar, Dr. Huyck and I hope that by identifying these problems, we can make clinicians more attentive to home environments and encourage early intervention. This would of course involve the insertion of tympanostomy tubes to alleviate the hearing loss. Additionally, clinical practices could become more aware of the home environments and help in alleviating some of that stress. They could also recommend auditory training for high-risk children. We’ll be looking into what types of auditory training regimens could help — for example, training that’s used for kids with sensory processing disorders. We’re hoping that the results from our study can inform clinical guidelines, so kids get appropriate early intervention that could make a big difference as they grow up.
HOW WILL THIS RESEARCH HELP CHILDREN? “If we could catch more of these children early without watching and waiting, with true evidence-based research showing there is a negative impact to watching and waiting, then we could change the lives of millions of kids,’’ says Dr. Jeyakumar. “We need that concrete research, because people tend to not believe that basic science research unless we can show it in humans. If we can translate that, the potential to have an impact would be huge.’’ “It would also give more support to our clinical guidelines that say, ‘Ok, if there’s fluid in the ear for this long, then do this.’ Then we can get age-specific guidelines for certain situations. For example, if there’s an older kid, we can watch and wait, but for a younger child at peak language development, we wouldn’t wait. But again, we need the evidence to support these things, because a lot of what’s out there now is very anecdotal.” – Anita Jeyakumar, M.D.
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TAKING CONTROL OF STINKIN’ THINKIN’ BY ELAINE GUREGIAN
orey (not his real name), has serious mental illness. He uses a community-based mental health service provider to stay on track with his medications and clinical needs. However, he senses that a piece of his treatment is missing. Corey is 38 years old and has been in and out of jail seven times. He wishes that he had some kind of program to help him stay out of the justice system — a tool to keep him focused and off something he calls stinkin’ thinkin.’ “Your thoughts lead to decisions,’’ Corey explains: When his thoughts drift, he may easily start thinking about picking up drugs or going out and doing bad things for money. Corey recognizes that he gets in trouble when he starts “thinking he’s slick,” as he puts it. Corey has learned to recognize how his patterns of thinking may lead to progressively negative — and potentially criminal — results. What Corey refers to as stinkin’ thinkin,’ others in the criminology and psychology literature call criminalness. This term refers to not just illegal behavior like committing crimes but also legal but
Illustration: Malieka Gurrera
“wrong’’ thoughts or behaviors like abusing sick leave, for instance. Programs that help people learn to manage criminal thinking can keep them from going down the wrong path. Such programs are usually offered within jails or other justice settings including probation or parole. And they’re effective for the general population. But they aren’t reaching enough of the people who have serious mental illness (SMI) and have become involved in the criminal justice system. It’s an especially pressing issue for people like Corey, their families and their friends — and for society, if you consider that at least one quarter of the people in the public mental health system who have what is termed serious mental illness (such as schizophrenia, bipolar disorder or major depressive disorder) will become involved with the criminal justice system in their lifetime. This population’s recidivism rate is 15 percent higher than the national average. And more people with serious mental illness are jailed than hospitalized, according to Pete Earley, who wrote about his own adult son’s heart-wrenching struggles
in the book Crazy: A Father’s Search Through America’s Mental Health Madness. Over and over, Earley saw his own son criminalized, he said in a recent Substance Abuse and Mental Health Services Administration (SAMHSA) symposium at which Mark Munetz, M.D., the Margaret Clark Morgan Foundation Endowed Chair of Psychiatry at NEOMED, was a featured speaker. Incarceration hits people with serious mental illness harder than those without it. Typically, they are incarcerated longer for the same charges; more likely to be victimized while incarcerated; and suffer from having treatment and medication disrupted.
CHANGING THE TRAJECTORY Natalie Bonfine, Ph.D., an assistant professor in the Department of Psychiatry at NEOMED, is part of a research team that is examining how to address criminalness for people with serious mental illness. Through her research, Dr. Bonfine has been talking with numerous clients and treatment providers at a community NORTHEAST OHIO MEDIC AL UNIVERSITY
mental health agency about their experiences with evidenced-based practices that are meant to help prevent clients from returning to jail or becoming criminally involved. One such approach is using cognitive behavioral therapy (CBT) interventions to address criminalness. Cognitive behavioral therapy, which is used across many settings, “teaches learners to examine their own thoughts and emotions, recognize when negative thoughts and emotions are escalating in intensity, and then use strategies to change their thinking and behavior,” according to the Frank Porter Graham Child Development Institute at the University of North Carolina. CBT interventions involve live demonstrations and practicing of interpersonal problem solving, including role playing, rehearsals and positive reinforcement, often in a group setting. For any of us, including people like Corey who have serious mental illness, certain factors are known to put people at risk for continued involvement in the criminal justice system, including: • prior and current antisocial behavior, activities or personality patterns, including tendencies for impulsive behavior, aggression or disregard for others • criminal thinking, meaning attitudes, beliefs and values that are favorable to crime • criminal associates (e.g., hanging out with the wrong crowd) CBT helps people develop skills and actually change their patterns of thinking so that they can avoid these risks.
A SAFE PLACE TO FIND HELP Cognitive behavioral therapy interventions that address criminal risk factors are
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“The focus of this project is to understand how to best deliver cognitive behavioral therapy interventions for people with SMI — and to deliver them in an integrated way in a community setting where they are already receiving treatment to address mental health needs and/or substance use needs.” – Natalie Bonﬁne, Ph.D. already being used with the general population, but they could be better targeted to meet the needs of people with serious mental illness, says Dr. Bonfine. For example, Corey completed a CBT intervention program during at least one of his incarcerations, but the program he attended was not specifically for people with SMI. And when Dr. Bonfine and her colleagues asked mental health services providers and clients, they learned that both groups would prefer that programming for people who are no longer incarcerated take place in a community mental health setting where clients already receive other services. “It may feel more natural in this environment,” said one mental health provider: “This may be a more accepting place.” This sentiment was echoed by another clinician who said, “Clients view this agency as a safe zone, not ‘Where my probation
officer sent me.’” “We all share the same risk factors for justice system involvement, whether we have serious mental illness or not,” says Dr. Bonfine. The focus of this project is to understand how to best deliver cognitive behavioral therapy interventions for people with SMI — and to deliver them in an integrated way in a community setting where they are already receiving treatment to address mental health needs and/or substance use needs. “The idea is to care for the whole person,” Dr. Bonfine says.
PURSUING THE VISION It all sounds sensible. But how do you make it happen? In October 2018, Dr. Munetz, along with Dr. Bonfine and Amy Blank Wilson, Ph.D. of University of North Carolina, Chapel Hill, convened a meeting of national experts to discuss their vision. And they have continued talking with providers, policy makers and people who receive services in community mental health settings and have heard about the need for such services in real-world settings — outside the walls of correctional settings such as jails. In the words of Megan (not her real name), a service provider who works with people with serious mental illness who live in the community (some of whom have had criminogenic involvement), “It makes more sense to prevent than to use [interventions] after they get arrested.” Alisha (not her real name), who has participated in the criminogenic programming, adds a practical note: “Most of us come from non-structured environments. Structure helps set a plan about what you’re doing day to day.” And finally, Corey notes that prevention sounds like the answer to him: “It helps me to not even let these thoughts enter my mind.”
DIABETES, OBESITY AND METABOLISM RESEARCH: Novel approaches for treatment and mechanisms for prevention BY RODERICK L. INGRAM SR.
hen you hear the words “liver disease,” what comes to mind? Alcohol abuse, right? But Yanqiao Zhang, M.D., FAHA, wants to set the record straight. Something called non-alcoholic fatty liver disease (NAFLD) is actually the most common chronic liver disease. And it afflicts 30 percent of the U.S. population. That’s not all, notes Dr. Zhang. Diabetes and obesity affect 9.4 and 34 percent of the U.S. population, respectively. And atherosclerosis (which results from high amounts of fats and cholesterol; sugar in the blood due to insulin resistance or diabetes; and high blood pressure, among other factors) is the major cause for coronary heart disease — the No. 1 killer in this country.
ANYTHING BUT BASIC…
While different from clinical research — which is patient-based — the basic science conducted by the Diabetes, ObeMetabolism allows the body to either sity and Metabolism Research Group is use food for energy now or store the anything but basic. energy in body tissues, such as the Basic science tries to figure out the liver, muscle or adipose ( fat ) tissue. processes as they occur in the body. “Since Abnormal biochemical reactions in most people don’t want you to take piecthe body can disrupt this process es of their body — i.e. liver — for testing, and an imbalance of substances members of the group use animal models, result in unhealthy outcomes. When usually mice,” says Dr. Zhang. Researchour bodies accumulate more fats ers can give mice a condition such as a or sugars, we may suffer from high-fat diet and compare it with a stanseveral common metabolic diseases, dard condition. The researchers take the including fatty liver disease, diabetes, tissues to see what’s happening in different obesity and atherosclerosis. parts of the body and each researcher’s lab adds a piece of research to the science. In the past, the researchers would test for individual genes using real-time polymerase chain reaction RIGOROUS RESEARCH (PCR) — a fast and inexpensive technique used to “amplify” Seeing the common threads among these chronic illnesses, (copy) small segments of DNA — but they first needed to Dr. Zhang envisioned the benefit of collaboration. To further determine which genes they should be seeking. Now, they use develop the basic science advancements already in motion by RNA (ribonucleic acid) sequencing – essentially, a massive his NEOMED colleagues, he assembled an eight-member snapshot of everything that’s happening, including how many team: John Chiang, Ph.D.; Jessica Ferrell, Ph.D.; James Hardgenes and how they’ve changed – which accelerates the research. wick, Ph.D.; Takhar Kasumov, Ph.D.; Yoon-Kwang Lee, Ph.D.; Dr. Zhang says that his group’s equipment is a game-changPriya Raman, Ph.D.; and Liya Yin, M.D., Ph.D. er in supporting innovative processes and accelerating their With 11 National Institutes of Health grants among them science. Just one example: “We can perform 16S ribosomal and collective expertise in studying bile acid, glucose, lipid and RNA (rRNA) sequencing to identify and compare bacteria lipoprotein metabolism, members of the Diabetes, Obesity present in the gut.” and Metabolism Research Focus Area — officially established To further explain the potential of such work, Dr. Zhang in summer 2018 – have already identified novel targets for gives an example of a study being done outside of NEOMED: treatment of NAFLD, atherosclerosis and obesity. The research By placing a microbiome (a community of microorganisms group’s director, Dr. Zhang, is one of a small number of resuch as bacteria, fungi and viruses that live in or on the human searchers across the country with five or more NIH grants, body) of feces from a lean person into an obese person, such including four R01s — highly competitive grants that provides sequencing could ultimately make that person lose weight. funding support for up to five years for studies designed to Though the thought of this process may be difficult to imagine, enhance health, extend healthy life, and reduce the burdens of the potential of such novel approaches boggles the imagination. illness and disability. And there’s nothing basic about that.
THE ROOT OF METABOLIC DISEASE
NORTHEAST OHIO MEDIC AL UNIVERSITY
THE HEART VALVE REPLACEMENT DILEMMA BY ELAINE GUREGIAN
ioethicist Julie Aultman, Ph.D., believes attention needs to be paid sooner, not later, to a life-threatening problem caused by the opioid epidemic. It’s a disease called infective endocarditis (IE) that often comes about from intravenous drug use (IVDU). Endocarditis is caused by bacteria on one or more heart valves, which leads to a mass or what is known as vegetation, which disrupts the ability of the valves to pump blood. Valve replacement then becomes a medical option in theory, but not always in practice — and that’s the crux of the problem. Whether to perform the surgery on this population has become a controversial topic, occupying researchers like Dr. Aultman, who heads the Medical Humanities Program at NEOMED, and her colleague, cardiac surgeon Michael Firstenberg, M.D., associate professor of surgery, adjunct graduate faculty in the College of Graduate Studies, and adjunct assistant professor in the Department of Integrative Medical Sciences. Emanuela Peshel, a Master of Medical Humanities and Ethics degree candidate, and Cyril Harfouche, a Medical Ethics certificate candidate, have been working with Drs. Aultman and Firstenberg on an extensive research project that looks into the problem from the perspectives of patients and health care professionals alike. The faculty-student research team have analyzed personal patient cases to identify ethical nuances and patients’ critical needs beyond simply heart valve replacement surgery — needs such as addiction counseling and behavioral interventions.
A TROUBLED PAST Peshel tells the story of Adam (not his real name), a 34-yearold relapsed IV drug user with a history of valve replacement. Adam found himself again in the hospital after an extensive regimen of antibiotic therapy failed to treat infective endocarditis of his prosthetic valve. Despite his previous sobriety and stable clinical condition, his troubled past made him a lessthan-ideal surgical candidate. This case required mediation by the ethics committee as issues of morality, justice, and non-maleficence (related to the physician’s oath to “do no harm”) were deliberated.
SEPARATING MEDICINE FROM MORALITY A variety of factors contribute to relapse in patients such as Illustration: Hui-Chu Ying
Adam, says Peshel, who is also a College of Medicine student, Class of 2019.The more common ones include limited addiction resources within their community, early discharge from drug rehabilitation, an unstable home environment, negative social influences and low self-determination to overcome addiction despite medical risks. Medical Ethics certificate candidate Cyril Harfouche remembers Amy (not her real name), a patient he cared for during his surgery clerkship. (Harfouche is also a College of Medicine student, Class of 2020.) Amy was a 24-year old mother of three who had first received a prosthetic valve at the age of 19, following three years of IV drug use. “What is particularly touching about that young lady was her past as a victim of human trafficking and sexual abuse, which haunted her recovery efforts,” says Harfouche. After her initial surgery, Amy was able to stay clean for two years before relapsing and requiring a second valve replacement operation. Harfouche’s final encounter with Amy was also Amy’s last hospital admission. She died after being treated for IE for a week in the Intensive Care Unit. Relapsing after both surgeries and the amount of scarring that had been present made it impossible for any surgeon to consider operating on her again. “Amy was a victim to her past and to a major lack of support and resources in her community,” Harfouche says. Among health care professionals, there’s a prevailing stigma that valuable resources are wasted on people whose IVDU may result in their needing multiple valve replacements, says Dr. Aultman, who is Principal Investigator (lead researcher) and advisor on the project. “Perpetuating the stigma reinforces the reluctance of health care professionals to provide multiple heart valve replacement surgeries as options among other medical interventions,” she adds. Dr. Aultman’s research team seeks to identify which factors impact medical decisions, and to assess the current opinions and practices of cardiothoracic surgeons. The faculty-student team hopes that clarifying the issues and working to separate medicine from morality will help to reduce stigma and put patients first. “Making the decision whether to operate is never easy,” says Peshel. “But as we continue to encounter patients like Adam, we need to find a better way to treat them holistically.” NORTHEAST OHIO MEDIC AL UNIVERSITY
RESEARCHER, MEET CLINICIAN Researcher Merri Rosen, photo by Lew Stamp
BY ELAINE GUREGIAN
magine a laboratory researcher, and the picture that comes to mind might be of a single person looking into a microscope. But ideas don’t flourish in a vacuum. Multiple perspectives bring them to life — especially perspectives that bring the real lives of patients into the picture. Advances in understanding the scientific basis of disease and the best strategies for treatment necessarily involve collaboration between university academics and health care professionals. Basic scientists can best inform their research designs based upon observations and data from patients and physicians can best inform their care practices by understanding basic research. Traditional academic health centers are 18 I G N I T I N G
designed such that universities own and operate hospitals in close proximity to the university. But NEOMED is a community-based academic health center that does not own nor operate a hospital, but rather collaborates with 24 hospital partners throughout the region. So, collaboration in research must necessarily be more intentional in order to succeed. To that end, partnerships are flourishing among NEOMED researchers and clinicians and scientists at Akron Children’s Hospital (ACH), a nationally acclaimed institution that now serves half a million children and adults each year at multiple locations in Northeast Ohio. Michael Kelly, M.D., Ph.D., a pediat-
ric oncologist who is the chief research officer at ACH as well as a professor of pediatrics at NEOMED, has been instrumental in cultivating partnerships between physicians and scientists at ACH and scientists at NEOMED. Pairing physician and scientist interests leverages strengths of both institutions and is critical to develop a broader pediatric research agenda, says Steven Schmidt, Ph.D., vice president for research at NEOMED. “The result will likely be enhanced patient care for pediatric patients and an increase in overall knowledge. Bringing together the strengths of researchers from NEOMED with the patient experiences of clinicians and scientists at ACH is a
Clinician Anita Jeyakumar, photo courtesy of Akron Children's Hospital
way to move research forward faster and better, to benefit the public,’’ says Dr. Schmidt, who is also a professor of pharmaceutical sciences and dean of the College of Graduate Studies. “The goal is to develop regional research relationships that will benefit many institutions — not only Akron Children’s,” says Dr. Kelly. Here’s what some of the clinicians and researchers have to say about some of the varied new opportunities that are already developing through this partnership – and the growing alliances and paths aimed at improving health.
VANISHING BONES Last fall, Fayez Safadi, Ph.D., director
of the Musculoskeletal Research Group, Ohio Research Scholar and professor in the Department of Anatomy and Neurobiology, began spending one day a week at ACH pursuing his interest in identifying treatment for bone and cartilage diseases — a research focus that dovetails with research being done at ACH. He has developed multiple collaborations with physician-scientists in the hematology and oncology group, pediatric orthopaedics and pediatric nephrology. Dr. Safadi collaborates with Dr. Kelly and Janice McDaniel, M.D., a pediatric interventional radiologist, on the bone loss that occurs with Gorham-Stout Disease – also known as Gorham’s Disease or
vanishing bone disease. This rare disease occurs when the lymphatic system does not develop well or correctly. Grants from the national Lymphatic Malformation Institute as well as Akron Children’s Hospital Foundation support the team’s study. In addition, Dr. Safadi is working with several orthopaedic surgeons and mentoring Ashley Mohrman, Ph.D., a young scientist focused on diseases in children’s growth plates. He is also mentoring Kirsten Kusumi, M.D., Ph.D., a physician-scientist in pediatric nephrology whose work is focused on understanding the relationship between kidney stones and bone loss in children. “These collaborations are exciting and NORTHEAST OHIO MEDIC AL UNIVERSITY
Mathew Smith, photo by Lew Stamp; Michael Kelly, photo courtesy of Akron Children's Hospital
only the beginning,” says Dr. Safadi. “Our goal is to develop strong research relationships that cultivate physician-scientists and help identify newer and safer treatments for children with diseases affecting bone.”
NEW OPPORTUNITIES FOR PATIENTS Anita Jeyakumar, M.D., says that the clinical world of hearing is based on failure — not prevention. The director of pediatric otolaryngology at Akron Children’s Hospital and an associate professor at NEOMED, Dr. Jeyakumar would like to turn that mindset around, so when she met Jeff Wenstrup, Ph.D., the director of hearing research at NEOMED, on a recruitment visit to ACH, she got excited. “They’re doing a lot of state-of-the-art work already, but 20 I G N I T I N G
Dr. Wenstrup said they didn’t have access to enough patients. I said, ‘Gosh, we have patients! We have a lot of patients – and we have a diverse population here, which from a research perspective is very interesting.’’’ Together, they decided to develop a collaborative center for hearing loss that would be both research- and clinically-based. “Our kids that are diagnosed will have the benefit of access to unique research, as well as all the state-of-the-art clinical opportunities — and they won’t have to leave the region,’’ says Dr. Jeyakumar. Some families have already come from out of state for a research study on environmental stress and chronic hearing loss led by Merri Rosen, Ph.D., an assistant professor of anatomy and neurobiology at NEOMED.
(See story “Stressful Home, Harder Hearing,” on Dr. Rosen’s research collaboration with Dr. Jeyakumar.)
BEGINNING A RESEARCH CAREER Matthew Smith, a visual neuroscientist who received a Ph.D. from NEOMED’s Integrated Pharmaceutical Medicine (IPM) program, was nearing the end of his post-doctoral fellowship work studying diseases that alter eyebrain communication and was looking for the next career step. When Dr. Schmidt approached him to spend half his time as an assistant professor developing the IPM program (including teaching) and doing independent research in NEOMED’s Neurodegenerative Disease and Aging Focus Group, and
Fayez Safadi, photo by Chris Smanto; Steven Schmidt, photo by Lew Stamp
to spend the other half of his time employed by ACH as a staff scientist carrying out independent research to improve understanding the pathophysiology/role of the visual system in several pediatric afflictions, the young researcher saw an opportunity too good to pass up. “This is a unique opportunity, for which I am really excited and grateful. On one hand, I get to help create a new relationship between two great institutions, while continuing to develop my own independent research program, and on the other, give back to the graduate program that I am a product of,” says Dr. Smith. As part of the Vision Research Group at ACH, he’ll pursue research including but not limited to visual deficits in pediatric/ adolescent traumatic brain injury and pediatric glaucoma.
Our kids that are diagnosed will have the beneﬁt of access to unique research, as well as all the state-of-the-art clinical opportunities — and they won’t
have to leave the region.” — Anita Jeyakumar, M.D.
NORTHEAST OHIO MEDIC AL UNIVERSITY
A SAFE LANDING FOR MR. BENNET A Geriatrics Interprofessional Education Team Training BY ELAINE GUREGIAN
You might know a man like Mr. Bennet. He’s 81 years old and determined to continue living alone in the house he shared with his late wife. Mr. Bennet subsists on fast food, since his wife used to do all the cooking, and the wrappers are scattered among dust bunnies and unwashed dishes. Mr. Bennet takes 10 different medications to manage his Type 2 diabetes and a few other conditions, including hypertension and osteoarthritis — and he drives himself to the pharmacy to pick them up. Besides getting food, that’s about the extent of his outings; he used to be a regular church-goer, but he quit attending after his wife died. Yesterday, Mr. Bennet crashed his car into his garage. The nurse who regularly visits him at home discovered him there, disoriented and in pain, so she had him transport22 I G N I T I N G
ed to a nearby emergency department. Bruised and with a sprained right arm, Mr. Bennet is now back home, being treated for pain. His daughter is worried about him, especially given his confusion. Is it safe for him to continue living at home? Will she have to give up her job to take care of him if he can’t afford the professional assistance he needs? And how many health care professionals will she have to consult to figure out what’s best for her dad? Family members struggle every day with scenarios like this one, which was the basis for a recent half-day interprofessional geriatrics training at NEOMED, supported by the Office of Interprofessional Training and a federal Geriatrics Workforce Enhancement Program (GWEP) grant. Over 270 health professions stu-
dents and 46 faculty members from seven local colleges and universities throughout the region joined NEOMED College of Medicine and College of Pharmacy students on campus to learn, by role-playing, how to work as a team, connecting all the dots to care for elderly patients like Mr. Bennet. Posters focused on four major aspects of geriatric care, including how to assess the safety of an older adult’s home, were placed around the training site. Here’s a look inside the training.
LAYING THE GROUNDWORK The students gather in groups with their team members representing physical therapy/exercise science; occupational therapy; nursing; advanced practice nursing (APN); medicine; pharmacy; social
work and dietetics. Then they travel to each of the four posters, discussing different concerns, from pharmacy to nutrition. The goal: In 15 minutes per poster, guided by facilitators, each group contributes from their area of expertise to identify the problems Mr. Bennet may have, and develop a care plan. GWEP program director Jennifer Drost, D.O., M.P.H., probes one group: What might have contributed to Mr. Bennet’s accident? Could medication he’s taking for a urinary tract infection or his general depression have played a part? How about the Benadryl he takes “to calm his nerves” and to help him sleep? Suggestions bubble up across the room: The nutrition group suggests someone contact Meals on Wheels for deliveries of nutritious food. The APN group recom-
mends talking with an orthopaedic surgeon about replacing or repositioning the splint, since Mr. Bennet says it’s painful. The physicians suggest screening for possible depression, which might be a cause of the confusion and is also likely due to Mr. Bennet’s isolation and loss of spouse. The pharmacists express concern about Mr. Bennet taking non-steroidal anti-inflammatories (NSAIDS), which are not recommended for people who have had a heart attack and can have side effects like gastrointestinal bleeding. And they want to be sure to try Tylenol first — not opioids — for pain.
PUTTING IT ALL TOGETHER Now comes the big test. Can these disparate groups of health professions students work together to
create a care plan for Mr. Bennet? All in 90 minutes? The students divide up among tables, so each table has a diverse group led by a facilitator or two. At our table: a Master of Occupational Therapy student; a nursing student; a NEOMED College of Medicine student; an exercise science student; an acute care nurse practitioner and instructor; and Erica Stovsky, M.D., M.P.H., a facilitator and NEOMED Department of Internal Medicine faculty member. The students dive in with concerns and ideas. Mr. Bennet is short on opportunities to socialize, and he’s too depressed to motivate himself to go to special programs for seniors. But he loves his dog, Mickey. “Instead of signing him up for workouts at a gym, why not have him get exercise through something that is meaningful to NORTHEAST OHIO MEDIC AL UNIVERSITY
him, like walking his dog at the local park?” suggests the occupational therapy student. He might even join a pet-owners group that meets there. And could a friend from church pick him up for services? The group considers his options for 24/7 care, then the occupational therapy student speaks up: Medicare does not pay for custodial care, so Mr. Bennet would have to pay privately for this service. So, an ongoing (paid) 24/7 care option seems to be out — but maybe the family could hire 24/7 care for the first few nights and daily help for the first couple of weeks, which would be safer than Mr. Bennet staying home alone. The group decides these are good options to consider. And because Mr. Bennet has a urinary tract infection and an allergy to penicillin, his medications, including diabetes medications, need to be re-evaluated, says the College of Medicine student.
ENTER THE DAUGHTER NEOMED's Wasson Center for Clinical Skills, Training, Assessment, and Scholarship trains people from the community to play the roles of so-called Standardized Patients, who help students develop caregiving skills. In this case, the Standardized Patient represents a family caregiver who will become an essential part of the care team. Today, the role of Mr. Bennet’s adult daughter is being played by a dozen people from the community who were given a script and backstory and then instructed in how to interact with the students. According to the script, Mr. Bennet was encouraged to attend the team meeting but refused. After the students discuss their care plan, the caregiver daughter joins them in his place — surprising the students, particularly since she has information to share that alters their care plan. According to the script, Mr. Bennet’s daughter holds a full-time job and is trying to balance it with taking care of her 24 I G N I T I N G
PARTNERSHIPS father. She lives about 20 minutes away from him. The car accident and his subsequent confusion have led her to believe he may need more care than he previously got. She’s a bit distraught at all of the pieces — emotional, physical and financial — of her father’s care that she needs to sort out. In this simulated meeting, the students practice working as a caregiving team, negotiating solutions and coming to compromises with Mr. Bennet’s daughter and each other. When they first meet the daughter, they don’t all remember to introduce themselves by name and what they do — a crucial step, says faculty facilitator Dr. Stovsky. (It’s easy for a lay person to confuse an occupational therapist with a physical therapist, for example.) The facilitator reminds them of another key step: learning what all the team members bring to the table, and exactly what they do. For example, if you don’t know that a speech therapist can perform a cognitive evaluation, you’ll never ask them for one. Another tip from Dr. Stovsky: Find out the starting point for each patient and their family members. Ask them whether they would like to hear a detailed explanation or just the highlights. “And ask them, ‘What do you need? What can
Much as the students collaborated, NEOMED partnered with others for this project. The Mr. Bennet case was designed as a part of a project in the NEOMED Office of Geriatrics called Building Caregiver Partnerships through Innovative Interdisciplinary Education, funded by the national Arthur Vining Davis Foundations. The grant was a partnership of Summa Health, NEOMED, the University of Akron, Cleveland State University and Direction Home Area Agency on Aging. we do to make things better for you?’” suggests Dr. Stovsky. The nursing student adds a technique she’s learned: Ask the person to say back to you, “What is it that you understand is happening (with the patient)?’’ Whatever you do, make sure to include the patient and their family member as part of the team, Dr. Stovsky urges the students. Be sure to listen carefully to the caregiver’s perspective to find out what the family can afford — and most important, what they need.
HUMANITIES IN MEDICINE
THE HEALING POWER OF REFLECTION BY RENEE BRUMBAUGH
’ve worked with patients actively suffering from addiction, more likely to rely solely on the facts stated in the room. by participating in the Hazelden-Betty Ford Summer InFor this reason, it is imperative to start these discussions by stitute for Medical Students program and working with asking what the patient knows. That way, I can address his Pedro Ballester, M.D., a family doctor in Warren, Ohio. I’ve concerns and understand whether he wants to hear his diagnosis at all. By reflecting meaning and emotions to his concerns, also worked with these patients’ families, who suffered in less obvious ways. Something important I picked up along the way I can help him feel more comfortable and understood — emis that the disease not only affects the individual — it also powering our patient-provider relationship. breaks the family, sometimes just as much. NEOMED teaches students about the biopsychosocial A technique we learn in Humodel of health care, and if any man Values in Medicine courses disease requires this model for re“When I ﬁ rst tried to state aloud and Foundations of Clinical Medcovery, it is addiction. We may icine courses at NEOMED is to the emotions of families of patients have a dictionary definition for addiction, but the true expression listen to what a patient or family who were struggling with addiction, of it includes emotions, reactions, member says, then repeat it right back to them. It feels really strange losses of function, family dysfuncI found it difﬁcult.” at first, but it helps both parties – Renee Brumbaugh tion, and other life-altering changunderstand each other better and es that are interpreted uniquely by focus on what was said. Reflecting each patient. My experiences so on the most meaningful phrases can bring out the emotions far have shown me that some doctors lose early on — or posthat are tied to our thoughts — and that’s key. sibly never find — any empathy for the addicted. As outsiders When I first tried to state aloud the emotions of families to this disease, we must strive to understand it holistically and of patients who were struggling with addiction, I found it empathetically from each patient’s perspective. difficult. I could only imagine that people who were truly I’ll never forget the discussion I had with a mother of suffering were also having difficulty understanding their own someone with substance use disorder. (Words do matter, and emotions. But that is the art of medicine: helping people come I’ve also been taught how hurtful the word “addict” is.) I to terms with their feelings as they face their own illness, or an simply said, “I know you are worried about your daughter, but how has that worry been affecting your life?” She looked me illness of their family member. This essential task in medicine is termed reflective practice, in disbelief and told me nobody had ever asked her that. By and it has been eye-opening to me because in class, we discuss the expressions on her face, I knew she really had to think to put the information together in her head. Our discussion things with each other that are interpreted differently by each person. It is interesting to see the same readings thought about ended in tears, but she thanked me sincerely and said that I from a variety of perspectives, and the discussion opens us up helped her understand things in a new way. The funny thing to a much broader realm of understanding. This is critical for is, all I did was listen to her make sense of her own situation. Remembering to address the mental, spiritual and social all aspects of medicine, since we will work with people from needs of each individual patient is critical to recovery. Nothing many different walks of life and need to expect that they excan replace the act of listening — and reflecting — to truly perience the world differently than we do. understand those needs. As a young woman raised at a time when seemingly every topic is open to discussion, I’ve come to respect the generational differences in health care delivery. For example, my Renee Brumbaugh, a third-year student in the Rural Pathway 80-year-old patient with new-onset heart failure symptoms program in the College of Medicine, was selected for the Society may want to know why he is feeling so unwell — but maybe of Teachers of Family Medicine 2019 Student Scholar Award. She shared some of these thoughts previously in the NEOMED he has never heard the term heart failure before. Even though my generation would likely pull up the Wikipedia page on series “Halting a Crisis.” heart failure after the doctor broke the news, this patient is NORTHEAST OHIO MEDIC AL UNIVERSITY
IN THE REDIZONE
A PATH LESS TAKEN
eveloping a new product that may help stimulate hair growth isn’t the usual focus of research for Charles Thodeti, Ph.D. But giving researchers the chance to branch out is a good thing, and a byproduct of the new faculty research awards presented for the first time this year by the Research, Entrepreneurship, Discovery and Innovation Zone (REDIzone®) at NEOMED, says program manager Elliot Reed, J.D., M.B.A. William Chilian, Ph.D., professor and chair of the Department of Integrative Medical Sciences; Gary Niehaus, Ph.D., professor of physiology; and Charles Thodeti, Ph.D., associate professor of integrative medical sciences, have been selected by a panel of external reviewers to each receive a $10,000 grant from the REDIzone program. These inaugural awards will take them one step further toward a goal of NEOMED’s life science business incubator: to accelerate the translation of technology through commercialization in order to improve healthcare outcomes worldwide. The REDIzone wants to support its researchers every step of the way in high-risk, high-reward research, says Reed. That includes at the beginning of a project, when funding is needed to generate the preliminary data to test the viability of ideas. The 2018-19 academic year was the first for the faculty awards, which were funded by income generated through the REDIzone program.
DR. CHILIAN: Chemical modiﬁcation of Chromonar to enhance coronary vasodilation (working toward a treatment for heart disease in women)
DR. NIEHAUS: Rapid, automated detection and identiﬁcation of bacteria infecting wounds
DR. THODETI: Identifying novel mechanisms for modulation of hair growth Visit www.neomed.edu/ignite for feature stories on the three researchers and their projects.
Pictured to the left; top: Gary Niehaus, bottom left: William Chilian, bottom right: Charles Thodeti, photos by Lew Stamp
NEW STUDENT INTERNSHIPS
Future Medtech Entrepreneur Internship for students will begin this summer at the REDIzone. The internship will provide all of the selected NEOMED students with a $3,000 stipend over the summer. The idea is to bring together an interprofessional team of students from the NEOMED College of Pharmacy and College of Medicine along with J.D. and M.B.A. students from our regional partner institutions, says program manager Reed, noting, “It’s a way to look at healthcare innovation from diverse perspectives: ethical, clinical utility, and market fit.” A two-week program teaching the concepts of medical innovation and taking innovative products to market will open the internship, which will continue with stu-
dents learning the elements of a strong business plan by reviewing investment presentations of regional life science startup companies. As a capstone project, teams will identify innovations of interest from regional universities and research hospitals; develop a business pitch; and present the concepts to regional economic development organizations and research institutions. The new internship program is supported by a grant to the NEOMED Foundation for this purpose from the Burton D. Morgan Foundation. This is an important step, says Reed: “A paid internship supported by the Burton D. Morgan Foundation will be enormously helpful in helping students pursue entrepreneurship in research.”
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1990 Rochelle Rosian, M.D., is looking forward to working on the Class of 1990 30-year reunion, coming up in 2020. Dr. Rosian would love to hear reunion ideas from fellow classmates.
1994 An-Yu Chen, M.D., was elected to the Board of Directors at the Lexington Kentucky Clinic. Dr. Chen was also reconfirmed as head of section for gastroenterology at the Clinic.
2006 Katherine Sheridan, M.D., recently relocated to Lumberton, North Carolina, after accepting the role of associate program director for Campbell University’s Southeastern Health Family Medicine Residency Program.
Amy Reese, M.D., retired in June 2018 from the United States Navy Reserve after 28 years of combined active duty and reserve service. Dr. Reese is currently the medical director of University Hospitals Seidman Cancer Center at Firelands Regional Medical Center in Sandusky, Ohio.
1995 Laura Divoky, M.D., serves as a cardiologist at The Heart Center of Northeast Georgia Medical Center. Dr. Divoky completed a fellowship in cardiovascular disease at the Medical University of South Carolina in Charleston, South Carolina. Kevin Dieter, M.D., received the Josefina B. Mango Distinguished Hospice Physician Award from the American Academy of Hospice and Palliative Medicine (AAHPM). Dr. Dieter serves as the associate medical director at Hospice of the Western Reserve in Cleveland, Ohio, and as an associate professor of Family and Community Medicine at NEOMED. Renee Wagner, M.D., was appointed chief medical officer at Fairfield Medical Center in Lancaster, Ohio, in November 2017. Dr. Wagner has been in practice at the Center since 1995 as an anesthesiologist.
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Gregory Ferner, M.D., was named the winner of the 2017 Distinguished Service Award by The Portage Medical Center Foundation.
1999 Jennifer Lin, M.D., will be opening an MDVIP concierge practice in Tucson, Arizona, at the end of February 2019.
2004 Justin Kunes, M.D., joined Piedmont Healthcare in 2017. Dr. Kunes was board certified in orthopedic surgery in 2015 and received a specialty certificate in hand surgery in 2017.
Megan Sampson, M.D., joined Akron Children’s Hospital in Akron, Ohio, as a pediatric hematologist/oncologist in the Showers Family Center for Childhood Cancer and Blood Disorders. Dr. Sampson recently completed a pediatric bone marrow transplant fellowship at Cincinnati Children’s Hospital in Cincinnati, Ohio.
Mahmoud El-Yassir, M.D., joined Specialty Eye Institute in Michigan as a cataract and glaucoma specialist. Daniel Smith, M.D., joined Akron Children’s Hospital in Akron, Ohio, as a developmental-behavioral pediatrician for the Hospital’s Department of Developmental and Behavioral Pediatrics in 2018.
Elya Vasiliou, M.D., joined Porter Medical Center at The University of Vermont, located in Middlebury, Vermont, as a general surgeon, in 2018. Dr. Vasiliou completed a fellowship in head and neck endocrine surgery at Johns Hopkins Hospital in Baltimore, Maryland.
Ashley Byrne, Pharm.D., and Eric Fela, Pharm.D. (’17), were married on October 6, 2018.
Nikolas Sekoulopoulos, M.D., and Katelin Dillon, a NEOMED College of Pharmacy curriculum coordinator, announced their engagement on July 27, 2018. Dr. Sekoulopoulos and Dillion will be married September 5, 2020.
Rachel Harpst, Pharm. D., and her husband welcomed a baby girl, Emma Marie, on June 22, 2018. Emma joins big brother, Mason, born in 2015. Melanie Rozum, Pharm.D. (’17), Jennifer McKay, Pharm.D. (’18), Sara Shuss, Pharm.D. (’18), and Taylor Engelhart, Pharm.D. (’18) (pictured left to right), took the opportunity to reconnect with former classmates and Dean Richard Kasmer, Pharm.D., J.D. (far right) at the College of Pharmacy’s Meet the Dean event in October 2018.
NORTHEAST OHIO MEDIC AL UNIVERSITY
One of Many Reasons to Reconnect …
During the 2018 Medical Innovation Summit (Cleveland, Ohio), Disruption: Reimagining Healthcare, NEOMED alumni, Frank Papay, M.D. (’84), chair, Dermatology & Plastic Surgery Institute, Cleveland Clinic, and Eric Kodish, M.D. (’86), staff, Center for Bioethics, Cleveland Clinic, discussed their experiences as members of the multi-disciplinary team who performed its ﬁrst total face transplant on 21-year-old Katie Stubbleﬁeld, the youngest face transplant patient in the U.S.
MORE NEOMED GRADUATES WHO ARE DOING AMAZING THINGS. NEOMED has 4,352 alumni representing all 50 states plus Canada and the U.S. Virgin Islands. Alumni hail from over 300 undergraduate universities, are employed by nearly 200 clinical institutions and pharmacies, and practice in more than 50 ﬁelds of health care.
Reconnect with a Who’s Who of Fellow Health Professionals Visit neomed.edu/alumni and check out Reconnect! to update your information and receive the following beneﬁts: • Keep in touch with fellow classmates. • Receive access to all registered NEOMED alumni for personal/business networking. • Get invitations to NEOMED events in your area. • Receive the monthly alumni e-newsletter and our daily or weekly University newsletter ( The Pulse).
Check out “Get Involved!” to see the full menu of options. THE NEOMED ALUMNI ASSOCIATION INVITES YOU TO RECONNECT IN THE ETERNAL CITY!
SIX NIGHTS IN ROME O C TO B E R 10 – 16 , 2 019 Get your complete package for as little as $3,499 per person/double occupancy Includes round trip air from Hopkins Intl. Airport , taxes, fees/surcharges and hotel transfers; luxurious hotel for 6 nights; 8 meals; guided tours; culinary experiences; and more.
HUMANITIES IN MEDICINE
FUNER AL FOR BILLY By Poorna Sreekumar
Death, I learned, holds minor consequence. Hindus are optimistic that way. A period at the end of a run-on sentence, or something as simple as changing coats when you’re tired of the weight of yours. Even my mother, who bawled after her father’s death 8,000 miles from home, looks now into other people’s eyes like she can tell who was who. When Billy died, I stood in the kitchen with my roommates watching light tremble on glass
ow in its 37 th year, NEOMED’s William Carlos Williams Poetry Competition is named for the American poetphysician who worked as a family doctor in Rutherford, New Jersey.
Poorna Sreekumar, a student at the University of Maryland School of Medicine in Baltimore, won third place in NEOMED’s 36 th annual competition. Nearly 400 students from across the U.S. entered the 37 th annual competition, which will celebrate its winners with an event at NEOMED this spring.
as they scooped out his dead body, orange and silver under the fluorescent bulb. Everyone else milled out but I waited next to his tank. His tender weight in my palm was so ripe, that I wished for a second life didn’t have to change coats so quickly.
NORTHEAST OHIO MEDIC AL UNIVERSITY
SIX ALUMNI FIND A NOVEL WAY TO GIVE They utilized a life insurance policy to maximize their giving potential
David Mallamaci, M.D. (’97)
Vimal Patel, M.D. (’96)
Albert Kim, M.D. (’97)
“We received a great medical education at NEOMED; our planned gift will help others do the same.” – Seilesh Babu, M.D. (’97)
Michael Huang, M.D. (’97)
Gagandeep Mangat, M.D. (’98)
In the company of friends, the conversation began as it often does — during a round of golf. But this time the friends — former classmates and fellow physicians — were simply spectators at the 2017 WGC-Bridgestone Invitational. The six friends share a love of the game, the medical profession and their alma mater — Northeast Ohio Medical University. Despite their busy lives and varied geographies, they get together for leisure activities and leisurely talks. So, when Seilesh Babu, M.D. (’97), a specialist in the treatment of ear and skull base disorders, started discussing a group gift in support of NEOMED, the conversation got really interesting. Drs. Seilesh Babu, Michael Huang, Albert Kim, David Mallamaci, Gagandeep Mangat and Vimal Patel decided to do what no group of NEOMED alumni had ever done — they decided to personally fund and donate a whole life insurance policy to beneﬁt the medical university they love.
How was this possible? And whose life would they insure? Here’s how it works: Seilesh volunteered to have his life insured, and all six friends would make tax-deductible gifts to the NEOMED Foundation totaling the policy’s annual premium cost. The NEOMED Foundation pays the premium cost, owns the policy and accumulates the policy beneﬁt over the next 10 years from the group’s annual gifts. The policy would pay up to a $150,000 beneﬁt to NEOMED on the death of the insured. Assuming there is no claim, the NEOMED Foundation can utilize the accumulated gifts. It’s as simple as that. By donating as a team, these classmates and friends chose to make a greater philanthropic impact on NEOMED than by giving separately. Although they were all on board, ﬁrst things ﬁrst: The guys had to ask their wives. No problem — they received full spousal support (it didn’t hurt that two spouses are also proud graduates of NEOMED). The group can nurture this long-term gift for the purpose of their choosing — scholarships, research funding, etc. It’s up to them.
Maybe you have thought about a future gift to Northeast Ohio Medical University through your estate plans or a seamless transfer of property. If you’ve already included NEOMED in your plans, THANK YOU! But please let us know so we can ensure that your legacy wishes come true.
A conversation that begins with you and your loved ones can move forward with a call to us. For assistance in accomplishing your planned giving goals, please contact: Michael A. Wolff, J.D. | 330.325.6667 | email@example.com
SUPPORTING COMPASSIONATE CARE BY ELAINE GUREGIAN
ortheast Ohioans Budd and Alice Meyers first en- to live for about six months or less if the condition follows its countered hospice when Alice’s brother-in-law re- expected course. Patients with Alzheimer’s, Parkinson’s or other ceived hospice care before his death. Several years neurodegenerative disease often benefit from palliative care and later, they lost three of their parents in the same year. Seeing eventually hospice care. That’s of special interest to Budd, since each of them through their time in hospice, the couple learned he has a sister who died from Alzheimer’s. “When I think of more than they could ever imagine about the healing power of these students being trained to help, I think about my sister and how much I wanted her to be cared for empathy and compassion from the docwith kindness,” he says. tors, nurses and hospice staff. They experienced firsthand the difference these pro- “I really liked going to It’s an isolating process, watching loved fessionals can make for both the patients the homes to relieve the ones die. Just a friendly hello or a little bit of conversation from the person giving and their families when palliative care is caregivers by sitting with their parent medicine or turning them in all that can be offered. As a result, Alice became a hospice the patients, praying with their bed went a long way, the couple says. volunteer after her retirement, assisting in And the opposite was true. “It’s all about some of them, holding various ways for many years. “I really liked compassion. If the caregivers don’t talk to going to the homes to relieve the caregivtheir hand or reminiscing you or if they aren’t welcoming…” Alice’s ers by sitting with the patients, praying voice trails off. She doesn’t need to finish about their lives. Some with some of them, holding their hand or the sentence to make her point. reminiscing about their lives. Some paSo, the Ohio couple was intrigued patients were very open tients were very open and just wanted to when they learned about NEOMED’s and just wanted to talk.” Office of Palliative Care, which trains Coltalk,” she says. Alice’s last job with hospice was making lege of Medicine and College of Pharmabereavement calls to caregivers or loved ones. When the couple cy students in compassionate care over the course of a four-year began visiting Florida, she continued these calls from the terrace curriculum that encompasses humanism and the arts, bioethics, of their condo, doing her best to bring the person on the other behavioral science and community health along with clinical end of the line some of the tranquility she felt as she watched sciences. Because they liked what they heard and observed when the ocean. “I talked with family members, including widows they visited campus, they established the Budd and Alice Meyand widowers who were alone for the first time in years and ers Scholarship Endowment. The merit-based scholarship will appreciated talking with someone who would just listen. They be awarded annually to a medicine or pharmacy student at were trying to be strong for their family and knew they could NEOMED. First preference will be given to students who have completed a summer fellowship or a national Medical Student be open and honest with me,” she says. Training in Aging Research (MSTAR) Program fellowship, in LEARNING HOW TO COMFORT association with the Office of Geriatrics and/or the Office of Palliative care is an approach to care that aims to improve Palliative Care. In tandem with their scholarship endowment, quality of life and function and relieve suffering for patients with the Meyers family also established a fund that will enable chronic, severe or life-limiting conditions. It is a holistic approach students to participate in fellowship programs (nationally and to care which focuses on the physical, emotional, social and at NEOMED) to gain experience. spiritual needs of patients and families. Palliative care is available The couple was excited to discover that their gift provided a to patients of all ages from the time of diagnosis through the significant portion of a matching gift requirement from anothend of life, including bereavement. It can be provided at the er generous palliative care donor, Eileen Burg. “It’s a warm, same time as curative and life-prolonging treatment. wonderful feeling to know that a student will receive enhanced Hospice care is that subset of palliative care which focuses training because of this fellowship,” say Alice and Budd. “From on alleviating the suffering of persons who are terminally ill, the students we met, NEOMED seems like a great place to get who no longer seek treatments to cure, and who are expected an education.” NORTHEAST OHIO MEDIC AL UNIVERSITY
STUDENT ORGANIZATIONS BY SAMANTHA HICKEY
From understanding and appreciating ethics to forming healthy ﬁnancial habits, NEOMED’s students are working to become more well-rounded health care professionals.
Who says you can’t take a break from studying to squeeze in a little exercise? Fit Club is dedicated to encouraging active lifestyles. Every other month, College of Medicine and College of Pharmacy students spend an hour with fourth- and ﬁfth-grade students at Rootstown Elementary School doing athletic activities including Zumba-style dancing and other games.
SPORTS MEDICINE INTEREST GROUP
ANESTHESIOLOGY INTEREST GROUP
Despite its name, Anesthesiology Interest Group won’t put you to sleep. The student organization offers a number of anesthesiology-related events, like intubation workshops and hosting current anesthesiologists as speakers to encourage and prepare College of Medicine students to become anesthesiologists.
STUDENTS FOR MEDICAL MISSIONS SERVICES
Score a new subspecialty with Sports Medicine Interest Group. Learn what it’s like to live life on the ﬁeld, explore different branches of sports medicine and meet team physicians from around Northeast Ohio. Being a member doesn’t commit students to a career in sports medicine — but it does broaden students’ horizons.
Students for Medical Missions Services brings together Northeast Ohio Medical University students who share an interest in service work and global medicine. The organization believes that learning about global healthcare, in conjunction with the practices of Western medicine, can further enrich students’ appreciation for the health care ﬁeld.
COLLEGE OF PSYCHIATRIC AND NEUROLOGIC PHARMACISTS
The College of Psychiatric and Neurologic Pharmacists’ vision is a world where all individuals living with mental illness, including those with substance use and neurologic disorders, receive safe, appropriate and effective treatment. The group’s mission is to advance the reach and practice of psychiatric pharmacy and serve as the voice of the specialty.
This new group is oriented towards the appreciation, understanding and discussion of ethics and the humanities. The Bioethics Club invites students to join its many clinical discussions and see just how much thought goes into every action taken as health care professionals.
FINANCIALLY FIT FUTURE PHARMACISTS CLUB
It’s no secret that student loans are an uphill battle. The Financially Fit Future Pharmacists Club has set out to bring awareness of personal ﬁnance to College of Pharmacy students and provide knowledge that can help them form healthy ﬁnancial habits.
Meet one of the largest international co-ed pharmaceutical fraternities: Kappa Psi. NEOMED’s Zeta Epsilon chapter allows pharmacy students to cross state lines and have an immediate bond with other Kappa Psi brothers — all while maintaining industry, fellowship and high ideals.
For more information on student groups, contact Student Affairs at 330.325.6735 or visit neomed.presence.io. 34 I G N I T I N G
SHINING AHEAD A flash mob of students surprised the nearly 400 NEOMED supporters seated for dinner at the Shine On gala last fall, bringing them to their feet at the news that their generosity had helped to raise a total of $44 million to advance students, advance community health, and advance innovation and research. Shine On, NEOMEDâ€™s first comprehensive university campaign, exceeded its goal by 10 percent, with over 2,800 donors, foundations and businesses contributing. An awards ceremony for distinguished alumni added to the eveningâ€™s festivities.
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NEOMEDâ€™s newest research focus area
DIABETES, OBESITY & METABOLISM RESEARCH Diabetes, obesity, fatty liver disease and atherosclerosis are among the most common, costly and preventable of all health problems.
The Diabetes, Obesity and Metabolism Research Group aims to build a collaborative internationally recognized research focus area for fundamental and translational research related to these chronic conditions.
With 11 NIH grants among them, these RESEARCHERS are collaborating to change lives. Learn more about THE STUDIES, THE STATISTICS, THE SUCCESSES, THE STORIES and THE SCIENTISTS by visiting neomed.edu/research/dom.
Yanqiao Zhang, M.D., FAHA
John Chiang, Ph.D.
Jessica Ferrell, Ph.D.
James Hardwick, Ph.D.
Takhar Kasumov, Ph.D.
Yoon-Kwang Lee, Ph.D.
Priya Raman, Ph.D.
Liya Yin, M.D., Ph.D.
Ignite is a biannual publication designed to showcase and celebrate the advancement of students, innovation and research, and community heal...
Published on Mar 7, 2019
Ignite is a biannual publication designed to showcase and celebrate the advancement of students, innovation and research, and community heal...