Pioneers magazine, Spring 2016

VOLUME 2 / SPRING 2016

EDUCATION / P. 06

RESEARCH / P. 12

PRACTICE / P. 15

NEW FACULTY / P. 34

• Executive edge • 4+1 bachelor’s/master’s program • New paths to public health

• Destined for diabetes?

• Internships’ crash course in public policy • Mind the gap • Gut healing

• Learn more about the exciting new additions to our team.

Pioneers UTHealth School of Public Health

DESTINED FOR DIABETES? ONE RESEARCHER LOOKS FOR ANSWERS IN STARR COUNTY, TEXAS

HOUSTON | AUSTIN | BROWNSVILLE | DALLAS | EL PASO | SAN ANTONIO

Giuseppe N. Colasurdo, M.D. President, The University of Texas Health Science Center at Houston (UTHealth) Eric Boerwinkle, Ph.D. Dean, UTHealth School of Public Health Margaret O. Caughy, Sc.D. Interim Regional Dean, Dallas Regional Campus Barry Davis, M.D., Ph.D. Interim Department Chair, Biostatistics Susan Tortolero Emery, Ph.D. Senior Associate Dean of Academic and Research Affairs Joseph McCormick, M.D. Regional Dean, Brownsville Regional Campus Kristina Mena, Ph.D. Interim Regional Dean, El Paso Regional Campus Robert Morgan, Ph.D. Department Chair, Management, Policy and Community Health Alanna C. Morrison, Ph.D., F.A.H.A. Department Chair, Epidemiology, Human Genetics and Environmental Sciences Cheryl Perry, Ph.D. Regional Dean, Austin Regional Campus Debra Ryan, M.Ed. Associate Dean, Management Melissa Valerio, Ph.D. Regional Dean, San Antonio Regional Campus Sally W. Vernon, Ph.D. Department Chair, Health Promotion and Behavioral Sciences Erin Meade Director of Development

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WELCOME Most people don’t know what public health is.

They don’t recognize that it is a well-defined professional discipline, and they certainly don’t know that it touches every single person throughout their lives. When I tell people that I’m in public health, they usually think I’m somehow involved in delivering medical care to poor people using taxpayer dollars. Because much of my work has focused on access to health and social services for vulnerable populations, who are often served by tax-funded programs, my identification as a public health professional can reinforce the misunderstanding of our field. Sometimes I take advantage of such teachable moments to explain what public health means and to distinguish it from medical care. When I do, people usually appreciate the new information — but getting the word out this way will take forever!

Fortunately for those of us steeped in and passionate about public health, our medical-care colleagues are beginning to lend a hand. Now more than ever before, the nation’s health care delivery system — in which we invest close to $3 trillion dollars annually — is beginning to focus on health rather than health care. Hospitals and physicians and other healthcare providers are being asked by their biggest funders — public and private insurers and large employers — to demonstrate their value in terms of quality of care. Quality of care is increasingly being measured by population health outcomes. And population health outcomes are aligned with public health measures. This means that the people and institutions in the health care delivery system who make decisions about how much of that $3 trillion is deployed now have incentives to invest in the good health and well-being of their patients, beyond delivering high volumes of medical services.

The Affordable Care Act, while best known for its health insurance provisions, also gives public health a boost. The act increases prevention and health promotion measures and invests in primary care workforce development initiatives. It also emphasizes the importance of the community as the locus of population health. The requirement that nonprofit hospitals conduct community health needs assessments and develop responsive community health improvement plans is designed to lead to improved health of populations.

Public Health: Now is our time

Our medical-care colleagues and the health care delivery system need those of us trained in public health to work side by side in this new era. Our understanding of the social, cultural and economic determinants of health can help health care providers identify opportunities outside of the delivery system to improve their patients’ health status. The strong link between the public health sector and the most vulnerable communities can serve as the entry point for providers who want to work at the grassroots level. And our systems of evaluation that look holistically at small and large groups of people can inform the health care delivery system’s self-assessment as it endeavors to meet population health outcomes.

This issue of Pioneers highlights the power of public health in action—from Craig Hanis’ groundbreaking genetics research that’s transforming our understanding and management of diabetes, to innovative community programs closing the health care gap. As an alumna of the UTHealth School of Public Health, I’m proud to see my alma mater blazing new trails in public health education, research and practice.

This is a great time to be in public health. Our skills and perspective are in high demand as our nation’s experiment in health and health care delivery moves forward. In another generation, when people think of health, they’ll be thinking about it the way we do.

Elena M. Marks, J.D., M.P.H. (UTHealth School of Public Health alumna, class of ’01) is president and chief executive officer the Episcopal Health Foundation, working to improve the health and well-being of the 10 million people of the Episcopal Diocese of Texas. She is also a nonresident fellow in health policy scholar at the Baker Institute for Public Policy at Rice University.

IN THIS ISSUE

CAMPUS NEWS / P. 04

P. 06

EDUCATION / P. 06 Executive Edge / P. 06 4+1 bachelor’s/master’s program / P. 08 Health informatics 4+1 / P. 09 New paths to public health / P. 10

P. 10

WELCOMING A NEW DEAN / P. 11 RESEARCH / P. 12

P. 11

P. 20

Destined for diabetes? / P. 12

PRACTICE / P. 16 Mind the gap / P. 16 D.C. internships offer crash course in public policy / P. 19 Gut healing / P. 20

P. 16 P. 19

10TH ANNIVERSARY OF HURRICANE KATRINA / P. 23 ALUMNI / P. 26 TRAILBLAZERS / P. 28 NEW FACULTY / P. 34

P. 23

GAME CHANGERS / P. 35

EDITOR

UTHealth School of Public Health is one school with six campuses across Texas: Houston, Austin, Brownsville, Dallas, El Paso and San Antonio. The School of Public Health works to improve the state of public health in Texas every day. The main campus, located in the heart of Houston’s Texas Medical Center, offers students unmatched opportunities for research and employment. Each of the regional campuses has its own faculty and research specialties. Our Interactive Television (ITV) system is used to make classes available throughout the six campuses of the school.

The School of Public Health is one of six schools at The University of Texas Health Science Center at Houston (UTHealth), the most comprehensive academic health system in The University of Texas System and the U.S. Gulf Coast region. In addition to the School of Public Health, UTHealth is home to schools of biomedical informatics, biomedical sciences, dentistry, medicine and nursing. It also includes a psychiatric hospital, numerous institutes and centers, a growing network of clinics and outreach programs in education and care throughout the region.

Shannon L. Neufeld

LEAD WRITER

Anissa Anderson Orr

OTHER CONTRIBUTORS Erin Meade Kimberly B. Karol Hannah Rhodes Lionel Santibáñez

Send your news or comments to: pioneers@uth.tmc.edu

The School of Public Health is accredited by the Council on Education for Public Health (CEPH) and the university is accredited by the Southern Association of Colleges and Schools (SACS).

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CAMPUS NEWS Each of our six campuses is strategically placed across the state to meet the public health education, research and practice needs of our diverse populations. Here’s a closer look at what has been happening on our campuses.

SAN ANTONIO

EL PASO •

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Collaborating across borders. Jennifer Salinas, Ph.D., established a binational research consortium between the El Paso Regional Campus and the Universidad Autónoma de Ciudad Juárez, which has lead collaborative research efforts between faculty at both institutions.

Working on water quality. George D. DiGiovanni, Ph.D., was appointed as a trustee to the American Water Works Association (AWWA), Water Quality Technology Division. In this national leadership role, Giovanni will develop communications and programming supporting water quality-related issues, and serve as a liaison to AWWA committees.

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Confronting Chagas. Paula Stigler-Granados, Ph.D., was awarded a five-year grant from the Centers for Disease Control and Prevention to conduct outreach and education on Chagas disease in South Texas. The partnership includes local health departments, academic universities, and military efforts to address provider education and community education.

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Improving military health. The campus is working to address the health needs of active and veteran military populations.

Proposed initiatives will focus on hearing loss in active and veteran populations, the economic burden of hearing loss and preventing risky health behaviors among army trainees.

BROWNSVILLE •

Promoting community health. Brownsville has eight Delivery System Reform Incentive Pool projects targeting community health, supported annually by nearly $7 million in state funding. The campus also is collaborating on community interventions with MD Anderson Cancer Center and Methodist Health Ministries, and has developed a community gardens program.

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Expanding reach. To accommodate a surge of growth in new projects, the campus has opened offices in Hidalgo County, added space and staff to its clinical research unit, and created new clinical research cohort units in Harlingen and Laredo.

DALLAS •

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Exemplifying excellence in teaching. Margaret O’Brien Caughy, Sc.D., interim regional dean for UTHealth School of Public Health in Dallas, recently won the UTHealth President’s Scholar Award for Teaching. The criteria for the teaching award encompass published works in teaching, enthusiasm, innovation, teachingrelated mentoring activities and peer and student recognition. The selection for the research honorees centers on research quality and importance, productivity and peer recognition.

AUSTIN

Leveling health disparities. Frank Bandiera, Ph.D., received funding from the Robert Wood Johnson Foundation to investigate tobacco- and alcohol-related health disparities in mental health among Latinos.

HOUSTON •

Welcoming a new dean. World-renowned genetics researcher and educator Eric Boerwinkle, Ph.D, has been appointed dean of UTHealth School of Public Health. Boerwinkle succeeds Roberta Ness, M.D., who stepped down from the position in September 2014 and interim dean Osama Mikhail, Ph.D. A member of the UTHealth faculty since 1986, Boerwinkle has served as professor and chair of the Department of Epidemiology, Human Genetics and Environmental Health since 2003 (learn more on page 11).

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Reporting on childhood obesity. Michael & Susan Dell Center for Healthy Living researchers published a special issue on childhood obesity in the International Journal of Behavioral Nutrition and Physical Activity.

The July issue, edited by Regional Dean Cheryl Perry, Ph.D., and Deanna Hoelscher, Ph.D, included eight research papers and an overview of the center’s work.

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Investigating e-cigarettes. Stephen Kelder, Ph.D., MeLisa Creamer, Ph.D. and Melissa Blythe Harrell, Ph.D., are the senior editors of the 2016 Surgeon General’s Call to Action on e-cigarettes and youth. In addition, the campus’ Tobacco Center of Regulatory Science has surveyed youth and young adults in Texas, collecting data on e-cigarettes in Houston, Austin, Dallas-Fort Worth and San Antonio.

Building a nutrition hub for Texans. The school’s growing Dietetic Internship Program has opened its state-of-the-art culinary research and development kitchen and a simulation and assessment skills center. The program’s holistic garden will supply the kitchen with fruits and vegetables, demonstrating a sustainable seed-toplate model for interns.

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EDUCATION

The Fleming Center’s Academic Medical Department Leadership program, “was a wonderful venue to begin the planning of our residency program,” says Jordan Orange, M.D., Ph.D., of Texas Children’s Hospital (center).

EXECUTIVE EDGE Jordan Orange, M.D., Ph.D., led a thriving immunology research program at Children’s Hospital of Philadelphia before moving to Houston in 2012 to become Texas Children’s Hospital’s chief of immunology, allergy and rheumatology.

Confident in his experience, but hoping to increase his knowledge of the Texas Medical Center (TMC) and sharpen his leadership skills, Orange enrolled in the George McMillan Fleming Center for Healthcare Management’s Academic Medical Department Leadership (AMDL) program at UTHealth School of Public Health soon after settling into his new position.

“The context the course gave me about the Texas Medical Center’s culture and history was a godsend as I transitioned into my new role,” says Orange, also director of Texas Children’s Center for Human Immunobiology and vice chair for research for Baylor College of Medicine’s Department of Pediatrics.

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He appreciated the course’s small class size, topping out at about 15 students handpicked from health care organizations, and its TMC–aligned curriculum and faculty. The program’s milieu also was a perfect incubator for his strategic project (a course requirement) — a new pediatrician scientist residency program he developed from the ground up with his sponsor Mark W. Kline, M.D., Texas Children’s Hospital’s physician in chief, and in partnership with Baylor College of Medicine and Texas Children’s Hospital. At last year’s medical residency match, 159 students applied for the program’s three slots, allowing Orange to select a talented crew of M.D./Ph.D. graduates, who were diverse in background and experience.

“AMDL was a wonderful venue to begin the planning of our residency program,” Orange says. “The feedback I received from colleagues about business plans and potential institutional cultural concerns was very useful.”

Courses help health care professionals level up in leadership COURSES SPUR COLLABORATION, INNOVATION Peer interaction forms the centerpiece of the Fleming Center’s executive education courses, says Lynn Schroth, Dr.P.H., program director for executive education and a professor of management, policy and community health.

“It’s one of the features that participants like most about the program,” she says.

“Workshops are an opportunity for physician leaders from different organizations to talk about how similar their problems are, and the strategies and successes other organizations have taken to deal with those issues.”

As a former executive vice president of Houston Methodist hospital system and top executive for other hospitals in the Houston area, Schroth understands the challenges of leading a large health care organization. At the same time, her early nursing experience gives her insight into patient care. Schroth says the AMDL program evolved from discussions she had with Osama I. Mikhail, Ph.D., founder of the Fleming Center, when

EDUCATION / EXECUTIVE EDGE >> EXECUTIVE EDUCATION COURSES

“...if you can take a clinician and teach that person the business side, you have the best of both worlds.”

he was a senior vice president at St. Luke’s Episcopal Hospital (now CHI St. Luke’s Health). Over the course of her career, they frequently would talk about the difficulties of running a large hospital when physician leadership didn’t have any experience or education in the business side of health care, and lacked mastery of organizational dynamics, human resources management and health care finance.

“We used to laugh and say that we wished we had a magic wand that fixed that,” Shroth says. “Then five years ago, when I retired from Methodist, Osama invited me to lunch and said, ‘Hey, remember that dream we had? Let’s do it.’”

“We agreed that academic hospitals were rarely better than their affiliated medical schools and that medical schools were rarely better than their chairs,” Mikhail adds. “So we wanted to create a program in the TMC that would provide clinician leaders (often the chairs) in academic medicine the organizational tools to become excellent organizational leaders in a very complex and demanding environment.”

ACADEMIC MEDICAL DEPARTMENT LEADERSHIP

Target audience: Physician leaders in academic medicine including department chairs, section/ division heads Course description: Participants strengthen their ability to lead and manage the three-fold mission of academic medicine: delivering quality clinical care, teaching future physicians and innovating through research. They learn to analyze their organizations and think strategically; plan, communicate and implement change; fine-tune their personal leadership style; and identify, plan and operationalize a strategic project.

Format: 12 sessions held from 8 a.m. to 4 p.m. on specific Fridays, fall through spring semesters.

PHYSICIAN LEADERSHIP

Target audience: Physicians in mid-level management positions or individuals desiring leadership experience Course description: In this abbreviated version of the Academic Medical Department Leadership course, participants learn critical business concepts necessary to support their roles as developing leaders within the organization.

They also learn to analyze their organization and prioritize options; plan, communicate and implement change; confidently lead teams within their organization; and identify, plan and operationalize a strategic project.

Format: Available to health care organizations. Course is customized to fit the organization that requests it, and the number of class sessions may vary accordingly.

NURSING LEADERSHIP

Together, Schroth and Mikhail designed a curriculum based on feedback from TMC leaders and crafted a 12-session course featuring engaging instruction with an emphasis on organizational dynamics, planning and implementing change, working in teams and real-world problem solving. Now in its fifth year, the program has had more than 60 graduates, many of whom have gone on to assume additional leadership roles.

Target audience: Nurse leaders in academic medicine including chief nursing officers Course description: This course empowers chief nursing officers and senior nurse leaders to manage complex health care settings.

Participants learn to analyze their organizations and think strategically; plan, communicate and implement change; fine-tune their personal leadership style; and identify, plan and operationalize a strategic project for individual departments.

Format: 12 sessions, fall through spring semesters.

ADDITIONAL PROGRAMS

LEAN SIX SIGMA

The Fleming Center has since added executive education programs aimed at mid-level physicians, nurses, and health care managers seeking to lead process improvement (see sidebar).

Schroth believes the demand for executive education programs in health care management will only continue to grow as health care professionals seek to keep up with the constantly changing health care industry.

“I believe that clinicians make better leaders because they do have that clinical perspective,” Schroth says. “It is hard for business people to understand the clinical side. But if you can take a clinician and teach that person the business side, you have the best of both worlds.”

Target audience: Health care managers seeking to lead process improvement Course description: Through hands-on activities, lab exercises, presentations and lectures, this course provides a strong foundation in Lean Six Sigma methodology. Participants map processes, identify root causes of problems, implement improvements and lead project teams to help organizations achieve performance improvements. They also conduct a real-world quality improvement project and become certified in Lean Six Sigma Green Belt.

Format: Nine-week hybrid course focuses on group training and is available to requesting health care organizations. Course is offered in partnership with the University of Houston College of Technology, and meets half of the time in a traditional face-to-face classroom environment, with the remainder of the course delivered electronically.

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EDUCATION

4+1

BACHELOR’S / MASTER’S PROGRAM

★

NEW PROGRAM JUMPSTARTS M.P.H.

UTHealth School of Public Health has introduced its bachelor’s/master’s program to four additional schools in Texas, including Rice University in Houston, the University of Houston, St. Mary’s University in San Antonio and The University of Texas at San Antonio.

The program allows students from partnering undergraduate institutions to earn a master’s degree in public health in as little as one year after completing their bachelor’s degree.

Established 4+1 programs operate at 4+1 bachelor’s/master’s students Sanjana Puri (left) the School of Public Health Austin and Cristell Perez (right).

Regional Campus in partnership with The University of Texas at Austin finding ways to reduce the amount of time and at the School of Public Health it takes to achieve a degree in order to save Brownsville Regional Campus in partnership students time and money on tuition.” with The University of Texas Rio Grande Valley.

Students interested in the 4+1 program typically apply at their undergraduate LESS TIME, LESS MONEY institution in their sophomore year and By shortening the time it takes to earn an M.P.H., the bachelor’s/master’s program gives to the School of Public Health’s graduate certificate program in their junior year. In students more bang for their tuition buck their senior year, students take the graduate and a head start should they want to pursue certificate program’s five core courses in a career, another advanced degree, or a dualpublic health including epidemiology; degree program, such as an M.D./M.P.H. biostatistics; management, policy and Students in the program graduate from their community health; environmental health; undergraduate institution having earned up and health promotion. After graduating from to 16 credits, which can be applied to an their undergraduate institution, students M.P.H. spend an additional year at the School of “In higher education we have noticed a trend Public Health completing their master’s degree. towards programs like the bachelor’s/master’s which are often referred to as 4+1 programs,” says Sam Neher, assistant director of student services in the School of Public Health’s Office of Academic Affairs and Student Services. “Like other institutions, we are

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“A NATURAL PARTNERSHIP” In the fall of 2015, the school rolled out the program at Rice University. Rice, with its location just a mile and a half away from

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the School of Public Health’s Texas Medical Center campus in Houston and its international reputation for academic excellence, is an ideal partner for the program, says Osama I. Mikhail, Ph.D., who was interim dean of the School of Public Health at the time the partnership was announced, and is senior vice president for strategic planning at UTHealth.

“This is a natural partnership between Rice and the School of Public Health,” he says. “Hopefully, it will grow and lead to other similar collaborative initiatives between the two institutions.”

Five Rice seniors, representing a diversity of academic fields including art history, biochemistry, business and women and gender studies, are taking part in the bachelor’s/master’s program this year.

“We are very happy about our pilot cohort, because it already accomplishes one of the key goals of this program: to bring students from a wide range of majors, from the humanities to the sciences, into public health,” says Kristen Ostherr, Ph.D., M.P.H., professor of English at Rice and an adjunct professor at the School of Public Health. Ostherr is an alumna of the School of Public Health and co-director of the Rice 4+1 program together with Nicholas Iammarino, Ph.D., a professor and chair of the Department of Kinesiology at Rice.

Iammarino says public health specialists with a master’s degree are highly valued.

“You’ll see a lot more clinical professionals

EDUCATION / 4+1 BACHELOR’S/MASTER’S PROGRAM

4+1

UTHealth School of Biomedical Informatics has collaborated with the UTHealth School of Public Health Brownsville Regional Campus to offer a 4+1 program in health informatics.

The 4+1 program, jointly offered with The University of Texas Rio Grande Valley (formerly The University of Texas at Brownsville), is an integrated program that allows students to graduate with a bachelor’s degree while also earning a graduate certificate in health informatics. All classes are offered online, with dedicated staff at the Brownsville Regional Campus providing on-site student support.

Launched in September 2014, the 4+1 program was initiated to meet the growing need for a health informatics workforce in the Lower Rio Grande Valley area of Texas. The Brownsville Regional Campus is a significant driver of that demand: the school is involved in three Medicaid 1115 waiver programs, which compel providers to access and share patient medical information electronically.

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HEALTH INFORMATICS 4+1

“That requires a workforce with the skills to navigate the software and systems used for exchanging patient health information,” says Brownsville Regional Campus dean, Joseph McCormick, M.D. Students in the School of Biomedical Informatics 4+1 program also learn to mine patient data for health information, enabling providers to offer a more personalized approach to medicine.

The program is the first 4+1 for the School of Biomedical Informatics, which plans to expand the 4+1 program to additional Texas universities.

“The School of Biomedical Informatics is very proud of our presence in the region and the opportunities it brings to the students and the community,” says Susan Fenton, Ph.D., UTHealth School of Biomedical Informatics associate dean for academic affairs.

“...when I learned of the 4+1 program, I thought it would enable me to use both policy and public health to broaden the impact that I had as an individual and later on in my career.”

— physicians, dentists, even veterinarians — who say they’re interested in public health issues that affect the community, rather than just treating a patient. They’re prime candidates for this program.”

WHAT STUDENTS SAY Sanjana Puri’s passion for policy and her desire to improve the health of women in developing countries led her to the 4+1 program. Puri, a health science major at Rice, moved from India to Dallas as a child, and her travels back to the country of her birth opened her eyes to the widespread sexual health problems confronting women there. Then, as an intern at Rice University’s Baker Institute for Public Policy, she investigated how the political climate in post-Arab Spring Egypt hampered women’s access to reproductive health resources, a transformative experience that set her on the path to public health.

“I was already very interested in using policy as a tool to reduce barriers to health care and empower individuals with the skills, knowledge and access to resources that they might not have through policy,” says Puri, who is currently applying to medical schools.

“So when I learned of the 4+1 program, I thought it would enable me to use both policy and public health to broaden the impact that I had as an individual and later on in my career.”

Puri’s colleague Cristell Perez, who is majoring in anthropology and the study of women, gender and sexuality, chose the 4+1 program to give her the public health skills necessary for a career in global health. Perez got her first taste of global public health practice while studying abroad in Ecuador, India, South Africa and Brazil, conducting ethnographic research and working on projects focusing on improving maternal

and child health. She was hooked, and says she probably would have continued to stay abroad, if she had not learned of the 4+1 program from a friend’s Facebook post.

“With the 4 +1, I not only get to earn an M.P.H. in less time than it would have normally taken me, but also, because I am on scholarship with Rice, my first year of the program is paid for, and that is very important for me,” says Perez, a native of a struggling Texas border town and the first in her family to go to college. “With my education taken care of, I will be able to learn, then travel the world and hopefully make an impact.”

This article includes information adapted from a press release from Rice University Media Relations.

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PHOTO BY TERRY VINE

EDUCATION

Workshop participants learned how to identify potential routes of infectious disease exposure, how to don and doff personal protective equipment, and proper decontamination methods.

NEW PATHS

TO PUBLIC HEALTH BIOSAFETY TRAINING

The 2014 Ebola crisis highlighted the increasing importance of global health security, and spurred the development of two new biosafety initiatives spearheaded by the UTHealth School of Public Health Southwest Center for Occupational and Environmental Health.

TRAINING THE TRAINERS

Researchers at the Southwest Center for Occupational and Environmental Health received a $100,000 supplemental grant from the National Institute of Environmental Health Sciences to establish a Biosafety and Infectious Disease Training Initiative in partnership with the Nebraska Biocontainment Unit, one of only three biocontainment units in the nation.

More than 1,500 people attended the initiative’s training workshops and seminars, which targeted workers at high risk for exposure to infectious diseases. Noted infectious disease experts, including a Nebraska Biocontainment Unit nurse who treated an Ebola patient, shared their experiences and taught the fundamentals of preventing infectious disease outbreaks.

“We delivered the training using a trainthe-trainer model to amplify the impact of the award in the community,” says Janelle Rios, Ph.D., deputy director and director of continuing education for the center. “And

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because our group represented a unique mix of workers from different backgrounds, they not only learned from us, but also from each other.”

Based on positive feedback (both workshops sold out), Rios is translating course materials into an online learning format, and applying for additional funding to extend the initiative.

ACADEMIC COURSE

The center’s new biosafety academic course focuses on core competencies essential to successfully control and prevent the spread of infectious diseases of public health significance. Students learn how to assess the risk of exposure to infectious disease agents, implement infection prevention and control strategies and collaborate with public health agencies to respond to outbreaks — skills benefitting a wide variety of public health professionals who deal with disease outbreaks (see sidebar), says Robert “Safety Bob” Emery, Dr.P.H., who co-developed the course and teaches it at the School of Public Health Houston campus.

Even though the widespread impact of Ebola is decreasing, “there still is a huge need for infection prevention and education,” says Emery, professor of occupational health and vice president for safety, health, environment and risk management at UTHealth. New emerging diseases of concern, such as Middle

East Respiratory Syndrome (MERS) and Lassa fever, continue to threaten our global health security, he adds. “These diseases are only a plane flight away, so we have to be prepared.”

The course, part of the Department of Epidemiology, Human Genetics and Environmental Sciences’ Environmental and Occupational Health Sciences Program, is available to students pursuing their Master of Public Health degree. Roberto Rodriguez, Ph.D., co-teaches the course from the School of Public Health El Paso Regional Campus.

>> WHO NEEDS BIOSAFETY TRAINING? Infection Preventionists

Primarily focused on protecting patients in clinical settings

Registered Environmental Health

Specialists (Registered Sanitarians) Focused on protection of public from infection from food, water, housing, waste

Biosafety Professionals

Primarily focused on protecting workers in laboratories

Public Health Professionals

Focused on the protection of the public from disease and other health threats in clinical settings.

ERIC BOERWINKLE NAMED DEAN OF UTHEALTH SCHOOL OF PUBLIC HEALTH World-renowned genetics researcher and educator, Eric Boerwinkle, Ph.D., has been appointed dean of UTHealth School of Public Health. He officially assumed the position on January 1.

Boerwinkle succeeds Roberta Ness, M.D., who stepped down from the position in September 2014. Osama Mikhail, Ph.D., served as interim dean while a national search to select a new dean was conducted.

“Dr. Boerwinkle is an outstanding scientist, known around the world for his research involving the genetic causes of our most common and debilitating diseases,” says Giuseppe N. Colasurdo, M.D., UTHealth president and Alkek-Williams Distinguished Chair. “Working with leaders and faculty members from across the school’s six campuses, Dr. Boerwinkle will leverage our state-wide reach to address critical public health issues, including population health, comparative effectiveness research and precision medicine. He will implement a new strategic direction founded on collaboration and team-building both within the school and with other programs throughout our university. I am confident that under his leadership our School of Public Health will be recognized as one of the best in the country.”

Boerwinkle joined the UTHealth faculty in 1986 and served as professor and chair of the Department of Epidemiology, Human Genetics and Environmental Sciences at the School of Public Health since 2003. He also directed the Human Genetics Center at the School of Public Health and the Brown Foundation Institute for Molecular Medicine for the Prevention of Human Diseases, which are a part of UTHealth.

today,” says Boerwinkle, who holds the Kozmetsky Family Chair in Human Genetics at UTHealth. “The size and diversity of Texas makes it a living laboratory for disease prevention and health promotion. People are our greatest asset both within the school and at all of our partner institutions and I will work side-by-side with people to build strong partnerships focusing on maintaining good health and improved health care outcomes using the latest technologies and all available evidence. The ever-changing nature of health care creates both challenges and opportunities for public health research and teaching. I look forward to working with my colleagues in Houston and throughout the state to seize those emerging opportunities and redefine public health for the 21st century.”

earned master’s degrees in human genetics and statistics. In 2003, he was the recipient of the President’s Scholar Award, which recognizes distinguished achievements in research and education at UTHealth.

Boerwinkle has served on several national research panels, including the Advisory Council for the National Human Genome Research Institute, the Board of External Advisors for the National Heart, Lung and Blood Institute, and the Council of Councils for the Office of the Director of the National Institutes of Health.

He has also served as an editor of several journals including Circulation, Epidemiology,Genetic Epidemiology and the American Journal of Epidemiology.

Author of more than 800 scientific publications in top-tier journals, Boerwinkle has led groundbreaking research on the connection between genes and health. He and his colleagues completed the world’s first genome-wide analyses for a variety of cardiovascular disease risk factors, including hypertension and diabetes. These investigations have been a critical step in developing drugs that lower disease risk.

Boerwinkle earned his doctorate in human genetics from the University of Michigan, Ann Arbor, where he also

“There is no better time for public health and the School of Public Health than

PHOTO BY DREW DONOVAN

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RESEARCH

DESTINED FOR DIABETES? PHOTO BY TERRY VINE Craig Hanis’ Starr County research has yielded a vast amount of information on more than 28,000 Mexican Americans with Type 2 diabetes — nearly 30 terabytes of data stored on the UTHealth School of Public Health’s servers.

>> FAST FACTS

Craig Hanis, Ph.D., Professor, Human Genetics Center, UTHealth School of Public Health Education: Bachelor’s and master’s degrees in zoology from Brigham Young University. Master’s degree in statistics from the University of Michigan.

Doctorate in human genetics from the University of Michigan.

Career: Joined UTHealth faculty in 1981. Recipient of the 2012 UTHealth President’s Scholar Award for Research and John P. McGovern Award for Outstanding Teaching at the Graduate School of Biomedical Sciences.

“The ability to study all aspects of the genetics of diabetes — from field studies to the laboratory to statistical analysis — has been remarkable,” Hanis says. “Few people have that opportunity, and the School of Public Health has been incredibly kind in supporting my efforts.”

Family: Married to wife Sally. Together, the couple has nine children and 14 grandchildren.

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Geneticist Craig Hanis has spent more than three decades studying Type 2 diabetes in Starr County, Texas. His discoveries provide critical insight into one of the most difficult-to-treat, and deadliest, diseases in the nation.

Located just across the Rio Grande from Mexico, Starr County exists far from the state’s bustling urban centers and the attention of most Texans. Yet this community of struggling ranches and colonias, where more than 40 percent of residents live below the poverty line, has more influence on the state, and the nation, than might be suspected.

“It is a canary in the coalmine,” says researcher Craig Hanis, Ph.D., who has spent more than three decades studying the impact of Type 2 diabetes in Starr County.

“Where Starr County is today in terms of diabetes, that’s where the rest of the

“Where Starr County is today in terms of diabetes, that’s where the rest of the population is headed 20 or 30 years from now.” population is headed 20 or 30 years from now.”

And that’s not a good place to be. Starr County has the highest mortality rate from diabetes of any county in Texas, and nearly 70 percent of those born there will develop

RESEARCH / DESTINED FOR DIABETES?

The researchers had a major breakthrough in 1996 when they found what appeared to be a susceptibility gene for diabetes near the end of chromosome 2. diabetes in their lifetime, more than double the percentage Hanis found when he began his research in 1981.

The area’s dearth of healthy food options, barriers to physical activity, and ethnicity — the county is 96 percent Mexican American, a group more likely to develop diabetes — explain how residents get diabetes, but not why.

“When someone asks, ‘Why do I have diabetes?’ Here’s our answer, ‘You’re older.

You’re Hispanic. You have a family history and you’re overweight.’” Patients can’t do anything about their age, family and ethnicity, and losing weight is difficult, adds Hanis, a professor of epidemiology, human genetics and environmental sciences at UTHealth School of Public Health.

“We haven’t given them anything that helps.”

THE SEARCH BEGINS This September marks 35 years since William Schull, Ph.D., the founding director of the Human Genetics Center at the School of Public Health, recruited Hanis to address Starr County’s sky-high mortality rates due to diabetes, brought to his attention by Mario Ramirez, M.D., a family physician in the area. Schull and Hanis opened the Starr County Health Studies office in Rio Grande City in a two-car garage they converted into a clinic, and began providing free diabetes screenings and collecting study data.

The team’s first study screened almost 4,000 individuals, uncovering rates of diabetes three to five times higher than the general United States population. One-half of all studied

The Starr County Health Studies office was opened in Rio Grande City in 1981.

adults over 30 either had diabetes or had a close relative with the disease.

“We first went door to door to find out how many diabetics were in the area, and it was a lot,” recalls Hilda Guerra, who retired in January after serving as the clinic’s office manager and research coordinator.

Since those initial studies, Guerra has screened generations of families for diabetes. In total, the Starr County Studies has collected data on more than 28,000 Mexican Americans.

Recently retired clinic manager, Hilda Guerra, with patient Alberto Barrera. Barrera’s family has participated in the Starr County Health Studies from the start.

“We have seen families where if one individual loses their vision, then their sibling is losing it too, or another family member has an amputation.” says Guerra, who works hard to keep her own diabetes under control.

NEW GENETIC DISCOVERY The researchers had a major breakthrough

in 1996 when they found what appeared to be a susceptibility gene for diabetes near the end of chromosome 2. Building on that discovery, Hanis’ team collaborated with the University of Chicago to identify the gene calpain 10 in 2000, the first susceptibility gene for Type 2 diabetes or any common chronic disease found using a genome-wide approach, a significant discovery says Hanis’s longtime colleague and fellow geneticist Eric

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RESEARCH / DESTINED FOR DIABETES?

>> STARR COUNTY STUDIES MILESTONES • First published genome-wide linkage study for Type 2 diabetes • First identification of a susceptibility gene for Type 2 diabetes or any common chronic disease using a genome-wide approach • 540+ genes and 80 loci associated with Type 2 diabetes • 28,000+ study participants, making the Starr County Studies one of the largest genetic epidemiologic investigations of Mexican Americans • 100,000+ free walk-in screenings for diabetes

Boerwinkle, Ph.D., dean of the School of Public Health.

“First, it documented that large-scale genome analyses could identify genes for a complex trait, such as diabetes. And second, it documented the utility of studies in diverse populations for studies seeking to identify novel genes influencing disease risk,” he says.

The researchers also launched a successful weight-loss intervention program in collaboration with Baylor College of Medicine in Houston, and a diabetes management program, designed by UTHealth School of Nursing professor Sharon Brown, Ph.D., now with The University of Texas at Austin School of Nursing. Spanish-speaking staff led the new culturally sensitive interventions, which taught participants to adapt traditional recipes into healthier meals.

TECHNOLOGY FUELS PROGRESS The first complete sequencing of the human genome in 2003 dramatically accelerated their research, enabling them to analyze the whole genome of study participants, and examine regions, genes and pathways for variations that might make people more susceptible to diabetes or impact the progression of the disease.

Today, Hanis maintains a list of more than 540 genes and 80 loci, the physical location of a gene or other DNA sequence on a chromosome, that seem to be associated with Type 2 diabetes. He is using whole exome sequencing to cast an even wider net, and analyze the coding sequence of nearly all genes carrying disease-causing mutations.

“Our best hope is to identify the genetic variation, and then we can figure out ways

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of changing metabolism, whether with educational interventions or with new drugs,” he says. “If we can understand what happens in even one person, then great things happen in terms of understanding the biology and coming up with new strategies to slow, prevent or reverse the disease.”

MOVING FORWARD Over the course of his career, Hanis has received close to $50 million in research grants from the National Institutes of Health, the State of Texas and other sources. He and colleagues have published more than 150 papers on diabetes and diabetes-related conditions.

Hanis’ research and the Starr County studies are, “critical to the identification of many of the sites in the genome we know to confer risk for Type 2 diabetes, and to our understanding of the basis of Type 2 diabetes in Mexican Americans,” says colleague Michael Boehnke, Ph.D., director of the University of Michigan Center for Statistical Genetics and Genome Science Training Program.

And while he was busy investigating diabetes, Hanis also built a life. He and his wife Candy raised five children, seeing them through

“We can’t afford diabetes either financially or socially. It has such a tremendous impact on both individuals and families.

We have to stop it.”

graduations, weddings and births (he has 14 grandchildren). Sadly, Candy died of ovarian cancer in 2011. Hanis remarried in 2013 to his wife Sally, who lost her husband to a heart attack. Both deaths brought home the personal cost of human disease.

“Now I see genetics from a different point of view,” Hanis says.

He channels his new perspective into his work, continuing to zero in on the genome, while championing interventions that help Starr County residents deal with their diabetes now. Hanis is investigating how metabolism and the body’s microbiome relate to diabetes, and has also rolled out a new program targeting individuals at risk for diabetes. He believes that an all-fronts approach is necessary to put the brakes on the disease.

“We have to understand diabetes, because if we don’t, the number of people with the disease is just going to go up and up and up,” Hanis says. “We can’t afford diabetes either financially or socially. It has such a tremendous impact on both individuals and families. We have to stop it.”

DIABETES FACTS • Diabetes costs the nation $245 billion in medical costs and lost work • One-third of deaths due to diabetes are in people younger than age 65 • Diabetic retinopathy is the leading cause of adult blindness and amputations in the United States • Previously rare in children, Type 2 diabetes is newly diagnosed in 5,000 children annually Source: American Diabetes Association

RESEARCH / DESTINED FOR DIABETES?

LIVING WITH DIABETES

MEET

Pat Alaniz, 67, of Starr County (pictured on the right above) – hospital payroll clerk, mother of twin adult daughters and grandmother of six.

Daughter of study participant.

“And I knew that my mother had been helped at the clinic in the past.

I went to the (diabetes education) classes, and they helped me a lot.”

WHAT SHE LEARNED

DIAGNOSED

In her mid-’50s

“They taught us what to eat, what is good for you, and how to prepare meals that were healthful,” she says. “They even took us to the supermarket. They also taught us how important exercise is.”

FAMILY WITH DIABETES

WHAT SHE CHANGED

Both grandmothers, mother and two brothers. Mother, 93, is one of the original participants in the Starr County Studies. Alaniz makes sure her mother checks her glucose regularly and eats a healthy diet, following the lessons she has learned from the clinic’s educational interventions. As a result, her mother is thriving and has few complications.

WHY SHE’S PARTICIPATING IN THE STARR COUNTY STUDIES “I decided that even though I work here in a hospital, I didn’t have a lot of time to research how to control my diabetes,” Alaniz says.

“Before, if I didn’t have anything sweet, it was like I was going to die,” Alaniz says. “But now I just have something sweet once in a while, and I buy more sugar-free stuff.”

WORDS OF WISDOM

By implementing the strategies she learned in class, Alaniz says she has kept her blood sugar under control and has avoided the complications of diabetes. “If we really pay attention to what the experts tell us about diet and exercise, we should be OK,” Alaniz says. “You can live a normal life if you know how to take care of yourself.”

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PRACTICE

CHOICES behavioral health specialist Beth Walsh, LPC (right), reviews contraception options with a patient in the program.

MIND THE

GAP PHOTO BY TERRY VINE

Backed by DSRIP funding, School of Public Health reaches Texans still lacking health care.

While the Lone Star State leads the nation in uninsured residents, Texas has not expanded Medicaid, widening the coverage gap for lowincome residents.

But there’s been a glimmer of hope for the state’s health in the form of Delivery System Reform Incentive Pool (DSRIP) projects.

Part of the state’s Medicaid 1115 waiver, which allocates funding to offset the cost of uncompensated care, DSRIP projects are designed with the “triple aim” of improving Texas’ health care delivery system, including access to care, quality of care and health outcomes. Funding was recently extended through 2017.

UTHealth School of Public Health has taken the lead on many of these projects. Here’s how the school is making a difference in Texas health.

BRIDGING GAPS IN PATIENT CARE Each day, community health worker Lawanda Tensley buzzes between her office and two UT Physicians clinics. She confirms appointments, follows up on physician and

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nurse requests and talks with patients waiting in the lobby, treating them with compassion and sensitivity.

“That is when I find out about their needs,” she says. “They just open up. I find out why they haven’t been coming to appointments — maybe they don’t have transportation or something else is going on — and we work to find a solution. We have been able to significantly bring down no-shows to appointments as a result.”

Tensley is one of a cadre of community health workers trained at the School of Public Health’s Houston campus to link patients with resources vital to their physical and mental health.

“Community health workers help bring the voice of the community back to health care providers,” says Rosalia Guerrero, who oversees the school’s training program, one of only two DSRIP projects in Southeast Texas aimed at workforce development.

In 2013, the school partnered with UT Physicians, the multispecialty clinical

“Community health workers provide effective and efficient health care services, and will continue to play an important role in our health care system in the years to come.” practice of the McGovern Medical School at UTHealth, and other Houston-area health care organizations to increase the number of certified community health workers in Southeast Texas. The program has produced more than 100 graduates.

“Community health workers provide effective and efficient health care services, and will continue to play an important role in our health care system in the years to come,” says Linda Lloyd, Ph.D., associate professor of community health

PRACTICE / MIND THE GAP

“It’s a way for all our partners to come together to provide seamless care for patients with uncontrolled diabetes, which is better for the patient and aligned with the goals of DSRIP.”

practice, who spearheaded the training program.

Focused on health in the Rio Grande Valley Home to eight DSRIP projects— the School of Public Health Brownsville Regional Campus is transforming how health services are delivered in the Rio Grande Valley.

Chief among these are projects aimed at creating patient-centered “medical homes” in two Federally Qualified Health Centers in the region, reaching nearly 60,000 area residents from poor, medically underserved backgrounds. The model provides patients with a one-stop shop for health services, with all members of the clinic’s staff coordinating patient care, from the front desk receptionist to the physician.

and diabetes self-management classes. Of the program’s nearly 2,500 patients with uncontrolled diabetes, more than 60 percent have shown a reduction in their HbA1c level.

“It’s a way for all our partners to come together to provide seamless care for patients with uncontrolled diabetes, which is better for the patient and aligned with the goals of DSRIP,” says program leader Belinda Reininger, Dr.P.H., professor of health promotion and behavioral sciences at the Brownsville campus.

PROMOTING HEALTHY PREGNANCIES Helping women of childbearing age choose healthy behaviors is the goal of CHOICES. The program, offered at UT Physicians clinics, has been shown to reduce the risk of alcohol-exposed pregnancies and has been widely disseminated by the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration. The DSRIP–funded version also addresses tobacco use and obesity.

Program patients see trained behavioral

“The patient-centered medical home is there to improve patient care through this teamwork, but also to improve efficiency,” says Joseph McCormick, M.D., regional dean in Brownsville. “An individual provider can, in fact, see more patients, and the physician sees the patients he or she really needs to see.”

Results have been promising. Glycated hemoglobin (HbA1c), the leading measure of diabetes control, has improved in a majority of clinic patients. Next steps include tracking additional health outcomes and implementing electronic medical records to further streamline patient care.

Patient-centered medical homes also play an important role in Brownsville’s Salud y Vida diabetes management program, a collaboration between the School of Public Health, The University of Texas at San Antonio and health care institutions in the Rio Grande Valley. Salud y Vida provides free home visits with community health workers, connections to health services, exercise classes

Community health worker, Lawanda Tensley, links patients and families with the resources they need.

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PRACTICE / MIND THE GAP

health specialists and family planning experts to discuss health and pregnancy risks, birth control, and meet with a family or OB-GYN practitioner if they are planning a pregnancy. Behavioral health specialists are trained in motivational interviewing, which emphasizes empathy and support instead of confrontation. The method works well with disadvantaged patients who may be resistant to outside help.

“They’ve been disapproved of and told what they’ve been doing is wrong,” says Patricia Dolan Mullen, Dr.P.H, a professor of health promotion and behavioral sciences, who designed the program together with Mary Velaquez, Ph.D. of The University of Texas at Austin School of Social Work. “Motivational interviewing is such a great contrast to that. Our behavioral health specialists actively listen to them instead of judging them.”

“When patients feel respected, they are more likely to make lasting changes that improve the health of their babies.”

When patients feel respected, they are more likely to make lasting changes that improve the health of their babies, Mullen adds.

Preventing obesity in moms-to-be

The Salud y Vida program provides free community and home-based services to individuals with uncontrolled diabetes.

Also offered at UT Physicians clinics, Healthy Eating/Active Living (HE/AL) works to prevent obesity in pregnant women, mothers and infants.

The program centers around an accessible curriculum focused on regular prenatal care, breastfeeding and overall healthy eating and physical activity during pregnancy; family participation in cooking demonstrations and recipe tastings using nutritious food; and fresh produce distribution through the Brighter Bites program, a collaboration with the Houston Food Bank.

Women meet with a registered dietitian and attend weekly group health education classes led by community health workers. Peer support is a critical part of the program, and helps women stay on the healthy path, says Shreela Sharma, Ph.D., R.D., L.D., who heads up HE/AL. Women in the program talk about making time to exercise, keeping their kids active and away from electronics and how to differentiate between true hunger and food cravings.

“Open discussions happen without judgement around these important issues in a very safe environment,” says Sharma, an associate professor in the Michael & Susan Dell Center for Healthy Living. “It goes a long way.”

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The HE/AL program offers exercise classes to help mothers stay physically active.

PRACTICE

D.C. INTERNSHIPS OFFER CRASH COURSE IN PUBLIC POLICY

Master of Public Health students Camille Range and Reginald Warren spent the summer of 2015 in Washington, D.C., learning how policy shapes public health, as part of The University of Texas System’s Archer Center’s Graduate Program in Public Policy. The program provides students with an opportunity to put into practice what they have learned at UTHealth School of Public Health through coursework, out-ofclassroom learning and faculty mentorship.

Students in the program are responsible for finding their own internships, and the program provides them with housing and classes on policy. Only 20–25 students from within the UT System are selected for the program each year.

PROMOTING “LET’S MOVE!” Range, a second-year student in the M.P.H. and Dietetic Internship Program, followed her passion for teaching families how to lead healthy lifestyles as an intern for First Lady Michelle Obama’s “Let’s Move!” campaign.

Camille Range tended produce and herbs growing in the White House Kitchen Garden as part of her internship with the “Let’s Move” program.

“I was thrilled to work for a national campaign promoting a healthier generation and I saw this internship as proof of the power of the mind,” she says. “My mom and I used to joke how I should write First Lady Michelle Obama a letter about how much she has inspired me as an African American female who focuses on nutrition and being active. Last fall, I decided it was time to put my best foot forward and spent months working on my application. I was fortunate to be accepted to the internship this year, before the administration leaves the White House and during the fifth anniversary of ‘Let’s Move!’” Range says.

Among Range’s duties were tending to produce and herbs growing in the White House Kitchen Garden, planning events, attending nutrition policy meetings and managing office business for “Let’s Move!”

Reginald Warren interned in the Office of Government Affairs for the March of Dimes.

Every Tuesday, Range managed a group of volunteers as they weeded, planted and picked produce for the chefs in the kitchen to use. She also helped organize events such as the Kids’ State Dinner, which included a student from each state. The students crafted a winning healthy recipe in order to be invited to the dinner at the White House.

And Range assisted in coordinating the first ever “camp out” with the Girl Scouts on the South Lawn in honor of the National Park Service Centennial, the “Let’s Move!” campaign and Great Outdoors Month.

Between taking classes at the Archer Center and sitting in on policy meetings at the White House, Range’s view of America’s obesity problem has changed.

“I’ve been working on child obesity issues since I was 15 and, this summer, I got to see this problem in a different light. Now I have a more comprehensive view of obesity and how various stakeholders can work together to find a solution. This internship experience exposed me to the impact policy has on nutrition and public health. I am looking forward to a career that allows me to intersect all three areas,” Range says.

ADVOCATING FOR HEALTHIER BABIES Warren, a second-year M.P.H. student studying health promotion with a concentration in maternal and child health, worked in the Government Affairs office for the March of Dimes, the nation’s leading nonprofit organization for pregnancy and baby health.

During his internship, Warren attended congressional hearings, briefings and coalition meetings on key maternal and child health issues and conducted research for both the federal and state teams on legislative issues.

He says he particularly enjoyed supporting a bill on neonatal abstinence syndrome, a group of health problems that occurs in newborns exposed to addictive opiate drugs while in the womb. Warren also helped draft fact sheets on other issues that can affect the health of babies including marijuana use during pregnancy.

The oldest of five children, Warren says maternal and child health is a cause close to his heart, and he hopes to one day open a women’s health center focusing on prenatal care and community engagement. During his internship, he discussed his future plans with the CEO of a nonprofit health center that serves the Latino and immigrant populations of the Washington, D.C., metro area. The feedback he received was invaluable, says Warren, as was his internship experience as a whole.

“I learned so much about the federal government, and the role nonprofits and other health organizations play in getting policies and appropriations to support the work being done in the states,” Warren says. “I’ve begun to recognize that the translation of research into policy is key and I’m excited that I gained some experience in this arena.”

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PRACTICE

GUT HEALING Investigators are harnessing the power of the microbiome to cure devastating intestinal infections. What’s next?

PHOTO BY TERRY VINE

his third recurrent C. diff infection. He comforted himself with the thought that should he die, he had at least lived a full life. “I was fighting as hard as I could. But at one point I caught myself thinking, ‘If I don’t make it through this, I am OK.’” While Siebert was relishing his thriving career and family life when sidetracked by C. diff, Diana Clayton, 27, had just become a newlywed.

FMT program leaders: Herbert L. DuPont, M.D. and Zhi-Dong Jiang, M.D., Dr.P.H.

Though nearing retirement age, John Siebert, 64, a professor of agricultural economics at Texas A&M University, wasn’t quite ready to rest on his laurels. He was having too much fun watching his students learn and launch careers of their own.

But Siebert’s plans were no match for Clostridium difficile (C. diff), a notoriously difficult-to-treat intestinal bacterium that wreaked havoc on his body last year, causing him to shed nearly 20 pounds and draining him of the energy to teach. Siebert reluctantly took leave, and began fighting for his life.

“I really didn’t think I was going to make it,” he says, recalling a low point when he was hospitalized and extremely weak following

She initially shrugged off the diarrhea and cramps she brought back from her honeymoon in Costa Rica as a side effect of drinking contaminated water. But unrelenting abdominal pain quickly sent her to the hospital, where CAT scans revealed a severely inflamed colon that was near-to-bursting.

The next few months were a nightmare of repeated C. diff infections, accompanied by cramps so debilitating, Clayton had to quit her job as a radiation therapist because she couldn’t stand without pain. The petite Clayton rapidly lost weight, becoming “a walking skeleton” at 87 pounds.

“I was so sick,” she says. “I couldn’t think straight anymore. I was walking sideways, calling things the wrong color. I felt I was close to death.”

Conventional treatments for C. diff failing them, Siebert and Clayton searched desperately for some shred of hope.

“I was so sick, I couldn’t think straight anymore. I was walking sideways, calling things the wrong color. I felt I was close to death.”

Y TERRY PHOTO B VINE

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The FMT product is stored in the freezer, until ready for use.

That hope arrived in the form of fecal microbial transplant (FMT), an innovative procedure under investigation at UTHealth School of Public Health’s Center for Infectious Diseases and the Kelsey Research Foundation.

RRY VINE PHOTO BY TE

TREATMENT HEALS THE GUT

The procedure introduces bacteria extracted from human stool from a well-screened, healthy donor into the colon of a patient sick with C. diff. Stool from a donor who has not received antibiotics contains a perfect sample of the flora inside our gut’s microbiome, which is an environment containing vast numbers of microbes including bacteria, both good and bad. FMT repopulates the unhealthy microbiome with healthy flora, curing patients sometimes within days.

That’s what happened to Siebert, who received FMT via colonoscopy last December after an Internet search led him to the School of Public Health’s FMT program, the only known adult, comprehensive research-based program of its kind in Texas. Siebert was enrolled in a clinical trial led by Herbert L. DuPont, M.D., professor and director of the Center for Infectious Diseases, and Zhi-Dong Jiang, M.D., Dr.PH., an associate professor for the Center for Infectious Diseases.

“I knew within 12 hours of the transplant that I had made a gigantic leap forward,” says Siebert, whose mild, non-progressive form of multiple sclerosis likely made him more vulnerable to contracting C. diff.

It took two transplants for Clayton to feel better, one performed by colonoscopy and the other by taking a pill form of FMT. Clayton remembers swallowing the 30 capsules containing purified fecal matter, one by one, without a hint of squeamishness (the entericcoated capsule stops the odor, and travels through the stomach to the small intestine before the content is released). A week later, her energy and appetite surged back.

“After my second FMT, I just knew I didn’t have C. diff anymore,” she says. “I actually started to have food cravings, and I hadn’t had a food craving in months. It was amazing!”

THE ROAD TO FMT Clayton owes her cure in part to a former patient of DuPont’s who nearly died of severe antibiotic-associated diarrhea back in 1970.

At the time, medical literature had described a handful of cases of antibiotic-associated diarrhea that had been successfully treated with FMT. DuPont decided to give the method a try. With approval from hospital and medical school leaders (he was on the faculty at the University of Maryland School of Medicine), DuPont ground up stool from a healthy patient in the hospital for elective surgery who he had screened for infection and disease, and administered it to his patient via enema. The procedure saved his patient’s life.

That was eight years before the medical community linked C. diff to antibiotic-associated diarrhea. FMT research then underwent a “long hiatus,” says DuPont, until it was rediscovered about a decade ago, aided by the National Institutes of Health’s Human Microbiome Project, which has mapped the normal microbial makeup of healthy humans.

In the intervening years, the increasing use of broad-spectrum antibiotics targeting a wide variety of bacteria spurred the spread of C. diff, allowing it to evolve into the major public health threat it is

An enteric coating seals in the odor, and allows the capsule’s purified fecal matter to travel through the stomach to the small intestine before being released.

today. C. diff is the number one hospital-acquired infection in the United States—causing an estimated half a million infections in the United States and 15,000 deaths in 2011. And the infection comes back in one in five patients.

“The intestinal flora is like a Persian carpet, with thousands of species interlocking to keep pathogens out,” says DuPont, internationally renowned for his groundbreaking research on the detection and prevention of diarrheal diseases. “When you deplete the diversity, now the carpet is not a Persian carpet, it is a carpet with one or two colors on it, and C. diff and other pathogens are allowed to go wild.”

Ironically, standard treatment protocols for C. diff. prescribe even more antibiotics. While these powerful antibiotics kill C. diff., they still upset the gut’s delicate bacterial balance and are expensive—a 10-day course of vancomycin costs between $1,400 and $2,000 depending on the dose—and many patients need multiple courses, upping the cost. In contrast, one round of FMT in Houston costs $1,500.

“The intestinal flora is like a Persian carpet, with thousands of species interlocking to keep pathogens out.”

“If you have recurrent disease, you could be taking months of antibiotics, with the cost of treatment easily reaching more than $10,000,” DuPont says. “Compared to that, FMT is cheap.”

TREATMENT REPLENISHES FLORA FMT replenishes the good bacteria in the gut and crowds out the bad bacteria, giving C. diff less room to proliferate. DuPont and Jiang, who oversees the FMT program’s laboratory research, launched their first FMT study in 2013, transplanting bacteria derived from human fecal matter into patients via colonoscopy at Baylor St. Luke’s Medical Center, a partner institution in the study. The procedure was successful in 90 percent of patients in their first study, which gave fresh, frozen or lyophilized (freeze-dried) stool to participants by colonoscopy, and has been equally successful in the second study started earlier this year, which delivers FMT by simpler methods including enemas and capsules.

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PRACTICE / GUT HEALING

All the studied FMT methods use human fecal bacterial material donated by individuals with healthy gut bacteria. Donors are rigorously screened and tested for conditions that might affect their microbiome including infections, gastrointestinal diseases, recent antibiotic use, diabetes and obesity.

“The reason we have such a small pool of donors is that it is easier to control and follow and is safer for recipients,” Jiang says.

She adds that if an FMT recipient develops a health condition in the future, they can see if the donor has that same condition.

After the stool samples are collected, they are sent to the lab, then diluted and filtered twice to eliminate non-bacterial fecal material, leaving the bacteria on the bottom.

Researchers take the filtered solution and either freeze it for later use or put it in the lab’s lyophilizing machine, which freezes and pressurizes the sample to remove all moisture, similar to the process used to make freezedried coffee. A Houston-area compounding pharmacy inserts the final, purified product into the 20 to 30 capsules used in a treatment dose, one dose taken at the research site and another at home.

“After it is lyophilized, the FMT is like cotton candy. And can you imagine the difficulty of putting a lot of cotton candy in pills? It is very fluffy and it needs to be compressed,” DuPont says, adding that they are working

at Baylor College of Medicine for insight into the health of their intestinal flora.

WHAT’S NEXT

In addition to C. diff. infection, abnormal intestinal flora has been associated with a wide variety of health conditions, ranging from obesity to mood disorders.

DuPont and Jiang are applying for an investigational new drug (IND) application Fecal microbial transplant recipient, Diana Clayton, presents the FMT from the Food and program with $1,500 raised at a benefit held in her honor.

Drug Administration (FDA) to test FMT “Dr. DuPont and Dr. Jiang, they saved my on new targets including inflammatory bowel life,” Siebert says with emotion. “Now I feel disease, non-alcoholic fatty liver disease and a tremendous debt to try to be a good citizen a chronic neurological disease, which may and take this extra bit of life, and to not let it include Parkinson’s, multiple sclerosis or go to waste.”

Alzheimer’s, depending on which funding organizations support the research.

Clayton is making up for the moments she and her husband missed as newlyweds, and has Houston’s Kelsey Seybold Research become FMT’s biggest cheerleader. She recently Foundation and Kelsey Seybold Clinic will gave the FMT program $1,500 raised at a benefit coordinate the clinical part of the project held in her honor. The event drew nearly 1,000 (DuPont is president and CEO of the Kelsey people who had followed her struggle on social Seybold Research Foundation). The School media (Google #prayerteamdiana to get a sense of Public Health will be responsible for of her impact). Clayton hopes her donation producing the FMT product. will help advance FMT research, and make the treatment available to everyone who needs it.

The researchers are also working to develop “I was so lucky that I received FMT,” she says. “I a version of FMT that doesn’t contain would have died without it.” any human fecal matter. Jiang is leading animal studies to isolate the active microbial products that help restore healthy gut flora, >> and replicate them into fecal bacteria that Healthy people don’t need to take can be given in a pill. Once that happens, probiotics, says DuPont. Instead they the treatment will be easier and cheaper should avoid unnecessary antibiotics and to produce, and within closer reach of the feed their own flora. DuPont recommends general public.

FEED YOUR FLORA

John Siebert, 64, a professor of agricultural economics at Texas A&M University, credits FMT for saving his life. (Photo courtesy of Certified Angus Beef LLC)

with the University of Houston College of Pharmacy on a new formulation that will help reduce the number of pills in a treatment.

Following treatment, researchers closely monitor patients for up to a year for signs of C. diff, relying on patient diaries and stool samples analyzed by the Alkek Center for Metagenomics and Microbiome Research

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LIFE AFTER C. DIFF Months after their FMT treatments, both Siebert and Clayton are settling back into their respective routines, grateful for a second chance at life. Siebert returned to Texas A&M and threw himself back into teaching.

He enjoys spending time with his wife and two adult sons, and is learning how to play guitar, a hobby he’ll take up in earnest when he really decides to retire.

adding the following five types of food to your diet for healthy intestinal flora.

1. Resistant starch (bananas, oats, beans) 2. Soluble fiber (onions and other root vegetables, nuts) 3. Insoluble fiber (whole grains like bran, avocados) 4. Anti-inflammatory lignan precursors (phytoestrogens: soybeans and flaxseed fiber) 5. Other phytonutrients (blueberries, grapes)

SPECIAL SECTION

REFLECTING ON

KATRINA:

Commemorating the 10th anniversary and remembering the compassionate public health care given in Houston

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SPECIAL SECTION / REFLECTING ON KATRINA

Days after Hurricane Katrina, the most devastating hurricane in recent U.S. history, a quarter of a million New Orleans residents poured into Houston, evacuated from their flooded homes when the levees of Lake Pontchartrain and surrounding waterways failed.

As busloads of evacuees arrived at Houston’s Reliant Park (now NRG Park) and the George R. Brown Convention Center, faculty, staff and students from UTHealth School of Public Health volunteered to provide evacuees with compassionate health care and public health services.

To honor their work and commemorate the 10th anniversary of Hurricane Katrina, here are some of their reflections from the relief efforts.

THE STORM HITS

Hurricane Katrina made landfall on Aug. 29, 2005.

Robert Emery, Dr.P.H., recalls following the storm on television when universities in New Orleans suddenly began reaching out to him for help. Emery, who is affectionately known around UTHealth as “Safety Bob,” was on UTHealth’s safety team at the time, and now serves as the vice president of safety, health, environment and risk management for UTHealth and is professor of occupational health at the School of Public Health.

“They wanted us to share our experiences with Tropical Storm Allison,” he remembers.

Allison devastated southeast Texas in 2001, dropping nearly 40 inches of rain on Houston and flooding the city. When the levees began to fail in New Orleans during Hurricane Katrina, the need for advice on the aftermath of the flooding became evident, he said.

Another School of Public Health faculty member, Lemuel A. Moyé, M.D., Ph.D., a professor of biostatistics, recalls the horror of the storm and its destruction in Louisiana.

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Moyé, who wrote a book about his experiences as a first responder in Houston following Hurricane Katrina, titled Face to Face with Survivors: a First Responder’s Tribute, says there were two major things of note after Hurricane Katrina: the physical damage to the land and people and the effect on the spirit of the people.

“There was the terrible flooding; the failure of the levees; the fear of imminent physical harm to you and your children,” says Moyé.

[Helping these people] “That’s where Houstonians had their greatest impact.”

FINDING REFUGE IN HOUSTON

After Katrina, the Louisiana Superdome (now the Mercedes-Benz Superdome) could no longer serve as a shelter for residents whose homes were underwater or destroyed.

It lacked functioning plumbing and air conditioning, and its roof had been shredded, leaving people wet and unprotected — so thousands of New Orleans residents were bused to Houston, settling into Reliant Center, the Houston Astrodome, and George R. Brown Convention Center. Faculty, students and staff from the School of Public Health immediately stepped forward to volunteer.

Beatrice Selwyn, Sc.D., an associate professor of epidemiology, human genetics and environmental sciences at the School of Public Health, who is well known for her background in rapid assessment, along with Kristy Murray, D.V.M., Ph.D., who was a faculty member at the school at that time but now works with Baylor College of Medicine and Texas Children’s Hospital, volunteered at Reliant Center from the beginning. Murray put to use her experience gained working with the prestigious Epidemic Intelligence Service of the Centers for Disease Control and Prevention.

As buses began to arrive at Reliant Center, it became apparent to Murray and Selwyn that the health of the evacuees was in a state of neglect, and norovirus was running rampant. Evacuees also arrived wet: either from being in the Superdome or from having been walking through dirty floodwaters.

“So when they arrived, a lot of people had skin trouble,” says Selwyn. “They were now developing skin lesions because they had been in these horrible waters.”

Selwyn says she remembers that evacuees had arrived with only the damp clothes on their backs. Houstonians rose to the occasion and donated huge amounts of clothing. Moyé recalls that he and his wife took donations

to a relief center that had been created near the Astrodome. “We bought some toiletries, towels, and clothes and got there – we didn’t know what to expect but we feared a free-forall,” he says. “As we got there, we opened the trunk and people came over — not to take — but to organize it.” In a time of distress, the evacuees came together to support one another.

EVACUEES “IN DESPERATE SITUATIONS”

Moyé remembers the first time he walked into the Astrodome’s makeshift clinic to volunteer.

“I had my black bag, but that was it,” he says.

“I was in a room of maybe 30 or 40 people who were in desperate situations. Obvious fractures; toxic cellulitis; pneumonia; chronic asthma that was getting worse by the minute in the humid environment.” Supplies were hard to come by, and the need to help was high.

“So many of them said, ‘Doctor, I don’t need your help — she does.’ In the depth of their anguish, they continued to be self-sacrificing,” says Moyé. “And it has an amazing effect on the human spirit because if any group of people had the right to be bitter, had the right to be selfish, had the right to demand, to tell — not ask — it was these people. I don’t know if it was deliberate or if it was just a part of their unique character, but they instead decided that it was more important to serve rather than be served…once they cleaned up, they asked how they themselves could volunteer.”

Seeing the state of the evacuees who would become residents of Reliant Center — some for more than two weeks — Selwyn, Murray and a team of students from the school’s Student Epidemic Intelligence Society conducted health surveys each night as evacuees settled into their cots. At first, they intended to take just a sampling of the population housed in the arena, but they later realized they needed to do a complete survey.

“The silly decision — which turned out to be excellent — was to interview everybody, to do a complete census every night,” says Selwyn. This was easier than trying to follow up with specific individuals because people were rearranging sleeping cots and families and did not remain in the same spot for long.

Selwyn, Murray and their volunteer team did this for 17 consecutive nights, gathering information so they could help improve or maintain the health of the evacuees.

The survey not only uncovered physical or mental health issues, but also served

SPECIAL SECTION / REFLECTING ON KATRINA as a sort of mental health service, Murray adds. “Somebody, every day, came by to ask [evacuees] how they were and how they were feeling; they seemed to really appreciate it,” she says. “We were basically the eyes and ears of the entire shelter population.”

Harris County Public Health and Environmental Services directed health care in Reliant Center and the Astrodome, and used data from the School of Public Health volunteer team survey to more efficiently and effectively meet the needs of evacuees.

Selwyn, Murray and other volunteers also tracked water distribution and sanitation.

In the beginning, the Astrodome lacked a method to dispose of medical waste.

“There was no mechanism in place to handle that,” Emery says. “So at that point, I said, ‘[UTHealth] will take care of this piece because we have the resources, we have the vehicles, we have the people who are trained.’ So we retreated back to the office and got containers and red bags.” Emery said volunteers ultimately had to make four or five trips per day, essentially “around the clock,” to properly remove medical waste from the Astrodome.

BEYOND THE MEDIA HYPE

As Selwyn, Murray and their crew uncovered health problems, evacuees were brought to the clinic in the Astrodome where Moyé was volunteering as a physician. Moyé was especially struck by the dedication of very young mothers to their children.

“When the media suggested that there were mothers who abandoned their children… in the Astrodome, what we saw was quite different,” says Moyé. “A mother who needed help and a child who needed help could not be examined separately…we think we know something of somebody based on what we see in the media, but, in fact, we don’t know anything about people.”

CHRONIC ILLNESSES PROVE CHALLENGING

Other School of Public Health faculty members, George P. Delclos, M.D., a professor of epidemiology, human genetics and environmental sciences, and Barry R. Davis, M.D., Ph.D., a professor who is currently interim chair of the Department of Biostatistics, volunteered at the George R. Brown Convention Center. As physicians, they faced issues similar to those at the Astrodome, finding that evacuees had the types of conditions that resulted from drinking bad water or being in unsanitary conditions after the storm. Delclos said the bigger issues were chronic illnesses left unchecked along with lost health records.

“People didn’t remember in some cases what medication they were on or what dose they were on,” Delclos says. “We had several people who were cancer patients and were still in the middle of their chemotherapy treatment and did not know where to turn. I think our whole attitude as a nation regarding the need to go beyond hardcopy, paper records and find other ways of storing a person’s medical history — that was not vulnerable to things like this, getting lost — really became apparent after this. I think the whole EMR [electronic medical records] movement really benefited from what happened in Katrina. The urgency was noted.”

Davis, an expert in hypertension, cared for many of the hypertension patients. Like Delclos, he found that people weren’t sure what medications they were supposed to be taking or what dose. “It was pretty hectic,” he says. “I hope we learned lessons from it.”

TRUE MISSION OF PUBLIC HEALTH

Katrina highlighted just how important public health services are in the aftermath of a natural disaster.

“I think we have to remember our true mission,” says Moyé. “Our true mission is really to provide public health services. Now, we have other things that we do. One of the ways we do that is to teach. Research grants are important, but in a sense, research grants are just station-keeping. We stay here, we stay invested in public health, and it is public health practice of a kind, but nothing like the practice that comes from helping real people in a dire emergency.”

“I think when the state looks at us and the city looks at us, that’s our true value,” says Moyé. “That we are a repository of knowledge, of strength, of discipline and of courage that the city and the neighborhoods can depend on in a time of crisis. I think that’s our real role here. Everything else is secondary to that. It’s important, but it’s secondary to that.”

Delclos said they just did the best they could.

He was also impressed with the level of Pictured below is the Houston Astrodome while organization that instantly sprang up. it was used as a shelter for Hurricane Katrina evacuees from Louisiana in 2005.

Sheryl A. McCurdy, Ph.D., an associate professor in health promotion and behavioral sciences at the School of Public Health, also noticed the same. “People started taking care of themselves. They did not want to be separated.

They had been separated enough.”

McCurdy brought her class to Reliant Center to volunteer. Some of the international students in her class observed that it was definitely not a “refugee camp” like they were used to seeing in Africa, noting that the shelter was far more organized with its ATM machines, phone booths and health care services.

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ALUMNI

SPOTLIGHTS BELLA DINH-ZARR NAMED NTSB VICE CHAIRMAN

Alumna T. Bella Dinh-Zarr, Ph.D., M.P.H., has been appointed to the position of vice chairman of the National Transportation Safety Board (NTSB). Dinh-Zarr earned both her Ph.D. (‘01) and M.P.H. (‘97) at the UTHealth School of Public Health.

An independent federal agency, the NTSB is charged by Congress with investigating all civil aviation accidents in the United States as well as significant railroad, highway, marine and pipeline accidents. Dinh-Zarr is concurrently serving a two-year term as the organization’s vice chairman and a three-year term as board member.

Born in Vietnam and raised on the Gulf Coast of Texas, DinhZarr is the first Asian American to serve on the five-member Board.

On how she ended up in transportation safety via an education in public health, she says, “I think it’s a really unusual path, perhaps, for someone from a public health background, but I

T. Bella Dinh-Zarr, Ph.D., M.P.H and Robert Zarr, M.D., M.P.H.

hope this encourages more people in public health to go into injury prevention related to transportation. I think it’s a great field — it’s very important. Our country and our world depend on transportation. Public health students and professionals have a key role to help make our roads, skies, rails and seas safer.”

PATLOVICH INVESTIGATES FIELD RESEARCH RISKS

The work of alumnus Scott Patlovich, Dr.P.H., made the cover of the April 2015 issue of Applied Biosafety, the peer-reviewed professional journal of the American Biological Safety Association, with his doctoral dissertation article on field research risk assessment.

Patlovich is UTHealth director of Environmental Health and Safety and a former Southwest Center for Occupational and Environmental Health (SWCOEH) Center trainee in industrial hygiene. His dissertation advisor was Robert Emery, Dr.P.H., professor of occupational health and UTHealth vice president for safety, health, environment and risk management.

Patlovich surveyed a cross section of more than 1,400 biosafety professionals with the American Biological Safety Association (ABSA) to get a better feel for how they approached field research safety. The results provided an eye-opening look at the current state of field research safety, and areas that need tweaking. Patlovich hopes to partner with the ABSA to develop a field-safety curriculum, available through the association to practicing biosafety professionals.

Scott Patlovich, Dr.P.H.

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“Right now, the toolbox biosafety professionals have for dealing with field safety doesn’t have all the right tools,” Patlovich says. “There’s definitely room for improvement.”

ALUMNI SPOTLIGHTS

ZARR LEADS PHYSICIANS FOR A NATIONAL HEALTH PROGRAM

Alumnus Robert Zarr, M.D., M.P.H., is heading Physicians for a National Health Program (PNHP), a nonprofit research and educational organization of more than 19,000 members (physicians, retired physicians and medical students) who support single-payer national health insurance. He was appointed president of the organization in October 2014.

“It seemed fitting for me to volunteer my time with PNHP because I personally see so much of the unnecessary lack of access to healthcare and all its consequences,” says Zarr. “We’re really about a single issue—which is, in my opinion and the opinions of thousands of other physicians around the country the most important first step—we’ve got to eliminate this financial barrier to seeking care.”

Robert Zarr, M.D., M.P.H.

Zarr earned his M.P.H. from the School of Public Health and M.D. from Baylor College of Medicine. He is a board-certified pediatrician at Unity Health Care in Washington, where he cares for a low-income and immigrant population.

Zarr is a past president of the Washington, D.C. chapter of the American Academy of Pediatrics and served as a CATCH facilitator in D.C. for five years. He holds adjunct professorships at Children’s National Medical Center and George Washington University and is active in a variety of quality improvement initiatives including asthma management, injury prevention and compliance with early and periodic health screening.

UTHEALTH SCHOOL OF PUBLIC HEALTH ALUMNI ASSOCIATION ALL ABOUT POLLY SPARKS TURNER PRESIDENT OF THE UTHEALTH SCHOOL OF PUBLIC HEALTH ALUMNI ASSOCIATION Years in public health work: 25+ years Hometown: Houston, Texas Family: One brother, James, Parents, sister, brother, husband deceased Hobbies: Traveling, Reading Favorite music: Jazz, Gospel Favorite movie: Mrs. Doubtfire; Red Tails; War Room Favorite television shows: 20/20; Kelly & Michael; The View; The Talk Why I love Texas/only in Texas favorite: Weather, congeniality, affordability, “It’s home.”

Polly loves…: A night out with friends; lunch bunch; playing bridge; crossword puzzles Why public health?: To address health disparities; use scholarly approaches to improve access and healthcare delivery among disadvantaged/underserved populations.

Favorite things you’ve done while working in public health: PH administration; university professor; active participation in APHA, UTSPH advisory council, endowed scholarships established, and alumni association.

Polly Sparks Turner, M.P.H., Dr.P.H.

There are two scholarships in the name of Turner and her late husband, Dr. Oddis Calvin Turner. Below are recent recipients of the scholarships.

Polly Sparks Turner, M.P.H., Dr. P.H. Endowed Scholarship in Community Health Recipient: Elias Berhanu

Dr. Oddis Calvin Turner Endowed Scholarship in Health Promotion and Behavioral Sciences Recipient: Margaret Raber

If you are interested in establishing a scholarship or making a donation to UTHealth School of Public Health, contact Erin Meade, director of development, on 713-500-3027 or email her at Erin.Meade@uth.tmc.edu.

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TRAILBLAZERS

TRAILBLAZERS

TREATING C. DIFF INFECTIONS Charles Darkoh, Ph.D., a researcher at UTHealth School of Public Health, was recently awarded a five-year, $1.9 million R01 grant by The National Institutes of Health-National Institute of Allergy and Infectious Diseases (NIH-NIAID) to develop a non-antibiotic treatment for Clostridium difficile (C. diff ) infections.

C. diff, a bacterium that causes diarrhea and inflammation of the colon, is one of the most common causes of hospital-acquired and antibiotic-associated diarrhea in the United States. Treatment of the infection costs the health care system at least $1 billion annually, according to the Centers for Disease Control and Prevention.

One of the major risk factors for C. diff infections is indiscriminate antibiotic use, which kills the good bacteria that protect the gut from bad bacteria.

“If we can prevent C. diff from making the toxins and/or make the toxins inactive in the gut without killing the good bacteria, that would be a better treatment option,” says Darkoh, the principal investigator and assistant professor in the school’s Department of Epidemiology, Human Genetics and Environmental Sciences.

Darkoh’s laboratory has identified potent novel compounds that prevent production of the C. diff toxins and also inactivate the toxins. During the pre-clinical study, Darkoh seeks to identify the target and mechanism of inhibition of the compounds, evaluate the compounds in different strains of C. diff and examine the efficacy of a cocktail of these compounds that could work as a combination therapy to prevent illness.

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TRAILBLAZERS

THE UPS AND DOWNS OF BLOOD SUGAR Glipulin, a glucagon-like peptide-1 receptor added to insulin, helps reduce the variability of blood sugar levels in patients with Type 2 diabetes, according to new findings from a multiinstitutional clinical trial including researchers from the UTHealth School of Public Health.

Called FLATSUGAR (FLuctuATion reduction with inSUlin and Glp-1 Added togetheR), the study seeks to determine which diabetes therapies best reduce blood sugar fluctuations. Good blood sugar control is essential for preventing many of the disease’s life-threatening complications—including heart attack and stroke.

The researchers found that giving a short-acting glucagonlike peptide (GLP-1) agonist with meals reduced glycemic variability compared with bolus insulin, while maintaining similar HbA1c levels (a standard measure of blood glucose).

Those taking the GLP-1 agonist also lost a significant amount of weight compared with the other group--an overall average of 12 pounds. The results pave the way for future studies exploring the impact of blood sugar fluctuations in patients with Type 2 diabetes, says Barry Davis, M.D., Ph.D., director of the Coordinating Center for Clinical Trials and principal investigator for the data coordinating center at the UTHealth School of Public Health.

DOES CHEMO HELP? Chemotherapy prolongs life for older adults with most types of cancer, but for women over the age of 80 with breast cancer, the chances of survival due to chemotherapy are significantly lower, according to new findings published in the August 2015 issue of the Journal of American Geriatrics Society.

“Chemotherapy’s reduced effect on the risk of mortality in older breast cancer patients could be due to several factors: tumors being less sensitive to chemotherapy, a decrease in dosage as the body gets weaker with age or chemotherapy killing healthy cells in addition to cancer cells,” explains Xianglin Du, M.D., Ph.D., the study’s lead author and a professor in the Department of Epidemiology, Human Genetics and Environmental Sciences.

Du and fellow researchers examined data from Surveillance, Epidemiology and End Results (SEER), a Medicare-linked database.

For women over the age of 80, chemotherapy alone did not significantly reduce the risk of mortality. The benefit of chemotherapy

“The FLAT-SUGAR trial demonstrated the successful completion of a complex trial and the utility of a GLP-1 agonist–based strategy for reducing glucose variability,” he says.

Jeffrey Probstfield, M.D. and Irl Hirsch, Ph.D. of the University of Washington were the study’s principal investigators.

Coordinating Center for Clinical Trials researchers Sara Pressel, Ph.D. and Dejian Lai, Ph.D. were co-investigators for the study at The University of Texas School of Public Health.

in reducing the risk of mortality decreased with age for female breast cancer patients. However, chemotherapy remained effective for males and female colon cancer patients until the age of 89.

Additional co-authors of the study from the School of Public Health include Yefei Zhang, M.S., Rohan Parikh, M.S., David Lairson, Ph.D., and Yi Cai, M.D.

BEHIND BARS

Kayo Fujimoto, Ph.D. leads a team of UTHealth School of Public Health researchers participating in a new $3.2 million multi-site study investigating the effectiveness of HIV prevention interventions in the criminal justice system.

Researchers will take on the core social network analysis for the study, which targets

substance-using younger black men who have sex with men (YBMSM). This project includes three sites: Houston, Los Angeles and Chicago, home to three of the four largest jails in the United States. The cities also have a high rate of HIV among YBMSM. “There is an urgent need in the criminal justice system for effective HIV interventions that engage younger black men who have sex with men,” says Fujimoto an assistant

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TRAILBLAZERS

“Given that there are currently more persons involved in the criminal justice system than any time in US history (an estimated 7.3 million individuals), we believe that prevention initiatives should focus on this population.”

professor with the Center for Health Promotion and Prevention Research at the School of Public Health and principal investigator of the large-scale R01 study, funded by the National Institute on Drug Abuse. “Given that there are currently more persons involved in the criminal justice system than any time in U.S. history (an estimated 7.3 million individuals), we believe that prevention initiatives should focus on this population.”

Pamela Diamond, Ph.D., an associate professor in Center for Health Promotion and Prevention Research, is a co-investigator.

The study also involves the University of Chicago, Argonne National Laboratory and UCLA.

SIMPLIFYING DATA

Sheng Luo, Ph.D., an associate professor in the Department of Biostatistics at UTHealth School of Public Health, was awarded a fouryear $1.2 million grant from the National Institutes of Health – National Institute of Neurological Disorders and Stroke (NIHNINDS).

The study is aimed at developing a multidimensional latent trial linear mixed model (MLTLMM) to address the difficulty associated with defining treatment effects in clinical trials which collect multivariate outcome data. The problem is complicated by the heterogeneous data, outcome scale, missing data, and correlation within and between outcomes of the same subject

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who had the greatest food dissimilarity experienced more central weight gain, with a 120 percent greater increase in waist circumference than participants with the lowest food dissimilarity.

therefore this study will help to define the treatment effect, and build the necessary complexity of the model to incorporate the major components of the data that could lead to strong biases in the treatment effect estimation. The MLTLMM method of defining and estimating the overall treatment effect in multivariate longitudinal data will address the critical need across trials of many medical conditions such as Alzheimer’s, and Huntington’s disease with a similar data structure.

EVERYTHING IN MODERATION? Advice to “eat everything in moderation,” may be linked to lower diet quality and worse metabolic health, finds UTHealth School of Public Health researcher Marcia C. de Oliveira Otto, Ph.D. in her study article in PLOS ONE. The study measured diet diversity using data from 6,814 participants in the Multi-Ethnic Study of Atherosclerosis, a study of whites, blacks, Hispanic-Americans and ChineseAmericans in the United States. Participants

“An unexpected finding was that participants with greater diversity in their diets, as measured by dissimilarity, actually had worse diet quality. They were eating less healthy foods, such as fruits and vegetables, and more unhealthy foods, such as processed meats, desserts and soda,” says Otto, first author and assistant professor of epidemiology, human genetics and environmental sciences at the School of Public Health. “This may help explain the relationship between greater food dissimilarity and increased waist circumference.”

The study results highlight the importance of valuing food quality over diversity, conclude the researchers. At 10 years into the study, higher diet quality was associated with about a 25 percent lower risk of developing Type 2 diabetes.

Dariush Mozaffarian, M.D., Dr.P.H., dean of the Friedman School of Nutrition Science and Policy at Tufts University in Boston, was the paper’s senior author. Nikhil S. Padhye, Ph.D., from UTHeath School of Nursing, was a coauthor on the study. The National Heart, Lung and Blood Institute provided funding.

TRAILBLAZERS

NEGATIVE BODY IMAGE INCREASES ADOLESCENT OBESITY Negative body image significantly increases the risk of obesity regardless of whether youth have depression, according to UTHealth School of Public Health researchers.

In the paper published in the Nov. 1, 2015 issue of the Journal of Affective Disorders, first author Robert E. Roberts, Ph.D. and his co-author examined data from a study called Teen Health 2000 (TH2K) which surveyed youth ages 11 to 17 in the Houston area.

Participants who perceived themselves to be overweight, regardless of how much they weighed, were twice as likely to be obese a year after they were surveyed. Young women in the group were three times more likely to be obese at the one-year mark.

“Clinically, addressing body image in depressed patients who are obese may improve outcomes,” said Roberts, professor of health promotion and behavioral sciences at the UTHealth School of Public Health San Antonio Regional Campus, and part of the Michael & Susan Dell Center for Healthy Living at the school’s Austin Regional Campus.

Hao T. Duong, M.D., Dr.P.H., from the Partnership for Health Advancement in Vietnam, was a co-author on the paper. The National Institutes of Health and Michael & Susan Dell Center for Healthy Living supported the study.

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TRAILBLAZERS

SKIP THIS KISS!

Paula Stigler-Granados, Ph.D., an assistant professor in the Department of Management, Policy & Community Health at the School of Public Health’s San Antonio Regional Campus, has received a five-year, $544,329 grant from the Centers for Disease Control to conduct outreach and education on Chagas disease in South Texas.

Chagas is a parasitic disease that affects more than 8 million people across the world. The disease’s parasite, Typranosoma cruzi (T. cruzi), is carried by a triatomine, also known as a kissing bug. Chagas can cause mild, flu-like symptoms, or in some cases develop into a lifethreatening chronic condition leading to heart disease.

While most prevalent in Latin America, Chagas also exists in South Texas.

“Chagas is largely considered to be an exotic or foreign disease, and as such, the disease is often not considered by physicians to be a viable diagnosis. This, coupled with the lack of ease in access to treatment, has created some major barriers for successful diagnosis and treatment of this emerging disease by U.S. physicians and health care providers,” says Stigler-Granados.

Jose Betancourt, Dr.P.H., associate professor in the Department of Management, Policy & Community Health, is a co-principal investigator for the project.

“Chagas is largely considered to be an exotic or foreign disease, and as such, the disease is often not considered by physicians to be a viable diagnosis.”

TEEN TOBACCO USE The goal of the Texas Tobacco Center of Regulatory Science on Youth & Young Adults (Texas TCORS) is to develop an integrated program of research and training providing scientific evidence and a career path for regulatory scientists to support U.S. tobacco regulation.

The center is a project between The University of Texas Health Science Center at Houston (UTHealth) Austin campus, The University of Texas MD Anderson Cancer Center, and The University of Texas at Austin. Texas TCORS received a five-year, $20 million grant from the Food and Drug Administration and the vision for the grant is “to eliminate the use of nicotine and tobacco products by young people to maximize public health.” The grant provides funding for three research projects conducted in partnership with the three Texas TCORS institutions as well as Rutgers School of Public Health.

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TRAILBLAZERS

RECYCLING POLLUTION IN HOUSTON The National Institute of Environmental Health Science (NIEHS) awarded $2.5 million to The University of Texas Health Science Center at Houston (UTHealth) School of Public Health to study emissions of metal particles from metal recycling facilities in Houston.

This innovative, five-year project, called “Metal Air Pollution Partnership Solutions” (MAPPS), brings together a unique team of scientists, environmental investigators, community organizers, neighborhood leaders, metal recyclers and an advocacy group. This team will assess potential health risks associated with metal exposures using community air monitoring results and obtain feedback about environmental health concerns via community surveys. The MAPPS team will use the results of the environmental risk assessments and the surveys to develop a public health action plan. The action plan may include the development and/or dissemination of emission reduction practices that can be adopted by the recycling industry, a

targeted educational program for the community and a public policy component for local and state-level legislative agencies.

“This award will allow us to conduct seminal research in a scientific area not well-studied that will draw upon evidence-based principles in environmental health sciences and behavioral sciences,” says principal investigator, Elaine Symanski, Ph.D., director of the Southwest Center for Occupational and Environmental Health and associate professor of epidemiology at the UTHealth School of Public Health.

“Additionally, the team of scientists from UTHealth School of Public Health is privileged to be working on a project in which scientists, advocates, industry, community and government have approached the project as a collaboration from the outset. Our research is translational as it includes developing, implementing and evaluating a multi-faceted intervention that has the potential to improve the health of communities in our city.”

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NEW FACULTY 1.

Sadie Conway, Ph.D. Assistant Professor, Epidemiology, Human Genetics & Environmental Sciences

2.

Hongyu Miao, Ph.D. Associate Professor, Biostatistics

3.

Thomas Reynolds, Ph.D. Faculty Associate, Management, Policy and Community Health

4.

Honora Swain, Ph.D. Faculty Associate, Health Promotion and Behavioral Sciences

5.

Jennifer Tektiridis, Ph.D. Lecturer, Management, Policy and Community Health

6.

Ningtao Wang, Ph.D. Assistant Professor, Biostatistics

7.

Hulin Wu, Ph.D. Professor and Associate Department Chair, Biostatistics

8.

Bing Yu, Ph.D. Assistant Professor, Epidemiology, Human Genetics & Environmental Sciences

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1 2

5

4

7 6

CLARIFICATION

Here are some clarifications from Vol. 1 of Pioneers magazine, “Claims data yields new research projects” and the “Payment systems overview” sidebar, which was on page 16 of that issue.

The Blue Cross Blue Shield of Texas (BCBSTX) Payment Systems and Policies Research Program is housed in the Center for Healthcare Data Research, not in the George McMillan Fleming Center for Healthcare Management.

The institutions mentioned in the article are collaborating with a wider group of UTHealth School of Public Health faculty members using the BCBSTX data, and are not collaborating solely with the school’s Fleming Center to use these data.

The photo captions in the article stated that Trudy Krause, Dr.P.H., and Lee Revere, Ph.D., are co-directors of the project. Krause is actually co-director of the Center for Healthcare Data Research and Revere is director for the Fleming Center.

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GAME CHANGERS ASHA KAPADIA, PH.D., PROFESSOR EMERITA OF BIOSTATISTICS Asha S. Kapadia, Ph.D., grew up in a family of five girls in India. Her father and mother had great expectations for her. She followed their wishes for her to excel in mathematics, has accomplished great things and is a “game changer” for UTHealth School of Public Health.

Kapadia was one of the first women to graduate with a Ph.D. in statistics from Harvard University in 1969. Before that, in 1965, she was one of the first women to graduate from Massachusetts Institute of Technology Sloan School of Management.

In the 1970s, Kapadia was working at another institution and was told she would not be promoted in her department because of her gender, despite her brilliance. At that time, she came across an advertisement

GIFTS TO UTHEALTH SCHOOL OF PUBLIC HEALTH SEPT. 1, 2014, THROUGH AUG. 31, 2015 We are pleased to recognize donors who contributed $1,000 or more to UTHealth School of Public Health in fiscal year 2015 (Sept. 1, 2014, through Aug. 31, 2015).

Thank you for joining us to improve public health in Texas and around the world. Our students, faculty and staff are proud to count you among our generous supporters and as a member of the UTHealth School of Public Health community.

for UTHealth School of Public Health in an operations research journal. Intrigued, she visited the campus and was personally welcomed by the school’s first dean, Reuel A. Stallones, who asked if she would join the biostatistics faculty and build the school’s operations research curriculum. UTHealth School of Public Health became her career home, in part because of her appreciation of the entrepreneurial spirit encouraged by all faculty.

To give back to UTHealth, Kapadia has funded a professorship named in honor of her parents, Dr. and Mrs. D. R. Seth. Her father, Dr. Seth, was an Air Force officer who committed his life’s work to support the undergraduate and graduate educations of his and Mrs. Seth’s five daughters. He had encouraged Asha, his second daughter, to study and work hard to excel in math.

Now a professor emerita at UTHealth School of Public Health, Kapadia gives this professorship in biostatistics to continue the

legacy of her parents’ devotion to education.

As her father said, “Unlike material possessions, an education is one gift that can never be stolen.”

$1,000,000+

$1,000 - $9,999

Houston Endowment* Jane Dale Owen

$500,000 - $999,999

Michael & Susan Dell Foundation Laura Moore and Don Sanders

$100,000 - $499,999

Margaret W. and Herbert L. DuPont, M.D.* Asha Seth Kapadia* Sue Smith and Craig Brown

$25,000 - $99,999

Virginia and Richard Mithoff*

$10,000 - $24,999

Baptist Health Foundation of San Antonio Suzan and Julius Glickman Healthy Weight Partnership, Inc. Cornelia and Meredith Long St. David’s Community Health Care Foundation Texas Medical Center

The information contained in this listing pertains to new outright gifts, new pledges and pledge payments made Sept.

1, 2014, through Aug. 31, 2015 to UTHealth School of Public Health. Donors who gave $1,000 or more are recognized in this listing. Although great care has been taken to ensure the accuracy of this list, unintentional errors might occur.

Please bring to our attention any discrepancies by contacting Kimberly Karol, director of stewardship and development communications, at 713-500-3005 or kimberly.b.karol@uth.tmc.edu. Thank you!

Mary and Lorne Bain Adele and Lan Bentsen* The Bhojani Family Foundation Joan and Robert Bigelow, Ph.D., M.S. ‘78, ‘80* Lynne and William Bonham Catherine and Gary Brock, M.D. Diana and Drew Clayton Congregation Emanu El Judith Craven, M.D., M.P.H. ‘81 Elizabeth and Ralph Frankowski* Carol Galeener, Ph.D. ‘97, ‘04 Lainie Gordon and David Mincberg Linda Highfield Robert MacLean, M.D.* MEND Foundation Osama Mikhail, Ph.D.* James J. Nahm Trust National Philanthropic Trust Produce for Better Health Foundation Sylvia Taborelli, M.P.H. ‘77* Texas A&M AgriLife Extension Service Mary and Will Williams Jay Wolfson, Dr.P.H. ‘81 Sarah Zetzman *10 or more years of loyal giving to the UTHealth School of Public Health

35

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HOUSTON, TX PERMIT No. 209

1200 Pressler Street Houston, TX 77030 Ph: 713-500-9050

TEXTBOOKS: NEW IN PRINT The following are textbooks that are new in print from the faculty of UTHealth School of Public Health.

Designing and Conducting Health Surveys, 3rd Edition, by Lu Ann Aday (professor emeritus), Llewellyn J. Cornelius.

Evaluating the Healthcare System Effectiveness, Efficiency and Equity, 4th Edition, by Charles Begley, David Lairson, Robert Morgan, Paul Rowan.

Evaluating the Healthcare System: Effectiveness, Efficiency and Equity, 3rd Edition, by Lu Ann Aday (professor emeritus), Charles Begley, David Lairson, Rajesh Balkrishnan.

Statistical Reasoning in Medicine – The Intuitive P value Primer, by Lemuel Moyé.

Planning Health Promotion Programs: An Intervention Mapping Approach, by Kay Bartholomew, Guy Parcel, G. Kok, Nell Gottlieb, Maria Fernandez.

Finding Your Way in Science: How You Can Combine Character, Compassion and Productivity in Your Career, by Lemuel Moyé.

Statistical Monitoring of Clinical Research: Fundamentals for Investigators, by Lemuel Moyé.

Reinventing Public Health: Policies and Practices for a Healthy Nation, by Lu Ann Aday (professor emeritus)

Innovation Generation, by Roberta B. Ness.

Creating Health Behavior Change: How to Develop Community-Wide Programs for Youth, by Cheryl L. Perry.

Classification Analysis of DNA Microarrays, by Leif E. Peterson.

Genius Unmasked, by Roberta B. Ness.

Creativity in the Sciences: A Workbook Companion to Innovation Generation, by Michael L. Goodman, Aisha S. Dickerson, Roberta B. Ness.

Integrating Quality and Strategy in Health Care Organizations, by Sarmad Sadeghi, Afsaneh Barzi, Osama Mikhail, M. Michael Shabot.

Essential Methods for Conducting Epidemiology Research: the Plan of Action Approach, (revised for 2016). (This is an “e-book” available to students in the class only via the Canvas website.) By. Beatrice J. Selwyn.

Example: Manual of Procedures from the Childbearing Women Survey, (revised for 2016).

(This is an “ebook” available to students in the class only via the Canvas website.) by Beatrice J. Selwyn. * Please note: a few of the coauthors on this list are not faculty members of UTHealth School of Public Health.