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CU Anschutz wins $46.5 million NIH grant

The National Institutes of Health (NIH) recently awarded $46.5 million to the University of Colorado Anschutz Medical Campus and its Colorado Clinical and Translational Sciences Institute (CCTSI), a research partnership designed to speed up development of new treatments to address the greatest health needs of Coloradans.

In 2008, the CCTSI was launched with a grant of $76 million—the largest biomedical research and training award in the state’s history. This new five-year award brings the total funding from NIH to the CCTSI to more than $187 million.

Dr. Shikha Sundaram“The general public may not know the CCTSI name,” says Ronald Sokol, MD, CCTSI director and professor of pediatrics in the School of Medicine. “But they have probably benefited from the research that has come out of our institute over the past 10 years.” Examples include:

  • A cure for hepatitis C, which was made possible in part by dozens of clinical trials that were conducted by CCTSI investigators in our facilities over the past 15 years.
  • Precision medicine treatments for cystic fibrosis that target the defective protein caused by specific gene mutations and which have transformed the lives of patients.
  • Boosting the rates of health screenings that save lives in underserved Colorado communities, such as urban Latino, urban African American and rural eastern Colorado.
  • Decreased mortality rates in five Denver neighborhoods by developing community-based, culturally responsive approaches to tailor educational programs for cardiopulmonary resuscitation (CPR).

“The CCTSI is an engine that has enhanced the research enterprise on the Anschutz Medical Campus for many years,” says Dean John J. Reilly, Jr., MD, of the University of Colorado School of Medicine. “We are proud of their work and confident they will continue to provide essential support and leadership for the next generation of physicians and researchers.”

Over the next five years, the CCTSI will:

  • Develop, educate and sustain a diverse translational science workforce to ensure the highest research innovation, quality and safety.
  • Create a translational research environment in which team science and collaboration both locally and nationally are facilitated, supported and valued.
  • Engage local and national communities and stakeholders in all phases of the translational research process.
  • Create novel methodologies and resources to support and integrate research in special populations, including children, the elderly, the underserved and those with rare diseases.

“The grant will further establish the University of Colorado Anschutz Medical Campus, and all of our institutional partners, as biomedical research leaders, pioneers and innovators,” says Sokol. “We are thrilled to have the opportunity to continue to engage in the full spectrum of translational science to achieve our ultimate goal of getting more treatments to more patients more quickly.”

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Firefighters learn ‘reality’ of virtual world

VR BugEditor’s note: This is the second in a periodic series of CU Anschutz Today articles focused on the potential of virtual reality technology in the medical setting. With its unique attributes, the University of Colorado Anschutz Medical Campus could lead the way in ensuring responsible and effective implementation of the gaming technology in health care.

 

Shuffling nervously back and forth as the perpetrator approached, unsure of the danger at hand, firefighter Zac Varela suddenly stilled. Regaining his focus, he raised his muscular arms and took a shooting stance, aiming directly at the culprit. Nothing happened.

Realizing he was unarmed, Varela restarted his nervous bobbing, when the perpetrator suddenly lunged. “Oh god,” he cried, as he fell back, his solid 6-foot, 3-inch frame nearly knocking a smaller crew member down as he struggled to regain his footing. “I need an ax or something.” But there was no ax, and no coworker who could help.

When Varela emerged from his virtual world, visibly shaken by the oversized spider, the generally clear-headed firefighter had gained a new appreciation of the power of virtual reality (VR). “I don’t like that spider,” he said, as his crew of colleagues, who had been watching his antics, laughed hysterically.

Scary VR moment

Firefighter Zac Varela experiences virtual reality.

For Varela, the mission was accomplished. And while the first-responder demonstration of the gaming technology on the University of Colorado Anschutz Medical Campus proved humorous and entertaining for his fellow firefighters, the purpose remained serious.

“When I was on the street with that giant spider, as soon as I saw it coming toward me, I was unable to control my brain. I didn’t feel like I was in a videogame anymore.”  ̶  Zac Varela, firefighter

Not all fun and games

Between 2004 and 2014, three times as many law enforcement officers died by suicide than by all other occupational hazards combined. Suicide is now recognized nationally as the leading occupational killer of emergency responders, including officers, firefighters, dispatchers, paramedics and EMTs.

With the growing number of high-profile, mass-casualty incidents, and an unmet mental health care need for the community protectors, the threat is only rising. Using VR as an integral tool, ResponderStrong™, together with the National Mental Health Innovation Center at CU Anschutz, aims to reverse the deadly trend.

“When we recognize a true threat, we are good at adapting and protecting ourselves against it,” said Rhonda Kelly, ResponderStrong™ project manager and a former Aurora firefighter of 17 years. Whether it’s high-tech body armor for officers, advanced breathing apparatus for firefighters, or protective CPR gear for paramedics, agencies seek top-of-the-line protection for their employees.

“That’s part of the reason physical line-of-duty deaths are going down,” said Kelly, who led the demonstration with the Aurora Fire Department crew. “Now we recognize the leading occupational killer of first-responders is, in fact, suicide, and we haven’t trained our people to protect themselves against it.”

A lesson in reality

After exiting a virtual elevator and bravely traversing a barely 2-foot-wide plank 26 stories above a bustling city streetscape, Commander Hunter Hackbarth began strutting his stuff too much.

Hackbarth gazes at sky
Commander Hunter Hackbarth gazes at the sky before his harrowing plank walk.

“Whoa,” Hackbarth yelled as he fell, his knees buckling before he hit the ground. “Am I in heaven now?” he joked after he recovered. The visually immersive VR experience can feel so real that it induces physiological responses, such as sweating, shaking and increased heart rate and respirations.

The reality of the virtual experience startles nearly every first-responder who tries it, Kelly said. Besides allowing displays of vulnerability and fostering camaraderie, the demonstrations are aimed at building buy-in to the more occupationally focused VR programs she and fellow innovators are creating.

Reducing the trauma

Soon, VR prototypes immersing responders in scenes of mass-shootings, burning skyscrapers and natural disasters will be tested for building stress-management skills, bolstering resiliency and improving performance of emergency responders through an accessible and easily repeatable training method.

“It’s called stress inoculation,” said Matt Vogl, who founded NMHIC to bring community-wide creative solutions to mental health care. “It’s exposing people to the bad thing before they actually experience it for real so that their brain has a reference point and is not completely in shock,” he said.

Numerous studies have shown the practice can lessen the impact of post-traumatic stress and reduce the likelihood of developing the disorder (PTSD), a chief cause of suicide for emergency responders and military personnel, Vogl said. “The Army has been using it for years.”

Many barriers block first-responders from adequate care, including a lack of access, resources and understanding by mental health providers of the responder community’s needs and culture.

After years of hearing repeatedly from the responder community that a crippling mental health scourge was going untreated, and talking with Kelly about the potential of ResponderStrong™, Vogl offered to support the program on a trial basis. It proved wildly successful.

Since leaving her firefighter job to take the reins of ResponderStrong™, Kelly has watched the group grow from about 30 to more than 500 first-responders and their advocates representing 300 agencies from across the state. Its members are passionate about breaking the mental-wellness barriers and reducing the wounds of their fellow responders, Kelly said.

“It’s exposing people to the bad thing before they actually experience it for real so that their brain has a reference point and is not completely in shock.”  ̶  Matt Vogl, NMHIC

A perfect storm

“When you look at the responder occupation, there’s this whole perfect storm of factors that, when they come together, can really have a negative impact on responders’ physical and mental health,” Kelly said. Daily stressors, such as sleep deprivation, busy shifts, hyper-vigilance to sounds and no time to eat or hydrate correctly, decrease resiliency.

Firefighter set to walk plank
Firefighter Paul Cordova gathers courage before walking the plank 26 stories above the city.

“Then there are the stressors of witnessing other people’s traumas, not only the big crisis events, such as the Aurora theater shooting, or Columbine or the World Trade Center, but also the day-to-day exposures. How many drive-by shootings, how many suicides, how many dead kids can you see? We haven’t taught them how to manage that stress,” Kelly said.

A culturally-ingrained belief that any admission of emotional or mental impact is a sign of weakness increases the burden, which Kelly felt even more heavily as a woman in a male-dominated profession.

“When a woman admits she’s struggling, she runs the risk of being seen as weak,” Kelly said. “But not only is she seen as weak; she’s seen as representative of why women don’t belong in this profession.” The stigma harms both women and men, she said. “It reinforces the idea in men’s minds that, yes, it is weak, and if she can’t express it, I most certainly can’t express it. And it becomes a self-sustaining culture.”

Building muscle memory

With the planned inoculation programs, responders, attached to biometric sensors, will enter a noisy, dimly-lighted and unmanageable scene. As they begin to self-regulate, lowering their pulse and respiration rates, the lights will become brighter and the sounds clearer, allowing them to make sense of the situation and do their jobs.

Most other work-skill training that responders undergo is done repetitiously in a scenario-based environment. “The idea is to ingrain those skills down to the muscle-memory level so that in time of crisis, we will respond in exactly the way we need to and maximize a positive outcome,” Kelly said.

VR allows stress-management and mental health training in a life-like scenario, so responders can deploy those skills in the same way, she said, adding that other prototypes focused on an array of mental health needs will follow.

“The researchers we are working with have a lengthy history in the treatment of PTSD among veterans and responders inside a virtual-reality realm,” Kelly said. “We know that exposure therapy is widely recognized as the best treatment for post-traumatic-stress injuries, and VR is essentially exposure therapy on steroids. I really think it’s limited only by our imagination what we can accomplish with this tool.”

Controlling the brain

Andersen adjusts mask
Rhonda Kelly helps Deputy Chief Cindy Andersen adjust her mask before she leaves the streetscape for her elevator ride.

“Look at that Z-pattern,” Kelly said, as she watched Deputy Chief Cindy Andersen put out a fire before using her jet pack to fly to another skyscraper. “Whoa, if I could only find another rooftop,” Andersen said, before Kelly asked her if she was nervous. “Oh my god, yes! I’m sweating like a pig!”

Varela, one of the few to visit Floor 666 on the virtual elevator, entering the land of monstrous spiders and knife-wielding clowns, told his buddies the initial flying section was fun and felt like a videogame.

“But as the stress got more intense, it was harder,” Varela said. “When I was on the street with that giant spider, as soon as I saw it coming toward me, I was unable to control my brain. I didn’t feel like I was in a videogame anymore. And when it lunged at me, I tried to jump back in the elevator and get against the wall, and there was no wall. That’s why I fell over.”

Varela and his coworkers agreed that VR could be a realistic immersion tool for first-responders capable of achieving the NMHIC’s goals. “That spider and that clown, they were messing with me,” Varela said. “I just want to go back in there and see if I can handle them better.”

 

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Celebrating variety: First-ever Diversity Showcase packs Krugman Hall

Once they’d hung up their lab coats and pushed in their chairs, an impressive cross-section of the University of Colorado Anschutz Medical Campus came together after work recently, filling the Krugman Conference Hall in what organizers called a dynamic show of dedication and celebration.

Visitors to the first-ever Chancellor’s Diversity Showcase on April 23 were greeted by upward of 30 booths displaying a variety of endeavors to foster inclusivity and enhance diversity within the university. Topics ranged from redacting practices in hiring to lactation needs on campus, and the audience teemed with everyone from deans to students.

Allen welcomes crowd
Brenda J. Allen, PhD, welcomes the large turnout for the first Chancellor’s Diversity Showcase on campus.

“I believe we exceeded our goals,” said Brenda J. Allen, PhD, vice chancellor for diversity and inclusion for both the CU Anschutz and CU Denver campuses. “Not only were there a lot of people packing both the interior and exterior of Krugman Hall, but the energy was so positive, and I saw so many different kinds of people interacting with one another.” Allen suspects the success will lead to an annual event.

Three aims, three checkmarks

Students at showcase
Many student organizations joined in the Diversity Showcase, including CU-SNPhA, an educational and service group that strives to improve health in underserved communities.

The goals of the event were three-fold. “One was to exhibit and celebrate the rich variety of programs, initiatives and projects that we are engaged in at the CU Anschutz Medical Campus to accomplish our diversity and inclusion goals,” Allen said.

All of the major schools and colleges at CU Anschutz were represented in the showcase, along with numerous organizations, from the Community-Campus Partnership to the Center for Women’s Health Research. Every category in the university’s framework for diversity was also embodied in some way, including race, ethnicity, gender, nationality, religion, ability, sexual orientation and veteran and socioeconomic status.

IN THEIR WORDS:

“It’s important to foster and develop empathy and sympathy for other people, because that’s what is going to make the world a more diverse and inclusive place.” – Amanda Beyer-Purvis, Anschutz Inclusivity Alliance

“We’ve gone from having about 20 percent diversity in our student population to 56 percent for this year’s entering class. And last year’s class was 63 percent women, which was a high for us. It’s just a very diverse class in the truest sense.” – Kenneth Durgans, School of Dental Medicine

“We do have a booth at recruitment where we advertise our resources for the LGBT community. We are also in the orientation materials, so we do let students know we are a safe place.” – Claire Gillette, PRISM Gay-Straight Alliance

“We are all about population health, so we have to be in the community eliminating population disparities and advancing equity. That’s what we are trying to do.” – Cerise Hunt, Colorado School of Public Health

“Another goal was to encourage interaction among the persons who are engaged in this work,” an aim seemingly met by the incessant buzz of voices among the 200-plus gatherers. “There were such a rich variety of the roles that represent our campus,” Allen said. “I was especially excited to see students interacting with each other in the section reserved for student groups that focus on diversity.”

Elliman at microphone
Chancellor Don Elliman takes part in an open-comment videotaping.

A third objective – to illuminate areas of possibility and encourage synergy and collaboration – was fueled by “idea walls,” which gathered a number of Post-its, and an opportunity to be videotaped, open to all participants for expressing experiences and thoughts surrounding diversity on campus. Both activities’ responses will become a part of a permanent webpage inspired by the event, Allen said.

A beginning, not an end

Looking out at the rows of booths lining the conference-room walls and stretching beyond the doors, Chancellor Don Elliman also indicated Allen’s team’s mission was accomplished. But it remains just a harbinger of what needs to come, he said.

“I had no idea that we would end up with what we have in front of us today: A graphic illustration of what we are trying to accomplish on this campus,” Elliman said. “I dearly wish that we didn’t have to have it. I wish that we were at a place today where people didn’t care what you looked like, what you thought, what your race or religion was,” he said.

Noting that he was inspired by the level of activity and the genuine enthusiasm in the room, Elliman said it was a great start. “But it’s by no means a finish line. I encourage you all to keep pushing.”

A push-start to more

Inclusivity booth
Participants have some fun at the Anschutz Inclusivity Alliance booth.

Much of the information shared by exhibitors and others will be posted on the new website, Allen said. “It will become one go-to place for people to have some sense of what’s going on at CU Anschutz in terms of diversity and inclusion.”

Many of the idea notes requested more training, particularly implicit bias programs, Allen said. And quite a few were centered on improved hiring and recruitment practices for diversifying faculty, student and staff populations. Allen, who said many people have asked her if she would organize a showcase again, assured that all suggestions would be taken seriously.

“It’s my mantra that we have to be systemic, strategic and sustainable in our efforts,” she said. “There is no magic pill or re-set button. It has to be something that really becomes part of who we are, embedded in our culture, and this type of event is a way to encourage and model that while also seeking guidance from those who care about these issues about what else we can do.”

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Study shows prenatal cannabis use associated with low birth weights

With marijuana use during pregnancy on the rise, a new study led by the Colorado School of Public Health shows that prenatal cannabis use was associated with a 50 percent increased likelihood of low birth weight, setting the stage for serious future health problems including infection and time spent in Neonatal Intensive Care Units.

Cannabis Sativa leaf
New study shows association between prenatal cannabis use and low birth weights.

“Our findings underscore the importance of screening for cannabis use during prenatal care and the need for provider counselling about the adverse health consequences of continued use during pregnancy,” said the study’s lead author Tessa Crume, PhD, MSPH, assistant professor of epidemiology at the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus.

The study was published last month in The Journal of Pediatrics.

Crume and her colleagues utilized survey data from 3,207 women who participated in the Colorado Pregnancy Risk Assessment Monitoring System in 2014 and 15. They found the prevalence of marijuana use in the state of Colorado was 5.7 percent during pregnancy and 5 percent among women who were breastfeeding.

Tessa Crume, assistant professor of epidemiology at the Colorado School of Public Health
Tessa Crume, PhD, MSPH, assistant professor of epidemiology at the Colorado School of Public Health

They also discovered that prenatal marijuana use was associated with a 50 percent increased chance of low birth weight regardless of tobacco use during pregnancy. Prenatal marijuana use was three to four times higher among women who were younger, less educated, received Medicaid or WIC, were white, unmarried and lived in poverty.

Crume said the numbers are surprising but also reflect changing attitudes toward marijuana, especially in a state like Colorado where it is legal.

“There is increased availability, increased potency and a vocal pro-cannabis advocacy movement that may be creating a perception that marijuana is safe to use during pregnancy,” Crume said.

The National Survey on Drug Use and Health suggests that cannabis use among pregnant women has increased as much as 62 percent between 2002 and 2014. At the same time, the potency of the drug has increased six or seven fold since the 1970s along with the ways it is consumed – eating, vaping, lotions etc.

“Growing evidence suggests prenatal cannabis exposure has a detrimental impact on offspring brain function starting in the toddler years, specifically issues related to attention deficit disorder,” Crume said. “But much of the research on the effects of prenatal cannabis on neonatal outcomes was based on marijuana exposures in the 1980s and 1990s which may not reflect the potency of today’s cannabis or the many ways it is used.”

The study found that 88.6 percent of women who used cannabis during pregnancy also breastfed. The risk of cannabis to the infant through breastmilk remains unknown. Various studies have found that cannabinoids are passed to the baby in this way. One of the study’s co-authors, Dr. Erica Wymore, MD, MPH, from Children’s Hospital Colorado and the CU School of Medicine, is currently conducting a study to evaluate this issue.

The researchers recommend that health care providers ask pregnant women about their cannabis use and advise them to stop during pregnancy and lactation.

“Obstetric providers should refrain from prescribing or recommending cannabis for medical purposes during preconception, pregnancy and lactation,” Crume said. “Guidance and messaging about this should be incorporated into prenatal care. And screening of pregnant women at risk for cannabis dependency should be linked to treatment options.”

The study co-authors include Ashley L. Juhl MSPH, of the Colorado Dept. of Public Health and Environment; Ashley Brooks-Russell, PhD, MPH, of the Colorado School of Public Health; Katelyn E. Hall, MPH, of the Colorado Dept. of Public Health and Environment; Erica Wymore, MD, MPH of the University of Colorado School of Medicine and Children’s Hospital Colorado and Laura M. Borgelt, PharmD, of the CU Skaggs School of Pharmacy and Pharmaceutical Sciences.

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Conversion to immersion: Medical campus poised as leader in bringing VR to health care

Editor’s note: This is the first in a periodic series of CU Anschutz Today articles focused on the potential of virtual reality technology in the medical setting. With its unique attributes, the University of Colorado Anschutz Medical Campus could lead the way in ensuring responsible and effective implementation of the gaming technology in health care. 

 

A nervous heart patient waiting for surgery suddenly finds herself immersed in an ocean of aqua blue. As she slowly treads the warm water, sparkling from the sun’s reflection, a pod of dolphins emerges, playfully swimming and circling her in the gently rolling sea. Her breathing slows. Her heart rate drops, as her meditative escape puts her in a better state for the surgery ahead.

Whether transporting anxious patients from hospital beds to sunny beaches, testing operating-room staff with explosive fires, or treating first-responders for post-traumatic stress disorder (PTSD), researchers on the University of Colorado Anschutz Medical Campus are launching pilot programs aimed at bringing virtual reality (VR) to the forefront of medicine.

Vogl and Greenleaf of CU Anschutz
Matt Vogl, NMHIC director, left, and Walter Greenleaf, a pioneer in virtual reality in medicine, take a break during a meeting at Facebook headquarters. The two aim to lead VR innovation in health care.

As interest in the medical uses of the gaming technology grows, with ideas bubbling up not just inside CU Anschutz’s walls but in most major medical centers across the country, some experts predict the uniquely-positioned Aurora campus could lead the way in ushering in a potentially transformative era that takes VR far beyond a teenage pastime.

“This new wave of technology is going to give us the tools to advance otherwise very difficult problems that we haven’t had a lot of success addressing,” said Walter Greenleaf, PhD, one of the most-noted experts in the field, who joined the CU Anschutz Medical Campus last April as director of technology strategy for the National Mental Health Innovation Center (NMHIC). “But we have a lot of work to do.”

Counselor trying VR
Laura McGladrey, NP, a specialist in psychiatry and emergency medicine, tries VR while discussing its potential in the field with NMHIC’s Rhonda Kelly.

‘More like the wild West’

A Stanford University visiting scholar, Greenleaf said CU Anschutz caught his eye because of its top experts, rigorous research, leading-edge innovation centers and ability to transfer its academic work directly to the clinical setting. Its attributes make the university the “right place to start” in advancing research while simultaneously diverting a path that could quickly lead in a dangerous direction, he said.

Although VR’s potential has been known for years, with Greenleaf pioneering the study of its medical uses in the early ‘80s, plummeting equipment prices spurred the recent rush to enter health care and other fields.

Hungry for ways to recoup billions of dollars spent in gaming development, companies are jumping in as technologists, game designers or computer scientists, Greenleaf said. “And they often don’t take the time or even know how to do a validation study,” he said. “I’m worried that there is some harm that could be done.”

In a “perfect world,” the hundreds of companies scrambling to be the “first to plant their flag” would slow down, work with the experts and make sure their products were truly effective and research-based, said Matt Vogl, MPH, executive director of the NMHIC. “But right now, it’s more like the wild West.”

‘Not a magic wand’

While VR programs for swimming with dolphins might be innocuous enough, targeting the public with platforms using war scenes from Afghanistan as exposure therapy for veterans or a virtual Paris nightclub to treat mass-shooting survivors would be dangerous, Greenleaf said. A rushed, poorly-designed program, combined with no expert supervision, could re-traumatize a person, he said.

Some questionable programs already exist, targeting the public online with phobia treatments, Vogl said. “It’s basically do-it-yourself-phobia therapy, and there is not a shred of data saying that you can do exposure therapy on yourself,” said Vogl, who founded the center because of the need for better and more accessible mental health care.

Finding that VR could fill the mental-health needs community members were expressing to his staff, Vogl and his center are working on pilot programs in area treatment centers, doctors’ offices, fire departments and more. “But it’s not a magic wand. It’s a tool,” Vogl said, adding that probably less than 30 percent of time spent in a VR session involves VR, with the rest focused on traditional therapy with a trained mental-health expert.

“The team at CU has been by far our best partner. (It has) been incredibly useful in introducing us to organizations that are interested in providing VR and giving us fantastic feedback.” – Limbix CEO Ben Lewis

‘By far our best partner’

By combining forces with the multiple innovation centers on the CU Anschutz Medical Campus and its two major hospitals, CU Anschutz staff hope to steer the implementation of VR technology for medical uses in a disciplined way.

Industry-based studies are always questionable, said Gali Baler, lead venture analyst for CU Innovations. “Here, we can really ensure that they are performed in a rigorous fashion and that they actually get outcomes and data that are meaningful both for the clinicians and the outside company,” Baler said. “With our partnerships with the hospitals, we can then test and deploy the technology in a clinical setting.”

With due diligence, CU’s innovation centers weed out companies that fail its standards. Vogl’s center, for instance, has partnered with Limbix, a Palo Alto, Calif., company focused solely on mental-health VR applications.

Limbix employs behavioral experts and works closely with CU Anschutz providers to study, fine-tune and implement platforms that target everything from fear of flying to PTSD, a chief cause of suicide in war veterans and first-responders.

“The team at CU has been by far our best partner,” said Limbix CEO Ben Lewis. “Matt and his team have been incredibly useful in introducing us to organizations that are interested in providing VR and giving us fantastic feedback,” Lewis said. Vogl’s NMHIC links reputable companies with professional providers, monitoring for and advising on effectiveness and keeping products out of laypersons’ hands.

“We need to show the right way to do it before the junk systems are developed, get headlines and cause problems. We need to stay ahead of the curve.” – Walter Greenleaf, PhD

‘We are not clinicians’

“Quality matters,” said Cole Sandau, president of the Optera Group in Westminster, which is working with CU Innovations in developing VR platforms for the hospitals on the CU Anschutz Medical Campus. Rushing to development will lead to failure, said Sandau, whose company focuses on health products and has worked with big industry names, such as Novartis and Mount Sinai Hospital.

Collaborating with providers at University of Colorado Hospital, Sandau’s company hopes to test a virtual training program that places OR staff members in a fire setting, which they must then extinguish while following set protocol. By eliminating the more dangerous and costly need of simulating an incident by lighting a “patient” on fire, the program can also make training more accessible and boost compliance.

“We just spent four months trying to figure out a set of hand controls that don’t cognitively overload the user,” said Sandau, who wants to create the standard for health care controllers for the industry. “You’ll drive everybody crazy if every VR app behaves differently,” he said, comparing the frustration to switching from a PC to a Mac.

Clunky, inconsistent products that fail realistic immersion of users in a 3-D virtual environment cannot effectively serve the medical community’s needs, Sandau said. And working side by side with medical providers is imperative for meeting objectives and being clinically accurate, he said. “We are very good developers, and we understand health care, but we are not clinicians.”

‘Only if it’s done right’

TO EXPERIENCE VR

Because experiencing virtual reality is the only way to truly understand its power, Matt Vogl, director of the National Mental Health Innovation Center, invites anyone who wants to dive into a virtual world to call his office and schedule an experience: 303-724-9955.

Many other applications are being investigated on campus and nearing pilot-program status, including using VR with Children’s Hospital Colorado patients pre- and post-procedure as a means of curbing anxiety and reducing pain medicine reliance during recovery. Also in conjunction with the pediatric hospital, Sandau’s company is developing an educational VR experience for parent caregivers.

Already powerful, VR will improve even more in the next two years or so and could change the face of health care, Greenleaf said. On the mental health side, the technology is poised to help victims of major health crises, such as opioid addiction, mass-shootings, national disasters and depression, Greenleaf said. In all medical areas, it can improve access and aid an overburdened system headed for trouble if issues aren’t addressed, he said.

“In my opinion, technology is the answer to addressing these issues,” he said. “But only if it’s done right. There is great potential and great concern. I’m glad we are the leaders. We need to show the right way to do it before the junk systems are developed, get headlines and cause problems. We need to stay ahead of the curve.”

 

 

 

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CU Anschutz stem-cell scientists awarded $3.8 million DOD grant

Scientists from the Gates Center for Regenerative Medicine at the University of Colorado School of Medicine are part of a consortium awarded $3.8 million from the U.S. Department of Defense (DOD) to move discoveries in stem cell-created skin grafts into the manufacturing stage, bringing further hope to victims of debilitating inherited skin diseases.

The major grant for the Epidermolysis Bullosa (EB) iPS Cell Consortium, which includes research teams from the University of Colorado Anschutz Medical Campus, Stanford University School of Medicine and Columbia University Medical Center, will move production of stem cells into the Gates Biomanufacturing Facility at CU Anschutz.

The $3.8 million grant follows recent awards for the same investigators by the 21st Century Cures Act and the California Institute of Regenerative Medicine, boosting research that could not only benefit EB sufferers, but also countless patients with severe chronic skin wounds.

In February, CU Anschutz’s EB researchers reported a more efficient approach to reprogramming a patient’s diseased skin cells into stem cells, raising hopes for future clinical trials and potential cures. The results were published in Nature Communications.

‘Cutting-edge science’

In announcing the new grant, DOD reviewers issued one of the most emphatic research endorsements possible, saying, “This study is based on the strongest cutting-edge scientific rationale in the field of wound care and dermatology. It is also a collaborative effort among top physician-scientists, scientists, health care providers, epidermolysis bullosa patients, families, and charities across the United States.”

One evaluator wrote: “The proposed research has the highest probability of success of bringing gene-corrected tissue to patients in the hospital  . . .”

The DOD award will allow the EB research team to further investigate best manufacturing practices for larger-scale production of stem cell-created skin grafts, utilizing the best-in-class resources of the Gates Biomanufacturing Facility on the CU Anschutz Medical Campus.

Seeking a permanent cure

The goal now is to move the technology from the laboratory into clinical trials. Gates Center Director Dennis Roop, PhD, is a lead researcher on the team making great progress on promising new corrective stem cell-based therapies for currently incurable diseases, such as Epidermolysis Bullosa (EB).

Research team at Gates Center for Regenerative Medicine
The research team includes, from left, Igor Kogut, PhD, Ganna Bilousova, PhD, and Dennis Roop, PhD.

Roop has had a long-standing interest in finding a permanent cure for EB, a group of inherited skin diseases that results in severe blistering and scarring. EB affects thousands of people across the United States and worldwide, and is characterized by chronic skin wounds similar in property to thermal burns, and indistinguishable from burns induced by chemical agents such as mustard gas. Many children afflicted with recessive dystrophic EB, one of the most painful and disfiguring forms of the condition, do not survive their teens after lives compromised by chronic, debilitating pain.

The consortium is funded by the U.S.-based EB Research Partnership (EBRP), EB Medical Research Foundation (EBMRF) and the Sohana Research Fund from Great Britain.

“We are very excited to receive such a strong endorsement from the U.S. Department of Defense,” said Ganna Bilousova, PhD, assistant professor of Dermatology at the CU School of Medicine and member of the EB Consortium. “It is extremely difficult to advance any type of novel therapies into the clinic without the benefit of compelling government interest and support.”

Guest contributor: Michael Booth wrote this story.

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Annual Department of Medicine Research Day 2018

Battling breast cancer, hepatitis C and the nationwide opioid-addiction crisis were just three of the research goals highlighted as part of the Department of Medicine’s sixth annual Research Day on the University of Colorado Anschutz Medical Campus.

Gathered in the Fulginiti Pavilion on April 6, the department within the CU School of Medicine recognized 22 students, faculty and staff for their outstanding research achievements as part of the event. Focused on showcasing the diverse accomplishments at CU Anschutz, the event encourages discussion and collaboration across the the Department of Medicine’s multiple disciplines.

This year, a diverse panel of faculty judges selected 22 outstanding abstracts – all submitted by Department of Medicine students, postdocs, fellows and junior faculty. The researchers were then invited to present their projects at Research Day, said Jennifer Kemp, director of the Department of Medicine Research Office.

“The Research Day poster session presents a unique opportunity for our researchers to present their latest work to a broader audience than is typically found at a more specialized conference,” Kemp said. “This broad audience brings the potential to spark new ideas and catalyze new collaborators in different fields.”

Cancer biology

Lynsey Crump shares her research in cancer biology.

Lyndsey Crump, a third-year student in the Cancer Biology

program in the Graduate School, works in Traci Lyons’s lab. Crump has been exploring how signaling proteins can affect breast cancer progression. Specifically, she has looked at SEMA7A (Semaphorin 7A) and how its presence may indicate a worse prognosis.

“I want to try to help people,” Crump said of her passion in cancer biology. “One day I want to see this lab work to translate to clinical work, to give patients another potential course of treatment.”

Hepatitis C and public health

Andy Bryant, MD, studies hepatitis C in special populations.

Andy Bryant, MD, is an internal medicine resident at CU Anschutz studying the treatment of hepatitis C in a “safety net” population, or those who are either uninsured or have Medicare or Medicaid.

“Until this study, this population was overlooked,” said Bryant as he walked onlookers through his research. “Unfortunately, these people usually come in a lot sicker than those with traditional insurance. This means that their prognosis isn’t very good.”

Recent studies have helped underscore the potential for a new drug (DAA) that can cure hepatitis C. Originally, Medicaid and Medicare did not cover this drug, but Bryant’s findings help show the long-term potential savings of administering DAA.

Opioid prescribing habits

Angela Keniston, MSPH, an instructor in the department of hospital medicine, studies the prescribing habits of health care providers across the world.

Angela Keniston researches cultural opioid prescribing habits.

“Specifically, we wondered, do doctors in the United States prescribe opioids more?” Keniston said. “The answer, one we’ve all suspected, was yes.”

 

In conjunction with her study, Keniston also looked into cross-cultural patients’ perceptions of pain across cultures.

In the long run, Keniston would like to help doctors understand their patients’ expectations of pain, and ultimately change prescribing habits. “Pain is a normal experience,” she said. “We need our providers to shape the conversation with patients to help curb this prescribing epidemic in our country.”

 

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New law updates language related to dementia

Based on the growing number of Coloradans living with dementia, a new law updates and broadens the language used in state statutes and gives this population the same legal status as people living with mental illness or with developmental and intellectual disabilities.

Colorado is the first state to change this language in its laws across the board. A total of 267,000 residents have some form of dementia, and that number is growing.

Huntington Potter with Gov. Hickenlooper
Gov. John Hickenlooper with Huntington Potter, director of the Rocky Mountain Alzheimer’s Disease Center.

Gov. John Hickenlooper, in signing the legislation, singled out Colorado as the first state to change its definition to include all of the diseases associated with the word “dementia.” He called the measure “forward thinking.”

Old statutes that will be changed used words such as “senile” and “senility,” or they mentioned only Alzheimer’s disease instead of referring to any or all neurodegenerative diseases. The new language reads “for persons with dementia diseases and related disabilities.” The word changes will be added to the state’s missing persons alert system.

The new law impacts the Rocky Mountain Alzheimer’s Disease Center (RMADC), which is part of the Department of Neurology in the University of Colorado School of Medicine. For official university purposes, the center will be renamed the Dementia Diseases and Related Disabilities Treatment and Research Center. As far as the public nomenclature, the center will remain the Rocky Mountain Alzheimer’s Disease Center.

“We’re not changing the public name of the center because Alzheimer’s is the disease most commonly thought of when it comes to dementia,” said Huntington Potter, PhD, RMADC director. “But this is an important behind-the-scenes change because it makes the law supporting us more accurate. We’re focused on treatment, clinical care and research for all of these diseases.”

The center will wear its new name in the state laws that help fund it. RMADC receives money from the state of Colorado for research into the causes of and treatments for a host of neurodegenerative diseases, namely Alzheimer’s disease, mixed dementia, Lewy Body dementia, vascular dementia, frontotemporal dementia and other forms of dementia.

“The new law recognizes the expansion of our mission to include all dementing diseases and related disabilities,” said Potter.

In response to the new law, RMADC Clinical Director Jonathan Woodcock, MD, said, “Our clinic, the Memory Disorders Clinic, treats patients with all forms of dementia. This change helps bring the public understanding of dementia more in line with the medical science associated with it.”

Rep. Susan Beckman (R-Littleton), the bill’s sponsor, said the measure takes away ambiguity in the law about people with dementia and brings them into the same reference points as others with disabling conditions.

Guest contributor: Helen Gray of the Rocky Mountain Alzheimer’s Disease Center. 

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Provost announces 2018 Faculty Excellence Awards

Dear colleagues,

Each year we honor one of the university’s greatest assets—our remarkable faculty—with the faculty awards. These accolades recognize superior accomplishments in teaching, leadership and service, research and creative activities, librarianship, faculty mentoring, and practices related to non-tenure-track faculty.

The awards are special not just because they acknowledge outstanding performance in our core areas as a university, but also because they are recognition by faculty peers of this exemplary work. Recipients are chosen by selection committees comprising previous award winners.

In addition to the faculty excellence award winners listed below, we recognize Professor of Emergency Medicine Benjamin Honigman, winner of the 2018 Joseph Addison Sewall Award for exceptional contributions of leadership and vision to CU Anschutz.

CU Anschutz faculty award winners will be recognized at the May 25 commencement, and CU Denver winners at a luncheon on October 5.

Please join me in congratulating the 2018 faculty honorees.

Sincerely,

Roderick Nairn
Provost and Executive Vice Chancellor for Academic and Student Affairs

2018 Faculty Award Winners 

CU Anschutz Medical Campus

President’s Excellence in Teaching Award
Patrick Judson Blatchford, Colorado School of Public Health (Biostatistics and Informatics)
James DeLapp, School of Dental Medicine (Restorative Dentistry)
Scott Mueller, Skaggs School of Pharmacy and Pharmaceutical Sciences (Clinical Pharmacy)
Tammy Spencer, College of Nursing
Kristina Tocce, School of Medicine (Obstetrics and Gynecology)

Chancellor’s Teaching Recognition Award
Daniel Bessesen, School of Medicine (Medicine)
Marcia Gilbert, College of Nursing
Jennifer Kiser, Graduate School (Skaggs School of Pharmacy and Pharmaceutical)
Ty Kiser, Skaggs School of Pharmacy and Pharmaceutical Sciences (Clinical Pharmacy)
Glenn Patterson, Colorado School of Public Health
Ethelyn Thomason, School of Dental Medicine (Restorative Dentistry)

CU Denver
Campus award winners are denoted with an asterisk. 

Excellence in Leadership and Service
Barbara Ambach, College of Architecture and Planning (Architecture, Planning, and Design)
Jeffrey Beall, Auraria Library
Sasha Breger Bush, College of Liberal Arts and Sciences (Political Science)
Caroline Clevenger, College of Engineering and Applied Sciences (Civil Engineering)
Mary Guy, School of Public Affairs
Kristin Kilbourn, College of Liberal Arts and Sciences (Psychology)
Gary Olson*, College of Liberal Arts and Sciences (Mathematical and Statistical Sciences)
Lori Ryan, School of Education and Human Development

Excellence in Teaching
Professor/Associate Professor/Assistant Professor
Stacey Bosick, College of Liberal Arts and Sciences (Sociology)
Storm Gloor*, College of Arts and Media (Music and Entertainment Industry Studies)
Jamie Hodgkins, College of Liberal Arts and Sciences (Anthropology)
Tim Lei, College of Engineering and Applied Sciences (Electrical Engineering)
Joanna Luloff, College of Liberal Arts and Sciences (English)
Onook Oh, Business School
Andrew Rumbach, College of Architecture and Planning (Urban and Regional Planning)
Elizabeth Steed, School of Education and Human Development
Chris Weible, School of Public Affairs

Senior Instructor/Instructor/Lecturer
Laurel Beck, College of Liberal Arts and Sciences (Integrative Biology)
Chris Daniels, College of Arts and Media (Music and Entertainment Industry Studies)
Bassem Hassan*, College of Liberal Arts and Sciences (Political Science)
Antwan Jefferson, School of Education and Human Development
RaKissa Manzanares, College of Liberal Arts and Sciences (Mathematical and Statistical Sciences)
Pamela Medina, School of Public Affairs
David Ruderman, Business School
Matthew Shea, College of Architecture and Planning (Architecture, Planning, and Design)

Excellence in Research and Creative Activities
Hamilton Bean, College of Liberal Arts and Sciences (Communication)
Nicole Beer, College of Liberal Arts and Sciences (English)
Sommer Browning, Auraria Library
Catalin Grigoras, College of Arts and Media (Music and Entertainment Industry Studies)
Bryn Harris, School of Education and Human Development
Tanya Heikkila, School of Public Affairs
Yail Jimmy Kim*, College of Engineering and Applied Science (Civil Engineering)
Jeremy Nemeth, College of Architecture and Planning (Urban and Regional Planning)
Traci Sitzman, Business School
Michael Wunder, College of Liberal Arts and Sciences (Integrative Biology)

Excellence in Faculty Mentoring
(Selected by the Center for Faculty Development)
Dawn Gregg, Business School

Excellence in Librarianship
(Selected by the Library Faculty Personnel Committee)
Katy DiVittorio, Auraria Library

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Vascular problems associated with symptoms of menopause and quality of life measures

A new study shows that more frequent and severe menopausal symptoms such as hot flashes, sleep disturbance, loss of sexual interest, weight gain and other quality of life measures, were associated with markers of vascular aging, according to researchers at the University of Colorado Anschutz Medical Campus.

The researchers, however, found no association between these vascular markers and symptoms of depression. The study was published online today in Menopause, the Journal of the North American Menopause Society.

Kerry Hildreth, MD
Dr. Kerry Hildreth, MD, assistant professor in the Division of Geriatric Medicine, CU School of Medicine.

“The menopausal transition is a vulnerable time for women in terms of vascular health,” said the study’s lead author Kerry Hildreth, MD, assistant professor in the Division of Geriatric Medicine at the University of Colorado School of Medicine. “Many women also experience menopausal symptoms that can negatively affect their quality of life and can contribute to depression, which is an established risk factor for cardiovascular disease. We investigated whether these symptom and mood aspects of menopause were associated with markers of vascular aging.”

Hildreth and her colleagues studied 138 healthy women grouped according to the stage of menopause. They found that arteries were stiffer, and the endothelium, the layer of cells that line the blood vessels, was progressively less healthy across the stages of menopause. Menopausal symptoms and depression symptoms were greatest, and quality of life was lowest, in the late-perimenopausal and early postmenopausal stages. Importantly, more severe menopausal symptoms and lower quality of life were associated with worse vascular function.

Unique study

“To our knowledge this was the first study to examine the association of mood, menopausal symptoms, and quality of life measures with these key markers of vascular aging in a well-characterized population of women spanning the stages of menopausal transition,” the study said.

Dr. Kerrie Moreau, PhD, associate professor
Dr. Kerrie Moreau, PhD, associate professor in the Division of Geriatric Medicine, CU School of Medicine

Women entering menopause experience profound hormonal changes coinciding with adverse changes in cardiovascular disease risk factors like high blood pressure, weight gain and insulin resistance, the study said. This may help explain the acceleration of vascular aging during the menopause transition.

Although the majority of women do not experience depression during the menopause transition, the risk is two to three times higher than in premenopausal women. One hypothesis is that the brain has to adapt to the irregular fluctuations in estrogen, a potent neurosteroid, during perimenopause, and eventually to a new, lower baseline level after menopause. This may explain why depressive symptoms returned to lower levels in the late postmenopausal women.

But while the researchers did not find an association between depression and vascular dysfunction across the stages of menopause, they did find an association with common menopausal symptoms. These include vasomotor symptoms, such as hot flashes, palpitations and headaches, and general symptoms, such as sleeplessness, poor appetite, constipation, weight gain, and poor concentration.

Estrogen loss could play role

The reasons behind these changes are unclear but loss of estrogen could play a key role.

“Estrogen modulates the synthesis and uptake of serotonin which has neuromodulatory, thermoregulatory, and cardiovascular actions,” the study said. “Fluctuating and declining levels of estrogen with the menopausal transition may alter serotonin activity.”

Another culprit could be oxidative stress. Estrogen is a potent anti-oxidant and higher levels of oxidative stress are seen in estrogen-deficient, post-menopausal women compared to premenopausal women, according to the study. Hot flashes are also associated with higher oxidative stress.

Hildreth said the next step is studying the mechanisms underlying these associations between vascular aging and symptoms of menopause.

“A better understanding of these aspects of the menopausal transition will be important for developing effective lifestyle and therapeutic interventions to promote psychosocial well-being and cardiovascular health in women,” Hildreth said.

The other authors of the study include Kerrie Moreau, Ph.D.*, University of Colorado School of Medicine; Cemal Ozemek, Ph.D., University of Illinois at Chicago; Wendy Kohrt, Ph.D.*, University of Colorado School of Medicine, Associate Director of the Center for Women’s Health Research; Patrick Blatchford, Ph.D.*, Colorado School of Public Health.
*Also affiliated with the Eastern Colorado VA Geriatric Research, Education and Clinical Center

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