The CU Anschutz Spring 2018 Commencement was held May 25 at Boettcher Commons. Additional school and college graduation ceremonies took place across campus. Graduates from a wide range of health care disciplines received their degrees and celebrated their achievements with friends and family.
Congratulations to all graduates! Scroll down to see images and messages from the day.
The battle between good and evil is a theme usually reserved for blockbuster movies or literature. However, biomedical researcher Donald Leung, MD, PhD, is engaged in his own epic battle, pitting good bacteria against bad in order to treat atopic dermatitis or eczema – the world’s most common skin disease.
“The beneficial bacteria actually make natural antibiotics that kill staph aureus, the bad bacteria on the skin,” says Leung, medical director of the Clinical and Translational Research Center of the Colorado Clinical and Translational Sciences Institute (CCTSI) and head of the Division of Pediatric Allergy & Immunology at National Jewish Health. “We know that eczema patients don’t have the good bacteria on their skin that’s needed to kill staph aureus. Our research has also shown that their skin immune system is also ineffective at eradicating staph aureus, so there is a double whammy plaguing these patients.”
Leung has been studying – and treating – atopic dermatitis for 30 years. Twenty percent of children and 10 percent of adults have it. And without effective treatment options, patients may suffer a lifetime of painful, itchy and often infected skin. The majority of these patients develop a problem with staph infections and receive treatment with antibiotics. As a result, many patients develop antibiotic resistant bacteria on their skin, which can be very dangerous.
‘Probiotic for the skin’
“Think of the good bacteria sort of like a probiotic for the skin,” says Leung. It may seem counterintuitive to apply bacteria to skin that is frequently plagued by bacterial infections, but the hope is that by applying good bacteria in a cream to eczema patients’ skin, a healthy bacterial balance will be restored.
Researchers hope that using the microbiome cream will offer a long-term solution where other treatments fall short. Powerful antibiotics are commonly prescribed for eczema, but they kill good bacteria on patients’ skin along with the bad. Creams containing corticosteroids are also often prescribed to eczema patients, but they come with harsh side effects, and patients usually can’t tolerate using them for long periods of time.
Eliminating bad bacteria
In a study that is being led by Leung and Richard Gallo, MD, PhD, of University of California San Diego, patients apply the bacteria-infused cream twice a day. Researchers are then able to analyze patients’ skin DNA to see if the bad bacteria have been reduced. The goal is to eliminate the bad bacteria on the skin altogether. The cream helps to restore the natural balance of bacteria on the skin, which will help improve the skin barrier required to keep harmful bacteria out.
Leung says in addition to strengthening the skin by using the good bacteria to restore a healthy microbiome, the study could also ultimately help people with antibiotic resistant staph infections such as MRSA who are running out of treatment options. For more information on how to participate in this study, or other eczema-related research at National Jewish Health, contact Sussmanj@njhealth.org.
Guest contributor: Wendy Meyer, director of communications and marketing, CCTSI.
The squad, Team CU Anschutz Fantastic Female Faculty, clocked the 26.2 miles, which started and finished in Denver’s City Park, traveling throughout the city and parts of Lakewood, in three hours, 34 minutes and 38 seconds to finish runner-up in the women’s corporate division.
For its strong overall finish in a field of 67 relay squads, Team CU Anschutz received $2,000 to designate to a charity. The team will donate its winnings to Children’s Hospital Colorado.
Members of Team CU Anschutz Fantastic Female Faculty are:
Emily Bates (team captain), PhD, Section of Developmental Biology, Department of Pediatrics, University of Colorado School of Medicine
Kristin Artinger, PhD, Department of Craniofacial Biology, University of Colorado School of Dental Medicine
Katherine Fantauzzo, PhD, Department of Craniofacial Biology, University of Colorado School of Dental Medicine
Lori Sussel, PhD, Barbara Davis Center, Department of Pediatrics, University of Colorado School of Medicine
Olivia S. Rissland, PhD, RNA Bioscience Initiative and Department of Biochemistry & Molecular Genetics, University of Colorado School of Medicine
Editor’s note: This is the third in a periodic series of 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.
Sitting in a soft, blue armchair in a quiet campus office, Nick Harrell slowly tensed. In his mind, the Denver librarian was standing on a busy airport curb near a line of passengers waiting their turn at a baggage check-in counter. The scene was enough to ignite his fear.
“Nick, what sensations are you feeling?” asked psychologist Sam Hubley, PhD, who had been monitoring Harrell’s virtual airport visit from an identical chair arms-length away.
“My chest feels warm, and my throat feels tight,” said Harrell, his eyes covered by a boxy, maroon headset. Without hesitation, Hubley begins guiding his patient through relaxation exercises, helping him confront his fear of flying while averting a full-blown panic attack.
The technique, called exposure therapy (ET), is not new. Experts have considered it the gold standard of treatment for an array of anxiety-related disorders for years. But Hubley and his colleagues on the University of Colorado Anschutz Medical Campus hope that by adding virtual reality (VR), they can make an effective therapy better.
“There are some major logistical issues with exposure therapy,” said Hubley, who works with the National Mental Health Innovation Center on campus testing virtual reality in a therapy setting. “And that’s putting it lightly.”
Hubley, who uses VR-assisted exposure therapy (VRET) at the University Family Medicine Practice in Boulder and at the Helen and Arthur E. Johnson Depression Center on the CU Anschutz Medical Campus, said the gaming technology could help overcome many obstacles that prevent some people from getting the mental health care they need.
With ET, therapists begin by gradually exposing patients to places or things that trigger their fears while teaching them coping skills, eventually reaching the grand finale, whether it’s a scene of a deadly car accident for a traumatized survivor, a beer-flowing pub for an alcoholic or a bumpy airplane flight for a phobia patient.
“The center has been phenomenal in introducing us to mental health clinics and helping us put together a really good list of problems that we can help solve with virtual reality.” – Ben Lewis, Limbix Inc., co-founder
The NMHIC has launched pilot studies in 13 area mental health clinics so far, a number Executive Director Matt Vogl, MPH, said will continue to grow. Using cellphone VR technology with a platform created by Limbix, Inc., a Palo Alto, Calif., company focused solely on mental health issues, these therapists can now transplant their patients into numerous scenarios straight from their office chairs.
Feeling virtually real
Limbix applies panoramic pictures and videos of real places for an immersive, life-like experience. As an example, Vogl explained how Limbix employees mounted a 360-degree VR camera on the roof of a car and traveled to San Francisco, driving over the Golden Gate Bridge, inside heavy highway traffic, and through hill country at night, all common driving phobia triggers.
VR can induce the same feelings and physiological reactions as the real thing, Vogl said. For example, a colleague of his created a virtual crack house and did CT scans on the patients in the environment that showed they were experiencing real cravings, he said.
Limbix was chosen as a NMHIC partner because of its emphasis on evidence-based therapies. The company shares its equipment and programs with researchers and qualified therapists only. “This is a tool designed to enhance therapy and make it more efficient and easier to access,” said Ben Lewis, Limbix co-founder. “It is not designed to replace therapists.”
Lewis said the NMHIC stands out as a leader in implementing the innovative technology in mental health care and beyond. “The center has been phenomenal in introducing us to mental health clinics and helping us put together a really good list of problems that we can help solve with virtual reality.” The company has at least 15 different exposure-therapy programs and anticipates substantial growth, Lewis said.
After completing seven VRET sessions, Harrell said his virtual trips to airports, including San Francisco and Denver International airports, felt real enough, one time coming close to inciting a full panic attack in the office. But he said the time-savings of VRET was the most attractive aspect.
Easing the load
“It feels less like homework,” said Harrell, one of the more than 75 million Americans who will experience some form of anxiety-related disorder in their lifetimes. Harrell, a former CU Boulder librarian, suffered a highly unexpected mid-flight panic attack about six years ago.
With a mother in the Air Force, Harrell grew up flying. “Getting on a plane was like hopping in a car,” he said, adding that he’d continued to fly for work and for pleasure as an adult, logging 40,000-plus air miles before the life-changing event.
A thwarted trip to Paris with his wife and some long train rides later, Harrell sought professional help, which gradually got him back on a plane. But it took intense dedication on his part.
“It’s really, really hard work,” Hubley said of exposure therapy. About 75 percent of people who complete exposure therapy get well and stay well, Hubley said. “But a lot of people drop out.”
Working with Hubley on his flying phobia before VR was introduced, Harrell would spend two-plus hours periodically busing to DIA for exposure work and practicing calming techniques. “It was really time-consuming,” Harrell said of the exercises he did alone in addition to his office sessions with Hubley.
Meeting a need
In an already strapped mental health care system, doing that type of exposure with patients is just not feasible, Vogl said. “I had a woman with a fear of flying call me shortly after we started doing VR saying: I can’t find a therapist in the state who will do exposure therapy with me,” he said.
But with VR, therapists can walk patients through the whole exposure process virtually, from buying a plane ticket, to packing the bags, to standing in the security line. Thanks to Limbix’s fear-of-flying program that includes some DIA-specific environments, Hubley has even “stood by” Harrell, as he confronted a terminal gate that reminded him of his last full panic attack.
“The more you can really let your brain experience those triggers, stick with the exposure, and reframe the negative thinking that so often goes along with anxiety, the more confidence we have about long-term protections against future relapse,” Hubley said, adding that expert guidance is critical.
“Without the right doses of exposure, re-traumatization can occur, potentially sabotaging a patient’s chance of recovery. And there’s a fine line,” he said, adding that the gaming technology makes managing the intensity level of exposures easier.
Finding the help
Harrell, who was prepping for a June plane trip with his wife with his recent sessions, said he believes there has been some improvements with the VR therapy.
“Two years ago, an exposure session at DIA would get me pretty amped up. Last time I went, I couldn’t get worked up. And the terminal VR exercises don’t bring up the same reactions and memories that they used to,” he said.
Whether using VR-assisted or traditional exposure therapy, people should seek care rather than missing out on life, Harrell said. “It might not always be pleasant, but it’s worth it,” he said. “I can say with pretty high confidence that I’m going on this next flight, whereas two years ago, I’d book a flight and say: We’ll see.”
Growing up with a pharmacist for a grandfather, Megan Wary always knew she wanted to work in the medical field. So, after earning her undergraduate degree at the University of Arkansas, she had a crucial decision to make: Where would she call home for the next four years and continue her education?
Today, Wary will join her fellow graduates in the 2018 Spring Commencement Ceremonies. Looking back, she said she’s glad she chose the top-ranked veteran-friendly university and the outdoor-oriented state, both of which helped shape Wary’s future.
Ticket to outdoor paradise
“I knew I was ready to move out of Arkansas,” Wary said. “I wanted to be able to hike and snowboard, to spend time in the sunshine.
There’s no better place.”
In between studying for her challenging courses, Wary enjoyed all that Colorado has to offer, especially hiking fourteeners and snowboarding Peak 6 at Breckenridge.
“There is such a special vibe about Coloradans,” she said of meeting new friends. “Everyone that moves here has something in common, whether it be hitting the trails or the slopes.”
While taking full advantage of Colorado’s outdoor sports and recreation two years ago, Wary slipped during a kickball match and tore her ACL.
She didn’t let her serious injury hold her back. One year after the tear, Wary participated in a “Tough Mudder,” a grueling race that involved trudging through thick mud while tackling a challenging obstacle course.
“This was something that I was really proud of,” she said. “If soldiers can recover from traumatic injuries and live their everyday lives, then I can heal from this ACL injury and finish this race.”
The symbolic victory highlights Wary’s passion for working with veterans.
Service through pharmacy
“It has always been a sweet spot for me,” she said. “I have a lot of family members in different military branches. I just really love working with that population. I know that I want to be with these people and serve them as they have served us.”
Faced with leaving Colorado, she will miss the great outdoors and the people she’s met along her journey, said Wary, who intends to complete a pharmacy residency with the Veterans Administration, her top choice.
“It’s going to be tough to leave this wonderful place,” she said. “But, I know that my education and training will help me achieve my goals in the years to come,” said Wary, who advises incoming pharmacy students to keep their studies first. “But, enjoy Colorado. Denver and the surrounding areas have so much to offer. Keep the faith. You will make it.”
Researchers at Children’s Hospital Colorado (Children’s Colorado) and the University of Colorado School of Medicine have found that taking a specially formulated antioxidant-enriched multivitamin may decrease respiratory illnesses in people with cystic fibrosis (CF).
The study, which was recently published online in the American Journal of Respiratory and Critical Care Medicine, looked at the effects of a ‘cocktail’ of multiple antioxidants on inflammation and health outcomes in patients with CF. Inflammation is an important contributor to lung damage in CF, and contributes to progressive lung function decline.
The 16-week study consisted of 73 pancreatic-insufficient CF patients ages 10 years and older (average age 22 years). These patients ordinarily do not adequately absorb important dietary antioxidants including carotenoids such as beta(β)-carotene, tocopherols (vitamin E), coenzyme Q10 (CoQ10), and selenium that help to neutralize inflammation in the body. To address this issue, the antioxidants used in the study were delivered in a capsule specifically designed for individuals with difficulties absorbing fats and proteins, including those with CF.
Antioxidant supplementation was safe and well-tolerated. Supplemental antioxidants increased antioxidant concentrations in the bloodstream in treated subjects and temporarily reduced inflammation in the blood at four weeks but not 16 weeks. Importantly, antioxidant treatment appeared to both prolong the time to the first respiratory illness requiring antibiotics and reduce the frequency of respiratory illnesses they experienced.
Specifically, half as many of the patients taking the supplemental antioxidants experienced a pulmonary exacerbation (or respiratory illness) requiring antibiotics compared to the group taking the control multivitamin without added antioxidants at 16 weeks. In addition, the antioxidant treated group experienced a lower frequency of respiratory illnesses compared to the control group.
“Single oral antioxidant formulations have been previously tested in CF with mixed results. However, there had not been a well-designed, randomized controlled trial of an antioxidant ‘cocktail’ that included multiple antioxidants in a single formulation,” said Scott D. Sagel, MD, PhD, pediatric pulmonologist at Children’s Colorado and professor of pediatrics at the University of Colorado School of Medicine. “While more research certainly needs to be done to find a treatment that delivers a sustained anti-inflammatory effect, we believe the fact that this antioxidant supplement prolonged the time patients had before their first illness is meaningful. It offers a simple, relatively inexpensive means for restoring and maintaining normal antioxidant levels in people who would otherwise have trouble doing so.”
This clinical trial, funded by a grant from the Cystic Fibrosis Foundation, was designed and led by Dr. Sagel. It was conducted from September 2013 to October 2015 at 15 CF centers across the U.S. affiliated with the CF Foundation Therapeutics Development Network.
Guest contributors: Mark Couch, CU School of Medicine, and Hollon Kohtz, Children’s Hospital Colorado.
Karim C. El Kasmi, MD, PhD, assistant professor of pediatrics, and Ronald Sokol, MD, professor of pediatrics, both of the CU School of Medicine, are authors of an article in the April 2018 Nature Communications that sheds light on the underlying cause of intestinal failure-associated liver disease and suggests new therapeutic approaches.
Intestinal failure is a condition that occurs when a person’s intestines are injured, damaged, or surgically shortened resulting in the need for the person to receive daily intravenous (IV) nutrition to sustain health. This IV nutrition, called parenteral nutrition, can be given in the hospital or at home through semi-permanent IV catheters.
Side effects of this form of nutrition are jaundice, liver injury called cholestasis, and eventually scarring in the liver. Intestinal failure-associated liver disease could eventually become so severe that the person would need a liver transplant or a combined liver and intestinal transplant to survive.
Until recently, there has been no effective therapy because of a poor understanding of how intestinal failure related to the development of the liver disease. Over the past decade, investigators have learned that reducing or changing the IV lipids can have a beneficial effect on some, but not all, patients.
Drs. El Kasmi and Sokol developed a mouse model that mimics the situation in humans with intestinal failure who depend on IV nutrition. Mice with intestinal injury that are given PN through a central venous catheter for 7 to 28 days develop decreased liver function, called cholestasis, and liver injury.
The researchers were able to show that products from bacteria in the intestine of the mice, called lipopolysaccharides (LPS), are absorbed through the injured intestine and activate the immune system in the liver to produce a cytokine, IL-1 beta, leading to cholestasis. The combination of IV lipids and intestinal injury lead to the intestinal failure-associated disease.
With this understanding, the researchers identified three possible new targets for drug intervention to prevent or treat intestinal failure-associated disease. Several drugs that target these disease-causing pathways are already approved or in development. Further testing in clinical trials with affected patients is required, but this research opens the possibility of treating patients who need long-term IV nutrition without the worry of developing serious liver damage.
Guest contributor: Mark Couch, CU School of Medicine.
Lee Amaya, stage name SouLeePharmD, is our very own rapping pharmacist.
Amaya fell in love with rap music and poetry during high school. “I became infatuated with the flow and rhyme schemes of songs while listening to my favorite artists. The raw passion displayed and the topics they rapped about resonated with me,” says Amaya.
Inspired, he began writing and producing his own rap music that he shared over the Internet. “Rap provided me with an outlet to voice my grief and frustrations with the world. Being a science nerd, this allowed me to express a side of me that I rarely revealed.”
One of his first live performances was in front of his entire high school. “No pressure there!” says Amaya.
The performance was part of a Senior Project that was required to graduate from the Skaggs School of Pharmacy and Pharmaceutical Sciences. Consisting of an internship, mentorship, faculty-run seminar or independent project of the student’s design, the project is quite the undertaking. Instead of the usual fare, Amaya asked if he could compose a rap album and the school agreed — of course with the oversight of his honors English teacher. Most would choose creating and producing one song in five weeks, but Amaya chose an album! Then, he selected one song to perform at a school-wide assembly. That project solidified his interest in the art form and he’s been writing, performing and producing ever since.
“Because my time was extremely limited during pharmacy school, I didn’t have a lot of time to be creative and write raps during the program,” says Amaya. He did, however, write and record one rap during his fourth year for a reflection project. The song, which highlights his experiences as a pharmacy student, is the basis for a music video that is currently in development at the school.
Future goals for Amaya include creating educational raps about pharmacy-related topics in a similar fashion to ZDoggMD, who raps about medical issues and conditions and releases them to the public through social media.
“I would love nothing more than to be able to combine my musical talents with my pharmacy knowledge by writing songs about various healthcare topics to educate those who learn in an auditory manner,” says Amaya.
In the meantime, Amaya has lined up a PGY-1 residency at Nebraska Medicine in Omaha, which is sure to consume a lot of his time. ”Once I’m finished with residency and have more free time on my hands, I will definitely try to become the rapping pharmacist!”
Reflections of a P-4
Let’s take a trip down memory lane
To recognize the school that left me better than I came
Now professionalism is steady flowing through the veins
And infected with wisdom to analyze gram stains
At the University of Colorado
Leadership in pharmacy has always been the motto
Faculty members have set examples we can follow
Phi Delta Chi Sigma Brothers yelling “bravo!”
Now looking back to first year
I get real sense of what I learned here
Communication skills, how to make the pills
And a genuine devotion to reshape the field
Through interprofessional education
Got to work with students of different healthcare occupations
Determining the plan of patient simulations
And giving way too many case presentations
And now I’m dosing Vanco
Pharmacokinetics is a pharmacy staple
Ensuring safety, and our patients are stable
Crash cart filled and the meds are labeled
We do more than count by fives
Always taking time saving patient lives
Looking over DDI’s
And the prodrugs that need to hydrolyze
We are the Skaggs School of Pharmacy
In the mile-high city where it’s hard to breathe
Whether asthma, infection, or heart disease
We stay monitoring meds in the chart with ease
In addition to creatinine clearance
Calling all our patients to verify their adherence
Giving education so that they can understand
That they’re taking Synthroid for their thyroid gland
And with so many doses
Always gotta remain focused
Learning pharmacotherapy from respected professors
Authors to guidelines every semester
They helped me become independent practitioner
When pharmacy training required analyzing literature
And working with a team to improve patient outcomes
In recognition of Inflammatory Bowel Disease (IBD) awareness month, students Diana Ir, Hailey Hyde and Jacqueline Garner in the Colorado School of Public Health created a public health awareness video about the disease. IBD, which includes Crohn’s disease and ulcerative colitis, currently affects about 1.6 million Americans.
Featuring Brett Forrest, a local reporter, and his personal experiences with IBD, the group hopes to shine a light on a stigmatized disease.
“Medications, surgery and lifestyle changes can have a life-changing effect for those who are suffering from IBD,” said Ir of the importance of spreading awareness. “Our message and goal is to encourage individuals to contact their physicians if they believe they may have IBD or symptoms of IBD. Through this video, we hope to reduce stigmas associated with the disease.”
Scattered newspapers, a dusty shoe print and a suspicious half-eaten peanut-butter-and-jelly sandwich greeted fifth-graders at Crawford Elementary School on May 10, but the mess wasn’t due to a lazy janitor. CU Anschutz Medical Campus students, postdocs and faculty planted the classic whodunit-like clues as part of a lesson plan aimed at engaging the youth in forensics science.
The event was organized by Young Hands in Science, a CU Anschutz-sponsored club dedicated to bringing science to Aurora community youth. Developed by postdocs a few years ago, the lesson plans range from health and chemistry to forensics and meteorology with the goal of attracting more students into STEM (science, technology, engineering and mathematics) professions.
For the Crawford fifth-graders, the case was split into three sections: examining a crime scene and practicing finger printing; preparing a wet slide with cheek cells; and looking under the microscope and extracting DNA from potential culprits.
“I can’t believe we get to extract our DNA,” one student said. “I thought we needed to use needles and draw blood.”
At the DNA extraction station, students followed a strict protocol to eliminate themselves as suspects. Using common household ingredients, including Dawn soap and Gatorade, the students extracted DNA from their cheek cells and placed them in tubes to bring home.
Students giggled, grimaced and expressed their disgust for their floating squiggles of DNA. Nevertheless, they seemed to have a lot of fun while learning foundational scientific principles.
“Wow,” said a student, as she squinted to examine her creation. “This is pretty cool.”
Young Hands in Science
The Young Hands in Science program immerses the university in the community, provides teaching experience for postdocs and graduate students, and offers an engaging learning experience for area youth.
“The idea was to help kids learn about science, but also to have the postdocs develop valuable communication skills,” said Farabi of her interest in the group. “I have always wanted to help get kids interested in science and make them realize it’s fun. I also believe that engagement with the community benefits everyone.”
“Working with children is amazing,” said Farabi. “They are so full of energy, and their enthusiasm is off the charts. I love how interested they are in learning. After each event, I leave with a renewed inspiration.”
Teachers interested in having Young Hands in Science come to their classrooms can email email@example.com.