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A cure for orphan disease homocystinuria?

Tomas Majtan and Jan Kraus

Born with a rare metabolic disease that increases his risk for stroke and other cardiovascular illness — and greatly limits what he can eat — Russell Maestas is excited about research at the University of Colorado Anschutz Medical Campus that has produced the first human clinical trial of a potential cure.

Russell Maestas
Russell Maestas is taking part in the first human clinical trial of a potential cure for homocystinuria. The genetic disorder increases his risk for stroke and other cardiovascular illness.

“If it’s a breakthrough, that’s absolutely fantastic,” said Maestas, a 25-year-old who, every month, drives four hours from San Luis to Children’s Hospital Colorado to participate in the clinical intervention. “Anything positive is always good.”

Historically, one-quarter of untreated homocystinuria patients died before the age of 30, but Maestas is one of the fortunate ones. His condition was discovered during newborn screening, and doctors told his parents to drastically limit his protein intake (along with nutrient supplementation, as advised by a metabolic nutritionist), one of the best-known methods of managing the illness.

Maestas shows no outward signs of the genetic disorder, which currently has no cure and can result in cognitive problems, dislocated lens, deformities of the skeleton and elevated risk for cardiovascular disease. Maestas, a social worker, has only the latter.

Decades in the making

He is one of the patients joining the national clinical trial that was developed in the Section of Genetics and Metabolism within the CU School of Medicine Department of Pediatrics. It is the product of decades of research by Jan Kraus, PhD, principal investigator of the Kraus Lab and Tomas Majtan, PhD, leading scientist on the project.

“I’ve been working on this disease for over 40 years,” Professor Kraus said. “With this therapy, we hope we can keep the homocysteine levels low, or at bay, so the end result is we can improve people’s health.”

Added Majtan, “It is our wish that the amazingly consistent and very encouraging results obtained from the pre-clinical testing using several mouse models of homocystinuria will be reproduced in the first-in-human clinical trial.”

Janet Thomas, MD, who has treated Maestas for many years, praises the work by the Kraus Lab, noting that it exemplifies the bench-to-bedside ethos of the CU Anschutz Medical Campus, where top-notch hospitals are located just a short walk from the research labs.

“It’s the first time we’ve been able to take what our researchers have done and move it to a clinical intervention,” Thomas said of the genetics section of the Department of Pediatrics. “It’s really cool, especially on this scale with industry involved and a national clinical protocol.”

CU has signed an exclusive licensing and collaboration agreements with Orphan Technologies, Ltd., a rare-disease and research-and-development firm, to develop the therapy.

Increasing prevalence

Recent research has estimated the prevalence of homocystinuria in the United States may be as high as 1 in 10,000 people, as symptoms of the disease can be mistaken for those of other disorders. This number is substantially higher than prior estimates of 1 in 100,000-200,000 in the United States and 1 in 200,000-335,000 worldwide. Rates are exceptionally high in the Middle East, especially in Qatar, where the incidence is approximately 1 in 1,000.

Tomas Majtan in lab
Tomas Majtan operates an instrument that measures sulphur metabolites in plasma.

“It occurs at higher rates in communities which are isolated. If there’s a mutation in the community, and the population is isolated, it gets propagated more often,” said Majtan, who came to CU as a postdoc in 2007.

“All the milestones related to homocystinuria have been achieved in the Kraus Lab,” Majtan said. “In Dr. Kraus, we have a world-class expert working on this disease.”

Before the enzyme therapy was developed by the Kraus Lab, leading to the current first-in-human interventional clinical trial, the lab found the “holy grail.” Five years ago, Kraus and Majtan, together with their collaborator Alfonso Martínez de la Cruz, PhD, discovered the crystallographic structures of the enzyme in basal and activated forms. The finding allowed the researchers to understand why and how mutations in the enzyme cause the disease.

Hopeful for ‘whatever the potential is’

Maestas is excited to take part in a trial that could, at long last, bring a cure to his lifelong disease. “I’m hopeful for whatever the potential is,” he said. “Even if it doesn’t work, at least we’ve closed one door and maybe it leads to another door to be opened.”

Calling himself a “stubborn and strong-willed patient,” Maestas has pushed to get to the point where his doctors would allow him to eat a hamburger. He still limits his protein intake, but Maestas occasionally enjoys a filet mignon or chicken breast. “Until three years ago, I would never have known what a steak tastes like, or how much I don’t like fish.”

The disease is caused by low levels of the enzyme cystathionine beta-synthase (CBS), which results in increased levels of both homocysteine and methionine, the latter being an amino acid found in nearly all foods.

NEWBORN SCREENING

There was a period of time, not long after Russell Maestas was born in 1993, when the state of Colorado stopped screening for homocystinuria at birth, mostly due to the inaccuracy of the testing and the fact that it missed cases. About 10 years ago, improvements to technology spurred the resumption of the tests as part of comprehensive newborn screening.

Unfortunately, newborn screening for homocystinuria is still not sensitive enough, and therefore many patients are still missed and only diagnosed later in life.

“When the enzyme replacement therapy successfully passes through the clinical trials – and we are optimistic this will occur – it will become even more relevant to identify patients and treat them with the available therapy as soon as possible,” said Tomas Majtan, PhD, a leading expert in the field of homocystinuria research. “Our experience with the animal models is that early continual treatment completely prevents even the most severe symptoms of the disease.”

By identifying the structural information of the enzyme, then learning exactly how the enzyme works, Kraus and Majtan were able to develop an enzyme replacement therapy. Kraus began studying homocystinuria as a postdoctoral fellow at Yale University. “Nothing was known about this disease at the time, so my advisor said, ‘Why don’t you work on homocystinuria and see if you can purify the enzyme,’” he said.

‘Critical unmet need’

Kraus discovered that the gene mutations exist on chromosome 21, and that the enzyme deficiency is chiefly caused by mutations in CBS. “Basically, there’s a critical unmet need for clinical options for these patients,” he said.

Maestas, the only member of his family to have homocystinuria, said he tended to worry more about the disease before his teenage years. “Around the time I was 10 or 12, it caused some anxiety when the doctors explained to me I could have these adverse effects if I didn’t take care of myself,” he said.

He’s felt less apprehensive with age, realizing that he can manage the illness by paying close attention to his diet. “It doesn’t dictate how I live my life.”

The degree to which patients struggle with the disease varies, but some face considerable challenges.

“The strict dietary requirements advised by doctors substantially affects the quality of life of the patients and their families,” said Majtan, who recently attended a homocystinuria patient advocacy groups gathering in Rome. “Based on our pre-clinical data, we are convinced that the enzyme replacement therapy could markedly reduce or entirely eliminate dietary management of the patients, who in turn could enjoy life in full.”

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Researchers creating the most advanced 3D human lung to test e-cigs

Lung

The University of Colorado Anschutz Medical Campus announced the funding of $3.4 million by the U.S. Food and Drug Administration (FDA) to create the most advanced living mimicry of a human lung to identify toxicity and cancer-causing potential of emerging tobacco products.

Kambez Benam's lab team at the CU Anschutz Medical Campus
Kambez Benam’s lab team at the CU Anschutz Medical Campus

To study the effects of a human smoker, the research team led by Kambez H. Benam, DPhil, assistant professor at the CU School of Medicine, will create the first-in-kind multi-cellular three-dimensional (3D) living structure of a human lung containing cells that naturally line our conducting airways. This includes the physiological scaffold – also known as extracellular matrix, on top of which the airway lining sits, the soldiers of our immune defense – also known as leukocytes, and the matrix-embedded stromal cells that are critical for development and resolution of organ injury.

This microengineered human lung will allow a better understanding of the harm of e-cigarettes and hookah by evaluating the impact on genes, proteins, pathways, and cell/organ function. In the past, laboratory animals have been widely used to assess the effects of conventional cigarette smoke and more recently e-cigarette vapors; however, translation of findings to human has been challenging.

Kambez Benam, DPhil, assistant professor at the CU School of Medicine
Kambez Benam, DPhil, assistant professor at the CU School of Medicine

“Providing the next generation of a human lung model to compare the toxicity of emerging products, particularly hookah and e-cigarettes, will help identify dangerous and carcinogenic formulations,” said Dr. Benam. “This study has an unprecedented potential to advance the available toolkits for FDA to better protect and promote public health concerns around tobacco products.”

Tobacco-related products such as e-cigarettes and hookah are drastically gaining popularity; but, the biological impact of their emissions on the human lung is not well characterized.

This project adds unique capabilities to Dr. Benam’s work on recently developed technological platforms, namely ‘Small Airway-on-a-Chip’ and ‘Breathing-Smoking Human Lung-on-a-Chip’ published in Nature Methods and Cell Systems.

With the passage of the Family Smoking Prevention and Tobacco Control Act in June 2009, the FDA acquired the authority to regulate the manufacturing, marketing, and distribution of tobacco products in order to protect public health. As of 2016, FDA finalized a rule extending its regulatory authority to cover all tobacco products, including waterpipe tobacco.

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Sexual behavior may influence gut microbiome

A person’s sexual behavior could affect their microbiome and immune system, potentially elevating their risk of HIV infection, according to a new study from researchers at the University of Colorado Anschutz Medical Campus.

The study was published last week in the journal PLOS Pathogens.

Brent Palmer, PhD, associate professor of medicine in the Division of Allergy and Clinical Immunology at the CU School of Medicine
Brent Palmer, PhD, associate professor of medicine in the Division of Allergy and Clinical Immunology at the CU School of Medicine

The microbiome, a community of microbes in the gut, play a major role in driving and shaping the human immune system. But recent studies have shown that men who have sex with men (MSM) have very distinct microbiomes compared with men who have sex with women (MSW), regardless of HIV-infection status.

CU Anschutz researchers wanted to know whether this altered microbiome induces T cell activation associated with HIV transmission risk and increased disease severity.

To study this they took stool samples of 35 healthy men – men who had sex with men and men who had sex with women – and transplanted them into mice. The mice who received the MSM stool samples showed increased evidence of activation of CD4+ T cells, which would put them at a higher risk of HIV if they were human.

They also isolated immune cells from the intestines of HIV negative individuals and exposed them to bacteria from MSM and MSW feces. Human gut derived immune cells exposed to MSM fecal bacteria were more likely to be infected by HIV virus in vitro. This was again linked with increased immune activation by these fecal bacteria.

“These results provide evidence for a direct link between microbiome composition and immune activation in HIV-negative and HIV-positive MSM, and a rationale for investigating the gut microbiome as a risk factor for HIV transmission,” said the study’s senior author Brent Palmer, PhD, associate professor of medicine in the Division of Allergy and Clinical Immunology at the CU School of Medicine.

Exactly why the microbiome of men who have sex with men is so distinct remains unknown. Some have theorized that diet may promote inflammation and thereby activate T cells.

“There is a unique microbiome associated with men who have sex with men that drives immune activation in the gut that may also drive higher levels of HIV infection,” Palmer said. “But we still don’t know exactly why this is.”

Yet understanding this microbiome is important, Palmer said, because it could directly affect the immune system of high-risk men and lead to an increased risk of HIV infection.

The study co-authors include Sam X. Li, PhD, and Catherine Lozupone, PhD, of the University of Colorado Anschutz Medical Campus.

 

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Women dominate OBGYN field but make less money than male counterparts

While women outnumber men as OB-GYN practitioners, they still make significantly less money and the pay gap extends to subspecialties like reproductive endocrinology and infertility (REI), according to researchers at the University of Colorado Anschutz Medical Campus.

“It’s interesting that the OB-GYN field is dominated by women and yet this gender inequality in pay persists,” said the study’s senior author Malgorzata Skaznik-Wikiel, MD, assistant professor of obstetrics and gynecology at the University of Colorado School of Medicine. “Why the discrepancy?”

The study was published on-line this month in the journal Fertility and Sterility.

It showed that even after adjusting for variables like hours worked, years in practice, location, academic vs. private practice, female reproductive endocrinology and infertility subspecialists make on average $67,000 less than male REIs per year.

Pay inequity among physicians in well-documented. According to Doximity, an online social network for health care professionals, women doctors make about 27.7 percent less than male physicians or about $105,000.

Dr. Skaznik-Wikiel | CU ARM
Malgorzata Skaznik-Wikiel, MD, assistant professor of obstetrics and gynecology at the University of Colorado School of Medicine.

A recent commentary in the journal Obstetrics and Gynecology noted that 82 percent of those going into OB-GYN were women, yet the field is the fourth worst of 18 specialties in pay inequity among the sexes. Skaznik-Wikiel and her colleagues sent surveys to 796 board-certified or board-eligible Society for Reproductive Endocrinology and Infertility members. Of those, 215 responded, an above average response for such surveys.

The study noted that although women were more likely to practice less than five days per week, there were no significant differences in the number of hours they spent per week seeing patients, doing research or being involved in other academic activities.

The researchers reviewed a number of reasons given for the pay gap – women working fewer hours, taking more personal leave, practicing in specialties that pay less or practicing in academia rather than privately.

Yet they found little to substantiate these suggestions.

For example, the study said it’s unlikely that a woman taking more personal leave, like maternity leave, would affect a base salary. Also, they said, more and more men are taking paternity leave as well.

One possible culprit is `salary compression.’ That’s when the market rate for a job outpaces pay increases for those already in those positions. New hires may get bigger salaries.

“There is some evidence that men switch jobs more often than women and sometimes new jobs will pay more to attract new employees,” Skaznik-Wikiel said.

She also said women are often reluctant to negotiate hard over salary for fear of being seen as overly aggressive, traits many do not associate with men who do the same thing.

Ultimately, Skaznik-Wikiel said, there is no good reason for the discrepancy.

“The first step in addressing the gender gap is acknowledging it exists,” she said. “Ignorance of this issue is no longer acceptable.”

The second step is opening a frank and honest discussion about income, salary negotiations and implementation of academic institutional and private practice policies addressing potential gender biases, the study said.

Salaries, raises and bonuses should be more transparent, said Skaznik-Wikiel.

“Women also need to step into mentorship roles now more than ever,” she said. “An opportunity exists for practitioners in the field of obstetrics and gynecology and its subspecialties to lead by example in establishing new transparent norms and better policies that create an environment of equity in pay.”

The study co-authors include: Sara Babcock Gilbert, MD, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology at the CU School of Medicine and Amanda Allshouse, MS, Department of Biostatistics and Informatics at the Colorado School of Public Health at CU Anschutz.

 

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Anti-seizure drug, reformulated by CU professor, used in first clinical trial

Tom Anchordoquy, PhD
Tom Anchordoquy, PhD, professor at the CU Skaggs School of Pharmacy and Pharmaceutical Sciences

An approved epileptic drug to treat seizures has been modified by a University of Colorado Anschutz Medical Campus professor and is currently being used in a clinical trial in Australia for medically refractory epilepsy.

Tom Anchordoquy, PhD, professor at the CU Skaggs School of Pharmacy and Pharmaceutical Sciences, and Dan Abrams, MD, CEO of Cerebral Therapeutics, have developed a proprietary reformulated specialty pharmaceutical, which bypasses the blood-brain barrier using a chronic implantable infusion system, to improve the lives of patients with severe medically refractory epilepsy. The two have worked together for over a decade developing drug formulations to be injected directly into the brain where it is needed.

Cerebral Therapeutics is conducting a proof-of-concept study in adult patients at Australia’s University of Melbourne using its proprietary anti-epileptic specialty formulation via direct intracerebroventricular (ICV) administration. This proof-of-concept study has demonstrated potentially enhanced efficacy and reduced toxicity in patients with medically refractory epilepsy. Proceeds from the financing will be used to file an IND with the U.S. Food and Drug Administration (FDA) to initiate a Phase 2 clinical trial.

“It is well established that getting drugs into the brain is very difficult,” said Anchordoquy. “Typically, patients have to take high doses of drugs that distribute all throughout the body in order to get some drug into the brain. As a result, most of the drug that the patient takes does not end up in the brain, and therefore cannot effectively treat the disease. For this reason, conventional treatment often causes adverse effects in other parts of the body. This technology allows the drug to be delivered directly into the brain where it is needed, and avoids exposing the rest of the body to the drug. This is a very clever idea that makes sense. While the advantages of using pump technology are clear, the formulation challenges associated with implementing this approach are significant. We need to be very creative and think outside of the box.”

Dan Abrams, MD
Dan Abrams, MD, CEO of Cerebral Therapeutics

“Patients who have multiple seizures every day cannot be left alone. They can’t work, drive, or even walk to the mailbox by themselves. This technology enables them to have the potential to do all these things and resume a relatively normal life. I am grateful to be a part of it,” said Anchordoquy. “There are so many reasons why the pump is the most effective way to get the drug to the seizure area in the brain,” he continued. “It eliminates the patient taking multiple pills every day and doesn’t saturate the entire body with the drug, minimizing adverse side effects. Their lives are changed dramatically.”

Epilepsy is the fourth most common neurological problem in the world. Approximately three million people in the United States are living with epilepsy with one million people experiencing uncontrolled seizures; medications and surgery have not been an option for the majority of these patients. Cerebral Therapeutics’ therapy uses a specialized implanted, refillable catheter pump infusion system to deliver a continuous micro dose of its proprietary specialty formulation of valproic acid called CT001 for which Cerebral Therapeutics has an exclusive license agreement from the University of Colorado.

Guest contributor: Jackie Brinkman

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Surgeon’s work spans saving limbs to curbing the need for opioids

Matt Iorio, MD

Matt Iorio, MD, has found a new professional home at the University of Colorado Anschutz Medical Campus after training at many prestigious universities and hospitals across the United States. He specializes in microvascular surgery that involves saving limbs of traumatically injured patients. When he is not treating patients, Iorio studies alternatives to one of the leading causes of addiction in America — opioids.

Iorio covered just about every region of the United States during his academic endeavors. After growing up in Phoenix, he attended college in Chicago and medical school in Washington, D.C., where he worked with injured veterans and developed an interest in limb salvage.

“We saw a lot of traumatic injuries where we successfully salvaged limbs,” said Iorio, who completed a fellowship in hand and microvascular surgery in Seattle. “Saving a limb has an incredible impact on a patient’s life. An amputation is a major mortality complication.”

Prior to Denver, Iorio was in Boston at Harvard Medical School as part of the plastic surgery and orthopaedic faculty.

He came to CU Anschutz in 2018 and is currently an associate professor of surgery in the School of Medicine and attending physician at both University of Colorado Hospital and Denver Health. He continues to perform limb salvage surgeries while pursuing research interests in the reconstruction of upper and lower extremities through microvascular surgery.

Limb-saving surgeries

Iorio frequently performs free flap surgery, a difficult procedure in plastic surgery to reintegrate soft tissue and blood vessels to a damaged area. During these procedures, he reattaches impossibly small blood vessels with stitches as thin as a single hair. Rebuilding the vascular system of a traumatically injured limb can not only save the aesthetic look of a limb, but more importantly, he says, its function.

Matt Iorio, MD
Matt Iorio, MD, associate professor of surgery in the CU School of Medicine

“We stand in the doorway of someone on the brink of losing a limb,” he said, referring to the complex procedures in the operating room.

The recovery from these surgeries can be very difficult and patients are subject to chronic pain.

“Patients undergoing these surgeries have polytraumas, and with a lot of injuries,” said Iorio, “They’re immobilized and bedridden for very long periods of time following tough surgeries. They can end up being on enormous doses of opioids and benzodiazepines.”

In an effort avoid these poor outcomes, he frequently employs peripheral nerve catheters during surgery.

Alternatives to problem-ridden pain killers

Nerve catheters are very small tubes that are placed near a surgical site to specifically anesthetize a nerve. Aside from helping block the pain, the catheters can also prevent spasms and protect the microvascular free flap.

“In lower-extremity reconstruction, microsurgery salvage failure rates can be as high as 20 percent due to the difficulty of the operation,” said Iorio. “Anything we can do to help that flap is beneficial to the outcome of the procedure.”

Recently, Iorio studied how peripheral nerve catheters can be used to curb the need for opioids, and the results are encouraging. He found that when peripheral nerve catheters were used, there was reduced concurrent narcotic use and the length of hospital stay was shortened. Also, patients reported lower amounts of immediate postoperative pain.

“In our study, our flap failure rates were 3 percent,” said Iorio. “So, we saw better outcomes, lower pain scores and lower opioid consumption. This looks very promising for the future of limb salvage.”

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Dermatology students improve Wikipedia entries on skin disease

A group of medical students recruited to improve Wikipedia articles on skin-related diseases, saw millions more views of those stories following their editing, highlighting the value of expert input on the popular web encyclopedia.

“We tried to make the articles more readable, while adding more relevant information,” said Olivia Hutton, BS, a medical student at the University of Colorado School of Medicine who led the project. “The articles we edited have been viewed 10 million times since adding the new information.”

Robert Dellavalle, MD, PhD, MSPH, professor of dermatology at the CU School of Medicine
Robert Dellavalle, MD, PhD, MSPH, professor of dermatology at the CU School of Medicine

The research letter was published online March 28 in the Journal of the American Academy of Dermatology.

Medical stories on Wikipedia receive 10 million views daily and the top 500 skin-related articles saw over 16 million views during August 2018 alone.

But in an effort to make those articles more complete and accurate, an editing partnership was set up between the evidence-based medicine organization Cochrane and Wikipedia in 2014. Cochrane Review Groups work with Wikipedia to recruit and train editors to share high-quality Cochrane Review evidence in Wikipedia stories.

In this case, five students were trained to beef up the articles on skin-diseases. They learned Wikipedia editing, were mentored by an experienced Wikipedia medical editor and were given a list of articles to improve.

The project was supervised by Robert Dellavalle, MD, PhD, MSPH, professor of dermatology at the CU School of Medicine. According to Hutton, the trainees improved 40 skin-specific articles on Wikipedia. They did this by adding paraphrased conclusions and background information from 60 Cochrane Reviews.

The 40 edited stories won millions more views. The top five most viewed articles dealt with psoriasis, leprosy, cellulitis, melanoma and molluscum contagiosum.

“Criticisms of Wikipedia include concerns over the quality of shared content,” Hutton said. “It is important to ensure that Wikipedia’s content is evidence-based, unbiased and up-to-date. We have shown that a small Wikipedia editing initiative has the potential to share evidence-based information with many people.”

Dellavalle, who is also a joint-coordinating editor of Cochrane Skin, said the students’ work with Wikipedia in this regard “is the most expansive provision of public health dermatology information in the world.”

The next step, he said, is to recruit more trainees, improve skin-related Wikipedia content in other languages and make further improvements in articles to increase accuracy and understandability.

The article co-authors include Jennifer E. Dawson, PhD; Kachiu C. Lee, MPH; Peter R. Shumaker, MD; Elizabeth Doney, MSc; Robert P. Dellavalle, MD, PhD, MSPH.

 

 

 

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‘Mayor of Anschutz’ becomes lead ambassador

Ron Washington, lead ambassador

When it comes to smiling faces and warm dispositions on the University of Colorado Anschutz Medical Campus, they don’t come much sunnier than Ron Washington.

Before retiring last fall, Washington worked in the CU Anschutz Facilities Management Department for 21 years. His departure left a void on campus, most notably among the scores of folks who missed Washington’s gregarious nature and ever-present smile.

Ron Washington and David Turnquist
Ron Washington, lead ambassador for CU Anschutz, shares a light moment with his boss, David Turnquist, Facilities Management, during the podcast.

So, David Turnquist, associate vice chancellor of Facilities Management, thought of a way to bring Washington back to campus: make him the lead ambassador of the campus’s fledgling Ambassador Program. It is actually a revival of an ambassador program that existed many years ago, when volunteers from University of Colorado Hospital staffed an information desk in the lobby of Building 500 (now the Fitzsimons Building) and gave campus tours. The program gradually faded, however.

In the intervening years, CU Anschutz has steadily grown, adding buildings, transportation options and interesting new campus features.

Washington will staff the information desk in the Fitzsimons Building from 8 a.m. to 4 p.m. on Tuesdays and Thursdays. Ida Lambert, another retiree who spent many years working at CU Anschutz, will soon join Washington as an ambassador. “The hope is that we can get enough retirees to come back and staff the desk five days a week,” Turnquist said.

The ambassadors will lead tours of the Eisenhower Suite, the art walk and main campus attractions, in addition to providing information to visitors inside Fitzsimons.

Washington, Turnquist and Del Quiel, director of Facilities Management, sat down with CU Anschutz Today for a candid chat about the Ambassadors Program and the reason Washington was the “perfect” choice to re-launch the outreach effort. In this podcast, learn about the mischievous ghosts of the Fitzsimons Building, Washington’s penchant for giving hugs and mooching your lunch, and, finally, why he’s known as the “Mayor of Anschutz.”

When asked about the warm reception he’s received since coming back to campus, Washington said, “It motivated me. I never knew I had an effect like that on this campus.”

LISTEN TO THE PODCAST:


 

 

 

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Women dominate Ob/Gyn field but make less money than male counterparts

Pregnant patient

While women outnumber men as Ob/Gyn practitioners, they still make significantly less money and the pay gap extends to subspecialties like reproductive endocrinology and infertility (REI), according to researchers at the University of Colorado Anschutz Medical Campus.

“It’s interesting that the Ob/Gyn field is dominated by women and yet this gender inequality in pay persists,” said the study’s senior author Malgorzata Skaznik-Wikiel, MD, assistant professor of obstetrics and gynecology at the University of Colorado School of Medicine. “Why the discrepancy?”

The study was published on-line this month in the journal Fertility and Sterility.

It showed that even after adjusting for variables like hours worked, years in practice, location, academic vs. private practice, female reproductive endocrinology and infertility subspecialists make on average $67,000 less than male REIs per year.

Pay inequity among physicians in well-documented. According to Doximity, an online social network for health care professionals, women doctors make about 27.7 percent less than male physicians or about $105,000.

Dr. Skaznik-Wikiel | CU ARM
Malgorzata Skaznik-Wikiel, MD, assistant professor of obstetrics and gynecology at the University of Colorado School of Medicine.

A recent commentary in the journal Obstetrics and Gynecology noted that 82 percent of those going into Ob/Gyn were women, yet the field is the fourth worst of 18 specialties in pay inequity among the sexes.  Skaznik-Wikiel and her colleagues sent surveys to 796 board-certified or board-eligible Society for Reproductive Endocrinology and Infertility members. Of those, 215 responded, an above average response for such surveys.

The study noted that although women were more likely to practice less than five days per week, there were no significant differences in the number of hours they spent per week seeing patients, doing research or being involved in other academic activities.

The researchers reviewed a number of reasons given for the pay gap – women working fewer hours, taking more personal leave, practicing in specialties that pay less or practicing in academia rather than privately.

Yet they found little to substantiate these suggestions.

For example, the study said it’s unlikely that a woman taking more personal leave, like maternity leave, would affect a base salary. Also, they said, more and more men are taking paternity leave as well.

One possible culprit is `salary compression.’ That’s when the market rate for a job outpaces pay increases for those already in those positions. New hires may get bigger salaries.

“There is some evidence that men switch jobs more often than women and sometimes new jobs will pay more to attract new employees,” Skaznik-Wikiel said.

She also said women are often reluctant to negotiate hard over salary for fear of being seen as overly aggressive, traits many do not associate with men who do the same thing.

Ultimately, Skaznik-Wikiel said, there is no good reason for the discrepancy.

“The first step in addressing the gender gap is acknowledging it exists,” she said. “Ignorance of this issue is no longer acceptable.”

The second step is opening a frank and honest discussion about income, salary negotiations and implementation of academic institutional and private practice policies addressing potential gender biases, the study said.

Salaries, raises and bonuses should be more transparent, said Skaznik-Wikiel.

“Women also need to step into mentorship roles now more than ever,” she said. “An opportunity exists for practitioners in the field of obstetrics and gynecology and its subspecialties to lead by example in establishing new transparent norms and better policies that create an environment of equity in pay.”

The study co-authors include: Sara Babcock Gilbert, MD, Division of Reproductive Endocrinology and Infertility, Dept. of Obstetrics and Gynecology at the CU School of Medicine and Amanda Allshouse, MS, Dept. of Biostatistics and Informatics at the Colorado School of Public Health at CU Anschutz.

 

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