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Grubstake Awards highlight remarkable return on investment

Grubstake awardees 2018-19

Pioneering research recognized by the 2018/19 Gates Grubstake Awards underscores promising strides in recent years in guiding basic science at the CU Anschutz Medical Campus toward commercialization and tangible benefits for patients.

Kenneth Liechty, MD
Kenneth Liechty, MD

The Grubstake Fund, with multiple awards of about $350,000 each year, is meant to bridge the “valley of death” funding gap that separates a promising medical concept from production and a business model that will make a difference in human lives.

It’s working.

The Gates Center for Regenerative Medicine and the CU Innovations Office, its Grubstake Fund collaborator, report that through early 2019, the cumulative $3.5 million in Grubstake awards had already produced nearly $20 million of follow-on funding from partners seeking to help develop and commercialize the concepts.

The more-than “5X” return is remarkable in any financial setting. For the Gates Center, it is confirmation that the mission of collaboration and entrepreneurship in the name of medical advancement is now producing results.

“The Grubstake Fund program has been so game-changing as far as impact and getting research to patients,” said Kim Muller, executive director of CU Innovations. “We are looking at using that model for all therapeutic areas around campus. We almost feel we have an ethical obligation to do it.”

This year’s winners

The 2018/19 Gates Grubstake Fund winners of $350,000 grants were selected from 15 applicants representing CU Anschutz schools, centers and institutes, CU Boulder, CU Denver and Children’s Hospital Colorado. They are:

  • Kenneth Liechty, MD, who is developing an inhaled formulation for the prevention and treatment of pulmonary fibrosis. Acute lung injury leading to Acute Respiratory Distress Syndrome (ARDS) causes 150,000 adult ICU admissions and 75,000 deaths annually in the US. Liechty and his team use nanoparticle therapy to regenerate healthy lung tissue in a mouse model of acute lung injury. The award will support an inhaled therapy and safety studies required prior to a clinical trial in ARDS patients.
  • Kunhua Song, PhD, for the regeneration of functional heart tissue from tissue damaged in a heart attack. Eight million Americans suffer a heart attack annually, and up to 40 percent of those develop heart failure. Despite the development of various therapies and medical devices, the five-year survival rate has not changed in the past 20 years. Song and his team have discovered a way to regenerate healthy cardiac cells from the fibrotic tissue causing heart failure using a gene therapy approach. The Grubstake Award will allow them to complete their animal studies and begin preparing to file an IND to enter clinical trials.
  • Michael Verneris, MD, for the generation of engraftable hematopoietic stem cells for use in bone marrow transplants. Bone marrow transplants are a high risk, high cost procedure used to treat leukemia, lymphoma, and genetic diseases. Autologous donation is the safest and quickest method. Recently, scientists have discovered how to create induced pluripotent stem cells (iPS cells) from a patient’s own cells, expand them, and convert them to bone marrow cells. So far these cells have not engrafted into the bone marrow of mouse models. Verneris and his team have discovered that adding a small molecule during the conversion of the iPS cells allows engraftment. The Grubstake Award will allow them to confirm their initial finding in animal models, and to determine the most promising small molecule for clinical and commercial use in humans.
Kunhua Song, PhD
Kunhua Song, PhD

To date, there are 105 ongoing regenerative medicine projects on campus with potential to compete for Grubstake awards, of which 25 have reached the product development stage. As word spreads of the program’s opportunities for researchers, being selected for the handful of awards has become increasingly competitive.

The Grubstake Fund goes a significant way toward addressing a gap between academia and “the real world” that has existed since the founding of medical schools. Researchers are constantly trying to broaden the impact of their work to help more than an individual patient. Yet when they have a promising concept, their scientific training lacks the background in regulatory approvals and how to access the capital required to prove a concept’s commercial value.

Intersecting with the private sector

“They’ve never had to intersect with the private sector,” Muller explained. “There’s no education in medical school or at work that helps them prepare for that.”

Members of the public who read casually about venture capital (VC) in hotbeds like California’s Silicon Valley may assume there are financiers with suitcases full of ready cash hovering around all PhDs. But that kind of capital tends to move in when an idea is ready for mass commercialization, innovation experts said. Before that stage, scientists need money for lab assistants and regulatory help to show that something seen under a microscope has real promise as a treatment.

“When you are at the proof-of-concept translational stage, that’s where most VCs aren’t going to invest,” said the Gates Center’s Entrepreneur in Residence Heather Callahan, who also serves as portfolio manager at CU Innovations, bringing the expertise of an Executive MBA, a law degree and a PhD in biochemistry. “That’s why this was the perfect place in the trajectory of invention to start putting money.”

The money and the mentoring have moved a growing portfolio of projects toward initial clinical trials in the next two to three years.

Michael Verneris, MD
Michael Verneris, MD

“The Gates Center has been phenomenally helpful in accelerating our work,” said Liechty, who received a previous Grubstake award in anti-inflammatory research. The Grubstake model and the Gates Biomanufacturing Facility address three keys to the drug commercialization process, he said: “It’s one thing to say, ‘Okay, we can manufacture things.’ Or another thing to say, ‘We have people who know the ins and outs.’ And another to say, ‘How do you pay for it?’ We’re a relatively new campus for that kind of idea, and this is what’s needed to really jumpstart this.”

Applications due at the end of August

The annual Grubstake award process has helped everyone involved with the Gates Center and wider campus research efforts keep an eye on the true significance of the scientific pursuit, said Gates Center Associate Director J. Mark Petrash, PhD.

“This is an important part of the mission of the university, to not only do good research but to make it of practical use to society,” he said.

Written applications for the 2020 round of Grubstake Awards are due at the end of August. Interested applicants are encouraged to reach out to the Gates Center’s Entrepreneur in Residence Heather Callahan for information.

Guest contributor: Michael Booth

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Book focuses on ‘the how’ of implementing integrated healthcare

Integrated care handbook
The evidence-based handbook “Integrated Behavioral Health in Primary Care” is available through Springer Publishing and Amazon.

For decades, mental health was largely divorced from physical health. While this perspective has changed, primary care physicians continue the challenging task of revising their practices to encompass mental and behavioral healthcare.

They are turning to an emerging approach to primary care practice called integrated behavioral healthcare — an area in which the University of Colorado Anschutz Medical Campus is leading. This patient-centric model focuses on care that treats the whole person; it relies on the idea that the mind and body are not separable. In other words, patients’ primary care and behavioral healthcare providers work together to deliver the best care.

CU Anschutz’s very own, Larry Green, MD, and  Stephanie Gold, MD, co-edited a handbook to help guide this process, “Integrated Behavioral Health in Primary Care: Your Patients Are Waiting.”

Leadership for transforming care

This evidence-based handbook is intended to give practical, firsthand advice from real-world practices that can be applied by large and small, rural and urban, and public and private primary care practices around the world. It is broken down into chapters that focus on “the how” of what it takes to implement integrated care.

Larry Green, MD
Larry Green, MD, professor in the Department of Family Medicine

“This handbook can be used as a walkthrough for practice transformation,” said Gold, an assistant professor in the Department of Family Medicine in the University of Colorado School of Medicine. “It is a ‘how to guide’ on integrating behavioral health into primary care clinics. It provides much-needed guidance and support in how to approach to care delivery.”

Each chapter includes extra resources including articles and websites that can assist in implementation.

Collaborating to create change

Gold and Green, MD, a professor in the Department of Family Medicine, were contacted by Springer, publisher of the handbook, to edit the piece and organize other expert opinion.

“The book is grounded in lessons learned from pioneers in integrated care,” Gold said of her collaborators.

The intended audience stretches far beyond physicians; it is for anyone involved in primary care, including practice administrators and practice facilitators. The content is general enough to be applicable to practices across the world, save some policy information specific to the United States.

Stephanie Gold, MD
Stephanie Gold, MD, assistant professor in the Department of Family Medicine

“This can be used in any community,” said Green. “It’s a practical guide to help healthcare providers know what it takes to get this implementation work done.”

Progressing despite barriers

“There has been a persistent failure of providing proper healthcare for people with mental, emotional, and behavioral problems,” Green added. “Primary care practices everywhere cannot escape this. Patients are waiting for this kind of care. We just need to get on with it. We know how; let’s work together and do it.”

Integrated Behavioral Health in Primary Care is available now through Springer Publishing and Amazon.

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Vic Lombardi: Men’s Health Month

Local legendary sports television and radio host Vic Lombardi knows what most men are thinking when someone nudges them to go to the doctor. 

“When they hear ‘Men’s Health Month,’ they’re like, ‘Oh quit bothering me!’” 

But, as Vic knows personally, that nudge to go the doctor can actually help save a life.  

“If nobody had bothered to bother me, I probably wouldn’t be standing here talking about my health.” 

Both now and in recent decades, men in all age groups visit their primary care/general physician at lower rates than women. It’s a persistent problem, and Vic acknowledges he didn’t see anything wrong. “I thought I was in the best health possible: I was in great shape, I had no symptoms, no family history, nothing.” 

See Vic Lombardi discuss Men’s Health Month in the video below. 

Last winter, however, Vic decided to go in and see his doctor. “Something was gnawing at me and I decided to go in and get a physical. One thing leads to another and I have a [prostate] cancer diagnosis, and it’s growing pretty aggressively.”  

By acting quickly Vic and his doctors at UCHealth University of Colorado Hospital were able to get surgery completed, and continue to monitor his health. “That’s the beauty of what’s happening at the CU Anschutz Medical Campus,” he said, speaking to the campus’ collaborative and interconnected nature, “you can walk in there, you can get seen, you can be seen, and you can see others.” 

“Even if you don’t think you’re sick,” Vic said, “There might be things developing that you may not see, feel, hear.” 

So, as for being a bother about visiting the doctor, Vic has a clear message for the stubborn and reticent men out there: “It’s my goal and my duty to bother you in Men’s Health Month to go get checked out. Bother to go get checked!” 

 

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Central HR team volunteers to help hungry Coloradans

HR volunteering at Food Bank of Rockies

HR volunteers at food bank
A group of 25 team HR team members pitch in at the food bank as part of the CU in the Community program.

In what’s become a spring tradition of service, the CU Denver | CU Anschutz Medical Campus Human Resources Office team once again spent a half day volunteering at the Food Bank of the Rockies. This year’s group of 25 team members marked the seventh consecutive year the HR Department has sorted, loaded and prepped food for distribution to Coloradans in need.

The department, along with scores of other CU teams, feels honored to donate time to such a worthy cause. The CU in the Community program encourages faculty and staff to spend a half-day of their work week volunteering in the activity of their choice in the community.

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What’s it like to practice medicine on Mars?

Arika Armstrong portrait

Ben Easter, larger portrait
Ben Easter is an Assistant Professor of Emergency Medicine at CU Anschutz and works at NASA.

INSIDE ‘THE HAB,’ MARS UTAH – When it comes to medicine on Mars, or even on a spaceflight to the Red Planet, “definitive care” means something very different than it does on Earth. Quite simply, it means that nobody is coming to help the crew tend to an injured or ill astronaut.

This was one of the more profound lessons students learned as part of a new Maymester course co-created and co-led by medical and engineering experts at CU Anschutz Medical Campus and CU Boulder. “Medicine in Space and Surface Environments” unfolded over three weeks in early May, with the last week taking place in the desolate surroundings of the Mars Desert Research Station near Hanksville, Utah.

The course is chock-full of simulation exercises that forced students to work as a unit and solve problems during fast-developing medical emergencies that could occur on Mars. The class is the brainchild of Ben Easter, MD, Assistant Professor of Emergency Medicine in the CU School of Medicine, and Allie Anderson, Assistant Professor of Aerospace Engineering at CU Boulder, in collaboration with other colleagues.

Arika Armstrong, an aerospace graduate student as well as an engineer for Lockheed Martin Corp., was among the 21 CU Boulder engineering students enrolled in the program. Taking a rare break from the rigorous slate of simulation drills – or extra-vehicular activities (EVAs) – Armstrong joined instructors Anderson and Easter for a candid chat about the class and space exploration.

The trio from the 2Mars crew sat down with CU Anschutz Today inside the Hab to record a podcast about this unique and innovative collaboration, one that positions CU Anschutz and CU Boulder as leaders in training some of the first of a new breed – first responders for deep space.

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The ‘serious business’ of sims

Allie Anderson, larger portrait
Allie Anderson, co-teacher of the new Maymester class, is an Assistant Professor of Aerospace Engineering at CU Boulder.

Because so much of the “Medicine in Space” class is focused on real-world training, CU Anschutz Today asked Arika Armstrong, an aerospace engineering graduate student, to elaborate on the simulations and their impact on her. Here are her thoughts:

Was there a moment during your week in the field where it dawned on you: “Wow, these simulations really are serious business.” If so, what triggered that moment?

The search-and-rescue EVA was the event where I realized these simulations were serious business. I was part of the group that found most of the patients during that EVA. We were down in the bottom of a canyon with a patient who was mostly unresponsive and another patient who was lunging herself at other crewmembers because she was worried. This ended up with an incredibly realistic scenario regarding patient management. What really triggered it for me though was when I realized we were going to have to carry this guy out of the canyon on a makeshift stretcher, and we had no idea how far it was to the road where the rovers would be able to pick him up.

What was your role during the search-and-rescue EVA and how did your learnings help you grow into the rest of the week’s simulations?

Personally, I primarily helped to calm a panicking and asthmatic patient and helped carry out another patient on a stretcher. I learned a lot in that simulation. For example, communication is incredibly difficult with 20 to 30 people, and it’s really important to keep track of every member of your team. More than anything, that simulation gave me a glimpse of how hectic a similar “real-life” situation might be, and it helped prepare me, mentally, for the simulations to come. I realized I needed to refine my communication methods, speak up when I noticed a hazard or issue, and stay calm despite any chaos around me. I continued working on those skills through the remaining EVAs.

What, in general, was the strangest or most profound thing that happened during the class and why? 

I think one of the most profound experiences of the week was an EVA where two unresponsive patients required significant resuscitation once they were returned to the Hab. What made this stick out in my mind so much was the need for us to consider stopping. All prior training told us to “keep going until the patient is under definitive care.” Unfortunately, “the Hab” is your definitive care on Mars – there’s nobody else coming to help you. The discussions about whether or not to continue were really insightful and provided a very important lesson.

Fun in Mars class
Not every moment of the “Medicine in Space” class was serious business and intense simulations. Students enjoyed many light moments during meals and in the classroom, as seen here in the Science Lab.

Photos by Matt Kaskavitch, director of digital engagement, Office of Communications at CU Anschutz.

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Scientists demonstrate the advantages of diverse populations when compiling genetic data

AURORA, Colo. (June 19, 2019) – Relying strictly on genetic data from those of European descent, rather than more diverse populations, can exacerbate existing disease and increase health care disparities, according to new research.

The research letter was published today in the journal Nature.

“There have been numerous discoveries in human genetics over the last few decades that have told us a lot about biology, but most of the work is being done on those of European descent,” said the study’s first author Christopher Gignoux, PhD, MS, associate professor at the Colorado Center for Personalized Medicine at the University of Colorado Anschutz Medical Campus. “By limiting our focus, we are limiting our understanding of the human genetics underlying complex traits. The PAGE Study gives us an overdue opportunity to look at what we can find when studying a large number of groups together.”

Associate Professor Chris Gignoux of the Colorado Center for Personalized Medicine.
Associate Professor Chris Gignoux of the Colorado Center for Personalized Medicine at CU Anschutz.

This was borne out in the study which examined thousands of individuals in the U.S. of non-European ancestry. The Population Architecture using Genomics and Epidemiology study (PAGE) was developed by the National Human Genome Research Institute and the National Institute on Minority Health and Health Disparities to conduct and empower genetic research in diverse populations.

Researchers genotyped 49,839 people and found a number of genetic variants replicated from studies strictly of European descent. But PAGE investigators found dozens of discoveries that would not have been possible in a single population study. This included both complex traits and in Mendelian, or monogenic disorders.

“In light of differential genetic architecture that is known to exist between populations, bias in representation can exacerbate existing disease and health care disparities,” the study said. “Critical variants can be missed if they have a low frequency or are completely absent in European populations…” Especially rare variants.

 

Kathleen Barnes, PhD, director of the Colorado Center for Personalized Medicine at CU Anschutz
Kathleen Barnes, PhD, director of the Colorado Center for Personalized Medicine at CU Anschutz

Gignoux said the success of precision medicine and genomics means recruiting people from underrepresented populations for genetic studies. Right now, those genomic databases lack critical diversity despite the fact that many of in underrepresented groups have the greatest health burden and stand to benefit the most from being included.

“The Colorado Center for Personalized Medicine on the Anschutz Medical Campus is committed to personalized medicine here in our state and region that will benefit ALL people, regardless of who you are or where you came from,” said Kathleen Barnes, PhD, director of the Colorado Center for Personalized Medicine. “Initiatives like PAGE, and the work summarized in this manuscript by Chris Gignoux and colleagues, show us the way forward in achieving our goals of inclusion. It also illuminates just how important genetic diversity is in our understanding of the architecture of genetic disease. These approaches can now feed into our personalized ancestry information resource for patients interested in their own ancestry, as well as benefit our research and clinical community.”

Gignoux agreed.

“With studies of diverse groups we got a better overall picture of the genetic architecture which show the underpinnings of disease,” Gignoux said. “We want to understand how genetics can improve and ameliorate disease rather than make it worse.”

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Pushing the limits of medicine in deep space

CPR on Mars

NEAR HANKSVILLE, UTAH – Ben Easter, MD, steps onto a rocky ledge overlooking a dry riverbed. He cranes his neck and points into the canyon.

Injured crewmate exercise
Students tend to an injured crewmate (instructor Allie Anderson) during a simulation exercise at the “Medicine in Space” class in southern Utah.

“Right here,” the emergency medicine doctor says with a gleeful glint, belying his boyish looks, “we’re going to foment some chaos and see what happens.”

The simulation is designed to test whether students, thrust into a search-and-rescue scenario where they must navigate rugged topography and rapid-fire events, are able to organize into teams and solve cascading problems, all the while racing the clock to save injured and ill crewmates.

“We want them to walk up onto this ridge and not know where exactly the patient is, and have a kind of ‘oh crap’ moment,” says Easter, on the teaching staff of a new class that blends wilderness medicine and aerospace engineering.

In a remote part of southern Utah – at the Mars Desert Research Station to be precise – 21 University of Colorado Boulder aerospace engineering students, a mix of graduate students and undergrads, became Martians. They experienced seven days of gut-knotting, brain-twisting moments along with after-burner bursts of inspiration – nudging more than a few students into changed-life territory.

New horizons

It all comes courtesy of a cross-discipline teaching team and its novel idea to create a boundary-pushing Maymester course.

“Medicine in Space and Surface Environments” blends the expertise of CU Anschutz emergency medicine physicians with the engineering minds of CU Boulder students and Assistant Professor of Aerospace Engineering Allie Anderson, PhD. Anderson and Easter co-led the three-week class, which started with the engineers obtaining Wilderness First Aid certification in Boulder.

The course cements the unique positioning of CU Anschutz and CU Boulder experts, along with aerospace firms on the Front Range, to solve the complex problems arising from humankind’s most ambitious quest – to travel the roughly 250 million miles to Mars, and ultimately colonize the desolate planet.

MEDICINE ON MARS – 3-part series

Part one, June 19: Students experience a Maymester class of gut-knotting, brain-twisting moments along with after-burner bursts of inspiration.

Part two, June 26: Podcast about the week of medical emergency simulations at the Mars station.

Part three, July: Video of the innovative CU Anschutz-CU Boulder collaboration.

Mit Senavinin, a senior in aerospace engineering, said the week in the desert propelled him to consider new career paths in aerospace medicine.

“You don’t really have that firsthand experience or get that frame of reference without these trainings,” he said, still sweating from doing 40 minutes of CPR on “fallen” crewmates who had been electrocuted.

So now Senavinin is rethinking his plan to become a jet pilot. “This class has really made me want to go into medicine,” he said. “This experience opened that door. It’s really the bridge between engineers and physicians.”

Impulse to explore

Conversely, Marissa Palamara said the medical scenarios gave her the “heebie jeebies,” but as a sophomore in aerospace engineering she relished all the engineering problems thrown at students.

Fire in the Mars Habitat
In one of the many emergency exercises, students battled a simulated fire that broke out inside the Habitat on Mars.

How do you perform CPR through a spacesuit (answer: not easily)? How can one piece of spacecraft equipment be designed for multiple functions? Can a spacesuit be retooled to minimize astronaut exertion? Because muscle atrophy is common for astronauts, what kinds of exercise equipment could keep crew members fit on a lengthy voyage?

‘This experience opened that door (to studying medicine). It’s really the bridge between engineers and physicians.’ – Mit Senavinin, a senior in aerospace engineering

As the trainings unfolded, each growing in complexity, the students navigated the unpredictable nature of the human factor – “the soft fleshy thing inside the spacesuit,” as one instructor put it – in all its messy and complicated glory.

“We get to see how different people lead, how people play different roles within the team, and just how to work more effectively as a team,” Palamara said. “That’s all very important as engineers.”

The simulation exercises, which are the norm in medical training, aren’t as typical for engineering students, according to Anderson. The class offered a pulse-pounding sense of what biomedical engineering is really like, she said.

“This course,” added Easter, “is all about bringing those two disciplines together to improve what we can accomplish in human space flight.”

Giving a lecture on Mars
Allie Anderson, PhD, center (gray T-shirt), leads a session on a rare sunny day during the Maymester week at the Mars Desert Research Station.

It’s also about a basic human impulse.

“Humans have an innate sense of exploration and desire to cross an ocean or climb the next hill to see the view,” Easter said. “And now that frontier has become space – the moon and eventually on to Mars. I think something about working together to accomplish those goals just satisfies something within us as explorers.”

‘Can anyone hear me?’

Search-and-rescue save
Crewmates come to the aid of Amin, center, during a search-and-rescue exercise in a rugged canyon.

For seven days the students were Martians. They donned orange spacesuits in addition to – during the many simulations (aka extra-vehicular activities, or EVAs) – helmets, gloves, air packs and radio units.

The brisk desert wind buffeted the group as excursions unfolded on foot and in motorized rovers across a very Martian-like backdrop. The research station campus stands in stark white contrast to the Playdough-esque jumble of Utah’s otherworldly landscape of red spires, hoodoos and powdery sand.

In the search-and-rescue EVA, the crisis was daunting: an aborted spacecraft launch left three astronauts strewn across a ravine, including a hypoxic one perched on a distant outcropping. The crash triggered a multifaceted operation that only intensified when a search-party member suffered a “broken” ankle and was mistakenly left behind.

He patched through a message: “This is Amin. Can anyone hear me? (Silence on the radio). Please come in. I’m hurt and lost and unable to walk. (More silence). I don’t want to die here.”

Ten minutes later, a crewmate scrambled to Amin’s canyon location with an urgent message about dwindling air. The rescuer, swinging Amin’s arm over his shoulder, was direct: “Our consumables are getting very low, so we need you to keep up the pace, OK?”

Cardiac arrest, asthma attack, hypoxia, disorientation, electrocution, broken bones and smoke inhalation were among the maladies the students confronted on Mars. Triage units sprang up in the Hab, splints were applied in the field, and stretchers were created from found fabrics.

“It’s like ‘The Martian’ movie – some true, some Hollywood – but it keeps your head spinning,” said Gregory Vorontsov, a graduate student in bioastronautics, who aspires to become an astronaut. “The instructors throw out these problems, and it becomes: What do you do? How do you keep your head cool in crazy environments when chaos breaks out?”

Thinking from a different angle

Compared to the resources available on Mars, the medical systems on the International Space Station (ISS) are luxurious. For instance, if an ultrasound image is needed in orbit, an Earth-based doctor can provide real-time, step-by-step guidance from Mission Control. Or, if a major medical emergency occurs, an ISS astronaut could be at a terrestrial hospital within one to two days.

Prepping a rocket for launch
Gregory Vorontsov, left, a graduate student in bioastronautics, helps Sean Serell, MD, an anesthesiologist at UCHealth, prepare a rocket at the Mars Desert Research Station.

But many Earth-based interventions don’t work on Mars.

“You’ve got to start thinking medically from a completely different angle,” Vorontsov said. “You can’t even get right to the patient’s skin. Plus, the factors of (spacesuit) decompression, and what do you do if something breaks?”

There is also the very serious issue of surviving the actual trip to Mars. It’s a six- to nine-month voyage with no instant messaging to Earth; one-way communication delays, between a spacecraft and command center, range from four to 20 minutes each way.

“Whatever resources we take with us when we leave Earth are what we’re going to have with us for the entire time period of the mission,” Easter said. “Evacuating an injured crewmember to a hospital will be impossible, and resupply will be minimal to non-existent. So the design and scope of an exploration medical system really needs to be much more comprehensive than our current paradigm with the International Space Station.”

Pushing the limits

James Kurrle, MD, who is training to be an aerospace doctor in his native Australia, met Easter at an aerospace medicine course offered through the University of Texas Medical Branch. The UTMB class is where several of the wilderness medicine instructors met and started putting together the space medicine curriculum.

On day six in the desert, when the sky finally cleared, Kurrle glanced between the heavens and the terrestrial actions of another EVA. He watched the students prepare to launch a small rocket 12,000 feet above the research station. The plan was to precisely propel medical supplies hundreds of miles, from one Martian Hab to another.

While this rocket exercise amounted to a “micro” training, the blunt-talking Aussie sums up the challenges of “macro” space travel – and aerospace medicine – thusly: “You need to engineer the hell out of it to make it safe.”

Hab at night
The Mars Desert Research Station, located near Hanksville, Utah, glows under the desert night sky.

And that’s just considering the relatively short, into-orbit-and-back trips being launched by private companies such as SpaceX, Blue Origin and Virgin Galactic. Issues multiply astronomically when spaceflight extends millions of miles into a highly radiated environment, a place of no do-overs.

“Especially when it comes to medicine,” Kurrle said, “there’s the known unknown, and then there’s the unknown unknown – you don’t even know that you don’t know something. With classes like this, that’s where we’re trying to push the limits.”

Rocketing toward ‘risk analysis’

Rocket launch on Mars
Students in the aerospace medicine course launch a rocket 12,000 feet above the research station. In the simulation exercise, they propelled medical supplies hundreds of miles, from one Martian Habitat to another.

In addition to being a physician and an assistant professor in the CU School of Medicine, the Harvard-educated Easter is the Deputy Element Scientist in NASA’s Exploration Medical Capability, part of the space agency’s Human Research Program.

Easter said the “Medicine in Space” class intentionally draws from “probabilistic risk analysis,” a key element of engineering. It’s all about learning how engineers think and talk about buying down risk.

“We’re translating our medical expertise into the language that the rest of NASA is using,” he said. “Certainly, CU Boulder is one of the leaders in the world in this field of doing the actual research that’s helping NASA to buy down those risks.”

In a different iteration of the course, “Martian Medicine Analogue and Research Simulation,” Easter’s team teaches physicians, who come from all over the world, about medical emergencies arising in space. The healthcare professionals experience similar trials of communicating on a single radio frequency, trekking over foreign terrain, and prioritizing multiple issues to achieve the best outcome.

Discovering exceptionalism

For the students, many unforeseen challenges were best weathered with a laugh.

Like when tents somersaulted in the desert wind. Or when the tarp protecting their makeshift “mess hall” collapsed. Or when overnight temperatures plunged into the 30s.

Arika Armstrong, an aerospace graduate student as well as an engineer for Lockheed Martin Corp., said the adversity only enhanced matters. “You’re talking about isolated, extreme environments (of space), so what better than to throw a group of college students out in the rain and wind and cold and have them figure out how to deal with things?”

She recounted how all 21 students got on the same radio channel in the first EVA – “a disaster; everyone was talking to each other” – and by week’s end were nearly flawless in their communications. “We had to figure out how to make it work, and we absolutely did,” Armstrong said.

Anderson, the aerospace engineering professor, likewise saw students change; they grew in confidence and even discovered their exceptionalism.

Glowing helmet
A space helmet, worn by a CU Boulder aerospace engineering student, glows in the dark desert night. Communicating by radio with over 20 people proved to be quite challenging, the students learned.

“You see some students who were almost fearful of a leadership position over the course of the week say, ‘Yeah, I want to do that. I want to take charge, because I know that I’m needed right now,’” she said. “I think that’s another reason why the experiential learning is so important.”

Out-of-this-world goosebumps

Britney Force, a sophomore in aerospace engineering, kissed her comfort zone goodbye almost immediately.

First, her tent was tossed by the wind, and she slept the rest of the week in her SUV. Then, after a communications snafu on the search-and-rescue drill, she was thrust into a point position for triaging patients. Force, who aspires to work for Elon Musk’s SpaceX, said, “It was fun to be in charge … even for me, with no medical experience.”

Reflecting on the week – the moody weather, the tedious camp food and the rigorous curriculum – Force realized she was smitten.

“We first got in the spacesuits and stepped in the airlock and did the light exercise just like astronauts do. And then walking out,” she said, her eyes scanning the horizon. “It gave me goosebumps just to imagine what that would actually be like. It was really cool.”

Group photo on Mars
Students and instructors participating in “Medicine in Space and Surface Environments” enjoy a light moment near the end of the three-week Maymester class.

Instructors in the CU Anschutz-CU Boulder collaborative Maymester course, “Medicine in Space and Surface Environments,” were:

  • Benjamin Easter, MD, assistant professor of emergency medicine at the CU School of Medicine
  • Allison Anderson, PhD, assistant professor of aerospace engineering sciences at CU Boulder
  • Dana Levin, MD, Columbia University Department of Emergency Medicine
  • James Kurrle, MD, aerospace medicine resident in Australia
  • Arian Anderson, MD, emergency medicine resident at Denver Health
  • Joel Vaughan, MD, an EMT for UCHealth
  • Katie Joy, teaching assistant for the Department of Emergency Medicine, Wilderness Medicine Section, CU School of Medicine
  • Sean Serell, MD, anesthesiologist at UCHealth
  • Rick Cole, MD, flight surgeon at NASA and emergency medicine physician

Photos by Matt Kaskavitch, director of digital engagement in the Office of Communications, CU Anschutz.

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Over 400 CU Anschutz alumni attend ‘Wicked’ cultural event

Wicked reception

Scott Arthur at "Wicked"
Scott Arthur, vice chancellor of advancement at the CU Anschutz Medical Campus, welcomes alumni and their friends and family to the performance of “Wicked” on June 5.

Over 400 alumni of the CU Anschutz Medical Campus had a wicked good time in downtown Denver on June 5.

They attended the acclaimed musical production “Wicked: The Untold Story of the Witches of Oz” at the Denver Center for the Performing Arts. Deans from several schools and colleges at CU Anschutz also attended the event, which began with food and refreshments before the show in the Buell Theatre.

Scott Arthur, vice chancellor of advancement at CU Anschutz, welcomed the large crowd to the reception, noting that the function represented the first Alumni Relations cultural event that brought together all of the schools and colleges.

He told the gathering, which included graduates from decades past, that the CU Anschutz Medical Campus now has a larger economic impact in Colorado than the ski industry. “Think about it,” he said. “Think about how it’s grown, and think about the foundation that the people in this room have set and what you represent in Colorado because of your experience. We’re so happy that you’re here.”

Arthur also introduced Kara Padgett, the new senior director in the Office of Alumni Relations, who came to CU Anschutz in January.

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Tanning industry uses promos, cheap prices to lure adolescents and young adults

Woman laying in tanning bed

It’s well-known that cigarette smoking causes cancer and as a result, prices and advertising are closely regulated to discourage youth from starting.  But another cancer risk, indoor tanning, shown to cause melanoma, lags in regulation.

Researchers at the Colorado School of Public Health have found that the tanning industry uses marketing strategies that appeal to adolescents and young adults, including unlimited tanning packages, discounts, and even offering free tanning when paired with other services like an apartment rental or gym membership.

“This study highlights the fact that a lot of businesses out there are providing this service at a low cost which removes a barrier to adolescents and young adults,” said Nancy Asdigian, lead author of the study and a research associate in the Department of Community and Behavioral Health at the Colorado School of Public Health. “Young people who want to tan do so when they can afford it and don’t when they can’t.  The industry capitalizes on this with the strategies they use to price and promote this risk behavior.”

The study was published this week in the Journal of Public Health Policy.

According to the Global Burden of Disease Study, about 352,000 people worldwide were diagnosed with potentially deadly melanoma in 2015. That includes 81,000 cases in the U.S.

High profile public health and policy efforts along with state age restrictions have helped decrease the prevalence of indoor tanning among youth, but the study said levels remain  `unacceptably high.’

The researchers posed as customers and contacted tanning facilities in Akron, Ohio, Denver, Colorado, Austin, Texas, Boston, Massachusetts, Portland, Oregon and Pittsburgh, Pennsylvania. These cities were selected because they represent a variety of climate and geography as well as a range of stringency of state indoor tanning laws.

Of the 94 tanning places they contacted, 54 were primary tanning salons, and 40 were ‘secondary facilities’ that offered indoor tanning secondary to some other service like hair styling or physical fitness.

The study found that indoor tanning was free at 35 percent of secondary facilities. Nearly all apartments with tanning offered it free compared to 12 percent of gyms. Free tanning was most common in Austin.

Nearly all primary tanning salons offered time-limited price reductions.

“Many provide promos geared toward young adults. They offer packages that incentivize more frequent tanning. The more you use them the cheaper tanning becomes,” Asdigian said. “Everyone wants to get their money’s worth. When you buy a ski pass, you want to ski as much as possible.” In some cases, an individual tanning session could cost as little as $1 if the customer buys an unlimited monthly plan and uses it frequently.

Some countries, including Brazil and Australia, have banned indoor tanning salons altogether. The U.S. imposed a 10% tax on indoor tanning in 2010 and 19 states and the District of Columbia have enacted complete bans on indoor tanning for those under age 18.

But few of these policies have focused on the advertising, promotions or pricing practices of these facilities.

“A next step is to work with policymakers to restrict the use of discounts and deals to lure customers,” said Lori Crane, PhD, MPH, the study’s senior author and professor at the Colorado School of Public Health.

Another strategy would be to eliminate tanning provided in apartment complexes and fitness centers where tanning services are often free and less likely to be licensed and inspected by local regulators.

Asdigian said it’s important to understand the connection between pricing and the use of indoor tanning.

“In this study we described the costs and promotions,” she said. “An important question to answer is how variability in pricing impacts behavior. Establishing that link is an important step.”

The study co-authors include: Yang Lui; Joni A. Mayer; Gery P. Guy and L. Miriam Dickinson.

 

 

 

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Cancer care providers see benefit in medical marijuana, but not comfortable prescribing

Marijuana leaves

Portrait of Ashley Glode, Pharm D
Ashley E. Glode, Assistant Professor at the CU Skaggs School of Pharmacy and Pharmaceutical Sciences

A University of Colorado Cancer Center study presented at the American Society for Clinical Oncology (ASCO) Annual Meeting 2019 shows that while 73 percent of surveyed oncology providers believe that medical marijuana provides benefits for cancer patients, only 46 percent are comfortable recommending it. Major concerns included uncertain dosing, limited knowledge of available products and where to get them, and possible interactions with other medications.

“I think in some cases we’re missing out on providing a useful tool. Providers think it has benefit, but aren’t comfortable recommending it,” says Ashley E. Glode, PharmD, assistant professor at the Skaggs School of Pharmacy and Pharmaceutical Sciences, and the study’s first author.

Survey respondents included 48 specialized oncologists, 47 physicians, 53 registered nurses, 17 pharmacists, and 7 “other” oncology providers. Seventy-nine percent reported that educational programs both during training and as continuing medical education courses could increase their comfort level with medical marijuana prescribing. Interestingly, 68 percent of providers reported receiving information about medical marijuana from their patients – the next most common sources of information were news media (accessed by 55 percent of providers), and other providers (53 percent).

“We asked and most providers didn’t train in a state where medical marijuana was legal. We need to adapt our healthcare education to include this, and also offer trainings on medical marijuana to current providers,” Glode says.

Providers also reported legal and regulatory concerns, especially providers working in academic medical centers who expressed uncertainty whether recommending medical marijuana could jeopardize federal funding (marijuana remains a U.S. Drug Enforcement Agency Schedule 1 drug). Providers felt as if additional clinical data describing the effectiveness of medical marijuana and endorsed guidelines describing the conditions and situations in which it should be used would increase their comfort in prescribing.

“Still, the biggest issue that providers saw is the lack of certainty in dosing,” Glode says. “The issue is it’s not regulated – a dispensary might say a product has this much THC and this much CBD, but no one is testing that for sure. Limited data suggest that patients should start low and slow, no more than 10mg of THC in a dose, but we don’t know that’s what patients are really getting. Then from a consumption perspective, inhalation and smoking is the least preferred due to possible damage to the lung. So many doctors recommend edibles, oils, and tinctures, but we still don’t have good data comparing dosage across these forms.”

Glode and study colleagues including Stephen Leong, MD, hope to expand the survey to gather a more nationally representative sample.

“Knowledge is an issue,” Glode says. “If we could do a better job educating our healthcare providers, it might be used more often and potentially more safely.”

Story by Garth Sundem, writer at the CU Cancer Center.

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