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Research day: speed dating, unicorns and a gong show

Speed networking at post-doc research day

A whole day to celebrate being a postdoc? To my jaded postdoc sensibilities, the 10th annual Postdoctoral Research Day, themed “Transcending Boundaries” and featuring speed networking and a Gong Show, seemed guaranteed to drag me, kicking and screaming, out of my comfort zone.

Let’s face it: A symposium lasting 11 hours was approximately 10 hours, 45 minutes longer than postdocs typically spend on self-assessment.

The day at the CU Anschutz Medical Campus started with speed networking, which I thought might be like speed dating for nerds. Unlike speed dating, everyone I spoke with at the networking session was interested in me. I talked to a financial planner, a clinical psychologist promoting wellness strategies and several fellow PhDs with successful careers in academia, industry and K-12 education.

Feeling inspired by the morning session, I was ready for keynote speaker Alaina G. Levine’s talk, “You’re essential! Marketing your value to craft your unicorn career”. Levine, initially trained in physics and mathematics, described how bleak prospective job prospects drove her to create her own “unicorn” career through nonconventional paths. Levine is now an international keynote speaker, STEM career consultant and author of Networking for Nerds.

Postdoc day keynotes
Keynote speaker Alaine G. Levine, left, purveyor of lessons on self-worth and balance, stands with Rushita Bagchi of the Postdoctoral Association in front of a full house of postdocs, graduate students and other community members.

She asked, “What is the purpose of any job in any company in any industry in any part of the known universe?” (My guess: world domination.) “To solve problems,” Levine said. While scientists and engineers are excellent problem solvers, she noted, they are less skilled in the art of marketing their value to potential employers.

Check scientific jargon at the door

Ten scientific presentations from postdocs is normally about as fun as alphabetizing your canned goods, but before you stop reading: this year’s symposium featured a science “Gong Show”.

This innovative idea was developed by Project Bridge, a science communication and policy organization founded by a group of CU Anschutz postdocs. The Gong Show featured presentations lasting less than three minutes with a twist: no scientific jargon allowed. Attendees were given cowbells to shake violently at the first hint of technical terminology.

Somewhat disappointingly, however, there was minimal gong-ing of presenters. I think scientists are a generally a well-mannered audience; we are used to nodding politely despite having no idea what we just heard. Presenters covered a range of topics including balloons to depict fat cell size, cocaine and tacos to describe our brain’s reward system and how to keep transplant organs from spoiling en route to surgery.

Sex, sleep and life as a Yorkie

Second keynote speaker Rebecca Heiss, PhD, who specializes in the biology of business, gave a talk titled, “Survive to thrive: rewiring our brains for better in an epidemically stressed society”. While waiting for Heiss’ talk, a junior faculty member said, “I’m trying to decide if I have time to go to a seminar about stress.” This reinforced one of Heiss’ key points: no one is crueler than the voice inside our heads.

Gong show at postdoc research day
At the science gong show, Allison Porman, PhD, uses balloons to demonstrate how a molecule called “HOTAIR” can disrupt gene activity in cancer.

Heiss boiled our brains down to two key motivators: sex and survival. While we think we’re wolves searching for food and mates, we are actually Yorkies. “We’re not struggling for anything anymore,” she said, so our brain, hard-wired for conditions of scarcity, chooses the safest path, often to our detriment.

Nightmare incarnate

To retrain our brains, Heiss recommended getting comfortable with discomfort. Alarm bells should have gone off here, but they weren’t fast enough to save me from what happened next. She made us dance. Without music. For 15 seconds. Maybe this was not so different from speed dating…

When everyone was sufficiently mortified, Heiss said, “My point is that everyone is thinking about themselves. No one is thinking that you can’t dance.” In addition to seven hours of sleep and 10 minutes of meditation daily, Heiss told us to stop believing we can multitask. “Multitasking lowers your IQ by about 15 points,” she said. “I don’t know about you, but I need those 15 points.”

Happy hour afterwards felt like a support group for survivors who stayed all day. Despite my initial lack of excitement, looking back, I laughed more than I expected, made several new connections and got free beer and tacos (cue brain’s reward system).

I also left the symposium suspecting that I might, in fact, per keynote speaker Alaina G. Levine’s repeated reminder, rule the universe.

Postdoctoral Research Day award winners:

Travel award winners: Rushita Bagchi, PhD, and Stanley Kanai, PhD

Postdoctoral Service Award: Madeline Keleher, PhD

Postdoctoral Mentor Award: Anushila Chatterjee, PhD

First place poster awards: Swati Jain, PhD, and Allison Porman, PhD

First place seminar series award: Nuria Alegret, PhD

People’s Choice Gong Show Award: Shawna Matthews, PhD

Judges’ Choice Gong Show Award: Swati Jain, PhD

Guest contributor: Shawna Matthews, a CU Anschutz postdoc

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Bus revs up innovative access to sun safety

Neil Box and Sun Bus

Strolling across the manicured lawn of the Denver Polo Club under a bluebird Colorado sky, Neil Box, PhD, walks his sun-safety talk. He wears a wide-brimmed Wallaroo hat, dark sunglasses and EltaMD sunscreen, while greeting the many attendees of the recent “Mallets for Melanoma,” an annual fundraising event for the Colorado Melanoma Foundation (CMF).

Box, associate professor of Dermatology in the CU School of Medicine, is an expert on UV exposure and the measures to prevent the sun’s damaging effects, especially here in Colorado, where the rate of skin cancer diagnosis well exceeds the national average.

“I like to say to people, ‘You only have one skin, and once you’ve ruined it, it’s ruined,’” he says. “Everybody’s got a skin on them, and everybody’s getting sun damage.”

Making Coloradans sun smart

Box shows a guest a Colorado health creation – the Sun Bus – which in just a few months has rolled to the fore of the CMF’s community education efforts. A fixture at many of the state’s biggest summer festivals, the Sun Bus offers free skin cancer screenings and education, sun-safety products such as hats, shirts and sunscreen, as well as cutting-edge technology that measures hidden sun damage and shows exactly how sunscreen is covering – or not – your body.

Polo match at Mallets for Melanoma
Attendees of the “Mallets for Melanoma” fundraiser enjoyed watching polo matches on the grounds of the Denver Polo Club.

The well-equipped 40-foot-by-10-foot vehicle casts an impressive shadow – as well it should.

“That’s the beauty of it,” Box says of the bright-yellow bus. “It’s a big presence – highly visible. It gets people’s attention, and that’s what you need to do. We need to get people’s attention on this subject and get them thinking about skin health.”

Reveal imager on Sun Bus
“Mallets for Melanoma” attendees get their faces photographed at the Sun Bus’s reveal imager. Using polarized wavelengths of light, the imager reveals hidden sun damage in the skin.

The Sun Bus is playing a key role in the CMF’s awareness building, including in July, which is UV Safety Awareness Month. “Our bus is a driving billboard – a massive billboard for our project. Our partners, who have their logos on the bus, help steer money toward a cause that we know is important to our community,” Box says. “There’s a huge interest in having free screenings available.”

Big numbers

Since debuting at Denver’s Cinco de Mayo festival, the Sun Bus has been at events with a total of over 600,000 people. Also:

  • It has provided over 550 free skin screenings;
  • It has referred over 70 people with lesions to specialty care, with the on-bus clinicians noting that at least three of those cases were likely to be melanomas.
  • It has hosted over 12,000 significant engagements where people interacted with the technology, information and products available on the bus.

“These are big numbers,” says Box, CMF president. “The bus is having an impact.”

And that’s a good thing, he adds, because skin-cancer prevention efforts in the United States haven’t kept up with how treatment options have significantly “launched forward” in the last eight years. “In the screening and prevention space, we need to keep up with the progress the oncologists have made.”

Researching susceptibility to skin cancer

The Sun Bus has a research component as well. Along with researchers in the CU Cancer Center, and assisted by interns from the Gates Summer Internship Program (through the Gates Center for Regenerative Medicine), and CU medical students and staff, Box is looking for genetic factors that make some people more susceptible to skin cancer.

Why Colorado is a burner

Colorado gets some of the highest UV exposure levels in the nation because of its altitude and average of 300 sunny days per year. Box said there are more UVA and UVB rays present in Colorado because of the state’s altitude.

Both UVA and UVB rays can cause mutations in the DNA and other kinds of skin damage, he said. “The nature of the problem here is that sun damage is higher than a lot of other places because the exposure you’re getting is that much more potent.”

At Denver’s altitude of 5,280 feet, people are exposed to 26 percent more UV in the visible light than at the same latitude at sea level, he said. At 10,000 feet, they are exposed to 50 percent more UV in the visible light, and climbing a 14,000-foot-peak they are exposed to 70 percent more UV.

Key measures to prevent sun damage are: limit your time in the sun; wear a hat, sunglasses, sun sleeves and/or a sun shirt; and use at least 30 SPF broad-spectrum sunscreen on exposed skin and reapply every two hours. For more information on sunscreens, follow the American Academy of Dermatology’s recommendations on sunscreen.

Researchers are age-, sex- and genotype-matching subjects from the Cancer Center’s cutaneous oncology clinic with non-melanoma subjects from the general community, he says, “and seeing if we can find better ways to capture the results of environmental exposures in relation to melanoma epidemiology and skin cancer epidemiology.”

Box notes there are more skin cancers than any other cancer type. In the United States, about 3 million non-melanoma skin cancers – such as basal- and squamous-cell carcinoma – are diagnosed each year. Melanoma, the deadliest type of skin cancer, is the most frequently diagnosed cancer in women in their 20s and 30s. In Colorado, 1,800 new melanomas will be diagnosed this year and about 140 of those patients will die.

“We’re above the national average for sure,” Box says. “We’re in the highest levels of UV exposure but states like Washington and Oregon get higher per-capital rates of melanoma than Colorado.”

Steering toward alignments

Box hails from Australia, which has mounted successful public awareness campaigns about sun safety, resulting in significant improvements in skin cancer rates, and he’d like to see similar efforts occur in the States. Unlike other nations where governmental programs lead the way in raising awareness, “in the U.S. it has to happen through corporate money and finding alignments where (the campaign) fits the business partners’ strategy.”

The Sun Bus concept is the brainchild of Karen Nern, MD, a CMF board member and the Market Medical Director for Epiphany Dermatology’s Vail, Aspen, Breckenridge and Glenwood Dermatology clinics. The Sun Bus is sponsored by EltaMD skincare, the Cancer League of Colorado, Vail Health and other local stakeholders.

It’s gratifying to see people of all ages stroll up to the Sun Bus and learn habits that can lead to a much healthier future, especially here in outdoors-oriented Colorado.

“We need to get creative in how we bring these types of services to people. It’s about creating reasonable healthcare access,” Box says. “And it’s very appropriate that we are trialing a program like the Sun Bus right here in Colorado because of the sun exposure we get. It would be great to see similar programs emerge in the Southern states as well.”

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Opioid Prescribing Rates Higher in U.S., Study Finds

Hydrocodone Pill Bottles

AURORA, Colo. (July 24, 2019) – Physicians in the United States may prescribe opioids more frequently to patients during hospitalization and at discharge when compared to their physician peers in other countries, according to a recently published study led by researchers from the University of Colorado School of Medicine.

The study reviewed prescribing practices at 11 academic hospitals in eight countries – the United States, Canada, Spain, Italy, Taiwan, South Korea, the United Kingdom, and New Zealand. The four hospitals in the United States were the University of Colorado Hospital, Denver Health, Hennepin Healthcare in Minneapolis, and Legacy Health in Portland, Oregon.

“Compared with patients hospitalized in other countries, a greater percentage of those hospitalized in the US were prescribed opioid analgesics both during hospitalization and at the time of discharge, even after adjustment for pain severity as well as several other factors like how ill the patients were,” wrote the authors of the article that was published online today in the Journal of Hospital Medicine.

The first author of the article is Marisha Burden, MD, associate professor of medicine at the CU School of Medicine and head of the Division of Hospital Medicine.

The study is important because the epidemic misuse of opioid medications has led to addiction and premature death in many communities across the country.

For the newly published study, the researchers approached 1,309 eligible patients and 981 of them consented to the study. Five hundred three were in the United States and 478 were from other countries. Seventy-nine percent of the patients in U.S. hospitals who experienced pain were prescribed opioids during hospitalization, compared with 51 percent of patients at the sites in other countries.

In addition to prescribing practices, the authors note that the patients’ perception of pain and the cultural biases toward pain medication may have affected the prescribing practices.

“While we observed that physicians in the US more frequently prescribed opioid analgesics during hospitalizations than physicians working in other countries, we also observed that patients in the US reported higher levels of pain during their hospitalization,” Burden and her co-authors wrote. “Our study also suggests that reducing the opioid epidemic in the US may require addressing patients’ expectations regarding pain control in addition to providers’ inpatient analgesic prescribing patterns.”

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Greater prevalence of congenital heart defects in areas with high intensity of oil and gas well activity

Mothers living near more intense oil and gas development activity have a 40-70% higher chance of having children with congenital heart defects (CHDs) compared to those living in areas of less intense activity, according to a new study from researchers at the Colorado School of Public Health.

“We observed more children were being born with a congenital heart defect in areas with the highest intensity of oil and gas well activity,” said the study’s senior author Lisa McKenzie, PhD, MPH, of the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus.  At least 17 million people in the U.S. and 6% of Colorado’s population live within one mile of an active oil and gas well site.

Dr. Lisa McKenzie
Lisa McKenzie, PhD, MPH, of the Colorado School of Public Health

The study was published today in the peer-reviewed journal Environment International.

The researchers studied 3,324 infants born in Colorado from 2005-2011. They looked at infants with several specific types of CHDs.

Researchers estimated the monthly intensity oil and gas well activity at mother’s residence from three months prior to conception through the second month of pregnancy.  This intensity measure accounted for the phase of development (drilling, well completion, or production), size of well sites, and production volumes.

They found mothers living in areas with the most intense levels of oil and gas well activity were about 40-70% more likely to have children with CHDs. This is the most common birth defect in the country and a leading cause of death among infants with birth defects. Infants with a CHD are less likely to thrive, more likely to have developmental problems and more vulnerable to brain injury.

Animal models show that CHDs can happen with a single environmental exposure during early pregnancy. Some of the most common hazardous air pollutants emitted from well sites are suspected teratogens – agents that can cause birth defects – known to cross the placenta.

The study builds on a previous one that looked at 124,842 births in rural Colorado between1996-2009 and found that CHDs increased with increasing density of oil and gas wells around the maternal residence. Another study in Oklahoma that looked at 476,000 births found positive but imprecise associations between proximity to oil and gas wells and several types of CHDs.

Those studies had several limitations including not being able to distinguish between well development and production phases at sites, and they did not confirm specific CHDs by reviewing medical records.

The limitations were addressed in this latest study. Researchers were able to confirm where the mothers lived in the first months of their pregnancy, estimate the intensity of well activity and account for the presence of other air pollution sources. The CHDs were also confirmed by a medical record review and did not include those with a known genetic origin.

“We observed positive associations between odds of a birth with a CHD and maternal exposure to oil and gas activities…in the second gestational month,” the study researchers said.

The study data showed higher levels of CHDs in rural areas with high intensities of oil and gas activity as opposed to those in more urban areas. McKenzie said it is likely that other sources of air pollution in urban areas obscured those associations.

Exactly how chemicals lead to CHDs is not entirely understood. Some evidence suggests that they may affect the formation of the heart in the second month of pregnancy. That could lead to birth defects.

McKenzie said the findings suggested but did not prove a causal relationship between oil and gas exploration and congenital heart defects and that more research needs to be done.

“This study provides further evidence of a positive association between maternal proximity to oil and gas well site activities and several types of CHDs,” she said. “Taken together, our results and expanding development of oil and gas well sites underscore the importance of continuing to conduct comprehensive and rigorous research on health consequences of early life exposure to oil and gas activities.”

The study co-authors include William Allshouse, PhD, BSPH and Stephen Daniels, MD, PhD, both of the University of Colorado Anschutz Medical Campus.  The study was funded by a grant from the American Heart Association.

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The importance of the mental side of healing

Bruce Gordon

Bruce Gordon has always been an athlete. Climbing mountains, endurance swimming and biking came naturally to him.

But he also had a lingering concern that had always weighed on him: a family history of heart attacks. And in November 2017, that genetic propensity caught up to him. While he was at the airport heading for his departure gate, Gordon suffered a major heart attack that required multiple resuscitations and triple bypass surgery at UCHealth University of Colorado Hospital to save his life.

After surgery and the physical recovery that followed, Gordon entered unfamiliar territory. He struggled with anxiety and a feeling of fragility, and he was ultimately afraid he was going to have another heart attack. It became clear that he needed to seek mental health support.

“The anxiety was paralyzing,” he says. “I remember my daughter coming up to me and touching me on the shoulder, and I jumped. I couldn’t believe it. It was like I was having PTSD.”

What many people don’t realize, says C. Neill Epperson, MD, chair of the Department of Psychiatry at the University of Colorado School of Medicine, is that “Having a severe or life-threatening medical problem like a heart attack can have a direct, negative effect on brain health – from functionality, to how you feel, to how you think about your health moving forward.

“When you’ve experienced a traumatic event or a life threatening health condition, you can feel terrified and helpless in the moment, and that feeling of extreme fear doesn’t automatically go away just because the event is over,” Epperson explains. “Memories of the event are indelibly encoded in the brain. However, things we may have seen, smelled, heard or thought during the event can also become linked to it in such a manner that they provoke a similar terror when re-experienced, even in a safe context. We can become anxious, irritable and jumpy. As Mr. Gordon discovered during his recovery, trauma-informed, cognitive behavioral therapies change the brain so that these memories – potential triggers for anxiety and worry – are no longer as powerful.”

“You have to address the mental side of healing,” says Gordon, who worked with a sports psychologist to help him navigate this essential aspect of his recovery. “Even if you reach a point when you’re feeling good physically, if you’re pushing down the pain or the trauma of the mental side, it’s going to manifest itself in a negative way. You can’t be afraid to face it – to let your emotion come out, to cry. Talking to someone professionally is super important.”

Learn more about Dr. Epperson’s insights into the relationship between mental health and physical health in the video below.

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Helicopter crash victim reflects on life-saving medical care

Repshers at waterfall

Amanda Repsher vividly recalls watching flight nurses load her husband on board a helicopter. Less than two hours earlier, his own crew’s helicopter had crashed during a failed takeoff, erupting into a ball of flames and scorching nearly all of Dave Repsher’s body.

As a wife, Amanda found the irony chilling. As a critical care nurse, she knew it could mean the difference between life and death.

“When he got here, he was so critical, they rushed him from the ED to the burn ICU,” Amanda told Theresa Nino’s Med-Surg II class. “By the time he got up there, he had lost pulses in his extremities.”

Amanda and Dave Repsher
It’s been four years since the helicopter crash that changed the lives of Amanda and Dave Repsher. They recently accepted the invitation of College of Nursing Clinical Instructor Theresa Nino to speak during one of her classes.

Nino, MSN, CCRN, clinical instructor in the University of Colorado College of Nursing, cared for Dave during his 397-day stay in the UCHealth University of Colorado Hospital. The highly publicized crash killed the pilot and injured another flight nurse.

Many things united in saving Dave’s life since that July 3 day four years ago, the Repshers said. However, a chief factor, and one reason they shared their story with Nino’s class, was the wide expertise found on the CU Anschutz Medical Campus and the quality of care they received.

‘I didn’t know if he was going to make it’

By the time Amanda rushed into the hospital after a 90-mile ride from Frisco, the site of the crash, her husband was through his first emergency surgical procedure in the tub room.

“He was in there for four hours,” Amanda said. “That’s where they make the determination of how badly burned you are and do immediate interventions,” she said of the tub room.

Dave, who had gone from ski patrol to paramedic to his longtime dream of flight nurse, suffered severe burns over 90 percent of his body, most of them full-thickness burns, some down to the bone.

“I was desperate to be with him, because I didn’t know if he was going to make it through the next couple of minutes,” said Amanda, whose critical-care background included five years at the UCHealth hospital that became her home for the next 13 months.

Her fear was warranted. The burn surgeon told family members he did not expect Dave to survive the night. “And if he does,” Amanda recalled him saying, “it’s going to be a marathon.”

‘I was probably on fire for a good couple of minutes’

A rush of cold fuel pouring over his shoulders and down his back was Dave’s first recollection after the crash. The drenching, combined with no clothes under his flight suit on the hot July day, literally fueled the burn.

“The only places that were spared were under my helmet and underwear and two spots where I had some reference books in my pockets,” Dave said, showing the class a slide of his flight suit, tattered and half gone despite its fire-retardant material.

Theresa Nino, clinical instructor College of Nursing
Theresa Nino, a clinical instructor in the College of Nursing, invited Dave and Amanda Repsher to speak during one of her classes.

“I was probably on fire for a good couple of minutes before a fire extinguisher finally got to me and put me out.”

During his hospital stay, Dave underwent 53 surgeries and lost more than half of his body size, going from a muscular 180 pounds to a low of 89. Labeled the “sickest patient in the hospital,” statistically speaking, he should have died.

‘Had they not known … he would be blind now’

“You guys will learn as you go through your burn rotations that you really want to be at a major burn center if you are in Dave’s situation,” Amanda said. Having the burn team’s expertise made a difference in his care, as did having the broad multidisciplinary skills that exist on this campus, she said.

Amanda counted 47 specialties involved in her husband’s care.

One example, she said, happened the day after the crash. Excess fluid that plagues burn patients was causing Dave’s entire body to swell.

“Right off the bat, he was tanking,” she said. But because staff members were keenly aware of all the complications that could arise, they noticed a dangerous pressure buildup behind his eyes.

With an ophthalmologist right there doing rounds, the team quickly performed pressure-reducing procedures (canthotomies). “That saved his vision,” Amanda said. “Had they not known to look for that, he would be blind now.”

‘You are the ones who are going to really make a difference’

After the team fixed his eyes, his burn ICU nurse noticed Dave was in real trouble, with pressure buildup compromising his blood flow. “They took him into the OR and opened up his belly, and he was like that for two days,” Amanda said.

Dave Repsher next to helicopter
Dave Repsher stands next to a Flight for Life helicopter at his job as a flight nurse. Four years ago this month, he was severely burned in a helicopter crash in Frisco.

Again, Dave beat the odds because of an alert nurse, Amanda said. “You are the ones who are going to really make a difference,” she said, her husband nodding from behind.

“There are going to be times,” Dave said, “where you need to be the one to step in. Don’t be afraid to do it.”

‘He wouldn’t be alive without the antibiotics’

For the next five and a half months, in a chemically induced state of sedation, Dave battled for his life, undergoing excruciatingly painful therapies along the way. He remembers none of it because of the sedatives, mostly ketamine, that Amanda insisted on his having to erase any memories that could haunt him later.

Amanda continually faced nearly impossible decisions and the fear of losing her partner. When one of the deadliest forms of infection for burn patients struck Dave (mold), doctors told Amanda that the antibiotic therapy needed would cost him his kidney function. It did, along with most of his hearing. He eventually underwent a kidney transplant.

“But he wouldn’t be alive without the antibiotics,” Amanda said.

‘I cried harder than I’ve ever cried’

When Dave then developed severe bleeding in his chest, things changed. He deteriorated so much after surgery that the team decided pulling back on the sedation drugs was necessary. Suddenly, Dave “woke up.”

“It just went from black to white, like a camera shutter,” Dave said. All of the sudden, he knew he was in a hospital bed, attached to a slew of tubes and machines. “I had no concept of the passage of time. I didn’t know if I’d been there for five days, five months or five years.”

All he knew was he could not move, and he could not talk, two things the active outdoor lover and passionate nurse did not like. “I thought: This isn’t good,” he said.

“I knew the second he woke up,” Amanda said, “because he looked me straight in the eyes, and he hadn’t done that for five and half months.” Immediately, Dave began mouthing the words: “I want to die.”

“I was a wreck,” Amanda said, adding that her husband eventually passed out, and she walked back to the apartment she stayed in on the edge of campus. “I cried harder than I’ve ever cried.”

The next day, however, after realizing his muteness and immobility were temporary and getting some encouraging words of support from his wife and former coworkers, it was, as his wife put it: “Game on.”

‘The therapy teams … helped me get that back’

“It was a long process,” the difficulty of the past four years indescribable, Dave said. Severe, full-body atrophy left ever swallowing food again, let alone walking again, questionable.

“It was scary,” he said. “The only PTSD I have is from ice chips and applesauce,” Dave said, drawing one of a few laughs from the class that morning, his sense of humor shining through despite the grim subject matter.

But he relearned to swallow and to walk, thanks to his multidisciplinary care team, he said. “I think we know the entire staff at this hospital,” said Dave, who still has regular medical visits on campus. “I can’t speak enough of the therapy teams here. They knew how we lived our lives, very active and outdoors, and helped me work toward getting that back.”

‘I love being a nurse. I miss it. I really do.’

Dave has had many firsts since that July 3 day. First time on skates (Dave loves hockey.) First time on skis. First time hiking.

Next up? “I’m looking forward to getting back on the river and going rafting and camping,” Dave said. “I think spiritually for us, that’s going to be the biggest milestone.”

Pointing out how hard his ordeal was on his wife mentally, Dave told the class to take care of their families. Talk to them. Talk to your patients, he said. “I can’t say that enough. Communication is everything.”

Although the students have a big job ahead, the rewards are unlike in any other career, Dave said. “It’s the only field I can think of — medicine and nursing — where people come to you and give you 100 percent trust,” he said. “I love being a nurse. I miss it. I really do.”

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Caring for the Frontline promotes teamwork and self-care

Morning sunlight pours through windows at the CU Anschutz Health and Wellness Center, inviting guests to take a break to focus on their health. A team of six nurses from the UCHealth Outpatient Infusion Clinic, still dressed in scrubs, are eager to spend an afternoon learning about wellness, nutrition and fitness.

They are here for Caring for the Frontline, which AHWC launched six months ago. The program, originally intended to address nurses’ daily stress and challenges, has since given 20 teams of nurses and healthcare professionals at CU Anschutz the tools to manage their health, wellness and nutrition. Although still in its pilot stage, the program is expected to become a regular AHWC offering and will likely expand to faculty and staff.

Lisa Wingrove, RD, CSO, has overseen the program’s development and credits its success to being offered at the AHWC rather than in the workplace, as the separation helps foster teambuilding and self-care. “The program is offered off-site at the Wellness Center and helps address team needs, especially in times of change, stress or burnout caused from the job,” she said.

Half-day of wellness

Participants begin with lunch, giving them time to bond as a team while sharing a healthy meal together. They then learn practical mindfulness techniques from a clinical psychologist.

But teambuilding is not the only outcome of Caring for the Frontline. Self-care is a major theme addressed during the half-day of wellness, where participants learn how to manage stress and take time out of their day to care for themselves.

Healthy meal prep at AHWC
As part of the Caring for the Frontline program participants learn how to cook healthy meals, including recipes that are fast and simple that can be cooked during the week.

A private one-hour yoga class is another part of the program, as well as a 10-minute massage. Finally, participants learn how to cook healthy meals, including recipes that are fast and simple that can be cooked during the week.

“We make recipes easy and affordable to show participants that healthy nutrition is attainable, and we show them how to cook recipes that are realistic, fast, taste good and budget-friendly that can fit within their busy lives,” said Wingrove.

Wingrove incorporates gratitude into every session. Before the team’s arrival, cards are shared with the nurses’ leadership and each session begins by giving the hand-written cards to each team member to show them that they are acknowledged and valued. “Demonstrating gratitude is important,” she said. “Receiving thanks makes everyone feel valued.”

Creating positive impacts

Caring for the Frontline has had a positive impact on participant’s lives, offering them support and resources and demonstrates the value of teamwork and practicing gratitude. “This program made me feel valued as an employee because my team thought enough to invite me,” said one participant.

The program teaches participants how to take care of themselves, which is essential to ensure they provide quality service to others.

“Taking care of themselves is essential if they are taking care of others,” said Wingrove.

Additionally, Caring for the Frontline shows participants the importance of self-care, urging them to take time out of their day to practice what they learned. According to one participant, “[I learned] how important it is to take time for myself, and that really 20 minutes of breathing, mindfulness or cooking a healthy meal is doable in that timeframe.”

Guest contributor: Katherine Phillips

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Story of a CU Anschutz-driven breakthrough

Nichol Miller and family

Under the sunny skies that return to Portland, Ore., every summer, Nichol Miller is enjoying a life of family and purpose. The mother of three soaks in the milestones of graduations, weddings and anniversaries as well as the simple pleasures of seeing her kids head off to school and her husband come home from work.

All this seemed improbable just a few years ago – even impossible. Stricken with an aggressive soft-tissue sarcoma that started in her hip flexor and quickly spread to her lungs, Miller traveled to Denver to participate in a clinical trial of an experimental therapy.

She called it her “hail Mary.”

Breakthrough in the making

At the CU Cancer Center at the CU Anschutz Medical Campus Miller met Robert Doebele, MD, PhD, associate professor of medicine, CU School of Medicine, who had found – thanks to an immortal cell line donated by another cancer patient – the abnormal gene NTRK1 in the cancer of that patient, who also happened to be a mother of three children.

Doebele’s discovery set the stage for a breakthrough therapy.

Nichol Miller and Robert Doebele
Nichol with Dr. Robert Doebele at the CU Cancer Center after undergoing the successful clinical trial drug for her aggressive cancer in 2015.

“The finding of an NTRK1 gene fusion in the lung cancer patient made me want to develop a therapy for patients with this type of genetic mutation as none had existed beforehand,” he said. “This led my lab to perform a number of experiments demonstrating that this gene was cancer-causing and, importantly, that cancer cells with this gene could be inhibited with a selective TRK inhibitor called ARRY-470, now better known as larotrectinib.”

When Miller arrived at the CU Cancer Center, breathing was almost impossible without five litres of oxygen per minute. Put on the targeted-therapy drug in spring 2015, called LOXO-101 at the time and taken orally as a pill, Miller showed immediate improvement.

FDA approves targeted-therapy drug

Miller still takes the drug, now commercially known as Vitrakvi, on cycles that start every 28 days. During the cycles ­– she’s currently on her 56th – Miller takes the pill twice a day, and will continue doing so for the rest of her life.

She and her family celebrated when the Food and Drug Administration (FDA) approved Vitrakvi last November.

Early on in the development of targeted therapies, Doebele said, researchers saw examples of cancers such as EGFR mutation-positive lung cancer in which mutations seemed to occur in only one type of cancer, or that perhaps a therapy would only work on a mutation when it was found in certain types of cancer.

“When we started planning the clinical trial (of LOXO-101) I had the idea, based on data from our laboratory showing that lung, colon and leukemia cells responded to therapy as long as they had the right genetic fusion in an NTRK gene, that we should include any tumor type as long as it had an NTRK gene fusion,” Doebele said.

Drug attacks the genetic markers in cancer

Because Miller’s tumors had this specific gene fusion, the therapy had the desired effect: her lung tumors began to shrink and disappear and tumor markers in her blood showed dramatic declines. The drug works by targeting the proteins that are abnormally turned on by a gene fusion event. It essentially kills the cancer or stops it from growing.

“The term is ‘tumor agnostic,’ and that’s part of what’s unique about this drug,” Miller said. “It’s not linked to a particular cancer, or where a cancer is found in the body, but linked instead to the genetic markers in the cancer.”

Now her life is marked by milestones.

‘Lab saved my life’

This spring, Miller, 46, got to see her oldest son get decked out for prom and then graduate from high school. For her birthday in March, she and her husband enjoyed a week in Florida – the first time in 18 years of marriage they vacationed without their children.

Nichol Miller is now a cancer patient advocate, frequently speaking in her home state of Oregon as well as during a recent trip to Denver. Here, she is pictured with fellow presenters at an Oregon Health & Science University panel. Pictured from left: Lara Davis, MD; Miller; Summer Gibbs, PhD; and Shannon McWeeney, PhD.

“I wouldn’t be talking to you without (the clinical trial at the Cancer Center),” she said. “It was huge. It was my miracle. It gets easier with time, but I still think about how close I came (to dying), and it makes you appreciate everything so much more and gives you a lot more patience.”

Miller likes to say “the lab saved my life” because she gives full credit to the important cancer studies being performed by researchers at the CU Cancer Center as well as, closer to her home, the Oregon Health & Science University. The gene mutation found in her cancer is very rare; only 1 to 3 percent of all solid cancers have the NTRK1 mutation.

“I wouldn’t be here without the all the work of the researchers and the doctors who are trying to solve the cancer puzzle.” – Nichol Miller

“I wouldn’t be here without the all the work of the researchers and the doctors who are trying to solve the cancer puzzle,” she said. “The genetic testing that found my alteration is incredibly important because the chances of finding something are rare, but for that one person it’s life or death. It’s a new way of looking at cancer.”

When physicians do genetic testing on a patient, Doebele said, they look not only for a specific mutation, such as NTRK, but rather a host of other rare genetic events that may already have, or may soon have, effective therapies.

A standout clinical trial

The clinical trial he administered to Miller stood out for a number of reasons. A key part was the 46-year-old mother who had never smoked but, by 2012, had developed metastatic lung cancer. Unfortunately, at the time there were no drugs available that could treat her illness. Before she died, the woman gave Doebele a sample of her tumor to grow an immortal cell line that could be used for further research and to test drugs against this type of cancer.

Nichol and Marc Miller
Nichol and her husband, Marc, take in the sunset at the Snake River gorge in Twin Falls, Idaho, on their return trip home from the clinical trial in Aurora in 2015. “We knew the drug was working,” Nichol says.

Her donation ended up helping another young mother, Miller, and potentially countless patients in the future.

“Her sacrifice and forethought is something I’m so grateful for,” Miller said of the patient who donated her cells. “I know that’s something people are working on at a national level – to make it easier for people to donate genetic material for research. There’s a lot of valuable information that just goes into the incinerator.”

And that’s another part of Miller’s clinical trial that stands out.

It shows how an understanding of cancer biology can reveal genetic markers which are tested in human tumors, thereby accelerating potential therapies to target the cancers, Doebele said. “We identified NTRK1 in lung cancer in 2012, published the initial laboratory findings in 2013 and 2014 and had started the trial by early 2014 with an FDA approval only a few years later in 2018.”

‘There’s always hope’

For Miller, telling her story and furthering the cause of genetic testing is now a big part of her purpose. She recently returned to Denver as a featured speaker at the “Stupid Cancer” conference, and she frequently shares her story at other venues as a patient advocate.

“My story is unique, and it’s a good story for giving people hope,” Miller said. “I read a lot of survivor stories and they’re what kept me going – knowing there’s always hope.”

Mainly, she’s joyful to share in the life of her family, and seeing her teenagers grow into healthy and happy adults.

“Ultimately, I’d like my children to grow up into a world where there is no longer a fear of cancer,” Miller said. “It doesn’t have to be a death sentence.”

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Has soccer become more dangerous?

Scoring a decisive 2-1 win over England in a dramatic Women’s World Cup semifinal match – and netting both of their goals via skillful “header” shots, no less – defending champions Team USA advance to play for their fourth World Cup title in the tournament final this Sunday, July 7.

Fan excitement for Women’s World Cup soccer is reaching a fever pitch – drawing record numbers of viewers for this year’s tournament in France, with a total of 1 billion viewers expected across platforms worldwide – and enthusiasm for playing the game is reflected in the breadth and depth of talented athletes taking the field. Globally, an estimated 30 million women play soccer today, and the elite-level players selected for World Cup competition are considered by some experts to be “the deepest and most talented” group ever.

As women’s soccer has become even more dynamic and fun to watch, has it also become more dangerous to play? Specifically with regard to concussions and head injuries?

In the United States, conversations around sports-related concussions often focus on athletes who play American football. To gain insight and answers about head injuries related to the sport the rest of the world calls “football,” we spoke with Dawn Comstock, PhD, associate professor of epidemiology at the Colorado School of Public Health.

Comstock has spent over a decade researching sports injuries across America in an effort to make sports safer for adolescent athletes. In 2014, she was one of five experts invited by the White House to meet President Obama and speak at the Healthy Kids and Safe Sports Concussion Summit. As part of her extensive research, Comstock developed High School RIO (Reporting Information Online), the country’s first national high school sports injury surveillance system, which collects athletic trainer-reported data from a large, nationally representative sample of U.S. high schools.

How prevalent are soccer-related injuries compared to injuries incurred by playing other sports? 

soccer injury
A soccer player goes down with a head injury in a game.

In 2017-2018, out of the 22 sports included in High School RIO, girls’ soccer had the second highest competition-related injury rate after football. The football competition injury rate was 14 injuries per 1,000 Athletic Exposures. (One high school athlete participating in any one practice or competition equals one Athletic Exposure, or “AE.”) The competition injury rate for girls’ soccer was 6 injuries per 1,000 AE, while boys’ wrestling, boys’ lacrosse, boys’ ice hockey, boys’ soccer, and girls’ basketball all had injury rates between 4 and 5 injuries per 1,000 AE.  However, during practice, the injury rate was lower in girls’ soccer than in football or wrestling and, again, similar to several other sports. So soccer simply is not as dangerous as the recent media has made it out to be.

Do youth soccer players suffer higher concussion rates than adolescents who play other sports?

In 2017-2018, girls’ soccer had the third highest competition concussion rate among the 22 sports in High School RIO (20.4 concussions per 10,000AE), but only the 5th highest practice concussion rate (1.9 concussions per 10,000 AE). Boys’ soccer had the 7th highest competition concussion rate (8.7 concussions per 10,000AE) and the 6th highest practice concussion rate (1.9 concussions per 10,000 AE).

To put this in perspective, football had a competition concussion rate of 39.1 per 10,000 AE and a practice concussion rate of 4.4 per 10,000 AE. Also, in all gender comparable sports, girls have higher concussion rates than boys.

Do soccer players who suffer concussions have longer recovery times than athletes who get concussions from playing other sports?

No. While we, and other researchers, have noted gender-related differences in the type of signs and symptoms athletes with concussions present with, and some researchers have reported that girls take longer to recover from concussions than boys, we have not seen any significant difference in type, number, or length of concussion signs and symptoms by sport.

Are soccer players more likely to suffer a concussion from “heading” the ball, or from head-to-head or head-to-body contact?

While heading the ball is the most common soccer-specific activity during which concussions occur (30.6 percent of all boys’ soccer concussions and 25.3 percent of all girls’ soccer concussions occurred when the player was heading the ball), the true culprit is actually athlete-to-athlete contact, which occurs in other phases of play as well as during heading. In fact, 78.1 percent of all boys’ soccer concussions and 61.9 percent of all girls’ soccer concussions resulted from athlete-to-athlete contact.

Remember, although soccer has become more and more aggressively played over time, most contact is still illegal by the rules of the game. Thus, if you really want to reduce concussions in soccer, you would be much more successful if you simply enforced the rules of play and decreased the amount of athlete-to-athlete contact than if you banned heading.

Have you recorded any data that show a change in concussion rates in states that have implemented guidelines to prevent/limit these types of injuries in soccer practice and matches?

We are conducting that study right now, but we don’t have results ready to share.

Are there any recommendations you would make, based on your research, for minimizing injuries and improving overall soccer safety for youth athletes?

Lower extremity (e.g., ankle and knee) sprains and strains are very common in soccer. Athletes should be well conditioned, as proficient as possible in soccer skills, and must be encouraged to follow the rules of the game and avoid foul play. Parents can make sure coaches are well trained and don’t run dangerous drills or push athletes beyond a safe limit. They can also be sure the league in which their child plays has well-trained refs who enforce the rules of the game.

Additionally, exertional heat events, while rare, are a concern. Athletes must stay hydrated and breaks must be provided in extreme temperatures. Athletes who experience any heat event must be cooled as quickly as possible; for minor events, moving them into shade/air conditioning and giving them cold fluids will likely be sufficient, but for serious events they should be immersed in ice water or have their armpits and groin packed with ice while EMS services make their way onto the field.

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Women in STEM symposium tackles tough issues

Women in STEM participants

After moving from Puerto Rico to the University of South Alabama for graduate school, Sonia Flores, PhD, encountered her share of biases. Recalling how she fit in to her new town and with her new classmates, Flores said, “It was a culture shock for me, and it was definitely a culture shock for them.”

Flores is now Vice Chair of Diversity and Justice for the Department of Medicine and a Professor in the Division of Pulmonary Sciences and Critical Care Medicine. As keynote speaker for the Women in STEM (WiSTEM) symposium held June 5 at the CU Anschutz Medical Campus, Flores tackled the subject of microaggressions and unconscious biases in academia.

Sonia Flores, PhD
Sonia Flores, PhD, delivered the keynote address at the WiSTEM symposium.

Flores distinctly remembers the first time she was made to feel like a minority for being different. In graduate school, while dissecting a cadaver with a group of three white men, her fellow group members constantly assigned her to note taking duty. After she finally suggested they take turns, Flores said, “I was surprised by the ferocity and meanness of the comments,” which included questions of citizenship, immigration status, and whether she had earned her place vs. being chosen to fill a diversity quota.

She began to question whether she had in fact earned her position. Though she didn’t know it at the time, she was experiencing imposter syndrome, a term for the pervasive self-doubt, insecurity, and feelings of fraudulence that accompany one’s position or accomplishments. Imposter syndrome is pervasive in academia, particularly among women and underrepresented minorities.

The new face of bias

While outright bigotry is easy to spot, Flores said that microaggressions, called the new face of bias, are much harder to identify as these are delivered in the form of subtle snubs, dismissive looks, gestures and tones. Examples include: “Don’t worry your pretty little head about it” and “Don’t you people all like spicy food?” Other examples include mansplaining, referencing appearance in the context of sexual orientation, and “translating” for an international student despite their strong grasp of English. “Feeling down, feeling burned out, lower job motivations”— these can all be after-effects of interactions plagued by microaggressions, she said.

If microaggressions are hard to identify, how can we deal with them? “Make the invisible visible,” Flores suggested, by engaging others in open conversation. Be observant; notice reactions when someone is uncomfortable. “Interrupt microaggressions even if you’re not the recipient.” She went on to add the importance of recognizing our own biases. “We all have biases, but studies show that the more we interact with people from other cultures, the more welcoming we are.”

Inherited biases

An attendee at the WiSTEM symposium, Xiao-Jing Wang, MD, PhD, Professor of Pathology and Director of the Head and Neck Cancer Research Program, believes that training in racial and gender diversity should be required, particularly for faculty in leadership positions. “It should be like the Responsible Conduct of Research training,” Wang said, which is mandatory for federally funded researchers at the university. “If someone messes up an experiment because they didn’t have the right training, it’s not their fault — they didn’t know the right way to do it.”

Wang wondered about the microaggressions and unconscious biases that trainees in her program could be exposed to as well as what they internalize. “As a faculty member training junior scientists, I feel like current social issues will not be issues for the next generation, because the next generation is more open-minded than our generation,” Wang explained. “But it doesn’t happen automatically. Without conscientious effort to promote racial and gender diversity, the next generation will inherit the same biases.”

Inspired by Flores’ talk, Wang created a plan for her own training program to help trainees recognize bias and microaggressions to promote a healthy work environment.

Conspicuous absences

Despite over 70 attendees at the WiSTEM symposium, one demographic was largely and conspicuously absent. Where were all the men?

Keynote speaker Flores, when asked about the low male attendance, said, “[Men] generally believe that these organizations have been formed to correct the issue of a lack of women in STEM and that in general, they would feel out of place in such a gathering. It is fairly intimidating when you are one of only a few; exactly the feeling we have experienced through years of women in science being under-represented.”

To paraphrase, men may be skipping events like the WiSTEM symposium out of a belief that these events, being organized BY women, are exclusively FOR women.

The symposium, organized entirely by women in academia at CU Anschutz, featured inspirational talks on non-traditional career paths, a career panel with industry and academic panelists, a workshop on coping with imposter syndrome developed by WiSTEM co-founder Ashley Bourke and a networking reception with awards ceremony.

2019 WiSTEM symposium awards:

  • Outstanding Admin: Teresa Bauer-Sogi, Graduate School
  • Outstanding Ally: Neel Mukherjee, PhD, Biochemistry and Molecular Genetics
  • Outstanding Community Service: Erin Chaussee, MS, Biostatistics and Informatics
  • Outstanding Mentor:‎ Linda van Dyk, PhD, Immunology and Microbiology
  • Outstanding Professor:‎ Jennifer Kiser, PhD, Pharmaceutical Sciences
  • Outstanding Researcher ($500 travel grant):‎ Bridget Graney, MD, Pulmonary Sciences and Critical Care Medicine

Guest contributor: Shawna Matthews is a postdoctoral fellow at CU Anschutz. 

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