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Hitting the streets in hepatitis A battle

Scott Harpin administers shots

With an armed police officer and grocery cart stuffed with backpacks and suitcases behind him, Scott Harpin snapped on his latex gloves and fished out his supplies from a six-pack cooler.

“Which side?” Harpin asked, as he de-capped a needle. His patient tapped his left arm in response and rolled up his sleeve.

“I’ll try to avoid the ink,” Harpin said, quick with some tattoo-related wit designed for relaxing his patient as he aimed the needle just below the man’s left shoulder.

Hardly the sterile, quiet scene of a medical office, Harpin’s mobile clinic environment that bright July morning included trees, fountains and the roar of traffic as he circled Denver’s central Civic Center Park in search of people in need of hepatitis A shots.

Harpin, PhD, MPH, RN, a University of Colorado College of Nursing and Colorado School of Public Health associate professor, joined a volunteer crew of public health workers focused on halting a hepatitis outbreak largely hitting the city’s swelling homeless population.

“This is my chance to come out and be a nurse,” said Harpin, whose research and community service projects focus largely on the nation’s homeless health issues. “I miss the one-to-one contact,” said the popular instructor, whose genuine smile and upbeat personality worked well with the day’s slightly leery clientele.

‘One shot is better than no shot’

“No, I’m good,” a lone woman on a park bench said, rejecting the free vaccine offer after hearing Harpin and his partner’s spiel about the viral liver disease spreading through homeless encampments nationwide.

“Are you sure? We’re in an outbreak. People are getting sick, and it’s really easy to spread,” said Harpin, co-director of the DNP/MPH dual degree program educating tomorrow’s public health nurse leaders.

Scott Harpin gives shot in Denver
Harpin gives a hepatitis A shot to a homeless person in Denver’s Civic Center Park.

The woman shared a common concern expressed that day — the vaccine requires a booster in six months, a tough commitment with a transient lifestyle.

Although the woman stuck with her decision, a few people changed their minds after Harpin explained an initial dose supplied at least 75% protection (up to 95%) against the liver disease. “One shot is better than no shot,” he told them.

Homeless conditions feed outbreaks

The threat is serious, particularly within large homeless populations. The unsanitary conditions of street living feed hepatitis A outbreaks. The virus spreads through infected stool, including via traces on the ground and unwashed hands. Washing hands with soap and water, often hard for people experiencing homelessness, was a chief message of the day.

Other routes of infection include sexual contact, shared smoking materials and IV drug use, with the opioid and homeless crises both boosting infection.

Although rarely fatal, the disease can kill people with compromised livers, such as those already infected with cirrhosis or hepatitis B or C. And it can make people really sick for as long as six months. A 2017 California outbreak centered on its homeless population, infecting 700 people and killing 21.

On the streets: ‘I can’t afford to get sick’

As of July 31 in Colorado, 106 cases and 75 hospitalizations had been reported in the state.

“Shoot me up,” one man said, sticking out his arm, after learning the disease’s transmission routes.

“I don’t want to get sick,” another man said. “I’m out here on the street, and I can’t afford to get sick. My health is already bad enough.”

With upwards of half of Colorado’s 10,000-plus homeless population entrenched in the Denver-metro area, health providers are offering free vaccine clinics across the city until the threat ceases.

Officer helps with team’s success

“This isn’t even the tip of the iceberg,” Denver Police Department Officer Toby Wilson said of the scores of homeless people filling the park.

Wilson works on the Homeless Outreach Team, monitoring and educating people generally in or near the city’s shelters.

Although it was his first time escorting a mobile vaccine clinic, his caring demeanor and ability to connect with people dramatically increased Harpin’s team’s success that day.

“He’s the hero,” Harpin said of Wilson, who, at times, was convincing people to get a vaccine faster than Harpin could keep up.

Volunteers make a difference

“Before we’d even gotten started, he called us over to check out a man who was sick,” Harpin said of Wilson. The man’s yellow skin and eyes were telltale hepatitis signs, and the team gave him a taxi voucher and sent him off for care.

Hepatitis A symptoms

Yellow eyes or skin, diarrhea, pale stools, cola-colored urine, nausea, fatigue.

“It’s an important drop in the bucket for public health,” Harpin said of his couple of hours of work that morning, which he does regularly. “Even if people have already been vaccinated, we are making connections with them and educating them,” he said. “We are letting them know that we are here for them and that we care.”

To volunteer for the city’s campaign, which has resulted in more than 4,200 people being vaccinated since October 2017, contact Allison Seidel at allison.seidel@dhha.org or 303-602-3587.  

Guest contributor: Debra Melani,  CU College of Nursing.

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Battling the opioid abuse crisis in Colorado

Robert Valuck at Naloxone event at the state capitol

The Colorado Consortium for Prescription Drug Abuse Prevention has a simple but important message for all Coloradans: Bring naloxone home.

The message is straightforward, but it packs an important punch. In Colorado in 2018, an opioid overdose occurred every 16 hours – many of which could have been prevented by administering naloxone, an easy-to-use medication available without a prescription to anyone at most pharmacies across the state.

State leaders recognize the scope of the crisis and the importance of naloxone. Gov. Jared Polis has declared August to be Colorado Naloxone Awareness Month. The proclamation recognizes that “prescription opioid misuse and abuse is a public health crisis in Colorado, with long-term health consequences, including addiction, overdose, and death, and has a profound impact on Colorado families and communities.”

The governor’s proclamation emphasizes that Coloradans should learn about and obtain naloxone. So does U.S. Surgeon General Jerome Adams, who recommends that any person exposed to opioids either through prescriptions, illicit drug use or via a friend or loved one using the drugs should know how to use naloxone and keep it within reach.

Ending opioid overdose deaths is an urgent issue in Colorado – in 2018, 543 people died from overdoses that involved prescription opioids such as oxycodone and hydrocodone or illegally obtained opioids such as heroin and fentanyl.

“We’re following the Surgeon General’s lead by encouraging Coloradans to understand how important it is to know what naloxone is, how to use it, how to purchase it, and to keep it in your home, car or on your person so it’s available when needed,” said Robert Valuck, PhD, RPh, executive director of the Colorado Consortium for Prescription Drug Abuse Prevention and a professor at the University of Colorado Skaggs School of Pharmacy. “The bottom line is: If you have opioids in your home, you should also have naloxone. If someone you know or love is taking opioids, be sure to tell them about naloxone.”

When administered at the moment of an opioid overdose, naloxone blocks opioid receptors in the body, effectively reversing the impact of the overdose and saving the person’s life – thereby allowing time to call 911 to receive medical assistance. Available as a nasal spray or injectable, naloxone is portable, affordable and easy to administer. Although naloxone (also known by the brand names Narcan and Evzio) requires a prescription, a standing order issued by the Colorado Department of Public Health and Environment allows any Colorado resident to purchase the drug at a pharmacy simply by requesting it. Naloxone has been used to reverse more than 1,122 opioid overdoses in Colorado since mid-2017.

A common misconception is that opioid overdoses only impact people who use heroin or others using illicit drugs. However, many people are prescribed opioids by their doctors to manage pain, which can cause accidental overdoses if used incorrectly or mixed with other medications or alcohol. People might be at risk even if they have a prescription and might only be taking opioids for a few days – which is why it’s critical for consumers to purchase naloxone and know how to use it.

“The opioid epidemic is a public health crisis for Colorado. We’ve lost far too many of our fellow citizens,” Sen. Brittany Pettersen and Rep. Chris Kennedy, the chair and vice-chair of the General Assembly’s Opioid and Other Substance Use Disorders Interim Study Committee, said in a joint statement. “Many overdose deaths occur at home by people who might not realize they’re at risk, and naloxone could have saved their lives. People should know if they or a loved one take an opioid medication, they should have naloxone, just to stay safe.”

Throughout the summer and fall, the Colorado Consortium for Prescription Drug Abuse Prevention is running paid advertisements throughout Colorado with the “Bring Naloxone Home” message, encouraging residents to visit their pharmacy, ask about naloxone and purchase it. In addition, many of the Consortium’s partners across the state will be holding events throughout the month to generate awareness of the issue in communities across all regions of Colorado.

“We’ve recently experienced a slight decrease in drug overdoses in Colorado, which is an encouraging sign,” said Valuck. “However, we still lost 543 people to opioid overdoses in 2018, which is a significant number of people to lose to something that is so preventable. Our goal is to continue that downward trend by getting naloxone into the hands and homes of as many Coloradans as possible.”

For more information, including a video about how to use naloxone, visit www.bringnaloxonehome.org.

Guest contributor: Michael Davidson, Colorado Consortium for Prescription Drug Abuse Prevention.

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Video: First Responders In Space

Your breath rasps as you carry out a strenuous EVA (extra-vehicular activity) rocket-payload retrieval to bring critical supplies to humanity’s first Martian colony. Suddenly, you lose your footing and feel a snap in your lower leg. Gut tells you: a break. Through the pain, you radio your team about the injury. What are you going to do when help is 250 million miles away? 

At the remote Mars Desert Research Station in southern Utah, where the landscape is bathed in reddish hues that mirror our solar system neighbor, a unique, collaborative and first-of-its-kind program to answer that question and tackle the practical needs of medicine beyond Earth is taking place. 

For everything from muscle atrophy to cardiac arrest to broken bones, future Red Planet explorers will need the skills and adaptable technology to respond quickly to health issues in the most extreme and austere of environments. Fitting challenges for a planet named, and represented in several cultures, for war and destruction. 

To address those life-and-death variables is where the combined knowledge of two powerhouse departments – CU Anschutz’s Emergency Medicine and CU Boulder’s Aerospace Engineering – comes together. “Medicine in Space and Surface Environments” is a Maymester course to train doctors and engineers to be the first first responders in space. 

With the close proximity, partnership and the high level of expertise of both institutions, as well as several Colorado-based aerospace firms, it’s the perfect environment in which to hold the only class of its kind in the nation. 

Take an inside look at the course and collaboration between the CU Anschutz Medical Campus and CU Boulder in the video here: 

This innovative blending of disciplines 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. One of the main goals of the course is connecting the disciplines of engineering and medicine to, as Easter puts it, “improve what we can accomplish in human space flight.” Easter and Anderson co-lead the class, which puts students through a variety of simulations to expose them to interconnected complexities of interplanetary travel. Simultaneously, the course offers an experience to take the synergy of medicine and engineering and apply it to extreme environments on Earth when help isn’t immediately around.

But travel to Mars, and the medical and technical challenges and solutions arising out of such an endeavor, is arguably a human impulse to see what’s over the horizon. 

It calls to mind the message Carl Sagan recorded for future astronauts on Mars, which was embedded on a special silica glass DVD on the Phoenix lander; touching down on the Martian surface in May of 2008. 

Maybe we’re on Mars because we have to be, because there’s a deep nomadic impulse built into us from the evolutionary process. We come after all from hunter gatherers and for 99.9 percent of our tenure on earth, we’ve been wanderers and the next place to wander to is Mars. 

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Researchers discover why intense light can protect cardiovascular health

Researchers at the University of Colorado Anschutz Medical Campus have found that intense light amplifies a specific gene that bolsters blood vessels and offers protection against heart attacks.

“We already knew that intense light can protect against heart attacks, but now we have found the mechanism behind it,” said the study’s senior author Tobias Eckle, MD, PhD, professor of anesthesiology at the University of Colorado School of Medicine.

The study was published today in the journal Cell Reports.

Tobias Eckle, MD, PhD, professor of anesthesiology
Tobias Eckle, MD, PhD, professor of anesthesiology

The scientists discovered that housing mice under intense light conditions for one week `robustly enhances cardio protection’, which resulted in a dramatic reduction of cardiac tissue damage after a heart attack. They also found that humans could potentially benefit from a similar light exposure strategy.

In an effort to find out why, they developed a strategy to protect the heart using intense light to target and manipulate the function of the PER2 gene which is expressed in a circadian pattern in the part of the brain that controls circadian rhythms.

By amplifying this gene through light, they found that it protected cardiovascular tissues against low oxygen conditions like myocardial ischemia, caused by reduced oxygen flow to the heart.

They also discovered that the light increased cardiac adenosine, a chemical that plays a role in blood flow regulation.

Mice that were blind, however, enjoyed no cardio protection indicating a need for visual light perception.

Next, they investigated whether intense light had similar effects on healthy human volunteers. The subjects were exposed to 30 minutes of intense light measured in lumens. In this case, volunteers were exposed to 10,000 LUX, or lumens, on five consecutive days. Researchers also did serial blood draws.

The light therapy increased PER2 levels as it did in mice. Plasma triglycerides, a surrogate for insulin sensitivity and carbohydrate metabolism, significantly decreased. Overall, the therapy improved metabolism.

Eckle has long known that light plays a critical role in cardiovascular health and regulating biological processes. He pointed out that past studies have shown an increase in myocardial infarctions during darker winter months in all U.S. states, including sunnier places like Arizona, Hawaii and California. The duration of the light isn’t as important as the intensity, he said.

“The most dramatic event in the history of earth was the arrival of sunlight,” Eckle said. “Sunlight caused the great oxygen event. With sunlight, trillions of algae could now make oxygen, transforming the entire planet.”

Eckle said the study shows, on a molecular level, that intensive light therapy offers a promising strategy in treating or preventing low oxygen conditions like myocardial ischemia.

He said if the therapy is given before high risk cardiac and non-cardiac surgery it could offer protection against injury to the heart muscle which can be fatal.

“Giving patients light therapy for a week before surgery could increase cardio protection,” he said. “Drugs could also be developed that offer similar protections based on these findings. However, future studies in humans will be necessary to understand the impact of intense light therapy and its potential for cardio protection.”

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University Police achieves prestigious accreditation from international organization

Police accreditation ceremony

CU Anschutz Chancellor Don Elliman welcomed the news that our University Police Department has been awarded a prestigious accreditation from an international law enforcement organization.

“It is with great pride that I share the news of this high honor, the c­ulmination of a lengthy effort by our outstanding police department to meet international best-practice standards and thereby further raise the exemplary service and stature of our campus public safety officials,” Elliman said.

The International Association of Campus Law Enforcement Administrations (IACLEA) has 1,033 institutional and more than 4,000 individual members worldwide, mostly in the United States and Canada, and only 69 have achieved this high honor of accreditation. The department went through an extensive on-site assessment last fall and subsequent commission review.

Statement of accountability

“It’s very relevant to what we do in a university setting,” said CU Anschutz Police Chief Randy Repola. “Also, it’s a statement to the community about our accountability.”

University Police Smidt
University Police Commander Steve Smidt talks about an emergency exercise between University Police and the Aurora Police Department earlier this summer.

Repola attended the June conference where University Police received its accreditation. Joining him in Vancouver, British Columbia, were University Police colleagues Steve Smidt, Doug Hayes and Wendy Grover, as well as Terri Carrothers, CU Anschutz Executive Vice Chancellor for Administration and Finance and Chief Financial Officer.

Smidt, Hayes and Grover played key roles in moving the four-plus-year process forward – momentum that was well under way when Repola became chief in April 2017. “Chief (Doug) Abraham had the wisdom and vision to start this process,” Repola said. “I inherited it halfway through and decided to finish it.”

“Working with this police department is very rewarding, and we appreciate what they do every day on our behalf,” EVC Carrothers said. “Being able to share in this event with Chief Repola and the team in Vancouver was  incredible. This IACLEA accreditation was hard work, and it further validates their sincere dedication and professionalism. Well done former Chief Abraham, Chief Repola, and your amazing team. You all knocked this one out of the park!”

Reaccreditation every four years

The IACLEA Accreditation Standards manual is made up of 215 standards in which police departments, in order to become accredited, must prove compliance. “So, there’s a lot of updating of your policy manual,” Repola said. “There were days we sat in the conference room for many hours rewriting policies.”

Besides requiring documented proof of compliance with the standards, IACLEA requires regular training to occur in key aspects of law enforcement. “Probably 90 percent (of the requirements) are things the community doesn’t see because our supervisors are doing what they’re supposed to do, so it doesn’t become an issue in the community,” the chief said.

IACLEA’s reaccreditation evaluations occur every four years. Repola said the process will likely be easier next time around, as the standards and best practices will have been in place with a consistent culture of compliance.

The cooperation and buy-in of everyone in University Police, including during a mock-assessment exercise the department put itself through before the assessors’ on-site visit, was essential to the successful bid for accreditation, Repola said.

“It’s fine to have policies in place, but if we didn’t have the buy-in from middle managers and the rest of the team, this would not have been possible,” he said.

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CU Movement Disorders Center named a Center of Excellence

The University of Colorado Movement Disorders Center is now one of now 48 International Centers of Excellence designated by the Parkinson’s Foundation.

CU Motion Disorders Center group photo.
Faculty and staff of the University of Colorado Motion Disorders Center. Center co-directors are Dr. Maureen Leehey, bottom row, far left, and Dr. Lauren Seeberger, bottom row, center.

Designations this year were focused on medical centers that focus on underserved populations. “Other criteria included the ability to provide the highest level of evidence-based patient-centered care, conduct relevant clinical research that serves patient priorities, demonstrate leadership in professional training and conduct impactful patient education and community outreach.”

Here is a link to the Parkinson’s Foundation news release.

The Center of Excellence network is an important part of the Parkinson’s Foundation goal to ensure everyone living with Parkinson’s has access to expert care so they can live better lives. Every center must recertify after five years to ensure the required standards of care.

The center is located within the CU School of Medicine. Dr. Lauren Seeberger and Dr. Maureen Leehey will serve as co-directors of the CU Movement Disorder Center.

Guest contributor: Nicole Leith, Movement Disorders Center Coordinator and Marketing Specialist.

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Expectant mothers can mitigate the impact of marijuana on baby’s brain development

Mother and baby

A team of researchers led by members of the University of Colorado School of Medicine at the Anschutz Medical Campus found that choline, an essential micronutrient, can prevent fetal brain developmental problems that can occur when mothers use marijuana while pregnant.

The findings are critical because marijuana use can negatively impact fetal brain development and early childhood behavior, such as increased impulsivity and memory dysfunction.

The study was published today in Psychological Medicine.

Camille Hoffman, MD, MSCS, associate professor, University of Colorado School of Medicine
Camille Hoffman, MD, MSCS, associate professor, University of Colorado School of Medicine

“In Colorado, it’s common for women to use marijuana before they know they’re pregnant and some continue to use as a natural remedy for morning sickness, depression and anxiety,” said Camille Hoffman, MD, MSCS, associate professor of maternal fetal medicine, University of Colorado School of Medicine. “In this study, we found that maternal marijuana use begins to negatively impact the fetal brain at an earlier stage in pregnancy than we expected. However, we also found that eating choline-rich foods or taking choline as a supplement may protect the child from potential harm.”

Negative impact of maternal marijuana use

Fifteen percent of 201 mothers in the study used marijuana both before and beyond 10 weeks gestation. Infants of mothers who continued to use marijuana beyond 10 weeks had decreased cerebral nervous system (brain) inhibition at one month of age. Decreased brain inhibition this early in development can relate to problems in attention and social function. Later in life, this can translate into a predisposition to conditions like substance abuse, depression and psychosis.

In addition, infants exposed to prenatal marijuana beyond 10 weeks gestation had lower “regulation” scores at 3 months of age. This can cause decreased reading readiness at age 4, decreased conscientiousness and organization as well as increased distractibility as far out as age 9. These adverse effects in the infant were not seen if women had higher gestational choline in the early second trimester.

Overall, results showed maternal choline levels correlated with the children’s improved duration of attention, cuddliness and bonding with parents.

A step in the right direction

“We already know that prenatal vitamins improve fetal and child development, but currently most prenatal vitamins do not include adequate amounts of the nutrient choline despite the overwhelming evidence of its benefits in protecting a baby’s brain health. We hope that this research is a step towards more OB-GYNs, midwives and other prenatal care providers encouraging pregnant women to include choline in their prenatal supplement regimen,” Hoffman adds.

This study is the first to detect central nervous system effects of marijuana in human newborns and it identifies a vulnerable gestational period for the impact of marijuana on fetal brain development that is earlier than anticipated – as early as the end of the first trimester. Usually reporting in studies are retrospective and don’t look at the effects of marijuana ingestion at different trimesters.

Marijuana use was assessed during pregnancy from women who later brought their newborns for study. Mothers were informed about choline and other prenatal nutrients and advised to avoid alcohol, tobacco, marijuana and other drug use. Maternal serum choline was measured at 16 weeks’ gestation.

This study was conceived and initiated by the late Randal G. Ross.

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CU Nursing’s Pearl Treyball wins Nightingale Luminary Award

Mona Pearl Treyball

Mona Pearl Treyball, PhD, hoists a 20-plus-pound trophy up in the air for a guest to see. For the nursing professor, the bronze statue of a kneeling Florence Nightingale cradling a patient in her arms represents more than her recent win. It affirms her life’s work.

From the frontlines of the battlefield to the halls of academia, the retired Air Force colonel and University of Colorado College of Nursing professor has fought for the care and protection of this country’s military families for nearly 30 years.

Pearl Treyball is a 2019 winner of the Nightingale Luminary Award. The prestigious award recognizes excellence and innovation in nursing that extends Nightingale’s legacy.

“If you look closely, it appears she’s caring for a soldier,” Pearl Treyball said of the poignant statue of Nightingale comforting a person on the ground, just as she did on the battlefields of the Crimean War 165 years ago. “So our nursing profession is really rooted in caring for our military veterans.”

One of 24 selected for the this year’s regional award (out of 255 nominations), and one of 12 selected from 60 luminaries across the state, Pearl Treyball won for her work as founder and specialty director of the Veteran and Military Health Care (VMHC) program on the CU Anschutz Medical Campus.

April Giles
April Giles, Fitzsimons Innovation Community vice president of business development

Last year, U.S. News and World Report recognized Pearl Treyball and her program for service and innovation.

Other CU Anschutz colleagues recently recognized:

  • April Giles, Fitzsimons Innovation Community vice president of business development, has been selected as a finalist for the Denver Business Journal’s “Outstanding Women in Business Award.” Giles leads strategy and growth initiatives for the Fitzsimons Innovation Community. The prestigious 21-year-old award program recognizes women from the Denver metro area for their innovation, entrepreneurship, professional accomplishment and community leadership.
  • The University of Colorado School of Medicine has been recognized as an Employer of Excellence (EOE) for its support of physician assistants and other advanced practice providers at the CU Anschutz Medical Campus. The recognition comes from the American Academy of Physician Assistants’ Center for Healthcare Leadership and Management (CHLM). CHLM partnered with HealthStream to gain an understanding of what PAs value in their place of employment. Criteria for the EOE awards focused on: a positive and supportive PA work environment; providing opportunities for PAs to provide meaningful input that leads to positive organizational change; keeping PAs informed about organizational activity and decisions; involving PAs in leadership efforts to improve the quality of patient care; and creating processes for effective conflict management.

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Mars Video

Your breath rasps as you carry out a strenuous EVA (extra-vehicular activity) rocket-payload retrieval to bring critical supplies to humanity’s first Martian colony. Suddenly, you lose your footing and feel a snap in your lower leg. Gut tells you: a break. Through the pain, you radio your team about the injury. What are you going to do when help is 250 million miles away? 

At the remote Mars Desert Research Station in southern Utah, where the landscape is bathed in reddish hues that mirror our solar system neighbor, a unique, collaborative and first-of-its-kind program to answer that question and tackle the practical needs of medicine beyond Earth is taking place. 

For everything from muscle atrophy to cardiac arrest to broken bones, future Red Planet explorers will need the skills and adaptable technology to respond quickly to health issues in the most extreme and austere of environments. Fitting challenges for a planet named, and represented in several cultures, for war and destruction. 

To address those life-and-death variables is where the combined knowledge of two powerhouse departments – CU Anschutz’s Emergency Medicine and CU Boulder’s Aerospace Engineering – comes together. “Medicine in Space and Surface Environments” is a Maymester course to train doctors and engineers to be the first first responders in space. 

With the close proximity, partnership and the high level of expertise of both institutions, as well as several Colorado-based aerospace firms, it’s the perfect environment in which to hold the only class of its kind in the nation. 

Take an inside look at the course and collaboration between the CU Anschutz Medical Campus and CU Boulder in the video here: 

This innovative blending of disciplines 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. One of the main goals of the course is connecting the disciplines of engineering and medicine to, as Easter puts it, “improve what we can accomplish in human space flight.” Easter and Anderson co-lead the class, which puts students through a variety of simulations to expose them to interconnected complexities of interplanetary travel. Simultaneously, the course offers an experience to take the synergy of medicine and engineering and apply it to extreme environments on Earth when help isn’t immediately around.

But travel to Mars, and the medical and technical challenges and solutions arising out of such an endeavor, is arguably a human impulse to see what’s over the horizon. 

It calls to mind the message Carl Sagan recorded for future astronauts on Mars, which was embedded on a special silica glass DVD on the Phoenix lander; touching down on the Martian surface in May of 2008. 

Maybe we’re on Mars because we have to be, because there’s a deep nomadic impulse built into us from the evolutionary process. We come after all from hunter gatherers and for 99.9 percent of our tenure on earth, we’ve been wanderers and the next place to wander to is Mars. 

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Researchers Making Progress On Causes of Vitiligo

Close up fashion portrait of a african male with white pigmentation caused by vitiligo.

AURORA, Colo. (July 30, 2019) – A pair of new journal articles by researchers at the University of Colorado School of Medicine indicate that both genetic and environmental factors play significant roles in the onset of vitiligo, an autoimmune disease that results in the loss of color in blotches of skin.

The findings also show that while the tools for scientific understanding of the genetic basis of a complex disease like vitiligo have advanced, there are still many other as-yet-unidentified factors that contribute to vitiligo’s onset.

“Vitiligo has been perhaps the easiest of all complex diseases to sort out,” said senior author Richard A. Spritz, MD, director of the Human Medical Genetics Program and professor of pediatrics at the CU School of Medicine. “Through years of previous studies, we have identified what could be called a ‘vitiligo parts list’ of 50 common contributory genes/risk variants.”

Spritz and his co-authors reviewed two types of vitiligo cases – simplex and multiplex. In most instances, vitiligo appears in individuals with no family history of the disease, which are referred to as the simplex cases. In the multiplex cases, there are other family members with vitiligo.

A paper by Spritz and his co-authors in The American Journal of Human Genetics combines the 50 vitiligo common risk variants together to make a vitiligo “genetic risk score,” and then compared the simplex and multiplex cases.

“The paper could be called a first chapter to the ‘vitiligo instruction manual,’” Spritz said. “We found that the vitiligo genetic risk score is higher in the multiplex families than in the simplex cases, and the more affected relatives in the family the higher the risk score. That means that vitiligo in multiplex families and simplex cases is basically the same, but that the families with multiple affected relatives have higher genetic risk. That means that the same treatments probably will be effective in both types of cases.”

Cropped back view of beautiful young European woman with skin condition that causes loss of melanin posing indoors. Slender slim female model in black tank top suffering from vitiligo disorder
A young woman posing who suffers from Vitiligo, an autoimmune disease that results in the loss of color in blotches of skin.

That finding complicates the ability of scientists and physicians who want to predict who might be affected by vitiligo. Simplex cases and multiplex cases seem to mostly involve the same underlying genetic variants, with different patients just having different combinations of genetic risk variants. Such a finding complicates the use of predictive personalized medicine to diagnose and treat complex diseases, Spritz said, because there doesn’t appear to be genetically-defined patient subgroups with different underlying biology who might thus respond differentially to personalized treatments.

In addition to Spritz, the authors of the article are Genevieve H.L. Roberts, a PhD candidate in human medical genetics and genomics at CU Anschutz Medical Campus at the time of writing the article; Subrata Paul, a PhD candidate in statistics at CU Denver; Daniel Yorgov, PhD, assistant professor of applied statistics at Purdue University Fort Wayne; and Stephanie Santorico, PhD, professor and director of statistical programs at the Colorado School of Public Health.

Second article

In the second article, which is published as a letter to the editor in the Journal of Investigative Dermatology, Spritz and his co-authors note that the average age of the onset of vitiligo in patients has changed dramatically over past decades.

“Vitiligo converted from being principally a pediatric-onset to principally an adult-onset disease over the period 1970-2004,” Spritz said. “That is amazing. Our genes haven’t changed over that period of time; altered genes or even gene effects don’t seem to be the cause. This must reflect some beneficial environmental change that somehow delays or reduces vitiligo triggering in people who are genetically susceptible. What was it? We don’t know.”

The authors write that one or more environmental changes seem to have altered triggering of vitiligo and delayed disease onset, with a similar pattern both in North America and in Europe. “While this apparently beneficial change provides an extraordinary inroad to discover vitiligo environmental triggers, the number of potential candidates is enormous,” Spritz and his colleagues write.

Among just a few of the possibilities in the United States: The Clean Air Acts of 1963 and 1970, the Nuclear Test Ban Treaty of 1963, the Water Quality Act of 1969, the establishment of the Occupational Safety and Health Administration in 1970. Globally, sunscreens with sun protection factor ratings were introduced in 1974. Even eating habits may contribute. The authors note that yogurt consumption became more common in the early 1970s, which potentially altered the gut microbiome for many people.

In addition to Spritz, the authors of the letter in Journal of Investigative Dermatology, are Ying Jin, MD, PhD, senior instructor of pediatrics, and Stephanie Santorico, PhD, professor and director of statistical programs at the Colorado School of Public Health.

Guest contributor: Mark Couch, School of Medicine. 

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