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Love dogs? Train a service canine for a good cause

Military member with puppy

Do you love dogs? The Warrior Canine Connection (WCC), a partner of the Marcus Institute for Brain Health, is looking for volunteers interested in puppy parenting and puppy sitting for its service dogs in training.

The WCC uses a mission-based trauma recovery model to help military service members recovering from the stress of combat, as well as reconnect with their families and communities and enhance their quality of life.

By interacting with the dogs as the canines move from puppy-hood to training to adult service dogs, warrior/veteran trainers benefit from a physiological and psychological animal-human connection. As a result of their efforts, veterans with disabilities receive the finest in trained service dogs.

This is an opportunity to give back to those who have served our nation. One service dog helps more than 60 recovering warriors as the canine is raised, trained and then paired with a veteran.

Service dog at CU Anschutz
A service dog poses outside the Marcus Institute for Brain Health at CU Anschutz.

If you are interested in being a part of raising and training these special dogs, or if you have any questions, please contact Ann Spader at aspader@warriorcanineconnection.org or 240-495-3008.

The Marcus Institute for Brain Health, located at the CU Anschutz Medical Campus, provides specialty care for military veterans and retired athletes struggling with mild to moderate traumatic brain injuries and changes in psychological health.

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Heart surgeon answers your most common heart health questions

Muhammad Aftab, MD

Ever wonder if a glass of red wine or piece of dark chocolate is actually good for you? Or if sitting all day is really that bad for you? Muhammad Aftab, MD, assistant professor of cardiothoracic surgery at the University of Colorado School of Medicine, answers common questions about heart health.

What is an easy step to take when shopping for groceries that’s heart healthy?

Fresh produce is always a great and easy step to take. Fresh fruits and vegetables are full of vitamins and minerals that are great for the body and are heart-healthy as well. Reducing processed carbs and replacing them with whole grains is also helpful, as is reducing the intake of saturated fats.

Gyms can be intimidating. Is there a simple exercise people can do every day to help the heart?

A brisk 30-45 minute walk every day or four to five times a week is easy to do and is effective not only for heart health, but also in maintaining a healthy body weight and metabolism.

What is most misunderstood about the heart or cardiovascular system you’ve seen on the internet/on TV?

People tend to assume that a heart attack happens all of a sudden and that it is just an acute process. However, most heart attacks occur because of sustained cholesterol accumulation in coronary arteries and the disease process occurs over the course of some years, or even decades.

Does sitting pose dangers to the heart?

Numerous studies have shown that a sedentary lifestyle leads to a significantly higher risk of stroke, heart attack and early death. There is an ongoing cumulative benefit of every kind of activity that an individual does during the day. Sitting for a long period of time puts you at risk for leg and lung clots, excessive weight gain, risk of back pain and decreased metabolism. All of these can pose dangers to the heart and put you at a higher risk for heart attack and other heart-related complications.

How much blood does your heart pump per minute/hour/day/year?

The heart pumps 5L of blood per minute. This works out to 300L (80 gallons)/hour, 7,200L (1,900 gallons)/day and 2,628,000L (approximately 7 million gallons)/year.

What is your favorite fact about the heart?

The heart is a unique muscle that has a spontaneous ability to beat. It always fascinates me that we stop the heart to perform an open-heart surgery while the patient is on the heart-lung machine, and as soon as we restore the normal blood flow to the heart, it spontaneously begins to beat again.

Does drinking a glass of red wine every day actually help your heart?

While some studies have shown that drinking a moderate amount of red wine can be a potential cardioprotective agent, the clear epidemiological evidence is still lacking. On a personal note, I don’t consume alcohol. There hasn’t really been any substantiated clinical advice to those who don’t drink to start the daily consumption of alcohol, based on the current literature. Caution must be used on an individual basis.

Is dark chocolate really good for your heart?

There is conflicting data when it comes to the benefits of dark chocolate for the heart. Certainly, some literature has shown that cocoa consumption can have beneficial effects on blood pressure, high cholesterol and glucose control, antioxidant and anti-inflammatory activity. However, there is also a need for longer and larger studies to establish the safety and effective dosage of the cocoa derivatives from which we can derive these benefits.

What are the signs of an unhealthy heart?

Signs of an unhealthy heart are very extensive. Some of these can be: becoming easily fatigued, difficulty in breathing, new onset chest pain or breathing problems, particularly with activity, excessive sleepiness, dizziness, frequent fainting and swelling of the legs.

Does taking aspirin help prevent a heart attack?

There is a large body of medical literature that supports the role of aspirin in the prevention of cardiovascular events in selected population. Aspirin certainly is a simple and inexpensive prophylactic measure which can be considered in patients that are at risk for cardiovascular conditions. Early aspirin use during a heart attack (as soon as 911 is called) can reduce the blood-clot size in the coronary arteries and minimize the damage from the heart attack.

Anything else about the heart that you would like people to know?

Although heart disease is the number one killer of men and women in America, we are also facing an epidemic of addiction to painkillers and opioids. This eventually leads to IV drug abuse (cocaine, heroin, methamphetamine etc.). We are facing an increasingly larger number of young men and women suffering from life-threatening infections of their heart valves, and thus needing heart surgeries due to drug abuse. Sometimes a simple dental procedure, a skin infection or untreated pneumonia can also lead to blood stream infection, resulting in the infection of the heart and heart valves (endocarditis). These can further complicate into heart attacks, strokes and sepsis and sepsis shocks.

As for heart health, I would suggest to set small goals for having a healthy heart: quit or avoid smoking, exercise regularly (30-45 minutes/four to five times per week), make healthy changes in eating habits, consume less salt and maintain a healthy weight.

Take care of your heart as if your life depends on it!

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Elm’s stellar legacy lives on in Pharmacy Practice Scholarship

David Elm

It’s not a stretch to say that David Elm, PhD, who mentored more than a thousand University of Colorado pharmacy students over three decades, has perhaps contributed to the health of more Coloradans than any other health care professional in the state.

Elm, now retired, will tell you that his career constituted the best pharmacy job in Colorado – with much enjoyment coming from his unmatched experience as a mentor. Starting in 1978, he became the manager of The Apothecary, a full-service professional pharmacy operated by licensed pharmacists, at CU Boulder’s Wardenburg Health Center, serving university students, faculty, staff and alumni.

“I probably had more one-to-one mentoring experience than anyone else on our faculty,” said Elm, adding that, until the School of Pharmacy moved to Denver in the 1980s, every pharmacy student was required to do a rotation at The Apothecary.

“I can go anywhere in the state and find someone I know from The Apothecary,” Elm said. “That was their first clinical exposure to physicians, nurses, patients and prescriptions.”

New scholarship in his name

Being one of eight children raised on a dryland farm in Nebraska, it’s not surprising that Elm has a direct, plainspoken nature. Asked why he stayed on at The Apothecary – where he also worked as a graduate student – for his entire career, Elm said, “I liked what I was doing. The school liked what I was doing. I was asked to stay, and so I did.”

David Elm from 1973
David Elm, 1973

Now his name and stellar contribution to the Skaggs School of Pharmacy and Pharmaceutical Sciences carry forward in the C. David Elm Pharmacy Practice Scholarship. The school created the scholarship in his honor to commemorate Elm’s extraordinary impact.

Elm first earned a pharmacy degree at the University of Nebraska-Lincoln before venturing west to further his education at CU. He earned a Master of Science in Hospital Pharmacy, a Master of Science in Health Administration, and a PhD in Pharmacy Administration, all within the University of Colorado system.

He modeled The Apothecary after the typical – and indispensable – corner drugstore found in any small town. “We felt we had a corner drugstore on campus, serving a ‘town’ of over 10,000 faculty and staff,” Elm said. “Then we had about 25,000 ‘visitors’ who came in for most of the year and then left for the summer – those were the students.

“It was just a small-town mentality, and people love that,” he said. “You get to know everybody by name.”

‘Stories about of Dave helping’

Lou Diamond, former dean of the CU School of Pharmacy, said Elm’s professionalism, high ethical standards and warm nature endeared him to everyone at The Apothecary – be they staff, patients or student trainees.

“Stories abound of Dave helping financially strapped patients get their medications without delay and making after-work deliveries of prescriptions to the homes of frail patients,” Diamond said.

Wardenburg Health Center
The Apothecary, which Elm managed for over three decades, is located inside Wardenburg Health Center at CU Boulder.

On one occasion, a university employee received an urgent call at work informing her that her house was on fire. Elm, knowing the circumstances of her family’s medications, refilled them, drove to the scene of the fire, talked his way past the fire perimeter, and delivered the medications to a grateful patient.

Meanwhile, student trainees going through The Apothecary (they still do, but the site is no longer required), “were absolutely ebullient in their comments,” Diamond said. “A rotation through The Apothecary was something to be prized because students knew the experience would open new doors, enrich their personal lives and guide them on their way to a fulfilling professional career as a pharmacist.”

Scholarship helps service members

Elm’s Midwestern upbringing also imbued a deeply-rooted love of country and “unabashed patriotism,” the former dean said. So, Elm asked that his scholarship be awarded to an active or honorably discharged member of the U.S. armed forces. The overall goal is to raise a minimum of $100,000 so his scholarship will be both significant (at least $4,000 per year) and last in perpetuity.

Elm’s son Jason served in both Gulf Wars and is, along with Elm’s grandson, currently serving in the reserves. Elm’s brother-in-law Lt. Gen. James Gordon Roudebush (retired) served as the 19th Surgeon General of the U.S. Air Force.

“I’ve seen what folks go through when they have a family member who is in the armed services,” Elm said. “Service members sacrifice, both financially and emotionally. When your family is split up, it’s just hard on family life. So, if I could ease that burden on someone else – say, through a scholarship – I would do it.”

Another aspect of Elm’s personality is reflected in the scholarship: He much prefers patient and practitioner contact over laboratory work. “I like the practice part of pharmacy more so than the research.”

Again, taking the mindset of the small-town pharmacist, Elm loved the milieu of the academic atmosphere. “We served everyone from A to Z – anthropologists to zoologists,” he said.

Special bond with the Buffs

He enjoyed his supervisors as well. “I was fortunate enough to work for deans who gave me a job to do, provided me the resources and authority to do my work, and then simply evaluated me on the results.”

Awards; how to contribute

In 1995 David Elm received the Distinguished Coloradan award – a lifetime achievement award in recognition of his sustained and significant contributions to the school, pharmacy profession and the health and welfare of the citizens of Colorado. He also was awarded a National Excellence in Teaching Award and the Rho Chi National Alumni Achievement Award.

To contribute to the C. David Elm Pharmacy Practice Scholarship, click here.

Elm also forged strong relationships with CU Athletics because The Apothecary provided the department with medical supplies. He became a devoted fan and is a 50-year season ticketholder to Buffaloes football – something that might surprise his childhood friends in the Cornhusker state.

Elm now lives in Lafayette, but he frequently returns to Nebraska to help his siblings farm and raise cattle. He remains a pharmacist at heart, and is glad to see the stature of his profession climb over the years.

He noted that the move toward integrating all the health-profession students, first on the Health Sciences Center campus in Denver, and later at the CU Anschutz Medical Campus, was a key impetus behind pharmacists becoming valued and contributing members of the health care team.

“It’s nice that we’ve become recognized and accepted,” Elm said.

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Youth movement aims to send nicotine use up in smoke

high school students UpRISE

Colorado’s reputation as one of the healthiest states in the nation is clouded by at least one inconvenient fact: more than one-quarter of high school students in the state used electronic cigarettes at least one day in the previous 30, according to a 2017 survey by the Centers for Disease Control and Prevention. That’s double the national rate.

Why the youthful embrace of nicotine-delivery systems in the guise of brightly colored, sweet-smelling, flavorful products? And why do large numbers of teens use nicotine products of any kind in the face of their well-established health risks?

Emery McDowell, a 14-year-old freshman at Grandview High School in Aurora, says the numbers of young people vaping and smoking show that the problem can’t be written off as one isolated to “unruly teenage behavior.” She sees the evidence in front of her every day, in person and online.

‘Normalized in our culture’

Nicotine use, McDowell said, “is normalized in our culture. I see people on Instagram and Snapchat posting pictures of people vaping, being all cool and stuff.” She’s upset by what she sees as a tobacco industry effort to market nicotine products to teens through social media.

“That’s not okay because you are using youths’ minds to build income for your companies,” she said.

McDowell is channeling her desire to change that as part of a state-funded program designed to pinpoint the reasons young people use nicotine and explore with them ways to prevent it. The program, called UpRISE, is funded by a three-year, $1.8 million innovative grant from the State Tobacco Education and Prevention Partnership, part of the Colorado Department of Public Health and Environment.

UpRISE provides funding to 21 youth-serving organizations and schools across Colorado to host coalitions of young people. The UpRISE movement is led by a 10-member Youth Action Board, which includes McDowell.

ColoradoSPH, CPHP contributions

Each coalition works with an adult advisor trained by the Center for Public Health Practice (CPHP) at the Colorado School of Public Health to identify young people who want to combat nicotine use.

Heather Kennedy
Heather Kennedy, a 2010 graduate of the Colorado School of Public Health, wrote the grant for the UpRISE program.

The primary goal isn’t to issue warnings about the health risks of nicotine, but rather to illuminate use of the substance as a social justice issue, said Heather Kennedy, youth movement project manager for CPHP, who wrote the grant for the UpRISE program. Kennedy received her Master of Public Health degree in Community and Behavioral Health from ColoradoSPH in 2010.

“We’re not here to say to young people, ‘Don’t smoke. It’s bad for you,’” Kennedy said. “We’re trying to move people to act.” That requires providing young people with facts that tie nicotine to a wide range of community problems. For example, she noted that nicotine use is highest among the most vulnerable: those disconnected from their schools and communities because of mental health issues, exposure to trauma, economic instability and experiences of discrimination due to gender or sexual identity.

“We can’t just be focusing on single issues like tobacco or mental health,” Kennedy said. “We need to see young people as humans that exist in the world with complexity and nuance and honor the full breadth of who they are.”

That idea is at the core of the training adult advisors receive, Kennedy said. Their role is to facilitate discussion of what students believe drives nicotine use by themselves and their peers, not to direct them toward preconceived goals.

“We meet with adults to talk about what it looks like to be a good facilitator,” Kennedy said. “That is not that you are delivering something to young people. It is that you are facilitating conversations about things you don’t know the answer to. You are inviting young people to have a conversation with one another and with you. It’s true dialogue, not instruction.”

Nicotine use: Finding the root cause

That can be easier said than done, said Natalie Moore, school counselor at Chaffee County High School, a small (39 students) alternative public school in Buena Vista. Moore advises an UpRISE coalition of six students who “got fired up” when she invited them to learn not only about nicotine use but also its connection to public health and social justice issues.

Heather Kennedy, ColoradoSPH
Heather Kennedy, youth movement project manager for the Center for Public Health Practice, speaks at the TEDxCrestmoorParkWomen event in 2017.

“As an adult and especially as an adult who values having control over a situation, it can be really awkward,” Moore said. “[As adults] we believe we’re supposed to be the experts. This is quite the opposite. The activities get students moving, thinking and doing and gets them to a space for a discussion.”

For a week, Moore led two-hour-plus discussions with the group that aimed to peel away “like an onion” the reasons for nicotine use among themselves  – five of the six smoke or vape – and other young people. The aim: find the root cause and then explore ways to address it.

Nicotine helps to relieve stress, the students said, but that opened the question of what causes the stress. They decided the primary driver is trauma, which includes bullying, witnessing domestic abuse and a friend being shot in a drive-by shooting, and enduring parental divorce and death, Moore said.

Materials supplied by the UpRISE program that showed how tobacco companies target specific communities also piqued the coalition students’ interest, said Moore. She noted that just one of the six students in the Chaffee County High School coalition identifies as a white heterosexual male. The CDC and other organizations have reported that smoking rates for LGBT adults are higher than for straight adults and that tobacco companies have used marketing campaigns aimed at the LGBT community.

Being targeted

“That hit home, that someone was targeting them,” she said. “When you connect with someone personally, that’s how you connect to a greater cause of social justice.”

All of this led to the question of what the Chaffee County students could do to help relieve stress without turning to nicotine. They settled on using some of the $5,000 their coalition received from the grant to get training in mindfulness techniques from a local instructor. With the training, which began on-site in mid-January, the students aim to become “mindfulness ambassadors” equipped to lead their peers in short stress-busting sessions that could short-circuit the vaping epidemic.

In the spring, UpRISE coalitions will create arts-based projects to share what they have learned about nicotine use with their broader communities. Therein lies valuethat goes beyond the health benefits of avoiding nicotine.

“[UpRISE] gives us a voice in the community,” one student in the Chaffee County coalition told Moore. “Being in this coalition, we are going to do awesome stuff.”

That positive attitude is a powerful antidote to feeling marginalized – a driver of nicotine and substance use, Moore said. “Making a connection to the community is not only about offering knowledge, but knowing there is a problem and that you can be part of the solution,” she said.

Similarly, McDowell says her work on the UpRISE Youth Action Board has helped her connect with peers who share her passion for counteracting the growing influence of vaping.

“More and more kids are [vaping] because they think it’s cool,” she said. “The program has been valuable because before I joined it, I felt like I was alone. Now I’m being around so many other people who know the same things I know and want to stop it and actually feel like this could work.”

The board members collectively have “a deep interest in vaping in their communities and how the tobacco industry exploits vulnerable populations,” added Daniel Martinez, Jr., youth programs senior specialist with CPHP – making it a prime focus of a planned statewide activity among the coalitions in 2019.

Kennedy believes UpRISE is an opportunity for cities and towns around the state to tap into the underutilized power of young people.

“One of the goals of UpRISE is to have youth be seen as passionate change-makers in their schools, neighborhoods, and communities,” she said. “Young people are starving for opportunities and I believe that it is our job as adults to figure out ways to integrate them into social, political and economic life.”

Guest contributor: Tyler Smith

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Q&A with Thomas Flaig, MD, on World Cancer Day

Thomas Flaig, MD

Thomas Flaig, MD, associate dean of clinical research at the CU School of Medicine, is heartened by the American Cancer Society’s report showing the U.S. cancer death rate has declined 27 percent over the past 25 years. But Flaig, who met with members of the African Cancer Coalition in Ghana last summer, says the trend doesn’t necessarily apply to the rest of the world, where cancer remains a huge health issue and is often the first or second leading cause of death.

Flaig, chief clinical research officer of UCHealth, also serves as chair of the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology Panel for Bladder Cancer. In Ghana, he met with a panel of six African physicians to harmonize NCCN genitourinary cancer treatments for the Sub-Saharan Africa context.

“It was a remarkable experience,” Flaig said. “I found the oncologists in Africa to be extremely well-trained and pragmatic providers working in a different resource environment. It was wonderful to watch them work as a team to harmonize these guidelines to their particular environment.”

In recognition of World Cancer Day, CU Anschutz Today sat down with Flaig to get his views on global cancer trends and challenges that remain in improving cancer mortality rates across the world.

Today: The American Cancer Society has released a report saying that the U.S. death rate from cancer has declined steadily over the past 25 years. What are trends showing when it comes to cancer mortality worldwide?

Flaig: As a practicing oncologist, it’s fantastic to see the death rates from cancer in the U.S., after many years of work, start to come down. What’s also clear – and I think it’s from increasing awareness – is the global attention being paid to cancer. Last year in the world, there were 18 million new cancer cases diagnosed, and 9 million deaths from cancer.

It’s great to see progress being made in the United States. I think that’s credited to all the advances we have in new drugs, in diagnostics, and in all the resources we have here. It’s also clear that those statistics and trend lines don’t necessarily apply to the rest of the world, in which cancer is still a huge burden.

Leading cause of death in nearly 100 nations

Today: What are the reasons for the difference between U.S. and global rates?

Flaig: As has been noted, the death rates for cancer in the United States have come down, and this has been a trend over decades. It’s truly heartening to see this, with all the energy we’ve put into treating cancer in the U.S.

Those same cancer statistics don’t necessarily apply to the rest of the world. In some areas, cancer is typically more common and it’s occurring more frequently in an aging population. Interestingly, as a relative measure, we’ve made more progress in addressing cardiovascular health. So in terms of the incidence of heart attacks and strokes, the death rates have come down, thereby accentuating the need to make more progress on cancer. It becomes a greater health burden, so there’s greater awareness around cancer as a cause of death. If you look at the statistics, there are nearly 100 countries in which cancer is the first or second leading cause of death.

Today: You serve as chair of the NCCN’s Clinical Practice Guidelines in Oncology Panel for Bladder Cancer, and you traveled to Ghana to work with the African Cancer Coalition. What are a few of the key ways that the NCCN is working to support providers and best clinical care in resource-poor countries?

Flaig: The NCCN, of which the University of Colorado is a member, is a wonderful organization which creates a number of guidelines – I think over 50 – which serve as detailed templates for clinicians in how to treat cancer and provides important supportive care around cancer. It’s pretty clear that these guidelines are very much based on resources in high-resource countries like the United States. Last year the NCCN guidelines were downloaded over 10 million times, so it’s also clear that these guidelines are highly utilized across the globe. The guidelines, which are largely focused on the United States, don’t necessarily apply in a medium- or low-resource environment. So, the NCCN has been working hard to essentially harmonize, or adapt, these guidelines to different settings.

I had the great pleasure of traveling to Ghana in 2018 as part of one of these efforts by the NCCN to really look at harmonizing the guidelines for bladder cancer and kidney cancer in the Sub-Saharan African context. For example, we looked at technological resources such as scans – MRIs and CTs – and assessed whether these were regularly available or not. We looked at different drugs, which we use in the American base guidelines, and assessed: do these apply or not?

The NCCN has pursued this work in many different settings. Again, with over 50 guidelines, they’ve picked different parts of the world in which to harmonize or enact these guidelines.

Cancer is becoming a global conversation

Today: Improvements in early detection have led to significant drops in cancer rates in the U.S. What are some of the continuing challenges of treating cancer in developing countries?

Flaig: Cancer is becoming a global conversation. At the American Society of Clinical Oncology (ASCO) meetings, global oncology has become a topic in which there is a lot of interest. More and more sessions are focused on it, and more papers are being written on this topic.

There are clear differences around the globe between the metropolitan areas, which tend to have a higher level of access to tertiary care and technologies, and the rural areas, which often may not. That’s true in the United States, and it’s certainly true in Africa. One of the biggest limitations in developing countries is the resource level. What are they able to provide? What is provided by the government? What’s provided through private insurance?

As you think about access to care in the United States – what’s covered and not covered – these become topics which are, in many cases, national based. One of the key factors in global oncology is understanding what resources are available to prevent and detect cancer in early stages, and how they can be best deployed in individual countries.

Resource and access issues

Today: What drives your interest to work on clinical practice guidelines for cancer treatment globally, and are you optimistic that worldwide cancer mortality will improve similar to the United States?

Flaig: I’m an optimist by nature. It’s really been a pleasure and a great privilege to serve on these guideline committees. When you think about the more than 20 centers (CU Cancer Center among them) that constitute the NCCN, leaders in their respective fields come together on a regular basis to say: what’s the optimal way to treat cancer?

I can say that all who are involved in the NCCN take that responsibility very seriously. I think it’s really important to think about how these guidelines are applied in different settings and what can we do as a guideline committee to essentially adapt these into different environments. My experience in that regard, with the African guidelines, was extremely professionally satisfying.

I enjoyed the chance to work with physicians in a different environment with different pressures. We’ve got our own pressures in the United States, but the physicians in Africa are dealing with resource issues and access issues. Some of the drugs we take for granted in the U.S. they don’t have access to. And then we’re looking at: how can we take all of our collective wisdom and experience and adapt it in a way that can be really useful to a larger group of physicians in a setting such as Africa.

Interest in global cancer topics expands

Today: What are your impressions of efforts such as World Cancer Day? Is it having the desired effect?

Flaig: If I look back over the past few years, I’d say that within the field of oncology in the U.S., the interest in global cancer topics has greatly expanded. On a personal level, this wasn’t necessarily an issue I was thinking about when I was training 10 or 15 years ago. Professional societies have brought these issues forward – ASCO among them – but you can certainly see that as focus on this as a global problem increases, we can learn from each other and we can apply things in different ways.

I also recently traveled to Mexico City and saw oncology care there; it was fascinating to see how a neighboring country dealt with these problems. It’s clear that with cancer, in some ways, it’s not been focused upon in the global sense. We focused on it on a national level, and likely each nation was doing that.

So, it’s great to see what World Cancer Day is doing for the oncology community in terms of focusing on those patients who are being treated in low-resource settings. How can we assist those providers? How can we even promote research to maximize the resources they have in those settings? It’s a rewarding endeavor.

Video by Matt Kaskavitch, Office of Communications

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CU Anschutz partners with Coursera to train next generation of health workers

Student on a computer

Coursera, the global online learning leader, announced the launch of its health vertical – a broad portfolio of health content from the world’s top universities curated specifically to help address the acute shortage of skilled workers in the health industry and meet the demands of a digital health economy.

The CU Anschutz Medical Campus is among the top-ranked institutions in health partnering with Coursera to release 100 new courses, 30 new specializations and two public health-focused master’s degrees to provide learners with the skills they need to enter high demand jobs, mainly related to Health Informatics, Healthcare Management and Public Health. Notably, CU Anschutz played a vital role in the launch, providing over one-fourth of the courses and more specializations than any other Coursera partner.

CU Anschutz plays vital role in offering new courses

“The University of Colorado Anschutz Medical Campus is pleased to be a national innovator in digital education. This past year, with our partners at Coursera, we have launched the first course specializations in health care on the Coursera platform, sharing some of our faculty’s educational expertise with 36 million learners throughout the world,” said Roderick Nairn, PhD, provost and executive vice chancellor for academic and student affairs at the University of Colorado Denver and Anschutz Medical Campus. “The breadth of our course offerings reflects the diversity of our campus; Palliative Care, Emergency Medical Services, Caring for Healthy Newborns, School Health, and Clinical Data Sciences are among Coursera’s inaugural healthcare course specializations and are a testament to the global reputation of CU Anschutz in both defining contemporary standards of medical innovation as well as training the next generation of healthcare leaders.”

New specializations to train future healthcare leaders

CU Anschutz offers many specializations, including:

  • Become an EMT: EMT medical and trauma emergency care. Gain the skills needed to provide first responder emergency medical care.
  • Clinical Data Science: Launch your career in clinical data science. A six-course introduction to using clinical data to improve the care of tomorrow’s patients.
  • Newborn Baby Care: Newborn baby care skills. Gain skills in newborn baby care, safety and health including breastfeeding, safe sleep and screenings.
  • School Health for Children and Adolescents: Promoting healthy practices in school. Learn to manage medical conditions and mental health services and facilitate healthy practices in schools.
  • Palliative Care: It’s Not Just Hospice Anymore: Palliative care easing pain and suffering. Learn strategies and techniques to assess suffering and support patients living with serious illness.

“I am deeply passionate about driving innovation in healthcare,” said Daphne Koller, co-founder of Coursera. “The sector, which is under enormous strain to support the needs of a growing and aging population, presents a huge opportunity for meaningful technological transformation that stands to not only improve health outcomes for people around the world but also reduce the increasingly unaffordable costs of healthcare, both to individuals and to society. I’m excited to see Coursera and its partners coming together to help realize that potential by providing access to flexible and affordable education options that can help usher in the next generation of healthcare workers in high-demand fields like health informatics, healthcare management, and public health.”

CU Anschutz joins Johns Hopkins University, University of Pennsylvania, Rice University, the University of Michigan and the Imperial College of London in launching health care specializations. The new specializations will roll-out through 2019 and will be available for a subscription range of $39 to $79 per month.

For more information, visit coursera.org/health.

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Answers To Every Thanksgiving Question You’ve Ever Had

Thanksgiving is almost here, and that means two things. Time spent with family and friends around the television watching football and turkey. Lots and lots of turkey. At this time of year, we often overindulge and loosen our belt and wonder how we fit all that stuffing and gravy into our stomach. Don’t worry. We asked leading health experts from the University of Colorado Anschutz Medical Campus a few of the Thanksgiving questions you’ve always wanted to know the answer to.

Mom’s turkey is legendary! Could I end up blowing a hole in my stomach by devouring too much turkey?

We’ve all been there. The awkward stares around the table as Uncle John says, “Who is going in for the last piece of that delicious bird?” You may wonder if it’s possible to overeat at your Thanksgiving meal to the point of health complications. “Thankfully the stomach has a thick muscular lining that makes it very resistant to stretch and pressure, so a perforated stomach is not really a concern on Thanksgiving Day,” says Paul Menard-Katcher, MD, assistant professor in the Division of Gastroenterology & Hepatology in the CU School of Medicine. “Unless you swallow a sharp turkey bone, so don’t do that,” he adds.

 

My grandma Betty makes her famous Thanksgiving casserole four weeks in advance and brags on how it keeps in the freezer. Needless to say, I’ll be passing on it this year. Is there any actual evidence that frozen food offers less nutritional value than freshly cooked food?

“There is very little nutritional value lost from freezing food in general, and food can be frozen for long periods of time which is one of the advantages of freezing,” says Marsha Miller, MS, RD, at the CU Anschutz Health and Wellness Center. The USDA recommends freezing food as quickly as possible to maintain quality. When it comes to thawing, it’s actually the opposite. Turkeys may take days to safely thaw in your refrigerator, approximately one day for every five pounds of weight.

 

Is it the turkey that leads to Aunt Judy passed out cold on the reclining chair after our meal?

This one is as old as Thanksgiving itself. Turkey contains an amino acid called tryptophan that makes you sleepy, right? Wrong. “Turkey contains no more tryptophan than other foods and actually less than chicken!” says Cristina Rebellon, RD, at the CU Anschutz Health and Wellness Center. “So, it’s likely not the turkey that’s the culprit but the high food and alcohol intake,” she adds.

 

If it were socially acceptable, I would drink right from the gravy boat. How much gravy is too much?


Gravy is the ultimate side at any Thanksgiving dinner. It helps the meal slide right down in all its sodium glory. However, Sarah Funk, RD, in the Division of Gastroenterology says it’s best to take it easy. “Gravy should be added to the meat for added flavor and moisture. If there is more gravy than meat, there’s probably too much gravy,” says Funk.

 

I’ve been told sweet potatoes are a healthier choice than white potatoes. Is that true?

Remember when your mom would tell you to eat all those colorful vegetables growing up? Maybe there is some truth to that. “Sweet potatoes and white potatoes have different nutrients. Sweet potatoes have more fiber (about 2 more grams more than white) and contain Vitamin A, while white potatoes don’t contain vitamin A but do contain more Vitamin C,” says Sarah Funk, RD, in the Division of Gastroenterology. “Include a variety of colors from fruits and vegetables — all in order to receive a variety of nutrients,” she adds.

 

I’ve heard cranberries are good for you and even prevent cancer and heart attacks. Should I load up on Thanksgiving?

Cranberries are commonly referred to as a superfood for their antioxidants and are rumored to help with all kinds of medical conditions from urinary tract infections to diabetes. But is that legit? “There is insufficient reliable evidence to support cranberry has any positive impact in the prevention of cancer and cardiovascular disease,” says Joseph Saseen, PharmD, at the CU School of Pharmacy. “Watch out for cranberry sauces and jellies. One typical serving (about half of an inch of the canned product) contains 86 calories and 22 grams of sugar,” he adds. I can already feel my blood sugar spiking!

 

I’ve heard that eating turkey without the skin is better for me. Is that true?

There are few things better in the world than lightly crisped turkey skin, but you may want to think again this year. “In a 3.5 oz portion of turkey breast, there’s almost double the amount of fat when the skin is left on versus if it is removed,” says Marsha Miller, MS, RD, at the CU Anschutz Health and Wellness Center. “If you’re looking for ways to reduce the calories in the meal, this is certainly one easy way to do it,” she said.

 

What tips would you give someone who wants to eat healthy during Thanksgiving?

This is the toughest time of the year to eat healthy. But there are things you can do to make your holiday less punishing on your body. Experts say a common mistake is not eating all day. “A big mistake people tend to make is to eat very little or nothing at all the whole day of Thanksgiving which often leads to overeating during the big meal,” says Cristina Rebellon, RD, at the CU Anschutz Health and Wellness Center. She recommends eating as you normally would and stay well hydrated. This will put you in a good position to not overeat.

 

How can the Thanksgiving cook make the meal healthier by substituting or preparing the meal in a different way?

 

  • Choose skim milk or 1 percent milk instead of cream or half-and-half.
  • Start with adding a smaller amount of fat and add as needed for taste.
  • To reduce added salt, season with herbs and spices and use low-salt broth or bouillon cubes.
  • Grill or bake instead of frying foods.
  • Try a fruit-based dessert. Substitute applesauce and yogurts for added butter and oils.
  • Leave sauces or dressings on the side to allow diners to choose how much of the higher-calorie items they want.
  • Offer up sparkling water or other low-calories drinks to help ease the calorie load for the meal.

Happy Thanksgiving to all from the CU Anschutz Medical Campus. With a little preparation and a lot of self-control you can have a healthy and enjoyable holiday surrounded by family and friends.

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Teeth restoration delivers beautiful smile, and confidence, for teen girl

A pair of words — beautiful smile — are heard all the time in dental and orthodontic clinics. These days, it’s practically an expectation for teenagers to, after wearing braces, end up with sparkling and picture-perfect teeth.

This wasn’t the case for Courtney Caudill. Whenever the Thornton teenager looked in the mirror, two other words came to mind: shark teeth.

Courtney's teeth starting high school
This photo of Courtney’s teeth was taken at another Denver-area dental clinic about five years ago, when she was starting high school.

“During my entire high school career, I barely found any photos of me showing my teeth,” she said. “It was a little sad and depressing that I was so embarrassed. You know, there was nothing I could do about it.”

Rare condition

She was born with ectodermal dysplasia, a condition that affects teeth, skin, hair, fingernails and eyes. In the mouth, the condition manifests in misshapen and often-missing teeth. Courtney’s permanent teeth didn’t come in until age 11 and her smile betrayed gaps where teeth should be. Many of the teeth that came in as permanents were conical-shaped — resembling those of a shark.

The condition left Courtney reluctant to smile much of her life, telling peers at every opportunity why she lacked “normal teeth.” Fortunately, teasing was kept to a minimum, mainly because her parents taught Courtney to be proud of herself and went out of their way to explain her condition to teachers and classmates. Entering college — she is currently a sophomore at CU Boulder studying psychology — the late-teen resigned herself to possibly no end in sight to this “very, very long journey” and “lifetime struggle.”

CU Dental School a ‘godsend’

Her mother, however, did some research and found the CU School of Dental Medicine and its Adolescent Dental Clinic, operated by Rick Mediavilla, DDS. After Mediavilla saw Courtney in June 2016, he carefully selected Kevin Moore, DDS, who at the time was a third-year dental student, to complete her care. Mediavilla saw a gentle chairside manner and excellent care standards in Moore, who immediately clicked with Courtney and began plotting her course toward a perfect smile.

Her father, Christopher, calls Moore a “godsend.” “When we first came and met Kevin, I just knew God had sent him to us. It was divine intervention.”

Christopher is made of strong stuff — he’s an Army veteran who has done two hitches in the Middle East — but he’s been reduced to tears — once when Courtney got crowns on her bottom teeth in May, and again when she received upper crowns in mid-October. Both procedures were performed by Moore, who is now in the general practice residency program at the CU Dental School, and overseen by Mediavilla and David Gozalo, DDS, a prosthodontist who specializes in replacement and dental implants.

Always smiling

Kevin Moore, DDS, places crowns
Kevin Moore, DDS, places a customized crowns — multiple-teeth bridges — in Courtney’s mouth during the Oct. 19 procedure.

After the latest crowns were placed, Courtney sat still in the dental chair, staring out the window and letting the profound change in her appearance soak in. The teen may have reflected on how, about two years ago, when a different Denver dentist suggested implants, at an out-of-pocket cost of $35,000 (the provider didn’t take her family’s insurance), she weighed the options and declined. Courtney knew that without sufficient upper-shelf bone, which was the case in her mouth, implants can fail.

Undoubtedly, the many disappointments she had endured over the years flooded her mind.

Christopher, meanwhile, stood nearby with reddened eyes. He could see the relief in his daughter’s expression. “We’ve noticed her whole demeanor has perked up incredibly,” he said. “She’s never let it bother her much, but now she’s persevered and she’s always smiling.”

Cutting-edge dentistry

model of Courtney's new smile
A model of Courtney’s new smile was created using a state-of-the-art software program and a 3D printer.

The story of this cutting-edge care in the CU Dental School includes a generous donation from Peebles Prosthetics, Inc., which supplies “removables” — dentures and arches — as well as “fixed appliances” — multiple-teeth bridges — to the CU Dental School. For Courtney’s upper mouth, she received a pair of three-unit bridges, which were fabricated by Peebles in consultation with the CU dentists. Company owner Rick Peebles watched the two fixed appliances — a donation valued at about $1,100 — transform Courtney’s smile at the Oct. 19 appointment.

“Kevin told us about Courtney’s case and asked us about (a donation),” Peebles said. “We thought it was a great cause, and we like what he does as both a person and a dentist. A lot of the kudos should go to Dr. Moore for being a champion for Courtney.”

Emotional and impactful

Moore credited Peebles and his firm, because without their donation the dental work might not have been financially feasible for Courtney’s family. Lonnie Johnson, DDS, senior associate dean of clinics and professional practice in the dental school, ensured completion of the project by covering costs not met by Peebles and the family.

Dental team and Courtney Caudill
Courtney Caudill, center, had a top-flight team working on her case: From left, Rick Mediavilla, DDS; David Gozalo, DDS; Rick Peebles, owner of Peebles Prosthetics; and Kevin Moore, DDS.

Moore had performed a similar procedure on an 86-year-old patient, but Courtney’s case was profoundly different. “This is definitely rewarding,” he said. “With a teenage girl, giving her a smile is pretty emotional and impactful.”

The final product of Courtney’s crowns started with the dental school’s Trios scanner, which makes an oral impression by scanning teeth digitally, allowing them to be designed to the patient’s specifications. A model of her new smile was also created — the analog way — using a state-of-the-art software program and a 3D printer. Lastly, both the model and the digital imaging were sent to Peebles Prosthetics, which fabricated Courtney’s crowns using technology that further improves the design and quality of dental restorations.

‘Loving my teeth’

“Restored” couldn’t be a more apropos term. The journey that has stretched over a dozen years, and taken the Caudills to multiple dentists, has at long last come to an end. Courtney finally has a complete and picture-perfect smile.

‘This is definitely rewarding. With a teenage girl, giving her a smile is pretty emotional and impactful.’ — Kevin Moore, DDS

Christopher said, “I’m just so absolutely grateful. I don’t think I’ll ever be able to repay everyone for everything.” He looks to the CU Dental School to perform a similar miracle on his 13-year-old son, who suffers from an even more severe case of ectodermal dysplasia. “One down, one to go,” he said.

Courtney, meanwhile, finds herself shedding the occasional tear of happiness. Mostly though, she’s flexing those smile muscles that she has restrained for so many years.

“I’m loving my teeth,” she said, after living with her new crowns for a couple weeks. “I don’t think I’ve ever smiled this much in my life!”

Editor’s note: Ryan Nisogi, senior director of digital marketing strategy, Office of Communications, contributed photography and video, while Matt Kaskavitch, director of digital strategy, contributed video packaging to this report. 

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Crisis management and recovery focus of Public Health Case Competition

A flash flood that left a community with contaminated water and facing other public health emergencies was the dilemma given to over a dozen teams at this year’s Rocky Mountain Region Public Health Case Competition.

The sixth annual event took place at the CU Anschutz Medical Campus last weekend. The event, hosted by the Colorado School of Public Health (ColoradoSPH), provides students from all the schools at CU Anschutz and selected disciplines from the CU Denver and CU Boulder campuses, an opportunity to work in collaborative teams to develop innovative solutions to a real-world health problem.

Second place team public health case competition
The second-place team in the competition, along with ColoradoSPH Dean Jonathan Samet: From left: Kathy Pang, Amber Vaughn, Ronald Truong and Hannah Parris.

Prizes for the top three teams were varying amounts of scholarship money up to $1,000. Two teams were selected as people’s choice recipients, with each member receiving $100 each.

“Public health stretches across all disciplines,” said Tonya Ewers, director of communications and alumni relations for the ColoradoSPH. “This is a great practice-learning opportunity for these students to learn to work together to solve health problems.”

The teams each spent 24 hours analyzing the case of the Many Forks flood disaster as well as creating a public health solution. They presented their solutions to a panel of judges.

third-place team public health case competition
The third-place team in the competition, along with Dean Jonathan Samet: From left: Jenny Yoo, Katherine Myers, Hannah Marinoff and Riley Stanton.

The teams came up with holistic, collaborative and far-reaching plans to address the emergency as well as increase the town’s capacity for full recovery. The winning team, whose plan was titled “Many Forks, One Community,” offered a multifaceted response that included the launch of a community-led resource center to act as both an emergency gathering site as well as a resource for mental health services, such as group counseling and social events. It also included neighborhood-tailored recovery plans and a disaster preparation initiative that set up a town-wide disaster alert system (flood siren) to reach residents who don’t own a mobile phone.

The second-place team focused on how the community, in the wake of a crisis, could best respond to the needs of children and youth, who make up 20 percent of the town’s population. The third-place team devised a solution focused on ensuring that community members have access, both immediately and for the long term, to clean drinking water.

Here are the results of the 2018 Rocky Mountain Regional Case Competition

First place ($1,000 scholarship each):

“Many Forks, One Community”

Team members and affiliations

  • Tamara Akers, ColoradoSPH
  • Robert Harr, ColoradoSPH
  • Jennifer Schulte, ColoradoSPH (Colorado State University home campus)
  • Jessica Stubblefield, ColoradoSPH

Second place, ($500 scholarship each)

“Learn, Empower, Action, Progress (LEAP): Many Forks’ Youth Program Helping Our Kids Leap Forward”

Team members and affiliations

  • Kathy Pang, ColoradoSPH
  • Ronald Truong, School of Medicine
  • Hannah Parris, ColoradoSPH
  • Amber Vaughn, ColoradoSPH

Third place ($250 scholarship each)

“Many Forks Clean WARS: Water. Access. Restoration. Sustainability.”

Team members and affiliations

Two teams received People’s Choice Awards ($100 scholarship each)

“Guidelines for Flood Disasters: A Plan for Prevention and What to Expect in the Moment of Crisis”

Team members and affiliations

  • Abdulrahman Alyamani, ColoradoSPH
  • Ann Giesenhagen, ColoradoSPH
  • Alexis Krause, ColoradoSPH
  • Simona Senovaityte, Skaggs School of Pharmacy and Pharmaceutical Sciences

“Flying Toward Better Solutions: Drones as the Future of Emergency Response”

Team members and affiliations

  • Sara Azimi, Skaggs School of Pharmacy and Pharmaceutical Sciences
  • Yuli Chen, ColoradoSPH
  • Leila Diab, ColoradoSPH
  • Elizabeth Kim, ColoradoSPH (CSU home campus)
  • William Windsor, ColoradoSPH

Editor’s note: Katie Brumfield, career services and practicum specialist, Colorado School of Public Health, contributed to this report.

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Researchers find common genetic link in lung ailments

An international research team led by members of the University of Colorado School of Medicine faculty has identified a genetic connection between rheumatoid arthritis-associated interstitial lung disease and idiopathic pulmonary fibrosis.

The findings are published in the current issue of the New England Journal of Medicine.

Joyce Lee, MD, associate professor in the Department of Medicine
Joyce Lee, MD, associate professor, Department of Medicine

“By uncovering this link in the genetic background between these conditions, we now know that rheumatoid arthritis associated-interstitial lung disease and idiopathic pulmonary fibrosis have similar causes and may prove to have similar treatments,” said first author Joyce Lee, MD, Associate Professor in the Department of Medicine.

Rheumatoid arthritis (RA) is an inflammatory and autoimmune disease that affects about 1 percent of the population. While it is commonly associated with progressive impairment, systemic complications and increased mortality, up to 60 percent of the patients with rheumatoid arthritis suffer from pulmonary conditions known as interstitial lung disease, which causes progressive scarring of lung tissue, lung impairment, and death.  Interstitial lung disease is a leading cause of morbidity and mortality in patients with RA.

Idiopathic pulmonary fibrosis (IPF) is the most common type of progressive lung fibrosis. Over time, the scarring gets worse and it becomes hard to take in a deep breath and the lungs cannot take in enough oxygen.  The average length of survival of patients with IPF is three to five years, and a critical unmet need is to identify patients before the lung is scarred irreversibly.

The investigators on the current study in the New England Journal hypothesized that there might be a common element in the genetics of RA-interstitial lung disease and IPF, so they studied a diverse population of patients with RA, including those who had and those who did not have interstitial lung disease. The study collected cases of patients from France, China, Greece, Japan, Mexico, the Netherlands and the United States. The number of study subjects totaled more than 6,000.

The investigators found that a specific genetic characteristic, known as the MUC5B promoter variant rs35705950, which results in a marked increase production of mucus in the lung and is the strongest genetic risk factor for idiopathic pulmonary fibrosis, is also the strongest risk factor for RA-interstitial lung disease.

“These findings will enable us to identify those with rheumatoid arthritis who are at risk of pulmonary fibrosis and design interventions to potentially prevent patients with rheumatoid arthritis from developing progressive pulmonary fibrosis,” said senior and corresponding author David Schwartz, MD, Chair of the Department of Medicine at the CU School of Medicine.

The research in the study was supported by grants from Société Française de Rhumatologie; the Fondation Arthritis Recherche & Rhumatismes; DHU FIRE; the National Heart, Lung and Blood Institute; the National Institute of Arthritis and Musculoskeletal and Skin Diseases (K23-AR051046); U.S. Department of Defense; the National Center for Advancing Translational Science; the Nina Ireland Program for Lung Health; Intramural Research Programs of the National Institute on Aging (NIA), part of the National Institutes of Health, Department of Health and Human Services.

Guest contributor: CU School of Medicine

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