The statistics you frequently hear on TV during medical stories dont necessarily come from the physician being interviewed. Often, they come from a crucial, but unsung, biostatistician.

These individuals often play a key role in designing studies and makesure they adhere to proper medical/scientific guidelines. Biostatisticians generally arent recognized in popular media for the studies to which they may have made important contributions. Its tough to explain in a one-minute story just what biostatisticians did, say, for a study showing a drug has treatment efficacy for 30 percent of people with diabetes.

A clinician using the new drug with patients is front and center for an interview with a reporter. Biostatisticians remain behind the scenes. To use a sports analogy, theyre best known for helping plan game strategy, rather than playing the game. Many medical experts refer to biostatistics as the science of obtaining, analyzing, and interpreting data in order to understand and improve human health. That information is at the heart of those study conclusions.

According to Dr. Kavita Batra, a new biostatistician at the UNLV School of Medicine, biostatisticians notonly can assist in designing studies;they review the data, perform quality assurance to statistical methods and outputs, and help interpret results of analyses to relay meaningful information to inform public health policies. Academic medicine, she notes, is evidence-based.

When Batra explains what she can bring to collaborations at the medical school, her scientific voice is evident: I bring my analytic, problem-solving, and communication skills to the School of Medicine. I perform advanced quantitative analysis modeling, bootstrap, meta-analysis etc. and have a firm grasp over the survey-based research. With my dental background [Batra is a former dental surgeon], I have a complete understanding of medical terminologies, which I get to apply and integrate with my statistical expertise to various areas across the school of medicine.

Dr. Deborah Kuhls, the interim assistant dean for research at the medical school, said that in hiring Batra the school found someone who has a skill set for academic medicine that is multidisciplinary. She can work as a key member of interdisciplinary research teams that include physician-scientists, residents, fellows, and medical students. Helping develop funding applications and contributing to proposal and budget development are also key parts of the job.

Batra, a native of India, received her Ph.D. in public health from UNLV in May. She focused on maternal and child health, assessing the health and financial burden of neonatal abstinence syndrome. Four years earlier, she earned her masters degree in public health at UNLV, writing a master's thesis analyzing the effectiveness of the national diabetes prevention program in reducing weight and promoting physical activity among adult Nevadans.

Cant isnt a word used much by Batra. Her personal story is a large reason for that.

Having had polio has made me stronger, said Batra, who now is matter-of-fact about the disease she contracted at the age of 6 months. Itparalyzed her lower right side, and it took five operations between the ages of 2 and 22 for her to walk well on her own. She says as a young girl she fell in love with numbers because she used to count the days she had to remain in a full-body cast after an operation.

Often it wasnt the physical problems that caused her the most distress as a young girl. Schools in India, believing her physical problems would translate into teachers having to spend time with her that didnt involve academia, wouldnt admit her. I was homeschooled by my mother. I missed being in school like other kids, she recalled.

Finally, when she passed all of a schools entrance exams, a school admitted her. My intellectual ability overcame my physical disability. She ended up skipping several grades, quickly catching up with her age group.

Emotionally, she said, her disability was difficult. When other kids were on the playground, she sat on a bench and wished she was there. People gave her strange looks when she moved. People imitated her gait. Sometimes I cried, but I was disciplined with my studies. If I couldn't be ahead with walking, Id be ahead with learning. Other students, often older, began to respect her because she could help them with their studies. Bullying ended.

As a 7-year-old,Batra began askingher parents questions that ultimately resulted in her going into medicine. I constantly asked, Why did this happen to me? Why am I different? The more I talked with them, I wanted to help people through medicine.

She initially wanted to go to medical school but decided against it because she didnt think she could move fast enough in an emergency. Instead, she went to one of Indias most prestigious dental schools. Dentists, she noted, are often the first health care professionals to recognize and identify various diseases, ranging from hypertension to oral cancer.

For five years she practiced dentistry. Then she became a public health officer, working heavily with statistics. I liked working to prevent diseases like polio, she said. I found it challenging and exciting to combine biology, statistics, and social science to address a health problem.

At the age of 30, she moved to the U.S. with her husband. The couple he works for Caesars now has an 8-year-old daughter. In addition to her studies at UNLV, she also has worked as a research coordinator and data analyst for Nevada Orthopedic & Spine Center and as an adjunct faculty member for UNLV, the Arizona College School of Nursing, the College of Southern Nevada, and Southern New Hampshire University (online).

Batra is excited about the statistical research shell be doing with the UNLV School of Medicine. I will be providing statistical consultation for research being conducted by faculty, residents, staff, and students. I will be providing support in empowering researchers in the study planning, developing the statistical models, power estimation, and interpreting results. I think the exciting piece is about the thrill of discovery, learning, and challenging your assumptions. One of the great things about statistics is that each investigation is new and unique, involves new data and hypotheses to explore, and new conclusions to be reached.

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Medical School Research Growing With Addition of Biostatistician - UNLV NewsCenter

Steve Marcus

An exterior view of Circa before the casino opening in downtown Las Vegas Tuesday, Oct. 27,2020.

Sunday, Nov. 1, 2020 | 2 a.m.

In one amazing 48-hour span last week, Las Vegas celebrated two landmark events that served as a tribute to the ingenuity, boldness and resiliency that put our community on the global map.

The first came when the spectacular Circa resort opened Wednesday on Fremont Street, marking the completion of the first ground-up casino-hotel project downtown in four decades. That gala occasion was followed Thursday mid-morning with a groundbreaking ceremony for the new academic building for the UNLV School of Medicine, located on the Shadow Ridge campus not far away from the new resort.

In both cases, those special events marked the beginning of something transformational for Las Vegas. Circa takes the Fremont Street Experience to a heightened level of modernity and luster that will undoubtedly boost tourism downtown, while the new medical school building puts Las Vegas on a path toward improving the quality of our health care regionally and enhancing our economy through medical education and research.

For that, credit goes to two sets of community leaders with extraordinary vision.

Circa is the brainchild of Derek and Greg Stevens, the brothers who have been infusing downtown with energy since acquiring a 50% interest in the Golden Gate in 2008. They followed by purchasing what is now The D in 2011 and obtaining 100% ownership of the Golden Gate in 2015 before embarking on Circa.

The new resort is simply stunning, a marriage of contemporary design and old-school Vegas featuring a 777-room hotel, a tiered water complex with six pools and two spas, and a colossal sports book, along with touches like historic Las Vegas images and artifacts, and the refurbished Vegas Vickie sign that once stood along Fremont Street.

The Stevenses havent revealed the cost of the resort, but needless to say it was a massive investment in downtown and in the future of Las Vegas.

We salute them and wish them the best as their new venture gets underway. Theyve shown once again that big, bold visions not only have a place in this town, they are the soul of Vegas.

As for the medical school building, credit goes to a broad group of Las Vegas philanthropists, civic leaders and campus administrators who worked unflaggingly to launch the UNLV School of Medicine in 2017 and devise a plan for construction of the new academic building.

In 2019, after years of facing hurdles from state-level higher education overseers on the project, the group cut to the chase by forming a nonprofit development corporation to construct the building with a combination of private and state funds. Once built, the $150 million facility will remain owned by the development corporation but will be leased to UNLV for $1 per year.

This was a practical, elegant solution to what had been a highly frustrating process. Before the development corporation was launched, three proposals for construction of the building came and went amid acrimony between donors and the Nevada Board of Regents and Nevada System of Higher Education.

But unfortunately, the medical school is still facing some uncertainty after state lawmakers withdrew $25 million in funding for the building amid state budget-cutting brought on by the coronavirus pandemic.

Supporters said at the groundbreaking ceremony that theyre advocating with state lawmakers to restore the funding, while also looking for third-party funding such as federal grants.

It is irresponsible to just continue to build buildings in Southern Nevada with philanthropic dollars, said Maureen Schafer, CEO of the development corporation. Its unsustainable, No. 1, and No. 2, this community has too many needs. Philanthropists have, for so long, been filling those needs.

Schafer was absolutely right, and our communitys state and national leaders should listen.

The building is a critical need for Southern Nevada, which will allow the school to expand to its full capacity of students. Currently, class sizes are limited to 60 per year, about a third of the designed capacity.

Bringing the medical school fully up to speed will make a huge impact on Southern Nevada, both by improving health care and helping expand our economy. The medical school offers potential to grow a lucrative biotechnical and pharmaceutical research sector here, which would diversify an economy that currently relies far too much on travel and tourism. In addition, improving our health care system throughout the valley will make us more attractive to businesses seeking to relocate or expand.

The bottom line: What started Thursday must be completed.

Las Vegas became the city it is today by constantly keeping an eye on its future, and taking bold steps to get us there. We had the audacity to embrace gaming at a much more puritanical time in America. During the jet age, we laid the groundwork to become an international destination. In more recent years, we adapted to changing consumer trends by blending in retail, dining, nightlife and outdoor recreation into our tourism offerings.

And we kept moving forward throughout the boom-and-bust cycles that have defined our history.

Both the Stevens brothers and the supporters of the medical school are doing just that today. We applaud them, and urge our leaders to follow their direction.

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Circa, medical school exemplify Las Vegas' tradition of thinking big - Las Vegas Sun

By Jennifer Micale

October 29, 2020

Pressured by her parents to study medicine, Nisha Gandhi 93 was determined to become an actuary instead. But the math majors equation for life worked out differently after she joined Harpurs Ferry, Binghamton Universitys student volunteer ambulance service.

It became an obsession. I lived in Delaware Hall, next to where the ambulances were kept, she said. I found I really enjoyed doing emergency and critical care more than being at a desk and doing math problems.

To fulfill her new dream, she did a year of graduate school to tackle her pre-med requirements, then enrolled in a Caribbean medical school before training in both the United Kingdom and the United States. Today, Dr. Nisha Gandhi is director of the medical-surgical intensive care unit at Englewood Hospital in New Jersey.

Theres nothing like being at the bedside and taking care of patients. Thats how you learn critical care, she said.

A screenshot from the Harpur Physician Alumni Panel, Greys Anatomy vs. Reality, held Oct. 23, 2020, on Zoom. Image Credit: Jennifer Micale.

Interested in a health career? Check out your options via pre-health professions advising, or listen to first-hand accounts of life in medicine with the Physician Alumni Lecture Series.

Biological sciences is a popular major for future doctors, but as Gandhis story shows, its not the only one. Dr. Adam Fox 92, the event moderator, graduated from Harpur with a degree in political science. Hes currently an associate professor of surgery and section chief of trauma at Rutgers New Jersey Medical School and the Eric Munoz Trauma Center at University Hospital in Newark.

Contrary to popular belief, getting a less than spectacular grade in one of your classes wont completely sink your medical school application. However, there are some limits, Fox explained.

I did not do amazingly well in college and I went to podiatry school before I got my grades up, Fox explained. But there is a big push to look at how people do with tests. If they feel you cant pass the boards, its a strike against you because residency and fellowship programs get dinged for it. You have to prove you can succeed in a very rigorous academic environment.

Having a compelling story behind your medical school application can help you stand out, especially if you have a bad grade or two, advised Dr. Desmond Sutton 10. His own story is particularly interesting: both he and his twin brother attended Binghamton and have since become physicians after attending different medical schools. Along the way, Sutton discovered his passion in high-risk obstetrics, and hes now in the last year of a fellowship in maternal fetal medicine at Columbia University.

Many people typically take a gap year or several before medical school, but that wasnt the case for Colin Pritchard and Alexandra Dolgetta. Pritchard, who graduated from Binghamton in May 2020, just started classes this fall at Upstate Medical University in Syracuse, where he is part of the Rural Medical Scholars Program. Dolgetta, who graduated in 2018, is now starting her rotations as a third-year medical student at the University of Maryland School of Medicine.

If you decide against taking a gap year, be prepared for interviewers to ask you about it, Dolgetta said. Once you get to medical school, the experience will be overwhelming, no matter how well you prepared, she said.

The first two years involve heavy studying; Dolgetta hit the books between 7 a.m. and 9 p.m. every day, with few breaks. She is enjoying her third year with its clinical rotations far more.

You do all of this work to get into medical school. None of that compares to the work you do in medical school. It is truly daunting, she said. The hard work truly begins when you get here. Youll be surprised at your capacity.

Sometimes, people decide to go into medicine to make money which is entirely the wrong reason, the panelists said.

While doctors are well-compensated, the debt burden is real, said Sutton, who started applying for 10-year loan forgiveness programs during his residency. That debt burden might influence your choice of specialty; Gandhis husband became an anesthesiologist rather than a pediatrician because he realized that he wouldnt be able to pay off his loans before retirement if he chose the latter path.

Medicine is also immensely stressful. Trauma surgeons such as Fox deal with life-and-death scenarios, all-nighters and grieving families on a regular basis. Gandhi, who has three children, has missed family events and celebrations.

The tests dont end with medical school, either, panelists said. To maintain their board certifications, physicians need to retest for them every 10 years and theyre grueling eight-hour exams, Gandhi explained. She should know: she has four board certifications that she must test for.

Shadowing and internships are good ways to find out if medicine is a good fit for you. Pritchard shadowed a colorectal surgeon in Sayre, Pa., as well as the local doctor in his small hometown. Dolgettas best shadowing experience came through the Summer Physician Mentor Program, which paired her up with a Harpur College alum. After five years, they still keep in touch, she said.

Medicine is immensely challenging, but it is just as fulfilling to people who have the mission and the passion, according to panelists.

You have to want to do it. Enjoy it, live it, love it, Gandhi said of medicine.

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Becoming a doctor: Physicians and med students talk about what it takes - Binghamton University

Gianna Nino-Tapias world as a first-year medical student is a chaotic mashup of virtual classes, anatomy labs and late-night, marathon study sessions. But life for the 24-year-old was drastically different just a few months ago.

Weeks after earning a masters degree in epidemiology in June, and two months before starting Stanford Medical School, Nino-Tapias returned home to Washington state to pick blueberries alongside her family after losing two jobs during the early days of the coronavirus pandemic.

Earning $3.50 for every gallon of blueberries she picked, Nino-Tapias rose at 3 a.m. each day to make the one-hour drive to a farm in Paterson, a town near the Oregon border. She would start picking the days harvest by 5 a.m.

Dressed daily in several layers, long sleeves, a face covering, a baseball cap and tattered sneakers, Nino-Tapias turned to the fields to make a living. Its a place shes known since she was 14.

I still had a lot of bills and things going on so I needed to find a job, she said. It was exciting and also a little disappointing ... but at the end of the day I was thankful that I was able to find a job, especially a job with my family.

Nino-Tapias straddles two worlds. At Stanford, wealth, privilege and education can afford many students endless opportunities. In the fields, farmworkers harvest up to 60 hours per week in unforgiving weather, often skipping bathroom breaks to pick more crops and showing up to work no matter the circumstance, even when theyre feeling ill or experiencing possible symptoms of the coronavirus.

Nino-Tapias story went viral over the summer after she tweeted photos from the fields. In one image, two white buckets brimmed with freshly-picked blueberries her harvest for the day. How much do you pay for your blueberries? she asked her followers.

As a low-income, first-generation Latina the daughter of a Mixtec woman from Oaxaca Nino-Tapias humble beginnings inspired in her a desire to excel in school and serve her community.

But her story also highlights the inequities that farmworkers have faced for decades, particularly as the pandemic rages on. She has seen those inequities play out in her family and in the lives of those that she has stood shoulder-to-shoulder with in the fields.

A lot of the things that I have seen in the fields and the health disparities the joint pain, the back pain and all of the things that you experience in the fields that was all seared into my mind and made me think, I want to serve my community as a medical practitioner, Nino-Tapias said.

When the pandemic hit in March and millions of residents across the Bay Area were ordered to shelter in place as businesses shut down, Nino-Tapias said she lost her job at Lush Cosmetics in the Stanford Mall. Stanford also shut down that month, which meant Nino-Tapias could no longer work at the universitys Native American Cultural Center, where she was a librarian and programming assistant.

She said she applied for several contact tracing positions, identifying people who might have been infected with the coronavirus, but did not hear back. Facing mounting school bills she paid for her masters degree on her own Nino-Tapias went home to work in a place that shaped her identity.

The days felt long, she said. It was hard because we had to start doing preparations for medical school so I was having to do modules and readings. I would have to come home, help my mom get everything ready (for the following day) and then do my work.

On Fridays, Nino-Tapias participated in a health journal club as part of Stanfords Leadership in Health Disparities program, in which incoming med students discussed academic articles about the social determinants of health. At first, Nino-Tapias called in from the fields through Zoom, but that became too hectic.

She stopped working on Fridays in order to focus on the journal club.

Farmworkers experience a multitude of socioeconomic and health disparities that have only worsened in recent months. As a vulnerable population, they are among the essential workers most devastated by the pandemic and account for a significant number of infections in agricultural regions like Sonoma, Monterey and Mendocino counties.

Nearly 168,000 farmworkers across the United States, including more than 12,600 in California, have tested positive for the coronavirus, according to data compiled by Purdue University.

Gabriela Diaz, a Cloverdale resident who works on a farm in Sonoma County, said she felt nervous working while most people sheltered in place.

We were all at work putting ourselves at risk while the rest of the world was home, said Diaz, 34. We were here, afraid of getting infected. We were really scared and nervous. At that point we just put our health in Gods hands and thats it. There was nothing left to do but work.

Several factors put farmworkers at an elevated risk of contracting the virus, including harvesting in close groups making it impossible to maintain a distance from peers living in overcrowded housing and not immediately seeking medical care due to lack of health insurance or fear of deportation, according to community advocates and researchers.

Farmworkers who may experience symptoms of the coronavirus dont always alert their employers because they cannot afford to miss work, they said.

No one is going to say that they are showing signs or symptoms because they need the money and they need to go into work, Nino-Tapias said. If they had anything going on, theyre not going to self-report that.

Nino-Tapias life experiences have defined her path toward medicine. Growing up, she often stepped in as an interpreter for her mother, Susana Tapia, who does not speak English. When her mothers friends had doctors appointments or gave birth to a child, Nino-Tapias mother would often send her to interpret on their behalf.

It was an incredible opportunity and I loved serving my community, she said. In my community, I also saw a lot of doctors who farmworkers could not identify with, so I hope that one day Ill be able to come back and serve my own farmworker community.

Black and Latino health care providers are more likely to have positive and productive interactions with patients who share the same cultural backgrounds, said Dr. Yvonne Maldonado, an epidemiologist and infectious disease specialist at Stanford, and one of Nino-Tapias mentors.

We are really disproportionately underrepresented in the health care workforce and this is true across the country as well, Maldonado said. Somebody like Gianna is a perfect example of an individual who is going to contribute greatly. ... This is what we would like to see happen in all diverse populations.

But as a student who started medical school during a pandemic that has killed more than 228,000 Americans and kept millions of people confined to their homes for months, Nino-Tapias has struggled to adjust to her new normal.

About five weeks into the semester, she drove back to Washington to be with family and continue her virtual classes from home.

My mental health was not doing well, Nino-Tapias said. It was very isolating and I didnt have a roommate at that point. I think a lot of the struggles for our class was that we were in our rooms all the time all the libraries are closed, everything is closed and so it became like us being in our rooms 24 hours a day. The smoke from the wildfires at one point became unbearable and so we couldnt even be outside.

Nino-Tapias has since returned to Stanford. While most of her classes are virtual, she attends a weekly anatomy lab on campus. The university also opened some classrooms so that students can take Zoom courses together at a distance, she said. And she recently got a therapy dog, Roxy, who gets long walks between classes.

On the day she took to Twitter over the summer, Nino-Tapias said she simply wanted to share a slice of her life on what was a particularly difficult day. She was struggling to fill enough buckets to make minimum wage.

She credits her mother for instilling her pride in being a farmworker.

She was the one who was willing to take me to the field when I was 14 and helped me not see it in a negative way, but rather a way to learn about hard work and inspire me to really want me to get an education so that one day I wouldnt have to go back.

Tatiana Sanchez is a San Francisco Chronicle staff writer. Email: tatiana.sanchez@sfchronicle.com Twitter: @TatianaYSanchez

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Stanford med student lost two jobs during the coronavirus pandemic. So she picked blueberries to make a living - San Francisco Chronicle

Daniel J. Nigrin, MD, is a pediatric endocrinologist who was drawn to the important role that technology plays in delivering world-class health care.

PORTLAND MaineHealth, northern New Englands largest integrated health system, has selected a physician-information technology leader from Boston Childrens Hospital to lead its IT team.

Daniel J. Nigrin, MD, who is currently the senior vice president and chief information officer at Boston Childrens Hospital, has been chosen as chief information officer of MaineHealth. He will replace Abdul Bengali, who came to MaineHealth this past January as interim CIO shortly before Marci Dunn, the health systems previous CIO, passed away after a long illness.

In Dan we get an experienced and knowledgeable physician-executive with strong credentials as an information technology leader, said Richard Petersen, president of MaineHealth.

Nigrin has been with Boston Childrens since 1995, shortly after completing medical school and his residency at Baltimores Johns Hopkins University Medical School and Johns Hopkins Hospital, respectively. During his time at Boston Childrens, he served as an attending physician specializing in pediatric endocrinology and found he was drawn to the role that technology plays in delivering high-quality care.

Nigrin began to assume increasing responsibility within Boston Childrens IT department and in 1999 obtained a masters degree in Medical Informatics from the Massachusetts Institute of Technology. In 2001, he was named senior vice president and chief information officer at Boston Childrens, however, he continued to practice medicine and see patients while serving in that role.

During his time leading the information technology team at Boston Childrens, Nigrin gained experience across a range of IT functions, including overseeing the installation of the clinical and business platforms that included Cerner and EPIC.

Nigrin says he was drawn to the opportunity at MaineHealth because it offers a chance to lead an enterprise with multiple local health systems pursuing a broad medical mission.

At MaineHealth, theres an opportunity to leverage technology in a way that positively impacts thousands of patients across Maine and Carroll County, N.H., said Nigrin. Its a unique opportunity to make a difference in peoples lives at a time when technology is playing an increasing role in the provision of health care.

Nigrin will begin his new duties at MaineHealth in January.

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MaineHealth taps Boston Children's physician with strong information technology background to lead its IT department - Bangor Daily News

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Effort could aid study of addiction, eating disorders, other neuropsychiatric conditions that involve faulty decision-making

By studying animals choosing between two drink options, researchers at Washington University School of Medicine in St. Louis have discovered that the activity of certain neurons in the brain leads directly to the choice of one option over another. The findings could lead to better understanding of how decision-making goes wrong in conditions such as addiction and depression.

When you are faced with a choice say, whether to have ice cream or chocolate cake for dessert sets of brain cells just above your eyes fire as you weigh your options. Animal studies have shown that each option activates a distinct set of neurons in the brain. The more enticing the offer, the faster the corresponding neurons fire.

Now, a study in monkeys by researchers at Washington University School of Medicine in St. Louis has shown that the activity of these neurons encodes the value of the options and determines the final decision. In the experiments, researchers let animals choose between different juice flavors. By changing the neurons activity, the researchers changed how appealing the monkeys found each option, leading the animals to make different choices. The study is published Nov. 2in the journal Nature.

A detailed understanding of how options are valued and choices are made in the brain will help us understand how decision-making goes wrong in people with conditions such as addiction, eating disorders, depression and schizophrenia.

In a number of mental and neuropsychiatric disorders, patients consistently make poor choices, but we dont understand exactly why, said senior author Camillo Padoa-Schioppa, PhD,a professor of neuroscience, of economics and of biomedical engineering. Now we have located one critical piece of this puzzle. As we shed light on the neural mechanisms underlying choices, well gain a deeper understanding of these disorders.

In the 18th century, economists Daniel Bernoulli, Adam Smith and Jeremy Bentham suggested that people choose among options by computing the subjective value of each offer, taking into consideration factors such as quantity, quality, cost and the probability of actually receiving the promised offer. Once computed, values would be compared to make a decision. It took nearly three centuries to find the first concrete evidence of such calculations and comparisons in the brain. In 2006, Padoa-Schioppa and John Assad, PhD, a professor of neurobiology at Harvard Medical School, published a groundbreaking paper in Nature describing the discovery of neurons that encode the subjective value offered and chosen goods. The neurons were found in the orbitofrontal cortex, an area of the brain just above the eyes involved in goal-directed behavior.

At the time, though, they were unable to demonstrate that the values encoded in the brain led directly to choosing one option over another.

We found neurons encoding subjective values, but value signals can guide all sorts of behaviors, not just choice, Padoa-Schioppa said. They can guide learning, emotion, perceptual attention, and aspects of motor control. We needed to show that value signals in a particular brain region guide choices.

To examine the connection between values encoded by neurons and choice behavior, researchers performed two experiments. The study was conducted by first authors Sbastien Ballesta, PhD, then a postdoctoral researcher, and Weikang Shi, a graduate student, with the help of Katherine Conen, PhD, then a graduate student, who designed one of the experiments. Ballesta is now an associate professor at the University of Strasbourg in Strasbourg, France; Conen is now at Brown University.

In one experiment, the researchers repeatedly presented monkeys with two drinks and recorded the animals selections. The drinks were offered in varying amounts and included lemonade, grape juice, cherry juice, peach juice, fruit punch, apple juice, cranberry juice, peppermint tea, kiwi punch, watermelon juice and salted water. The monkeys often preferred one flavor over another, but they also liked to get more rather than less, so their decisions were not always easy. Each monkey indicated its choice by glancing toward it, and the chosen drink was delivered.

Then, the researchers placed tiny electrodes in each monkeys orbitofrontal cortex. The electrodes painlessly stimulate the neurons that represent the value of each option. When the researchers delivered a low current through the electrodes while a monkey was offered two drinks, neurons dedicated to both options began to fire faster. From the perspective of the monkey, this meant that both options became more appealing but, because of the way values are encoded in the brain, the appeal of one option increased more than that of the other. The upshot is that low-level stimulation made the animal more likely to choose one particular option, in a predictable way.

In another experiment, the monkeys saw first one option, then the other, before they made a choice. Delivering a higher current while the monkey was considering one option disrupted the computation of value taking place at that time, making the monkey more likely to choose whichever option was not disrupted. This result indicates that values computed in the orbitofrontal cortex are a necessary part of making a choice.

When it comes to this kind of choices, the monkey brain and the human brain appear very similar, Padoa-Schioppa said. We think that this same neural circuit underlies all sorts of choices people make, such as between different dishes on a restaurant menu, financial investments, or candidates in an election. Even major life decisions like which career to choose or whom to marry probably utilize this circuit. Every time a choice is based on subjective preferences, this neural circuit is responsible for it.

Ballesta S, Shi W, Conen KE, Padoa-Schioppa C. Values Encoded in Orbitofrontal Cortex Are Causally Related to Economic Choices. Nature. Nov. 2, 2020. DOI: 10.1038/s41586-020-2880-x

This research was supported by the National Institutes of Health (NIH), grant numbers R01-DA032758, R01-MH104494 and F31-MH107111; and the McDonnell Center for Systems Neuroscience.

Washington University School of Medicines 1,500 faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Childrens hospitals. The School of Medicine is a leader in medical research, teaching and patient care, ranking among the top 10 medical schools in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Childrens hospitals, the School of Medicine is linked to BJC HealthCare.

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New insight into how brain neurons influence choices Washington University School of Medicine in St. Louis - Washington University School of Medicine...

In an August column in STAT News, Megan Mahoney, MD, Stanford Health Care's chief of staff, wrote, "In medical school, I was diligently trained to report to my attending physicians the age, race, and gender of my patients -- in that order."

She wondered how a doctor would describe her, a biracial woman, and what the medical consequences might be for her.

For a 1:2:1 podcast, I spoke with Mahoney, a family medicine clinician, about her background; about race and how it plays out in clinical settings; and about what needs to change to overcome systemic racial inequities in the nation's health care system.

This Q&A is edited and condensed from that conversation.

You wrote in your column: "It's time to stop using skin color and race in medicine and see patients for who they really are." It came out of your experience as a biracial woman. Tell me about your parents.

My father was born to Irish-American parents. After graduating from prep school and the U.S. Naval Academy, he married, but he lost his wife to meningitis. He decided to go into the priesthood. As a priest, he began working in Memphis and became very active in the civil rights movement.

My mother was born in Memphis -- the Jim Crow South -- as one of 13 children. Sometimes all the family had to eat were peaches from the trees in their backyard.

She received a full scholarship to a small Catholic college in Kansas. She returned to Memphis after college to teach at a high school. She also was treasurer at the Catholic parish church where my father served, which is how they met.

My mother received a PhD in mathematics, and later was one of the first African-American women in the United States to become a university president. She served as president of Lincoln University of Missouri for seven years.

My father was by her side throughout her career. It was quite a love story.

When were you first aware of being biracial?

I grew up in Columbus, Ohio. I was in kindergarten, the very first day of school, on the playground with a group of kids. They looked at me quizzically, trying to size me up, and asked, "So, what are you?" I had no idea what they were referring to.

Later, at the dinner table, I asked my parents, "There's this question I'm not really sure how to answer." They told me to go back the next day. If I was asked again, I should respond, "I'm mixed." I felt very prepared. I went back and was asked again, "What are you?" I responded, "I'm mixed up."

As you moved through life, college and medical school, how did being a biracial woman impact you?

For most of my adult life, I was categorized as "other." On applications for various schools, I've had to be limited in how I describe my racial background. They'd ask, White, African American, Asian, Pacific Islander, Hispanic, but there often was not a box that gave me an opportunity to write in, "White and Black."

When I was in high school, my counselors were pushing me towards Ivy League colleges, but I selected a school -- UC Berkeley -- because of its racial diversity.

For the first time, I could experience being surrounded by people of all different backgrounds. I can just share with you that that sense of belonging was truly cherished. For once, I didn't have to be asked, "Where are you really from?" It didn't matter.

In your opinion piece for STAT news, you write that it's time for medicine to look beyond race as a determinant factor and see people as individuals.

The practice of medicine has not truly accounted for mixed-race individuals and lacks the precision to recognize our whole, inclusive identities. A lot of it is based in our history in medicine.

Fortunately, there is now a greater appreciation that race is a social concept, rather than a genetically bounded category, thanks to the genomic revolution. We know now that we, as a species, share 99.9% of our DNA with each other, and that our traits that are typically associated with race are not linked genetically to health-related genes.

There is a greater appreciation for the role of environmental, social and behavioral factors, their influence on health outcomes, and how they probably determine over 70% of what determines health, according to the Centers for Disease Control and Prevention. That exceeds the contribution made by genetics and even medical treatment.

Black Americans have higher rates of morbidity and mortality for COVID-19. Systemic inequities also bear out for Latinos and Indigenous Americans. Are racial inequities baked into the health care system?

Sadly, racism and bias are baked into most, if not all, of our institutions. We need to identify where they exist and then address and change them. I'm committed to that.

A recent Kaiser Family Foundation survey found that one in five Black Americans say they've experienced discrimination while seeking health care in a clinic.

That's a stark statistic, and it likely does reflect the experiences of Black Americans. I think that we as physicians are morally obligated to practice cultural humility -- the fact that we all carry unconscious biases. We all do. We have to become aware of that and approach it with a certain level of humble inquiry, questioning ourselves in how we're practicing medicine.

How do the murders of George Floyd, Breonna Taylor and many others, and the data you're talking about, meet this particular moment? Are we at an inflection point?

I think so. There is a greater interest in raising our collective awareness around these issues. I've also noticed that there is a concerted effort behind wanting to make curricular changes in medical school, so we are understanding how race and racism impacts health and health outcomes.

I'm seeing changes I've never witnessed before, happening throughout our institutions.It's really an important time.

Top image of Megan Mahoney, MD, with a patient by Steve Fisch. Family photos courtesy of Mahoney.

See original here:
Biracial Stanford physician: We must look beyond race in medicine - Scope

DULUTH Every time the phone rang, it seemed to Kristine Smoley like more bad news about her husband, who contracted COVID-19 and was in a hospital intensive care unit on a ventilator because he couldnt breathe on his own.

Smoley was prepared for the worst when a nurse from Duluths Essentia Health called with hope albeit with risks and no solid evidence it would save her husband.

They asked if I wanted to consider signing off on an experimental treatment for him, Smoley said. A treatment that had never been done before.

Essentias Dr. Tim Rich and the University of Minnesota Medical Schools Dr. David Ingbar had studied for years whether a common thyroid hormone could be repurposed for the treatment of acute respiratory distress syndrome (ARDS), an often fatal type of lung failure. The doctors received federal approval late last year to test the therapy, so when COVID-19 caused a sudden surge in ARDS, they were ready for their first patient Smoleys husband, Bob Schlicht.

It was scary, Smoley said. But I dont know that I really had an option. Because the other option wasnt good.

The turnaround that followed was so remarkable that Rich and Ingbar have advanced their research unique for a regional medical provider in a world of urban and academic COVID-19 studies to a phase 2 U.S. Food and Drug Administration (FDA) study. The doctors have optimism about the impact their treatment could have amid the pandemic.

There has been a lot of highly technical science to understand this biology, but the elegance now is in its simplicity, said Rich, a pulmonologist. This is not a designer drug. This is something we know the lung needs and uses.

New therapies are needed against a pandemic that has caused 150,672 known infections, 10,334 hospitalizations and 2,475 deaths among Minnesotans. Only the antiviral remdesivir has received full FDA approval as a COVID-19 therapy for hospitalized patients, while treatments such as plasma infusions remain experimental and available only under emergency authorization.

Rich and Ingbar made a key discovery during the H1N1 pandemic of 2009, when families of those who died from influenza-related ARDS permitted autopsies. Rich found the victims lungs lacked T3, a thyroid hormone that would normally be detectable.

Ingbar said T3 reduces inflammation and coaxes epithelial cells in the lungs to absorb fluids which is vital for patients with ARDS.

A part of this acute lung injury with ARDS is the lungs get leaky, and they tend to fill with fluid, Ingbar said. That makes it really hard to get oxygen in or carbon dioxide out.

Schlicht was coughing and congested when Smoley dropped him at an emergency room in Grand Rapids on March 26, a few days after the retired couple cut cross-country travels short due to the spread of the novel coronavirus that causes COVID-19.

Schlicht, 68, was Itasca Countys first known positive case of COVID-19. Smoley watched medical staff garbed in full protective gear take her husband to an isolated room. He was transferred to Duluth within two days.

A few weeks later, Mary Ellen Evangelista found herself in a similar situation. Her brother, Tim White, was a corrections officer at the Moose Lake prison, where inmates and workers tested positive for COVID-19 in early April.

Evangelista, who lives in Georgia, urged White to call an ambulance after he spent a week getting sicker at home. He was placed on a ventilator in Duluth late that night because the virus led to ARDS.

Doctors told Evengelista that her 51-year-old brother might not survive and asked to try the thyroid hormone.

And every day, I just had a little more glimmer of hope, she said.

White spent more than a month in the Duluth hospital but has been back home since spring and is working to gain enough strength to return to work. Chest X-rays for months have shown healthy lungs.

This is really a much faster recovery than we see with typical ARDS, said Ingbar, noting that many survivors have lung scarring that can cause breathing problems for years and the need for supplemental oxygen.

White plans to visit his family in Georgia for the holidays. Evangelista choked up discussing the trip.

That hes going to be with us at Christmas was not a foregone conclusion back in April, she said.

Schlicht said he feels 100% healthy and has been helping build an event center near home for his sons upcoming wedding.

Each visit really puts in perspective how close we were to death, he said.

While the timing of recovery and abrupt reversal of symptoms suggest that T3 worked, doctors cant rule out that the men recovered due to other medical care.

The trial was paused for months following the treatment of Schlicht and White for a safety review, but Rich and Ingbar recently received the go-ahead to give the therapy to more patients in Duluth and plan to expand to three Twin Cities-area hospitals.

The next step to prove cause and effect is to recruit 68 patients with ARDS from COVID-19 or other causes for the FDA-approved study, and to compare 50 who receive supplemental T3 with 18 who receive standard care.

ARDS stems from a variety of causes, including heat, physical trauma or inhaled substances. Research showed that any such lung injury produces more of an enzyme that breaks down T3.

Theres a real local destruction of the hormone that explains why its concentration is so low, Ingbar said.

Doctors administer the hormone directly to a patients lungs through a breathing tube. That is a novel part of this study, as sick people have received thyroid hormones for years, but never straight into their lungs in this manner.

The Us Center for Translational Medicine is working to produce a patented powder T3 formulation. That inhaled or nebulized form would be cheaper and easier to administer, meaning more patients could receive it if it proves safe and effective.

Our hope is actually that this therapy should work for some other illnesses in addition to ARDS, Ingbar said. He and Rich may explore administering the treatment earlier to see if it prevents patients lungs from suffering distress.

Success of the ongoing study will be measured by whether supplemental T3 sops up enough lung fluid and allows for healthy blood oxygen levels. Rich said the overriding hope is not only survival but a return to life without chronic breathing problems and disabilities.

Any survival of ARDS, especially this COVID ARDS, is exciting, but its not enough to survive, Rich said. Its to not have the morbidity of a compromised lung for the rest of your life.

The recoveries of Schlicht and White will be featured in an upcoming medical journal. The two men, the first people in the world to receive this experimental treatment, met after Whites October checkup at the hospital where they spent so many sick days. They exchanged an elbow bump.

Im a very lucky man, White said, to be sitting here today.

See the article here:
Experimental hormone therapy may speed recovery for COVID patients - Minneapolis Star Tribune

CAMBRIDGE, Mass., Nov. 02, 2020 (GLOBE NEWSWIRE) -- Trillium Therapeutics Inc. (Trillium or the Company) (NASDAQ/TSX: TRIL), a clinical stage immuno-oncology company developing innovative therapies for the treatment of cancer, today announced the formation of a Scientific Advisory Board (SAB), including Karen Ferrante, MD, Gordon Freeman, PhD, Tom Reynolds, MD, PhD, Steven Rosen, MD, and Jeff Settleman, PhD.

It is a true privilege to announce this SAB, comprised of leading experts who have had major formative impact on the field of oncology/immuno-oncology over the past 25 years, said Jan Skvarka, Trillium President and Chief Executive Officer. Their combined resume includes several of the most groundbreaking oncology drugs or underlying scientific discoveries, including the PD-1/PD-L1 class, Adcetris, interferon, Iressa, Lemtrada, Velcade, Tarceva, Taxol, and Xalkori, among others. We are looking forward to their guidance as we continue expanding our research and development activities.

Members of the Trilliums SAB include:

Karen J. Ferrante, MD Dr. Ferrante is a hematologist-oncologist with 25 years of experience in oncology drug development. She was the Head of R&D and CMO at Tokai Pharmaceuticals, and Head of the Oncology Therapeutic Area at Takeda and CMO at Millennium Pharmaceuticals, after holding a variety of roles in oncology clinical development at Pfizer and BMS. During her career she was involved in the clinical development of a number of important cancer therapeutics including Taxol, Tarceva and Velcade.

Gordon Freeman, PhD Dr. Freeman is an immunology researcher in the Department of Medical Oncology at Dana-Farber Cancer Institute and a Professor of Medicine at Harvard Medical School. Dr. Freeman is best known for the discovery of the PD-1/PD-L1 pathway, which provided the foundation for developing immune checkpoint blockade immunotherapies. Dr. Freeman is the 2014 recipient of the William B. Coley Award for Distinguished Research in Tumor Immunology, the 2017 recipient of the Warren Alpert Foundation award, and a 2020 co-recipient of the Richard V. Smalley, MD award, the highest award of the Society for Immunotherapy of Cancer.

Tom Reynolds, MD, PhD Dr. Reynolds served as Chief Medical Officer of Seattle Genetics, where he was responsible for building and leading an integrated clinical development, regulatory and medical affairs organization, highlighted by the development and approval of Adcetris. Previously, Dr. Reynolds served at ZymoGenetics (acquired by Bristol-Myers Squibb in 2010), most recently as VP Medical Affairs, where he oversaw the clinical development and regulatory filing of recothrom, and VP Clinical Affairs at Targeted Genetics.

Steven T. Rosen, MD Dr. Rosen is the Provost and Chief Scientific Officer of the City of Hope National Medical Center in Duarte, California. In addition to directing City of Hopes Comprehensive Cancer Center, Dr. Rosen leads the Beckman Research Institute at City of Hope. Previously, Dr. Rosen was the director of the Robert H. Lurie Comprehensive Cancer Center at Northwestern University. In 2015, Dr. Rosen received a lifetime achievement award from the Israel Cancer Research Fund for his work in cancer research. His main areas of research involve the development of new treatments, particularly for hematologic malignancies.

Jeff Settleman, PhD Dr. Settleman is the Chief Scientific Officer for Oncology R&D at Pfizer, where he leads all oncology research from discovery to proof of concept clinical studies. Prior to Pfizer, Dr. Settleman was the Head of Oncology Research at Calico Life Sciences, and the Head of Discovery Oncology at Genentech, following an 18 year career in academia as a Professor at the Harvard School of Medicine, a Director of the Center for Molecular Therapeutics and Scientific Director of the Massachusetts General Hospital Cancer Center, as well as the Head of the Cancer Cell Biology program of the Dana-Farber/Harvard Cancer Center.

About Trillium Therapeutics

Trillium is an immuno-oncology company developing innovative therapies for the treatment of cancer. The companys two clinical programs, TTI-621 and TTI-622,target CD47, a dont eat me signal that cancer cells frequently use to evade the immune system.

For more information visit: http://www.trilliumtherapeutics.com

Caution Regarding Forward-Looking Information

This press release contains forward-looking statements within the meaning of applicable United States securities laws and forward-looking information within the meaning of Canadian securities laws (collectively, "forward-looking statements"). Forward-looking statements in this press release include statements about, without limitation, the membership and our plans for our scientific advisory board. With respect to the forward-looking statements contained in this press release, Trillium has made numerous assumptions regarding, among other things: the impact of the COVID-19 pandemic on its operations, the effectiveness and timeliness of preclinical and clinical trials; and the completeness, accuracy and usefulness of the data. While Trillium considers these assumptions to be reasonable, these assumptions are inherently subject to significant scientific, business, economic, competitive, market and social uncertainties and contingencies. Additionally, there are known and unknown risk factors that could cause Trillium's actual results, performance or achievements to be materially different from any future results, performance or achievements expressed or implied by the forward-looking statements contained in this press release. A discussion of risks and uncertainties facing Trillium appears in Trillium's Annual Information Form for the year ended December 31, 2019 filed with Canadian securities authorities and on Form 40-F with the U.S. Securities Exchange Commission, each as updated by Trillium's continuous disclosure filings, which are available at http://www.sedar.comand at http://www.sec.gov. All forward-looking statements herein are qualified in their entirety by this cautionary statement, and Trillium disclaims any obligation to revise or update any such forward-looking statements or to publicly announce the result of any revisions to any of the forward-looking statements contained herein to reflect future results, events or developments, except as required by law.

Investor Relations:James ParsonsChief Financial OfficerTrillium Therapeutics Inc. 416-595-0627 x232james@trilliumtherapeutics.com http://www.trilliumtherapeutics.com

Media Relations:Mike BeyerSam Brown Inc.312-961-2502mikebeyer@sambrown.com

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Trillium Therapeutics Announces Formation of Scientific Advisory Board - GlobeNewswire

EDINBURG, Texas (KVEO) UTRGVSSchool of Medicineis growing againbyaddingapodiatry program the only one inTexas.

Historically, anyone inTexaswho wanted to be a podiatrist had to leave the state to get a degree to come back,Dr. Lawrence Harkless,UTRGV School of Podiatry interim dean said.

Dr.Harkless came out of retirementto serve as the new schools deanand prepare the academic plan.

We will be taking the classes the medical school takes in the first two years,and then we will start teaching more podiatry-specific courses earlier,he said.

Dr. Harkless previously helped establish aCollege ofPodiatricMedicine inPomona,California, and saysstudent mentorship will be at the forefront of this new program.

The foundation for that would be learn, serve, lead,he said.

According to theAmericanDiabetesAssociation, theRGV has a diabetes rate three times higher than the national average, whichDr.Harkless says makes the area an ideal spot fortheschool.

(People) Can really stay inthecommunity where they grewup andserve,he said.

The inaugural class will be welcomed in the fall of 2022,andUTRGVisalready looking to hire 20 faculty with a passion for both teaching as well as research.

Tohaveexcellence in a student, every faculty member has to be excellentbecause they have to be able to teach thatwhetherin basic science, two years theory andfactorwhetherin clinical years, he said.

Along with theSouthTexasDiabetes andObesityInstitute ofBrownsville,Dr.Harkless says theRGV could become medical leaders over genetics and genomics of the feet.

Read the original post:
UTRGV to offer 10th school of podiatric medicine in entire nation - KGBT-TV

Internationally regarded as a brilliant researcher, David Boothman helped pioneer a promising approach to fighting cancer by turning diseased cells against themselves in a process he dubbed the Kiss of Death.

The work helped draw Boothman to Indiana in 2017 to serve as the inaugural Sid and Lois Eskenazi Chair in Cancer Research at the Indiana University School of Medicine and Associate Director of Translational Research at the Simon Cancer Center.

His hire was a significant coup for the school. But Boothman will never get the opportunity to see if his research translates into saving lives.

Boothman died after a nurse at the Sid and Lois Eskenazi Hospital in Indianapolis mistakenly administered a massive dose of fentanyl a synthetic opioid nearly 100 time stronger than morphine instead of a benign hydrating solution as he recovered from a stroke.

The 61-year-old molecular biologists death on Nov. 1, 2019, came a week after the medication error. The fentanyl depressed his blood pressure, causing brain damage that pushed Boothman into an irreversible coma. An autopsy revealed he died from respiratory failure following the fentanyl overdose. The coroner ruled his death an accident.

For the last 10 months, his widow, Dr. Sue Strickfaden, has been locked in a malpractice dispute with the hospital, the flagship of the public Health & Hospital Corp. of Marion County. Officials acknowledged the medical error but denied the mistake caused Boothmans death, according to her attorney, Michael J. Woody of Findling Park Conyers Woody & Sniderman.

But last week the hospital proposed a settlement with Strickfaden. The offer came after IndyStar interviewed Woody, Strickfaden and others and then reached out to HHC with questions about Boothmans death. The confidential settlement, which has not been finalized, prohibits the parties from discussing this case. This story is based on those prior interviews.

Boothmans death culminated what Woody called a tragic circus of errors that occurred during his two-week stay at Eskenazi last October.

Strickfaden was seeking compensation for the loss of the love, care, affection and support of her husband, Woody said. But her ultimate goal is broader: She wants the hospital to be held accountable so no one else dies from a mistake like the one that killed her husband, he said.

The main issue is how lethal and dangerous fentanyl is as a medication, not just on the streets but even in the hospitals, and how little the very people that are in the hospital handling it actually seem to have been trained, Strickfaden said. I think and I hope that that certainly will change.

An Eskenazi Health spokesperson said in a written statement Oct. 21 that they can not talk about the case because of privacy laws and the litigation.

We can, however, state, unequivocally, that Eskenazi Health is committed to high quality patient care, and never wants a medical error to occur, said Michelle OKeefe. In the unfortunate and infrequent circumstance when a medical error does occur, we immediately conduct a thorough review to determine the cause of the event, learn everything that we can from the situation, and develop specific action plans to reduce risk and further improve patient safety.

Coup for med school

Officials at the medical school and cancer center declined to comment for this story, but luring a researcher of Boothmans prowess to IU was a coup, according to Lindsey Mayo, an associate professor at IU who worked with Boothman.

He was starting a whole new group to work on a specific area, which we didnt have at IU, and he was pivotal, because he has such an infectious personality, in getting a lot of these junior people to come here, said Mayo.

A molecular biologist, Boothman came to IU with a distinguished track record of innovation and a knack for securing grants to further research, including his Kiss of Death approach to attacking lung and pancreatic cancer cells. After more than a decade of research, he had found a way to trick the cancer cells into producing a self-defeating toxin that didnt affect other cells.

Boothmans groundbreaking work had the potential to jumpstart the medical schools aspiration of becoming one of the nations preeminent medical schools, according to a memorandum of understanding detailing his role and expectations. A copy provided by Woody and dated Aug. 2, 2017, said the goals included aiming toward developing cures for at least one cancer and a childhood disease in the next decade.

The memorandum said school officials believed Boothman was the kind of researcher to make this happen.

In my opinion, Dave was a superstar, said Marc Mendonca, Director of Radiation and Cancer Biology and Associate Vice Chancellor for Research in the IUPUI Departments of Radiation Oncology & Medical and Molecular Genetics. He had known Boothman for years and worked with him at IU.

In the last few years he hit the big time. He published major papers. But he worked many, many years to get there. And then, suddenly, all the grants came and, you know, he was rocking.

Strickfaden said he was involved in research projects that attracted more than $20 million in grants.

There was no roadmap for their pancreatic cancer research, Mendonca said, and Boothman was doing stuff that many other people were not even thinking about.

Prior to being recruited to Indiana, Boothman had been Associate Director of Translational Research at the University of Texas Southwestern Medical Center and Co-Director of Experimental Therapeutics at the schools Simmons Comprehensive Cancer Center in Dallas.

Boothman grew up in the Detroit area, where his father operated an auto body shop. Boothman and his siblings often helped at the family business. Thats where they learned about work ethic, Strickfaden said.

He graduated from the University of Michigan-Ann Arbor, then received his Ph.D in microbiology and immunology at the University of Miami Medical School. Boothman did postdoctoral research at the Dana-Farber Cancer Institute of Harvard Medical School before taking a position at his alma mater. Thats where he met Strickfaden, who was working as a lab assistant before leaving to attend chiropractic school in Texas.

Their friendship turned to romance in 1996 after Boothman moved on to the University of Wisconsin-Madison and then Case Western Reserve University in Cleveland. They were reunited geographically when Boothman went to UT Southwestern Texas in 2005.

The couple married in 2007. Away from their work, Strickfaden said they lived a quiet life, going to movies, gardening and traveling.

Boothmans real passion, however, revolved around his work and colleagues.

Mad scientist in shorts, sandals

Circus of errors

Last October, Boothman and Strickfaden had just celebrated their 12th wedding anniversary and were preparing to close on a house. It was a busy time. They were selling a home in Texas, and Boothman had presentations coming up in Baltimore and London. He also was reviewing grant applications for the National Institutes of Health.

On Oct. 17, he complained about fatigue and balance problems to Strickfaden, who had returned to Texas to handle the home sale there. It wasnt like him to complain, so she asked one of his Indianapolis colleagues to take him to the doctor.

The friend arrived at Boothmans home the next day. Boothman had fallen. He wasnt able to get him up and they called an ambulance that took him to Eskenazi.

Over the next two days, Boothmans condition stabilized. He began speech, physical and occupational therapies, according to Woody, the attorney representing Strickfaden. As he continued to improve, his diet was advanced on Oct. 20 to solid foods.

A photo of Boothman taken by Strickfaden that day shows him reclining in a hospital bed. He is smiling and holding a foam cup. A plate with remnants of the omelet and fruit hed had for breakfast sits on a tray in front of him.

While Boothman likely faced an extensive rehabilitation regime, Woody said he was expected to survive the stroke. Plans were being made for his move to a rehab facility when his condition took a turn for the worse two days later. Boothman failed a swallowing test.

That marked the start, Woody said, of the tragic circus of errors that would culminate in Boothmans death.

On Oct. 23, Boothmans breathing became labored. The next day, a feeding tube was inserted due to his difficulty swallowing. During the procedure, Boothman aspirated a large piece of food from his stomach. It lodged in his airway. He suffered acute respiratory arrest and was placed on a ventilator.

To sedate Boothman while he was on the ventilator, records show he was given four small doses of fentanyl, ranging from 18 to 59 micrograms, on Oct 24 and Oct. 25. Still, he was responsive. Medical records show he was following simple commands and moving all limbs spontaneously. Woody said neurology progress notes indicated he was expected to come off the ventilator by Oct. 26.

But a little after 11 p.m. on Oct. 25, a nurse covering for Boothmans primary nurse responded to an alarm going off on a medication pump next to Boothmans bed. An IV bag of Lactated Ringers solution, a common hydrating fluid, needed to be replaced.

Nurses fatal mistake

The nurse obtained a new bag of the solution and hung it on the pole along with other medications also attached to the pump. One of those bags contained the fentanyl, which had been discontinued earlier in the day.

The nurse said in a deposition that she scanned the solution and a barcode that came up on the pump before restarting it at 11:24 p.m. The steps were part of a confirmation procedure intended to track medications and catch errors. But there was a gap in the fail-safe system.

She had attached the hydrating solution to one channel on the pump, but mistakenly pushed the start button for another channel the one attached to a bag of fentanyl. The pouch holding the drug he had been off of since earlier in the day remained attached to the pump nearly 12 hours later.

As soon as she pushed the start button on the module that was actually going to give the fentanyl the alarm went off. And instead of checking the alarm and reading the alarm code, the nurse just hit a silence button, Woody said.

A few minutes later, another nurse who checked the pump also missed the error.

If the nurses would have looked at the drip chamber, they would have seen that the bag of Lactated Ringers wasnt running, he said.

Because the mix-up went unnoticed, over the next 69 minutes Boothman received 1119.4 mcg of fentanyl. That was nearly 20 times the largest dose he had received for sedation before it had been discontinued. A doctor in Ohio was charged with murder last year after prescribing patients 500 mcg of the drug.

The error was finally discovered at 12:33 p.m. Oct. 26. But Boothman wasnt given Narcan, which can counter the effects of opioid overdoses. A doctor didnt come to his bedside until 2 a.m., according to the chart. Even then, no Narcan was administered as Boothmans blood pressure plummeted to a level too low to provide an adequate oxygen supply to his brain and other organs.

Its unclear whether the reversal agent would have been able to help after that huge dose of fentanyl, Woody said. But by not doing that it took away any chance that he would have had.

Boothman never regained consciousness. He was removed from life support Nov. 1. It was All Saints Day, a Christian holiday celebrating a believer who has entered heaven. Strickfaden said the timing offered a small measure of solace to her and Boothmans mother, a devout Catholic.

Error nearlyoverlooked

The medical error that killed Boothman could easily have escaped detection, Woody said. When reviewing records from the hospital he found no indication Boothman had received the massive dose of fentanyl.

A medication log from that night showed Boothman had, however, received the Lactated Ringers solution as ordered. But there was a note from the critical care doctor in the chart from the next morning. It mentioned a one milligram fentanyl bolus that was consistent with Dr. Boothmans state of not being responsive.

Details of what really happened came out after the malpractice complaint was filed in January and Woody began taking testimony from hospital officials. I asked what was this doctor talking about when she said there was a one milligram dose of fentanyl ... Where is that in the records? And so then they produce the records and said, Well, its under Lactated Ringers, Woody said.

Woody said hospital officials refused to admit the medication error was below the standard of care or constituted malpractice.

Theyre claiming that his underlying stroke was the cause of this event that he had an underlying stroke that just kept getting worse and that was the cause of his death, Woody said.

But two independent doctors who reviewed the case dispute that claim, Woody said. They include Dr. Max Wintermark, Chief of Neuroradiology at Stanford University and Medical Center, who said Boothmans stroke is not the type Eskenazi claims it was in the hospitals defense.

Dave was expected to recover, Woody said. Up until after the fentanyl overdose, theres nothing to suggest that anybody felt that this was a terminal condition.

Widow suffered in silence

The cause of Boothmans death has not been previously made public. Most everyone has no idea what really happened to my husband in that hospital, Strickfaden told IndyStar.

Even though I did know, I had to suffer in silence so to be as strong as I could be for everyone else. And while the time I should have been able to grieve, instead I needed to immediately direct my attention to this case in hopes it will bring the much needed awareness and a wake-up call about the incredible deadly danger of fentanyl.

On a personal note, she is also devastated that Boothmans wedding ring which he hadnt taken off since they were married went missing at the hospital.

Strickfaden said she hopes that speaking about the tragedy increases awareness about the danger of fentanyl, even in a hospital setting, and what she believes were inexcusable gaps in her husbands care.

Her attorney, Woody, added the role of a medical malpractice lawyer is to hold hospitals and healthcare providers accountable when basic safety violations result in serious injury or death. If accountability in this case creates necessary safety changes that help prevent a fatal medication error from happening to someone elses loved one, then Ive done my job and our malpractice law has served its primary purpose of promoting patient safety, he said.

OKeefe, the Eskenazi spokesperson, said the hospital promotes a culture of safety by encouraging our providers and staff to report errors and near misses to continuously improve our processes and ensure the same medical errors do not happen again.

She did not disclose what, if any, changes were made in response to Boothmans death.

Excerpt from:
Cancer researcher dead after Indianapolis hospital gave him fentanyl rather than fluids - South Bend Tribune

Thats a sentiment shared by Yang Li, asecond-yeardoctoralstudent from China who is earning her degree in higher education.Li has taken the typical CGE experience a step further by working for the center as part of her graduate assistantship. Li said its a choice shes glad she made.

I have made most of my friends through the CGE and enjoy many research opportunities, she said. My research interest is international student success in the UnitedStates,and I am exposed to so muchoftheinternationalstudent experience here on campus.I feel lucky to work there.

Opportunities for travel and culturally immersive experiencesare offeredthroughFSUprogramssuch asGlobal Scholars,Global Exchanges,Beyond Borders, theMoellership ProgramandInternational Programs.

International opportunities are also found in classrooms across campus. One example is at the College of Law where students can take a class in international human rights. The course includes about 30 students, 15 of them domestic and 15 from schools of law around the world, said Terry Coonan, an instructor in the course and the director of FSUs Center for the Advancement of Human Rights.

Its a dynamic experience in which we are working with superb law schools around the world to confront human rights issues that are worldwide, he said. For our FSU students,especially, its a great reminder on a weekly basis of how international the field of human rights is.Its one of the great classes I am so fortunate to teach.

FSUs Global Citizenship Certificate is another opportunity for students to plug international learning and experiences into their classes.The certificate requires students takefour courses with a global or cross-cultural themeand engage in intercultural experiencesto help themlearnto meet the new challenges of living and working in the global society of the 21st century.

HennaAwad, a senior from Jacksonville, Florida,saidthe certificate helped her build her cross-cultural knowledge in profound ways.

Ihad the opportunity to travel a lot before I came to FSU and I could maybe identify a different culture but not how or why it was different, she said.Like the perspective on time can be different between cultures. The certificate programimproves your critical thinking skills.Its just been a really great opportunity.

FSU womens soccer player Gabby Carle,anative of Levi, Quebec, Canada, didnt have international experiences on her mind when she chose to take her talents to Tallahassee over offers from other American universities.

Carle,whosefirst language is French, is set to graduate next spring withadegree in exercise physiology.

The biggest concern for me was I was looking to play soccer at the highest level, she said, before adding that sheaccomplishedthat goal and much more. I plan to play soccer professionally either here or in Europe. Then, post soccer, I plan to go to medical school and become adoctor.

Carle said the experience of being an international student at FSU was unquestionably a positive one and while her teammates hail from England, Venezuela, Costa Rica, Japan, IrelandandFinland to name a few, she said the international influence at FSU is everywhere.

One time,I was in biology lab andwaspaired with some classmates.We startedsharingstories and four out of five of us werefrom differentcountries, she said.I think when you walk on campus the diversity iseverywhere. Maybe sometimes you cant see it,but when you sit down and talk to your classmates,theres a lot of diversity here at Florida State.

For more information about International Education Month, visit global.fsu.edu/iem.

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International influences and opportunities abound at FSU - Florida State News