Dr. Frederick Rick Morin plans to retire next summer. File photo by Morgan True/VTDigger

(This story was updated and expanded Aug. 30 at 8:30 p.m.)

Dr. Frederick Rick Morin, 68, has been dean since 2007. In addition to leading the medical school, he sits on the board of directors for the UVM Medical Center, the UVM Health Network and the UVM Health Networks Medical Practice Group.

When he came to the medical school 10 years ago, Morin said, he was the fifth person to serve as dean in seven years. He said it was hard for the medical school to live up to its potential with such high turnover among leadership.

My goal was to come in, stay for 10 years, and then be able to decide whether the College of Medicine needs me, Morin said. Its been a wonderful 10 years at the college almost by any measurement you want to make.

Morin is trained as a pediatrician and neonatologist specializing in treating critically ill newborns. His research focused on lung diseases in premature babies. He attended the University of Notre Dame and Yale University School of Medicine.

Among his accomplishments, Morin was dean when the UVM medical school saw its total philanthropic gifts from Dr. Robert Larner surpass $100 million. The medical school subsequently was renamed for Larner, an alumnus.

Morin said the money is being used specifically to make the medical schools education second to none. The college is nine months into a five-year plan to implement sweeping changes to the curriculum, he said.

The transformation includes a recent decision to eliminate lectures in favor of active learning and the creation of a simulation laboratory where medical students and even practicing physicians use machines and actors to simulate procedures and diagnoses.

Its not the fanciest or biggest or flashiest, but we surveyed all the other academic medical centers, and we havent found one thats as busy as ours, Morin said. Were actually using it. Its just another example of how real innovation makes just a great big difference.

Morin said now is the right time for him and his wife to spend more time on other interests, such as fly fishing. He compared the situation at the medical school to catching a really big wave when surfing.

The wave were on is a wave that doesnt occur in a decade often, or in most peoples careers, and were on the front of one of those. But at the same time, its been 10 years.

My wife and I want to spend more time on our personal interests, on our families, on our travel, and all sorts of things like that, and you cant be in the front of that wave and have a split second of inattention because its not able to surf on it.

Tom Sullivan, the president of UVM, called Morin truly extraordinary. He added: His creativity, persistence and strong leadership have created a legacy for the Larner College of Medicine that will last for generations. I will be forever grateful for his remarkable leadership of the college and his many contributions across the university.

Dr. John Brumsted, the CEO of the UVM Health Network and UVM Medical Center, said in a statement that Morin has been an important and steadfast source of support throughout a period of enormous change in health care, and we will miss having the benefit of his guidance.

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UPDATED: Dean of UVM medical school to retire - vtdigger.org

A wounded Army veteran is close to achieving his dream of becoming a doctor after earning admittance to the prestigious Harvard Medical School.

GregGaleazzi, 31, lost both of his legs and part of his right arm when a roadside bomb exploded in May 2011 during his deployment to Afghanistan. Since then, he has endured dozens of surgeries and hundreds of hours of physical therapy, which he called a nightmare. But through all the trauma he experienced,Galeazzi held on to his dream of one day becoming a doctor.

Not only did I still want to practice medicine, but it strengthened my resolve to do it, he toldABC News.

Galeazzi took 18 pre-med courses over two years at the University of Maryland, before finishing in May 2016. It was in those classes that Galeazzi met his future fianc,Jazmine Romero, who he plans to marry next year.

Around that time, Galeazzi studied for six months to prepare for the hours-long Medical College Assessment Test, and after passing it, he sent applications to 19 medical schools on the East Coast. While he was accepted to many, Galeazzi announced in a blog poston August 5 that he had chosen to attend thetop-ranking medical institution in the world, Harvard Medical School, where he will study for the next four years.

It is tough to explain just how thrilled I was to simply be invited to interview at Harvard, let alone be accepted, Galeazzi wrote in his announcement. Mostly, it came as an immense relief to know that my hard work in pre-med and MCAT preparation paid off; and it reminded me just how grateful I am to have survived my injuries, and still have talents to share with the world.

Galeazzi is still deciding what type of medicine hellpractice, but hes leaning toward primary care, he told ABC News. In the end, Galeazzi said, he just wants to be a good doctor.

While Ive overcome some pretty harrowing life challenges, medical school is going to be an entirely different struggle, so please wish me luck! he wrote. Then again, I recognize that this is a wonderful challenge to have, and I am happy and eager to take it on!

Excerpt from:
Army Vet Who Lost Both Legs to a Roadside Bomb Is Accepted to Harvard Medical School - PEOPLE.com

Ed note: With the overload of coronavirus news articles right now, we think its important to continue publishing other things to read. These stories may be adjacent to the global health crisis, but are not directly related. Catch up on all our COVID-19 coverage here.

The precursor to Drexels medical school was the worlds first place women could earn MDs.

A lot took place between 1850, when Womans Medical College of Pennsylvania was chartered on Arch Street, and 2002, when it became part of the Drexel University College of Medicine.

Over that time, the institution had a continuous stream of women deans, moved its campus to a larger location, experienced a dramatic spat with male students at Pennsylvania Hospital and was pivotal in the establishment of the Womans Hospital of Philadelphia.

At the early epicenter was Ann Preston, a Quaker dynamo who served on the board of the Pennsylvania Anti-Slavery Sociery, wrote a childrens book, and helped launch that womens hospital in North Philly.

Heres how it all went down.

Phillys medical school for women opened at the location that eventually became 627 Arch St. Today, you can spot a plaque dedicated to its establishment on the 7th Street wall of the William J. Green Federal Building, which now stands in its place.

Originally called the Female Medical School of Pennsylvania, the college received its charter from the state legislature in May 1850, making it the worlds first to award women medical degrees. (A womens school in Boston opened two years before the Philly school, but didnt give out degrees.)

As it happens, the Womans Medical College of Pennsylvania was founded by Quaker men, including a businessman philanthropist and abolitionists William J. Mullen, Dr. Joseph S. Longshore and Dr. Bartholomew Fussell.

The colleges first announcement publicizing the program, made in a July 1850 edition of the Public Ledger, listed a few admission and graduation qualifications:

About that tuition: Students owed $10 for each professor, a one-time matriculation fee of $5 and a $15 graduation fee. With six professors, the women paid a grand total of about $80 for their medical degree. Adjusted for inflation, thats about $2,600 in todays money.

Instruction included four months of lectures beginning in October that covered topics like anatomy, obstetrics, chemistry and clinical practice.

Ann Preston, born in 1813, was part of the inaugural eight-person graduating class of 1851 at the Womans Medical College.

A Chester County native born into a Quaker family, she accomplished a lot before enrolling, and shed go on to do much more before her death in 1872.

Preston was involved in anti-slavery efforts as early as 1837. In 1849, a 36-year-old Preston published an abolitionist childrens book called Cousin Anns Stories. The Freeman paper lauded the project and recommended it for parents who wish to instill in the minds of their children a sentiment of opposition to slavery, war, intemperence, the use of tobacco and other evils.

It was around that time Preston sought to establish her medical career. She tried to gain admission into four traditional medical schools in Philadelphia, to no avail. When the womens college was open, she jumped at the chance.

After graduating in 1851, Preston became the schools first woman professor. In 1866 she rose to become the schools first dean, starting a tradition of all woman-deans for nearly the entire next century.

Preston also headed the effort to open the Womans Hospital of Philadelphia in 1861.

Anti-woman discrimination during this time was ever-present.

Despite Prestons accomplishments in the medical field in Philadelphia, in 1869 she and her students were verbally and physically attacked when they traveled to Pennsylvania Hospital for clinical hours.

When the women arrived at the surgical amphitheater for class on Nov. 6, what they encountered was a mob hurling spitballs, cat-calls and tobacco juice at the She Doctors, as they were bitterly referred to.

The much-publicized incident became known as the jeering episode.

One edition of the Pennsylvania Evening Bulletin referred to it as an outrage, saying that the police should arrest as many as possible of the offenders for insulting women in the street, and subject them to the penalties of the law.

Preston and the Womans Medical College secretary, Dr. Emeline H. Cleveland, wrote a letter to the editor defending the woman students after the event.

If they have been forced into unwelcome notoriety, they wrote, it has not been of their own seeking.

The first womens college in the world pushed on, accomplishing several more firsts through its graduates.

Graduate Catherine Macfarlane conducted the first pelvic cancer prevention study. Graduate Anna Broomall created some of the first prenatal medical programs. Graduates Rebecca Cole and Eliza Grier were some of the first Black woman doctors. And the first ever Native American doctor, named Susan LaFlesche Picotte, was also a graduate.

In 1862, the college moved into the Womans Hospital of Philadelphia on 22nd Street and North College Avenue.

In 1970, the first four male students were admitted, ending the colleges 120-year all-woman reign. It was renamed the Medical College of Pennsylvania.

In 1995, the college merged with the Hahnemann University Medical School. In 2002, it was acquired by Drexel to create the universitys med school program that still continues today. Tuition is close to $60,000 per year.

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When Philly abolitionists opened the first women's medical school in the world - Billy Penn

SACRAMENTO Fall will be quiet this year at San Diego State University. No big lecture classes. No parking lots packed with commuting students. No campus hubbub around Greek life, and perhaps no pep rallies for the Aztecs football team.

As one of the 23 schools in the enormous California State University system, San Diego State will hold classes primarily online, a decision the systems chancellor announced this week.

But 20 minutes up the freeway at the University of California, San Diego, things could look very different, with tens of thousands of students streaming back to campus, if only to single dorm rooms and socially distanced classrooms.

Across the country this fall, college life is likely to be vastly different from campus to campus a patchwork that mirrors what is currently happening in states and communities, as some move toward widespread reopening and others keep their economies mostly closed.

Shut down in a stricken wave this March as the coronavirus pandemic spread across America, colleges and universities are now studying whether and how to move forward, with plans ranging wildly between hope and grim epidemiology.

The University of Washington was one of the first large schools to make the shift to online classes after the Seattle area emerged as an early center of the outbreak. Now, it is developing plans to allow at least some in-person instruction, a spokesman said.

But Harvard Medical School said Wednesday that its first-year students would start remotely in the fall. A handful of other schools, mostly small ones, have said they are leaning toward online-only classes, including Wayne State University in Detroit, a virus hot spot, and Sierra College outside Sacramento.

Most other college and universities, though, have painted optimistic pictures about reopening, hoping to avoid massive drops in enrollment and tuition revenue. But they are privately making plans for remote-learning alternatives if necessary.

At U.C. San Diego, hope rests on a pilot project for mass testing of students during the summer session. If new coronavirus cases can be quickly isolated and traced, the reasoning goes, many of the universitys 40,000 students can return in the fall.

This is completely uncharted territory, and there is no clear indication of what is the right answer, said the schools chancellor, Pradeep Khosla. Universities have all sorts of models. Some will come back in person, some remote, some only hybrid. People are making choices based on their situations and on what makes them comfortable.

Like the rest of the country, colleges face formidable risks, both human and economic. Students and faculty members must be kept safe and healthy, but so must a segment of the economy that employs nearly four million people and operates as the nations predominant social mobility engine.

Even before the pandemic, college enrollment was on the decline nationwide as soaring tuition and student debt raised questions about the worth of a college education. Now many colleges are in critical condition, as the coronavirus has stalled the economy, gutted state budgets, cratered endowments and made heading off to college seem less an adventure than a threat.

Cal State, the nations largest four-year public university system, this week became the first large institution in the country to tell students their classes would take place almost exclusively online this fall, with some possible exceptions for clinical classes in the nursing program or certain science labs.

But the choice for those schools is arguably less complex than at the large research universities that make up the University of California system.

Most of the nearly 500,000 Cal State students are undergraduates whose coursework includes large lecture classes that are more adaptable to remote learning. At many Cal States, as they are known, 80 percent or more of the students live off-campus.

Testing all of those students regularly, as Mr. Khosla hopes to do at U.C. San Diego, would be cost prohibitive about $25 million a week, Timothy P. White, the systems chancellor, told the Cal State board of trustees on Tuesday.

Not that it will be cheap at U.C. San Diego. Mr. Khosla said it would cost about $500,000 to test about 5,000 mostly graduate students once a month during the summer pilot program. But it could cost north of $2 million a month for the whole campus starting in the fall.

Its an expensive experiment, theres no doubt about it, Mr. Khosla said. But the schools willingness to try shows how important it is for universities to offer students an on-campus experience, which generates a significant portion of an institutions revenue through everything from room and board to dining hall charges.

Higher education experts said the decision on whether to hold in-person classes in the fall would most likely depend on a number of factors, including the type of institution, location, size of the student body and funding.

States are in different circumstances in terms of the proliferation of the virus, and also the funding they receive, said Lynn Pasquerella, the president of the Association of American Colleges and Universities.

Small, cash-rich colleges may be better able to afford to go back, with masks, social distancing and extra sanitation. And schools in rural areas without major outbreaks may consider themselves less at risk.

Institutions with aging faculty members and more students who already live off-campus or take more online courses could opt for a longer stretch of remote learning.

I think we are going to see a lot of variation, said Laura W. Perna, a professor at the Graduate School of Education at the University of Pennsylvania.

Still, the pressure on many institutions to open will be great, if for potentially different reasons.

At community colleges, for example, many students also rely on campus resources for access to the internet, food and child care. Students are now in parking lots in order to get remote access to their classes online, Dr. Pasquerella said.

At the same time, she said, private liberal arts colleges will want to bring students back because the cost of tuition is often premised on the added value of a rigorous, close-knit campus environment.

Without revenue from sporting events, bookstores, summer camps and campus parking, even large, powerhouse universities may find themselves hurting for cash. Penn State, for example, has projected losses of at least $260 million over the next 14 months because of the coronavirus. The university has said it hopes to resume in-person classes by autumn.

In California, which was among the earliest states to shut down, Mr. Khosla said that if any campus could responsibly open, it would be U.C. San Diego. The campus has two teaching hospitals and some of the nations leading experts in epidemiology and infectious disease.

And, he said, there are opportunities in crisis.

This is a research institution, Mr. Khosla said. What we learn could teach us a lot about how to manage pandemics like this.

Sarah Mervosh contributed reporting from Canton, Ohio, and Mike Baker from Seattle.

Continued here:
Coronavirus Could Create a Hodgepodge of Campus Life in the Fall - The New York Times

Prof Deenan Pillay, professor of virology, University College London

The ways these measures are developed and issued will be balancing the urgency of trying to flatten the curve of the peak versus activities that are sustainable and realistic. The purpose of staying at home for seven days if you have a new continuous cough or a high temperature is to blunt the number of people contributing to ongoing transmission, and that is a very important step. It will help reduce deaths, but also reduce the number of people who are admitted to hospital and intensive care. From the situation in Italy, we can see that intensive care is one of the services that will soon become overwhelmed.

Its very sensible to try to limit the chances of infection in those at high risk of needing intensive care. We can also see around the world that cruise ships are more likely to have older people, but also that the cruise ship environment is an ideal chance for infections to circulate widely.

Banning overseas school trips is a difficult one, but remember that any trips involve groups of people going to airports, going on boats and coaches, and living together, and since this virus is ubiquitous now, anything like that is likely to increase acquisition. We know that children are less likely to get severe disease from coronavirus, but they nevertheless are likely, if they do get infection, to spread it to others. Its a sensible measure before closing the schools.

Many organisations and businesses are already implementing working from home and reducing meetings. Im surprised theres not an emphasis on that, it would be good for government policy to reflect it.

Im very pleased there isnt the sort of reaction weve seen in the US to close borders. This infection is now circulating in the UK and its important that, wherever those infections come from, theres an understanding that were responsible for dealing with all of them and avoid the xenophobia that has emerged and that would be perpetuated by an insular approach.

Dr Jennifer Rohn, cell biologist, University College London

Empowering ill people to stay home is a good thing. Some might have felt that their employers would not allow this, and the government mandate gives them license to do the sensible thing and stay home just in case.

Not closing schools seems understandable to me. Children will be the least likely to be affected, and therefore the least likely to be shedding virus, which is directly proportional to more serious symptoms. In contrast, if you close schools youre keeping a very large number of parents away from work as long as it is deemed feasible to keep workplaces open, its probably better not to harm the economy further in this way.

I was surprised and disappointed to see nothing on testing. The people with suggestive symptoms should be tested during their self-isolation, so that we can maintain more reliable data about the actual real-time reach and spread of this epidemic, and so that crucially their immediate contacts can be traced. What is government doing on increasing our supply of testing kits and the workforce to go out and test people at their homes? I was disappointed to hear no update on that.

People over 70 with pre-existing conditions could get into trouble in crowded settings far beyond cruise ships. I think the advice could have been more broadly reaching for this group of particularly vulnerable individuals. [Banning] international school trips feels very arbitrary to me. What about other forms of travel?

Not banning major events now is the biggest disappointment and surprise for me. I think buy-in would be high anyway many will already choose not to attend. The virus is clearly circulating in communities, and large gatherings in confined spaces could accelerate onward transmission.

Prof Paul Hunter, professor in medicine, Norwich Medical School, University of East Anglia

I was expecting there to be something a bit more rigorous. I cant see that any of these measures are going to have a big impact on the current situation.

The guidance about self-isolating if you have any respiratory symptoms for a week is absolutely spot on. Im not sure how many people will actually follow that advice we shall see. But even if people ignore the advice themselves, you can imagine that if they turn up to work, colleagues and bosses will be on their case and there will be increased peer pressure.

Just telling elderly people to not go on cruises isnt enough to protect them. I wouldve hoped wed be seeing more targeted advice for elderly and vulnerable citizens on what sort of things they should be thinking about. I think theyve been left out on a limb.

The issue for me with not going on cruises would be not so you can protect yourself its because you could get quarantined for god knows how long. Its the same for the new advice on school trips: you dont want them going off and then travel bans come in and theyre quarantined in a hotel.

However, none of that is really going to affect transmission in the UK. I think at this point we are being perceived as lagging behind a lot of countries. And presumably other countries are basing their decisions on scientific information too.

I would like to see a bit more about why theyre not closing schools and banning large events. We do know, in general, that school holidays lead to a marked reduction of transmission in infections and at the end of school holidays, infection rates take off.

Im sure its based on good quality science. But we dont know what that science is. The science isnt being shared with us in a way that makes it easy for us to understand the logical basis for all of this.

I would hope that more of the information and science that the government is relying on to make these decisions would be made available so we could interrogate it and see if its valid. Unless that happens, theres a risk of losing the trust of the scientific community and the public.

One of the biggest reassurances from my perspective is having Chris Whitty as chief medical officer. Of all the chief medical officers weve had in the last few decades, he is the one with the best background to have coped with this.

Prof John Ashton, former regional director of public health for north-west England

This is a kind of ragbag with no particular logic to it. The fact that they are now declaring were moving into this second phase, as if its some kind of planned event, is really meaningless. We need to mobilise the whole community response to this and they are behaving in a top-down way, in a half-hearted way, so its neither one thing nor the other.

They are issuing some semi-directive things but they are not really doing what we need to do, which is to mobilise and encourage communities, neighbourhoods, families to form their own plans for the next period in which the local situation will influence what happens whether its not going out to eat, or stopping sporting events. It will be determined by the data, which they should be sharing promptly and fully with everybody so that people can decide for their town, village, neighbourhood what they need to do.

If everybody reduced the amount of mixing time that theyve got, that would help to slow things down. We should take this as an opportunity to develop home working. Universities dont need so much bricks and mortar because theres so much learning online.

What weve got is this cack-handed centralised country trying to run everything from London. In a period of three months weve gone from we dont need experts to we are the experts, we will tell you what to do and neither position is right. You do need expertise but you also need to trust the population.

Read the original here:
Verdicts of experts on UK government's new coronavirus measures - The Guardian

A reminder to college students especially male students that one drunken night can ruin your entire life.

This particular example comes from the College of Human Medicine at Michigan State University (MSU). A male student, known only as Dev, attended a yearly event on April 23, 2016, known as the Med Ball. Before the main event, Dev met up with a few people he had met a few weeks earlier during a service trip to Cuba. They are being referred to as Harry, who hosted a pre-party to the Med Ball; Jillian, who had recently broken up with her boyfriend and had begun a friends-with-benefits relationship with Harry; and Valerie, who attended the Med Ball with Lucas, her husband she was about to divorce. The story has been reported at length by Reasons Robby Soave.

Devs lawsuit is ongoing. The elements of his case resemble many others: a night of drunken sex that one party claims was consensual and another party remembers differently; a significant passage of time; an insinuation that eventually becomes a formal accusation; a fraught effort to mount a defense; a life-derailing finding of guilt. But with one court decision already against him, hes in a tough spot. Hes financially ruined as well, and he cant afford the caliber of lawyer he needs, Soave wrote.

Dev, whose parents are Sri Lankan, moved to Michigan when he was young. A bright student, Dev would go on to graduate from Harvard in 2014 with multiple degrees. He then returned to Michigan for medical school. The Med Ball in question occurred during his first year of medical school.

At the pre-party, Dev spoke with Jillian and Valerie. While everyone was drinking, everyone agreed no one was too drunk before the pre-party ended. Valerie fought with her husband throughout the night. At the Med Ball, Dev taught Jillian how to waltz and to the cha-cha. In a lawsuit he would later file against MSU, he said that he and Jillian began grinding on the dance floor and that Jillian told him I guess youre my date.

While Dev was dancing with Jillian, Valerie and her husband had one last major fight. Her husband, referred to as Lucas, demanded a divorce and left the event. Jillian ran after Valerie when she went to the bathroom to try and cheer her up.

At some point Valerie disappeared so Jillian went to find her. Jillian soon found her outside the restaurant where the Med Ball was taking place and kissing Harry, with whom Jillian had a sexual relationship. Jillian fled up a flight of stairs and texted Valerie, Just done. Dont expect me to be ur friend anymore.

Dev found Jillian upset, fairly drunk, and crying, a judicial opinion would later state. Jillian told Dev about her and Harry. Dev comforted her and eventually the two began kissing and groping each other. The two found a stairwell. Dev says Jillian removed her own dress and got down on her hands and knees even asking for his jacket for cushion. Dev was too drunk to engage in penetrative sex, so they gave up.

Everything was reciprocated, Dev would later tell MSU investigators. There was no hesitation. If anything, there was eagerness.

Jillian would later claim that she was too drunk to consent and she had shut down during the sexual encounter as a reaction to the hurt she felt from seeing [Valerie and Harry] kissing. She told investigators she never explicitly agreed to the encounter but also never said no.

The group then went to a nightclub. Dev left the area momentarily. Harry apologized to Jillian for kissing Valerie. Jillian told him about her sexual encounter with Dev. Outside, Valerie couldnt get in at first because Harry had her ID. When she entered the club, she found Harry and Jillian together.

Valerie would later tell investigators she didnt remember dancing with Dev at the nightclub. Dev says they danced while Harry and Jillian talked. Valerie, according to Devs lawsuit, insisted Dev and Jillian would be good together and Dev at that point thought it was a possibility. Valerie then started kissing Dev, his lawsuit states.

They left the club and returned to Harrys house. Jillian went to bed but Dev, Harry, and Valerie kept talking. Dev said he left the room and returned to find Harry and Valerie having sex.

Dev said he then went to sleep in Harrys bed and found Jillian already in it. Both were fully clothed. Dev said he tried to kiss Jillian but she wanted to sleep. Jillian even acknowledged that nothing else happened after that.

Harry would later say he found Dev cuddling Jillian, so he kicked him out of the room and spoke to Jillian. Harry was upset with her.

Dev went to the living room and laid down on a large couch next to Valerie. Dev says Valerie was awake and made room for him on the couch, allowing him to touch her. Valerie later said she was asleep and awoke to Dev touching her sexually. She claims she said no and he left the couch.

Dev drove home in the morning, while Harry and Jillian went to brunch with another couple. That couple would tell investigators that when they saw the group of four at the Med Ball they all seemed unhappy. Harry and Jillian were unhappy at brunch as well, since Harry was mad at Jillian for her encounter with Dev.

For two years, Dev continued to study at MSU and had little interaction with Harry, Jillian, or Valerie. Dev wanted to try and spark up a relationship with Jillian, but she wanted to be with Harry.

Harry and Jillian didnt last, and Jillian two years later requested that she not be placed in clinical rotation with Harry or Dev, claiming it would significantly negatively affect my learning and well-being. Valerie around that time also requested not to be placed with Dev. Because two people made a similar request about the same person, MSU met with the women and eventually opened a sexual misconduct into Dev. Jillian had gone to therapy in the two years since that fateful Med Ball, and now considered her brief encounter with Dev as sexual assault. She claimed it caused her to struggle in school. Valerie made a similar claim.

Dev was informed of Valeries allegation on April 17, 2018. He was not told about Jillians allegation until July 31. Jillian had initially said she didnt want to cooperate with MSUs investigation, but when she was interviewed about Valeries claim, she decided to move forward with her own claim.

Valerie had a month to prepare for her interview with the investigators. Dev was given three days. His interview was scheduled for April 20the same day as his internal medicine shelf exam, one of the toughest tests for doctors in training, Soave reported. Dev failed itin large part, he claims, because of the pending investigation. It affected my academic performance, to say the least, says Dev.

Dev spoke with investigators, having no idea just how serious the situation was. He didnt know at the time that the meeting would be his only chance to defend himself. Dev was suspended from MSU and expelled from the College of Medicine. He appealed and lost.

Dev sued the school, but a judge claimed that because the ulterior motives of the women were allegedly considered by MSUs investigator, the accuracy of the proceedings could not be questioned. The judge didnt seem to care that Dev couldnt effectively cross-examine his accuser or the discrepancy between investigator reports regarding Jillians alcohol level and ability to consent.

Devs attorney abandoned his case, saying an appeal wasnt realistic.

When Dev was expelled, he was $283, 000 in debt from Harvard and medical school. Had he become a doctor, he would have been able to pay off the debt, but he now believes he will never be able to graduate or become a doctor.

Im done, Dev tellsReason.I dedicated 8 to 12 years of studying for this. That was my life.

Read the original here:
She Accused Him Of Sexual Assault Two Years After Their Drunken Hookup. Now He's Destitute. - The Daily Wire

As a novel and dangerous coronavirus continues to sicken thousands in China and a few dozen others in countries around the world, including the United States, U.S. academic researchers and government experts are working around the clock to understand, treat, and help prevent further spread of this emerging viral threat.

We are already functioning as if there is a worldwide pandemic, says James Crowe, Jr., MD, an immunologist at Vanderbilt University School of Medicine and director of the Vanderbilt Vaccine Center.

Although in 24/7 scramble mode, Crowe recently took time to update AAMCNews on whats happening behind the scenes in a well-developed nationwide system created to handle such potential disasters. Below are key insights that he shared.

Do you anticipate that we may see many more cases in the United States and worldwide soon?Because of the amount of travel between the United States and Asia, I think its likely there will be more cases in the next few weeks here. Also, even excluding ill persons at the border isnt going to keep the virus out [because] travelers may board an airplane while infected but without any symptoms. We think that's already happened.

Do you have a sense of whether this is going to be a manageable outbreak or a global crisis?If you connect the dots of the number of cases being tracked, at present it's not possible to say when that line stops going up. Two weeks ago, people thought it was just smoldering, and this week its clear the number of cases has continued to increase dramatically. So it's possible that this will be a major worldwide outbreak, but predicting is very difficult.

How are researchers in medical schools and teaching hospitals responding? What's going on right now is that academics who have capacity to contribute are contacting government sponsors with whom they already have relationships and are offering their services. Its very encouraging that the entire community that has capabilities has made themselves available.

Also, the U.S. government has been convening both government and extramural experts almost on an hourly basis. There have been callswith people from all over the country and the world, the CDC [Centers for Disease Control and Prevention], the NIH [National Institutes of Health], the Department of Defense, and experts in major medical research centers in the U.S.

What are you personally working on?Vanderbilt is a contractor in the federal Pandemic Prevention Platform, and we were already starting a year and a half ago to prepare to rapidly respond to an epidemic by developing antibody treatments. Two weeks ago, the potential targets for these programs were still called Pathogen X. Everyone would say, When Pathogen X occurs, you will execute your program. Now, X has been filled in with the word coronavirus.

We are also embedded in a greater virology community, so with collaborators at the medical schools of Washington University in St. Louis, the University of North Carolina at Chapel Hill, and other institutions, we immediately started having conversations about sharing cells [and other tools]. Within a day, we had a plan of how to do an antibody discovery program and get it into the clinic.

What we need to do is get blood cells from people who have survived the infection and who are now immune, and we will use their blood cells to make a biological drug. So, we are working on that process now.

Also, weve already had some very good conversations with manufacturers and biotechs offering to engage them if we have a lead antibody drug candidate. Our goal would be to have the drug ready for clinical trials within about three months and that would be the fastest response ever in history.

Are there other potential significant leads on treatments?Another category is antivirals. Gilead Sciences will be testing whether or not their existing drug for other coronaviruses, remdesivir, works against this virus. If so, that drug could be made available very rapidly. But first, investigators need to test the drug against the virus. So they would need to get the virus, most likely from the CDC. Also, it is possible to make the virus synthetically from DNA, and there are groups that are actively working on that approach. But all of those procedures take days or a couple of weeks.

Those are treatments. What about a vaccine? At least two companies are working on a vaccine, Moderna and Inovio, and certainly there will be more to follow rapidly. First, there is development of vaccine candidates, and then there is a selection of a final vaccine to be tested. Certainly, they have candidates already. I suspect that they will have a final selection of a possible vaccine within a few weeks, and they might be able to be in clinical trials by early summer. They want to move fast, but they also don't want to hurt people while developing the vaccine.

What else is a high priority for researchers in academic medicine? We need animal models to test vaccines, antivirals, and antibodies. Academics are much better than industry about developing new models, and that's going on right now at several places, including Washington University and UNC Chapel Hill medical schools, figuring out which small animal will best replicate the virus or mimic human disease.

And then there are some very basic, fundamental questions about how the virus attaches to the human body that are being researched at Harvard, Washington University, and UNC Chapel Hill medical schools, Vanderbilt University Medical Center, and some of the NIH government laboratories as we speak.

What's being done in terms of preventing further transmission of the virus?There are a lot of things we need to know immediately, and many academics are working on that, such as how many people one person infects. Right now, we think it's between one and a half and two, but if that number were higher, it would be even more concerning.

Then another question is, "How does the virus move from person to person?" That mode of transmission will determine what PPE [personal protective equipment] and facilities are needed. So if its spread by contact, providers will need to wear gloves and gowns and masks and face shields. And people will retrain on proper donning and doffing of PPE to be up to speed.

If it turns out that it's spread by small particle aerosol, that will be very challenging because hospitals have negative pressure facilities for these issues, but they don't have an unlimited number of those rooms.

Look at China. They're going to build an entire hospital on the fly because theres just not sufficient capacity to keep these people in isolation. So in terms of infection control and personnel protection, academics are figuring that out, and the CDC will establish recommendations.

How prepared are hospitals to handle an outbreak?After some of the events that we've had like bird flu and Ebola, most hospitals in the country have created a plan. At a big hospital like Vanderbilt, weve also had war game-like simulations where we used the NFL football stadium to triage patients. We also have rooms in the emergency department with special showers to bring the person in and contain them right at the door, but not every facility would have that.

Then there are even very special containment units for things like Ebola at Emory University, the University of Nebraska Medical Center, the NIH, and elsewhere. They don't have a huge capacity, but no one's talking about that right now. This is probably going to be containable under some sort of rather standard hospital facility.

How would you say this compares to previous global outbreaks such as SARS or Ebola?That's a good question. I've lived through the response to chikungunya, Ebola, Zika, and bird flu outbreaks weve responded to all of these and I would say the country is in a much better place now to respond rapidly than it's ever been before.

In some ways, it still seems like a surprise every time it happens even though thats what we do in my lab, continually prepare to respond to an epidemic. Last week, we were still arguing with ourselves: Should we pull the trigger and go full blown in sprint mode, or should we keep on with our other important work? By yesterday, the answer was "pull the trigger.

What is your long-term goal in terms of potential outbreaks like this?Outside of the current episode, what we're doing on a day-to-day basis is trying to make human antibodies for 100 of the known viruses in the world that cause human disease and to have candidate treatments ready prior to an epidemic, a program we have called AHEAD100.

We've been systematically developing antibodies for as many viruses as possible. Once the current event is over, we'll reset and well go back and try to prepare for all the other viruses that are out there. I think that would be preferable to everyone scrambling every 12 months in urgent mode.

For more information, visit the Centers for Disease Control and Prevention coronavirus webpage.

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Academic medicine on the front lines of the coronavirus outbreak - AAMCNews

Tuesday, February 25, 2020

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Brown Alpert Medical School stroke researcher to discuss big finding

"In recent years, we have started to learn more about how well-established stroke risk factors like high blood pressure and diabetes differ between women and men. Unfortunately, we still lack an understanding of how female hormones affect stroke risk across the lifespan for women," said Madsen, M.D., Sc.M., lead author of the study and assistant professor of emergency medicine at the Warren Alpert Medical School.

Low levels of a protein that binds to and transports sex hormones in the blood may indicate women who have a higher risk of ischemic stroke, according to preliminary research just presented by Madsen at the American Stroke Association's International Stroke Conference 2020 in Los Angeles, a world premiere meeting for researchers and clinicians dedicated to the science of stroke and brain health. The corresponding article was published in the journal Stroke.

About Madsen

Madsen is an Assistant Professor of Emergency Medicine in the Division of Sex and Gender in Emergency Medicine within the Department of Emergency Medicine. Dr. Madsen completed both her undergraduate and medical degrees at Boston University before coming to Providence to complete a residency in Emergency Medicine.

Following residency, Dr. Madsen completed a 2-year research fellowship with a focus on sex and gender differences in acute aspects of disease and earned a Master's degree in Clinical and Translational Research.

About Alpert Medical School -- and Smart Health

Since granting its first Doctor of Medicine degrees in 1975, the Warren Alpert Medical School has become a national leader in medical education and biomedical research.

By attracting first-class physicians and researchers to Rhode Island over the past four decades, the Medical School and its seven affiliated teaching hospitals have radically improved the state's health care environment, from health care policy to patient care.

"Smart Health" is a GoLocalProv.com segment featuring experts from The Warren Alpert Medical School GoLocal LIVE.

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Brown Alpert Medical School Stroke Researcher to Discuss Big Finding on LIVE at 4:15 PM - GoLocalProv

Jimmy Zheng was in the 10th grade whenhe decided to try to pay his own way through college and beyond.

His mother, who worked as a grocery store clerk, had recently fallen from a ladder, and was forced to give up her job after a hospital stay. Though his father continued to put in long hours for his online leather goods business, the return was modest -- not the dream they had hoped to achieve when they immigrated from China to California.

"I realized they were working really hard, but theywere not really succeeding in the way they thought they would, coming here toAmerica," Zheng told me. "That moment was really critical for me to realize,I'm actually going to need to do some work to lift up this family, movingforward."

Scholarships and multiple jobs helped Zheng pay for college; and after graduating, he took a consulting position to continue supporting himself. He dreamed of becoming a doctor, but thought he'd have to delay a few years because of the cost. Stanford Medicine worked with him to provide an option he could afford, and he's now in his second year of medical school.

"The financial aid made a difference in terms of the timeline of my trajectory and my career path," Zheng said. "To me, that's everything, because the earlier I can go into medicine, the earlier I can start living my dream and my passion -- and also support myself and my family."

His words resonated with me and my colleagues, as we worked on #WeAreStanfordMed, a series of videos exploring how financial assistance impacts Stanford Medicine students. We wanted to tell the stories of those who have benefitted from scholarships and programs that defray the costs of medical school.

Many fall into this category. During the past academic year, more than two-thirds of Stanford medical students received some form of financial aid, and the median debt for last year's graduating class -- just over $89,000 -- was significantly less than the national median of $200,000 reported by the Association of American Medical Colleges.

This is no coincidence: Stanford Medicine leaders have long worked to address the rising cost of medical education, including through an ongoing mission to reduce graduating debt. Last week, the school reached a milestone in that journey, announcing a $90 million program that will eliminate medical school debt for students with the most need.

Removing financial barriers can make a big difference for promising young physicians-in-training, as we learned from Zheng and the other students in our videos.

Zheng told us that his aid means he doesn't have to work side jobs, like he did in college, and he can focus on his studies and an array of related activities. In his first year of medical school, he worked on machine-learning research to automate detection and classification of certain diseases and conditions. He also was a student leader in a public health effort to get flu vaccines to underserved communities, and he mentored high school students interested in science and medicine.

Zheng said that his strong sense of service comes from his parents. Inspired by them and his volunteer work at a homeless clinic, he envisions a career in primary care, working with the medically underserved. The decision will be easier because he knows he'll have minimal debt from medical school, Zheng said.

"Something about working with people who have been overlooked by society, people who are struggling and don't have the resources to thrive -- that reminded me a lot of immigrant populations, of people I came from," Zheng told me, my colleague Margarita Gallardo and videographer Kevin German during filming.

Seeing him with his parents -- casually joking with them, draping his arms protectively around their shoulders -- touched our hearts. Learning his story -- and those of the four other students -- inspired us and made us feel proud to be part of an institution that is ensuring the next generation of physicians reflects the diversity of the communities they serve.

#WeAreStanfordMed is a video series spotlighting Stanford medical students and the impact of financial assistance on their education and aspirations.

Photo and video by Luceo

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Realizing the medical school dream, for himself and his family - Scope

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Professorship honors former neurosurgery head

Gregory Zipfel, MD, (right) has been named the Ralph G. Dacey Distinguished Professor of Neurological Surgery at Washington University School of Medicine in St. Louis. The professorship was established in honor of Ralph G. Dacey, MD, (left) former head of the Department of Neurosurgery.

Gregory J. Zipfel, MD, the recently named head of theDepartment of Neurosurgery at Washington University School of Medicine in St. Louis and neurosurgeon-in-chief at Barnes-Jewish Hospital (BJH),is also now the inaugural Ralph G. Dacey Distinguished Professor of Neurological Surgery.

The professorship was funded by dozens of friends, colleagues and admirers of Dacey, the Henry G. & Edith R. Schwartz Professor of Neurological Surgery. Dacey served as the head of the neurosurgery department at the School of Medicine and neurosurgeon-in-chief at BJH from 1989 to earlier this year.

Zipfel, a noted expert on aneurysms and other disorders of blood vessels in the brain, was installed by Chancellor Andrew D. Martin and David H. Perlmutter, MD, executive vice chancellor for medical affairs, the George and Carol Bauer Dean of the School of Medicine, and the Spencer T. and Ann W. Olin Distinguished Professor.

Im honored to recognize both Dr. Dacey and Dr. Zipfel with this professorship, Martin said. Under Dr. Daceys leadership, the Department of Neurosurgery grew into one of the best in the world, known for cutting-edge research, high-quality and compassionate care, and world-class neurosurgical training. Dr. Zipfel an accomplished neurosurgeon, teacher and scientist is an able successor to Dr. Dacey, and I believe he will help build on our momentum of national and international leadership in neurosurgery at Washington University and BJC HealthCare.

Dacey is renowned for his accomplishments in cerebrovascular research, particularly in regard to diseases of the cerebrovascular system. He also has made myriad contributions to the clinical practice of neurosurgery and to resident training and education.

This professorship is a true testament to Dr. Daceys achievements in medicine and to the high regard in which friends, colleagues and patients hold him, Perlmutter said. For many years, if something happened in St. Louis that involved the brain, Ralph was there. If he couldnt do it himself, he assembled a team of the most talented neurosurgeons in the world to handle it. His accomplishments have elevated the field, the faculty, his students and clinical care to new heights.

During his three decades at the helm of the Department of Neurosurgery, Dacey promoted an expansion of clinical and basic research efforts, while maintaining the departments emphasis on clinical excellence and world-class training and education. Nearly 70% of the graduates of the departments residency program enter academic careers at some of the most highly regarded neurosurgery departments in the country, including several who have become faculty here at Washington University.

In December 1998, Dacey performed the first neurosurgery that used magnetic gradients to direct probes in the brain. He also spearheaded the creation of an intraoperative MRI facility at BJH to allow physicians to scan the brain during a surgery to ensure complete removal of tumors.

This is the greatest honor of my life, Dacey said of the named professorship. I am incredibly lucky to have such generous friends and colleagues. Greg Zipfel is a great researcher, leader and surgeon, and I am confident that under his leadership, the department will continue to thrive.

Dacey is a former chair of the American Board of Neurological Surgery and has served as president of the Congress of Neurological Surgeons, the American Academy of Neurological Surgeons, and the Society of Neurological Surgeons. He was elected to the Institute of Medicine of the National Academy of Sciences, was named an honorary fellow of the Royal College of Surgeons in Ireland, and is a recipient of the Harvey Cushing Medal from the American Association of Neurological Surgeons, the highest honor bestowed by the association.

In 2018, the Joint Cerebrovascular Section of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons established the Ralph G. Dacey Jr., MD, Medal for Outstanding Cerebrovascular Research in recognition of his accomplishments in the area of cerebrovascular research, his myriad contributions to neurosurgery, and his unwavering leadership in the area of resident training and education.

Ralph is the kind of leader who brings out the best in his team, Zipfel said. He creates the environment that encourages excellence, recruits talented and dedicated people, and challenges us all to do our best. He is truly a giant, and we all stand on his shoulders. I am honored to be named the first Dacey professor.

From the left, Chancellor Andrew D. Martin, Gregory Zipfel, MD, Ralph Dacey, MD, and David H. Perlmutter, MD, dean of the medical school and executive vice chancellor for medical affairs, pose for a photo taken by Jana Holstein, of Alumni & Development, as they celebrate Zipfels installation as the inaugural Ralph G. Dacey Distinguished Professor of Neurological Surgery.

Zipfels surgical practice is focused on cerebrovascular disease and tumors that grow near the base of the skull. He is known for his expertise in surgically correcting weak spots in blood vessels, known as aneurysms, and other blood vessel malformations in the brain; removing complicated tumors near the skull base; and creating surgical bypasses around blocked or diseased arteries of the brain to increase blood supply.

Also a professor of neurology and co-director of the Stroke and Cerebrovascular Center at BJH, Zipfel has focused his laboratory research on understanding how aneurysm ruptures cause brain injury. Such ruptures often lead to permanent brain damage or death, even following emergency surgery. Zipfel has helped identify some of the molecular and cellular features associated with brain injury after sudden rupture of aneurysms. This work has led to the discovery of experimental drugs aimed at reducing brain injury after aneurysm rupture, two of which are being evaluated in clinical trials.

Zipfel also studies how altered blood flow in the brain contributes to dementia. By investigating the impact of amyloid plaques a hallmark of Alzheimers disease and stress from reactive oxygen molecules a common feature of aging on blood vessels in the brain, Zipfel has advanced the understanding of cognitive decline in Alzheimers and aging.

Following his undergraduate studies at the University of Illinois, Zipfel earned his medical degree at Northwestern University and completed a residency in neurosurgery at the University of Florida. During residency, Zipfel spent two years doing postdoctoral research with Dennis Choi, MD, PhD, at the School of Medicine. Zipfel then completed a fellowship in cerebrovascular and skull-base surgery at the University of Miami. In 2004, he returned to St. Louis and joined the faculty of the School of Medicine.

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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Zipfel named Dacey Distinguished Professor of Neurological Surgery - Washington University School of Medicine in St. Louis

For the first time, women outnumber men in medical school. According to a new report from the Association of American Medical Colleges, women made up 50% of medical students in 2019, while men made up 49% of students.

Overall, men still make up the majority of doctors with 64% dominating in the profession, as compared to 36% of women. A joint report between the AAMC and the American Medical Association found disparities among men in women in their chosen fields.

Male doctors outnumber female doctors in the orthopedic, neurological and interventional radiology fields. Female doctors dominate in pediatrics, obstetrics and gynecology, allergy and immunology. Fields with an equal amount of men and women include pathology, psychiatry, sleep medicine and preventive medicine.

Theres also an age disparity among doctors with 80% of doctors age 65 or older in 2017 being men and 60% of younger doctors under the age of 35 being women.

The Realist Womans take:

Women surpassed men as students in medical school for the first time ever. Its incredible. I specifically love the fact that 60% of doctors under age 35 are female. Women really are making their mark in the world of medicine and I hope this story inspires young girls who dream of being doctors.

I noticed in the report that female doctors dominate in the fields that serve female patients, which makes sense because female doctors understand women's issues in a way that men cannot. But I'm sure that women in the fields that male doctors dominate are just as excellent as their male counterparts as women can do everything men can.

Excerpt from:
Women Outnumber Men in Medical School - The Realist Woman

January 03, 2020 -Primary care has the potential to transform the healthcare industry by improving patient outcomes and reducing overall spend on healthcare services. Study after study shows that value-based care, population health management, chronic disease treatment, and other value-adding activities hinge on the delivery of comprehensive, coordinated primary care.

Yet, fewer patients than ever before have an established primary care provider, according to a study conducted by a group of researchers from Harvard Medical School, Brigham and Womens Hospital, and Beth Israel Deaconess Medical Center.

Primary care is the thread that runs through the fabric of all health care, and this study demonstrates we are potentially slowly unweaving that fabric, David Levine, Harvard Medical School instructor in medicine at Brigham and Womens Hospital, said in a statement. America is already behind the curve when it comes to primary care; this shows we are moving in the wrong direction.

However, even when primary care is available, physicians and their team members are finding it difficult to deliver the level of care needed to improve outcomes and lower costs. For example, family physicians surveyed by the American Academy of Family Physicians last year complained about a lack of time and resources, which impacted the quality of conversations they were having with patients.

Researchers from Harvard Medical School, Brigham and Womens Hospital, and Beth Israel Deaconess Medical Center also criticized the industrys low reimbursement rates for primary care and the dearth of policies that support primary care infrastructure investments.

The advanced primary care (APC) model is the business of whole patient health, according to Stuart Pollack, MD, the medical director of Brigham and Womens Advanced Primary Care Associates.

Its a new design of primary care where instead of being in the visit business, we are in the whole patient business, he recently told HealthITAnalytics.com.

Stuart Pollack, MD, Medical Director of Brigham and Women's Advanced Primary Care Associates, South Huntington

Overall, the APC model differs from traditional primary care because of its definition of health.

We think of whole health: social, mental, and physical wellbeing, Ryan Schmid, MBA, chief executive officer and president of Vera Whole Health, which uses the APC model for all its primary care patients. Unless you build a care model thats designed to treat the whole person as opposed to physical disease or infirmity, its really not advanced primary care.

For example, a patient recently diagnosed with type two diabetes will talk with a health coach about their underlying motivations for better health under an APC model, Schmid explained.

The coach is going to understand that whats motivating the person is their kids wedding or being alive to play with their grandkids, he said. This is all in partnership with the provider, but its a totally different experience for that patient. The integration piece is super critical.

A large piece of creating a holistic approach to patient care requires delivering empathy towards patients, added Kyle Grunder, MBA, director of provider operations and program development Courage Kenny Rehabilitation Institute at Allina Health. At Courage Kenney, the APC model is for specific patient populations, such as those with a neurologic deficit, neurological impairment, or mobility impairment.

What weve been able to do is form a bond with these patients so were their first call, Grunder said. They entrust us with their care, and we take that seriously. In creating that really close bond, confidence, and trust you have an ideal patient experience.

A system of trust creates strong patient-provider relationships. Patients who make their primary care provider their first call are more likely to stay out of the emergency department, receiving less fragmented care and reducing care costs.

But for organizations to realize the benefits of APC, they need to implement a team-based care approach, data analytics tools, a social determinants of health strategy, and a new financial model.

Creating care teams is a pillar of the APC model. The team-based approach allows the entire team to work towards bettering patients health, addressing their medical, behavioral, and social determinant of health needs.

Most primary care physicians are sophisticated enough to recognize that you cant really provide good primary care without a team, said Pollack.

Vera, Brigham, and Courage Kennys care teams are all unique. However, these teams are typically centered around a physician, nurse or advanced practice provider, and a medical assistant. Depending on the care model and the needs of the patient, these teams can also include behavioral health specialists, health coaches, pharmacists, nutritionists, social workers, and other healthcare professionals.

Who is on the care team in an APC model will depend on patient mix at the practice.

The team for our Medicare population is going to look different than the team for our commercial population, Schmid explained. You could certainly extend that team depending on the population and the degree to which you want to bring in certain specialists.

The patient population should also dictate how care team members interact and deliver care.

Ryan Schmid, MBA, President and CEO of Vera Whole Health

That care team has to be specifically built to target specific populations, Schmid continued. Its not enough to throw a bunch of folks wearing different hats in the same building. They have to be functioning off the same care plan for individual members and offer a broader population health strategy for whichever population theyre serving.

In Brighams model, the medical assistants are responsible for conducting initial screenings with the patient such as behavioral health, domestic violence, and depression. Information from this screening is then passed on to the rest of the team to coordinate further care.

We expect the medical assistants to start looking at the real-time overdue health maintenance items and tee the patient up for the physicians, Pollack said. Theres more work to be done but were trying to spread it out over the entire team.

Tailored care teams are key to accomplishing one of the overarching goals of the APC model: coordinating care.

The advanced primary care team is in the quarterback seat with the patient as opposed to the patient getting sucked up into specialty land where there are multiple specialists managing their care, said Schmid.

Brigham and Womens Advanced Primary Care Associates also coordinates care on site. For example, a patient newly diagnosed with diabetes will see a pharmacist for insulin and a nutritionist to go over healthy eating habits on site at the point of diagnosis.

Rather than wait weeks between appointments and risking disjointed care, all of the patients needs are coordinated or delivered on sites. Patients are then set up to successfully adhere to care recommendations.

Its more of a one-stop-shop. Patients can get their lab work done, walk away with their prepackaged medication, and in some cases, get imaging done. They can meet with the health coach and the behavioral health consultant under one roof, said Schmid. Its an infinitely better experience.

Relying on a team of providers also supports longer care visits, which are another pillar of the APC model.

We have extended visit length, so most patients are seen in a 60-minute window versus a traditional primary care model where appointments are between 15 and 30 minutes, Grunder explained.

The care team needs actionable data to provide insights and direct the best care possible.

Traditionally, actionable data meant identifying high-risk patients and connecting them to high-quality care quickly. But this is not enough under the APC model.

The traditional population health risk pyramid of low risk, rising risk, and high risk are too static for a true advanced primary care solution, said Schmid. You have, for example, a rising risk person with depression and diabetes who, unless you take further preventive action, may end up developing additional chronic conditions. Understanding where folks are in real-time and having specific care models designed to treat those people is what we mean by a population health strategy.

Sophisticated data and analytics can inform population health strategies.

Were as much a digital company as we are a healthcare company, Schmid explained You have to ingest a ton of data, mash it together, and then spit out hyper actionable data to people who understand what to do with it. Information is useless unless its actionable and to be actionable folks have to understand it.

To make all this data actionable, Brigham and Womens Advanced Primary Care Associates uses algorithms to identify patients best suited for their care delivery model. But everyone else is identified based on what they need at the moment, Pollack noted. So, real-time data and analytics are also critical.

Data and analytics also demonstrate effective cost savings. For Grunder at Courage Kenny, this helps grant applications and donor relations.

We were able to create a database of all the claims costs for our patients and marry that with our clinical informatics to have a true picture of how much these individuals are spending, he noted. We found through our data analytics that on a year by year basis, we were saving just Medicaid fee-for-service patients enrolled in our clinic an upwards of $1.5 to 2 million per year.

Providers cannot furnish holistic care without addressing social determinants of health. Factors such as the environment, socioeconomic status, and access to healthy food options account for 60 percent of an individuals health.

That means while most patients come into the clinic with a physical condition, there is often an underlying psychosocial theme that contributes to the physical condition, Schmid explained.

Unless you really have a model with the time and resources to support the patient, youre just putting a Band-Aid on things, he furthered.

The APC model, however, can help primary care practices develop the resources needed to identify and treat all the factors impacting patient outcomes and spending, the industry experts agreed.

Particularly, the team-based care model of advanced primary care encourages addressing these factors by various members of the team.

Kyle Grunder, MBA, Director of Provider Operations and Program Development, Courage Kenny Rehabilitation Institute and Spine Clinical Service Lines, Allina Health

So much of managing this patient population is navigating the healthcare system, which you dont need a physician to do, Grunder emphasized. The physicians in our model are focusing on the patients that are in a tough spot and need to be seen. Theyre not spending their time making sure a patient is food secure. We have other team members doing that.

One of the most overlooked social determinants of health is the accessibility of healthcare. An inaccessible system, regardless of its quality, can lead to delayed and disjointed care. Extending visit times and managing all aspects of care can help overcome these challenges and make the patient less intimidated by the healthcare system.

If you can immediately get roomed and then all services come to the member as opposed to making them walk around, it's infinitelymore consumer-centric, Schmid explained. The unsolicited feedback that we receive is that this is the first time patients ever truly felt heard by their doctors or care team.

Courage Kenny takes accessibility one step further, ensuring their patients have no physical barriers to entering the clinic doors.

Part of the reason why the clinic is unique and different is that we are structurally and physically set up to take care of some of the most complex patient populations, noted Grunder.

The APC model elevates primary care by enabling providers to deliver coordinated, preventive care that treats the whole patient, not just his physical conditions. But providers can only achieve these goals by implementing a financial model alongside the APC model.

The traditional healthcare financing system does not support the APC model, industry experts agreed.

The way that the fee-for-service financial model works is physicians are actually incentivized to not provide the care and refer out because it can be done and charged more somewhere else in the system. From an intrinsically motivated primary care provider standpoint, it's really, really disheartening, noted Schmid.

With fee-for-service still being the dominant revenue stream for provider organizations, the APC model may not be gaining the traction experts have hoped for.

Our financial model is not one that is sustainable in a fee-for-service environment, Grunder explained. Most clinic models do not have the funding mechanism or the drive to add in lay healthcare workers to support the clinician because theyre still in a fee-for-service environment. Theyre more driven to see patients frequently than to manage them outside of the visit.

That means organizations cannot do even the most basic APC capabilities, such as emailing the patient and coordinating care over the phone whenever possible.

Frankly, there's no financial incentive to bring somebody in if you can help them over the phone, video, or even messaging, noted Schmid.

Such a system requires strong financial backing and alignment of financial incentives across all aspects of the system, Schmid added.

In our world, that means the patient, the care teams, the company, and then whomever were contracting with, he said. Unless everybody has the same financial goals in mind, youre just recreating some version of a sick care fee-for-service world.

Without financial alignment across payers and providers, grants and donations are keeping the APC model alive at organizations like Courage Kenny.

We have largely survived over the last five years by grants and demonstration projects. We were part of the CMS innovation grant and received a grant from CMS to run the clinic. Weve had support from our Courage Kenny Foundation, he reported.

However, Grunder stressed that this APC financing model is not sustainable. Fortunately, payers and providers are starting to see the value in switching their revenue sources to deliver better primary care.

Innovative payment mechanisms are quickly taking off to support these care models, including the Center for Medicare and Medicaids Comprehensive Primary Care Plus. The goal of the model is to increase access to care while improving the quality and efficiency through advanced primary care methods. It aims to do that by paying participants a non-visit-based care management fee paid per-beneficiary-per-month. Participants can also earn value-based incentive payments based on their performance on quality metrics.

Similar models are starting to crop up across the industry, too. The Health Care Payment Learning & Action Network recently reported that the number of healthcare payments made through an alternative payment model increased to 35.8 percent in 2018.

The industry is slowly transitioning to a more sustainable payment model for APC. But being in the patient business is worth it.

Its the right thing to do for patients and its the right thing to do for society, Pollack concluded.

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Providing Holistic Preventive Health with Advanced Primary Care - HealthITAnalytics.com

VALENCIA, Calif., MELBOURNE, Australia & AURORA, Colo.--(BUSINESS WIRE)--AVITA Medical (ASX: AVH, NASDAQ: RCEL), a regenerative medicine company with a technology platform positioned to address unmet medical needs in therapeutic skin restoration, and scientists at the Gates Center for Regenerative Medicine at the University of Colorado School of Medicine announced today a preclinical research collaboration to establish proof-of-concept and explore further development of a spray-on treatment of genetically modified cells for patients with epidermolysis bullosa (EB), with potential applicability to other genetic skin disorders.

The partnership will pair AVITA Medicals patented and proprietary Spray-On Skin Cells technology and expertise with the Gates Centers innovative, patent-pending combined reprogramming and gene-editing technology to allow cells to function properly. Under the terms of the Sponsored Research Agreement (SRA), AVITA Medical retains the option to exclusively license technologies emerging from the partnership for further development and commercialization. The Gates Center team is further supported by the EB Research Partnership in New York, the Los Angeles-based EB Medical Research Foundation, the London-based Cure EB Charity, and government grants in a collaborative effort to rapidly develop and translate this technology to the clinic for meaningful impact on patient lives.

The Gates Center is a leader in developing therapeutic approaches for genetic skin diseases. Researchers at the Gates Center have developed a powerful new approach for treating genetic skin disorders and improving the lives of patients with epidermolysis bullosa, said Dr. Mike Perry, Chief Executive Officer of AVITA Medical and adjunct professor at the Gates Center for Regenerative Medicine. We look forward to collaborating with the team at the Gates Center on the expanded use of our technology. This agreement marks an important milestone in AVITAs mission to harness the potential of regenerative medicine to address unmet medical needs across a broad range of dermatological indications, including genetic disorders of the skin.

Epidermolysis bullosa is a group of rare and incurable skin disorders caused by mutations in genes encoding structural proteins resulting in skin fragility and blistering, leading to chronic wounds and, in some sub-types, an increased risk of squamous cell carcinoma or death. There are no approved curative therapies, and current treatment is palliativefocused primarily on pain and nutritional management, itching relief, wound care, and bandaging.

Its very exciting to partner with AVITA Medical to help advance our epidermolysis bullosa program, said Director of the Gates Center for Regenerative Medicine Dr. Dennis Roop. Were looking forward to exploring a novel approach to delivering gene-edited skin cells to patients that addresses current treatment challenges.

We believe that Spray-On Skin Cells technology combined with our genetically corrected cells has the potential to be game changing in the treatment of this disease. This combination could reduce time to treatment, lower manufacturing complexity, reduce costs, and improve patient outcomes, said Dr. Ganna Bilousova, assistant professor of dermatology, who is a co-principal investigator on this research program.

ABOUT THE CHARLES C. GATES CENTER FOR REGENERATIVE MEDICINE

The Charles C. Gates Center for Regenerative Medicine was established in 2006 with a gift in memory of Denver industrialist and philanthropist Charles C. Gates, who was captivated by the hope and benefit stem cell research promised for so many people in the world. The Gates Center aspires to honor what he envisionedby doing everything possible to support the collaboration between basic scientific researchers and clinical faculty to transition scientific breakthroughs into clinical practice as quickly as possible.

Led by Founding Director Dennis Roop, Ph.D., the Gates Center is located at the University of Colorados Anschutz Medical Campus, the largest new biomedical and clinical campus in the United States. Operating as the only comprehensive Stem Cell Center within a 500-mile radius, the Gates Center shares its services and resources with an ever-enlarging membership of researchers and clinicians at the Anschutz Medical Campus, which includes University of Colorado Hospital, Childrens Hospital Colorado, and the Veterans Administration Medical Center, as well as the Boulder campus, Colorado State University, the Colorado School of Mines, and business startups. This collaboration is designed to draw on the widest possible array of scientific exploration relevant to stem cell technology focused on the delivery of innovative therapies in Colorado and beyond.

ABOUT THE UNIVERSITY OF COLORADO SCHOOL OF MEDICINE

Faculty at the University of Colorado School of Medicine work to advance science and improve care. These faculty members include physicians, educators, and scientists at University of Colorado Hospital, Childrens Hospital Colorado, Denver Health, National Jewish Health, and the Denver Veterans Affairs Medical Center. The school is located on the Anschutz Medical Campus, one of four campuses in the University of Colorado system. To learn more about the medical schools care, education, research, and community engagement, visit its web site.

ABOUT AVITA MEDICAL LIMITED

AVITA Medical is a regenerative medicine company with a technology platform positioned to address unmet medical needs in burns, chronic wounds, and aesthetics indications. AVITA Medicals patented and proprietary collection and application technology provides innovative treatment solutions derived from the regenerative properties of a patients own skin. The medical devices work by preparing a REGENERATIVE EPIDERMAL SUSPENSION (RES), an autologous suspension comprised of the patients skin cells necessary to regenerate natural healthy epidermis. This autologous suspension is then sprayed onto the areas of the patient requiring treatment.

AVITA Medicals first U.S. product, the RECELL System, was approved by the U.S. Food and Drug Administration (FDA) in September 2018. The RECELL System is indicated for use in the treatment of acute thermal burns in patients 18 years and older. The RECELL System is used to prepare Spray-On Skin Cells using a small amount of a patients own skin, providing a new way to treat severe burns, while significantly reducing the amount of donor skin required. The RECELL System is designed to be used at the point of care alone or in combination with autografts depending on the depth of the burn injury. Compelling data from randomized, controlled clinical trials conducted at major U.S. Burn Centers and real-world use in more than 8,000 patients globally, reinforce that the RECELL System is a significant advancement over the current standard of care for burn patients and offers benefits in clinical outcomes and cost savings. Healthcare professionals should read the INSTRUCTIONS FOR USE - RECELL Autologous Cell Harvesting Device (https://recellsystem.com/) for a full description of indications for use and important safety information, including contraindications, warnings, and precautions.

In international markets, our products are marketed under the RECELL System brand to promote skin healing in a wide range of applications, including burns, chronic wounds, and aesthetics. The RECELL System is TGA-registered in Australia and received CE-mark approval in Europe.

To learn more, visit http://www.avitamedical.com.

CAUTIONARY NOTE REGARDING FORWARD-LOOKING STATEMENTS

This letter includes forward-looking statements. These forward-looking statements generally can be identified by the use of words such as anticipate, expect, intend, could, may, will, believe, estimate, look forward, forecast, goal, target, project, continue, outlook, guidance, future, other words of similar meaning and the use of future dates. Forward-looking statements in this letter include, but are not limited to, statements concerning, among other things, our ongoing clinical trials and product development activities, regulatory approval of our products, the potential for future growth in our business, and our ability to achieve our key strategic, operational and financial goal. Forward-looking statements by their nature address matters that are, to different degrees, uncertain. Each forward- looking statement contained in this letter is subject to risks and uncertainties that could cause actual results to differ materially from those expressed or implied by such statement. Applicable risks and uncertainties include, among others, the timing of regulatory approvals of our products; physician acceptance, endorsement, and use of our products; failure to achieve the anticipated benefits from approval of our products; the effect of regulatory actions; product liability claims; risks associated with international operations and expansion; and other business effects, including the effects of industry, economic or political conditions outside of the companys control. Investors should not place considerable reliance on the forward-looking statements contained in this letter. Investors are encouraged to read our publicly available filings for a discussion of these and other risks and uncertainties. The forward-looking statements in this letter speak only as of the date of this release, and we undertake no obligation to update or revise any of these statements.

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AVITA Medical and the Gates Center for Regenerative Medicine at the University of Colorado Anschutz Medical Campus Enter into Collaboration to Explore...

Home is now the most common place people are choosing to spend their final days of life, outpacing hospital deaths for the first time in more than half a century, according to a study published Wednesday in the New England Journal of Medicine.

The findings are reflective of an end-of-life trend that's been growing since the early 2000s.

From 2003 to 2017, the percentage of people dying at home increased from 23.8 percent to 30.7 percent, researchers found. At the same time, deaths that occurred in hospitals fell from 39.7 percent in 2003, to 29.8 percent in 2017. The research is based on an analysis of federal death certificate data from natural deaths during that time period.

The flip-flop may be attributed in part to growth in home hospice care, which is covered by Medicare, said study co-author Dr. Haider Warraich, associate director of the heart failure program at the VA Boston Healthcare System. Hospice provides pain management, along with emotional support and care to terminally ill patients nearing the end of their lives, as well as their families.

The number of Medicare beneficiaries receiving hospice care has steadily grown over the past decade. The National Hospice and Palliative Care Organization reports there were 1.49 million such recipients in 2017, a 4.5 percent increase from the year before.

But the rise in at-home deaths also "reflects that perhaps we're able to honor more people's wishes and help them pass away in a place that's most familiar to them," said Warraich, who is also a cardiologist at Brigham and Women's Hospital and an instructor in cardiology at Harvard Medical School.

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Dying at home was less common among younger patients, the study found. That's likely because of two reasons: young people in life-threatening situations are more likely to undergo emergency medical interventions in a hospital, and insurance other than Medicare may not cover hospice care.

Racial minorities were also less likely to die at home, perhaps because of either health care access disparities or cultural preferences. Women, too, had lower odds of a home death, as they tend to be more likely than men to fill the caregiver role.

Dying at home may be preferred because of "the degree of control that you and your family have over how things are going to happen," said Harleah Buck, an associate professor in the College of Nursing at the University of South Florida.

Buck, who wasn't involved with the new study, said that people have a variety of cultural and spiritual needs related to death, often involving large gatherings of family members. "As soon as you step into a hospital, you lose the ability to pack 30 people into a room," Buck said. Many hospitals also have strict limits on young children and beloved pets as visitors.

But the rise in at-home deaths "also raises important questions about how well are we supporting not only those patients, but the caregivers who are now responsible for taking care of these patients," Warraich said.

A home death can be extraordinarily difficult for family members who are thrust into unfamiliar health care roles. "You're handing off the primary responsibility for the daily care of the patient from the medical system to the patient themselves and/or their informal caregivers," he said.

Patients at the end of life often have pain and shortness of breath two potentially upsetting experiences for loved ones to witness and treat.

Family members often feel "a sense of obligation" to take care of their loved ones," said Sharon Kozachik, an associate professor at the Johns Hopkins School of Nursing.

"Sometimes we ask family members to do medical tasks of care that we don't allow students to do without someone at their elbow," Kozachik said, "and it can be frightening and hard on families."

Kozachik and Buck said that's when hospice care can step in to assist in comforting patients, as well as caregivers.

"It's really important that people be able to die the way they want to in the environment where they would like, with the people and belongings that they cherish," Kozachik said.

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Erika Edwards is the health and medical news writer/reporter for NBC News and Today.

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More people are choosing to die at home, instead of in a hospital - NBC News

NEW LENOX, IL Margaret Randle, a sophomore at Lincoln-Way West will be a delegate to the Congress of Future Medical Leaders in Lowell, Massachusetts June 24-26, 2020. According to the district, Randle's nomination was signed by Dr. Mario Capecchi, winner of the Nobel Prize in Medicine and the Science Director of the National Academy of Future Physicians and Medical Scientists to represent Illinois based on her academic achievement, leadership potential and determination to serve humanity in the field of medicine.

The Congress is an honors-only program for high school students who want to become physicians or go into medical research fields.

During the three-day Congress, the district said Randle will join students from across the country and hear Nobel Laureates and National Medal of Science Winners talk about leading medical research; be given advice from Ivy League and top medical school deans on what to expect in medical school; witness stories told by patients who are living medical miracles; be inspired by fellow teen medical science prodigies; and learn about cutting edge advances and the future in medicine and medical technology.

Randle's acceptance letter states: "This is a crucial time in America when we need more doctors and medical scientists who are even better prepared for a future that is changing exponentially. Focused, bright and determined students like Margaret Randle are our future and she deserves all the mentoring and guidance we can give her."

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LW West Student Nominated For Congress Of Future Medical Leaders - New Lenox, IL Patch

Researchers from the Italian Institute of Technology (IIT) and the University of Salento, both in Lecce, Italy, and Harvard Medical School in Boston have developed a new light-based method to capture and pinpoint the epicenter of neural activity in the brain.

The approach, described Oct. 7 inNature Methods, lays the foundation for novel ways tomap connections across different brain regionsan ability that can enable the design of devices to image various areas of the brain and even treat conditions that arise from malfunctions in cells inhabiting these regions, the researchers said.

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The work was led by Ferruccio Pisanello at IIT, Massimo De Vittorio at IIT and University of Salento, and Bernardo Sabatini, the Alice and Rodman W. Moorhead III Professor of Neurobiology in the Blavantik Institute at Harvard Medical School, and funded by the European Research Council and by the National Institutes of Health in the United States.

One of the central challenges in modern neuroscience is recording the exchange of information between different regions of the brain, as well as between different cell types. The new method overcomes this challenge by allowing the simultaneous collection of signals from various brain regions through the use of a tapered optical probe.

The study marks the first instance of successfully using light to decode the activity of specific neuronal populations as well as manipulation of different brain regions with the use of a single probe. The approach relies on bringing fluorescent molecules into specific nerve cells in order to track their electric activity and to measure the level of neurotransmittersmolecules that act as chemical messengers across neurons.

To achieve this, the team used an optical fibre in the shape of a narrow cone with a tip so thin and so precise that it is capable of capturing light from single neurons along regions as long as 2 millimetres (0.07 inches).

The researchers inserted the light-sensing probe inside the striatum, a region of the brain involved in planning movements, and used it to track the release of dopamine,a critical neurotransmitter involved in motor control which also plays a key role in the development ofdisorders like Parkinsons disease, schizophrenia and depression.

The device successfully captured neural activity in specific sub-regions of the striatum involved in the release of dopamine during specific behaviours.

The approach has effectively allowed scientists to capture how nerve signals travel in time and space and to gauge the concentration of specific neurotransmitters during specific actions. The method enriches researchers methodological repertoire and augments their ability to study the central nervous system and probe the molecular causes of neurological disorders.

Publication:doi.org/10.1038/s41592-019-0581-xRead-only free access copy of the manuscript:link

Other authors involved in the study included:Filippo Pisano, Marco Pisanello, Suk Joon Lee, Jaeeon Lee, Emanuela Maglie, Antonio Balena, Leonardo Sileo, Barbara Spagnolo, Marco Bianco, and Minsuk Hyun.

Funding:The work was supported by the European Research Council under the European Unions Horizon 2020 research and innovation program (grants 677683 and 692943) and from the National Institutes of Health (grants U01NS0941901 and UF1NS108177-01).

Relevant disclosures:Sileo, De Vittorio, Sabatini and Pisanello are founders and hold private equity in OptogeniX, a company that develops, produces and sells technologies to deliver light into the brain. Tapered fibers commercially available from OptogeniX were used as tools in the research.

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Lighting the Way - Harvard Medical School

There are connections between what we eat and how we feel, and the growing field of culinary medicine looks to capitalize on that link by joining the foundations of nutrition science with teaching people how to cook healthy, tasteful meals.

One North Country doctors office is taking it to the next level by offering patients cooking tips and techniques from a teaching kitchen thats part of their clinic.

Joe Wetterhahn, a family practice physician and his wife Gina, a physicians assistant, ditch their stethoscopes one night a month for a set of knives and cutting boards, teaching patients how to make tasty, healthy food.

The genesis of this whole thing?

"Gina one day in frustration saying 'nobody is getting better. Were spending time with people, doing the best we can, but the weight is going up, the blood sugars are going up, blood pressure is going up'," Wetterhahn said. "Its not just us, its obviously happening across the country. But the way to really impact that is at the plate."

So after a conference on culinary medicine introduced them to teaching kitchens, they pitched the idea to Samaritan Hospital in Watertown, which was building a new health center in Adams. And the hospital took it on, creating a restaurant grade fully equipped teaching kitchen right off their office.

"They invested into this to the point where you walk into our office, and you can sit down take out three cutting boards, grab a knife set and learn how to cook," said Wetterhahn.

So far, the program has grown to about 20 people per session. And Gina and Joe emphasize this is not like a visit to a nutritionist. While science does play a role in what dishes they teach, these classes are more practical.

"Heres something you could make and eat that will make you healthy, without talking about the milligrams of sodium, or the grams of fiber, or the things that dont really translate into how we put food on our plate," said Wetterhahn.

So instead of boiling squash, the 20 or so patients who come to the testing kitchen get a lesson in roasting veggies, like a delicata squash.

"With a delicata squash, the idea is that you eat the rind. Just pick it up and eat it. Because the rind is delate," the Wetterhahns said during a recent class.

Joe and Gina make up their menus the morning of class. Most are based on the Mediterranean diet. They do all the shopping at a local grocery store. So far they say there havent been any cooking busts, but they do admit, one of the biggest challenges is getting folks to try fish.

"Theres this hesitancy because of cooking fish that it wont turn out, or Im not going to like it and its expensive and I dont want to take a chance with it. So we try to integrate fish and seafood a lot in our menus," Wetterhahn said.

A recent class though turned some fish doubters into cod lovers.

"Sometimes certain fishes are fishy. Fishes are fishy. But cod is dense and not fishy," Gina said.

Wetterhahn said the field of culinary medicine is growing. There are teaching kitchens in tech companies like Google. Some medical school are offering classes in teaching kitchens. But hed like to see it in more communities like his, rural populations where studies show there are greater rates of obesity and diets higher in fat.

"The challenge is, again, getting it into areas like northern New York. Getting it into more rural areas, instead of having pockets in urban areas where you have a medical school and it doesnt filter out beyond that," Wetterhahn said.

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Growing field of culinary medicine helps people get healthy by teaching them to cook healthier foods - WRVO Public Media

Its like the parable about the blindfolded men and the elephantonly instead of an elephant, its an enzyme.

For decades, researchers have groped at a family of proteins called Rafs. These proteinsincluding A-Raf, B-Raf and C-Raftransmit signals that control proliferation, differentiation and survival in every cell in the body.

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Raf proteins, especially B-Raf, are also well-known cancer drivers. Hence Rafs full name: rapidly accelerated fibrosarcoma. Faulty control of their activity can cause melanoma; thyroid, colorectal, non-small cell lung and pediatric brain cancers; and other malignancies. Two FDA-approved drugs treat cancer by inhibiting B-Raf.

Given B-Rafs critical roles in health and disease, scientists have been keen to understand its structure. Theyve used genetics, chemistry, biology and other scientific approaches, but they havent been able to piece together a complete picture of Raf.

People had poked and prodded Raf for more than 30 years, but we could only see parts of it, saidMichael J. Eck, professor of biological chemistry and molecular pharmacology in the Blavatnik Institute at Harvard Medical School and Dana-Farber Cancer Institute.

Now, thanks to work by Eck and colleagues, researchers can see the whole enzyme.

As reported online this month inNature, Ecks team at last captured high-resolution images of B-Raf in its inactive or off state and in several active or on positions.

The findings clarify how B-Raf functions normally in the body as well as what happens when mutations alter its shape and lead to cancer.

The work should help researchers seeking to develop safer, more effective cancer drugs that lock onto particular forms of the enzyme like custom-made puzzle pieces.

Illuminating the huge, unsolved problem of B-Rafs structure could have major importance for understanding its biology and for drug discovery, said Eck.

Its exciting to see something no one has seen before, he added. Now that we can look at the thing, we can tell a coherent story that integrates many previous studies.

Protein whisperer

Several factors made the discovery possible.

First, Ecks team didnt try to study B-Raf alone but instead prepared it as a complex with two additional proteins: a known regulator of Raf with the catchy name of 14-3-3, plus MEK, the next link in the Raf signaling chain.

MEK was the crucial missing piece for solving the structure, said Eck, who is co-senior author of the study along withHyesung Jeon, research associate at HMS and a senior scientist at Dana-Farber. MEK is not just the next step in the signaling cascade, its also key for keeping Raf turned off.

Second, HMS research associateEunyoung Park, a senior scientist in the Eck Lab and first author of the study, served as a protein whisperer who tamed B-Raf, coaxing it into those well-behaved complexes with 14-3-3 and MEK, said Eck.

Third, researchers hadnt been able to determine B-Rafs structure using traditional methods such as X-ray crystallography. Advances incryo-electron microscopy, which visualizes molecules at near-atomic resolution, finally opened the door.

The Raf that rocks the cradle

At long last, the structures revealed themselves.

Like a snowman with a rocker base, the complex in its inactive or off state includes MEK on top, B-Raf in the middle and 14-3-3 on the bottom, cradle-shaped.

The team showed how 14-3-3 normally blocks B-Raf from binding with other B-Rafs, keeping it shut off as a default. When an incoming cell signal calls B-Raf to action, however, 14-3-3 swings aside and allows two B-Raf/MEK complexes to form a pair.

In doing so, 14-3-3 exposes a region of B-Raf that draws the complex to the cell membrane. There, B-Raf gets activated and in turn activates and releases MEK to send its growth-promoting signal.

The structural snapshots also revealed how mutations subvert this normal activation process by causing the B-Raf switch to get stuck in the on position.

The discovery isnt without precedent in the cancer biology world.

Weve seen this in other cancer-causing enzymes weve studied, said Eck.

The results could lead to improved treatments for people with cancers driven by dysfunctional B-Raf.

Current drugs that target mutated B-Raf are used to treat malignant melanoma, but they sometimes also stimulate the growth of new skin cancers by paradoxically activating the normal form of the enzyme. Patients then need to take a second drug, which can cause serious side effects.

The structure gives us ideas about new approaches for drug discovery, said Eck.

His group also plans to uncover more details about B-Raf activation in both healthy cells and cancers.

Funding and authorship

Additional coauthors are Shaun Rawson, Kunhua Li, Byeong-Won Kim, Scott Ficarro, Gonzalo Gonzalez-Del Pino, Humayun Sharif and Jarrod Marto.

This work was supported in part by the PLGA fund at the Pediatric Brain Tumor Foundation, Novartis Institutes for Biomedical Research and the National Institutes of Health (grants P50CA165962, P01CA154303 and R50CA221830). Cryo-EM imaging was carried out at the University of Massachusetts Medical School Cryo-EM Core Facility and theHarvard Cryo-EM Center for Structural Biology.

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Caught in the Act - Harvard Medical School

The University of Mississippi School of Medicine trains physicians to deliver skilled, equitable health care to all citizens of Mississippi, the region and nation; this is the essential goal of the medical school.

The program is accredited by the Liaison Committee on Medical Education.

Along the way, students who complete the four-year course of study leading to the Doctor of Medicine degree absorb the schools core values, including respect for the range of diversity reflected in all people.

The School of Medicines pledge is to educate physicians who are compassionate and considerate, and whose numbers meet the health care needs of the state, including those of the underserved. These professionals are mindful of the health problems and disparities faced by the people of Mississippi. They understand that medical education is a lifelong commitment.

As part of the states only academic health science campus, the school plays an important role in deepening the body of knowledge in medicine and science for the state, nation and world, and in making health care more available and valuable for patients of various backgrounds.

Appreciation and respect for the traditions, customs and cultures of a diverse state is a must if the schools students, faculty, administration and staff are to fulfill the schools mission. This diversity embraces demographic attributes, personal attributes, varied life experiences, and much more.

Diversity and inclusion enrich the learning environment and better prepare physicians to offer quality care to everyone.

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School of Medicine - University of Mississippi Medical Center

One medical professional is defending what we see in the cheerleading video.

Next with Kyle Clark , KUSA 8:36 PM. MDT August 25, 2017

Tweet screenshot

DENVER - A senior instructor at the University of Colorado Medical School took to Twitter to mock teenage cheerleaders who were seen screaming in pain while being forced into the splits.

The 9Wants to Know team was the first to report on the incident on Wednesday. The video shows cheerleaders from East High School in Denver crying as their coach - OzellWilliams, who's known for his tumbling at Broncos and CU football games - and fellow teammates hold them in position.

RELATED:Videos show East High cheerleaders repeatedly forced into splits, police investigating

RELATED:East High coach let go from previous job over forced splits

Dr. Jim Mosher, whose specialty is listed as Obstetrics and Gynecology on the CU website,tweeted to Kyle Clark when the story broke that:

Screenshot

Every athlete goes through some difficult pain. If you cannot deal with it mommy is always at home.

"Every athlete goes through some difficult pain. If you cannot deal with it mommy is always at home."

The University of Colorado told Next that Dr. Mosher was not speaking for the university or the medical school on his personal Twitter account when he posted that message.

The doctor has since changed his account name, and he declined to comment when we asked.

--

UPDATE: Dr. Mosher reached out to Next on Twitter Thursday evening to issue an apology. He writes:

I'm SINCERELY sorry for that tweet. I hadn't read the news story. I apologize for any pain caused by this uninformed, unsympathetic comment.

#heynext Tweets

2017 KUSA-TV

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Instructor at CU Medical School mocks East High cheerleaders in splits video - 9NEWS.com