What I'm Working on: LA Anxiety? Welcome to the Jungle

By Dr. Alex Van Ness

The running of the bulls in Pamplona? Indiana Jones fleeing the boulder?!? Yeah, they’ve got nothing on me.

I’m talking about the recent International Stroke Conference (ISC) in Los Angeles, California. I have to admit that learning of this location provoked something akin to PTSD in me. The last time I was in Los Angeles for an ISC meeting, I was traumatized.

Imagine, if you will, a budding physician-scientist walking back from the conference center on a sunny California afternoon, mulling over the latest clinical trials, pulling a stuffed laptop case. Suddenly, a red double-decker bus comes out of nowhere, blasting some sort of horrible sound that passes for music. I turned and looked, unable to ignore the music any more than I could an ice pick in my brain. The bus was large and filled with ponytail sporting Tweens, all of whom appeared to be screaming or singing along to a throbbing and undecipherable jingle.

Streetwise, I tucked my head and tried to ignore them, while continuing down the sidewalk to my hotel. The next thing I knew, something, a projectile of sorts, hit me in the right shoulder. When I looked around, the only possible culprit was the double-decker bus. On the ground, lay a red bundle. Instinctively, I picked it up, stuffed it in my bag, and kept walking. I didn’t even make it another block before I sustained another direct hit—this time by a white tube-like structure. Again, I saw no one around me except the ponytailed troop on that double-decker bus. Realizing that the second piece of ammo was a T-shirt, I deduced that the singing ponytails were sniping me using T-shirt guns.

That was it.  A woman has her limits.  I accelerated and veered left, shaking them off the trail to my hotel. Just when I thought I had escaped, I was surrounded by high-pitched screams. Looking over my shoulder, I confronted a herd of girls running right at me (not unlike that terrible scene from “The Lion King.”)  I quickly realized I was trapped between the charging pigtails and a performance stage. I did what any sane academic would do… I grabbed the handle of my laptop pull case and ran for my life!

I didn’t stop until I reached the hotel lobby, a sweating, panting heap. I must have looked shaken, because the bartender inquired about my well-being. Astutely, he offered me a drink, and I ordered a Tanqueray and tonic with two limes.While I was still gathering my bearings at bar, one of my colleagues approached me and asked what was wrong. I described the traumatic event. After comforting me with a series of snorts and laughs, she inquired about the projectiles that struck me.

I took them out of my bag, holding them at arm’s length for her to see. Chuckling, she asked if I knew who Justin Bieber was. Who??? He is a pop icon starring at a concert nearby, she explained, happily securing the T-shirts in her backpack for her daughters. I said I hoped that her daughters would appreciate the genuine artifacts, given that I had risked my life acquiring them. She was pretty sure that they would since “he’s to die for.”

What I'm Working On: Innovative Leadership in Health

Posted by Tonya Breaux-Shropshire

Creativity is a thinking process that gives us the ability to generate ideas, and innovation puts those ideas into practice to create value. Leading companies, such a General Electric and Google, are famous for using innovation to create value. But hospitals? Well, we may be less well-known as innovators, but that is starting to change.

I say that as I move forward with a new quality improvement program to increase innovation in the staff at UAB Hospital and the Veterans Administration (VA) Hospital in Birmingham, AL. This idea began when I met Dr. Rubin Pillay, the futurist and Professor of Innovation and Entrepreneurship at the Collat School of Business and Assistant Dean for Global Health Innovation at the UAB School of Medicine​ after hearing his inspiring speech in July 2014.

Now, I am a Veterans Administration (VA) Quality Scholar Fellow at UAB with a specialty in hypertension in the School of Medicine, Cardiovascular Division/Vascular Biology and Hypertension Program. I also serve as Adjunct Faculty for the UAB School of Nursing Family, Community Health, and Outcomes. I know a great deal about evidence-based practices in cardiovascular medicine, nursing, and community health.

However, Dr. Pillay’s talk about medical innovation centers made me realize how little I knew about the science in this area, for which he edits an academic journal, Innovation and Entrepreneurship in Health. Intrigued, I approached him, we talked, and we decided to propose using his copyrighted tool to assess UAB Hospital and VA Medical Center nurse managers. The objective would be to determine their innovative competencies and provide training targeting the gaps to improve their skill levels. VA leadership has approved the new program and leaders at the UAB School of Nursing are very interested in the idea. A meeting is pending to discuss logistics.

Why should we do innovation training, and why train nurse managers? Because nurse managers need to be equipped to lead and create an environment for new ideas to thrive. And because it works. Dr. Pillay cites numerous example of how training and the adoption of innovation thinking as led to better health outcomes. For example, one hospital clinic in Uganda used his innovation model  to build a quality health service for HIV patients. In another example, his work is well known at the Oklahoma State University Center for Health Sciences in Tulsa where he spearheaded the Oklahoma State University’s new Center for Health Systems Innovation. This center was the first in the nation dedicated to harnessing entrepreneurship, creativity and innovation to improve health and health care systemically.

Perhaps most importantly, at UAB, we live in a world of evidence-based medicine, where science is put to work every day to make our lives better. Evidence-based intervention calls for innovative and trained interdisciplinary teams to improve the likeness of success. It is no surprise that our tagline is “UAB: Knowledge that will change your world.” Stay tuned as we embark on this foray into the science of purposeful change built around new ideas, problem finding, and problem solving.

Image credit: www.reply-mc.com

What I'm Working On: Brain Tumor Associated Seizures



Posted by Stephanie Robert

Magnetic Resonance Image (MRI) of the brain
Pixabay.com

Each year, approximately 20,000 adults are diagnosed with a malignant brain or CNS tumor in the United States. The majority of these tumors are thought to be derived from the malignant transformation of glial cells, which are the non-neuronal cells of the brain. These glial-derived tumors are called gliomas. There are many classifications of gliomas, however the most prevalent and deadly are classified as Glioblastoma Multiforme, or GBM. GBM patients typically survive only 12-15 months after diagnosis. In addition to a short survival, over half of these patients experience seizures during the course of their illness. 

In our lab, we study how these tumors cause seizures in patients. We have found that many GBMs express a transporter called System xc- (SXC), which functions to protect cells from free radicals - which is important because they can kill cells if not controlled. In order for this transporter to function, it must release glutamate, which is an excitatory neurotransmitter in the brain. This is important because too much excitatory drive will initiate seizure activity by causing abberant neuronal firing. We have found that this release of glutamate into the extracellular space in the brain, affects peri-tumoral neurons and causes seizures. Excitingly, there in an FDA-approved drug, Sulfasalazine, which inhibits the activity of SXC, preventing the relase of glutamate. Since this drug is currently used in patients to treat inflammatory bowel disease, it is a potential adjuvant treatment that can be readily tested in patients with GBMs and other gliomas causing seizures.

What I'm Working On: Managing a Classroom

Posted by Randall Hall

My Classroom at Carver High School

Prior to September 2014, I had literally no experience managing a classroom. Since then, I have completed a Classroom Management course through my Master's Program at UAB and spent more than 150 hours teaching and managing students in my new career as a full-time English Language Arts teacher at Carver High School.

The three main learning points I have taken from my experiences are that teachers who are effective classroom managers (1) possess excellent organization skills, (2) communicate expectations clearly, and (3) "model" appropriate skills and behavior for their students on a consistent basis.

As to (1), all teachers - but especially new teachers - must maintain an organized classroom in order to promote a productive learning environment. Aspects of this element of good teaching include creating a student-centered classroom through desk arrangement, ensuring student work is promptly graded and placed in each student's separate portfolio, and meticulously recording information about each student's performance and behavior. Without documentation and data, a teacher cannot assess their students' academic and behavioral performance, so it is imperative that teachers maintain a highly organized classroom in order to be as efficient and effective as possible.

As to (2), I have concluded that communication of expectations to students (and their parents) is critical when it comes to both their academic work and their behavior. I did not do a good enough job of making my expectations clear when I was a student teacher, and - as a result - I dealt with behavior problems that were caused by students being unaware their actions - while perhaps considered appropriate in other teachers' classrooms - would not be considered acceptable in my class (for example, use of cell phones or eating during class). After I was hired at Carver, I spent the entire first day informing my students of my expectations and the consequences for falling short of them, and I have been pleased with both their behavior and academic performance thus far.

Finally, as to (3), the major thing I have learned this year as a student and new teacher is that teachers must "model" everything for their students. This idea is evidenced in my use of the "I Do, We Do, You Do" method of instruction, but it also extends to behavioral lessons as well. Just as I model for my students how to write a well-organized essay if I expect them to be able to do it, I must also model respectful, responsible, and resourceful behavior if I expect them to display it. I must hold myself to the highest standard of professionalism and be a "role model" for them both inside the classroom and in the community in large.

In sum, I have made it my career goal to not just instruct my students in a manner that improves their reading and writing skills, but to also inspire them to make good decisions so they can one day independently improve their future - both academic and professional. By modeling for them the skills and behaviors they will need to succeed in life, I can hopefully mold my students into compassionate citizens who exhibit a lifelong love of learning.

What I’m Working On: How Microbes Contribute to Health

Posted by Katie Alexander

Green Fluorescent Protein (GFP) labeled bacteria

As a member of the Elson lab at UAB, I examine the relationships between a certain cell type, regulatory T cells (Tregs), and the microbiota. Tregs are major players in immune tolerance and homeostasis, the policemen of the immune response. They are essential in anti-inflammatory mechanisms. Recently, researchers have shown that certain species of bacteria effectively induce Tregs and anti-inflammatory responses (1). Conversely, other types of bacteria encourage pro-inflammatory cells to thrive and can damage the immune system. During IBD, the microbiota becomes unbalanced, and the bacterial species associated with inflammation tip the scales in their favor, ousting the beneficial bacteria. This is also what happens when a person is infected with the bacterium Clostridium difficile (C.diff).

Additionally, bacteria can interact with components of our food directly. A recent report by Suez et al. (2) outlined the relationship between non-caloric artificial sweeteners (NAS) and the microbiota. NAS are ubiquitous in the Western diet, with saccharin and aspartame being some of the most commonly used. Interestingly, our bodies do not recognize NAS and therefore cannot absorb or use them as energy sources. For that reason, numerous health officials have considered these sweeteners harmless, or in the case of a person with diabetes, beneficial. Suez and colleagues demonstrated that NAS interact closely with intestinal bacteria, causing shifts in the balance of good and bad bacteria. In fact, mice subjected to a diet supplemented with NAS were susceptible to increased glucose intolerance. This finding was recapitulated in a small-scale human study. It is obvious that microbes affect countless aspects of human health, and therefore further research into understanding how to maintain a healthy population of microbes will contribute profoundly to overall human wellbeing.   

References:

  

Atarashi K. et al. Induction of colonic regulatory T cells by indigenous Clostridium species. Science. 2011. Jan 21:331(6015):337-41.

Suez J. et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014 Oct 9:514 (7521):181-6.

What I'm Working On: Better Health, Better Care, at Lower Costs for our Veterans

Posted by Tonya L. Breaux-Shropshire

As recent media coverage has shown, few issues are as important to this country as healthcare for veterans. What most people don’t see, however, when they read the headlines, is the research that takes place behind the scenes on new solutions to our vets’ most common medical problems. For example, hypertension is the number one reason for a primary care visit, and that is one of my areas of research as a Veterans Administration (VA) Quality Scholar Fellow at the University of Alabama at Birmingham (UAB) School of Medicine. In particular, I facilitated first steps in how to boost blood pressure control in hypertensive veterans by using quality improvement tools, such as a process map, SWOT analyses, check sheets, and evidence-based interventions like “a hypertension bundle.” This bundle, which has been successful in one patient aligned care team (PACT) in the Primary Care Clinic at our VA Hospital, employs the electronic medical record, medication adherence assessment, and appropriate nontraditional care visits to achieve greater patient engagement, hence superior care for vets. What is more, the bundle could potentially lower costs by helping vets avoid expensive emergency room visits for what could be routine care.

Research into hypertension is not new for the VA system, which has led the way to blood pressure treatment and control. As early as the 1960’s, for example, the VA conducted pioneering studies to determine that blood pressure was a disease that needed to be treated to prevent heart attacks, strokes, kidney disease, and death. In addition, VA conducted one of the first studies that determined that step care, or medication intensification starting with one medication, is required for blood pressure (BP) control. Admittedly, much more needs to be done to improve primary care and access to care for vets. Yet, on many fronts, we are making real progress, including the availability of user-friendly resources, such as the My Healthy Vet program (https://www.myhealth.va.gov/index.html), TeleHealth (http://www.telehealth.va.gov/ccht/), and the Get Well Network (http://www.getwellnetwork.com/). Today, VA blood pressure control rates and target goals are higher than national goals, and I think that make sense, given the strategic and human importance of keeping our vets healthy. In fact, at the Birmingham VA, we recently improved blood pressure control over and above the VA target goal rate within 6 months. You might not read about that in the headlines, but that doesn’t mean we aren’t working 24/7, for better health, better care, at lower costs, for our veterans.

What I’m Working On: Epigenetics & Leadership, From the Green Light “Go”

Posted by Tandy L. Dolin Petrov

Throughout my entire life, I have suffered from a series of health issues that have called for repeated surgeries at either Children’s Hospital or other medical centers at the University of Birmingham at Alabama (UAB) in Birmingham, Ala. I recollect countless moments staring out the window of either Children’s Hospital  or  Spain Rehabilitation

Tandy Dolin Petrov and Kartik Manne

(GSA President and Vice President @ NSO 2014)

Center.   In the sanctuary of my room I would gaze at the city’s hilltop iron statute of Vulcan -- with its green light for safe roads and red light when a traffic accident had occurred – and think of all the things I would do in life. For me, Vulcan’s persistent reaching to the stars symbolized victory and the green light represented a start, and literally, the word “go” in life.

 

Today, as a doctoral student at UAB, I sometimes find myself staring at the Vulcan and realizing how lucky I am to be doing everything I dreamed. Recently, for example, I graduated from UAB with my Masters of Science in Biology.  For three years, I was able to explore the salt marshes of Dauphin Island, an out-of-the-way barrier island that borders Alabama’s Gulf Coast, on the hunt for the elusive diamondback terrapin.  My thesis focused on this keystone species and I had the remarkable opportunity of managing the UAB Terrapin Head-start Project, a conservation effort that provided a unique opportunity to study the ecology and life history of the terrapin while rehabilitating their population. 

Now, I am a 1^st year PhD student, I have moved into to a challenging new field and a new lab, where I study epigenetics, using fruit flies.  Epigenetics is the study of changes in DNA structure without actually changing the genetic code.  My goal with this research is to understand how silencing genes inhibit protein production and if the underlying mechanism can be therapy for a variety of diseases.  This abstract, fast-paced molecular world is completely different than my laid-back, sun-loving ecology realm.  Everything is high-speed and expeditious until it comes to waiting for the results.  So, I took up another venture, becoming President of the Graduate Student Association (GSA). 

Presidency is a terrifying term, or at least I thought when I first won an election to lead more than 5,000 graduate and professional students. Yet, as I quickly learned, leadership is teamwork, and I am lucky to have great team, Kartik Manne, Vice President (show with me in the above photo), Jocelyn Hauser, Treasurer (who is also the BGSA President), and Mallory Cases, Secretary extraordinaire, that keeps the GSA resilient and moving forward.  It is important for everyone to learn how to juggle full plates and to be a team.   Not only do I have a plate full of research and administration, I also teach microbiology labs in my department.  Yes, I’m a very busy individual.  But it’s what I want.  After sitting, not being able to move or run or even wiggle a toe, for so long, I now find myself constantly maneuvering forward, with one eye on Vulcan, and one eye on the road to life, looking for the green lights.