Aug 15th, 2014
Two APK faculty members are being recognized for performing with distinction. Read more here […]
Aug 15th, 2014
Dr. Ashley Smuder, a NIH post-doctoral fellow in the Department of Applied Physiology and Kinesiology, has been promoted to Research Assistant Professor. She will continue her work in Dr. Scott […]
Nov 3rd, 2014
We are excited to announce that Dr. Beth Barton, currently in the Department of Anatomy and Cell Biology at the University of Pennsylvania, has been hired by APK as part […]
June 29, 2016
The likelihood adolescents will try marijuana rises steadily from age 11 to age 16, then decreases before hitting another peak at age 18, according to a new University of Florida study. The study findings, which appear in the American Journal of Drug and Alcohol Abuse, may help experts develop new marijuana prevention strategies, says lead author Xinguang (Jim) Chen, M.D., Ph.D., a professor in the department of epidemiology in the UF College of Public Health and Health Professions and the UF College of Medicine, which are both part of UF Health. “Many existing marijuana intervention programs target students age 15 and older,” Chen said. “Our findings demonstrate the need to start drug education much earlier, in the fourth or fifth grade. This gives us an opportunity to make a preemptive strike before they actually start using marijuana.” As medical marijuana laws are passed in more states, there is concern among some experts that adolescents may view marijuana as a substance that can be used safely by anyone, regardless of whether it is part of a treatment plan under a physician’s supervision. Using marijuana at a young age could put adolescents at risk for cognitive problems, according to the National Institute on Drug Abuse. Teens who use marijuana may have impaired brain development and lower IQ. They may receive lower grades and are more likely to drop out of high school. The UF study was designed to learn when adolescents are most at risk for starting marijuana use. It is one of the first studies to examine the likelihood of marijuana initiation as a function of age and it used a study method called survival analysis that is more sensitive to fluctuations across age groups, Chen said. The team analyzed data from the 2013 National Survey on Drug Use and Health, a nationwide cross-sectional survey including approximately 27,000 respondents ages 12 to 21, sponsored by the Substance Abuse and Mental Health Services Administration. The researchers found the likelihood that adolescents would start using marijuana climbed steadily starting at age 11, reaching a first peak at age 16. But the researchers were surprised to discover that at age 17, there was a dip in the possibility that teens would start using marijuana. The team theorizes that many 17-year-olds are focused on improving grades and preparing for college entrance exams, which could pull their attention away from experimenting with drugs. This finding may represent an additional approach for developing interventions, Chen said. “Increasing adolescents’ academic responsibilities and placing more emphasis on education could be one way to postpone drug use initiation, ultimately preventing drug use,” he said. The likelihood of marijuana initiation rebounded at age 18 for a second peak. This corresponds to another major milestone in the lives of many young adults, said Bin Yu, M.D., M.P.H., one of the study’s co-authors, and a research assistant in the UF department of epidemiology. “At 18, many adolescents leave their parents’ homes to start college or enter the workforce,” Yu said. “They may be more susceptible to influence from peers and they have less monitoring by their parents and the community.” The researchers found that by age 21, 54 percent of young adults will have used marijuana. The research team, which also included Sonam Lasopa, Ph.D., a recent graduate of the UF doctoral program in epidemiology, and Linda B. Cottler, Ph.D., M.P.H., a dean’s professor, chair of the UF department of epidemiology and PHHP’s associate dean for research, noted a second surprise finding when they analyzed the likelihood of marijuana use by race. Adolescents who self-identified as having a multiracial background were significantly more likely to use marijuana than any other racial or ethnic group. More research is needed to understand the reasons why adolescents from multiracial backgrounds may be at increased risk for initiating marijuana use, Chen said. With that knowledge, experts can develop prevention programs that take into account racial and ethnic differences, as well as age. “This study finding supports the idea of precision intervention,” he said. “Intervention programs should be developed for both parents and adolescents, and delivered to the right target population at the right time for the best prevention effect.”
June 22, 2016
When the green sea turtle named Cisco Kid washed up on Hammock Beach in Palm Coast, it seemed his luck had run out. He was anemic, underweight, fighting a blood infection, stunned by the January cold, too weak to swim or eat. Tumors beneath his back flippers sapped his energy, robbing his blood supply and hindering his movement. One thing was in Cisco’s favor, though: He had come ashore just a few miles from the University of Florida’s Whitney Laboratory Sea Turtle Hospital in St. Augustine, where researchers are working to understand and treat the fibropapilloma virus spreading through sea turtle populations, causing tumors that can hamper their ability to breed, feed, even see. The hospital's major benefectors, the Condron family, had just donated a $40,000 carbon-dioxide laser to remove tumors like Cisco’s. The surgery could save Cisco’s life, but he was too sick to survive it. The hospital staff was determined to change that. *** Seven turtles, all with fibropapilloma tumors, paddled around four 1,100-gallon tanks as Burkhalter and her team brought Cisco into the hospital and placed him in a shallow padded pool. “When they're that weak, they're not able to surface,” she said. “If you put them in deeper water, they'll drown.” The staff didn’t know if the turtle was male or female, and they never would – juvenile green sea turtles have no outward indication of gender. But when donor Gary Condron chose the name Cisco Kid after a beloved family dog, they came to think of Cisco as a he. Cisco didn’t fight Burkhalter as she gave him antibiotics and fed him through a tube the team had MacGyvered from a rubber dog toy. His lab tests revealed a red blood cell count less than half of normal. On the 1-5 scale used to rank a turtle’s body condition, Cisco was a 1, the worst possible score. His condition could have been due to the virus, which is related to herpes. Or the virus could have taken hold because his immune system was already challenged. Scientists don’t know how the disease spreads, but they do know it’s spreading, says David Duffy, a Whitney Lab researcher studying potential treatments. The virus occurs naturally in the ocean, but it didn’t seem to impact many turtles until the 1970s. Now the disease has been spotted in turtles all over the world, particularly in the southern United States. Studies have linked its spread to human impact: A study in Hawaii compared the water near a pristine, uninhabited island to the water surrounding a populated island. The virus was present in both places, but only the turtles near the populated area had tumors. “It’s not a classical viral spread where it goes from one population to another,” Duffy said. “There’s a clear link back to people. Something we're doing to the aquatic environment is activating the virus and promoting tumor growth.” Cisco's tumors before surgery.Green turtles – one of the five species found in Florida – are particularly vulnerable. The tumors start in their adolescence, when they venture back from the middle of the Atlantic Ocean to forage along coastal waterways. When they’re healthy, green turtles can live more than 100 years. To have a shot at that kind of lifespan, Cisco needed help. A CT scan donated by a human clinic delivered some much-needed good news: Cisco’s tumors hadn’t spread to his internal organs. But as the days went by, Cisco refused even the most tempting treats – herring, mackerel, shrimp. Seven days a week, the staff fed him formula made of powdered fish and seaweed. Then, three weeks into his treatment, he began to resist coming out of the water for his treatments. Turtles, like cats and dogs, have distinct personalities, Burkhalter says: Some, like their young patient Squidlips, are curious and friendly, sticking their heads out of their tanks to greet their caretakers. Others are standoffish. Cisco was beginning to show some spunk. “When I saw that he didn’t want to be handled, that was a good sign,” she said. “It was the first time I felt like I knew he was going to survive.” Even for outgoing turtles, the hospital staff tries to limit interactions that could habituate turtles to people. They devised a system of PVC pipes to hold cucumbers and peppers at the bottom of the tanks to mimic feeding off of grasses on the sea floor, and they toss fish and squid into the water instead of feeding the turtles by hand. “We don’t want turtles associating people with food,” Burkhalter said. The staff devises enrichments to keep the turtles busy and keep stress at bay. They freeze food inside ice cubes to make dinner more of a hunt than a handout. They build obstacle courses for the turtles to swim through and back scratchers for them to rub their shells on. “We’re doing a lot of research on how to reduce their stress, because stress works against you when you’re trying to heal,” Burkhalter said. It’s just one type of research going on at Whitney Lab, which opened in 1974. Here, scientists look to marine organisms for clues to how the senses function, how regeneration works and how these discoveries could someday apply to humans. The hospital followed in 2015 and has treated more than 60 injured or ill turtles since opening. Supported by private donations, the university and the Sea Turtle Conservancy’s Florida Sea Turtle Grants Program, the hospital works in conjunction with UF's Archie Carr Center for Sea Turtle Research, which was recently named as part of a Disney initiative to protect these endangered animals. Along with rehabilitating sick and injured turtles and researching fibropapilloma, the hospital raises public awareness about the importance of sea turtles and the issues they face. “Helping Cisco as an individual isn’t going to save the species,” Burkhalter said. "What it does is give people something to see and bond to. They learn the story and realize the bigger picture – the impact of marine debris, pollution, climate changes. All of these things aren’t just hurting turtles, they’re hurting the world. If we lose turtles, it upsets the balance of the entire ocean.” *** On April 11, Cisco lay on his back, flippers splayed, under anesthesia. Burkhalter stood over him, ready to use the laser on a patient for the first time. She had prepared for this moment in continuing-education sessions, practicing on oranges and chicken breasts. Unlike traditional surgery, which can cause too much blood loss, the laser cauterizes as it cuts away the tumors, resulting in less pain, less bleeding and faster healing. A less-invasive treatment could be on the horizon: Duffy, the fibropapilloma researcher, is genetically profiling tumors like Cisco's to identify medicines that could fight them. Just as in humans, determining the genes involved in creating the tumors can lead to treatments that target those genes. That could lead to a drug that could prevent the tumors from recurring after surgery, or point to the environmental factors switching on the cancer genes in the first place. “I beg him every day to hurry up,” Burkhalter said. Burkhalter uses a laser to remove Cisco's tumors.As a camera crew from Discovery Channel Canada looked on, Burkhalter began removing Cisco’s tumors. Then her heart sank. Although the procedure was going perfectly, she saw that the tumors had grown deep under the skin, almost down to the knee joints. She continued removing them, hoping Cisco was strong enough to recover from the more-extensive surgery. With a waterproof bandage wound around both back flippers, Cisco slept off his anesthesia resting on foam noodles in a plastic kiddie pool. The next day, he ate. A few days later, he was swimming in his regular tank with his roommate, Mudpie. “His recovery was picture perfect,” Burkhalter said. *** On a Monday morning in June, more than 200 people lined up on the beach to cheer Cisco home. Burkhalter's daughter waved a hand-lettered "Goodbye Cisco" poster signed by the kids in the Whitney Lab’s marine-biology summer camp. A hospital volunteer live-streamed the festivities to a second-grade class in England. Inside a 27-gallon storage bin, Cisco rested on towels after being lifted from his tank, loaded into a Jeep and driven across the street to River to Sea Preserve. After his surgery and recovery, when she determined that Cisco’s tumors weren’t growing back, Burkhalter contacted the Florida Fish and Wildlife Conservation Commission, which chose the date and place for his release. Weekdays are best, she explained, because there are fewer people and boats in the water that could disorient or endanger a newly released turtle. But the crowd that turned out for Cisco’s release gave the staff another opportunity to convey that our actions – collectively and individually – have an impact on sea turtles. Duffy listed a few simple steps: preventing boat strikes by respecting no-wake zones. Safely disposing of fishing line to keep turtles from getting tangled. Reducing plastic garbage and runoff that degrades their habitat. “We need to be more aware of impact people are having on the marine environment,” he said. Burkhalter lifted Cisco and carried him toward the crashing surf, his flippers flapping faster and faster as he neared the water. She waded in until she was waist deep. A wave crashed over her, but she held on to Cisco. She wanted to get him out just a little deeper, beyond the worst of the waves and into calmer waters. After months of nursing him back to health, it was one last gift she could give him, a tiny head start in the vast ocean. She lowered him into the water and let go. Cisco darted north, raising his head and taking three deep breaths before diving beneath the waves. “They don’t tend to turn around and say thank you. There's no little wave goodbye," Burkhalter said. "But the faster they leave, the stronger they are, and that makes us happy.” After the crowd dispersed, the team regrouped in the hospital’s surgical suite. Burkhalter and veterinary care manager Rachel Thomas scrolled through comments on the hospital’s Facebook page, where people as far away as Hungary wished Cisco well. Thomas erased Cisco’s name from a whiteboard diagram of the hospital’s four tanks, leaving a blank space next to Mudpie. At 11:03, less than an hour after Cisco’s release, the phone rang. It was the Volusia Marine Science Center an hour south in Ponce Inlet, asking if the hospital had an opening for another green sea turtle with fibropapilloma tumors. The team began rallying volunteers to transfer the turtle to the hospital. In a few hours, they would start again. gallery Video by Brenton Richardson/UF Office of Development and Alumni Affairs. Additional photos courtesy of Jessica Long and Brooke Burkhalter/Whitney Laboratory for Marine Bioscience.
June 22, 2016
May’s announcement that a strain of bacteria with genes conferring resistance to colistin, our antibiotic of last resort, was identified in the United States, is just the latest report highlighting the growing threat of antibiotic resistance. Antibiotic resistance is driven by many factors, the most significant of which is inappropriate prescribing. This is when patients get a prescription for an antibiotic that they don’t really need, or get a prescription for the wrong antibiotic, the wrong dose or the wrong duration. And doctors know that inappropriate prescribing feeds the problem. So why do they keep doing it? As a clinical pharmacist who has studied antimicrobial resistance and developed intervention programs to reverse the trend, I know firsthand how challenging this problem is to solve. I believe there are two reasons inappropriate prescribing is so hard to curb. First, there is a philosophical disconnect between the data about antibiotic resistance and what drives prescriber behavior. The second is that physicians may bend to patient demand for antibiotics, even if the physician knows it won’t help or isn’t really needed. Physicians: Does your hospital have a resistance problem? Typically, antibiotic resistance data is captured at the population level. Reports about resistance look at what is going on in countries, states or regions. But antibiotics are prescribed by individual physicians to individual patients. So looking at population-level data makes it easy to deny that it’s a problem in your clinic or hospital, and that your behavior is contributing to it. That means one of the solutions to curbing antibiotic resistance is to personalize the problem for doctors to get them to change their prescribing habits. And, at least in hospitals, this approach has been shown to work. In the 1990s, I led a group at the University of Florida College of Pharmacy that established the Antimicrobial Resistance Management (ARM) Program. ARM worked with over 400 hospitals nationwide and in Puerto Rico. We sent customized reports to hospitals that included their antibiotic use over at least the past three years, which was compared to resistance levels for several types of bacteria that commonly cause infections. That meant we could determine if there was any statistically significant relationship between antibiotic prescribing habits and resistance at the hospital level. Because the data was institution-specific, providers couldn’t deny that their hospital had a resistance program, and that they may be contributing to it. What does that mean in practice? ARM examined the relationship between imipenem, a broad spectrum antibiotic, and Pseudomonas, a bacteria that often causes healthcare-acquired infections, at a particular medical center. The program found that if the medical center did not change their prescriber behavior for this antibiotic, resistance would rise one percent for every 30 average daily doses in adults. This tells prescribers much more about the chance that a key antibiotic will become less effective against a common infection than general population-level data would. Knowing this, hospital staff and individual providers might think carefully about when to prescribe antibiotics, and to prescribe the right dose, the right frequency of dose and the right duration if and when they do. Those behavior changes have a big effect. For example, at the same medical center, these reports helped to change prescribing habits for ciprofloxacin, a widely used antibiotic that you may know as Cipro, to the point that it became 26-76 percent more effective at treating infections caused by certain organisms, especially those associated with hospital-acquired infections. Patients play a role So there’s a way to get physicians in hospitals to think about how they prescribe antibiotics. But most antibiotics are prescribed in outpatient clinics. In fact, a recent sample of outpatient visits in the United States revealed that there were about 506 antibiotic prescriptions per 1,000 people in the U.S. Of these, about 69.7 were deemed appropriate. The rest weren’t, and were often prescribed for diseases include bronchitis, sinusitis, ear infections and sore throats, which will often go away on their own. And many of these diseases are often caused by viruses, which won’t respond to antibiotics. So to really combat inappropriate prescribing, we also need to reach physicians in outpatient clinics. Targeted data could help here. But the problem is that the systems that monitor antibiotic resistance and prescribing rates do not collect quality data on outpatient clinics. Even if they did, there is no standardized mechanism to deliver that information back to the community-based provider. Beyond that, we also need to reach their patients. Part of the reason physicians prescribe antibiotics is that they bend to the expectations of their patients. If a patient with a chest cold decides to see his provider, the patient most likely took off work, spent time in a waiting room, then more time waiting in the exam room until the provider finally came in to spend a few minutes of face-to-face time with him. The last thing the patient wants to hear is that he should get some rest, drink plenty of fluids and take Tylenol. He feels as if he made an investment, and for his investment, he wants a return. Hence a prescription, often for an antibiotic. Providers know this and realize that patients will leave sooner and happier if the provider gives patients what they want. The challenge for patients is complicated by the fact that numerous pharmacies will now provide them free antibiotics with a proper prescription. This not only increases the demand from patients for an antibiotic from their provider but it also increases the demand for select antibiotics since not all antibiotics are offered free of charge. The increased demand for a select group of antibiotics speeds up the development of resistance against those drugs and cuts down on the time before they become useless. While physicians should avoid prescribing antibiotics to patients unless they are truly necessary, patients must also accept the fact that not all infections require an antibiotic. Patients have to take responsibility for the retention of antibiotic efficacy for future generations. They should share with their provider that they want to partner with him or her toward a more responsible level of infectious disease care. There are solutions, but to realize them, we need to stop discussing antibiotic resistance as an abstract, population-level problem and drive the solutions down to where the problem started, the patient-provider relationship. This article originally appeared in The Conversation on June 21, 2016.