It happens every first Monday in May - Melanoma Monday- a decades old tradition at the USF Clinic and a potential life-saver for patients!

USF's Department of Dermatology & Cutaneous Surgery has held an "open-house" of sorts, openning their doors to the community for a night of free skin cancer screenings. By the hundreds patients come. The event brings together the university's skin cancer experts and medical residents with folks from across the Tampa Bay area - many of them "Melanoma Monday" veterans. This year's event falls on May 5th.

Melanoma Monday '08
May 5, 2008
5:00 PM - 7:00 PM
USF Clinic - Zone A
12901 Bruce B. Downs Blvd.
Tampa FL 33612

"Melanoma Monday" is an annual event created by the American Academy of Dermatology to increase public awareness of this potentially fatal skin cancer. Dermatologists across the U.S.A. are donating their time and facilities to screen patients for melanoma," says Neil Fenske, MD, Chair of the USF Department of Dermatology & Cutaneous Surgery. "Many of these patients have limited access to care and for some this is their very first total skin examination! Numerous lives have been saved over the years due to the efforts of dermatologists, and Department of Dermatology and Cutaneous Surgery at USF Health is proud to be a leader in this endeavor."

Dr. Mary Lien

Mary Lien, MD, Assistant Professor of Dermatology & Cutaneous Surgery, USF College of Medicine and Chief of Dermatology, James Haley V.A. Hospital in Tampa, has seen it all over the years. From a skin cancer patient only in elementary school to the woman who lost part of her face and ear because she ignored the signs of cancer for years. "Some people will say ''Oh it's just a pimple.' referring to something growing on their skin. Well the pimple has been there for four years! It’s not going anywhere,” says Dr. Lien. “The power of denial is incredible!”

Dr. Lien takes advantage of every opportunity to talk to people about the importance of skin cancer screenings. This past April 15th, she spoke before a crowd of approximately 200 employees from the Florida Department of Transportation- bringing along photos of fingers, faces, arms, legs, even a penis, plagued by cancer. “The photos are not intended to be gross,” she told the standing room only crowd, “but pretty power-point slides don’t help you remember. I want these pictures to be ingrained in your minds, so that if you see anything that looks like this (referring to a photo on the screen) then you will go to the doctor to have it examined.”

On this particular outing at DOT District headquarters in Tampa, Lien does her talk with Dermatology Resident Donald Stranahan, MD. Not one to just stick to powerpoint, at one point, Lien calls out for volunteers to demonstrate how to properly check one’s scalp for signs of cancer. DOT employee Susetta Cannon is among the volunteers. Lien and Stranahan telling the crowd that even in cases like Cannon’s, who has a full head of hair, skin cancer lessions can occur. Combing through the woman’s hair with their finger tips, they search section by section. Lien gives the “how to’s” aloud and then sends the volunteer on her way. “I feel better now,” says Cannon, smiling as she walks back to her seat.

April 15, 2008. Florida Dept. of Transportation Safety Meeting, Tampa, FL. From L to R: Dr. Mary Lien, DOT employee Susetta Cannon and Medical Resident Donald Stranahan-1st year Dermatology resident.

“There was a terrific ‘buzz’ from the attendees after the presentation! Dr. Lien’s message was taken to heart and very well received,” said Patricia Short, Finance and Administration Operations Manager, Florida Department of Transportation, District 7. “Being a melanoma surgical patient myself, over the years I have researched and learned a lot about skin cancer. Even so, Dr. Lien presented information that was new to me. I was very pleased to have had the opportunity to see her presentation.”

Skin Cancer 101
Caught in time, the cure rate for the most common skin cancers, Basal Cell Carcinoma & Squamous, is 90% - 95%. The key is early detection and treatment. No one knows the exact causes of melanoma. Doctors can seldom explain why some individuals get melanoma and others do not. What researchers do know is that people with certain risk factors are more likely than others to develop melanoma. A risk factor is defined as anything that increases a person’s chance of developing a disease.

Below is a listing of factors & recommended measures for prevention provided by the National Institutes of Health, National Cancer Institute.

Known risk factors for melanoma…

Dysplastic nevi:
Dysplastic nevi are more likely than ordinary moles to become cancerous. Dysplastic nevi are common, and many people have a few of these abnormal moles. The risk of melanoma is greatest for people who have a large number of dysplastic nevi. The risk is especially high for people with a family history of both dysplastic nevi and melanoma.

Many moles (more than 50):
Having many moles increases the risk of developing melanoma.

Fair skin:
Melanoma occurs more frequently in people who have fair skin that burns or freckles easily. Individuals usually have red or blond hair and blue eyes. More at risk than individuals with dark skin.

Family history of melanoma or skin cancer:
People who have been treated for melanoma have a high risk of developing a second melanoma. Individuals who have had one or more of the common skin cancers (basal cell carcinoma or squamous cell carcinoma) are at increased risk of melanoma.

Family history of melanoma:
Melanoma sometimes runs in families. Having two or more close relatives who have had this disease is a risk factor. About 10 percent of all patients with melanoma have a family member with this disease. When melanoma runs in a family, all family members should be checked regularly by a doctor.

Weakened immune system:
Individuals whose immune system is weakened by certain cancers, by drugs given following organ transplantation, or by HIV are at increased risk of developing melanoma.

Severe, blistering sunburns:
Individuals who have had at least one severe, blistering sunburn as a child or teenager are at increased risk of melanoma. Because of this, doctors advise that parents protect children’s skin from the sun. Such protection may reduce the risk of melanoma later in life. Sunburns in adulthood are also a risk factor for melanoma.

Ultraviolet (UV) radiation:
Experts believe that much of the worldwide increase in melanoma is related to an increase in the amount of time people spend in the sun. This disease is also more common in people who live in areas that get large amounts of UV radiation from the sun. UV radiation from the sun causes premature aging of the skin and skin damage that can lead to melanoma. Artificial sources of UV radiation, such as sunlamps and tanning booths, also can cause skin damage and increase the risk of melanoma. Doctors encourage people to limit their exposure to natural UV radiation and to avoid artificial sources.

How to protect yourself from melanoma caused by UV radiation...
Avoid exposure to the midday sun (from 10 a.m. to 4 p.m.) whenever possible. Experts say when your shadow is shorter than you are, protect yourself from the sun.
If you must be outside, wear long sleeves, long pants, and a hat with a wide brim.
Protect yourself from UV radiation that can penetrate light clothing, windshields, and windows, and UV radiation reflected by sand, water, snow, and ice.
Experts recommend sunscreen products that provide “broad-spectrum coverage.” Sunscreens are rated in strength according to a sun protection factor (SPF). The higher the SPF, the more sunburn protection is provided. Sunscreens with an SPF value of 2 to 11 provide minimal protection against sunburns. Sunscreens with an SPF of 12 to 29 provide moderate protection. Those with an SPF of 30 or higher provide the most protection against sunburn.
The label should specify that the lenses block at least 99 percent of UVA and UVB radiation.

OTHER LINKS…

“Hairdressers - Unexpected Allies in the Battle Against Skin Cancer”

Dr. Neil Fenske, Chair of USF Department of Dermatology & Cutaneous Surgery.
To link to Dr. Fenske's Tampa Tribune columns on skin cancer prevention, click below.
- Skin cancer
- Sun screen abuse
- Scalp cancer
- Tanning beds

Click here to view National Institutes of Health on Melanoma

Dr. Lewis Rubin, Muma Endowed Chair in Neonatology

Lewis P. Rubin, MD, neonatologist is settling in to his new life in Florida. A recent transplant from Ohio, Dr. Rubin is approaching the one month mark at the University of South Florida as the Pamela S. and Leslie M. Muma Endowed Chair in Neonatology, Professor and Chief of Neonatology in the Department of Pediatrics, and Medical Director of the Neonatal Intensive Care Unit at Tampa General Hospital. He was recruited this past winter from the Cleveland Clinic's Fetal Care Center in Cleveland, Ohio, where he served as a co-director. He sat down for an interview on April 24th, after talking to USF faculty and medical residents during the Dept. of Pediatrics' Grand Rounds.

April 24, 2008 Interview

Audio Clip 1: USF Health and Tampa General Hospital expansion of neonatal care in Tampa Bay area.

Audio Clip 2: Why USF? Why now?

Audio Clip3: The importance of multidisciplinary collaboration in neonatology

In addition to conducting research meant to advance the care and well-being of premature babies, Dr. Rubin will work with Ruben Quintero, MD, director of the USF Health Division of Maternal and Fetal Medicine, and regional hospitals to expand the diagnostic and treatment capacity of the USF Fetal Therapy Center.

“Dr. Rubin and his collaboration with existing USF Health specialists will be a tremendous resource for the region, and I believe will quickly be one of the world’s centers for neonatal treatment that helps prevent lifelong complications in these children,” said Stephen K. Klasko, MD, MBA, senior vice president for USF Health and dean of the USF College of Medicine.

“Dr. Rubin is an internationally respected researcher in newborn medicine as well as an experienced clinician and educator,” said Robert M. Nelson, MD, professor and chair of the Department of Pediatrics at USF Health. “The strengths he brings to USF and the Tampa Bay region will help us attract other top investigators and clinicians and advance our neonatal, pediatric and obstetric services to the next level.”

The $4-million research endowed chair that Dr. Rubin will hold is a vital piece of one the largest gifts given in Florida to support research and care for newborns. The Mumas’ gift -- with a total impact of $14-million after eligible state matches -- supports an initiative by Tampa General Hospital and USF to build research and medical teams, laboratories at USF Health and expand the NICU at TGH.

“A goal of the Division of Neonatology is to provide innovative, technologically sophisticated, evidence-based, and family-centered care,” Dr. Rubin said. “We want to make the NICU as welcoming a place as possible for families and maximize the comfort and health of these smallest and most vulnerable babies.”

Prior to his arrival at USF, Dr. Rubin also served as chair of the Department of Neonatology and staff scientist in the Department of Cell Biology at the Cleveland Clinic and a professor of pediatrics and molecular medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University in Cleveland, OH, and directed neonatology for the Cleveland Clinic Fetal Care Center, which teams with physicians who direct obstetrics and surgery and a fetal care nurse coordinator.

Dr. Rubin specializes in intensive care of premature babies and infants who have complex congenital, metabolic, cardiorespiratory or neurodevelopmental disorders.

His laboratory studies the interplay between genetics and environment, focusing on the effects of intrauterine stress, nutrition and other factors on fetal and newborn growth and development. He is directing a multisite clinical study, including TGH, evaluating whether antioxidant-enriched formula can improve lung function and decrease the risk of neurodevelopmental abnormalities in low-birth-weight and other at-risk babies.

At the Cleveland Clinic, Dr. Rubin helped create a comprehensive fetal evaluation program that gives patients access to a broad range of maternal, pediatric and surgical subspecialists. He wants to help establish a similar program at the USF Fetal Therapy Center.

“Many of the core specialists already are present at TGH and USF Health,” he said. “We will develop a multidisciplinary program where a woman with any suspicion or diagnosis of a fetal problem can, in one day, have diagnostic tests like high resolution ultrasound, fetal echocardiography or fetal MRI and meet with a team of experienced experts. The family will come away with fuller understanding and a plan for continuing prenatal care, delivery, and options for fetal or neonatal treatment. USF Health and Tampa Bay should increasingly become known as an international destination for evaluation and care of the fetus and newborn.”

Dr. Rubin’s team plans to work with faculty in the USF Health Center for Aging and Brain Repair, who conduct cutting-edge research on potential treatments using stem cells derived from human umbilical cord blood and adult bone marrow cells. Such therapies may have applications for replacing or repairing cell populations in the damaged lungs, hearts or brains of premature infants as well as in aging adults, Dr. Rubin said.

“The best perinatal and neonatal research does not occur in isolation. It thrives by close collaboration with clinicians and scientists at the forefront in diseases that, at first glance, may not seem relevant to newborns,” Dr. Rubin said.

“For instance, a major complication for preemies is bleeding into the brain’s white matter. Neurological diseases in adults, including Alzheimer’s, multiple sclerosis and stroke involve similar processes of nerve inflammation and regeneration," he said. “Our partnering with colleagues in the USF Signature Interdisciplinary Programs should advance prevention and treatments for persons across the lifespan.”

Dr. Rubin also hopes to work with faculty in the USF Colleges of Nursing and Public Health, which have strong community-based research initiatives in maternal and child health.

Dr. Rubin received his MD degree from Yale School of Medicine and completed a residency in pediatrics at Children’s Hospital in Boston, MA and a joint fellowship program in neonatology at Children’s Hospital, Brigham & Women’s Hospital and Beth Israel Hospital. He also took postdoctoral fellowships in molecular endocrinology and pediatric endocrinology. Before joining the Cleveland Clinic and Lerner College of Medicine, he was a faculty member at Harvard Medical School and an associate professor of pediatrics and co-director of the Fetal Medicine Program at Brown University Medical School in Providence, RI. He is listed in Best Doctors in America, 2007-2008.

Dr. Rubin is a member of the American Pediatric Society and is on the editorial board of several scientific journals. He is the author of more than 50 peer-reviewed journal articles and a dozen book chapters and reviews. He has a strong track record of National Institutes of Health funding and is currently the principal investigator for a $1.1-million NIH grant studying how carotenoids (antioxidant micronutrients) regulate fetal vitamin A production and gene expression.

Coverage by Anne DeLotto Baier & Lissette Campos, USF Health Communications

USF psychiatrist Dr. Pauline Powers says finding the right balance of exercise can be difficult in a society that has shifted the focus of exercise from health to appearance.

University of South Florida psychiatry professor Pauline Powers, MD, is all for exercise being part of a healthy lifestyle. In fact, she manages to fit time with a personal trainer twice a week and YMCA aerobics into her hectic schedule.

But, she also wryly notes that working out won’t prevent death. In fact –like too much of any good thing – too much exercise can make you sick, Dr. Powers said.

“There’s a real emphasis on the obesity epidemic in today’s society. The message that tends to come across is that everyone is overweight and under-exercising," she said. "While not enough people are exercising and too many people are overweight, it is not true that the majority is overweight and not exercising. We just don’t really hear much about the dangers of extreme exercise.”

Dr. Powers co-authored the recently published book The Exercise Balance with psychologist colleague Ron Thompson, PhD. Both specialize in the treatment of eating disorders, including anorexia nervosa, bulimia and severe obesity.

The book discusses both ends of the exercise spectrum -- from addictive exercisers who push their bodies to extremes to meet unrealistic standards for thinness or “fitness” to sedentary people who need to be more active. Using a combination of clinical studies and real-life examples, the authors offer practical guidelines for creating individualized, balanced exercise plans, including those tailored for different age groups and people with chronic illnesses.

Dr. Powers, past president of the National Eating Disorders Association, became interested in exercise addiction because many patients she treats have developed a dysfunctional relationship between exercise and eating. “At least half of the people with anorexia nervosa or bulimia nervosa started with too much exercise,” she said, “and the more compulsive the exercise the greater the psychopathology of their eating disorders.”

Ironically, Dr. Powers said, while the debate about obesity grabs the headlines, increasing numbers of people are also engaging in excessive exercise – spending hours a day at the gym or training for ultramarathons that tax their endurance in extreme temperatures and terrain.

The health hazards of a sedentary lifestyle, including hypertension, diabetes and heart disease, have been widely publicized, but excessive exercise has its own set of medical consequences, she added. These include stress fractures, musculoskeletal injuries, cardiovascular complications, and, among women who train excessively, a condition known as female athlete triad, which is characterized by dieting, menstrual irregularity, and bone loss.

Some people erroneously believe “if some exercise is good, then more must be better,’ much like ‘if thin is good, thinner is better,’” Dr Powers said. But, among even competitive athletes who train more intensively than the average American, too much exercise may lead to “overtraining syndrome” or “staleness” – a condition marked by fatigue, weight loss, depression, and even a decrease in sports performance.

“More exercise does not necessarily improve athletic performance, nor does reducing weight or body fat,” she said. “It might if an athlete is not training enough, or if they’ve become overweight. But, usually that’s not the case, and it’s factors like genetics and personality traits that make the competitive difference.”

Most people (who are not competitive athletes) need to set reasonable and realistic goals for health and fitness, taking into account physical factors, such as their body type and muscle mass, and life circumstances like age and health status, Dr. Powers said. “My neighbor, who is a triathlete, wants me to run a marathon with her. Well, I’ll never be able to run a marathon. I can run 2 miles, but not a marathon.”

So, how do you know if you’re just embracing physical fitness or overdoing exercise? A big indication is if the intensity of exercise starts interfering with your work, school or relationships, Dr. Powers said. For instance, family and friends complain that they never see you anymore, or your boss notices you’re not finishing projects on time.

“If exercise becomes so all-consuming that you can’t interrupt your workout to go on vacation – you have to exercise when the plane is taking off – then that’s a problem!”

Here are a few more signs of excessive exercise:

-- Compulsively following the same exercise routine for years without missing a day

-- Feeling obliged to exercise no matter what the circumstances, or feeling guilty or anxious about any lapse or reduction in activity.

-- Relying on physical activity as the only means of coping with stress.

-- Continuing to exercise despite illness or injury, even when advised by your doctor to take a break while you heal.

-- Automatically equating exercise with eating and weight control. For instance, developing a preoccupation with having to exercise to compensate for eating.

The book includes a more extensive questionnaire for assessing exercise abuse among the general public. It also includes a chapter discussing the special circumstances of competitive athletes, a group at higher risk for excessive exercise and eating disorders.

Dr. Powers emphasizes the importance of the circumstances and context surrounding your exercise routine in determining whether it's balanced. “When my neighbor is training for triathlons she steps up her exercise regimen,” she said. “But once the competition is over, she goes back to a more moderate routine. And if she hurts something while she’s training, she does not continue running, biking or swimming.”

Dr. Powers in one of few photos with a scale. As a physician who treats many patients with eating disorders, she discourages the connection of eating with exercise and weight control.

Achieving exercise balance has become more challenging as society has shifted the focus of exercise from health to appearance – for instance, glamorizing people in entertainment or sports who maintain a low weight, Dr. Powers said. “It’s especially a real problem to figure out how to help people who adore exercise and also have an eating disorder.”

Dr. Powers recalled the first patient she met with anorexia. Even though the emaciated young girl was strapped to the bed in a pediatric intensive care unit, she was lifting her body up and down and moving her arms as much as possible within the arm restraints. She was in danger of losing her life, and she was exercising.

“You really can’t stop people from exercising unless you sedate them. It’s better to work with people to help them recognize the difference between moderation and too much exercise,” she said. “I discourage patients with eating disorders from exercising right after they eat a meal – to try to get them away from that mindset that says ‘OK, I can only eat if I exercise for half an hour.’”

“I want them to think of eating normally as one thing you do for your health, and exercising moderately is another – rather than making a compulsive connection between the two.”

Click here to visit the CDC’s “Growing Stronger” website recommended in Dr. Power’s new book.

- Story by Anne DeLotto Baier/USF Health Communications
- Photos by Eric Younghans/USF Health Media Center

IDPodcast.net Celebrates its 50th Podcast!

It’s only fitting that a milestone podcast from USF infectious disease experts, one that will reach audiences around the globe, will touch on the current and urgent global topic of climate change.

On April 30, the USF Division of Infectious Diseases, which is in the College of Medicine’s Department of Internal Medicine, will post its 50th online podcast titled “A Global Swarming: Infectious Diseases and Climate Change.” This podcast will feature the division’s webcast co-founder Richard L. Oehler, MD, assistant professor at the College of Medicine.

USF infectious disease faculty, staff, and fellows regularly contribute presentations to the podcasts on such varied and pertinent topics as community-acquired methicillin-resistant staph aureus (MRSA), HIV/AIDS, sexually transmitted diseases, tuberculosis, West Nile virus, and emerging infectious diseases.

The effort is one of the first, if not the first, university-affiliated medical podcast site of its kind on the internet, Dr. Oehler said, offering remote access to healthcare professionals seeking clinical expertise on a broad range of infectious disease topics. Anyone worldwide with an internet connection can download the presentations without charge.

Building upon a broad vision

The website (IDPodcasts.net) was originally conceived by Dr. Oehler, Julian Corvin, the division’s project administrator, and Dr. John T Sinnott, MD, director of the division and associate dean of International Affairs for the College of Medicine. The idea came about because, “we realized that our infectious disease faculty did not have a way of sharing their vast experience and teaching skills outside of the small groups of students and medical residents who attend our lectures,” Dr. Oehler said.

“With the podcast site, we truly have not only a university audience, but also a worldwide audience.”

IDPodcasts.net's audience is growing each month, with thousands of hits since the beginning of 2008, he said.

“I felt especially rewarded to hear a recent applicant to our infectious disease fellowship training program from Alabama tell me that ‘I watched your podcasts online and decided to apply to your program because I realized what good teachers you were,’” Dr. Oehler said. "We are proud to make this important contribution to the USF Health’s Strategic Initiative to enhance the use of instructional technology. We also recognize that the changing technology of education and the changing realities of health care require flexibility and willingness to share knowledge within our university and throughout our community."

In the milestone 50th podcast, Dr. Oehler examines how climate change is likely to affect the global burden of infectious disease pathogens, from malaria to foodborne illness. This presentation is a culmination of a 6-month exploration of the literature surrounding climate change and its effect on disease vectors.

“I started with a simple premise,” Dr. Oehler said. “We know that we are likely to be affected by climate change--in fact all life on earth will be influenced by global warming. It seems clear to me that the relationships between man and the microbes would be heavily influenced by this change.”

In his presentation, Dr. Oehler takes the listener on a journey from the South American Andes to northern Italy to the western highlands of Kenya to tell the story of how climate change is in the process of influencing the burden of infectious diseases worldwide.

Planning for the future

IDPodcasts.net is entirely university supported and funded, with no advertising or commercial content. The site also features a section with lecture handouts and other information resources, podcasts for patients, as well as links to other important infectious disease educational resources.

Building the site over the last year was quite a challenge for a first time website designer, Dr. Oehler said.

“But the biggest credit for its success goes to our contributors,” he said. “We are great educators in the Division of Infectious Diseases. If we did not have the resource of our great infectious disease faculty to draw from, IDPodcasts.net would not exist. My great thanks to all of our contributors who have made the website such a success this year.”

Future plans for the site include further expansion of the library of infectious disease titles available online and pursuing CME capability within the website to permit clinicians to meet their educational requirements through the podcasts. Nevertheless, with remote learning becoming an increasingly popular way of keeping up to date with the latest medical developments, IDPodcasts.net will most certainly continue to be an important online resource for clinicians everywhere. All content can be accessed through www.idpodcasts.net. Dr. Oehler can be reached for further comment at richard.oehler@va.gov.

Check out the Division's web site.

Story by Richard Oehler, MD, and Julian Corvin, of the USF Health Division of Infectious Disease and International Medicine, and Sarah Worth, USF Health Communications.

Blog open for commentary @ bottom.

April 22, 2008
An Open Letter to the USF Community
From Ralph Wilcox, PhD, USF Provost and Senior Vice President

Letter as it appeared in the Oracle, USF student run newspaper

As the Spring semester draws to a close, I wanted to take this opportunity to thank you for
your many valued contributions toward enhancing USF and to making our community a better
place to study, live and work.

These are difficult economic times for the State of Florida, and there is little doubt that USF
along with other state universities will be changed organizations by the time the new fiscal
year starts on July 1, 2008. As we’ve received budget cuts throughout the current year, we have
engaged all stakeholder groups in developing responsible budget reduction recommendations
that are intended to preserve our core commitment to serving the needs of currently enrolled
students and to providing the support that our professors so richly deserve.

To this point in time, we know that the state’s investment in USF has been reduced by 5.4
percent or $19 million in the current year, and we are waiting to hear what next year’s budget
will bring. With the state’s economic health in continuing decline, we anticipate further cuts
(perhaps as much as another 5-10 percent) to our budget beginning July 1, 2008, with the
possibility of even more reductions by the beginning of 2009 if we don’t see an upturn in our
economy. Accordingly, President Genshaft has asked us to prepare a 15 percent budget
reduction plan for a $52 million cut across the USF System.

With reduction planning still underway, no final decisions will be made until USF has
received its 2008-09 budget from the state Legislature.

On the Tampa campus we must prepare to serve nearly 40,000 students with $34 million less
next year. We have sought input from faculty and the Faculty Senate (through the Budget
Priorities Advisory Task Force), department chairs, deans, students and staff. We’ve been guided
by the principles of equity and transparency. We are carefully evaluating programs based upon
quality, alignment with our strategic priorities, demand, and viability for the future. This is not
an easy process but one that is essential to our future growth and prosperity.

At the same time, we continue to explore administrative cost-saving measures—in advancement,
business, communications, information technology, research, and student affairs,
along with the offices of the President and Provost—initiatives that may allow us to mitigate
the impact of budget cuts on our core academic and research activities. We are also seeking
new sources of revenue.

It is important to point out that we are committed to the following:

• Continuing delivery of all undergraduate and graduate degree programs—no
degree programs are being targeted for elimination, and
• Retaining all tenured and tenure-eligible faculty.

We have already received some recommendations from deans and have frozen a large number
of vacant faculty and staff positions. Presently, we are carefully reviewing all small departments,
schools, centers and institutes, to explore how we might realize operational and administrative
efficiencies and cost-savings, while preserving their identity. We are also exploring new academic
alignments that promise continued and improved services for students, faculty and staff,
streamlined and non-duplicative curriculum delivery, shared resources, and greater synergy, in
anticipation of lean times ahead.

As I wrote earlier this semester, it would be naïve for any of us to think that we will be able to balance
our budget without transformative shifts in the way we look, deliver our core academic and
research programs, and conduct our business activities at USF. Change is inevitable and necessary.

Over the past months, I have sought to keep our faculty and others informed of developments
through letters (http://www.acad.usf.edu/), small group meetings and, just last week, a series of
open “Campus Conversations” that were attended by faculty, students and staff. If you have
questions or are unclear about the messages that you may be hearing, I would encourage you
to contact me at http://www.acad.usf.edu/Office/Provost/send-note-provost.htm. Meanwhile, I
am confident that together we will successfully navigate these difficult waters and emerge as a
stronger university community.

Sincerely,

RALPH WILCOX, PHD
PROVOST AND SENIOR VICE PRESIDENT

Tampa, FL (April 18, 2008) -- Graduates of the USF College of Nursing achieved a 100-percent pass rate on the required exam to practice as a nurse. The college’s graduates have attained this benchmark several times, previously in Feb. 2007.

All Florida nursing graduates averaged 77.4 percent on the Registered Nurse Licensure Examination (NCLEX) reported most recently by the Florida Board of Nursing. The report covers all graduates of baccalaureate and associate nursing degree programs who took the exam the first quarter of 2008.

Only 23 percent (12) the 52 nursing schools in the state scored a 100-percent pass rate.

“This is a special recognition, and tribute to our hardworking faculty,” said Patricia Burns, PhD, FAAN, dean of the College of Nursing. “I congratulate our graduates on a job well done.”

“It’s quite an achievement, especially when you consider that every single one of our 33 students who graduated in December 2007 sat for the licensure exam and passed it the first time,” said Sandra Cadena, PhD, ARNP, assistant dean of undergraduate programs for the College of Nursing.

“It’s a testament to the clinical collaborative model and how well our faculty work with our Tampa Bay area hospital partners to prepare the best nursing graduates possible.”

Of the 11 other nursing schools with a 100-percent pass rate, none had more than 10 student nurses successfully completing the state board exam in the first quarter of 2008.

Dr. Cadena said a majority of the 33 December 2007 USF graduates who passed the exam were in the college’s accelerated second degree program, and 10 to 15 percent of these graduates have applied to advanced nursing degree programs.

Student nurses who have completed their coursework are eligible to take the national licensing exam.

Before nurses begin practicing, they must graduate from a recognized nursing program, like USF’s, meet specific requirements of the state board of nursing, and pass the National Council for State Boards of Nursing NCLEX exam for registered nurses. USF student nurses who sat for the exam in 2003 were the first to have completed their baccalaureate study in the College’s community-based clinical collaborative curriculum. The USF College of Nursing teamed up with nurse leaders from community hospitals to devise the Clinical Collaborative curriculum -- a plan to keep new nurses in nursing and in Florida by bridging the gap between academic preparation and professional application of the skills and knowledge a nurse uses every day.

- USF Health -

USF Health is dedicated to creating a model of health care based on understanding the full spectrum of health. It includes the University of South Florida’s colleges of medicine, nursing, and public health; the schools of biomedical sciences as well as physical therapy & rehabilitation sciences; and the USF Physicians Group. With $308 million in research funding last year, USF is one of the nation’s top 63 public research universities and one of Florida’s top three research universities.

- News release by Anne DeLotto Baier/USF Health Communications

Blog open for commentary @ bottom.

Every day, at public universities across Florida, folks are poring over budgets trying to weather the storm of an estimated $3 billion state shortfall. All told, budget cuts are in the hundreds-of-millions of dollars at public universities from Florida’s panhandle to the everglades.

The University of South Florida has reduced its state funded budget for Fiscal Year 2008 by approximately $19 million – a 5.4 percent reduction in base funding.

Last summer’s approved state budget now feels light-years away.

With no end in sight to Florida’s dropping revenues, public universities are bracing for even deeper cuts to their Fiscal Year 2009 budget. That new fiscal year begins July 1, 2008. “There’s no easy answer. If there was, we’d have it,” says Stephen K. Klasko, MD, MBA, Senior Vice President of USF Health and Dean of the USF College of Medicine.

Sitting down to an interview days before meeting with USF's Board of Trustees, Klasko knows he’s in USF Health’s hottest hot seat – in the unenviable position of calling the shots in a crisis that some experts characterize as “the worst economy in Florida history”.

“On a personal level, I think the thing that drives me is my passion for USF Health. I am humbled by the true heroes that are out there among our faculty, our staff and our students, recognizing that many of our students could’ve gone to a different school. Certainly, many of our faculty could be in private practice making more money or at a different medical school with more resources. Our staff could be in the private sector. Most of them are here because they believe in USF. They believe in our mission and that’s a humbling thing,” says Klasko. “That’s where, personally, it gets difficult for me because I don’t want to let anybody down. I personally think that the only way I could let them down is for me not to be passionate, not putting in my time, and taking the easy way out."

Navigating through a mine field of choices, Klasko says even options that appear easier at first, can have devastating effects long-term. So, how does he choose? Slowly and deliberately.

How does one choose?
Klasko’s decisions, he says, are anchored in the vision of USF Health. “If you believe the vision and the goal can vary, then it’s just a matter of 'What’s going to be the least amount of pain?' or 'What’s the easiest?'. That’s one model. We’ve basically said the USF Health vision and the goal are not up for discussion. We’re going to move forward when it comes to being one of the first academic ambulatory health centers in the country based on service, quality and technology. We’re going to move forward and create a translational research enterprise. We’re going to move forward in some of our educational innovations like simulation and that kind of thing. So the variable, for us, is how we finance those things.”

Klasko’s strategy for the future is to create a ‘real’ USF Health enterprise - integrating services across the colleges of medicine, nursing and public health; pursuing a more progressive ‘academic medical center’ model; and a major overhaul of finance and operations in support of the medical school’s clinical operations. “Cutting budgets while preserving the mission,” says Klasko.

More USF Health-ness...
“We need to take advantage of both the strength and the hard work that faculty and staff have done over the last few years in building a real enterprise of USF Health, take some of the budget opportunities & challenges and really look to create a new vision,” says Klasko. “2008 - 2009 will be the year we begin implementing a strategy that realizes the efficiencies and community benefits of a unified USF Health.”

“I get a feeling, certainly among the other deans, (College of Public Health’s Dean Donna Petersen and College of Nursing’s Dean Patricia Burns) that this is a good tool for us to use to implement USF Health. So the vision that we see is a single budget. I think that will be worthwhile (A) if we save money in efficiencies, (B), and just as important, if it gets us to our strategic outcomes quicker,” says Klasko. “I think that some of the people who weren’t as strategically oriented may be enticed by the efficiencies, but we don’t want it to be just about the efficiencies.”

Integrating Services…
“We’re going to look across all administrative areas…and look at how we can make them very much USF Health oriented,” says Klasko. We have groups talking with Facilities, Human Resources, Faculty Affairs, Government Relations, Finance & Budget, Legal and Research Administration. In areas like Development and Information Technology, now known as ‘Information Systems’, integration has already begun and will continue to permeate daily operations and policies.

“What I hope that people would see beyond that we’ve saved money is that faculty affairs, for example, runs better. That finance runs better. That the reporting runs better. That any critics left would say ‘Boy, that’s what re-engineering should do! They save money and operate better. There are many areas where the perception from faculty and staff is that we’re not doing things as easily and as customer friendly as we can,” says Klasko.

It’s also about creating more USF Health-ness. “This enterprise of USF Health will begin to allow for increased synergies between faculty, students and others as we strive to increase interdisciplinary research and education between USF Health and other aspects of the university. It will also allow nursing, public health, medicine and pharmacy to work together seamlessly in such areas as prevention, wellness and care for the underserved,” says Klasko.

Q: How can shared administrative departments increase collaboration across colleges? What does one thing have to do with the other?
“I think it does!” responds Klasko in rapid fire. “We’re already doing that in things like Development, where we’ve realized that development professionals work on behalf of USF Health. If someone wants to give money to public health, they can advocate for that. We’ve done that in Communications very well. If we hadn’t combined communications, would we ever have been able to have a single vision around USF Health? More likely, we would’ve had medicine doing one thing, nursing doing another, and public health another.”

His thoughts on possible job losses to come...
Asked about possible job losses to come, his tone visibly changes. “The number one thing that we care about, from where I sit, is the folks who work for USF Health. They are our lifeblood, what drives us. We’ve already taken about 3- 4 million dollars worth of cuts decreasing as few human resources as possible and we’ll continue to look at that as the last resort. Each person that, for whatever reason has to leave – because they feel they have to leave USF Health to make more money or a program is being closed like what occurred in anesthesiology or when our faculty at Moffitt moved out we used less billers – each of those people represent a real asset to USF Health (A) that we’re losing, (B) that we feel for and (C) that needs to be handled with and dealt with respect,” says Klasko. “Every time we look at removing a person as a budget cutting exercise, we think twice, three times, four times. We look if there’s another alternative.”

Creating a True Academic Medical Center…
Another key piece of Klasko’s strategy involves increasing USF Health revenues by negotiating changes to the university’s hospital partnerships. “The dilemma we find ourselves in – a research intensive medical school in community based skin – as well as an under-functioning, under-resourced and follow-the-hospital-money practice group. That did not occur in a year and will take more than a year to fix,” says Klasko.

“2008 – 2009 will be the year we begin to assert USF Health’s role as a hub, along with our hospital partners and others, in changing the dynamics for Tampa as a health care destination site. Components of this will include establishing a healthy and hopefully more vibrant relationship with Tampa General Hospital and All Children’s Hospital, as well as one that is sustainable as the reputation of USF Health continues to grow,” says Klasko. Tampa General Hospital is the medical school’s main teaching hospital.

“The fact is that as the reputation of USF Health grows, we need a reality based relationship with our hospital partners. You’ll see this year that we are going to look at a budget that doesn’t limit our clinical practice activities to just the areas where we’re allowed to participate by our hospital partners,” notes Klasko. “Just as we have begun to do with orthopedics, we will expand, as needed, with new partners in areas such as radiology, anesthesiology, pathology, orthopedics and cardiology.”

Hospital relationships...
“Our hospital relationships were primarily set up when we started in the 1970’s as a nice community based medical group without many aspirations on our own. Our hospitals were neither strategically aligned with each other, nor strategically aligned with us, in many cases. People have heard me talk about this a lot, but we are the only large academic practice group in the country that cannot practice radiology, pathology and anesthesiology!” says Klasko, and then, compares USF Health to “Bedouins”, nomadic desert tribes of Arabia, to make his point. “It has to feel like we’re Bedouins in the desert when it comes to orthopedics because we go from hospital to hospital! Those are not trivial things. They’re not trivial financially. They’re not trivial morale-wise and they’re not trivial strategically.”

“The amount of dollars that we lose because we don’t have the ability to do any of these hospital based practices, both on the dean’s tax and academic support, as well as the practice group, is staggering. It’s in the millions of dollars,” says Klasko.

Q: How much?
“The real simple math,” says Klasko, “if you take a place like the University of Florida or the University of Alabama at Birmingham, a surgeon doing a case there is generating income for that case. Then he or she is sending the case to a university radiologist, to a university anesthesiologist and to a university pathologist...but we have to send it to different private anesthesiologists, radiologists, pathologists - somewhere to the tune of $20 million."

Klasko, as well as other leaders, point to academic medical centers across the nation which own a hospital and refer within their medical group. The results, they say, bear fruit in all their education, research and clinical missions and produce greater clinical revenues. "It’s a huge deal when people look at us from the outside and our ability to do something great," says Klasko. "They’ll say to me ‘You’ll never be great until those kinds of issues are resolved'.”

Story by Lissette Campos, USF Health Communications

Other links:
USF Provost
Office of USF President Judy Genshaft
Florida Economy at a Glance

BUDGET TALK Directory.

USF Health Human Resources Consolidating with USF Human Resources Division. Posted 7/09/08

Klasko on Budget Reductions to All USF Health. Posted 5/23/08

USF Health E&G 15% Budget Reductions. Posted 5/22/08

USF Approves Budget Cuts. Posted 5/21/08

Budget Talk: Part 3. Posted 5/19/08

Budget Talk: Part 2. Posted 5/6/08

Open Letter to USF Community. Posted 4/22/08

Budget Talk: Part 1. Posted 4/21/08

Florida Today - The Economy at a Glance. Posted 4/18/08

Series Background
The week of April 21st marked the launch of a new series Budget Talk . These special reports focus on Florida's current budget crisis, its impact on USF Health, in-depth interviews with leaders on strategies being pursued, and more. Since April 28th, the series includes a blog for reader commentary. This new feature to the USF Health homepage was made possible in partnership with USF Health Information Systems. We invite you to post your comments.

Blogging...
Your email address will not be displayed in the posting to prevent spamming to your email account. In order to prevent automated spamming to the USF Health blog site, all blog entries first go into a moderation mailbox where members of our Communications Office filter out spam emails and manually approve all other commentaries. Comments are not sensored, however, we reserve the right not to upload personal attacks and inappropriate language.

Blog submissions may result in future Budget Talk stories, not individual email responses. If you'd like to contact Dr. Stephen K. Klasko with a question directly, you are welcome to do so.

Other links:
USF Provost
Office of USF President Judy Genshaft

By Lissette Campos, USF Health Communications

Blog open for commentary @ bottom.

To date, the state of Florida has faced $542 million in cuts to its Fiscal Year (FY) 2008 Budget (2007 – 2008). The state’s total budget is just over $70 billion. Since last October, decreased state revenues have resulted in two separate rollbacks.

Reductions in State Budget- Fiscal Year 2008 (2007-2008)
Education Cuts = approx. $350 million
Court System Cuts = approx. $48 million
Healthcare Cuts = approx. $37 million

Looking ahead to Florida's budget for Fiscal Year (FY) 2009, which begins July 1, 2008, state legislators are preparing for a $3 billion shortfall. Economists blame slumping home sales, mortgage industry woes and a decrease in the number of people moving to Florida - a combination that has resulted in plummeting state tax collections.

Adding to Florida's internal factors is the slow down in the U.S. economy. The U.S. Labor Department reported the worst job loss in five years during March ’08. Eighty-thousand jobs were cut nationwide in March alone - the biggest one-month drop in five years, according to U.S. Labor Department data.

Last month, Governor Charlie Crist proposed dipping into the state’s reserves to soften the blow of budget cuts in the courts, public schools and healthcare. The state’s reserve accounts are $5 billion. Those reserves include: a $1.4 billion ‘budget stabilization fund’; $2.5 billion from Florida’s share of the national lawsuit settlement against tobacco companies; and another $1 billion comes from various trust funds and a capital projects account.

Legislators will have until the end of this session, May 2, to vote on the Fiscal Year 2009 state budget.

Crunching the numbers. Where official state forecast comes from...
The official state forecast, which includes the projected $3 billion shortfall, comes from the state's General Revenue Estimating Conference. Since the 1970's, the state has placed the responsibility of revenue forecasting with a conference specifically designed for this purpose. Over the years the process was further formalized by Florida's Division of Economic and Demographic Research and was put into law in 1982. The conference is comprised by 4 individuals - one from the Governor's Office, Senate, House of Representatives, and the Division of Economic & Demographic Research. The General Revenue Estimating Conference must reach a consensus in order to reach an 'official' revenue forecast. Although a rarity, we should note that if consensus is not reached, no 'official' state forecast is announced. Once the General Revenue Estimating Conference's forecast is adopted, it is used in all planning and budgeting actions of the state. The conference normally meets twice a year --in late autumn to establish a forecast for the budget recommendations made by the Governor to the Legislature, and in the spring to determine the amount available for appropriation during the session. However, any one of the 4 conference members can call a conference at any time, if needed.

Florida is not alone...
At least 22 states are facing significant budget shortfalls for the coming fiscal year. (FY 2009) According to the Center on Budget & Policy Priorities, the combined deficits of these 22 states plus the District of Columbia are expected to total at least $39 billion for the new fiscal year which begins July 1, 2008 in most states. These states are: Alabama, Arizona, California, Florida, Illinois, Iowa, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Nevada, New Hampshire, New Jersey, New York, Ohio, Oklahoma, Rhode Island, South Carolina, Vermont, Virginia and Wisconsin. The largest budget shortfalls are expected in California, where the anticipated drop in state revenues is approximately $16 billion, followed by New York, New Jersey, Florida and Illinois. In contrast, the Centers found that mineral-rich states, like New Mexico, Alaska and Montana, are seeing a growth in state revenues as a result of high oil prices.

Projected Budget Shortfalls for Fiscal Year 2009

California $16 billion
New York $4.9 billion
New Jersey $2.5 - $3.5 billion
Florida $3.4 billion
Illinois $1.8 billion

*Data Source: Center on Budget & Policy Priorities

Sources for this article: State government's official website, "myflorida.com"; the state's General Revenue Estimating Conference; and the nonprofit fiscal organization "Center on Budget & Policy Priorities" based in Washington D.C.

Newsbrief by Lissette Campos, USF Health Communications

Información y video en Español
"La depresión es la complicación psiquiatrica más frecuente en hombres Latino. Estos trastornos del estado de ánimo pueden ser primarios, secundarios a complicaciones de enfermedades médicas y sus tratamientos. El riesgo suicida es elevado a lo largo del curso de una depresión en hombres. Es importante reconocer que se dispone de múltiples estrategias terapéuticas efectivas para el manejo de la depresión y deben recibir el mismo abordaje agresivo que cualquier otra enfermedad sistémica,” Dr. Francisco Fernández, Profesor y Catedra de Psiquiatría, Jefe del Instituto de Investigaciones Psiquiatrica- USF Institute for Research in Psychiatry.

El Dr. Fernández fue seleccionado para el documentario nacional “Men Get Depression” - Los Hombres Padecen de la Depresión. El documentario fue producido para la cadena nacional American Public Broadcasting y sera televisado en ciudades a traves de la nacion durante el mes de Mayo como parte de una campaña nacional para educar al publico sobre la depresión.

Video en Español

Para más información sobre La Depresióny los Hombres

En el area de Tampa, el documental "Men Get Depression" sera televisado los siguientes dias.
WUSF - tv: martes, May 6, at 1pm and miercoles, May 7 at 4:30am.
WEDU - tv: jueves, May 29, at 11pm.

Mas...
Para ordenar copias del documental en Español o Ingles

May 2008 Seminarios sobre la depresión y los hombres
(Seminarios estan auspiciados por el Departamento de Psiquiatría, University of South Florida, Tampa.)

Reportera Lissette Campos, USF Health Communications
Segmentos de video cortesia State of the Art, Inc.