These are a few of the things Dr. Peter (Jeff) Fabri already plans to start doing next year, when he semi-retires:

      Teach his grandson to ski; work on his boat, his bonsai and his gourmet cooking skills; get to know his soon-to-arrive second grandchild; fish more; listen to all the works of J.S. Bach.

     And, for good measure, learn to play the mandolin.

     To most people, this sounds like an ambitious list of goals.

     Not to Dr. Fabri.

     But then, Dr. Fabri is not most people. He's winding down a multi-faceted career spent as a surgeon, dean and advisor to scores of students. He's the kind of guy who gets a PhD in engineering on the side, is always impeccably dressed, and is an expert sailor to boot. Colleagues describe him as the ultimate Renaissance man.

     So maybe it's not surprising that Dr. Fabri insisted that these are not, in fact, goals.

     "No more goals," he joked. "I have lived all my life with goals."

     We shall think of them as relaxation activities.

    Dr. Fabri training for an around-the-world race.

       Dr. Fabri, 61, who has been associate dean of graduate medical education for 16 years, has decided to give up his administrative responsibilities at the end of the year. He plans to continue work on his research interests about three days a week.

     Dr. Stephen Klasko, CEO of USF Health and dean of the USF College of Medicine, praised Dr. Fabri's high standards and reputation for fairness.

     "Jeff's experience and judgment have been an invaluable help to me in moving our graduate programs forward," he said. "Jeff's principled leadership has been the glue that binds these programs together."

     Dr. Fabri is the first and only person to hold the job at the medical school.

     "He put accountability and oversight in place," said Dr. John Curran, associate vice president for academic and faculty affairs, as well as a charter faculty member at USF. "Before that, everyone did their own thing. He changed the culture."

     During that time, Dr. Fabri has overseen and expanded USF's residency programs, which sprawl across Tampa Bay at several different hospitals. He's helped re-institute the medical school's orthopedics residency, which already is getting 500 applicants for four slots. He's won praise from national experts by starting an unusual course in patient safety.

      In addition to his work as a surgeon and serving as the associate dean for veterans' affairs, Dr. Fabri has been a significant national voice for graduate medical education. He's served on many national boards, including the Governing Council of the Section on Medical Schools of the American Medical Association, two steering committees of the Association of American Medical Colleges, and as the Designated Institutional Official to the Accreditation Council for Graduate Medical Education and to the National Resident Match Program.

     "Jeff is one of the great guys around this place because he's always willing to pitch in to do something to benefit students," said Dr. Steven Specter, associate dean for student affairs.

        Dr. Fabri in the classroom, 1990.

     Dr. Fabri always takes time to help senior medical students who are graduating out of cycle or having trouble finding a residency to match to, Dr. Specter said.

     "Even though his role is with residents, he's always an advocate for students," he said.
When he first became a doctor, Dr. Fabri didn't plan to spend most of his career helping young doctors learn. But when the opportunity arose, he thought it would be a way for him to learn as well.

     "I don't think I've ever turned down an opportunity to learn something new," Dr. Fabri said.

     That chance, some 34 years ago, turned into a career devoted to graduate medical education.

     Dr. Fabri would like to see more teaching that brings together students from different disciplines. During his career, he's mentored medical students and residents. But he's also advised doctoral students in biochemistry, education, psychology, and engineering, as well as graduate students in nursing and physician assistants. He and a colleague recently started an innovative patient safety course open to students from many fields.

      "If you pay attention to what you're doing, all these students have something to contribute - and that is not the way medical education has been taught," Dr. Fabri said. "Medical education has been taught as the exclusive purview of physicians. But I've learned there's a lot we can learn from other people."

     Others have learned a lot from him. Dr. Bryan Bognar, associate professor of internal medicine, has known Dr. Fabri for years as a colleague. But Dr. Bognar also knows Dr. Fabri as a teacher, since he took Dr. Fabri's safety course last year, when he was completing his MPH degree.

     "He's one of the smartest people I know," Dr. Bognar said. "I want to be just like him when I grow up."

      What impresses Dr. Bognar the most is that Dr. Fabri keeps stretching. Dr. Bognar pointed to Dr. Fabri's pursuit of his PhD as an example.

     "He has a way of keeping himself out of his comfort zone," Dr. Bognar said. "It would be so easy for someone like Jeff to sit back and rest on his achievements. Getting his PhD speaks volumes about Jeff."

     Dr. Curran also remarked on the range of Dr. Fabri's talents, calling him "one of the brightest and widest minds at this institution."

     "I call him my favorite Boy Scout," Dr. Curran added. "He always wants to do the right thing."

     Every program has its own challenges, and at USF, that challenge for Dr. Fabri has been running residency programs at so many different hospitals, separated by several miles, each with their own way of doing things.

     "There's a micro-culture at each (hospital) institution," Dr. Fabri said. "So trying to maintain an (educational) institutional culture is very difficult. It requires constant work."

     But what Dr. Fabri is most proud of is achieving that unity of purpose and mission.

     "I believe that we have a real culture of graduate medical education as an institution, that has overcome the geographic boundaries and transcended the differences," he said. "A large part of that is because we have crafted a set of principles that have allowed us to make consistent decisions and have a consistent direction."

      A rare moment: at rest.

     Starting Jan. 1, Dr. Fabri will move in a different direction. He'll cut back to working three days a week, doing research on health systems engineering. He'll study ways to make health care safer, more effective and more efficient.

     "I hope to make a difference," he said.

     And the mandolin?

     Dr. Fabri's sister gave him one - "a very nice mandolin" - as a wedding gift almost 40 years ago. He's kept it for decades without learning to play it.

     "I've never had time," he said.

     We wonder why.

      -- Story by Lisa Greene, USF Health Communications

      -- Lead photo by Eric Younghans, USF Health Communications; sailing photos courtesy of Dr. Fabri; classroom photo, USF Health archives

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The Department of Pediatrics new simulation center emphasizes multidisciplinary team training for routine and crisis medical scenarios

Dr. John Curran works with a team of residents and neontal nurse to stabilize a "newborn" during a recent emergency simulation exercise at the TEAMS Center.

It was a delivery room complication. The full-term newborn had inhaled meconium, its own feces, on its way out the birth canal and was having trouble breathing.

In a nearby room, USF Health Associate Vice President Dr. John Curran, a veteran pediatrician and neonatologist, was touring the Department of Pediatrics new Team Education and Multidisciplinary Simulation (TEAMS) Center with guest and colleague Dr. David Tayloe, president of the American Academy of Pediatrics. The 2,300-square-foot facility houses more than $250,000 worth of high-fidelity patient simulators – adults, a child and newborns – each with a computer-driven age-appropriate physiology that can mimic routine and crisis medical scenarios. The life-like mannequins can convulse, turn blue around the mouth, reproduce breathing sounds, recreate variations in blood pressure and heart rate, even secrete blood and other imitation bodily fluids.

With Dr. Tayloe at his side, Dr. Curran was unexpectedly whisked away to the simulation center’s labor and delivery room, where a team of USF neonatologists and an NICU nurse were already working on the tiny patient in distress – a newborn mannequin hooked up to a beeping monitor. In a nearby bed, the mother, an adult-size mannequin, shouts out: “What’s going on with my baby? Is he alright? Why won’t anyone tell me anything?”

Dr. Curran suctions and opens the airway.

Dr. Curran begins ventilation as USF neonatology fellow Dr. Cathy Kotto-Kome performs chest compressions. Assisting at left is neontalogy fellow Yahdira Rodriguez-Prado.

Dr. Latha Kumaraswamy, a neonatology fellow, loads a syringe with epinephrine.

As the senior physician, Dr. Curran steps in to open the newborn’s airway by inserting a breathing tube. When the newborn’s heart rate continues to fall after the tube is inserted, ventilation and CPR compressions are begun. A succession of rapid-fire questions and commands cuts through the tension. Dr. Curran: “Where’s the oxygen?…Give me a good-size tube; you have all kinds of smaller ones.” Nurse: “Have we confirmed placement of the tube?” Neonatology fellow: “It’s good!” Dr. Curran: “Let’s get an umbilical cord line in.” Nurse: “Can we get a dose of epinephrine?” Neonatology fellow: “Epi in.” Nurse: “Heart rate coming up… Let’s call NICU and tell them we’re bringing a baby over and have a ventilator ready!”

Outside the room, TEAMS Center Director Laura Haubner, MD, and coordinator Jason Fields, punch up different angles of the scene on a computer monitor for better views of the team at work and control the infant’s vital signs as the drill unfolds. Once Dr. Haubner is satisfied with the team’s response, she brings up the baby’s heart rate with a few clicks of the computer mouse.

Above: USF pediatrician Dr. Laura Haubner, director of the TEAMS Center, and Jason Fields, center coordinator, monitor the team's responses from a control station outside the L&D room. Below: They punch up different views on a computer screen as the emergency scenario unfolds and record for evaluation after the simulation exercise.

Following the emergency scenario, Dr. Haubner ushers the team and residents who observed the simulation into the center’s conference room, where she facilitates a debriefing. The health professionals watch a replay of their performance on a giant screen, critique their strengths and weaknesses, and discuss what they’ve learned. Dr. Haubner prods with questions: “When the heart rate dropped to 35, what were you thinking?... Were the chest compressions and ventilation well coordinated?... Do you feel you called for help readily enough?”

The debriefings are often an “eye-opening” experience for physicians and nurses, said Dr. Haubner, an assistant professor of pediatrics. “The teaching points elicited by the videotape can be very powerful. They get a sense of how important it is to set roles for each team member in advance and clearly designate a team leader.”

Dr. Haubner leads the team in a post-simulation debriefing, where members can critique their performance replayed on a giant screen.

Seated next to Dr. Terri Ashmeade (left), USF assistant professor of pediatrics and TGH NICU medical director, and Jason Fields (right), TEAMS coordinator, Dr. Curran poses a question to the group based on a rare, real-life delivery complication he experienced.

The center is intended to do more than allow physicians, nurses and medical students to practice, hone or retool their clinical skills in an environment without risk to real patients. “We strategically teach them how to deal with conflict and emotional distractions in both routine and crisis situations,” Dr. Haubner said.

The simulation team training focuses on multidisciplinary group dynamics, leadership, interpersonal communications skills and decision making under pressure, and emphasizes using all available information, equipment and people to achieve safe and efficient outcomes. “This crew resources management approach has traditionally been used by high stakes industries like aviation and nuclear power for simulation training, but it’s slowly being adapted by medicine, Dr. Haubner said. “We’re pretty high stakes too.”

The potential benefit for patient safety and improved outcomes is huge, she said. “According to the Institute of Medicine, most medical errors are based on lack of teamwork and miscommunication, not caused by inadequate medical knowledge.”

Dr. Curran with Dr. Paul Tayloe, president of the American Academy of Pediatrics, who observed the emergency L&D simulation during his visit to the TEAMS Center July 23. Dr. Tayloe earlier that morning had delivered the annual John S. Curran Lectureship, speaking to USF pediatrics faculty and residents about health reform.

Dr. Tayloe, who observed the emergency scenario and debriefing, was impressed by what he saw. “This is great. I can see how this type of simulation training would help take a lot of the anxiety out of having to walk into a real-life emergency and respond effectively as part of a team,” he said. “But keep in mind, if you find yourself practicing in a rural area, usually you are the team and must be able to save a baby’s life on your own. I still advise residents to take plenty of call in the delivery room!”

Housed on the first floor of the 17 Davis Building, the TEAMS Center formally opened July 1 and is operated by the Department of Pediatrics with support from the Office of Graduate Medical Education. It has been used by more than 130 USF faculty, residents and fellows -- primarily from Pediatrics, Internal Medicine and Emergency Medicine -- as well advanced registered nurse practitioners and respiratory therapists from Tampa General Hospital. The center expects to expand its simulation training to more health professionals and disciplines in the coming months, Dr. Haubner said.

Using one of the center's task-trainer simulators, third-year pediatrics resident Dr. Karolina Dembinski practices placing an umbilical catheter, used to deliver medications and fluids to critically ill infants, as neonatology fellow Luis Munoz observes.

In addition to Dr. Haubner and Jason Fields, TEAMS Center faculty include Brad Peckler, MD, from Emergency Medicine (Team Health), and Erika Abel, MD, USF assistant professor and program director of Med-Peds. For more information, please contact Dr. Haubner at lhaubner@health.usf.edu, or Jason Fields at jfields@health.usf.edu.

- Story by Anne DeLotto Baier, USF Health Communications
- Photos by Eric Younghans, USF Health Communications

L to R: Dr. Alexander Rosemurgy, Dr. Sharona Ross and Dr. Devanand Mangar

Tampa FL (July 24, 2009) -- Dr. Sharona Ross and Dr. Alexander Rosemurgy – both University of South Florida general surgeons and Dr. Devanand Mangar, anesthesiologist with Gulf-to-Bay Anesthesiology and Chief of Staff at Tampa General Hospital -- last week performed what they believe is the first single incision gallbladder removal without the use of general anesthesia.

Instead of fully sedating the patient as is traditionally practiced, they used an epidural in the thoracic area. The patient was able to converse with the medical team in the operating room. Epidurals are used for women delivering babies -- to reduce the pain during labor, but are inserted in a different part of the spine, the lumbar.

The 54 year-old patient, mother of two and grandmother of 10, returned to her Tampa home on Monday and is recovering well.

USF Health's Dr. Ross and her partners Alex Rosemurgy, MD, and Michael Albrink, MD, pioneered the first laparoscopic endoscopic single site "LESS" surgeries (one incision through the belly button) in Fall 2007 at Tampa General.

“Since the entire operation is performed through the belly button, it does not leave a visible scar like the traditional multi-port laparoscopic approach - which could be anywhere from three to six incisions”, Dr. Ross explains. “This new method benefits the patient by less post-operative pain, less blood loss, faster recovery time, fewer complications and better cosmetic results….with no visible scar.”

More than 300 physicians across the country have trained with USF/TGH and Drs. Ross, Rosemurgy and Albrink have traveled the world to teach the LESS method at conferences. To date, they have performed anti-reflux operations, appendix removals, small bowel resections, liver cysts resections, stomach tumor resections, inguinal hernia repair, removal of adrenal gland and recently the first pancreatic mass resection utilizing the LESS surgical approach - to name a few.

They have also performed combined operations in the same patient (i.e., a hysterectomy and a gallbladder removal, or a gallbladder removal and an anti-reflux procedure). They continue to refine the LESS approach to surgery, and are developing surgeries using natural orifices (vagina, anus, mouth). The physicians with the USF Digestive Disorders Center are hosting a CME LESS Course at Tampa General in November.

About 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 more than $360 million in research grants and contracts last year, USF is one of the nation’s top 63 public research universities and one of 39 community-engaged, four-year public universities designated by the Carnegie Foundation for the Advancement of Teaching. For more information, visit www.health.usf.edu

About TGH
Tampa General is a 958-bed acute care hospital on the west coast of Florida that serves as the region’s only center for Level I trauma care, comprehensive burn care and adult solid organ transplants. It is the primary teaching hospital for the University of South Florida College of Medicine. TGH is also one of only eleven comprehensive stroke centers in Florida and is a state-certified spinal cord and head injury rehabilitation center. For more information, visit www.tgh.org

The study by scientists from Laval University and USF has implications for the development of future cell therapies for Parkinson's and Huntington's disease

July 20, 2009 -- Results of a new study published online this week in the Proceedings of the National Academy of Sciences question the long-term effects of transplanted cells in the brains of patients suffering from Huntington’s disease. The study, conducted by Dr. Francesca Cicchetti of Laval University in Québec, Canada, Dr. Thomas B. Freeman of the University of South Florida (USF) Department of Neurosurgery and Brain Repair, Tampa, FL, and colleagues provides the first demonstration that transplanted cells fail to offer a long-term replacement for degenerating neurons in patients with Huntington’s disease.

Huntington’s disease is a neurodegenerative disease of genetic origin that targets a particular type of neuron. The loss of these neurons is responsible for the appearance of involuntary movements as well as cognitive and psychiatric impairments. Over a decade ago, USF neurosurgeon Dr. Freeman initiated a clinical trial of neural cell transplantation in patients with Huntington’s disease in an attempt to alleviate the devastating symptoms that characterize this disease.

Some patients demonstrated some mild, transient clinical benefits that lasted for about two years. However, the loss of functional recovery after this time indicated that graft survival and functionality may be jeopardized long-term.

Study senior co-author Dr. Thomas Freeman, a professor in the USF Department of Neurosurgery and Brain Repair, is a leader in stem cell transplantation research for neurodegenerative disorders.

The post-mortem study of three cases described in PNAS is the first demonstration that 1) graft survival is indeed attenuated long-term, 2) the grafts undergo degeneration that resembles the pathology observed in Huntington’s disease, and 3) the brain’s inflammatory response could contribute to the compromised survival of grafted cells. The authors also demonstrated that cortical neurons develop Huntington’s disease synapse on the grafts, and may cause neurotoxicity to the healthy cells, inducing grafted neuronal cell death.

Last year, researchers at Rush University Medical Center, USF, and Mount Sinai School of Medicine published research in Nature Medicine showing that grafts in patients with Parkinson’s disease develop Lewy bodies -- a marker of Parkinson’s disease -- after 14 years. Those patients benefited from the grafts for about 12 years, and only about 5 to 8 percent of the transplanted cells had this finding.

“This latest study shows that grafts in patients with Huntington’s disease also undergo disease-specific neuronal degeneration,” said USF's Dr. Freeman, a senior co-author of the study. “However, the neural degeneration in the (genetically unrelated) grafts was even more severe than what was observed in the patient’s own brain. Additionally, clinical benefit, if any, only lasted about two years. These findings may be important to future therapeutic trials of stem cells for the treatment of Parkinson’s and Huntington’s diseases.”

Despite the excitement for cell transplantation therapy using embryonic or stem cells, these results raise concerns for the therapeutic potential of transplantation as a treatment option for Huntington’s disease, the study authors report. However, these observations suggest new potential mechanisms involved in the development of the disease, they conclude. A more in-depth investigation could allow the development of novel therapeutic strategies. The control of the patient’s immune and inflammatory responses holds therapeutic potential and Dr. Cicchetti and colleagues continue their research in that direction.

Dr. Francesca Cicchetti is a professor at the Department of Psychiatry/Neuroscience at Laval University and a researcher in neurobiology. She directs a research laboratory, which focuses on the understanding of neuronal degeneration and the development of treatment strategies for neurodegenerative diseases.

Dr. Thomas B. Freeman is a USF neurosurgeon at Tampa General Hospital, and director of clinical research and medical director of the Center of Excellence for Aging and Brain Repair at the University of South Florida.

This work includes the scientific contribution of the following authors: Samuel Saporta (USF Department of Neurosurgery and Brain Repair), Robert Hauser (Parkinson's Disease and Movement Disorders National Parkinson's Foundation Center of Excellence, USF), Martin Parent (Groupe de recherche sur le système nerveux central (GRSNC)), Martine Saint-Pierre (Centre de Recherche du CHUL (CHUQ)), Paul Sanberg (USF Department of Neurosurgery and Brain Repair), Xiao Li (Emory University School of Medicine), John Parker (University of Louisville Health Sciences Center), Yaping Chu (Rush University Medical Center), Elliot Mufson (Rush University Medical Center), and Jeffrey Kordower (Rush University Medical Center).

Dr. Robert Brooks

Tampa, FL (July 20, 2009) -- Dr. Robert Brooks, a nationally recognized patient safety, health informatics and policy scholar, researcher and educator, has been recruited from the Florida State University to USF Health. Dr. Brooks will build upon his well-established research and teaching record and will be professor of medicine and public health and associate vice president for health leadership at USF.

Robert Brooks, MD, MA, MBA, MPH, brings to USF an extensive and intricate working knowledge of academic medicine, curriculum development, student recruitment and advisement, health policy and practice.

“USF will tap Dr. Brooks’ distinctive and well proven academic talents. He will play a directive role in the medical student admissions process as we seek to bring diversity, competence and exceptional quality to our student body. Dr. Brooks will also be responsible for building the health leadership program at USF Health,” said Dr. Stephen Klasko, dean of medicine and CEO of USF Health. “We are exceptionally fortunate to bring Bob Brooks’ talents, knowledge and experience to USF Health.”

A former secretary of health for the state of Florida and a former Florida state legislator, Dr. Brooks has played a significant role in formulating and administering health policy.

“Dr. Brooks brings the rare combination of real scholarship and pragmatic, national leadership to our students and faculty. He will be designing and participating in health policy and leadership research and courses that will provide our public health, medical, nursing and graduate students with insight, knowledge and skills that will benefit them throughout their careers,” said Donna Petersen, ScD, dean of public health at USF.

“Bob is a gifted and dedicated teacher, a highly productive researcher, and a policy architect who has made vital contributions to health improvement in Florida. He has been a singular force in advancing patient safety, health informatics research and data-driven health policy decisions,” said Jay Wolfson, DrPH, JD, USF professor of public health and medicine.

Dr. Brooks will also work with USF’s clinical and research team to design a new system of care to more effectively manage diabetes and other chronic disorders, and to build upon the program of patient safety research with which he has previously collaborated.

USF’s recently announced partnership with the Lehigh Valley Health Network is expected to benefit from Dr. Brooks’ leadership training for medical students. In that program, students from Pennsylvania will attend USF for their first two years of medical school, then return to Lehigh Valley for their third and fourth years of clinical medical education.

At USF Health, Dr. Brooks also will serve as a professor of medicine in the Division of Infectious Diseases (Department of Internal Medicine) in the College of Medicine and as a professor in the Department of Health Policy and Management in the College of Public Health.

“I am excited to have the opportunity to join the already outstanding executive team assembled by Dean Klasko and to assist USF in its mission to train and equip world-class physicians and other health care professionals to be leaders in the 21st century,” Dr. Brooks said.

Dr. Brooks has served as the associate dean for health affairs at Florida State University, where he helped establish the first new allopathic medical school in the United States in more than 20 years. Since joining FSU in 2001, he has started five separate Centers of Excellence on Terrorism, Public Health, Patient Safety, Rural Health and Global Health.

Dr. Brooks was appointed Florida’s secretary of health in 1999. He had previously served in the Florida House of Representatives and as chief of infectious diseases at Orlando Regional Medical Center.

A Michigan native, Dr. Brooks received his B.A. and M.D. degrees from Wayne State University. He is board certified in internal medicine, infectious diseases, and preventive medicine and general public health. He also holds an MPH from the Harvard School of Public Health, an MBA from Auburn University and an MA in theology from the Reformed Theological Seminary.

- 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 more than $360 million in research grants and contracts last year, USF is one of the nation’s top 63 public research universities and one of 39 community-engaged, four-year public universities designated by the Carnegie Foundation for the Advancement of Teaching. For more information, visit www.health.usf.edu

- News release by Lisa Greene, USF Health Communications

David Morgan, PhD

David Morgan, PhD, professor of molecular pharmacology and physiology, was recently named chief scientific officer at the USF Health Byrd Alzheimer’s Institute.

The Byrd Institute this month was legislatively established as a center within USF, and Dr. Morgan will oversee both clinical and basic research at the facility, said Stephen K. Klasko, MD, MBA, CEO for USF Health and the Byrd Institute. A leading neuroscientist in the field of Alzheimer’s research, he will also continue his duties as the director of basic neuroscience research for the College of Medicine.

Dr. Morgan said he plans to work with colleagues at USF Health to make progress on three initiatives over the next year:

• Creating a state-of-the-art center for the diagnosis of Alzheimer’s and other dementias, and using this knowledge to deliver the right drugs to the right patients.

• Building a research team of highly interactive scientists, each of whom works on a different piece of the Alzheimer’s puzzle and understands how to share this expertise with others.

• Starting a patient-dignity initiative that uses students to help patients find their way through the maze of medical offices and procedures and advises patients and families about what to expect during their clinical visits.

Our success will require support from federal, state and private philanthropic sources,” Dr. Morgan said. “We want to create a first-class center for the 21st century that will be ranked among the world’s leading Alzheimer’s research centers – where scientists in our laboratories upstairs can rapidly test their ideas with patients seen in our clinics downstairs.”

Dr. Morgan joined USF in 1992 from the University of Southern California School of Gerontology. He holds a PhD degree in neurobiology from Northwestern University and completed a postdoctoral fellowship in neurogenerontology at USC.

Working with USF colleagues, Dr. Morgan was instrumental in creating a mouse genetically modified to develop Alzheimer’s-like symptoms early in life. Using this Alzheimer’s mouse model, Dr. Morgan’s research focuses on testing therapies that could delay or prevent Alzheimer's disease, determining the role that inflammation plays in the brain, and exploring the development of antibodies to prevent the buildup of beta-amyloid, the substance that clumps into plaques in the brains of Alzheimer's patients. He is a recipient of research grants from the National Institute on Aging and the American Federation of Aging Research. His work has been published in Science, Nature and Journal of Neuroscience.

In other news at the USF Health Byrd Institute:

• Amanda Smith, MD, interim director of the Eric Pfeiffer Suncoast Alzheimer’s and Gerontology Center, is taking on a new role as medical director of the Byrd Institute. She’ll be responsible for the clinical operations there.

• Huntington Potter, PhD, professor of molecular medicine, will continue his work as director of the Alzheimer’s Disease Research Center, a statewide project sponsored by the National Institute on Aging and housed at the Byrd Institute.

• A new board has been formed to advise Dr. Klasko on scientific issues. Dr. Clifton Gooch, MD, professor and chair of neurology, will chair the Byrd Institute Scientific Advisory Board. Other board members are Robert Deschenes, PhD; David Diamond, PhD; Francisco Fernandez, MD; Junius Gonzales, Bruce Lindsey, PhD; Dr. Morgan, Huntington Potter, PhD; Paul Sanberg, DSc, PhD, and Dr. Smith.

      Kaitlin Spears, a 9-year-old Pinellas County resident, doesn't let her insulin pump stop her from coloring on the floor during a USF focus group at the Children With Diabetes conference.

      If you imagined the perfect place for children with diabetes, what would it have?

      For families of these children, the list is long and varied: Health professionals who really understand diabetes. Less time waiting to be seen. Someone available to answer questions at all hours of the day, who can tell parents what to do when their child's blood sugar is too high at midnight.

      A medical center that has healthy extras: a gym, a kitchen, and a children's play area.

     More places to learn about diabetes and more people to teach it.

     And, maybe most of all, each other.

     "To meet other people" with diabetes, said Clearwater parent Scott Roan. "To learn from others."

     Those were among the items on the wish list at an unusual focus group meeting hosted by USF Health Wednesday in Orlando at "Friends for Life," an international conference sponsored by Children With Diabetes, Inc. USF invited families there to brainstorm. The university is planning a new center for people with diabetes and wanted to hear from families about their needs.

     The focus group, led by Nicole Johnson, Miss America 1999 and director of communications and education for the USF Diabetes Center, became a standing-room only crowd. It included parents and children with diabetes, as well as doctors and other health care providers.

     Two other USF Health staffers - Michael Hoad, vice president of communications, and Jay Wolfson, assistant vice president for health law, policy and safety - prepared to help Johnson lead the focus group by getting some first-hand experience. Johnson made both men spend 24 hours wearing an insulin pump. Johnson has Type 1 diabetes herself, so the ones they wore were just like hers: hot pink.

The hot pink triplets: Jay Wolfson, Nicole Johnson and Michael Hoad (L to R) show off their matching insulin pumps.   

     Parents told the USF trio that finding out your child has diabetes is an overwhelming, often isolating experience. With that moment of diagnosis, their lives changed forever - yet they often felt lost. They had been thrown into deep water with little knowledge and fewer resources.

     "You're sent home and supposed to be Dr. Mom," said Tampa parent Alysia Ekizian. "It would be great if there were someone you could get 24 hours. We, as parents, need constant coaching."

      Parents often feel that they don't have anywhere to turn for that kind of help. What's more, outside of their children's endocrinologists, sometimes even the medical professionals seem to know little about their problems. Roan once brought his daughter to the emergency room because she was suffering from ketosis, a condition that occurs when chemical ketones start building up in the body because insulin is too low and the body starts breaking down fat for energy. Because insulin levels are low, blood sugar levels also rise.

     "They come back and say, ‘Did you know, her sugar is high?' " Roan told the group with exasperation.

     Another parent said one doctor told him it was the first time he had ever seen an insulin pump.
Such stories are one reason USF Health wants to develop a center that specializes in care for diabetes, Wolfson said. Studies have shown that when diabetes patients need other medical care, whether it's for having knee surgery or giving birth, caring for their diabetes often gets lost in the shuffle.

     "Things break down a lot," Wolfson said. "They don't seem to be able to coordinate with your diabetes."

     Health care providers aren't the only ones with that problem, said Holly Plotts, a Pennsylvania mom whose teen-age daughter has diabetes. Parents sometimes find that schools are reluctant to let children check their sugar or carry snacks, and may not know that federal law requires them to accommodate diabetes.

     Pennsylvania cardiologist Bob Bulgarelli told the group that he envisions a diabetes center where patients don't feel like they're visiting an uncomfortable doctor's office. No exam rooms with paper on the tables, he said. Lamps and cozy furniture. A gym and a kitchen, so people can practice the healthy eating and exercise habits that are so important to diabetes.

     Cardiologist Bob Bulgarelli talks about what diabetes patients need.

     "It needs to be more than your standard terrible box office," Dr. Bulgarelli said. "It can be a place they can spend the day."

     Again and again, parents returned to the importance of having children be able to meet other children with diabetes . They want their kids to play with other kids who wear insulin pumps. Kids who don't think it's weird to check your blood sugar. Kids who understand how you feel when your blood sugar gets low.

     The best part of the Orlando conference, parents said, was to watch their children doing exactly that. Imagine a center where parents could do that in their own hometown, said Adina Singer, of Quebec. She envisioned a place that would provide health care, yet also be something of a hub for the diabetes community. It could host support groups, social events, even the occasional party.

     "You want to recruit families. You want families to join you and stay with you for years and years," Singer said. "You want to create something that's more inviting... A place where people are going to want to come."

      -- Story and photos by Lisa Greene, USF Health Communications

Florida Alzheimer’s Disease Research Center studies demonstrate caffeine reverses memory impairment and markedly reduces the hallmark protein for Alzheimer’s disease in the brains and blood of Alzheimer's mice

Tampa, FL (July 6, 2009) -- Coffee drinkers may have another reason to pour that extra cup. When aged mice bred to develop symptoms of Alzheimer’s disease were given caffeine – the equivalent of five cups of coffee a day – their memory impairment was reversed, report University of South Florida researchers at the Florida Alzheimer’s Disease Research Center.

Back-to-back studies published online today in the Journal of Alzheimer’s Disease show caffeine significantly decreased abnormal levels of the protein linked to Alzheimer’s disease, both in the brains and in the blood of mice exhibiting symptoms of the disease. Both studies build upon previous research by the Florida ADRC group showing that caffeine in early adulthood prevented the onset of memory problems in mice bred to develop Alzheimer’s symptoms in old age.

“The new findings provide evidence that caffeine could be a viable ‘treatment’ for established Alzheimer’s disease, and not simply a protective strategy,” said lead author Gary Arendash, PhD, a USF neuroscientist with the Florida ADRC. “That’s important because caffeine is a safe drug for most people, it easily enters the brain, and it appears to directly affect the disease process.”

USF neuroscientist Gary Arendash, PhD, says the preclinical findings suggest caffeine could be a viable treatment for established Alzheimer's.

Based on these promising findings in mice, researchers at the Florida ADRC and Byrd Alzheimer’s Center at USF hope to begin human trials to evaluate whether caffeine can benefit people with mild cognitive impairment or early Alzheimer’s disease, said Huntington Potter, PhD, director of the Florida ADRC and an investigator for the caffeine studies. The research group has already determined that caffeine administered to elderly humans without dementia quickly affects their blood levels of β-amyloid, just as it did in the Alzheimer’s mice.

“These are some of the most promising Alzheimer’s mouse experiments ever done showing that caffeine rapidly reduces beta amyloid protein in the blood, an effect that is mirrored in the brain, and this reduction is linked to cognitive benefit,” Potter said. “Our goal is to obtain the funding needed to translate the therapeutic discoveries in mice into well-designed clinical trials.”

Arendash and his colleagues became interested in caffeine’s potential for treating Alzheimer’s several years ago, after a Portuguese study reported that people with Alzheimer’s had consumed less caffeine over the last 20 years than people without the neurodegenerative disease. Since then, several uncontrolled clinical studies have reported moderate caffeine consumption may protect against memory decline during normal aging. The highly controlled studies using Alzheimer’s mice allowed researchers to isolate the effects of caffeine on memory from other lifestyle factors such as diet and exercise, Arendash said.

Huntington Potter, PhD, director of the Florida Alzheimer's Disease Research Center, says the Byrd Alzheimer's Center at USF hopes to begin clinical trials testing caffeine treatment in people with mild cognitive impairment or early Alzheimer's.

The just-published Florida ADRC study included 55 mice genetically altered to develop memory problems mimicking Alzheimer’s disease as they aged. After behavioral tests confirmed the mice were exhibiting signs of memory impairment at age 18 to 19 months – about age 70 in human years – the researchers gave half the mice caffeine in their drinking water. The other half got plain water.

The Alzheimer’s mice received the equivalent of five 8-oz. cups of regular coffee a day. That’s the same amount of caffeine – 500 milligrams -- as contained in two cups of specialty coffees like Starbucks, or 14 cups of tea, or 20 soft drinks.

At the end of the two-month study, the caffeinated mice performed much better on tests measuring their memory and thinking skills. In fact, their memories were identical to normal aged mice without dementia. The Alzheimer’s mice drinking plain water continued to do poorly on the tests.

Caffeine treatment removed beta amyloid plaques from the brains of the Alzheimer’s mice.

In addition, the brains of the caffeinated mice showed nearly a 50-percent reduction in levels of beta amyloid, a substance forming the sticky clumps of plaques that are a hallmark of Alzheimer’s disease. Other experiments by the same investigators indicate that caffeine appears to restore memory by reducing both enzymes needed to produce beta amyloid. The researchers also suggest that caffeine suppresses inflammatory changes in the brain that lead to an overabundance of beta amyloid.

Since caffeine improved the memory of mice with pre-existing Alzheimer’s, the researchers were curious to know if it might further boost the memory of non-demented (normal) mice administered caffeine from young adulthood through old age. It did not. Control mice given regular drinking water throughout their lives performed as well on behavioral tests in old age as normal mice who received long-term caffeine treatment, Arendash said. “This suggests that caffeine will not increase memory performance above normal levels. Rather, it appears to benefit those destined to develop Alzheimer’s disease.”

Caffeinated Alzheimer's mice performed much better on tests measuring their memory and thinking skills, like finding the submerged platform (circled in photo) in this water maze. Their memories were the same as normal aged mice without dementia.

The researchers do not know if an amount lower than the 500 mg. daily caffeine intake received by the Alzheimer’s mice would be effective, Arendash said. For most individuals, however, this moderate level of caffeine intake poses no adverse health effects, according to both the National Research Council and the National Academy of Sciences. Nonetheless, Arendash said, individuals with high blood pressure or those who are pregnant should limit their daily caffeine intake.

If larger, more rigorous clinical studies confirm that caffeine staves off Alzheimer’s in humans, as it does in mice, this benefit would be substantial, Arendash said. Alzheimer’s disease attacks nearly half of Americans age 85 and older, and Alzheimer’s and other dementias triple healthcare costs for those age 65 and older, according to the Alzheimer’s Association.

In addition to the Florida ADRC, Byrd Alzheimer’s Center and Eric Pfeiffer Suncoast Alzheimer’s and Gerontology Center at USF, researchers from the Bay Pines VA Healthcare System; Saitama Medical University, Saitama, Japan; and Washington University School of Medicine, St. Louis, collaborated on the research. The studies were supported by grants to investigators in the Florida ADRC, a statewide project sponsored by the National Institute on Aging and housed at the University of South Florida’s Byrd Alzheimer’s Center.

Chuanhai Cao, PhD, was lead author of the paper reporting caffeine reduces beta amyloid in the brains and blood of Alzheimer's mice.

Journal articles cited:

1. Caffeine Reverses Cognitive Impairment and Decreases Brain Amyloid-β Levels in Aged Alzheimer’s Disease Mice; Gary W Arendash, Takashi Mori, Chuanhai Cao, Malgorzata Mamcarz, Melissa Runfeldt, Alexander Dickson, Kavon Rezai-Zadeh, Jun Tan, Bruce A Citron, Xiaoyang Lin, Valentina Echeverria, and Huntington Potter; Journal of Alzheimer’s Disease, Volume 17:3 (July 2009).

2. Caffeine Suppresses Amyloid-β Levels in Plasma and Brain of Alzheimer’s Disease Transgenic Mice; Chuanhai Cao, John R Cirrito, Xiaoyang Lin, Lilly Wang, Deborah K Verges, Alexander Dickson, Malgorzata Mamcarz, Chi Zhang, Takashi Mori, Gary W Arendash, David M Holzman, and Huntington Potter; Journal of Alzheimer’s Disease, Volume 17:3 (July 2009).

- About USF Health -

USF Health (www.health.usf.edu) 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 more than $360 million in research grants and contracts last year, USF is one of the nation’s top 63 public research universities and one of 39 community-engaged, four-year public universities designated by the Carnegie Foundation for the Advancement of Teaching.

- About the Journal of Alzheimer’s Disease -

The Journal of Alzheimer's Disease (http://www.j-alz.com) is an international multidisciplinary journal to facilitate progress in understanding the etiology, pathogenesis, epidemiology, genetics, behavior, treatment and psychology of Alzheimer's disease. The journal publishes research reports, reviews, short communications, book reviews, and letters-to-the-editor. Groundbreaking research that has appeared in the journal includes novel therapeutic targets, mechanisms of disease and clinical trial outcomes. The Journal of Alzheimer's Disease has an Impact Factor of 5.101 according to Thomson Reuters' 2008 Journal Citation Reports. The Journal is published by IOS Press (http://www.iospress.nl).

The new study shows GCSF impacts both bone marrow and brain to improve cognition

Tampa, FL (July 1, 2009) -- A human growth factor that stimulates blood stem cells to proliferate in the bone marrow reverses memory impairment in mice genetically altered to develop Alzheimer’s disease, researchers at the University of South Florida and James A. Haley Hospital found. The granulocyte-colony stimulating factor (GCSF) significantly reduced levels of the brain-clogging protein beta amyloid deposited in excess in the brains of the Alzheimer’s mice, increased the production of new neurons and promoted nerve cell connections.

The findings were reported online in Neuroscience earlier this month and will appear in the journal’s print edition in August.

GCSF is a blood stem cell growth factor or hormone routinely administered to cancer patients whose blood stem cells and white blood cells have been depleted following chemotherapy or radiation. GCSF stimulates the bone marrow to produce more white blood cells needed to fight infection. It is also used to boost the numbers of stem cells circulating in the blood of donors before the cells are harvested for bone marrow transplants. Advanced clinical trials are now investigating the effectiveness of GCSF to treat stroke, and the compound was safe and well tolerated in early clinical studies of ischemic stroke patients.

“GCSF has been used and studied clinically for a long time, but we’re the first group to apply it to Alzheimer’s disease,” said USF neuroscientist Juan Sanchez-Ramos, MD, PhD, the study’s lead author. “This growth factor could potentially provide a powerful new therapy for Alzheimer’s disease – one that may actually reverse disease, not just alleviate symptoms like currently available drugs.”

Microglia (in green) attack the beta amyloid deposits (red) in GCSF-treated Alzheimer's mice.

The researchers showed that injections under the skin of filgrastim (Neupogen®) -- one of three commercially available GCSF compounds -- mobilized blood stem cells in the bone marrow and neural stem cells within the brain and both of these actions led to improved memory and learning behavior in the Alzheimer’s mice. “The beauty in this less invasive approach is that it obviates the need for neurosurgery to transplant stem cells into the brain,” Dr. Sanchez-Ramos said.

Based on the promising findings in mice, the Alzheimer’s Drug Discovery Foundation is funding a pilot clinical trial at USF’s Byrd Alzheimer’s Center. The randomized, controlled trial, led by Dr. Sanchez-Ramos and Dr. Ashok Raj, will test the safety and effectiveness of filgrastim in 12 patients with mild to moderate Alzheimer’s disease

The researchers worked with 52 elderly mice, equivalent to the human ages of 60 to 80 years. About half (24) were mice genetically altered to develop symptoms mimicking Alzheimer’s disease by the time they reach 5-months old. The others (28 normal, or non-Alzheimer’s, mice) were not. The researchers confirmed through a series of tests that the Alzheimer’s mice were memory impaired before beginning the experiments.

Some mice were treated for three weeks with injections of the GCSF compound filgrastim. At the end of study, the Alzheimer’s mice treated with GCSF demonstrated clearly improved memory, performing as well on behavioral tests as their non-Alzheimer’s counterparts. The Alzheimer’s mice administered saline injections instead of GCSF continued to perform poorly. GCSF treatment did not boost the already excellent memory performance demonstrated by the non-Alzheimer’s mice tested before the study began.

Based on the promising findings in mice, Dr. Juan Sanchez-Ramos and Dr. Ashok Raj will lead a pilot clinical trial at the USF Byrd Center testing GCSF (filgrastim) in patients with mild to moderate Alzheimer's disease.

Further experiments showed that the size and extent of beta amyloid deposited in the brains of the Alzheimer’s mice was significantly less in those treated with GCSF. Depending on their ages, mice treated with GCSF had a 36 to 42-percent reduction in beta amyloid, the protein considered a major culprit in the development of Alzheimer’s disease.

GCSF reduced the burden of beta amyloid deposited in the brains of the Alzheimer’s mice by several means, the researchers found. One was by recruiting reinforcements to clear beta amyloid accumulating abnormally in the brain. The growth factor prodded bone-marrow derived microglia outside the brain to join forces with the brain’s already-activated microglia in eliminating the Alzheimer’s protein from the brain. Microglia are brain cells that act as the central nervous system’s main form of immune defense. Like molecular “Pac-men,” they rush to the defense of damaged or inflamed areas to gobble up toxic substances.

The growth factor also appeared to increase the production of new neurons in the area of the brain (hippocampus) associated with memory decline in Alzheimer’s disease and to form new neural connections.

“The concept of using GCSF to harness bone marrow-derived cells for Alzheimer’s therapy is exciting and the findings in mice are promising, but we still need to prove that this works in humans” said Dr. Raj, a physician researcher at the Byrd Alzheimer’s Center at USF Health.

In addition to Dr. Sanchez-Ramos, other authors of the Neuroscience paper were Shijie Song, PhD; Vasyl Sava, PhD; Briony Catlow, PhD; Xiaoyang Lin; Takashi Mori, PhD; Chuanhai Cao, PhD; and Gary Arendash, PhD. The study was funded by grants from the Alzehimer's Drug Discovery Foundation, Helen Ellis Foundation, Florida Alzheimer's Disease Research Center, and the Byrd Alzheimer's Center at USF.

- 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 more than $360 million in research grants and contracts last year, USF is one of the nation’s top 63 public research universities and one of 39 community-engaged, four-year public universities designated by the Carnegie Foundation for the Advancement of Teaching.

- Photo by Eric Younghans, USF Health Communications