Research | The Elm Archive

February President’s Message

Check out the February issue of The President’s Message. It includes Dr. Perman’s column on his Panel on Politics and Policy; sexual harassment addressed at Q&A; the new Elm is coming to the UMB website; Police Chief Cary reflects on her first six months; art and literary journal, 1807, to launch; 20 employees benefit from Live Near Your Work Program in 2018; campus climate survey coming in mid-February; and a roundup of student, faculty, and staff achievements.

Back issues of the newsletter can be found in the archives.

Chris ZangABAE, Bulletin Board, Clinical Care, Collaboration, Community Service, Contests, Education, For B'more, People, Research, Technology, UMB News, University Life, USGAFebruary 5, 20190 comments

VisualDx Clinical Support Tool Now Available

VisualDx is a visual diagnostic clinical support tool that includes over 2,800 adult and pediatric conditions and thousands of images. Search by a diagnosis, build patient-specific differentials, or review medication reactions and adverse events. This versatile tool delivers speed and diagnostic accuracy in your clinical work.

Find it in the Databases list on the Health Sciences and Human Services Library’s website. Download the iOS or Android app from the library’s VisualDx account for use off campus.

Access over 40,000 medical images. See the variations of disease presentation by age, skin type, etc.
Build a differential diagnosis in seconds.
Review succinct disease information.
Provide patients with images and information designed to improve follow-up.

To learn more, watch these VisualDX video tutorials.

Everly BrownClinical Care, Education, People, Research, TechnologyFebruary 5, 20190 comments

A Step Toward Precision Therapeutics in the Treatment of Complicated Infections

A new study from researchers at the University of Maryland School of Pharmacy and Johns Hopkins University School of Medicine uses non-invasive positron emission tomography (PET) scans and advanced pharmacometric modeling techniques to help optimize dosing recommendations for rifampin in patients diagnosed with tuberculosis meningitis (TBM), an often- deadly strain of tuberculosis that infects the brain. Published in Science Translational Medicine, the study recommends an increase in current dose recommendations to ensure a sufficient amount of rifampin can reach the infection in the brain and decrease patients’ risk of developing an antibiotic-resistant infection.

“Rifampin is an important drug in the treatment of tuberculosis,” says Vijay Ivaturi, PhD, assistant professor in the Department of Pharmacy Practice and Science (PPS) and pharmacometrician in the Center for Translational Medicine (CTM) at the School of Pharmacy. “However, although this drug has been around for nearly 50 years, information about the optimal dose to administer to patients remains limited. This study offered our team an opportunity to explore the use of non-traditional, non-invasive methods to help determine the optimal treatment regimen for rifampin for patients diagnosed with TBM.”

A Novel Approach to Dose Optimization

According to the World Health Organization, tuberculosis is responsible for more than 1 million deaths around the world each year, making it one of the top 10 causes of death worldwide. TBM, which results from tuberculosis bacteria spreading to a patient’s brain and cerebral spinal fluid, is the most devastating and deadly form of this disease. It disproportionately affects children under age five and individuals who have been diagnosed with other chronic illnesses, such as human immunodeficiency virus (HIV).

Researchers have long known that rifampin, when administered at the current recommended dose, is not able to adequately penetrate and treat infections in the brain. There also exists a lack of reliable data on how the small percentage of drug that reaches the brain is distributed throughout the tissue, as current methods to measure the drug at the infection site involve surgical resection of the infected tissue. These limitations have hampered previous pharmacokinetic modeling efforts to optimize treatments for TBM.

“Traditional dosing recommendations for rifampin have been based on measurements of the drug in the patient’s blood,” Ivaturi says. “But we know that the bacteria in TBM infections are sitting deeper in the tissue. Since it is incredibly difficult for us to measure the concentration of the drug at the tissue level, we must explore other options to help us best determine the right dose of medication needed to kill the bacteria where it lives.”

To help with this endeavor, Ivaturi collaborated with Sanjay Jain, MD, professor of pediatrics and international health and director of the Center for Infection and Inflammation Imaging Research at Johns Hopkins University School of Medicine. Jain and his team engineered a version of rifampin with a charged particle, known as a positron, attached to the drug. This allowed the researchers to track the movement of the drug throughout the body and measure its concentration at the site of infection using PET scans.

Taking the Results a Step Further

Equipped with data from these scans, Ivaturi and his team used advanced pharmacometric modeling and simulation techniques — which they combined with known clinical pharmacology information for rifampin — to show that the concentration of rifampin at the site of infection in the brain significantly decreased over time. They also were able to extrapolate those results to optimize the dose of rifampin for children diagnosed with TBM.

“Through the use of these integrated technologies, including state-of-the-art imaging and advanced pharmacometric modeling, we were able to optimize treatments for patients with TBM,” says Ivaturi, who also explained that the models showed that patients diagnosed with TBM should be given a much higher dose of rifampin than is currently recommended — a minimum of 30 milligrams/kilogram (mg/kg), compared to the currently prescribed 10 to 20 mg/kg.

However, perhaps the most significant finding from this research is that this novel method is not limited to rifampin and TBM, but is applicable to a wide range of antibiotic drugs and illnesses.

“In this study, we show proof-of-concept that PET scans are a clinically translatable tool to help clinicians non-invasively measure antibiotic distribution in infected tissues,” Jain says. “In the near future, we envision that this technology could be used to help us not only develop better treatments for TBM, but also to enable precision medicine techniques for patients with other complicated infections.”

“While we focused on individualizing treatment for TBM in this particular study, the techniques and tools that we used can be applied to a variety of other conditions,” Ivaturi adds. “In fact, we at CTM are currently working to develop a clinical decision support system that will be able to optimize treatments for a range of conditions and numerous therapeutics. This system will be available very soon, and it is going to revolutionize the field of precision therapeutics.”

— Malissa Carroll

Malissa CarrollResearch, Technology, UMB NewsJanuary 28, 20190 comments

Campus Climate Survey Coming in Mid-February

As a follow-up to a 2017 survey, UMB is launching a campus climate survey that will run between Feb. 18 and March 18, 2019.

The confidential survey will measure perceptions among segments of the University community on topics such as diversity and inclusion, job satisfaction, and campus environment.

Gallup, a respected research-based global consulting organization, is partnering with UMB on the project. When your invitation arrives from Gallup via email in the coming weeks, please take part in the brief survey. Your opinions will help UMB in its efforts to become a best place to work and learn. Your identity will be kept private by individual access codes.

Stay tuned for more on this survey, and thanks in advance for your participation.

Communications and Public AffairsPeople, Research, UMB News, University Administration, University Life, USGAJanuary 25, 20190 comments

Improving Health for All of Us in Baltimore and Beyond

Are you a Baltimore resident who identifies as African-American/black, Hispanic, and/or LGBTQIA?

Join the University of Maryland School of Nursing for a free event to learn more about a National Institutes of Health-funded national research program seeking to gather important health information from 1 million-plus people in the United States. The anonymous data will help scientists prevent and treat illnesses for generations to come.

When: Saturday, Feb. 9, 10 a.m. to 11:30 a.m.
Where: William Pinderhughes Elementary Middle School, 701 Gold St., Baltimore, MD 21217
Food: Free light breakfast served at 9 a.m. and lunch served at 12:30 p.m.
Learn more: JoinAllOfUs.org/together
Questions: Contact Kristen Rawlett at krawlett@umaryland.edu or 410-706-3906

Giordana SegneriFor B'more, People, ResearchJanuary 15, 20190 comments

The President’s Message

Check out the January issue of The President’s Message. It includes Dr. Perman’s column on the Graduate School’s centennial. Also, former Senator Barbara Mikulski urges civic engagement at the President’s Panel on Politics and Policy; crime was down 21 percent in 2018, UMB Police Force reports; the School of Medicine launches a cultural transformation; seed grant events here and at College Park show the importance of collaboration; UMB CURE Scholars enjoy a Winter Wonderland; and a roundup of student, faculty, and staff achievements.

Free Spring Workshops at HS/HSL

The Health Sciences and Human Services Library offers a variety of free workshops to faculty, students, and staff. Classes are offered online and in person.

This semester’s topics include:

Managing citations using EndNote, Zotero, or Mendeley
Introduction to conducting systematic reviews
Graphic design principles in PowerPoint presentations
Scholarly publishing and research impact

See the full schedule and registration information.

Emily GormanBulletin Board, Education, Research, TechnologyJanuary 10, 20190 comments

UMGCCC Flow Cytometry Monthly Lecture Scheduled for Feb. 4

The next Flow Cytometry Monthly Lecture will be held Monday, Feb. 4, 10:30 a.m. to 1 p.m., at the Bressler Research Building, Room 7-035.

This course — led by Xiaoxuan Fan, PhD, director, Flow Cytometry Shared Service — is needed to become a trained user at the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC) Flow Cytometry Shared Services. However, all are welcome to attend.

This lecture will cover:

How flow cytometry works
Multi-color design and compensation
Instruments and services
New technology and tools.
Online booking system

To RSVP, go to this link.

Karen UnderwoodBulletin Board, Clinical Care, Collaboration, Education, ResearchJanuary 7, 20190 comments

Study: How Are Your Eyes Affected by Your Environment?

Do you want to know how your environment affects your eyes?

University of Maryland Eye Associates is participating in a new research study titled “Personalized Microenvironment and Dry Eye.” The goal of the study is to understand how your personal environment affects your eyes. The study involves four visits to the eye clinic. You will be compensated $200 for your time.

If you are interested in participating or have any questions, please contact Ginger Thompson via email at GThompson@som.umaryland.edu or call 667-214-1161.

Zaka AhmedResearchJanuary 2, 20190 comments

Building a Learning Health Care Community

Editor’s Note: This post was originally published on Inside SOP, the University of Maryland School of Pharmacy’s blog. It is reprinted here with permission.

Medically underserved populations have traditionally faced poor health care system experiences and lack of trust in the medical system, which has contributed to poor health outcomes. To tackle these problems, the PATIENTS Program at the University of Maryland School of Pharmacy has developed the Learning Health Care Community model, envisioning a community where health care systems and providers learn directly from patients what issues actually matter in their communities, and where patients learn from providers how to live a healthy lifestyle.

What is a Learning Health Care Community?

In 2015, the Institute of Medicine (IOM) — now the National Academy of Medicine — released a new model for health care delivery termed the Learning Healthcare System, a health system where data and knowledge are used to improve patient care and patient care contributes to data and knowledge.

The Learning Health Care Community model aims to bring the Learning Healthcare System concept more authentically into the community. In a Learning Health Care Community, there is bi-directional learning and partnership between community members and health care systems and providers — they learn to speak each other’s language. Providers are culturally competent, and patients are health literate. A Learning Health Care Community addresses the diverse needs of all patients and families. In particular, neighborhoods that historically have been medically underserved become part of a Learning Health Care Community where medical needs and patient preferences are addressed more effectively through lasting relationships built on trust.

West Baltimore as a National Model for Success

Health disparities in West Baltimore are widely recognized on the state and national level. To tackle these disparities and bridge the gap between health care providers/systems and communities, the PATIENTS Program set out to engage members of the West Baltimore community and elicit their perspectives on how to develop a culturally sensitive, competent, and sustainable Learning Health Care Community.

We conducted 15 focus group sessions and 21 interviews, with a total of 109 participants representing patients, community members and leaders, health care professionals and administrators, and others who have a personal stake in health care delivery in West Baltimore.

What Did We Find?

The focus groups and interviews were very informative in a number of ways. It was clear that health is the No. 1 priority for the vast majority of people. They want to stay healthy not only for themselves, but also for their families. Community members acknowledged that they learn about their health needs mostly through their providers, but expressed frustration with the limited time and attention they are given when they visit their providers. Another key finding was surrounding what questions providers should be asking patients. While providers mainly focused on questions related to medical care, such as their medical history or symptoms, patients expressed the desire to be asked about broader determinants of health — their thoughts and feelings, mental health, social support and barriers to care, their understanding of and questions related to personal diagnoses. By addressing these aspects of health care, we will start to establish the rapport needed for bi-directional learning and care.

Participants provided great ideas on how to operationalize the Learning Health Care Community model. When asked what the Learning Health Care Community should look like, many themes arose, some of which included individualizing the model to each community and making it sustainable and community-based. They also suggested that there should be a collaborative portal for community members to provide ideas and an integrated data system to combine and track information. Many participants thought that a Learning Health Care Community should incorporate social determinants of health, and that providers should go into the community and meet patients where they are, instead of waiting for patients to come to them. Specifically, participants want to see a return to home visits and office visits that do not feel rushed because the provider has a 15-minute time limit to meet with them.

Where Do We Go from Here?

Our participants described the Learning Health Care Community as “an integration of the community and health care systems,” which is exactly what we had envisioned. We are very excited to have taken the first step toward building a Learning Health Care Community and are grateful to the community members, providers, and others who collaborated with us on this effort to ultimately reduce health disparities and improve the health of medically underserved communities.

Now that the study has been completed, the PATIENTS Program is beginning to disseminate its findings to stakeholders through community gatherings, conferences, and other media. If you are interested in learning more about the project, please visit the Learning Health Care Community webpage on the PATIENTS Program website.

— Yoon Duk Hong, PHSR graduate student, and Gail Graham, patient partner/LHCC Stakeholder Advisory Board member

Yoon Duk HongEducation, ResearchDecember 13, 20180 comments

Check Out the Latest ‘Connective Issues’ Newsletter

The December 2018 issue of the Connective Issues newsletter from the Health Sciences and Human Services Library is now available.

Included in this issue:

A Celebration of 21 Years at the HS/HSL – “21@601”
Celebrating 21 Years of Art at the HS/HSL
The New Booths Are Here! The New Booths Are Here!
VisualDx is available at the HS/HSL
HSHSL Hosts DaSH 8 Hackathon
Wikipedia Edit-a-Thon at HS/HSL
Library Genie 2018 Survey Results
Data Catalog Collaboration Project Receives CTSA Great Team Science Award
Innovation Space Adds Specialized 3D Printer for Research
Google Dataset Search (Beta)
The James Carroll, Yellow Fever Commission Letters

Everly BrownCollaboration, Education, People, Research, Technology, University LifeDecember 13, 20180 comments

Hugh Arthur Pritchard Memorial Lecture for Graduate Students on Jan. 10

The Department of Pharmacology at the University of Maryland School of Medicine invites you to join us as P. Jeffrey Conn, PhD, the Lee E. Limbird Professor of Pharmacology and director of the Vanderbilt Center for Neuroscience Drug Discovery at Vanderbilt University, presents the 5th Hugh Arthur Pritchard Memorial Lecture for Graduate Students.

The lecture is titled “Positive Allosteric Modulators of GPCRs as a Novel Treatment for Schizophrenia” and will be held Thursday, Jan. 10, at 3 p.m. in the Health Science Research Facility II Auditorium, with a reception to follow.

Previous clinical studies as well as a large number of cellular and animal behavioral studies suggest that selective activators of M1 and/or M4 subtypes of muscarinic acetylcholine receptors (mAChRs) could provide a novel approach to treatment of schizophrenia. Especially exciting is the possibility that such agents could have efficacy in treatment of positive, negative, and cognitive symptoms in schizophrenia patients. Unfortunately, previous efforts to develop selective agonists of individual mAChR subtypes have not been successful and previous compounds have failed in development because of adverse effects due to activation of multiple mAChR subtypes.

Furthermore, the relative roles of M1 and M4 in mediating the overall therapeutic effects of less-selective mACh agonists are not understood. We have developed highly selective positive allosteric modulators (PAMs) of both M1 and M4 that have excellent properties for in vivo studies and as drug candidates. Electrophysiology and genetic studies are providing important new insights into the mechanisms by which M1 and M4 PAMs act in specific cortical and midbrain circuits that are relevant for treatment of different symptom domains in schizophrenia patients. Interestingly, selective M1 PAMs have specific effects in forebrain circuits that are relevant for cognitive deficits and negative symptoms and have robust efficacy in animal models of these symptom domains. In contrast, selective M4 PAMs have novel cellular actions in the basal ganglia relevant for positive symptoms and have robust antipsychotic-like effects in animal models. Also we have now advanced highly optimized M1 and M4 PAMs into preclinical and clinical development to evaluate their potential utility in treatment of schizophrenia.

More recently, we have built on recent human genetic studies that implicate two specific subtypes of metabotropic glutamate (mGlu) receptors, mGlu1 and mGlu3, in schizophrenia. Optimized mGlu1 and mGlu3 PAMs were used along with mouse genetic studies to evaluate the roles of these receptors in specific basal ganglia and forebrain circuits that have been implicated in schizophrenia. These studies are providing exciting new evidence that highly selective activators of these two glutamate receptors have potential utility in treatment of positive (mGlu1), negative (mGlu1), and cognitive (mGlu3) symptoms of schizophrenia patients. Furthermore, the novel mGlu1 and mGlu3 PAMs discovered in these studies provide excellent drug leads for further optimization and ultimate clinical testing. Collectively, these studies are providing insights that could lead to exciting new approaches for treatment of multiple symptom clusters in schizophrenia patients.

Shalon EdwardsBulletin Board, Research, UMB NewsDecember 11, 20180 comments

The President’s Message

Check out the December issue of The President’s Message. It includes Dr. Perman’s column on our record-shattering year in extramural funding — $667.4 million in grants and contracts. Also, a holiday greeting; TEDx UMB showcases our big ideas; ceremonial opening for HSRF III; Project Feast serves Thanksgiving meals to those in need; Nursing, Social Work win HEED awards for diversity; students prevail in national public health interprofessional challenge; informatics pioneer saluted at UMB; University takes the fight against opioid addiction on the road; be merry, and wary, around the holidays; and a roundup of student, faculty, and staff achievements.

Back issues of the newsletter can be found in the archives.

Chris ZangABAE, Bulletin Board, Clinical Care, Collaboration, Community Service, Contests, Education, For B'more, People, Research, UMB News, University Life, USGADecember 10, 20180 comments

Mattingly Awarded $2.2 Million Grant to Investigate Bulk Drug Substances for Compounding

Ashlee Mattingly, PharmD, BCPS, assistant professor in the Department of Pharmacy Practice and Science (PPS) at the University of Maryland School of Pharmacy, has been awarded a three-year, $2.2 million grant from the U.S. Food and Drug Administration (FDA) to investigate the use in clinical practice of drugs, including certain bulk drug substances (active ingredients) that have been nominated for use in compounding by outsourcing facilities. The research will assist the FDA in its efforts to develop a list of bulk drug substances that outsourcing facilities can use in compounding under the Federal Food, Drug, and Cosmetic Act.

“Compounded drugs serve an important role for patients whose medication needs cannot be met by an FDA-approved drug product, such as patients who have an allergy and need a medication to be made without a certain dye,” says Mattingly. “Our research will examine how drugs compounded with certain bulk drug substances have been used historically, as well as how they are currently used in clinical practice, which will help the FDA determine whether these substances should be included on its list of bulk drug substances that outsourcing facilities can use in compounding.”

Improving Drug Quality

In 2012, contaminated injectable drugs that a state-licensed compounding pharmacy shipped across the country caused an outbreak of fungal meningitis that led to more than 60 deaths and 750 cases of infection across the United States. In response to this outbreak, Congress enacted the Drug Quality and Security Act (DQSA), which amended the Federal Food, Drug, and Cosmetic Act to strengthen the FDA’s authority to regulate and monitor compounded drugs.

The legislation, among other things, established a new category of compounders known as outsourcing facilities, which are registered with the FDA and operate under the direct supervision of a licensed pharmacist. These facilities can only compound using bulk drug substances if the substance is used to compound a drug on the FDA’s drug shortage list, or appears on a list that will be developed by the FDA of bulk drug substances for which there is a clinical need.

Stephen Hoag, PhD, professor in the Department of Pharmaceutical Sciences (PSC) and director of the Applied Pharmaceutics Lab at the School of Pharmacy, who joins Mattingly as a collaborator on this project, explains, “It’s a difficult balancing act with which the FDA has been tasked. The FDA wants to make compounded medications available for the patients who need them, but it must also take certain precautions to help ensure that the medications are compounded properly, and not otherwise harmful to patients. We will help the FDA collect information that it will use to make informed decisions about which substances should be used in compounding, as well as which substances should not be used in compounding.”

Leveraging an Existing Partnership

This University of Maryland Center of Excellence in Regulatory Science and Innovation (M-CERSI) grant is part of an ongoing partnership between the University of Maryland, Baltimore; the University of Maryland, College Park; and the FDA. M-CERSI focuses on modernizing and improving the ways drugs and medical devices are evaluated. James Polli, PhD, the Shangraw/Noxell Endowed Chair in Industrial Pharmacy and Pharmaceutics at the School of Pharmacy and co-principal investigator for M-CERSI, will partner with Mattingly and Hoag on this project.

“The goal of M-CERSI is to bring together researchers from across the University of Maryland to assist the FDA with a wide range of regulatory science issues,” says Polli. “We want FDA scientists to be best informed when making decisions that will affect patients, providers, researchers, and manufacturers across the country. Through our involvement in this project, we are helping to support FDA’s efforts in identifying bulk drug substances for which there is a clinical need.”

Reaching Out to the Experts

The project will include an in-depth review of clinical practice guidelines, published literature, and other relevant sources regarding the clinical use of drugs containing certain bulk drug substances. Some of the bulk drug substances that Mattingly and her team have been tasked with evaluating include alpha lipoic acid (a supplement often used by individuals with diabetes and peripheral neuropathy) and glycolic acid (a substance used to treat conditions affecting the skin, such as scarring and hyperpigmentation).

Mattingly and her team will also conduct outreach to medical specialty groups, medical experts, and specialists in the relevant fields to gain a better understanding of the medical conditions these substances are used to treat, how long these substances have been in use in the clinical setting, the patient populations in which the substances have been used, the extent of their use, and whether the substances are used to compound drugs that health care providers store in their offices in advance of identifying the individual patients that will receive the drugs, as was the case for the contaminated steroid injections linked to the fungal meningitis outbreak in 2012.

“We want to make sure FDA has all of the information it needs to develop the best, most thorough list of bulk drug substances for use in compounding,” says Mattingly.

Informing Best Practices

From 2014 to 2015, FDA sought nominations from relevant medical experts and existing outsourcing facilities for bulk drug substances to include on its list. More than 200 substances have been nominated to-date.

Mattingly and her team will work together, while leveraging their individual expertise in pharmacy practice and pharmaceutical sciences as well as their extensive outreach to medical experts, to understand use in clinical practice of more than 200 substances. Once the research is complete, the team will prepare a report summarizing its findings, which the FDA will use to help inform its decisions regarding each substance.

“This project is really about learning as much as we can about each substance that has been nominated for inclusion on FDA’s list of bulk drug substances for which there is a clinical need,” says Mattingly. “Our goal is to support FDA’s efforts to preserve access to compounded drug products that meet individual patients’ medical needs.”

For more information about this project, please visit pharmacy.umaryland.edu/compounding.

Malissa CarrollClinical Care, Research, UMB NewsDecember 4, 20180 comments

Female Research Volunteers Needed for Cytomegalovirus Vaccine Study

The Center for Vaccine Development and Global Health (CVD) at the School of Medicine is recruiting healthy females for a study on human cytomegalovirus (CMV). To learn more, go to this webpage.

You may be eligible if you are:

A female
16 to 35 years old
In good health
Have exposure to young children

Participation lasts about three years. You will receive three investigational vaccinations. You will be compensated for your time and transportation. For more information, call 410-706-6156 between 8 a.m. and 4 p.m.

Human CMV also is known as human herpesvirus 5 (HHV-5). Contracting CMV appears to require close or intimate contact with persons who are releasing CMV in their urine, saliva, or other secretions. CMV also can be transmitted via blood transfusion, breast milk, sexual intercourse, and transplanted organs.

In most healthy individuals, CMV infection is symptom-free. When symptoms are present, they are often mild, can be confused with other illnesses, and include fever, sore throat, fatigue, and/or swollen glands. After infection, the virus remains in the body. Healthy individuals with latent CMV infection can reactivate to shed the virus in their saliva or urine, which also is predominantly symptom-free. It is known that CMV can cause serious disease in newborns who are exposed during the pregnancy and in immuno-compromised individuals. The range of disease in newborns with CMV infection includes fetal/infant death to neurological and sensory impairments, which are diagnosed later in childhood.

Linda WadsworthBulletin Board, ResearchDecember 3, 20180 comments

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